Consensus statement on occupational rhinitis

Unlike the BOHRF guidelines for occupational asthma, these are not the result of an evidence-based review, but a consensus of experts. The evidence available is much less than for occupational asthma, which it often preceeds.

The key messages are as follows

Definition and classification

Occupational rhinitis is an inflammatory disease of the nose, which is characterised by intermittent or persistent symptoms (i.e. nasal congestion, sneezing, rhinorrhoea, itching), and/or variable nasal airflow limitation and/or hypersecretion arising out of causes and conditions attributable to a particular work environment and not to stimuli encountered outside the workplace.

Work-related rhinitis may be divided into

     a.  Occupational rhinitis: arising out of causes and conditions attributable to a particular work environment

     b.  Work-exacerbated rhinitis: pre-existing or concurrent rhinitis that is pre-existing or current rhinitis exacerbated by workplace exposures

Epidemiology

• Surveys of workforces exposed to sensitising agents indicate that occupational rhinitis is 2-4 times more common than occupational asthma, although the contribution of workplace exposures to the general burden of rhinitis remains unknown
• The level of exposure is the most important determinant of IgE mediated sensitisation to occupational agents and occupational rhinitis
• Atopy is a risk factor for the development of IgE mediated sensitisation to high molecular weight agents, but the association with clinical occupational rhinitis caused by high molecular weight agents is less well substantiated

Relationships with occupational asthma

The majority of patients diagnosed with occupational asthma also suffer from occupational rhinitis, which most often preceeds the development of occupational asthma, especially when high molecular weight agents are involved

Occupational rhinitis is associated with an increased risk of asthma, although the proportion of subjects with occupational rhinitis who will develop occupational asthma remains uncertain

Investigation and diagnostic approach

Questionnaires and clinical history have a low specificity for diagnosing occupational rhinitis

Immunological tests (Skin prick tests or specific IgE) are sensitive but not specific tools for diagnosing occupational rhinitis caused by most high molecular weight and some low molecular weight agents (e.g. platinum salts, acid anhydrides and reactive dyes).

In the presence of work-related rhinitis symptoms, objective assessment using nasal provocation challenges in the laboratory, or in the workplace, should be strongly recommended.

Socio-economic impact

The socio-economic impact of occupational rhinitis remains unknown, but is likely to be substantial in terms of work productivity as can be extrapolated from data available for allergic rhinitis in general.

Prevention

Primary prevention strategies should focus on reducing exposure to potentially sensitising agents.

Identification and exclusion of susceptible workers is not efficient, particularly when the marker of susceptibility (e.g. atopy) is prevalent in the general population

Surveillance programmes aimed at early identification of occupational rhinitis should involve periodic administration of questionnaires and immunological tests when available

Surveillance of workers should focus on the first 2-5 years after entering exposure

The possibility of occupational asthma should be carefully evaluated in all workers with occupational rhinitis

References

	Moscato G, Vandenplas O, Van Gerth Wijk R, Malo JL, Quirce S, Walusiak J, Castano R, De Groot H, Folletti I, Gautrin D, Yacoub MR, Perfetti L, Siracusa A, Occupational rhinitis , Allergy, 2008;63:969-980,

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