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Occupational rhinitis

INTRODUCTION

Occupational rhinitis (OR) may be defined as "an inflammatory condition of the nose, which is characterized by intermittent or persistent symptoms (ie, nasal congestion, sneezing, rhinorrhea, itching) and/or variable nasal airflow limitation and/or hypersecretion, due to causes and conditions attributable to a particular work environment and not to stimuli encountered outside the workplace" [1]. OR is different from work-exacerbated rhinitis (WER), which is preexisting or concurrent (allergic or nonallergic) rhinitis that is worsened by, but not caused by, workplace exposures. OR can develop in response to allergens, inhaled irritants, or corrosive gases.

OR may have a profound effect on the worker, resulting in performance deficits, reduced productivity, and psychosocial problems. OR often coexists with occupational asthma.

The epidemiology, pathophysiology, clinical manifestations, diagnosis, and management of OR will be discussed here. Occupational asthma is reviewed separately. (See "Occupational asthma: Definitions, epidemiology, causes, and risk factors" and "Occupational asthma: Clinical features and diagnosis" and "Occupational asthma: Pathogenesis".)

EPIDEMIOLOGY

Occupational allergic diseases are common and appear to be increasing, with an estimated worldwide prevalence of 5 to 15 percent [2,3]. The prevalence of occupational rhinitis (OR) specifically is not precisely known.

Prevalence estimates of OR vary with the methods used for diagnosis (questionnaire, objective evaluation), the occupation studied, and the geographic area in question (which may have distinctive industries).

                                   

