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Baker's asthma
  1. Jonas Brisman
  1. Correspondence to:
 Dr Jonas Brisman, Department of Occupational and Environmental Medicine, Sahlgrenska University Hospital, S:t Sigfridsgatan 85, SE-412 66 Göteborg, Sweden;
 jonas.brisman{at}ymk.gu.se

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Baker's asthma is one of the most common forms of occupational asthma. The increasing knowledge in exposure–response relations accumulated in recent years is important in the understanding of baker's asthma. This development has made scientifically based prevention feasible today and baker's asthma should not be regarded as an inevitable occurrence any more.

In 1700 Bernardo Ramazzini described respiratory symptoms among bakers caused by exposure to flour dust. However, there are anecdotal references from antiquity describing how Roman slaves working in bakeries protected themselves by using cloth as a primitive respirator to cover their faces because their breathing suffered from inhaling flour.

CLINICAL PICTURE

Case reports from the beginning of the 20th century established the concept of baker's asthma as an allergic disease because of the observed combination of positive skin tests to flour extracts and respiratory symptoms suggestive of asthma. The aetiological role of sensitisation to flour in these cases was confirmed by bronchial challenge tests. Rhinitis is very common and usually precedes asthma. Conjunctivitis and skin symptoms may also occur. The baker is often atopic by skin or IgE tests. Symptoms develop after a latency period of months or years, even decades. Initially there is often a clear temporal relation between symptoms and periods of bakery work. Over time, respiratory symptoms may cease to resolve during time off from the bakery. Sensitisation to flour is traditionally often regarded as a prerequisite for the diagnosis of baker's asthma. Although the prognosis of baker's asthma is not reported in the literature, it is usually presumed that symptoms resolve if exposure to offending allergens is stopped.

EPIDEMIOLOGY

From the 1930s onward there was a number of cross sectional studies surveying populations of bakers, unfortunately many of them uncontrolled—that is, without comparing the bakers with controls. These studies varied considerably in the description of symptoms, and …

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