Wheat allergen exposure and the prevalence of work-related sensitization and allergy in bakery workers

Allergy. 2008 Dec;63(12):1597-604. doi: 10.1111/j.1398-9995.2008.01698.x. Epub 2008 May 30.


Background: Occupational airway diseases are common among bakers. The present study describes the association between exposure to wheat allergen levels and sensitization to wheat allergens, work-related upper and lower respiratory symptoms and asthma in bakery workers.

Methods: As part of a Health Surveillance System for early detection of (allergic) occupational airway diseases a so-called 'validation study' was performed among Dutch bakers for validation of a diagnostic model that predict the likelihood of sensitization to specific workplace allergens. The present study used serology and questionnaire results of a subgroup of 860 bakers participating in the validation study. An earlier developed job-exposure matrix was used to predict average and cumulative personal exposure to wheat allergens.

Results: The prevalence of wheat sensitization, work-related respiratory symptoms and asthma increased till average wheat exposure levels of approximately 25-30 microg/m3, leveled off and decreased at higher exposure concentrations. Exposure-response curves showed a stronger pronounced bell-shape with cumulative exposure. Associations were strongest for asthma and work-related lower respiratory symptoms (PR approximately 2 and PR approximately 3.5-4.5 for average and cumulative exposure, respectively). Associations were only found in atopics. Wheat sensitization was an important factor in the prevalence of respiratory symptoms.

Conclusion: In accordance with earlier studies, the present study showed a bell-shaped exposure-response relationship especially for cumulative wheat allergen exposure with sensitization, allergic respiratory symptoms and asthma. The healthy worker effect may be the possible explanation for the bell-shaped relationship.

Publication types

  • Comparative Study

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Allergens / adverse effects
  • Allergens / immunology*
  • Antigens, Plant / adverse effects
  • Antigens, Plant / immunology*
  • Cooking*
  • Cross-Sectional Studies
  • Dust / immunology
  • Flour
  • Humans
  • Hypersensitivity / epidemiology*
  • Hypersensitivity / immunology
  • Immunization* / trends
  • Middle Aged
  • Occupational Diseases / epidemiology*
  • Occupational Diseases / immunology*
  • Prevalence
  • Triticum / immunology*
  • Young Adult


  • Allergens
  • Antigens, Plant
  • Dust