Diagnosis Of Occupational Rhinitis Research Articles

Occupational Rhinitis

There is convincing evidence that tight relationships between the upper and lower airways also apply to the workplace context. Most patients with occupational asthma (OA) also suffer from occupational rhinitis (OR), although OR is 2 to 3 times more common than OA. OR most often precedes the development of OA, especially when high-molecular-weight protein agents are involved, and longitudinal cohort studies have confirmed that OR is associated with an increased risk for the development of OA. The level of exposure to sensitizing agents at the workplace is the most important determinant for the development of IgE-mediated sensitization and OR. Atopy is a risk factor for the development of IgE-mediated sensitization only to high-molecular-weight agents. In workers with work-related rhinitis symptoms, documentation of IgE-mediated sensitization to a workplace agent via skin prick testing or serum specific IgE confirms a diagnosis of probable OR, whereas specific nasal provocation testing in the laboratory remains the reference method to establish a definite diagnosis of OR. Complete avoidance of exposure to the causal agent is the most effective therapeutic option for controlling work-related nasal symptoms and preventing the development of OA. If complete elimination of exposure is expected to induce meaningful adverse socioeconomic consequences, reduction of exposure can be considered as an alternative approach, but it is important to consider the individual risk factors for the development of OA to implement a more personalized management of OR.

Occupational Rhinitis: Classification, Diagnosis, and Therapeutics.

Occupational rhinitis (OR), an inflammatory disease of the nose, refers to any nasal symptoms reported to be work-related. The purpose of this review is to provide a current overview of the classification, diagnosis, and treatment of OR. Occupational rhinitis (OR) can further beclassified into allergic or non-allergic depending on the causative agent(s) and pathogenesis. Presenting symptoms are similar to non-OR including nasal congestion, anterior and posterior rhinorrhea, sneezing, and nasal itching. Despite its high prevalence in a spectrum of workplaces, OR is under reported as it is often considered a nuisance rather than a potential precursor to occupational asthma (OA). The diagnosis of OR is obfuscated as it is difficult to determine if this condition was caused by environmental determinants in or outside the workplace. Furthermore, workers may have a pre-existing history of allergic or non-allergic rhinitis leading theclinician and worker to overlook inciting agents in the workplace. In this case, a diagnosis ofOR is still possible depending on the exposures but must be differentiated from work-exacerbated rhinitis. Further complicating the diagnosis of OR is the lack of evidence-based research focused on this condition as it is often trivialized due to the perception that it has an insignificant impact on the worker's health. The reality is that OR can have a significant impact on the worker's quality of life and is associated with a number of comorbidities including occupationalasthma, recurrent sinusitis, headaches, eustachian tube dysfunction, and sleep disorders similar to non-occupational rhinitis. However, one significant difference between these disorders is that workers diagnosed with OR are eligible for worker's compensation. Treatment of OR involves avoidance of the inciting agent(s) and medications similar to those used to treat non-OR conditions. This review summarizes recent progresses on the etiology, risk factors, diagnosis, and therapy of OR. In addition, suggested areas of further research with potential targets for modifications in the workplace environment as well as therapeutic interventions will be discussed.

Diagnosis of occupational rhinitis to dust and gasses using peak nasal inspiratory flow

