Contact allergen alternatives: 1986

Allergic contact dermatitis among maintenance and clerical workers in a military population

Contact dermatitis is one of the leading causes of occupational morbidity and absenteeism and has become an intolerable cause of missed workdays and health problems in the Israeli military. The aim of this study was to determine the rate of contact dermatitis in maintenance and clerical workers, the common allergens causing it, and the background of atopy in the subjects in order to design preventive measures. Medical records of all recruits to the Israel Defense Forces from 2000 to 2003 were reviewed for contact dermatitis. The 102 cases found were further assessed for job assignment, atopic background, and allergens. Of the 102 cases, 60 had irritant contact dermatitis and 42 had allergic contact dermatitis, of which 33 (78.6%) were maintenance workers, mainly mechanics. 13 soldiers in the maintenance job category (39%) and 2 soldiers in the clerical group (22.2%) had atopic background. There were 55 positive reactions in patch tests, 25 of them to oil and cooling fluids, with 14.5% attributed to methylchloroisothiazolinone/methylisothiazolinone) (Kathon CG). Atopy was found to be a risk factor for allergic contact dermatitis in our study and should be screened for in job assignment procedures in the military. Oil and greases contain significant allergens, especially their preservatives.

Occupational contact dermatitis

The two commonest forms of occupational skin disease are irritant and allergic contact dermatitis. Morphology and history are used to establish the diagnosis and the relation of the disorder to work exposure, respectively. Diagnostic patch tests are used to define further the diagnosis and aetiology of the dermatitis.

Comparison of 2 tests for clinical assessment of formaldehyde exposure

The objective of the study was to obtain further experience on the applicability of 2 tests for clinical assessment of formaldehyde exposure. About 1300 products brought in by consecutive formaldehyde-sensitive eczema patients during a 2-year period were tested with both the chromotropic acid test and the acetylacetone test. The chromotropic acid test was modified by including a 2nd reading after 2 days. The outcome was identical for about 90% of the products, and 74% of the products that were positive on day 2 were also positive on day 1. More than 1/2 of the tests that scored as traces or caused problems on day 1 became positive on day 2. For products analyzed with both the chromotropic acid test (day 2 readings) and the acetylacetone test, about 80% gave identical results. Positive reactions were frequently found for hair shampoo, creams and lotions, soap and skin cleansers, make-up and dishwashing liquids. The samples causing discolouration or problems in the tests were mostly concentrated in specific product categories. Very few products caused problems in both test methods. Thus, the most convenient test can be used as the 1st choice and, for product categories causing discolouration or problems with a specific test, the other test method can be used.

Skin Diseases of the Hands and Feet

In brief A variety of dermatologic problems affect the hands and feet of active patients, often producing significant pain and disability. Traumatic disorders include friction blisters, calcaneal petechiae, subungual hemorrhage, and plezogenic papules. Infectious disorders include hot tub folliculitis, swimming pool granuloma, tinea pedis, warts, and herpetic whitlow. Athletic shoe dermatitis is a common allergic disorder, and hand eczema is a common disorder with a strong hereditary component. Prompt diagnosis and treatment can minimize morbidity. Some traumatic disorders can be prevented.

Identification of formaldehyde releasers and occurrence of formaldehyde and formaldehyde releasers in registered chemical products

Substances referred to as formaldehyde releasers were identified on review of the literature. Information on product categories and typical concentrations for chemical products containing formaldehyde and formaldehyde releasers was obtained from the Danish Product Register Data Base (PROBAS). As of February 1992, 62,000 products were registered in PROBAS, 30,900 of these with information on composition and product category. Among the components of these products, 19 of the 22 identified formaldehyde releasers were found. The number of products registered with each formaldehyde releaser varied from 4 to 171, with cleaning agents, soaps, shampoos, paint/lacquers, and cutting fluids as the most frequent product categories. The most frequently registered formaldehyde releasers were bromonitropropanediol, bromonitrodioxane, and chloroallylhexaminium chloride. Formaldehyde itself was registered in 1,781 products, and was found in all product categories included in the study. It is concluded that products for industrial use as well as household and personal care products should be considered as sources of formaldehyde exposure. The use of unsystematic chemical names in literature is discussed.

