Can allergy be an occupational disease?
A condition caused by harmful factors associated with work is called an occupational disease. According to the legal definition, it is related to the working environment or can be induced by the way the work is performed [1].
Allergic diseases are also included in the list of occupational diseases. According to the current register, such allergy-related conditions include:
- respiratory system:
– bronchial asthma
– extrinsic allergic alveolitis (ADP)
– allergic laryngeal oedema
– allergic rhinitis
– pulmonary diseases caused by hard metal dust (i.e. cobalt, tungsten)
- skin:
– allergic contact dermatitis
– irritant contact dermatitis
– contact urticaria
– occupational photodermatoses
– allergic conjunctivitis
– acute generalised allergic reactions (including anaphylaxis) [2].
Occupational allergy – how to recognise it?
It is not without reason that allergy has become known as a civilisation disease. It is a serious problem faced by patients and the health service. The increase in diagnosing allergic diseases categorises allergy as a “21st century epidemic”. [3].
Right next to such conditions, healthcare professionals are grappling with common patient conditions: obesity, diabetes, depression, ischaemic heart disease, cancer, and chronic stress. All of the above diseases mainly affect highly developed societies [4][5][6].
Statistics on allergic diseases leave no illusions. The possible burden of occupational allergies on the worker has also long become a fact of life. The working environment, as well as the way in which work is performed , can be associated with an increased risk of exposure to risk factors for allergy.
How then is an occupational allergy diagnosed? According to Article 235 § 1 and 2 of the Labour Code, in order to diagnose and establish an occupational allergy, the employee and, in turn, the employer and the doctor (the entity competent to diagnose the disease) report the suspected occurrence of worrying symptoms in the employee. An occupational allergy can be diagnosed during the period of employment and also after the employment relationship has ended [1].
Occupational exposure in allergy
Occupational exposure is a term that refers to factors that potentially threaten health in the workplace. These include:
- chemical and physical agents
- biological agents
- sensitising factors (allergens)
- as well as factors related to the way the work is performed [7].
The diagnosis of a work-related allergy is made by the specialist on the basis of an occupational exposure assessment. This involves checking the factors that contribute to the development of the disease. In doing so, it is important to remember that only conditions included in the register of occupational diseases can be considered an occupational allergy.
In the three-step procedure (suspicion, diagnosis, determination), it must be established conclusively or with a high degree of probability that the exposure to harmful agents present in the working environment contributed to the development of an occupational allergy in the worker [8].
Types of occupational allergens
Not every worker is or will be at risk of developing an occupational disease. However, it is also worth being vigilant here. The introduction of new technologies, the intensity of contact with allergens, exposure to irritants, work tools, raw materials, as well as the semi-finished and finished products used, can all contribute to the development of an occupational allergy.
Allergens are antigenic molecules that can trigger an undesirable immune response in the worker’s body. They are present in a variety of occupational environments: factories, chemical industry, construction, agriculture, laboratories, as well as in doctors’ and cosmetologists’ offices.
Allergens can be classified according to their molecular weight, or the way in which the sensitising agent enters (inhalant and contact).
Allergens – breakdown:
- High-molecular-weight allergens (HMW-A):
– animal proteins (epidermis, egg white, and animal urine proteins), sources include: pets, rodents, livestock, birds, insect venom
– fish and seafood (shrimps, crabs, oysters)
– plant dusts (flour, natural rubber latex dust, coffee bean dust and tobacco leaf dust)
– micro-organisms and their products (fungi, grain mites, enzymes present in flours, baking additives and detergents: alpha-amylase, papain, trypsin, cellulase and alkalase)
– antibiotics
- Low-molecular-weight allergens (LMW-A):
– acid anhydrides (production of resins and dyes)
– metal dusts (zinc, nickel, chromium, vanadium, cobalt, platinum, as well as iron)
– isocyanates (plastic compounds, car paints and shoe manufacturing)
– dyes and bleaches (textiles)
– disinfectants (formaldehyde, as well as chloramine)
– persulphates and henna (hair dyes) [9][10].
Occupational allergy – what effects does it have?
Contact with allergens in the workplace can contribute to troublesome complaints, such as persistent coughing, runny nose, watery eyes, and itchy skin. The effects of an occupational allergy can range from mild rhinitis and contact eczema to the constriction of the lower respiratory tract. Prolonged exposure to occupational allergens can also contribute to significant deterioration of health.
In the case of this type of allergy, the worker may also be exposed to its most dangerous form, which is associated with direct exposure liable to affect health and life. The risk of occupational anaphylaxis may arise from contact with allergens whose sources include natural rubber latex, hymenopterous insect venom, seafood, certain drugs and disinfectants, and laboratory animals [8].
High risk professions
There is a group of professions characterised by a high rate of allergy. Representatives of these professions are also at higher risk of occupational allergies. The working environment, as well as the scope of work, may trigger undesirable allergy symptoms in the employee or aggravate symptoms of an existing, non-occupational allergy [9].
People with a family history of predisposition and sensitisation should avoid employment in areas with particularly high rates of allergy. Occupations with an increased risk of allergic occupational diseases include:
- workers in the chemical industry and painters
- workers in the plastics industry
- workers in metallurgy, processing, electroplating, and welding
- workers in the rubber industry
- construction workers, tile-layers, terrazzo workers, locksmiths, fitters, mechanics, and shipyard workers
- gardeners, florists, planters, and farmers
- healthcare workers and auxiliary staff, dental technicians, dentists, orthopaedists, and pharmacists
- laboratory technicians and chemists
- workers in the textile industry
- fur industry workers
- bakers, millers, confectioners, and chocolate makersveterinarians and animal breeders
- laundry workers
- workers in the cosmetics and perfume industry, beauticians, and manicurists
- hairdressers [8][9][10].
Prevention of occupational allergies
Workplaces with a higher risk of allergy should be adequately protected. A proper risk assessment of a workplace with a high allergenic potential is one of the basic duties of the employer (enterprise).
The employer should take care, among other things, of the education and training of the workers, the proper ventilation of the premises, the modification of the production processes, and the provision of personal protective equipment. The employee, in turn, should comply with the requirements indicated for his or her position, e.g. the use of protective masks, gloves or goggles.
The employer, in turn, is obliged to create conditions that reduce or eliminate the possibility of harmful factors penetrating into the worker’s body. On the other hand, the occupational risk assessment should be continuously updated.
In addition, correct prevention includes medical examinations: an initial examination (before the employee joins the workplace), follow-up examinations, as well as periodic examinations. In case of the first symptoms of allergy, the employee should be removed from activities that increase the risk of occupational allergy. All activities related to occupational health and safety procedures should also be diagnosed early [11].
Agnieszka Reptowska
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translation: Julia Majsiak
