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Sedeh FB, Michaelsdóttir TE, Christiensen KB, Mortensen OS, Jemec GBE, Ibler KS. Prevalence and risk factors for hand eczema among professional hospital cleaners in Denmark: A cross-sectional questionnaire-based study. Contact Dermatitis 2023; 89:241-249. [PMID: 37438897 DOI: 10.1111/cod.14379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 05/23/2023] [Accepted: 06/20/2023] [Indexed: 07/14/2023]
Abstract
BACKGROUND Professional cleaners are commonly affected by hand eczema (HE) due to wet work and exposure to cleaning products in the work environment. OBJECTIVE To investigate (1) the prevalence of HE in a group of professional hospital cleaners, (2) the association of HE with various comorbidities and self-reported signs/symptoms of skin lesions and (3) the association of HE with various occupational and personal risk factors in the same population. METHODS A cross-sectional questionnaire-based study including all cleaners working in three hospitals in Denmark. The questionnaire was composed of 35 questions. Prevalence is reported using proportions with 95% confidence intervals and compared using difference of proportions and Fisher's exact test. RESULTS A total of 122 out of 180 cleaners (response rate = 68%) participated in this study. The self-reported lifetime prevalence of HE among the cleaners was 30.3%, while the 1-year prevalence was 18.9%. HE was significantly associated with a history of atopic diseases. There was a significant correlation between having HE, and self-reported redness and itch of the hands in the last 12 months, as well as the use of hydrochloric acid ≥4 days/week during the last 12 months. Logistic regression analysis found HE significantly associated with washing hands ≥20 times during a working day and a history of atopic dermatitis. CONCLUSION Cleaners are at an elevated risk of developing HE. More focus on education/information regarding the prevention and treatment of HE is necessary for the cleaning profession. Self-reported redness and itching of the hands may be a useful prediction of HE in cleaners.
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Affiliation(s)
| | | | - Karl Bang Christiensen
- Department of Public Health, Section of Biostatistics, University of Copenhagen, Copenhagen, Denmark
| | - Ole Steen Mortensen
- Department of Occupational and Social Medicine, Holbaek University Hospital, Holbaek, Denmark
- Department of Public Health, Section of Social Medicine, University of Copenhagen, Copenhagen, Denmark
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Clément A, Ferrier le Bouëdec MC, Crépy MN, Raison-Peyron N, Tétart F, Marcant P, Pralong P, Valois A, Pasteur J, Assier H, Bernier C, Le Cam MT, Hacard F, Nosbaum A, Giordano Labadie F, Morice C, Leleu C, Milpied B, Darrigade AS, Delaunay J, Barbaud A, Castelain F, Collet E, Amsler E. Hand eczema in glove-wearing patients. Contact Dermatitis 2023. [PMID: 37331721 DOI: 10.1111/cod.14357] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 04/28/2023] [Accepted: 05/25/2023] [Indexed: 06/20/2023]
Abstract
BACKGROUND Allergic contact dermatitis to gloves is mostly induced by rubber accelerators. The European baseline series (EBS) appears insufficient to detect glove allergy. Since 2017, it is recommended to use the European rubber series (ERS) and to test the patients' own gloves. OBJECTIVES To investigate the clinical profile of glove-wearing patients with hand eczema (HE) and to evaluate their sensitisation profile to glove allergens and the value of testing the patients' own gloves. METHODS We conducted a French multicentre study of patients evaluated for HE between 2018 and 2020 and tested with the EBS, the ERS and their own gloves in patch tests and semi-open (SO) tests. RESULTS A total of 279 patients were included; 32.6% of patients had positive tests to their own gloves or to glove allergens. Almost 45% of the sensitisations to glove allergens were detected only by the ERS. Among the patients tested both in patch tests and SO tests with their own gloves with positive results, 28% had positive SO tests only. Polyvinylchloride (PVC) gloves were positive in four patients. CONCLUSION Our series confirms the need to test the ERS. All the patients' gloves must also be tested including PVC gloves. SO tests with gloves are useful as a complement to patch tests.
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Affiliation(s)
- Aude Clément
- Department of Dermatology, Hôpital Estaing, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | | | - Marie-Noëlle Crépy
- Department of Dermatology, Hôpital Cochin Port-Royal, APHP, Paris, France
| | - Nadia Raison-Peyron
- Department of Dermatology, Hôpital Saint Eloi, CHU Montpellier, Montpellier, France
| | - Florence Tétart
- Department of Allergology, Centre Erik Satie, CHU Rouen, Rouen, France
| | - Pierre Marcant
- Department of Dermatology, Hôpital Claude Huriez, CHU Lille, Lille, France
| | - Pauline Pralong
- Department of Dermatology, Hôpital Nord, CHU Grenoble, La Tronche, France
| | - Aude Valois
- Department of Dermatology, Hôpital d'instruction des armées Sainte Anne, Toulon, France
| | - Justine Pasteur
- Department of Dermatology, Hôpital Estaing, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Haudrey Assier
- Department of Dermatology, CHU Henri Mondor, Créteil, France
| | - Claire Bernier
- Department of Dermatology, Hôpital Hotel Dieu, CHU Nantes, Nantes, France
| | - Marie-Thérèse Le Cam
- Department of Professional Pathology, Centre hospitalier intercommunal, Créteil, France
| | - Florence Hacard
- Department of Allergology and Immunology, CHU Lyon sud, Lyon, France
| | - Audrey Nosbaum
- Department of Allergology and Immunology, CHU Lyon sud, Lyon, France
| | | | | | - Camille Leleu
- Department of Dermatology, CHU Dijon-Bourgogne, Dijon, France
| | - Brigitte Milpied
- Department of Dermatology, Hôpital Saint-André, CHU Bordeaux, Bordeaux, France
| | | | | | - Annick Barbaud
- Département de dermatologie et allergologie, Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP.Sorbonne Université, Hôpital Tenon, Paris, France
| | - Florence Castelain
- Department of Dermatology, Hôpital Jean Minjoz, CHU Besançon, Besançon, France
| | - Evelyne Collet
- Department of Dermatology, CHU Dijon-Bourgogne, Dijon, France
| | - Emmanuelle Amsler
- Département de dermatologie et allergologie, Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP.Sorbonne Université, Hôpital Tenon, Paris, France
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Prevalence, risk factors, and prevention of occupational contact dermatitis among professional cleaners: a systematic review. Int Arch Occup Environ Health 2023; 96:345-354. [PMID: 36409350 DOI: 10.1007/s00420-022-01937-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 11/11/2022] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The aim of this study was to investigate the prevalence, risk factors, and prevention of occupational contact dermatitis (OCD), as well as risk factors and consequences of OCD among professional cleaners. METHODS A systematic review following PRISMA guidelines was performed using Medline, EMBASE, and Cochrane Library. RESULTS Thirty-nine studies containing over 109.000 participants were included in the review. The prevalence of OCD varied between 2.2% and 30.1%. Main occupational risk factors for developing OCD among cleaners included wet work and irritants in cleaning products (bleach, chlorine, ammonia, multi-use-cleaning) and skin contact to metal. The most common contact allergies included rubber, biocides, nickel/cobalt, and perfumes. Other risk factors were inconsistent use of protective gloves and low educational level. Consequences associated with OCD included significant impairment in quality of life, tendency to have unscheduled absence from work, sick leave, increased rate of disability, and recognized degree of injury. Only one prevention study has been published investigating the effect of an educative course in skin-protective behavior in cleaners. The study reported a higher degree of knowledge of skin protection, a decrease in the severity of hand eczema, and a shift toward fewer daily hand washings at follow-up after 3 months. CONCLUSION Our study proves that OCD is common in cleaners, and the main risk factors included wet work, irritants, and contact allergies, as well as inconsistent use of protective gloves and low educational level. More focus and a greater number of studies are needed on skin protection in this population.
