Byssinotic reaction, acute

Etiologic Agents and Pathogenic Mechanisms in the Acute Byssinotic Reaction... 

Further assessment of atopy in the pathogenesis of the acute byssinotic reaction necessitates purification of well characterized and standardized cotton dust antigens, and the development of an allergy specific test (HAST) to measure serum IgE antibodies to cotton dust allergens. Such developments would allow correlation of skin tests, clinical history, dust exposure, FEVj and serum IgE level with specific IgE to cotton dust allergens. 

Endotoxin inhalation has been proposed to explain symptoms of the acute byssinotic reaction ( ) and implicated as the causative... 

Involvement of complement activation in the etiology of the acute byssinotic reaction could explain the pathogenic mechanism of histamine release, non-histamine-mediated bronchoconstriction, chemotaxis, endotoxin and bacterial proteolytic enzyme action. Bronchoconstriction experienced in the acute byssinotic reaction might be attributed to the combined action of C3a and C5a mediated histamine release and non-histamine mediated kinin activity. The presence of PMN in the nasal airways of byssinotics might be explained by the chemotactic action of C5a and the C567 complex. 

As the major clinical manifestation of the acute byssinotic reaction is a drop in FEV, it is interesting to speculate that the bronchoconstriction observed in cotton mill workers may be in part or in full the result of constrictor substances in inhaled cotton dust. 

If the receptors involved in the acute byssinotic reaction can be determined, pharmacologic blocking agents may be used to treat affected cotton mill workers or, conversely, preprocessing of cotton to eliminate the constrictor might prove feasible. 

Certain Investigators, however, have expressed interest in the matter recently. The possibility that a history of asthma may increase the probability of an acute byssinotic reaction to cotton dust is suggested by a paper by Hamilton et al. ( ). The senior author of this paper had had asthma as a child. Promptly after exposure to the air in a dusty part of a cotton mill he exhibited pronounced shortness of breath with tightness in the chest and accompanying major temporary decreases in FEVi and arterial oxygen tension. The episode is described as "byssinosis". The authors remark It is unlikely that many textile workers with an initial response to cotton dust such as the one described here would remain working in dusty areas." Although the authors state that "It is not possible from the present study to conclude that a prior history of atopy confers sensitivity to cotton dust", the present writers were left with the impression that the authors suspect that such may be the case. 

---