industrial allergies. Allergens of infectious origin

Allergensare antigens that cause allergies. The properties of allergens under certain conditions can acquire factors of a diverse nature, in the first place - all high and low molecular weight 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 complete antigens(synthetic polymeric materials, components of varnishes, resins, adhesives, elastomers, cements, compounds, etc.).

In industry, a worker also encounters 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 allergy 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 correspond to non-professional allergies: hypersensitivity, manifested in reactions of an immediate type, delayed type, antibody-dependent cytotoxicity, immunocomplex 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 way the allergen enters the body, as a rule, determines the form of the occupational allergic disease. With inhalation, allergic diseases of the respiratory organs develop, with admission through the skin - skin diseases. Prolonged 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 a professional

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

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

Of particular importance in the development of allergic reactions are the effects of irritation of the mucous membranes of the respiratory tract and

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

The phenotype of allergic diseases is fundamentally different from the forms of a healthy body's response to industrial allergens and, first of all, in that the sensitization reaction develops against the background of the functional activity of the T-or T- and B-systems of immunity.

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

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

others

Main way prevention of occupational allergic diseases- hygienic regulation of allergens in the air of the 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, the identification of persons with a genetic or acquired predisposition to allergic reactions and the formation of risk groups.

At present, specialized allergological examinations of industrial workers are carried out by scientific research institutions. In accordance with the prospective program for the medical examination of workers, work should be intensified to

training of allergologists, 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, treatment and preventive elements and sanitary and educational work.

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

First, let's look at what an allergy is. An allergy is an increased sensitivity of the body to a substance, characterized by various manifestations. Local symptoms include:

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

Almost any substance (paint, varnish, cement dust), a plant (allergy to weeds, flowering plants), fumes (gas, oil), compounds, etc. can become an allergen. 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 he 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 are harmful working conditions at work. In accordance with par. 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 to only provide employees working in such conditions with increased guarantees and compensation, for example, in the form of the maximum allowable duration of daily work (shift) with reduced working hours at work in hazardous 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 hiring in hazardous conditions (passing preliminary and then periodic medical examinations, Articles 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 an allergy

The easiest consequence of an allergy for a worker is a slight malaise, expressed in sneezing and coughing, i.e. such manifestations that, in general, do not interfere with the work or make it slightly difficult. Such indisposition does not lead to temporary disability of the employee. But more serious consequences are possible:

The employer should also not forget about the increased guarantees and compensations associated both with the establishment, based on the results of a special assessment of harmful working conditions at the employee’s workplace, and with the confirmation of an occupational disease by a medical certificate in an employee and / or the establishment of his 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 the acquired disease for the labor process may be the termination of the employment contract with such an employee, both at 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 at the initiative of the employer. In the second case, dismissal is possible under paragraph 8 of part 1 of Art. 77 of the Labor Code of the Russian Federation in connection with the employee’s refusal to transfer to another job, which is necessary for him in accordance with a medical certificate issued in the manner prescribed by federal laws and other regulatory legal acts, or the employer’s lack of appropriate work (parts 3 and 4 of article 73 TC RF). However, we recall that until the confirmation of an occupational disease and the receipt of an appropriate medical certificate, according to which the employee is recognized as in need of transfer 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 of the Labor Code of the Russian Federation.

Disputes with employees

One of the most negative consequences of identifying an occupational disease in a worker associated with an allergic reaction to substances with which the worker is forced to work day after day is litigation. Let's take a look at some examples of what can be their subject, what claims employers usually face and what court decisions they most often have to deal with.

Disputes about 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.

