1
|
Baatjies R, Meijster T, Heederik D, Jeebhay MF. Exposure-response relationships for inhalant wheat allergen exposure and asthma. Occup Environ Med 2014; 72:200-7. [PMID: 25535033 DOI: 10.1136/oemed-2013-101853] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND A few studies have investigated exposure-response relationships for sensitisation to wheat, work-related symptoms and wheat allergen exposure. IgG4 is suggested to protect against the development of allergic sensitisation. The main aim of this current study was to explore the nature of exposure-response relationships for a range of clinically relevant endpoints among bakery workers, and to investigate the role of IgG4 in these relationships. METHODS A cross-sectional study of 517 supermarket bakery workers in 31 bakeries used a questionnaire, serum-specific IgE and IgG4 to wheat, and methacholine challenge testing. Exposure models were developed previously using job, bakery size, tasks and specific ingredients used. These models were used to predict average personal exposure to wheat allergens. RESULTS The exposure-response relationships for average exposure followed a linear relationship for sensitisation, but a bell-shaped curve for allergic symptoms and probable occupational asthma, increasing up to 10-15 µg/m(3) wheat allergen concentration after which they plateau off and decrease at higher exposure concentrations. This relationship was modified by atopic status. IgG4 levels were strongly exposure related: a clear increase in prevalence of higher IgG4 with increase in wheat allergen exposure was observed among those sensitised and non-sensitised to wheat, with IgG4 even more strongly associated with exposure than IgE to wheat. CONCLUSIONS The bell-shaped exposure-response relationship in the current study is consistent with the findings of previous studies. IgG4 showed no protective effect for sensitisation, confirming the findings of previous studies, suggesting that the pattern is probably related to a healthy worker effect.
Collapse
Affiliation(s)
- R Baatjies
- Faculty of Applied Sciences, Department of Environmental and Occupational Studies, Cape Peninsula University of Technology, Cape Town, Western Cape, South Africa Centre for Environmental and Occupational Health Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, Western Cape, South Africa
| | - T Meijster
- Division of Environmental Epidemiology, Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
| | - D Heederik
- Division of Environmental Epidemiology, Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
| | - M F Jeebhay
- Centre for Environmental and Occupational Health Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, Western Cape, South Africa
| |
Collapse
|
2
|
Raulf M, Buters J, Chapman M, Cecchi L, de Blay F, Doekes G, Eduard W, Heederik D, Jeebhay MF, Kespohl S, Krop E, Moscato G, Pala G, Quirce S, Sander I, Schlünssen V, Sigsgaard T, Walusiak-Skorupa J, Wiszniewska M, Wouters IM, Annesi-Maesano I. Monitoring of occupational and environmental aeroallergens-- EAACI Position Paper. Concerted action of the EAACI IG Occupational Allergy and Aerobiology & Air Pollution. Allergy 2014; 69:1280-99. [PMID: 24894737 DOI: 10.1111/all.12456] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2014] [Indexed: 11/28/2022]
Abstract
Exposure to high molecular weight sensitizers of biological origin is an important risk factor for the development of asthma and rhinitis. Most of the causal allergens have been defined based on their reactivity with IgE antibodies, and in many cases, the molecular structure and function of the allergens have been established. Significant information on allergen levels that cause sensitization and allergic symptoms for several major environmental and occupational allergens has been reported. Monitoring of high molecular weight allergens and allergen carrier particles is an important part of the management of allergic respiratory diseases and requires standardized allergen assessment methods for occupational and environmental (indoor and outdoor) allergen exposure. The aim of this EAACI task force was to review the essential points for monitoring environmental and occupational allergen exposure including sampling strategies and methods, processing of dust samples, allergen analysis, and quantification. The paper includes a summary of different methods for sampling and allergen quantification, as well as their pros and cons for various exposure settings. Recommendations are being made for different exposure scenarios.
