History

Fact Explanation
History of exposure to coffee bean dust Inhalation of coffee bean dust can produce various allergic manifestations in the workers who handle the green coffee beans (GCB)[4].Studies have shown that exposure to green coffee dust in the working environment can lead to reduction of the lung functions[1].
Degree and length of exposure When the degree and length of exposure is increases, the risk of developing the disease is higher. [2]
Symptoms of rhinitis There is an allergic response due to the action of plasma cells, mast cells, and eosinophils. [9] The allergic response occurs after exposure to coffee beans. It has two stages ("early" and "late" stage). Early stage immediately after exposure to produces sneezing, itching and rhinorrhea.paroxysmal sneezing, itching, nasal congestion, lacrimation and rhinorrhea[3,5,6,7].
Cough They will have productive cough which will be lasting from days to years. If they are having chronic bronchitis, there will be a history of cough (minimum of three months to years)[1].
Conjunctivitis There will be red eye, itching and lacrimation. Itching is the most prominent feature.[2,3,5,10]
Symptoms of asthma There is a hypersensitivity reaction to the coffee bean dust and, circulating IgE antibodies bind to the IgE receptors on mast cells and basophils, forming crosslinks and initiate the secretion of inflammatory mediators. These mediators will be histamine, leukotrienes, and cytokines which can give rise to symptoms of asthma such as wheezing. [3,9]
Shortness of breath There can be airway obstruction due to bronchial hyperresponsiveness. [6]
Pruritus This occurs as a result of allergic reactions. [3]
Fever Sometimes they can present with fever, as there is inflammation of the alveoli and small airways with releasing cytokines due to allergic alveolitis. [8]
Risk factors:-History of smoking This is a predisposing factor for the development of sensitization. [2]
Risk factors:-History of aopic status A risk factor for the sensitization. [2]
References
  1. ZUSKIN E, KANCELJAK B, SKURIć Z, BUTKOVIć D. Bronchial reactivity in green coffee exposure. Br J Ind Med [online] 1985 Jun, 42(6):415-420 [viewed 19 June 2014] Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1007501
  2. OSTERMAN K, ZETTERSTRöM O, JOHANSSON SG. Coffee worker's allergy. Allergy [online] 1982 Jul, 37(5):313-22 [viewed 19 June 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/6214962
  3. DE ZOTTI R, PATUSSI V, FIORITO A, LARESE F. Sensitization to green coffee bean (GCB) and castor bean (CB) allergens among dock workers. Int Arch Occup Environ Health [online] 1988, 61(1-2):7-12 [viewed 19 June 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/3198285
  4. PATUSSI V, DE ZOTTI R, RIVA G, FIORITO A, LARESE F. Allergic manifestations due to castor beans: an undue risk for the dock workers handling green coffee beans. Med Lav [online] 1990 Jul-Aug, 81(4):301-7 [viewed 19 June 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/2150429
  5. GLAUSER T, BIRCHER A, WüTHRICH B. [Allergic rhinoconjunctivitis caused by the dust of green coffee beans]. Schweiz Med Wochenschr [online] 1992 Aug 29, 122(35):1279-81 [viewed 19 June 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/1529315
  6. ANTóN GIRONéS M, DE LA HOZ CABALLER B, MUñOZ MARTíN T, CUEVAS AGUSTíN M, SáNCHEZ-CANO M. Occupational rhinoconjunctivitis and asthma by exposure to Lathyrus sativus flour. Allergol Immunopathol (Madr) [online] 2005 Nov-Dec, 33(6):326-8 [viewed 19 June 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/16371220
  7. MONERET-VAUTRIN DA. [Diagnosis of allergic rhinitis: from clues to evidence]. Rev Prat [online] 2007 Jun 30, 57(12):1320-5 [viewed 19 June 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/17717944
  8. KILBURN KH. Particles causing lung disease. Environ Health Perspect [online] 1984 Apr:97-109 [viewed 17 September 2014] Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1568366
  9. SKONER DP. Allergic rhinitis: definition, epidemiology, pathophysiology, detection, and diagnosis. J Allergy Clin Immunol [online] 2001 Jul, 108(1 Suppl):S2-8 [viewed 20 June 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/11449200
  10. AZARI AA, BARNEY NP. Conjunctivitis: a systematic review of diagnosis and treatment. JAMA [online] 2013 Oct 23, 310(16):1721-9 [viewed 20 June 2014] Available from: doi:10.1001/jama.2013.280318

