Occupational Asthma and Its Relationship to Occupational Rhinitis

  • Gianna Moscato
  • Eugenia Galdi
Part of the Allergy Frontiers book series (ALLERGY, volume 3)


Occupational asthma (OA) is a type of bronchial asthma caused by the workplace, and it accounts for 10-15% of adult asthma.

Two types of OA are distinguished: allergic OA that occurs after a latency period, and non-allergic OA characterized by the absence of a latency period, also defined as irritant-induced OA.

A wide spectrum of agents both high molecular weight proteins and low molecular weight compounds can induce OA, acting with allergic or non-allergic irritant mechanisms.

The diagnosis of OA is based on a compatible history and on the objective demonstration of bronchial asthma and of its relationship to the work. Objective testing encoppasses a combination of tools, partially different for allergic and for irritant-induced OA.

OA can lead to disability and to significant social and financial consequences, thus prevention is mandatory.

Occupational rhinitis (OR) is a type of rhinitis due to the workplace, whose burden is considered to be largely undestimated in comparison to OA.

A close relationship exists between OA and OR: the same etiological agents and mechanisms of OA are implicated in OR; in subjects with OA, symptoms of rhinitis are frequently present, and workers with OR have a greatest risk of developing OA.


Allergy Clin Immunol Occupational Asthma Natural Rubber Latex Occupational Rhinitis Specific Inhalation Challenge 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Blanc PD, Toren K (1999) How much adult asthma can be attributed to occupational factors? Am J Med 107: 580–587PubMedCrossRefGoogle Scholar
  2. 2.
    Balmes J, Becklacke M, Blanc P, Henneberger P, Kreiss K, Mapp C, Milton D, Schwartz D, Toren K, Viegi G (2003) American Thoracic Society Statement. Occupational contribution to the burden of airway disease. Am J Respir Crit Care Med 167: 787–797Google Scholar
  3. 3.
    Vandenplas O, Malo J-L (2003) Definitions and types of work-related asthma: a nosological approach. Eur Respir J 21: 706–712PubMedCrossRefGoogle Scholar
  4. 4.
    Malo J-L (2005) Future advances in work-related asthma and the impact on occupational health. Occup Med 55: 606–611CrossRefGoogle Scholar
  5. 5.
    Pepys J (1980) Occupational asthma: review of present clinical and immunological status. J Allergy Clin Immunol 66: 179–185PubMedCrossRefGoogle Scholar
  6. 6.
    Meredith S, Nordman H (1996) Occupational asthma: measures and frequency from four countries. Thorax 51: 435–440PubMedCrossRefGoogle Scholar
  7. 7.
    Mannino DM (2000) How much asthma is occupationally related? Occup Med 15: 359–368PubMedGoogle Scholar
  8. 8.
    Siracusa A, Desrosiers M, Marabini A (2000) Epidemiology of occupational rhinitis: prevalence, aetiology and determinants. Clin Exp Allergy 30: 1519–1534PubMedCrossRefGoogle Scholar
  9. 9.
    Moscato G, Vandenplas O, Gerth Van Wijk R, Malo J-L, Quirce S, Walusiak J, Castano R, De Groot H, Folletti I, Gautrin D, Yacoub MR, Perfetti L, Siracusa A. EAACI Task Force on Occupational Rhinitis (2008) Occupational rhinitis. Allergy 63: 969–980PubMedCrossRefGoogle Scholar
  10. 10.
