D2.114 - Occupational asthma and rhinitis in a worker in the single-use food packaging industry: challenges of multi-agent exposure

Introduction: Occupational respiratory diseases, including allergic rhinitis and asthma, are an important concern in industrial settings with chemical exposures. This study aimed to report a case of occupational allergic asthma and rhinitis in a worker employed in food packaging manufacturing.

Results: A 38-year-old female worker employed 4 years prior in a factory producing single-use food packaging developed work-related respiratory symptoms. She was primarily assigned to the disposable aluminum tray production line and later to food plastic wrap machines handling plastic films, aluminum, and baking paper. Her tasks included thermoforming of aluminum trays, heat-sealing of plastic wrap rolls and manual packaging with hot-melt adhesives. Occupational exposures included heated plastics (such as polyvinyl chloride and linear low-density polyethylene), alcohols, oils and hot-melt adhesives potentially exposing to thermoplastics, natural and synthetic resins, isocyanates and formaldehyde. She had no history of atopy. Three years after her employment, she started experiencing paroxysmal wheezing dyspnea, nasal obstruction, rhinorrhea, sneezing, nasal pruritus, and intermittent dysphonia. These symptoms occurred during work and markedly improved on leaves. Examination revealed nasal mucosa congestion, and spirometry demonstrated a reversible obstructive ventilatory disorder. Based on the temporal relationship with occupational exposure, known sensitizing potential of formaldehyde, rosin, and isocyanates, and clinical features, an occupational allergic rhinitis and asthma diagnosis was established. The primary incriminated allergen was formaldehyde since it was the common agent present in all workstations she had been assigned to, potentially released from the plastic heat-sealing and hot-melt adhesive bonding workstations. Allergic asthma and rhinitis were considered as compensable occupational diseases. The patient underwent a job reassignment to eliminate exposure to respiratory allergens and irritants, which was particularly challenging due to the widespread presence of these agents throughout the work facility.

Conclusions: This case highlights the challenges of occupational allergic rhinitis and asthma in a food packaging worker exposed to multiple respiratory allergens. Diagnosis relied on symptom timing and clinical evaluation, and management required job reassignment to reduce exposure, emphasizing the importance of prevention and maintaining fitness for work.