Baker’s asthma: Still among the most frequent occupational respiratory disorders,☆☆,

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Abstract

Background: Baker’s asthma and rhinitis are among the most frequent occupational respiratory disorders. Objective: The aim of the study was to evaluate the frequency of work-related symptoms and the clinical relevance of sensitization to allergens in screened and symptomatic bakers. Methods: Eighty-nine bakers participating in a screening study and 104 bakers filing a claim for compensation were examined with regard to occupational and clinical case history, lung function parameters, and sensitization to bakery allergens by skin prick tests, specific IgE analyses, and inhalative challenge tests. Results: A high prevalence of respiratory disorders, abnormal lung function parameters, and sensitization to bakery allergens exists. Most frequently, bakers with workplace-related respiratory symptoms showed sensitization to wheat flour (64%), rye flour (52%), soy bean flour (25%), and α-amylase (21%). The correlation between these sensitizations and asthma case history and inhalative challenge test responses was significant. However, approximately 29% of the bakers with respiratory symptoms showed no sensitization to these bakery allergens, whereas 32% of the sensitized bakers in the screening group had no workplace-related symptoms. Atopic status defined by skin prick test sensitization to common allergens or elevated total IgE levels was found to be a risk factor for the development of sensitization to bakery allergens and respiratory symptoms. On the other hand, there is evidence for an increased frequency of elevated total IgE as the result of occupational allergen exposure because respective findings were observed in bakers without symptoms. Conclusion: Sensitization to bakery allergens seems to be the main cause of baker’s asthma and rhinitis but cannot explain the asthma case history in each case. Further methods are required to objectively assume irritative pathomechanisms. Our findings indicate the necessity for an improved primary prevention of exposure to inhalative noxae in bakeries. (J Allergy Clin Immunol 1998;102:984-97.)

Section snippets

Subjects

Group A comprised 89 people who were working in bakeries in the eastern part of the Ruhr area (82 men, 7 women). All were recruited on a voluntary basis by telephone calls to bakeries; 91 employers refused to participate, and 89 employers agreed to send employees to participate in the screening.

Group B comprised 104 subjects (85 men, 19 women) filing a claim for compensation of baker’s asthma. All were subjected to a medical expert opinion in our medical department. Occupational and medical

Case history

Because none of the subjects worked in a bakery, respective workplace-related symptoms were, as expected, not reported.

Skin prick testing

Two subjects (5%) were sensitized to rye flour, one (2%) to α-amylase; and 16 (37%) to at least one common allergen.

IgE antibody determination

Six subjects (15%) had IgE antibodies to wheat flour, 4 (10%) to rye flour, 4 (10%) to α-amylase; and 2 (5%) to soy bean flour. Total IgE was elevated in 18% of the subjects.

Lung function testing

Three people demonstrated bronchial hyperresponsiveness, and one person demonstrated an

DISCUSSION

Our study on screened bakers confirms the high prevalence of sensitization, symptoms, and abnormal lung function parameters in this profession.

Although we cannot exclude a certain healthy worker effect and bias because of the participation of about 50% of the working population in the Bochum area in the screening (and in the selection of bakeries instead of bakers; group A), we do not think that this caused a major bias. Principally, our data are compatible with those of other investigators.

Acknowledgements

We thank Iris Franzen for assistance in data analysis and Karin Weber for improvement of the English.

References (45)

  • Hauptverband der gewerblichen Berufsgenossenschaften Geschäfts- und Rechnungsergebnisse der gewerblichen Berufsgenossenschaften 1997

    (1998)
  • A Burdorf et al.

    Characterization of exposure to inhalable flour dust in Swedish bakeries

    Ann Occup Hyg

    (1994)
  • R. Houba

    Occupational respiratory allergy in bakery workers: relationship with wheat and fungal α-amylase aeroallergen exposure. Thesis Landbouwuniversiteit Wageningen

  • AW Musk et al.

    Respiratory symptoms, lung function and sensitization to flour in a British bakery

    Br J Ind Med

    (1989)
  • MJ Nieuwenhuijsen et al.

    Dust and flour aeroallergen exposure in flour mills and bakeries

    Occup Environ Med

    (1994)
  • I Sander et al.

    Quantifizierung der inhalativen Belastung mit α-Amylase in zwei Bäckereien

    Pneumologie

    (1998)
  • X Baur et al.

    Isolation and denomination of an important allergen in baking additives: α-amylase from Aspergillus oryzae (Asp o II)

    Clin Exp Allergy

    (1994)
  • X Baur et al.

    Baker’s asthma due to the enzyme xylanase: a new occupational allergen

    (1998)
  • A Andrejs et al.

    Chemische Verbindungen und ihre Quellen

  • X. Baur

    Registration and assessment of unspecific bronchial sensitivity

    Arbeitsmed Sozialmed Umweltmed

    (1996)
  • J Baltsch et al.

    Detection of bronchial hyperreactivity with the single step histamine provocation test

    Pneumologie

    (1990)
  • M Schmitz-Schumann et al.

    Experiences with the inhalative challenge test with histamine according to Cockcroft by using the pari challenge test I

    Dtsch Med Wschr

    (1991)
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    From the Professional Associations’ Research Institute for Occupational Medicine, University of Bochum, Bochum.

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    Reprint requests: Xaver Baur, MD, Research Institute for Occupational Medicine, University of Bochum, Bürkle-de-la-Camp-Platz 1, D-44789 Bochum, Germany.

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