Industrial allergies. Allergens of infectious origin

Allergens- these are antigens causing allergies. Under certain conditions, the properties of allergens can be acquired by factors of various natures, primarily all high- and low-molecular substances of organic and inorganic origin. The list of industrial allergens exceeds a hundred items and includes haptens(formaldehyde, epichlorohydrin, furan, diisocyanate, aromatic nitrobenzenes, ursol, salts of chromium, nickel, cobalt, manganese, platinum, etc.) and full antigens(synthetic polymer materials, components of varnishes, resins, adhesives, elastomers, cements, compounds, etc.).

In industry, workers also encounter allergens. natural composition: dust of grain, flour, tobacco, cotton, wool and animal dander, plant pollen. The latter, being household allergens, can also cause occupational diseases.

The mechanisms of formation of allergies to industrial allergens depend on the properties of the allergen itself and its combination with other factors. Allergic reactions to full(high-molecular-weight) allergens according to the mechanism of development do not correspond occupational allergies: hypersensitivity, manifested in immediate-type reactions, delayed-type reactions, antibody-dependent cytotoxicity, immune complex cytotoxicity, granulomatous reaction.

Allergy to haptens(low molecular weight allergens) is formed due to the formation of the so-called “complex antigen”, i.e. compounds of hapten with protein molecules.

The route of entry of the allergen into the body, as a rule, determines the form of occupational allergic disease. When inhaled, allergic diseases of the respiratory system develop, and when taken through the skin, skin diseases develop. Long-term exposure to these substances disrupts the barrier function of the mucous membranes and skin, which increases their permeability to the allergen, resulting in the formation of professional

sional allergic disease in the form of rhinitis, sinusitis, rhinosinusitis, pharyngitis, rhinopharyngitis, bronchial asthma, asthmatic bronchitis, exogenous allergic alveolitis, epidermitis, dermatitis, eczema and toxicoderma. These forms of diseases are most often observed in chemical industry(from operators at chemical-pharmaceutical and chemical plants), workers in the woodworking and electronic industries, in construction industry, production of polymer materials, biotechnology, medicine, etc.

The risk of developing occupational allergic diseases largely depends on the conditions of exposure and the entire complex of occupational factors. In this case, the routes of entry and concentration of allergens, exposure modes and dose loads play a particularly important role. Under production conditions, there is an unfavorable course (hypersensitivity) of allergic reactions with complex exposure to allergens. Finally, an important place is occupied by the increased individual sensitivity of the body.

The effects of irritation of the mucous membranes of the respiratory tract and

skin. As a result of their mechanical traumatization (quartz dust), maceration skin, associated with high humidity with increased sweating in a heating microclimate, there is an increase in the allergenic effect when the skin is exposed to a chemical product.

The phenotype of allergic diseases is fundamentally different from the forms of response healthy body on industrial allergens and, first of all, by the fact that the sensitization reaction develops against the background of the functional activity of the T- or T- and B-immune systems.

It should be noted that in modern production conditions, in combination with or without allergens, the body of workers may be exposed to substances that cause clinically similar reactions to those of a true allergy. This applies to compounds with immunomodulating and immunotoxic effects. Moreover, depending on the characteristics of the immune and biochemical status of the worker, the reactions are dominated by allergic or toxic-allergic responses or non-immune direct degranulation of tissue basophils with hyperproduction of inflammatory mediators and bronchospasm.

In this regard, as a rule, it is carried out comprehensive assessment the state of cells of the immune system and other inflammatory cells, their mediators, cytotoxins, antibodies for the purpose of diagnosis, examination and prognosis. Using this approach, such forms of occupational diseases as berylliosis, bronchial asthma(when exposed to solvents), metalloconiosis, byssinosis and

etc.

Main path prevention of occupational allergic diseases- hygienic regulation of allergens in the air working area and contamination of the skin, taking into account their specific sensitizing effect.

An important place in the system of prevention of occupational allergic diseases is occupied by the diagnosis of their early signs with subsequent treatment, identification of persons with a genetic or acquired predisposition to allergic reactions and formation of risk groups.

Currently, specialized allergological examinations of industrial workers are carried out by research institutions. In accordance with the long-term program of medical examination of workers, work on

training of allergists, immunologists and occupational pathologists and the introduction into the practice of health care at enterprises of express and microvariants of immunological tests for quantitative and functional assessment of the immune system. The effectiveness of the prevention of occupational allergic diseases depends on a set of measures, including socio-economic, sanitary and hygienic, therapeutic and preventive elements and sanitary educational work.

The company has finally found a specialist with the profile and work experience that it has been looking for for so long. He started work, but suddenly began to get sick. The reason for this was an allergy. What should an employer know about this?

First, let's look at what an allergy is. Allergy is increased sensitivity body to any substance, characterized various manifestations. TO local symptoms include:

swelling of the nasal mucosa (allergic rhinitis);
redness and pain in the conjunctiva (allergic conjunctivitis);
bronchospasm, wheezing, shortness of breath, sometimes true asthma attacks occur;
hearing loss;
various rashes on the skin;
headache.

