Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Job Classification

In most duration tables, five job classifications are displayed. These job classifications are based on the amount of physical effort required to perform the work. The classifications correspond to the Strength Factor classifications described in the United States Department of Labor's Dictionary of Occupational Titles. The following definitions are quoted directly from that publication.

Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Allergy


Related Terms

  • Allergic Reaction
  • Atopic Disease
  • Hypersensitivity Reaction

Differential Diagnosis

Specialists

  • Allergist/Immunologist
  • Dermatologist
  • Internal Medicine Physician

Comorbid Conditions

Factors Influencing Duration

Factors such as advanced age, cigarette use, and severity of symptoms can influence the length of disability. With industrial or chemical allergies, workplace accommodations influence the individual's ability to return to work.

Medical Codes

ICD-9-CM:
995.3 - Certain Adverse Effects Not Elsewhere Classified, Allergy, Unspecified

Overview

Allergy is a condition that occurs when an individual's immune system is hypersensitive or over-reactive. Ordinarily, the human immune system has a fine-tuned ability to distinguish between harmless substances in the environment, such as dust, and potentially harmful agents, such as viruses and bacteria. For an individual with allergies, however, the immune system reacts quickly, intensely, and inappropriately to one or more foreign substances that are ordinarily harmless.

The foreign substance that triggers an allergic reaction is called an allergen or antigen. When individuals with an allergy eat, touch, or inhale the particular foreign substance or allergen, their immune system mistakenly launches an attack against it. Allergic individuals produce an antibody called immunoglobulin G (IgG) as well as a large amount of another antibody called immunoglobulin E (IgE). IgE is responsible for generating a full-scale reaction with symptoms such as swelling, skin rashes, or constant sneezing or coughing each and every time the individual is exposed to the offending substance (allergen).

In addition to heredity or genetic traits, certain environmental exposures (e.g., tobacco smoke), emotional factors, and conditions of physiological stress (e.g., puberty, pregnancy, or illness) may predispose individuals to allergic symptoms. Food, drugs, mold, pollen, insect bites, infection, physical agents (e.g., heat, cold, sun, pressure, or exercise), polyurethane plastics, paints, varnish, and latex or rubber products may trigger allergic reactions. Recently, there have been growing reports of allergic reactions to water-soluble proteins in latex products (e.g., rubber gloves, dental dams, condoms, and medical devices), particularly among medical personnel and individuals receiving medical care. Animal dander is another common occupational allergen that typically affects farmers, veterinarians, groomers, and laboratory workers. Hospital workers, photographers, and food service workers most commonly encounter allergenic chemicals such as formalin, hexachlorophene, ethylene diamine, and metabisulfite. Dust from flour, grains and wood can affect mill workers, carpenters, bakers, and lumberjacks.

Allergic reactions are usually relatively localized to one or more body systems. For example, hay fever (allergic rhinitis) causes a runny nose and sneezing, allergic conjunctivitis is characterized by itching and red eyes, and bronchial asthma causes narrowing of airways. Ocular (or eye) allergies result in symptoms of itching, redness, and tearing of the eyes following exposure to allergens in the air or substances coming in contact with the eye. Allergic conjunctivitis is the most common ocular allergy and occurs in the spring and fall months in conjunction with hay fever.

On rare occasions, an allergic reaction can result in a whole body response (anaphylaxis). This sudden, life-threatening allergic reaction can trigger a swollen throat and a constriction of the airways, rapid pulse, loss of consciousness, and a sudden drop in blood pressure (shock).

Incidence and Prevalence: Approximately 50 million Americans have one or more significant allergies and suffers from a wide array of symptoms, and the incidence is increasing. Each year, Americans lose 3.5 million workdays because of allergies. Allergic rhinitis, often referred to as hay fever, affects more than 35 million people. This reaction to outdoor airborne allergens, usually tree and grass pollen, occurs on a seasonal basis. A second type of airborne allergy called perennial allergic rhinitis occurs year-round and is more likely due to indoor allergens such as pet dander or dust mites. Approximately 6 to 10 million Americans are allergic to animal dander and about 2 million have allergic reactions to insect stings. Food allergies occur in about 8% of children but affect only 2% of adults. Approximately 17 million Americans have asthma caused by allergies, 5 million of whom are children ("Tips to Remember").

