Occupational Allergy

Occupational allergy is defined as allergy caused by exposure to a product that is present in the workplace. Both elements of the definition are important as the agent should be specific to the workplace and be causally related to the disease. The recognition of occupational allergy goes back to Olaus Magnus who, in 1555, wrote ‘When sifting the chaff from the wheat, one must carefully consider the time when a suitable wind is available that sweeps away the harmful dust. This fine-grained material readily makes its way into the mouth, congests in the throat, and threatens the life organs of the threshing men. If one does not seek instant remedy by drinking one’s beer, one may never more, or only for a short time, be able to enjoy what one has threshed.’ Since then, many agents encountered at the workplace have been associated with allergic reactions in various organs. These include, for example, high-molecular-weight agents in flour, castor beans or vegetable gums, and low-molecular-weight agents such as platinum salts, diisocyanates or those in wood dust. Reactions can lead to permanent impairment and disability. Due to its significant medical, social, and possibly, legal consequences, a definitive diagnosis of occupational allergy, including identification of the causative agent, is imperative. Whenever possible, prevention programs should be set up in high-risk workplaces. Occupational allergy can affect many target organs, including the lungs, nose, eyes, and skin. This chapter focuses on occupational allergy affecting upper and lower airways, i.e. occupational asthma and occupational rhinitis. Early diagnosis of OA and early removal from exposure to the causative agent in the workplace improve the chance of recovery. Suspecting work exposure as a cause of asthma in all individuals with new-onset or worsening asthma, and asking key questions about work exposures while history taking, is crucial in the work-up of OA. Despite the efforts of standardization, the diagnosis of OA and OR still remains complicated and controversial. OR is frequently present in OA, and may precede development of OA, particularly with HMW sensitizers. OA and OR can lead to permanent impairment and disability