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Angora Wool Asthma in Textile Industry

Angora Wool Asthma in Textile Industry Hindawi Publishing Corporation Case Reports in Immunology Volume 2012, Article ID 358271, 3 pages doi:10.1155/2012/358271 Case Report Pietro Sartorelli, Riccardo Romeo, Giuseppina Coppola, Roberta Nuti, and Valentina Paolucci Unit of Occupational Medicine and Toxicology, University of Siena, 16 Bracci Avenue, 53100 Siena, Italy Correspondence should be addressed to Pietro Sartorelli, pietro.sartorelli@unisi.it Received 6 August 2012; Accepted 28 August 2012 Academic Editors: M. T. Siddiqui and A. Vojdani Copyright © 2012 Pietro Sartorelli et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Up to now the exposures to hair and skin derivatives of animals have not yet been the subject of systematic studies. The observation of a clinical case has provided the opportunity for a review of the literature. The inpatient was a 49-year-old man, a carder in a textile factory, exposed to angora wool. He noticed the appearance of dyspnea during working hours. There was no eosinophilia in blood, and the results of pulmonary function tests were normal. The nonspecific bronchial provocation test with methacholine demonstrated an abnormal bronchial reactivity. The challenge test with angora wool was positive (decrease in FEV1 of more than 40%) as well as total IGE and specific IgE to rabbit epithelium (433 KU/l and 12.1 KUA/l, resp.). Several sources of allergens were found in the rabbit, and the main allergen was represented by proteins from epithelia, urine, and saliva. Most of these proteins belong to the family of lipocalin, they function as carriers for small hydrophobic molecules (vitamins and pheromones). If the diagnosis of occupational asthma caused by animal hair and skin derivatives may be relatively easy by means of the challenge test, defining etiology is complicated because of the lack of in vitro tests. 1. Introduction have not yet been the subject to systematic studies as literature only reports cases of laboratory animal allergy and Defining the pathogenesis, prevention, and management of domestic exposures. occupational asthma is an involved process. Diagnosis of There are various types of angora rabbit. Each breed occupational asthma requires the integration of a multi- produces different fur. Angora wool harvesting occurs up plicity of data such as respiratory function test, nonspe- to three times a year and is collected by shearing or from cific bronchial hyperreactivity test, occupational challenge the molting fur. This type of wool is commonly used in the test (OCT), and the timing of symptoms in relation to textile industry for apparel such as sweaters and suits. The the occupational activities. Cutaneous tests are particularly observation of a case of angora wool asthma has provided helpful in IgE-mediated asthma in relation to the inhalation the opportunity for a review of the literature. of protein aeroallergens. For haptens, because they require prior coupling to a protein carrier, they cause problems in 2. Case Report laboratory tests. The OCT represents the golden standard for etiological diagnosis of occupational asthma. The substances The in-patient was a 49-year-old man, a carder in a textile responsible for occupational asthma are mainly animal factory, mainly exposed to angora wool. He noticed the allergens, vegetable agents, and chemicals. In addition to appearance of dyspnea during working hours. There was major inducers of occupational asthma, there are other no eosinophilia in his blood and the results of pulmonary agents whose importance is still difficult to understand. function tests were normal compared to CECA 1971 ref- Among these there are high molecular weight substances erence values. The nonspecific bronchial provocation test such as hair and skin derivatives of animals. The exposed with methacholine through dosimeter [2] demonstrated professional categories are mainly farmers and workers in an abnormal bronchial reactivity. A prick test of 12 com- charge of laboratory animals [1]. Up to now these exposures mon allergens (grass, composite, pellitory, olives, cypress, 2 Case Reports in Immunology alternaria, dermatophagoides farinaceous and pteronyssinus, 120 