Colistin
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Occupational asthma and rhinitis following occupational exposure: case report A 24-year-old man developed occupational asthma and rhinitis following occupational exposure to colistin. The man had been working at a pharmaceutical company for 15 months and was involved in the transportation and storing of raw materials, which included colistin. He developed rhinitis after 3 months of employment; the rhinitis lessened during the weekends. Nine months following the onset of rhinitis, he experienced coughing, wheezing and dyspnoea during exposure to colistin. Hospitalisation was required following one such episode. Subsequently, he was referred to another department for further investigation. He was asymptomatic on presentation. Lung function tests revealed a FEV1 of 97%, a FVC of 88% and a FEV1/FVC ratio of 88%. To attain a 20% reduction in FEV1, a methacholine provocation concentration of 16 mg/mL was necessitated. Positive skin prick results were seen for Artemisia sp and Alternaria sp. The results of a specific inhalation challenge (SIC), which involved colistin 1g mixed with lactose 49g, were positive with the observation of an early asthmatic reaction and rhinitis. A healthy volunteer was subjected to the same challenge and showed a negative result, which dispelled the possibility of an irritant effect. The man ceased working in a colistin-exposed environment. At follow-up, a methacholine provocation concentration of > 32 mg/mL was required to induce a 20% reduction in FEV1 and he remained asymptomatic. Author comment: "The combination of the disappearance of asthmatic symptoms and the improvement in airway responsiveness after cessation of exposure, the type of response after the SIC, and no change in lung function in the control subject after the SIC provide evidence for a definitive diagnosis of [occupational asthma]." Gomez-Olles S, et al. Occupational asthma due to colistin in a pharmaceutical worker. Chest 137: 1200-1202, No. 5, May 2010. Available from: URL: http:// 803019281 dx.doi.org/10.1378/chest.09-1881 - Spain
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Reactions 19 Jun 2010 No. 1306
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