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Diagnosing Enzyme-induced Asthma-using Specific Bronchial Provocation Test
The challenge protocol used in this study appeared to be practical for powdered enzymes. The workplace conditions could be mimicked to a reasonable degree, as cellulase was commonly spray-dried and handled as powder at the workplace. The same method has been used for other dust provocations, such as flour and fungal a -amylase. The protocol also enables nasal and conjunctival symptoms to be assessed, and possibly also urticarial skin symptoms. However, the method is not suitable for liquid enzymes. Air monitoring of the enzyme was possible with the immonologic assay, but the method as such was time consuming, and only a few measurements were done. The bronchial challenge test is generally accepted as the gold standard for diagnosing occupational asthma, especially when the specific cause is searched for and when the suspected agent is new (Nordman 1994a, Chan-Yeung & Malo 1995, Cartier 1998, Cartier 1999). We performed the tests for these reasons. However, challenge tests for enzymes at a clinic are not always necessary (e.g., when sensitization is proved and the symptoms are typical, and PEFR monitoring is convincing for work-induced asthma).
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