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Kyritsi A, Tagka A, Stratigos A, Karalis V. Preservative contact allergy in occupational dermatitis: a machine learning analysis. Arch Dermatol Res 2024; 316:372. [PMID: 38850385 DOI: 10.1007/s00403-024-03101-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 01/26/2024] [Accepted: 04/26/2024] [Indexed: 06/10/2024]
Abstract
Occupational dermatoses impose a significant socioeconomic burden. Allergic contact dermatitis related to occupation is prevalent among healthcare workers, cleaning service personnel, individuals in the beauty industry and industrial workers. Among risk factors, the exposure to preservatives is frequent, since they are extensively added in products for occupational use. The goal of this study is to investigate the contact allergy patterns in order to understand the linkage among hypersensitivity to preservatives, occupational profiles, patients' clinical and demographic characteristics. Patch test results were collected from monosensitized patients to Formaldehyde 2%, KATHON 0.02%, thimerosal 0.1%, and MDBGN 0.5%; information was also collected for an extended MOAHLFA (Male-Occupational-Atopic-Hand-Leg-Face-Age) index. To assess the relationship between allergen group and occupational-related ACD, the chi-square test for independence was utilized. To uncover underlying relationships in the data, multiple correspondence analysis (MCA) and categorical principal components analysis (CATPCA), which are machine learning approaches, were applied. Significant relationships were found between allergen group and: occupation class, atopy, hand, leg, facial, trunk, neck, head dermatitis, clinical characteristics, ICDRG 48 h and ICDRG 72 h clinical evaluation. MCA and CATPCA findings revealed a link among allergen group, occupation class, patients' demographic and clinical characteristics, the MOAHLFA index, and the ICDRG scores. Significant relationships were identified between the allergen group and various manifestations of dermatitis. The utilization of machine learning techniques facilitated the discernment of meaningful patterns in the data.
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Affiliation(s)
- Aikaterini Kyritsi
- Department of Pharmacy, School of Health Sciences, National and Kapodistrian University of Athens, Panepistimioupolis, Zografou, 15784, Athens, Greece
| | - Anna Tagka
- First Department of Dermatology and Venereology, "Andreas Syggros" Hospital, Medical School, National and Kapodistrian University of Athens, Ionos Dragoumi 5, 11621, Athens, Greece
| | - Alexandros Stratigos
- First Department of Dermatology and Venereology, "Andreas Syggros" Hospital, Medical School, National and Kapodistrian University of Athens, Ionos Dragoumi 5, 11621, Athens, Greece
| | - Vangelis Karalis
- Department of Pharmacy, School of Health Sciences, National and Kapodistrian University of Athens, Panepistimioupolis, Zografou, 15784, Athens, Greece.
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Yan Y, Huang S, Zeng Y, Yue S, Wang T, Yuan L, Nie J. Long-Term Disinfection in Operating Rooms Affects Skin Microbiota and Metabolites of Medical Personnel. Skin Pharmacol Physiol 2024:1-13. [PMID: 38710161 DOI: 10.1159/000539100] [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: 08/01/2023] [Accepted: 04/22/2024] [Indexed: 05/08/2024]
Abstract
INTRODUCTION Disinfectants play a critical role in reducing healthcare-associated infections by eliminating microorganisms on surfaces. However, prolonged use of disinfectants may adversely affect the skin microflora, essential for skin health and infection prevention. This study investigates the impact of disinfection on the skin microbiota and metabolites of medical personnel in operating rooms, aiming to provide a scientific foundation for safeguarding their skin health. METHODS We conducted 16S sequencing and metabolomic analysis to assess the effects of disinfection on the skin microbiota and metabolites of medical personnel. Samples were collected from operating room personnel after disinfectant exposure to identify changes in microbial communities and metabolite profiles. RESULTS Our analysis revealed that prolonged use of disinfectants led to alterations in skin microbial communities and microbial metabolites. These alterations included the production of harmful metabolites that could potentially promote skin infections and other health issues among medical personnel. CONCLUSION The findings underscore the importance of minimizing disruptions to skin microbiota and metabolites caused by long-term disinfectant use to preserve the overall health of medical personnel. This study provides valuable insights into the relationship between disinfectant use, skin microbiota, and metabolites, highlighting the necessity for further research in this area.
