Occupational Asthma Reference

Salvatori N, Reccardini F, Convento M, Purinan A, Colle R, De Carli S, Garzoni M, Lafiandra D, De Carli M, Asthma induced by inhalation of flour in adults with food allergy to wheat, Clin Exp Allergy, 2008;38:1349-1356,

Keywords: baker's asthma, flour, food allergy, wheat, Italy, NSBR, bronchial reactivity, challenge, cook, baker

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Wheat is one of the major food allergens and it is also an inhalant allergen in workers exposed to flour dusts. Food allergy to wheat in adulthood seems to be rare and has never been reported to be associated with asthma induced by flour inhalation.

The study aimed at detecting adults with food allergy to wheat and screening them for the presence of specific bronchial reactivity to inhaled wheat proteins.

Adults with a history of adverse reactions to ingestion of wheat underwent skin prick test with commercial wheat extract and were assessed for the presence of specific wheat IgE in the sera. Food sensitivity to wheat was confirmed by double-blind, placebo-controlled food challenge (DBPCFC). Specific bronchial reactivity was investigated through a specific bronchial challenge with wheat proteins.

In nine patients with evidence of specific IgE response to wheat, a diagnosis of food allergy was made by DBPCFC. Only two subjects had asthma as disease induced by ingestion of wheat. Seven subjects reported a history of respiratory symptoms when exposed to flour dusts. A significant reduction of forced expiratory volume in 1 s (FEV1) was detected in these seven patients when a specific bronchial challenge with flour proteins was performed. Only three out of seven subjects with asthma induced by flour could be considered occupationally exposed to flour dusts.

For the first time, it has been shown that specific bronchial reactivity to wheat proteins can be detected in patients with different disorders associated with food allergy to wheat. The presence of asthma induced by inhaled flour is not strictly related to occupational exposure and it may also occur in subjects not displaying asthma among symptoms induced by wheat ingestion.

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Bakers with occupatiuonal asthma caused by flour very rarely have adverse reactions when eating cooked bread. This paper reports patients with food allergy shown to be due to wheat following double blind food challenge who had asthma or rhinitis following inhaled challenge with nebulised wheat proteins. Two worked in bakeries as salers (I'm not sure what job this is, but translates as a salter, one who adds salt), 2 were cooks, the other 4 had jobs unrelated to wheat exposure.


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