Current Allergy and Asthma Reports

, Volume 10, Issue 2, pp 77–83 | Cite as

Occupational Rhinosinusitis and Upper Airway Disease: The World Trade Center Experience

  • Rafael E. de la Hoz
  • Michael R. Shohet
  • Jeffrey M. Cohen


The World Trade Center disaster and its recovery work involved a range of hazardous occupational exposures that have not been fully characterized but that can be reasonably assumed to have the potential to cause mucosal inflammation, preferentially (but not exclusively) in the upper airway. A high prevalence of rhinosinusitis and upper airway disease (UAD) symptoms was reported by several early surveys. Clinical studies demonstrated objective, clinically significant, and persistent chronic perennial rhinosinusitis and UAD—with or without seasonal exacerbation—in a large proportion of patients. Demonstration of an association between UAD and available exposure indicators has been limited. Atopy seemed to be associated with increased UAD symptom severity and to be a risk factor for upper, but not lower, airway disease. World Trade Center-related UAD is considered an irritant-induced disease but not, in many cases, of acute onset. No data thus far suggest an increased upper airway cancer incidence.


Occupational medicine Rhinitis Sinusitis Inhalation injury Atopy Allergy Pharyngitis Laryngitis Reflux disease 



The publication of this work was made possible by the Centers for Disease Control and Prevention and the National Institute for Occupational Safety and Health (CDC/NIOSH) cooperative agreement no. U10 OH008225. The contents of this article are the sole responsibility of the authors and do not necessarily represent the official views of the CDC/NIOSH. The work described in this article was done before October 2006, when the WTC HETP had been funded by the following philanthropic organizations: the American Red Cross, the September 11 Fund, the Robin Hood Foundation, and the Bear Stearns Charitable Foundation.


No potential conflicts of interest relevant to this article were reported.