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Rojruthai P, Sakdapipanich J, Wiriyanantawong J, Ho CC, Chaiear N. Effect of Latex Purification and Accelerator Types on Rubber Allergens Prevalent in Sulphur Prevulcanized Natural Rubber Latex: Potential Application for Allergy-Free Natural Rubber Gloves. Polymers (Basel) 2022; 14:4679. [PMID: 36365670 PMCID: PMC9654386 DOI: 10.3390/polym14214679] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 10/22/2022] [Accepted: 10/27/2022] [Indexed: 01/25/2024] Open
Abstract
Natural rubber (NR) gloves manufactured from NR latex are widely utilized in various applications as a personal protective device due to their exceptional barrier characteristics in infection control. However, the use of NR gloves was associated with concerns on NR protein allergy. With comprehensive leaching procedures now a common practice in NR latex glove factories to eliminate latent rubber proteins and chemical allergens, occurrences and complaints of protein allergy from medical glove users have decreased drastically over the past two decades. The present work aims to eliminate further the residual rubber allergens in NR latex through effective purification of the NR latex and compounding the thus purified latex with an established formulation for allergy-free NR for glove applications. NR latex was purified by deproteinization and saponification, respectively. Several analytical techniques were used to verify rubber allergens eliminated in the purified latexes. Saponified NR (SPNR) latex was the purified NR latex of choice since it is devoid of allergenic proteins and poses the lowest risk of Type I allergy. The purified NR latex was compounded with zinc diethyldithiocarbamate (ZDEC), zinc dibutyldithiocarbamate (ZDBC), and zinc 2-mercaptobenzothiazole (ZMBT), respectively, for glove dipping. Among the investigated accelerators, only ZDBC was not detected in the artificial sweat that came into contact with the dipped articles. Thus, it is deduced that ZDBC poses the lowest risk of Type IV allergy to consumers. Additionally, the morphological and physical properties of dipped articles were assessed. It was revealed that the dipped film from the SPNR latex compounded with ZDBC provided thinner and less yellow products with a more uniform internal structure and a tensile strength comparable to those of commercial NR gloves.
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Affiliation(s)
- Porntip Rojruthai
- Division of Chemical Industrial Process and Environment, Faculty of Science, Energy and Environment, King Mongkut’s University of Technology North Bangkok, Rayong 21120, Thailand
| | - Jitladda Sakdapipanich
- Department of Chemistry and Center of Excellence for Innovation in Chemistry (PERCH-CIC), Faculty of Science, Mahidol University, Salaya Campus, Phutthamonthon, Nakhon Pathom 73170, Thailand
| | - Jinjutha Wiriyanantawong
- Department of Chemistry and Center of Excellence for Innovation in Chemistry (PERCH-CIC), Faculty of Science, Mahidol University, Salaya Campus, Phutthamonthon, Nakhon Pathom 73170, Thailand
| | - Chee-Cheong Ho
- Sungai Long Campus, University Tunku Abdul Rahman, Cheras Kajang 43000, Malaysia
| | - Naesinee Chaiear
- Department of Community, Family and Occupational Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand
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Marques Dos Santos M, Tan Pei Fei M, Li C, Jia S, Snyder SA. Cell-line and culture model specific responses to organic contaminants in house dust: Cell bioenergetics, oxidative stress, and inflammation endpoints. ENVIRONMENT INTERNATIONAL 2022; 167:107403. [PMID: 35863240 DOI: 10.1016/j.envint.2022.107403] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 07/05/2022] [Accepted: 07/07/2022] [Indexed: 06/15/2023]
Abstract
Exposure to organic contaminants in house dust is linked to the development or exacerbation of many allergic and immune disorders. In this work, we evaluate the effects of organic contaminants on different cell bioenergetics endpoints using five different cell lines (16HBE14o-, NuLi-1, A549, THP-1 and HepG2), and examine its effects on lung epithelial cells using conventional 2D and 3D (air-liquid interface/ALI) models. Proposed rapid bioenergetic assays relies on a quick, 40 min, exposure protocol that provides equivalent dose-response curves for ATP production, spare respiratory capacity, and cell respiration. Although cell-line differences play an important role in assay performance, established EC50 concentrations for immortalized lung epithelial cells ranged from 0.11 to 0.15 mg/mL (∼2 µg of dust in a 96-well microplate format). Bioenergetic response of distinct cell types (i.e., monocytes and hepatocytes) was significantly different from epithelial cells; with HepG2 showing metabolic activity that might adversely affect results in 24 h exposure experiments. Like in cell bioenergetics, cell barrier function assay in ALI showed a dose dependent response. Although this is a physiologically relevant model, measurements are not as sensitivity as cytokine profiling and reactive oxygen species (ROS) assays. Observed effects are not solely explained by exposure to individual contaminants, this suggests that many causal agents responsible for adverse effects are still unknown. While 16HBE14o- cells show batter barrier formation characteristics, NuLi-1 cells are more sensitivity to oxidative stress induction even at low house dust extract concentrations, (NuLi-1 2.11-fold-change vs. 16HBE14o- 1.36-fold change) at 0.06 µg/mL. Results show that immortalized cell lines can be a suitable alternative to primary cells or other testing models, especially in the development of high-throughput assays. Observed cell line specific responses with different biomarker also highlights the importance of careful in-vitro model selection and potential drawbacks in risk assessment studies.
