Findings are presented from the initial cross sectional phase of a cohort study of employees exposed to flour in bakeries or mills. Of 401 eligible workers in seven sites 344 (86%) were surveyed; symptoms assessed by self completed questionnaire, and sensitisation measured by the response to skin prick tests, were related to intensity of exposure both to total dust and to flour aeroallergen. Among 264 subjects without previous occupational exposure to flour, work related symptoms which started after first employment at the site were related to exposure intensity, especially when exposure was expressed in terms of flour aeroallergen. The relations with eyelnose and skin symptoms were independent of atopic status and cigarette smoking. Positive skin test responses to mixed flour and to a amylase were also more frequent with increasing exposure intensity, although this was confounded by atopic status. There was only a weak association between symptoms and specific sensitisation.
A survey of dust exposure, respiratory symptoms, lung function, and response to skin prick tests was conducted in a modern British bakery. Of the 318 bakery employees, 279 (88%) took part. Jobs were ranked from 0 to 10 by perceived dustiness and this ranking correlated well with total dust concentration measured in 79 personal dust samples. Nine samples had concentrations greater than 10 mg/m3, the exposure limit for nuisance dust. All participants completed a self administered questionnaire on symptoms and their relation to work. FEVy and FVC were measured by a dry wedge spirometer and bronchial reactivity to methacholine was estimated. Skin prick tests were performed with three common allergens and with 11 allergens likely to be found in bakery dust, including mites and moulds. Of the participants in the main exposure group, 35% reported chest symptoms which in 13% were work related. The corresponding figures for nasal symptoms were 38% and 19%. Symptoms, lung function, bronchial reactivity, and response to skin prick tests were related to current or past exposure to dust using logistic or linear regression analysis as appropriate. Exposure rank was significantly associated with most of the response variables studied. The study shows that respiratory symptoms and sensitisation are common, even in a modern bakery.Occupational asthma and rhinitis occur in bakers' and the environmental agents responsible appear to be components of the grain itself" or grain contaminants, such as mites, weevils, and moulds"7 The relative importance of these potential allergens may vary according to the source of the flour, conditions of storage, and intensity of exposure. Recent papers describing grain components as important allergens have come from Australia,24 where grain has a low moisture content. A higher moisture content, or storage ofgrain or flour for long periods, may promote the growth of contaminant micro-organisms, mites, and insects. Materials added to flour before baking, such as yeast and amylase, derived from Aspergillus species,' may also be allergenic. As many as a third ofbakers and grain workers may show evidence of sensitisation,9" which appears to be related to intensity and duration of exposure in the industry as well as to host factors, such as atopy." 12 Mechanisms involving IgE and the mast cell have been implicated,'2 13 but precipitins to components of flour have also been identified' and non-immunological processes, such as direct activation of complement pathways, may be involved.'4Apart from case reports, there is little information about asthma and sensitisation in British bakers. This study was designed to (a) describe the levels of exposure to bakery dust in a modern British bakery, (b) estimate the prevalence of symptoms and sensitisation in the workforce of the bakery, and (c) explore relations between indices of exposure and response. Methods STUDY DESIGN AND SUBJECTSThe study was a cross sectional survey of current employees conducted over six consecutive days and nights. All current...
Findings are presented from the initial cross sectional phase of a cohort study of employees exposed to laboratory rats. Of 366 eligible workers at four sites 323 (88%) were surveyed; symptoms assessed by self completed questionnaire and sensitisation measured by the response to skin prick tests were related to intensity of exposure both to total dust and to rat urinary aeroallergen. Among 238 workers, without previous occupational expo--sure to rats, work related symptoms, which started after first employment at the site were related to exposure intensity (expressed either in terms of dust or of aeroallergen) at the time of onset of symptoms. These relations were stronger in atopic subjects but were unrelated to smoking. Positive skin tests to rat urinary extract were also more frequent with increased exposure, a relation found in both atopic subjects and in smokers. There was a strong association between work related symptoms and specific sensitisation. ( information; the current cohort study was designed to correct these deficiencies. We report findings of the initial phase. Subjects and methods SURVEY METHODSFour institutions specialising in small animal research in the United Kingdom were identified: three use a variety of animals including rats; the fourth uses almost exclusively mice and is not described in this paper. All full time employees in occupational groups where exposure to laboratory rats or mice was probable and a group of non-exposed office workers, who had started work at the site from 1 January 1986 onwards and had worked for at least one month, were invited to participate.Members of the cohort still employed at the sites have been surveyed at six-monthly intervals since 1990. We describe the findings from the initial survey. Two visits to each site were made, the second to collect information from those missed at the first visit. Of 366 eligible subjects 323 (88%) were surveyed, with no difference in response rates between the three workforces. Questionnaires were completed by 315 subjects (84%) and skin prick tests by 295
A survey was carried out of a population of workers exposed to tetrachlorophthalic anhydride, an acid anhydride epoxy resin curing agent known to cause asthma. Using a radioallergosorbent test with a tetrachlorophthalic anhydride human serum albumin conjugate, specific IgE antibody was detected in serum from 24 out of 300 factory floor workers exposed to tetrachlorophthalic anhydride. Of these 24, 20 (83-3%) were current smokers compared with 133 (48 2%) of 276 without antibody (p <0 01), and there was a weaker association with atopy, defined by skin tests with common allergens. Smoking and atopy interacted, the prevalence of antibody being 16 1% in atopic smokers, 11-7% in non-atopic smokers, 8-3% in atopic non-smokers, and nil in non-atopic non-smokers (p <0 025). Smoking may predispose to, and interact with atopy in, the production of specific IgE antibody to this hapten protein conjugate.
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