aspergillus fumigatus, dog, cat and horse, as well as the negative and positive controls; Lofarma Laboratories, Milan, Italy) were positive to pollens. The results of the prick tests 80 were considered positive when they provoked a rash with an average diameter of ≥5mm [3]. Measurement of total and specific IgE (CAP System, 40 Phadia, Uppsala, Sweden) showed a significant positive finding of total IGE (433 KU/l) and a positive IgE to rabbit epithelium (12.1 KUA/l). After the test with a control 123456789 10 11 12 13 substance (talc powder) OCT was carried out by tipping Hours angora wool into a 8 m ventilated room and assessing FEV1 for 8 hours (Figure 1). Exposure to angora wool was stopped Figure 1: Occupational challenge test with angora wool. after 15 minutes due to the onset of coughing and dyspnea with a decrease in FEV1 of more than 40%. The nasal lavage cell counts after OCT showed an increased percentage of exposed workers [7]. Lipocalins share common biological neutrophils (96% neutrophils, 4% epithelial cells). functions, predominantly related to the transport of small The patient was also suffering from hands dermatitis. hydrophobic molecules, such as vitamins and pheromones. Allergens from the standard tray (SIDAPA) and the textile Immune reactivity to lipocalin allergens is not well known. industry tray were used for patch testing (Firma, Florence, Three of their epitopes were colocalized in their structurally Italy) by the Italian public employers’ liability insurance conserved regions. Interestingly, one of the epitopes was (INAIL) showing a skin positivity to balsam of Peru (++), recognized by the T cells of all patients and the computer dimethylaminopropylamine (++), benzalkonium chlorure predictions suggested that there would be an epitope in (++), and triethanolamine (+). An occupational allergic the corresponding parts of human endogenous lipocalins contact dermatitis was diagnosed because triethanolamine is [6, 8]. Experimental studies on sensitizing properties of used as surface-active agent in textile industry. these molecules were only carried out on laboratory animal allergies [9, 10]. Lipocalins share sequence homology with antigens of the parasitic agent that causes schistosomiasis. 3. Literature Analysis The fact that parasite infections also trigger IgE antibody responses may account for the development of laboratory Recently two PubMed search strings determinants (one animal allergies in subjects who have never had any previous more specific, the other more sensitive) have been used to allergy [9]. retrieve information on the possible association between occupational risk factors and some pathologies [4]. Using wool asthma, asthma and rabbit, asthma and rabbit hair, 4. Discussion rabbit allergens and lipocalin, 116 papers were found with the specific string (25 pertinent and 1 highly pertinent) Analysis of the case gives the impression that the detection of and 197 with the sensitive one (3 pertinent and 5 highly specific antigens responsible of asthma in workers exposed to pertinent not retrieved by the specific string). Articles mainly dermal derivatives and skin of animals is quite complex. Even regarding workers in charge of laboratory animals were if in the specific case the diagnosis was relatively simple by found. Cases of asthma due to hair and skin derivatives using OCT, etiology is not easily understandable because of of animals which occurred in the textile industry were not the lack of immunological tests referring asthma to specific reported in literature. In all 1 case of angora wool asthma occupational compounds. At the moment OCT represents was only found [5]. the golden standard for diagnosis and only prick tests can Several allergenic proteins from rabbit have been recog- be used in prevention to single out subjects susceptible to nized by crossed immunoelectrophoresis but have not been developing an allergic respiratory disease to hair and skin characterized. Understanding of these important occupa- derivatives of animals. In textile industry individuals with tional allergens will allow the development of a new diag- IgE response to rabbit epithelium should be considered nostic approach for affected workers and others who may susceptible to developing angora wool asthma. be