Occupational IgE-mediated psyllium allergy in contemporary gluten-free and vegan baking: A case of allergic rhinitis

Occupational anaphylaxis-Data from the anaphylaxis registry

BACKGROUND

Epidemiologic data on occupational anaphylaxis is scarce, and there is a need of more knowledge about work-related anaphylactic episodes.

METHODS

Based on the data of the Anaphylaxis Registry, we identified cases related to occupational exposure and analyzed the elicitors, demographics, severity of clinical reaction and management.

RESULTS

Since 2017, 5851 cases with an information about the occupational relation of the anaphylactic episode were registered whereby 225 (3.8%) were assigned to be caused by an occupational allergen. The vast majority of these occupational anaphylaxis cases were caused by insects (n = 186, 82.7%) followed by food (n = 27, 12.0%) and drugs (n = 8, 3.6%). Latex elicited occupational anaphylaxis in only two cases. Beekeepers, gardeners, farmers, and individuals working in professions associated with food handling, for example, employees in restaurants, bakery, pastry, and cooks were most frequently affected. The comparison of the occupational insect venom-induced anaphylaxis to a group of non-occupational insect anaphylaxis in adults (n = 1842) revealed a significant younger age in occupational anaphylaxis (46 vs. 53 years), a predominance of bee-induced cases (38% vs. 17%), and a higher rate of venom immunotherapy in a primary care setting (3.3% vs. 1.3%, p = .044). In the occupational- versus non-occupational adults with food-induced anaphylaxis atopic dermatitis as concomitant atopic disease was observed more frequently (n = 486; 20% vs. 10%), although this was not significant.

CONCLUSION

Our data demonstrate the impact of venom allergy in work-related anaphylaxis. Foods and drugs are less frequently elicitors, and latex-induced occupational anaphylaxis was rare. More data are needed to determine risk factors associated with occupational anaphylaxis.

Occupational Rhinitis: An Update

PURPOSE OF REVIEW

Occupational rhinitis is an underdiagnosed disease with significant morbidity and implications in the workplace. Multiple factors associated with this disease continue to pose a challenge to investigators. This review aims to summarize recent literature in occupational rhinitis, including classifications, pathogenesis, diagnosis, and treatment, as well as the impact of occupational rhinitis on individuals. Additionally, it identifies areas in need of further research and investigation.

RECENT FINDINGS

We highlight current research on the association between occupational rhinitis and occupational asthma and the role of immunotherapy in this disease. Discussion includes the impact of social trends on workers and the wider consequences of occupational rhinitis including decreased work productivity, absenteeism, and socioeconomic burden. Occupational rhinitis remains a challenging disease entity due to the numerous potential causative factors, reduced recognition, morbidity in asthma, and therapeutic limitations. Additional research is needed to better identify disease predictors and develop effective management strategies.

Occupational inhalant allergy in food handling occupations

PURPOSE OF REVIEW

Review article on recent developments on inhalant food allergens associated with occupational respiratory allergy and asthma.

RECENT FINDINGS

This review has found that occupational inhalant allergy in food handling occupations is a common and recognisable clinical entity (class 3 food allergy) in high-risk food occupations such as bakeries and seafood processing. Aerosolised food proteins from plant or animal food sources, additives and biological food contaminants cause occupational sensitization, rhinitis and asthma. The risk of allergy may be enhanced across the food value chain as a result of food processing techniques including the introduction of new food allergens in the food matrix. Occupational food allergy and asthma can be prevented by improved health-based exposure standards, workplace control measures, education and training activities, and early diagnosis accompanied with exposure reduction.

SUMMARY

Future studies need to focus on exposure-response studies to establish improved exposure limits especially for flour dust, the relevance of cooked vs raw foods in influencing risk, identifying and characterising major inhalant food allergens accompanied with component resolved diagnostic approaches, and evaluating the effectiveness of interventions for common high-risk food sensitizers causing occupational rhinitis and asthma.

[New allergens for occupational dermatology?]

BACKGROUND

The environment is continuously subject to change. Exposures in the work environment and therefore the importance of occupational type I and type IV allergens may change.

OBJECTIVES

The most important trends concerning occupational allergens, new occupational allergens/allergen exposures, the diagnostic procedure to detect new allergens in practice and regulatory developments are presented.

MATERIALS AND METHODS

Building on known relevant allergen exposures in occupational dermatology, published trends from clinical cohorts are evaluated and a systematic literature search (PubMed 2016-2021) for new occupational allergens is also performed RESULTS: Occupations with the highest incidence of occupational allergic contact urticaria and/or protein contact dermatitis include bakers, farmers and farm workers, veterinary technicians, veterinarians, cooks, dairy and livestock workers, gardeners, and hairdressers. The highest risk of developing occupational contact dermatitis is in health care, agriculture, metalworking occupations and machine operators, the food sector, service industries, and construction occupations. The search strategy "new occupational allerg*" yielded 603 hits and "novel occupational allerg*" 158 hits. A total of 25 papers included results relevant to the research question and were processed. New protein-based immediate-type allergens, as well as contact allergens (haptens) relevant for occupational dermatology, are presented.

CONCLUSIONS

Current trends on known occupational allergens and new occupational allergens in the period 2016-2021 can be identified. Only a thorough individual workplace history and testing of patients' own materials can identify new allergens in occupational dermatology.