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(BQ) Part 2 book “Food allergy molecular and clinical practice” has contents: Occupational allergy and asthma associated with inhalant food allergens, the inflence of dietary protein modifiation during food processing on food allergy,… and other contents.
8 Occupational Allergy and Asthma Associated with Inhalant Food Allergens Mohamed F Jeebhay 1,* and Berit Bang CONTENTS 8.1 8.2 8.3 8.4 8.5 Introduction—Food Industry and High Risk Working Populations Food Processing Activities and Allergen Sources Epidemiology and Risk Factors Clinical Features and Diagnostic Approaches Biological and Biochemical Characteristics of known Occupational Allergens 8.5.1 Seafood Allergens 8.5.2 Flour Allergens Including Enzyme Additions 8.5.3 Spice Allergens Division of Occupational Medicine and Centre for Environmental and Occupational Health Research, School of Public Health and Family Medicine, University of Cape Town, South Africa Department of Occupational and Environmental Medicine, University Hospital of North Norway, Tromso, Norway * Corresponding author: Mohamed.Jeebhay@uct.ac.za 176 Occupational Allergy and Asthma Associated with Inhalant Food Allergens 8.6 Preventive Approaches 8.7 Conclusion References 8.1 Introduction—Food industry and high risk working populations The food industry is one of the largest employers of workers exposed to numerous allergens that are capable of inducing immunological reactions resulting in allergic disease (Jeebhay 2002a, Cartier 2010, Sikora 2008) Such allergic reactions can occur at every level of the industry, from growing/harvesting of crops or animals, storage of grains, processing and cooking, conversion, preparation, preservation and packaging of food substances (Gill 2002) It is estimated that at least one third of the world’s population is engaged in the agricultural sector, the figure increases to 40% in developing countries and 50% for the African population (FAO (year 2010) The International Labour Organisation estimates that the food industry comprises about 10% of the global working population The largest food-handling population is employed in the agricultural sector followed by the food manufacturing and processing industry that employs workers involved in a broad spectrum of occupations These include sectors involved in processing of fruit, vegetables, meat, fish, oils and fats; dairy products; grain mill products, starches and starch products (e.g., sweets, chocolates, confectionery); prepared animal feeds; and beverages Materials processed include both naturally occurring biological raw products (plant/vegetable, animal or microbial origin) as well as chemicals for food preservation, flavouring, packaging and labelling Both these biological and chemical materials are known to contain sensitising agents capable of causing occupational allergies among high risk working populations (Jeebhay 2002b) Workers considered to be at increased risk include farmers who grow and harvest crops; factory workers involved in food processing, storage and packing; as well as those involved in food preparation (chefs and waiters) and transport 177 Food Allergy: Molecular and Clinical Practice 8.2 Food processing activities and allergen sources In the occupational setting, hazardous constituents of food products enter the body either through inhalation or dermal contact resulting in adverse reactions on an irritant or allergic basis Allergic diseases commonly encountered in the food industry include respiratory diseases such as occupational asthma, rhinitis, conjunctivitis and hypersensitivity pneumonitis, as well as skin disease such as contact dermatitis (Sikora 2008, Gill 2002) Tables 8.1 and 8.2 outline common food sources (cereals, plants/ vegetables/fruits/spices, seeds, herbal teas, mushrooms, farm products) as well additives (colorants, thickening agents, sulphites and enzymes) and food contaminants (mites and other insects, fungi, parasites) associated with food storage that are found in food processing industries Most