Arbitrage practice

Collapse Show

The employee filed a lawsuit against the employer for the recovery of a one-time 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 causing harm to health as a result of an occupational disease is confirmed by the materials of the case, including an act on the case of an occupational disease, according to which the cause of the occupational disease of the plaintiff was work in conditions of prolonged exposure to the worker's body of harmful production factors. According to the collective agreement, in the event that for the first time an employee has been diagnosed with a loss of professional ability to work due to an industrial injury or an occupational disease, the employer ensures the payment of a one-time compensation at the rate of at least 20% of the average monthly earnings for each percentage of the loss of professional ability to work (taking into account the amount of the lump-sum allowance paid from the FSS RF). Considering the employer’s failure to comply with this condition, the court ordered the defendant to pay compensation to the plaintiff (decision of the Gukovsky City Court of the Rostov Region dated August 28, 2014, appeal ruling of the Rostov Regional Court dated December 8, 2014 in case No. 33-16493 / 2014).

Disputes about paperwork

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

Arbitrage practice

Collapse Show

The employee filed a lawsuit against the employer to recognize as unlawful the employer's refusal to sign the act on the case of an occupational disease. The court found that the plaintiff had developed an occupational disease - bronchial asthma, allergic and non-allergic. Based on the results of the established commission, an act was drawn up on the investigation of the disease, signed by the deputy head of the department of the Office of Rospotrebnadzor for Moscow, approved by the chief state sanitary doctor of Moscow. At the same time, the employer refused to sign the act, referring to the lack of information about the plaintiff's state of health in the twenty years preceding the plaintiff's employment with the defendant. The court decided to invalidate the employer's refusal to sign the act on the case of an occupational disease and ordered the defendant to sign it (decision of the Kireevsky 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).

Wrongful dismissal dispute

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

Arbitrage practice

Collapse Show

The employee applied to the court with a request to recognize the dismissal under paragraph 5 of part 1 of Art. 83 of the Labor Code of the Russian Federation (recognition of an employee as completely incapable of working in accordance with a medical certificate issued in the manner prescribed 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 prohibited from working in her position, but she did not recognize a complete and permanent loss of her ability to work. 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 FSS of the Russian Federation on the appointment of insurance payments

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

Arbitrage practice

Collapse Show

The plaintiff filed a lawsuit against the department of the FSS of the Russian Federation, asking that the fund's refusal to assign insurance payments due to an occupational disease be recognized as illegal, to oblige it to assign these payments and collect a lump-sum insurance payment from the defendant in its favor. In support of his claims, he referred to the fact that during the period of work at the OJSC he received an occupational disease, about which the employer issued a corresponding act, but the defendant illegally did not recognize this case as insurance 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 claims 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 employees. Therefore, it is in the interests of the employer to reduce any negative factors that may lead to the formation of allergies in employees.

A decade and a half ago, the Federal Archival Service of Russia acquired its own holiday - the Day of Archives, which has traditionally been celebrated on March 10 since then. Archival service workers are people who are familiar with allergies to archival dust firsthand. No wonder from the 1970s to the 1990s they were even given milk "for harmfulness."

However, it is not only archivists who suffer from “paper allergy”. Paper is present in our lives in huge quantities and in a wide variety of forms. And if there is an allergy, but the cause is unknown, you should take a closer look at the world around you - maybe it's all about the paper sources of allergens. MedAboutMe understood the allergic risks and dangers of plain paper.

Where does paper allergy come from?

An allergy is an excessive sensitivity of the body to certain substances. The immune system of an allergic person sees them as a threat. At the first acquaintance with a substance that the body has considered an allergen for itself, 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 on, the body is “ready” to meet the allergen. As soon as this happens, a number of events are triggered - enzymes are activated, histamine, serotonin, prostaglandins and other allergy mediators are released, specific cells of the immune system are formed. The person sneezes, breaks out in a rash, and in the worst cases begins to choke and may even die if he is not treated in time.

Of course, the paper itself is not an allergen per se. Allergy develops to proteins, to glycoproteins (compounds of proteins with carbohydrates) and less often to certain substances (for example, to certain metals). Paper, on the other hand, consists of cellulose, and there is no allergy to cellulose - just as there is no allergy to poplar fluff (which, in fact, is 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 hover in the air on their own, but are part of, for example, plant pollen - and here it is the key 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 the waste products of life that the secret of allergy to dust, including archival dust, lies.

book runny nose

Old books that have been in unventilated rooms for decades, out of sunlight and often in high humidity, are an ideal environment for dust mites to live on them. Feces and body particles of dead book dwellers, along with dust, enter the respiratory organs of a person, 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 of mucus in the nasal cavity. If such symptoms appear, you should leave the room with old books and minimize such contacts for the future. Continued work in such conditions can cause the development of chronic bronchial asthma.

