Occupational allergies in the seafood industry: a comparative study of Australian and South African workplaces

Although seafood allergy due to ingestion is commonly observed in clinical practice, the incidence of seafood allergies in general and more specifically in the occupational setting in Australia is largely unknown. The work practices, occupational health services and allergic health problems in 140 seafood processing workplaces in Australia were examined and compared to previous studies in South Africa. A cross-sectional employer-based survey design was used to conduct the study in both countries. In the South African study a response rate of 60% (n = 41) was obtained, compared to a response rate of 18% (n = 140) in Australia. The most common seafood processed by workplaces in South Africa was finfish (76%) and rock lobster (34%). Similarly in Australia, finfish (34%) was the most frequently handled seafood. However, processing of prawns (24%) and oysters (21%) was more common in Australia. Common work processes in South Africa involved freezing (71%), cutting/filleting (63%) and degutting (58%) procedures. Similar processes were followed in Australian industries with the exception of shucking of oysters, particularly common in the aquaculture industries. About half of the workplaces in both countries provided an occupational health service and medical surveillance of workers. However, none of the workplaces in South Africa and only 9% of the workplaces in Australia had industrial hygiene programs for seafood aerosols in place. In both countries positive trends were observed between the size of the workforce and the provision of occupational health services (p<0.005). Similarly, skin rash accounted for highest of all reported health problems (78-81%) followed by asthmatic symptoms (7-10%) and other non-specific allergic symptoms (9-15%) in both countries. Most workplaces reported the annual prevalence of work-related symptoms to be less than 5%. In Australia 7% of respondents in workplaces reported workers having left their workplace due to work-related allergic problems. Despite a low response rate of contacted companies in Australia, there were great similarities between the two countries suggesting that there is a significantly elevated prevalence of work related allergic symptoms in both countries. Unexpectedly, mollusc processing was more common in Australia although the occupational health related effects among exposed workers has previously not been investigated in detail and merits further study. It is recommended that further epidemiological studies focus on seafood exposure in Australia and identify specific risk factors for sensitisation

Exposure-response relationships for inhalant wheat allergen exposure and asthma

BACKGROUND: A few studies have investigated exposure-response relationships for sensitisation to wheat, work-related symptoms and wheat allergen exposure. IgG4 is suggested to protect against the development of allergic sensitisation. The main aim of this current study was to explore the nature of exposure-response relationships for a range of clinically relevant endpoints among bakery workers, and to investigate the role of IgG4 in these relationships. METHODS: A cross-sectional study of 517 supermarket bakery workers in 31 bakeries used a questionnaire, serum-specific IgE and IgG4 to wheat, and methacholine challenge testing. Exposure models were developed previously using job, bakery size, tasks and specific ingredients used. These models were used to predict average personal exposure to wheat allergens. RESULTS: The exposure-response relationships for average exposure followed a linear relationship for sensitisation, but a bell-shaped curve for allergic symptoms and probable occupational asthma, increasing up to 10-15 µg/m(3) wheat allergen concentration after which they plateau off and decrease at higher exposure concentrations. This relationship was modified by atopic status. IgG4 levels were strongly exposure related: a clear increase in prevalence of higher IgG4 with increase in wheat allergen exposure was observed among those sensitised and non-sensitised to wheat, with IgG4 even more strongly associated with exposure than IgE to wheat. CONCLUSIONS: The bell-shaped exposure-response relationship in the current study is consistent with the findings of previous studies. IgG4 showed no protective effect for sensitisation, confirming the findings of previous studies, suggesting that the pattern is probably related to a healthy worker effect

Exposure to flour dust in South African supermarket bakeries: Modeling of baseline measurements of an intervention study

