title: Work-related allergic respiratory disease and asthma in spice mill workers is associated with inhalant chili pepper and garlic exposures.
abstract: OBJECTIVE
  The aim of the study was to determine the prevalence and risk factors for allergic respiratory disease in spice mill workers.
  
  
  METHODS
  A cross-sectional study of 150 workers used European Community Respiratory Health Survey questionnaires, Phadiatop, serum specific IgE (garlic, chili pepper), spirometry and fractional exhaled nitric oxide (FeNO). Personal air samples (n=62) collected from eight-hour shifts were analysed for inhalable particulate mass. Novel immunological assays quantified airborne garlic and chili pepper allergen concentrations.
  
  
  RESULTS
  Mean dust particulate mass (geometric mean (GM)=2.06 mg/m(3)), chili pepper (GM=0.44 µg/m(3)) and garlic allergen (GM=0.24 µg/m(3)) were highest in blending and were highly correlated. Workers' mean age was 33 years, 71% were men, 46% current smokers and 45% atopic. Spice-dust-related asthma-like symptoms (17%) were common, as was garlic sensitisation (19%), with 13% being monosensitised and 6% cosensitised to chili pepper. Airflow reversibility and FeNO>50 ppb was present in 4% and 8% of workers respectively. Spice-dust-related ocular-nasal (OR 2.40, CI 1.09 to 5.27) and asthma-like (OR 4.15, CI 1.09 to 15.72) symptoms were strongly associated with airborne garlic in the highly exposed (>0.235 µg/m(3)) workers. Workers monosensitised to garlic were more likely to be exposed to higher airborne chili pepper (>0.92 µg/m(3)) (OR 11.52, CI 1.17 to 113.11) than garlic allergens (OR 5.08, CI 1.17 to 22.08) in this mill. Probable asthma was also more strongly associated with chili pepper than with garlic sensitisation.
  
  
  CONCLUSIONS
  Exposure to inhalable spice dust (GM >2.06 mg/m(3)) containing garlic (GM>0.24 µg/m&sup3;) and chili pepper (GM >0.44 µg/m(3)) allergens increase the risk of allergic respiratory disease and asthma.
authors.affiliation: Faculty of Health Sciences, Centre for Occupational and Environmental Health Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town 7925, South Africa.
authors.forename: Anita
authors.initials: A
authors.lastname: van der Walt
authors.forename: Tanusha
authors.initials: T
authors.lastname: Singh
authors.forename: Roslynn
authors.initials: R
authors.lastname: Baatjies
authors.forename: Andreas Ludwig
authors.initials: AL
authors.lastname: Lopata
authors.forename: Mohamed Fareed
authors.initials: MF
authors.lastname: Jeebhay
mesh_terms: D000328:Adult; D000395:Air Pollutants, Occupational / Q000633:toxicity*; D059366:Asthma, Occupational / Q000453:epidemiology / Q000209:etiology* / Q000276:immunology; D002212:Capsicum / Q000633:toxicity*; D003430:Cross-Sectional Studies; D004391:Dust / Q000032:analysis; D005060:Europe / Q000453:epidemiology; D005260:Female; D019649:Food Industry; D005737:Garlic / Q000633:toxicity*; D006801:Humans; D007073:Immunoglobulin E / Q000097:blood; D008297:Male; D016273:Occupational Exposure / Q000009:adverse effects* / Q000032:analysis; D012120:Respiration Disorders / Q000453:epidemiology / Q000209:etiology* / Q000276:immunology
chemical_list: D000395:Air Pollutants, Occupational; D004391:Dust; D007073:Immunoglobulin E
keywords: chili pepper; garlic; inhalant allergy; work-related