A majority of cases of occupational anaphylaxis are the result of insects, food, and drugs, according to new findings, with the effects of venom allergy in work-related anaphylaxis being highlighted as well.¹

These data resulted from a new analysis of anaphylaxis registry data looking at occupational exposure and related information on demographics, reaction elicitors, reaction severity, and condition management.

The research was authored by Margitta Worm, from the Department of Dermatology’s Division of Allergy and Immunology at the Universitätsmedizin Berlin in Germany. Worm and colleagues noted that the current and limited data available on the topic indicate that latex and venom may be among the most frequent occupational anaphylaxis causes.²

“The aim of this study was to extract cases related to occupational exposure based on the data of the anaphylaxis registry and to analyze these in respect to elicitors, concomitant diseases, severity, but also its management,” Worm and colleagues wrote.

Background and Findings

The investigators implemented an analysis of the anaphylaxis registry, a database begun in 2007 in German-speaking countries and expanded globally by the year 2011. The registry is known for its collection of real-life information regarding anaphylaxis spanning moderate to severe reactions due to allergy.

More than 100 specialized tertiary allergy centers found in several different European countries and Brazil provide data contributing to the database. Standardized data capture is done through the use of a secure online survey which is designed to examine data regarding anaphylaxis symptoms, elicitors, course of reaction, emergency treatments, long-term management, and more.

By the year 2017, there were occupational details integrated into the system, with the registry helping to assess if the allergen was related to work. This was later refined through the use of an inquiry about patients’ occupations at the time of reactions.

Participants in this study were deemed eligible by the investigators provided they had experienced an occurrence of anaphylaxis in the prior year. Other criteria for inclusion used by the research team were related to severe, unintended reactions related to the lower respiratory or cardiovascular systems of the body.

Health professionals who were trained in this process captured de-identified data by using the web interface following the investigators’ receipt of patient consent. They documented the diagnostic certainty of allergen sources through a confirmation or a strong suspicion by local specialists.

The investigators’ research involved an extraction of cases from the database based on affirmative responses to the question that related to occupational allergens, though they also had to meet the modified criteria of the National Institute of Allergy and Infectious Diseases/Food Allergy and Anaphylaxis Network.

The research team only included adult participants in their non-occupational group involved in their comparison of occupational versus non-occupational cases of anaphylaxis.

Overall, the team found that there were 5851 cases reported since 2017 on information related to the occupational context of anaphylactic episodes, adding that 3.8% were linked to occupational allergens.

The investigators reported that the majority of these instances related to insects (n = 186, 82.7%), food (n = 27, 12.0%), and then drugs (n = 8, 3.6%). They found that there were only 2 occurrences of work-related anaphylaxis related to exposure to latex.

The research team reported that food-related jobs such as bakers, restaurant employees, pastry chefs, and cooks, were most frequently impacted, as were gardeners, beekeepers, and those who were farmers.

The team also included data on their comparison made between work-related insect venom-induced anaphylaxis and non-occupational occurrences among those who were adults. This ended up revealing that occupational cases had been shown to be much younger (46 compared to 53 years).

In this same comparison, the investigators also noted a higher incidence of cases which were shown to be bee-induced (38% compared to 17%) and a greater implementation of venom immunotherapy in primary care settings (3.3% compared to 1.3%, P = .044). Lastly, they found that adult patients with food-induced occurrences saw atopic dermatitis as a concurrent atopic disease more often among those in the occupational cohort (20% compared to 10%), though it was not shown to be statistically significant.

“This enabled us not only to describe this cohort regarding elicitors and severity in more detail, but also to unravel characteristics in comparison with non-occupational anaphylaxis,” they wrote. “Further data in the future are needed to get a better insight on country specific issues, but also professional exposures in order to develop optimized prevention.”

References

1. ^{Worm M, Höfer V, Dölle-Bierke S, et al. Occupational anaphylaxis—Data from the anaphylaxis registry. Allergy. 2023; 00: 1-9. doi:10.1111/all.15974.}
2. ^{Siracusa A, Folletti I, Gerth van Wijk R, et al. Occupational anaphylaxis – an EAACI task force consensus statement. Allergy. 2015; 70(2): 141-152.}