Challenge Exposure to Isocyanates Induces Changes in Nasal Patency in Patients Reporting Work-Related Respiratory Symptoms

Local allergic rhinitis: mechanisms, diagnosis and relevance for occupational rhinitis

PURPOSE OF REVIEW

Local allergic rhinitis (LAR) is a new form of allergic rhinitis that has caused a growing interest. The possibility of an occupational equivalent (occupational rhinitis) has not been yet explored. The purpose of this review is to summarize the most relevant and recent scientific evidence on LAR and occupational rhinitis.

RECENT FINDINGS

LAR is a prevalent entity well differentiated from allergic rhinitis, affecting patients from different countries, ethnic groups and ages. Occupational rhinitis appears earlier and more frequently than occupational asthma, especially for high molecular weight substances. Diagnosis of LAR is based on nasal allergen provocation test and/or detection of nasal specific IgE, and other techniques such as basophil activation test may support the diagnosis. Skin prick tests and immunological determinations are of limited use for diagnosis of occupational rhinitis caused by low molecular weight agents. Performance of nasal allergen provocation test for confirming diagnosis of occupational rhinitis is strongly recommended. Uncommon allergens should also be investigated.

SUMMARY

The possibility of a local occupational rhinitis should be considered in workers with a clear history of occupational rhinitis and negative immunological test, especially in the case of high molecular weight allergens.

Occupational rhinitis: an update

Occupational rhinitis is characterized by nasal congestion, rhinorrhea, nasal itching, and/or sneezing that occur secondary to exposures in the workplace. This disease can be classified into allergic or nonallergic subgroups based upon the underlying disease pathogenesis as well as the type of causative agent. While the true prevalence of occupational rhinitis is unknown, there are certain professions and occupational exposures that place workers at a higher risk for developing the disease. Additionally, occupational rhinitis can be associated with occupational asthma and upper airway symptoms may precede those of the lower respiratory tract. Taken together, occupational rhinitis is an important disease for study given its medical as well as socioeconomic implications. This review will focus on the classification of occupational rhinitis as well the prevalence, diagnosis, and treatment strategies.

Occupational rhinitis due to steel welding fumes

Exposure to welding fumes is a recognized respiratory hazard. Occupational asthma but not occupational rhinitis has been documented in workers exposed to steel welding fumes. We report a 26-year-old male with work-related rhinitis symptoms as well as lower airways symptoms suggestive of occupational asthma and metal fume fever associated with exposure to steel welding fumes. The diagnosis of occupational rhinitis was confirmed by specific inhalation challenge.