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Does Your Job Make You Itch and Wheeze?

Allergy and Asthma image

Occupational contact dermatitis and asthma are two of the most common work-related health issues facing workers worldwide, according to experts presenting the latest research at the 2009 Annual Meeting of the American College of Allergy, Asthma & Immunology.

“In many countries, occupational contact dermatitis ranks first among occupational diseases,” says Donald Belsito, MD, clinical professor of Dermatology at the University of Missouri in Kansas City, MO.

Occupational contact dermatitis involves an acute or chronic inflammation of the skin from exposure to chemical, biological, or physical agents in the workplace.

“After the skin, the lungs are the most commonly affected organ in the workplace,” says Emil J. Bardana Jr., MD, professor of Medicine in the division of Allergy-Immunology at Oregon Health and Science University in Portland, OR.

Occupational asthma, which is characterized by inflammation of the airways with coughing, wheezing, or shortness of breath, is caused by inhalation of dust, gases, fumes, vapors, or allergens in the workplace. “Somewhere between 9 and 15 percent of asthma is probably work-related,” says Dr. Bardana.

With both contact dermatitis and asthma, the reaction can be either allergic or caused by irritation. In the case of occupational contact dermatitis, 80 percent of cases occur on the hands, which may become dry, chapped, patchy, red, and scaly. Most often, the problem is caused by chronic irritation from water, soaps, solvents, and greases. It can take months and even years of exposure before symptoms occur.

Occupational contact dermatitis and asthma are two of the most common work-related health issues facing workers worldwide.

In the case of occupational asthma, spray paint is one common trigger, but anything from chemicals to welding fumes to soybean dust can be a culprit.

“There are hundreds of potential triggers of occupational asthma,” says Paul A. Greenberger, MD, professor of Medicine in the division of Allergy- Immunology at Northwestern University, Feinberg School of Medicine in Chicago, IL.

Workers at Risk
“In the United States, agricultural and manufacturing have particularly high rates of occupational contact dermatitis,” says Dr. Belsito. Other jobs associated with higher rates of contact dermatitis include mechanic, metalworker, cleaner, healthcare worker, construction worker, cosmetologist, baker/cook, and housekeeper.

“One European study showed the highest risk occupation for asthma was cleaning – a broad group, including janitorial, custodial, and commercial,” says Dr. Bardana.

Difficult Diagnosis
Diagnosing occupational asthma is complicated by the fact that several respiratory conditions have similar symptoms. Difficulty also arises in differentiating between new cases of asthma caused by a work environment (occupational asthma) and the worsening of symptoms in workers who had asthma prior to their job.

“Often times, there is aggravation of pre-existing asthma that gets blamed on what’s going on at the job,” says Dr. Bardana. “Many people who have asthma don’t even know it.”

With both occupational asthma and contact dermatitis, avoiding the irritant or allergen is the best line of defense.

“Eighty percent of workers recover from occupational contact dermatitis without impairment when managed correctly,” says Dr. Belsito. “This includes accurately identifying the irritant or allergen and taking preventive efforts.”

He adds that most workers with occupational contact dermatitis who change jobs should do so for reasons other than dermatitis. A job change is only necessary in cases of severe allergy, where the agent causing the problem cannot be avoided.

While occupational contact dermatitis often can be successfully managed without having to leave a profession, this is not always the case with occupational asthma.

“The outcome is related to whether an allergy or irritant is causing the asthma, and it depends on how long the person is exposed,” says Dr. Bardana. “In general, if an allergy is causing the asthma, a person can’t go back to the profession. The quicker they are removed from the agent they are allergic to, the better.”

“It may be reasonable to go back to work if asthma is mild,” Dr. Greenberger adds. “But there are some workers that have loss of lung function, and this is a serious concern.”

In cases where an irritant is causing asthma, worker education, appropriate ventilation, or the use of masks might allow someone to continue the job.

Tough Choices in a Tough Economy
Dr. Greenberger acknowledges the difficult choices people face when trying to hold on to a good, paying job while coping with coughing, wheezing, and loss of breath; and it is not always clear whether occupational asthma is the driving factor.

“Some workers seek compensation with a belief that everything is caused by their work environment, even when it is not,” says Dr. Greenberger. “But there are also workers with occupational asthma who refuse to stay off the job because they need to make a living. It’s difficult. We want workers to keep their jobs, but we don’t want them to lose their lung function.”


Source: American College of Allergy, Asthma & Immunology,

This article was originally published in Coping® with Allergies & Asthma magazine, March/April 2010.