at risk. Baker et al. [6] recognized as allergens 26 protein bands in the three extracts: 12 in saliva, 7 in urine, and 7 References in fur. This was the first evidence that allergens from the rabbit are members of the lipocalin superfamily of proteins, [1] K. Aoyama, A. Ueda, F. Manda, T. Matsushita, T. Ueda, and C. suggesting that similar mechanisms may be involved in Yamauchi, “Allergy to laboratory animals: an epidemiological eliciting the allergic response to rabbits. The 18 kDa allergen study,” British Journal of Industrial Medicine, vol. 49, no. 1, pp. from saliva may be the previously named rabbit allergen, Ory 41–47, 1992. c 1. The major laboratory animal allergens are carried on [2] S. Amaducci, I. Cerveri, C. Rampulla et al., “Protocollo per small particles that are both capable of remaining airborne l’esecuzione del test di provocazione bronchiale aspecifica,” for extended periods and penetrating the lower airways of Fisiop Resp, vol. 3, pp. 3–15, 1982 (Italian). FEV1 Case Reports in Immunology 3 [3] P. L. Paggiaro, E. Bacci, D. L. Amram, O. Rossi, and D. Talini, “Skin reactivity and specific IgE levels in the evaluation of allergic sensitivity to common allergens for epidemiological purposes,” Clinical Allergy, vol. 16, no. 1, pp. 49–55, 1986. [4] S. Mattioli, F. Zanardi, A. Baldasseroni et al., “Search strings for the study of putative occupational determinants of dis- ease,” Occupational and Environmental Medicine, vol. 67, no. 7, pp. 436–443, 2010. [5] M. R. Atazhanov, “Case of bronchial asthma due to increased sensitivity to rabbit wool,” Klinicheskaya Meditsina, vol. 55, no. 5, p. 133, 1977 (Russian). [6] J.Baker,A.Berry,L.M.Boscato,S.Gordon, B. J. Walsh, and M. C. Stuart, “Identification of some rabbit allergens as lipocalins,” Clinical and Experimental Allergy,vol. 31, no.2, pp. 303–312, 2001. [7] R. A. Wood, “Laboratory animal allergens,” ILAR Journal, vol. 42, no. 1, pp. 12–16, 2001. [8] T. Virtanen, T. Zeiler, and R. Mant ¨ yjar ¨ vi, “Important animal allergens are lipocalin proteins: Why are they allergenic?” International Archives of Allergy and Immunology, vol. 120, no. 4, pp. 247–258, 1999. [9] R. K. Bush and G. M. Stave, “Laboratory animal allergy: an update,” ILAR Journal, vol. 44, no. 1, pp. 28–51, 2003. [10] J. A. Price and J. L. Longbottom, “Allergy to rabbits. I. Specificity and non-specificity of RAST and crossed- radioimmunoelectrophoresis due to the presence of light chains in rabbit allergenic extracts,” Allergy,vol. 41, no.8,pp. 603–612, 1986. MEDIATORS of INFLAMMATION The Scientific Gastroenterology Journal of World Journal Research and Practice Diabetes Research Disease Markers Hindawi Publishing Corporation Hindawi Publishing Corporation Hindawi Publishing Corporation Hindawi Publishing Corporation Hindawi Publishing Corporation http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 International Journal of Journal of Immunology Research Endocrinology Hindawi Publishing Corporation Hindawi Publishing Corporation http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 Submit your manuscripts at http://www.hindawi.com BioMed PPAR Research Research International Hindawi Publishing Corporation Hindawi Publishing Corporation http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 Journal of Obesity Evidence-Based Journal of Journal of Stem Cells Complementary and Ophthalmology International Alternative Medicine Oncology Hindawi Publishing Corporation Hindawi Publishing Corporation Hindawi Publishing Corporation Hindawi Publishing Corporation Hindawi Publishing Corporation http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 Parkinson’s Disease Computational and Behavioural Mathematical Methods AIDS Oxidative Medicine and in Medicine Research and Treatment Cellular Longevity Neurology Hindawi Publishing Corporation Hindawi Publishing Corporation Hindawi Publishing Corporation Hindawi Publishing Corporation Hindawi Publishing Corporation http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Case Reports in Immunology Hindawi Publishing Corporation

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Publisher
Hindawi Publishing Corporation
Copyright
Copyright © 2012 Pietro Sartorelli et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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2090-6609
