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What is the best strategy to reduce the burden of occupational asthma and allergy in bakers?
  1. Tim Meijster1,2,
  2. Nick Warren3,
  3. Dick Heederik2,
  4. Erik Tielemans1
  1. 1TNO Quality of Life, Department of Food and Chemical Risk Analysis, Zeist, the Netherlands
  2. 2Utrecht University, Institute for Risk Assessment Sciences, Utrecht, the Netherlands
  3. 3Health and Safety Laboratory, Harpur Hill, Buxton, Derbyshire, UK
  1. Correspondence to Tim Meijster, TNO Quality of Life, PO Box 360, 3700 AJ Zeist, the Netherlands; tim.meijster{at}


Rationale Insight into the effectiveness of intervention strategies will help realise a decrease in the occupational disease burden from (allergic) respiratory diseases in the bakery population.

Objectives To use a simulation model to assess the impact of different intervention strategies on the disease burden of the bakery population over time.

Methods A recently developed dynamic population based model was used to prospectively evaluate the impact on disease burden resulting from different intervention strategies. We distinguished interventions based on exposure reductions for flour dust and fungal α-amylase, health surveillance combined with reduction in exposure, and pre-employment screening.

Main Results The impact of most interventions on disease burden was limited, generally less than 50% for lower respiratory symptoms and disabling occupational asthma. Only the rigorous health surveillance strategy, identifying workers who are sensitised or report upper respiratory symptoms and decreasing their individual exposures by 90% shortly after diagnosis, resulted in a decrease of almost 60% in disease burden after 20 years.

Conclusions This study demonstrates that different intervention strategies have substantially different impacts on the burden of disease. The time window during which changes occur differs considerably between strategies. This information can assist policy makers in their choice of intervention and gives guidance for achievable reductions in disease burden.

  • Intervention strategies
  • occupational asthma
  • health impact assessment
  • disease burden
  • allergen exposure
  • health surveillance
  • intervention studies
  • sensitizers

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  • Funding Part of this study was subsidised by the Dutch Ministry of Social Affairs and Employment and the UK Health and Safety Executive.

  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.