Workplace Allergy: Can your occupation be a hazard and be a cause of your allergy?

Allergies in our workplace can occur insidiously and post a significant cause of concern to our health. It is imperative to pick up and identify occupation allergies early to reverse and alleviate the allergic symptoms. Prolonged exposure to occupational related allergens may lead to detrimental health complications and possible irreversibility of the symptoms despite withdrawal from the offending trigger.

In this article, we would like to highlight the subtle yet potential allergens that we may have encountered in our daily workplace. 

The Triad of Allergy

Allergy is a medical condition that occurs following an exaggerated immune response towards an external harmless substance. An allergen is a substance that is harmless but able to trigger the immune response, resulting in an allergic reaction. 

One can be exposed to the allergen by inhaling it through the nose, upper airway, then into the lungs, or through direct skin contact or even via oral consumption into the gut. Once the body is exposed to the allergen, immune cells in our body can recognise and produce an inflammatory response against these substances. With repeated process of exposure and recognition of the allergen, the body becomes 'sensitised' and mount a quick yet abnormal response whenever it encounters the same allergen. 

Clinically, this manifests as allergy symptoms. If the symptoms occur on the skin, one may experience itchy eczematous rashes or in the form of contact dermatitis. When the symptoms affect the respiratory system, one may present with asthma or allergic rhinitis symptoms.

Allergic Asthma due to Workplace

Workplace asthma can be induced over time by air particles that are inhaled during work, eventually causing persistent cough, wheezing and shortness of breath. The symptoms that are related to workplace can be insidious and slow, and occur after years of working in the same environment. This is due to progressive sensitisation when a person is chronically exposed to the airborne chemicals and allergens in the workplace.

Some of the common airborne allergens associated with allergic asthma and the association with certain jobs are highlighted below:

Job Nature	Airborne allergens
Hairdresser	Hair perming agents such as persulphates
Baker	Wheat flour, amylase enzyme
Builders	Sawdust, wood dust
Solder technician	Solder fumes
Factory workers	Colophony, epoxy resin, plastics, glues
Storehouse keeper	Dustmites, Mold

Furthermore, airborne irritants such as dust, fumes, and chlorine can irk the respiratory system and trigger asthma symptoms as well.

Sensitivity to the airborne allergen increases over a time period upon repeated exposure at work workplace. Once sensitisation occurs, the affected person can develop asthmatic symptoms even with a mild/ small amount of exposure to the allergen. Allergic asthma symptoms tend to improve when one is on leave, away from the affected workplace, or better during the weekends.

Allergic Rhinitis due to Workplace

If you notice you have a tendency to sneeze, have excessive nasal secretion, blocked nose, cough, when you are at work, there is a possibility this can be occupational-related. One tends to develop symptoms of allergic rhinitis secondary to the workplace following repeated and chronic exposure of the triggering allergens in the same environment. 

This is commonly seen in dust mite allergies leading to chronic unresolved allergic rhinitis symptoms in dusty working environment. Allergens such as wheat, flour, yeast can trigger allergic rhinitis symptoms in bakers who inevitably inhale in these allergens during the preparation of dough. Irritants such as coal dust, chlorine, and talc can also trigger allergic rhinitis symptoms.

It is worth noting that often allergic rhinitis precedes the progression of allergic asthma. Being able to pick up, manage allergic rhinitis and identify the triggering allergen early are vital in preventing the progression of allergic asthma.

Contact Dermatitis due to Workplace

The most common occupational-related allergy condition is related to allergic skin diseases, such as contact dermatitis. It is also one of the main causes a person takes time-off or unable to complete his work. 

Due to direct skin contact to the allergen that is found at the workplace environment, the immune system can be sensitised and manifest itself with skin eczematous rashes that is worse when one is at work, and improve when one is away from work and away from the offending allergen. Skin allergic symptoms can be a nuisance, resulting in incessant itch, broken skin, pain, and affects negatively a person’s quality of life and work performance.

