Methods: skin prick test (SPT) to flours, chest computed tomography (CCT), spirometry, fraction of exhaled nitric oxide (FeNO), bronchial challenge with methacoline (BCM), expiratory peak-flow (EPF) and eosinophil count in sputum (ECE) basal and after challenge test (CT) were performed.
Results: we present a 30 year old, female, smoker, working in the laboratory of a flour factory for 3 years. She has had itchy eyes, rhinorrhea and cough, with minimal expectoration, without wheezing for two months. Improved when she was treated with steroids, symptoms reappeared when discontinued. Asymptomatic during holidays. Evaluation was done during her 1 week of sick leave. Lung auscultation, CCT, spirometry, FeNO, BCM and ECE were normal. She had only one positive SPT with semolina. A CT was performed by passing the semolina, from her factory, from one tray to another; tracking the EPF and serial spirometries, presenting cough, without fall in FEV1 values and normal EPF. But after 4 to 5 days, she presented variability in the EPF with continuous cough. 7 days post CT, we repeated the ECE detecting 5% eosinophils. BCM was negative at all times. ECE was repeated while she was away from her job with only 1% eosinophils seen.
Conclusions: we report an unusual of EB caused by wheat flour exposure in the workplace.