Almost any substance (paint, varnish, cement dust), plant (allergy to weeds, flowering plants), fumes (gas, oil), compounds, etc. That is, the increased sensitivity of the human body can manifest itself in relation to any substances (including in the composition of things) with which it has to live and work.

Excessive manifestations of allergies are anaphylactic shock and Quincke's edema.

One of the reasons for the development of allergies is harmful working conditions in production. In accordance with paragraph. 4 hours 2 tbsp. 22 of the Labor Code of the Russian Federation, the employer is obliged to ensure safety and working conditions that comply with state regulatory requirements for labor protection (Article 212 of the Labor Code of the Russian Federation). Despite this, the legislator provides for the possibility of working in hazardous working conditions, obliging the employer only to provide employees working in such conditions with increased guarantees and compensation, for example, in the form of the maximum permissible duration of daily work (shift) with a reduced working time for work in hazardous conditions. conditions (Articles 92, 94 of the Labor Code of the Russian Federation).

In addition, the Labor Code of the Russian Federation establishes certain requirements for employment in hazardous conditions (preliminary and then periodic medical examinations, Art. 69, 213 of the Labor Code of the Russian Federation) and restrictions on the use of certain categories of workers at work in hazardous working conditions, for example, women (Article 253 of the Labor Code of the Russian Federation), persons under the age of 18 (Article 265 of the Labor Code of the Russian Federation).

Consequences of allergies

Most easy consequence Allergy for an employee is a slight malaise, expressed in sneezing and coughing, i.e. such manifestations that, in general, do not interfere with work or slightly complicate it. Such ailment does not lead to temporary disability of the employee. But more serious consequences are possible:

The employer should also not forget about increased guarantees and compensation associated both with the establishment, based on the results of a special assessment, of harmful working conditions at the employee’s workplace, and with confirmation by a medical report of an occupational disease in the employee and / or the establishment of a disability.

For information on how to conduct a special assessment and what to do after it, read the article “Special assessment of working conditions: how to avoid a fine”

Another consequence of an acquired disease for the work process may be termination of employment. employment contract with such an employee, both on the initiative of the employee himself (due to the impossibility of working with constant manifestations of allergies (Article 80 of the Labor Code of the Russian Federation)), and on the initiative of the employer. In the second case, dismissal is possible under clause 8, part 1, art. 77 of the Labor Code of the Russian Federation in connection with the employee’s refusal to transfer to another job, necessary for him in accordance with the medical certificate issued in the manner established federal laws and other regulatory legal acts, or the employer’s lack of relevant work (parts 3 and 4 of Article 73 of the Labor Code of the Russian Federation). However, we would like to remind you that until an occupational disease is confirmed and the corresponding medical report is received, according to which the employee is recognized as needing to be transferred to another job (in accordance with Part 1 of Article 73 of the Labor Code of the Russian Federation), the employer is not obliged to transfer him. Transfer is possible only by agreement of the parties in accordance with Art. 72 Labor Code of the Russian Federation.

Disputes with employees

One of the most negative consequences detection of an occupational disease in an employee associated with an allergic reaction to substances with which the employee is forced to work day after day is a legal dispute. Let's look at individual examples of what may be the subject of them, what claims employers usually face and what court decisions they most often have to deal with.

Disputes regarding the recovery of lump sum compensation from the employer

This type of dispute is based on the material interests of the employee when the employer refuses to fulfill its obligations to pay money.

Judicial practice

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The employee filed a lawsuit against the employer for recovery lump sum compensation for compensation for damage to health caused by an occupational disease, which is established by the collective agreement in force in the organization. The fact of injury to health due to an occupational disease is confirmed by the case materials, including the report on the case of an occupational disease, according to which the cause of the plaintiff’s occupational disease was work under conditions of prolonged exposure to harmful production factors on the employee’s body. According to the collective agreement, if for the first time an employee is diagnosed with loss of professional ability due to work injury or occupational disease for compensation moral damage the employer provides payment of a one-time compensation at the rate of at least 20% of average monthly earnings for each percentage of loss of professional ability to work (taking into account the amount of the one-time benefit paid from the Social Insurance Fund of the Russian Federation). Given the employer's failure to comply this condition, the court ordered the defendant to pay compensation to the plaintiff (decision of the Gukovsky City Court Rostov region dated August 28, 2014, appeal ruling of Rostovsky regional court dated December 8, 2014 in case No. 33-16493/2014).

Disputes about paperwork

As practice shows, disputes often arise due to the employer’s actions related to the procedure for establishing an employee’s occupational disease.