    Bousquet J, Khaltaev N, Cruz AA, Denburg J, Fokkens WJ, Togias A, Zuberbier T, Baena-Cagnani CE, Canonica GW, van Weel C, Agache I, Ait-Khaled N, Bachert C, Blaiss MS, Bonini S, Boulet MP, Bousquet PJ, Camargos P, Carlsen KH, Chen Y, Custovic A, Dahl R, Demoly P, Douagui H, Durham SR, van Wijk RG, Kalayci O, Kaliner MA, Kim YY, Kowalski ML, Kuna P, Le LT, Lemiere C, Li J, Lockey RF, Mavale-Manuel S, Meltzer EO, Mohammad Y, Mullol J, Naclerio R, O'Heir RE, Ohta K, Ouedraogo S, Palkonen S, Papadopoulos N, Passalacqua G, Pawankar R, Popov TA, Rabe KF, Rosado-Pinto J, Scadding GK, Simons FE, Toskala E, Valovirta E, van Cauwenberge P, Wang DY, Wickman M, Yawn BP, Yorgancioglu A, Yusuf OM, Zar H, Annesi-Maesano I, Bateman ED, Ben Kheder A, Boakye DA, Bouchard J, Burney P, Busse WW, Chan-Yeung M, Chavannes NH, Chuchalin A, Dolen WK, Emuzyte R, Grouse L, Humbert M, Jackson C, Johnston SL, Keith PK, Kemp JP, Klossek JM, Larenas-Linnemann, Lipworth B, Malo JL, Marshall GD, Naspitz C, Nekam K, Niggemann B, Nizankowska-Mogilnicka E, Okamoto Y, Orru MP, Potter P, Price D, Stoloff SW, Vandenplas O, Viegi G, Williams D; World Health Organization; Ga(2)LEN; AllerGen (2008) Allegic Rhinits and its Impact on Asthma (ARIA) 2008 update (in collaboration with the World Health Organization, GA(2)LEN and AllerGen. Allergy 63 (86 suppl): 8–160PubMedCrossRefGoogle Scholar
  11. 11.
    Bernstein IL, Bernstein DI, Chan-Yeung M, Malo J-L (2006) Definition and classification of asthma in the workplace. In: Bernstein IL, Chan-Yeung M, Malo J-L, Bernstein DI (eds) Asthma in the Workplace. Taylor Francis, New York, pp 1–8Google Scholar
  12. 12.
    Tarlo SM, Broder I (1989) Irritant induced asthma. Chest 96: 297–300PubMedCrossRefGoogle Scholar
  13. 13.
    Gautrin D, Bernstein IL, Brooks S (2006) Reactive airways dysfunction syndrome or irritant induced asthma. In: Bernstein IL, Chan-Yeung M, Malo J-L, Bernstein DI (eds) Asthma in the Workplace. Taylor & Francis, New York, pp 581–629Google Scholar
  14. 14.
    Brooks SM, Weiss MA, Bernstein IL (1985) Reactive airways dysfunction syndrome (RADS): persistent asthma syndrome after high level irritant exposures. Chest 88: 376–384PubMedCrossRefGoogle Scholar
  15. 15.
    Mapp CE, Boschetto P, Maestrelli P, Fabbri LM (2005) Occupational asthma. Am J Respir Crit Care Med 172: 280–305PubMedCrossRefGoogle Scholar
  16. 16.
    Newman-Taylor AJ (1995) Non-malignant diseases. Asthma. In: McDonald JC (ed) Epidemiology of Work-Related Diseases. BMJ, London, pp 117–143Google Scholar
  17. 17.
    Malo JL, Chan-Yeung M (2006) Appendix. Agents causing occupational asthma with key references. In: Bernstein IL, Chan-Yeung M, Malo J-L, Bernstein DI (eds) Asthma in the Workplace. Taylor & Francis, New York, pp 825–849Google Scholar
  18. 18.
    Malo JL, Chan-Yeung M (2001) Occupational asthma. J Allergy Clin Immunol 108: 317–328PubMedCrossRefGoogle Scholar
  19. 19.
    Maestrelli P, Fabbri LM, Mapp CE (2006) Pathophysiology. In: Bernstein IL, Chan-Yeung M, Malo J-L, Bernstein DI (eds) Asthma in the Workplace. Taylor & Francis, New York, pp 109–140Google Scholar
  20. 20.
    Meggs WJ (1994) RADS and RUDS-the toxic induction of asthma and rhinitis. J Toxicol Clin Toxicol 32(5): 487–501PubMedGoogle Scholar
  21. 21.
    Castano R, Thériault G (2006) Defining and classifying occupational rhinitis. J Laryngol Otol 120: 812–817PubMedCrossRefGoogle Scholar
  22. 22.
    Houba R, Heederik DJ, Doekes G, van Run PE (1996) Exposure-sensitization relationship for alpha-amylase allergens in the baking industry. Am J Respir Crit Care Med 154: 130–136PubMedGoogle Scholar
  23. 23.
    Heederik D, Venables KM, Malmberg P, Hollander A, Karlsson A-S, Renström A, Doekes G, Nieuwenhijsen M, Gordon S (1999) Exposure-response relationships for work-related sensitization in workers exposed to rat urinary allergens: results from a pooled study. J Allergy Clin Immunol 103: 678–684PubMedCrossRefGoogle Scholar
  24. 24.
    Nieuwenhuijsen MJ, Putcha V, Gordon S, Heederik D, Venables KM, Cullinan P, Newman-Taylor AJ (2003) Exposure-response relations among laboratory animal workers exposed to rats. Occup Environ Med 60: 104–108PubMedCrossRefGoogle Scholar
  25. 25.
    Mapp CE (2005) Genetics and the occupational environment. Curr Opin Allergy Clin Immunol 5: 113–118PubMedGoogle Scholar
  26. 26.
