Assessment of exposure to wheat flour and the shape of its relationship with specific sensitization

Peretz, Chava; Pater, N. de; Monchy, J. de; Oostenbrink, J; Heederik, Dick

doi:10.5271/sjweh.850

Cited by 29 publications

(15 citation statements)

References 13 publications

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“…The probabilities assume a linear yearly dose response dependent upon the current year’s exposure with no threshold. The assumption of a linear yearly dose response which, for low probabilities, approximates a lifetime risk proportional to cumulative exposure, is compatible with recent studies4 26 which present a reasonable linear shape for the first part of the dose–response curve, flattening off at higher exposures (most likely caused by a healthy worker effect or development of tolerance).…”

Section: The Modelsupporting

confidence: 79%

A dynamic population-based model for the development of work-related respiratory health effects among bakery workers

et al. 2009

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Objectives:This paper presents a dynamic population-based model for the development of sensitisation and respiratory symptoms in bakery workers. The model simulates a population of individual workers longitudinally and tracks the development of work-related sensitisation and respiratory symptoms in each worker.Methods:The model has three components: a multi-stage disease model describing the development of sensitisation and respiratory symptoms in each worker over time; an exposure model describing occupational exposure to flour dust and allergens; and a basic population model describing the length of a worker’s career in the bakery sector and the influx of new workers. Each worker’s disease state is modelled independently using a discrete time Markov Chain, updated yearly using each individual’s simulated exposure. A Bayesian analysis of data from a recent epidemiological study provided estimates of the yearly transition probabilities between disease states.Results:For non-atopic/non-sensitised workers the estimated probabilities of developing moderate (upper respiratory) symptoms and progression to severe (lower respiratory) symptoms are 0.4% (95% CI 0.3 to 0.5%) and 1.1% (95% CI 0.6 to 1.9%) per mg/m3/year of flour dust, respectively, and approximately twice these for atopic workers. The model predicts that 36% (95% CI 26 to 46%) of workers with severe symptoms are sensitised to wheat and 22% (95% CI 12 to 37%) to α-amylase. The predicted mean latency period for respiratory symptoms was 10.3 years (95% CI 8.3 to 12.3).Conclusions:While the model provides a valuable population-level representation of the mechanisms contributing to respiratory diseases in bakers, it was primarily developed for use in quantitative health impact assessment. Future research will use the model to evaluate a range of workplace interventions, including achievable reductions in exposure and health surveillance. The general methodology is applicable to other diseases such as chronic obstructive pulmonary disease, silicosis and musculoskeletal disorders and could be particularly valuable for forecasting changes in long latency diseases.

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Section: The Modelsupporting

confidence: 79%

A dynamic population-based model for the development of work-related respiratory health effects among bakery workers

et al. 2009

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“…These findings are consistent with previous studies, showing a similar bell-shaped exposure–response relationship. In one of these studies, the prevalence of sensitisation and symptoms increased with increasing wheat allergen concentrations up to 10 µg/m 3 ,3 as has been shown in the current study, whereas another study demonstrated increased sensitisation up to 25 µg/m 3 wheat allergen concentration,4 which was followed by declining risks at higher exposures. Bell-shaped curves for sensitisation are not consistently observed.…”

Section: Discussionsupporting

confidence: 66%

“…Bell-shaped curves for sensitisation are not consistently observed. For instance, Houba et al 2 had no bell shape, while Peretz et al 4 reported that the relationship for sensitisation to wheat may be non-linear but differs between industries. Recently, Jacobs et al 5 also observed a bell-shaped exposure–response relationship.…”

Section: Discussionmentioning

confidence: 99%

“…The following three exposure assessment approaches were considered according to methods employed in previous studies4: (1) measured exposure for each individual worker, (2) estimated exposure based on the predictive model (which accounts for bakery size, job title and tasks performed) and (3) a combination of the previous two approaches, referred to as the variance-weighted estimator of exposure, based on measured and estimated exposure.…”

Section: Exposure Assessmentmentioning

confidence: 99%

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Exposure-response relationships for inhalant wheat allergen exposure and asthma

et al. 2014

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“…In a dusty workplace such as bakeries, the flour allergen levels show a high correlation with dust concentrations (66), but for most other allergens and worksites, the allergen content of the airborne dust is highly variable, and dust is a very poor proxy of allergen exposure (67). Detailed exposure characterization studies are helpful in identifying high-risk groups of workers, work processes, or tasks, and the use of such information in exposure modeling has allowed the establishment of dose-response relationships for various occupational allergens (4,(68)(69)(70)(71).…”

Section: Occupational Environmentmentioning

confidence: 99%

Monitoring of occupational and environmental aeroallergens – EAACI Position Paper

Raulf

Buters

Chapman³

et al. 2014

Allergy

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Exposure to high molecular weight sensitizers of biological origin is an important risk factor for the development of asthma and rhinitis. Most of the causal allergens have been defined based on their reactivity with IgE antibodies, and in many cases, the molecular structure and function of the allergens have been established. Significant information on allergen levels that cause sensitization and allergic symptoms for several major environmental and occupational allergens has been reported. Monitoring of high molecular weight allergens and allergen carrier particles is an important part of the management of allergic respiratory diseases and requires standardized allergen assessment methods for occupational and environmental (indoor and outdoor) allergen exposure. The aim of this EAACI task force was to review the essential points for monitoring environmental and occupational allergen exposure including sampling strategies and methods, processing of dust samples, allergen analysis, and quantification. The paper includes a summary of different methods for sampling and allergen quantification, as well as their pros and cons for various exposure settings. Recommendations are being made for different exposure scenarios.

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Assessment of exposure to wheat flour and the shape of its relationship with specific sensitization

Cited by 29 publications

References 13 publications

A dynamic population-based model for the development of work-related respiratory health effects among bakery workers

A dynamic population-based model for the development of work-related respiratory health effects among bakery workers

Exposure-response relationships for inhalant wheat allergen exposure and asthma

Monitoring of occupational and environmental aeroallergens – EAACI Position Paper

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