title: Sensitization to xylanolytic enzymes: an underestimated health hazard among bakers.
abstract: BACKGROUND
  The most important occupational allergens in baking include flour and enzymes, especially α-amylase. Although xylanolytic enzymes have previously been described as sensitizers, they may be overlooked during assessment of bakery workers with work-related symptoms.
  
  
  OBJECTIVE
  To report a case of a baker who suffered from work-related respiratory, ocular and skin symptoms as a consequence of sensitization to xylanolytic enzymes.
  
  
  METHODS
  Physical examination, chest X-ray, routine laboratory tests, skin prick tests (SPTs) with common and occupational allergens (wheat, pearl, rye, corn and oat flours, α-amylase, bakery adjuvants) and spirometric measurements, as well as assessments by a laryngologist, dermatologist and ophthalmologist were performed. Specific IgE (sIgE) to occupational agents were evaluated for flours, α-amylase, xylanase, cellulose and glucoamylase. Specific inhalation challenges (SICs) with flours and bakery adjuvants were carried out.
  
  
  RESULTS
  Hypersensitivity to Aspergillus moulds, flours and α-amylase was confirmed in SPTs; however, SIC with those agents gave a negative result. Further investigation revealed the presence of sIgE to xylanolytic enzymes. During SIC with bakery adjuvants, allergic skin, ocular and respiratory symptoms occurred and were confirmed by objective assessment.
  
  
  CONCLUSIONS
  In the assessment of work-related allergic symptoms in bakers, sensitization to xylanolytic enzymes should be considered. Completion of diagnostic procedures having excluded asthma and rhino-conjunctivitis related to flour hypersensitivity might result in a false-negative assessment.
authors.affiliation: Department of Occupational Diseases and Environmental Health, Nofer Institute of Occupational Medicine, 91-348 Lodz, Poland. lipinska@imp.lodz.pl.
authors.forename: A
authors.initials: A
authors.lastname: Lipińska-Ojrzanowska
authors.affiliation: Department of Occupational Diseases and Environmental Health, Nofer Institute of Occupational Medicine, 91-348 Lodz, Poland.
authors.forename: M
authors.initials: M
authors.lastname: Wiszniewska
authors.affiliation: Department of Occupational Diseases and Environmental Health, Nofer Institute of Occupational Medicine, 91-348 Lodz, Poland.
authors.forename: A
authors.initials: A
authors.lastname: Pas-Wyroślak
authors.affiliation: Department of Occupational Diseases and Environmental Health, Nofer Institute of Occupational Medicine, 91-348 Lodz, Poland.
authors.forename: J
authors.initials: J
authors.lastname: Walusiak-Skorupa
mesh_terms: D000328:Adult; D000485:Allergens / Q000009:adverse effects*; D001249:Asthma / Q000175:diagnosis; D005433:Flour / Q000009:adverse effects*; D006801:Humans; D008297:Male; D016273:Occupational Exposure / Q000009:adverse effects / Q000032:analysis; D010426:Pentosan Sulfuric Polyester / Q000009:adverse effects*; D012434:Secale / Q000009:adverse effects; D014908:Triticum / Q000009:adverse effects; D000516:alpha-Amylases / Q000009:adverse effects*
chemical_list: D000485:Allergens; D010426:Pentosan Sulfuric Polyester; D000516:alpha-Amylases
keywords: Bakers; occupational allergy; occupational asthma; occupational rhino-conjunctivitis; occupational urticaria; xylanolytic enzymes.