Determinants of asthma phenotypes in supermarket bakery workers

Abstract

While baker's asthma has been well described, various asthma phenotypes in bakery workers have yet to be characterised. Our study aims to describe the asthma phenotypes in supermarket bakery workers in relation to host risk factors and self-reported exposure to flour dust.A cross-sectional study of 517 supermarket bakery workers in 31 bakeries used a questionnaire, skin prick tests, and specific immunoglobulin E to wheat, rye and fungal aamylase and methacholine challenge testing.The prevalence of probable occupational asthma (OA, 13%) was higher than atopic (6%), nonatopic (6%) and work-aggravated asthma (WAA, 3%) phenotypes. Previous episodes of high exposure to dusts, fumes and vapours causing asthma symptoms were more strongly associated with WAA (OR 5.8, 95% CI 1.7-19.2) than OA (2.8, 1.4-5.5). Work-related ocular-nasal symptoms were significantly associated with WAA (4.3, 1.3-13.8) and OA (3.1, 1.8-5.5). Bakers with OA had an increased odds ratio of reporting adverse reactions to ingested grain products (6.4, 2.0-19.8).OA is the most common phenotype among supermarket bakery workers. Analysis of risk factors contributes to defining clinical phenotypes, which will guide ongoing medical surveillance and clinical management of bakery workers.

Exposure-response relationships for inhalant wheat allergen exposure and asthma

“…A cross-sectional study of 517 supermarket bakery workers employed in 31 bakeries used a European Community Respiratory Health Survey questionnaire, skin prick tests for atopy, and specific IgE to flour dust allergens and methacholine challenge testing 16. While all permanent (n=318) and casual workers (n=168) in the bakery and ex-bakers with asthma redeployed from the bakery section 2 years prior to the study (n=31) were investigated in the initial study, only permanent and casual workers were included in this current analysis since no data on current exposures were available for the ex-baker group.…”

“…This study is based on the results of a detailed health survey of South African bakery workers 16. The exposure estimates for wheat allergen used in the current study were based on baseline measurements of a subgroup of supermarket bakery workers previously reported 17.…”

IgE Reactivity, Work Related Allergic Symptoms, Asthma Severity, and Quality of Life in Bakers with Occupational Asthma

“…For bakers, the greatest reduction in flour dust was achieved with control measures such as the use of a mixer lid (67 %), divider oil (63 %), or focused training (54 %). However, the greatest reduction (80 %) was observed when using a combination of all control measures (Baatjies et al 2009). …”

Inflammatory Markers and Genetic Polymorphisms in Workers Exposed to Flour Dust

“…There has recently been a dramatic increase in the number of in-store franchise bakeries in Northern Europe and South Africa. 2,3 Studies conducted among bakery workers have reported the prevalence of baker asthma to be 5 to 17%. 4 Respiratory symptoms in bakery workers have commonly been attributed to the exposure to wheat flour proteins and the enzymes used to improve dough flavor.…”

“…6 Atopy has also been found to be an important independent risk factor for the development of baker asthma, 7 and at least one previous study has examined the prevalence of different asthma phenotypes in bakery workers. 3 Baker asthma is associated with prolonged exposure to flour dust that includes a complex mixture of proteins and other organic materials, including the bacterial endotoxin, lipopolysaccharide (LPS). 8 LPS stimulates an inflammatory response by ligating the Toll-like Receptor 4 (TLR4) receptor and its coreceptor CD14.…”