title: A cross-sectional survey of sensitization to Aspergillus oryzae-derived lactase in pharmaceutical workers.
abstract: BACKGROUND
  The presence of IgE-mediated occupational respiratory sensitization to microbial enzymes has been well documented in a variety of industries. Aspergillus oryzae -derived lactase is used as a dietary aid for patients with lactose intolerance.
  
  
  OBJECTIVE
  In 1993, a cross-sectional survey of 94 pharmaceutical workers exposed to lactase for a mean duration of 23 months and 24 nonexposed recently hired employees was initiated to identify lactase-sensitized workers and potential risk factors that could be used in making recommendations for preventing future cases of lactase sensitization.
  
  
  METHODS
  The survey included a physician-administered questionnaire, skin prick testing to lactase enzyme and a panel of common aeroallergens, and spirometry.
  
  
  RESULTS
  Twenty-seven of 94 lactase-exposed workers (29%) had positive skin test responses to lactase. These workers were 9 times more likely to have upper or lower respiratory symptoms compared with workers with negative skin test responses. Atopic workers were 4 times more likely to have lactase skin sensitivity than nonatopic workers. However, atopy was not a risk factor for the development of upper and/or lower respiratory symptoms. Lactase skin reactivity was not observed in the 24 nonexposed employees.
  
  
  CONCLUSIONS
  This cross-sectional survey revealed that atopic workers were more likely to have lactase sensitization and that lactase-sensitized workers were more likely to have upper and/or lower respiratory symptoms, but atopy was not a risk factor for upper or lower respiratory symptoms. In spite of these findings, the company allowed only nonatopic, nonlactase-sensitized workers to continue working in high lactase-exposure areas with careful symptom monitoring and use of protective clothing. Although this strategy was successful in total prevention of new cases of occupational respiratory disease after 5 years, the results of this cross-sectional survey do not support exclusion of atopic workers from working with industrial enzymes.
authors.affiliation: Division of Immunology, Department of Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.
authors.forename: J A
authors.initials: JA
authors.lastname: Bernstein
authors.forename: D I
authors.initials: DI
authors.lastname: Bernstein
authors.forename: T
authors.initials: T
authors.lastname: Stauder
authors.forename: Z
authors.initials: Z
authors.lastname: Lummus
authors.forename: I L
authors.initials: IL
authors.lastname: Bernstein
mesh_terms: D001236:Aspergillus oryzae / Q000201:enzymology*; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D003876:Dermatitis, Atopic / Q000209:etiology; D004345:Drug Industry; D004781:Environmental Exposure / Q000009:adverse effects*; D006801:Humans; D007114:Immunization; D043322:Lactase; D012882:Skin Tests; D011795:Surveys and Questionnaires; D001616:beta-Galactosidase / Q000276:immunology*
chemical_list: D043322:Lactase; D001616:beta-Galactosidase