Background: The recent development in technology and industry has increased the incidence of occupational disorders of which eventually affect the productivity and cost of related industries. Whether the products or the waste-materials are harmful to airway function, it needs to be investigated. Purpose: To study the incidence of occupational \rhinitis (OR) caused by exposure of sodium lauryl sulfate dust and irritant gases in the workplace. Methods: In this prospective study, 115 industrial workers who were exposed daily to multi–irritant material were investigated with questionnaire, anterior rhinoscopy, nasal endoscopy, peak nasal inspiratory flow (PNIF) meter, skin prick test, and nasal mucous scrapping before (V1) and after 8 hours (V2) work. The diagnosis of OR was made when symptoms of rhinitis worsened on workdays and a decrease of PNIF (≥20%) at V2. In addition, hours of daily exposure to irritant, years of working, improper usage of personal protection device (nasal and oral mask), and smoking were assessed by bivariate and multivariate analysis. Result: 32 workers of 115 (27.8%) were diagnosed as OR based on increased rhinitis symptoms during workdays and decreased PNIF after work. Incidence of OR increased in workers who had worked >10 years=2.15 (IC 95%:1.19-3.87, p=0.009) and who did not use personal protective equipment properly (p=0.04, RR:2.3, IC 95%:1.29-4.28). Conclusion: Exposure to occupational reagent such as sodium lauryl sulfate dust and multi-irritant gasses was a causal factor of OR. A proper perusal of personal protection equipment (PPE) is mandatory in workplace to minimize the risk of developing OR. Keywords: Occupational rhinitis, nature exposure of occupational agents, peak nasal inspiratory flow,nasal obstruction, personal protection equipment. ABSTRAKLatar belakang: Kemajuan teknologi dan industri akhir-akhir ini, meningkatkan pemaparan saluran napas terhadap produk atau sisa industri yang merupakan zat iritan. Sebagai akibatnya, insidens kelainan akibat kerja semakin meningkat, yang dapat mempengaruhi produktivitas dan peningkatan beban biaya industri. Seberapa besar pengaruhnya terhadap fungsi saluran napas, hal ini masih perlu diteliti lebih lanjut. Tujuan: Penelitian dilakukan untuk mengetahui insidens Rinitis Akibat Kerja (RAK) yang diakibatkan pajanan debu sodium lauryl sulfate dan gas iritan di tempat kerja. Metode: Pada studi prospektif ini, 115 pekerja yang terpajan setiap hari dengan material multi-iritan diteliti berdasarkan kuesioner, pemeriksan rinoskopi anterior, nasoendoskopi, Peak Nasal Inspiratory Flow (PNIF) meter, uji cukit kulit dan kerokan mukosa hidung sebelum (V1) dan sesudah 8 jam (V2) bekerja. Diagnosis RAK ditegakkan jika didapati perburukan gejala hidung disertai dengan penurunan (>20%) hasil PNIF pada V2. Sebagai tambahan, waktu pajanan iritan (jam), masa kerja (tahun), penggunaan alat perlindungan diri (APD) seperti masker hidung dan mulut secara kurang benar, serta kebiasaan merokok dianalisis dengan analisis bivariat dan multivariat (model regresi logistik). Hasil: 32 dari 115 pekerja (27,8%) didiagnosis sebagai RAK berdasarkan perburukan gejala hidung selama bekerja dan penurunan PNIF sesudah bekerja. Insidens RAK meningkat pada pekerja yang telah bekerja lebih dari 10 tahun=2.15 (95% IK:1,19–3,87, p=0,009) dan para pekerja yang tidak menggunakan APD (masker hidung dan mulut) secara benar, yaitu (p=0,04, RR: 2.4, 95% IK:1,29–2,48). Kesimpulan: Pajanan bahan kimia seperti debu sodium lauryl sulfate dan berbagai gas iritan merupakan faktor penyebab RAK. Penggunaan APD secara benar adalah mutlak untuk menurunkan risiko terjadinya RAK. Kata kunci: Rinitis akibat kerja, pajanan alamiah bahan berbahaya di tempat kerja, peak nasal inspiratory flow, hidung tersumbat, alat pelindung diri

Occupational rhinitis and allergic conjunctivitis

Occupational rhinitis is an inflammatory disease of the nose, which is characterised by intermittent or persistent symptoms, arising from causes and conditions attributable to a particular work environment and not from stimuli encountered outside the workplace. Its clinical symptoms such as nasal congestion, sneezing, rhinorrhoea, itching, nasal airflow limitation are very similar to the symptoms of allergic rhinitis caused by other (classical) agents. Occupational allergic conjunctivitis is an IgE mediated disease, provoked by a substance in the air of the workplace. Its clinical signs (itching, tearing, conjunctival hyperaemia and oedema and, in some cases when the cornea is also involved, blurred vision, photosensitivity) are similar to other forms of allergic conjunctivitis. Risk factors (which in most of the cases occur in both diseases) include history of atopy, high concentration of the irritant agent and multiple irritant agents in the air of the workplace. Atopy has been associated with an increased risk of specific sensitisation to a variety of high molecular weight agents. For the diagnosis of occupational rhinitis and occupational allergic conjunctivitis objective investigations such as allergen specific provocations are necessary in addition to clinical and occupational history. Management of these occupational diseases needs environmental interventions (increasing ventilation, decreasing the time of exposure, substitution of the irritant agent). Medical treatment of occupational rhinitis is very similar to other allergic diseases: oral antihistamines, local (nasal) corticosteroids, combined (antihistamine plus membrane stabilizer) eyedrops. The most important step in medical treatment of occupational allergic conjunctivitis is the daily application of combined eyedrops (for example: olopatadine). Orv. Hetil., 2014, 155(5), 170-175.

