Analytics: Allergic occupational diseases of workers. Industrial allergies

The rapid development of the chemical industry has led to a significant increase in the number of various substances in production and in everyday life that people have to come into contact with. This led to the occurrence of allergic reactions of different nature, mainly in the form of skin lesions - allergic occupational contact dermatitis. Industrial allergens can be: turpentine, mineral oil, nickel, chromium, arsenic, tar, tannins, azonaphthol and other dyes, varnishes, insectofungicides, substances containing Bakelite, formalin, urea, epoxy resins, hardeners, detergents, aminobenzenes, quinoline derivatives, chlorobenzene and many other substances. In hairdressing and beauty parlors, hair dyes can be allergens; in darkrooms - metol, hydroquinone, bromine compounds.

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ONE INQUIRY medieval doctor, watching the 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.
So in the late 1600s it was noted key moment in the birth of occupational health. The Italian physician Bernardino Ramassini continued to investigate diseases commonly found in various professions, including artists, rural workers, fishermen caring for the sick, processing food.

Some 300 years later, those same occupations still feature prominently on 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 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 paints 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 the effects 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 notes, working carefully, collecting important information about your workplace and supporting a good relationship with your employer.

Main players

See how your work can contribute to major allergic conditions: asthma, skin problems, and allergic rhinitis, and you'll see how complex allergies can be in the workplace (for more information on these diseases, see the dedicated 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 with medical point vision.

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. By creating additional nuisance symptoms may return up to 12 hours after you have 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 compress 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 in 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 have 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 the body takes time 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 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 treating any of these conditions, a dermatologist may be the best choice for skin conditions, a pulmonologist for lung problems, and an otolaryngologist - with 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 history. The more documentation the patient brings, the faster and better the doctor can make an assessment. Provide the physician with detailed information regarding previous illnesses, any family and personal allergies, medications taken or used, and bad habits like smoking. Also include full descriptions of current and previous job responsibilities and a description of the workplace environment;
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 available information on safe methods of working with them. 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. With an indefinite 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 case of occurrence. 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 bad situation and in the case of asthma, exposure to a large number of 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 permit voluntary use masks. 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.

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. Allergy is hypersensitivity organism to any substance, characterized various manifestations. TO local symptoms relate:

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 rashes on the skin;
headache.

Almost any substance can become an allergen (paint, varnish, cement dust), a 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 he has to live and work.

Excessive manifestations of allergies are anaphylactic shock and angioedema.

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

Most slight 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 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 not forget also about the increased guarantees and compensations associated both with the establishment based on the results of a special assessment harmful conditions labor at the employee's workplace, and with confirmation of a medical certificate of an occupational disease 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 an acquired disease for the labor process may be the termination 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

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The employee filed a lawsuit against the employer to recover lump sum compensation in compensation for harm 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). Given the failure of the employer to comply with 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, the appeal ruling of Rostov regional court dated December 08, 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

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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

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The employee asked the court to recognize illegal dismissal according to paragraph 5 of part 1 of Art. 83 of the Labor Code of the Russian Federation (recognition of an employee as completely incapable of labor activity in accordance with a medical report issued in accordance with the procedure 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 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

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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 requirements of the employee 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.

In connection with 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. Clinical course Contact dermatitis is characterized at the beginning of the disease by lesions 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.

At individual people dermatitis immediately takes on a papular-infiltrative character with severe itching, with sharply defined edges. IN chronic phase 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. Questions etiological diagnosis with professional dermatitis are very relevant, however skin tests in such patients, it is not always possible to carry out because of 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.

Forecast for professional contact dermatitis favorable - at timely diagnosis elimination of occupational hazards (transfer to another job), proper treatment. True, often, despite all the measures, dermatitis, arising on the basis of occupational hazards, can continue and full recovery does not come. This indicates the existence of complicating factors (other chronic diseases, polyvalence, superinfection, improper treatment).

Prevention is based on general and personal means 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 suitability is desirable this person to work with one or another substance - 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 commonly cause urticaria and erythema in individuals associated with pharmaceutical industry, nurses, pharmacy workers. There are known cases of urticaria on morphine, arnica, ipecac, mercury preparations, penicillin, novocaine, phenol, ammonia, as well as on herbal remedies- thuja, rhododendron, nettle, tobacco and oils; for biological preparations - tetanus toxoid, influenza vaccines, etc.

