Letter to the Editor
Rhinoconjunctivitis and Occupational Asthma in a Furniture Factory Worker
Rinoconjuntivitis y asma ocupacional en una trabajadora de una fábrica de muebles
Elisa Gómez-Torrijos
, Mendez Núñez, Rosa García Rodríguez
Corresponding author
Departamento de Alergología, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain
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She reported a 3-year history of work-related rhinoconjunctivitis. Two years before referral to our clinic she began to have dry cough and breathlessness, which she also attributed to her work environment. All these symptoms increased minutes after handling rye flour, a component of the wood glue used for building furniture.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Skin prick tests (SPT) were positive for grass and olive pollens, <span class="elsevierStyleItalic">Dermatophagoides pteronyssinus</span>, wheat flour and rye flour. SPT using a specially prepared extract of wheat flour and rye flour (10%, wt/vol) were strongly positive (papules measuring 10 and 12<span class="elsevierStyleHsp" style=""></span>mm respectively). Specific IgE (ImmunoCAP, ThermoFisher, Uppsala) was 4<span class="elsevierStyleHsp" style=""></span>kU/L for rye flour, 2.6<span class="elsevierStyleHsp" style=""></span>kU/L for <span class="elsevierStyleItalic">D. pteronyssinus</span>, and 2.1<span class="elsevierStyleHsp" style=""></span>kU/L for wheat flour.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Spirometry performed when the patient was at work showed FEV1 2.40<span class="elsevierStyleHsp" style=""></span>L (82%) and FEV1/FVC 80%. A methacholine inhalation challenge test also performed in the workplace following an abbreviated protocol<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> was positive (0.21<span class="elsevierStyleHsp" style=""></span>mg cumulative dose).</p><p id="par0025" class="elsevierStylePara elsevierViewall">A specific inhalation challenge test was carried out in the hospital lab by tipping rye flour from one tray to another, increasing the duration of exposure to a maximum of 15<span class="elsevierStyleHsp" style=""></span>min. Spirometry was performed at baseline, after each exposure and at 2, 5, 10, 15, 20, 30, 45, 60, 90, and 180<span class="elsevierStyleHsp" style=""></span>min after the challenge with rye flour. Peak expiratory flow was then measured hourly over 24<span class="elsevierStyleHsp" style=""></span>h (except during sleep). Exposure to rye flour was interrupted after the 2<span class="elsevierStyleHsp" style=""></span>min challenge because of cough and dyspnea. A 70% fall in FEV1 with respect to baseline values was observed at 5<span class="elsevierStyleHsp" style=""></span>min (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). A control challenge with normal saline was performed 1 day before the inhalation challenge and no significant changes were observed.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Discussion</span><p id="par0030" class="elsevierStylePara elsevierViewall">Our patient's respiratory symptoms were work-related; her disease course, together with the results of diagnostic tests, indicated an occupational allergic respiratory disease triggered by IgE-mediated allergy to inhaled rye flour.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Rye flour allergens should be considered in the diagnosis of occupational asthma in bakers, farmers, and millers.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a> However, the task performed in the workplace must also be taken into account, because, while some jobs are not generally associated with occupational exposure to flour, these substances can be used in certain circumstances for specific tasks, as in the reported case.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Workers at risk of sensitization are those who are atopic and whose tasks include sieving and mixing ingredients, as occurred in our patient.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> She also showed very high specific bronchial hyperreactivity, similar to that found by other authors reporting rye flour allergy.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">We describe a rare case of occupational rhinoconjunctivitis and asthma caused by rye flour in a furniture factory worker, a job not usually associated with occupational respiratory disease caused by cereal flours.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Discussion" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Gómez-Torrijos E, Núñez M, Rodríguez RG. Rinoconjuntivitis y asma ocupacional en una trabajadora de una fábrica de muebles. Arch Bronconeumol. 2016;52:227–228.</p>" ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1513 "Ancho" => 2511 "Tamanyo" => 193686 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Bronchial provocation test with rye flour.