Paul J Nicholson

Evidence-based guidelines for the prevention, identification and management of occupational contact dermatitis and urticaria*

Background: Occupational contact dermatitis is the most frequently reported work‐related skin disease in many countries. A systematic review was commissioned by the British Occupational Health Research Foundation in response to a House of Lords Science and Technology Committee recommendation.

Standards of care for occupational asthma

Occupational asthma remains a common disease in the UK with up to 3000 new cases diagnosed each year. The Health and Safety Executive (HSE) estimates the cost to our society to be over £1.1 billion for each 10-year period.1 In October 2001 the Health and Safety Commission agreed a package of measures aimed at reducing the incidence of asthma caused by exposure to substances in the workplace by 30% by 2010. Key to this aim are primary prevention by proper risk assessment and exposure control, together with secondary prevention to ensure reduction in the delay between the development of allergic symptoms at work (normally nasal or respiratory) and appropriate advice to the affected worker and workplace. Conservative estimates suggest that one in 10 cases of adult onset asthma relate directly to sensitisation in the workplace,2 with a smaller subset of workers with acute irritant induced asthma. The latter—formerly termed reactive airway dysfunction syndrome (RADS)—relates to asthma caused by exposure to high levels of airborne irritants. The prognosis of individuals with occupational asthma is better if they are removed from exposure quickly, particularly within a year of first symptoms.3–5 However, removing individuals often leads to unemployment. If the diagnosis of occupational asthma is incorrect, advising individuals whose asthma is not caused by work to be removed from exposure may have unnecessary financial and social consequences. The intent of this article is not to document the entire current evidence base related to occupational asthma, as the British Occupational Health Research Foundation (BOHRF) recently completed such an evidence review.7 The key points of this article are summarised in box …

Standards of care for occupational asthma: an update

Background The British Thoracic Society (BTS) Standards of Care (SoC) Committee produced a standard of care for occupational asthma (OA) in 2008, based on a systematic evidence review performed in 2004 by the British Occupational Health Research Foundation (BOHRF). Methods BOHRF updated the evidence base from 2004–2009 in 2010. Results This article summarises the changes in evidence and is aimed at physicians, nurses and other healthcare professionals in primary and secondary care, occupational health and public health and at employers, workers and their health, safety and other representatives. Conclusions Various recommendations and evidence ratings have changed in the management of asthma that may have an occupational cause.

BOHRF guidelines for occupational asthma

Publication of the first evidence based guidelines for occupational asthma New guidelines for the identification, management, and prevention of occupational asthma are published this month in Occupational and Environmental Medicine .1 The first evidence based guidelines for occupational asthma, they were prepared by a working group that included clinicians, patients, occupational hygienists, and representatives of the Health and Safety Executive. The work was supported by a grant from the British Occupational Health Research Foundation (BOHRF). The guidelines will be supplemented by an abbreviated version for primary care practitioners, occupational health practitioners, employers, employees, and workplace safety representatives. These guidelines are intended to increase awareness and improve the management of occupational asthma by all practitioners who encounter such patients, and to stimulate the means to reduce its incidence by those able to effect this. The important issues in occupational asthma concern its aetiology, diagnosis, outcome and prevention. Questions about these are not readily answered by randomised controlled trials (RCTs) and, arguably, conventional hierarchies with the RCT at the apex are not appropriate for assessing the strength of evidence used in the generation of guidelines.2 Although not having the high internal validity of the RCT, strong inferences can be drawn from observational studies (whose external validity can be greater than that of an RCT) when these are well designed and their findings consistent and plausible. The guidelines address several questions that are of key importance to respiratory physicians: Asthma can be …