Occupational respiratory allergy in bakery workers: A review of the literature

Abstract

Baker's asthma has long been recognized as a serious disease among workers in the bakery industry and the number of cases with baker's asthma is steadily increasing. This paper presents a review of the available literature on baker's allergy with a special focus on the allergens involved, the epidemiologic research and issues on exposure assessment, evidence of exposure‐response‐relationships, and possible prevention strategies. A large number of potential allergens have been identified and are described here. At present little is known about the incidence of baker's allergy. On the other hand, a large number of cross‐sectional studies have been performed, showing that sensitization and work‐related symptoms are common among bakery workers. Only atopy and exposure level have consistently been reported as determinants of this occupational disease. Age, gender, and smoking habits do not seem to be associated with sensitization or work‐related respiratory symptoms. Recently, immunochemical methods have been developed to measure specific allergens in the bakery industry, which have been used to unravel the role of allergen exposure in the development of baker's asthma. Clear exposure‐response‐relationships have been found. The implications of these recent findings for prevention strategies and standard setting are discussed. Am. J. Ind. Med. 34:529–546, 1998. © 1998 Wiley‐Liss, Inc.

Evaluation of specific occupational asthma risks in a community-based study with special reference to single and multiple exposures

“…Exposure to flour and enzymes mainly occurs in bakery workers and grain-processing operators. Flour dust has frequently been associated with occupational asthma in epidemiological studies based on general population samples or asthma registries (Meredith, 1993;Tore´n et al, 1999), and both flour and biological enzymes in studies among bakers (Houba et al, 1998). To date, asthma caused by exposure to mites in the workplace has only been reported for storage mites (Chan-Yeung and Malo, 1999).…”

Diagnostic model for sensitization in workers exposed to occupational high molecular weight allergens

“…Several previous studies have shown that exposure level is a strong predictor of HMW allergens sensitization [Houba et al, 1998a;Jeffrey et al, 1999;Nieuwenhuijsen et al, 1999Nieuwenhuijsen et al, , 2003. We did, intentionally, not include exposure level in our diagnostic model as we aimed to develop a model consisting of simple questionnaires and laboratory tests.…”

“…Work-related allergic symptoms, for example, asthma, rhinitis, conjunctivitis, and/or eczema are frequently severe enough to produce social and economic consequences at the individual level. A survey in the UK among patients diagnosed with asthma showed that persons with occupational asthma had greater difficulty in finding new jobs, greater loss of income, and were less likely to be currently employed than those with asthma that was unrelated to work [Houba et al, 1998a].…”

Evaluation of sensitization and exposure to flour dust, spices, and other ingredients among poultry breading workers.

“…Symptoms of baker's asthma may develop months or years after first exposure, and risk increases with increasing exposure concentration. In addition to allergy, nonspecific mucous membrane and respiratory irritation also occur frequently among those exposed to flour, possibly more commonly than allergic symptoms [Houba et al 1998b]. …”