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Affiliation(s)
- Yu Yan
- Anesthesia Operation Department, the First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Shuzheng Huang
- Anesthesia Operation Department, the First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yu Zeng
- Anesthesia Operation Department, the First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Siyuan Yue
- Institute of Microbiology, Jiangxi Academy of Sciences, Nanchang, China
| | - Tong Wang
- Institute of Microbiology, Jiangxi Academy of Sciences, Nanchang, China
| | - Lin Yuan
- Institute of Microbiology, Jiangxi Academy of Sciences, Nanchang, China
| | - Junhui Nie
- Institute of Microbiology, Jiangxi Academy of Sciences, Nanchang, China
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Drozdowska A, Drozdowski P, Jaworski A, Ryczek A, Bula D, Adamczyk D, Adamczyk J, Łątkowska A, Sławińska B, Reich A. Occupational Exposure of Employees in a Multispecialty Hospital to Factors Causing Contact Dermatitis-A Questionnaire Study. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:2084. [PMID: 38138187 PMCID: PMC10744976 DOI: 10.3390/medicina59122084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 11/15/2023] [Accepted: 11/24/2023] [Indexed: 12/24/2023]
Abstract
Background and Objectives: Allergic contact dermatitis (ACD) is a serious health and socio-economic problem. Accurate and reliable assessment of exposure to ACD factors in the work environment would increase quality of life and work of employees. The aim of this study was to assess the level of exposure of workers of a multidisciplinary hospital to the factors causing ACD. Material and Methods: The proprietary OSDES-16 questionnaire was used. The effectiveness of the OSDES-16 was confirmed statistically. The study included 230 employees of the medical center in Polanica Zdrój, divided into groups. Results: The differences in the overall assessment of exposure between the individual groups in the OSDES-16 scale were statistically insignificant (p > 0.05). There was no significant correlation between the current workplace and the level of exposure to ACD (p > 0.05). The level of exposure to ACD in the group of employees with work experience in the current position for more than 10 years was significantly higher than those working less than 6 years (p < 0.05). Conclusions: Nurses, midwives and paramedics are the occupational group most exposed to the development of contact allergy related to exposure to factors present in the work environment. The seniority of more than 10 years in the current position was linked with a higher level of occupational exposure.
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Affiliation(s)
- Aneta Drozdowska
- High Medical School in Klodzko, 57-300 Kłodzko, Poland; (A.D.); (P.D.)
| | - Piotr Drozdowski
- High Medical School in Klodzko, 57-300 Kłodzko, Poland; (A.D.); (P.D.)
| | | | | | - Daniel Bula
- Oncological and Reconstructive Surgery Department, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, 44-102 Gliwice, Poland;
| | - Dawid Adamczyk
- Department of Radiology and Radiodiagnostics, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, 40-055 Katowice, Poland;
| | - Jowita Adamczyk
- Ophthalmology Department, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, 40-055 Katowice, Poland;
| | - Ada Łątkowska
- Faculty of Medicine, Wroclaw Medical University, 50-367 Wroclaw, Poland;
| | - Barbara Sławińska
- Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, 40-055 Katowice, Poland;
| | - Adam Reich
- Adam Reich, Department of Dermatology, Institute of Medical Sciences, Medical College of Rzeszow University, 35-055 Rzeszow, Poland
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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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Nettis E, Casella R, Incorvaia C, Miniello A. Secondary prevention of latex allergy. Curr Opin Allergy Clin Immunol 2022; 22:250-256. [PMID: 35852898 DOI: 10.1097/aci.0000000000000838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW The present review addresses the secondary prevention in healthcare worker, healthcare setting, and in patients outside the healthcare setting. RECENT FINDINGS There is sufficient knowledge of the broad aetiology of latex allergy for secondary preventive programmes to be widely adopted. Currently, avoidance of latex-containing surgical products is mandatory in the care of sensitized patients. They should also have a list of occult sources of natural rubber latex exposure and cross-reacting fruits. During all health-care procedures latex allergic patients should be treated in a 'latex-free' environment. Specific sublingual immunotherapy has been suggested as a suitable therapeutic option. It can be offered, in addition to symptomatic treatment, to selected patients, when avoidance measures are not feasible or effective. The use of omalizumab could also be extended as an adjunct to latex immunotherapy. SUMMARY Despite of the progress made in the secondary prevention of latex allergy, the disease still continues to be a global health problem.