Judicial practice

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The employee filed a lawsuit against the employer to declare illegal the employer’s refusal to sign a report on the case of an occupational disease. The court found that the plaintiff developed an occupational disease - bronchial asthma, allergic and non-allergic. Based on the results of the established commission, an act of investigation of the disease was drawn up, signed by the deputy head of the department of the Rospotrebnadzor Office for the city of Moscow, approved by the chief state sanitary doctor of the city of Moscow. At the same time, the employer refused to sign the act, citing the lack of information about the plaintiff’s health status in the twenty years preceding the plaintiff’s entry to work for the defendant. The court decided to recognize as illegal the employer’s refusal to sign a report on a case of occupational disease and ordered the defendant to sign it (decision of the Kireyevsky District Court of the Tula Region dated 06/01/2011; cassation ruling of the Tula Regional Court dated 07/28/2011 in case No. 33-2540).

Dispute about illegal dismissal

If illness forced an employer to dismiss an employee, the latter can challenge this. Especially if there was no reason for dismissal.

Judicial practice

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The employee appealed to the court with a request to recognize illegal dismissal according to clause 5, part 1, art. 83 of the Labor Code of the Russian Federation (recognizing an employee as completely incapable of labor activity in accordance with a medical report issued in the manner established by federal laws and other regulatory legal acts of the Russian Federation). The court found that, in accordance with the medical report issued to the plaintiff, she was contraindicated from working in her position, but a complete and permanent loss of ability to work was not recognized. In this regard, the court declared the dismissal illegal, reinstating the employee at work (appeal ruling of the Rostov Regional Court dated November 6, 2014 in case No. 33-14749/2014).

Disputes with the Federal Insurance Service of the Russian Federation regarding the assignment of insurance payments

This type of dispute differs from others cited in the article in that the participant in the dispute, in addition to the employee and the employer (the latter, as a rule, acts as a third party), is also (as a defendant) the FSS of the Russian Federation.

Judicial practice

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The plaintiff filed a lawsuit against the branch of the Federal Social Insurance Fund of the Russian Federation, asking that the fund’s refusal to provide insurance payments in connection with an occupational disease be declared illegal, oblige it to assign these payments and collect a lump sum from the defendant in its favor. insurance payment. In support of his claims, he referred to the fact that while working at the OJSC he received an occupational disease, about which the employer drew up a corresponding report, but the defendant illegally did not recognize this case as insured and, as a result, refused to assign insurance payments.

The court did not recognize the existence of grounds for refusing to assign insurance payments, since the fact that the plaintiff had an occupational disease was confirmed by appropriate documents. In connection with the above, the employee’s demands were satisfied (decision of the Tverskoy District Court of Moscow dated May 20, 2014, appeal ruling of the Moscow City Court dated October 6, 2014 in case No. 33-26501/2014).

Disputes are usually resolved in favor of the employees. Therefore, it is in the employer’s interests to reduce any negative factors, which can lead to allergies in employees.

A decade and a half ago, the Federal Archive Service of Russia acquired its own holiday - Archive Day, which has since traditionally been celebrated on March 10. Archival service workers are people who are familiar with allergies to archival dust firsthand. It’s not for nothing that from the 1970s to the 1990s they were even given milk “for being harmful.”

However, not only archivists suffer from “paper allergy”. Paper is present in our lives in huge quantities and in the most various types. And if you have an allergy, but the cause is unknown, you should take a closer look at the world around you - maybe it’s all about paper sources of allergens. MedAboutMe understands the allergy risks and dangers of plain paper.

Where does paper allergy come from?

An allergy is the body's excessive sensitivity to certain substances. The immune system of an allergy sufferer sees them as a threat. When first meeting a substance that the body considers an allergen, this reaction is not yet noticeable. At this stage, sensitization to this substance occurs: antibodies are produced or lymphocytes activated to specific antigens are formed. From this moment the body is “ready” to meet the allergen. As soon as this happens, it starts a whole series events - enzymes are activated, histamine, serotonin, prostaglandins and other allergy mediator substances are released, specific cells of the immune system are formed. A person sneezes, breaks out in a rash, and in worst cases begins to choke and may even die if he is not helped in time.

Of course, the paper itself is not an allergen, as such. Allergies develop to proteins, to glycoproteins (compounds of proteins with carbohydrates) and, less commonly, to certain substances (for example, certain metals). Paper consists of cellulose, and there is no allergy to cellulose - just as there is no allergy to poplar fluff (which is, in fact, cotton, that is, the same cellulose). But there is an allergy to various proteins that settle on paper (and on poplar fluff). These proteins most often do not float in the air by themselves, but are part of, for example, plant pollen - and here is the answer to “fluff allergy”, or are components of the feces of dust mites - miniature creatures ranging in size from 0.1 to 0.25 mm. It is in the proteins contained in their bodies and in waste products that the secret of allergy to dust, including archival dust, lies.

Book runny nose

Old books, which have been kept in unventilated areas for decades, out of sunlight and often in high humidity, are an ideal environment for dust mites living on them. Feces and particles from the bodies of the dead inhabitants of the books, along with dust, enter the human respiratory system, which leads to the development of an allergic reaction.

