Brisman J, Torén K, Lillienberg L, Karlsson G, Ahlstedt S
Department of Occupational Medicine, Göteborg University, Sweden.
Int Arch Occup Environ Health. 1998 Nov;71(8):525-32. doi: 10.1007/s004200050318.
To analyze whether indices of nasal airway inflammation in bakers were related to nasal symptoms and exposure to airborne flour dust.
A cross-sectional study was performed in 12 currently flour-exposed bakers. They were examined by nasal lavage (NAL), visual inspection, a test of mucociliary clearance, and nasal peak expiratory flow (nasal PEF). NAL fluid was analyzed according to the inflammatory markers eosinophil cationic protein (ECP), indicating eosinophilic activity; myeloperoxidase (MPO), indicating active neutrophils; hyaluronic acid (HA) from active fibroblasts; tryptase, indicating activation of mast cells; and albumin, indicating plasma exudation. The bakers were also questioned about respiratory symptoms and working history. Their current and cumulative exposure to inhalable flour dust was estimated after exposure measurements and information about earlier work tasks. Office workers (n=16) without occupational exposure to dust or any other known nasal irritant or sensitizer served as controls.
Personal inhalable dust measurements among the bakers working as dough makers or bread formers ranged from 1.0 to 3.8 mg/m3. Of the 12 bakers, 10 reported at least 1 nasal symptom (crusts, blockage, or a runny nose), a proportion significantly greater than that of the controls (P=0.009). Bakers with nasal symptoms had higher concentrations of markers of inflammation in their NALs as compared with nonsymptomatic bakers. The difference was significant for MPO (P=0.02) and HA (P=0.04) in relation to a runny nose. Tryptase was detected in only one NAL of the bakers. There was a positive correlation between the cumulative dose of inhalable flour dust and concentrations of MPO and HA in NAL. Two bakers were sensitized to wheat; they had the highest NAL concentrations of inflammatory markers.
Our results indicate that flour dust exposure in bakers at levels below the current occupational exposure limit causes nasal mucosal inflammation, which, in turn, is related to nasal symptoms. We propose that the inflammation may be nonallergic, characterized by activation of neutrophils and fibroblasts.
分析面包师鼻腔气道炎症指标是否与鼻部症状及吸入面粉粉尘暴露有关。
对12名目前仍暴露于面粉环境的面包师进行了一项横断面研究。对他们进行了鼻腔灌洗（NAL）、视诊、黏液纤毛清除功能测试以及鼻呼气峰流量（鼻PEF）检查。根据炎症标志物分析NAL液，包括嗜酸性粒细胞阳离子蛋白（ECP），指示嗜酸性粒细胞活性；髓过氧化物酶（MPO），指示活性中性粒细胞；来自活性成纤维细胞的透明质酸（HA）；类胰蛋白酶，指示肥大细胞活化；以及白蛋白，指示血浆渗出。还询问了面包师的呼吸道症状和工作史。在进行暴露测量并获取有关早期工作任务的信息后，估算了他们当前和累积的可吸入面粉粉尘暴露量。16名无职业性粉尘暴露或任何其他已知鼻腔刺激物或致敏原接触史的办公室工作人员作为对照。
担任面团制作工或面包成型工的面包师个人可吸入粉尘测量值范围为1.0至3.8毫克/立方米。12名面包师中，10人报告至少有1种鼻部症状（结痂、堵塞或流涕），这一比例显著高于对照组（P = 0.009）。有鼻部症状的面包师其NAL中的炎症标志物浓度高于无症状面包师。流涕方面，MPO（P = 0.02）和HA（P = 0.04）的差异具有统计学意义。仅在一名面包师的一份NAL中检测到类胰蛋白酶。可吸入面粉粉尘的累积剂量与NAL中MPO和HA的浓度之间存在正相关。两名面包师对小麦过敏；他们的NAL中炎症标志物浓度最高。
我们的结果表明，面包师接触低于当前职业暴露限值水平的面粉粉尘会导致鼻黏膜炎症，而这又与鼻部症状有关。我们认为这种炎症可能是非过敏性的，其特征为中性粒细胞和成纤维细胞的活化。
