Mechanisms, Diagnosis and Relevance for Occupational Rhinitis
Mechanisms, Diagnosis and Relevance for Occupational Rhinitis
Occupational rhinitis is an inflammatory disease of the nose, characterized by intermittent/persistent symptoms and/or variable nasal airflow limitation and/or hypersecretion due to causes and conditions from a particular work environment and not to stimuli encountered outside the workplace. Two types of occupational rhinitis can be distinguished based on the presence (allergic) or absence (nonallergic) of a latency period from the beginning of the exposure to the onset of symptoms.
The prevalence of occupational rhinitis in the general population has barely been investigated. Some cross-sectional studies conducted in various working populations exposed to HMW and low molecular weight (LMW) agents have been recently reported. A study by Ameille et al. examined the relationship between occupational rhinitis and occupational asthma; the frequency of association was higher for HMW compared with LMW agents, and also occupational rhinitis symptoms occurred earlier than occupational asthma for the HMW allergens. This high frequency of occupational rhinitis symptoms has been also reported among bakers with occupational asthma. Regarding LMW agents, a questionnaire-based study in almost 5000 hairdressing students revealed that 18% had rhinitis symptoms. Nasal symptoms were also common among waste collectors and significantly higher among healthcare and kitchen workers compared with the general population. A systematic review of epidemiological studies performed in cleaning workers revealed than almost 80% of these studies showed an increased risk of rhinitis in this population. The recent Study on Occupational Allergy Risks that followed participants from International Study of Asthma and Allergies in Childhood (ISAAC) phase II until adulthood collected information on first job experiences and its association with their respiratory symptoms, analyzing the potential impact of occupational exposure and other risk factors on participants' respiratory health during the first years of employment. Results indicated that occupational exposure had little influence for work-related sensitization prevalence and allergic rhinitis/asthma incidence in early work life, whereas other risk factors were related with the disease (childhood sensitization, parental asthma, tobacco smoke exposure during puberty, sex and study location).
More than 300 substances have been identified as possible agents producing occupational rhinitis. Recently, several case reports have highlighted the importance of investigating unusual or not-so-frequent allergens in which diagnosis was demonstrated by a positive specific challenge. These reports were mostly cases of HMW allergens such as chicken proteins, chamomile, lipid transfer proteins from maize in a snack processor and wheat in hairdresser, so sIgE could be detected in most cases. Finally, several interesting reviews have been published regarding recent developments in occupational rhinitis.
Novel Aspects in the Investigation of Occupational Rhinitis
Occupational rhinitis is an inflammatory disease of the nose, characterized by intermittent/persistent symptoms and/or variable nasal airflow limitation and/or hypersecretion due to causes and conditions from a particular work environment and not to stimuli encountered outside the workplace. Two types of occupational rhinitis can be distinguished based on the presence (allergic) or absence (nonallergic) of a latency period from the beginning of the exposure to the onset of symptoms.
The prevalence of occupational rhinitis in the general population has barely been investigated. Some cross-sectional studies conducted in various working populations exposed to HMW and low molecular weight (LMW) agents have been recently reported. A study by Ameille et al. examined the relationship between occupational rhinitis and occupational asthma; the frequency of association was higher for HMW compared with LMW agents, and also occupational rhinitis symptoms occurred earlier than occupational asthma for the HMW allergens. This high frequency of occupational rhinitis symptoms has been also reported among bakers with occupational asthma. Regarding LMW agents, a questionnaire-based study in almost 5000 hairdressing students revealed that 18% had rhinitis symptoms. Nasal symptoms were also common among waste collectors and significantly higher among healthcare and kitchen workers compared with the general population. A systematic review of epidemiological studies performed in cleaning workers revealed than almost 80% of these studies showed an increased risk of rhinitis in this population. The recent Study on Occupational Allergy Risks that followed participants from International Study of Asthma and Allergies in Childhood (ISAAC) phase II until adulthood collected information on first job experiences and its association with their respiratory symptoms, analyzing the potential impact of occupational exposure and other risk factors on participants' respiratory health during the first years of employment. Results indicated that occupational exposure had little influence for work-related sensitization prevalence and allergic rhinitis/asthma incidence in early work life, whereas other risk factors were related with the disease (childhood sensitization, parental asthma, tobacco smoke exposure during puberty, sex and study location).
More than 300 substances have been identified as possible agents producing occupational rhinitis. Recently, several case reports have highlighted the importance of investigating unusual or not-so-frequent allergens in which diagnosis was demonstrated by a positive specific challenge. These reports were mostly cases of HMW allergens such as chicken proteins, chamomile, lipid transfer proteins from maize in a snack processor and wheat in hairdresser, so sIgE could be detected in most cases. Finally, several interesting reviews have been published regarding recent developments in occupational rhinitis.
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