Examination

Fact Explanation
Dyspnoea There can be airway obstruction due to bronchial hyperresponsiveness. [4]
Red eye This is due to the conjunctivitis. [2]
Scratch marks There can be pruritus due to release of cytokines during the hypersensitivity reaction. [1]
Tachypnea Increased respiratory rate can occur if there is allergic alveolitis. [1]
Features of consolidation There will be fibrosis in the later stages and they may have features of consolidation on examination(reduced chest expansion and moments , dull percussion note, increased vocal fremitus and reduced breath sounds over the affected area) [7].
Rhonchi There is a hypersensitivity reaction to the coffee bean dust and, circulating IgE antibodies bind to the IgE receptors on mast cells and basophils, forming crosslinks and initiate the secretion of inflammatory mediators. These mediators will be histamine, leukotrienes, and cytokines which can give rise to symptoms of asthma[1].
Crepitations They might have chronic bronchitis, and may presents with a history of cough for months to years[6]. Crepitations can be heard on auscultation specially if they are having bronchitis.[3]
Eczema Atopy is a risk factor for sensitization and eczema is a common finding in people with atopy[5].
References
  1. DE ZOTTI R, PATUSSI V, FIORITO A, LARESE F. Sensitization to green coffee bean (GCB) and castor bean (CB) allergens among dock workers. Int Arch Occup Environ Health [online] 1988, 61(1-2):7-12 [viewed 19 June 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/3198285
  2. AZARI AA, BARNEY NP. Conjunctivitis: a systematic review of diagnosis and treatment. JAMA [online] 2013 Oct 23, 310(16):1721-9 [viewed 20 June 2014] Available from: doi:10.1001/jama.2013.280318
  3. STOCKS NP, FAHEY T. The treatment of acute bronchitis by general practitioners in the UK. Results of a cross sectional postal survey. Aust Fam Physician [online] 2002 Jul, 31(7):676-9 [viewed 20 June 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/12143330
  4. ANTóN GIRONéS M, DE LA HOZ CABALLER B, MUñOZ MARTíN T, CUEVAS AGUSTíN M, SáNCHEZ-CANO M. Occupational rhinoconjunctivitis and asthma by exposure to Lathyrus sativus flour. Allergol Immunopathol (Madr) [online] 2005 Nov-Dec, 33(6):326-8 [viewed 19 June 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/16371220
  5. OSTERMAN K, ZETTERSTRöM O, JOHANSSON SG. Coffee worker's allergy. Allergy [online] 1982 Jul, 37(5):313-22 [viewed 19 June 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/6214962
  6. ZUSKIN E, KANCELJAK B, SKURIć Z, BUTKOVIć D. Bronchial reactivity in green coffee exposure. Br J Ind Med [online] 1985 Jun, 42(6):415-420 [viewed 19 June 2014] Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1007501
  7. VAN TOORN DW. Coffee worker's lung: A new example of extrinsic allergic alveolitis Thorax [online] 1970 Jul, 25(4):399-405 [viewed 21 June 2014] Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC514665

