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Allergic contact dermatitis to glutaraldehyde was found in 13 health-care workers with hand dermatitis. Concomitant sensitivity to other chemicals was noted in 10. The positive patch test response was only evident for every 2nd observation in 4. The eruption persisted for more than 6 months in 10 subjects. In 5, the skin disease forced the worker to leave his occupation.
We describe the cases of three hospital nurses who presented eczematous lesions on the hands and eyelids. They worked in surgery department or in post anaesthesia recovery room, all preparing syringes of Pro-Dafalgan (propacetamol: parenteral paracetamol form). They were not sensitive to oral paracetamol or occupational products and latex. During week-end or holidays when they stopped handling Pro-Dafalgan, the eczema recovered but relapsed on working. A few cases are described in the literature so precautions begin to be preconized for healthcare workers but they are not usually in practice. Test performed with solvent, paracetamol, latex, formol and other hospital allergen tests were negative. The only allergen would be propacetamol because all tests performed with it were strongly positive. Following the official evaluation method in pharmacovigilance, based on chronologic and semiologic criterias, considering the positivity of rechallenge and specific tests, propacetamol imputability was probable in all our cases. It is preconized to declare cases to Regional Pharmacovigilance Centers to complete information about handling risks of this very usual analgesic.
We compared the incidence of occupational dermatitis and transepidermal water vapour loss (TEWL) changes from cutting fluids (neat mineral oils) in 24 new machinists with 27 armed forces paramedics (controls) over a 6-month period. The cumulative incidence of occupational dermatitis in positive controls increased from 38% at week 3 to 77% at week 6. It then decreased to 50% at week 9 and thereafter remained constant at about 50% throughout the remaining study period. 2 workers sought medical treatment for their dermatitis. Only 1 worker had a job transfer because of his dermatitis. None of the paramedics developed dermatitis during the study period. The mean basal TEWL values on the hands of machinists and controls were 17.6 and 14.5 g/m2/h (n.s.) respectively. The mean TEWL values of machinists increased to 22 g/m2/h by week 3 and then remained fairly constant throughout the remaining study period. The mean TEWL of negative controls remained fairly constant (at about 14 g/m2/h) from the beginning to the end of the study period. The mean TEWL value of machinists was significantly higher than that of negative controls throughout the study period. There was no significant difference in the prevalence of cutting fluid dermatitis between machinists with high basal TEWL values (> or = 17 g/m2/h) and those with low basal TEWL values (< 17 g/m2/h).
The lymphocyte proliferation test (LPT) was compared with the patch test in the diagnosis of nickel contact sensitivity. Of the 21 subjects with nickel contact allergy, the patch test detected 20 (95%). The subject remaining negative in the patch test was positive in the intradermal test. 18/21 subjects with nickel contact sensitivity were positive in the LPT, whereas in the control group 2/23 subjects were false positive. These results were obtained at nickel sulfate concentrations of less than 10 micrograms/ml, higher concentrations led to nonspecific lymphocyte stimulation. 3 nickel-sensitive cashiers with suspected coin contact-induced deterioration of their hand eczema were challenged by having them count nickel-containing coins daily for 15 min. 2 of them developed vesicular eczema on their palms and fingers in 2 to 3 days. The present results show that the LPT is a reliable additional test in the diagnosis of nickel contact sensitivity. Furthermore, provocation is a valuable procedure when assessing the relevance of nickel contact in occupational hand eczema in certain occupations.
Within DSM Chemicals BV, a producer of acrylonitrile, skin complaints are frequent. The majority of these are of an irritant nature, while a smaller portion is based on acquired allergies. Allergological examination revealed 5 employees with an allergy to acrylonitrile. 1 of these subjects also developed paraesthesiae in the skin sites affected, a finding not previously described for acrylonitrile. In the guinea pig maximization test (GPMT), acrylonitrile showed strong allergenic potential. For prevention and treatment of contact allergologic disorders, close cooperation between occupational health officer, dermatologist and toxicologist in chemical companies is recommended.
