Occupational allergy to food-derived allergens

Gianna Moscato; Gianni Pala; Gianna Moscato; Gianni Pala

doi:10.3934/Allergy.2017.1.21

AIMS Allergy and Immunology

2017, Volume 1, Issue 1: 21-30. doi: 10.3934/Allergy.2017.1.21

Previous Article Next Article

Review

Occupational allergy to food-derived allergens

Gianna Moscato ^{1
,
,},
Gianni Pala ²

1.
Specialization School in Occupational Medicine, Department of Public Health, Forensic and Experimental Medicine, University of Pavia, Italy
2.
Occupational Physician’s Division, Healthcare Authority of Sardinia, Area of Sassari, Italy

Received: 02 May 2017 Accepted: 12 June 2017 Published: 27 June 2017

Although most cases of food allergy are related to food ingestion, occupational exposure to foods by contact or inhalation may also lead to adverse reactions, inducing contact urticaria or dermatitis, asthma, rhinitis, hypersensitivity pneumonitis, and anaphylaxis. Almost 10–25% of cases of allergic occupational asthma and rhinitis are due to food products. Animal and vegetal high-molecular weight proteins derived from aerosolized foods during food processing or handling at the workplace, as well as additives used as preservatives and antioxidants, and food contaminants, are the main causal agents. Farmers who grow and harvest crops and workers employed in food processing, storage and packing, and those involved in food preparation and transport are considered at increased risk for developing food-induced occupational asthma and rhinitis. Bakers’ asthma is the most frequent type of occupational asthma all around the world. Seafood processing industry is also at higher risk for asthma and rhinitis. A proportion of cases of asthma and rhinitis in food industry is also related to latex gloves used during food processing. The diagnosis of food-related occupational asthma and rhinitis includes a careful clinical and occupational history, respiratory functional assessment and measurement of non-specific bronchial hyperresponsiveness, immunologic assessment and specific inhalation challenge. The management includes environmental interventions aimed to avoid or reduce exposure to the offending agent, pharmacologic therapy, and allergen immunotherapy when available. Only few cases of food-induced occupational anaphylaxis have been described. The management of these emergencies should follow the current guidelines on anaphylaxis. The worker should be educated in managing future possible episodes that may also occur out of the workplace, by instance after accidental ingestion of the culprit allergen, and to carry 2 pre-loaded adrenaline delivery systems and a MedicAlert bracelet.
- occupational asthma,
- occupational rhinitis,
- occupational anaphylaxis,
- food industry,
- food processing
Citation: Gianna Moscato, Gianni Pala. Occupational allergy to food-derived allergens[J]. AIMS Allergy and Immunology, 2017, 1(1): 21-30. doi: 10.3934/Allergy.2017.1.21

Related Papers:

Abstract

Although most cases of food allergy are related to food ingestion, occupational exposure to foods by contact or inhalation may also lead to adverse reactions, inducing contact urticaria or dermatitis, asthma, rhinitis, hypersensitivity pneumonitis, and anaphylaxis. Almost 10–25% of cases of allergic occupational asthma and rhinitis are due to food products. Animal and vegetal high-molecular weight proteins derived from aerosolized foods during food processing or handling at the workplace, as well as additives used as preservatives and antioxidants, and food contaminants, are the main causal agents. Farmers who grow and harvest crops and workers employed in food processing, storage and packing, and those involved in food preparation and transport are considered at increased risk for developing food-induced occupational asthma and rhinitis. Bakers’ asthma is the most frequent type of occupational asthma all around the world. Seafood processing industry is also at higher risk for asthma and rhinitis. A proportion of cases of asthma and rhinitis in food industry is also related to latex gloves used during food processing. The diagnosis of food-related occupational asthma and rhinitis includes a careful clinical and occupational history, respiratory functional assessment and measurement of non-specific bronchial hyperresponsiveness, immunologic assessment and specific inhalation challenge. The management includes environmental interventions aimed to avoid or reduce exposure to the offending agent, pharmacologic therapy, and allergen immunotherapy when available. Only few cases of food-induced occupational anaphylaxis have been described. The management of these emergencies should follow the current guidelines on anaphylaxis. The worker should be educated in managing future possible episodes that may also occur out of the workplace, by instance after accidental ingestion of the culprit allergen, and to carry 2 pre-loaded adrenaline delivery systems and a MedicAlert bracelet.

