Occupational Allergy in Strawberry Greenhouse Workers

Employees in strawberry greenhouses are highly exposed to several (potential) allergenic agents. However, no occupational allergy in this branch has been described before. During this study, the authors explored the presence of work-related allergic symptoms in strawberry workers. They then aim to prove the concept that an IgE-mediated allergy could be responsible for work-related symptoms. To test the possibility of an IgE response secondary to cross-reactivity to birch or grass pollen, inhibition experiments were performed. A questionnaire survey concerning work-related allergic symptoms among strawberry workers in the Netherlands was carried out. Three workers with work-related symptoms were further investigated in detail. Skin tests, serum-specific IgE tests with home-made extracts of strawberry pollen and other possible allergenic agents of the strawberry greenhouse environment were executed. Furthermore, immunoblots and nasal provocations with strawberry pollen extract were performed. In addition, inhibition experiments were performed. The results showed 29 of 75 questionnaire respondents (38.7%) reported work-related symptoms. Sensitisation to strawberry pollen was found in skin tests in all 3 employees with work-related symptoms. ELISA and immunoblotting with strawberry pollen showed positive results in 2 employees. Birch and grass pollen failed to inhibit IgE binding to strawberry pollen in 1 of 2 employees. Partial inhibition was seen in the second employee. Nasal provocation validated clinical relevant allergy to these pollens in 2 of 3 subjects. The authors concluded that allergic symptoms attributable to the workplace are present among a proportion of strawberry greenhouse employees. An IgE-mediated occupational allergy to strawberry pollen may contribute to these symptoms.