Doctors recommend that 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, use respirators and disposable gloves. If possible, rooms where books are stored should be regularly dusted and ventilated. The lower the concentration of dust, the lower the risk of allergy.

Allergic to new books and documents

The smell of printing ink for most book lovers is an exciting scent that speaks of the anticipation of reading a freshly purchased edition. 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. In the high-risk group are employees of the printing houses themselves. Microscopic paint particles enter the respiratory tract and start a chain of reactions, the result of which is an allergy. That is, in this case, we are not talking about paper, as such, but about what is applied to it.

In the same way, there is no allergy to office paper - there is nowhere to get dust 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 photocopiers that require paper to work can indeed cause an allergic reaction.

It's about 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 depress the immune system.

hypoallergenic paper

The word "hypoallergenic" can often be found on toilet paper packages - this is how manufacturers assure buyers that their paper will definitely not cause allergies in the most intimate use of it. What does this mean? Only that it's just paper - no dyes, no fragrances and flavors. When buying, you should only check the integrity of the package. There is nothing more special in hypoallergenic paper, as we indicated above - the paper itself, as such, cannot cause allergies.

allergy to money

This is perhaps the most offensive allergy for a working person. Moreover, it manifests itself in contact with both paper money and coins. And this means that the matter 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 already these altered proteins are perceived by the body as foreign, that is, they become allergens. As a result, a skin allergic 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 an occasional runny nose. You should monitor yourself and the symptoms of the disease. So, it is enough for an allergic person to spend half an hour in a potentially dangerous room - and the symptoms will begin to appear. But it is worth leaving the room - and within a short time the condition will improve. With the usual runny nose, changing the room will not work. You can also give the suffering person an antihistamine. If it's an allergy, then the improvement will come instantly.

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

And then it is possible that you will have to make a choice: change jobs and maintain health or stay in the same place, fighting invisible enemies. Few people agree to put on a respirator, gloves and fight with colleagues for regular airing of the room. But as a result of the constant exposure to allergens on the body sensitized to them, even while taking antihistamines, the situation will worsen over time. So the choice will still have to be made - and it is better to take care of it before the condition of the body 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 the child should avoid and what measures to take.

ONE INQUISIOUS medieval doctor, watching a worker clean his drains very quickly, asked a very obvious question: why is he working so fast? The worker replied that spending a long time in such a harmful environment irritates the eyes and can cause blindness.
Thus, in the late 1600s, a key moment in the birth of occupational health was noted. The Italian physician Bernardino Ramassini continued to investigate diseases commonly found in various professions, including artists, rural workers, fishermen, caregivers, and food processors.

Some 300 years later, those same occupations still feature prominently on the list of jobs that can cause allergic conditions such as skin rashes, 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 response. At least 250 substances are known to cause occupational asthma, and the list of common suspects grows every year as more troublesome products are identified.

Some occupations are known for specific components that disgust most workers. Chemicals called di-isocyanates, which are used in spray paint in the manufacture 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 detergent was responsible for an epidemic of asthma among workers who worked with the material in the 1960s and 1970s.

If allergens or irritants are used in your work, the solution may be different. In some cases, it is enough to use a mask, gloves and other protective equipment to protect yourself from exposure to harmful substances. If your exposure to that allergen or irritant is significant, you may need 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 life-threatening. The best health solution is simply to avoid exposure to the harmful substance. This may mean that if your employer is unable or unwilling to create devices that prevent allergy symptoms, then you may have to find a new job.
This may be a difficult decision, but the problem cannot be left unattended.
Fortunately, a doctor with good research skills can help identify what makes you sick. And you can do a lot to protect your health by taking notice, working carefully, gathering important information about your workplace, and maintaining a good relationship with your employer.