From physical factors that cause urticaria and erythema should be called the action of high and low temperature. 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 inhomogeneous. 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 industrial 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 in different time, 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 development typical seizures quite lengthy.

Asthmatic phenomena develop in such patients gradually, against the background of previous bronchitis, persistent 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 bronchial mucosa leads to the development of professional bronchitis, on the basis of which bronchial asthma develops for the second time, often an infectious-allergic form.

EXOGENOUS ALLERGIC ALVEOLITIS

It is especially necessary to single out 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 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. deposition immune complexes promotes increased permeability of the vascular wall. 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).
At acute form the disease is often interpreted as pneumonia, since there is an abundance of physical data (wet wheezing, finely 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 acute and subacute stages shows the use of glucocorticoid hormones. Prevention consists in preventing contact of patients with the corresponding allergen (change of profession). Chronic form exogenous allergic alveolitis is difficult to treat, symptomatic therapy is usually carried out.

Industrial allergens

The rapid development of the chemical industry has significantly increased the amount of various chemicals in production and at home, and therefore, people's contact with them. This caused the appearance of allergic reactions of various nature. Industrial allergens are overwhelmingly haptens, which bind to proteins through their reactive group. For example, through the halogen atom, aromatic nitro compounds are attached, the mercapto groups of a number of pesticides react with the HS groups of proteins, etc. It is believed that the higher the ability of the hapten to form a chemical bond with the protein, the higher its allergenic activity. The most common industrial allergens are turpentine, oils, nickel, chromium, arsenic, tar, resins, tannins, many dyes, etc. In hairdressing and beauty salons, allergens can be dyes for hair, eyebrows and eyelashes, liquid for perm etc. In everyday life, allergens can be soap, detergents, synthetic fabrics, etc.

Allergens of infectious origin

Allergic processes can cause a variety of pathogens of infectious diseases, as well as their metabolic products. These processes become integral part the pathogenesis of the disease. Those infectious diseases, in the pathogenesis of which allergy plays a leading role, are called infectious-allergic diseases. These include all chronic infections (tuberculosis, leprosy, brucellosis, syphilis, rheumatism, chronic candidiasis, etc.). With the elimination of epidemic diseases began to acquire all great importance allergic processes that are caused by opportunistic and saprophytic flora. The source of sensitization is usually the flora of chronic foci of inflammation in the area paranasal sinuses nose, middle ear, tonsils, carious teeth, gallbladder, etc. In this case, some forms of bronchial asthma, Quincke's edema, urticaria, rheumatism, nonspecific ulcerative colitis and other diseases. Mushrooms are very common allergens. About 350 species of mushrooms show allergenic activity. Among them, there are species pathogenic for humans that cause diseases with allergies at the basis of pathogenesis. Such diseases are, for example, aspergillosis, actinomycosis, coccidioidomycosis, histoplasmosis, etc. However, many fungi that are not pathogenic for humans, when they enter the body, cause sensitization and the development of various allergic diseases (bronchial asthma, etc.). Such fungi are found in the atmospheric air, dwellings, house dust, moldy foods, etc. Their concentration depends on the season, humidity, temperature and other conditions.

The most common classification divides all allergic reactions into immediate-type allergic reactions and delayed-type allergic reactions. This classification is based on the time of occurrence of the reaction after contact with the allergen. The reaction of the immediate type develops within 15-20 min-1 day, the delayed type - after 24-72 hours.

All allergic reactions are divided into true, or actually allergic, and false, or pseudo-allergic (non-immunological).

Pseudo-allergy is a pathological process that is clinically similar to allergy, but does not have an immune stage of its development. Pseudoallergy is distinguished from true allergy the absence of the first (immune) stage of development. The remaining two stages - the release of mediators (pathochemical) and pathophysiological (the stage of clinical manifestations) coincide with pseudo-allergy and true allergy.