Collapse
Affiliation(s)
- M. Raulf
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance; Ruhr-Universität Bochum (IPA); Bochum Germany
| | - J. Buters
- ZAUM- Center of Allergy & Environment; Helmholtz Zentrum München/Technical Universität München; Christine Kühne Center for Allergy Research and Education (CK-CARE); Member of the German Center of Lung Research (DZL); Munich Germany
| | | | - L. Cecchi
- Interdepartmental Centre of Bioclimatology; University of Florence; Allergy and Clinical Immunology Section; Azienda Sanitaria di Prato; Prato Italy
| | - F. de Blay
- Department of Chest Diseases; University Hospital Strasbourg; Strasbourg France
| | - G. Doekes
- Division of Environmental Epidemiology; Institute for Risk Assessment Sciences (IRAS); Utrecht University; Utrecht the Netherlands
| | - W. Eduard
- Department of Chemical and Biological Work Environment/National Institute of Occupational Health; Institute of Medical Biology; University in Tromsø; Tromsø Norway
| | - D. Heederik
- Division of Environmental Epidemiology; Institute for Risk Assessment Sciences (IRAS); Utrecht University; Utrecht the Netherlands
| | - M. F. Jeebhay
- Centre for Occupational and Environmental Health Research; School of Public Health and Family Medicine, University of Cape Town; Cape Town South Africa
| | - S. Kespohl
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance; Ruhr-Universität Bochum (IPA); Bochum Germany
| | - E. Krop
- Division of Environmental Epidemiology; Institute for Risk Assessment Sciences (IRAS); Utrecht University; Utrecht the Netherlands
| | - G. Moscato
- Department of Public Health; Experimental and Forensic Medicine of the University of Pavia; Pavia Italy
| | - G. Pala
- Occupational Physician's Division; Local Health Authority of Sassari; Sassari Italy
| | - S. Quirce
- Department of Allergy; Hospital La Paz Institute for Health Research (IdiPAZ) and CIBER of Respiratory Diseases CIBERES; Madrid Spain
| | - I. Sander
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance; Ruhr-Universität Bochum (IPA); Bochum Germany
| | - V. Schlünssen
- Department of Public Health; Section for Environment; Occupation and Health; Aarhus University; Aarhus Denmark
| | - T. Sigsgaard
- Department of Public Health; Section for Environment; Occupation and Health; Aarhus University; Aarhus Denmark
| | | | | | - I. M. Wouters
- Division of Environmental Epidemiology; Institute for Risk Assessment Sciences (IRAS); Utrecht University; Utrecht the Netherlands
| | - I. Annesi-Maesano
- INSERM; Equipe Epidémiologie des allergies et des maladies respiratorires UMR-S 707; Paris France
- EPAR; Faculté de Médecine Saint-Antoine; UPMC; Paris France
| | | |
Collapse
|
3
|
Baatjies R, Meijster T, Heederik D, Sander I, Jeebhay MF. Effectiveness of interventions to reduce flour dust exposures in supermarket bakeries in South Africa. Occup Environ Med 2014; 71:811-8. [PMID: 24899339 DOI: 10.1136/oemed-2013-101971] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
RATIONALE A recent study of supermarket bakery workers in South Africa demonstrated that 25% of workers were sensitised to flour allergens and 13% had baker's asthma. Evidence on exposure reduction strategies using specifically designed interventions aimed at reducing the risk of baker's asthma is scarce. OBJECTIVES The aim of this study was to evaluate the effectiveness of different control measures to reduce airborne flour dust exposure using a randomised design. METHODS A group-randomised study design was used to assign 30 bakeries of a large supermarket chain store to two intervention groups and a control group, of which 15 bakeries were studied. Full-shift environmental personal samples were used to characterise exposure to flour dust and wheat and rye allergens levels pre-intervention (n=176) and post-intervention (n=208). RESULTS The overall intervention effect revealed a 50% decrease in mean flour dust, wheat and rye allergen exposure. The reduction in exposure was highest for managers (67%) and bakers (47%), and lowest for counterhands (23%). For bakers, the greatest reduction in flour dust was associated with control measures such as the use of the mixer lid (67%), divider oil (63%) or focused training (54%). However, the greatest reduction (80%) was observed when using a combination of all control measures. CONCLUSIONS A specially designed intervention strategy reduced both flour dust and allergen levels. Best results were observed when combining both engineering controls and training. Further studies will investigate the long-term health impact of these interventions on reducing the disease burden among this group of bakers.
