title: Respiratory disease associated with occupational inhalation to hop (Humulus lupulus) during harvest and processing.
abstract: BACKGROUND
  There is little published evidence for occupational respiratory disease caused by hop dust inhalation. In the United States, hops are commercially produced in the Pacific Northwest region.
  
  
  OBJECTIVE
  To describe occupational respiratory disease in hop workers.
  
  
  METHODS
  Washington State workers' compensation claims filed by hop workers for respiratory disease were systematically identified and reviewed. Incidence rates of respiratory disease in hop workers were compared with rates in field vegetable crop farm workers.
  
  
  RESULTS
  Fifty-seven cases of respiratory disease associated with hop dust inhalation were reported from 1995 to 2011. Most cases (61%) were diagnosed by the attending health care practitioner as having work-related asthma. Seven percent of cases were diagnosed as chronic obstructive pulmonary disease, and the remaining cases were diagnosed as allergic respiratory disorders (eg, allergic rhinitis) or asthma-associated symptoms (eg, dyspnea). Cases were associated with hop harvesting, secondary hop processing, and indirect exposure. The incidence rate of respiratory disease in hop workers was 15 cases per 10,000 full-time workers, which was 30 times greater than the incidence rate for field vegetable crop workers. A strong temporal association between hop dust exposure and respiratory symptoms and a clear association between an increase in hop dust concentrations and the clinical onset of symptoms were apparent in 3 cases.
  
  
  CONCLUSIONS
  Occupational exposure to hop dust is associated with respiratory disease. Respiratory disease rates were higher in hop workers than in a comparison group of agricultural workers. Additional research is needed before hop dust can be confirmed as a causative agent for occupational asthma.
authors.affiliation: Washington State Department of Labor & Industries, Safety and Health Assessment and Research for Prevention Program, Olympia, Washington. Electronic address: Carolyn.Whitaker@Lni.wa.gov.
authors.forename: Carolyn K
authors.initials: CK
authors.lastname: Reeb-Whitaker
authors.affiliation: Washington State Department of Labor & Industries, Safety and Health Assessment and Research for Prevention Program, Olympia, Washington.
authors.forename: David K
authors.initials: DK
authors.lastname: Bonauto
mesh_terms: D000328:Adult; D000382:Agricultural Workers' Diseases / Q000453:epidemiology* / Q000209:etiology; D059366:Asthma, Occupational / Q000453:epidemiology* / Q000209:etiology; D006801:Humans; D027582:Humulus / Q000009:adverse effects*; D015994:Incidence; D019570:Inhalation Exposure / Q000009:adverse effects / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D016273:Occupational Exposure / Q000009:adverse effects / Q000706:statistics & numerical data*; D014861:Washington / Q000453:epidemiology; D014942:Workers' Compensation