Page 1 Health Hazard Evaluation Report 2009-0131-3171 Evaluation of Sensitization and Exposure to Flour Dust, Spices, and Other Ingredients Among Poultry Breading Workers Report No. 2009-0131-3171 April 2013 Elena H
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- Page 26
- Exposure Assessment
- Statistical Analysis
- Page 28
- Page 31
- Acknowledgments
- Availability of Report
- Recommended citation for this report
- Delivering on the Nation’s promise: Safety and health at work for all people through research and prevention
Page 26 Health Hazard Evaluation Report 2009-0131-3171 Questionnaire We administered a questionnaire to all study participants that included questions about their workplace, job duties, medical history, and current respiratory and eye symptoms. Questions concerning work-related rhinoconjunctivitis (allergic eye and nose symptoms) are derived from International Study of Asthma and Allergies in Childhood [Asher et al. 1995]. The respiratory questions, including validated questions on asthma symptoms from the European Community Respiratory Health Survey [Grassi et al. 2003], included the following: 1. Have you been woken up with a feeling of tightness in your chest at any time in the last 12 months? 2. Have you had an attack of asthma in the last 12 months? 3. Are you currently taking any medicine (including inhalers or pumps, aerosols, or tablets) for breathing problems or asthma? 4. Have you had wheezing or whistling in your chest at any time in the last 12 months? A positive response on any of these questions has a sensitivity of 75% and a specificity of 80% for asthma symptoms on the basis of a clinical examination with IgE testing against common allergens, spirometry, and methacholine challenge testing. We modified these questions by adding “or since beginning your current position if in that position less than 12 months,” because some participants had not been in their current position for 12 months. If a participant responded positively to any of these questions, they were classified as having asthma symptoms. In addition, we added questions about changes in symptoms or medication use on days off work or on vacation. If the participant responded that symptoms improved on days off work or on vacation, or that medication use or asthma attacks were less frequent on days off or on vacation, then their symptoms were classified as work related.
Personal breathing zone air sampling was used to characterize employees’ exposure to flour dust, wheat, and soy. Full-shift personal breathing zone air samples for inhalable flour dust were collected across job titles on all six lines using IOM samplers with Teflon® filters (pore size 1.0 micron with laminated polytetrafluoroethylene support). IOM samplers were connected to personal sampling pumps calibrated to a flow rate of 2 liters per minute. Filter samples were changed throughout the shift to prevent overloading. The inhalable flour dust samples were stored at ambient temperatures in sealed containers to prevent additional exposure to moisture during storage and shipment. The samples were first analyzed by the NIOSH contract lab for inhalable flour dust (weight gain). The inhalable flour dust samples had a limit of detection of 100 micrograms and a limit of quantitation of 360 micrograms. Following the weight gain analysis, the inhalable flour dust samples were then shipped to the Institute for Risk Assessment Sciences, University of Utrecht, Utrecht, Netherlands, where they were analyzed using the methods outlined below for inhalable wheat and soy allergens.
Page 27 Health Hazard Evaluation Report 2009-0131-3171 Wheat and soy allergens were recovered from the filters by extraction with phosphate- buffered saline. Concentrations of wheat were measured in the extract by inhibition immunoassay, using a pool of human immunoglobulin G4 and rabbit immunoglobulin G polyclonal antibodies [Bogdanovic et al. 2006]. The soy allergens were measured using a sandwich enzyme immunoassay with rabbit immunoglobulin G antibodies [Gomez-Olles et al. 2007]. The wheat samples had a limit of detection of 15% inhibition, and the soy was 0.1 optical density above the blank on the plate.
SAS Version 9.1.3 software (SAS Institute, Cary, North Carolina) was used for the statistical analyses. Results with P values ≤ 0.05 were considered statistically significant. Medians were reported for personal breathing zone air samples because some distributions were skewed, and others were not. Prevalence ratios were used to compare prevalences between exposure groups. A prevalence ratio greater than 1 indicates a positive relationship between a having a symptom/sensitization and being in the higher-exposure group. Along with the prevalence ratio, a 95% confidence interval for the prevalence ratio was calculated. The prevalence ratio is considered statistically significant if the 95% confidence interval does not include the number 1. Chi square or Fisher’s exact tests were used to compare the prevalence of sensitization to allergens between participants with and those without atopy and to compare symptom prevalences for those with and without sensitization to specific allergens. Spearman’s correlation coefficient was used to determine the correlation between inhalable dust concentrations and soy and wheat concentrations. Personal breathing zone air samples were corrected by subtracting the median value of the field blanks. When the field blank correction resulted in a negative value a value of zero was used in the statistical analysis, and the results were reported as not detected. Because of the lack of a reported limit of detection, inhalable wheat and soy samples were analyzed statistically using a zero when the results were reported as not detected.
