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Rhinoconjunctivitis can be caused by allergenic as well as non-allergenic factors. When no allergy is involved, it is important to ask the patient about possible daily exposure to factors that may irritate the mucous membranes. The work environment may play a part, but other things may also be provoking factors, including paper tissues, which, besides the fibres of the paper itself, may contain chemical substances that irritate the mucous membranes. The treatment is to replace the paper tissues with well-washed cotton handkerchiefs. The use of a nasal steroid may be necessary for a short time.

At a public office with a staff of 129, twenty people work for short periods with large amounts of self-copying paper. A controlled study has shown a significantly higher incidence of pruritus and nasal congestion amongst staff exposed to large amounts of self-copying paper or its components, no drying of the skin after working with the paper and no increased degree of irritation of the skin were found in the study group at dermatological examination. No differences were found between the study group and the control group with respect to allergy or skin status or working conditions apart from the contact with self-copying paper. The study confirms that contact with fresh self-copying paper may result in pruritus and skin irritation, but allergy to the paper or microcapsule contents could not be demonstrated in this study.