Skip to main content
Log in

Occupational Rhinitis: an Update

  • Occupational Allergies (JA Poole, Section Editor)
  • Published:
Current Allergy and Asthma Reports Aims and scope Submit manuscript

Abstract

Occupational rhinitis is characterized by nasal congestion, rhinorrhea, nasal itching, and/or sneezing that occur secondary to exposures in the workplace. This disease can be classified into allergic or nonallergic subgroups based upon the underlying disease pathogenesis as well as the type of causative agent. While the true prevalence of occupational rhinitis is unknown, there are certain professions and occupational exposures that place workers at a higher risk for developing the disease. Additionally, occupational rhinitis can be associated with occupational asthma and upper airway symptoms may precede those of the lower respiratory tract. Taken together, occupational rhinitis is an important disease for study given its medical as well as socioeconomic implications. This review will focus on the classification of occupational rhinitis as well the prevalence, diagnosis, and treatment strategies.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. Wallace DV, Dykewicz MS, Bernstein DI, Blessing-Moore J, Cox L, Khan DA, et al. The diagnosis and management of rhinitis: an updated practice parameter. J Allergy Clin Immunol. 2008;122:S1–84.

    Article  PubMed  Google Scholar 

  2. Moscato G, Vandenplas O, Van Wijk RG, Malo JL, Perfetti L, Quirce S, et al. EAACI position paper on occupational rhinitis. Respir Res. 2009;10:16.

    Article  PubMed Central  PubMed  Google Scholar 

  3. Castano R, Maghni K, Castellanos L, Trudeau C, Malo JL, Gautrin D. Proinflammatory mediators in nasal lavage of subjects with occupational rhinitis. Otolaryngol Head Neck Surg. 2010;143:301–3.e1.

    Article  PubMed  Google Scholar 

  4. Grammer LC, Shaughnessy MA, Lowenthal M. An immunologic disease due to hexahydrophthalic anhydride. Chest. 1993;104:1792–4.

    Article  CAS  PubMed  Google Scholar 

  5. Hox V, Steelant B, Fokkens W, Nemery B, Hellings PW. Occupational upper airway disease: how work affects the nose. Allergy. 2014;69:282–91. This review summarizes a recent literature investigating the prevalence, pathophysiology, diagnosis, and management of occupational rhinitis.

    Article  CAS  PubMed  Google Scholar 

  6. Meggs WJ. Hypothesis for induction and propagation of chemical sensitivity based on biopsy studies. Environ Health Perspect. 1997;105 Suppl 2:473–8.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  7. Zhao YA, Shusterman D. Occupational rhinitis and other work-related upper respiratory tract conditions. Clin Chest Med. 2012;33:637–47.

    Article  PubMed  Google Scholar 

  8. Castano R, Malo JL. Occupational rhinitis and asthma: where do we stand, where do we go? Curr Allergy Asthma Rep. 2010;10:135–42.

    Article  PubMed  Google Scholar 

  9. Antolin-Amerigo D, Rodriguez-Rodriguez M, Barbarroja Escudero J, Perez Bustamante MS, Jimeno Nogales L, Guerrero Rios JA, et al. Occupational rhinitis caused by rice flour in a pizzeria worker. Allergol Immunopathol (Madr). 2013;41:130–3.

    Article  CAS  Google Scholar 

  10. Kim JH, Kim JE, Choi GS, Hwang EK, An S, Ye YM, et al. A case of occupational rhinitis caused by rice powder in the grain industry. Allergy Asthma Immunol Res. 2010;2:141–3.

    Article  PubMed Central  PubMed  Google Scholar 

  11. Sung SY, Lee WY, Yong SJ, Shin KC, Park HS, Kim HM, et al. A case of occupational rhinitis induced by maize pollen exposure in a farmer: detection of IgE-binding components. Allergy Asthma Immunol Res. 2012;4:49–51.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  12. Oldenburg M, Petersen A, Baur X. Maize pollen is an important allergen in occupationally exposed workers. J Occup Med Toxicol. 2011;6:32.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  13. Campbell CP, Jackson AS, Johnson AR, Thomas PS, Yates DH. Occupational sensitization to lupin in the workplace: occupational asthma, rhinitis, and work-aggravated asthma. J Allergy Clin Immunol. 2007;119:1133–9.

