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. 2000 May;57(5):335–340. doi: 10.1136/oem.57.5.335

Exposure-response relations for self reported asthma and rhinitis in bakers

J Brisman 1, B Jarvholm 1, L Lillienberg 1
PMCID: PMC1739948  PMID: 10769299

Abstract

OBJECTIVES—To explore relations between two estimates of exposure to inhalable flour dust, and the incidence rates (IRs) of asthma and rhinitis in bakers.
METHODS—This was a retrospective cohort study among 2923 bakers. A posted questionnaire registered the disease and work history. For every year, each baker was assigned an estimate of the exposure concentration to inhalable flour dust derived from reported job-tasks and dust measurements. Exposure at onset of disease was expressed as current dust exposure concentration, and as cumulative dose of exposure to dust. A multiple Poisson regression analysis assessed the impacts of the exposure estimates on the IRs of asthma and rhinitis.
RESULTS—IRs of asthma and rhinitis increased by dust concentration at onset of disease. The IR of asthma for the bakers with highest exposure (dough makers) was 7.3/1000 person-years in men and 6.5 in women and for rhinitis 43.4 and 38.5, respectively. There was a significant association between the dust concentration at onset of disease and the risk for asthma or rhinitis, but not of the cumulative exposure.
CONCLUSION—The risk of asthma seemed to be increased at inhalable dust concentrations ⩾3 mg/m3 (dough making or bread forming), whereas the risk of rhinitis was increased at all concentrations ⩾1 mg/m3, indicating an increased risk in all bakery job-tasks. The risks seemed to be less dependent on the cumulative exposure dust than the inhalable dust concentrations.


