Aeroallergens, allergic rhinitis, and sedating antihistamines: Risk factors for traumatic occupational injury and economic impact

Background The U.S. workplace injury burden is significant. Our objective was to assess the particular impact of aeroallergen, allergic rhinitis, and antihistamine exposures and side effects on the risk of traumatic work‐related injuries, and the associated economic impact. Methods This is an observational case‐control study with 1,223 acute traumatic injury cases that are compared to 1,202 chronic back injury controls. Structured telephone interviews were conducted in 1998 and 1999 on Workers' Compensation applicants injured in 1997. Antihistamine use and pollen levels were measured 2 weeks prior to the injury date. Results Sedating antihistamine exposures elevated acute injury risk (main effect OR: 2.93). A significant increase in traumatic injury risk was observed for combined sedating antihistamine and high pollen exposures among subjects with physician and self‐diagnosed allergic rhinitis (OR: 2.41). Direct medical costs associated with this increased risk were estimated at $143 million in 2001. Conclusions Workers with physician‐diagnosed allergic rhinitis have as high a reliance on sedating antihistamines as do self‐diagnosed and self‐medicating nasal allergy sufferers. High pollen exposures along with sedating antihistamine use may confer significant additional injury risks among allergic rhinitis sufferers. Medical management “best practices” of diagnosed allergic rhinitis should include avoidance of sedating antihistamines to minimize acute, traumatic injury risks. Am. J. Ind. Med. 44:438–446, 2003. © 2003 Wiley‐Liss, Inc.