A 21-Year Perspective on Occupational Skin and Respiratory Diseases Among Food Handlers
Main Article Content
Keywords
cooks, , pastry-makers, bakers, occupational skin diseases, rhinitis, protein contact dermatis
Abstract
Background: Food handlers may have an increased risk of developing occupational skin and respiratory diseases. Methods: This retrospective study was based on examinations, skin prick testing, and patch testing performed at the Unit of Occupational Medicine at the University of Trieste (N-E Italy) between 2002 and 2022 in food-handler workers referred to the unit for suspected occupational allergic diseases. Results: More than half of the population (58.1%) experienced occupational skin diseases, with a higher prevalence among women (OR 3.3, 95% CI 1.5-7.6). Irritant contact dermatitis was the most prevalent skin condition (22.9%), followed by allergic contact dermatitis (20%) and protein contact dermatitis (15.1%). Pastry makers and bakers exhibited a high rate of protein contact dermatitis (20.6 and 17.7%, respectively), which was primarily attributed to wheat flour. Of the participants, 47.8% reported having rhinitis, and 17.6% reported having asthma. Positive SPT results were observed in 34.4% of workers with rhinitis and 58.3% of those with asthma, with bakers and pastry makers being more frequently sensitized to wheat flour (22.8% and 20.6%, respectively). Cooks reported rhinitis (43.2%) and asthma (12.3%) with sensitization to soy, scampi, peanuts, and other foods. Atopy determined by prick test was significantly linked to respiratory symptoms. Bakers and pastry makers showed significantly higher sensitivity to wheat flour (OR 3.3, 95% CI 1.3-7.8). Conclusions: Food handlers can experience occupational skin and respiratory diseases, and more efforts are needed to prevent such diseases by improving preventive habits and avoiding exposure to allergens.
References
2. Dickel H, Bruckner T, Bernhard-Klimt C, Koch T, Scheidt R, Diepgen TL. Surveillance scheme for occupa-tional skin disease in the Saarland, FRG. First report from BKH-S. Contact Dermatitis. 2002; 46(4):197-206. Doi: 10.1034/j.1600-0536.2002.460403.x.
3. Scheinman PL, Vocanson M, Thyssen JP, et al. Contact dermatitis, Nat Rev Dis Primers. 2021;7:38. Doi: 10.1038/s41572-021-00271-4
4. Steenkamp I. Occupational disease in bread bakers. Current Allergy & Clinical Immunology. 2013, 26(1).
5. Vergara C, Mauro M, Belloni Fortina A, Giulioni E, Larese Filon F. Occupational Contact Dermatitis in Food Handlers: A 26-Year Retrospective Multicentre Study in North-East Italy (Triveneto Group on Research on Contact Dermatitis). Dermatitis. 2025;36(1):e104-e105. Doi: 10.1089/derm.2023.0408. Epub 2024 May 24. PMID: 38785115.
6. Bauer A, Johannes G, Peter E. Type IV allergy in the food processing industry: sensitisation profiles in bakers, cooks and butchers. Contact Dermatitis. 2002;46: 228-235.
7. Levin C. Protein contact dermatitis. Dermatology. 2021;4:7.
8. Nieto M.A.P, Gimenez-Arnau A.M. Immediate and Delayed Hypersensitivity Reactions Occurring in the Kitchen: The Hazards Related to Being a Chef or Kitchen Staff. Kanerva's OD. 2018; 1-40.
9. Baatjies R, Jeebhay MF. Baker's allergy and asthma – a review of the literature. Curr Opin Allergy Clin Immunol. 2013;26:4.
10. Brant A. Baker's asthma. Curr Opin Allergy Clin Immunol. 2007;7:152-155.
11. Olivieri M, Murgia N, Spiteri G, et al. Exposure to additives or multigrain flour is associated with high risk of work-related allergic symptoms among bakers. Occup Environ Med. 2020, 20:1-5.