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

  1. 1.
    Lioy PJ, Weisel C, Millette JR, 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, 110:703–714.PubMedGoogle Scholar
  2. 2.
    McGee JK, Chen LC, Cohen MD, et al.: Chemical analysis of World Trade Center fine particulate matter for use in toxicologic assessment. Environ Health Perspect 2003, 111:972–980.PubMedGoogle Scholar
  3. 3.
    Offenberg JH, Eisenreich SJ, Chen LC, et al.: Persistent organic pollutants in the dusts that settled across Lower Manhattan after September 11, 2001. Environ Sci Technol 2003, 37:502–508.CrossRefPubMedGoogle Scholar
  4. 4.
    Geyh AS, Chillrud S, Williams DL, et al.: Assessing truck driver exposure at the World Trade Center disaster site: personal and area monitoring for particulate matter and volatile organic compounds during October 2001 and April 2002. J Occup Environ Hyg 2005, 2:179–193.CrossRefPubMedGoogle Scholar
  5. 5.
    Centers for Disease Control and Prevention: Use of respiratory protection among responders at the World Trade Center—New York City, September 2001. MMWR Morb Mortal Wkly Rep 2002, 51:6–8.Google Scholar
  6. 6.
    Centers for Disease Control and Prevention: Physical health status of World Trade Center rescue and recovery workers and volunteers—New York City, July, 2002–August, 2004. MMWR Morb Mortal Wkly Rep 2004, 53:807–812.Google Scholar
  7. 7.
    Feldman DM, Baron SL, Bernard BP, et al.: Symptoms, respiratory use, and pulmonary function changes among New York City firefighters responding to the World Trade Center disaster. Chest 2004, 125:1256–1264.CrossRefPubMedGoogle Scholar
  8. 8.
    Shusterman D: Toxicology of nasal irritants. Curr Allergy Asthma Rep 2003, 3:258–265.CrossRefPubMedGoogle Scholar
  9. 9.
    Wallingford KM, Snyder EM: Occupational exposures during the World Trade Center disaster response. Toxicol Ind Health 2001, 17:247–253.CrossRefPubMedGoogle Scholar
  10. 10.
    Diaz-Sanchez D, Tsien A, Casillas A, et al.: Enhanced nasal cytokine production in human beings after in vivo challenge with diesel exhaust particles. J Allergy Clin Immunol 1996, 98:114–123.CrossRefPubMedGoogle Scholar
  11. 11.
    Berríos-Torres SI, Greenko JA, Phillips M, et al.: World Trade Center rescue worker injury and illness surveillance, New York, 2001. Am J Prev Med 2003, 25:79–87.CrossRefPubMedGoogle Scholar
  12. 12.
    Irwin RS, Madison JM: The diagnosis and treatment of cough. N Engl J Med 2000, 343:1715–1721.CrossRefPubMedGoogle Scholar
  13. 13.
    Prezant DJ, Weiden M, Banauch GI, et al.: Cough and bronchial responsiveness in firefighters at the World Trade Center site. N Engl J Med 2002, 347:806–815.CrossRefPubMedGoogle Scholar
  14. 14.
    Herbstman JB, Frank R, Schwab M, et al.: Respiratory effects of inhalation exposure among workers during the clean-up effort at the World Trade Center disaster site. Environ Res 2005, 99:85–92.CrossRefPubMedGoogle Scholar
  15. 15.
    Skloot G, Goldman M, Fischler D, et al.: Respiratory symptoms and physiologic assessment or ironworkers at the World Trade Center disaster site. Chest 2004, 125:1248–1255.CrossRefPubMedGoogle Scholar
  16. 16.
    Salzman SH, Moosavy FM, Miskoff JA, et al.: Early respiratory abnormalities in emergency services police officers at the World Trade Center site. J Occup Environ Med 2004, 46:113–122.CrossRefPubMedGoogle Scholar
  17. 17.
    Webber MP, Gustave J, Lee R, et al.: Trends in respiratory symptoms of firefighters exposed to the World Trade Center disaster: 2001–2005. Environ Health Perspect 2009, 117:975–980.PubMedGoogle Scholar
  18. 18.
    Farfel M, DiGrande L, Brackbill R, et al.: An overview of 9/11 experiences and respiratory and mental health conditions among World Trade Center Health Registry enrollees. J Urban Health 2008, 85:880–909.CrossRefPubMedGoogle Scholar
  19. 19.
    •• de la Hoz RE, Shohet MR, Chasan R, et al.: Occupational toxicant inhalation injury: the World Trade Center (WTC) experience. Int Arch Occup Environ Health 2008, 81:479–485. This is the largest clinical study published to date that characterizes the different diseases that account for the symptoms reported by former WTC site workers.CrossRefPubMedGoogle Scholar
  20. 20.
    Belafsky PC, Postma GN, Koufman JA: The validity and reliability of the reflux finding score (RFS). Laryngoscope 2001, 111:1313–1317.CrossRefPubMedGoogle Scholar
  21. 21.
    Settipane RA, Lieberman P: Update on nonallergic rhinitis. Ann Allergy Asthma Immunol 2001, 86:494–508.CrossRefPubMedGoogle Scholar
  22. 22.
    de la Hoz RE, Hill S, Chasan R, et al.: Health care and social issues of immigrant rescue and recovery workers at the World Trade Center site. J Occup Environ Med 2008, 50:1329–1334.CrossRefPubMedGoogle Scholar