Source: Medical Disability Advisor



Causation and Known Risk Factors

Researchers believe the tendency to develop allergies is primarily inherited. Children of parents with allergies have a much greater chance of developing them than children with nonallergic parents. A child who has one parent with allergies has a nearly 50% chance of developing allergies. If both parents have allergies, the odds are further increased to 70% ("Tips to Remember").

Source: Medical Disability Advisor



Diagnosis

History: Depending on the system involved, the individual may complain of itching, rash, swelling, sneezing, runny nose, tearing, earache, sore throat, cough, breathing difficulties, and gastrointestinal symptoms like diarrhea. Individuals may describe certain conditions that trigger their symptoms. For example, they may report that the symptoms arise every time they are around animals or worsen in the spring and disappear during winter.

Common symptoms associated with reactions to latex are skin rashes, eye irritation (conjunctivitis), runny nose (rhinitis), narrowing of airways (bronchospasm), and even anaphylaxis.

Physical exam: The lungs, heart, and all other body areas affected by the allergic symptoms are examined. In mild cases of allergic rhinitis, the exam may reveal swelling and inflammation of the nasal passages and nasal discharge. Swelling, redness, and tearing of the eyes are common in allergic conjunctivitis. Additional findings of redness and swelling in the ear canal and throat are not uncommon.

Large, irregular, red bumps on the skin (hives) may be present with food allergies, drug allergies, or allergic reaction to insect stings. Gastrointestinal symptoms are most common with food, food preservatives, and food additive allergies.

Wheezing or absent lung sounds and a rapid respiratory rate may be present in asthma or anaphylaxis. Cool, moist, and pale skin in conjunction with a rapid pulse and low blood pressure may be signs of shock due to anaphylaxis.

Tests: In addition to a physical exam, one or more diagnostic tests may be done. These tests help determine what triggers the allergy and evaluate the severity of the allergic reactions.

A spirometer measures the amount of air entering and leaving the lungs (spirometry). It is useful in identifying lung disorders such as asthma that may cause narrowing of the airways.

In a scratch test, small amounts of the suspected allergen (e.g., dust, dander, or food) are placed on the skin surface. Development of a small, raised bump on the skin indicates an allergic response to that particular substance. In intradermal tests, small quantities of the suspected allergen are injected under the skin. A reaction of redness or swelling at the injection site indicates an allergic response. The radioallergosorbent test (RAST test) is a blood test used in individuals with disorders that may interfere with skin testing.

The patch test involves applying adhesive patches with allergens to the skin. Localized redness and swelling at the application site indicate positive reaction. In a challenge test, the suspected foods or medications are eliminated for a period of time and then, under medical observation, small amounts are reintroduced to see if they trigger an allergic reaction.

Source: Medical Disability Advisor



Treatment

The treatment of allergies often requires a combination of several approaches and therapies. The goals of treatment are to minimize the frequency and severity of reactions, maintain good health, and prevent complications. Current medical approaches to achieve these goals include allergen avoidance, medication to control or relieve symptoms, and allergy shots for the purpose of desensitization.

Antihistamines, decongestants, topical nasal steroids, eye drops, and inhalers are among the drugs used for short-term relief of some common allergy symptoms. For long-term management of severe allergy symptoms, a series of allergy shots (immunotherapy) may be effective. With immunotherapy, the allergy sufferer receives a series of shots with increasing doses of the offending allergen. When effective, the sensitivity to the allergen will gradually diminish until symptoms disappear. Stress reduction and relaxation techniques may also aid in managing symptoms. The specific treatment plan depends on the type and severity of the condition as well as lifestyle and environmental factors.

Source: Medical Disability Advisor



Prognosis

The duration of a single allergic episode may vary from a few minutes to several days. With no complications, an allergic reaction often has a good outcome but the condition may be chronic. However, with proper medical management and compliance with avoidance procedures and medication regimens, allergy symptoms can be well controlled. Immunotherapy has been shown to be an effective and safe treatment for severe cases of asthma, allergic rhinitis, and insect venom allergy that are unresponsive to other therapies.