    Karjalainen A, Martikainen R, Klaukka T, Saarinen K, Uitti J (2003) Risk of asthma among Finnish patients with occupational rhinitis. Chest 123: 283–288PubMedCrossRefGoogle Scholar
  27. 27.
    Gautrin D, Ghezzo H, Infante-Rivard C, Malo JL (2001) Natural history of sensitization, symptoms and diseases in apprentices exposed to laboratory animal. Eur Respir J 17: 904–908PubMedCrossRefGoogle Scholar
  28. 28.
    Gautrin D, Infante-Rivard C, Ghezzo H, Malo J-L (2001) Incidence and host determinants of probable occupational asthma in apprentices exposed to laboratory animals. Am J Respir Crit Care Med 163: 899–904PubMedGoogle Scholar
  29. 29.
    Siracusa A, Marabini A, Folletti I, Moscato G (2006) Smoking and occupational asthma. Clin Exp Allergy 36: 577–584PubMedCrossRefGoogle Scholar
  30. 30.
    Piirila P, Wikman H, Luukkonen R, Kaaria K, Rosenberg C, Nordman H, Norpaa H, Vainio H, Hirvonen A (2001) Glutathione S-transferase genotypes in allergic response to diisocyanate exposure. Pharmacogenetics 11: 437–445PubMedCrossRefGoogle Scholar
  31. 31.
    Wikman J, Piirila R, Rosenberg C, Luukkonen R, Kaaria K, Nordman H, Norppa H, Vainio H, Hirvonen A (2002) N-acetyltransferase genotypes as modifiers of diisocyanate exposure-associated asthma risk. Pharmacogenetics 12: 227–233PubMedCrossRefGoogle Scholar
  32. 32.
    Malo JL, Ghezzo H, D'Aquino C, L'Archeveque J, Cartier A, Chan-Yeung M (1992) Natural history of occupational asthma: relevance of type of agent and other factors in the rate of development of symptoms in affected subjects. J Allergy Clin Immunol 90: 937–944PubMedCrossRefGoogle Scholar
  33. 33.
    Malo J-L, Lemière C, Desjardins A, Cartier A (1997) Prevalence and intensity of rhinoconjunctivitis in subjects with occupational asthma. Eur Respir J 10: 1513–1515PubMedCrossRefGoogle Scholar
  34. 34.
    Storaas T, Steinvag SK, Florvaag E, Irgens A, Aasen TB (2005) Occupational rhinitis: diagnostic criteria, relation to lower airway symptoms and IgE sensitization in bakery workers. Acta Oto-Laryngoiatrica 125: 1211–1217CrossRefGoogle Scholar
  35. 35.
    Abramson M, Sim MR (2006) Occupational asthma. Thorax 61: 741–742PubMedCrossRefGoogle Scholar
  36. 36.
    Moscato G, Dellabianca A, Perfetti L, Bramé B, Galdi E, Niniano R, Paggiaro PL (1999) Occupational asthma: a longitudinal study on the clinical and socioeconomic outcome after diagnosis. Chest 115: 249–256PubMedCrossRefGoogle Scholar
  37. 37.
    Ameille J, Descatha A (2005) Outcome of occupational asthma. Curr Opin Allergy Clin Immunol 5: 125–128PubMedGoogle Scholar
  38. 38.
    Chan-Yeung M (1995) Assessment of asthma in the workplace. ACCP consensus statement. American College of Chest Physicians. Chest 108: 1084–1117Google Scholar
  39. 39.
    Marabini A, Siracusa A, Stopponi R, Tacconi C, Abbritti G (2003) Outcome of occupational asthma in patients with continuous exposure: a 3-year longitudinal study during pharmacological treatment. Chest 124: 2372–2376PubMedCrossRefGoogle Scholar
  40. 40.
    Vandenplas O, Toren K, Blanc PD (2003) Health and socioeconomic impact of work-related asthma. Eur Respir J 22: 689–697PubMedCrossRefGoogle Scholar
  41. 41.
    Cockcroft DW (1990) Occupational asthma. Ann Allergy 65: 169–175PubMedGoogle Scholar
  42. 42.
    Quirce S, Sastre J (1998) Occupational asthma. Allergy 53: 633–641PubMedCrossRefGoogle Scholar
  43. 43.
    Malo JL, Ghezzo H, L'Archeveque J, Lagier F, Perrin B, Cartier A (1991) Is the clinical history a satisfactory means of diagnosing occupational asthma? Am Rev Respir Dis 143: 528–532PubMedGoogle Scholar
  44. 44.
    Subcommittee on “Occupational Allergy” of the European Academy of Allerology and Clinical Immunology (1992) Guidelines for the diagnosis of occupational asthma. Clin Exp Allergy 22: 103–108CrossRefGoogle Scholar
