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Original research
Exposure to additives or multigrain flour is associated with high risk of work-related allergic symptoms among bakers
  1. Mario Olivieri1,
  2. Nicola Murgia2,
  3. Gianluca Spiteri1,
  4. Carlo Alberto Biscardo1,
  5. Pierpaolo Marchetti3,
  6. Ilenia Folletti4,
  7. Giuseppe Verlato3
  1. 1 Diagnostics and Public Health—Unit of Occupational Medicine, University of Verona, Verona, Italy
  2. 2 Occupational Medicine, Respiratory Diseases and Toxicology, University of Perugia, Perugia, Italy
  3. 3 Diagnostics and Public Health—Unit of Epidemiology and Medical Statistics, University of Verona, Verona, Italy
  4. 4 Clinical and Experimental Medicine, Occupational Medicine, University of Perugia, Terni, Italy
  1. Correspondence to Dr Mario Olivieri, Diagnostics & Public Health - Unit of Occupational Medicine, University of Verona, Verona 37134, Italy; mario.olivieri{at}


Objectives Wheat flour exposure in bakers can elicit respiratory and skin symptoms. Scarce data are available on the prevalence of such conditions in bakers. We investigated the prevalence of work-related rhinitis, asthma-like symptoms and dermatitis in bakers according to job task and type of allergens involved.

Methods Of the 229 traditional bakeries in Verona area who were invited to participate in a cross-sectional survey, 211 (92%) accepted; 727 employees in these bakeries answered a modified version of a questionnaire on job tasks; allergen exposure within the bakery; and work-related nasal, asthma-like and skin symptoms during 2010–2014. Determinants of work-related nasal, asthma-like or skin disorders were separately evaluated using different logistic models.

Results The prevalence of work-related nasal and asthma-like symptoms was, respectively, 15.1% and 4.2% in bakery shop assistants, increasing to 25.7% and 9.5% in bakers using only wheat flour, and further to 31.8% and 13.6% in bakers using flour and additives, and then to 34.1% and 18.2% in bakers using flour with additives and multigrain (p<0.001). The risk of work-related asthma-like symptoms was more than doubled in bakers using additives without or with multigrain than in shop assistants (OR 2.3, 95% CI 1.0 to 5.5 and OR 3.4, 95% CI 1.1 to 10.8, respectively). Making bread with additives alone or with multigrain significantly increased the risk of work-related nasal symptoms in shop assistants, while the risk of skin symptoms was not significantly affected.

Conclusions Bakers using additives alone or with multigrain are at a high risk of experiencing nasal and asthma-like symptoms.

  • allergy
  • sensitisers
  • occupational asthma
  • dermatology
  • respiratory

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  • Contributors MO contributed to the study design. GS and CAB contributed to data collection. NM and GV performed the analyses. All authors contributed to the writing, revision and approval of the final version of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The ethics committee of Verona University Hospital approved the study, and informed consent was obtained from all participating workers.

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

  • Data availability statement Data are available on reasonable request to the corresponding author (MO).