Main players

See how your work can contribute to the major allergic conditions: asthma, skin problems, and allergic rhinitis, and you'll see just how complex workplace allergies can be (for more information on these diseases, see their respective sections).

As a sawmill operator cuts a tree trunk amidst a shower of sawdust, he feels a familiar tightness in his chest from an approaching asthma attack.
If the workplace creates breathing problems, it is no less important than the salary, which must be taken very seriously.
There are several cases where people died from occupational asthma after it was diagnosed. Worldwide, at least 10 percent of asthma cases that affect adults may be workplace related. This includes both formerly healthy people who acquired asthma in the workplace and those who had the disease and were aggravated by harmful substances they were exposed to at work. Both of these situations pose a health risk and should be considered medically.

Sometimes asthma is caused by an allergen. It usually takes several months or years of exposure to a harmful substance before symptoms begin to be felt because the body's immune system takes time for an allergic reaction to occur. This is the type of situation that exists in veterinarians who become allergic to cat dander and sawmill workers who develop asthma from wood dust.

Asthma symptoms may appear up to an hour after you've been exposed to an allergy trigger and disappear within 1-3 hours after it's removed, or it may take several hours for the symptoms to come on and go. Adding to the nuisance, the symptoms may return up to 12 hours after you've recovered from the first encounter.
But workplace asthma 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 breathe in a large amount of an irritant, such as noxious fumes or leaking gases, is called RADS, or Reactive Airway Dysfunction Syndrome. This can have long-term consequences, putting you out of action for a long time.
Another cause of asthma is the inhalation of certain aerosol chemicals, such as small amounts of insecticides used in agriculture, which cause the 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 a predisposition to having allergic diseases, is an increased risk factor. Smoking also increases the likelihood of occupational asthma, exacerbates it if already present, and poses further challenges in proving work-associated asthma.

If asthma is indeed workplace related, you will probably notice that asthma symptoms increase during the week and decrease during the weekend. But the problems can persist throughout the weekend, becoming almost continuous (making it difficult to find the source).

Skin problems

After the hairdresser does a perm to a client, his hands are covered with 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 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, fiberglass, acids, and alkalis. Allergic contact dermatitis can be caused by ingredients in cosmetics, rubber and epoxy, ivy and oak poisons. Some substances can act as both irritants and allergens at the same time.

Irritant contact dermatitis is found within a few minutes to several days after contact with 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. A rash, which cannot be definitely said to be caused by irritants, may appear 1-6 days after contact with a harmful substance, and it will take at least a week for it to pass.

Another skin condition that may be related to the work environment is urticaria, or hives. 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, fruits, and cheese.
The risk group of people most susceptible to these skin conditions 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 often come into contact with irritants and allergens.

allergic rhinitis

A graduate student sneezes as she examines the itchy eyes of 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 commonly affected by work-related rhinitis, and rats are the most common source of allergens.
Allergic rhinitis, better 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 only a problem for laboratory workers. Psullium, a component of laxative medicines, can cause rhinitis in pharmacists who prepare the medicine and in nurses who give it to patients. Guar gum, used to thicken foods and dye 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. Since rhinitis does cause unpleasant symptoms and may appear before or with asthma, certain measures must be taken if it occurs.
If your rhinitis is workplace related, you will probably notice symptoms at work, but they may continue later in the evening as it takes time for the body to react to allergens and irritants. And at a time when you feel better, i.e. on weekends and holidays, flaccid symptoms may continue for several days before finally disappearing.
Now that we know how work-related allergic conditions manifest, it's time to learn what to do about them.
This is hard work.

