Egg white proteins as inhalant allergens associated with baker's asthma

Background: Bakery workers may develop IgE‐mediated allergy to liquid and aerosolized hen's egg proteins that are commonly used in the baking and confectionery industries. Methods: We studied four bakery workers who had work‐related allergic respiratory symptoms upon exposure to egg aerosols. The causative role of egg proteins in their respiratory symptoms was investigated by immunologic and specific inhalation challenge (SIC) tests. Results: Skin prick tests to egg white extract and to lysozyme gave positives responses in all the subjects, to ovalbumin in two, to ovomucoid in one and to egg yolk in two subjects. They were also sensitized to wheat, rye and barley flours. Specific IgE determinations to egg white were positive in all patients, to lysozyme in two, to ovalbumin in three, to ovomucoid in two and to egg yolk in two of them. Methacholine inhalation tests revealed bronchial hyperresponsiveness in all workers (PC 20 < 16 mg/ml). SICs were performed with aqueous extracts of lysozyme ( n = 4), ovalbumin ( n = 2) and ovomucoid ( n = 1), which elicited isolated early asthmatic reactions in all subjects. Double‐blind, placebo‐controlled, oral challenge tests with raw egg white were positive in three subjects. Conclusions: These bakery workers had developed IgE‐mediated occupational asthma to hen's egg white proteins.