Occupational asthma and rhinitis due to wheat flour: sublingual specific immunotherapy treatment.
Journal
La Medicina del lavoro
ISSN: 0025-7818
Titre abrégé: Med Lav
Pays: Italy
ID NLM: 0401176
Informations de publication
Date de publication:
26 Jun 2020
26 Jun 2020
Historique:
received:
22
03
2020
accepted:
05
05
2020
entrez:
7
7
2020
pubmed:
7
7
2020
medline:
13
8
2020
Statut:
epublish
Résumé
There are several potential sensitizers in the bakery environment and wheat flour appears to be the dominant sensitizer in most bakeries. Apart from traditional drug therapy or a change in profession, there are no effective therapies for workers who develop serious respiratory symptoms in the workplace. To describe clinical and laboratory findings in workers with asthma and/or rhinitis induced by wheat flour who underwent sublingual specific immunotherapy (SLIT). Since drug therapy and prevention strategies were not effective, five bakers were elected to undergo SLIT. A three-year study was led by administering a sublingual wheat flour extract. Questionnaires, allergy and respiratory tests were performed before and after SLIT. After SLIT an improvement in symptoms is observed in every patient: Asthma Control Test and a quality-of-life questionnaire show higher scores and as a result, workers have reduced the use of drug therapy. We observed significantly reduced exhaled nitric oxide (FeNO) and eosinophil cationic protein (ECP) levels after SLIT, hypothesizing that these parameters may be used to monitor the effectiveness of immunotherapy. The improvement of FEV1 (forced expiratory volume in 1second) and responsiveness to bronchoprovocative tests with methacholine denotes a possible role of SLIT in treating patients with low-respiratory tract involvement, even though more data are needed. This is the first report in the literature on the use of SLIT for baker's asthma and rhinitis. SLIT for occupational wheat flour allergy should be possible and efficient, saving vocational training, professionalism, and avoiding job loss.
Sections du résumé
BACKGROUND
BACKGROUND
There are several potential sensitizers in the bakery environment and wheat flour appears to be the dominant sensitizer in most bakeries. Apart from traditional drug therapy or a change in profession, there are no effective therapies for workers who develop serious respiratory symptoms in the workplace.
OBJECTIVES
OBJECTIVE
To describe clinical and laboratory findings in workers with asthma and/or rhinitis induced by wheat flour who underwent sublingual specific immunotherapy (SLIT).
METHODS
METHODS
Since drug therapy and prevention strategies were not effective, five bakers were elected to undergo SLIT. A three-year study was led by administering a sublingual wheat flour extract. Questionnaires, allergy and respiratory tests were performed before and after SLIT.
RESULTS
RESULTS
After SLIT an improvement in symptoms is observed in every patient: Asthma Control Test and a quality-of-life questionnaire show higher scores and as a result, workers have reduced the use of drug therapy. We observed significantly reduced exhaled nitric oxide (FeNO) and eosinophil cationic protein (ECP) levels after SLIT, hypothesizing that these parameters may be used to monitor the effectiveness of immunotherapy. The improvement of FEV1 (forced expiratory volume in 1second) and responsiveness to bronchoprovocative tests with methacholine denotes a possible role of SLIT in treating patients with low-respiratory tract involvement, even though more data are needed.
DISCUSSIONS
CONCLUSIONS
This is the first report in the literature on the use of SLIT for baker's asthma and rhinitis. SLIT for occupational wheat flour allergy should be possible and efficient, saving vocational training, professionalism, and avoiding job loss.
Identifiants
pubmed: 32624562
doi: 10.23749/mdl.v111i3.9446
pmc: PMC7809951
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
203-209Références
Allergy. 2009 Jul;64(7):1030-7
pubmed: 19210348
Ann Allergy. 1992 Nov;69(5):441-4
pubmed: 1456487
Clin Transl Allergy. 2016 Jun 22;6:22
pubmed: 27335632
Scand J Clin Lab Invest. 2016;76(2):118-27
pubmed: 26878875
Allergy Asthma Immunol Res. 2013 Nov;5(6):348-56
pubmed: 24179680
Hum Vaccin Immunother. 2017 Oct 3;13(10):2462-2466
pubmed: 28895784
J Allergy Clin Immunol. 2006 Mar;117(3):549-56
pubmed: 16522452
Curr Allergy Asthma Rep. 2016 Sep;16(9):63
pubmed: 27520939
J Allergy Clin Immunol. 2006 Nov;118(5):1026-32
pubmed: 17088125
Allergy. 2016 Jun;71(6):765-79
pubmed: 26913451
J Occup Med Toxicol. 2013 Jun 14;8(1):17
pubmed: 23768266
Allergy. 2015 Aug;70(8):897-909
pubmed: 25913519
G Ital Med Lav Ergon. 2007 Jul-Sep;29(3 Suppl):443-5
pubmed: 18409768
Int Arch Occup Environ Health. 2020 Jul;93(5):589-599
pubmed: 31927662
Int J Immunopathol Pharmacol. 2013 Jul-Sep;26(3):579-84
pubmed: 24067454
Intern Med J. 2007 Sep;37(9):663-4
pubmed: 17714210
Curr Allergy Asthma Rep. 2016 Nov;16(12):88
pubmed: 27957697
J Allergy Clin Immunol. 1998 Dec;102(6 Pt 1):984-97
pubmed: 9847440
Allergy. 2017 Aug;72(8):1156-1173
pubmed: 28152201
Curr Opin Allergy Clin Immunol. 2016 Apr;16(2):93-100
pubmed: 26866431
Ann Allergy. 1990 Oct;65(4):265-72
pubmed: 2221484
Int J Occup Saf Ergon. 2015;21(3):241-9
pubmed: 26414680
Int Arch Allergy Immunol. 2013;161(3):252-7
pubmed: 23548438
J Clin Epidemiol. 1998 Nov;51(11):1171-8
pubmed: 9817135
Ann Allergy Asthma Immunol. 2016 Mar;116(3):194-8
pubmed: 26837608
J Asthma Allergy. 2016 Jan 29;9:13-25
pubmed: 26889090
Allergy. 2008 Jun;63(6):790-1
pubmed: 18445199
Eur Respir J. 2014 Jun;43(6):1573-87
pubmed: 24603815