No participating core and specialty programs

Employers, policy-makers, trade associations, and manufacturers use NIOSH information to prevent immune and dermal diseases among services sector workers.

NOTE: Goals in bold in the table below are priorities for extramural research

Health Outcome Research Focus Worker Population Research Type
A Dermatitis Exposures to chemicals (e.g., biocides, pesticides, solvents, acrylates) Service workers with exposures (e.g., personal care, building maintenance, food handling and preparation, automotive) Basic/etiologic
B Work-related asthma Mechanistic studies of exposures leading to allergic sensitization (e.g., high molecular weight, low molecular weight antigens, microbiological exposures) Service workers with exposures (e.g., personal care, food handling and preparation, building maintenance, office workers, education) Basic/etiologic
C Hypersensitivity pneumonitis (HP) Mechanistic laboratory-based studies of exposures to organic and inorganic substances Service workers with exposures (e.g., building maintenance, office workers, education) Basic/etiologic
D Immune suppressive disorders Identification of substances and the mechanism by which they cause immune suppression Service workers with exposures (e.g., personal care, food handling and preparation, building maintenance, office workers, education) Basic/etiologic

Activity Goal 3.9.1 (Basic/etiologic research): Conduct basic/etiologic research to better characterize exposures related to immune and dermal disorders among services sector workers with an emphasis on studies to better understand basic immunological mechanisms.


Services sector workers are routinely subjected to a wide array of exposures that can lead to chronic disease including immune-mediated diseases. The Personal Care Services component of the sector employs approximately 1.45 million [BLS 2017]. Many of these workers are employed in hair and nail salons and are exposed to a variety of chemicals that potentially cause a number of health effects, including allergic and irritant contact dermatitis [Lyons et al. 2013]. These skin disorders have been associated most commonly with chemical exposures from the detergents/surfactant/colors/fragrances present in shampoos, additives such as preservatives or biocides, permanent wave solutions, bleaching agents, fragrances or dyes present in other hair product formulations, acrylates used for nail art acrylic products, and nickel sulfate used in the cosmetology equipment [Hougaard et al. 2012, Krecisz et al. 2011, Landers et al. 2003, Uter et al. 1998, Warshaw et al. 2013].

There are approximately 2.5 million workers employed in building services. These individuals are exposed to pesticides and other chemicals, solvents, asbestos, lead, as well as microbial agents such as bacteria and fungi [OSHA 2017]. Allergic diseases such as dermatitis and asthma are common among workers that have cleaning related occupational tasks. Additionally, there are 1.8 million workers employed in the hotel industry. Hotel room cleaners are likewise exposed to chemicals and other sources of high molecular weight proteins that can result in allergic sensitization or the development and exacerbation of dermatitis and asthma.

Food preparation and handling can also be a source of worker exposure to high molecular weight allergens derived from a variety of botanical, animal, or seafood sources. Personal exposure to high molecular weight allergens during preparative stages can result in allergic sensitization and occupational asthma. Although broadly characterized in European studies, these scenarios are an emerging issue within the United States especially due to the rapid growth of the food preparation and meal delivery industries [Bauer et al. 2017, Cartier 2010, Desjardins et al. 1995, Lopata and Jeebhay 2013, Zuskin et al. 1992, Green et al. 2011].

Moisture damage within the built environment continues to be a public health burden in the United States and has resulted in community and worker concern regarding personal exposures to microorganisms including fungi and fungal associated byproducts. Dampness and fungal contamination are commonly identified within US schools [Sahakian 2008, GAO 1990]; however little is known about the effects of reduced indoor air quality on teachers’ health. Recent studies have identified that the teachers work environment can be the source of a range of adverse respiratory health effects including self-reported sinus problems, headache, allergies/nasal congestion, and throat irritation.

Workers in repair and maintenance (such as automotive technicians) and personal services (such as hair dressers and nail technicians) are also exposed to an array of industrial chemicals including heavy metals contained in break fluids, degreasers, detergents, lubricants, metal cleaners, paints, fuel, solvents, etc. [International Labour Organization 2000]. In these fields, there is an increased prevalence of potential skin hazards of 52.4% and 51.5%, respectively, compared to 20.5% in all industries [NIOSH 2010].


