Studies Call for New Approaches to Allergies in the Workplace

Traditional diagnostic methods and educational programs aren't enough to deal with the absenteeism, safety risks, and productivity loss caused by allergies among workers, according to a series of papers in the September Journal of Occupational and Environmental Medicine.

The studies, involving more than 10,700 employees at six U.S. sites of the International Truck and Engine Corp., were led by International's vice president of health, safety and productivity, William B. Bunn, M.D., J.D., M.P.H., Chicago, and Harris Allen, Ph.D of Harris Allen Associates, Brookline, Mass.

The researchers developed a confidential database integrating employee survey measures of health and productivity with administrative data on "adverse events," such as absenteeism, workers' compensation, disability, and health care and medication use. An initial study validated the credibility of workers' self-reported productivity: a key source of data that is often viewed with skepticism by business decision makers.

The workers' reports showed the expected relationships with a wide variety of adverse event measures, whether they were assessed before, during or after these events. The results indicated that, to better understand the impact of the disease on health and productivity, information must be obtained directly from allergy sufferers, since this impact is less apparent with traditional markers such as medical care costs. "Productivity self-reports", the researchers write, "provide new rationale for focusing on what historically has been an underappreciated cause of performance loss in the workplace."

An observational study of allergies and allergy medication found that health and productivity losses increased dramatically with the severity of allergy symptoms, a pattern in which those with high severity stood out. This group accounted for just 16.8 per 1,000 employees, but these workers reported an average loss of effectiveness equivalent to 3.9 full-time employees. Severe allergies were also associated with a threefold increase in injury risk and a 67 percent increase in absenteeism.

Workers taking the newer, non-sedating antihistamines for allergy symptoms showed fewer reductions in health and productivity than those taking older, sedative antihistamines. "A regimen that includes non-sedating antihistamines but no sedative antihistamines appears to perform best," the researchers write. Nevertheless, only one-fourth of employees with allergies took non-sedating antihistamines as recommended.

The results suggest that there is a significant opportunity to lower the documented productivity losses if this regimen is understood and accepted. The intervention phase of the study developed and evaluated a communication program to inform employees about allergies and available medication options. Traditional educational methods newsletters, brochures and billboard displays were supplemented by innovative approaches, such as directing workers to useful Web sites and having on-site visits by an allergist.

"Usual health and safety communication and certainly any reliance on one-shot education will not be effective," the researchers write. They urge an integrated approach, including aggressive case management and better communication between patients and their support networks, including their personal physicians.

"Hands-on, one-to-one work with the employee, particularly when delivered with the involvement and support of their clinicians, improves the chances for achieving the desired changes: better treatment choices and improved compliance with taking medications as directed," said Bunn and Allen.

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