12. Crivellaro MA, Ottaviano G, Maculan P, et al. Upper and Lower Respiratory Signs and Symptoms in Workers Occupationally Exposed to Flour Dust. Int J Environ Res Public Health. 202027; 17(19):7075.
13. Houba R, Doekes G. Occupational respiratory allergy in bakery workers: A Review of the Literature. Am J Ind Med. 1998;34:529-546.
14. Quirce S, Diaz-Perales A. Diagnosis and Management of Grain-Induced Asthma. Allergy Asthma Immunol Res. 2013;5(6):348-356.
15. Tarlo S, Vanderplas, Malo GL, Asthma in the Workplace. CRC Press Boca Raton 2021. Doi: https://doi.org/10.1201/9781003000624
16. Salcedo G, Quirce S, Diaz-Perales A. Wheat allergens associated with baker's asthma. J Investig Allergol Clin Immunol. 2011;21(2):81-92.
17. Merget R, Sander I, Raulf-Heimsoth M, Baur X. Baker's asthma due to xylanase and cellulase without sensitization to alpha-amylase and only weak sensitization to flour. Int Arch Allergy Immunol. 2001; 124:502-5.
18. Quirce S, Polo F, Figueredo E, Gonzàlez R, Sastre J. Occupational asthma caused by soybean flour in bak-ers--differences with soybean-induced epidemic asthma. Clin Exp Allergy. 2000; 30(6):839-46.
19. Quirce S, Nieto MF, Polo F, Sastre J. Saybean trypsin inhibitor is an occupational inhalant allergen. J Al-lergy Clin Immunol. 2002;109(1):178.
20. Jungewelter S, Suomela S, Airaksinen L. Occupational Ig-E‐mediated psyllium allergy in contemporary gluten‐free and vegan baking: A case of allergic rhinitis. Am J Ind Med. 2021;64:431–434.
21. Zamri ASS, Saruddin MZ, Harun A, et al. Factors associated with occupational asthma among food industry workers: A systematic review. PLoS One. 2023;18(6):e0287040.
22. Chiesi A, Pellacani G, Di Rico R, et al. Italian translation and validation of the Nordic Occupational Skin Questionnaire (NOSQ-2002). Med Lav. 2016;107(3):205-12. Italian. PMID: 27240224.
23. Vester L, Thyssen JP, Menné T, Johansen JD. Occupational food-related hand dermatoses seen over a 10-year period. Contact Dermat. 2012;66(5):264-270.
24. Thyssen JP, Schuttelaar MLA, Alfonso JH, et al. Guidelines for diagnosis, prevention, and treatment of hand eczema. Contact Dermat. 2022;86(5):357–78. Doi: 10.1007/s00420-019-01511-7. Epub 2020 Jan 11. PMID: 31927662; PMCID: PMC7261635.
25. Tacke J, Schimdt A, Fartash M, Diepgen TL. Occupational contact dermatitis in bakers, confectioners and cooks. A population-based study. Contact Dermat. 1995:33:112-117.
26. Al Badri FM, Baatjies R, Jeebhay MF. Assessing the health impact of interventions for baker's allergy and asthma in supermarket bakeries: a group randomised trial. Int Arch Occup Environ Health. 2020;93(5):589-28.
27. Mauro M, Bovenzi M, Larese Filon F. Occupational contact dermatitis in a gender perspective: North East Italian data 1996-2016. Med Lav. 2021;112(1):34-43.
28. Olivieri M, Malerba M, Spiteri G, et al. Fractional exhaled nitric oxide levels in relation to work-related respiratory burden and sensitization to wheat flour and multigrain in bakers. Clin Transl Allergy. 2021;11(8):e12018. Doi: 10.1002/clt2.12018. PMID: 34708942; PMCID: PMC8694179.
29. Hisinger-Molkanen H, Piirila P, Haahtela T, Sovijarvi A, Pallasaho P. Smoking, environmental tobacco smoke and occupational irritants increase the risk of chronic rhinitis. WAO J. (2018);11:6.
