Late asthma caused by inhalation of Lepidoglyphus destructor

We report the case of a grain worker who had immediate nasal and conjunctival symptoms and late-phase asthmatic reactions after handling stored grain. Allergy to one storage mite, Lepidoglyphus destructor, was demonstrated by skin testing, specific IgE, and bronchial provocation tests. Bronchial challenge with L. destructor provoked only a late phase asthmatic reaction without an immediate reaction despite the fact that immediate skin tests and specific IgE had been positive. Pretreatment with cromolyn sodium prevented any asthmatic reaction after bronchial challenge. An IgE immunologic mechanism could explain the clinical findings.