Abstract：
A-55-year-old man who have been working in a Sake (Japanese rice wine) brewer for 27 years, came to the outpatient clinic because cough, dyspnea, and wheeze gradually worsen. These symptoms occurred immediately after exposure to Aspergillus oryzae in the brewing process since age 43. A dust mask was required to reduce these symptoms, but that work was interrupted by exacerbation of these symptoms. These symptoms disappeared when he was away from the on-site work. The SMART therapy using combined inhaler of budesonide (ICS) with formoterol (LABA) was effective to reduce these symptoms. In serological test total IgE antibody and Aspergillus specific IgE antibodies increased, whereas Aspergillus precipitating antibody and Asp f 1 (a major allergen of Aspergillus fumigatus) specific IgE antibody were negative. Eosinophilia in peripheral blood was not observed, and FeNO was not increased. Values of peak expiratory flow was reduced by 20.8% after exposure to Aspergillus oryzae in that work. Lung function test including reversibility test was intact, but FEV1 was fluctuated up to 400mL (15.9%) in the clinical course. Based on these variable clinical manifestations, laboratory data, and lung function test findings, this case was diagnosed as adult-onset atopic (Aspergillus-sensitized) bronchial asthma without allergic bronchopulmonary aspergillosis. Involvement of eosinophilic inflammation is unknown. Allergen may be considered to be Aspergillus oryzae, because these symptoms do not occur in any environment without exposure to Aspergillus oryzae. This patient is the first case of occupational asthma related to Aspergillus oryzae in a Japanese rise wine brewer.
摘要：
一名55岁的男子，在清酒（日本米酒）酿酒厂工作了27年，因为咳嗽来到门诊，呼吸困难,喘息逐渐恶化。这些症状在43岁开始在酿造过程中接触米曲霉后立即发生。需要一个防尘口罩来减轻这些症状，但是这些症状的恶化中断了这项工作。当他离开现场工作时，这些症状消失了。使用布地奈德（ICS）与福莫特罗（LABA）联合吸入器的SMART治疗可有效减轻这些症状。血清学检测中总IgE抗体和曲霉特异性IgE抗体增高，而曲霉沉淀抗体和Aspf1（烟曲霉的主要过敏原）特异性IgE抗体均为阴性。未观察到外周血中的嗜酸性粒细胞增多,FeNO没有增加。在这项工作中，暴露于米曲霉后，呼气流量峰值降低了20.8％。肺功能测试包括可逆性测试是完整的，但FEV1在临床过程中波动达400mL（15.9%）。基于这些可变的临床表现，实验室数据,和肺功能检查结果，该病例被诊断为成人发作的特应性（曲霉致敏）支气管哮喘，无过敏性支气管肺曲霉病。嗜酸性粒细胞炎症的参与是未知的。过敏原可能被认为是米曲霉，因为这些症状在没有接触米曲霉的任何环境中都不会发生。该患者是日本酿造葡萄酒的第一例与米曲霉有关的职业性哮喘。
