Sensitization to wheat flour and enzymes and associated respiratory symptoms in British bakers

Rationale Current literature suggests that flour exposed workers continue to be at risk of allergic sensitization to flour dust and respiratory ill health. Objectives A cross-sectional study of 225 workers currently potentially exposed to flour dust in British bakeries was performed to identify predictors of sensitization to wheat flour and enzymes. Results Work-related nasal irritation was the most commonly reported symptom (28.9%) followed by eye irritation (13.3%) and work-related cough or chest tightness (both 10.2%). Work-related chest tightness was significantly associated (OR 7.9, 1.3-46.0) with co-sensitization to wheat flour and any added enzyme. Working at a bakery with inadequate control measures was not a risk factor for reporting work-related respiratory symptoms (OR 1.3, 0.4-3.7). Fifty-one workers were atopic and 23 (14%) were sensitized to workplace allergens. Atopy was the strongest predictive factor (OR 18.4, 5.3-64.3) determining sensitization. Current versus never smoking (OR 4.7, 1.1-20.8) was a significant risk factor for sensitization to wheat flour or enzymes in atopic workers only, corrected for current level and duration of exposure. This effect was not seen in non-atopic workers (OR 1.9, 0.2-17.9). Evidence of sensitization to less commonly encountered allergens was also seen to Aspergillus niger derived cellulase, hemicellulase and xylanase mix, in addition to glucose oxidase and amyloglucosidase mix. Conclusions The combination of health surveillance and exposure control in this population has been insufficient to prevent clinically significant workplace sensitization. Smoking may pose an additional risk factor for sensitization in atopic workers. Am. J. Ind. Med. 52:133-140, 2009.

Joanne Harris-Roberts PhD1 Edward Robinson BSc1 Judith C. Waterhouse HND2 3 Catherine G. Billings PhD3 Alison R. Proctor MSc3 Micah Stocks-Greaves1 Shamim Rahman PhD1 Gareth Evans PhD1 Andrew Garrod MRSC4 Andrew D. Curran PhD1 David Fishwick MD1 2 3 *
[1]Centre for Workplace Health, Health and Safety Laboratory, Harpur Hill, Buxton, Derbyshire, UK;[2]University of Sheffield, Western Bank, Sheffield, UK;[3]Centre for Workplace Health, Respiratory Function Unit, Royal Hallamshire Hospital, Sheffield, UK;[4]Health and Safety Executive, Redgrave Court, Bootle, UK