Can exposure to petroleum distillates, molybdenum sulfide, kerosene, isopropanol, aromatic naphtha, tricresyl phosphate, cryogenic liquid, oils, or Jet-A (Jet Fuel A) aircraft fuels cause allergic rhinitis?

Occupational Exposure to Petroleum Products and Allergic Rhinitis

Yes, exposure to petroleum distillates, kerosene, isopropanol, aromatic naphtha, and other industrial chemicals can cause allergic rhinitis through irritant mechanisms and potentially through immunologic sensitization. The evidence supports that workplace chemical exposures can induce or aggravate rhinitis symptoms through multiple pathways.

Mechanisms of Chemical-Induced Rhinitis

Occupational rhinitis can develop through two main mechanisms:

1. Irritant-induced rhinitis:

   • Low-level workplace respiratory irritant exposures can induce cough and rhinitis through mucous membrane irritation 1
   • Chemicals such as solvents can cause upper airway irritation 1
   • This is sometimes referred to as Reactive Upper Airways Dysfunction Syndrome (RUDS) when triggered by high-level exposure to irritants 1

2. Allergic occupational rhinitis:

   • Less commonly, chemical sensitizers can induce an immunologic response 1
   • Low-molecular-weight chemicals like acid anhydrides and diisocyanates can cause rhinitis through immunologic mechanisms that are not always IgE-mediated 1

Evidence for Specific Chemicals

Among the chemicals mentioned in your question:

• Kerosene: Research has shown an increased risk of allergic sensitization and rhinitis symptoms associated with kerosene fuel use 2. A study in Ethiopia found that kerosene use was significantly related to rhinitis with an adjusted odds ratio of 2.06 (95% CI: 1.46 to 2.91) 2

• Jet fuels (including Jet-A): These are kerosene-based hydrocarbon fuels containing complex mixtures of aliphatic and aromatic hydrocarbons, including potential toxicants like benzene, toluene, and xylenes 3

• Tricresyl phosphate: Found in jet engine oil and hydraulic fluid, exposure to this chemical has been detected in jet airplane passengers 4, though the specific link to rhinitis is less established

Clinical Presentation

Patients with occupational rhinitis typically present with:

• Nasal congestion
• Rhinorrhea (runny nose)
• Sneezing
• Nasal pruritus (itching)
• Symptoms that are temporally related to workplace exposure 1
• Improvement of symptoms when away from the workplace 1

Diagnosis

Diagnosis of occupational rhinitis related to these exposures requires:

1. Establishing a temporal relationship between exposure and symptoms
2. Demonstrating that the substance is present in sufficient concentration in the environment 1
3. Ruling out other potential causes of symptoms 1
4. In allergic mechanisms, skin prick testing or specific IgE testing may confirm sensitization (though this is often not possible for chemical sensitizers) 1

Management

The optimal management approach includes:

1. Primary intervention: Avoidance of the occupational trigger by:

   • Modifying the workplace
   • Using appropriate filtering masks
   • Removing the patient from the adverse exposure 1

2. Pharmacologic therapy:

   • Intranasal corticosteroids for daily use
   • Antihistamines (preferably second-generation) for symptom control
   • Intranasal cromolyn administered before anticipated exposure 1

Important Considerations

• An asymptomatic latency period of exposure lasting weeks to years often precedes the development of work-related symptoms 1
• Occupational rhinitis may coexist with occupational asthma, especially with high-molecular-weight sensitizers 1
• The prevalence of occupational rhinitis varies by industry and exposure type 1
• Chemical exposures can induce both allergic and non-allergic forms of rhinitis 1

Preventive Measures

• Ensure adequate ventilation in workplaces where these chemicals are used
• Use appropriate personal protective equipment
• Implement regular monitoring of air quality in workplaces with these exposures
• Provide worker education about potential symptoms and when to seek medical attention

Early recognition and intervention are critical to prevent progression to more severe disease and to minimize impact on quality of life and work performance.