Differential Diagnoses

Fact Explanation
Bronchial asthma Some of the symptoms of coffee worker's lung are same as the symptoms of occupational asthma[1]. But in asthmatics, usually there is a past history of same episodes triggered by various allergens such as dust, mite, smoking, respiratory tract infections and a family history of bronchial asthma. They will also have nocturnal cough ,wheezing which has a diurnal variation.
Sinusitis The symptoms of sinusitis are due to the inflammation of the paranasal sinuses Patient may be having fever, cough, and pain in the forehead, jaw and around the eyes. On examination patients will have tenderness over the sinuses. [3].
Upper and lower respiratory tract infections Upper respiratory tract infections will also be having rhinorrhoea, nasal congestion and malaise. Lower respiratory tract infections, sometimes have the same presentation[1]. Patients will have fever, productive cough, pleuritic chest pain apart from the other symptoms.
Vasomotor rhinitis These patients are also presenting with the same features of allergic rhinitis with rhinorrhoea being the most prominent symptom.[1,2]
References
  1. ZUSKIN E, KANCELJAK B, SKURIć Z, BUTKOVIć D. Bronchial reactivity in green coffee exposure. Br J Ind Med [online] 1985 Jun, 42(6):415-420 [viewed 19 June 2014] Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1007501
  2. PATTANAIK D, LIEBERMAN P. Vasomotor rhinitis. Curr Allergy Asthma Rep [online] 2010 Mar, 10(2):84-91 [viewed 21 June 2014] Available from: doi:10.1007/s11882-010-0089-z
  3. AH-SEE K. Sinusitis (acute) Clin Evid (Online) [online] :0511 [viewed 21 June 2014] Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3275132

Investigations - for Diagnosis

Fact Explanation
Lung function tests Lung function tests show obstructive changes in the smaller airways[1]. Studies have shown that simple lung function tests for one or a few weeks is one of the best tools when investigating for occupational allergies[4]. Vital capacity and forced expiratory volume in first second has shown reductions in these patients[5].
Bronchoprovocation testing Bronchoprovocation testing with with methacholine/green coffee allergen provoked immediate asthmatic reactions and acute reductions of ventilatory capacity.[1,2]. This indicates a nonspecific bronchial hyperreactivity[3].
Radioallergosorbent test (RAST) The presence of specific immunoglobulin E (IgE) antibodies to Green Coffee Bean(GCB) and Castor Bean Extract (CAB) are suggestive of coffee bean allergy. This is done by radioallergosorbent test (RAST)[2].
Chest X-ray Chest x-ray will show macronodular mottling and consolidation in basal areas of the lung[6].
Histology Histology will reveal extrinsic allergic alveolitis with the features of interstitial inflammation of the alveolar wall, vasculitis and giant cells[6].
References
  1. ZUSKIN E, KANCELJAK B, SKURIć Z, BUTKOVIć D. Bronchial reactivity in green coffee exposure. Br J Ind Med [online] 1985 Jun, 42(6):415-420 [viewed 19 June 2014] Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1007501
  2. THOMAS KE, TRIGG CJ, BAXTER PJ, TOPPING M, LACEY J, CROOK B, WHITEHEAD P, BENNETT JB, DAVIES RJ. Factors relating to the development of respiratory symptoms in coffee process workers. Br J Ind Med [online] 1991 May, 48(5):314-22 [viewed 19 June 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/2039743
  3. OSTERMAN K, JOHANSSON SG, ZETTERSTRöM O. Diagnostic tests in allergy to green coffee. Allergy [online] 1985 Jul, 40(5):336-43 [viewed 19 June 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/4037254
  4. OSTERMAN K, JOHANSSON SG, ZETTERSTRöM O. Diagnostic tests in allergy to green coffee. Allergy [online] 1985 Jul, 40(5):336-43 [viewed 19 June 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/4037254
  5. ZUSKIN E, VALIć F, SKURIć Z. Respiratory function in coffee workers. Br J Ind Med [online] 1979 May, 36(2):117-122 [viewed 20 June 2014] Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1008526
  6. VAN TOORN DW. Coffee worker's lung: A new example of extrinsic allergic alveolitis Thorax [online] 1970 Jul, 25(4):399-405 [viewed 21 June 2014] Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC514665

