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Validity Of The Methods-assessment Of Sensitization
SPTs were performed with a routine and well-documented method. Enzyme test concentrations of 50 µg (protein)/ml (study I–II) or 100 µg/ml (studies III–V) were used. The shift to the stronger concentration was prompted by experience indicating that the milder concentration caused rather small reactions in many workers for whom the RAST was positive. The stronger concentration gave clearer reactions but still reactions larger than those obtained with histamine were uncommon. In the literature the material and concentrations used in enzyme tests varies greatly. It is even common that the origin and the concentrations used are left undescribed. For fungal a -amylase, test concentrations of 1mg/ml (Baur 1998a), 5 mg/ml (Houba et al 1996), 10 mg/ml (Cullinan et al 1994, Nieuwenhuijsen et al 1999) and 50 mg/ml (Brisman & Belin 1991) have been reported. In comparison, the test concentration for workers in the bakeries (study I), 50 µg protein/ml, was low, and, accordingly, some cases of sensitization may have been missed. However, as the origin of the extracts differed, the concentration figures are not directly comparable. A large series of RAST tests were also made on bakers with negative SPTs, and they too were negative. For detergent bacterial proteases, Flindt used a concentration of 1 mg/ml (Flindt 1969); later varying concentrations between 0.01 mg/ml and 10 mg/ml have been described (Weill et al 1971, Pepys et al 1973, Belin & Norman 1977). Belin and Norman (1977) found that test concentrations greater than 1 mg/ml caused nonspecific irritant responses in unexposed control subjects. Their test preparations were standardized in terms of protein concentration.
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