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Affiliation(s)
- Mauricius Marques Dos Santos
- Nanyang Environment & Water Research Institute (NEWRI), Nanyang Technological University, 1 Cleantech Loop, CleanTech One, #06-08, 637141, Singapore; Department of Chemical & Environmental Engineering, University of Arizona, 1133 E James E Rogers Way, Harshbarger 108, Tucson, AZ 85721-0011, USA
| | - Megan Tan Pei Fei
- School of Civil and Environmental Engineering, Nanyang Technological University, Singapore 639798, Singapore
| | - Caixia Li
- Nanyang Environment & Water Research Institute (NEWRI), Nanyang Technological University, 1 Cleantech Loop, CleanTech One, #06-08, 637141, Singapore
| | - Shenglan Jia
- Nanyang Environment & Water Research Institute (NEWRI), Nanyang Technological University, 1 Cleantech Loop, CleanTech One, #06-08, 637141, Singapore
| | - Shane Allen Snyder
- Nanyang Environment & Water Research Institute (NEWRI), Nanyang Technological University, 1 Cleantech Loop, CleanTech One, #06-08, 637141, Singapore; School of Civil and Environmental Engineering, Nanyang Technological University, Singapore 639798, Singapore.
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Marques Dos Santos M, Cheriaux C, Jia S, Thomas M, Gallard H, Croué JP, Carato P, Snyder SA. Genotoxic effects of chlorinated disinfection by-products of 1,3-diphenylguanidine (DPG): Cell-based in-vitro testing and formation potential during water disinfection. JOURNAL OF HAZARDOUS MATERIALS 2022; 436:129114. [PMID: 35739694 DOI: 10.1016/j.jhazmat.2022.129114] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 05/05/2022] [Accepted: 05/06/2022] [Indexed: 06/15/2023]
Abstract
1,3-diphenylguanidine (DPG) is a commonly used rubber and polymer additive, that has been found to be one of the main leachate products of tire wear particles and from HDPE pipes. Its introduction to aquatic environments and potentially water supplies lead to further questions regarding the effects of disinfection by-products potentially formed. Using different bioassay approaches and NGS RNA-sequencing, we show that some of the chlorinated by-products of DPG exert significant toxicity. DPG and its chlorinated by-products also can alter cell bioenergetic processes, affecting cellular basal respiration rates and ATP production, moreover, DPG and its two chlorination products, 1,3-bis-(4-chlorophenyl)guanidine (CC04) and 1-(4-chlorophenyl)-3-(2,4-dichlorophenyl)guanidine (CC11), have an impact on mitochondrial proton leak, which is an indicator of mitochondria damage. Evidence of genotoxic effects in the form of DNA double strand breaks (DSBs) was suggested by RNA-sequencing results and further validated by an increased expression of genes associated with DNA damage response (DDR), specifically the canonical non-homologous end joining (c-NHEJ) pathway, as determined by qPCR analysis of different pathway specific genes (XRCC6, PRKDC, LIG4 and XRCC4). Immunofluorescence analysis of phosphorylated histone H2AX, another DSB biomarker, also confirmed the potential genotoxic effects observed for the chlorinated products. In addition, chlorination of DPG leads to the formation of different chlorinated products (CC04, CC05 and CC15), with analysed compounds representing up to 42% of formed products, monochloramine is not able to effectively react with DPG. These findings indicate that DPG reaction with free chlorine doses commonly applied during drinking water treatment or in water distribution networks (0.2-0.5 mg/L) can lead to the formation of toxic and genotoxic chlorinated products.
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Affiliation(s)
- Mauricius Marques Dos Santos
- Nanyang Environment & Water Research Institute (NEWRI), Nanyang Technological University, CleanTech One, 1 Cleantech Loop, 637141, Singapore
| | - Camille Cheriaux
- Laboratoire Ecologie & Biologie des Interactions, UMR CNRS 7267, Université de Poitiers, France; INSERM CIC1402, Université de Poitiers, IHES Research Group, Poitiers, France
| | - Shenglan Jia
- Nanyang Environment & Water Research Institute (NEWRI), Nanyang Technological University, CleanTech One, 1 Cleantech Loop, 637141, Singapore
| | - Mikael Thomas
- Institut de Chimie des Milieux et des Matériaux de Poitiers, IC2MP UMR 7285 CNRS, Université de Poitiers, France
| | - Hervé Gallard
- Institut de Chimie des Milieux et des Matériaux de Poitiers, IC2MP UMR 7285 CNRS, Université de Poitiers, France
| | - Jean-Philippe Croué
- Institut de Chimie des Milieux et des Matériaux de Poitiers, IC2MP UMR 7285 CNRS, Université de Poitiers, France
| | - Pascal Carato
- Laboratoire Ecologie & Biologie des Interactions, UMR CNRS 7267, Université de Poitiers, France; INSERM CIC1402, Université de Poitiers, IHES Research Group, Poitiers, France
| | - Shane Allen Snyder
- Nanyang Environment & Water Research Institute (NEWRI), Nanyang Technological University, CleanTech One, 1 Cleantech Loop, 637141, Singapore.
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Rehabilitation and Prevention of Hand Eczema. Contact Dermatitis 2021. [DOI: 10.1007/978-3-030-36335-2_71] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Aalto-Korte K. Contact Allergy to Protective Gloves. Contact Dermatitis 2021. [DOI: 10.1007/978-3-030-36335-2_74] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Patch Testing of Mercaptobenzothiazole and Mercapto Mix: The North American Contact Dermatitis Group Experience, 1994-2016. Dermatitis 2020; 32:232-244. [PMID: 33273233 DOI: 10.1097/der.0000000000000675] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVES Mercapto compounds are a category of rubber accelerators that may cause allergic contact dermatitis. This study characterizes patch test reactions to mercaptobenzothiazole (MBT) and mercapto mix (MM) in a large North American population. METHODS The 1994-2016 North American Contact Dermatitis Group screening series data were analyzed. Patients with allergic reactions to either MBT or MM (mercapto+) were included. The following characteristics were analyzed: strength of reaction, clinical and occupational relevance, coreactivity with other rubber accelerators, and sources of exposure. RESULTS A total of 49,795 patients were tested to mercapto compounds from 1994 to 2016; 633 (1.3%) had positive reactions to MBT and/or MM. The frequency to both MBT and MM significantly decreased over time (P < 0.0001). Mercapto+ patients were significantly more likely to be male, have occupationally related skin disease, and report involvement of the hands and/or feet (P < 0.0001). They were significantly less likely to have face, scalp/ears/neck, or trunk involvement (P ≤ 0.0001). There was significant coreactivity with carba mix (23.4%) and thiuram mix (32.5%). Mercaptobenzothiazole and MM reactions were frequently clinically (81.7% and 83.5%, respectively) and occupationally relevant (29.8% and 33.4%, respectively). Gloves were the most common source (31.3% and 30.9%, respectively). CONCLUSIONS Patch test positivity to mercapto compounds significantly decreased from 1994 to 2016 but remains clinically and occupationally relevant.
