Hi there! Thank you for your question. Agricultural producers are exposed to a wide variety of allergens than can cause asthma or aggravate existing asthma. Grain-induced asthma is a frequent occupational allergic disease mainly caused by inhalation of cereal flour or powder.

The main professions affected are farmer and bakers. The major causative allergens of grain-related asthma are proteins derived from wheat, rye and barley flour. Asthma resulting from grain dust occurs when a person is sensitized to the grain dust or a dust component. This disorder is usually due to an IgE-mediated allergic response to inhalation of wheat proteins. Additional risk factors for the development of asthma include genetics, gender, allergies, and environmental factors.

Some other triggering environment agents in agriculture including bacteria and fungi (airborne bacteria and fungi residing in agricultural structures can get into the lungs of an agricultural producer and cause an immune response that can result in an asthma attack), insects (storage and dust mites as well as cockroaches can be found in most agricultural settings and they may trigger asthma attacks for some people), pesticides (have been known to trigger with agricultural asthma), animal products (animal excretions can cause a release of ammonia in the environment that can be a respiratory irritant), pollen, chemicals (polyvinyl chloride vapor can trigger an attack) and wood smoke (mixture of harmful gases when burning wood that can cause asthma attacks).

Just like other types of immunologic disease, early diagnosis and early avoidance of further exposure are the cornerstones of management for patients with grain-induced asthma. A diagnosis can be made by a skin prick test, specific inhalation challenge or specific IgE measurements.

Allergen-specific immunotherapy (SIT) and other biological treatments, such as anti-IgE monoclonal antibodies (omalizumab), also may play a role in management.So see your doctor to decide whether to step up (poor control) or step down (good control) your treatment depending on which step you are in and your medical record. Since currently you are having poor control, the doctor will carry out necessary test and increase the dose or add a new drug.

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