Occupational Rhinitis: A Hard Day's Work for Noses

About 5% to 15% of the global workforce is estimated to have an occupational disease.

About 5% to 15% of the global workforce is estimated to have an occupational disease.

In its May 2016 issue, Immunology and Allergy Clinics of North America published a clinical overview of one such disease known as occupational rhinitis.

Occupational rhinitis is an inflammatory condition of the nose. Its nasal congestion, sneezing, rhinorrhea, itching, airflow impairment, and hypersecretion are all related to causes and conditions from particular workplace stimuli.

Occupational rhinitis is aggravated solely by workplace factors and unassociated with preexisting allergic or nonallergic rhinitis. It develops in response to allergens, inhaled irritants, or corrosive gases.

Workers experience performance deficits, reduced productivity, and psychosocial problems from occupational rhinitis. Occupational asthma commonly coexists with occupational rhinitis, as well.

Substances commonly linked to occupational rhinitis include laboratory animals, flour, foods, acid anhydrides, cleaning products, and strong irritants.

Occupational rhinitis’ exact prevalence is unknown since it isn’t a reportable condition in the United States.

Two classes of occupational rhinitis exist. Allergic occupational rhinitis is very similar to IgE-mediated rhinitis seen with pollens. Meanwhile, nonallergic occupational rhinitis hasn’t received as much attention and its mechanism remains unknown.

Management of occupational rhinitis is straightforward, with avoidance being the primary intervention. After minimizing exposure, medications used for allergic rhinitis will also work well for occupational rhinitis.

Intranasal glucocorticoids and antihistamines are proven to be the most effective agents. Affected workers should use sedating antihistamine only with caution, especially in hazardous or dangerous work environments. Use of a mask or respirator and improved ventilation may also mitigate symptoms.

While immunotherapy is used in IgE-mediated rhinitis, it has not been studied for use in occupational rhinitis and isn’t usually advised. However, nasal irrigations and leukotriene inhibitors, like Singulair, may be beneficial.

Most cases of occupational rhinitis can be managed easily, but this under-recognized condition needs to be studied more closely to better understand its prevalence and impact. In the meantime, pharmacists are well positioned to offer OTC and prescription guidance to this population.