of these are biological agents containing high molecular weight (> 10 kDa) proteins derived from plant or animal sources, that are both naturally occurring or synthetically derived, and which act as allergic respiratory sensitisers (James and Crespo 2007, Cartier 2010) Various work processes are employed in the food industry that produce wet aerosols and dust particulates that are capable of being inhaled and causing allergic reactions This is typically illustrated in the seafood industry in which processes such as cutting, scrubbing or cleaning, cooking or boiling, and drying are commonly used (Table 8.3) (Jeebhay 2001) Various immunological techniques have been developed to determine the allergen concentrations produced by these work processes in the various industrial sectors (Raulf 2014) For some dust particulate there is a strong linear correlation with airborne allergen concentrations as has been observed for flour dust measurements in the baking industries, whereas this has not been borne out for studies in the seafood processing industry due to the nature of the aerosolised particles (Baatjies 2010, Jeebhay 2005a) Other food processing activities such as storage, thermal denaturation, acidification and fermentation may destroy allergens, cause conformational changes or result in the formation of new 178 Occupational Allergy and Asthma Associated with Inhalant Food Allergens Table 8.1 Food allergens responsible for occupational asthma Agent Cereals Occupational exposure Wheat, rye, barley Baker, pastry maker (Cartier 2010) Gluten Baker (Cartier 2010) Corn Making stock feed (Cartier 2010) Rice Rice miller (Sikora 2008, Cartier 2010) Malt Machine operator (Miedinger 2009) Plants, vegetables, fruits, and spices Spinach Baker (handling spinach) (Sikora 2008, Cartier 2010) Asparagus Harvesting asparagus (Sikora 2008, Cartier 2010) Broccoli, cauliflower Plant breeder, restaurant worker (Sikora 2008) Artichokes Warehouse (packaging artichokes) (Cartier 2010) Bell peppers Greenhouse worker (Cartier 2010) Courgettes (zucchini) Warehouse (packaging courgette) (Cartier 2010) Carrots Cook (handling and cutting raw carrots) (Sikora 2008) Tomatoes (flower) Greenhouse grower (Cartier 2010) Raspberries Chewing gum coating (Cartier 2010) Peaches Farmer, factory worker handling peaches (Cartier 2010) Oranges (pollen and zest/flavido) Farmer (de las Marinas 2013), orange peeling (Felix 2013) Aniseed Meat industry (handling spices) (Cartier 2010) Saffron (pollen) Saffron worker (Cartier 2010) Hops Baker (Cartier 2010), brewery chemist (Sikora 2008) Soybeans Dairy food product company, baker, animal food preparation (Sikora 2008, Cartier 2010) Chicory Factory producing inulin from chicory roots, chicory grower (Cartier 2010) Coffee beans (raw and roasted) Roasting green coffee beans (Cartier 2010) Green beans Handling green beans (Cartier 2010) Cacao Confectionery (Cartier 2010) Anise Anise liqueur factory (Cartier 2010) Almonds Almond-processing plant (Cartier 2010) Olive oil Olive mill worker (Cartier 2010) Devil’s tongue root (maiko) Food processor (Cartier 2010) Garlic, onion, chilli pepper Sausage makers, garlic harvesters, spice factory, packing and handling garlic (Sikora 2008, Cartier 2010, van der Walt 2010) Table 8.1 contd 179 Food Allergy: Molecular and Clinical Practice Table 8.1 contd Agent Occupational exposure Plants, vegetables, fruits, and spices Plants, vegetables, fruits, and spices Aromatic herbs (rosemary, thyme, bay leaf, garlic) Butcher (Cartier 2010), greenhouse worker (Sikora 2008) Paprika, coriander, mace Seeds Anise liqueur factory (Cartier 2010) Red onion (Allium cepa) seeds Seed-packing factory worker (Cartier 2010) Sesame seeds Miller (grounding waste bread for animal food), baker (Cartier 2010) Fennel seeds Sausage-manufacturing plant (Cartier 2010) Lupine seeds Agricultural research worker (Cartier 2010) Buckwheat flour Health food products, noodle maker, cook (Sikora 2008, Cartier 2010) Herbal teas Tea Green tea factory, tea packer (Cartier 2010) Cinnamon Worker processing cinnamon (Cartier 2010) Chamomile Tea-packing plant worker (Cartier 2010) Sarsaparilla root Mushrooms Herbal tea worker (Cartier 2010) Boletus edulis (porcino or king bolete) Saccharomyces cerevisiae Pasta factory (Cartier 2010) Mushroom powder Pleurotus cornucopiae Food manufacturer (Cartier 2010) Mixing baker’s yeast (Cartier 2010) Mushroom grower (Cartier 2010) Seafood (shellfish and fish) Crustaceans Snow crabs, Alaskan king crabs, Crab-processing worker (Cartier 2010, Lopata and dungeness crabs, tanner crabs, rock Jeebhay 2013) crabs Prawns, shrimp/shrimpmeal, clams Prawn processor, food processor (lyophilized powder), fishmonger, seafood delivery (Cartier 2010, Lopata and Jeebhay 2013) Lobster Cook, fishmonger (Cartier 2010, Lopata and Jeebhay 2013) Table 8.1 contd 180 Occupational Allergy and Asthma Associated with Inhalant Food Allergens Table 8.1 contd Agent Occupational exposure Mollusks Cuttlefish Deep sea fisherman (Cartier 2010, Lopata and Jeebhay 2013) Mussels Mussels opener, cook (Cartier 2010, Lopata and Jeebhay 2013) King and queen scallops Processor (Cartier 2010, Lopata and Jeebhay 2013) Abalone Fisherman (Cartier 2010, Lopata and Jeebhay 2013) Octopi and squid Processor (Cartier 2010, Rosado 2009, Wiszniewska 2013, Lopata and Jeebhay 2013) Fish Salmon, pilchard, anchovy, plaice, Fish processor, fishmonger (Cartier 2010, Lopata hake, tuna, trout, turbot, cod, and Jeebhay 2013) swordfish, sole, pomfret, yellowfin, herring, fishmeal flour Farm products Pork (raw) Meat-processing plant (Cartier 2010), meat packer (Hilger 2010) Beef (raw) Cook (Cartier 2010) Lamb (raw) Cutting raw lamb meat (Cartier 2010) Hogs Pig farmer (Sikora 2008) Cows Dairy farmer (Sikora 2008) Poultry (turkey, chicken) Food-processing plant, poultry slaughterhouse (Cartier 2010) Eggs Confectionary worker, bakery, egg-processing plant (Cartier 2010) Pheasants, quails, doves Milk derivatives Breeder (Sikora 2008) a-lactalbumin Candy maker, baker (Cartier 2010) Lactoserum Cheese maker (Cartier 2010) Casein Delicatessen factory, milking sheep, candy maker (Cartier 2010) Rennet Cheese maker (Cartier 2010) Bovine serum albumin powder Laboratory worker (Choi 2009) Bees, honey, pollens Beekeeper, honey processor, cereal producer (Sikora 2008, Cartier 2010) (Adapted from Cartier 2010 and Sikora 2008 with permission) 181 Food Allergy: Molecular and Clinical Practice Table 8.2 Food additives and contaminants responsible for occupational asthma Agent Occupational exposure Food additives Colorants Carmine Butcher (production of sausages) (Sikora 2008) Chinese red rice (derived from Monascus ruber) Delicatessen manufacturing plant (Cartier 2010) Marigold flour (derived from Tagetes erecta) Porter in animal fodder factory (Lluch-Perez 2009) Bacterial enzymes Transglutaminase (Bacillus subtilis) Superintendent involved in ingredient commercialisation for food industry (De Palma 2014) Fungal enzymes A-amylase, cellulase, xylanase Baker (Cartier 2010) Glucoamylase Baker (Cartier 2010) Pectinase, glucanase Fruit salad processing (Cartier 2010) Papain, bromelain Meat tenderizer (Sikora 2008) Thickening agents Carob bean flour Jam factory (Sikora 2008), ice cream maker (Cartier 2010) Pectin Candy maker, preparation of jam (Cartier 2010) Konjac glucomannan Food-manufacturing plant (Cartier 2010) Vitamins (thiamine) Castor oil Factory and dock workers (Cartier 2010) Gluten Manufacturing-enriched breakfast cereals (Cartier 2010) Sodium metabisulfite Biscuit maker (Cartier 2010) Food contaminants Insects Poultry mites (Ornithonyssus sylviarum) Poultry worker (Sikora 2008) Grain storage mites (Glycyphagus destructor) Grain worker (Sikora 2008) Storage mite (Tyrophagus putrescentiae) Van driver for dry cured ham (Rodriguez 2012) Spider mites (Tetranychus urticae), Panonychus ulmi Table grape (Jeebhay 2007), apple (Kim 1999), citrus farmers (Burches 1996) Flour moth (Ephestia kuehniella) Cereal stocker, baker (Cartier 2010) Table 8.2 contd 182 Occupational Allergy and Asthma Associated with Inhalant Food Allergens Table 8.2 contd Agent Occupational