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Patch Testing to Diphenylguanidine by the North American Contact Dermatitis Group (2013–2016). Dermatitis 2020; 31:350-358. [DOI: 10.1097/der.0000000000000629] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Are Rubber Gloves Marketed as Accelerator-Free Truly Free of Accelerators? [RETRACTED]. Dermatitis 2020; 31:128-133. [DOI: 10.1097/der.0000000000000508] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Rehabilitation and Prevention of Hand Eczema. Contact Dermatitis 2020. [DOI: 10.1007/978-3-319-72451-5_71-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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15
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Allergic Reactions to Rubber Components. Contact Dermatitis 2020. [DOI: 10.1007/978-3-319-72451-5_87-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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16
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Aalto-Korte K. Contact Allergy to Protective Gloves. Contact Dermatitis 2020. [DOI: 10.1007/978-3-319-72451-5_74-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Dejonckheere G, Herman A, Baeck M. Allergic contact dermatitis caused by synthetic rubber gloves in healthcare workers: Sensitization to 1,3-diphenylguanidine is common. Contact Dermatitis 2019; 81:167-173. [PMID: 30891769 DOI: 10.1111/cod.13269] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 03/12/2019] [Accepted: 03/16/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND The frequency of allergic contact dermatitis has significantly increased in healthcare workers since the transition from latex to synthetic rubber gloves, with 1,3-diphenylguanidine being identified as the most frequently implicated allergen. OBJECTIVES To highlight the role of 1,3-diphenylguanidine as the culprit allergen in contact allergies to synthetic rubber gloves, to propose recommendations for patch testing, and to discuss alternatives for sensitized subjects. MATERIALS AND METHODS Patch test data from healthcare workers who developed hand dermatitis after wearing rubber gloves and who reacted positively to glove samples and rubber additives were collected from September 2010 to December 2017 in a Belgian hospital. RESULTS A total of 44 caregivers were included in this study. Patch tests showed that: (a) 84% of the study population reacted positively to carba mix; (b) 86% reacted positively to 1,3-diphenylguanidine; and (c) 13 (30%) reacted positively to thiuram mix. Half of the subjects reacted positively to gloves containing 1,3-diphenylguanidine, whereas none reacted to accelerator-free gloves. CONCLUSION The most commonly identified allergen was 1,3-diphenylguanidine, far ahead of thiurams, which were previously described as the most sensitizing accelerators. The use of 1,3-diphenylguanidine-free gloves is recommended. No subject reacted to gloves without accelerators, thus confirming their efficiency among accelerator-sensitized patients. We recommend that 1,3-diphenylguanidine be added to the European baseline series.
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Affiliation(s)
- Guillaume Dejonckheere
- Department of Dermatology, Cliniques universitaires Saint-Luc, Brussels, Belgium and IREC (Institut de Recherche Experimentale et Clinique) Pôle Pneumologie, ORL, Dermatologie, Université Catholique de Louvain, Brussels, Belgium
| | - Anne Herman
- Department of Dermatology, Cliniques universitaires Saint-Luc, Brussels, Belgium and IREC (Institut de Recherche Experimentale et Clinique) Pôle Pneumologie, ORL, Dermatologie, Université Catholique de Louvain, Brussels, Belgium
| | - Marie Baeck
- Department of Dermatology, Cliniques universitaires Saint-Luc, Brussels, Belgium and IREC (Institut de Recherche Experimentale et Clinique) Pôle Pneumologie, ORL, Dermatologie, Université Catholique de Louvain, Brussels, Belgium
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Oosterhaven JAF, Uter W, Aberer W, Armario-Hita JC, Ballmer-Weber BK, Bauer A, Czarnecka-Operacz M, Elsner P, García-Gavín J, Giménez-Arnau AM, John SM, Kręcisz B, Mahler V, Rustemeyer T, Sadowska-Przytocka A, Sánchez-Pérez J, Simon D, Valiukevičienė S, Weisshaar E, Schuttelaar MLA. European Surveillance System on Contact Allergies (ESSCA): Contact allergies in relation to body sites in patients with allergic contact dermatitis. Contact Dermatitis 2019; 80:263-272. [PMID: 30520058 PMCID: PMC6590142 DOI: 10.1111/cod.13192] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2018] [Revised: 11/08/2018] [Accepted: 12/02/2018] [Indexed: 12/30/2022]
Abstract
Background Analyses of the European Surveillance System on Contact Allergies (ESSCA) database have focused primarily on the prevalence of contact allergies to the European baseline series, both overall and in subgroups of patients. However, affected body sites have hitherto not been addressed. Objective To determine the prevalence of contact allergies for distinct body sites in patients with allergic contact dermatitis (ACD). Methods Analysis of data collected by the ESSCA (www.essca‐dc.org) in consecutively patch tested patients, from 2009 to 2014, in eight European countries was performed. Cases were selected on the basis of the presence of minimally one positive patch test reaction to the baseline series, and a final diagnosis of ACD attributed to only one body site. Results Six thousand two hundred and fifty‐five cases were analysed. The head and hand were the most common single sites that ACD was attributed to. Differences between countries were seen for several body sites. Nickel, fragrance mix I, cobalt and methylchloroisothiazolinone/methylisothiazolinone were the most frequent allergens reported for various body sites. Conclusions Distinct allergen patterns per body site were observed. However, contact allergies were probably not always relevant for the dermatitis that patients presented with. The possibility of linking positive patch test reactions to relevance, along with affected body sites, should be a useful addition to patch test documentation systems.
