A cross-sectional study was conducted among 393 workers from 21 bakeries to study the relationship between wheat allergen exposure and wheat sensitization and work-related allergic symptoms. Exposure to wheat allergens was characterized by a recently developed and validated immunoassay. Specific IgE antibodies against wheat flour and common allergens were measured by immunoassays, and work-related allergic symptoms were registered by questionnaire. A strong and positive association was found between wheat flour allergen exposure and wheat flour sensitization. This relationship was steepest and strongest in atopics. Prevalence ratios for high and medium wheat allergen exposure were 5.2 (95% confidence interval [CI], 1.6-16.2), and 2.7 (0.5-14.5) for atopic workers, and 2.5 (0.8-7.5) and 1.4 (0. 3-6.4) for nonatopics, compared with workers with low wheat allergen exposure. In sensitized bakers those with an elevated allergen exposure had more often work-related symptoms, with prevalence ratios for high and medium wheat allergen exposure of 3.5 (CI 1.6-7. 5) and 2.6 (CI 0.9-7.8), respectively, compared with workers with low wheat allergen exposure. The existence of exposure-sensitization gradients suggests that work-related sensitization risk will be negligible when exposure levels will be reduced to average exposure concentration of 0.2 microgram/m3 wheat allergen or approximately 0.5 mg/m3 inhalable dust during a work shift.