STRATEGIES TO PREVENT OCCUPATIONAL ALLERGIC DISEASES
5.42.Although it is difficult to estimate the true number of people
who suffer from occupational allergic disorders (see Chapter 3),
the prevalence and accompanying burden of occupational allergic
conditions has a significant impact upon individual workers and
the economy as a whole. The most reliable estimates suggest that
the incidence of occupational allergic conditions may be on the
decline (para 4.61).
5.43.Unfortunately the general trend of a decline in incidence
is not universal across all occupational allergic diseases. Professor
Newman Taylor reported that cases of occupational asthma "attributable
to isocyanates is now less and the increase in the number of cases
caused by latex allergy has decreased since the widespread use
of low protein non-powdered rubber gloves. However, a similar
decline has not occurred in the number of cases attributed to
flour in bakery workers" (p 92).
5.44.The HSE reported that under the Control of Substances Hazardous
to Health 2002 (as amended) Regulations (COSHH), employers must
prevent or control exposure to harmful substances, and "all
employees exposed, or liable to be exposed, to a substance that
may cause occupational asthma or severe dermatitis should be under
suitable health surveillance" (p 13).
5.45.To enhance the effectiveness of the COSHH regulations, the
HSE said it was providing industry with free "task-specific
COSHH guidance sheets tailored to a wide range of businesses and
employees" (p 13). However, Mr Miguel felt that the COSHH
regulations were "procedurally fine" but "identifying
the sensitiser" in complex allergy cases could be difficult,
and the guidance was too "generic" so did not necessarily
help employers (Q 275). New EU regulationsRegistration,
Evaluation, Authorisation and Restriction of Chemicals (REACH)require
manufacturers and importers of chemicals to provide safety information
on substances and to manage their risks safely.
Mr Miguel felt that REACH might identify sensitisers in these
materials if combined with existing COSHH legislation and "backed
up further by UK legislation" (QQ 275, 277).
5.46.Dangerous chemicals are covered by the Chemicals (Hazard
Information and Packaging for Supply) Regulations 2002, which
require the supplier to "identify the hazards of the chemical,
give information about the hazards to their customers and package
the chemical safely" but as there was room for improvement,
the HSE was "working with suppliers to achieve this."
In 2005, specific legislation addressed skin allergens in the
workplace, restricting the marketing and use of chromium (VI)
in cement which "will have a very significant impact on the
incidence of chromium-related skin allergy in workers exposed
to cement" (p 13).
5.47.There is a limit to what can be achieved through regulation
alone and past experience has shown that simple control measures
can make a significant difference to the incidence of disease.
For example, Professor Newman Taylor told us that latex allergy
problems amongst healthcare workers had been caused by "the
powder which the protein from the rubber was absorbing;"
the use of gloves with no powder and a low protein content had
essentially eliminated the problem. However such a simple solution
was not always available for other occupational allergies. For
instance, many animal handlers in laboratories develop allergy
to proteins in animal urine, but neither these proteins or the
animals can be encapsulated to prevent exposure. Instead, it is
necessary to find ways to "prevent the urine deposited on
the dust in the cage getting into the air and being inhaled"
5.48.In the words of Professor Newman Taylor, the prevention of
occupational allergies is made harder by the fact that the structure
of industry in the United Kingdom is changing "from manufacturing
to service, with smaller workforces, smaller factories and more
self-employed people." Whereas big companies might employ
"occupational health physicians and safety advisors"
to implement safety advice, it is more difficult to ensure safe
working practices within businesses such as the "local hairdresser"
(Q 273). In fact, the BOHRF noted that "only one in eight
of the UK workforce has access to comprehensive occupational health
support" (p 341). The key is therefore to raise awareness
of occupational allergic conditions and to review the incentives
for employers to ensure that "it is in their interests to
ensure safe working conditions" (Q 273).
5.49.A number of HSE strategies have been developed to tackle
the prevalence of occupational allergies. Occupational asthma
and allergic contact dermatitis are priorities within its "Disease
Reduction Programme" which aims, from a 2004 baseline, to
reduce the incidence of these diseases by 10 per cent by 2008
(p 11). Mr Miguel noted the importance of running campaigns "in
combination with the workforce through trade unions and employers"
and so commended the Disease Reduction Programme Board which has
been established to bring together "trade unions, employers"
and "medical people" (Q 273).
5.50.More specifically, Mr Steve Coldrick, Head of the
Disease Reduction Programme at the HSE, told us about the first
"National Hairdressers' Day" in 2006, which had been
organised to decrease dermatitis and change attitudes (Q 63).