Hazards for Services workers include pesticides, cleaning compounds, microbial agents, high molecular weight allergens and other secondary metabolites, solvents, and degreasing agents. Studies evaluating the immunological hazards from exposure to many of these agents are needed. Indoor dust including bacteria and fungi as well as high molecular weight allergens (dust mite and pets) and chemical irritants have been associated with many symptoms but there continues to be a lack of understanding of the immunological mechanisms and the diversity of microorganisms and other chemical exposures that contribute to these health effects [Kielb et al. 2015]. Considering that the service sector employs over 70 million workers, research on work-related immune diseases is needed.

Bauer A, Geier J, Elsner P [2002] Type IV allergy in the food processing industry: sensitization profiles in bakers, cooks and butchers. Contact Dermatitis 46(4):228-235.

BLS [2017] Personal and Laundry Services: NAICS 812. Washington, D.C.: U.S. Department of Labor, Bureau of Labor Statistics, icon.

Cartier A [2010]. The role of inhalant food allergens in occupational asthma. Curr Allergy Asthma Rep 10(5):349-356.

Desjardins A, Malo JL, L’Archevêque J, Cartier A, McCants M, Lehrer SB [1995]. Occupational IgE-mediated sensitization and asthma caused by clam and shrimp. J Allergy Clin Immunol 96(5 Pt 1):608-617.

GAO [1996]. America’s schools report differing conditions. Washington, DC: US General Accounting Office, Health, Education, and Human Services Division, icon.

Green BJ, Cummings KJ, Rittenour WR, Hettick JM, Bledsoe TA, Blachere FM, Siegel PD, Gaughan DM, Kullman GJ, Kreiss K, Cox-Ganser J [2011]. Occupational sensitization to soy allergens in workers at a processing facility. Clin Exp Allergy 41(7):1022-1030.

Hougaard MG, Menne T, Sosted H [2012]. Occupational eczema and asthma in a hairdresser caused by hair-bleaching products. Dermatitis 23(6):284-287.

Kielb C, Lin S, Muscatiello N, Hord W, Rogers-Harrington J, Healy J [2015]. Building-related health symptoms and classroom indoor air quality: a survey of school teachers in New York State. Indoor Air 25(4):371-80.

Krecisz B, Kiec-Swierczynska M, Chomiczewska D [2011]. Dermatological screening and results of patch testing among Polish apprentice hairdressers. Contact Dermatitis 64(2):90-95.

Landers MC, Law S, Storrs FJ [2003]. Permanent-wave dermatitis: contact allergy to cysteamine hydrochloride. Am J Contact Dermat 14(3):157-160.

Lopata AL, Jeebhay MF [2013]. Airborne seafood allergens as a cause of occupational allergy and asthma. Curr Allergy Asthma Rep 13(3):288-297.

Lyons G, Roberts H, Palmer A, Matheson M, Nixon R [2013]. Hairdressers presenting to an occupational dermatology clinic in Melbourne, Australia. Contact Dermatitis 68(5):300-306.

NIOSH [2010]. National Health Interview Survey Occupational Health Supplement. Cincinnati, OH: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health,

OSHA [2017]. Landscape and horticultural service: hazards and solutions. Washington, DC: Department of Labor, Occupational Safety and Health Administration, icon.

Sahakian NM, White SK, Park JH, Cox-Ganser JM, Kreiss K [2008]. Identification of mold and dampness-associated respiratory morbidity in 2 schools: comparison of questionnaire survey responses to national data. J Sch Health 78(1):32-37.

Uter W, Schnuch A, Geier J, Frosch PJ [1998]. Epidemiology of contact dermatitis. The information network of departments of dermatology (IVDK) in Germany. Eur J Dermatol 8(1):36-40.

Warshaw EM, Kwon GP, Mathias CT, Maibach HI, Fowler Jr JF, Belsito DV, Sasseville D, Zug KA, Taylor JS, Fransway AF, DeLeo VA [2013]. Occupationally related contact dermatitis in North American food service workers referred for patch testing, 1994 to 2010. Dermatitis 24(1):22-28.

Zuskin E, Kanceljak B, Schachter EN, Witek TJ, Maayani S, Goswami S, Marom Z, Rienzi N [1992]. Immunological and respiratory changes in animal food processing workers. Am J Ind Med 21(2):177-191

Page last reviewed: February 1, 2019