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0030" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Wheat allergens associated with baker's asthma" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "G. Salcedo" 1 => "S. Quirce" 2 => "A. Díaz-Perales" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Investig Allergol Clin Immunol" "fecha" => "2011" "volumen" => "21" "paginaInicial" => "81" "paginaFinal" => "92" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21462797" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0035" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Occupational asthma from exposure to rye flour in a Japanese baker" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "C. Oshikata" 1 => "N. Tsurikisawa" 2 => "A. Saito" 3 => "H. Yasueda" 4 => "K. Akiyama" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/rcr2.63" "Revista" => array:6 [ "tituloSerie" => "Respirol Case Rep" "fecha" => "2014" "volumen" => "2" "paginaInicial" => "102" "paginaFinal" => "104" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25473582" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0040" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Methacholine challenge – comparison of an ATS protocol to a new rapid single concentration technique" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "J. Schulze" 1 => "M. Rosewich" 2 => "C. Riemer" 3 => "M. Dressler" 4 => "M.A. Rose" 5 => "S. Zielen" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.rmed.2009.06.007" "Revista" => array:6 [ "tituloSerie" => "Respir Med" "fecha" => "2009" "volumen" => "103" "paginaInicial" => "1898" "paginaFinal" => "1903" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19596563" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0045" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Rye flour allergens: an emerging role in baker's asthma" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "A. Letran" 1 => "A. Palacín" 2 => "P. Barranco" 3 => "G. Salcedo" 4 => "C. Pascula" 5 => "S. Quirce" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/ajim.20566" "Revista" => array:6 [ "tituloSerie" => "Am J Ind Med" "fecha" => "2008" "volumen" => "51" "paginaInicial" => "324" "paginaFinal" => "328" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18302143" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0050" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Alergenos de la harina de centeno: papel emergente en el asma del panadero (archivos selección)" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "A. Letran" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Arch Prev Riesgos Labor" "fecha" => "2008" "volumen" => "11" "paginaInicial" => "224" "paginaFinal" => "225" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15792129/0000005200000004/v2_201604010234/S1579212915003298/v2_201604010234/en/main.assets" "Apartado" => array:4 [ "identificador" => "49861" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Scientific letters" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/15792129/0000005200000004/v2_201604010234/S1579212915003298/v2_201604010234/en/main.pdf?idApp=UINPBA00003Z&text.app=https://archbronconeumol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212915003298?idApp=UINPBA00003Z" ]
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| 2020 August | 14 | 16 | 30 |
| 2020 July | 29 | 23 | 52 |
| 2020 June | 18 | 15 | 33 |
| 2020 May | 29 | 12 | 41 |
| 2020 April | 36 | 16 | 52 |
| 2020 March | 30 | 13 | 43 |
| 2020 February | 39 | 22 | 61 |
| 2020 January | 35 | 19 | 54 |
| 2019 December | 27 | 25 | 52 |
| 2019 November | 34 | 19 | 53 |
| 2019 October | 18 | 12 | 30 |
| 2019 September | 23 | 7 | 30 |
| 2019 August | 24 | 13 | 37 |
| 2019 July | 25 | 13 | 38 |
| 2019 June | 19 | 7 | 26 |
| 2019 May | 26 | 15 | 41 |
| 2019 April | 44 | 49 | 93 |
| 2019 March | 20 | 23 | 43 |
| 2019 February | 22 | 21 | 43 |
| 2019 January | 20 | 13 | 33 |
| 2018 December | 21 | 13 | 34 |
| 2018 November | 41 | 21 | 62 |
| 2018 October | 55 | 21 | 76 |
| 2018 September | 30 | 7 | 37 |
| 2018 May | 13 | 0 | 13 |
| 2018 April | 16 | 4 | 20 |
| 2018 March | 15 | 6 | 21 |
| 2018 February | 13 | 6 | 19 |
| 2018 January | 22 | 5 | 27 |
| 2017 December | 22 | 7 | 29 |
| 2017 November | 21 | 10 | 31 |
| 2017 October | 18 | 8 | 26 |
| 2017 September | 11 | 4 | 15 |
| 2017 August | 12 | 7 | 19 |
| 2017 July | 15 | 3 | 18 |
| 2017 June | 30 | 9 | 39 |
| 2017 May | 27 | 6 | 33 |
| 2017 April | 24 | 7 | 31 |
| 2017 March | 20 | 3 | 23 |
| 2017 February | 9 | 6 | 15 |
| 2017 January | 16 | 10 | 26 |
| 2016 December | 18 | 7 | 25 |
| 2016 November | 35 | 21 | 56 |
| 2016 October | 33 | 21 | 54 |
| 2016 September | 23 | 6 | 29 |
| 2016 August | 48 | 4 | 52 |
| 2016 July | 30 | 4 | 34 |
Show all
