Papain-induced occupational rhinoconjunctivitis and asthma - A case report

Area of Science:

• Occupational medicine
• Allergology
• Enzymology

Background:

• Occupational exposure to enzymes can cause respiratory and ocular allergies.
• Papain, a protease found in herbs and spices, is a potential occupational sensitizer.

Observation:

• A 50-year-old herbs and spices packer developed symptoms of asthma, rhinitis, and conjunctivitis.
• Increased eosinophils were observed in induced sputum and nasal lavage fluids.

Findings:

• Specific inhalation challenge test (SICT) and specific nasal challenge test (SNCT) confirmed papain allergy.
• Immunoglobulin E (IgE) sensitization to papain was verified by skin prick testing.
• SNCT induced severe conjunctivitis and increased eosinophils in tears, despite no direct eye contact.

Implications:

• This case highlights papain as an occupational allergen causing multi-systemic allergic reactions.
• Early diagnosis and avoidance are crucial for managing enzyme-induced occupational allergies.
• Further research into enzyme-specific desensitization protocols may be warranted.