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Occupational Asthma in the Food Industry

  • Occupational Allergy (S Quirce and J Sastre, Section Editors)
  • Published:
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Opinion statement

Inhalation of food-derived allergens during food processing at the workplace represents a risk for developing occupational asthma (OA) in exposed workers. Cereal flours and seafood are the causal agents most frequently involved. The management of food-derived OA includes timely pharmacologic therapy and environmental interventions aimed to avoid or reduce exposure to the offending agent to increase the probability of recovery. Cessation of exposure is the best option, but when the causative agent cannot be completely avoided reduction of exposure, through modification of food processing, improving ventilation, mechanization, etc. can be considered as an alternative. Quantification of real exposure levels is crucial, and new accurate immunologic and chemical assays able to detect low levels of aerosolized flour and seafood allergens have recently been developed. Recent papers have described intervention strategies effective in reducing airborne allergen exposure in flour and seafood industry, but the long-term health impact of this intervention has still to be defined. Specific allergen immunotherapy (SIT) might be another management option in individuals with IgE-mediated food-induced OA. Both a short- and a long-lasting beneficial effect of SIT with wheat flour in reducing symptoms whilst keeping the patient at work has been shown in bakers’ asthma, but at present, SIT is not for routine use for bakers’ asthma due to the lack of commercial standardized extracts. A better identification on a molecular basis of allergens involved in flour and in other IgE-mediated food-derived OA might help in preparing new extracts suitable for immunotherapy. In selected cases of bakers’ asthma, the monoclonal antibody omalizumab has been effective in reducing symptoms. SIT and omalizumab might represent further management options in IgE-mediated OA in food industry.

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References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Moscato G, Pala G, Barnig C, De Blay F, Del Giacco SR, Folletti I, Heffler E, Maestrelli P, Pauli G, Perfetti L, Quirce S, Sastre J, Siracusa A, Walusiak-Skorupa J, van Wjik RG. EAACI consensus statement for investigation of work-related asthma in non-specialized centres. Allergy. 2012 Apr;67(4):491–501.

    Article  CAS  PubMed  Google Scholar 

  2. Vandenplas O, Wiszniewska M, Raulf M, de Blay F, Gerth van Wijk R, Moscato G, Nemery B, Pala G, Quirce S, Sastre J, Schlünssen V, Sigsgaard T, Siracusa A, Tarlo SM, van Kampen V, Zock JP, Walusiak-Skorupa J, European Academy of Allergy and Clinical Immunology. EAACI position paper: irritant-induced asthma. Allergy. 2014;69(9):1141–53.

    Article  CAS  PubMed  Google Scholar 

  3. Moscato G, Vandenplas O, Gerth Van Wijk R, Malo JL, Quirce S, Walusiak J, Castano R, De Groot H, Folletti I, Gautrin D, Yacoub MR, Perfetti L, Siracusa A. Occupational rhinitis. EAACI position paper. Allergy. 2008;63:969–80.

    Article  CAS  PubMed  Google Scholar 

  4. Aresery M, Lehrer SB. Occupational reactions to foods. Curr Allergy Asthma Rep. 2002;2:78–86.

    Article  PubMed  Google Scholar 

  5. Roberts G, Gideon L. Relevance of inhalational exposure to food allergens. Curr Opin Allergy Clin Immunol. 2003;3:211–5.

    Article  PubMed  Google Scholar 

  6. Cartier A. The role of inhalant food allergens in occupational asthma. Curr Allergy Asthma Rep. 2010;10:349–56.

    Article  PubMed  Google Scholar 

  7. Siracusa A, Folletti I, Gerth van Wijk R, Jeebhay MF, Moscato G, Quirce S, Raulf M, Ruëff F, Walusiak-Skorupa J, Whitaker P, Tarlo SM. Occupational anaphylaxis—an EAACI task force consensus statement. Allergy. 2015;70(2):141–52.

