A study was conducted examining lung and immune function in cocoa (n=40) and flour (n=53) workers compared to unexposed referents (n=65). Subjects were studied using a questionnaire for respiratory disease, measurements of ventilatory capacity, bronchoprovocation testing, skin prick tests, and measurements of total serum IgE. The protective effect of disodium-cromoglycate (DSCG) on across shift reductions in lung function were examined. Both the cocoa and flour exposed workers had significantly higher prevalences of all chronic respiratory symptoms, with the exception of occupational asthma, than referents. Exposed workers also demonstrated significant reductions across the work shift for all ventilatory capacity tests. Pretreatment with DSCG decreased the magnitude of across shift variations in maximum flow rates at 50% and the last 25% of the vital capacity in nine workers who had exhibited large across shift reductions in these parameters. Bronchoprovocation testing using cocoa extract resulted in consistent immediate decreases in 1 second forced expiratory volume (FEV1) measurements in two of the three cocoa workers tested. Marked decreases in FEV1 were also seen in all three flour workers challenged with wheat and/or rye flour. Cocoa workers had a higher prevalence of positive skin tests than flour workers; exposed workers had significantly higher prevalences of positive skin tests to cocoa and flour than referents. Seven cocoa workers and 10 flour workers had increased total serum IgE levels compared with none of the referents. The mean total dust level in the cocoa processing area was 9.1mg/m3 and the mean respirable fraction was 2.1mg/m3; respective values for the flour processing area were 12.3mg/m3 and 1.9mg/m3. These values were in excess of recommended standards. The authors conclude that exposure to cocoa and flour dust may be associated with acute and chronic respiratory symptoms.
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