Collapse
Affiliation(s)
- Roslynn Baatjies
- Department of Environmental and Occupational Studies, Faculty of Applied Sciences, Cape Peninsula University of Technology, Cape Town, South Africa Centre for Occupational and Environmental Health Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Tim Meijster
- Division of Environmental Epidemiology, Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
| | - Dick Heederik
- Division of Environmental Epidemiology, Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
| | - Ingrid Sander
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance (IPA), Ruhr-University Bochum, Germany, Germany
| | - Mohamed F Jeebhay
- Centre for Occupational and Environmental Health Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| |
Collapse
|
4
|
van Kampen V, de Blay F, Folletti I, Kobierski P, Moscato G, Olivieri M, Quirce S, Sastre J, Walusiak-Skorupa J, Kotschy-Lang N, Müsken H, Mahler V, Schliemann S, Ochmann U, Sültz J, Worm M, Sander I, Zahradnik E, Brüning T, Merget R, Raulf-Heimsoth M. Evaluation of commercial skin prick test solutions for selected occupational allergens. Allergy 2013; 68:651-8. [PMID: 23421494 DOI: 10.1111/all.12116] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/17/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND Skin prick testing (SPT) is an important step in the diagnosis of IgE-mediated occupational allergic diseases. The outcome of SPT is related to the quality of allergen extracts. Thus, the aim of the study was to assess different commercially available SPT solutions for selected occupational allergens. METHODS SPT was performed in 116 bakers, 47 farmers and 33 subjects exposed to natural rubber latex (NRL), all with work-related allergic symptoms. The SPT solutions from different manufacturers (n = 3-5) for wheat flour, rye flour, soy, cow hair/dander, storage mites (Tyrophagus putrescentiae, Lepidoglyphus destructor, Acarus siro) and NRL were analysed with respect to their protein and antigen contents. SPT was carried out in 16 allergy centres in six European countries using standardized procedures. Specific IgE values were used as the gold standard to calculate the sensitivity and specificity of SPT solutions. The optimal cut-point for each SPT solution was determined by Youden Index. RESULTS Protein and antigen contents and patterns of the SPT solutions varied remarkably depending on the manufacturer. While SPT solutions for wheat flour and soy reached overall low sensitivities, sensitivities of other tested SPT solutions depended on the manufacturer. As a rule, solutions with higher protein and antigen content showed higher sensitivities and test efficiencies. CONCLUSIONS There is a wide variability of SPT solutions for occupational allergens, and the sensitivity of several solutions is low. Thus, improvement and standardization of SPT solutions for occupational allergens is essential.
Collapse
Affiliation(s)
- V. van Kampen
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance Ruhr-University Bochum (IPA); Bochum; Germany
| | - F. de Blay
- Department of Chest Diseases; University Hospital Strasbourg; Strasbourg; France
| | - I. Folletti
- Occupational Medicine; Terni Hospital; University of Perugia; Perugia; Italy
| | - P. Kobierski
- Rehabilitation Clinic Tobelbad; Austrian workers compensation board; Tobelbad; Austria
| | - G. Moscato
- Allergy and Immunology Unit; Fondazione ‘Salvatore Maugeri’; Institute of Research and Care; Scientific Institute of Pavia; Pavia
| | - M. Olivieri
- Unit of Occupational Medicine; University Hospital of Verona; Verona; Italy
| | - S. Quirce
- Department of Allergy; Hospital La Paz (IdiPAZ) and CIBER of Respiratory Diseases CIBERES; Madrid
| | - J. Sastre
- Department of Allergy; Fundación Jiménez Díaz and CIBER of Respiratory Diseases CIBERES; Madrid; Spain
| | | | | | - H. Müsken
- Institute for Pneumological and Allergological Expertises; Bad Lippspringe
| | - V. Mahler
- Department of Dermatology; University Hospital; Erlangen
| | - S. Schliemann
- Department of Dermatology and Allergology; Friedrich Schiller University Jena; Jena
| | - U. Ochmann
- Institute and Outpatient Clinic for Occupational, Social, and Environmental Medicine, Ludwig-Maximilians-Universität
| | - J. Sültz
- Occupational Physician; Neusaess
| | - M. Worm
- Allergy Centre - Department of Dermatology; Charité; University Berlin; Berlin; Germany
| | - I. Sander
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance Ruhr-University Bochum (IPA); Bochum; Germany
| | - E. Zahradnik
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance Ruhr-University Bochum (IPA); Bochum; Germany
| | - T. Brüning
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance Ruhr-University Bochum (IPA); Bochum; Germany
| | - R. Merget
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance Ruhr-University Bochum (IPA); Bochum; Germany
| | - M. Raulf-Heimsoth
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance Ruhr-University Bochum (IPA); Bochum; Germany
| |
Collapse
|
5
|
