Specific inhalation challenge with wheat flour in workers with suspected baker's asthma

Objective: The aim of this study was to evaluate the outcome of the specifi c inhalation challenge test (SIC) in 160 subjects with suspected baker's as thma and to assess its relation to total flour dust levels and to personal characteristics such as specific skin sensitisation, non-specific bronchial hyper-responsiveness (NSBH) and atopy. Methods: We investigated the outcom e of SIC tests performed with wheat flour in six Italian laboratories. For each subject, data was available regarding skin sensitisation to wheat flou r, NSBH, atopy, forced expiratory volume at 1 s (FEV1) monitoring and airbo rne flour dust in the challenge chamber measured by the gravimetric method (total dust in mg/m(3)). Results: The SIC test was positive for early asthm a in 42 subjects (26%) and for late/dual asthma in 18 (11%). Positive outco me to SIC was significantly associated with NBSH (odds ratio, OR: 3.5, 95% CI: 1.6-7.7) and skill sensitisation to wheat flour (OR: 3.1, 95% CI: 1.3-7 .0). Exposure level to wheat flour was less than or equal to 10 mg/m(3) in 12% of individuals, ranged between 11 and 30 mg/m(3) in 43% and exceeded 30 mg/m(3) in 45%. The outcome of SIC was always negative among workers not s kin sensitised to wheat flour and without NSBH and atopy. An increasing pre valence of positive SIC was observed among workers with one or more of the above-mentioned personal characteristics whose challenge exposure was great er than 10 mg/m(3) (P < 0.001). Conclusion: Procedures currently adopted fo r wheat flour dust exposure during SIC need to be better standardised in or der to avoid excessive airborne dust exposure. Over-exposure seems to be of no use for the diagnosis and risks making the asthmatic reaction worse, pa rticularly in patients who are both sensitised to wheat allergens and have NSBH and/or atopy.