Determinants of asthma phenotypes in supermarket bakery workers

Published on May 14, 2009 ERJ Express (e-pub ahead of print)

R. Baatjies, A. L. Lopata, I. Sander, M. Raulf-Heimsoth, E.D. Bateman, T.

Meijster, D. Heederik, T.G. Robins, M.F. Jeebhay

ABSTRACT

Background: While baker’s asthma has been well described, various asthma

phenotypes in bakery workers have yet to be characterized. This study aims to

describe the asthma phenotypes in supermarket bakery workers in relation to host risk

factors and self-reported exposure to flour dust.

Methods: A cross-sectional study of 517 supermarket bakery workers in 31 bakeries

used a questionnaire, skin prick tests, specific IgE to wheat, rye and alpha-amylase

and methacholine challenge testing.

Results: The prevalence of probable occupational asthma (OA, 13%) was higher than

atopic (AA, 6%), non-atopic (NAA, 6%) and work-aggravated asthma (WAA, 3%)

phenotypes. Previous episodes of high exposure to dusts, fumes and vapours causing

asthma symptoms were more strongly associated with WAA (OR=5.8, CI: 1.7 – 19.2)

than OA (OR=2.8, CI: 1.4 – 5.5). Work-related ocular-nasal symptoms were

significantly associated with WAA (OR=4.3, CI: 1.3 – 13.8) and OA (OR=3.1, CI: 1.8

– 5.5). Bakers with OA had an increased odds of reporting adverse reactions to

ingested grain products (OR=6.4, CI: 2.0 – 19.8).

Conclusion: Occupational asthma is the most common phenotype among supermarket

bakery workers. Analysis of risk factors contributes to defining clinical phenotypes,

which will guide ongoing medical surveillance and clinical management of bakery

workers.

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