    Article  CAS  PubMed  Google Scholar 

  8. Moscato G, Pala G, Crivellaro M, Siracusa A. Anaphylaxis as occupational risk. Curr Opin Allergy Clin Immunol. 2014;14(4):328–33.

    Article  PubMed  Google Scholar 

  9. Vally H, Misso NL, Madan V. Clinical effects of sulphite additives. Clin Exp Allergy. 2009;39(11):164351.

    Article  Google Scholar 

  10. Brant A. Baker's asthma. Curr Opin Allergy Clin Immunol. 2007;7(2):152–5.

    Article  PubMed  Google Scholar 

  11. Armentia A, Lombardero M, Martinez C, Barber D, Vega JM, Callejo A. Occupational asthma due to grain pests Eurygaster and Ephestia. J Asthma. 2004;41(1):99–107.

    Article  PubMed  Google Scholar 

  12. Pala G, Pignatti P Perfetti L, Caminati M, Moscato G. Usefulness of basophil activation test in a case of occupational rhinitis and asthma due to Ephestia kuehniella in a grain stocker. 1st International Congress Southern European Allergy Societies—Florence, Italy. 2010.

  13. Nieuwenhuizen N, Lopata AL, Jeebhay MF, et al. Exposure to the fish parasite Anisakis causes allergic airway hyperreactivity and dermatitis. J Allergy Clin Immunol. 2006;117:1098–105.

    Article  CAS  PubMed  Google Scholar 

  14. Caballero ML, Quirce S. Identification and practical management of latex allergy in occupational settings. Expert Rev Clin Immunol. 2015;11(9):977–92.

    Article  CAS  PubMed  Google Scholar 

  15. Jeebhay MF, Cartier A. Seafood workers and respiratory disease: an update. Curr Opin Allergy Clin Immunol. 2010;10:104–13.

    Article  PubMed  Google Scholar 

  16. Uriarte SA, Fernández-Nieto M, Arochena L, Sastre J. Occupational asthma in seafood manufacturing and food allergy to seafood. J Investig Allergol Clin Immunol. 2015;25(1):59–60.

    CAS  PubMed  Google Scholar 

  17. Pala G, Pignatti P, Perfetti L, Caminati M, Gentile E, Moscato G. Usefulness of basophil activation test in diagnosis of occupational nonasthmatic eosinophilic bronchitis. Allergy. 2010;65:924–32.

    Google Scholar 

  18. Viinanen A, Salokannel M, Lammintausta K. Gum arabic as a cause of occupational allergy. J Allergy [Cairo]. 2011;2011:841508.

    Google Scholar 

  19. Tonini S, Perfetti L, Pignatti P, Pala G, Moscato G. Occupational asthma induced by exposure to lima bean [Phaseolus lunatus]. Ann Allergy Asthma Immunol. 2012;108(1):66–7.

    Article  PubMed  Google Scholar 

  20. Villalta D, Longo G, Mistrello G, et al. A case of rice allergy in a patient with baker's asthma. Eur Ann Allergy Clin Immunol. 2012;44:207–9.

    CAS  PubMed  Google Scholar 

  21. Sastre I, Rodríguez-Perez R, García F, Juste S, Moneo I, Caballero ML. Occupational allergic rhinoconjunctivitis and bronchial asthma induced by goat cheese. Occup Environ Med. 2013;70(2):141–2.

    Article  PubMed  Google Scholar 

  22. Wiszniewska M, Tymoszuk D, Pas-Wyroślak A, Nowakowska-Świrta E, Chomiczewska-Skóra D, Pałczyński C, Walusiak-Skorupa J. Occupational allergy to squid [Loligo vulgaris]. Occup Med (Lond). 2013;63(4):298–300.

    Article  CAS  Google Scholar 

  23. Boulet LP, Laberge F. Occupational asthma to fish. Occup Environ Med. 2014;71(11):804.

    Article  PubMed  Google Scholar 

  24. Tafuro F, Ridolo E, Goldoni M, et al. Work related allergies to storage mites in Parma [Italy] ham workers. BMJ Open. 2015;5:e007502.