Page 28 Health Hazard Evaluation Report 2009-0131-3171 Appendix C: Occupational Exposure Limits and Health Effects NIOSH investigators refer to mandatory (legally enforceable) and recommended occupational exposure limits (OELs) for chemical, physical, and biological agents when evaluating workplace hazards. OELs have been developed by federal agencies and safety and health organizations to prevent adverse health effects from workplace exposures. Generally, OELs suggest levels of exposure that most employees may be exposed to for up to 10 hours per day, 40 hours per week, for a working lifetime, without experiencing adverse health effects. However, not all employees will be protected if their exposures are maintained below these levels. Some may have adverse health effects because of individual susceptibility, a preexisting medical condition, or a hypersensitivity (allergy). In addition, some hazardous substances act in combination with other exposures, with the general environment, or with medications or personal habits of the employee to produce adverse health effects. Most OELs address airborne exposures. But, some substances can be absorbed directly through the skin and mucous membranes. Most OELs are expressed as a time-weighted average (TWA) exposure. A TWA refers to the average exposure during a normal 8- to 10-hour workday. Some chemical substances and physical agents have recommended short-term exposure limits (STEL) or ceiling values. Unless otherwise noted, the STEL is a 15-minute TWA exposure. It should not be exceeded at any time during a workday. The ceiling limit should not be exceeded at any time. In the United States, OELs have been established by federal agencies, professional organizations, state and local governments, and other entities. Some OELs are legally enforceable limits; others are recommendations.
1926 [construction industry]; and 29 CFR 1917 [maritime industry]) are legal limits. These limits are enforceable in workplaces covered under the Occupational Safety and Health Act of 1970.
technical information and the adequacy of methods to identify and control the hazard. NIOSH RELs are published in the NIOSH Pocket Guide to Chemical Hazards [NIOSH 2010]. NIOSH also recommends risk management practices (e.g., engineering controls, safe work practices, employee education/training, personal protective equipment, and exposure and medical monitoring) to minimize the risk of exposure and adverse health effects.
are recommended by ACGIH, a professional organization, and (b) the Workplace environmental exposure levels (WEELs), which are recommended by the American Industrial Hygiene Association, another professional organization. The TLVs and WEELs are developed by committee members of these associations from a review of Page 29 Health Hazard Evaluation Report 2009-0131-3171 the published, peer-reviewed literature. These OELs are not consensus standards. TLVs are considered voluntary exposure guidelines for use by industrial hygienists and others trained in this discipline “to assist in the control of health hazards” [ACGIH 2012]. WEELs have been established for some chemicals “when no other legal or authoritative limits exist” [AIHA 2011]. Outside the United States, OELs have been established by various agencies and organizations and include legal and recommended limits. The Institut für Arbeitsschutz der Deutschen Gesetzlichen Unfallversicherung (IFA, Institute for Occupational Safety and Health of the German Social Accident Insurance) maintains a database of international OELs from European Union member states, Canada (Québec), Japan, Switzerland, and the United States. The database, available at http://www.dguv.de/ifa/en/gestis/limit_values/index.jsp , contains international limits for more than 1,500 hazardous substances and is updated periodically. OSHA requires an employer to furnish employees a place of employment free from recognized hazards that cause or are likely to cause death or serious physical harm [Occupational Safety and Health Act of 1970 (Public Law 91–596, sec. 5(a)(1))]. This is true in the absence of a specific OEL. It also is important to keep in mind that OELs may not reflect current health-based information. When multiple OELs exist for a substance or agent, NIOSH investigators generally encourage employers to use the lowest OEL when making risk assessment and risk management decisions. NIOSH investigators also encourage use of the hierarchy of controls approach to eliminate or minimize workplace hazards. This includes, in order of preference, the use of (1) substitution or elimination of the hazardous agent, (2) engineering controls (e.g., local exhaust ventilation, process enclosure, dilution ventilation), (3) administrative controls (e.g., limiting time of exposure, employee training, work practice changes, medical surveillance), and (4) personal protective equipment (e.g., respiratory protection, gloves, eye protection, hearing protection). Control banding, a qualitative risk assessment and risk management tool, is a complementary approach to protecting employee health. Control banding focuses on how broad categories of risk should be managed. Information on control banding is available at http://www.cdc.gov/niosh/topics/ctrlbanding/ . This approach can be applied in situations where OELs have not been established or can be used to supplement existing OELs. Below we provide the OELs and surface contamination limits for the compounds we measured, as well as a discussion of the potential health effects from exposure to these compounds.
