Health surveillance in milling, baking and other food manufacturing operation—five years' experience

Abstract

The objective of this study was to describe the incidence of allergic respiratory disease and its outcome in terms of symptoms and jobs, across different flour-using industries. It uses the findings of a health surveillance programme in a large food organization over a five-year period. The population under surveillance consisted of 3,450 employees with exposure to ingredient dusts, of whom 400 were in flour milling, 1,650 in bread baking, 550 in cake baking and 850 in other flour-using operations. A total of 66 employees with either asthma or rhinitis symptoms attributable to sensitization to allergens in the workplace were identified. The majority of these (48/66) had become symptomatic prior to the commencement of the health surveillance programme in 1993. The incidence rates (per million employees per year) for those who developed symptoms between 1993 and 1997 were 550 for flour milling, 1,940 for bread baking, 0 for cake baking and 235 for other flour-using operations. The agent believed to be responsible for symptoms was most commonly grain dust in flour millers and fungal amylase in bread bakers. Wheat flour appeared to have a weaker sensitizing potential than these other two substances. In terms of outcome, at follow-up 18% of symptomatically sensitized employees had left the company. Two of the ex-employees retired through ill health due to occupational asthma. Of those still in employment, 63% described an improvement in symptoms, 32% were unchanged and 4% were worse than when first diagnosed. Over half the cases still in employment were continuing to work in the same job as at the time of diagnosis.

Pulmonary function impairment and airway allergy among workers in traditional bakeries

“…Positive SPT to wheat grain was more prevalent among bakers compared to the control group with statistically significant difference. This is in accordance with many authors, who reported that the principal sensitizer in bread bakeries is wheat flour dust [2,3,[18][19][20][21][22]. [27] investigated pulmonary function parameters in non-smoking bakery workers and reported that the exposed group had lower forced expiratory indices than the control group.…”

Management of occupational asthma: cessation or reduction of exposure? A systematic review of available evidence

“…These findings do not provide sufficient evidence for using exposure reduction as a management option in patients with OA and they further support the statements that reduction of exposure ''is not always effective'' [5] and that ''there is little evidence for using this approach'' [6]. The systematic review on the management of OA by BEACH et al [7] examined the outcome of symptoms [11,12,17,18,22,23,26,27,41], medications [11,12,18,23,35], FEV1 [11,12,18] and NSBHR [11,12,18] after the reduction of exposure in studies published up to 2004. The authors concluded that the majority of the studies on subjects who reduced exposure reported the following: some improvement in asthma symptoms; no clear pattern of changes in medication use; an improvement in FEV1 over time in less than half of the studies; and that there were insufficient data (improvement in one of three studies) to draw conclusions about the changes in NSBHR.…”

“…recovery, improvement and worsening) as proposed by RACHIOTIS et al [8] in their systematic review of the outcome of OA after avoidance of exposure. Six [22,23,26,27,35,41] of the 10 studies [11,12,17,18,22,23,26,27,35,41] on workers with reduced exposure in the review by BEACH et al [7] were excluded from our analysis because they did not match our pre-defined inclusion criteria. However, we analysed six studies [13-16, 19, 20] that were not included in the review of BEACH et al [7].…”

“…Of these 32 publications, 10 studies met the inclusion criteria and were included in the analysis (table 1) [11][12][13][14][15][16][17][18][19][20]. 22 articles were excluded for the following reasons: 1) lack of a comparison group of workers who avoided exposure [21][22][23][24][25][26][27]; 2) comparison with asymptomatic workers who remained exposed to the offending agent [28]; 3) serial assessments of the same or a portion of the same cohort of workers with OA due to red cedar dust [13,[29][30][31][32][33], isocyanates [34] or persulphate salts [35]; 4) failure to provide appropriate data on the outcomes of patients who had ''reduced exposure'' [36][37][38][39][40]; and 5) single case report [41].…”

Allergic Rhinitis and its Impact on Asthma (ARIA) 2008*

“…Patients may not change or lose jobs except in the case of occupational allergy (1122). On the other hand, some allergic subjects may not take part in work with a high allergen load, e.g.…”