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Affiliation(s)
- Jart A F Oosterhaven
- Department of Dermatology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Wolfgang Uter
- Department of Medical Informatics, Biometry and Epidemiology, Friedrich-Alexander-University Erlangen/Nürnberg, Erlangen, Germany
| | - Werner Aberer
- Department of Dermatology, Medical University of Graz, Graz, Austria
| | - José C Armario-Hita
- Department of Dermatology, University Hospital of Puerto Real, University of Cádiz, Cádiz, Spain
| | - Barbara K Ballmer-Weber
- Department of Dermatology, University Hospital Zürich and Clinic of Dermatology and Allergology, Kantonsspital St Gallen, Zürich, Switzerland
| | - Andrea Bauer
- Department of Dermatology, University Hospital Carl Gustav Carus, University Allergy Centre, Technical University Dresden, Dresden, Germany
| | | | - Peter Elsner
- Department of Dermatology, University Hospital Jena, Jena, Germany
| | - Juan García-Gavín
- Department of Dermatology, University Hospital Complex, Faculty of Medicine, A Coruña, Santiago de Compostela; also: Dermatological Office, Vigo, Spain
| | - Ana M Giménez-Arnau
- Department of Dermatology, Hospital del Mar, IMIM Universitat Autònoma, Barcelona, Spain
| | - Swen M John
- Department of Dermatology and Environmental Medicine, Institute for Interdisciplinary Dermatologic Prevention and Rehabilitation (iDerm), Lower Saxony Institute for Occupational Dermatology (NIB), University of Osnabrück, Osnabrück, Germany
| | - Beata Kręcisz
- Faculty of Medicine and Health Science, The Jan Kochanowski University, Kielce, Poland
| | - Vera Mahler
- Department of Dermatology, University of Erlangen/Nürnberg, Erlangen, Bavaria.,Division of Allergology, Paul-Ehrlich-Institut, Langen, Germany
| | - Thomas Rustemeyer
- Department of Dermatology and Allergology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | | | | | - Dagmar Simon
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Skaidra Valiukevičienė
- Department of Skin and Venereal Diseases, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Elke Weisshaar
- Department of Clinical Social Medicine, Environmental and Occupational Dermatology, University of Heidelberg, Heidelberg, Germany
| | - Marie L A Schuttelaar
- Department of Dermatology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
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Gloves. Contact Dermatitis 2019. [DOI: 10.1007/978-3-319-72451-5_74-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
Hand dermatitis is a common condition with a lifetime prevalence of 20%. Glove allergic contact dermatitis (ACD) is a very important dermatitis affecting health care workers, hairdressers, cleaning personnel, kitchen workers, craftsmen, construction workers, laboratory workers, and homemakers. Occupationally related cases may be severe and can result in significant disability. Glove ACD is most commonly due to exposure to rubber accelerators, which are compounds that are added to rubber during production to increase strength and durability. Given the known allergic potential of these compounds, glove manufacturing companies have reformulated gloves leading to the introduction of new rubber allergens. In this review, we will discuss risk factors for glove ACD, both common and uncommon allergens in gloves, common contact allergens that permeate gloves, and patch testing to help uncover the inciting allergen(s).
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Hamnerius N, Svedman C, Bergendorff O, Björk J, Bruze M, Engfeldt M, Pontén A. Hand eczema and occupational contact allergies in healthcare workers with a focus on rubber additives. Contact Dermatitis 2018; 79:149-156. [PMID: 29923205 DOI: 10.1111/cod.13042] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 05/01/2018] [Accepted: 05/03/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Hand eczema (HE) in healthcare workers (HCWs) is common. Besides wet work, healthcare work also implies exposure to contact allergens. OBJECTIVES To assess HE and contact allergy related to occupational exposures in HCWs. METHODS In a cross-sectional study, 311 HCWs with HE within the preceding 12 months and a control group of 114 HCWs without HE were investigated with the baseline series and a special patch test series based on substances found in the gloves, soaps, alcoholic hand disinfectants and hand creams provided at the hospitals. RESULTS Contact allergy to rubber additives was significantly more common in HCWs with HE (6%) than in HCWs without HE (1%, P = .02). The corresponding percentages for fragrances were 11% and 3%, respectively (P = .004). Occupational HE was found in 193 of 311 (62%) HCWs. Of these, 22 of 193 (11%) had occupational allergic contact dermatitis, including 17 with glove-related rubber contact allergy. Contact allergy to diphenylguanidine was as common as contact allergy to thiurams. Occupational contact allergy to rubber additives was significantly associated with sick-leave related to HE. CONCLUSION Contact allergy to rubber additives in medical gloves is the most common cause of occupational allergic contact dermatitis in HCWs. Aimed patch testing with relevant rubber additives is mandatory when HE in HCWs is investigated.
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Affiliation(s)
- Nils Hamnerius
- Department of Occupational and Environmental Dermatology, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Cecilia Svedman
- Department of Occupational and Environmental Dermatology, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Ola Bergendorff
- Department of Occupational and Environmental Dermatology, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Jonas Björk
- Department of Occupational and Environmental Medicine, Lund University, Lund, Sweden
- Clinical Studies Sweden, Forum South, Skåne University Hospital, Lund, Sweden
| | - Magnus Bruze
- Department of Occupational and Environmental Dermatology, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Malin Engfeldt
- Department of Occupational and Environmental Dermatology, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Ann Pontén
- Department of Occupational and Environmental Dermatology, Lund University, Skåne University Hospital, Malmö, Sweden
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Warburton KL, Uter W, Geier J, Spiewak R, Mahler V, Crépy MN, Schuttelaar ML, Bauer A, Wilkinson M. Patch testing with rubber series in Europe: a critical review and recommendation. Contact Dermatitis 2016; 76:195-203. [DOI: 10.1111/cod.12736] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Revised: 10/26/2016] [Accepted: 10/27/2016] [Indexed: 11/27/2022]
Affiliation(s)
| | - Wolfgang Uter
- Department of Medical Informatics, Biometry and Epidemiology; University of Erlangen/Nürnberg; 91054 Erlangen Germany
| | - Johannes Geier
- Information Network of Departments of Dermatology (IVDK); University Medical Centre; 37075 Goettingen Germany
| | - Radoslaw Spiewak
- Department of Experimental Dermatology and Cosmetology; Jagiellonian University Medical College; 30-688 Krakow Poland
| | - Vera Mahler
- Department of Dermatology; University Hospital of Erlangen; 91054 Erlangen Germany
| | - Marie-Noëlle Crépy
- Department of Occupational Diseases, Centre Hôtel-Dieu, AP-HP; Paris University Hospital; 75004 Paris France
| | - Marie Louise Schuttelaar
- Department of Dermatology; University Medical Centre Groningen, University of Groningen; 9713 GZ Groningen The Netherlands
| | - Andrea Bauer
- Department of Dermatology, University Allergy Centre, University Hospital Carl Gustav Carus; Technical University Dresden; 01307 Dresden Germany
| | - Mark Wilkinson
