New method for an occupational dust challenge test.

OBJECTIVES: Specific challenge tests with a suspected allergen in the workplace are standard to confirm the diagnosis of asthma. Facilities for sophisticated exposure tests are available only in a few institutions. A pilot study was carried out that used a novel approach for an occupational dust challenge test with a rotahaler.
METHODS: Nine consecutive patients were enrolled in this study. Six of these proved to have asthma to red cedar by challenge tests with plicatic acid. They were challenged with a maximum dosage of 80 mg of red cedar dust and spruce dust (control) with a rotahaler on separate days in a single blinded manner. A positive reaction was defined as a fall in the forced expiratory volume in one second (FEV1) or the peak expiratory flow (PEF) after a challenge test of > or = 20% below the baseline value.
RESULTS: Three of the six patients who reacted to plicatic acid also had a positive response to red cedar dust delivered through a rotahaler. All three patients with a negative response to challenge with plicatic acid also showed a negative response to red cedar dust.
CONCLUSIONS: This pilot study showed that a positive challenge test with a rotahaler to deliver red cedar dust was specific in the diagnosis of red cedar asthma but a negative response could not rule out the diagnosis. The rotahaler has merits of being easy to operate, safe, inexpensive, and readily available. The usefulness of this method and its reproducibility have to be examined in a series of patients.