Occupational Rhinosinusitis and Upper Airway Disease: The World Trade Center Experience

Abstract

The World Trade Center disaster and its recovery work involved a range of hazardous occupational exposures that have not been fully characterized but that can be reasonably assumed to have the potential to cause mucosal inflammation, preferentially (but not exclusively) in the upper airway. A high prevalence of rhinosinusitis and upper airway disease (UAD) symptoms was reported by several early surveys. Clinical studies demonstrated objective, clinically significant, and persistent chronic perennial rhinosinusitis and UAD-with or without seasonal exacerbation-in a large proportion of patients. Demonstration of an association between UAD and available exposure indicators has been limited. Atopy seemed to be associated with increased UAD symptom severity and to be a risk factor for upper, but not lower, airway disease. World Trade Center-related UAD is considered an irritant-induced disease but not, in many cases, of acute onset. No data thus far suggest an increased upper airway cancer incidence.

Occupational rhinitis: consensus on diagnosis and medicolegal implications

“…The diagnosis was based on work-related rhinitis symptoms, specific skin prick test (SPT) and inhalation challenges. Recently, de la Hoz et al [32 ] published an interesting review on occupational rhinosinusitis and upper airway disease in firefighters and other workers exposed to dust, smoke, and combustion products after the terrorist attacks on the World Trade Center (WTC) on 11 September 2001. In a large proportion of workers there was persistent rhinosinusitis and upper airway disease, which characteristically appeared rather insidiously over an exposure of weeks to months at the WTC site.…”

Occupational Asthma and Lower Airway Disease Among World Trade Center Workers and Volunteers

“…From the limited knowledge about the inhaled particles at the WTC disaster site briefly summarized in the previous section, and in consideration of their hydrosolubility and size characteristics, the estimation has been that many of them were irritants capable of causing inflammatory mucosal changes, with the upper airway as their primary, but not exclusive target [22,23]. There clearly were enough particulates capable of reaching and injuring the distal airways.…”

Occupational Rhinitis: an Update

“…Air samples collected locally within days after the attacks contained a variety of organic as well as inorganic compounds including cement, lead, asbestos, polycyclic aromatic hydrocarbons, and pesticides [28]. A large majority of the WTC responders developed upper airway symptoms such as pharyngitis, nasal congestion, and rhinorrhea within weeks to months following the exposure [29,30]. This form of nonallergic irritant occupational rhinitis secondary to a complex particulate matter exposure remains to be a continued focus of investigation.…”