Show professional allergies who's boss

As you have already learned in this book, an allergy-free lifestyle requires a certain amount of detective work. And if you're looking to deal with workplace allergies, curiosity, observation, and communication skills can play a role in how well you succeed.
In this chapter, experts share insider information about how to work with a doctor, employer, and workers' compensation system to get what you need.

your doctor

Bernardino Ramassini, the founder of occupational medicine mentioned earlier, frequented 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 the real world, however, convincing a busy doctor to come to your office is about as likely as getting compensation from the company for a sore leg 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 fixing cosmetic problems.
While an allergist is a good option for any of these conditions, a dermatologist may be the best choice for skin conditions, a pulmonologist for lung problems, and an otolaryngologist for rhinitis. You can also contact an occupational medicine specialist for additional expertise to deal with the problem in your situation. Since time is precious, 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 family and personal allergies, medications taken or used, and bad habits such as smoking. Also include full descriptions of current and previous job responsibilities and a description of the workplace environment;
a diary. Make very detailed notes about your work schedule and symptoms, including when they appear: at work or in your free time. This will help establish how the symptoms are occurring and may even indicate that you are allergic to something unrelated to work;
MSDS. It is an acronym for "safe material data lists". Companies that use certain chemicals are legally required to have lists that describe the substances used and offer accessible information on safe handling practices. Not only do you have to use them and learn how to handle any chemicals present at work, you need to show them to a doctor. These lists are important to understand the nature of the chemicals you handle at work, to understand their potential adverse health effects, and to make recommendations for protection. If you suspect that you have a health problem, bring the MSDS to your doctor so that he can familiarize himself with the chemicals and their properties. Many high-tech industries use a myriad of agents that would not be suspected if the MSDS was not available.

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

Asthma. Your doctor may order a skin test to see if you are allergic to proteins, such as animal dander or soy. For unspecified bronchial disease, you may need to be tested for asthma by inhaling histamine or methacholine to determine how overreacting your lungs are.

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, with results recorded.
The gold standard for proving occupational asthma, however, involves exposing you to certain suspected substances and observing how you react to them. This, however, requires special equipment and medical professionals who can help in the event of an acute reaction to the substance.

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

Rhinitis. Your 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 the mucous membranes for any changes, and possibly take measurements of airflow through the nose.
The single best solution to nip an occupational allergy in the bud is to avoid contact with the unpleasant substance. Merely treating your symptoms with medication only masks a bad situation, and in the case of asthma, exposure to too many triggers can be fatal.

Given your individual circumstances, you may not have to leave your job and look for another one. Instead, you can change the type of work with your employer to make it suitable for health reasons.
Since many of us have environmental limitations, it is necessary to interact more 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 tell your employer about it, along with a recommendation about what kind 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 burdensome 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 the chemicals known as isocyanates are regulated, but the amount of dust from wheat flour that causes asthma in bakers is not. In addition, the norms are designed more to protect workers in general, rather than the individual worker with his special needs.

Regardless of whether you have legal support, your requests will be heard more carefully if you become an ally of the labor watchdog instead of seeing them as opponents. Don't contact a lawyer right away, involving a lawyer in solving the problem from the very beginning can create a competitive position that will not help to get the desired result.
The next successful solution may be administrative control, as a result of which the sick person is moved to another working environment. This may mean a shorter working day, doing a different job, or doing the same job but in a different location. For example, lab workers sensitive to mice usually react to protein in their urine and can perform autopsies on animals away from urine-soaked cages.

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

Due to the widespread introduction of 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 a particular production has increased. True, cases of the occurrence of bronchial asthma in flour millers, workers in fur and leather industries, and woodworking plants have long been known.

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 working with formalin, chromium, mercury, turpentine, antibiotics, glue, dyes. The clinical course of contact dermatitis is characterized at the beginning of the disease by a lesion of the skin itself - hyperemia and edema. Later, symptoms of damage to deeper layers of the skin appear - bubbles form that burst, weeping yellow scabs appear, that is, eczematization occurs. With the appearance of large confluent blisters with a large area of ​​hyperemia, even burns of the I or II degree can be assumed.

In some people, dermatitis immediately takes on a papular-infiltrative character with severe itching, with sharply limited edges. In the chronic phase of the disease, the clinical picture is no different from non-professional contact dermatitis, it can only be the location, that is, 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.