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Many plants and flowers can cause dermatitis in florists, growers, and others working in the industry. In the United States, Alstromeria, also called Peruvian Lily, has frequently been reported to cause hand eczema in floral workers. This interesting report details sesquiterpene lactone allergy in the occupational setting. Fortunately, in this case, it seems that resolution of the dermatitis was achieved fairly rapidly by avoiding the occupational situation. Unfortunately, for many of our patients with airborne compositae dermatitis, there is no way to avoid the allergen; therefore, many of these individuals develop severe, chronic recalcitrant dermatitis requiring aggressive therapy. Diagnosis of this condition is not always easy, as it appears that the sesquiterpene lactone mix allergen that we have commercially available misses a number of cases, at least in the United States. Better characterization of the allergens involved and better supply of allergenic extracts for testing is critical to improve our diagnostic ability.
BACKGROUND: In spite of promising experimental data demonstrating the efficacy of protective creams (PC), their practical value is still viewed with scepticism. Lack of protection could be caused simply by uneven or spotty application of these products. How precisely workers apply PC at the workplace can be monitored and quantified by a recently developed fluorescence technique. OBJECTIVE: The goal of the present study was to use this technique to teach workers in high-risk occupations the proper use of PCs and to compare the benefit of this method with the use of an instructive videotape. METHODS: Fifty healthy metal workers were recruited to self-apply a fluorescent preparation 6 weeks after being taught either by a fluorescence test or by a 20-min videotape. The application was evaluated under Wood's light examination. RESULTS: The performance of the fluorescence group had improved significantly over the initial test (p < 0.001) and was significantly better than that of the videotape group (p < 0.001). CONCLUSION: Our results indicate that this method may become a useful adjunct to improve the daily application of PC as a preventive measure.
We report 4 cases of contact sensitization to propacetamol. They presented with lesions on the hands, forearms, crease of the elbows, and neck. They were all sensitized to multiple allergens and 2 of them were atopic. Patch tests to Pro-Dafalgan and propacetamol were positive; sodium citrate and paracetamol were negative. Our cases were similar to those published for the first time by Barbaud in 1995. The only allergen was propacetamol; patch tests with diethyglycine and paracetamol were negative. Propacetamol chlorhydrate is composed of a complex paracetamol-diethylglycine, which probably acts like a hapten capable of inducing cutaneous allergy. It is an occupational allergy affecting nurses who work in surgery departments or post-anesthesia recovery rooms, where high doses of analgesics are widely used. The patients were not allergic to oral paracetamol. Despite the usual precautions, the mixture of propacetamol chlorhydrate and solvent leaks onto the nurses' hands, suggesting that health care workers handling propacetamol chlorhydrate should wear gloves.
A population-based study was performed to investigate incidence rates of occupational skin disease (OSD) in bakers, confectioners and cooks, as well as the rôle of endogenous and exogenous risk factors. In North Bavaria, all closed cases of OSD were recorded systematically in a 3-year period and the total number of employees in the food industry was known over the same period of time. Incidence rates of OSD and relative risks of atopic skin diathesis (AD) and respiratory atopy (RA) were calculated. The overall incidence rate (I) of OSD (in 3 years per 10.000 employees) was 67 (95% CI 58;76) in these occupations. Bakers had a higher risk of OSD, with an incidence of 191 (95% CI 156;226) compared to confectioners with I = 84 (95% CI 55;113) and cooks I = 34 (95% CI 28;40). Incidence rates were sex- and age-related. Females developed OSD with an incidence rate of 74 (95% CI 64;84) compared to males with I = 58 (95% CI 48;70). OSD occurred mostly between the ages of 15 and 24 years. Irritant contact dermatitis (ICD) was the main type of OSD. 36% of the bakers had an occupationally relevant Type I allergy, while Type I allergies were less frequent in confectioners (16%) and cooks (9%). Assuming a prevalence of 10% of AD in the general population the relative risk (RR) of developing OSD in bakers, confectioners and cooks with AD was 9.7, 10.5 and 5.2, respectively. There were only small differences in calculating sex-related RR of AD.(ABSTRACT TRUNCATED AT 250 WORDS)
Contact sensitivity to ranitidine hydrochloride has been demonstrated in 6 of 8 symptomatic exposed pharmaceutical manufacturing employees; a 7th has been found to be sensitized to ranitidine base. Although closed manufacturing processes diminish the risk of such sensitization, operatives with potential exposure should be made aware of the importance of avoiding skin contact.
