Allergies on the Job: 7 Workplace Irritants
What You're Exposed to at Work Can Bring on the Wheezing, Sneezing, Itching
By CARI NIERENBERG
ABC News Medical Unit
April 9, 2009—
To many employees, the workplace can be a source of irritation -- for reasons other than their boss, co-workers or paychecks.
Something in your physical surroundings may act as an irritant that triggers an allergic reaction or asthmatic symptoms in susceptible workers.
Of course, some professions have a higher risk of possible exposure to allergic or asthmatic triggers than others. Although there can be plenty of dust in the offices of people in white-collar occupations, dust mites can also annoy warehouse, maintenance and construction workers.
Still, dust can come in many forms: Wood dust may be troublesome to carpenters and woodworkers, and food dust from flour could irk bakers, pastry chefs and pizza makers.
Seasonal pollen allergies can be a real nuisance to those who work outdoors as landscapers, postal carriers or on highway maintenance crews.
Any number of jobs at manufacturing plants or refineries can cause employees to regularly breathe in chemical vapors that may bother nasal and lung passageways.
According to the World Health Organization, workplace exposure to fumes, gases or dust are responsible for 11 percent of asthma cases worldwide. And some estimates suggest that roughly 20 percent of new cases of asthma in adults are work related.
Compared to your surroundings at home, you have less control over the work environment, said Dr. Jonathan Bernstein, a professor of medicine in the division of allergy and immunology section at the University of Cincinnati.
You have less control over the ventilation system, the location where you work, how often it gets cleaned, the temperature and humidity, and even the materials used on the job. These factors can influence your risk of work-related reactions.
But not all symptoms that erupt at work are from allergies or asthma. Often they are a reaction to irritants.
"There are lots of funky reactions that people may have been told are caused by allergies that probably aren't," said Dr. Karin Pacheco, an assistant professor in the division of environmental and occupational medicine at National Jewish Health in Denver.
These symptoms come from being exposed to an irritant and may include irritated eyes, headache, tightness in the throat, post-nasal drip and feeling bad, in general. These complaints are not always long-lasting and tend to go away with less exposure to them, she said.
An allergist is not the only health professional who may diagnose these reactions. Sometimes you might touch or be exposed to a material at work that affects your skin, and you would visit a dermatologist if it doesn't clear up or happens frequently.
"In an irritant reaction, the skin looks red and feels a little painful," said Dr. Mathew Avram, a dermatologist at Massachusetts General Hospital in Boston. "In an allergic reaction, there's more intense itching and blistering of the skin."
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Whether you're sneezing, wheezing or getting rashes on the job, here's a rundown of seven common workplace troublemakers.
Latex Allergy
A woman who runs an Italian restaurant around the corner from the offices of Dr. Clifford Bassett, medical director of Allergy and Asthma Care of New York, came to see him after she had a life-threatening allergic reaction and she didn't know why.
"One of my hats is to be an investigator," Bassett said.
He learned that the restaurateur had been having hives and trouble breathing, and was feeling faint when she was at the restaurant, where she often had to sample food made by employees wearing latex gloves.
She was coming in contact with latex all the time at the restaurant," said Bassett.
Besides people in the food service industry, others who regularly wear gloves on the job include beauticians and health care workers, whether in a dental office or operating room.
In fact, research suggests that 5 to 15 percent of health care workers have a latex allergy, while only 1 percent of the general population does.
"Your risk goes up if you're regularly exposed to latex products," Bassett said.
People get exposed to a protein in this rubber material by having direct contact with it (blowing a balloon or wearing a condom), inhaling airborne particles from it (putting on or taking off gloves often releases latex-laden, powdery particles), or ingesting it (eating a sandwich made by someone wearing a latex glove).
Testing identified that the woman was indeed allergic to latex. She then worked with her kitchen staff to get rid of latex gloves and use alternatives instead.
Interestingly, some people with latex allergies have cross reactions when they eat certain foods such as kiwi, avocado, banana and chestnut.
Pet Allergies
Ten to 15 percent of all people with allergies have an allergy to pets, said Bassett.
You might think that veterinarians as well as dog walkers, trainers or animal groomers might shy away from working with pets on a daily basis if they had this sensitivity, but that's not always the case.
Bassett recalled a case involving a female veterinarian who had bad allergies to dogs and cats.
"Imagine the irony of being allergic to your clients," he exclaimed.
Throughout her veterinary training, the vet knew she had mild allergies to her patients. But with more exposure to the animals, the allergies grew worse.
She was sneezing, had nasal congestion and itchy eyes with every visit from Fido or Fluffy. In the morning, she woke up with a dry throat and "allergic shiners" or dark circles under her eyes.
Caring for dogs and cats was her livelihood, so avoiding exposure to her allergens would mean changing careers.
For her, pet dander was the trigger. But for some people with cat allergies, the feline's saliva is the main irritant.
Pet dander in a vet's office can be everywhere. It collects on the pet's fur, and once airborne it may settle on clothes, walls and other surfaces. So, to feel better, she had to clean these areas more scrupulously.
