Occupation and smoking

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Respiratory diseases have known associations with those working in the food and food-related industries. These include occupational asthma, occupational rhinitis and hypersensitivity pneumonitis. Skin diseases such as contact dermatitis and contact urticaria are also associated with work in these industries.

These diseases are not all Type I, IgE-mediated reactions. Some cases of occupational asthma and some of contact dermatitis occur as a result of irritation.12 Hypersensitivity pneumonitis occurs as a result of a Type III or possibly a Type IV hypersensitivity reaction.13 As with non-industrial food allergy or intolerance, the pathophysiological mechanism affects the choice of diagnostic tests.

All histories should include questions about the individual's employment and hobbies. If the pattern of disease makes the clinician suspect a temporal relationship with work, they should seek details about recent changes of workplace and recent changes in tasks and the introduction of new materials and processes.

The temporal relationship is not always obvious. Some individuals suffer from a late bronchial reaction to the agent, with the decline in lung function seen only at 2-10 hours post exposure and not returning to normal until sometimes 36 hours later. A latent period between exposure to the allergen and subsequent development of the symptoms is usually reported. As with all allergic diseases, the individual requires a period to acquire sensitisation; this can be anything up to 20 years after the initial exposure. Workers in particular industries are known to be at higher risk of occupational asthma. More than 50 agents have been implicated. Such diseases among workers in food industries are sometimes due to the food proteins themselves, but in other cases the specific IgE is directed against microorganisms or insects involved in food production or storage. Workers at risk include those in contact with wheat and rye flour, green coffee beans and snow crab. Workers who handle mushrooms and celery can be sensitised either to the food proteins or to micro-organisms associated with these vegetables.14

The diagnosis of work-related illnesses has important implications for the individual's livelihood, often necessitating permanent removal from exposure to the agent. It may also have important legal consequences for the employer.

It appears that smoking may well increase the risk and speed of sensitisation to inhalant allergens, making smokers more at risk of IgE-mediated illness when exposed to sensitising agents, particularly in the workplace.15

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