The definition of rhinitis and occupational rhinitis needs to be revisited

Occupational rhinitis

Occupational rhinitis (OR) has so far received little attention even though it shares common pathophysiological features and trigger factors and is closely associated with occupational asthma (OA). Work-related exposure to certain substances, such as animal dander, is considered to be the main factor for the development of OR. The new EAACI definition of OR stresses the causal relationship between workplace exposure and onset of rhinitis symptoms as opposed to previous definitions that mainly focused on a temporal relationship between workplace exposure and occurrence of nasal symptoms. Also, it has been suggested to use the term “work-related rhinitis” for classifying the different forms of rhinitis associated with the workplace. These forms can be subdivided into allergic or non-allergic OR, which is due to causes and conditions related to a particular work environment, as well as work-exacerbated rhinitis, which is defined as a pre-existing rhinitis exacerbated by exposure at the workplace. Even though taking a detailed patient history is especially important when it comes to diagnosing OR, the gold standard for confirming the diagnosis is nasal provocation testing. Best possible symptomatic relief and prevention of development of OA constitute the main therapeutic objectives in OR. Treatment options consist of total avoidance of trigger substances (main goal), reduction of exposure to certain substances, and pharmacotherapy. Furthermore, it is important to note that allergic OR is an occupational disease in Germany (Berufskrankheit No 4301) and needs to be reported to health authorities.

EAACI position paper on occupational rhinitis

The present document is the result of a consensus reached by a panel of experts from European and non-European countries on Occupational Rhinitis (OR), a disease of emerging relevance which has received little attention in comparison to occupational asthma. The document covers the main items of OR including epidemiology, diagnosis, management, socio-economic impact, preventive strategies and medicolegal issues. An operational definition and classification of OR tailored on that of occupational asthma, as well as a diagnostic algorithm based on steps allowing for different levels of diagnostic evidence are proposed. The needs for future research are pointed out. Key messages are issued for each item.

Occupational rhinitis

The present document is the result of a consensus reached by a panel of experts from European and nonEuropean countries on Occupational Rhinitis (OR), a disease of emerging relevance, which has received little attention in comparison to occupational asthma. The document covers the main items of OR including epidemiology, diagnosis, management, socio-economic impact, preventive strategies and medicolegal issues. An operational definition and classification of OR tailored to that of occupational asthma, as well as a diagnostic algorithm based on steps allowing different levels of diagnostic evidence, are proposed. The needs for future research are pointed out. Key messages are issued for each item.

Occupational rhinosinusitis

In contrast to most allergic rhinitis and nasal hyperresponsiveness, occupational rhinosinusitis offers a unique and effective measure-control of exposure-to reduce its medical impact on patients. Prospective data from adolescents introduced to the work environment show that working in high-risk environments results in a higher incidence of rhinitis compared with those not employed in such settings. Data also show that the highest incidence of occupational rhinosinusitis is found during the first months of exposure to irritants and sensitizers, emphasizing the importance of early prevention. The study of occupational rhinosinusitis is complicated by factors related to poor definitions, clear-cut differentiation from other nasal inflammatory disease, and the industrial, economic, and political considerations in the implementation of preventive measures. This review focuses on new insights on occupational rhinosinusitis, including the impact on health-related quality of life.

Categorizing nasal septal perforations of occupational origin as cases of corrosive rhinitis

BACKGROUND

In clinical practice a perforation of the nasal septum secondary to an occupational exposure to corrosive chemicals is not considered a sequel of rhinitis.

METHODS

Relevant articles published in the last 26 years were searched and retrieved from PubMed.

RESULTS

Patients with nasal septal perforations of occupational origin show a history of rhinitis with a gradual installation of symptoms and damage of the nasal mucosa progressing to ulceration and ultimately to perforation of the nasal septum.

CONCLUSION

Patients with nasal septal perforations of occupational origin exhibit the clinical and histopathological features of rhinitis whereby they should be categorized as rhinitics. This rhinitis should be considered as a type of irritant-induced occupational rhinitis and classified as corrosive rhinitis.