    Article  PubMed  PubMed Central  Google Scholar 

  25. • Lipińska-Ojrzanowska A, Wiszniewska M, Pas-Wyroślak A, Walusiak-Skorupa J. Sensitization to xylanolytic enzymes: an underestimated health hazard among bakers. Occup Med (Lond). 2016;66(5):415–8. An interesting paper highlighting the relevance of sensitization to enzymes other than alpha-amylase in UK supermarket bakers

    Article  Google Scholar 

  26. Baldassarre A, Dragonieri S, Luisi V, Musti M, Vimercati L. Occupational asthma in a fruit and vegetables vendor. Med Lav. 2016;107(2):87–91.

    PubMed  Google Scholar 

  27. •• Quirce S, Diaz-Perales A. Diagnosis and management of grain-induced asthma. Allergy Asthma Immunol Res. 2013;5:348–56. An excellent review of the diagnosis and management of grain-induced occupational asthma

    Article  PubMed  PubMed Central  Google Scholar 

  28. Brant A, Berriman J, Sharp C, et al. The changing distribution of occupational asthma: a survey of supermarket bakery workers. Eur Respir J. 2005;25:303–8.

    Article  CAS  PubMed  Google Scholar 

  29. •• Raulf M. Allergen component analysis as a tool in the diagnosis of occupational allergy. Curr Opin Allergy Clin Immunol. 2016;16(2):93–100. A comprehensive review of the component resolved diagnosis in occupational allergy

    Article  CAS  PubMed  Google Scholar 

  30. • Jones M, Welch J, Turvey J, Cannon J, Clark P, Szram J, Cullinan P. Prevalence of sensitization to ‘improver’ enzymes in UK supermarket bakers. Allergy. 2016;71(7):997–1000. An interesting paper highlighting the relevance of sensitization to enzymes other than alpha-amylase in UK supermarket bakers

    Article  CAS  PubMed  Google Scholar 

  31. Baur X, Aasen TB, Burge PS, Heederik D, Henneberger PK, Maestrelli P, Schlünssen V, Vandenplas O, Wilken D. ERS Task Force on the Management of Work-related Asthma. The management of work-related asthma guidelines: a broader perspective. Eur Respir Rev. 2012;21:125–39.

    Article  PubMed  Google Scholar 

  32. Moscato G, Galdi G. Occupational asthma and its relationship to occupational rhinitis. In: Pawankar R, Holgate S, Rossenwasser LJ, editors. Allergy frontiers: from epigenetics to future perspectives. Volume 3: clinical manifestation: Springer; 2009. p. 303–20, Japan.

  33. Global Initiative for Asthma. Global strategy for asthma management and prevention. 2016. Available from: www.ginasthma.org

  34. Vandenplas O, Dressel H, Nowak D, Jamart J, ERS Task Force on the Management of Work-related Asthma. What is the optimal management option for occupational asthma? Eur Respir Rev. 2012;21(124):97–104.

    Article  PubMed  Google Scholar 

  35. Sastre J, Quirce S. Immunotherapy: an option in the management of occupational asthma? Curr Opin Allergy Clin Immunol. 2006;6:96–100.

    Article  PubMed  Google Scholar 

  36. •• Moscato G, Pala G, Sastre J. Specific immunotherapy and biological treatments for occupational allergy. Curr Opin Allergy Clin Immunol. 2014, 576–581. A recent review highlighting the importance of specific allergen immunotherapy and biologic treatments in occupational asthma.

  37. •• Cianferoni A. Wheat allergy: diagnosis and management. Journal of Asthma and Allergy. 2016;9:13–25. A comprehensive review of the diagnosis and management of wheat allergy in occupational and non-occupational field.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Bousquet J, Lockey R, Malling HJ. Allergen immunotherapy: therapeutic vaccines for allergic diseases. A WHO position paper. J Allergy Clin Immunol. 1998;102:558–62.

