What is occupational baker’s asthma?
Occupational asthma is asthma in which the causative agent of the asthma is specific to the patient’s work environment. Currently, occupational asthma, i.e. due to some component of work, is the most common occupational respiratory disease in industrialized countries, with an incidence of 15% of adult-onset asthma cases. Early diagnosis in Allergology is key to the prognosis of the disease and the health and socio-economic consequences it may represent for the patient.
Baker’s asthma is an occupational respiratory disease of immunological cause, as it is caused by prolonged exposure to allergens.
Allergens influencing Baker’s Asthma
- Allergens from cereal grains: Albumins and Globulins, present in wheat and rye flour, are the main allergens involved in Baker’s Asthma, most of the affectations are caused by wheat flour. Although patients have also been affected by flours that do not come from cereals, such as soybean flour.
- Bakery additives: there is also a prolonged exposure to enzymes used as additives in many products, such as Amylase, Cellulase, Hemicellulase, Xylanase and Glucoamylase.
- Natural contaminants: the most frequent are fungi, weevils and certain mites. Mites are also the main responsible for “Barn Asthma”, which is common among mill, silo and farm workers.
- Other environmental allergens, such as egg proteins or latex proteins used for example in gloves.
Symptoms of Baker’s Asthma
- Oculo-nasal symptomatology: patients exposed to flours usually start with symptoms typical of allergic rhinitis and conjunctivitis, to evolve to respiratory problems or asthma symptoms.
- Respiratory symptomatology: once sensitivity to allergens has reached the stage of asthma, the only effective intervention is to avoid exposure to the allergen in question, as continued exposure to the allergen in asthmatic conditions is associated with worsening of symptoms and lung function.
- Cutaneous symptomatology: bakers who react to flours and their additives with dermatitis symptoms will not normally present respiratory problems. Occupational dermatitis in bakers can be caused by both an irritative pathogenic mechanism and an immunological mechanism.
Prognosis of Baker’s Asthma
The prognosis of occupational allergy depends on the stage of the disease at the time of diagnosis. The earlier the allergy is detected and environmental hygiene and personal protection measures are taken to avoid the allergen as far as possible, the better the prognosis of the disease. With early diagnosis, symptoms can be controlled and disease progression can be prevented.
Allergen protection measures
Environmental measures: the control of environmental levels of the sensitizing agent or allergen is essential to prevent the development of occupational asthma. In the case of Baker’s Asthma, the concentration of flour in the work environment should be controlled below the level that causes symptoms in already sensitized individuals, which is 10 ng/m3.
Respiratory protection measures: some preventive measures for people sensitive to flour are to use a protective mask, even with a high efficiency filter so as not to breathe flour particles present in the environment.
Treatment of Baker’s Occupational Asthma
- Immunotherapy: consists in the progressive administration of increasing doses of the allergen in question to increase the tolerance of the organism to it. In Baker’s Asthma, immunotherapy will be effective in patients sensitized to wheat flour or natural pollutants, who already present symptoms. Studies have shown that after 20 months of immunotherapy treatment against wheat flour, there has been a significant decrease in bronchial hyperreactivity and skin sensitivity in patients.
- Monoclonal antibodies: this treatment has shown high efficacy in the control of allergy and occupational asthma due to flour. It is recommended in patients with severe asthma, which has not been controlled with other treatments such as drugs or immunotherapy.