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Literature review current through: Mar 2014. | This topic last updated: May 28, 2013.
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References
Top
  1. Moscato G, Vandenplas O, Van Wijk RG, et al. EAACI position paper on occupational rhinitis. Respir Res 2009; 10:16.
  2. Slavin RG. Occupational rhinitis. Immunol Allergy Clin North Am 1992; 12:769.
  3. Slavin RG. Update on occupational rhinitis and asthma. Allergy Asthma Proc 2010; 31:437.
  4. Ruoppi P, Koistinen T, Susitaival P, et al. Frequency of allergic rhinitis to laboratory animals in university employees as confirmed by chamber challenges. Allergy 2004; 59:295.
  5. Chloros D, Sichletidis L, Kyriazis G, et al. Respiratory effects in workers processing dried tobacco leaves. Allergol Immunopathol (Madr) 2004; 32:344.
  6. Le Moual N, Kauffmann F, Eisen EA, Kennedy SM. The healthy worker effect in asthma: work may cause asthma, but asthma may also influence work. Am J Respir Crit Care Med 2008; 177:4.
  7. Walusiak J, Hanke W, Górski P, Pałczyński C. Respiratory allergy in apprentice bakers: do occupational allergies follow the allergic march? Allergy 2004; 59:442.
  8. Rodier F, Gautrin D, Ghezzo H, Malo JL. Incidence of occupational rhinoconjunctivitis and risk factors in animal-health apprentices. J Allergy Clin Immunol 2003; 112:1105.
  9. Jang JH, Kim DW, Kim SW, et al. Allergic rhinitis in laboratory animal workers and its risk factors. Ann Allergy Asthma Immunol 2009; 102:373.
  10. Puchner TC, Fink JN. Occupational Rhinitis. Immunol Allergy Clin North Am 2000; 20:303.
  11. Gautrin D, Ghezzo H, Infante-Rivard C, Malo JL. Incidence and host determinants of work-related rhinoconjunctivitis in apprentice pastry-makers. Allergy 2002; 57:913.
  12. Hytönen M, Kanerva L, Malmberg H, et al. The risk of occupational rhinitis. Int Arch Occup Environ Health 1997; 69:487.
  13. Moscato G, Siracusa A. Rhinitis guidelines and implications for occupational rhinitis. Curr Opin Allergy Clin Immunol 2009; 9:110.
  14. Lutsky II, Neuman I. Laboratory animal dander allergy: I. An occupational disease. Ann Allergy 1975; 35:201.
  15. Aoyama K, Ueda A, Manda F, et al. Allergy to laboratory animals: an epidemiological study. Br J Ind Med 1992; 49:41.
  16. Hollander A, Doekes G, Heederik D. Cat and dog allergy and total IgE as risk factors of laboratory animal allergy. J Allergy Clin Immunol 1996; 98:545.
  17. Elliott L, Heederik D, Marshall S, et al. Incidence of allergy and allergy symptoms among workers exposed to laboratory animals. Occup Environ Med 2005; 62:766.
  18. Naclerio RM, Meier HL, Kagey-Sobotka A, et al. Mediator release after nasal airway challenge with allergen. Am Rev Respir Dis 1983; 128:597.
  19. Naclerio RM, Proud D, Togias AG, et al. Inflammatory mediators in late antigen-induced rhinitis. N Engl J Med 1985; 313:65.
  20. Bardana EJ Jr. Occupational asthma and related respiratory disorders. Dis Mon 1995; 41:143.
  21. de Fátima Maçãira E, Algranti E, Medina Coeli Mendonça E, Antônio Bussacos M. Rhinitis and asthma symptoms in non-domestic cleaners from the Sao Paulo metropolitan area, Brazil. Occup Environ Med 2007; 64:446.
  22. Radon K, Gerhardinger U, Schulze A, et al. Occupation and adult onset of rhinitis in the general population. Occup Environ Med 2008; 65:38.
  23. Hellgren J, Torén K. Nonallergic occupational rhinitis. Clin Allergy Immunol 2007; 19:241.
  24. Slavin RG. Occupational rhinitis. Ann Allergy Asthma Immunol 2003; 90:2.
  25. Cullinan P, Cook A, Nieuwenhuijsen MJ, et al. Allergen and dust exposure as determinants of work-related symptoms and sensitization in a cohort of flour-exposed workers; a case-control analysis. Ann Occup Hyg 2001; 45:97.
  26. Glück U, Schütz R, Gebbers JO. Cytopathology of the nasal mucosa in chronic exposure to diesel engine emission: a five-year survey of Swiss customs officers. Environ Health Perspect 2003; 111:925.
  27. Blainey AD, Graham VA, Phillips MJ, Davies RJ. Respiratory tract reactions to western red cedar. Hum Toxicol 1981; 1:41.
  28. Cullinan P, Cook A, Gordon S, et al. Allergen exposure, atopy and smoking as determinants of allergy to rats in a cohort of laboratory employees. Eur Respir J 1999; 13:1139.
  29. Gautrin D, Ghezzo H, Infante-Rivard C, Malo JL. Natural history of sensitization, symptoms and occupational diseases in apprentices exposed to laboratory animals. Eur Respir J 2001; 17:904.
  30. Sharma HP, Wood RA, Bravo AR, Matsui EC. A comparison of skin prick tests, intradermal skin tests, and specific IgE in the diagnosis of mouse allergy. J Allergy Clin Immunol 2008; 121:933.
  31. van Kampen V, de Blay F, Folletti I, et al. EAACI position paper: skin prick testing in the diagnosis of occupational type I allergies. Allergy 2013; 68:580.
  32. Practice parameters for assessing the severity of allergic rhinitis have been developed by the Joint Task Force on Practice Parameters, a body representing the American Academy of Allergy, Asthma, and Immunology, and the American College of Allergy, Asthma, and Immunology. http://www.allergyparameters.org/file_depot/0-10000000/30000-40000/30326/folder/73825/2003Rhinitis.pdf#page=1&zoom=auto,9,800 (Accessed on April 26, 2013).
  33. Schumacher MJ. Rhinomanometry. J Allergy Clin Immunol 1989; 83:711.
  34. Baraniuk JN, Kim D. Nasonasal reflexes, the nasal cycle, and sneeze. Curr Allergy Asthma Rep 2007; 7:105.
  35. Hytonen ML, Sala EL, Malmberg HO, Nordman H. Acoustic rhinomanometry in the diagnosis of occupational rhinitis. Am J Rhinol 1996; 10:393.
  36. Castano R, Thériault G, Gautrin D, et al. Reproducibility of acoustic rhinometry in the investigation of occupational rhinitis. Am J Rhinol 2007; 21:474.
  37. Gerth van Wijk R, Patiwael JA, de Jong NW, et al. Occupational rhinitis in bell pepper greenhouse workers: determinants of leaving work and the effects of subsequent allergen avoidance on health-related quality of life. Allergy 2011; 66:903.
  38. Castano R, Trudeau C, Castellanos L, Malo JL. Prospective outcome assessment of occupational rhinitis after removal from exposure. J Occup Environ Med 2013; 55:579.
  39. Gautrin D, Desrosiers M, Castano R. Occupational rhinitis. Curr Opin Allergy Clin Immunol 2006; 6:77.
  40. Hellgren J, Karlsson G, Torén K. The dilemma of occupational rhinitis: management options. Am J Respir Med 2003; 2:333.
  41. Puchner TC, Fink JN. Occupational Rhinitis. Immunol Allergy Clin North Am 2000; 20:303.
  42. Sastre J, Fernández-Nieto M, Rico P, et al. Specific immunotherapy with a standardized latex extract in allergic workers: a double-blind, placebo-controlled study. J Allergy Clin Immunol 2003; 111:985.
  43. Nettis E, Colanardi MC, Soccio AL, et al. Double-blind, placebo-controlled study of sublingual immunotherapy in patients with latex-induced urticaria: a 12-month study. Br J Dermatol 2007; 156:674.
  44. Hansen I, Hörmann K, Klimek L. [Specific immunotherapy in inhalative allergy to rat epithelium]. Laryngorhinootologie 2004; 83:512.
  45. Settipane RJ, Hagy GW, Settipane GA. Long-term risk factors for developing asthma and allergic rhinitis: a 23-year follow-up study of college students. Allergy Proc 1994; 15:21.
  46. Airaksinen LK, Luukkonen RA, Lindström I, et al. Long-term exposure and health-related quality of life among patients with occupational rhinitis. J Occup Environ Med 2009; 51:1288.
  47. Moscato G, Pala G, Boillat MA, et al. EAACI position paper: prevention of work-related respiratory allergies among pre-apprentices or apprentices and young workers. Allergy 2011; 66:1164.
  48. Krop EJ, Heederik DJ, Lutter R, et al. Associations between pre-employment immunologic and airway mucosal factors and the development of occupational allergy. J Allergy Clin Immunol 2009; 123:694.
  49. Platts-Mills TA, Longbottom J, Edwards J, et al. Occupational asthma and rhinitis related to laboratory rats: serum IgG and IgE antibodies to the rat urinary allergen. J Allergy Clin Immunol 1987; 79:505.
  50. Phipatanakul W, Matsui E, Portnoy J, et al. Environmental assessment and exposure reduction of rodents: a practice parameter. Ann Allergy Asthma Immunol 2012; 109:375.
  51. Slavin RG, Lewis CR. Sensitivity to enzyme additives in laundry detergent workers. J Allergy Clin Immunol 1971; 48:262.