Occupational rhinitis in agriculture is an occupational disease that is becoming increasingly important and their relationship and association with occupational asthma. The data on the epidemiology, diagnosis, treatment and socio-economic impact of occupational rhinitis and prevention strategies are presented. The most important aspect of this definition is the causal relationship between occupational exposure and disease development. The Agriculture is one of the productive sectors most at risk of exposure.

Keywords: Occupational rhinitis, Agriculture, Nose, Prevention

CLASSIFICATION

Depending on its pathogenesis, professional rhinitis can be classified as allergic and non-allergic; another subdivision is in reactive, irritative or immunological forms. Most cases of allergic rhinitis in the workplace derive from exposure to high molecular weight allergens such as animal, vegetable, food and enzymatic proteins.

The professional noxas that can cause allergic rhinitis in farmers are wheat powders, molds, fungal spores, proteins derived from epithelia and urine from farm animals [6].

The form of irritative rhinitis can be caused by nitrogen dioxide, bacterial endotoxins, pesticides (organophosphorus and organochlorines), fertilizers (ammonium sulfate and nitrate and potassium chlorate) and disinfectants (aldehydes). Allergic rhinitis in agriculture is underestimated especially when compared to allergic asthma and industrial rhinitis.

PROBLEMS

The presence of numerous “confounding” factors, the lesser current interest in literature, often “spurious” epidemiological data, the difficulty of establishing causation, the normative coding, the diversity of classification criteria, the unvalidated diagnostic methods, sometimes entrusted more to a clinical diagnosis than an instrumental one, they are just some of the elements, which tend to contaminate the clinical and medico-legal evaluation.

“Occupational” allergic rhinitis in agriculture, in addition to determining sensitive direct and indirect social-health costs, significantly altering the quality of life of patients, determines  a  significant impact on  work performance, also associated with repercussions on work absenteeism [7]. The first approach to managing work-related rhinitis involves risk assessment, exposure estimates and prevention measures with interventions aimed at reducing or eliminating exposure to the causative agent. Occupational rhinitis therapy has a twofold objective: to alleviate the nasal symptoms and their impact on the well-being of the worker and possibly prevent the development of occupational asthma [8].

THERAPY AND PREVENTION MEASURES

Therapeutic options include both environmental interventions aimed at avoiding exposure to the causative agent and pharmacological treatment. The first objective, often burdened by socio-economic implications, can be achieved through the transfer of the interested party, where possible, to another production line or through the adoption of protective measures (for example masks, filters or barriers).

Nasal symptoms, however, may not completely resolve even after complete elimination of exposure, which is why clinical surveillance is always appropriate [9].

The effect of non-sedating antihistamines and topical corticosteroids has not yet been the subject of in-depth studies, but it is clear that they, along with decongestants, constitute an important resource and an appropriate alternative to the elimination or reduction of exposure to work with the sensitizing agent.

Specific immunotherapy is currently limited by the unavailability of standardized extracts for most occupational allergens and should be used with caution.

"Occupational" allergic rhinitis in agriculture, in addition to determining sensitive direct and indirect social-health costs, significantly altering the quality of life of patients, determines a significant impact on work performance, also associated with repercussions on work absenteeism [10] The first approach to managing work-related rhinitis involves risk assessment, exposure estimates and prevention measures with interventions aimed at reducing or eliminating exposure to the causative agent. Occupational rhinitis therapy has a twofold objective: to alleviate the nasal symptoms and their impact on the well-being of the worker and possibly prevent the development of occupational asthma.

Therapeutic options include both environmental interventions aimed at avoiding exposure to the causative agent and pharmacological treatment. The first objective, often burdened by socio-economic implications, can be achieved through the transfer of the interested party, where possible, to another production line or through the adoption of protective measures (for example masks, filters or barriers).

Nasal symptoms, however, may not completely resolve even after complete elimination of exposure, which is why clinical surveillance is always appropriate.

The effect of non-sedating antihistamines and topical corticosteroids has not yet been the subject of in-depth studies, but it is clear that they, along with decongestants, constitute an important resource and an appropriate alternative to the elimination or reduction of exposure to work with the sensitizing agent.

Specific immunotherapy is currently limited by the unavailability of standardized extracts for most occupational allergens and should be used with caution.

CONCLUSION

Modern agriculture has changed, far from the bucolic visions of the past. Diseases that are directly or indirectly linked to field work must also be viewed in a different light. The allergic rhinitis is surely for frequency and for incidence on costs and absences a still underestimated and in some ways little known reality. We need a joint effort between the various actors of this process so that they can find unequivocal and concrete answers to the problems of these workers and these rural environments.

1.       EAACI (2009) XXVIII Congress of the European Academy of Allergy and Clinical Immunology, Warszawa, Poland. Available at: http://www.eaaci2009.com/

2.       Slavin RG (1992) Occupational rhinitis. Immunol Allerg Clin North Am 12: 769-777.

3.       Le riniti ML (1998) “occupazionali” – Atti Convegno “Habitat e salute” – Società d’Allergologia Clinica Appulolucana, Gallipoli (LE), 10 maggio.

4.       Maci L, Tavolaro M (2007) Riniti “Occupazionali” I° congresso dei Comitati Regionali. A.I.O.L.P. “Integrazione fra territorio e degenza”. Roma 7-9 giugno.

5.       Zeiger RS (1989) Allergic and non-allergic rhinitis: Classification and pathogenesis, I. allergic rhinitis. Am J Rhinol 3: 21-47.

6.       Kanerva L, Vaheri E (1997). Occupational rhinitis in Finland. Int Arch Occup Environ Health 64: 5658.

7.       Bardana EJ Jr (1995) Occupational asthma and related respiratory disorders. Dis Month 41: 141-200.

8.       Enfermedades Profesionales de los Agricultores (2008) Comisión Nacional de Seguridad y Salud en el Trabajo. Grupo de Trabajo “Sector Agrario”.

9.       I.N.R.S. (2008) Prévention des risques liés aux émissions de poussières de farine (asthme, rhinites, allergies respiratoires) en boulangerie artisanale.

10.    Maci L, Tavolaro M (2011) Les rhinites professionnelles. CAMIP 2: 1-10.