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Safe and effective hyposensitization in bakers suffering from year-round allergic rhinoconjunctivitis and allergic bronchial asthma caused by flour dust allergy

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Abstract

Background

The inhalation of flour dust increases the risk of allergic obstructive respiratory disease in bakers. Therefore, flour-induced bronchial asthma is one of the most common work-related respiratory diseases, the symptoms of which often lead to disability.

Methods

Since 2002, 39 patients with flour-induced allergic rhinoconjunctivitis and baker’s asthma have undergone hyposensitization in the author’s department using specific immunotherapy (SIT) with a flour mixture. In addition, 10 cases of treatment failure were treated for a further 5 years with a dual therapy consisting of causal SIT and symptomatic treatment using the anti-IgE antibody omalizumab.

Results

SIT- and dual-treated patients showed a marked improvement in nasal, conjunctival, and bronchial symptoms. No severe local or systemic side effects were observed.

Conclusion

Both SIT and dual therapy represent an effective and well-tolerated treatment option in flour dust-allergic individuals.

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Abbreviations

FEV1:

Forced expiratory volume in 1 s

IgE:

Immunoglobulin E

MAE11:

Monoclonal mouse antibody

NPT:

Nasal provocation test

rhuMAb-E25:

Humanized, monoclonal anti-IgE antibodies

SCIT:

Subcutaneous immunotherapy

SIT:

Specific immunotherapy

VAS:

Visual analog scales

References

  1. Saak A. Unser täglich Brot … Segen oder Gefährdung? Allergiker. 1993;4:8–11.

    Google Scholar 

  2. Sander I, Raulf-Heimsoth M. Ursachen des Bäckerasthmas auf der Spur. Neue Methoden zur Ermittlung des Sensibilisierungsprofils. IPA J. 2011;2:20–1.

    Google Scholar 

  3. Schönberger A, Mehrtens G, Valentin H, editors. Arbeitsunfall und Berufskrankheit. Rechtliche und Medizinische Grundlagen für Gutachter, Sozialverwaltung, Berater und Gerichte. Berlin: Erich Schmidt; 1993.

    Google Scholar 

  4. Straube M, Szliska C, Schwanitz HJ. Allergene und Irritanzien im Bäckerhandwerk. Allergologie. 1996;19:494–9.

    Google Scholar 

  5. Nahrungsmittel-Kontaktallergie bei Bäckern und Konditoren. Umwelt- und berufsdermatologischer Bulletin, Fa. Asche AG, ed. 1997;67

  6. Quirce S, Diaz-Perales A. Diagnosis and management of grain-induced asthma. Allergy Asthma Immunol Res. 2013;5:348–56.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Nemat K, Henker J. Glutenintoleranz. Weizenallergie, Zöliakie, Glutensensitivität. Arztebl Sachsen. 2014;1:27–9.

    Google Scholar 

  8. Raulf-Heimsoth M, van Kampen V, Kespohl S, Sander I, Merget R, Brüning T. Inhalationsallergien am Arbeitsplatz. Aktuelle Entwicklungen. Bundesgesundheitsblatt. 2012;55:363–72.

    Article  CAS  Google Scholar 

  9. Sander I, Raulf-Heimsoth M, Düser M, Flagge A, Czuppon AB, Baur X. Differentiation between cosensitization and cross-reactivity of wheat flour and grass pollen allergens. Int Arch Allergy Immunol. 1997;112:378–85.

    Article  CAS  PubMed  Google Scholar 

  10. Tasman AJ, Witzel A, Simonis B, Sohmen R, Grieshaber R, Heppt W. Prick-Test und nasaler Provokationstest mit individuellen Mehlextrakten bei Bäckerrhinitis. HNO. 1999;47:718–22.

    Article  CAS  PubMed  Google Scholar 

  11. Kniel B, Würth C. Allergien in Zusammenhang mit Backwaren und deren Herstellung – ein Diskussionsbeitrag. Inf Backmittelinst. 1996;22:1–8.

    Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  13. Kanerva L, Vaheri E. Occupational allergic rhinitis in Finland. Int Arch Occup Environ Health. 1993;64:565–8.

    Article  CAS  PubMed  Google Scholar 

  14. Houba R, Doekes G, Heederik D. Occupational respiratory allergy in bakery workers: a review of the literature. Am J Ind Med. 1998;34:529–46.

    Article  CAS  PubMed  Google Scholar 

  15. Baur X, Sander I, Jansen A, Czuppon AB. Are amylases in bakery products and flour potential food allergens? Schweiz Med Wochenschr. 1994;124:846–51.

    CAS  PubMed  Google Scholar 

  16. Fränken J, Ulmer WT, Altmeyer P, Stephan U, Das Bäckerasthma KW. Auslösende Allergene und der Einfluss von Hauptallergenen auf immunmodulatorische Vorgänge in vitro. Allergologie. 1993;16:83–6.

    Google Scholar 

  17. Pahr S, Constantin C, Papadopoulos NG, Giavi S, Mäkelä M, Pelkonen A, et al. α‑Purothionin, a new wheat allergen associated with severe allergy. J Allergy Clin Immunol. 2013;132(4):1000–1003.e4.

    Article  CAS  PubMed  Google Scholar 

  18. Simonis B, Sohmen R, Grün L, Heimbüchel G, Grieshaber R. alpha-Amylase-Exposition bei sensibilisierten und nichtsensibilisierten Bäckern mit obstruktiven allergischen Atemwegserkrankungen. Allergo J. 1998;7:425–30.