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

According to the clinical picture of contact dermatitis, it is not always possible to decide which allergen it is caused by, since allergens of different nature can cause the same clinical manifestations. Issues of etiological diagnosis in occupational dermatitis are very relevant, however, skin tests in such patients are not always possible due to the danger of causing an exacerbation. The 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 a correct diagnosis.

The prognosis for occupational contact dermatitis is favorable - with timely diagnosis, elimination of occupational hazards (transfer to another job), and proper treatment. True, often, despite all the measures, dermatitis, having arisen on the basis of occupational hazards, can continue and complete recovery does not occur. This indicates the existence of complicating factors (other chronic diseases, polyvalence, superinfection, improper treatment).

Prevention is based on general and individual means of protection when working with industrial hazards. In addition to these measures, people with a predisposition to allergies, with skin dysfunction should be avoided working in chemically and biologically hazardous industries. Preliminary determination of the suitability of a given person for working with a particular substance is also desirable - conducting an appropriate test.

urticaria and erythema

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

Chemical causes most often cause urticaria and erythema in those associated with the pharmaceutical industry, nurses, and pharmacy workers. Known cases of urticaria on morphine, arnica, ipecac, mercury preparations, penicillin, novocaine, phenol, ammonia, as well as herbal remedies - thuja, rhododendron, nettle, tobacco and oils; for biological preparations - tetanus toxoid, influenza vaccines, etc.

Of the physical factors that cause urticaria and erythema, the action of high and low temperature should be mentioned. Employees of ceramic factories, steel-smelting shops often have 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 (lumberjacks, 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 professional bronchial asthma:

• caused by substances-sensitizers (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 of various substances. Very rarely, bronchial asthma occurs when harmful substances enter through the gastrointestinal tract when tasting cheeses, coffee, tea, wines, etc.

Occupational bronchial asthma has some distinctive features depending on the nature of occupational hazards. At different times from the beginning of contact with industrial hazards, the first attack of bronchial asthma may occur.

Sometimes bronchial asthma occurs in people without any other manifestations of allergies, but more often it is combined with the presence of eczema, dermatitis, rhinitis, Quincke's edema, etc. 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, the attacks of suffocation are not severe, they are removed if you leave the production room, but over time, the attacks become more severe, coughing attacks with thick, viscous sputum are disturbing. Later attacks are also caused by other factors, excitement, weather changes, etc.
In cases where occupational asthma occurs not as a primary disease, but against the background of a chronic pathological process in the bronchopulmonary apparatus (silicosis, pneumoconiosis, bronchitis), the period before the development of typical attacks is quite long.

Asthmatic phenomena develop in such patients gradually, against the background of previous bronchitis, constant cough. In cases of secondary asthma, it is difficult to establish a connection with occupational hazards, since attacks also occur outside of work, during vacations, etc. In these cases, the primary chemical or mechanical damage to the 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 single out a group of diseases associated with damage to the lung tissue by immune mechanisms under the influence of exogenous allergens - fungal spores, protein antigens. Since exogenous allergic alveolitis is associated with the inhalation of certain occupational allergens, they are named according to the profession, for example, "farmer's lung", "lung of furriers", "lung of coffee grinders", "lung of pigeon breeders", etc.
Currently, more than 20 professions are known in which exogenous alveolitis occurs, which are based on immunological mechanisms (the “allergen-antibody” reaction).

A feature of these mechanisms is the formation of precipitating antibodies, which, when combined with the allergen, form immune complexes that settle in the walls of the alveoli, small bronchi. The increased permeability of the vascular wall contributes to the deposition of immune complexes. During allergic exogenous alveolitis, all 3 types of allergic reactions are traced (see Chapter 2).

People who are predisposed to allergic reactions get sick with exogenous pulmonary alveolitis after prolonged contact with the allergen. The course of the disease can be acute, subacute and chronic. Sometimes alveolitis occurs periodically in the form of acute outbreaks when inhaling large doses of the allergen (cleaning the dovecote, sorting out the rotten hay, working at the mill).
In the acute form, the disease is often interpreted as pneumonia, since there is an abundance of physical data (wet wheezing, small bubbling), increased ESR, leukocytosis.

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

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