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Determinants of asthma phenotypes in supermarket bakery workers

¹ Centre for Occupational and Environmental Health Research Unit, School of Public Health and Family Medicine, University of Cape Town, ³ Division of Immunology, IIDMM, Faculty of Health Sciences, University of Cape Town, ⁶ University of Cape Town Lung Institute, ² Dept of Environmental and Occupational Studies, Faculty of Applied Sciences, Cape Peninsula University of Technology, Cape Town, South Africa, ⁴ Royal Melbourne Institute of Technology, Allergy Research Group, Melbourne, Australia. ⁵ BGFA – Research Institute of Occupational Medicine, German Social Accident Insurance, Ruhr University Bochum, Bochum, Germany. ⁷ Dept of Food and Chemical Risk Analysis, TNO Quality of Life, Zeist, ⁸ Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands. ⁹ Dept of Environmental Health Sciences, University of Michigan, Ann Arbor, MI, USA.

CORRESPONDENCE: M. F. Jeebhay, Centre for Occupational and Environmental Health Research Unit, School of Public Health and Family Medicine, University of Cape Town, Room 4.44, Fourth Level, Falmouth Building, Anzio Road, Observatory, 7925 South Africa. E-mail: Mohamed.Jeebhay{at}uct.ac.za

Keywords: Asthma phenotypes, bakery workers, determinants, risk factors, work-related asthma

Received: October 30, 2008
Accepted March 12, 2009

While baker's asthma has been well described, various asthma phenotypes in bakery workers have yet to be characterised. Our study aims to describe the asthma phenotypes in supermarket bakery workers in relation to host risk factors and self-reported exposure to flour dust.

A cross-sectional study of 517 supermarket bakery workers in 31 bakeries used a questionnaire, skin prick tests, and specific immunoglobulin E to wheat, rye and fungal -amylase and methacholine challenge testing.

The prevalence of probable occupational asthma (OA, 13%) was higher than atopic (6%), nonatopic (6%) and work-aggravated asthma (WAA, 3%) phenotypes. Previous episodes of high exposure to dusts, fumes and vapours causing asthma symptoms were more strongly associated with WAA (OR 5.8, 95% CI 1.7–19.2) than OA (2.8, 1.4–5.5). Work-related ocular–nasal symptoms were significantly associated with WAA (4.3, 1.3–13.8) and OA (3.1, 1.8–5.5). Bakers with OA had an increased odds ratio of reporting adverse reactions to ingested grain products (6.4, 2.0–19.8).

OA is the most common phenotype among supermarket bakery workers. Analysis of risk factors contributes to defining clinical phenotypes, which will guide ongoing medical surveillance and clinical management of bakery workers.