    Article  CAS  PubMed  Google Scholar 

  14. Campbell CP, Yates DH. Lupin allergy: a hidden killer at home, a menace at work; occupational disease due to lupin allergy. Clin Exp Allergy. 2010;40:1467–72.

    Article  CAS  PubMed  Google Scholar 

  15. Toskala E, Piipari R, Aalto-Korte K, Tuppurainen M, Kuuliala O, Keskinen H. Occupational asthma and rhinitis caused by milk proteins. J Occup Environ Med. 2004;46:1100–1.

    Article  PubMed  Google Scholar 

  16. Airaksinen L, Pallasaho P, Voutilainen R, Pesonen M. Occupational rhinitis, asthma, and contact urticaria caused by hydrolyzed wheat protein in hairdressers. Ann Allergy Asthma Immunol. 2013;111:577–9.

    Article  CAS  PubMed  Google Scholar 

  17. Wiszniewska M, Tymoszuk D, Pas-Wyroslak A, Nowakowska-Swirta E, Chomiczewska-Skora D, Palczynski C, et al. Occupational allergy to squid (Loligo vulgaris). Occup Med (Lond). 2013;63:298–300.

    Article  CAS  Google Scholar 

  18. Castano R. Occupational rhinitis caused by concurrent sensitization to two different allergens. Occup Med (Lond). 2012;62:466–8.

    Article  CAS  Google Scholar 

  19. Shin SY, Hur GY, Ye YM, Park HS. A case of occupational rhinitis caused by porcine pancreatic extract developing into occupational asthma. J Korean Med Sci. 2008;23:347–9.

    Article  PubMed Central  PubMed  Google Scholar 

  20. Zeiss CR, Patterson R, Pruzansky JJ, Miller MM, Rosenberg M, Levitz D. Trimellitic anhydride-induced airway syndromes: clinical and immunologic studies. J Allergy Clin Immunol. 1977;60:96–103.

    Article  CAS  PubMed  Google Scholar 

  21. Kronholm Diab K, Jonsson BA, Axmon A, Nielsen J. Work-related airway symptoms, nasal reactivity and health-related quality of life in female hairdressers: a follow-up study during exposure. Int Arch Occup Environ Health. 2014;87:61–71.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  22. Helaskoski E, Suojalehto H, Virtanen H, Airaksinen L, Kuuliala O, Aalto-Korte K, et al. Occupational asthma, rhinitis, and contact urticaria caused by oxidative hair dyes in hairdressers. Ann Allergy Asthma Immunol. 2014;112:46–52.

    Article  CAS  PubMed  Google Scholar 

  23. Lindstrom I, Suojalehto H, Henriks-Eckerman ML, Suuronen K. Occupational asthma and rhinitis caused by cyanoacrylate-based eyelash extension glues. Occup Med (Lond). 2013;63:294–7.

    Article  CAS  Google Scholar 

  24. Merget R, Sander I, van Kampen V, Raulf-Heimsoth M, Ulmer HM, Kulzer R, et al. Occupational immediate-type asthma and rhinitis due to rhodium salts. Am J Ind Med. 2010;53:42–6.

    PubMed  Google Scholar 

  25. Wittczak T, Dudek W, Walusiak-Skorupa J, Swierczynska-Machura D, Palczynski C. Chlorhexidine—still an underestimated allergic hazard for health care professionals. Occup Med (Lond). 2013;63:301–5.

    Article  CAS  Google Scholar 

  26. Pala G, Perfetti L, Cappelli I, Caminati M, Moscato G. Occupational rhinitis to sodium alendronate. Allergy. 2008;63:1092–3.

    Article  CAS  PubMed  Google Scholar 

  27. Shusterman D. Occupational irritant and allergic rhinitis. Curr Allergy Asthma Rep. 2014;14:425.

    Article  PubMed  Google Scholar 

  28. Lioy PJ, Weisel CP, Millette JR, Eisenreich S, Vallero D, Offenberg J, et al. Characterization of the dust/smoke aerosol that settled east of the World Trade Center (WTC) in lower Manhattan after the collapse of the WTC 11 September 2001. Environ Health Perspect. 2002;110:703–14.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  29. de la Hoz RE. Occupational asthma and lower airway disease among World Trade Center workers and volunteers. Curr Allergy Asthma Rep. 2010;10:287–94.

    Article  PubMed  Google Scholar 

  30. de la Hoz RE, Shohet MR, Cohen JM. Occupational rhinosinusitis and upper airway disease: the world trade center experience. Curr Allergy Asthma Rep. 2010;10:77–83.