- Department of Dermatology; Chapel Allerton Hospital; Leeds LS7 4SA UK
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Forreryd A, Zeller KS, Lindberg T, Johansson H, Lindstedt M. From genome-wide arrays to tailor-made biomarker readout – Progress towards routine analysis of skin sensitizing chemicals with GARD. Toxicol In Vitro 2016; 37:178-188. [DOI: 10.1016/j.tiv.2016.09.013] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Accepted: 09/09/2016] [Indexed: 11/28/2022]
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Aalto-Korte K, Pesonen M. Patterns of simultaneous patch test reactions to thiurams and dithiocarbamates in 164 patients. Contact Dermatitis 2016; 75:353-357. [DOI: 10.1111/cod.12687] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 08/03/2016] [Accepted: 08/07/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Kristiina Aalto-Korte
- Occupational Medicine; Finnish Institute of Occupational Health (FIOH); 00250 Helsinki Finland
| | - Maria Pesonen
- Occupational Medicine; Finnish Institute of Occupational Health (FIOH); 00250 Helsinki Finland
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Sensitization to Rubber Accelerators in Northeastern Italy: The Triveneto Patch Test Database. Dermatitis 2016; 27:222-6. [DOI: 10.1097/der.0000000000000205] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Bauer A, Geier J, Mahler V, Uter W. [Contact allergies in the German workforce : Data of the IVDK network from 2003-2013]. Hautarzt 2016; 66:652-64. [PMID: 26228172 DOI: 10.1007/s00105-015-3660-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND In Germany, occupational skin diseases rank first in the occupational skin disease statistics for many years. Especially, occupationally acquired contact allergies as well as multi-sensitization are the most important predictors for a poor prognosis and persistent eczema. OBJECTIVES To update the spectrum and sensitization frequencies of most frequent allergens from the standard series in Germany in patients with occupationally acquired type IV sensitizations in general and within different occupational groups. METHODS Data of all employed patients (age range: 16-68 years, n = 14234) patch tested between 2003 and 2013 in the German Departments of the Information Network of Departments of Dermatology (IVDK) and diagnosed occupationally acquired contact dermatitis after patch testing were analyzed. The control group was composed of all other patients (n = 31706) within the same time frame, in which occupationally acquired allergic contact dermatitis was negated explicitly. RESULTS The prevalence Ratio (PR; indicating risk) was significantly increased for: Thiuram-mix (PR 5.63 95 %CI 4.97-6.4), zinkdiethyldithiocarbamate (PR 6.22 95 %CI 4.76-8.22), mercaptobenzothiazole (MBT) (PR 3.88 95 %CI 3.09-4.89), mercapto-mix without MBT (PR 3.23 95 %CI 2.59-4.03), N-isopropyl-N'-phenyl-p-phenylene diamine (IPPD) (PR 2.3195 %CI 1.87-2.86), epoxy resin (PR 2.82 95 %CI 2.45-3.25), chloromethylisothiazolinone/methylisothiazolinone (MCI/MI) (PR 2.19 95 %CI 1.97-2.42) and compositae mix II (PR 2.05 95 %CI 1.45-2.89). They were the predominant occupational allergens and were at least associated with a doubled risk (PR ≥ 2.0) for acquiring occupationally allergic contact dermatitis. The highest risk increase was identified in employees in the health services, in agriculture, metal industry, food and service industry as well as building trades CONCLUSIONS A limited number of occupationally relevant allergens cause the majority of sensitizations in the workforce, if standard series allergens are concerned. Data analysis of national and international contact allergy data bases provide valuable information on sensitization rates and profiles in skin risk occupations to implement targeted prevention strategies. To diagnose occupational allergic contact dermatitis in individual cases additional testing of occupation related patch test series as well as patients' own products is commonly inevitable.
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Affiliation(s)
- A Bauer
- Klinik und Poliklinik für Dermatologie, UniversitätsAllergieZentrum, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland.
| | - J Geier
- Informationsverbund Dermatologischer Kliniken (IVDK), Universitätsmedizin Göttingen, Georg-August Universität Göttingen, Göttingen, Deutschland
| | - V Mahler
- Hautklinik, Universitätsklinikum Erlangen, Friedrich-Alexander Universität Erlangen/Nürnberg, Erlangen, Deutschland
| | - W Uter
- Institut für Medizininformatik, Biometrie und Epidemiologie, Friedrich-Alexander Universität Erlangen/Nürnberg, Erlangen, Deutschland
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Warburton KL, Bauer A, Chowdhury MMU, Cooper S, Kręcisz B, Chomiczewska-Skóra D, Kieć-Świerczyńska M, Filon FL, Mahler V, Sánchez-Pérez J, Schnuch A, Uter W, Wilkinson M. ESSCA results with the baseline series, 2009-2012: rubber allergens. Contact Dermatitis 2015; 73:305-12. [DOI: 10.1111/cod.12454] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Revised: 06/10/2015] [Accepted: 06/13/2015] [Indexed: 11/29/2022]
Affiliation(s)
| | - Andrea Bauer
- Department of Dermatology; University Allergy Centre, University Hospital Carl Gustav Carus, Technical University Dresden; Dresden D-01307 Germany
| | | | - Susan Cooper
- Department of Dermatology; Churchill Hospital; Oxford OX3 7LJ UK
| | - Beata Kręcisz
- Nofer Institute of Occupational Medicine; Lodz 91-348 Poland
| | | | | | - Francesca L. Filon
- Department of Public Health, Occupational Medicine; University of Trieste; IT-34129 Trieste Italy
| | - Vera Mahler
- Allergy Unit, Department of Dermatology; University Hospital Erlangen; 91054 Erlangen Germany
| | - Javier Sánchez-Pérez
- Department of Dermatology; Hospital Universitario de la Princesa; 28006 Madrid Spain
| | - Axel Schnuch
- Information Network of Departments of Dermatology; University Medicine Göttingen; 37075 Göttingen Germany
| | - Wolfgang Uter
- Department of Medical Informatics, Biometry and Epidemiology; University of Erlangen/Nurnberg; 91054 Erlangen Germany
| | - Mark Wilkinson
- Department of Dermatology; The Leeds Teaching Hospitals NHS Trust; Leeds LS7 4SA UK
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Frosch PJ, Mahler V, Uter W. Dihydroxydiphenyl - a historical rubber contact allergen? Contact Dermatitis 2015; 73:377-80. [PMID: 26234388 DOI: 10.1111/cod.12459] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Revised: 06/29/2015] [Accepted: 06/30/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Peter J Frosch
- Department of Dermatology, University of Witten/Herdecke and Klinikum Dortmund (formerly), 44137, Dortmund, Germany
| | - Vera Mahler
- Allergy Unit, Department of Dermatology, University Hospital Erlangen, 91054, Erlangen, Germany
| | - Wolfgang Uter
- Department of Medical Informatics, Biometry and Epidemiology, Friedrich-Alexander University Erlangen-Nürnberg, 91054, Erlangen, Germany
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30
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Schwensen JF, Menné T, Hald M, Johansen JD, Thyssen JP. Allergic perioral contact dermatitis caused by rubber chemicals during dental treatment. Contact Dermatitis 2015; 74:110-1. [PMID: 26234523 DOI: 10.1111/cod.12461] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Revised: 06/30/2015] [Accepted: 07/02/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Jakob F Schwensen
- Department of Dermato-Allergology, National Allergy Research Centre, Copenhagen University Hospital Gentofte, 2900, Hellerup, Denmark
| | - Torkil Menné
- Department of Dermato-Allergology, National Allergy Research Centre, Copenhagen University Hospital Gentofte, 2900, Hellerup, Denmark