Investigations - Fitness for Management

Fact Explanation
Pulse oximetry This indicates the oxygen level in the blood, as there can be impairment of gas exchange in severe cases[2].
Chest X-ray Chest X-ray will show the features of hyperinflation in patients who were having chronic lung disease due to repeated, prolonged exposure[1].
Full blood count Patient may be having anaemia due to chronic lung disease. Patient may be having fever along with the other symptoms of coffee worker's lung disease. Therefore it is important to look for the leucocytosis(elevated white cell count) to exclude the bacterial infection[3], lymphocytosis (elevated lymphocytes) to exclude viral infections and platelet count. Usually in patients with coffee worker's lung disease these parameters may be normal[4].
References
  1. GIBSON GJ. Pulmonary hyperinflation a clinical overview. Eur Respir J [online] 1996 Dec, 9(12):2640-9 [viewed 21 June 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/8980982
  2. ZUSKIN E, KANCELJAK B, SKURIć Z, BUTKOVIć D. Bronchial reactivity in green coffee exposure. Br J Ind Med [online] 1985 Jun, 42(6):415-420 [viewed 19 June 2014] Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1007501
  3. KRAMER MS, TANGE SM, MILLS EL, CIAMPI A, BERNSTEIN ML, DRUMMOND KN. Role of the complete blood count in detecting occult focal bacterial infection in the young febrile child. J Clin Epidemiol [online] 1993 Apr, 46(4):349-57 [viewed 21 June 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/8482999
  4. VAN TOORN DW. Coffee worker's lung: A new example of extrinsic allergic alveolitis Thorax [online] 1970 Jul, 25(4):399-405 [viewed 21 June 2014] Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC514665

Investigations - Followup

Fact Explanation
Lung functions Lung function show obstructive changes in the smaller airways in coffee worker's lung disease[1,3]. Vital capacity and forced expiratory volume will show improvement as the disease settles and avoidance of exposure to coffee bean dust.
Radioallergosorbent test (RAST) The presence of specific immunoglobulin E (IgE) antibodies to Green Coffee Bean(GCB) and Castor Bean Extract (CAB) are suggestive of coffee bean allergy[2].When the person is avoiding the exposure to the allergen, the level of IgE in the blood will be gradually going down.
References
  1. ZUSKIN E, KANCELJAK B, SKURIć Z, BUTKOVIć D. Bronchial reactivity in green coffee exposure. Br J Ind Med [online] 1985 Jun, 42(6):415-420 [viewed 19 June 2014] Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1007501
  2. THOMAS KE, TRIGG CJ, BAXTER PJ, TOPPING M, LACEY J, CROOK B, WHITEHEAD P, BENNETT JB, DAVIES RJ. Factors relating to the development of respiratory symptoms in coffee process workers. Br J Ind Med [online] 1991 May, 48(5):314-22 [viewed 19 June 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/2039743
  3. GARSHICK E, SCHENKER MB, DOSMAN JA. Occupationally induced airways obstruction. Med Clin North Am [online] 1996 Jul, 80(4):851-78 [viewed 21 June 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/8676617

Investigations - Screening/Staging

Fact Explanation
Bronchoscopy This is used to obtain a sample to visualize the inflammatory cells and to exclude the other conditions[2].
C Reactive protein(CRP) C Reactive protein is released by the liver in response to inflammation. If, this is elevated if there is a significant inflammation due to the alveolitis[1].
Chest x-ray There will be abundant fibrosis in the later stages of the disease[3].
References
  1. DU CLOS TW. Function of C-reactive protein. Ann Med [online] 2000 May, 32(4):274-8 [viewed 21 June 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/10852144
  2. ZUSKIN E, KANCELJAK B, SKURIć Z, BUTKOVIć D. Bronchial reactivity in green coffee exposure. Br J Ind Med [online] 1985 Jun, 42(6):415-420 [viewed 19 June 2014] Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1007501
  3. VAN TOORN DW. Coffee worker's lung: A new example of extrinsic allergic alveolitis Thorax [online] 1970 Jul, 25(4):399-405 [viewed 21 June 2014] Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC514665

