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Patients & Consumers Online Tools Find an Allergist / Immunologist Pollen Counts Diseases 101 Drug Guide Featured Resources » AAAAI Tips Brochures Topic of the Month New Research Information Request Form Donate Now En Español Just for Kids Seniors Contact Us Search by Condition (A-Z) Request a Speaker Smoke Free Homes Referral Guidelines Other Resources En Español Just for Kids Seniors		Topic of the Month - October - Occupational Asthma: Are You at Risk? In this Topic of the Month, you will learn about:: What are the signs of occupational asthma? What are the causes? Who is at risk? How can occupational asthma be prevented? When should you see an allergist/immunologist? Did you know that your job can trigger allergies and asthma? Occupational asthma, defined as a lung disorder caused by inhaling fumes, gases, dust or other potentially harmful substances while "on the job," is the most prevalent work-related disease in developed countries. In fact, it is estimated that up to 15% of asthma cases in adults may have job-related factors. Occupational asthma also accounts for approximately 24.5 million missed work days for adults annually in the United States. What are the signs of occupational asthma? Symptoms may include: Wheezing Shortness of breath Chest tightness Cough Runny nose or nasal congestion Eye irritation The disease may last for a lengthy period of time in workers, even if they are no longer exposed to the agents. Symptoms will usually worsen through the work week, improve on the weekend and reappear when an employee returns to the job. The length of occupational exposure that triggers asthma varies, and can range from months to years before symptoms occur. Occasionally, an accident at work involving high exposure to irritating fumes or dusts may cause asthma within 24 hours. Early recognition and control of triggers are important in occupational-induced asthma because the longer employees are exposed, the less likely it is that they will completely overcome their asthma symptoms. If you experience any of the above symptoms, be sure to see an allergist/immunologist for an evaluation. Unfortunately, many workers with persistent asthma symptoms caused by substances at the workplace are incorrectly diagnosed as having bronchitis. If occupational asthma is not correctly diagnosed early, and the worker is not protected or removed from the exposure, lung damage can occur and asthma symptoms may persist even after exposure has ceased. What causes occupational asthma? Occupational asthma may be caused by one of three mechanisms: Direct irritant effects - Irritants that provoke occupational asthma include hydrochloric acid, sulfur dioxide or ammonia, which is found in the petroleum or chemical industries. Workers exposed to these substances will frequently begin wheezing and experiencing other asthma symptoms immediately after exposure to the irritant substances. This is an irritant reaction rather than an allergic reaction because it does not involve the immune system. Workers who already have asthma or some other respiratory disorder are particularly affected by this type of exposure. Allergy (long-term exposure) - Allergies play a role in many cases of occupational asthma. This type of asthma generally develops only after long-term exposure (e.g., months or years) to a work-related substance. This is because the body's immune system needs time to develop allergic antibodies or other immune responses to a particular substance. For example, workers in the washing powder industry may develop an allergy to the enzymes of the bacteria Bacillus Subtilis, and food processing workers may develop an allergy and occupational asthma symptoms from exposure to castor beans or green coffee beans. Allergic occupational asthma can occur in workers in the plastic, rubber or resin industries following repeated exposure to small chemical molecules in the air. Veterinarians, fishermen and animal handlers in laboratories can develop allergic reactions to animal proteins, and health care workers can develop asthma from breathing in powdered proteins from latex gloves or from mixing powdered medications. Pharmacologic mechanisms - Inhalation of some substances in aerosol form can directly lead to the accumulation of naturally occurring chemicals in the body, such as histamine or acetylcholine within the lung, which can lead to asthma. For example, insecticides, used in agricultural work, can cause a buildup of acetylcholine, which causes airway muscles to contract and constrict. Who is at risk for occupational asthma? With occupational asthma, symptoms of asthma may develop for the first time in a previously healthy worker, or childhood asthma that had previously cleared may recur due to new exposure. In many cases, a previous personal or family history of allergies will make a person more likely to develop occupational asthma. However, many individuals who have no such history still will develop asthma if exposed to conditions that trigger it. Additionally, workers who smoke are at greater risk for developing asthma after occupational exposures. The incidence of occupational asthma varies by industry. For example, in the detergent industry, inhalation of a particular enzyme used to produce washing powders has led to the development of respiratory symptoms in 25% of exposed employees. Approximately 5% of people working with laboratory animals or with powdered natural rubber latex gloves have developed occupational asthma. Chemicals widely used in many industries, including spray painting, insulation installation, and in manufacturing plastics, rubber and foam, can cause asthma in up to 10% of exposed workers. Other workers who are at risk for occupational asthma include: Adhesive handlers Beauticians and hairdressers Janitors Textile workers Carpet makers Health care professionals How can occupational asthma be prevented? Once the cause of occupational asthma is identified, exposure to the triggers should be reduced. Work areas should be closely monitored so exposure to asthma-causing substances is kept to a minimum. Workers who are currently experiencing symptoms or who anticipate being exposed to agents that increase their risk of developing asthma should see an allergist/immunologist for an evaluation and proper diagnosis. In some cases, pre-treatment with specific medications to counteract the effects of workplace substances may be helpful. In other situations, however, complete avoidance is necessary. Reducing exposure to occupational asthma triggers, receiving appropriate treatment and practicing careful avoidance measures will improve your quality of life and help you feel relief from symptoms. If you have questions about treatments available for occupational asthma, be sure to ask your allergist/immunologist. When should you see an allergist/immunologist? The AAAAI's How the Allergist/Immunologist Can Help: Consultation and Referral Guidelines Citing the Evidence provide information to assist patients and health care professionals in determining when a patient may need consultation or ongoing specialty care from an allergist/immunologist. Patients should see an allergist/immunologist if they: Have a history suggesting occupational asthma Need to undergo testing to confirm the diagnosis of asthma Need to determine whether the asthma is caused by or triggered by agents in the workplace Need an evaluation of workplace exposures that could worsen or exacerbate asthma Consulting with an allergist/immunologist before your symptoms begin, or before they worsen, is an important first step in maintaining proper allergy and asthma control. An allergist/immunologist is the best qualified medical professional trained to manage the prevention, diagnosis and treatment of allergic disease. To find an allergist/immunologist in your area, please visit www.aaaai.org/physref. Additional Resources Tips to Remember: Occupational asthma Patient Update: Your job may trigger asthma and allergies Allergic Conditions: Occupational asthma Tips to Remember: Asthma triggers and management Practice Parameter: Attaining optimal asthma control This topic was reviewed on 10/1/2007 by Stuart Friedman, MD, FAAAAI, Patients & Consumers Web Editor. <back>
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