Baker's asthma

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Abstract
Seven bakers with respiratory symptoms were evaluated by skin tests, RAST [radioallergosorbent test] assay for specific IgE antibodies to rye and wheat, inhalation challenge with methacholine for the determination of nonspecific bronchial reactivity, and bronchoprovocation with rye and wheat extracts for the determination of antigen-specific bronchial reactivity. An immediate asthmatic response to antigen challenge was observed in 4 subjects, and all had a high level of flour-specific IgE antibodies. The serum RAST values provided a more accurate predictive value than the degree of cutaneous sensitivity determined by skin testing with respect to the bronchial response to antigenic challenge. Among those who reacted positively to antigenic bronchoprovocation, a much lower antigen dose was required to elicit a positive reaction if the subject also had an increased degree of nonspecific bronchial reactivity. An elevated RAST value was not found in 38 asymptomatic bakers or in 10 asthmatics who had no occupational exposure to flour. Baker''s asthma appears to be a form of allergic asthma to cereal flours mediated by specific IgE antibodies. Both the level of serum IgE antibodies and the degree of nonspecific bronchial reactivity are important factors which may influence a baker''s bronchial response upon inhalation of cereal flours.

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