exposure Champignon flies Champignon cultivator (Cartier 2010) Cockroaches (Blattella spp.) Baker (Cartier 2010) Granary weevils (Sitophilus granarius) Baker (Cartier 2010) Rice flour beetles (Tribolium confusum) Baker (Sikora 2008) Fungi Aspergillus niger Brewer (contaminated malt) (Cartier 2010) Chrysonilia (Neurospora) sitophila Service operator of coffee dispenser (Cartier 2010) Aspergillus, Alternaria spp Baker (Cartier 2010) Verticillium alboatrum Greenhouse tomato grower (Sikora 2008) Penicillium nalgiovensis Semi-industrial pork butcher (Talleu 2009) Parasites Anisakis simplex Fish-processing workers, frozen fish factory (Cartier 2010) Plants Hoya (sea squirts) Oysters handlers (Cartier 2010) Others Soft red coral Spiny lobster fisherman (Cartier 2010) (Adapted from Cartier 2010 and Sikora 2008 with permission) sensitising epitopes which may increase the allergenicity of the food protein (Lopata 2010a, van der Walt 2010) 8.3 Epidemiology and risk factors Various studies have demonstrated that between 10–25% of occupational allergic rhinitis or asthma reported to voluntary respiratory surveillance programmes are due to food and food products (Meredith and Nordman 1996) Esterhuizen et al also reported that the food processing industry in South Africa has been one of the top three industries reporting workers with occupational asthma under the SORDSA voluntary surveillance programme (Esterhuizen 2002) The proportion of occupational asthma cases reported in food handlers was 14.4% The majority of cases were due to flour and grain 183 Food Allergy: Molecular and Clinical Practice Table 8.3 Common processing techniques employed for seafood groups that are sources of potential high risk exposure to seafood products Seafood category Processing techniques Sources of potential high-risk exposure to seafood product/s Crabs, lobsters cooking (boiling or steaming) “tailing” lobsters, “cracking”, butchering and degilling crabs, manual picking of meat, cutting, grinding, mincing, scrubbing and washing, cooling, crab leg “blowing inhalation of wet aerosols from lobster “tailing”, crab “cracking”, butchering and degilling, boiling, scrubbing and washing, spraying, cutting, grinding, mincing, crab leg blowing Prawns, shrimps heading, peeling, deveining, prawn “blowing” (water jets or compressed air) prawn “blowing”, cleaning processing lines/tanks with pressurised water washing, oyster “shucking”, shellfish depuration, chopping, dicing, slicing inhalation of wet aerosols from oyster “shucking”, washing heading, degutting, skinning, mincing, filleting, trimming, cooking (boiling or steaming), spice/batter application, frying, milling, bagging inhalation of wet aerosols from fish heading, degutting, boiling Crustaceans Molluscs Oysters, mussels, cuttlefish, scallops, octopi Finfish Various species: Salmon, pilchard, anchovy, plaice, hake, tuna, trout, turbot, cod, swordfish, sole, pomfret, yellowfin, herring inhalation of dry aerosols from fishmeal bagging cleaning floors, trays and machineries using pressurized water (Updated and modified from Jeebhay 2001 with permission with references from Sikora 2008 and Shiryaeva 2014) (80%), with baking and milling contributing almost half the cases (Figure 8.1) The common agents responsible for these cases were flour, grain/maize, onion and garlic (Figure 8.2) Comprehensive data for the prevalence of occupational asthma in various food sectors are not available However, in those food-related industries in which prevalence of occupational asthma is available, rates not significantly differ from those found in non-food industries For example, occupational asthma occurs in 3% to 10% of workers exposed to green coffee beans, 4% to 13% of bakers, 4% to 36% of shellfish and to 8% of bony fish processors (Sikora 2008, Baatjies and Jeebhay 2013, Pacheco 184 Occupational Allergy and Asthma Associated with Inhalant Food Allergens 2013) This is also observed in the South African industrial setting (Jeebhay 2012), although what is evident is that the prevalence of work-related