Occupational Rhinitis

Background

• Occupational rhinitis is an inflammatory disease of the nose characterized by nasal symptoms such as congestion, rhinorrhea, or itching attributable to exposure to airborne substances in the workplace and not in other environments.
• Occupational rhinitis may be either allergic or nonallergic.
• Prevalence of occupational rhinitis is unknown but reportedly highest in certain occupations, particularly in baking, food processing, farming, veterinary care, furriery, livestock breeding, electronic product assembly, and boat building.
• Occupational rhinitis is strongly associated with occupational asthma and is thought to precede the development of occupational asthma in some workers.

Evaluation

• Diagnosis is based on patient history, particularly correlation of symptoms with time in the workplace, and with physical exam findings on anterior rhinoscopy.
• Perform either skin prick testing or serum immunoassay to assess for immunoglobulin E (IgE)-mediated response to determine if rhinitis is allergic or nonallergic.
• Consider nasal challenge testing in occupational allergic rhinitis if there is discrepancy between history and if there are important occupational implications.
• Consider lung function tests to identify potential comorbid asthma in patients with persistent rhinitis.

Management

• First-line management is identification and avoidance of inciting agent.
• Medical management of occupational rhinitis follows management of non-occupational rhinitis:
  • Medical management of allergic rhinitis involves stepwise approach based on symptom severity, using antihistamines and/or intranasal corticosteroids, with additional medications as needed.
  • Medical management of nonallergic rhinitis is based on presence or absence of inflammation on nasal smears and may include intranasal corticosteroid and/or intranasal antihistamine for inflammatory cases or intranasal ipratropium or capsaicin for noninflammatory cases.