van Kampen V, de Blay F, Folletti I, Kobierski P, Moscato G, Olivieri M, Quirce S, Sastre J, Walusiak-Skorupa J, Raulf-Heimsoth M. EAACI position paper: skin prick testing in the diagnosis of occupational type I allergies. Allergy 2013; 68:580-4. [PMID: 23409759 DOI: 10.1111/all.12120] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2012] [Indexed: 11/27/2022]
Abstract
Skin prick testing (SPT) in combination with the clinical history of the patient is one important step in the diagnosis of IgE-mediated occupational allergies. However, skin test performance is related to the quality of allergen extracts. The present consensus document was prepared by an EAACI Task Force consisting of an expert panel of allergologists and occupational physicians from Germany, Italy, Spain, France, Austria, and Poland. All members of the panel were also involved in the data collection within the European multicentre study STADOCA (Standard diagnosis for occupational allergy). The aim of this Task Force was the assessment of the quality of commercially available SPT solutions for selected occupational allergens under standardized procedure conditions in different European centres and institutes of Occupational Medicine. The data evaluation shows a wide variability among SPT solutions and also indicates that the sensitivity of several SPT solutions is low. Therefore, improvement and standardization of SPT solutions for occupational allergens is highly recommended. Clinical practitioners should also not presume that their SPT solutions are fully reliable. The main objective of the document is to issue consensus suggestions for the use of SPT with occupational allergens based on the European multicentre study STADOCA, on existing scientific evidence and the expertise of a panel of allergologists.
Collapse
Affiliation(s)
- V. van Kampen
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance; Ruhr-University Bochum (IPA); Bochum; Germany
| | - F. de Blay
- Department of Chest Diseases; University Hospital Strasbourg; Strasbourg; France
| | - I. Folletti
- Occupational Medicine; Terni Hospital; University of Perugia; Perugia; Italy
| | - P. Kobierski
- Austrian workers compensation board; Rehabilitation Clinic Tobelbad; Tobelbad; Austria
| | - G. Moscato
- Allergy and Immunology Unit; Fondazione ‘Salvatore Maugeri’; Institute of Research and Care; Scientific Institute of Pavia; Pavia; Italy
| | - M. Olivieri
- Unit of Occupational Medicine; University Hospital of Verona; Verona; Italy
| | - S. Quirce
- Department of Allergy; Hospital La Paz (IdiPAZ) and CIBER of Respiratory Diseases CIBERES; Madrid; Spain
| | - J. Sastre
- Department of Allergy; Fundación Jiménez Díaz and CIBER of Respiratory Diseases CIBERES; Madrid; Spain
| | | | - M. Raulf-Heimsoth
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance; Ruhr-University Bochum (IPA); Bochum; Germany
| |
Collapse
|
6
|
Eduard W, Heederik D, Duchaine C, Green BJ. Bioaerosol exposure assessment in the workplace: the past, present and recent advances. JOURNAL OF ENVIRONMENTAL MONITORING : JEM 2012; 14:334-9. [PMID: 22267210 PMCID: PMC4687010 DOI: 10.1039/c2em10717a] [Citation(s) in RCA: 97] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Louis Pasteur described the first measurements of airborne microorganisms in 1861. A century later, the inhalation of spores from thermophilic microorganisms was shown to induce attacks of farmers' lung in patients with this disease, while endotoxins originating from Gram-negative bacteria were identified as causal agents for byssinosis in cotton workers. Further epidemiological and toxicological studies have demonstrated inflammatory, respiratory, and pathogenic effects following exposure to bioaerosols. Exposure assessment is often confounded by the diversity of bioaerosol agents in the environment. Microorganisms represent a highly diverse group that may vary in toxicity. Fungi and bacteria are mainly quantified as broad groups using a variety of viable and nonviable assessment methods. Endotoxins and β(1 → 3)-glucans are mainly measured by their activity in the Limulus amebocyte lysate assay, enzymes by immuno-chemical methods and mycotoxins by liquid chromatography-mass spectrometry. Few health-based occupational exposure limits (OELs) are available for risk assessment. For endotoxins, a health-based OEL of 90 endotoxin units m(-3) has been proposed in the Netherlands. A criteria document for fungal spores recently proposed a lowest observed effect level of 100,000 spores m(-3) for non-pathogenic and non-mycotoxin producing species based on inflammatory respiratory effects. Recent developments in bioaerosol assessment were presented at the Organic Dust Tromsø Symposium including molecular biological methods for infectious agents and organisms that are difficult to cultivate; studies of submicronic and hyphal fragments from fungi; the effect of biodiversity of microorganisms in asthma studies; and new/improved measurement methods for fungal antigens, enzymes and allergens. Although exposure assessment of bioaerosol agents is complex and limited by the availability of methods and criteria, the field is rapidly evolving.