Source: Medical Disability Advisor



Complications

Some individuals develop associated medical problems that include nasal polyps, sinusitis, ear infections, bronchitis, eczema, and asthma.

Severe cases can occur within seconds and trigger a swollen throat and constriction of the airways (allergic asthma), rapid pulse, loss of consciousness, sudden drop in blood pressure, weakness, and cardiac collapse (shock) that require immediate medical treatment. Anaphylaxis usually results from allergic reactions to insect venom, vaccinations, medications, injections of x-ray contrast, and foods like peanuts and shellfish.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Allergic individuals need to avoid exposure to potential allergens. Work environments are generally safe for most individuals. However, there are substances in certain work environments that may present problems for some individuals with allergies. Individuals at most risk and who need special accommodations include farmers, veterinarians, groomers (for reaction to animal dander), laboratory workers, hospital workers, photographers, food service workers (for reaction to chemicals and food), mill workers, carpenters, bakers, and lumberjacks (for reactions to wood, dust, grains, and flours). Avoiding the areas at work where the offending triggers are located can often minimize symptoms. In a few cases, asthma and allergy symptoms may be so severe that a change in occupation is the best solution.

Those treated with sedating antihistamines may suffer side effects of drowsiness and dizziness that can interfere with safe operation of machinery and equipment. Newer, less sedating antihistamines are available.

The National Institute for Occupational Safety and Health (NIOSH) published recommendations regarding prevention of latex-related allergies. These recommendations include providing non-latex gloves when workers are not handling infectious materials, and using low-protein, powder-free gloves to protect workers handling infectious materials. In addition, NIOSH has several publications on guidelines for chemical safety in the workplace.

Source: Medical Disability Advisor



Failure to Recover

If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case.

Regarding diagnosis:

  • Did the physical exam reveal findings of hives, rash, gastrointestinal distress, bronchospasm, conjunctivitis, rhinitis or anaphylactic shock? If so, was individual promptly referred to an emergency physician or allergist for treatment?
  • Was allergen(s) positively identified? Was there more than one allergen in play?
  • How was allergen(s) identified? Skin test? Direct allergen challenge?
  • Was the offending allergen a substance exposed to in the work environment (latex, industrial material)?
  • Was the allergen airborne or seasonal (e.g., pollen, dust, smoke)?
  • Was the allergen present in the home environment (e.g., mold, dust mites, animal dander)?
  • Were other conditions with similar symptoms ruled out?
  • Was an elimination diet used to identify common foods that can trigger allergies?

Regarding treatment:

  • Did individual receive prompt and appropriate control of the immediate allergy symptoms?
  • Was anaphylaxis present? If so, was emergency intervention and support received?
  • Is individual compliant with allergen avoidance recommendations? If not, are there barriers to compliance (such as lack of understanding, employment concerns)?
  • Did individual receive treatment specific for the symptoms displayed?
  • Were symptoms effectively relieved? If not, were more aggressive interventions considered?
  • Is immunotherapy indicated?
  • If a food allergy, was a nutritionist consulted to help individual restructure diet and increase awareness of ingredient combinations found in common foods?

Regarding prognosis:

  • Are the frequency and severity of the allergy symptoms well controlled with the present therapy? If not, were other treatments tried?
  • Were additional diagnostic tests done to determine if there are other possible allergens involved or if there is an associated complication such as a secondary infection (e.g., sinusitis, bronchitis)?
  • Is individual compliant with the treatment recommendations? If not, why?
  • If individual has had adverse reactions (e.g., dry mouth, palpitations, insomnia) to the medications, were other medications substituted?
  • Was individual provided a smoke-free work environment? A pollution-free work environment? Improved ventilation or air filters? Protective masks or clothing? If not, could individual be moved to a different work site? A different type of work?
  • Has immunotherapy been considered?
  • Are there comorbid conditions or complications that may have impacted ability to recover?

Source: Medical Disability Advisor



References

Cited

"Tips to Remember: What is an Allergic Reaction?" American Academy of Allergy Asthma & Immunology. 9 Oct. 2004 <http://www.aaaai.org/patients/publicedmat/tips/whatisallergicreaction.stm>.

Source: Medical Disability Advisor






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