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Affiliation(s)
- Eustachio Nettis
- Department of Emergency and Organ Transplantation, School of Allergology and Clinical Immunology, University of Bari Aldo Moro, Policlinico di Bari, Bari
| | - Rossella Casella
- Department of Emergency and Organ Transplantation, School of Allergology and Clinical Immunology, University of Bari Aldo Moro, Policlinico di Bari, Bari
| | | | - Andrea Miniello
- Department of Emergency and Organ Transplantation, School of Allergology and Clinical Immunology, University of Bari Aldo Moro, Policlinico di Bari, Bari
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OUP accepted manuscript. Occup Med (Lond) 2022; 72:343-346. [DOI: 10.1093/occmed/kqac038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Šakić F, Babić Ž, Franić Z, Macan J. Characteristics of hand eczema in final-year apprentice nurses during the COVID-19 pandemic. Contact Dermatitis 2021; 86:98-106. [PMID: 34773266 PMCID: PMC8652632 DOI: 10.1111/cod.14006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 11/01/2021] [Accepted: 11/09/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND Apprentice nurses are considered at high risk to developing occupational skin diseases. OBJECTIVES This study assessed the frequency and origin of hand eczema, and work-related risk factors in apprentice nurses. METHODS The study involved 240 final-year apprentice nurses (females 75%, median age 19 years) from vocational schools in Zagreb, Croatia. The study was performed in 2020/2021 and included a questionnaire and clinical examination by means of the Osnabrück Hand Eczema Severity Index (OHSI). Skin prick test (SPT) with natural rubber latex (NRL) allergen, and patch test with the basic series of allergens, and disinfectants, were performed in 42 apprentice nurses with hand eczema that lasted more than 3 months. RESULTS Clinically observed and self-reported hand eczema were found in 49% and 46% of apprentice nurses, respectively. Those with observed changes were older and reported more days per month spent on practical work than those with healthy skin (P = .001). Median OHSI was 4 (interquartile range 2-6). There were no positive SPTs to latex, and 11 (26%) apprentice nurses had positive patch test reactions to one or more tested allergens, mostly nickel. CONCLUSIONS Hand eczema was common in final-year apprentice nurses during the COVID-19 pandemic. It was mostly of irritative origin, associated with the duration of practical training, confirming cumulative effect of hazards on skin barrier.
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Affiliation(s)
- Franka Šakić
- Unit for Occupational and Environmental Medicine, Institute for Medical Research and Occupational Health, Zagreb, Croatia
| | - Željka Babić
- Unit for Occupational and Environmental Medicine, Institute for Medical Research and Occupational Health, Zagreb, Croatia
| | - Zrinka Franić
- Unit for Occupational and Environmental Medicine, Institute for Medical Research and Occupational Health, Zagreb, Croatia
| | - Jelena Macan
- Unit for Occupational and Environmental Medicine, Institute for Medical Research and Occupational Health, Zagreb, Croatia
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Yüksel YT, Ebbehøj NE, Agner T. An update on the prevalence and risk exposures associated with hand eczema in Danish hospital employees: A cross-sectional questionnaire-based study. Contact Dermatitis 2021; 86:89-97. [PMID: 34655082 DOI: 10.1111/cod.13990] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 10/09/2021] [Accepted: 10/11/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Hand eczema (HE) is common in health care workers (HCWs). During the last decade, new recommendations have supported increased use of alcohol-based hand rub (ABHR) to partially replace hand washings to lower the prevalence of HE. However, newer data on this recommendation is lacking. OBJECTIVES To assess current 1-year prevalence of HE in HCWs, to investigate exposure, and the extent of subjective discomfort to hand washings and ABHR. METHODS A digital questionnaire was sent to 4876 HCWs from April to May 2020. RESULTS Of 2125 respondents (1779 women, 346 men), 14.7% reported HE within the last year. In total, 9.1% reported >20 hand washings per shift and 76.0% reported ABHR use >20 times per shift. HE was significantly associated with hand washings (adjusted odds ratio [OR] 1.73 [95% confidence interval [CI] 1.26-2.36]) and glove use on wet skin (adjusted OR 1.99 [95% CI 1.27-3.12]). Subjective discomfort to ABHR was reported significantly more often than to hand washings (P < .001) and significantly more often in HCWs with HE than in those without HE (P < .001). CONCLUSIONS The current 1-year HE prevalence in HCWs of 14.7% was lower than in previously reported Scandinavian data. HE was related to frequent hand washings, as previously reported, and to glove use on wet skin, which is a possible risk factor for HE that should be further explored.
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Affiliation(s)
- Yasemin T Yüksel
- Department of Dermatology, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Niels E Ebbehøj
- Department of Occupational and Environmental Medicine, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Tove Agner
- Department of Dermatology, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
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Huang C, Greig D, Cheng H. Allergic contact dermatitis in healthcare workers. Occup Med (Lond) 2021; 71:294-297. [PMID: 34455441 DOI: 10.1093/occmed/kqab118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Allergic contact dermatitis is a common occupational skin disease among healthcare workers (HCWs). AIMS This study describes causes of allergic contact dermatitis in New Zealand HCWs. METHODS All HCWs undergoing patch testing between July 2008 and January 2020 at a public hospital patch test clinic and between June 2019 and January 2020 at a private dermatology clinic were included. Data collected included patient demographics, occupation, results of patch testing and pre- and post-patch test diagnoses. RESULTS Out of 837 patients tested, 67 were HCWs. The mean age of HCWs was 41 years (SD 14) and 58 (87%) were female. The most common occupations were nurses (40%), allied health (22%) and doctors (18%). Forty-six (69%) patients had a background of atopic dermatitis. Hand dermatitis was the most common presentation (49%), followed by facial/neck dermatitis (25%). Thirty-eight (57%) had at least one positive reaction on patch testing, including 19 (28%) with a positive result of current relevance. There were 16 relevant reactions to rubber accelerators, 11 to fragrances, 10 to preservatives and 6 to corticosteroids. The most frequent relevant allergens were methylisothiazolinone/methylchloroisothiazolinone (4%), hydroxyisohexyl 3-cyclohexene carboxaldehyde (4%) and methylisothiazolinone (4%). CONCLUSIONS The most common allergens in HCWs were rubber chemicals, fragrances, preservatives and topical corticosteroids. Important allergens for patch testing HCWs are outlined, in particular, those with hand dermatitis should be tested to a rubber series.
