Exposure to flour dust and sensitization among bakery employees

Comparison of high- and low-molecular-weight sensitizing agents causing occupational asthma: an evidence-based insight

INTRODUCTION

The many substances used at the workplace that can cause sensitizer-induced occupational asthma are conventionally categorized into high-molecular-weight (HMW) agents and low-molecular-weight (LMW) agents, implying implicitly that these two categories of agents are associated with distinct phenotypic profiles and pathophysiological mechanisms.

AREAS COVERED

The authors conducted an evidence-based review of available data in order to identify the similarities and differences between HMW and LMW sensitizing agents.

EXPERT OPINION

Compared with LMW agents, HMW agents are associated with a few distinct clinical features (i.e. concomitant work-related rhinitis, incidence of immediate asthmatic reactions and increase in fractional exhaled nitric oxide upon exposure) and risk factors (i.e. atopy and smoking). However, some LMW agents may exhibit 'HMW-like' phenotypic characteristics, indicating that LMW agents are a heterogeneous group of agents and that pooling them into a single group may be misleading. Regardless of the presence of detectable specific IgE antibodies, both HMW and LMW agents are associated with a mixed Th1/Th2 immune response and a predominantly eosinophilic pattern of airway inflammation. Large-scale multicenter studies are needed that use objective diagnostic criteria and assessment of airway inflammatory biomarkers to identify the pathobiological pathways involved in OA caused by the various non-protein agents.

On the Role of Starchy Grains in Ice Nucleation Processes

Little is known about the role of starchy food on climate change processes like ice nucleation. Here, we investigate the ice nucleation efficiency (INE) of eight different starchy food materials, namely, corn (CO), potato (PO), barley (BA), brown rice (BR), white rice (WR), oats (OA), wheat (WH), and sweet potato (SP), in immersion freezing mode under mixed-phase cloud conditions. Notably, among all these food materials, PO and BA exhibit the highest ice nucleation efficiency with ice nucleation temperatures as high as -4.3 °C (T50 ∼ -7.0 ± 0.5 °C) and -6.5 °C (T50 ∼ -7.2 ± 0.2 °C), respectively. We also explore the effect of environmentally relevant physicochemical conditions on ice nucleation efficiency, including different pH, temperature, UV/O3/NOx exposure, and various cocontaminants. The change in shape, size, surface properties, hydrophobicity, and crystallinity of materials accounted for the altered INE. The increase in shape, size, and hydrophobicity of the sample generally reduces the INE, whereas an increase in crystallinity enhances the INE of the sample under our experimental conditions. The results suggest that environmentally relevant concentrations slightly alter INE, indicating their role as catalysts in environmental matrices. The outcome of studies on the ice nucleation properties of these food-containing aerosols might help in the physicochemical understanding of other biomolecule-induced ice nucleation, which is still an underdeveloped research area.

Real-time automatic detection of starch particles in ambient air

Considerable amounts of starch granules can be present in the atmosphere from both natural and anthropogenic sources. The aim of this study is to investigate the variability and potential origin of starch granules in ambient air recorded at six cities situated in a region with dominantly agricultural land use. This is achieved by using a combination of laser spectroscopy bioaerosol measurements with 1 min temporal resolution, traditional volumetric Hirst type bioaerosol sampling and atmospheric modelling. The analysis of wind roses identified potential sources of airborne starch (i.e., cereal grain storage facilities) in the vicinity of all aerobiological stations analysed in this study. The analysis of the CALPUFF dispersion model confirmed that emission of dust from the location of storage towers situated about 2.5 km north of the aerobiological station in Novi Sad is a plausible source of high airborne concentrations of starch granules. This study is important for environmental health since it contributes body of knowledge about sources, emission, and dispersion of airborne starch, known to be involved in phenomena such as thunderstorm-triggered asthma. The presented approach integrates monitoring and modelling, and provides a roadmap for examining a variety of bioaerosols previously considered to be outside the scope of traditional aerobiological measurements.

Longitudinal predictors of bronchial hyperresponsiveness and FEV1 decline in bakers

OBJECTIVE

To determine long-term predictors of bronchial hyperresponsiveness (BHR) and forced expiratory volume in one second (FEV₁) decline.

METHODS

A longitudinal study in 110 bakers in 4 industrial bakeries and 38 non-exposed workers was conducted at the workplace with a mean of 3.3 visits per subject over a period of 13 years and a mean duration of follow-up of 6 years in bakers and 8 years in non-exposed subjects. A respiratory health questionnaire was administered; occupational allergen skin prick tests, spirometry and a methacholine bronchial challenge test were performed at each visit. In each bakery, full-shift dust samples of the inhalable fraction were obtained in order to assess the exposure of each job assignment. The repeated measurements of BHR and FEV₁ were analyzed using mixed effects logistic and linear regression models in subjects seen at least twice.