Prevention of epoxy resin dermatitis: failure of manufacturers to use available research information

Research information is often recommended as a solution for occupational disease and injury. This study asks whether publicly available research information on prevention of a well-documented occupational hazard is acted on by an important sector in industry. The hazard, allergic contact dermatitis (ACD) caused by epoxy resins in paints, is particularly significant for painters, who may have to leave their jobs as a consequence of the condition. No evidence is found, according to a priori criteria, that paint manufacturers/suppliers acted on known prevention measures for epoxy resin ACD that are within their control to implement. The findings suggest that availability of research information alone fails to solve health and safety problems. Recommendations for avenues of direct and indirect enforcement where voluntary implementation is absent in the painting industry are suggested.

Allergic Contact Dermatitis

In brief Allergic contact dermatitis in active Patients can arise from exposure to certain types of sports equipment and topical analgesics. The reaction usually produces pruritus, erythema, and eczema. Patch tests are not usually needed; a clinical diagnosis is readily made when the allergen no longer touches the skin and the rash disappears quickly. Management also includes treating the presenting dermatitis and suggesting allergy-free alternatives.

Allergic contact dermatitis from formaldehyde. A case study focussing on sources of formaldehyde exposure

Formaldehyde is a common contact allergen. The prognosis of formaldehyde-sensitive patients is generally considered to be bad because of widespread exposure to formaldehyde. 11 patients with eczema and a positive patch test to formaldehyde were interviewed by a dermatologist and a toxicologist/chemist and instructed to fill in a questionnaire on exposure to chemical products. The content of formaldehyde and formaldehyde releasers in such products was examined using the database of the Danish Product Register (PROBAS) and by supplemental inquiries of manufacturers or importers. All the patients used one or more products containing formaldehyde or formaldehyde releasers. Sources of exposure were cosmetics and personal care products, dishwashing liquids, water-based paints, photographic products, etc. Patients were advised to use alternatives to those products containing formaldehyde or formaldehyde releasers. The status of 10 out of the 11 patients' eczema at follow-up was about 1/3 healed, 1/3 improved and in 1/3 no change. When the relevance of positive patch test reactions to formaldehyde was based on information obtained on exposure, a very high rate of current relevance was found. Computerized data on product composition allows the screening of products for contact allergens and also generates lists of contact allergens indicated for patch testing, based on the patients' own products.

Contact dermatitis in hairdressers' clients

The aim of our study was to report the frequency of sensitization to hairdressing allergens in a group of patients with contact dermatitis, in whom previous treatments with hair dyes or permanent wave solutions were suspected to be the cause. 49 of 261 hairdressers' clients (18.7%), who were patch tested with the hairdressers' screening series in the years 1985-1990, showed one (27) or more (22) positive reactions to hairdressing chemicals. This study confirms hair dyeing to be the procedure associated with the highest risk of sensitization among hairdressers' clients. Among hair dye allergens, PPD is the most frequent sensitizer (7.3%). A low rate of sensitization to the PPD derivatives PAP, ONPPD and PTD was detected in these clients, there being no differences in the frequency of sensitization to the 3 substances (4.2%, 4.6% and 4.6%, respectively). Only 0.4% of clients were positive to resorcinol, while pyrogallol showed a 2.3% rate of sensitization. Sensitization to GMTG was found in 3.3% of patients. ATG was an infrequent sensitizer (1.1%). Allergic contact dermatitis due to APS is quite rare (2.7%), in view of the widespread use of this compound. A positive open patch test in 1 hairdressers' client, who complained of generalized urticaria after hair bleaching, confirmed the diagnosis of immediate contact reaction due to APS. Sensitization to hairdressing allergens among consumers (18.7%) is possibly more frequent than sensitization to other cosmetic ingredients. We previously detected a 14.3% rate of sensitization to cosmetic ingredients in patients with suspected allergic contact dermatitis caused by cosmetics. On the other hand, reactions to cosmetic ingredients were also common in our patients. This may indicate that hairdressers' clients make greater use of cosmetics than average.