Occupational rhinitis caused by concurrent * sensitization to two different allergens

Exposure to wheat flour and guar gum is a well-known cause of occupational respiratory allergies among workers in the food processing industry. To date, there have been no reports of occupational rhinitis (OR) caused concurrently by two different allergens present in the workplace. To report a case of OR likely to be induced concurrently by exposure to wheat flour and guar gum in a mid-40s male employed in the food processing industry. Allergy tests and nasal challenge tests were performed to investigate and confirm the diagnosis of OR. We discuss potential mechanisms involved in the observed dual sensitization. The patient showed positive responses to wheat and guar gum extracts on skin prick testing. The total IgE was 1680 kU/l (0-100 kU/l). The diagnosis of OR was confirmed by nasal challenge tests with wheat flour and guar gum on different days. In contrast to the control day, the challenge with flour and guar gum induced an immediate clinical reaction associated with a decrease in nasal volume measured by acoustic rhinometry. The patient was advised to avoid exposure to wheat and guar gum, which resulted in a gradual resolution of nasal symptoms. Co-sensitization and cross-reactivity are possible mechanisms involved in cases of concurrent sensitization to related and unrelated allergens in patients complaining of work-related rhinitis symptoms.

Update on occupational rhinitis and asthma

The workplace is emerging as an increasingly important venue for the development of rhinitis and asthma. There is no question that allergic diseases of the respiratory tract caused by occupational exposure are on the increase. The clinician's diagnostic index of suspicion must be high so that a diagnosis of occupational rhinitis and/or asthma can be made in a timely fashion. Altering the environment of the workplace or removing the patient from that workplace may spare the patient permanent damage.

Occupational rhinitis

Occupational rhinitis (OR) is an inflammatory disease of the nose, which is characterized by intermittent or persistent symptoms, arising out of causes and conditions attributable to a particular work environment and not to stimuli encountered outside the workplace. Its clinical symptoms (nasal congestion, sneezing, rhinorrhea, itching, nasal airflow limitation) are very similar with the symptoms of the allergic rhinitis caused by other (classical) agents. According to the 27/1996 NM Departmental Order, OR in Hungary is a notifiable disease. Despite, between year 1997 and 2009, not even a single case was reported in Hungary. In the last 20 years the only Hungarian reference in this field was published in 2004, in the Textbook of Occupational Medicine, edited by Ungváry. This disease is not unknown in other European countries. It can be produced by both high and low molecular weight agents. For example, according to the publications, its prevalence among bakers can be 18-29%, and among workers with diisocyanates (painters, urethane mould workers) 36-42%. Risk factors are atopy, high concentration and multiple irritant agents in the air of workplace. Atopy has been associated with an increased risk of specific sensitization to a variety of HMW agents. Beside of the clinical and occupational history, objective investigations have to be used as well, for the diagnosis of OR. The gold standard for confirming the diagnosis of OR is the nasal provocation test. Objective methods that can be used for assessing nasal patency during the investigation of OR include rhinomanometry, acoustic rhinometry, peak nasal inspiratory flow, and gravimetry of the nasal secret. The management of the OR needs environmental interventions. These are: increasing the ventilation, decreasing the time of exposure, substitution of the irritant agent, investigation of possible asthma in all workers with OR. Medical treatments are: oral antihistamines, local (nasal) corticosteroids, combined (antihistamine+membrane-stabilizer) eyedrops.

Usefulness of nasal provocation tests in occupational rhinitis

The aim of the study was to determine whether Nasal Provocation Tests (NPT) could help in the diagnosis of occupational rhinitis (OR). Changes in nasal airway resistance (NAR), measured by posterior rhinomanometry during specific nasal challenge associated with per and post test clinical scores, were compared to a prior probability, based on the patient's history, determined by occupational physicians, in 41 hairdressers and 33 bakers referred for suspected OR. A DeltaNAR >or= 150% defined the positivity of the NPT. DeltaNAR demonstrated 50% sensitivity and a 86% specificity in hairdressers and a 95% sensitivity with 100 % specificity in bakers. DeltaNAR presented significant positive correlations with both per (p = 0.0003, r = 0.48) and post test clinical scores (p < 0.005, r = 0.39). The addition of clinical scores increased the sensitivity to 100% in hairdressers with 81% specificity. The NPT constitutes a safe procedure of nasal reactivity with good levels of sensitivity and specificity in both hairdressers and bakers when nasal resistance and clinical scores are taken into account.

Occupational Rhinitis in Damp and Moldy Workplaces

Numerous studies confirm the association between exposure to indoor air dampness and molds and different health outcomes. Of these, upper respiratory tract problems are the most commonly reported work-related symptoms in damp indoor environments. The aim of this study was to describe a clinically investigated patient series with occupational rhinitis induced by molds. Nasal provocation test (NPT) with commercial fungal allergens was performed in 369 patients during 1995-2004 at the Finnish Institute of Occupational Health. Of these, 60 (16%) were positive. In addition to positive NPT, the diagnosis of occupational rhinitis was based on verified exposure to molds, work-related nasal symptoms, and clinical investigations. We wanted to review the patient files of these 60 patients retrospectively, and 56 patients gave their informed consent. The mean age of the patients was 43.7 years (SD +/- 9.5). Fifty (89.3%) patients were women. In 23% of the patients, IgE-mediated allergy to molds could be established. Atopy significantly increased IgE sensitization to molds (OR, 10.3 [95% CI, 2.0-52.5]). The most common mold to induce occupational rhinitis was Aspergillus fumigatus. Exposure time was over 5 years in 63% of the patients. Association between the IgE sensitization to molds and exposure level was statistically significant (Fisher's exact test, p = 0.046). This is the first clinically investigated series on occupational rhinitis in relation to a moldy environment. Based on our findings, we conclude that molds growing in conjunction with moisture damages can induce occupational rhinitis. IgE-mediated allergy to molds was not common. Atopy and significant exposure level increased IgE sensitization to molds. zri00508.

