But dangers are not confined to the metropolitan industrial setting; recent reports suggest that occupationally-related respiratory diseases are common among grain elevator workers90 and farm workers who evidence symptoms ranging from rhinitis to asthma.91
A number of familiar trades have come to be associated with chemical risks in recent years, among them carpentry92 (in which contact sensitivities to woods are reported widely), painting, identified with severe respiratory symptoms,93 and bricklaying, where sensitivities to chemicals such as cobal are now extensively described.94
There are increasing reports of chemically induced reactions among beauticians,95 and researchers have now incriminated a vast number of chemicals to which such workers are exposed on a daily basis, among them nickel sulfate, pellidol, and cobal chloride.96 Bakery work has come to be identified with risks in the form of chromium exposure through contact with a chromium compound in flour,97 as well as exposure to gas from the ovens; photographers and those responsible for developing photographs now appear at high risk for chemically induced respiratory disease,98 as well as cerebral and vascular dysfunction.
The list of occupations in which exposures to potentially hazardous chemicals may occur seems endless. It is now clear that physicians, laboratory technicians,99 nurses100 and others in direct contact with numerous drugs and chemicals face potential dangers. What is remarkable, however, is the extent to which seemingly safe occupations are fraught with risks; witness Fisher=s101 report of a chemically-triggered reaction in a concert violinist caused by contact with his rosin.
It would, of course, be impossible to discuss here all of the chemical agents encountered in the occupational environment to which reactions have been observed; the spectrum of incitants ranges from organic chemicals102 and inhalants103 to natural dyes104 and synthetic compounds.105 Symptoms have been found to be provoked by natural metals such as zinc and cobalt,106 as well as industrial chemicals, among them chloramine,107 formalin,108paraformaldehyde, zylene,109 and the persulfates.110 Moreover, an array of reactions has been reported in association with common industrial agents such as the diisocyanates111 and toluenes.112 It is of critical importance to consider the chemicals confronted in occupational products which are apparently benign: recent reports have isolated chemical contaminants in cement,113 printing paper,114 and even latex surgical gloves.115
The spectrum of disease processes secondary to occupational incitant exposure is a broad one. Over the past three years, some 60 reports have associated dermatitis with chemical sensitivity in the work environment. It has been observed that occupational dermatitis may range from mild discomfort to permanent incapacity; such reactions have been found in association with a multitude of occupations: physician, dentist,116 medical technician,117metalworker,118 musician,119 florist,120 caterer,121 office worker,122 and retail salesperson.123 Against the backdrop of present research it seems clear that a virtually infinite number of occupational milieus contain dangers for the susceptible patient. Data clearly reveal the necessity of environmental control for the evaluation and treatment of such occupational sensitivities.
Other disease processes that may assume the dimensions of an occupational illness include erythema and vesiculation,124 thrombocytopenic purpura,125 Raynaud=s phenomenon,126 and coronary artery spasm.127 A number of environmentally-triggered respiratory symptoms have been noted, among them bronchoconstriction,128 airway obstruction,129 pneumonitis,130 dyspnea,131 alveolitis,132 and asthma.133 Recent data also suggest that CNS dysfunctions, including depression, fatigue, and sleep disturbances,134 and even some forms of carcinoma135 may exist secondary to occupational chemical exposure.
This information is from a paper by Dr. William Rea
Chemical Sensitivity and the Environment
