Evaluation of Grass Pollen Sensitization Among Professionals Exposed or Not Exposed to Flour

15% of adult asthma cases are related to occupational exposure. Bakers are among the professions at the highest risk of developing allergies, particularly respiratory allergies. Cereals, including flour, are identified as a major cause. Cereals belong to the Poaceae family (wheat, rice, corn, barley, oats, rye, millet…). They are grasses, which gives them cross-allergenicity with grass pollens that are Group 4 allergens (83% homology between Phl p 4 and cereals). However, the professional factors and predispositions that might influence the occurrence and severity of asthma are not known. This study proposes, through an analysis of various data collected from bakers who consulted over a period of more than 10 years for asthma-related issues, as well as a comparison to other populations of workers who also consulted for asthma issues, to explore potential factors that seem relevant to investigate in more detail in the future.

GRAMIPRO is a retrospective cohort study that analyzes data from one Parisian center specialized in occupational dermatology and allergology - Centre Hospitalier Intercommunal de Créteil. This center is recognized at the national level as the Occupational and Environmental Disease Consultation Center (Centre de Consultation de Pathologies Professionnelles et de l'Environnement).

The primary goal is to analyze the impact of the prevalence of pollen grass sensitization in professionals with asthma, whether or not associated with allergic rhinitis, and exposed to flour or other allergens besides flour.

Secondary objectives focuses on the onset time and severity of respiratory symptoms (rhinitis and asthma) between patients sensitized and not sensitized to grass pollen by comparing FEV1 (in absolute and theoretical values), the FEV1/VC ratio, and the expected number of years from the onset of the first symptoms to the date of the first consultation The Inclusion criteria require to be aged 18 or older at the date of the first consultation. Further criteria are to have consulted for asthma-allergology related motifs between Patient identification involves querying the National Network for Surveillance and Prevention of Occupational Diseases (RNV3P, Réseau National de Vigilance et de Prévention des Pathologies professionnelles). Eligible patients will be informed by mail or post, and if no opposition expressed, their data will be collected and stored anonymously for analysis. Patient data will be collected from medical records, anonymized, and stored securely. Data collection is programmed between January 1 and 31, 2025. The study comprises patients from one center. In total, 405 patients were included, consisting of 135 cases and 2 matched controls for each case based on age, gender, date of first consultation, and type of tests conducted.

The collected data will include:

Initials of last name and first name, month and year of birth, sex, age on the day of consultation Referral type between occupational physician, general practitioner and specialist.

Start date of the profession Date of first consultation Presence of confirmed nasosinusis polyposis Date of symptom onset Smoking habits and status Maintenance and rescue treatments for asthma Hospitalization caused by an asthma attack Symptoms of rhinitis, asthma and conjunctivitis, Atopic history: asthma, atopic dermatitis, rhinitis, food and medication allergy, COPD Other known allergies: dust mites, mold, animal dander, tree and grass pollen… PFT: FEV1, Tiffeneau index, reversibility, Methacholine, PTN Prick Tests, Pulmonary Function Testing, biological analyzes Social security scheme: employee/self-employed Activity sector (NAF Code) Job position (CITP-8 Code) Work environment including : artisanal/industrial flour, hood, cleaning frequency, ventilation, individual protection Socio-professionnal outcome such as Recognition as an occupational disease and professional retraining Occupationnal specific IgE and this relative to grass pollen

Statistical analyses will use EasyMedStat to respond to the primary and secondary objectives.

The study has been officially approved by the Local Ethics Committee (CEL) of Créteil on the July 10th, 2024.

In conclusion, this research aims to explore predisposing factors in flour-induced allergic asthma to enable the implementation of individual and collective respiratory preventive measures in the workplace. Based on the results obtained, the study will allow the adaptation of preventive messages to be transmitted early to young atopic individuals sensitized to grass pollens who have a professional project exposing them to flour.