Letter to the Editor

This letter responds to “Evaluating impairment from allergic disorders” in the March/April 1999 issue of The Guides Newsletter. The AMA Guides to the Evaluation of Permanent Impairment (AMA Guides) does not provide clear direction about whether allergies themselves constitute impairment. Consider a worker whose symptoms of asthma subsequent to workplace exposure to toluene diioscyanate resolve when he or she is removed from the job and is no longer exposed to the chemical. Because everyday exposure to diisocyanates is not common and the patient no longer requires medication, one could conclude the patient has no impairment. In contrast, consider a patient who has developed latex allergies as a result of being a health care worker and has experienced two anaphylactic reactions at work after entering rooms where powdered latex gloves had been used and must travel with an epinephrine pen. This person would have a minimum of a Class I impairment because of the few limitations of this person's activities of daily living (ADLs) and the condition requires no or intermittent treatment. Both patients might feel they had permanent changes in their body functions that required permanent changes in their ADLs. Clinicians who make evaluations should be aware of patients’ need for medications or monitoring, the severity of the patient's reactions, and limitations on social activities (eg, need for medications and need to avoid seasonal pollens).