Baker's asthma with a predominant clinical response to rye flour

BACKGROUND: Relatively little attention has been paid to rye flour as opposed to wheat flour in clinical and epidemiological research into Baker's asthma. METHODS: This report describes the investigation of a baker with asthma who reported a workplace response to rye flour and none to wheat flour, despite co-reactivity to both wheat and rye antigen. RESULTS: Skin prick tests, RASTs and basophil stimulation tests were positive for both wheat and rye antigen, but quantitatively greater for rye than wheat. Bronchial challenge elicited a much greater response to the rye-wheat flour mix used in the bakery than to 100% wheat flour. CONCLUSIONS: The greater clinical response to rye than to wheat may be immunologically mediated, but could also be due to physical characteristics of rye flour such as greater dose of inhaled airborne particles or an irritative effect. This information may be useful for medical management and occupational hygiene control, and should stimulate further research into rye flour in Baker's asthma.