According to Bassett, the vet decided to undergo immunotherapy. While she was getting the allergy shots over a three- to four-month period, she also took a daily antihistamine before work. And she did daily nasal rinsing with salt water every evening to wash away the irritants.
The treatment provided the long-term relief she needed to continue to stay in the profession. These days, both the vet and her furry four-legged friends are happy once again.
Beauty Products
Hair stylists, nail salon workers and make-up artists sometimes find that the beauty products they frequently use on their clients makes them feel pretty lousy.
Bassett had a patient who owned a hair salon. For many years, this gentleman had skin and respiratory complaints after being exposed to various products at his salon.
His skin rashes and asthma symptoms had gotten worse and disappeared on his days off, so he finally sought medical help.
Bassett sent him to an occupational dermatologist to pinpoint the substances that were provoking his skin problems.
"Patch testing is what we do," said Avram, who did not see this particular patient. Small amounts of allergens are placed on the person's back, then examined a couple of days later to see which substances produce a rash or skin reaction consistent with the patient's initial symptoms, he said.
"Sometimes, it's difficult to find out exactly what the culprit is," he admitted.
Once the salon owner's irritants were identified, he was advised to replace some of the products the shop used. In addition, he was told to wear a protective mask around the triggers. But sometimes, stylists and manicurists feel odd about wearing a mask at work for fear it might scare away their clients.
"An allergist is good at developing strategies to evaluate and investigate a case, but we also need a patient's help," said Bassett.
When possible, he suggested, bring along some of the products you suspect you might be sensitive to.
Cleaning Supplies
For 20 years, Kathy Sperrazza was a nurse in a Boston teaching hospital. During the early 1990s, many health care facilities, including the one where she worked, instituted universal precautions to protect medical personnel from infections such as HIV and hepatitis B when they came in contact with patients' blood and body fluids.
"We were using many more latex gloves, and there were lots of chemicals in those gloves," explained Sperrazza. And "we were also spraying more cleaning solutions that left a cloud of chemicals."
She recalled that "many of the nurses, especially the ones who worked in the operating rooms or in the intensive care units -- areas that required lots of regular cleaning and frequent glove use -- were developing rashes and their hands looked like raw meat."
Although she had reactions to wearing latex gloves, her test for latex allergy came back negative.
But all around Sperrazza, employees continued getting sick. Struggling to stay in this environment despite the toll it was taking on their health, many doctors and nurses were carrying around inhalers and popping antihistamines.
At first, she would just get headaches while at the hospital. If she worked several days in a row, though, her symptoms went far beyond headaches. She also had chest tightness, wheezing, difficulty breathing and nausea.
Many cleaning agents cause lots of irritation -- headaches, irritated eyes and nose -- and it's usually based on exposure, said Pacheco. "But they usually don't cause long-lasting problems."
Sperrazza eventually reached the point where "I didn't feel well in my own house," and she was getting worse and worse each day. So she took time off.
"I thought I would be back to work in a week, but I was never able to go back," she said.
She went from doctor to doctor -- an occupational medicine physician, a pulmonologist -- and they diagnosed her with occupational asthma as a result of her workplace exposure. But the chemicals seemed to do more than affect her lungs, they also affected her immune system and nervous system.
Only years later would she learn that she had developed multiple chemical sensitivity.
Although Sperrazza did not return to hospital-based nursing, her experiences shaped her current career path. She's now a hospice nurse and also working toward her doctoral degree in occupational and environmental hygiene, where she is doing research on nurses' occupational health.
And she has become a workplace health advocate.
"Lots of modifications can be made to accommodate people who have a problem," she said. "You can increase ventilation when you might be doing something harmful and you can find alternative products to use to make workplaces safer."
She passed on yet another piece of health advice that she learned the hard way: "Some people don't know why they have asthma. They don't understand that it might be their work."
Fragrance Sensitivity
You may have caught a whiff of a person's overpowering perfume or cologne in a confined space, like an elevator, airplane or religious service, and were bothered by the aroma, but it didn't make you ill.
But others are extremely sensitive to fragrances. Although this sensitivity often is not a full-blown allergy, it can make the daily grind extremely uncomfortable.
Jessica Kaufman works in a health care facility in Vermont where her co-workers have tried to accommodate her sensitivity to scents.
But it's not just her colleagues she needs to worry about. It's the constant shuffle of patients and visitors wearing scented products that she has no control over.
"I can't tell what perfume I will react to, and I react to all different degrees," said Kaufman. "It has nothing to do with the strength of the fragrance."
To make it through the day, she takes antihistamines and decongestants every morning.
Before she realized she had a problem, she was fond of putting on fragrances or lighting a scented candle. However, the candle would cause her to wheeze and cough.
"I was so used to being this way," she said of her asthma-like symptoms.
Kaufman has taken steps to make her home fragrance-free and requests a fragrance-free room when she travels. Her husband is also fragrant sensitive, so they deal with the problem together.
