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Baking Industry
The first report of Aspergillus-derived a -amylase allergy was published by Flindt in 1979, when five out of eight symptomatic employees in an enzyme-handling factory were sensitized to a -amylase. In the mid-1980s, reports from allergies induced by exposure to a -amylase in the baking industry started to appear. Baur et al (1986) reported sensitization, in a radioallergosorbent test (RAST), to a -amylase in 34% of 27 symptomatic bakery workers in Germany. In a subsequent paper, Baur et al (1988) reported a sensitization rate (by RAST) of 24% for a -amylase, 8% for hemicellulase or cellulase, and 5% for amyloglucosidase. In Sweden, Brisman and Belin (1991) published a report on four symptomatic workers in a factory where amylase-contained baking additives were prepared. In Spain, Quirce et al (1992) described five symptomatic bakers. In Italy, 17 (7.5%) of 226 bakers and pastry makers were sensitized to enzymes (De Zotti et al 1994). In the United Kingdom, 5% of 344 subjects were sensitized in bakery or flour mill work (Cullinan et al 1994), and up to 16% sensitization was reported in a selected plant bakery population (Smith et al 1997). In The Netherlands, 9% of 178 bakery workers were sensitized to a -amylase (Houba et al 1996). A German study comprising a retrospective analysis of sera from 171 symptomatic bakers revealed a sensitization rate of 23% for a -amylase, 8% for amyloglucosidase, 13% for cellulase and 11% for xylanase (Sander et al 1998). In Scotland, 15% of 205 bakery employees were found to be sensitized to a -amylase by RAST (Jeffrey et al 1999). In the United Kingdom, 5% of 264 employees were sensitized to amylase (Nieuwenhuijsen et al 1999). Few longitudinal studies have been published on the incidence of enzyme allergy in the baking industry. In a cohort of Italian trainee bakers, 125 subjects were tested at 6, 18 and 30 months after the baseline examination. At the baseline, 4 were sensitized to flour or a -amylase; at 30 months, the corresponding number was 10 sensitized to flours, 3 of whom also showed sensitization to amylase (De Zotti & Bovenzi 2000). In the United Kingdom, a nested case-control analysis of a cohort of new bakers was reported recently (Cullinan et al 2001). Out of 300 bakers, 21 had developed sensitization to flour, 2.2. cases per 100 person-years (py), and 24 to a -amylase, 2.5 cases per 100 py. A correlation between a -amylase and flour sensitization was found in studies in which both substances were assessed. For example, the amylase/flour sensitization prevalences were 5%/5% (Cullinan et al 1994), 7.5%/11.9% (De Zotti et al 1994), 9%/8% (Houba et al 1996), 19%/16% (Baur et al 1998a); 16%/6% (Smith & Smith 1998), and 15%/ 24% (Jeffrey et al 1999). Co-sensitization (amylase and flour) was common. The reported work-related respiratory symptoms in bakeries have a wide range: from a prevalence of 0.5% for asthmatic symptoms and 2.6% for rhinitis (Smith & Smith 1998) to 33% for rhinitis and dyspnea (Baur et al 1998a). A high prevalence of asthmatic symptoms (20.9%) was reported in small bakeries in Scotland (Jeffrey et al 1999). In a United Kingdom cohort of new bakers, the incidence was 11.8/100 py for work-related eye or nose symptoms and 4.1/100 py for chest symptoms (Cullinan et al 2001). The incidence of work-related chest symptoms in the presence of a positive SPT to flour or amylase was 1/100 py. In Finland, only a few bakery workers, out of a total of about 9000 people per year working in the industry, have been diagnosed as having occupational disease as a result of exposure to enzymes. In 1990–1999, altogether 263 cases of occupational asthma due to flour exposure and only 3 due to amylase exposure were reported, as were 278 cases of rhinitis due to flour exposure, and 3 cases due to amylase exposure (Finnish Register of Occupational Diseases). The following reasons have been proposed: (1) flour-induced allergy is primarily searched for and diagnosed, leaving simultaneous enzyme allergy unrecorded, and (2) workers and health professionals are often unaware of the use of enzymes in the workplace.
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