Management - General Measures

Fact Explanation
Antipyretics Fever may be a presenting feature. [3] Antipyretics such as paracetamol can be given to control fever.
Oxygen Oxygen is required in acute situations where the patient has low oxygen saturation. [4]
Prevention During stocking and transport of coffee beans, contamination can occur and there can be coffee bean allergen on the surface of the sacks. Prevention of this contamination will be helpful in prevention of sensitization to coffee bean dust[1]. Use of respiratory protective equipment is also helpful in preventing the exposure[2].
References
  1. PATUSSI V, DE ZOTTI R, RIVA G, FIORITO A, LARESE F. Allergic manifestations due to castor beans: an undue risk for the dock workers handling green coffee beans. Med Lav [online] 1990 Jul-Aug, 81(4):301-7 [viewed 19 June 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/2150429
  2. SAKWARI G, BRåTVEIT M, MAMUYA SH, MOEN BE. Dust exposure and chronic respiratory symptoms among coffee curing workers in Kilimanjaro: a cross sectional study BMC Pulm Med [online] :54 [viewed 21 June 2014] Available from: doi:10.1186/1471-2466-11-54
  3. KILBURN KH. Particles causing lung disease. Environ Health Perspect [online] 1984 Apr:97-109 [viewed 17 September 2014] Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1568366
  4. RASTOGI SK, KESAVACHANDRAN C, MAHDI F, PANDEY A. Occupational cancers in leather tanning industries: A short review. Indian J Occup Environ Med [online] 2007 Jan, 11(1):3-5 [viewed 17 September 2014] Available from: doi:10.4103/0019-5278.32456

Management - Specific Treatments

Fact Explanation
Avoidance of allergen Allergen avoidance is the best therapy for all patients. For patients who are not responding to the appropriate medications, allergen specific immunotherapy can be used[1].
Treatment of allergic rhinitis Intranasal corticosteroids, antihistamines, decongestants, and nasal cromolyn sodium are used to treat the allergic rhinitis[1]. Main action of the antihistamine is blockade of central histaminergic receptors, it also acts on other receptors, such as serotonergic, cholinergic, and central alpha-adrenergic receptors[3]. Drowsiness is one of the main side effects of antihistamines. New, second-generation antihistamines usually do not cause sedation[4]. Corticosteroids causes oral candidiasis with inhalation and occasionally causes systemic side effects such as osteoporosis, hypertension and diabetes[5].
Treatment of allergic conjunctivitis Topical antihistamines and mast cell inhibitors are used[2].
References
  1. BUSH RK. Etiopathogenesis and management of perennial allergic rhinitis: a state-of-the-art review. Treat Respir Med [online] 2004, 3(1):45-57 [viewed 20 June 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/15174893
  2. AZARI AA, BARNEY NP. Conjunctivitis: a systematic review of diagnosis and treatment. JAMA [online] 2013 Oct 23, 310(16):1721-9 [viewed 20 June 2014] Available from: doi:10.1001/jama.2013.280318
  3. MELTZER EO. Performance effects of antihistamines. J Allergy Clin Immunol [online] 1990 Oct, 86(4 Pt 2):613-9 [viewed 21 June 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/2229823
  4. QIDWAI JC, WATSON GS, WEILER JM. Sedation, cognition, and antihistamines. Curr Allergy Asthma Rep [online] 2002 May, 2(3):216-22 [viewed 21 June 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/11918863
  5. BARNES NC. The properties of inhaled corticosteroids: similarities and differences. Prim Care Respir J [online] 2007 Jun, 16(3):149-54 [viewed 21 June 2014] Available from: doi:10.3132/pcrj.2007.00038