| | - Marianne Hald
- Department of Dermato-Allergology, Copenhagen University Hospital Gentofte, 2900, Hellerup, Denmark
| | - Jeanne D Johansen
- Department of Dermato-Allergology, National Allergy Research Centre, Copenhagen University Hospital Gentofte, 2900, Hellerup, Denmark
| | - Jacob P Thyssen
- Department of Dermato-Allergology, Copenhagen University Hospital Gentofte, 2900, Hellerup, Denmark
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Warburton KL, Urwin R, Carder M, Turner S, Agius R, Wilkinson SM. UK rates of occupational skin disease attributed to rubber accelerators, 1996-2012. Contact Dermatitis 2015; 72:305-11. [DOI: 10.1111/cod.12356] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Revised: 12/13/2014] [Accepted: 12/23/2014] [Indexed: 11/28/2022]
Affiliation(s)
| | - Rachel Urwin
- Department of Dermatology; Leeds Teaching Hospitals NHS Trust; Leeds LS7 4SA UK
| | - Melanie Carder
- Centre for Occupational and Environmental Health, Centre for Epidemiology, Institute of Population Health, Faculty of Medical and Human Sciences, The University of Manchester; Manchester M13 9PL UK
| | - Susan Turner
- Centre for Occupational and Environmental Health, Centre for Epidemiology, Institute of Population Health, Faculty of Medical and Human Sciences, The University of Manchester; Manchester M13 9PL UK
| | - Raymond Agius
- Centre for Occupational and Environmental Health, Centre for Epidemiology, Institute of Population Health, Faculty of Medical and Human Sciences, The University of Manchester; Manchester M13 9PL UK
- Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre; Manchester M13 9WL UK
| | - S. Mark Wilkinson
- Department of Dermatology; Leeds Teaching Hospitals NHS Trust; Leeds LS7 4SA UK
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Pesonen M, Jolanki R, Larese Filon F, Wilkinson M, Kręcisz B, Kieć-Świerczyńska M, Bauer A, Mahler V, John SM, Schnuch A, Uter W. Patch test results of the European baseline series among patients with occupational contact dermatitis across Europe - analyses of the European Surveillance System on Contact Allergy network, 2002-2010. Contact Dermatitis 2015; 72:154-63. [DOI: 10.1111/cod.12333] [Citation(s) in RCA: 125] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Revised: 11/17/2014] [Accepted: 11/17/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Maria Pesonen
- Occupational Medicine; Finnish Institute of Occupational Health; Topeliuksenkatu 41 a A, 00250 Helsinki Finland
| | - Riitta Jolanki
- Occupational Medicine; Finnish Institute of Occupational Health; Topeliuksenkatu 41 a A, 00250 Helsinki Finland
| | - Francesca Larese Filon
- Unit of Occupational Medicine, Department of Medicine and Public Health; University of Trieste; Via della Pietà 19, 34129 Trieste Italy
| | - Mark Wilkinson
- Department of Dermatology; The Leeds Teaching Hospitals NHS Trust; Harehills Lane, Leeds LS7 4SA UK
| | - Beata Kręcisz
- Department of Allergology and Environmental Health; Nofer Institute of Occupational Medicine; 8 Teresy Street, 91-348 Lodz Poland
| | - Marta Kieć-Świerczyńska
- Department of Allergology and Environmental Health; Nofer Institute of Occupational Medicine; 8 Teresy Street, 91-348 Lodz Poland
| | - Andrea Bauer
- Department of Dermatology; University Allergy Centre, University Hospital Carl Gustav Carus, Technical University Dresden; Fetscherstraße 74, D-01307 Dresden Germany
| | - Vera Mahler
- Department of Dermatology; University Hospital Erlangen; Ulmenweg 18, D-91054 Erlangen Germany
| | - Swen M. John
- Department of Dermatology; Environmental Medicine and Health Theory, University of Osnabrueck; Sedanstrasse 115, 49069 Osnabrueck Germany
| | - Axel Schnuch
- Information Network of Departments of Dermatology (IVDK); University of Göttingen; von-Sieboldstr. 3, D-37075 Göttingen Germany
| | - Wolfgang Uter
- Department of Medical Informatics, Biometry and Epidemiology; University of Erlangen/Nürnberg; Waldstr. 6, D-91054 Erlangen Germany
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Landeck L, Gonzalez E, Koch OM. Handling chemotherapy drugs-Do medical gloves really protect? Int J Cancer 2014; 137:1800-5. [PMID: 24978061 DOI: 10.1002/ijc.29058] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Accepted: 06/13/2014] [Indexed: 11/06/2022]
Abstract
Due to their potential mutagenic, carcinogenic and teratogenic effects occupational exposure to chemotherapy drugs should be kept to a minimum. Utilization of personnel protective devices, especially the use of protective medical gloves, is a mainstay to avoid skin contact. The choice of appropriate gloves is of outstanding importance. For optimal protection in the oncology setting it is essential to establish general guidelines evaluating appropriate materials and defining quality standards. Establishing these guidelines can facilitate better handling and avoid potential hazards and late sequelae. In Europe there are no specific requirements or test methodologies for medical gloves used in the oncology environment. The implementation of uniform standards for gloves used while handling chemotherapy drugs would be desirable. In contrast, in the US medical gloves used to handle chemotherapy drugs have to fulfill requirements according to the ASTM International (American Society of Testing and Materials) standard D 6978-05. Nitrile or natural rubber latex is a preferred basic glove material, while vinyl is considered inappropriate because of its generally increased permeability. For extended exposure to chemotherapy drugs, double gloving, the use of thicker gloves and the frequent change of gloves increases their protective power.
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Affiliation(s)
- Lilla Landeck
- Department of Dermatology, Ernst von Bergmann General Hospital, Potsdam, Germany
| | - Ernesto Gonzalez
- Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
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Abstract
PURPOSE OF REVIEW The review summarizes recent findings on contact dermatitis in the cleaning industry. RECENT FINDINGS Contact dermatitis is still an important issue in cleaning. Recent studies identified cleaning work sites and tasks, as well as specific cleaning products, which incur a risk increase for occupational contact dermatitis in cleaning. Workers involved in cleaning outdoors prevalence ratio [PR 1.85, 95% confidence interval (CI) 1.16-2.96], cleaning common areas of residential buildings (PR 1.77, 95% CI 1.11-2.84), schools (PR 1.84, 95% CI 1.15-2.93) and cleaning building sites (PR 1.87, 95% CI 1.18-2.95) showed significantly higher rates of contact dermatitis. Relevant allergens in cleaning are rubber chemicals and disinfectants. Leading allergens are thiurams (11.6%, 95% CI 9.1-14.1) and formaldehyde (3.4%, 95% CI 2.0-4.7), but contact with metal allergens might also be important. The most likely allergen sources for sensitization against rubber chemicals are protective gloves. High sensitization rates for disinfectants might result from the fact that employees in cleaning often use single-use medical examination gloves while cleaning. These gloves are not resistant to chemicals, which may break through the gloves within a short period of time, depending on glove material and thickness. No differences in sensitization rates and sensitization profiles were seen in cleaners of younger (≤40 years) and older (>40 years) age. SUMMARY Prevalence of occupational contact dermatitis is still high in cleaning. Irritant contact dermatitis is prevailing, but allergic contact dermatitis is quite frequent, too. Up to now, prevention strategies in cleaning seem to be insufficient.
