Occupational Respiratory Allergy to Flour in the Modern Era

A comprehensive literature review was conducted in order to identify and summarize recent research on IgE-mediated occupational respiratory allergy to flour, focusing on the impact of modern developments in the baking industry characterized by industrialization of production processes and a growing use of baking "improvers".

Although respiratory allergy to flour is a potentially preventable condition through effective workplace control measures, available data indicate that exposure to flour dust has not decreased in the last decade and flour remains the most prevalent cause of occupational respiratory allergy. The development of the baking industry has led to the introduction of new allergen sources, although their contribution to the development of clinical respiratory allergy remains largely uncertain. In recent years, the diagnostic performance of serum-specific IgE antibody determination against wheat/rye flour and α-amylase compared with specific inhalation challenge with flour as the reference standard has been clarified, making these tests a first-line component of diagnostic algorithms. Available information on the prevalence and incidence of respiratory allergy to flour in recent decades indicates that this condition still imposes a substantial health and socioeconomic burden worldwide. Available data highlight the need to reinforce workplace health-related policies and regulations.