References

[1]	Marchisotto MJ, Harada L, Blumenstock J, et al. (2016) Global perceptions of food allergy thresholds in 16 countries. Allergy 71: 1081–1085. doi: 10.1111/all.12933
[2]	Aresery M, Lehrer SB (2002) Occupational reactions to foods. Curr Allergy Asthm R 2: 78–86. doi: 10.1007/s11882-002-0044-8
[3]	Roberts G, Gideon L (2003) Relevance of inhalational exposure to food allergens. Curr Opin Allergy Clin Immunol 3: 211–215. doi: 10.1097/00130832-200306000-00010
[4]	Cartier A (2010) The role of inhalant food allergens in occupational asthma. Curr Allergy Asthm R 10: 349–356. doi: 10.1007/s11882-010-0130-2
[5]	Quirce S, Vandenplas O, Campo P, et al. (2016) Occupational hypersensitivity pneumonitis: an EAACI position paper. Allergy 71: 765–779. doi: 10.1111/all.12866
[6]	Seitz CS, Brocker EB, Trautmann A (2008) Occupational allergy due to seafood delivery: case report. J Occup Med Toxicol 3: 11. doi: 10.1186/1745-6673-3-11
[7]	Siracusa A, Folletti I, Gerth van WR, et al. (2015) Occupational anaphylaxis-an EAACI task force consensus statement. Allergy 70: 141–152. doi: 10.1111/all.12541
[8]	Moscato G, Pala G, Barnig C, et al. (2012) EAACI consensus statement for investigation of work-related asthma in non-specialized centres. Allergy 67: 491–501. doi: 10.1111/j.1398-9995.2011.02784.x
[9]	Vandenplas O, Wiszniewska M, Raulf M, et al. (2014) EAACI position paper: irritant-induced asthma. Allergy 69: 1141–1153. doi: 10.1111/all.12448
[10]	Moscato G, Vandenplas O, Gerth Van WR, et al. (2008) EAACI position paper: occupational rhinitis. Allergy 63: 969–980. doi: 10.1111/j.1398-9995.2008.01801.x
[11]	Vally H, Misso NL, Madan V (2009) Clinical effects of sulphite additives. Clin Exp Allergy 39: 1643–1651. doi: 10.1111/j.1365-2222.2009.03362.x
[12]	EAACI Interest Group on Occupational Allergy: Sensitizing Agents Inducers of Occupational Asthma, Hypersensitivity Pneumonitis and Eosinophilic Bronchitis, 2016. Available from: http://www.eaaci.org/images/pdf.files/Occupational_Allergens_1-16.pdf.
[13]	Meredith S, Nordman H (1996) Occupational asthma: measures of frequency from four countries. Thorax 51: 435–440. doi: 10.1136/thx.51.4.435
[14]	Brant A (2007) Baker's asthma. Curr Opin Allergy Clin Immunol 7: 152–155. doi: 10.1097/ACI.0b013e328042ba77
[15]	Quirce S, Diaz-Perales A (2013) Diagnosis and management of grain-induced asthma. Allergy Asthma Immun 5: 348–356. doi: 10.4168/aair.2013.5.6.348
[16]	Brant A1, Berriman J, Sharp C, et al. (2005) The changing distribution of occupational asthma: a survey of supermarket bakery workers. Eur Respir J 25: 303–308. doi: 10.1183/09031936.05.00054004
[17]	Raulf M (2016) Allergen component analysis as a tool in the diagnosis of occupational allergy. Curr Opin Allergy Clin Immunol 16: 93–100. doi: 10.1097/ACI.0000000000000246
[18]	Jones M, Welch J, Turvey J, et al. (2016) Prevalence of sensitization to 'improver' enzymes in UK supermarket bakers. Allergy 71: 997–1000. doi: 10.1111/all.12854
[19]	Lipińska OA, Wiszniewska M, Pas-Wyroślak A, et al. (2016) Sensitization to xylanolytic enzymes: an underestimated health hazard among bakers. Occup Med 66: 415–418. doi: 10.1093/occmed/kqw048
[20]	Armentia A, Lombardero M, Martinez C, et al. (2004) Occupational asthma due to grain pests Eurygaster and Ephestia. J Asthma 41: 99–107. doi: 10.1081/JAS-120026067
