title: Wheat flour exposure results in recruitment of inflammatory cells in the lungs of healthy individuals.
abstract: BACKGROUND
  Flour dust in bakeries is known to cause allergic as well as nonallergic respiratory symptoms. Fungal alpha-amylase is a commonly used baking additive that has been shown to have allergenic properties. The aim of this study was to investigate any effects on bronchoalveolar lavage (BAL) cells and peripheral blood lymphocytes (PBL) of healthy individuals exposed to airborne wheat flour dust with or without fungal alpha-amylase added.
  
  
  METHODS
  Fifteen subjects were exposed during 1 hr in an exposure chamber, ten individuals to wheat flour alone and five with alpha-amylase added. BAL was performed 2-6 weeks before and 1 day after the exposure. BAL cells were differentially counted and flowcytometric analysis of the expression of activation, adhesion, and subset markers on alveolar macrophages (AM) and T cells in BAL fluid and peripheral blood were carried out.
  
  
  RESULTS
  Exposure to wheat flour dust increased the total number of cells in BAL fluid from 75.4 (i.q. range 70.4-104.1) to 127.4 (92.1-187.4) cells x 10(6)/L, P < 0.01. There was a significant difference in the change of total BAL cell concentration between the study group exposed to wheat flour only (n = 10; increase with 91.9 x 10(6)/L) and the group exposed to wheat flour with the baking additive fungal alpha-amylase (n = 5; decrease with 5.4 x 10(6)/L). The exposure level of respirable dust was lower in the group that received alpha-amylase and the increase in BAL cell concentration showed a positive correlation with the concentration of respirable dust in the exposure chamber (r = 0.80, P < 0.001). The phenotypic analysis of AM indicated an influx of monocytic cells.
  
  
  CONCLUSIONS
  The results indicate that the concentration of respirable dust, but not alpha-amylase, is of importance for the recruitment of inflammatory cells to the peripheral airways in healthy individuals exposed to wheat flour dust.
authors.affiliation: Department of Medicine, Division of Respiratory Medicine, Karolinska Institutet, Stockholm, Sweden. sofia.gripenback@ks.se
authors.forename: Sofia
authors.initials: S
authors.lastname: Gripenbäck
authors.forename: Lennart
authors.initials: L
authors.lastname: Lundgren
authors.forename: Anders
authors.initials: A
authors.lastname: Eklund
authors.forename: Carola
authors.initials: C
authors.lastname: Lidén
authors.forename: Lizbet
authors.initials: L
authors.lastname: Skare
authors.forename: Göran
authors.initials: G
authors.lastname: Tornling
authors.forename: Johan
authors.initials: J
authors.lastname: Grunewald
mesh_terms: D000328:Adult; D001992:Bronchoalveolar Lavage Fluid / Q000166:cytology / Q000276:immunology*; D004391:Dust / Q000032:analysis; D005260:Female; D005433:Flour / Q000032:analysis*; D005434:Flow Cytometry; D006801:Humans; D019570:Inhalation Exposure / Q000032:analysis*; D008213:Lymphocyte Activation; D016676:Macrophages, Alveolar / Q000276:immunology*; D008297:Male; D008875:Middle Aged; D000516:alpha-Amylases / Q000032:analysis*
chemical_list: D004391:Dust; D000516:alpha-Amylases