title: Incidence and host determinants of work-related rhinoconjunctivitis in apprentice pastry-makers.
abstract: BACKGROUND
  The authors recently assessed the incidence and determinants of immunologic sensitization to flour in apprentice pastry-makers. The aim of this work was to determine the incidence of work-related rhinoconjunctivitis (RC) symptoms and their determinants.
  
  
  METHODS
  For this 188/230 entrants (81.7%) were evaluated before starting exposure to flour, and again 10.8 and 16.8 months after. Questionnaires and skin prick testing to common and work-related allergens were administered at each visit. Bronchial responsiveness to methacholine was assessed at baseline in all subjects and in a subgroup at follow-up.
  
  
  RESULTS
  Thirty subjects (16.1%) reported new work-related RC symptoms (13.1 per 100 person-years); in three subjects (1.6%), these were accompanied by incident skin prick test reactivity to flour-derived allergens. Skin prick test reactivity to grass pollens (OR = 3.0, 95% CI, 1.3-6.7) and to pets (OR = 2.5, 95% CI, 1.1-5.9), persistent rhinitis (OR = 3.1, 95% CI, 1.1-8.4), seasonal RC (OR = 2.5, 95% CI, 1.1-5.5), RC on contact with pets (OR = 2.3, 95% CI, 1.03-5.0) and skin prick test reactivity to wheat flour (OR = 10.5, 95% CI, 2.3-46.8), assessed at baseline, were significantly associated with the incidence of work-related RC symptoms. Multivariate logistic regression analysis yielded significant OR of skin prick test reactivity to wheat flour at baseline (OR = 7.1, 95% CI, 1.7-35.1) and persistent rhinitis (OR = 3.9, 95% CI, 1.01-9.6) for the incidence of work-related RC symptoms. Increased bronchial hyperresponsiveness at follow-up was more frequent, although not significantly, in subjects positive to skin prick test to flour on entry and reporting new work-related symptoms (3/5), than in other subjects (4/17).
  
  
  CONCLUSIONS
  The incidence of work-related RC symptoms among apprentice pastry-makers was high (16.1% 30/186), while a minority (3/30) also developed skin prick test reactivity to flour. Skin prick test reactivity to wheat flour and persistent allergic rhinitis on starting exposure to flour are significant determinants for the development of work-related RC symptoms.
authors.affiliation: The Department of Chest Medicine, Hôpital du Sacré-Coeur, Montreal, Canada.
authors.forename: D
authors.initials: D
authors.lastname: Gautrin
authors.forename: H
authors.initials: H
authors.lastname: Ghezzo
authors.forename: C
authors.initials: C
authors.lastname: Infante-Rivard
authors.forename: J-L
authors.initials: JL
authors.lastname: Malo
mesh_terms: D000293:Adolescent; D000328:Adult; D015331:Cohort Studies; D003231:Conjunctivitis / Q000453:epidemiology* / Q000209:etiology*; D015981:Epidemiologic Factors; D005260:Female; D005433:Flour; D005500:Follow-Up Studies; D005525:Food-Processing Industry; D006801:Humans; D015994:Incidence; D008297:Male; D015999:Multivariate Analysis; D009784:Occupational Diseases / Q000150:complications* / Q000453:epidemiology* / Q000276:immunology; D011792:Quebec; D012220:Rhinitis / Q000453:epidemiology* / Q000209:etiology*; D012307:Risk Factors; D012572:School Health Services; D012882:Skin Tests