[21]	Pala G, Pignatti P, Perfetti L, et al. Usefulness of basophil activation test in a case of occupational rhinitis and asthma due to Ephestia kuehniella in a grain stocker. 1st International Congress Southern European Allergy Societies-Florence, Italy, March 18–20, 2010.
[22]	Lopata AL, Jeebhay MF (2013) Airborne seafood allergens as a cause of occupational allergy and asthma. Curr Allergy Asthma Rep 13: 288–297. doi: 10.1007/s11882-013-0347-y
[23]	Caballero ML, Quirce S (2015) Identification and practical management of latex allergy in occupational settings. Expert Rev Clin Immunol 11: 977–992. doi: 10.1586/1744666X.2015.1059754
[24]	Nicholson PJ, Cullinan P, Newman TAJ, et al. (2005) Evidence based guidelines for the prevention identification, and management of occupational asthma. Occup Environ Med 62: 290–299. doi: 10.1136/oem.2004.016287
[25]	Pacheco KA, Jeebhay MF, Gautrin D, et al. (2013) Asthma and allergy to animals, In: Jean-Luc M, Moira CY, David I, Bernstein Eds. Asthma in the Workplace, 4th edition, CRC Press, Florida, 17: 238–261.
[26]	Baatjies R, Meijster T, Heederik D, et al. (2015) Exposure-response relationships for inhalant wheat allergen exposure and asthma. Occup Environ Med 72: 200–207. doi: 10.1136/oemed-2013-101853
[27]	Raulf M, Buters J, Chapman M, et al. (2014) EAACI position paper: monitoring of occupational and environmental aeroallergens. Allergy 69: 1280–1299. doi: 10.1111/all.12456
[28]	ACGIH (2016) 2016 TLVs® and BEIs®: threshold limit values for chemical substances and physical agents and biological exposure indices. Cincinnati, OH: American Conference of Governmental Industrial Hygienists.
[29]	Heederik D, Houba R (2001) An exploratory quantitative risk assessment for high molecular weight sensitizers: wheat flour. Ann Occup Hyg 45: 175–185. doi: 10.1016/S0003-4878(00)00044-2
[30]	Jeebhay MF, Cartier A (2010) Seafood workers and respiratory disease: an update. Curr Opin Allergy Clin Immunol 10: 104–113. doi: 10.1097/ACI.0b013e3283373bd0
[31]	Uriarte SA, Fernández NM, Arochena L, et al. (2015) Occupational asthma in seafood manufacturing and food allergy to seafood. J Investig Allergol Clin Immunol 25: 59–60.
[32]	Listed N (1992) Guidelines for the diagnosis of occupational asthma. Subcommittee on "occupational allergy" of the european academy of allergology and clinical immunology. Clin Exp Allergy 22: 103–108. doi: 10.1111/j.1365-2222.1992.tb00121.x
[33]	Moscato G, Malo JL, Bernstein D (2003) Diagnosing occupational asthma: how, how much, how far? Eur Respir J 21: 879–885. doi: 10.1183/09031936.03.00000403
[34]	Tarlo SM, Balmes J, Balkissoon R, et al. (2008) Diagnosis and management of work-related asthma: American college of chest physicians consensus statement. Chest 134: 1S–41S.
[35]	Moscato G, Galdi G (2009) Occupational asthma and its relationship to occupational rhinitis, In: Pawankar R, Holgate S, Rossenwasser LJ, Allergy Frontiers: From Epigenetics to Future Perspectives. Clinical manifestation, Japan, Tokyo, Berlin, Heidelberg, New York: Springer, 303–320.
[36]	Malo GL, Ghezzo H, L'Archeveque J, et al. (1991) Is the clinical history a satisfactory means of diagnosing occupational asthma? Am Rev Respir Dis 143: 528–532. doi: 10.1164/ajrccm/143.3.528