    Article  PubMed  Google Scholar 

  31. Leigh JP. Economic burden of occupational injury and illness in the United States. Milbank Q. 2011;89:728–72.

    Article  PubMed Central  PubMed  Google Scholar 

  32. Hytonen M, Kanerva L, Malmberg H, Martikainen R, Mutanen P, Toikkanen J. The risk of occupational rhinitis. Int Arch Occup Environ Health. 1997;69:487–90.

    Article  CAS  PubMed  Google Scholar 

  33. Storaas T, Steinsvag SK, Florvaag E, Irgens A, Aasen TB. Occupational rhinitis: diagnostic criteria, relation to lower airway symptoms and IgE sensitization in bakery workers. Acta Otolaryngol. 2005;125:1211–7.

    Article  PubMed  Google Scholar 

  34. Folletti I, Forcina A, Marabini A, Bussetti A, Siracusa A. Have the prevalence and incidence of occupational asthma and rhinitis because of laboratory animals declined in the last 25 years? Allergy. 2008;63:834–41.

    Article  CAS  PubMed  Google Scholar 

  35. Ferraz E, Arruda LK, Bagatin E, Martinez EZ, Cetlin AA, Simoneti CS, et al. Laboratory animals and respiratory allergies: the prevalence of allergies among laboratory animal workers and the need for prophylaxis. Clinics (Sao Paulo). 2013;68:750–9.

    Article  Google Scholar 

  36. Gautrin D, Desrosiers M, Castano R. Occupational rhinitis. Curr Opin Allergy Clin Immunol. 2006;6:77–84.

    PubMed  Google Scholar 

  37. Moscato G, Siracusa A. Rhinitis guidelines and implications for occupational rhinitis. Curr Opin Allergy Clin Immunol. 2009;9:110–5.

    Article  PubMed  Google Scholar 

  38. Moscato G, Rolla G, Siracusa A. Occupational rhinitis: consensus on diagnosis and medicolegal implications. Curr Opin Otolaryngol Head Neck Surg. 2011;19:36–42.

    Article  PubMed  Google Scholar 

  39. Siracusa A, Folletti I, Moscato G. Non-IgE-mediated and irritant-induced work-related rhinitis. Curr Opin Allergy Clin Immunol. 2013;13:159–66. This review summarizes a recent literature investigating non-allergic and irritant-induced work-related rhinitis.

    Article  CAS  PubMed  Google Scholar 

  40. Seed MJ, Gittins M, De Vocht F, Agiu RM. Occupational rhinitis and occupational asthma; one airway two diseases? J Phys Conf Ser. 2009;151.

  41. Moscato G, Pala G, Cullinan P, Folletti I, Gerth van Wijk R, Pignatti P, et al. EAACI position paper on assessment of cough in the workplace. Allergy. 2014;69:292–304. This consensus document from the European Academy of Allergy and Clinical Immunology describes important medical conditions that should be considered when evaluating cough in the workplace.

    Article  CAS  PubMed  Google Scholar 

  42. Karjalainen A, Martikainen R, Klaukka T, Saarinen K, Uitti J. Risk of asthma among Finnish patients with occupational rhinitis. Chest. 2003;123:283–8.

    Article  PubMed  Google Scholar 

  43. Malo JL, Lemiere C, Desjardins A, Cartier A. Prevalence and intensity of rhinoconjunctivitis in subjects with occupational asthma. Eur Respir J. 1997;10:1513–5.

    Article  CAS  PubMed  Google Scholar 

  44. Vandenplas O, Van Brussel P, D’Alpaos V, Wattiez M, Jamart J, Thimpont J. Rhinitis in subjects with work-exacerbated asthma. Respir Med. 2010;104:497–503.

    Article  PubMed  Google Scholar 

  45. Grammer LC, Ditto AM, Tripathi A, Harris KE. Prevalence and onset of rhinitis and conjunctivitis in subjects with occupational asthma caused by trimellitic anhydride (TMA). J Occup Environ Med. 2002;44:1179–81.

    Article  CAS  PubMed  Google Scholar 

  46. Castano R, Gautrin D, Theriault G, Trudeau C, Ghezzo H, Malo JL. Occupational rhinitis in workers investigated for occupational asthma. Thorax. 2009;64:50–4.