Most often it manifests itself in the form of a runny nose with watery eyes, frequent sneezing and increased production mucus in the nasal cavity. When similar symptoms You should leave the room with old books and minimize such contacts in the future. Continuing to work in such conditions can cause the development of chronic bronchial asthma.

For bibliophiles who keep old books at home, librarians whose work is related to archives, and other people who are forced to come into contact with archival dust, doctors recommend using respirators and disposable gloves. If possible, rooms where books are stored should be regularly dusted and ventilated. The lower the dust concentration, the lower the risk of allergies.

Allergy to new books and documents

For most book lovers, the smell of printing ink is an exciting aroma that speaks of the anticipation of reading a freshly purchased publication. But there are people who love to read, but are in no hurry to inhale the smell of a new book. The reason is an allergy to printing ink. Employees of printing houses themselves are in the high-risk group. Microscopic paint particles penetrate into respiratory tract and trigger a chain of reactions that result in an allergy. That is, in this case, we are not talking about the paper as such, but about what is applied to it.

In the same way, there is no allergy to office paper - there is nowhere for dust to come from, a freshly opened pack in a large office “flies away” within a few days. The paper itself, if it is not impregnated with flavors and dyes, does not contain any allergenic components. But printers and copiers that require paper to operate can actually cause an allergic reaction.

It's the toner. Like printing ink, its microscopic (3-4 microns) particles can cause allergies in some people, as they contain:

heavy metals (nickel, chromium, copper, aluminum, etc.), volatile compounds (benzene, phenol, toluene, etc.), tin compounds dangerous to the body, etc.

Substances such as nickel are allergens, and organotin compounds have a depressant effect on the immune system.

Hypoallergenic paper

The word “hypoallergenic” can often be found on toilet paper packaging - this is how manufacturers assure customers that their paper will definitely not cause allergies even when used in the most intimate way. What does this mean? Only that it is just paper - without dyes, without fragrances or fragrances. When purchasing, you just need to check the integrity of the packaging. There is nothing more special about hypoallergenic paper, as we indicated above - the paper itself, as such, cannot cause allergies.

Allergy to money

This is perhaps the most annoying allergy for a working person. Moreover, it manifests itself upon contact with both paper money and coins. This means that the problem is in the metal particles that are used in the production of both types of money - most often it is nickel. Its particles are so small that they can penetrate the upper layers of the skin upon contact with banknotes and change the configuration of some skin proteins. And these altered proteins are perceived by the body as foreign, that is, they become allergens. As a result, an allergic skin reaction develops - a rash on the hands, irritation, redness of the skin. People who are allergic to money have to use plastic cards.

What to do?

First, you need to accurately determine that this is an allergy, and not a random runny nose. You should monitor yourself and the symptoms of the disease. So, an allergic person only needs to spend half an hour in a potentially dangerous room and the symptoms will begin to appear. But as soon as you leave the room, the condition will improve within a short time. With a normal runny nose, changing the room will do nothing. You can also give the suffering person an antihistamine. If it's an allergy, the improvement will come instantly.

If a person suffers from an allergy, but cannot understand where it came from, the allergens - the cause of the disease - should be determined. To do this, you need to contact an allergist and undergo skin tests or a blood test to identify the allergen.

And then it’s possible that you’ll have to make a choice: change jobs and maintain your health, or stay in your job. same place, fighting with invisible enemies. Few people agree to wear a respirator, gloves and fight with colleagues for regular ventilation of the room. But as a result of constant exposure to allergens on an organism sensitized to them, even while taking antihistamines, the situation will worsen over time. So you still have to make a choice - and it’s better to take care of it before the body’s condition worsens.

Take the testIs your child prone to allergic diseasesIs your child prone to allergic diseases and what is the allergen? Take the test and find out what your child should avoid and what measures to take.

ONE CURIOUS medieval doctor, watching a worker clean out his drain very quickly, asked a very obvious question: why is he working so fast? The worker responded that spending long periods of time in such a harmful environment irritated the eyes and could cause blindness.
So in the late 1600s it was noted key point at birth professional health. The Italian physician Bernardino Ramassini continued to research diseases commonly found in various professions, including artists, rural workers, fishermen, caring for the sick, involved in food processing.

Some 300 years later, the same occupations still figure prominently in lists of jobs that can cause allergic conditions, such as skin rash, runny nose, itchy eyes, asthma and anaphylaxis.
Many workplaces use substances that can irritate the lungs, nose, skin, eyes, or enter the body causing an immune system reaction. There are at least 250 substances known to cause occupational asthma, and the list of usual suspects grows every year as more culprit products are identified.