But the workplace is another matter. Although the hospital where she works has a no-fragrance policy, it's a tough thing to enforce -- not only for employees, but for all the other folks who come and go each day.
"We've received an ongoing and steady increase in calls from employees and employers about fragrance sensitivities," said Linda Batiste, a principal consultant at the Job Accommodation Network, a service of the U.S. Department of Labor's Office of Disability Employment Policy. "There's a lot more awareness about it."
Usually, Batiste said an employer is willing to ask workers for voluntary compliance to avoid wearing fragrances.
"But it's virtually impossible to police this," she admitted.
Sometimes, an employee can be moved to a different location in the building where he or she will have access to a window, better ventilation or a private office to reduce exposure.
Batiste offered this piece of advice to employers: "Be careful about confidentiality. Unless the employee has given you permission, you can't say who the person is with the sensitivity."
Mice Allergy
Most of us try to avoid mice, but Bev Paigen studies them. She's a mouse geneticist who uses the rodents as a model to research the genetics of heart disease.
As a professor at the Jackson Laboratory in Bar Harbor, Maine, Paigen can't help but be surrounded by mice.
"This is the lab that produces mice. We grow them and send out about 2 million of them to other labs for research," she said.
And yet, Paigen is allergic to mice and gets asthmatic symptoms when she's around them or near people who have been.
She developed an allergy to mice in her first research job out of college, so she explored other areas of genetics that would not put her in contact with the rodents.
She dabbled with bacterial genetics and then human genetics.
But after 10 years away -- without any symptoms -- the excitement in the field of mouse genetics enticed her once again.
"Scientists were making more progress in the genetics of disease in mice than in humans," she said. "So I came back to the mouse."
Paigen tried to cope as best she could.
"I didn't go in the mouse room," she said. "I didn't touch them. And I was pretty careful to avoid my exposure."
Despite these efforts, she had trouble breathing and "had such severe asthma, I thought I would have to stop working."
Rather than retire, she decided to do something to solve the problem. Fifty thousand to 100,000 workers in the U.S. have a significant mouse allergy, noted Paigen.
With the cooperation of the director of the lab, who happened to be Paigen's husband, scientists there did a lot of studies on the cause of mice allergies and ways to reduce the allergens employees were exposed to.
According to Paigen, there's a protein in mouse urine that's very potent, and this is often the allergic irritant.
"This protein is easily airborne and it's sticky. It clings to the walls, and it gets on your clothes," she said.
"We measured the levels of this protein throughout the building, and we found it in the library and where people ate lunch."
As a result of these findings, the lab made major changes. They improved the ventilation in some areas of the building. They put mice in a newer type of cage that filtered the allergenic protein from the air.
They gave every new employee a lung function test and skin test to see if they had mice allergies, and then retested them six months later to catch symptoms early.
And they continued their monitoring efforts: During the 1990s, 50 percent of Jackson Lab employees had symptoms -- sneezing, watery eyes, skin rashes, or asthma -- on a daily basis.
"Now that figure is closer to 10 percent," said Paigen.
No doubt, Paigen and her colleagues are breathing a little easier as a result.
Mold Allergies
In New York, mold is very common, noted Dr. Hale Yarmohammadi, an allergy and asthma specialist at Beth Israel Medical Center in New York City.
"It's an old city and many of the buildings have water leaks that are tough to get rid of," Yarmohammadi said.
Mold, she explained, can wreak havoc with your health in two different ways.
"One is an allergic reaction, but not everyone gets this," she said. "And the other problem results from the toxins the mold secretes."
People often get vague symptoms from mold exposure, said Yarmohammadii. They might get headaches or feel nauseous or have asthma symptoms.
The kind of mold found in homes that can bring about asthma is called stachybotrys -- a black, sticky, slimy fungus. To grow indoors, it needs water, so it's often found around water pipes or in areas moistened by a leaky roof, wall or plumbing.
In your own home, mold might be easier to spot. At work, it could be hidden. Employees recognize that factors that affect mold growth or its spread might not be in their hands, such as the ventilation system, building maintenance, and the cleanliness of the workplace.
Most of the mold-related symptoms -- perhaps, for example, to teachers who work in old school buildings, are not allergenic -- said Bernstein from the University of Cincinnati. They primarily come from working in a damp environment, he added.
"In the work place, you're being exposed to one or more specific agents over a prolonged period of time, and it's harder to change the environment," Bernstein said.
But the occupational allergy and asthma specialists ABCNews.com spoke to did offer some words of wisdom to workers who may be experiencing symptoms while on the job.
"Determine if you feel worse at home or at the office," offered Bernstein.
"Get a handle on what your symptoms are, " suggested Pacheco. "Know when they happen, and what particular activities or exposures seem to trigger them. Figure out what makes them better, and notice whether others are having similar problems."
She advised working with your employer to find ways to modify the environment and the exposure.
"Leaving the job is not the only solution to avoid an occupational allergen, irritant or asthma trigger," said Pacheco. "It's the last resort."
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