    Google Scholar 

  19. Baur X, Sander I. Allergien auf Getreidelebensmittel einschließlich Backmittel, Getreide, Mehl und Brot. Inf Backmittelinst. 1995;49:58–61.

    Google Scholar 

  20. Baur X, Chen Z, Sander I. Isolation and denomination of an important allergen in baking additives: alpha-amylase from Aspergillus oryzae (Asp o II). Clin Exp Allergy. 1994;24:465–70.

    Article  CAS  PubMed  Google Scholar 

  21. Sander I, Rozynek P, Rihs HP, van Kampen V, Chew FT, Lee WS, et al. Multiple wheat flour allergens and cross-reactive carbohydrate determinants bind IgE in baker’s asthma. Allergy. 2011;66:1208–15.

    Article  CAS  PubMed  Google Scholar 

  22. bmi aktuell. Informationen aus dem Backmittelinstitut 2001;2

  23. Ring J, Bachert C, Bauer C‑P, Czech W, editors. Weißbuch Allergie in Deutschland. München: Springer; 2010. pp. 17–9.

    Google Scholar 

  24. Braun E. Mehl, das nicht den Atem nimmt. BGN Akzente. 2011. http://www.bgn.de/464/35532?wc_origin=%2F10331%3Fsk%3D2736%26page%3D&wc_mb=WC.

    Google Scholar 

  25. Vermeidung von Bäckerasthma. In: Arbeits-Sicherheits-Informationen der BGN. ASI 8.80 [vorschriften.portal.bgn.de/9427]

  26. Hytönen M, Sala E. Nasal provocation test in the diagnostics of occupational allergic rhinitis. Rhinology. 1996;34:86–90.

    PubMed  Google Scholar 

  27. Riechelmann H, Bachert C, Goldschmidt O, Hauswald B, Klimek L, Schlenter WW, et al. Durchführung des nasalen Provokationstests bei Erkrankungen der oberen Atemwege. Allergo J. 2002;11:29–36.

    Google Scholar 

  28. Hauswald B, Yarin YM. Moderne Diagnostik und Therapie der Rhinitis allergica. Laryngorhinootologie. 2015;94:331–45.

    Article  CAS  PubMed  Google Scholar 

  29. Wedi B. Stellenwert und Indikation der SLIT im Vergleich zur SCIT. Hautarzt. 2008;59:537–43.

    Article  CAS  PubMed  Google Scholar 

  30. Kleine-Tebbe J, Fuchs T, Klimek L, Kühr J, Kunkel G, Lepp U, et al. Spezifische Immuntherapie bei IgE vermittelten allergischen Atemwegserkrankungen. Dtsch Arztebl. 2003;100:A 334–A 9.

    Google Scholar 

  31. Mösges R. Is classical immunotherapy dead? Curr Opin Allergy Clin Immunol. 2010;10:167.

    Article  PubMed  Google Scholar 

  32. Armentia A, Martin-Santos JM, Quintero A, Fernandez A, Barber D, Alonso E, et al. Baker’s asthma: prevalence and evaluation of immunotherapy with a wheat flour extract. Ann Allergy. 1990;65:265–72.

    CAS  PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  34. Brown SG, Wiese MD, van Eeden P, Stone SF, Chuter CL, Gunner J, et al. Ultrarush versus semirush initiation of insect venom immunotherapy: a randomized controlled trial. J Allergy Clin Immunol. 2012;130:162–8.

    Article  PubMed  Google Scholar 

  35. Cirla AM, Lorenzini RA, Cirla PE. Specific immunotherapy and relocation in occupational allergic bakers. G Ital Med Lav Ergon. 2007;29(3 Suppl):443–5.

    CAS  PubMed  Google Scholar 

  36. Pérez Pimiento A, Buesco Fernández A, García LJ, Rodríguez Cabreros MI, et al. Effect of omalizumab treatment in a baker with occupational asthma. J Investig Allergol Clin Immunol. 2008;18:490–1.

    PubMed  Google Scholar 

  37. Brown R, Turk F, Dale P, Bousquet J. Cost-effectiveness of omalizumab in patients with severe persistent allergic asthma. Allergy. 2007;62:149–53.

    Article  CAS  PubMed  Google Scholar 

  38. Verbruggen K, Van Cauwenberge P, Bachert C. Anti-IgE zur Behandlung der Rhinitis allergica – und der Polyposis nasi? Allergologie. 2007;30:338–54.

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Otorhinolaryngology, Carl Gustav Carus University Hospital Dresden, Fetscherstraße 74, 01307, Dresden, Germany

    Bettina Hauswald, Mandy Cuevas, Jürgen Boxberger & Thomas Zahnert

Authors
  1. Bettina Hauswald
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  2. Mandy Cuevas
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  3. Jürgen Boxberger
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  4. Thomas Zahnert
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Corresponding author

Correspondence to Bettina Hauswald.

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Conflict of interest

B. Hauswald, M. Cuevas, J. Boxberger and T. Zahnert declare that they have no competing interests.

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Hauswald, B., Cuevas, M., Boxberger, J. et al. Safe and effective hyposensitization in bakers suffering from year-round allergic rhinoconjunctivitis and allergic bronchial asthma caused by flour dust allergy. Allergo J Int 27, 43–48 (2018). https://doi.org/10.1007/s40629-018-0052-4

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  • DOI: https://doi.org/10.1007/s40629-018-0052-4

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