The online version of this article (doi:10.1186/s12890-015-0013-3) contains supplementary material, which is available to authorized users.
The authors declare that they have no competing interests.
CP contributed to the study design; data acquisition, their analysis, and their interpretation; drafting and revision of the manuscript and is the guarantor of the content of the manuscript including the data and analysis. FH, contributed to the study design; data acquisition, analysis, and interpretation and revision of the manuscript GR contributed to study design, acquisition, analysis, and interpretation of data related to microbiological analysis, culture and antigen extracts, and serology, and revision of the manuscript. EP, contributed to the study design; data acquisition, analysis, and interpretation and revision of the manuscript. CB, contributed to acquisition, analysis, and interpretation of data related to microbiological analysis, culture and antigen extracts, and serology and revision of the manuscript. CG, contributed to clinical data acquisition in particular and organization of challenge and revision of the manuscript. IT contributed to the study design; interpretation of data; drafting and revision of the manuscript. All authors read and approved the final manuscript.
Argan is now used worldwide in numerous cosmetic products. Nine workers from a cosmetic factory were examined in our occupational medicine department, following the diagnosis of a case of hypersensitivity pneumonitis (HP) related to handling of argan cakes.
Operators were exposed to three forms of argan (crude granulates, powder or liquid) depending on the step of the process. All workers systematically completed standardized questionnaires on occupational and medical history, followed by medical investigations, comprising, in particular, physical examination and chest X-rays, total IgE and a systematic screening for specific serum antibodies directed against the usual microbial agents of domestic and farmer’s HP and antigens derived from microbiological culture and extracts of various argan products. Subjects with episodes of flu-like syndrome several hours after handling argan cakes, were submitted to a one-hour challenge to argan cakes followed by physical examination, determination of Carbon Monoxide Diffusing Capacity (DLCO) and chest CT-scan on day 2, and, when necessary, bronchoalveolar lavage on day 4.
Six of the nine workers experienced flu-like symptoms within 8 hours after argan handling. After challenge, two subjects presented a significant decrease of DLCO and alveolitis with mild lymphocytosis, and one presented ground glass opacities. These two patients and another patient presented significant arcs to both granulates and non-sterile powder. No reactivity was observed to sterile argan finished product, antigens derived from argan cultures (various species of Bacillus) and Streptomyces marokkonensis (reported in the literature to contaminate argan roots).
We report the first evidence of hypersensitivity pneumonitis related to argan powder in two patients. This implies preventive measures to reduce their exposure and clinical survey to diagnose early symptoms. As exposure routes are different and antibodies were observed against argan powder and not the sterile form, consumers using argan-based cosmetics should not be concerned.
Additional file 1: Culture and antigen extract.12890_2015_13_MOESM1_ESM.doc
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- Working with argan cake: a new etiology for hypersensitivity pneumonitis
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