Occupational Upper Airway Disease

Jolanta Walusiak

Disclosures

Curr Opin Allergy Clin Immunol. 2006;6(1):1-6. 

In This Article

Abstract and Introduction

Abstract

Purpose of Review: This article reviews recent findings concerning occupational upper airway diseases, which, although very frequent, are usually not considered serious. However, the concept of the 'united airway', evoked during recent years, should change our attitude regarding these diseases. Moreover, new agents in the occupational environment must be characterized. Furthermore, exposure to carcinogens has changed over the years, and in most cases risk should be reassessed.
Recent Findings: Recent findings concerning work-related upper airway diseases caused by allergens and irritants, and their relationship to lower airway diseases, are reviewed. Findings of studies aimed at characterizing occupational allergens of plant and animal origin are presented. Recognition of work-related upper airway diseases both in clinic and in epidemiological studies is discussed. Current evidence on occupational cancer of the upper airways, its risk factors and changes in them over the years resulting from preventative measures are also described.
Summary: There is significant evidence that occupational allergic diseases of the upper airways can pose important health problems because they represent an early stage of allergy throughout the respiratory system. However, how to detect those rhinitic patients who will develop asthma remains unresolved. New occupational health problems due to irritants were recently reported, and both follow-up studies and evaluations of their implications for the lower airways are warranted. Although preventative measures have been effective to some extent, risk for occupational cancer of the upper airways persists and more targeted epidemiological studies in this area are needed.

Introduction

The upper airways are a portal of entry for workplace-related hazardous materials into the respiratory system. Allergens, irritants and carcinogens can all cause occupational diseases of the upper airways. Such diseases, especially those induced by allergens and irritants, are usually not considered serious. However, the concept of the 'united airway', evoked in recent years, may change our attitude toward them. The most important link between rhinitis and asthma is the presence of inflammation of the nasal and bronchial mucosae.[1] Local allergen challenge can induce allergic inflammation in the entire airway system, irrespective of the site of allergen application.[2,3] Up to 40% of patients with allergic rhinitis also have asthma, and as many as 80% of patients with asthma suffer from nasal symptoms.[4] However, the contention that allergic rhinitis is a risk factor for development of asthma is not entirely correct, because rhinitis may represent an early stage in united airway disease, and subsequent onset of asthma may be a further component in its evolution.[5] Regarding upper and lower airways as one functional entity has diagnostic and therapeutic implications. In the light of this approach, when qualifying into vocational training and work, individuals with allergic rhinitis should be treated in the same way as those with asthma.

Allergic diseases frequently attract the interests of researchers, but the effects on health of exposure to irritants and carcinogens are less investigated. Data on the nose-lung link in persons exposed to such agents are lacking. Moreover, new agents are introduced into the occupational environment before their effects have been fully characterized. Furthermore, exposure to carcinogens has changed over the years, and in most cases risk should be reassessed. Development of diagnostic tools that can be used in epidemiological studies is also needed. This review summarizes recently reported findings concerning these issues.

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