Chronic rhinosinusitis: an underrecognized occupational disease

The review by Chin and colleagues recently published in CMAJ¹ is an excellent update on chronic rhinosinusitis, which is usually perceived as a minor inconvenience rather than a serious chronic condition. The authors outline that treatment could escalate to costly interventions, such as endoscopic sinus surgery or even monoclonal antibody therapy.

Clinicians should be reminded that chronic rhinosinusitis is a typical occupational disease. Work-related rhinitis is usually classified under either occupational rhinitis, which is caused by work and can be either allergic or nonallergic (i.e., caused by workplace irritants); or work-exacerbated rhinitis, when a preexisting rhinitis is made worse by work.² The exact prevalence of work-related rhinitis is unclear. The usually low severity of the disease makes it unlikely to be reported to workers’ compensation boards, so their statistics are certainly an underestimate. However, in occupational groups at risk, prevalence rates have been estimated to be 36%–42% in painters and urethane mould workers, 10%–36% in carpentry and furniture-making workers, 9%–41% in health care workers, 6%–33% in laboratory workers, and 28%–64% in grain elevator workers.³

Nevertheless, the proper identification and correction of occupational exposures has 2 very important impacts for patients. First, it helps with treatment. Although Chin and colleagues outline pharmacologic treatments, including oral medication and monoclonal antibody therapy, as well as surgical options, one important missing point is the eviction of the causal factor, when identified. A thorough occupational history is a key element. Even if the identification of a single causative agent is difficult, there might be circumstances when workers are exposed to a recognized causative agent (e.g., isocyanates, animal allergens, grain dust, flour, wood dust, seafood proteins), with a clear temporality of symptoms (i.e., improving during time off work). The workers’ quality of life improves when the exposure to a workplace causative agent is removed.⁴

Second, it helps cover the cost of treatment. Workers’ compensation is typically regulated at the provincial or territorial level in Canada. Benefits include wage replacement (compensation of lost income), and medical benefits (coverage of the cost of medical care related to the occupational disease).

Some elements of proper management for work-related rhinitis require the involvement of an occupational medicine specialist. Taking a thorough occupational history is long and complex, and the identification of typical causative agents in the workplace requires expert knowledge in occupational medicine. Hence, a referral to a qualified occupational medicine specialist is extremely helpful to address fitness-for-work considerations (and management of workplace exposures) as well as workers’ compensation in patients diagnosed with chronic rhinosinusitis.