  45. 45.
    Moscato G, Malo J-L, Bernstein D (2003) Diagnosing occupational asthma: how. How much, how far? Eur Respir J 21: 879–885PubMedCrossRefGoogle Scholar
  46. 46.
    Moscato G, Perfetti L, Galdi E (1997) Clinical evaluation of occupational asthma. Monaldi Arch Chest Dis 5: 469–473Google Scholar
  47. 47.
    global Strategy for Asthma Management and Prevention, Global Initiative for Asthma (GINA) (2008) Available from:
  48. 48.
    Moscato G, Godnic-Cvar J, Maestrelli P, Malo J-L, Burge PS, Coifman R (1995) Statement on self monitoring of peak expiratory flow in the investigation of occupational asthma. Official Statement. Eur Respir J 8: 1605–1610Google Scholar
  49. 49.
    Burge PS, Moscato G, Johnson A, Chan-Yeung M (2006) Physiological assessment: serial measurements of lung function and bronchial responsiveness. Bernstein IL, Chan-Yeung M, Malo J-L, Bernstein DI (eds) Asthma in the Workplace. Taylor & Francis, New York, pp 199–226Google Scholar
  50. 50.
    Cartier A, Pineau L, Malo J-L (1984) Monitoring of maximum expiratory peak flow rates and histamine inhalation tests in the investigation of occupational asthma. Clin Allergy 14: 193–196PubMedCrossRefGoogle Scholar
  51. 51.
    Coté J, Kennedy S, Chan-Yeung M (1990) Sensitivity and specificity of PC20 and peak expiratory flow rate in cedar asthma. J Allergy Clin Immunol 85: 592–598PubMedCrossRefGoogle Scholar
  52. 52.
    Perrin B, Lagier F, L'Archeveque J, Cartier A, Boulet LP, Coté J, Malo JL (1992) Occupational asthma: validity of monitoring of peak expiratory flow rates and non-allergic bronchial responsiveness as compared to specific inhalation challenge. Eur Respir J 51: 40–48Google Scholar
  53. 53.
    Lemiere C, Pizzichini MM, Balkissoon R, Clelland L, Efthimidias A, O'Shaughnessy D, Dolovich J, Hargreave FE (1999) Diagnosing occupational asthma: use of induced sputum. Eur Respir J 13: 482–488PubMedCrossRefGoogle Scholar
  54. 54.
    Girard F, Chaboillez S, Cartier A, Coté J, Hargreave FE, Labrecque M, Malo JL, Tarlo SM, Lemiere C (2004) An effective strategy for diagnosing occupational asthma: use of induced sputum. Am J Respir Crit Care Med 170: 845–850PubMedCrossRefGoogle Scholar
  55. 55.
    Vandenplas O, Malo JL (1997) Inhalation challenges with agents causing occupational asthma. Eur Respir J 10: 2612–2629PubMedCrossRefGoogle Scholar
  56. 56.
    Djukanovic R, Sterk PJ, Fahy JV, Hargreave FE (2002) Standardised methodology of sputum induction and processing. Eur Respir J 20 (s37): 1s–55sCrossRefGoogle Scholar
  57. 57.
    Anees W, Huggings V, Pavord ID, Robertson AS, Burge PS (2002) Occupational asthma due to low molecular weight agents: eosinophilic and non-eosinophilic variants. Thorax 57: 231–236PubMedCrossRefGoogle Scholar
  58. 58.
    Lemiere C (2007) Induced sputum and exhaled nitric oxide as noninvasive markers of airway inflammation from work exposure. Curr Opin Allergy Clin Immunol 7: 133–137PubMedCrossRefGoogle Scholar
  59. 59.
    Recommendations for standardized procedures for the on-line and off-line measurement of exhaled lower respiratory nitric oxide and nasal nitric oxide in adults and children (1999) Am J Respir Crit Care Med 160: 2104–2117Google Scholar
  60. 60.
    Babinova L, Baur X (2006) Increase in exhaled (eNO) after work-related isocyanate exposure. Int Arch Occup Environ Health 79: 387–395CrossRefGoogle Scholar
  61. 61.
    Maestrelli P, Calcagni PG, Saetta M, Di Stefano A, Hosselet JJ, Santonastaso A, Fabbri LM, Mapp CE (1994) Sputum eosinophilia after asthmatic responses induced by isocyanates in sensitized subjects. Clin Exp Allergy 24: 29–34PubMedCrossRefGoogle Scholar
  62. 62.
    Obata H, Cittrick M, Chan H, Chan-Yeung M (1999) Sputum eosinophils and exaled nitric oxide during late asthmatic reaction in patients with western red cedar asthma. Eur Respir J 13: 489–495PubMedCrossRefGoogle Scholar
