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A case of occupational asthma and rhinitis caused by Sanyak and Korean ginseng dusts

Sanyak has been used as a food and herbal material for various symptoms in oriental medicine. There have been few reports of occupational asthma induced by herb materials (1–6). Until now there has been no account of occupational asthma caused by Korean ginseng. We describe a case of occupational asthma and rhinitis caused by Sanyak (Dioscorea batatas) and Korean ginseng (Panax ginseng), as confirmed by specific inhalation challenge tests. A 29-year-old female patient was presented to the emergency department (ED) of Eulji University Hospital in Daejeon, Korea, for the treatment of dyspnea, wheezing, and cough. The patient had been incidentally exposed to airborne Sanyak dust, during the process of grinding dried Sanyak into powder, 5 min before the onset of symptoms. She had been a merchant of herbal materials for the previous 26 months. Twelve months before her visit, she had been admitted to another hospital and diagnosed with bronchial asthma after the sudden onset of dyspnea following an exposure to airborne ginseng dust. The patient had been suffering from nasal itching, sneezing, rhinorrhea, and nasal obstruction during the spring season for 6 years and had also experienced itching and swelling of the lips, tongue, and throat after ingesting fresh chestnut, sweet potato, and ginseng. The patient was a non-smoker and had no family history of allergic diseases. The patient appeared acutely ill and had tachypnea. Diffuse expiratory wheezes were noted over both lung fields. Arterial blood gas measurements at the ED indicated a pH of 7.414, PaCO2 of 30.8 mmHg, PaO2 of 70.4 mmHg and SaO2 94.6%. The total IgE level was 663.0 IU/ml. After pharmacological treatment, her symptoms resolved in a day. Proteins were extracted from Ginseng and Sanyak, and used for skin-prick tests, inhalation challenge tests, and laboratory studies. The skin-prick testing was expressed as mean wheal diameter/ mean erythema diameter (in millimeters): Dermatophagoides pteronyssinus 6.5/23.5 (Allergopharma, Reinbek, Germany); alder tree pollen 5.5/33.5 (Allergopharma); birch tree pollen 3.5/17 (Allergopharma); ginseng (1 : 100 w/v) 3/12; Sanyak (1 : 100 w/v) 3.75/19; histamine 4/17.5; and saline 0/0. Nonspecific and specific challenge tests were performed during her stable state. The methacholine bronchial challenge test revealed a 20% decline of forced expiratory volume in 1 s[FEV1] at the concentration of 0.75 mg/ml. The bronchoprovocation tests showed early asthmatic responses to both Sanyak and ginseng extracts (1 : 1000 and 1 : 100 w/ v, respectively). Serum-specific IgE and IgG4 antibodies to Sanyak were detected by enzyme linked immunosorbent assay[ELISA], but there was no specific antibody binding to ginseng. The sodium dodecyl sulphate-polyacrylamide gel electrophoresis[SDS-PAGE] and an IgEimmunoblot, a 35-kDa IgE-binding component was detected in the Sanyak extracts (Fig. 1), but no IgE-binding component was noted in the ginseng extract. The ELISA inhibition test, specific IgE binding, and IgG4 binding to Sanyak demonstrated specific, dosedependent inhibition by Sanyak extracts but not by other control agents. The patient in this study showed the occurrence of occupational asthma induced by Sanyak and Korean ginseng. Although there is a report of occupational asthma being induced by Brazilian ginseng (1) no cases of bronchial asthma caused by Korean ginseng have been previously reported. Brazilian ginseng and Korean ginseng are different plants in terms of taxonomic classification. Brazilian ginseng (Pfaffia paniculata) belongs to the Amaranthaceae family; in contrast, the Korean ginseng (Panax ginseng) belongs to the Araliaceae family (1). This study, it is suggested that Sanyakderived allergen can induce IgE-mediated allergic reactions. We were unable to demonstrate specific IgE and IgG4 antibodies to Korean ginseng extract despite the fact that the patient showed a positive bronchial provocation and positive responses to a skin-prick test. Further studies are needed to investigate the pathogenic mechanism of occupational asthma caused by Korean ginseng. This study was funded by the Korean government (A0505171).