Allergic contact dermatitis from disinfectants in farmers.
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Biomedical subjects
Publications and source records attributed to B Krecisz.
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The causes of skin diseases associated with photosensitivity are presented. The combined effect of light and exogenous light sensitizing substances leads to the occurrence of phototoxic and photoallergic reactions, and what is more, UVA spectrum is most active in their pathogenesis. The light sensitizing compounds are contained in cosmetic preparations, drugs and certain plants. They are characterized by a tricyclic structure and the ability to absorb ultraviolet radiation. The light sensitizing properties are exhibited primarily by non-steroid anti-inflammatory drugs, preservatives, sun filters, phenothiazine derivatives and odorants. Photoallergic reactions may be of occupational nature. The majority of reports found in the literature concern farmers, gardeners, fruit-growers and breeders, as well as representatives of other occupations. They usually emerge after the contact with pesticides of the thiocarbamide group, tetrachloroisophthalonitryl and veterinary drugs. The cases of occupational eczema in farmers and gardeners induced by the effect of light sensitizing plants have also been reported. In addition, the photoallergy diagnostic methods are discussed.
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The causes of occupational dermatosis were analysed in 27 dental nurses examined at The Nofer Institute of Occupational Medicine during the years 1995-99. Contact sensitisation (at least one positive epidermal test) was found in 18 subjects (66.7%). Occupational allergic dermatitis was induced most frequently by: glutaraldehyde (7 positive patch tests), nickel (7), benzalkonium (4), formaldehyde (4), fragrances (4), chromium compounds (3), glyoxal (3), and thiuram (3). In the authors' opinion, dental nurses are nowadays sensitised to other chemical compounds than it used to be in the past. The present components of disinfectants (aldehydes, quaternary ammonium bases), metals and rubber are the major etiologic agents that induce occupational allergy.
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We examined 223 nurses from the Lódź region, referred to the Nofer Institute of Occupational Medicine in 1995-99 because of suspected occupational dermatoses. The diagnosis of contact allergy was based on the positive results of patch tests, and immediate allergy to common allergens and latex on the results of prick tests, as well as on the determinations of specific IgE antibodies. Contact allergy was diagnosed in 66.4% of nurses. The most frequent sensitisers were quaternary ammonium compounds (benzalkonium) (23.8%), nickel (21.5%) and formaldehyde (20.6%); allergy was somewhat less frequently caused by thimerosal (14.3%), fragrances (12.1%), glutaraldehyde (10.8%), cobalt (9.9%), thiurams (6.7%) or glyoxal (4.9%). Allergy to rubber was diagnosed in 40 patients (17.9%), including 25 cases of immediate allergy to latex, 8 cases of contact dermatitis from thiuram rubber curing accelerators, and 7 cases of mixed allergy. It has been concluded that the contact with disinfectants (40.8% of allergic nurses), metals (30.9%) and rubber (17.9%) was the most frequent source of allergy in this group of medical personnel.
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The incidence of allergy to aldehydes (formaldehyde, glutaraldehyde, glyoxal) was examined in 280 health care workers suffering from skin lesions. Allergy was diagnosed in 64 (22.8%) patients. The majority of them (85.9%) were sensitive only to 1 aldehyde. Formaldehyde caused allergy slightly more frequently (13.9%) than glutaraldehyde (12.4%). Only 5 (1.9%) patients were sensitive to glyoxal. The irritant effect of aldehydes to the rabbit eye and skin was tested by the Draize and OECD methods. Formaldehyde and glutaraldehyde showed stronger irritant effect than glyoxal. The sensitizing activity of aldehydes was also confirmed in guinea pigs (using the Maximization Test and the OECD methods). Formaldehyde showed the strongest and most persistent reactions. Significantly higher eosinophil and basophil counts were found in the blood samples of the sensitized guinea pigs. Cytotoxicity of glutaraldehyde and glyoxal was tested on mouse 3T3-L1 fibroblasts by the Neutral Red Uptake and MTT Reduction Assay. It was shown that both aldehydes were cytotoxic, and that the cytotoxic effect of glutaraldehyde was stronger than that of glyoxal.
The authors present the major sources of formaldehyde, and discuss the incidence of contact allergy to this compound in Poland and throughout the world. The attention was turned to an increasing trend in the incidence of allergy in question, as well as to the problem of cross-sensitization to other chemical compounds of the aldehyde group (glyoxal, glutaraldehyde, succinaldehyde and cinnamic aldehyde).
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The concentration of eosinophil cationic protein (ECP) in blood serum was determined in 53 health service workers (women) with contact allergy to disinfectants and in 16 healthy women using a radioimmunological method. The mean ECP concentration in the study group accounted for 7.518 micrograms/l, and in the control group 4.893 micrograms/l. The concentration of 8.403 micrograms/l (the mean concentration in the control group + 2 SD) was taken as a cut off concentration value. In 17 (32.1%) persons with contact dermatitis, pathological ECP values were found. An increased ECP was observed in persons with positive results of prick test, especially in the case of Dermatophagoides, pollens and latex as well as in those with increased total IgE concentration. Our results indicate the involvement of immediate allergy in the incidence of contact allergy to disinfectants.
In 53 female health service workers with contact allergy to disinfectants (formaldehyde, glutaraldehyde, benzalkonium, lisoformine) the results of skin prick tests using common environment allergens were analysed, and concentrations of total IgE in blood serum were identified. In 29 (54.7%) persons positive prick tests (Dermatophytes--21, pollens--21, latex--7, domestic dust--5, goose and duck feathers--3, dog hair--2, and cat hair--1) were noted. In the whole group mean IgE concentration accounted for 88.2 kU/1, whereas in the group with positive skin prick test the value increased to 136.1 kU/1. The authors are of the opinion that in patients with contact allergy to disinfectant some symptoms of atopic diathesis are observed.