Series of papers homes in on allergies’ impact

Nonsedative antihistamines most effective

Traditional diagnostic methods and educational programs aren’t enough to deal with the absenteeism, safety risks, and productivity loss caused by allergies among workers. A series of four papers on the impact of allergies in the workplace has provided a new perspective on just how significant an impact these conditions can have on productivity — and gives valuable insight into the most efficacious treatments for workers who are allergy sufferers.

The papers appeared in the September issue of the Journal of Occupational and Environmental Medicine, published by the American College of Occupational and Environmental Medicine (ACOEM). All four articles, along with a news release and a letter to the editor, have been made available by ACOEM on its web site: www.joem. org.

The studies, involving more than 10,700 employees at six U.S. sites of the International Truck and Engine Corp. in Warrenville, IL, were conducted with a grant from the Schering-Plough Corp. The research was led by International’s vice president of health, safety and productivity, William B. Bunn, MD, JD, MPH, and Harris Allen, PhD, of Harris Allen Associates in Brookline, MA.

The researchers developed a confidential database integrating employee survey measures of health and productivity with administrative data on adverse events, such as absenteeism, workers’ compensation, disability, and health care and medication use. An initial study validated the credibility of workers’ self-reported productivity, a key source of data that often is viewed with skepticism by business decision makers. The workers’ reports showed the expected relationships with a wide variety of adverse event measures, whether they were assessed before, during, or after these events. The results indicated that, to better understand the impact of the disease on health and productivity, information must be obtained directly from allergy sufferers, since this impact is less apparent with traditional markers such as medical care costs.

The studies address both the methodology used to gather the data and the results of self-reported employee surveys, data from administrative databases, and employee responses to different medical interventions.

"I think the inclination is to underestimate the impact of allergies on productivity," says Allen, whose health care performance-consulting firm served as the objective third-party evaluator for the studies. "The tendency is to put the greatest weight on those conditions that exact the greatest [financial] toll on group health, and allergies is not one of them," he continues. "But if you take the additional step of going directly to the employees and asking what impacts their productivity, it becomes very clear that presenteeism is the greatest contributor to loss of productivity, and the best way get at it is through self-reporting."

Presenteeism is a term used to describe the condition that exists when employees are present at work, but perform at a level that is below par.

The first of the four articles explores and documents the validity of productivity self-reports. "What is accomplished with this is a mechanism or framework that addresses the skepticism of business decision makers who wish to target productivity issues but who are not familiar with survey techniques," Allen explains. "When you take the additional step of going beyond claims and asking people directly about impact on productivity, a condition like allergies becomes very prominent. You don’t see much [of an impact] in the way of claims, but when you address the issue of presenteeism, allergies come to the top of the radar screen."

Documenting the impact

The second article, which Allen dubs the "observation paper," poses these basic questions: What is the burden of allergies on health and safety, and what is the capacity of medications to reduce that burden? "The analyses make a very strong case for the burden of allergies in respect to health status, presenteeism, absenteeism, workers’ comp, disability, even paid prescriptions," he notes. "The impact in group health is quite dramatic."

In general, employees with allergies reported greater rates of presenteeism levels than the healthy benchmark group. In fact, the observational study found that health and productivity losses increased dramatically with the severity of allergy symptoms, a pattern in which those with high severity stood out. This group accounted for just 16.8 per 1,000 employees, but these workers reported an average loss of effectiveness equivalent to 3.9 full-time employees. Severe allergies also were associated with a threefold increase in injury risk and a 67% increase in absenteeism.

In terms of the second part of the question, afflicted employees on various medical regimens were compared, ranging from the recommended regimen — one or more nonsedative antihistamines to those who took sedative antihistamines and those who took no meds at all. "The upshot is that the recommended regimen reported the greatest capacity to reduce the burden of allergies," Allen reports. Workers taking the newer, nonsedating antihistamines for allergy symptoms showed fewer reductions in health and productivity than those taking older, sedative antihistamines.

Intervention falls short

The third, or intervention paper, reports the results of a concerted series of steps taken by International to reduce the burden of allergies — i.e., the development and implementation of an educational intervention. Information addressing the pros and cons and importance of taking medications as directed was distributed or disseminated through eight different modalities at each of five different International locations. This included entries on billboards, brochures, the company health program’s regular newsletter, and web site links. An allergist also came for on-site visits.

"We found that the intervention was reasonably effective at improving employee knowledge about how to manage allergies, but no one either bombed or hit a home run," Allen recalls. "In fact, the intervention that got the most positive results was a conventional method; people talking directly with their physician."

The researchers did observe positive changes at one experimental site, where reduced limitations and absenteeism were noted. However, they could not discover why this particular site had better results than the others. What they did determine was the fact that the intervention in and of itself was not sufficient. "A one-shot education is just not enough," Allen asserts. "This was actually a useful finding."

The final paper had to do with exploring the capacity of productivity self-reports to distinguish groups over time. "The bottom line is we did quite well in group discrimination," Allen observes. "This says that if you are about the business of needing to distinguish things and you have a limited budget, a survey will offer a reasonably good platform for distinguishing whether your intervention worked."

What have we learned?

In addition to the aforementioned findings, what other take-home messages do the papers have for occ-health professionals? For one thing, Allen says, the results are translatable to workplaces other than manufacturing companies. "The International work force is roughly three-fourths manufacturing — blue-collar — and one-fourth white-collar office workers," he explains. "The prevalence of allergens is quite substantial among office workers and is generally seasonally active whether or not you work in an office."

Hopefully, these findings will cause occupational health professionals to look at allergies differently in the future, Allen continues. "Allergies typically impact 20%-30% of the work force," he notes. "They pack a pretty substantial wallop on the ability to concentrate and handle workload. This is a very important lesson."

In addition, Allen says, awareness is evolving in the purchaser community that health does impact productivity, and attending to health concerns offers purchasers a win-win with their employees. "If they can help employees to manage chronic diseases better, the employees will experience gains in quality of life and become more productive," he explains. "Allergies become a big deal when you start looking at things this way."

Another learning, says Allen, is the fact that the impact of allergies is very broad-based, in ways that should present concerns to employers. "People who reported a doctor’s diagnosis of allergies and a high severity level of symptoms were literally three times more likely to report an accident over the last year than people in our healthy person benchmark group," he notes. "Some the impact is broad-based in a way that means something to employers, and part of this impact has to do not only with the disease, but with what is being used to treat it. There’s a wealth of information that makes a good, strong case that a nonsedative antihistamine is better able help employees retain more alertness, and limit drowsiness. This is all related to better performance at work."

Finally, he says, education in and of itself is not a sufficient intervention. "Some kind of hands-on case management is needed, along with mechanisms that elicit and promote and encourage the support of communication between the clinician and the family with respect to implementing and maintaining changes in behavior," he concludes.

For more information, contact:

Harris Allen, PhD, Harris Allen Associates, 42 Naples Road, Brookline, MA 02446. Telephone: (617) 730-5523. Fax: (617) 734-9249. E-mail: harris-allen@msn.com.