asthma is higher in the plant (4–25%) as opposed to the animal handling or processing industry (4–12%) (Table 8.4) Although the differences in prevalence observed may be due to the use of varying definitions of occupational asthma, the allergenic potential of the specific proteins as well as the type of work process causing excessive exposure, play a role Various epidemiological studies and case reports indicate that ocular-nasal symptoms and allergic rhinitis are commonly encountered in food exposed workers (Sikora 2008, Baatjies and Jeebhay 2013, Pacheco 2013) Frequently, this is the first indicator of underlying allergic disease and a large proportion of individuals with occupational asthma also report co-existing occupational rhinitis Rhino-conjunctivitis may therefore precede or coincide with the onset of occupational asthma The prevalence of occupational rhinitis associated with food proteins appears to be double the prevalence of occupational asthma in these settings Occupational allergic respiratory disease is commonly the result of an interaction between genetic, environmental and host Figure 8.1 Industries associated with occupational asthma in food handlers: 44 cases reported to SORDSA (Reproduced with permission from Esterhuizen 2002) 185 Food Allergy: Molecular and Clinical Practice small to cross-link surface bound IgE on mast cells and basophils, and therefore cannot invoke release of inflammatory mediators as extracts containing intact allergenic components This is a seminal requirement for a safe therapeutic for peanut allergy Further promoting their efficacy, T-cell epitope peptides can load directly on to HLA class II molecules on the surface of APC and hence be presented at higher frequency than peptides processed from the whole molecule by APC This also allows peptides to be presented by non-professional or immature APC, including human T cells, without activating pro-inflammatory and co-stimulatory signals (in contrast to whole allergen extracts) The net effect is to promote the induction of immunological tolerance (frequently called anergy), apoptosis and/or suppressive activity in responding T cells, a property believed to be pivotal in achieving successful outcome during SPIRE treatment Importantly, findings to date indicate that T-cell epitope peptides used in SPIRE therapy not themselves elicit antibody production with the consequent risk of immune complex formation In addition to their potential for increased efficacy and safety, peptides are an attractive alternative to whole extracts due to their ease of standardization, cost-effective production in large quantities at high purity and consistency, stability in lyophilized form and ease of modification to achieve desired chemical and biological properties It has been demonstrated directly that using peptides to target T cells specific for dominant epitopes of major allergens can alter responses to whole allergen extracts, known as linked epitope suppression In early in vitro and murine studies, O’Hehir and colleagues showed that the dominant T-cell epitope peptide of Der p 1, the major allergen of house dust mite (HDM), could induce tolerance not only to this peptide, but to the whole Der p allergen and HDM extract (Higgins et al 1992, Hoyne et al 1993) This phenomenon has been validated subsequently in different murine models of allergy, and also in human studies of SPIRE therapy for cat allergy (Briner et al 1993, Couroux et al 2015, Patel et al 2013, Worm et al 2013) Clinical administration of dominant Fel d (major 360 Peanut Allergy cat allergen) T-cell epitope peptides altered T-cell responses to those peptides, other non-related Fel d peptides, and whole cat allergen extract 12.7.2 Validation of Allergen SPIRE Therapeutics in Clinical Trials Placebo-controlled phase IIb trials using SPIRE therapy for cat allergy, and more recently, grass, ragweed and HDM allergy (Circassia Ltd; www.circassia.co.uk.) have confirmed safety and efficacy of SPIRE immunotherapy Each of the vaccines consists of a mixture of seven peptides