Prevention and Management

Frequently used forms of protective clothing (e.g., long-sleeved shirts), appear to provide little benefit. It is believed that waterproof protective clothing would provide significant protection from green tobacco sickness, but such equipment is not practical for use during the warm and humid tobacco harvesting months in the Southern United States. Such equipment could lead to heat exhaustion, and is not favored by tobacco workers. It has been suggested that harvesters not pick the tobacco leaves in the early morning when the leaves are still wet, or after a heavy rainfall, however this solution must be weighed against the economic cost (50,52,55,59).

Prophylactic drug use has also been proposed but not fully evaluated for effectiveness. Once a tobacco farmer has suffered from green tobacco syndrome and is fully recovered, 50 mg of dimenhydrinate or 25 mg of diphenhydramine could be taken before breakfast and lunch to prevent the onset of symptoms when conditions are such that exposure is likely, but there has been no controlled clinical trial of the effectiveness of this preventive treatment. Theoretically these drugs could also be used immediately after exposure. Due to the self-limiting nature of most cases of green tobacco sickness, treatment may not be necessary. To prevent symptoms or reduce their severity, it is recommended that a worker, if exposed, increase fluid intake and rest. If symptoms are severe and vomiting is prolonged, a physician could administer intravenous hydration, anti-emetics, and 25 mg dyphenhydramine im. In cases where bradycardia or tachycardia is involved, treatment with atropine may be required, however it should be used only in patients with hemodynamic compromise. Green tobacco sickness must be differentially diagnosed from pesticide poisoning. Although symptoms may be similar in some cases, treatment differs significantly (60,61).

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