RESULTS

BHR, respiratory symptoms and their simultaneous occurrence depended on the duration of exposure. FEV₁ significantly decreased with duration of exposure and BHR at a preceding visit. This result persisted when adjusting for the effect of BHR at the current visit. The measured exposure levels were not a significant predictor for any outcome. Occupational sensitization was only a predictor of a decline in FEV₁ when duration of exposure was not included.

CONCLUSION

In flour-exposed industrial bakers, length of exposure and smoking are long-term determinants of BHR and of the decrease in FEV₁. BHR at a preceding visit predicted lower FEV₁ even when accounting for the effect of BHR at the current visit.

The role of oxidative stress in pulmonary function in bakers exposed to flour dust

Objective. This study aimed to determine the effect of exposure to flour dust on pulmonary function and the role of oxidative stress. Methods. This case-control study was conducted on 163 bakery workers (exposed group) and 177 administrative workers (unexposed group). Pulmonary function and flour dust exposure were measured by spirometry and NIOSH 0500 and 0600 methods. Oxidative stress indices including malondialdehyde (MDA), nitric oxide (NO) and total antioxidant capacity (TAC) were measured in serum samples. Results. The mean respirable and total dust exposure of bakery workers were 2.5 ± 1.72 and 6.53 ± 3.26 mg/m³. The forced vital capacity (FVC) and forced expiratory volume in the first 1 s (FEV1) were significantly lower in the exposed group than in the unexposed group. The levels of MDA and NO were higher in smokers than in non-smokers in the exposed group. The most important variables that predicted FVC and FEV1 were MDA, NO and TAC. With increased exposure to respirable dust, the levels of MDA (β = 3.39, p < 0.001) and NO (β = 16.48, p < 0.001) increased and total antioxidant levels decreased (β = -0.37, p < 0.001). Conclusions. Exposure to flour dust may impair pulmonary function by increasing oxidative stress and weakening antioxidant defense.

Occupational Exposure to Flour Dust. Exposure Assessment and Effectiveness of Control Measures

The adverse effects associated with exposure to flour dust have been known since the 1700s. The aim of the study was to assess the occupational exposure to flour dust in Italian facilities, identify the activities characterized by the highest exposure, and provide information to reduce workers’ exposure. The study was performed in different facilities such as flourmills (n = 2), confectioneries (n = 2), bakeries (n = 24), and pizzerias (n = 2). Inhalable flour dust was assessed by personal and area samplings (n = 250) using IOM (Institute of Occupational Medicine) samplers. The results showed personal occupational exposure to flour dust over the American Conference of Governmental Industrial Hygiene (ACGIH) and the Scientific Committee on Occupational Exposure Limit (SCOEL) occupational limits (mean 1.987 mg/m³; range 0.093–14.055 mg/m³). The levels were significantly higher for dough makers in comparison to the dough formers and packaging area subjects. In four bakeries the industrial hygiene surveys were re-performed after some control measures, such as installation of a sleeve to the end of pipeline, a lid on the mixer tub or local exhaust ventilation system, were installed. The exposure levels were significantly lower than those measured before the introduction of control measures. The exposure level reduction was observed not only in the dough making area but also in all bakeries locals.

Occupational exposures of flour dust and airborne chemicals at bakeries in Taiwan

Walk-through surveys were carried out for bakeries in this study to determine the environmental characteristics of bakeries in Taiwan. Questionnaires were administrated to discover whether job-related asthma-like symptoms occurred among workers. Air sampling and analysis were also performed. The results show that the levels of inhalable flour dust ranged from 0.01-0.83 mg m^-3 with an average of 0.27 mg m^-3. Among the samples collected, 23% of them had concentrations higher than the ACGIH TLV-TWA (0.5 mg m^-3), which indicated that inhalable flour dust was an important air pollutant for bakery workers in Taiwan. Airborne chemicals such as diacetyl, acetoin, 2,3-pentanedione, 2,3-hexanedione, 2,3-heptanedione, furfural, and acetaldehyde were also found in various levels in this study. The concentrations of acetaldehyde measured in these bakeries were 37-83 times higher than what have been reported from other studies for residential areas and Chinese restaurants. In addition, the concentrations of total VOCs in the working areas of the bakeries were over 21 times higher than the levels determined in the non-working areas. Based on our results, there appears to be a need to improve the air quality of the working environments of bakeries in Taiwan.

