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.
Exposure Assessment
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.
Statistical Analysis
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.
● The U.S. Department of Labor OSHA PELs (29 CFR 1910 [general industry]; 29 CFR
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.
● NIOSH RELs are recommendations based on a critical review of the scientific and
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.
● Other OELs commonly used and cited in the United States include (a) the TLVs, which
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.
Flour Dust
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
26(3):289–354.
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
155(6):1841–1847.
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).
Acknowledgments
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
Availability of Report
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.
Recommended citation for this report:
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.
Delivering on the Nation’s promise:
Safety and health at work for all people through research and prevention
To receive NIOSH documents or more information about
occupational safety and health topics, please contact NIOSH:
Telephone: 1–800–CDC–INFO (1–800–232–4636)
TTY: 1–888–232–6348
CDC INFO: www.cdc.gov/info
or visit the NIOSH Web site at www.cdc.gov/niosh
For a monthly update on news at NIOSH, subscribe to NIOSH
eNews by visiting www.cdc.gov/niosh/eNews.
Document Outline - Contents
- Highlights of this Evaluation
- Abbreviations
- Introduction
- Background
- Methods
- Results
- Discussion
- Conclusions
- Recommendations
- Appendix A: Tables
- Appendix B: Methods
- Appendix C: Occupational Exposure Limits and Health Effects
- References
- Acknowledgments
- Availability of Report
Dostları ilə paylaş: |