Neither NIOSH nor OSHA has a specific occupational exposure limit for flour dust. OSHA does have a PEL for particulates not otherwise regulated of 15 milligrams per cubic meter for total dust, and 5 milligrams per cubic meter for respirable dust. However, our opinion is that the OSHA PEL for particulates not otherwise regulated is inappropriate for flour because that PEL is intended for biologically “inert” dusts. For evaluating exposure, we recommend the ACGIH TLV, or another occupational exposure limit specific to flour dust, because
Page 30 Health Hazard Evaluation Report 2009-0131-3171 flour dust is an allergen and not an inert dust. The ACGIH TLV for inhalable flour dust is 0.5 milligrams per cubic meter, expressed as a TWA for up to an 8-hour workday. British Columbia, Ontario, Hong Kong, and Ireland have the same occupational exposure limit for flour dust. No occupational exposure limits specific for wheat or spices have been developed. Page 31 Health Hazard Evaluation Report 2009-0131-3171 References ACGIH [2012]. 2012 TLVs® and BEIs®: threshold limit values for chemical substances and physical agents and biological exposure indices. Cincinnati, OH: American Conference of Governmental Industrial Hygienists. AIHA [2011]. AIHA 2011 Emergency response planning guidelines (ERPG) & workplace environmental exposure levels (WEEL) handbook. Fairfax, VA: American Industrial Hygiene Association. Asher MI, Anderson HR, Beasley R, Crane J, Martinez F, Mitchell EA, Peace N, Sibbald B, Stewart AW, Strachan D, Weiland SK, Williams HC [1995]. International study of asthma and allergies in childhood (ISAAC): rationale and methods. Eur Resp J 8(3):483–491. Baatjies R, Meijster T, Lopata A, Sander I, Raulf-Heimsoth M, Heederik D, Jeebhay M [2010]. Exposure to flour dust in South African supermarket bakeries: modeling of baseline measurements of an intervention study. Ann Occup Hyg 54(3):309–318. Baur X, Degens P, Sander I [1998]. Baker’s asthma: still amongst the most frequent occupational respiratory disorders. J All Clin Immunol 102(6 Pt 1):984–997. Biagini RE, MacKenzie BA, Sammons DL, Smith JP, Striley CA, Robertson SK, Snawder JE [2004]. Evaluation of the prevalence of anti-wheat, anti-flour dust, and anti-α-amylase specific IgE antibodies in US blood donors. Ann Allergy Asthma Immun 92(6):649–653. Bogdanovic J, Wouters IM, Sander I, Zahradnik E, Harris-Roberts J, Rodrigo M, Gomez- Olles S, Heederick DJJ, Goekes G [2006]. Airborne exposure to wheat allergens: optimized elution for airborne dust samples. J Environ Monit 8(10):1043–1048. Bulat P, Myny K, Braeckman L, van Sprundel M, Kusters E, Doekes G, Pössel K, Droste J, Vanhoorne M [2004]. Exposure to inhalable dust, wheat flour and alpha-amylase allergens in industrial and traditional bakeries. Ann Occup Hyg 48(1):57–63. CDC [1998]. Guideline for infection control in health care personnel. Am J Infect Control
CFR. Code of Federal Regulations. Washington, DC: U.S. Government Printing Office, Office of the Federal Register. Cummings KJ, Gaughan DM, Kullman GJ, Beezhold DH, Green BJ, Blachere FM, Bledsoe T, Kreiss K, Cox-Ganser J [2010]. Adverse respiratory outcomes associated with occupational exposures at a soy processing plant. Eur Respir J 36(5):1007–1015. De Zotti R, Larese F, Bovenzi M, Negro C, Molinari S [1994]. Allergic airway disease in Italian bakers and pastry makers. Occup Environ Med 51(8):548–552. Page 32 Health Hazard Evaluation Report 2009-0131-3171 Elms J, Robinson E, Rahman S, Garrod A [2005]. Exposure to flour dust in UK bakeries: current use of control measures. Ann Occup Hyg 49(1):85–91. Gautrin D, Infante-Rivard C, Dao TV, Magnan-Larose M, Desjardins J, Malo JM [1997]. Specific IgE-dependent sensitization, atopy, and bronchial hyperresponsiveness in apprentices starting exposure to protein derived agents. Am J Respir Crit Care Med
