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July 21, 2014

Baker's Asthma

Question

I continue to see Baker’s Asthma in Australia. Often, bakers are exposed to multiple allergens, not just wheat. Sometimes it is difficult to obtain details of all potential allergens. What is the minimum allergen work-up you recommend, both in skin testing, and allergen serology?

Answers

From the Editors: Ever since Bernardino Ramazzini (1633-1714), the father of occupational medicine, encouraged us to ask patients "what is your occupation", work-related causes of disease, and specifically of allergic disease, have formed an important niche in our clinical work. Baker's asthma, one of the first described occupational diseases, continues as a problem to this day. Here three experts provide up-to-date information on the allergy work-up for these patients"

By Dr. Alexander Diaz Rodriguez

Baker’s asthma is a frequent occupational allergic disease caused mainly by inhalation of cereal flour, particularly wheat flour. It is considered one of the most common types of occupational asthma. Although wheat is the most commonly involved cereal, others (rye, barley, rice, maize, and oats) also play a role in baker’s asthma. Other allergens like soy, various enzyme additives (amylase, cellulose), storage and house dust mites, yeast and molds have also been involved.

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By Prof Hae Sim Park

Within wheat flour allergen, house dust mite, storage mites and fungus (Aspergillus spp etc.) can be included and induce allergic responses.

Also atopy is a predisposing factor for baker’s asthma; I recommend doing skin test with common inhalant allergens in your environment to screen atopy status and to identify the causative allergens of underlying allergic diseases such as allergic rhinitis.

Also skin prick test or in vitro testing with wheat flour, house dust mite, storage mites and fungus should be checked.

Hae Sim Park, MD, PhD
Dept of Allergy and Clinical Immunology
Ajou University School of Medicine
Suwon, South Korea

By Prof Brett J Green

Occupational exposure to cereal flour and associated additives has been identified as determinants of allergic sensitization and work-related respiratory symptoms (baker’s asthma) among bakery workers [1]. During the last several decades, research has focused on sensitization to wheat (Triticum aestivum) due to the prevalence of this flour in bakery operations [2, 3]. Rye (Secale cereale), barley (Hordeum vulgare), buckwheat (Fagopyrum esculentum), and cereal malt flours are also utilized in bakeries and have been implicated in cases of baker’s asthma [1, 4-6]. To date, the role of other commercially available cereals such as maize, rice, sorghum, triticale, millet, and oats as determinants of occupational sensitization among bakery workers requires further clinical evaluation.

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