title: Diagnosis and frequency of work-exacerbated asthma among bakers.
abstract: BACKGROUND
  Work-exacerbated asthma (WEA) is asthma worsened by workplace exposures, although the asthma is not caused by sensitizers in the work environment.
  
  
  OBJECTIVE
  To evaluate the frequency of WEA in bakers reporting work-related respiratory symptoms and the usefulness of diagnostic tests in differentiating WEA from occupational asthma (OA).
  
  
  METHODS
  The study group included 393 bakers reporting respiratory symptoms at the workplace. In all patients, questionnaire, spirometry, skin prick tests (SPTs), and evaluation of serum total and specific IgE levels were performed. Recognition of OA was based on a specific inhalation challenge test.
  
  
  RESULTS
  Occupational asthma was found in 44.5% of patients, whereas WEA was recognized in 16%. The latency period was 11.2 ± 8.2 years in patients with OA vs 13.3 ± 9.7 years in those with WEA. Sixty percent of patients with OA and 50.8% of those with WEA had positive SPT reactions to common allergens; occupational SPT results were positive in 74.9% and 34.9%, respectively. Specific IgE to flours were found in 61.7% of patients with OA and 28.6% of those with WEA. In addition, OA frequently coexisted with occupational rhinitis (53.7% of patients), whereas WEA and rhinitis were found in 31.7% of patients.
  
  
  CONCLUSIONS
  Work-exacerbated asthma was diagnosed in 16% of bakers who reported allergic respiratory symptoms. The specific challenge test for occupational allergens should be performed in bakers with suspected work-related asthma, because an assessment of sensitization (SPT to occupational allergens, evaluation of specific IgE) is not specific enough to differentiate OA from WEA.
authors.affiliation: Department of Occupational Diseases, Nofer Institute of Occupational Medicine, Lodz, Poland. Electronic address: martaz@imp.lodz.pl.
authors.forename: Marta
authors.initials: M
authors.lastname: Wiszniewska
authors.forename: Jolanta
authors.initials: J
authors.lastname: Walusiak-Skorupa
mesh_terms: D000328:Adult; D000485:Allergens / Q000009:adverse effects*; D059366:Asthma, Occupational / Q000175:diagnosis* / Q000453:epidemiology* / Q000276:immunology; D005260:Female; D005433:Flour / Q000009:adverse effects; D006801:Humans; D007073:Immunoglobulin E / Q000097:blood; D008297:Male; D016273:Occupational Exposure; D012220:Rhinitis / Q000175:diagnosis; D012882:Skin Tests / Q000009:adverse effects / Q000379:methods; D013147:Spirometry; D011795:Surveys and Questionnaires
chemical_list: D000485:Allergens; D007073:Immunoglobulin E