Occupational allergic diseases as a clinical model to approach specific environmental reactivity

Abstract

Hyperreactivity to environmental factors is objectively expressed as respiratory, cutaneous and gastrointestinal disease. Approaching the diagnosis of an occupational disorder, a practical distinction was made between toxicity and allergy. The study of occupational allergic disease included particular procedures that led to standardized models and concepts. The contribution to the improvement of medical knowledge is reviewed according to selected experiences. The diagnostic aspects of asthma, rhinitis, dermatitis and urticaria are considered as regards to methodology of assessment of the occupational etiology with attention to demonstrative examples, which are worthwhile for the general medicine, too. Basic steps of risk agent identification, exposure assessment, threshold dose response measurement, allergen challenges and interaction are the original contribution of the occupational medicine to the diagnosis of allergic disorder. The clinical picture of asthma was clarified by the results of the specific bronchial provocation test, proving the important role of di-isocyanates and metal salts. Occupational rhinitis showed to be connected to asthma with predictive aspects in bakers' disease. Occupational dermatitis was linked to the development of experimental patch tests. Occupational urticaria included the concept of airborne contact allergy or nickel interactive food and occupational sensitivity. Occupational allergic diseases are emerging as a consequence of low environmental exposure, but they were remarkably studied in the past either for pathogenesis or for diagnostic procedures. Methods and acquisition are available also for the general medicine when an individual's specific reactivity is under investigation.