Health surveillance of workers exposed to laboratory animal allergens

Background Laboratory animal allergy (LAA) remains prevalent among workers exposed to laboratory animals. Pre-placement and health surveillance procedures vary between different employers. Aims To determine evidence-based strategies for pre-placement and periodic health assessments for workers exposed to laboratory animals. Methods Literature was searched systematically using Medline and EMBASE for articles published in all languages up to the end of May 2010. Evidence-based statements and recommendations were graded according to a modified Royal College of General Practitioner's star system. Results Hundred and nine studies were identified from the literature search; 59 of these were accessed for critical appraisal and 50 contributed to the evidence statements. Conclusions We recommend that laboratory animal workers should have a baseline health assessment that includes a health questionnaire, face-to-face assessment and spirometry. Identification of specific immunoglobulin E to common aero-allergens and to domestic and laboratory animal allergens may be used to identify workers who would benefit from further advice about managing their exposure, where risk assessment indicates that this might be prudent. Thereafter health surveillance should be performed by administering an appropriate health questionnaire, covering upper and lower respiratory, eye and skin symptoms on exposure, and wheals with animal scratches. The questionnaire should be administered at increased frequency for the first few years, the frequency being determined by a risk assessment. Where a worker develops new symptoms suggestive of LAA or where an asthmatic employee experiences deterioration either in symptoms or in control, they should be assessed further and a multicause multidisciplinary investigation performed.