Sensitisation to occupational allergens in bakers' asthma and rhinitis: a case-referent study.
OBJECTIVE
To study the importance of sensitisation to occupational allergens for the occurrence of asthma and rhinitis in bakers.


METHODS
This is a nested clinical case-referent study of bakers based on a cohort of Swedish former bakery students. Cases were asthmatic ( n=25) or rhinitic bakers ( n=20). Randomly selected bakers ( n=44) were referents. All subjects underwent skin prick tests (SPTs) with common allergens, flours, fungal alpha-amylase and the storage mite L. destructor. Indices of airway inflammation were assessed in serum and the nose.


RESULTS
Seven of the asthmatics and eight of the rhinitics reported onset of disease during bakery work. Flour SPTs were positive in 43% of the asthmatics or rhinitics vs 16% of referents. The corresponding figures for alpha-amylase were 29%, 25%, and 7%. The odds ratio, adjusted for atopy, for an SPT positive to flour or alpha-amylase for asthmatics with onset during bakery work was 5.8 (95% confidence interval 1.1-32), and 2.6 (0.4-16) for the corresponding rhinitics. The positive predictive value of sensitisation to flour or alpha-amylase in relation to a clinical diagnosis of asthma or rhinitis was 71%. Sensitisation to L. destructor was rare. The indices of airway inflammation were similar in cases and in referents.


CONCLUSIONS
Bakers' asthma is associated with sensitisation to flour and/or alpha-amylase, atopy taken into account. A similar association was suggested in bakers' rhinitis. Indices of airway inflammation were of low predictive value for detecting bakers' asthma or rhinitis in this study.
Occupational Medicine, Department of Internal Medicine, Sahlgrenska University Hospital, S:t Sigfridsgatan 85, 412 66 Gothenburg, Sweden. jonas.brisman@ymk.gu.se
Jonas
J
Brisman
Linnéa
L
Lillienberg
Lars
L
Belin
Mats
M
Ahman
Bengt
B
Järvholm
D000328:Adult; D001249:Asthma / Q000453:epidemiology*; D001798:Blood Proteins / Q000032:analysis; D016022:Case-Control Studies; D003296:Cooking; D047091:Eosinophil Granule Proteins; D006801:Humans; D009784:Occupational Diseases / Q000453:epidemiology*; D016017:Odds Ratio; D011237:Predictive Value of Tests; D012220:Rhinitis / Q000453:epidemiology*; D012260:Ribonucleases; D012882:Skin Tests
D001798:Blood Proteins; D047091:Eosinophil Granule Proteins; D012260:Ribonucleases