Occupational Asthma Reference

Wiszniewska M, Nowakowska-Swirta E, Palczynski C, Walusiak-Skorupa J, Diagnosing of bakers' respiratory allergy: Is specific inhalation challenge test essential?, Allergy and Asthma Proc, 2011;32:111-118,

Keywords: Asthma; Poland, bakers; diagnostic methods; occupational allergy; rhinitis; specific inhalation test; wheat flour, SIC

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Jolanta Walusiak, Lodz Jolanta Walusiak

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The diagnosis of occupational asthma (OA) and/or rhinitis needs to be confirmed by means of objective methods, because it is followed by important social and financial consequences. The aim of the study was to evaluate sensitivity and specificity of diagnostic methods as skin-prick tests (SPTs) to occupational allergens, evaluation of allergen-specific serum IgE, and nonspecific bronchial hyperreactivity with reference to a specific inhalation challenge test in diagnosing bakers' respiratory allergy due to wheat flour. The study group included 358 bakers suspected of having OA due to wheat flour. They underwent physical examination, SPTs to common and occupational allergens, allergen-specific IgE determination, spirometry, nonspecific bronchial challenge, and specific inhalation test. The sensitivity of SPTs to occupational allergens in recognition of baker's rhinitis was low (47.9%) unlike the estimation of allergen-specific IgE (76.4%), with relatively high specificity (77.4 and 68.3%, respectively). Bronchial hyperreactivity (PC20 < 8 mg/mL) was the most sensitive method, whereas high degree of bronchial hyperreactivity (PC20 < 1 mg/m3) alone or bronchial hyperreactivity (PC20 < 8 mg/m3) combined with the skin reactivity to wheat flour was the most specific method of recognizing OA. Neither SPTs to occupational allergens nor evaluation of serum allergen-specific IgE alone or combined with nonspecific bronchial hyperreactivity are characterized by sufficient diagnostic accuracy to replace the specific inhalation challenge test. For the establishment of a definite diagnosis of baker's asthma, specific challenge testing with occupational allergens should be performed.

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Good study of Polish bakers referred for evaluation. Mean time from first symptom to challenge long (6.7 +/- 6.6 years for OA group) and latency also long (10.9 +/- 7.9 years for OA group). SIC with high levels of tipped flour for up to 3 hours (mean 33.6 +/- 12.3 mg/m3). SPT to wheat positive in 63/151 with wheat OA (41.7%) and 69/151 to rye. IgE to a baking antigen positive in 77.3% OA and PC20 <8mg in 73.6%. Positive wheat IgE plus NSBR <8 sensitivity 47.7% (specificity 87.7%).
The data probably applies to a highly exposed group although workplace exposure levels are not given

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