    Article  CAS  PubMed  Google Scholar 

  47. Seed MJ, Carder M, Gittins M, Agius RM. Do all occupational respiratory sensitisers follow the united airways disease model? Thorax. 2009;64:642–3.

    Article  CAS  PubMed  Google Scholar 

  48. Nguyen SB, Castano R, Labrecque M. Integrated approach to diagnosis of associated occupational asthma and rhinitis. Can Respir J. 2012;19:385–7.

    PubMed Central  PubMed  Google Scholar 

  49. Castano R, Johnson VJ, Cartier A. Challenge exposure to isocyanates induces changes in nasal patency in patients reporting work-related respiratory symptoms. J Occup Environ Med. 2013;55:954–9. This article described how a nasal provocation test (specific inhalation challenge) can be performed for diagnosing occupational rhinitis.

    Article  CAS  PubMed  Google Scholar 

  50. Riu E, Dressel H, Windstetter D, Weinmayr G, Weiland S, Vogelberg C, et al. First months of employment and new onset of rhinitis in adolescents. Eur Respir J. 2007;30:549–55.

    Article  CAS  PubMed  Google Scholar 

  51. Rhinitis ETFO, Moscato G, Vandenplas O, Gerth Van Wijk R, Malo JL, Quirce S, et al. Occupational rhinitis. Allergy. 2008;63:969–80.

    Article  Google Scholar 

  52. Moscato G, Pala G, Boillat MA, Folletti I, Gerth van Wijk R, Olgiati-Des Gouttes D, et al. EAACI position paper: prevention of work-related respiratory allergies among pre-apprentices or apprentices and young workers. Allergy. 2011;66:1164–73.

    Article  CAS  PubMed  Google Scholar 

  53. Gerth van Wijk R, Patiwael JA, de Jong NW, de Groot H, Burdorf A. Occupational rhinitis in bell pepper greenhouse workers: determinants of leaving work and the effects of subsequent allergen avoidance on health-related quality of life. Allergy. 2011;66:903–8.

    Article  CAS  PubMed  Google Scholar 

  54. Castano R, Trudeau C, Castellanos L, Malo JL. Prospective outcome assessment of occupational rhinitis after removal from exposure. J Occup Environ Med. 2013;55:579–85. This article demonstrated how avoidance of the causal agent in the management of occupational rhinitis can improve both patient symptoms and quality of life.

    Article  PubMed  Google Scholar 

  55. Castano R. Persistent specific nasal reactivity to occupational allergens after removal from exposure. Ann Allergy Asthma Immunol. 2013;111:66–7.

    Article  PubMed  Google Scholar 

  56. Rodrigo GJ, Yanez A. The role of antileukotriene therapy in seasonal allergic rhinitis: a systematic review of randomized trials. Ann Allergy Asthma Immunol. 2006;96:779–86.

    Article  CAS  PubMed  Google Scholar 

  57. Weiner JM, Abramson MJ, Puy RM. Intranasal corticosteroids versus oral H1 receptor antagonists in allergic rhinitis: systematic review of randomised controlled trials. BMJ. 1998;317:1624–9.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  58. Yanez A, Rodrigo GJ. Intranasal corticosteroids versus topical H1 receptor antagonists for the treatment of allergic rhinitis: a systematic review with meta-analysis. Ann Allergy Asthma Immunol. 2002;89:479–84.

    Article  CAS  PubMed  Google Scholar 

  59. Banerji A, Long AA, Camargo Jr CA. Diphenhydramine versus nonsedating antihistamines for acute allergic reactions: a literature review. Allergy Asthma Proc. 2007;28:418–26.

    Article  CAS  PubMed  Google Scholar 

Download references

Compliance with Ethics Guidelines

Conflict of Interest

Leslie Grammer reports grants from the NIH, the Bazley Foundation, Food Allergy Network, and S&C Electric; is a consultant for Astellas Pharmaceuticals; has given paid lectures at AAAAI and Mount Sinai; and receives royalties from Lippincott, BMJ, and Elsevier. Whitney Stevens reports no disclosures.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by the authors.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Leslie C. Grammer III.

Additional information

This article is part of the Topical Collection on Occupational Allergies

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Stevens, W.W., Grammer, L.C. Occupational Rhinitis: an Update. Curr Allergy Asthma Rep 15, 487 (2015). https://doi.org/10.1007/s11882-014-0487-8

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11882-014-0487-8

Keywords

Navigation