Some occupations are known for specific ingredients that make most workers sick. Chemicals called di-isocyanates, which are used in aerosol paints in the production of plastics and polyurethane products are the leading cause of occupational asthma in industrialized countries. Latex products cause many nurses, doctors and other healthcare workers to develop allergic reactions ranging from skin irritation to life-threatening shock.
And an enzyme used in the detergent was blamed for an epidemic of asthma among workers who handled the material in the 1960s and 1970s.

If allergens or irritants are used in your work, the solution may vary. In some cases, it is enough to use a mask, gloves and other protective equipment to protect yourself from exposure harmful substances. If your exposure to this allergen or irritant is significant, you may have to convince your employer to transfer you to another location or company.

But for many sick people, exposure to an allergen or irritant can be simply life-threatening. The best health solution is to simply avoid exposure to the harmful substance. This may mean that if your employer is unable or unwilling to make accommodations that would prevent allergy symptoms, then you may have to find a new job.
This may be a difficult decision, but the problem cannot be ignored.
Luckily, a doctor with good research skills can help identify what's making you sick. And you can do a lot to protect your health by taking notes, working carefully, collecting important information about your workplace and supporting good relationship with your employer.

Main players

Look at how your job can contribute to the major allergic conditions: asthma, skin problems and allergic rhinitis, and you will see how complex workplace allergies can be (for more detailed information on these diseases, see their sections).

As a sawmill operator saws through a tree trunk amid a downpour of sawdust, he feels the familiar tightness in his chest of an approaching asthma attack.
If the workplace creates breathing problems, it is as important an issue as salary and should be taken very seriously.
There are several cases of people dying from occupational asthma after it was diagnosed. Worldwide, at least 10 percent of asthma cases that affect adults can be linked to the workplace. This includes before healthy people those who acquired asthma at work, and those who had this disease and aggravated it under the influence of harmful substances to which they were exposed during work. Both of these situations pose health risks and should be considered with medical point vision.

Sometimes asthma occurs due to an allergen. It usually takes months or years of exposure before symptoms of the disease begin to be felt because immune system It takes time for the body to develop an allergic reaction. This is the type of situation that exists among veterinarians who become allergic to cat dander and sawmill workers who develop asthma from wood dust.

Asthma symptoms may appear an hour after you are exposed to the allergy trigger and disappear within 1 to 3 hours after it is removed, or it may take several hours for symptoms to come and go. Creating additional nuisance, symptoms may return 12 hours after you have recovered from your initial encounter.
But asthma in the workplace is not always caused by allergens. Irritants such as hydrochloric acid and sulfur dioxide can cause wheezing immediately after you encounter them. The reaction that occurs after you inhale large amounts of an irritant, such as toxic fumes or gases from a leak, is called RADS, or reactive airway dysfunction syndrome. This can have long-term consequences, keeping you out of action for a long time.
Another cause of asthma is inhalation of certain aerosolized chemicals, such as large quantity insecticides used in agriculture, which cause natural substances histamine and acetylcholine to be produced in the body and constrict the airways.

Several factors increase the chances of getting work-related asthma. Atopicity, or predisposition to the presence of allergic diseases, is an increased risk factor. Smoking also increases the likelihood of developing work-related asthma, worsens it if you already have it, and creates additional problems in proving a work-related asthma link.

If your asthma is truly work-related, you will likely notice that your asthma symptoms increase during the week and decrease on the weekends. But problems can persist throughout the weekend, becoming almost continuous (which makes it difficult to find the source).

Skin problems

After a hairdresser gives a client a perm, his hands break out in an itchy rash.
Occupational skin diseases affect up to 20 percent of people with occupational diseases. Of all skin problems, by far the most common is contact dermatitis caused by irritants and allergens (3/4 of cases).
The most common patients of allergists are hairdressers, who, due to the nature of their work, often come into contact with water and chemicals, bartenders and food handlers, who often immerse their hands in soapy water.
Water and soap are sources of irritant contact dermatitis, as are solvents, resins, fats, glass fibers, acids and alkalis. Allergic contact dermatitis can be caused by components of cosmetics, rubber and epoxy resins, poison ivy and oak. Some substances can act as both irritants and allergens.

Irritant contact dermatitis is detected within minutes to several days after exposure to a harmful substance. The boundaries of the rash are often sharply defined, and then it completely disappears within 4 days.
Allergic contact dermatitis, however, only affects people who have already become sensitive to the substance. They experience severe itching and red, fluid-filled blisters may appear on the affected area. The rash, which is not definitely caused by irritants, may appear 1-6 days after exposure to the harmful substance and will take at least a week to resolve.

Another skin condition that may be caused by the work environment is urticarial rash, or urticaria. It occurs within a period of time from several minutes to an hour after contact with a harmful substance and disappears within a few hours. It can be caused by latex and foods such as seafood, fruit and cheese.
The risk group of people most susceptible to these skin diseases are people with atopic dermatitis, a condition in which the skin is extremely sensitive and overreacts to substances it comes into contact with. If you've ever had atopic dermatitis, even as a child, think twice about working as a hairdresser or cook, where wet hands will frequently come into contact with irritants and allergens.

