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Original Article
Predicting occupational asthma and rhinitis in bakery workers referred for clinical evaluation
  1. Badri Sadat Jonaid1,2,
  2. Jos Rooyackers1,3,
  3. Erik Stigter3,
  4. Lützen Portengen1,
  5. Esmeralda Krop1,
  6. Dick Heederik1
  1. 1 Division of Environmental Epidemiology, Institute for Risk Assessment Sciences (IRAS), Utrecht University, Utrecht, The Netherlands
  2. 2 Arak University of Medical Sciences, Arak, Iran
  3. 3 Netherlands Expertise Center for Occupational Respiratory Disorders, Division Heart and Lungs, University Medical Centre, Utrecht, The Netherlands
  1. Correspondence to Badri Sadat Jonaid, Division of Environmental Epidemiology, Institute for Risk Assessment Sciences (IRAS), Utrecht University, P.O. Box 80178, 3508 TD Utrecht, The Netherlands; B.S.Jonaid{at}


Background Occupational allergic diseases are a major problem in some workplaces like in the baking industry. Diagnostic rules have been used in surveillance but not yet in the occupational respiratory clinic.

Objective To develop diagnostic models predicting baker’s asthma and rhinitis among bakery workers at high risk of sensitisation to bakery allergens referred to a specialised clinic.

Methods As part of a medical surveillance programme, clinical evaluation was performed on 436 referred Dutch bakery workers at high risk for sensitisation to bakery allergens. Multivariable logistic regression analyses were developed to identify the predictors of onset of baker’s asthma and rhinitis using a self-administered questionnaire and compared using a structured medical history. Performance of models was assessed by discrimination (area under the receiver operating characteristics curve) and calibration (Hosmer-Lemeshow test). Internal validity of the models was assessed by a bootstrapping procedure.

Results The prediction models included the predictors of work-related upper and lower respiratory symptoms, the presence of allergy and allergic symptoms, use of medication (last year), type of job, type of shift and working years with symptoms (≥10 years). The developed models derived from both self-administered questionnaire and the medical history showed a relatively good discrimination and calibration. The internal validity showed that the models developed had satisfactory discrimination. To improve calibrations of models, shrinkage factors were applied to model coefficients.

Conclusion The probability of allergic asthma and rhinitis in referred bakers could be estimated by diagnostic models based on both a self-administered questionnaire and by taking a structured medical history.

  • Bakery worker
  • sensitisation
  • baker’s asthma and rhinitis
  • diagnostic prediction modelling

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  • Competing interests None declared.

  • Ethics approval This study was conducted as usual medical care.

  • Provenance and peer review Not commissioned; externally peer reviewed