Collapse
Affiliation(s)
- Wijnand Eduard
- National Institute of Occupational Health, PO Box 8149, Oslo, Norway. ; Fax: +47 2319 5206; Tel: +47 2319 5324
- Medical Pharmacology and Toxicology, Dept. Of Medical Biology, Faculty of Health Science, University of Tromsø, NO-9037, Tromsø, Norway
| | - Dick Heederik
- Division Environmental Epidemiology, Institute of Risk Assessment Sciences, Universiteit Utrecht, PO Box 80178, 3508 TD, Utrecht, The Netherlands. ; Fax: +31 30 2539499; Tel: +31 30 2539480
| | - Caroline Duchaine
- Centre de rechercheé de l’Institut Universitaire de cardiologie et de pneumologie de Québec, 2725 Chemin Ste-Foy, Quebec City, Canada.
- Biochemistry, microbiology and bioinformatics department, Université Laval, Quebec City, Canada
| | - Brett James Green
- National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, 1095 Willowdale Road, Morgantown, West Virginia, USA. ; Fax: +1 304-285-6126; Tel: +1-304-285-6127
| |
Collapse
|
7
|
Baatjies R, Meijster T, Lopata A, Sander I, Raulf-Heimsoth M, Heederik D, Jeebhay M. Exposure to flour dust in South African supermarket bakeries: modeling of baseline measurements of an intervention study. ACTA ACUST UNITED AC 2010; 54:309-18. [PMID: 20200089 DOI: 10.1093/annhyg/meq005] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Exposure to flour dust has been reported as an important risk factor for allergic respiratory disease among bakery workers. A high prevalence of allergic sensitization and asthma was recently reported in South African supermarket bakeries. The aim of this study was to conduct a detailed exposure assessment of these bakeries so as to provide the baseline for a broader intervention study. METHODS A total of 211 full-shift personal samples were collected on randomly selected individuals within five different job categories in 18 bakeries. The samples were analyzed for particulate mass and specific flour dust allergens (wheat, rye, and fungal alpha-amylase). Exposure models were developed using job, bakery size, tasks, and specific ingredients used. Bakery and worker were regarded as random effect components. RESULTS Bread bakers had the highest average (geometric mean) exposures (1.33 mg m(-3) flour dust particulate, 13.66 microg m(-3) wheat allergens, and 5.14 microg m(-3) rye allergens). For alpha-amylase allergens, most samples were below the limit of detection for several occupational titles. In the mixed effect models, the significant predictors of elevated exposure to inhalable dust particulate as well as wheat and rye allergen concentrations were large bakery size, bread baking, and use of cereal flours, while tasks such as confectionery work were negatively correlated with these exposure metrics. Weighing tasks and use of premix products were associated with increased exposure to fungal alpha-amylase. A high correlation between particulate dust and wheat (r = 0.84) as well as rye (r = 0.86) was observed, with a much lower correlation between particulate dust and fungal alpha-amylase (r = 0.33). Overall, a low proportion (39%) of bakery stores implemented various control measures to reduce dust exposures in the bakeries. CONCLUSIONS This study confirms that current exposure control strategies in supermarket bakery stores are inadequate in reducing dust exposures to protect the health of bakery workers.