Allergic rhinitis

A graduate student sneezes as she examines the itchy eyes of the lab rats in the cages surrounding her.
Lab rats used for experiments often take “revenge” on the white-coated workers who surround them. Laboratory workers are one of the groups most often affected by work-related rhinitis, and rats are the most common source of allergens.
Allergic rhinitis, more commonly known as hay fever, causes symptoms such as a runny and swollen nose, sneezing, itchy palate, watery eyes and itchy eyes. It can be caused by allergens, irritating odors (such as perfume), fumes and particles (cigarette smoke, coal dust and emissions of concentrated chemicals such as chlorine).
Of course, this is not just a problem for laboratory workers. Psullium, an ingredient in laxative medications, can cause rhinitis in pharmacists who prepare the medicine and in nurses who administer it to patients. Guar gum used for thickening food products and coloring of carpet fibers, can cause rhinitis in workers.

Although rhinitis is also a work environment condition, it has not received as much attention as asthma, perhaps because it is not as severe and potentially dangerous disease. Because rhinitis really causes unpleasant symptoms and may appear before or along with asthma, certain measures must be taken if it appears.
If your rhinitis is work-related, you'll likely notice symptoms at work, but they may continue into the evening as your body takes time to respond to allergens and irritants. And at the time when you feel better, i.e. On weekends and holidays, mild symptoms may continue for several more days before finally disappearing.
Now that we know how work-related allergies manifest themselves, it's time to learn what to do about them.
It's hard work.

Show professional allergies who's boss

As you've learned in this book, living an allergy-free lifestyle requires a bit of detective work. And if you want to overcome workplace allergies, then curiosity, observation and communication skills can play a determining role in how successful you are.
In this chapter, experts will share confidential information about how to work with your doctor, employer, and workers' compensation system to get what you need.

Your doctor

Bernardino Ramassini, the founder of professional medicine mentioned earlier, often visited his patients' workplaces, no matter how unpleasant they were. And modern experts emphasize the importance of doctors visiting workplaces to make observations and conclusions.
IN real world however, convincing a busy doctor to come to your workplace is about as likely as getting the company to compensate you for a sore foot at the end of the day. Although occupational skin conditions are very common, most doctors don't want to deal with them because they make twice as much money solving cosmetic problems.
While an allergist is a good option for treating any of these conditions, a dermatologist may be best choice for skin diseases, pulmonologist - for lung problems, and an otolaryngologist - for rhinitis. You can also contact an occupational health professional for additional expertise to help address the problem in your situation. Since time is valuable, the more information you bring to the doctor's office, the better.

Here's what you need to collect:
your story. The more documentation the patient brings, the faster and better the doctor can make an assessment. Provide the doctor with detailed information regarding previous illnesses, any allergies in the family or yourself, medications taken or used, and bad habits, for example about smoking. Also include full descriptions existing and previous job responsibilities and characteristics of the workplace environment;
diary. Make very detailed notes on your work schedule and symptoms, including whether they occur at work or when you are not at work. This will help determine how symptoms arise and may even show that you are allergic to something unrelated to your work;
MSDS. This is an acronym for “Contained Material Data Lists.” Companies that use some chemicals, are legally required to have lists that describe the substances used and suggest available information By safe methods working with them. Not only should you use them and learn how to handle any chemicals present at work, you need to take them to the doctor. These lists are important to understand the nature of the chemicals you handle at work, understand their potential adverse health effects, and provide recommendations for protection. If you suspect you have a health problem, bring the MSDS to your doctor so he can become familiar with the chemicals and their properties. Many high-tech industries use a myriad of agents that would not be suspected if MSDS were not available.

Depending on the specific circumstances, the doctor will use the information you provide, a physical examination, and possibly a variety of tests to pinpoint the source of the allergen.

Asthma. Your doctor may do a skin test to see if you are allergic to proteins such as animal dander or soy. When uncertain bronchial disease you may need to be tested for asthma by inhaling histamine or methacholine to determine how much your lungs react to them.

The doctor may also ask you to use an airflow meter - an inexpensive, simple device that is small in size and therefore suitable for testing at home and at work and recording the results.
The gold standard for proving occupational asthma, however, involves exposing you to certain suspected substances and observing your response to them. This, however, requires special equipment and medical professionals who can help if it occurs. acute reaction on the substance.

Skin problems. Your doctor can test your exposure to many possible allergens by applying them to your skin and covering them with a bandage. Since all standard allergen test kits available may not be exhaustive, you may need to bring samples of each suspected substance you encounter on the job.

Rhinitis. The doctor may do a skin test to see if you are allergic to specific proteins. In a simple test called a nasal challenge, the doctor will expose your nose to a suspected substance, then examine the surfaces of your mucous membranes to look for any changes, and perhaps take measurements of the air flow through your nose.
The single best solution to nipping an occupational allergy in the bud is to avoid exposure to the offending substance. Simply treating your symptoms with medication only masks a bad situation, and in the case of asthma, exposure to a large number of triggers can have fatal results.

