Allergy Asthma Immunol Res.  2013 Nov;5(6):348-356. 10.4168/aair.2013.5.6.348.

Diagnosis and Management of Grain-Induced Asthma

• Quirce S
• Diaz-Perales A

• KMID: 2260277
• DOI: http://doi.org/10.4168/aair.2013.5.6.348

Abstract

Grain-induced asthma is a frequent occupational allergic disease mainly caused by inhalation of cereal flour or powder. The main professions affected are bakers, confectioners, pastry factory workers, millers, farmers, and cereal handlers. This disorder is usually due to an IgE-mediated allergic response to inhalation of cereal flour proteins. The major causative allergens of grain-related asthma are proteins derived from wheat, rye and barley flour, although baking additives, such as fungal alpha-amylase are also important. This review deals with the current diagnosis and treatment of grain-induced asthma, emphasizing the role of cereal allergens as molecular tools to enhance diagnosis and management of this disorder. Asthma-like symptoms caused by endotoxin exposure among grain workers are beyond the scope of this review. Progress is being made in the characterization of grain and bakery allergens, particularly cereal-derived allergens, as well as in the standardization of allergy tests. Salt-soluble proteins (albumins plus globulins), particularly members of the alpha-amylase/trypsin inhibitor family, thioredoxins, peroxidase, lipid transfer protein and other soluble enzymes show the strongest IgE reactivities in wheat flour. In addition, prolamins (not extractable by salt solutions) have also been claimed as potential allergens. However, the large variability of IgE-binding patterns of cereal proteins among patients with grain-induced asthma, together with the great differences in the concentrations of potential allergens observed in commercial cereal extracts used for diagnosis, highlight the necessity to standardize and improve the diagnostic tools. Removal from exposure to the offending agents is the cornerstone of the management of grain-induced asthma. The availability of purified allergens should be very helpful for a more refined diagnosis, and new immunomodulatory treatments, including allergen immunotherapy and biological drugs, should aid in the management of patients with this disorder.

Keyword

Baker's asthma; cereals; wheat allergens; soya flour; fungal enzymes; allergen immunotherapy

MeSH Terms

Allergens
alpha-Amylases
Asthma
Candy
Carrier Proteins
Cereals
Desensitization, Immunologic
Flour
Hordeum
Humans
Hypersensitivity
Immunoglobulin E
Inhalation
Peroxidase
Prolamins
Proteins
Secale cereale
Thioredoxins
Triticum
Allergens
Carrier Proteins
Immunoglobulin E
Peroxidase
Prolamins
Proteins
Thioredoxins
alpha-Amylases

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