Occupational allergy to food-derived allergens

Abstract

Although most cases of food allergy are related to food ingestion, occupational exposure to foods by contact or inhalation may also lead to adverse reactions, inducing contact urticaria or dermatitis, asthma, rhinitis, hypersensitivity pneumonitis, and anaphylaxis. Almost 10–25% of cases of allergic occupational asthma and rhinitis are due to food products. Animal and vegetal high-molecular weight proteins derived from aerosolized foods during food processing or handling at the workplace, as well as additives used as preservatives and antioxidants, and food contaminants, are the main causal agents. Farmers who grow and harvest crops and workers employed in food processing, storage and packing, and those involved in food preparation and transport are considered at increased risk for developing food-induced occupational asthma and rhinitis. Bakers’ asthma is the most frequent type of occupational asthma all around the world. Seafood processing industry is also at higher risk for asthma and rhinitis. A proportion of cases of asthma and rhinitis in food industry is also related to latex gloves used during food processing. The diagnosis of food-related occupational asthma and rhinitis includes a careful clinical and occupational history, respiratory functional assessment and measurement of non-specific bronchial hyperresponsiveness, immunologic assessment and specific inhalation challenge. The management includes environmental interventions aimed to avoid or reduce exposure to the offending agent, pharmacologic therapy, and allergen immunotherapy when available. Only few cases of food-induced occupational anaphylaxis have been described. The management of these emergencies should follow the current guidelines on anaphylaxis. The worker should be educated in managing future possible episodes that may also occur out of the workplace, by instance after accidental ingestion of the culprit allergen, and to carry 2 pre-loaded adrenaline delivery systems and a MedicAlert bracelet.