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Bergen Open Research Archive >
Faculty of Medicine >
Department of Surgical Sciences >
Section for Otorhinolaryngology >
Denne identifikatoren kan du bruke til å sitere eller lenke til denne innførselen:
http://hdl.handle.net/1956/2648
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| Tittel: | Bakers’ rhinitis : diagnostic criteria, flour dust exposure, mucosal inflammation, IgE sensitization, and relation to lower airways |
| Forfattere: | Storaas, Torgeir |
| Dato: | 16-Jan-2008 |
| Forlag: | The University of Bergen |
| Sammendrag: | This thesis is the results of a cross-sectional epidemiological study undertaken in the period
from March 2000 to January 2002 on bakery workers in 6 bakeries in Bergen, Norway. The
aims were to study the consequences of different criteria for the diagnosis of occupational
rhinitis (OcR), assess the prevalence of IgE sensitization, and to explore the relationships
between OcR, upper and lower airway symptoms, IgE-sensitization, nasal indices of
inflammation, bronchial responsiveness, and flour dust exposure. We have taken into
account possible confounders such as age, gender, smoking, and baseline lung function, and
we also present an alternative continuous outcome estimate of bronchial responsiveness.
Bakery workers (n=197) were subjected to interviews, questionnaires, workplace dust
measurements, allergy tests, and nasal lavages with and without histamine provocation. The
criteria for the diagnosis of OcR were based on the International Consensus Report on
Rhinitis (ICR) from 1994. α2-Macroglobulin and eosinophil cationic protein (ECP) were
measured in nasal lavage fluid. Bronchial provocation test with metacholine was carried out
according to the American Thoracic Society’s guidelines. Bronchial responsiveness was
expressed as slopeconc, a measurement derived by regressing the percent reduction in FEV1 at
each provocation step.
The prevalence of OcR varied between 23 and 50% depending on the diagnostic criteria
used. OcR, both IgE- and non-IgE-mediated, was associated with asthma symptoms. The
most frequent causes of sensitization were various species of storage mites (20%). Storagemite
sensitization was related to both OcR and work exposure (production workers versus
administrative staff).
α2-Macroglobulin, ECP, and the exudative responsiveness to histamine increased
significantly with increasing workplace dust exposure (p≤ 0.035). Similar patterns were
seen in workers with OcR and with work related rhinitis symptoms, but occupational
sensitization was not a discriminating factor. Bronchial hyperresponsiveness (BHR)
expressed as slopeconc was associated with smoking (p=0.017) and asthma symptoms at work
(p=0.003), but not with IgE sensitization to occupational allergens (p=0.221) when we also
adjusted for baseline lung function. We demonstrated an association between ECP in nasal
lavage and BHR in a subgroup where BHR was defined as slopeconc < 3 (p=0.012). No
association was seen between bronchial responsiveness and current exposure level of flour
dust, nasal symptoms, and a diagnosis of OcR.
Using different diagnostic criteria have considerable consequences for the prevalence of
OcR. There is a strong relationship between OcR and lower airway symptoms. Storage mites
maybe important occupational allergens in Norwegian bakeries. OcR and occupational dust
exposure in bakery workers is associated with nasal eosinophilic exudative inflammation. In
contrast, occupational sensitization is not a discriminating factor with regard to nasal indices
of eosinophilic, exudative inflammation. Bronchial hyperresponsiveness measured by
metacholine provocation is related to baseline lung function, smoking, work related asthma
symptoms, and nasal eosinophil activity, but not to occupational IgE sensitization. The
slopeconc expression seems to be a useful continuous outcome in bronchial responsiveness
testing with metacholine. |
| URI: | http://hdl.handle.net/1956/2648 |
| ISBN: | 978-82-308-0495-7 (print version) |
| Vises i samlingene: | Section for Otorhinolaryngology
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