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Occupationally related contact dermatitis in North American food service workers referred for patch testing, 1994 to 2010. Dermatitis 2013; 24:22-8. [PMID: 23340395 DOI: 10.1097/der.0b013e31827b14e1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Contact dermatoses are common in food service workers (FSWs). OBJECTIVES This study aims to (1) determine the prevalence of occupationally related contact dermatitis among FSWs patch tested by the North American Contact Dermatitis Group (NACDG) and (2) characterize responsible allergens and irritants as well as sources. METHODS Cross-sectional analysis of patients patch tested by the NACDG, 1994 to 2010, was conducted. RESULTS Of 35,872 patients patch tested, 1237 (3.4%) were FSWs. Occupationally related skin disease was significantly more common in FSWs when compared with employed non-FSWs. Food service workers were significantly more likely to have hand (P < 0.0001) and arm (P < 0.0006) involvement. The rates for irritant and allergic contact dermatitis in FSWs were 30.6% and 54.7%, respectively. Although the final diagnosis of irritant contact dermatitis was statistically higher in FSWs as compared with non-FSWs, allergic contact dermatitis was lower in FSWs as compared with non-FSWs. The most frequent currently relevant and occupationally related allergens were thiuram mix (32.5%) and carba mix (28.9%). Gloves were the most common source of responsible allergens. The NACDG standard tray missed at least 1 occupationally related allergen in 38 patients (4.3%). CONCLUSIONS Among FSWs patch tested by the NACDG between 1994 and 2010, the most common allergens were thiuram mix and carba mix. Gloves were the most common source of responsible allergens.
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Pontén A, Hamnerius N, Bruze M, Hansson C, Persson C, Svedman C, Thörneby Andersson K, Bergendorff O. Occupational allergic contact dermatitis caused by sterile non-latex protective gloves: clinical investigation and chemical analyses. Contact Dermatitis 2012. [DOI: 10.1111/cod.12010] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Geier J, Lessmann H, Mahler V, Pohrt U, Uter W, Schnuch A. Occupational contact allergy caused by rubber gloves - nothing has changed. Contact Dermatitis 2012; 67:149-56. [DOI: 10.1111/j.1600-0536.2012.02139.x] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Febriana SA, Jungbauer F, Soebono H, Coenraads PJ. Occupational allergic contact dermatitis and patch test results of leather workers at two Indonesian tanneries. Contact Dermatitis 2012; 67:277-83. [DOI: 10.1111/j.1600-0536.2012.02060.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Liskowsky J, Geier J, Bauer A. Contact allergy in the cleaning industry: analysis of contact allergy surveillance data of the Information Network of Departments of Dermatology. Contact Dermatitis 2011; 65:159-66. [DOI: 10.1111/j.1600-0536.2011.01937.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Liippo J, Ackermann L, Lammintausta K. Occupational allergic contact dermatitis caused by diethylthiourea in a neoprene handle of a cleaning trolley. Contact Dermatitis 2011; 64:359-60. [DOI: 10.1111/j.1600-0536.2011.01904.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Dupupet JL, Adjémian A, Grillet JP, Garnier R. Étude d’ergoexpologie aux fongicides dithiocarbamates auprès de professionnels de trois secteurs agricoles. ARCH MAL PROF ENVIRO 2010. [DOI: 10.1016/j.admp.2010.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Liippo J, Ackermann L, Hasan T, Laukkanen A, Rantanen T, Lammintausta K. Sensitization to thiourea derivatives among Finnish patients with suspected contact dermatitis. Contact Dermatitis 2010; 63:37-41. [DOI: 10.1111/j.1600-0536.2010.01731.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Uter W, Hegewald J, Pfahlberg A, Lessmann H, Schnuch A, Gefeller O. Contact allergy to thiurams: multifactorial analysis of clinical surveillance data collected by the IVDK network. Int Arch Occup Environ Health 2009; 83:675-81. [PMID: 20041260 PMCID: PMC2902739 DOI: 10.1007/s00420-009-0503-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2009] [Accepted: 12/15/2009] [Indexed: 11/02/2022]
Abstract
PURPOSE To analyse the association between occupation (represented by job title) and contact allergy to thiuram vulcanising agents based on data of a clinical registry (IVDK, www.ivdk.org ). METHODS Clinical, demographic and allergy patch test data of all patients tested between 1992 and 2006 with the thiuram mix (1% in petrolatum) as part of the baseline series was analysed (n = 121,051). Poisson regression analysis was used to quantify the association between different occupations (and other relevant factors) and a positive patch test reaction to the thiuram mix. Furthermore, the time trend of sensitisation prevalence was analysed in high-risk occupational subgroups identified. RESULTS In comparison to a largely unexposed reference group (office workers and teachers), rubber manufacturers had a significantly elevated risk (prevalence ratio (PR): 5.1, 95% confidence interval (CI) 2.0-10.5). However, health care workers such as physicians and dentists (PR: 3.8, 95% CI: 3.0-4.8) or nursing staff (PR: 3.0, 95% CI: 2.5-3.6) as well as meat and fish processors (PR 3.5, 95% CI: 2.2-5.3) and cleaners (PR 3.1, 95% CI: 2.5-3.8) were found to have a high sensitisation risk as well. In case of health care workers, a significant downward trend during the study period was observed; while in food processors and cleaners, sensitisation prevalence remained largely stable. CONCLUSION The adjusted multifactorial analysis identified occupations yet unknown to be associated with elevated thiuram contact allergy risk, e.g., food processors and cleaners. Thus, (i) further in-depth research can be targeted and (ii) efforts to prevent sensitisation to thiurams focussed, e.g., by limiting thiuram concentrations in products to a residual level which is technically inevitable.
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Affiliation(s)
- Wolfgang Uter
- Department of Medical Informatics, Biometry and Epidemiology, University of Erlangen/Nürnberg, Waldstr. 6, 91054 Erlangen, Germany.
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Rose RF, Lyons P, Horne H, Mark Wilkinson S. A review of the materials and allergens in protective gloves. Contact Dermatitis 2009; 61:129-37. [DOI: 10.1111/j.1600-0536.2009.01580.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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