Occupational Rhinitis

Abstract

The term occupational rhinitis (OR) refers to the inception of rhinitis induced by either immunologically mediated sensitization to a specific substance at the workplace (i.e. sensitizer-induced occupational rhinitis or allergic occupational rhinitis—hereafter referred to as OR) or by exposure to an inhaled irritant at work, which is termed irritant-induced occupational rhinitis. OR is characterized clinically by the development of nasal hypersensitivity to a specific occupational agent after an asymptomatic period of exposure, the so-called latency period, which is necessary to acquire immunological sensitization to the causal agent. The workplace agents capable of causing OR are the same as those identified as inducing sensitizer-induced OA, including high-molecular-weight (HMW) and low-molecular-weight (LMW) agents. In the case of irritant-induced OR, transient or persistent nasal symptoms may occur within a few hours after a single or repeated exposure to high concentrations of irritant compounds, such as chlorine, chlorine dioxide, sulfur dioxide, ozone, and hydrogen sulfide. By analogy with work-exacerbated asthma, work-exacerbated rhinitis has been defined as preexisting or concurrent (allergic or nonallergic) rhinitis that is worsened by workplace exposures, while the disease itself was not initiated by the work environment. There is a significant association between OR and OA in individual workers. OR is probably two to three times more frequent than OA. As for OA, the level of exposure to the sensitizing agent is the most important determinant of the development of IgE-mediated sensitization and OR due to HMW agents. Nasal provocation test is a useful test to confirm the diagnosis of OR. A diagnostic algorithm is proposed. Subjects with OR should be advised to diminish exposure to the causal agent to reduce the risk of developing OA.