Occupational allergic rhinitis: work-related nasal symptoms and what to do

Rhinitis means inflammation of the lining of the nose. A published review in the journal Allergologie Select, written by German specialists, quotes the European Academy of Allergy and Clinical Immunology definition: occupational rhinitis is an inflammatory disease of the nose characterised by intermittent or persistent symptoms such as nasal obstruction, runny nose, sneezing and itching, caused by factors attributable to a particular workplace environment and not by factors that occur outside it.

The review divides occupational rhinitis into allergic and non-allergic forms. In the allergic form the nose becomes hyper-reactive to specific workplace substances after an initial latency period in which sensitisation occurs; repeated exposure then leads to intermittent or persistent symptoms. The non-allergic form is triggered by irritants such as chlorine and has no latency period. It also describes work-exacerbated rhinitis, a pre-existing rhinitis made worse by workplace exposure but not caused by it.

The review is from Germany rather than the UK and describes German reporting rules, which do not apply here. A UK-specific patient page on occupational rhinitis was not found, so this page also draws on the Health and Safety Executive's description of related occupational asthma.

The review says occupational exposure to substances such as flour dust or the epithelia of laboratory animals is considered one of the main causes. A Finnish study it cites found the risk is particularly high for bakers, food processing workers, farmers, veterinarians, animal breeders, electronic product manufacturers and boat builders. It names exposure to certain substances, smoking and atopic predisposition (a tendency towards allergy) as considered major risk factors, while noting that no clear link with smoking has been identified.

HSE explains the related idea for the lungs: some substances in the workplace are respiratory sensitisers, or asthmagens, which cause a change in the airways known as the hypersensitive state. Not everyone who becomes sensitised goes on to get asthma, but once sensitised further exposure, even at low levels, may trigger symptoms. HSE says the occupations with the highest incidence rates of occupational asthma include bakers and vehicle paint sprayers, and that the most commonly cited causes were isocyanates followed by flour.

The symptoms are a blocked nose, runny nose, sneezing and itching, as in hay fever or other allergic rhinitis. HSE adds that rhinitis can come with conjunctivitis (itchy, inflamed red eyes) in people exposed to workplace substances that can also cause occupational asthma, whose symptoms include wheezing, coughing and chest tightness.

What distinguishes it is the pattern. The review says the key question in diagnosis is the link between symptoms and the workplace, with attention to current tasks, processes in adjacent work areas, recent changes in materials and the length of employment before symptoms began. HSE notes that asthma symptoms can develop right after exposure but sometimes several hours later, possibly at night, which can make the link with work unclear; the same may be true for nasal symptoms.

• Blocked nose, runny nose, sneezing and itching.

• Symptoms that appear or worsen during working days.

• Improvement at weekends or on holiday (a useful pattern to note).

• Itchy, red eyes.

• Wheeze, cough or chest tightness, which should be reported promptly.

The review says taking a detailed history is especially important and that the gold standard for confirming the diagnosis is nasal provocation testing, in which the nose is exposed to the suspected substance under supervision. Because a diagnosis can have serious social and financial consequences, it says objective methods should be used to avoid misclassification, and that a possible involvement of the lower airways should always be investigated, for example with spirometry.

In practice, a GP will ask about your job, what you work with and when symptoms occur, and may refer to an allergy, ENT or occupational health service. A symptom diary linked to work days and days off is often useful. Occupational health teams and employers have a part to play in identifying the substance.

The review says the main therapeutic objectives are best possible symptom relief and prevention of occupational asthma, and that treatment options consist of total avoidance of trigger substances (the main goal), reduction of exposure and pharmacotherapy. It says allergic occupational rhinitis is closely associated with occupational asthma, which is why early recognition matters.

HSE explains that under the Control of Substances Hazardous to Health (COSHH) Regulations, employers are required to prevent or control exposures to hazardous substances to protect employees' health, and that there is a specific Approved Code of Practice for the control of substances that cause occupational asthma. It suggests looking for the risk phrase R42, may cause sensitisation by inhalation, on product labels or safety data sheets.

Practical steps usually involve talking to your employer or occupational health team about changing processes, ventilation or protective equipment, or redeployment, as well as seeing a GP about medicines for the nose. Do not stop work or change duties without discussing your options and your rights.

On the NHS, a GP is the first contact and can refer to allergy, ENT or respiratory services. Many employers also provide occupational health services, which can assess the workplace link and advise on adjustments.

Private allergy or occupational medicine specialists can offer skin prick or blood testing and workplace-focused assessment. Testing for workplace substances is specialised, so the main value of a private route is usually speed and a second opinion; the principles of avoidance and early review remain the same.