Given your individual circumstances, you may not have to leave your job and look for another. Instead, you can change the type of work you do with your employer to make it suitable for your health.
Since many of us have environmental constraints, it is necessary to work closely with observers to find the right solution.

Your employer

If the doctor can prove that a substance you come into contact with at work is harmful to your health, ask him to report this to your employer, along with a recommendation on what type of changes are needed. In this case, the employer must do something to help make the necessary changes, but not necessarily the ones you would prefer. This means that, as an entrepreneur, he can think of a cheaper or any less onerous way to fulfill the requirements that he is obliged to fulfill. Some laws can help you with this.
But not all potentially harmful substances are regulated. Levels of chemicals known as isocyanates are regulated, but the amount of dust from wheat flour, which causes asthma in bakers, no. Moreover, the regulations are designed to protect workers in general rather than the individual worker with his or her specific need.

Regardless of whether you have legal support, your requests will be more listened to if you become an ally of the labor watchdog instead of being seen as their opponent. Do not contact a lawyer right away; involving a lawyer in solving a problem from the very beginning can create an adversarial situation that will not contribute to obtaining the desired result.
The next best solution may be administrative control, as a result of which the sick person is moved to another production environment. This could mean shorter hours, doing a different job, or doing the same job in a different location. For example, lab workers who are sensitive to mice usually react to protein in their urine and may perform necropsies on the animals while away from the urine-soaked cages.

The choice that doctors least approve of, but which employees must often make because it is easiest for employers to make, is that workers wear protective equipment, such as a mask or respirator to avoid breathing in dust, or wear gloves to hold hands dry. The employer retains the right to permission voluntary use masks. Sometimes masks are complex, requiring filters or cartridges to be replaced regularly.
No matter what the employer chooses, they will have many potential reasons to try to give you a job. The cost of the compromise may be less than the cost of finding and training a new employee. Plus, if the employer understands that you will have good conditions job, he won't want to risk time and workers' compensation money, and he's better off with healthy workers, Dr. Riscitelli says.

Due to the widespread implementation chemical technologies into production, the organization of factories producing protein concentrates and additives, the development of the pharmaceutical industry, etc. the number of patients suffering from allergic diseases associated with one or another production has increased. True, cases of bronchial asthma have long been known in flour millers, fur workers and leather production, woodworking factories.

The influence of production conditions on the occurrence of the disease, the pathogenesis of the disease and its clinical picture in each individual case may be different, however, in each production the development of an allergic disease has its own characteristics.

CONTACT DERMATITIS

Most often, dermatitis occurs in people who work with formaldehyde, chromium, mercury, turpentine, antibiotics, glue, and dyes. The clinical course of contact dermatitis is characterized at the onset of the disease by damage to the skin itself - hyperemia and swelling. Later, symptoms of damage to the deeper layers of the skin appear - blisters form that burst, wet yellow scabs appear, that is, eczematization occurs. When large confluent blisters with a large area of hyperemia appear, even I or II degree burns can be assumed.

U individuals dermatitis immediately takes on a papular-infiltrative character with severe itching, with sharply limited edges. IN chronic phase The clinical picture of the disease is no different from non-occupational contact dermatitis; it can only be the location, i.e., damage to those areas of the skin that are exposed to aggressive hazards (hands, face and other exposed parts of the body). Often, such dermatitis is accompanied by damage to the mucous membranes of the eyes, nose, and oral cavity.

Edema on the eyelids and dyshidrosis of the palms and soles are also observed. Features of occupational contact dermatitis are sudden onset and frequent recurrence upon resumption of work. In the future, due to constant itching, scratching and superinfection occur, and with continued exposure to the allergen due to its spread through the affected skin by the lymphohematogenous route, symptoms may occur general- fever, malaise, weakness, etc.

By clinical picture contact dermatitis, it is not always possible to resolve the question of what allergen it is caused by, since allergens that are different in nature can cause the same clinical manifestations. Questions etiological diagnosis for occupational dermatitis are very relevant, however skin tests in such patients it is not always possible to carry out due to the risk of causing an exacerbation. Detection of antibodies is also not possible, since they do not have freely circulating antibodies, therefore a correctly collected anamnesis, data on the course of the disease and the presence of an elimination factor are sometimes decisive for correct diagnosis.

Prognosis for professional contact dermatitis favorable - when timely diagnosis, elimination of occupational hazards (transfer to another job), proper treatment. True, often, despite all the measures, dermatitis, having arisen due to occupational hazards, can continue and full recovery does not occur. This indicates the existence of complicating factors (other chronic diseases, polyvalency, superinfection, improper treatment).