Some of the common occupation and allergens that can cause allergic contact dermatitis are summarized here:

Job Nature	Contact Dermatitis Allergens
Healthcare workers such as nurses/dentist	Latex found in gloves, medical instruments, surgical equipment
Hairdressers	Paraphenylenediamine (PPD) found in hair dyes
Printers	Acrylic dyes, adhesive tapes
Florists	Flowers such as Ivy, ilies
Mechanics	Benzene
Scuba diver	Latex found in scuba diving/ elastic suits
Food handlers	Latex found in gloves, Nickel allergies, certain food proteins

Jobs that may have higher risk of developing occupational-related allergies

• Hospital workers
• Laboratory workers
• Detergent or pharmaceutical factor workers
• Farmers, cotton workers
• Bakers
• Carpenters
• Builders
• Florist
• Printers

What are the potential allergies that I may face if my job is mainly a 9-5pm office job?

You may be surprised that one can still have allergy issues in an average office indoor environment.

Due to prolonged air-conditioned indoor environment, poor proper air ventilation, minimal sunlight penetration, and lack of proper maintenance of the ventilation circulation, one can be exposed to airborne allergens such as dust mites, mold, cockroach particles and etc. Less commonly, one may even experience contact dermatitis over their fingers, arms due to direct contact to cleaning agents that are used to wipe desk surfaces.

You may wish to discuss with your doctor on your job nature and environment for your health care professional to tease out further any potential allergens.

What should I do if I suspect of having occupational-related allergy?

If you suspect of having occupational allergy, you can consider discussing your symptoms with your health care professionals.

Your doctor would want to understand further on your symptoms and correlation with your work. History on your job nature, working environment will be useful. Your doctor will also want to understand whether your condition is better over the weekend or when you are away from your work.

In circumstances that there is concern of allergy to substances from workplace, your doctor may offer allergy test in the form of blood RAST test, skin prick test, patch test to evaluate further.

You can also inform your work place supervisor/ management of your health conditions if you have concerned about occupational related allergies.

What can I do if I have an occupational allergy?

The key management of occupational allergies is to avoid the triggering allergen and minimise exposure to the responsible allergen. However, this can be easier said than done due to the difficulty one may encounter to switch jobs without impacting socio-economically such as loss of income or even loss of employment.

• Allergy treatment involves antihistamines, steroid medications, other symptomatic relievers such as nose sprays or even inhalers.  
• In certain occupational-related allergies that the triggering allergen can be identified, one may benefit from specific-allergen immunotherapy. Immunotherapy can be safely offered to one who is inevitability exposed to the allergens (when a person wishes to keep the current job) and the allergic symptoms are not controlled with conventional medical treatment. 
• Protective measures such as PPE, gloves, face masks, air filtering system can be considered at workplace to reduce allergies at workplace.
• If all fails, final resort of managing occupational-related allergies involve changing job altogether. 

Noticing allergy symptoms that get worse at work? Your job environment could be a contributing factor. Book a personalised consultation at Dr Ben Medical to better understand your triggers and how to manage them.

Take home messages…

• Occupation-related allergies can be common and unknowingly cause long term health burdens.
• Occupation-related allergies are preventable. Suitable preventive measures can reduce the exposure risk and minimize allergies from occurring. 
• Recognizing potential triggering allergens, tweaking job nature/ work place can be effective in management of occupation-related allergies
• Medical management with antihistamine, steroid, immunotherapy may mediate symptoms related to occupational allergies. 
• In severe cases, drastic measures such as relocation of affected worker or switching of job scope maybe required to control allergy symptoms.

References:

1. Raulf M. Occupational Respiratory Allergy: Risk Factors, Diagnosis, and Management. Handb Exp Pharmacol. 2022:268:213-225.
2. Jeebhay MF et al. Occupational inhalant allergy in food handling occupations. Curr Opin Allergy Clin Immunol. 2022 Apr 1;22(2):64-72.
3. Anderson SE, Long C, Dotson GS. Occupational Allergy.  Eur Med J (Chelmsf). 2017 Jun;2(2):65–71
4. Peden D, Reed CE. Environmental and occupational allergies. J Allergy Clin Immunol. 2010 Feb;125(2 Suppl 2):S150-60.
5. Bernstein DI. Allergic reactions to workplace allergens. JAMA. 1997 Dec 10;278(22):1907-13.