Q:

9/26/2012
I was asked to see a nurse who works in another allergy office. She does not handle extracts except when doing allergy testing or administering allergy shots. She does not work with extract mixing. She feels whenever she is in the allergy lab area where extracts are being mixed she has cough, sinus drainage and runny nose. Allergy lab nurses do flush some of the extra allergy extract in the sink while mixing. She was seen in an urgent care for bronchitis and sinusitis after she had been in the area where extracts were being mixed. She does show positive allergy skin tests to various environmental allergens. The question is: Can the liquid extract when being handled in the allergy lab area and being flushed in the sink, get airborne in large quantities and even if some one is in that area for a few minutes, trigger severe allergy symptoms in that individual resulting into an urgent care visit. This does not include any venom extracts.  Thanks.

A:

Thank you for your inquiry.

Unfortunately I am not going to be able to give you a definitive answer to your inquiry. I do not know of any literature dealing with the topic, and could find none with a literature search.

One, however, would classify this as a possible occupational-induced respiratory reaction, and therefore the classic techniques that one employs to evaluate any such exposure can be used in her case.

If the issue is not a problem, and she can continue working without exposure, then I would go no further. However, if the issue is a problem for her at work, and she needs to be exposed, then I would suggest a blinded challenge. This would require of course at least blinding the patient, and it can be double-blinded if you prefer. You would then mimic the occupational exposure that she experiences in her office in your office, employing placebo and bona fide allergy extracts.

I surmise that it is very unlikely her reactions are allergic in nature, because I would doubt that the allergen would be disseminated in the air via any of the procedures you mentioned, but since this has not been studied to my knowledge, the only way you could approach it scientifically is by employing the strategy described above.

Thank you again for your inquiry and we hope this response is helpful to you.

Sincerely,
Phil Lieberman, M.D.

AAAAI - American Academy of Allergy Asthma & Immunology