Prevention is based on general and individual means protection when working with industrial hazards. In addition to these measures, people with a predisposition to allergies and skin dysfunction should avoid working in chemically and biologically hazardous industries. Preliminary determination of suitability is also desirable. of this person to work with a particular substance, carry out an appropriate test.

HURTICS AND ERYTHEMA

Occupational urticaria is much less common. The causes of urticaria and erythema can be chemical, physical and biological.

Chemical causes most often cause urticaria and erythema in persons associated with pharmaceutical industry, nurses, pharmacy workers. There are known cases of urticaria due to morphine, arnica, ipecac, mercury preparations, penicillin, novocaine, phenol, ammonia, as well as herbal remedies - thuja, rhododendron, nettle, tobacco and oils; on biological drugs- anti-tetanus serum, influenza vaccines, etc.

From physical factors, causing urticaria and erythema, the action of high and low temperatures should be called. Workers at ceramic factories and steel smelting shops often experience extensive erythema and urticaria at high temperatures, and traffic police officers at low temperatures. Biological factors that cause urticaria and erythema include dust, animal hair (veterinarians), insect bites (loggers, beekeepers), contact with fish, jellyfish (ichthyologists, fishermen), etc.

BRONCHIAL ASTHMA

Bronchial asthma associated with occupational hazards is heterogeneous. A. E. VERMEL (1966) distinguishes 3 groups of occupational bronchial asthma:

caused by sensitizing substances (primary asthma);
caused by substances that irritate the local respiratory tract, leading to chronic bronchitis and only then to bronchial asthma (secondary asthma);
caused by sensitizers that simultaneously have a local irritant effect.

Occupational bronchial asthma occurs when inhaling dust, smoke, vapors various substances. Very rarely, bronchial asthma occurs when harmful substances enter through gastrointestinal tract when tasting cheeses, coffee, tea, wines, etc.

Occupational bronchial asthma has some distinctive features depending on the nature of occupational hazards. IN different terms From the beginning of contact with occupational hazards, the first attack of bronchial asthma may occur.

Sometimes bronchial asthma occurs in people without any other manifestations of allergies, but is more often combined with the presence of eczema, dermatitis, rhinitis, angioedema, etc. in the patient. Often the cause of bronchial asthma and other manifestations of allergies are the same occupational allergens.
Asthma attacks occur at different times, but more often at work, at the end of a shift, after some exposure to an industrial allergen.

At the beginning of the disease, attacks of suffocation are not severe, they are relieved if you leave the production premises, but over time the attacks become more severe, and coughing attacks with the release of thick viscous sputum are disturbing. Later attacks are caused by other factors, excitement, weather changes, etc.
In cases where occupational asthma does not arise as primary disease, and against the background of a chronic pathological process in the bronchopulmonary apparatus (silicosis, pneumoconiosis, bronchitis), the period before the development typical attacks quite long.

Asthmatic phenomena develop in such patients gradually, against the background of previous bronchitis and constant cough. In cases of secondary asthma, connections with occupational hazards are difficult to establish, since attacks also occur outside of work, during vacations, etc. In these cases, the primary chemical or mechanical damage bronchial mucosa leads to the development of occupational bronchitis, on the basis of which bronchial asthma develops secondarily, often an infectious-allergic form.

EXOGENOUS ALLERGIC ALVEOLITIS

It is especially necessary to highlight a group of diseases associated with damage lung tissue immune mechanisms under the influence of exogenous allergens - fungal spores, protein antigens. Since exogenous allergic alveolitis is associated with inhalation of certain occupational allergens, they have names corresponding to the profession, for example, “farmer’s lung,” “furriers’ lung,” “coffee grinders’ lung,” “pigeon breeders’ lung,” etc.
Currently, more than 20 professions are known in which exogenous alveolitis occurs, which is based on immunological mechanisms (the “allergen-antibody” reaction).

A feature of these mechanisms is the formation of precipitating antibodies, which, combining with the allergen, form immune complexes that settle in the walls of the alveoli and small bronchi. Deposition immune complexes promotes increased permeability vascular wall. During allergic exogenous alveolitis, all 3 types of allergic reactions can be traced (see Chapter 2).

People predisposed to allergic reactions develop exogenous pulmonary alveolitis after prolonged contact with an allergen. The course of the disease can be acute, subacute and chronic. Sometimes alveolitis occurs periodically in the form of acute outbreaks when inhaled large doses allergen (cleaning the dovecote, sorting rotted hay, working at the mill).
In the acute form, the disease is often interpreted as pneumonia, since there is an abundance of physical findings (moist, fine-bubble rales), increased ESR, and leukocytosis.

During the course of the disease, lung tissue develops irreversible changes associated with the formation of granulomas and scarring, which lead to the development of pulmonary fibrosis.

In acute and subacute stages the use of glucocorticoid hormones is indicated. Prevention consists of preventing contacts of patients with the corresponding allergen (change of profession). Chronic form exogenous allergic alveolitis is difficult to treat; symptomatic therapy is usually carried out.