[37]	Global Initiative for Asthma. Global Strategy for Asthma Management and Prevention (2016). Available from: www.ginasthma.org.
[38]	Moscato G, Godnic CJ, Maestrelli P, et al. (1995) Statement on self-monitoring of peak expiratory flow in the investigation of occupational asthma. Official Statement. Eur Respir J 8: 1605–1610.
[39]	Tonini S, Perfetti L, Pignatti P, et al. (2012) Occupational asthma induced by exposure to Phaseolus lunatus. Ann Allergy Clin Immunol 108: 66–67. doi: 10.1016/j.anai.2011.10.009
[40]	Vandenplas O, Suojalehto H, Aasen TB, et al. (2014) Specific inhalation challenge in the diagnosis of occupational asthma: consensus statement. Eur Respir J 43: 1573–1587. doi: 10.1183/09031936.00180313
[41]	Vandenplas O, Dressel H, Nowak D, et al. (2012) ERS task force on the management of work-related asthma. What is the optimal management option for occupational asthma? Eur Respir Rev 21: 97–104.
[42]	Swaminathan S, Heddle RJ (2007) Wheat flour immunotherapy in baker's asthma. Intern Med J 37: 663–664. doi: 10.1111/j.1445-5994.2007.01422.x
[43]	Olivieri M, Biscardo CA, Turri S, et al. (2008) Omalizumab in persistent severe bakers' asthma. Allergy 63: 790–791. doi: 10.1111/j.1398-9995.2008.01702.x
[44]	Pérez PA, Bueso FA, García LJ, et al. (2008) Effect of omalizumab treatment in a baker with occupational asthma. J Investig Allergol Clin Immunol 18: 490–491.
[45]	Muraro A, Roberts G, Worm M, et al. (2014) Anaphylaxis: guidelines from the european academy of allergy and clinical immunology. Allergy 69: 1026–1045. doi: 10.1111/all.12437
[46]	Vidal C, González QA, Rodriguez V, et al. (2006) Anaphylaxis to cyphomandra betacea sendth (tamarillo) in an obeche wood (triplochiton scleroxylon) allergic patient. Ann Allergy Asthma Immunol 96: 870–873. doi: 10.1016/S1081-1206(10)61352-X
[47]	Ebo DG, Bridts CH, Mertens MH, et al. (2006) Coriander anaphylaxis in a spice grinder with undetected occupational allergy. Acta Clin Belg 61: 152–156. doi: 10.1179/acb.2006.025
[48]	Vega de la OF, Esteve KP, Alonso LE, et al. (1998) Sensitization to paprika: anaphylaxis after intake and rhinoconjunctivitis after contact through airways. Med Clin (Barc) 111: 263–266.
[49]	Davidson AE, Passero MA, Settipane GA (1992) Buckwheat-induced anaphylaxis: a case report. Ann Allergy 69: 439–440.
[50]	Willi R, Pfab F, Huss MJ, et al. (2009) Contact anaphylaxis and protein contact dermatitis in a cook handling chicory leaves. Contact Dermatitis 60: 226–227. doi: 10.1111/j.1600-0536.2008.01461.x
[51]	Muraro A, Werfel T, Hoffmann SK, et al. (2014) EAACI food allergy and anaphylaxis guidelines: diagnosis and management of food allergy. Allergy 69: 1008–1025. doi: 10.1111/all.12429
[52]	Quirce S, Fiandor A (2016) How should occupational anaphylaxis be investigated and managed? Curr Opin Allergy Clin Immunol 16: 86–92. doi: 10.1097/ACI.0000000000000241
[53]	Simons FE, Ardusso LR, Dimov V, et al. (2013) World allergy organization anaphylaxis guidelines: 2013 update of the evidence base. Int Arch Allergy Imm 162: 193–204.

Reader Comments

Your name:*

Email:*
© 2017 the Author(s), licensee AIMS Press. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0)