ABSTRACT
Occupational allergens or occupational triggers may affect 15% or more of adult patients with asthma. Allergen immunotherapy (AIT) may be a therapeutic consideration for some patients with confirmed occupational asthma and/or occupational rhinitis caused by high molecular weight protein allergens. Although there are relatively few published reports in this area, there may be an unmet need for AIT in those patients with work-related allergic respiratory symptoms associated with unavoidable exposure to workplace aeroallergens. Considerable numbers of studies have appeared evaluating subcutaneous immunotherapy (SCIT) and sublingual immunotherapy (SLIT) treatment of natural rubber latex allergy and are reviewed extensively here. Although informative, the studies are not clinically relevant at this time, since new cases of latex allergy have been effectively prevented by exposure control measures. There have been small studies evaluating SCIT for treatment of bakers' asthma with wheat flour extract, laboratory animal workers with mammalian allergen extracts (e.g., mouse and rat), and veterinary workers treated with standardized cat extract. The SCIT studies are placebo controlled, and some of these have shown improvements in asthma symptoms, but none are powered adequately due to small numbers of subjects. The U.S. Food and Drug Administration approved SLIT tablets that have shown efficacy and safety in large placebo-controlled studies of house dust mite sensitized patients with perennial allergic rhinitis and allergic asthma. Although not studied in workers specifically, this modality may be applied in the future in treating house dust mite sensitized cleaning workers exposed regularly to house dust mites. Stinging insect allergy presents a major risk of fatal or near-fatal anaphylaxis in beekeepers and outdoor workers sensitized to Hymenoptera venoms. Subcutaneous Hymenoptera venom immunotherapy is highly effective in workers at risk in preventing subsequent systemic reactions and anaphylaxis after resting events.
