title: Specific inhalation challenge with wheat flour in workers with suspected baker's asthma.
abstract: OBJECTIVE
  The aim of this study was to evaluate the outcome of the specific inhalation challenge test (SIC) in 160 subjects with suspected baker's asthma and to assess its relation to total flour dust levels and to personal characteristics such as specific skin sensitisation, non-specific bronchial hyper-responsiveness (NSBH) and atopy.
  
  
  METHODS
  We investigated the outcome of SIC tests performed with wheat flour in six Italian laboratories. For each subject, data was available regarding skin sensitisation to wheat flour, NSBH, atopy, forced expiratory volume at 1 s (FEV1) monitoring and airborne flour dust in the challenge chamber measured by the gravimetric method (total dust in mg/m(3)).
  
  
  RESULTS
  The SIC test was positive for early asthma in 42 subjects (26%) and for late/dual asthma in 18 (11%). Positive outcome to SIC was significantly associated with NBSH (odds ratio, OR: 3.5, 95% CI: 1. 6-7.7) and skin sensitisation to wheat flour (OR: 3.1, 95% CI: 1.3-7. 0). Exposure level to wheat flour was less than or equal to 10 mg/m(3 )in 12% of individuals, ranged between 11 and 30 mg/m(3) in 43% and exceeded 30 mg/m(3) in 45%. The outcome of SIC was always negative among workers not skin sensitised to wheat flour and without NSBH and atopy. An increasing prevalence of positive SIC was observed among workers with one or more of the above-mentioned personal characteristics whose challenge exposure was greater than 10 mg/m(3) (P < 0.001).
  
  
  CONCLUSIONS
  Procedures currently adopted for wheat flour dust exposure during SIC need to be better standardised in order to avoid excessive airborne dust exposure. Over-exposure seems to be of no use for the diagnosis and risks making the asthmatic reaction worse, particularly in patients who are both sensitised to wheat allergens and have NSBH and/or atopy.
authors.affiliation: Institute of Occupational Medicine, University of Trieste, Via della Pietà 19, I-34129 Trieste, Italy.
authors.forename: R
authors.initials: R
authors.lastname: De Zotti
authors.forename: M
authors.initials: M
authors.lastname: Bovenzi
authors.forename: C
authors.initials: C
authors.lastname: Negro
authors.forename: A
authors.initials: A
authors.lastname: Cirla
authors.forename: A
authors.initials: A
authors.lastname: Innocenti
authors.forename: A
authors.initials: A
authors.lastname: Lorusso
authors.forename: A
authors.initials: A
authors.lastname: Mariano
authors.forename: P L
authors.initials: PL
authors.lastname: Paggiaro
authors.forename: D
authors.initials: D
authors.lastname: Talini
authors.forename: G
authors.initials: G
authors.lastname: Pisati
authors.forename: C
authors.initials: C
authors.lastname: Romano
authors.forename: F
authors.initials: F
authors.lastname: Sulotto
mesh_terms: D001249:Asthma / Q000175:diagnosis* / Q000209:etiology / Q000276:immunology; D001985:Bronchial Provocation Tests; D003937:Diagnosis, Differential; D004391:Dust; D005433:Flour; D006801:Humans; D009784:Occupational Diseases / Q000175:diagnosis* / Q000209:etiology / Q000276:immunology; D016273:Occupational Exposure; D012016:Reference Values; D014908:Triticum
chemical_list: D004391:Dust