title: Sensitization to wheat flour and enzymes and associated respiratory symptoms in British bakers.
abstract: BACKGROUND
  Current literature suggests that flour exposed workers continue to be at risk of allergic sensitization to flour dust and respiratory ill health.
  
  
  OBJECTIVE
  A cross-sectional study of 225 workers currently potentially exposed to flour dust in British bakeries was performed to identify predictors of sensitization to wheat flour and enzymes.
  
  
  RESULTS
  Work-related nasal irritation was the most commonly reported symptom (28.9%) followed by eye irritation (13.3%) and work-related cough or chest tightness (both 10.2%). Work-related chest tightness was significantly associated (OR 7.9, 1.3-46.0) with co-sensitization to wheat flour and any added enzyme. Working at a bakery with inadequate control measures was not a risk factor for reporting work-related respiratory symptoms (OR 1.3, 0.4-3.7). Fifty-one workers were atopic and 23 (14%) were sensitized to workplace allergens. Atopy was the strongest predictive factor (OR 18.4, 5.3-64.3) determining sensitization. Current versus never smoking (OR 4.7, 1.1-20.8) was a significant risk factor for sensitization to wheat flour or enzymes in atopic workers only, corrected for current level and duration of exposure. This effect was not seen in non-atopic workers (OR 1.9, 0.2-17.9). Evidence of sensitization to less commonly encountered allergens was also seen to Aspergillus niger derived cellulase, hemicellulase and xylanase mix, in addition to glucose oxidase and amyloglucosidase mix.
  
  
  CONCLUSIONS
  The combination of health surveillance and exposure control in this population has been insufficient to prevent clinically significant workplace sensitization. Smoking may pose an additional risk factor for sensitization in atopic workers. Am. J. Ind. Med. 52:133-140, 2009.
authors.affiliation: Centre for Workplace Health, Health and Safety Laboratory, Harpur Hill, Buxton, Derbyshire, UK.
authors.forename: Joanne
authors.initials: J
authors.lastname: Harris-Roberts
authors.forename: Edward
authors.initials: E
authors.lastname: Robinson
authors.forename: Judith C
authors.initials: JC
authors.lastname: Waterhouse
authors.forename: Catherine G
authors.initials: CG
authors.lastname: Billings
authors.forename: Alison R
authors.initials: AR
authors.lastname: Proctor
authors.forename: Micah
authors.initials: M
authors.lastname: Stocks-Greaves
authors.forename: Shamim
authors.initials: S
authors.lastname: Rahman
authors.forename: Gareth
authors.initials: G
authors.lastname: Evans
authors.forename: Andrew
authors.initials: A
authors.lastname: Garrod
authors.forename: Andrew D
authors.initials: AD
authors.lastname: Curran
authors.forename: David
authors.initials: D
authors.lastname: Fishwick
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003296:Cooking; D003430:Cross-Sectional Studies; D005260:Female; D005433:Flour / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016273:Occupational Exposure / Q000009:adverse effects* / Q000517:prevention & control; D016017:Odds Ratio; D012129:Respiratory Function Tests; D012130:Respiratory Hypersensitivity / Q000201:enzymology / Q000453:epidemiology* / Q000209:etiology* / Q000517:prevention & control; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects; D006113:United Kingdom / Q000453:epidemiology; D021182:Wheat Hypersensitivity / Q000201:enzymology*; D055815:Young Adult