  23. 23.
    •• de la Hoz RE, Shohet MR, Wisnivesky JP, et al.: Atopy and upper and lower airway disease among former World Trade Center workers and volunteers. J Occup Environ Med 2009, 51:992–995. This was a study of a commonly investigated potential risk factor for occupational airway diseases.CrossRefPubMedGoogle Scholar
  24. 24.
    Young T, Finn L, Palta M: Chronic nasal congestion at night is a risk factor for snoring in a population-based cohort study. Arch Intern Med 2001, 161:1514–1519.CrossRefPubMedGoogle Scholar
  25. 25.
    de la Hoz RE, Aurora RN, Landsbergis P, et al.: Snoring and obstructive sleep apnea among former World Trade Center rescue workers and volunteers. J Occup Environ Med 2010, 52:29–32.CrossRefPubMedGoogle Scholar
  26. 26.
    McNicholas WT: The nose and OSA: variable nasal obstruction may be more important in pathophysiology than fixed obstruction. Eur Respir J 2008, 32:3–8.CrossRefPubMedGoogle Scholar
  27. 27.
    Zanation AM, Senior BA: The relationship between extraesophageal reflux (EER) and obstructive sleep apnea (OSA). Sleep Med Rev 2005, 9:453–458.CrossRefPubMedGoogle Scholar
  28. 28.
    Redolfi S, Yumino D, Ruttanaumpawan P, et al.: Relationship between overnight rostral fluid shift and obstructive sleep apnea in nonobese men. Am J Respir Crit Care Med 2009, 179:241–246.CrossRefPubMedGoogle Scholar
  29. 29.
    de la Hoz RE, Christie J, Teamer J, et al.: Reflux symptoms and disorders and pulmonary disease in former World Trade Center rescue and recovery workers and volunteers. J Occup Environ Med 2008, 50:1351–1354.CrossRefPubMedGoogle Scholar
  30. 30.
    de la Hoz RE, Shohet MR, Bienenfeld LA, et al.: Vocal cord dysfunction in former World Trade Center (WTC) rescue and recovery workers. Am J Ind Med 2008, 51:161–165.CrossRefPubMedGoogle Scholar
  31. 31.
    Perkner JJ, Fennelly KP, Balkissoon R, et al.: Irritant-associated vocal cord dysfunction. J Occup Environ Med 1998, 40:136–143.CrossRefPubMedGoogle Scholar
  32. 32.
    Allan PF, Abouchahine S, Harvis L, et al.: Progressive vocal cord dysfunction subsequent to a chlorine gas exposure. J Voice 2006, 20:291–296.CrossRefPubMedGoogle Scholar
  33. 33.
    Irwin RS, Pratter MR, Holland PS, et al.: Postnasal drip causes cough and is associated with reversible upper airway obstruction. Chest 1984, 85:346–352.CrossRefPubMedGoogle Scholar
  34. 34.
    Williams AN, Simon RA, Woessner KM: Sinusitis and chronic progressive exercise- induced cough and dyspnea. Allergy Asthma Proc 2008, 29:669–675.CrossRefPubMedGoogle Scholar
  35. 35.
    Brown TM, Merritt WD, Evans DL: Psychogenic vocal cord dysfunction masquerading as asthma. J Nerv Ment Dis 1988, 176:308–310.PubMedCrossRefGoogle Scholar
  36. 36.
    Moscato G, Vandenplas O, Van Wijk G, et al.: Occupational rhinitis. Allergy 2008, 63:969–980.CrossRefPubMedGoogle Scholar
  37. 37.
    Long A, McFadden C, DeVine D, et al.: Management of Allergic and Nonallergic Rhinitis. AHRQ Evidence Report/Technology Assessment, No. 54. Rockville, MD: Agency for Healthcare Research and Quality; 2002Google Scholar
  38. 38.
    •• Wallace DV, Dykewicz MS, Bernstein DI, et al.: The diagnosis and management of rhinitis. J Allergy Clin Immunol 2008, 122:S1–S84. This is an authoritative, comprehensive, and up-to-date guideline on the diagnosis and treatment of rhinitis.CrossRefPubMedGoogle Scholar
  39. 39.
    Shusterman D, Murphy MA, Balmes J: Influence of age, gender, and allergy status on nasal reactivity to inhaled chlorine. Inhal Toxicol 2003, 15:1179–1189.PubMedGoogle Scholar
  40. 40.
    Shusterman D, Tarun A, Murphy MA, et al.: Seasonal allergic rhinitic and normal subjects respond differentially to nasal provocation with acetic acid vapor. Inhal Toxicol 2005, 17:147–152.CrossRefPubMedGoogle Scholar
  41. 41.
    Siracusa A, Desrosiers M, Marabini A: Epidemiology of occupational rhinitis: prevalence, aetiology and determinants. Clin Exp Allergy 2000, 30:1519–1534.CrossRefPubMedGoogle Scholar
  42. 42.
    Mapp CE, Boschetto P, Maestrelli P, et al.: Occupational asthma. Am J Respir Crit Care Med 2005, 172:280–305.CrossRefPubMedGoogle Scholar
  43. 43.
    Brackbill RM, Hadler JL, DiGrande L, et al.: Asthma and posttraumatic stress symptoms 5–6 years following exposure to the World Trade Center terrorist attack. JAMA 2009, 302:502–516.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • Rafael E. de la Hoz
    • 1
  • Michael R. Shohet
    • 2
  • Jeffrey M. Cohen
    • 1
  1. 1.Department of Preventive MedicineMount Sinai School of MedicineNew YorkUSA
  2. 2.Department of Otolaryngology and Head and Neck SurgeryMount Sinai School of MedicineNew YorkUSA

Personalised recommendations