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2090-6617
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10.1155/2012/358271
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Abstract

Hindawi Publishing Corporation Case Reports in Immunology Volume 2012, Article ID 358271, 3 pages doi:10.1155/2012/358271 Case Report Pietro Sartorelli, Riccardo Romeo, Giuseppina Coppola, Roberta Nuti, and Valentina Paolucci Unit of Occupational Medicine and Toxicology, University of Siena, 16 Bracci Avenue, 53100 Siena, Italy Correspondence should be addressed to Pietro Sartorelli, pietro.sartorelli@unisi.it Received 6 August 2012; Accepted 28 August 2012 Academic Editors: M. T. Siddiqui and A. Vojdani Copyright © 2012 Pietro Sartorelli et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Up to now the exposures to hair and skin derivatives of animals have not yet been the subject of systematic studies. The observation of a clinical case has provided the opportunity for a review of the literature. The inpatient was a 49-year-old man, a carder in a textile factory, exposed to angora wool. He noticed the appearance of dyspnea during working hours. There was no eosinophilia in blood, and the results of pulmonary function tests were normal. The nonspecific bronchial provocation test with methacholine demonstrated an abnormal bronchial reactivity. The challenge test with angora wool was positive (decrease in FEV1 of more than 40%) as well as total IGE and specific IgE to rabbit epithelium (433 KU/l and 12.1 KUA/l, resp.). Several sources of allergens were found in the rabbit, and the main allergen was represented by proteins from epithelia, urine, and saliva. Most of these proteins belong to the family of lipocalin, they function as carriers for small hydrophobic molecules (vitamins and pheromones). If the diagnosis of occupational asthma caused by animal hair and skin derivatives may be relatively easy by means of the challenge test, defining etiology is complicated because of the lack of in vitro tests. 1. Introduction have not yet been the subject to systematic studies as literature only reports cases of laboratory animal allergy and Defining the pathogenesis, prevention, and management of domestic exposures. occupational asthma is an involved process. Diagnosis of There are various types of angora rabbit. Each breed occupational asthma requires the integration of a multi- produces different fur. Angora wool harvesting occurs up plicity of data such as respiratory function test, nonspe- to three times a year and is collected by shearing or from cific bronchial hyperreactivity test, occupational challenge the molting fur. This type of wool is commonly used in the test (OCT), and the timing of symptoms in relation to textile industry for apparel such as sweaters and suits. The the occupational activities. Cutaneous tests are particularly observation of a case of angora wool asthma has provided helpful in IgE-mediated asthma in relation to the inhalation the opportunity for a review of the literature. of protein aeroallergens. For haptens, because they require prior coupling to a protein carrier, they cause problems in 2. Case Report laboratory tests. The OCT represents the golden standard for etiological diagnosis of occupational asthma. The substances The in-patient was a 49-year-old man, a carder in a textile responsible for occupational asthma are mainly animal factory, mainly exposed to angora wool. He noticed the allergens, vegetable agents, and chemicals. In addition to appearance of dyspnea during working hours. There was major inducers of occupational asthma, there are other no eosinophilia in his blood and the results of pulmonary agents whose importance is still difficult to understand. function tests were normal compared to CECA 1971 ref- Among these there are high molecular weight substances erence values. The nonspecific bronchial provocation test such as hair and skin derivatives of animals. The exposed with methacholine through dosimeter [2] demonstrated professional categories are mainly farmers and workers in an abnormal bronchial reactivity. A prick test of 12 com- charge of laboratory animals [1]. Up to now these exposures mon allergens (grass, composite, pellitory, olives, cypress, 