Asthma on the Job

MILWAUKEE-Could you actually be allergic to work? If you experience symptoms of allergies or asthma in the workplace, you may suffer from occupational asthma. This disorder is defined as reversible airflow obstruction caused by inhaling allergens, chemicals, fumes, gases, dusts or other potentially harmful substances while "on the job," according to the American Academy of Allergy, Asthma & Immunology (AAAAI).

"We estimate that about 15%, or 1 in 7, of adult cases of asthma are caused by the workplace. Occupational asthma accounts for 24.5 million missed workdays for adults each year in the United States," said Karin A. Pacheco, MD, MSPH, FAAAAI, and Chair of the AAAAI's Occupational Diseases Committee. "One of the difficulties in diagnosing occupational asthma is that the symptoms are the same as non-occupational asthma - wheezing, shortness of breath, chest tightness, difficulty exercising and cough. Similar to non-occupational asthma, runny nose, nasal congestion and eye irritation may accompany chest symptoms. The trained physician must first consider an occupational cause, and then look for clues in the patient's history, or the diagnosis will be missed," Pacheco added.

For example, physicians should consider the following questions: Do asthma symptoms worsen during the workweek and improve on the weekends? Did asthma symptoms begin after starting a new job or work practice? Is the patient exposed to products or chemicals known to cause asthma? "Making the connection to the workplace is vital," said Pacheco, "because it offers the best chance of cure by removal from exposure, and may also help prevent disease in other exposed workers."

Are You at Risk?
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 some 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 may develop asthma if exposed to conditions that trigger it. Workers who smoke are at greater risk for developing asthma to some occupational exposures, but not to others.

The incidence of occupational asthma varies by industry, but some workers are at a greater risk than others. Workers who may be at a higher risk include:

• Health care professionals
• Employees who wear powdered natural rubber latex gloves
• Workers manufacturing plastics, rubbers or foam products
• Bakers and pastry makers
• Cosmetologists and hairdressers
• Housekeepers and janitors
• Workers handling two part adhesives or paints
• Textile and carpet workers
• Animal handlers, veterinarians and scientists working with laboratory animals

Preventing Occupational Asthma
Occupational asthma is one disease that potentially can be cured, once the cause is identified and worker exposure is reduced or eliminated. Some, though not all, occupational allergens have exposure limits set by the Occupational Safety and Health Administration (OSHA), and exposed workers should be monitored by health and safety officers in the workplace. However, the introduction of new materials and processes, as well as new uses for old materials, mean that workers remain exposed to asthma causing agents in the workplace. Workers who have allergic or asthmatic symptoms on the job, 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 asthma and/or allergy medications may counteract the effects of such workplace substances. In other situations, however, complete avoidance of exposure is necessary.

Reducing exposure to occupational asthma triggers, receiving appropriate diagnosis and treatment, and help with establishing avoidance measures will relieve symptoms and improve your quality of life. If you have questions about treatments available for occupational asthma, be sure to ask your allergist/immunologist.

How Can an Allergist/Immunologist Help?
Patients should see an allergist/immunologist if they need to undergo testing to confirm the diagnosis of asthma or to determine whether their asthma is caused by or triggered by agents in the workplace. To find an allergist/immunologist in your area or to learn more about allergies and asthma, visit the AAAAI Web site at www.aaaai.org.

The AAAAI represents allergists, asthma specialists, clinical immunologists, allied health professionals and others with a special interest in the research and treatment of allergic disease. Allergy/immunology specialists are pediatric or internal medicine physicians who have elected an additional two years of training to become specialized in the treatment of asthma, allergy and immunologic disease. Established in 1943, the AAAAI has more than 6,500 members in the United States, Canada and 60 other countries. The AAAAI serves as an advocate to the public by providing educational information through its Web site at www.aaaai.org.

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