Anaphylaxis in the Workplace
Anthony was climbing a ladder when he accidentally disturbed a nest of angry hornets. He was stung several times and when his throat began to tighten and he had trouble breathing, he knew he was in trouble. His swollen red face alarmed his co-worker who made the lifesaving 911 call. Anthony is one of millions in North America who experience a life threatening anaphylactic reaction each year.
Everyone deserves a safe workplace. There are things employers can do to prevent and prepare for anaphylaxis, and ensure they can respond effectively to protect the lives of their employees.
Anaphylaxis is a life threatening allergic reaction that can develop quickly, affecting many different body organs and systems. Allergic reactions can be mild, affecting only the skin, to severe, affecting the airways and/or the heart, resulting in death.
Signs and symptoms
Anaphylaxis includes a range of symptoms that can occur in various combinations and be hard to recognize. If you are having an anaphylactic reaction, you may experience a few or all of these signs and symptoms
- itching and/or swelling of the lips, tongue, palate, and throat
- swelling of the eyelids, and itchy, watery eyes
- hives and itching, flushing, or swelling of the skin
- rapid heart rate
- abdominal cramps, nausea, vomiting, diarrhea
- difficulty breathing, wheezing, and asthma
- a feeling of impending doom
- weakness, faintness, and loss of consciousness
Severe symptoms can develop within minutes after being exposed to an allergen, and the severity usually peaks within three to thirty minutes. There can be an equally serious second phase reaction, one to eight hours after the initial anaphylaxis.
Anaphylaxis can be triggered by many different allergens, the most common being those found in certain foods such as peanuts and shellfish, and in insect venom such as bee or wasp stings. These severe allergic reactions may also be caused by medications, certain chemicals (for example diisocyantes), latex, and less commonly, exercising within 2-4 hours after eating a food to which you are allergic.
What can be done
Workers have the right to be informed about the hazards they are exposed to and how to work safely. While it may not be possible to completely eliminate the risk of anaphylaxis in the workplace, employers and employees can take steps to reduce the risk, and respond effectively if and when someone has a life threatening reaction.
The first line of defense in managing the risk of anaphylactic reactions is strict avoidance of allergens. It’s important to be aware of the ingredients in foods, stay away from at-risk areas if allergic to insect venom, and reduce or eliminate exposure to chemical sensitizers.
Epinephrine is the preferred first-line treatment for anaphylaxis. However, at-risk people don’t always own or carry epinephrine auto-injectors. In fact, many people don’t know they have an allergy until their first anaphylactic reaction begins.
Prevention of occupational anaphylaxis
Occupational anaphylaxis results from causes and conditions that exist in a work environment. Work-exacerbated anaphylaxis is pre-existing or co-existing allergy (for example, a food or pollen allergy) to a particular agent that is triggered by workplace exposures.
The main efforts to prevent work-related anaphylaxis centre on avoiding worker exposure to sensitizers whether at the source (elimination, substitution, local exhaust ventilation), along the path (enclosure of emission source) or at the worker level (administrative controls, respiratory protective equipment). Employers are encouraged to consult experts such as engineers and occupational hygienists to find ways to substitute or eliminate allergens from the workplace, or to reduce exposures as much as possible.
For instance, elimination of exposure to natural rubber latex (a causative agent) would involve making the environment latex-free. In some production processes elimination is not always possible. In these situations, employers should make every effort to reduce airborne concentrations of the allergen. With latex, this may involve changing from powdered latex gloves to powder-free low-protein latex gloves to reduce airborne latex particles. For a healthcare worker with a known allergy to latex, the use of latex-free surgical or dental procedures is necessary.
Employer preparedness and response
- Ask employees if they have a life-threatening allergy to certain foods, insect bites, medications, chemicals, or other materials.
- Educate employees about the dangers of anaphylaxis, how to recognize and respond to the signs of anaphylaxis, and how best to avoid known allergens.
- Promote basic principles of allergen control including handwashing, cleaning and disinfecting work surfaces, and properly handling and/or preparing food.
- Obtain permission from employees with allergies to make information and identification sheets about them (photographs, allergens to avoid and an emergency response plan) readily available to others in the workplace.
- Teach employees how to recognize the signs and symptoms of an allergic reaction and how to use an epinephrine auto-injector properly.
- Provide immediate assistance if an employee is unable to self-administer the epinephrine auto-injector due to the severity of the anaphylactic symptoms; a delay could be fatal.
- Ensure that your employee gets immediate emergency medical treatment after use of the epinephrine auto-injector either by calling 911 for medical assistance and/or taking the victim immediately to an emergency care
Employees with known anaphylaxis
- Tell your manager and co-workers about your allergies and help create your emergency response plan together.
- Keep an epinephrine auto-injector with you at all times, and another labelled with your name, in a readily available location at work. Note that these auto-injectors expire – replace them as necessary.
- Tell your manager and others where to find your epinephrine auto-injector.
- Wear identification such as a medical alert bracelet or necklace that would alert others of your allergies if you were unable to do so.
- Seek immediate emergency medical treatment after use; an epinephrine auto-injector does not prevent a reaction from re-occurring.
- Replace your epinephrine auto-injector immediately after use.
This article is not intended to be a comprehensive paper on work-related anaphylaxis, but rather endeavors to raise awareness of this serious issue so that everyone involved can take steps to ensure worker safety and even save lives.
- Anaphylaxis, World Allergy Organization
- Importance of Anaphylaxis Awareness in the Workplace PDF, American College of Occupational and Environmental Medicine (ACOEM)
- Managing Anaphylaxis in the Workplace Health and Safety Checklist PDF, ACOEM
- Work-related Anaphylaxis PDF, Allergy Society of South Africa
- Anaphylaxis, National Institute of Allergy and Infectious Disease
- Anaphylaxis Canada
- Allergy/Asthma Information Association
- Association québécoise des allergies alimentaires
- The Food Allergy & Anaphylaxis Alliance