He told us that as part of the programme, "local authority
environmental health officers
[were] visiting about 20,000
hairdressers over the coming year" to demonstrate "the
use of gloves and moisturising cream
but later in the programme
we will be turning to enforcement" (Q 64). But Professor
Agius doubted "the extent to which education alone"
would help and felt that efforts should be made to regulate "at
the highest level
what manufacturers produce and what employers
expect by way of work practices" (Q 275).
5.51.Initiatives to tackle occupational respiratory conditions
include the HSE's establishment of an Asthma Project Board with
"representatives from unions, industry, an asthma charity
and health professionals." This aims to share information
and reduce the incidence of occupational asthma by 30 per cent
by 2010 compared with the 2000 baseline (p 11). The HSE, in partnership
with Asthma UK and others, has produced a 10-step workplace charter
to reduce asthma in the workplace,
and has also supported BOHRF to produce guidelines on occupational
asthma. BOHRF described this work as the "world's first evidence
based guidelines for occupational asthma hence the UK is seen
as a world leader in this area along with Canada, France and Spain"
5.52.The HSE has a planned "programme of evaluation"
which will assess how its policies and advice have lowered the
prevalence of occupational allergic conditions (p 11); although
figures are not yet available, it is probably fair to assume that
the work of the Health and Safety Executive has played a significant
5.53.We welcome the educational work of the Health and Safety
Executive to raise awareness and decrease the risk of occupational
allergic disorders amongst employers and staff, and would like
to see this work developed. Once allergy centres have been developed
(Chapter 9), we recommend that the HSE should liaise with the
occupational allergy specialist in each centre to inform its policies
and develop strategies to prevent occupational allergic disorders.
MANAGING OCCUPATIONAL ALLERGIC DISEASES
5.54.The BOHRF point to strong evidence that "the symptoms
and functional impairment of occupational asthma caused by various
agents may persist for many years after avoidance of further exposure
to the causative agent" (p 339). This was reinforced by the
HSE, which noted that those with prolonged exposure and more severe
disease before diagnosis were likely to have a "poorer prognosis."
In extrinsic allergic alveolitis, "irreversible fibrosisscarringof
the lung" can develop, so even complete removal of the exposure
will not lead to complete remission, although improvement may
be seen over a number of years. Workers with skin allergy also
need to avoid exposure to "control the progression of the
disease and prevent the reoccurrence of symptoms" (p 9).
However, Dr Orton added that "persistent post-occupational
dermatitis" could sometimes occur where dermatitis persisted
even after removal from the exposure (Q 280).
5.55.Diagnosis of occupational allergic conditions is often delayed
due to a lack of education amongst general practitioners (Chapter
9), but once an occupational allergic condition is diagnosed,
it is often necessary for the worker to give up their current
occupation. As explained in paragraph 4.62, Industrial Injuries
Disablement Benefit may be paid to workers, whether working or
not, whose occupational allergic disorder causes chronic symptoms
and a minimum degree of disability for over 90 days. However,
this scheme provides benefits for all industrial illnesses in
a uniform manner and may not necessarily be the best way to help
people suffering from occupational allergic conditions.
5.56.Professor Newman Taylor noted that "if you can identify
the disease sufficiently early there is the potential for it to
resolve completely" (Q 280). However, it means that the worker
will have to find alternative employment which does not involve
exposure to that allergen and "there is evidence from a number
of studies that those who leave their job because of occupational
asthma can remain out of work for several years" (p 93).
5.57.There is therefore a real need to provide the means to support
retraining schemes for these workers. In January 2007, the DWP
published a consultation document to review the Industrial Injuries
Disablement Benefit scheme.
The consultation period ended in April 2007, and Ministers have
asked for further information on possible options before holding
a review seminar, which is planned for October 2007. Professor
Newman Taylor felt that "the introduction of a benefit which
could support and enable re-training of individuals unable to
continue in their current job
to enable them to remain
in or return to work should be an important function of a reformed
scheme" (p 93). Mr Miguel agreed with this and suggested
that a "Government-led training initiative for people with
allergies" should be established which involved job centres
and employers working together (Q 289).
5.58.We are concerned that employees who are forced to leave
work due to an occupational allergic disease can remain unemployed
for long periods of time. We recommend that job centres should
review the way they work with employers, to improve the way in
which they can assist these workers to enter retraining schemes
and find alternative employment.
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