Keywords: bakers; exposure-response relations; flour dust

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Selected References

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  1. Bohadana A. B., Massin N., Wild P., Kolopp M. N., Toamain J. P. Respiratory symptoms and airway responsiveness in apparently healthy workers exposed to flour dust. Eur Respir J. 1994 Jun;7(6):1070–1076. [PubMed] [Google Scholar]
  2. Brisman J., Järvholm B. Bakery work, atopy and the incidence of self-reported hay fever and rhinitis. Eur Respir J. 1999 Mar;13(3):502–507. doi: 10.1183/09031936.99.13350299. [DOI] [PubMed] [Google Scholar]
  3. Brisman J., Meding B., Järvholm B. Occurrence of self reported hand eczema in Swedish bakers. Occup Environ Med. 1998 Nov;55(11):750–754. doi: 10.1136/oem.55.11.750. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Brisman J., Torén K., Lillienberg L., Karlsson G., Ahlstedt S. Nasal symptoms and indices of nasal inflammation in flour-dust-exposed bakers. Int Arch Occup Environ Health. 1998 Nov;71(8):525–532. doi: 10.1007/s004200050318. [DOI] [PubMed] [Google Scholar]
  5. Brisman S. J., Järvholm B. G. Occurrence of self-reported asthma among Swedish bakers. Scand J Work Environ Health. 1995 Dec;21(6):487–493. doi: 10.5271/sjweh.65. [DOI] [PubMed] [Google Scholar]
  6. Brower P. S., Attfield M. D. Reliability of reported occupational history information for US coal miners, 1969-1977. Am J Epidemiol. 1998 Nov 1;148(9):920–926. doi: 10.1093/oxfordjournals.aje.a009718. [DOI] [PubMed] [Google Scholar]
  7. Burdorf A., Lillienberg L., Brisman J. Characterization of exposure to inhalable flour dust in Swedish bakeries. Ann Occup Hyg. 1994 Feb;38(1):67–78. doi: 10.1093/annhyg/38.1.67. [DOI] [PubMed] [Google Scholar]
  8. Burney P. G., Chinn S., Britton J. R., Tattersfield A. E., Papacosta A. O. What symptoms predict the bronchial response to histamine? Evaluation in a community survey of the bronchial symptoms questionnaire (1984) of the International Union Against Tuberculosis and Lung Disease. Int J Epidemiol. 1989 Mar;18(1):165–173. doi: 10.1093/ije/18.1.165. [DOI] [PubMed] [Google Scholar]
  9. Charpin D., Sibbald B., Weeke E., Wüthrich B. Epidemiologic identification of allergic rhinitis. Allergy. 1996 May;51(5):293–298. doi: 10.1111/j.1398-9995.1996.tb04612.x. [DOI] [PubMed] [Google Scholar]
  10. Copeland K. T., Checkoway H., McMichael A. J., Holbrook R. H. Bias due to misclassification in the estimation of relative risk. Am J Epidemiol. 1977 May;105(5):488–495. doi: 10.1093/oxfordjournals.aje.a112408. [DOI] [PubMed] [Google Scholar]
  11. Cullinan P., Lowson D., Nieuwenhuijsen M. J., Sandiford C., Tee R. D., Venables K. M., McDonald J. C., Newman Taylor A. J. Work related symptoms, sensitisation, and estimated exposure in workers not previously exposed to flour. Occup Environ Med. 1994 Sep;51(9):579–583. doi: 10.1136/oem.51.9.579. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. De Zotti R., Larese F., Bovenzi M., Negro C., Molinari S. Allergic airway disease in Italian bakers and pastry makers. Occup Environ Med. 1994 Aug;51(8):548–552. doi: 10.1136/oem.51.8.548. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Gannon P. F., Burge P. S. The SHIELD scheme in the West Midlands Region, United Kingdom. Midland Thoracic Society Research Group. Br J Ind Med. 1993 Sep;50(9):791–796. doi: 10.1136/oem.50.9.791. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Houba R., Heederik D. J., Doekes G., van Run P. E. Exposure-sensitization relationship for alpha-amylase allergens in the baking industry. Am J Respir Crit Care Med. 1996 Jul;154(1):130–136. doi: 10.1164/ajrccm.154.1.8680668. [DOI] [PubMed] [Google Scholar]
  15. Houba R., Heederik D., Doekes G. Wheat sensitization and work-related symptoms in the baking industry are preventable. An epidemiologic study. Am J Respir Crit Care Med. 1998 Nov;158(5 Pt 1):1499–1503. doi: 10.1164/ajrccm.158.5.9803055. [DOI] [PubMed] [Google Scholar]
  16. Houba R., Heederik D., Kromhout H. Grouping strategies for exposure to inhalable dust, wheat allergens and alpha-amylase allergens in bakeries. Ann Occup Hyg. 1997 Jun;41(3):287–296. doi: 10.1016/S0003-4878(96)00047-6. [DOI] [PubMed] [Google Scholar]
  17. Järvinen K. A., Pirilä V., Björksten F., Keskinen H., Lehtinen M., Stubb S. Unsuitability of bakery work for a person with atopy: a study of 234 bakery workers. Ann Allergy. 1979 Mar;42(3):192–195. [PubMed] [Google Scholar]
  18. Lebowitz M. D., Burrows B. Comparison of questionnaires: the BMRC and NHLI respiratory questionnaires and a new self-completion questionnaire. Am Rev Respir Dis. 1976 May;113(5):627–635. doi: 10.1164/arrd.1976.113.5.627. [DOI] [PubMed] [Google Scholar]
  19. Meredith S. K., Taylor V. M., McDonald J. C. Occupational respiratory disease in the United Kingdom 1989: a report to the British Thoracic Society and the Society of Occupational Medicine by the SWORD project group. Br J Ind Med. 1991 May;48(5):292–298. doi: 10.1136/oem.48.5.292. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Musk A. W., Venables K. M., Crook B., Nunn A. J., Hawkins R., Crook G. D., Graneek B. J., Tee R. D., Farrer N., Johnson D. A. Respiratory symptoms, lung function, and sensitisation to flour in a British bakery. Br J Ind Med. 1989 Sep;46(9):636–642. doi: 10.1136/oem.46.9.636. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Nieuwenhuijsen M. J., Lowson D., Venables K. M., Newman Taylor A. J. Flour dust exposure variability in flour mills and bakeries. Ann Occup Hyg. 1995 Jun;39(3):299–305. [PubMed] [Google Scholar]
  22. Nordman H. Occupational asthma--time for prevention. Scand J Work Environ Health. 1994;20(Spec No):108–115. [PubMed] [Google Scholar]
  23. Prichard M. G., Ryan G., Musk A. W. Wheat flour sensitisation and airways disease in urban bakers. Br J Ind Med. 1984 Nov;41(4):450–454. doi: 10.1136/oem.41.4.450. [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. Sandiford C. P. Cereal-induced occupational asthma. Clin Exp Allergy. 1996 Feb;26(2):128–131. doi: 10.1111/j.1365-2222.1996.tb00070.x. [DOI] [PubMed] [Google Scholar]
  25. Sibbald B., Rink E. Epidemiology of seasonal and perennial rhinitis: clinical presentation and medical history. Thorax. 1991 Dec;46(12):895–901. doi: 10.1136/thx.46.12.895. [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. Tielemans E., Kupper L. L., Kromhout H., Heederik D., Houba R. Individual-based and group-based occupational exposure assessment: some equations to evaluate different strategies. Ann Occup Hyg. 1998 Feb;42(2):115–119. doi: 10.1016/s0003-4878(97)00051-3. [DOI] [PubMed] [Google Scholar]
  27. Torén K., Brisman J., Järvholm B. Asthma and asthma-like symptoms in adults assessed by questionnaires. A literature review. Chest. 1993 Aug;104(2):600–608. doi: 10.1378/chest.104.2.600. [DOI] [PubMed] [Google Scholar]

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