A diagnostic model for the detection of sensitization to wheat allergens was developed and validated in bakery workers

Abstract

OBJECTIVES: To develop and validate a prediction model to detect sensitization to wheat allergens in bakery workers. STUDY DESIGN AND SETTING: The prediction model was developed in 867 Dutch bakery workers (development set, prevalence of sensitization 13%) and included questionnaire items (candidate predictors). First, principal component analysis was used to reduce the number of candidate predictors. Then, multivariable logistic regression analysis was used to develop the model. Internal validation and extent of optimism was assessed with bootstrapping. External validation was studied in 390 independent Dutch bakery workers (validation set, prevalence of sensitization 20%). RESULTS: The prediction model contained the predictors nasoconjunctival symptoms, asthma symptoms, shortness of breath and wheeze, work-related upper and lower respiratory symptoms, and traditional bakery. The model showed good discrimination with an area under the receiver operating characteristic (ROC) curve area of 0.76 (and 0.75 after internal validation). Application of the model in the validation set gave a reasonable discrimination (ROC area=0.69) and good calibration after a small adjustment of the model intercept. CONCLUSION: A simple model with questionnaire items only can be used to stratify bakers according to their risk of sensitization to wheat allergens. Its use may increase the cost-effectiveness of (subsequent) medical surveillance.