Concentrations and number size distribution of fine and nanoparticles in a traditional Finnish bakery

In bakeries, high concentrations of flour dust can exist and ovens release particles into the air as well. Particle concentrations (mass, number) and number size distribution may vary considerably but the variation is not commonly studied. Furthermore, the role of the smallest size fractions is rarely considered in the exposure assessment due to their small mass. The objectives of this work were to find out how concentrations and number size distribution of fine and nanoparticles vary in a traditional Finnish bakery and to determine the exposure of a dough maker to the nanoparticle fraction of the inhalable dust. Two measurement campaigns were carried out in a traditional, small-scale bakery. Sampling was performed at the breathing zone of the dough maker and three stationary locations: baking area, oven area, and flour depository. Both real-time measurements and conventional gravimetric sampling were conducted. Nanoparticle fraction of the inhalable dust was determined using an IOM sampler with a customized precyclone. Number concentration of fine and nanoparticles, and mass concentrations of both the inhalable dust and nanoparticles were high. The nanoparticle fraction was 9-15% of the inhalable dust at the breathing zone of the dough maker. Different sources, such as ovens and doughnut baking affected the number size distribution. Flour dust contained nanoparticles but most of the fine and nanoparticles were released into the air from the oven operations. However, nanoparticles are not a primary concern in bakeries compared to health effects linked to the large flour particles such as flour-induced sensitization or asthma and development of occupational rhinitis.

Occupational Allergy

An estimated 11 million workers in the USA are potentially exposed to agents that can become a cause of allergic diseases such as occupational asthma and allergic contact dermatitis, which can adversely affect health and well-being. Hundreds of chemicals (e.g. metals, epoxy and acrylic resins, rubber additives, and chemical intermediates) and proteins (e.g. natural rubber latex, plant proteins, mould, animal dander) present in virtually every industry have been identified as causes of allergic disease. In general, allergens can be classified as low molecular weight (chemical) allergens and high molecular weight (protein) allergens. These agents are capable of inducing immunological responses that are both immunoglobulin E and non-immunoglobulin E-mediated. Interestingly, the same chemical can induce diverse immune responses in different individuals. As new hazards continue to emerge, it is critical to understand the immunological mechanisms of occupational allergic disease. Specific understanding of these mechanisms has direct implications in hazard identification, hazard communication, and risk assessment. Such efforts will ultimately assist in the development of risk management strategies capable of controlling workplace exposures to allergens to prevent the induction of sensitisation in naïve individuals and inhibit elicitation of allergic responses. The purpose of this short review is to give a brief synopsis of the incidence, agents, mechanisms, and research needs related to occupational allergy.

Exposure to flour dust in the occupational environment

Exposure to flour dust can be found in the food industry and animal feed production. It may result in various adverse health outcomes from conjunctivitis to baker's asthma. In this paper, flour dust exposure in the above-mentioned occupational environments is characterized and its health effects are discussed. A peer-reviewed literature search was carried out and all available published materials were included if they provided information on the above-mentioned elements. The hitherto conducted studies show that different components of flour dust like enzymes, proteins and baker's additives can cause both non-allergic and allergic reactions among exposed workers. Moreover, the problem of exposure to cereal allergens present in flour dust can also be a concern for bakers' family members. Appreciating the importance of all these issues, the exposure assessment methods, hygienic standards and preventive measures are also addressed in this paper.

Experiences from occupational exposure limits set on aerosols containing allergenic proteins

Occupational exposure limits (OELs) together with determined airborne exposures are used in risk assessment based managements of occupational exposures to prevent occupational diseases. In most countries, OELs have only been set for few protein-containing aerosols causing IgE-mediated allergies. They comprise aerosols of flour dust, grain dust, wood dust, natural rubber latex, and the subtilisins, which are proteolytic enzymes. These aerosols show dose-dependent effects and levels have been established, where nearly all workers may be exposed without adverse health effects, which are required for setting OELs. Our aim is to analyse prerequisites for setting OELs for the allergenic protein-containing aerosols. Opposite to the key effect of toxicological reactions, two thresholds, one for the sensitization phase and one for elicitation of IgE-mediated symptoms in sensitized individuals, are used in the OEL settings. For example, this was the case for flour dust, where OELs were based on dust levels due to linearity between flour dust and its allergen levels. The critical effects for flour and grain dust OELs were different, which indicates that conclusion by analogy (read-across) must be scientifically well founded. Except for subtilisins, no OEL have been set for other industrial enzymes, where many of which are high volume chemicals. For several of these, OELs have been proposed in the scientific literature during the last two decades. It is apparent that the scientific methodology is available for setting OELs for proteins and protein-containing aerosols where the critical effect is IgE sensitization and IgE-mediated airway diseases.

Industrial fungal enzymes: an occupational allergen perspective

Occupational exposure to high-molecular-weight allergens is a risk factor for the development and pathogenesis of IgE-mediated respiratory disease. In some occupational environments, workers are at an increased risk of exposure to fungal enzymes used in industrial production. Fungal enzymes have been associated with adverse health effects in the work place, in particular in baking occupations. Exposure-response relationships have been demonstrated, and atopic workers directly handling fungal enzymes are at an increased risk for IgE-mediated disease and occupational asthma. The utilization of new and emerging fungal enzymes in industrial production will present new occupational exposures. The production of antibody-based immunoassays is necessary for the assessment of occupational exposure and the development of threshold limit values. Allergen avoidance strategies including personal protective equipment, engineering controls, protein encapsulation, and reduction of airborne enzyme concentrations are required to mitigate occupational exposure to fungal enzymes.