2 Case Reports in Immunology alternaria, dermatophagoides farinaceous and pteronyssinus, 120 aspergillus fumigatus, dog, cat and horse, as well as the negative and positive controls; Lofarma Laboratories, Milan, Italy) were positive to pollens. The results of the prick tests 80 were considered positive when they provoked a rash with an average diameter of ≥5mm [3]. Measurement of total and specific IgE (CAP System, 40 Phadia, Uppsala, Sweden) showed a significant positive finding of total IGE (433 KU/l) and a positive IgE to rabbit epithelium (12.1 KUA/l). After the test with a control 123456789 10 11 12 13 substance (talc powder) OCT was carried out by tipping Hours angora wool into a 8 m ventilated room and assessing FEV1 for 8 hours (Figure 1). Exposure to angora wool was stopped Figure 1: Occupational challenge test with angora wool. after 15 minutes due to the onset of coughing and dyspnea with a decrease in FEV1 of more than 40%. The nasal lavage cell counts after OCT showed an increased percentage of exposed workers [7]. Lipocalins share common biological neutrophils (96% neutrophils, 4% epithelial cells). functions, predominantly related to the transport of small The patient was also suffering from hands dermatitis. hydrophobic molecules, such as vitamins and pheromones. Allergens from the standard tray (SIDAPA) and the textile Immune reactivity to lipocalin allergens is not well known. industry tray were used for patch testing (Firma, Florence, Three of their epitopes were colocalized in their structurally Italy) by the Italian public employers’ liability insurance conserved regions. Interestingly, one of the epitopes was (INAIL) showing a skin positivity to balsam of Peru (++), recognized by the T cells of all patients and the computer dimethylaminopropylamine (++), benzalkonium chlorure predictions suggested that there would be an epitope in (++), and triethanolamine (+). An occupational allergic the corresponding parts of human endogenous lipocalins contact dermatitis was diagnosed because triethanolamine is [6, 8]. Experimental studies on sensitizing properties of used as surface-active agent in textile industry. these molecules were only carried out on laboratory animal allergies [9, 10]. Lipocalins share sequence homology with antigens of the parasitic agent that causes schistosomiasis. 3. Literature Analysis The fact that parasite infections also trigger IgE antibody responses may account for the development of laboratory Recently two PubMed search strings determinants (one animal allergies in subjects who have never had any previous more specific, the other more sensitive) have been used to allergy [9]. retrieve information on the possible association between occupational risk factors and some pathologies [4]. Using wool asthma, asthma and rabbit, asthma and rabbit hair, 4. Discussion rabbit allergens and lipocalin, 116 papers were found with the specific string (25 pertinent and 1 highly pertinent) Analysis of the case gives the impression that the detection of and 197 with the sensitive one (3 pertinent and 5 highly specific antigens responsible of asthma in workers exposed to pertinent not retrieved by the specific string). Articles mainly dermal derivatives and skin of animals is quite complex. Even regarding workers in charge of laboratory animals were if in the specific case the diagnosis was relatively simple by found. Cases of asthma due to hair and skin derivatives using OCT, etiology is not easily understandable because of of animals which occurred in the textile industry were not the lack of immunological tests referring asthma to specific reported in literature. In all 1 case of angora wool asthma occupational compounds. At the moment OCT represents was only found [5]. the golden standard for diagnosis and only prick tests can Several allergenic proteins from rabbit have been recog- be used in prevention to single out subjects susceptible to nized by crossed immunoelectrophoresis but have not been developing an allergic respiratory disease to hair and skin characterized. Understanding of these important occupa- derivatives of animals. In textile industry individuals with tional allergens will allow the development of a new diag- IgE response to rabbit epithelium should be considered nostic