    Article  CAS  PubMed  Google Scholar 

  39. Passalacqua G. Specific immunotherapy in asthma: a comprehensive review. J Asthma. 2014;51:29–33.

    Article  CAS  PubMed  Google Scholar 

  40. Armentia A, Martin-Santos JM, Quintero A, et al. Bakers’ asthma: prevalence and evaluation of immunotherapy with a wheat flour extract. Ann Allergy. 1990;65:265–72.

    CAS  PubMed  Google Scholar 

  41. Cirla AM, Lorenzini RA, Cirla PE. Specific immunotherapy and relocation in occupational allergic bakers. G Ital Med Lav Ergon. 2007;29:443–5.

    CAS  PubMed  Google Scholar 

  42. Swaminathan S, Heddle RJ. Wheat flour immunotherapy in baker’s asthma. Intern Med J. 2007;37:663–4.

    Article  CAS  PubMed  Google Scholar 

  43. Tarlo SM, Balmes J, Balkissoon R, et al. Diagnosis and management of work-related asthma: American College of Chest Physicians Consensus Statement. Chest. 2008;134:1S–41S.

    Article  CAS  PubMed  Google Scholar 

  44. Olivieri M, Biscardo CA, Turri S, Perbellini L. Omalizumab in persistent severe bakers’ asthma. Allergy. 2008;63:790–1.

    Article  CAS  PubMed  Google Scholar 

  45. Nathan RA, Sorkness CA, Kosinski M, Schatz M, Li JT, Marcus P, et al. Development of the asthma control test: a survey for assessing asthma control. J Allergy Clin Immunol. 2004;113:59–65.

    Article  PubMed  Google Scholar 

  46. Juniper EF, Guyatt GH, Ferrie PJ, Griffith LE. Measuring quality of life in asthma. Am Rev Respir Dis. 1993;147:832–8.

    Article  CAS  PubMed  Google Scholar 

  47. Pérez Pimiento A, Bueso Fernández A, García Loria J, Rodríguez Cabreros MI, Mosquera MR, García CA. Effect of omalizumab treatment in a baker with occupational asthma. J Investig Allergol Clin Immunol. 2008;18:490–1.

    PubMed  Google Scholar 

  48. Vandenplas O, Dressel H, Wilken D, Jamart J, Heederik D, Maestrelli P, Sigsgaard T, Henneberger P, Baur X. Management of occupational asthma: cessation or reduction of exposure? A systematic review of available evidence. Eur Respir J. 2011;38(4):804–11.

    Article  CAS  PubMed  Google Scholar 

  49. Moscato G, Dellabianca A, Perfetti L, et al. Occupational asthma: a longitudinal study on the clinical and socioeconomic outcome after diagnosis. Chest. 1999;115:249–56.

    Article  CAS  PubMed  Google Scholar 

  50. Vandenplas O, Toren K, Blanc PD. Health and socioeconomic impact of work-related asthma. Eur Respir J. 2003;22:689–97.

    Article  CAS  PubMed  Google Scholar 

  51. Casper R, Zacharisen MC, Fink JN. Occupational asthma secondary to enzymes used in cheese production. Allergy Asthma Proc. 2008;29(4):376–9.

    Article  PubMed  Google Scholar 

  52. •• Raulf M, Buters J, Chapman M, et al. Monitoring of occupational and environmental aeroallergens—EAACI position paper. Allergy. 2014;69:1280–99. Landmark consensus paper on validated methods for monitoring aeroallergens

    Article  CAS  PubMed  Google Scholar 

  53. American Conference of Governmental Industrial Hygienists. Flour dust. Documentation of the threshold limit values. Cincinnati: ACGIH; 2001.

    Google Scholar 

  54. Heederik D, Houba R. An exploratory quantitative risk assessment for high molecular weight sensitizers: wheat flour. Ann Occup Hyg. 2001;45(3):175–85.