Pseudo-allergic processes include only those in the development of which such mediators play a leading role, which are also formed in the pathochemical stage of true allergic reactions. The cause of pseudo-allergy is any substance that acts directly on effector cells (mast cells, basophils, etc.) or biological fluids and causes the release from cells or the formation of mediators in fluids. In practice, most allergens can lead to the development of both allergic and pseudo-allergic reactions. It depends on the nature of the substance, its phase, the frequency of introduction into the organism and the reactivity of the organism itself. Pseudo-allergic reactions are most common with drug and food intolerance. very many medications more often lead to the development of pseudo-allergies than allergies.

Three groups of mechanisms are involved in the pathogenesis of pseudoallergy:

1) histamine;
2) violation of the activation of the complement system;
3) a violation of the metabolism of arachidonic acid.

The clinical picture of pseudo-allergic diseases is close to that of allergic diseases. It is based on the development of such pathological processes as increased vascular permeability, edema, inflammation, spasm smooth muscle, destruction of blood cells. These processes can be local, organ, systemic. They are manifested by rhinitis, urticaria, Quincke's edema, periodic headaches, disorders gastrointestinal tract, bronchial asthma, serum sickness, anaphylactoid shock, as well as damage to individual organs.

In accordance with the classification proposed by P. Gell and R. Coombs in 1969, there are 4 main types of hypersensitivity reactions:

Type 1 - immediate type hypersensitivity. It is caused by the release of active substances from mast cells sensitized by IgE antibodies when they bind the allergen.
Type 2 hypersensitivity due to the cytotoxic effect of antibodies involving complement or effector cells.
3rd type - immunocomplex reaction. Due to the pro-inflammatory action of soluble immune complexes.
Type 4 - delayed type hypersensitivity. Associated with the activity of pro-inflammatory T-lymphocytes and macrophages activated by them, as well as cytokines secreted by these cells.

To date, some experts distinguish the 5th type - receptor-mediated.

1. type - anaphylactic,……… classic allergic reaction of immediate type.

Ingestion of an antigen causes its sensitization. Sensitization is an immunologically mediated increase in the body's sensitivity to antigens (allergens) of exogenous or endogenous origin. The concentration of IgE in the blood serum of a healthy person is lower than that of any other immunoglobulins. It ranges from 85-350 ng/ml. IgE content is expressed in international units - 1 IU = 2.42 ng IgE. IgE is absent in the blood serum of newborns, but starting from 3 months, its concentration gradually increases, reaching the level of adults only by 10 years. The content of IgE in secrets is higher than in blood serum (especially a lot of it in colostrum). Most IgE is secreted by mucosal lymphoid cells. Whey

IgE has short term life - 2.5 days. The production of IgE is also stimulated by the Th2 cytokines IL-5 and IL-6.

mast cells.

There are a lot of them in barrier tissues, especially in mucous membranes. The development of mast cells, in addition to the main factor SCF, involves cytokines secreted by Th2-lymphocytes and mast cells themselves - IL-4, IL-3, IL-9, IL-10. Mast cells are involved in starting inflammatory response and act as effector cells in

Several processes underlie the local manifestations of allergies.

Local vasodilation. It manifests itself quickly and is due to the action of histamine and other preformed factors, a little later - eicosanoids (especially LTC4). Visible manifestation is redness. Increased vascular permeability. Its cause is vasoconstriction by histamine, leukotrienes, and platelet aggregation factor (PAF). Leads to the development of edema, promotes extravasation of blood cells. Local violation permeability with the formation of leukocyte exudates and hemorrhages is the basis skin rashes. The accumulation of fluid in the subepidermal space is the morphological basis of blisters. Spasm of smooth muscles, especially bronchi. Spasm is caused by eicosanoids (lecotriens C4 and D4, prostaglandin D2, PAF), to a lesser extent histamine. The manifestation is an asthmatic attack (an attack of bronchospasm). Hyperproduction of mucus (nasal, bronchial) and other secrets (for example, tears). Called leukotrienes. It accompanies bronchospasm or serves as an independent manifestation of an allergic reaction. Similar phenomena in the intestines cause diarrhea. Irritation nerve endings leading to itching and pain.

Cytotoxic type of hypersensitivity (type II hypersensitivity) Type II hypersensitivity refers to pathological processes, which are based only on cytotoxic activity associated with antibodies. This type of hypersensitivity is interpreted as cytotoxic reactions caused by the binding of antibodies to the surface of target cells and the attraction of complement or effector cells to immune complexes, which cause the manifestation of this form of cytotoxicity.

