Inhalation challenge with bovine dander allergens: who needs it?

Chest. 2003 Jul;124(1):383-91. doi: 10.1378/chest.124.1.383.


Study objectives: To identify which tests would be useful in selecting patients for a specific inhalation challenge with bovine dander allergens (bSIC).

Design: A prospective study.

Setting: A university hospital.

Patients: Thirty-seven dairy farmers with a clinical suspicion of occupational asthma due to bovine allergens.

Interventions: Each patient (n = 27) underwent histamine challenge, mannitol challenge, exhaled nitric oxide (NO) measurement, bovine-specific serum IgE measurement, and skin-prick test (SPT) with bovine allergens prior to undergoing a bSIC.

Results: Eleven patients responded to the inhalation challenge with bovine allergens. The sensitivity and specificity of the tests, based on this response, were 82% and 65%, respectively, for the histamine challenge; 20% and 94%, respectively, for the mannitol challenge; 27% and 77%, respectively, for the NO measurement; 82% and 100%, respectively, for the bovine-specific serum IgE measurement; and 100% and 50%, respectively, for the SPT. Multiple regression analysis revealed that only IgE-mediated sensitivity to bovine allergens, but neither bronchial hyperreactivity nor exhaled NO concentration, contributed significantly to the response.

Conclusion: Only the SPT with bovine allergens and bovine-specific serum IgE measurements were useful in selecting patients for the bSIC. This challenge should not be performed in SPT-negative subjects. A diagnosis of occupational asthma due to bovine dander allergens could be made without an inhalation challenge test in asthmatic patients with high bovine-specific serum IgE levels. This practice would eliminate the need for the majority of bSICs.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Agricultural Workers' Diseases / diagnosis*
  • Agricultural Workers' Diseases / immunology
  • Allergens*
  • Animals
  • Asthma / diagnosis*
  • Asthma / immunology
  • Bronchial Provocation Tests*
  • Cattle
  • Dairying*
  • Female
  • Histamine
  • Humans
  • Immunoglobulin E / blood
  • Male
  • Mannitol
  • Prospective Studies
  • Regression Analysis
  • Sensitivity and Specificity
  • Skin Tests


  • Allergens
  • Immunoglobulin E
  • Mannitol
  • Histamine