Background. Allergy nurses are exposed to allergens and respiratory irritants, and there are no national guidelines addressing personnel safety when working with these agents. Objective. To investigate the prevalence of allergies, asthma, and hypersensitivity symptoms among allergy nurses and the use of protective equipment and measures when working with allergen concentrates and respiratory irritants. Methods. A questionnaire survey was performed among the members of the Swedish Association of Allergy Nurses. Results. Diagnosed asthma was reported by 17%, while 18% had allergy to pets, 28% had allergy to pollens, and 26% reported nasal symptoms. Fifty-one percent reported a history of asthma, allergic diseases, or hypersensitivity symptoms in their family. Exhaust ventilation was used by 24% during skin prick tests, 17% during allergen specific immunotherapy, and 33% when performing methacholine challenge tests. Tightly closed containers for disposable waste were used by 58% during skin prick tests, by 60% during immunotherapy, and by 40% during Pc provocation tests. Conclusion. Allergy nurses had a tendency to increased prevalence of lower respiratory symptoms, asthma, and allergic rhinitis and more than half of the nurses had a family history of asthma, allergic diseases, or hypersensitivity symptoms. Additional studies are needed to evaluate the validity of these results. 1. Introduction Allergy nurses work with various tests aimed at diagnosing allergic diseases and other hypersensitivity disorders. Common tests are skin prick test (SPT), where different allergens are used, penicillin (Pc) provocation tests, and tests with various respiratory irritants, such as methacholine (MCH). Many allergy nurses also perform allergen specific immunotherapy (ASIT) by injecting the allergen concentrates. In the clinical working situation with the patients, it is common to be exposed to drops of allergen extracts and to dried allergen on extract bottles and tissues used when performing SPT and ASIT. All these exposures may potentially lead to effects on the health of the nurses. Efforts have been made to improve the working environment in some clinics, using fume or downdraft hoods for diagnostic tests, whereas such preventive and safety measures are missing in other clinics. There are no existing national guidelines for these specific tests concerning safety for the allergy nurses and local recommendations may vary. Four main risk factors have been identified for developing occupational asthma (OA): the causative factor of exposure to an agent at work, the
References
[1]
P. J. Nicholson, P. Cullinan, A. J. Newman Taylor, P. S. Burge, and C. Boyle, “Evidence based guidelines for the prevention, identification, and management of occupational asthma,” Occupational and Environmental Medicine, vol. 62, no. 5, pp. 290–299, 2005.
[2]
R. Lundgren, M. Soderberg, L. Rosenhall, and E. Norrman, “Development of increased airway responsiveness in two nurses performing methacholine and histamine challenge tests,” Allergy, vol. 47, no. 2, pp. 188–189, 1992.
[3]
B. Balder, E. Bergmann, A. M. Ericson, and I. L. Henriksson, “Work environment survey of asthma and allergen diagnostics,” Hygiea, vol. 101, no. 2, p. 99, 1992 (Swedish).
[4]
J. Brisman, B. Balder, and S. Hagberg, Aerosol Leakage at Methacholine Testing, Department of Occupational Medicine, Gothenburg, Sweden, 1996, (Swedish).
[5]
D. C. Christiani and D. G. Kern, “Asthma risk and occupation as a respiratory therapist,” American Review of Respiratory Disease, vol. 148, no. 3, pp. 671–674, 1993.
[6]
D. G. Kern and H. Frumkin, “Asthma in respiratory therapists,” Annals of Internal Medicine, vol. 110, no. 10, pp. 767–773, 1989.
[7]
H. Dimich-Ward, M. L. Wymer, and M. Chan-Yeung, “Respiratory health survey of respiratory therapists,” Chest, vol. 126, no. 4, pp. 1048–1053, 2004.
[8]
H. Dimich-Ward, P. G. Camp, and S. M. Kennedy, “Gender differences in respiratory symptoms-Does occupation matter?” Environmental Research, vol. 101, no. 2, pp. 175–183, 2006.
[9]
A. A. Arif, G. L. Delclos, and C. Serra, “Occupational exposures and asthma among nursing professionals,” Occupational and Environmental Medicine, vol. 66, no. 4, pp. 274–278, 2009.
[10]
G. L. Delclos, D. Gimeno, A. A. Arif et al., “Occupational risk factors and asthma among health care professionals,” American Journal of Respiratory and Critical Care Medicine, vol. 175, no. 7, pp. 667–675, 2007.
[11]
M. Kogevinas, J.-P. Zock, D. Jarvis et al., “Exposure to substances in the workplace and new-onset asthma: an international prospective population-based study (ECRHS-II),” The Lancet, vol. 370, no. 9584, pp. 336–341, 2007.
[12]
M. C. Mirabelli, J.-P. Zock, E. Plana et al., “Occupational risk factors for asthma among nurses and related healthcare professionals in an international study,” Occupational and Environmental Medicine, vol. 64, no. 7, pp. 474–479, 2007.
[13]
M. L. Bandino and M. S. Tankersley, “Anaphylaxis in an allergy immunotherapy extract-compounding technician after an extract needle stick,” Journal of Allergy and Clinical Immunology, vol. 129, no. 1, pp. 250–251, 2012.
[14]
European Community Respiratory Health Survey II Steering Committee, “The European Community Respiratory Health Survey II,” European Respiratory Journal, vol. 20, no. 5, pp. 1071–1079, 2002.
[15]
F. Sundbom, E. Lindberg, A. Bjerg, et al., “Asthma symtoms and nasal congestion as independent risk factors for insomnia in a general population. Results from the GA2LEN survey,” Allergy, vol. 68, no. 2, pp. 213–219, 2013.
[16]
A. Bjerg, L. Ekerljung, R. Middelveld et al., “Increased prevalence of symptoms of rhinitis but not of asthma between 1990 and 2008 in Swedish adults: comparisons of the ECRHS and GA2LEN surveys,” PLoS ONE, vol. 6, no. 2, Article ID e16082, 2011.
[17]
“Questionnaire survey of the residents' perceived indoor environment and health—results from the BETSI project,” Swedish National Board of Housing, Building and Planning, 2009 (Swedish).
[18]
Work Environment Act with Comments, Swedish Work Environment Authority, Stockholm, Sweden, 2011.
[19]
Provision; Systematic Work 2001:1, Swedish Work Environment Authority, Stockholm, Sweden, 2001.
[20]
Provision; Workplace Design 2009:2, Swedish Work Environment Authority, Stockholm, Sweden, 2001.
[21]
Provision; Chemical Work Hazards. 2011:19, Swedish Work Environment Authorithy, Stockholm, Sweden, 2011.
[22]
K. Torén, L. Ekerljung, J.-L. Kim et al., “Adult-onset asthma in west Sweden—incidence, sex differences and impact of occupational exposures,” Respiratory Medicine, vol. 105, no. 11, pp. 1622–1628, 2011.
[23]
U. Nihlén, L. Greiff, P. Montnémery et al., “Incidence and remission of self-reported allergic rhinitis symptoms in adults,” Allergy, vol. 61, no. 11, pp. 1299–1304, 2006.
