Diagnostics of IgE-mediated occupational allergies: Between reality, requirements, and opportunities

Abstract

Occupational skin and respiratory allergies are among the most common occupational diseases in Germany. The identification of the allergy trigger is essential for the recognition of an occupational allergy as well as for effective individual prevention. However, occupational type I allergens are among the "rare" allergens and the possibilities of guideline-compliant diagnosis using quality-tested skin test solutions is becoming increasingly difficult due to the reduction in commercially available test allergens. In order to guarantee meaningful diagnostic workup for all affected insured persons with suspected occupational type I allergies and to ensure this in the future, a durable optimization, standardization, and availability of allergy tests for occupational allergic diseases is urgently required. The need for action has been recognized by the German Social Accident Insurance (DGUV), and steps to eliminate the diagnostic gaps have been initiated by a joint research project at the Institute for Prevention and Occupational Medicine of the DGUV (IPA) and the Paul Ehrlich Institut (PEI). The evaluation of alternative methods for the production of standardized test allergen solutions can also be used for newly emerging allergens in the workplace. New allergen sources at workplaces and thus also sensitization and allergies among employees can be expected as a result of changes in work processes and the introduction of new technologies and/or working materials, which are also introduced in connection with climate change and the concept of sustainability.

Keywords: allergy diagnosis; high molecular weight allergens; individual prevention; occupational allergens; occupational disease; standardization.

Figure 1. Frequency of the triggering allergen sources of occupational disease BK No. 4301 (“obstructive respiratory diseases caused by allergenic substances including rhinopathy”). Summarized representation of the most frequent triggering allergen sources from the data of the BK-DOK of the German statutory accident insurance institutions and the German Social Insurance for Agriculture, Forestry and Horticulture (SVLFG) for the period 2018 – 2022.

Figure 2. Step-by-step workflow for allergy diagnosis in cases of suspected occupational type I allergies.