Introduction: Exposure to flour dust has been reported as an important risk factor for allergic respiratory disease among bakery workers. A high prevalence of allergic sensitization and asthma was recently reported in South African supermarket bakeries. The aim of this study was to conduct a detailed exposure assessment of these bakeries so as to provide the baseline for a broader intervention study. Methods: A total of 211 full-shift personal samples were collected on randomly selected individuals within five different job categories in 18 bakeries. The samples were analyzed for particulate mass and specific flour dust allergens (wheat, rye, and fungal alpha-amylase). Exposure models were developed using job, bakery size, tasks, and specific ingredients used. Bakery and worker were regarded as random effect components. Results: Bread bakers had the highest average (geometric mean) exposures (1.33 mg m-3 flour dust particulate, 13.66 μg m-3 wheat allergens, and 5.14 μg m-3 rye allergens). For alpha-amylase allergens, most samples were below the limit of detection for several occupational titles. In the mixed effect models, the significant predictors of elevated exposure to inhalable dust particulate as well as wheat and rye allergen concentrations were large bakery size, bread baking, and use of cereal flours, while tasks such as confectionery work were negatively correlated with these exposure metrics. Weighing tasks and use of premix products were associated with increased exposure to fungal alpha-amylase. A high correlation between particulate dust and wheat (r = 0.84) as well as rye (r = 0.86) was observed, with a much lower correlation between particulate dust and fungal alpha-amylase (r = 0.33). Overall, a low proportion (39%) of bakery stores implemented various control measures to reduce dust exposures in the bakeries. Conclusions: This study confirms that current exposure control strategies in supermarket bakery stores are inadequate in reducing dust exposures to protect the health of bakery workers

Occupational allergy and asthma among salt water fish processing workers

Background: Fish processing is a common economic activity in Southern Africa. The aim of this study was to determine the prevalence and host determinants of allergic symptoms, allergic sensitization, bronchial hyper-responsiveness and asthma among workers processing saltwater fish. Methods: A cross-sectional study was conducted on 594 currently employed workers in two processing plants involved in pilchard canning and fishmeal processing. A modified European Community Respiratory Health Survey (ECRHS) questionnaire was used. Skin prick tests (SPT) used extracts of common airborne allergens, fresh fish (pilchard, anchovy, maasbanker, mackerel, red eye) and fishmeal. Spirometry and methacholine challenge tests (MCTs; tidal breathing method) used ATS guidelines. Results: Work-related ocular-nasal symptoms (26%) were more common than asthma symptoms (16%). The prevalence of atopy was 36%, while 7% were sensitized to fish species and 26% had NSBH (PC20 = 8 mg/ml or = 12% increase in FEV1 post-bronchodilator). The prevalence of probable occupational asthma was 1.8% and fish allergic rhino-conjunctivitis 2.6%. Women were more likely to report work-related asthma symptoms (OR = 1.94) and have NSBH (OR = 3.09), while men were more likely to be sensitized to fish (OR = 2.06) and have airway obstruction (OR = 4.17). Atopy (OR = 3.16) and current smoking (OR = 2.37), but not habitual seafood consumption were associated with sensitization to fish. Conclusions: Based on comparison with previous published studies, the prevalence of occupational asthma to saltwater fish is lower than due to shellfish. The gendered distribution of work and exposures in fish processing operations together with atopy and cigarette smoking are important determinants of occupational allergy and asthma