Collapse
Affiliation(s)
- Roslynn Baatjies
- Department of Environmental and Occupational Studies, Faculty of Applied Sciences, Cape Peninsula University of Technology, Cape Town 8001, South Africa
| | | | | | | | | | | | | |
Collapse
|
8
|
van Kampen V, Merget R, Rabstein S, Sander I, Bruening T, Broding HC, Keller C, Muesken H, Overlack A, Schultze-Werninghaus G, Walusiak J, Raulf-Heimsoth M. Comparison of wheat and rye flour solutions for skin prick testing: a multi-centre study (Stad 1). Clin Exp Allergy 2009; 39:1896-902. [PMID: 19709069 DOI: 10.1111/j.1365-2222.2009.03342.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Skin prick testing (SPT) is the basic method for diagnosing IgE-mediated allergies. However, skin reactivity is related to the quality of allergen extracts, which are often poorly defined for occupational allergens. OBJECTIVE To compare wheat and rye flour SPT solutions from different producers. MATERIALS AND METHODS Standardized SPTs were performed in seven allergy centres with wheat and rye flour solutions from four producers in 125 symptomatic bakers. Optimal cut-off levels for weal sizes were assessed with the Youden Index. Comparisons between SPT results of different solutions were made with flour-specific IgE (sIgE) as the gold standard. Sensitivities, specificities, positive and negative predictive values, and test efficiencies were calculated and compared with McNemar and chi(2)-tests. The influence of the choice of the gold standard (sIgE or challenge) test was examined for 95 subjects. Additionally, SPT solutions were analysed for protein and antigen content. RESULTS The optimal cut-off level for all SPT solutions was a weal size of >or=1.5 mm. While differences between wheat and rye flours were small, differences between producers were important. Variability of sensitivities (0.31-0.96), negative predictive values (0.42-0.91), and test efficiencies (0.54-0.90) were higher than variations of specificities (0.74-1.00) and positive predictive values (0.88-1.00). Similar results were obtained when using challenge test results as the gold standard. Variability could be explained by the different antigen contents of the SPT solutions. CONCLUSION There is a wide variability of SPT solutions for wheat and rye flour from different producers, mainly with respect to sensitivities, negative predictive values, and test efficiencies. Improvement and standardization of SPT solutions used for the diagnosis of baker's asthma are highly recommended.
Collapse
Affiliation(s)
- V van Kampen
- BGFA - Research Institute of Occupational Medicine, Ruhr University, Bochum, Germany.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
9
|
Gómez-Ollés S, Cruz MJ, Bogdanovic J, Wouters IM, Doekes G, Sander I, Morell F, Rodrigo MJ. Assessment of soy aeroallergen levels in different work environments. Clin Exp Allergy 2007; 37:1863-72. [PMID: 17927797 DOI: 10.1111/j.1365-2222.2007.02827.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Airborne soybean hull proteins are known causes of asthma epidemics around harbours and soy processing plants. Soy flour dust proteins may cause occupational allergy in food and feed industries. OBJECTIVE To compare enzyme immunoassays (EIAs) for soy hull and soy flour aeroallergens, exposure assessment in various work environments. METHODS Airborne dust samples (n=324) from soy unloading and/or processing plants, the animal feed industry and pig stables were analysed by two soy flour assays: one assay for measuring complete soy hull proteins and two assays for measuring the purified low-molecular-weight (LMW) soy hull allergens. RESULTS Immunoblotting confirmed strong differences between antibody specificities and soy preparations. The results of the two soy flour assays and the assay for measuring complete soy hull proteins were highly correlated (r>0.85). The two LMW soy hull assays also showed a strong mutual correlation (r=0.91), but much less correlation with assays for measuring soy flour and complete soy hull. The levels of LMW soy hull proteins were the highest at sites of soybean unloading or processing, while soy flour levels were particularly high in the soy and animal feed industry. CONCLUSIONS The optimal EIA procedure for soy aeroallergen exposure assessment depends on the type of work environment and the local soy dust composition. Thus, the type of work environment should always be taken into account in future soy allergy studies in order to prevent a possible underestimation of the workers' actual risk of developing soy allergy.
Collapse
Affiliation(s)
- S Gómez-Ollés
- Pulmonology Department, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | | | | | | | | | | | | | | |
Collapse
|