Utilization of Allergy and Immunology Services Among Rescue Workers Exposed to the World Trade Center Disaster

ABSTRACT

RATIONALE Over 400,000 individuals are estimated to have been exposed to the fallout of the World Trade Center (WTC) disaster. The incidence of acquired allergy and lung injury among rescue and cleanup workers exposed to the WTC fallout has been established. Briefly, rescue and cleanup workers exposed to the WTC fallout had a high incidence of allergic hypersensitivity and permanent small airways dysfunction characterized by distal airways narrowing and airway hyperresponsiveness. The current study sought to quantify the utilization of allergy/immunology services among rescue and cleanup workers exposed to the WTC fallout. METHODS: Subjects (N=65) were referred from the WTC Health Program to a multispecialty allergy/immunology and pulmonology clinic for provision of allergy-immunology specialty services. Electronic health records of all subjects were retrospectively reviewed from the date of first referral to March 2020-when routine care was interrupted due to the coronavirus disease 2019 pandemic-to quantify utilization of allergy/immunology and pulmonology services;10 subjects were excluded from analysis due to incomplete health records. RESULTS: On average, time to referral for allergy-immunology services by the WTC Health Program was 15.2 years (SD=1.7). The majority of the subjects were male (89.1%), police officers (67.3%) who never smoked (65.5%) and had no history of allergic or respiratory disease prior to being exposed to the WTC fallout. Most were found to have environmental allergies (83.6%);the most common comorbidities were allergic rhinitis (89.1%), asthma (67.3%), and chronic sinusitis (63.6%). All subjects underwent environmental allergy testing. Most subjects-35 of 55 (63.6%)-were prescribed an epinephrine autoinjector for environmental allergies. Regarding allergic immunotherapy (IT), 33 of 55 (60.0%) received IT;additionally, 7 subjects (12.7%) were determined to be IT candidates but did not receive IT. The most common monoclonal antibody therapy used in this cohort was omalizumab (18.2%). Only 11 (20.0%) and 3 (5.5%) underwent serum IgE and IgG testing, respectively. CONCLUSION: Rescue and cleanup workers referred to a multispecialty allergy/immunology and pulmonology practice from the WTC Health Program not only had a high incidence of acquired allergies to environmental allergens, but the majority were prescribed and epinephrine autoinjector and either received or were candidates to receive allergy immunotherapy. Given that hundreds of thousands of individuals were exposed to the WTC fallout and exposure is an independent risk factor for developing allergic disease, this research may have identified ways we may be falling short in providing allergy/immunology services to exposed individuals.