30. Brans R, Skudlik C, Weisshaar E, et al. Association between tobacco smoking and prognosis of occupa-tional hand eczema: a prospective cohort study. Br J Dermatol. 2014;171:1108-1115.
31. de Jong NW, Elbert NJ, Mensink-Bout SM, et al. Parental and child factors associated with inhalant and food allergy in a population-based prospective cohort study: the Generation R Study. Eur J Pediatr. 2019;178(10):1507-1517. Doi: 10.1007/s00431-019-03441-5. Epub 2019 Aug 15. PMID: 31414213; PMCID: PMC6733817.
32. Basso P, Mauro M, Miani A, et al. Sensitization to nickel in the Triveneto region: Temporal trend after European Union regulations. Contact Dermat. 2020;82(4):247-250. Doi: 10.1111/cod.13450. Epub 2019 Dec 29. PMID: 31811647.
33. Larese Filon F, Ricci F, Piapan L, Fortina AB, Mauro M, Rui F. Sensitization to Fragrance Markers From 1996 to 2016 in Northeastern Italy and Analysis of Occupational Relevance. Dermatitis. 2023;34(5):468-469.
34. Pesonen M, Koskela K, Aalto-Korte K. Contact urticaria and protein contact dermatitis in the Finnish Register of Occupational Diseases in a period of 12 years. Contact Dermat. 2020;83(1):1-7. Doi: 10.1111/cod.13547. Epub 2020 Apr 29
35. Barbaud A, Poreaux C, Penven E, Waton J. Occupational protein contact dermatitis Eur J Dermatol. 2015;25(6):527-34. Doi: 10.1684/ejd.2015.2593
36. Lukács J, Schliemann S, Elsner P. Occupational contact urticaria caused by food - a systematic clinical re-view. Contact Dermat. 2016;75(4):195-204. Doi: 10.1111/cod.12653. Epub 2016 Jul 18.
37. Aydın Ö, Sözener ZÇ, Demirel YS, Seçil D, Mungan D. Baker's asthma in bread factory workers. Allergy Asthma Proc. 2021;42(1):72-77. Doi: 10.2500/aap.2021.42.200090. PMID: 33404390.
38. Tashiro T, Sasaki N, Yamamoto K, et al. The prevalence of urticaria, hand eczema, atopic dermatitis and asthma among bakers in Japan. Eur J Dermatol. 2019;29(6):663-664. Doi: 10.1684/ejd.2019.3665. PMID: 31903965.
39. Jonaid BS, Rooyackers J, Stigter E, Portengen L, Krop E, Heederik D. Predicting occupational asthma and rhinitis in bakery workers referred for clinical evaluation. Occup Environ Med. 2017;74(8):564-572. Doi: 10.1136/oemed-2016-103934. Epub 2017 Mar 17. PMID: 28314756.
40. Jeebhay MF, Moscato G, Bang BE, et al. Food processing and occupational respiratory allergy- An EAACI position paper. Allergy. 2019;74(10):1852-1871. Doi: 10.1111/all.13807. Epub 2019 Jun 23. PMID: 30953601.
41. Cullinan P, Vandenplas O, Bernstein D. Assessment and Management of Occupational Asthma. J Allergy Clin Immunol Pract. 2020;8(10):3264-3275. Doi: 10.1016/j.jaip.2020.06.031. PMID: 33161958.
Article Sidebar
Article Details
How to Cite
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
All Journal's articles are Open Access papers distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by-nc/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Reproductions with commercial intent will require written permission and payment of royalties.
This work is licensed under a CC BY-NC 4.0 Creative Commons Attribution-NonCommercial 4.0 International License.
Francesca Larese Filon, Unit of Occupational Medicine, University Clinical Department of Medical, Surgical and Health Sciences, University of Trieste, Italy
Unità Clinico Operativa di Medicina del Lavoro - Ambulatorio di AllergologiaHow to Cite
