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< 病理診断は絶対ではない | メイン | 胸部単純（平面）レントゲンで前立腺癌の診... >
2008.12.23 21:00 |  診療  |  その他（医療関連）  |  ミチバ  | 推薦数 : 2

おすし屋さんの職業性疾患：接触蕁麻疹と口腔アレルギー症候群

・子育ては大変です。失敗したなと思うことたびたび。今でも、心が痛むのは、長女が小さいとき私の勉強部屋によく遊びに来ましたが、文献を読んでいた私は、「お父さんは勉強してるから、あっちへ行きなさい」と、冷たくあしらったこと。本当に、あの時相手してやったらと反省します。あの時期は、あの時しかないのですから。

・子育てで、うまくいったと思うのは、おすし屋のこと。 お寿司とは、回るものであるというのを小さいうちから頭に刷り込みました。ですから、我が家ですし屋といえば当然回転寿司です。普通のすし屋のことは、「回らない寿司」といいます。

・マエフリはこれくらいにして、職業性疾患のはなし。以下のような症例報告があります。 

 

【症例】シーフードによる職業性の接触蕁麻疹と口腔アレルギー症候群の1例

【著者】山口絢子(横浜市立大学 大学院医学研究科環境免疫病態皮膚科学), 猪又直子, 広門未知子, 嶋倉邦嘉, 塩見一雄, 池澤善郎

アレルギー(0021-4884)56巻1号 Page49-53(2007.01)

【著者抄録】20歳女性.乳児期よりアトピー性皮膚炎.幼少時より生魚を接触した際に掻痒を認めたが経口摂取は可能であった.2年前に回転寿司屋でアルバイトを開始してから,数滴の魚液に接触しただけで手の腫脹が出現した.1年前からはシタビラメやサンマ,アジ,サケ,ホッケ,ブリを加熱調理して摂取時に口唇掻痒や腫脹,アナゴ摂取時に喉頭閉塞感や嗄声,エビやカニを摂取時に口唇腫脹,アワビに似た貝を摂取時に喘鳴や嗄声,呼吸困難,全身性蕁麻疹が出現した.特異IgE抗体やプリックテストでは硬骨魚綱,甲殻鋼,軟体動物等多種で陽性.焼シタビラメによる口含み試験では口唇違和感が出現し,経口負荷試験では口唇腫脹や喉頭閉塞感,嚥下困難感,腹痛が出現した.パルブアルブミンとコラーゲンに対する血清特異IgE抗体は,ELISA法にて検出.以上よりシーフードによる職業性の接触蕁麻疹と口腔アレルギー症候群と診断した.

・私の補足

接触蕁麻疹とは、経皮的な物質の接触でおこる蕁麻疹です。口腔アレルギー症候群とは、Ⅰ型アレルギーによる口腔粘膜症状を主症状とする疾患です。

本文の考察で、職業性の接触蕁麻疹を検索したら、圧倒的にラテックスが多く、2位に魚介類、3位に塩酸セフォチアムだったそうです。（ヘーッ！）職業性の口腔アレルギー症候群は見つからなかったということです。（見つければ、学会報告しましょう）

回転寿司で働いている若者を良く見ます。外来でも同様な症例が見らるかもしれません。職歴はしっかり聞きましょう。（アルバイトや、フリーターといった問診はペケ）

・この論文の最後のAuthorの池澤善郎先生は、立派な先生だと思います。（直接面識はありません）先生が学会長のときの職業・環境アレルギー学会で症例発表をさせていただきました。また、何回か講演を聞かせていただきましたが、素晴らしいです。（アレルギーの病態のみでなく、アトピー性皮膚炎の診療で、「お母さんがハッピーでないと、子供もハッピーになれない」とかいうセリフ）唯一難は、早口なところですね。

 

 

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喫煙をはじめたばかりの若者だと急性好酸球性肺炎と誤診して一過性のもので喫煙さえやめれば再発はしないと言ってしまいそうですね。

大変勉強になりました。いつもありがとうございます。

＞Paul Carpenterさま，コメントありがとうございます．
急性好酸球性肺炎は，つねに若者の疾患の鑑別に考えておかなければならないですね．（じゃ，中年は？・・・良く知りません）
written by Paul Carpenter / 2008.12.24 09:20

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