Baker’s asthma with oculorhinitis: case report

Abstract

Summary Introduction. Baker’s asthma is one of the most common causes of occupational asthma worldwide. Beside bread production, all occupations in contact with flour (confectioning, pastry making, milling, farming, cereal handling) can be affected. Objective. To illustrate, through the presentation of a clinical case, an updated interdisciplinary diagnostic approach for the evaluation of suspected occupational asthma, with the aim: to identify the possible causal link between the occupational exposure and the disease, and to formulate a correct judgment for job fitness. Materials and methods. Interdisciplinary (occupational medicine and allergology) specialist evaluation, blood and urine analysis, patch tests, total and specific IgE dosage, eosinophilic cationic protein assay, spirometry, non-specific metacholine bronchostimulation, specific inhalation challenge, with monitoring of airway resistance by FOT (forced oscillation technique), and of nasal and bronchial FeNO (fractional exhaled nitric oxide). Results. Fifty-four year-old man, baker since 1993. In recent months, dyspnoea and dry cough, accompanied by ocular and nasal flogosis, as well as itchy skin rash, mainly during work shifts. High total and specific IgE values. Increased eosinophilic cationic protein. Negative metacholine test. Specific inhalation challenge with buckwheat stopped after 15 minutes due to the onset of rhinitis, conjunctivitis, cough with shortness of breath and wheezing. Post-exposure FEV1 decrease (> 12%) and +76% FOT increase. Progressive and persistent nasal FeNO increase with normalization after 24 hours. These findings indicated bronchial and oculonasal allergic response to buckwheat and other cereals. Conclusion. The diagnostic protocol allowed demonstrating the causal link between occupational exposure and the disease, which was reported to the competent authorities. The patient was advised to refrain from further exposure. The evolution of processing techniques and the new substances used in bread production, require continuous updating of diagnostic and health surveillance protocols.