Gomez-Olles S, Cruz MJ, Bogdanovic J, Wouters IM, Doekes G, Sander I, Morell F, Rodrigo MJ [2007]. Assessment of soy aeroallergen levels in different work environments. Clin Exp Allergy 37(12):1863–1872. Grassi M, Rezzani C, Biino G, Marinoni A [2003]. Asthma-like symptoms assessment through ECRHS screening questionnaire scoring. J Clin Epidem 56(3):238–247. Houba R, Heederick D, Doekes G, van Run P [1996]. Exposure sensitization relationship for α-amylase allergens in the baking industry. Am J Respir Crit Care Med 154(1):130–136. Houba R, Heederik D, Doekes G [1998a]. Wheat sensitization and work related symptoms in the baking industry are preventable: an epidemiologic study. Am J Respir Crit Care Med 158(5 Pt 1):1499–1503. Houba R, Doekes G, Heederick D [1998b]. Occupational respiratory allergy in bakery workers: a review of the literature. Am J Ind Med 34(6):529–546. NIOSH [2004]. NIOSH respirator selection logic. Cincinnati, OH: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, DHHS (NIOSH) Publication No. 2005-100. [ http:// www.cdc.gov/niosh/docs/2005-100/pdfs/2005-100.pdf ]. Date accessed: April 2013. NIOSH [2010]. NIOSH pocket guide to chemical hazards. Cincinnati, OH: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, DHHS (NIOSH) Publication No. 2010-168c. [ http://www.cdc.gov/niosh/npg/ ]. Date accessed: April 2013. OSHA [2009]. Assigned protection factors for the revised respiratory protection standard. Washington, D.C. U.S. Department of Labor, Occupational Safety and Health Administration, OSHA 3352-02. Page EH, Dowell CH, Mueller CA, Biagini RE, Heederick D [2010]. Exposure to flour dust and sensitization among bakery employees. Am J Ind Med 53(12):1225–32. Park HS, Nahm DH [1997]. Identification of IgE-binding components in occupational asthma caused by corn dust. Ann Allergy Asthma Immunol 79(1):75–79. Page 33 Health Hazard Evaluation Report 2009-0131-3171 Sander I, Flagge A, Merget R, Halder TM, Meyer HE, Baur X [2001]. Identification of wheat flour allergens by means of 2-dimensional immunoblotting. J Allergy Clin Immunol 107(5):907–913. Schöll I, Jensen-Jarolim E [2004]. Allergenic potency of spices: hot, medium hot, or very hot. Int Arch Allergy Immunol 135(3):247–261.
Page 34 Health Hazard Evaluation Report 2009-0131-3171 Keywords: NAICS 31165 (poultry processing), flour dust, flour, wheat, soy, asthma, sensitization, poultry processing, poultry breading, spices Page 35 Health Hazard Evaluation Report 2009-0131-3171 The Health Hazard Evaluation Program investigates possible health hazards in the workplace under the authority of Section 20(a)(6) of the Occupational Safety and Health Act of 1970, 29 U.S.C. 669(a)(6). The Health Hazard Evaluation Program also provides, upon request, technical assistance to federal, state, and local agencies to control occupational health hazards and to prevent occupational illness and disease. Regulations guiding the Program can be found in Title 42, Code of Federal Regulations, Part 85; Requests for Health Hazard Evaluations (42 CFR 85).
Analytical Support: Barbara MacKenzie, Bureau Veritas North America, and the Universiteit Utrecht Institute for Risk Assessment Sciences Desktop Publishers: Greg Hartle and Mary Winfree Editor: Ellen Galloway Health Communicator: Stefanie Brown Industrial Hygiene Field Assistance: Donald Booher, Gregory Burr, Kevin L. Dunn, and Todd Niemeier Logistics: Karl Feldmann Medical Field Assistance: Judith Eisenberg, Loren Tapp, Carlos Aristeguieta, Barbara MacKenzie, Deborah Sammons, Gowtham Rao, Shirley Robertson, and John Clark
Copies of this report have been sent to the employer, employees, and union at the plant. The state and local health department and the Occupational Safety and Health Administration Regional Office have also received a copy. This report is not copyrighted and may be freely reproduced. This report is available at http://www.cdc.gov/niosh/hhe/reports/pdfs/2009-0131-3171.pdf.
NIOSH [2013]. Health hazard evaluation report: evaluation of sensitization and exposure to flour dust, spices, and other ingredients among poultry breading workers. By Page EH, Dowell CH, Mueller CA, Biagini RE. Cincinnati, OH: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, NIOSH HETA No. 2009-0131-3171.
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