Occupational Asthma in the Food Industry

Opinion statement

Inhalation of food-derived allergens during food processing at the workplace represents a risk for developing occupational asthma (OA) in exposed workers. Cereal flours and seafood are the causal agents most frequently involved. The management of food-derived OA includes timely pharmacologic therapy and environmental interventions aimed to avoid or reduce exposure to the offending agent to increase the probability of recovery. Cessation of exposure is the best option, but when the causative agent cannot be completely avoided reduction of exposure, through modification of food processing, improving ventilation, mechanization, etc. can be considered as an alternative. Quantification of real exposure levels is crucial, and new accurate immunologic and chemical assays able to detect low levels of aerosolized flour and seafood allergens have recently been developed. Recent papers have described intervention strategies effective in reducing airborne allergen exposure in flour and seafood industry, but the long-term health impact of this intervention has still to be defined. Specific allergen immunotherapy (SIT) might be another management option in individuals with IgE-mediated food-induced OA. Both a short- and a long-lasting beneficial effect of SIT with wheat flour in reducing symptoms whilst keeping the patient at work has been shown in bakers' asthma, but at present, SIT is not for routine use for bakers' asthma due to the lack of commercial standardized extracts. A better identification on a molecular basis of allergens involved in flour and in other IgE-mediated food-derived OA might help in preparing new extracts suitable for immunotherapy. In selected cases of bakers' asthma, the monoclonal antibody omalizumab has been effective in reducing symptoms. SIT and omalizumab might represent further management options in IgE-mediated OA in food industry.

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