There are several groups of diseases caused by type II hypersensitivity:

alloimmune hemolytic diseases;

hemolytic processes associated with drug hypersensitivity.

Alloimmune hemolytic diseases. This group of diseases includes blood transfusion complications and hemolytic disease newborns. The immunological bases of hemolysis caused by incompatibility in blood groups AB0 are discussed above. They are associated with the preexistence of antibodies to the missing group antigens. That is why the transfusion of incompatible erythrocytes that bind to antibodies in the bloodstream leads to their mass lysis and the development of complications such as jaundice and tissue damage when complexes of erythrocyte membrane proteins with antibodies are deposited. Rh-conflict hemolytic anemia has a slightly different basis (Fig. 4.36). Among several antigens (C, D, E, c, d, e) of the Rh system, antigen D is the most powerful and is able to induce the production of a large number of antibodies. It encodes dominant gene D, the recessive allelic variant of which is gene d. Conflict situation, caused by incompatibility for these genes, does not appear during blood transfusions, but during pregnancy of an Rh-negative mother (with the dd genotype) with an Rh-positive fetus (DD and Dd genotypes). During the first pregnancy, usually there are no violations of the immune nature in the body of the mother and fetus.

III type. When the system of elimination of immune complexes is damaged.

Normally, during the interaction of antigens coming from outside and the resulting antibodies, immune complexes are formed, with which complement components are connected when it is activated along the classical path. way. The complexes interact with CR1 (CD35) receptors on erythrocytes. Such erythrocytes are engulfed by liver macrophages, which leads to the elimination of the complexes. When antibodies interact with antigens cell membrane pathogens or other foreign cells, their opsonization occurs, which also contributes to the phagocytosis of these cells. Accumulation of immune complexes in the circulation and their deposition in tissues does not occur in either the first or second situations.

If the system of elimination of immune complexes is damaged (insufficient function of phagocytes or the complement system), prolonged or too massive intake of the antigen, as well as the accumulation of a large number of antibodies, the implementation of the processes described above is disrupted. Most an important event in the development of immunocomplex pathology -- the formation of insoluble immune complexes and their deposition in tissues. The transition to an insoluble state is facilitated by an excess of antibodies or a deficiency of the complement system (complement binding contributes to the preservation of complexes in the soluble phase). Immune complexes are most often deposited on basement membranes, as well as on vascular endothelial cells, which is associated with the presence of Fc receptors on their surface. The deposition of complexes contributes to the development of inflammation. The role of inflammatory triggers in this case is played by small fragments of complement components C3a and C5a, which are formed during complement activation. The listed factors, also called anaphylotoxins, cause vascular changes characteristic of inflammation and attract neutrophils and monocytes to the place of deposition of complexes, causing their activation. Activated phagocytes secrete pro-inflammatory cytokines (IL-1, TNFb, IL-8, etc.), as well as cationic proteins, enzymes, and other active molecules, which leads to the development of a full-scale inflammatory response. Cell damage can also be caused by complement activation and the formation of a membrane attack complex. Another factor of damage is platelet aggregation, which occurs during the intravascular formation of immune complexes. It leads to the formation of microthrombi and the release of vasoactive molecules. Immunocomplex pathology can be caused not only by local deposition of complexes, but also by the systemic action of circulating immune complexes. It is characterized by a combination of general symptoms with local inflammatory processes in the places where the complexes are deposited.

Autoimmune cytotoxic receptor-mediated pathology - this type, some authors refer to the 5-type.

Antibodies are produced that can bind to cell receptors, either activating their function or closing the receptor from bioactive substances.

So at diabetes Type II antibodies circulate competitively binding to insulin receptors, thus closing them from insulin.

Delayed type hypersensitivity (type IV hypersensitivity)

Delayed-type hypersensitivity is the only type of hypersensitivity that is directly based on cellular rather than humoral mechanisms. Its prototype is the Mantoux reaction, the response of a sensitized organism to the intradermal administration of tuberculin. The delayed-type hypersensitivity reaction underlies one of two forms of cellular immune response - inflammatory, caused by CD4+ T cells and their interaction with macrophages. The main result of the sensitizing effect is the development of an inflammatory immune response with the formation of effector Th1 cells.