  63. 63.
    Moscato G, Pignatti P, Yacoub MR, Romano C, Spezia S, Perfetti L (2005) Occupational asthma and occupational rhinitis in hairdressers. Chest 128: 3590–3598PubMedCrossRefGoogle Scholar
  64. 64.
    Castano R, Malo J-L (2007) Toward a ‘united’ management of ‘united airways disease’: the role of otorhinolaryngologists and pneumologists. Allergy 62: 708PubMedCrossRefGoogle Scholar
  65. 65.
    Nicholson PJ, Cullinan P, Newman Taylor AJ, Burge PS, Boyle C (2005) Evidence based guidelines for the prevention, identification, and management of occupational asthma. Occup Environ Med 62: 290–299PubMedCrossRefGoogle Scholar
  66. 66.
    Rachiotis G, Savani R, Brant A, MacNeill SJ, Newman Taylor A, Cullinan P (2007) Outcome of occupational asthma after cessation of exposure: a systematic review. Thorax 62: 147–152PubMedCrossRefGoogle Scholar
  67. 67.
    Ameille J, Parion JC, Bayeux MC, Brochard P, Choudat D, Conso F, Devienne A, Garnier R, Iwatsubo Y (1997) Consequences of occupational asthma on employment and financial status: a follow-up study. Eur Respir J 10: 55–58PubMedCrossRefGoogle Scholar
  68. 68.
    Malo JL, Cartier A, Coté J, Milot J, Lablanc C, Paquette L, Ghezzo H, Boulet LP (1996) Influence of inhaled steroids on the recovery of occupational asthma after cessation of exposure: an 18-month double-blind cross-over study. Am J Respir Crit Care Med 153: 953–960PubMedGoogle Scholar
  69. 69.
    Sastre J, Quirce S (2006) Immunotherapy: an option in the management of occupational asthma? Curr Opin Allergy Clin Immunol 6: 96–100PubMedGoogle Scholar
  70. 70.
    American Thoracic Society (1993) Guidelines for the evaluation of impairment/disability in patients with asthma. Am Rev Respir Dis 147: 1056–1061Google Scholar
  71. 71.
    Yacoub MR, Lavoie K, Lacoste G, Daigle S, L'Archevecque J, Ghezzo H, Lemiere C, Malo JL (2007) Assessment of impairment/disability due to occupational asthma through a multidimensional approach. Eur Respir J 29: 889–896PubMedCrossRefGoogle Scholar
  72. 72.
    Tarlo SM, Liss GM (2005) Evidence based guidelines for the prevention, identification, and management of occupational asthma. Occup Environ Med 62: 288–289PubMedCrossRefGoogle Scholar
  73. 73.
    Allmers H, Schmengler J, Skudlik C (2002) Primary prevention of natural rubber latex allergy in the German health care system through education and intervention. J Allergy Clin Immunol 110: 318–323PubMedCrossRefGoogle Scholar
  74. 74.
    Liss GM, Tarlo SM (2001) Natural rubber latex-related occupational asthma: association with interventions and glove changes over time. Am J Ind Med 40(4): 347–353PubMedCrossRefGoogle Scholar
  75. 75.
    Brant A (2007) Baker's asthma. Curr Opin Allergy Clin Immunol 7: 152–155PubMedGoogle Scholar
  76. 76.
    Tarlo SM, Malo J-L (2006) An ATS/ERS report: 100 key questions and needs in occupational asthma. Eur Respir J 27: 607–614PubMedCrossRefGoogle Scholar
  77. 77.
    Liss GM, Nordman H, Tarlo SM, Bernstein DI (2006) Prevention and Surveillance. In: Bernstein IL, Chan-Yeung M, Malo J-L, Bernstein DI (eds) Asthma in the Workplace. Taylor & Francis, New York, pp 353–375Google Scholar
  78. 78.
    Vandenplas O, Jamart J, Delwiche JP, Evrard G, Larbanois A (2002) Occupational asthma caused by natural rubber latex: outcome according to cessation or reduction of exposure. J Allergy Clin Immunol 109: 125–130PubMedCrossRefGoogle Scholar

Copyright information

© Springer 2009

Authors and Affiliations

  • Gianna Moscato
    • 1
  • Eugenia Galdi
    • 1
  1. 1.Allergy and Immunology Unit, Fondazione “Salvatore Maugeri”, Institute of Research and CareScientific Institute of PaviaItaly

Personalised recommendations