    Article  CAS  PubMed  Google Scholar 

  55. DECOS. Wheat and other cereal flour dust: an approach for evaluating health effects from occupational exposure. Gezondheidsraad, Den Haag, The Netherlands; 2004. [downloadable from www.gr.nl].

  56. Baatjies R, Meijster T, Lopata A, Sander I, Raulf-Heimsoth M, Heederik D, et al. Exposure to flour dust in South African supermarket bakeries: modeling of baseline measurements of an intervention study. Ann Occup Hyg. 2010;54:309–18.

    PubMed  Google Scholar 

  57. •• Baatjies R, Meijster T, Heederick D, et al. Effectiveness of interventions to reduce flour dust exposures in supermarket bakeries in South Africa. Occup Environ Med. 2014;71:811–8. This group-randomised study conducted in supermarket bakeries demonstrates the effectiveness of different control measures in reducing airborne flour dust exposure.

    Article  PubMed  Google Scholar 

  58. Rees D, Phillips JI. Investigating the effectiveness of occupational health interventions in the workplace. Occup Environ Med. 2014;71:809–10.

    Article  PubMed  Google Scholar 

  59. Smith TA. Preventing baker's asthma: an alternative strategy. Occup Med (Lond). 2004;54(1):21–7.

    Article  CAS  Google Scholar 

  60. •• Lopata AL, Jeebhay MF. Airborne seafood allergens as a cause of occupational allergy and asthma. Curr Allergy Asthma Rep. 2013;13(3):288–97. This comprehensive review discusses recent findings in diagnosing and managing occupational allergy and asthma associated with seafood processing

    Article  CAS  PubMed  Google Scholar 

  61. Jeebhay MF, Robins TG, Seixas N, Baatjies R, George DA, Rusford E, et al. Environmental exposure characterization of fish processing workers. Ann Occup Hyg. 2005;49:423–37.

    CAS  PubMed  Google Scholar 

  62. Lopata AL, Jeebhay MF, Reese G, Fernandes J, Swoboda I, Robins TG, et al. Detection of fish antigens aerosolized during fish processing using newly developed immunoassays. Int Arch Allergy Immunol. 2005;138:21–8.

    Article  CAS  PubMed  Google Scholar 

  63. Kamath SD, Thomassen MR, Saptarshi SR, Nguyen HM, Aasmoe L, Bang BE, Lopata AL. Molecular and immunological approaches in quantifying the air-borne food allergen tropomyosin in crab processing facilities. Int J Hyg Environ Health. 2014;217(7):740–50. doi:10.1016/j.ijheh.2014.03.006.

    Article  CAS  PubMed  Google Scholar 

  64. Dahlman-Höglund A, Renström A, Larsson PH, Elsayed S, Andersson E. Salmon allergen exposure, occupational asthma, and respiratory symptoms among salmon processing workers. Am J Ind Med. 2012;55(7):624–30.

    Article  PubMed  Google Scholar 

  65. Dahlman-Höglund A, Renström A, Acevedo F, Andersson E. Exposure to parvalbumin allergen and aerosols among herring processing workers. Ann Occup Hyg. 2013;57(8):1020–9.

    PubMed  Google Scholar 

  66. Thomassen MR, Kamath SD, Lopata AL, Madsen AM, Eduard W, Bang BE, Aasmoe L. Occupational exposure to bioaerosols in Norwegian crab processing plants. Ann Occup Hyg. 2016;60(7):781–94.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Specialization School in Occupational Medicine, Department of Public Health, Forensic and Experimental Medicine, University of Pavia, Via San Felice 2, 27100, Pavia, Italy

    G. Moscato MD

  2. Occupational Physician’s Division, Local Authority of Sassari, Sassari, Italy

    G. Pala MD

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Gianni Pala declares that he has no conflict of interest.

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Moscato, G., Pala, G. Occupational Asthma in the Food Industry. Curr Treat Options Allergy 4, 191–200 (2017). https://doi.org/10.1007/s40521-017-0120-x

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