Patch testing is valuable for the management of most forms of hand eczema; it tends to be diagnostically useful, however, only in the nonendogenous forms. Historical and morphologic clues that distinguish hand eczema of endogenous from that of exogenous causes can increase the yield of valuable information from patch testing. Knowledge of the occupations at risk for skin disease and the time required for irritant and allergic contact dermatitis to develop will improve history taking--the key to suspecting an occupational component.
Occupationally related hand dermatitis has been attributed to frequent hand-washing, exposure to possible sensitizers and latex glove use. The authors conducted a study to determine the prevalence of occupationally related hand dermatitis in dental personnel. They found that 75 (19.2 percent) of 390 subjects self-reported they had a positive history of hand dermatitis. Further testing of 53 of these subjects indicated that only 9.4 percent reacted to the 45 allergens tested, and 3.8 percent had an allergy to latex.
Skin reactions are common in the workplace. The skin, which constantly is exposed to chemicals and industrial processes, develops inflammatory reactions, most commonly dermatitis, which may have an allergic or irritant basis. The epidemiology, pathophysiology, and clinical features of common occupational dermatoses are discussed. Irritant, allergic, and urticarial contact reactions are compared, and their clinical features are outlined. Important occupational irritants and allergens, their sources, and the industries in which they most commonly are found are listed. The prognosis and therapy of these occupational reactions are examined.
While disinfection is essential in medical practice, it carries the risk of serious adverse effects, including allergic contact dermatitis. To assess the current importance of glyoxal [CAS 107-22-2] as occupational allergen, a retrospective descriptive analysis of records of an occupational dermatitis clinic in Osnabrück and of national surveillance data of the Information Network of Departments of Dermatology (IVDK) in Germany and Austria was performed. Of 189 highly selected patients with occupational dermatitis tested with glyoxal (1% in water or, as trimer, 1% in petrolatum) in Osnabrück, 11 had positive reactions to glyoxal, which were occupationally relevant in 9 cases. Causative occupations included mainly nursing and room cleaning. In a less selected population of 2626 additional patients tested in other centres of the IVDK, 40 further positive reactions to glyoxal were observed. Concomitant sensitisation to glutardialdehyde and formaldehyde, respectively, was frequently observed. In conclusion, glyoxal should be tested in all patients with contact dermatitis working in occupations with possible exposure to respective disinfecting/cleaning agents.
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Occupational allergic contact dermatitis (OACD) is an important medical and occupational health problem. If undiagnosed, the disease may persist and even spread widely, resulting in severe and permanent disability to the worker, who may be deprived of his legal right to compensation. OACD is not uncommon in China, although many dermatologists fail to establish the connection between disease and working conditions, because they think that the diagnosis of OACD is the work of occupational medicine and that special diagnostic methods are required. The Ministry of Health and Ministry of Labour and Social Security of China have issued a new law recently to emphasize the prevention and treatment of occupational disease. It requires physicians to make an accurate diagnosis and report of occupation-related diseases. In this study, we have successfully investigated 14 cases of OACD in our hospital by patch testing the patients with a standard series of allergens and investigating by questionnaire the suspected offending occupational allergens. During a 2-year period (2001-2003), 14 patients with suspected allergic contact dermatitis were investigated and confirmed as having OACD. OACD may develop in many different occupations. In this study, nickel, 4-phenylenediamine, fragrance mix, black rubber mix, colophonium, epoxy resin and thiuram mix were identified by patch testing as the main offending allergens in such patients. These results indicate that patch testing plays a vital role in the diagnosis and identification of occupational allergens, and our study shows that OACD can often be diagnosed by patch testing patients with a standard series. The clinician should be alert to recognize the offending allergens of OACD by referring to patch testing all patients with clinically suspected contact dermatitis, and then educating the sensitized worker in how to avoid further exposure to the causative allergens.
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