title: Diversity of allergens causing occupational asthma among cereal workers as demonstrated by exposure procedures.
abstract: BACKGROUND
  Occupational asthma among cereal workers is frequently due to cereals but other allergens can also be responsible.
  
  
  OBJECTIVE
  We evaluated the allergens causing occupational asthma in the patients who had been diagnosed in our Department during the last 5 years. Specific bronchial reactivity to the implicated allergens was assessed and compared by standardized bronchial challenge.
  
  
  METHODS
  Twenty-one patients (12 bakers, three millers and six farmers) were studied. We carried out in vivo tests (skin and challenge tests) and in vitro tests (specific IgE measurement) with cereals, enzymes, soyabean, storage mites and egg. A definitive diagnosis was established by means of specific bronchial provocation tests (BPT), except in three patients in whom it could not be carried out due to the severity of their asthma. In these cases the causative agent had to be determined by means of conjunctival challenge.
  
  
  RESULTS
  Cereals were the main sensitizers among bakers (75%) and farmers (66%). Bakers were also sensitive to alpha-amylase (41%) and soyabean (25%), and farmers, to soyabean (33%) and storage mites (33%). Occupational asthma was due to cereals, soyabean and storage mites among millers.
  
  
  CONCLUSIONS
  Besides cereals, other allergens such as enzymes, leguminous, egg and storage mites can be the causative agents of occupational asthma among cereal workers. Sensitization to different allergens in the different jobs is very likely due to differences in exposure.
authors.affiliation: Sección de Alergología, Hospital Virgen de Camino, Pamplona, Spain.
authors.forename: M J
authors.initials: MJ
authors.lastname: Alvarez
authors.forename: A I
authors.initials: AI
authors.lastname: Tabar
authors.forename: S
authors.initials: S
authors.lastname: Quirce
authors.forename: J M
authors.initials: JM
authors.lastname: Olaguíbel
authors.forename: M T
authors.initials: MT
authors.lastname: Lizaso
authors.forename: S
authors.initials: S
authors.lastname: Echechipía
authors.forename: A
authors.initials: A
authors.lastname: Rodríguez
authors.forename: B E
authors.initials: BE
authors.lastname: García
mesh_terms: D000328:Adult; D000383:Agriculture; D000485:Allergens / Q000009:adverse effects*; D000681:Amylases / Q000009:adverse effects*; D000818:Animals; D001249:Asthma / Q000209:etiology*; D001985:Bronchial Provocation Tests; D002523:Edible Grain / Q000009:adverse effects*; D005260:Female; D005525:Food-Processing Industry; D006801:Humans; D007073:Immunoglobulin E / Q000097:blood; D008297:Male; D008875:Middle Aged; D008925:Mites; D009784:Occupational Diseases / Q000209:etiology*; D012882:Skin Tests; D013030:Spain
chemical_list: D000485:Allergens; D007073:Immunoglobulin E; D000681:Amylases