approach for affected workers and others who may susceptible to developing angora wool asthma. be at risk. Baker et al. [6] recognized as allergens 26 protein bands in the three extracts: 12 in saliva, 7 in urine, and 7 References in fur. This was the first evidence that allergens from the rabbit are members of the lipocalin superfamily of proteins, [1] K. Aoyama, A. Ueda, F. Manda, T. Matsushita, T. Ueda, and C. suggesting that similar mechanisms may be involved in Yamauchi, “Allergy to laboratory animals: an epidemiological eliciting the allergic response to rabbits. The 18 kDa allergen study,” British Journal of Industrial Medicine, vol. 49, no. 1, pp. from saliva may be the previously named rabbit allergen, Ory 41–47, 1992. c 1. The major laboratory animal allergens are carried on [2] S. Amaducci, I. Cerveri, C. Rampulla et al., “Protocollo per small particles that are both capable of remaining airborne l’esecuzione del test di provocazione bronchiale aspecifica,” for extended periods and penetrating the lower airways of Fisiop Resp, vol. 3, pp. 3–15, 1982 (Italian). FEV1 Case Reports in Immunology 3 [3] P. L. Paggiaro, E. Bacci, D. L. Amram, O. Rossi, and D. Talini, “Skin reactivity and specific IgE levels in the evaluation of allergic sensitivity to common allergens for epidemiological purposes,” Clinical Allergy, vol. 16, no. 1, pp. 49–55, 1986. [4] S. Mattioli, F. Zanardi, A. Baldasseroni et al., “Search strings for the study of putative occupational determinants of dis- ease,” Occupational and Environmental Medicine, vol. 67, no. 7, pp. 436–443, 2010. [5] M. R. Atazhanov, “Case of bronchial asthma due to increased sensitivity to rabbit wool,” Klinicheskaya Meditsina, vol. 55, no. 5, p. 133, 1977 (Russian). [6] J.Baker,A.Berry,L.M.Boscato,S.Gordon, B. J. Walsh, and M. C. Stuart, “Identification of some rabbit allergens as lipocalins,” Clinical and Experimental Allergy,vol. 31, no.2, pp. 303–312, 2001. [7] R. A. Wood, “Laboratory animal allergens,” ILAR Journal, vol. 42, no. 1, pp. 12–16, 2001. [8] T. Virtanen, T. Zeiler, and R. Mant ¨ yjar ¨ vi, “Important animal allergens are lipocalin proteins: Why are they allergenic?” International Archives of Allergy and Immunology, vol. 120, no. 4, pp. 247–258, 1999. [9] R. K. Bush and G. M. Stave, “Laboratory animal allergy: an update,” ILAR Journal, vol. 44, no. 1, pp. 28–51, 2003. [10] J. A. Price and J. L. Longbottom, “Allergy to rabbits. I. Specificity and non-specificity of RAST and crossed- radioimmunoelectrophoresis due to the presence of light chains in rabbit allergenic extracts,” Allergy,vol. 41, no.8,pp. 603–612, 1986. MEDIATORS of INFLAMMATION The Scientific Gastroenterology Journal of World Journal Research and Practice Diabetes Research Disease Markers Hindawi Publishing Corporation Hindawi Publishing Corporation Hindawi Publishing Corporation Hindawi Publishing Corporation Hindawi Publishing Corporation http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 International Journal of Journal of Immunology Research Endocrinology Hindawi Publishing Corporation Hindawi Publishing Corporation http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 Submit your manuscripts at http://www.hindawi.com BioMed PPAR Research Research International Hindawi Publishing Corporation Hindawi Publishing Corporation http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 Journal of Obesity Evidence-Based Journal of Journal of Stem Cells Complementary and Ophthalmology International Alternative Medicine Oncology Hindawi Publishing Corporation Hindawi Publishing Corporation Hindawi Publishing Corporation Hindawi Publishing Corporation Hindawi Publishing Corporation http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 Parkinson’s Disease Computational and Behavioural Mathematical Methods AIDS Oxidative Medicine and in Medicine Research and Treatment Cellular Longevity Neurology Hindawi Publishing Corporation Hindawi Publishing Corporation Hindawi Publishing Corporation Hindawi Publishing Corporation Hindawi Publishing Corporation http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014

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Case Reports in ImmunologyHindawi Publishing Corporation

Published: Sep 23, 2012

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