Inhalation Challenge Test in the Diagnosis of Occupational Rhinitis

Evaluations of rhinitis reactions in inhalation challenges (ICs) are sparse compared with research on nasal challenges. This study evaluates the outcome of IC tests in assessing occupational rhinitis (OR). It presents the largest rhinologic IC data in the literature, analyzing the exposure method of various agents causing OR and their relation to asthma. Challenge tests performed on 829 individuals with suspected cases of OR were reviewed. Results from both exposures with occupational agents (n = 1229) and placebo (n = 838) were evaluated. A total of 10% of the occupational ICs (n = 123) were positive, suggesting OR, and 13% (n = 161) showed asthmatic reaction in the same challenge. In control challenges 2% showed rhinitis and 6% showed asthma symptoms. The most common agents tested were molds (160 tests), flours, and animal fodders (115 tests) and formaldehyde (122 tests). Obeche wood dust and latex produced positive nasal reactions the most frequently, followed by acid anhydrides. Although IC is a resource-intensive methodology, the evaluation of nasal symptoms and signs together with bronchial reactions saves time and expense compared with the organization of multiple individual challenges. We encourage the simultaneous evaluation of both nasal and bronchial reactions in IC tests.

Rhinites professionnelles

Rhinitis is one of the most common occupational diseases. It is often neglected by those affected because it causes little disability. It is poorly understood by doctors who have insufficient experience of occupational diseases and their causes. However it is often the first manifestation of a respiratory disorder that may cause physical complications and socio-economic disability. Numerous diverse agents are potential causes of rhinitis. The diagnosis of occupational rhinitis should be considered when sneezing, rhinorrhoea or nasal obstruction are associated with work. The causal agent can be identified by ta-king a careful history. When the mechanism of the disease is immunologic the suspected antigen can be confirmed by skin testing, specific IgE or nasal provocation. The respiratory disorder of which rhinitis is the first manifestation may progress to asthma if the exposure continues. The prevention of occupational rhinitis depends on the reduction of exposure to allergens and/or irritants. When it has developed removal of the causative agent is essential to prevent progression to asthma.

Occupational rhinitis: diagnostic criteria, relation to lower airway symptoms and IgE sensitization in bakery workers

Conclusions. The use of different diagnostic criteria has considerable consequences for the prevalence estimates of occupational rhinitis. There is a strong relationship between occupational rhinitis and lower airway symptoms. Storage mites appear to be important occupational allergens in Norwegian bakeries. Objectives. To study the consequences of various diagnostic criteria on the prevalence of occupational rhinitis, assess the prevalence of IgE sensitization and explore the relationships between upper and lower airway symptoms and between symptoms and IgE sensitization. Material and methods. A total of 197 employees in 6 bakeries were interviewed and completed a questionnaire. A skin prick test was performed, total and specific IgE were determined and a histamine release test was performed for relevant allergens. The criteria for the diagnosis of occupational rhinitis were based on the 1994 International Consensus Report on Rhinitis. Results. The prevalence of occupational rhinitis varied between 23% and 50%, depending on the criteria used. The occurrence of nasal symptoms was found to precede the development of lower airway symptoms. Occupational rhinitis, both IgE- and non-IgE-mediated, was associated with asthma symptoms. The most frequent causes of sensitization (20%) were different species of storage mites. Storage mite sensitization was related to occupational rhinitis and work exposure.

Acoustic Rhinometry in the Diagnosis of Occupational Rhinitis

Acoustic rhinometry (ARM) has been used to study the nasal cavity geometry and the response in nasal provocations. However, the use of ARM in the diagnosis of occupational rhinitis (OR) has not been reported. The purpose of this study was to find an ARM parameter and a limit value that could be used in provocation tests to express an objective change in the nasal cavity geometry. We used a new calculated parameter, Volume MCA%, for describing the change in the nasal geometry. Volume MCA% is the mean of the percentile changes of nasal volumes and minimal cross-sectional areas in a provocation test. We recommend a decrease of at least 15% in Volume MCA% for the limit of an essential change in the nasal cavity.

Acoustic rhinometry in the diagnosis of occupational rhinitis

Acoustic rhinometry in the diagnosis of occupational rhinitis