Facial contact dermatitis. Pathogenetic factors in China

In 107 cases of facial contact dermatitis, routine Finn chamber epicutaneous tests with TROLAB European Standard Allergens (ESAs) were performed. Sixty-one (57%) had positive reaction. The most frequent contact allergens were paraphenylenediamine dihydrochloride (16%), followed by fragrance mix (15%), and nickel sulfate (13%). The major sensitized contactants were rims of spectacles, hair dyes, cosmetic creams, and topical medications. Among the cases caused by cosmetic cream, the positive allergens were fragrance mix, formaldehyde, wood alcohols, and balsam of Peru. In ten season-incidence cases in which ESAs and cosmetic cream epicutaneous tests were negative, the chamber and scratch-chamber tests were performed using five kinds of pollen. The results show that all chamber tests were negative, but two cases with scratch-chamber tests were positive.

Prevention of occupational contact dermatitis

Contact dermatitis is the most frequent type of occupational skin disease. Although prevention of contact dermatitis in the workplace should ideally be accomplished through total elimination of cutaneous exposure to hazardous substances, this is often not feasible. Therefore eight basic elements of a multidimensional approach to prevention have been identified. These elements include recognition of potential cutaneous irritants and allergens, engineering controls or chemical substitution to prevent skin exposure, personal protection with appropriate clothing or barrier creams, personal and environmental hygiene, regulation of potential allergens and irritants within the workplace, educational efforts to promote awareness of potential allergens and irritants, motivational techniques to promote safe work conditions and practices, and preemployment and periodic health screening. A comprehensive prevention program based on this multidimensional approach requires the cooperative efforts of employees, employers, engineers, chemists, industrial hygienists, safety and supervisory personnel, union representatives, governmental agencies, and occupational health practitioners.

Easier patch testing with TRUE Test

TRUE Test, a standardized, ready-to-apply patch test system, is made from polyester covered with a film of allergens incorporated in a hydrophilic polymer. The patches are mounted on nonwoven cellulose tape with acrylic adhesive, covered with siliconized plastic, and packed in an air-tight and light-impermeable envelope. When the test strip is taped on the skin, perspiration hydrates the film and transforms it to a gel, which causes the allergen to be released. The first panel of 12 allergens and allergen mixes is standardized and tested for stability in vitro and in vivo. The accuracy of the test panel has been certified in international multicenter studies by comparing it with present patch test techniques. A second panel of 11 more allergens was completed in 1988. The two test panels include the full standard panel of the North American Contact Dermatitis Group.

The usefulness of detailed information to patients with contact allergy

To find out if patients with contact allergy are helped by computerized information lists, a retrospective study was carried out on 58 patients with contact allergy to lanolin, traced through our local database DALUK. All were sent a questionnaire about their usage of the information list, clearance of their eczema, their education and other details. Clearance of the patient's eczema was found to correlate with use of the information list. It was also found that the effectiveness of the information depended on factors such as education, family circumstances, ethnic background and, most of all, how and where the information list was used.

Trends in allergic contact sensitization

A standard patch test series was tested for 7 years (1977-1983) in a total of 11,962 patients. The annual frequency of positive reactions to the compounds tested was assessed for the total and for males and females separately. During the observation period, there were significant increases in positive reactions in the total group from 6.2% to 12.7% for nickel sulphate, from 5.3% to 7.0% for balsam of Peru and from 3.8% to 6.5% for potassium dichromate, reflecting significant changes in both sexes. The frequency of positive reactions to wool alcohols, formaldehyde, neomycin sulphate, paraben mix and gentamycin sulphate significantly increased, while that of positive reactions to clioquinol, mercuric chloride and turpentine peroxide significantly decreased in either males or females, sometimes leading to significant changes in the total group.