Investigators: Roberto Castano MD, PhD (PI); Denyse Gautrin PhD; Jean-Luc Malo MD; Partner : CSST.
Student: D. Miedinger MD, post-doctoral fellow.
Background: Occupational rhinitis (OR) is a type of rhinitis caused by airborne sensitizers and irritants present in the workplace. OR may potentially have an important impact on worker’s quality of life depending on severity and chronicity of nasal symptoms. (1) While numerous studies have shown that health related quality of life (HRQL) is affected in allergic rhinitis, (2) no studies have been conducted to assess HRQL in patients with a confirmed diagnosis of OR. In the period 2005-2007 we conducted a study in which we investigated OR in subjects undergoing investigation for occupational asthma (OA). At the end of the study period 14 subjects had a diagnosis of both OR and OA (Group I) and 15 subjects had a diagnosis of OR alone (Group II). After diagnosis, the working status of subjects in each group is likely different. Presumably, subjects in Group I will not continue working exposed to the harmful causal agent due to a confirmed diagnosis of OA. For subjects in Group II the scenario is different; contrary to OA, they remain at work and are managed with medical treatment and measures to reduce exposure to the causal agent. Consequently, in most cases a patient with a diagnosis of OR alone will have to continue working exposed to the agent to which he has been demonstrated to be sensitized or sensitive. This means that nasal symptoms may eventually worsen with time and raise concern of a higher risk for later developing OA; these facts in turn may have an impact in quality of life of patients. This study will investigate for the first time long-term outcomes of allergic and nonallergic OR. Hypothesis and objective: We hypothesise that after cessation of exposure subjects with OR will improve substantially their rhinitis symptoms severity and HRQL. In the opposed situation of continued work exposure, we hypothesise worsening of rhinitis symptoms and HRQL parameters. Some subjects might have developed OA also. Methods: Participants in this retro-prospective follow-up assessment will be: i) subjects with a diagnosis of OR confirmed by challenge test in the past 2 years at Hôpital du Sacré-Coeur de Montréal and, ii) new cases of OR confirmed by challenge test starting Summer 2009. At visit 1, subjects will complete (or completed in the past): i) a questionnaire on frequency of nasal symptoms and their relation to environmental and occupational exposures; ii) a scale rating the severity of rhinitis symptoms at work and away from work and; iii) the Rhinasthma questionnaire which was designed to assess HRQL in subjects affected of both rhinitis and asthma to avoid the administration of two different questionnaires. Also, subject will undergo (or underwent in the past) an examination of the nose by anterior rhinoscopy. A follow-up assessment will take place at least 2 years after confirmation of diagnosis of OR. At this time we will invite study participants to come to the hospital to answer the same questionnaires with some additions to investigate patients' perception of current exposure to the original agent that cause OR and use of medications for rhinitis and asthma since diagnosis; as well as to undergo an examination of the nose. The major outcomes will be: i) changes in frequency and severity of nasal symptoms from visit 1 to visit 2 and; iii) quantitative changes in scores of quality of life from visit 1 to visit 2. Comparisons will be made based on the type of causal agent (animal and plants proteins vs chemicals); based on an associated diagnosis of OA (GroupI vs GroupII) and also based on whether or not the subjects are still exposed to the causal agent. Significance: This will be the first study assessing long-term outcomes of OR. If as hypothesized results show deterioration in outcome measurements parameters, this will modify the management of subjects with OR. Budget: The budget requested ($20.000) will cover costs of a research assistant for recruitment and data collection, study materials and compensation offered to participants.
References: 1. Groenewoud GC, et al. Ann Allergy Asthma Immunol 2006; 96(1):92-7. 2. Petersen KD, et al. Allergy. 2008 Mar; 63(3):284-91 3. Castano R, et al. Thorax. 2009 Jan; 64(1):50-4. 4. Baiardini I, et al. Allergy. 2003 Apr;58(4):289-94.