Novel way to study the function of native proteins in solution

Introduction: Aerosolisation of components when processing king crab (Paralithodes camtschaticus) and edible crab (Cancer pagurus) may cause occupational health problems when inhaled by workers. Methods: A cross-sectional study was carried out in three king crab plants and one edible crab plant. Personal exposure measurements were performed throughout work shifts. Air was collected for measurement of tropomyosin, total protein, endotoxin, trypsin and N-acetyl-β-D-glucosaminidase (NAGase). T-tests and ANOVAs were used to compare the levels of exposure in the different plants and areas in the plants. Results: Total protein and tropomyosin levels were highest in the edible crab plant, endotoxin levels were highest in king crab plants. King crab exposure levels were highest during raw processing. Tropomyosin levels were highest during raw king crab processing with geometric mean (GM) 9.6 ng/m3 vs 2.5 ng/m3 during cooked processing. Conversely, edible crab tropomyosin levels were highest during cooked processing with GM 45.4 ng/m3 vs 8.7 ng/m3 during raw processing. Endotoxin levels were higher in king crab plants than in the edible crab plant with GM=6285.5 endotoxin units (EU)/m3 vs 72 EU/m3. In the edible crab plant, NAGase levels were highest during raw processing with GM=853 pmol4- methylumbelliferone (MU)/m3 vs 422 pmol4-MU/m3 during cooked processing. Trypsin activity was found in both king crab and edible crab plants and levels were higher in raw than cooked processing. Differences in exposure levels between plants and worker groups (raw and cooked processing) were identified Conclusions: Norwegian crab processing workers are exposed to airborne proteins, tropomyosin, endotoxins, trypsin and NAGase in their breathing zone. Levels vary between worker groups and factories

Determinants of asthma phenotypes in supermarket bakery workers

While baker&#039;s asthma has been well described, various asthma phenotypes in bakery workers have yet to be characterized. This study aims to describe the asthma phenotypes in supermarket bakery workers in relation to host risk factors and self-reported exposure to flour dust. A cross-sectional study of 517 supermarket bakery workers in 31 bakeries used a questionnaire, skin prick tests, specific IgE to wheat, rye and alpha-amylase and methacholine challenge testing. The prevalence of probable occupational asthma (OA, 13%) was higher than atopic (AA, 6%), non-atopic (NAA, 6%) and work-aggravated asthma (WAA, 3%) phenotypes. Previous episodes of high exposure to dusts, fumes and vapours causing asthma symptoms were more strongly associated with WAA (OR 5.8, CI: 1.7-19.2) than OA (OR 2.8, CI: 1.4-5.5). Work-related ocular-nasal symptoms were significantly associated with WAA (OR 4.3, CI: 1.3-13.8) and OA (OR 3.1, CI: 1.8-5.5). Bakers with OA had an increased odds of reporting adverse reactions to ingested grain products (OR 6.4, CI: 2.0-19.8). Occupational asthma is the most common phenotype among supermarket bakery workers. Analysis of risk factors contributes to defining clinical phenotypes, which will guide ongoing medical surveillance and clinical management of bakery workers

Land Use Regression Modelling of Outdoor NO₂ and PM2.5 Concentrations in Three Low Income Areas in the Western Cape Province, South Africa

Air pollution can cause many adverse health outcomes, including cardiovascular and respiratory disorders. Land use regression (LUR) models are frequently used to describe small-scale spatial variation in air pollution levels based on measurements and geographical predictors. They are particularly suitable in resource limited settings and can help to inform communities, industries, and policy makers. Weekly measurements of NO₂ and PM2.5 were performed in three informal areas of the Western Cape in the warm and cold seasons 2015⁻2016. Seasonal means were calculated using routinely monitored pollution data. Six LUR models were developed (four seasonal and two annual) using a supervised stepwise land-use-regression method. The models were validated using leave-one-out-cross-validation and tested for spatial autocorrelation. Annual measured mean NO₂ and PM2.5 were 22.1 &mu;g/m³ and 10.2 &mu;g/m³, respectively. The NO₂ models for the warm season, cold season, and overall year explained 62%, 77%, and 76% of the variance (R²). The PM2.5 annual models had lower explanatory power (R² = 0.36, 0.29, and 0.29). The best predictors for NO₂ were traffic related variables (major roads, bus routes). Local sources such as grills and waste burning sites appeared to be good predictors for PM2.5, together with population density. This study demonstrates that land-use-regression modelling for NO₂ can be successfully applied to informal peri-urban settlements in South Africa using similar predictor variables to those performed in Europe and North America. Explanatory power for PM2.5 models is lower due to lower spatial variability and the possible impact of local transient sources. The study was able to provide NO₂ and PM2.5 seasonal exposure estimates and maps for further health studies