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Occupational Asthma Due to Subtilisin: The Power of Specific Inhalation Challenge
Filippo Liviero1, Laura Fabris1, Marco Biasioli1
1Department of Cardiac-Vascular-Thoracic Sciences and Public Health, University of Padova, Padova, Italy.
La Medicina Del Lavoro
|October 28, 2025
Summary
This case study confirms occupational asthma from subtilisin in an Italian healthcare worker. A specific inhalation challenge (SIC) proved crucial for diagnosis, even with a Type-2-high phenotype and negative allergy tests.
Area of Science:
- Occupational Medicine
- Pulmonology
- Allergy and Immunology
Background:
- Occupational asthma is a significant work-related respiratory condition.
- Subtilisin, a high-molecular-weight (HMW) enzyme, is used in surgical instrument cleaning.
- Accurate diagnosis of occupational asthma can be challenging, particularly with HMW agents.
Purpose of the Study:
- To report the first confirmed case of occupational asthma caused by subtilisin in Italy.
- To highlight the diagnostic utility of specific inhalation challenge (SIC) for HMW agents.
- To emphasize the complex interplay of host and environmental factors in occupational asthma.
Main Methods:
- A healthcare worker with suspected occupational asthma underwent diagnostic evaluation.
- A specific inhalation challenge (SIC) with diluted Neogiozym™ was performed.
- Pulmonary function tests, including FEV1, and immunological markers were assessed.
Main Results:
- The patient experienced an immediate asthmatic reaction upon exposure to subtilisin during the SIC.
- A 30% decrease in FEV1 was recorded within three minutes of exposure.
- The patient displayed a Type-2-high phenotype, despite negative skin prick tests and normal IgE levels.
Conclusions:
- Specific inhalation challenge (SIC) is a valuable diagnostic tool for occupational asthma, even with HMW agents and atypical immunological profiles.
- Occupational asthma is a complex disease influenced by host factors (e.g., Type-2-high phenotype) and environmental exposures.
- Dynamic, multi-marker assessment is essential for accurate occupational asthma endotyping, especially when standard allergy tests are inconclusive.
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