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The aim of the study was to evaluate the risk factors for hypersensitivity to occupational allergens in apprentice bakers. The study group comprised 287 persons. A questionnaire survey, as well as skin prick tests (SPT) with common and occupational allergens were performed in all subjects prior to occupational exposure and one and two years after starting vocational training. In addition, the total IgE level was evaluated in all of them at the beginning of the study. In selected cases, specific anti-flour and alpha-amylase IgE were estimated. Almost 2% of the study subjects showed positive SPT with occupational allergens before vocational training. After two years of occupational exposure, the occurrence of at least one positive SPT increased from 19.2 to 30.7%, including common (from 18.8 to 30%) and occupational (from 1.7 to 12.9%) allergens. In 18.1% of subjects, hypersensitivity to occupational allergens assessed by positive SPT, and/or the presence of antigen specific IgE developed during the study period. Logistic regression analysis revealed that positive SPT with common allergens is a significant risk factor for the development of hypersensitivity to occupational allergens (OR = 9.06, 95% CI: 2.53-32.46). The results of the study suggest that skin prick tests with common and occupational allergens should be performed in bakers prior to occupational exposure. The outcome of the tests should enable better identification of subjects at the highest risk of occupational allergy and their referral to more frequent screening. A relatively high prevalence of positive SPT with occupational allergens (2%) at the beginning of vocational training should be taken into account to avoid possible future diagnostic mistakes.

Baker's respiratory allergy is reported as one of the most common forms of occupational allergy in many countries. At the first stage of a three-year study of risk factors of occupational allergy we investigated the symptoms reported, and the results of skin prick tests (SPT) to common and flour allergens in 461 current apprentice bakers from three different regions of Poland before starting occupational exposure. The occurrence of cough was reported by 14 subjects (3%), dyspnoea by 4 (0.87%), rhinitis by 18 (3.9%), conjunctivitis by 12 (2.6%) and skin symptoms by 12 subjects (2.6%). Generally, 48 subjects (10.41%) reported at least one symptom, which might suggest the existence of allergic disease. Positive SPT to at least one allergen was found in 99 subjects (21.5%), including 82 subjects (17.78%) with positive SPT to common allergens, 13 subjects (2.81%) to flour allergens and 4 subjects (0.88%) sensitised only to Dermatophagoides farinae. The statistical analysis revealed significant correlation between positive SPT to common allergens and reported rhinitis and conjunctivitis, and between positive SPT to occupational allergens and reported dyspnoea. Moreover, a significant correlation between positive SPT to D. pteronyssinus and D. farinae was found. In our opinion, the results of SPT should be very carefully examined, when diagnosing occupational allergy, as in some apprentice bakers positive results of SPT to flour allergens are found before vocational training. In all apprentice bakers, SPT to common and occupational allergens should be performed before starting occupational exposure. It would ensure the exclusion of subjects already sensitised to occupational allergens. Positive SPT to Dermatophagoides farinae has a very limited value in recognising baker's allergy.