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Affiliation(s)
- C Huang
- Department of Dermatology, Auckland City Hospital, Auckland, New Zealand
| | - D Greig
- Department of Dermatology, North Shore Hospital, Auckland, New Zealand.,Department of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand
| | - H Cheng
- Department of Dermatology, Auckland City Hospital, Auckland, New Zealand.,Department of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand
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Özkaya E, Elinç Aslan MS. Occupational allergic contact dermatitis: A 24-year, retrospective cohort study from Turkey. Contact Dermatitis 2021; 85:503-513. [PMID: 34263479 DOI: 10.1111/cod.13938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 07/07/2021] [Accepted: 07/13/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Limited data exist on occupational allergic contact dermatitis (OACD) in Turkey. OBJECTIVES To investigate the epidemiologic profile of OACD in Turkey. METHODS A retrospective cohort study on 294 patients with OACD among 2801 consecutively patch-tested patients in the Allergy Unit of the Dermatology Department of İstanbul Faculty of Medicine between 1996 and 2019. RESULTS The overall prevalence of OACD was 10.5%, showing a male predominance. OACD was most frequently seen in construction workers (45.2%), followed by hairdressers, metalworkers, health care workers, and miscellaneous. The main relevant allergens were chromium in cement, thiurams in rubber gloves, hairdressing chemicals, resins/glues/plastics, metals, isothiazolinones, and fragrances. Hands were the mainly involved site (95.6%). Airborne eczema was observed in 21.4%. Hand and foot eczema and co-sensitizations to chrome and thiuram and chrome and cobalt were significantly associated with being a construction worker. Sensitizations to isothiazolinones in house painters, ammonium persulfate and p-phenylenediamine in hairdressers, and colophonium increased after 2010. CONCLUSION This was the largest group of data on OACD from Turkey, reflecting the importance of rubber glove allergy in all occupations and the striking increase in ammonium persulfate allergy among hairdressers. Chrome and cobalt were still the main cement allergens in Turkey, where the cement directive is not yet in force.
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Affiliation(s)
- Esen Özkaya
- Department of Dermatology and Venereology, İstanbul Faculty of Medicine, İstanbul University, İstanbul, Turkey
| | - Meryem Sevinç Elinç Aslan
- Department of Dermatology and Venereology, İstanbul Faculty of Medicine, İstanbul University, İstanbul, Turkey.,Department of Dermatology, Saltat Klinik, İstanbul, Turkey
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Holness DL. Occupational Dermatitis and Urticaria. Immunol Allergy Clin North Am 2021; 41:439-453. [PMID: 34225899 DOI: 10.1016/j.iac.2021.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Occupational contact dermatitis is the most common occupational skin disease (OSD), and most of them are irritant in nature. There is less information available about contact urticaria than contact dermatitis. There are several strategies to prevent OSD, although workplace studies suggest there are gaps in their use in the workplace. Because early detection leads to improved outcomes, screening for dermatitis in industries such as health care would be useful. Both diagnosis and management involve 2 components: the actual disease diagnosis and medical treatment and the work-relatedness and management of the workplace to reduce exposures.
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Affiliation(s)
- Dorothy Linn Holness
- Department of Medicine and Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Division of Occupational Medicine, Department of Medicine, St Michael's Hospital, 30 Bond Street, Toronto, Ontario M5B 1W8, Canada; MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael's Hospital, 30 Bond Street, Toronto, Ontario M5B 1W8, Canada.
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Henning MAS, Jemec GB, Ibler KS. Occupational Skin Disease in Physicians: A Review of the Literature. Ann Work Expo Health 2021; 65:11-25. [PMID: 33009561 DOI: 10.1093/annweh/wxaa091] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 06/29/2020] [Accepted: 08/13/2020] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVES Occupational skin disease (OSD) arises from work-related activity. However, there is a paucity of literature on OSD in physicians. The aim of the this review was therefore to examine and summarize what types of symptomatic OSD physicians experience. METHODS We conducted a systematic literature search on Cochrane Library, Embase, and Pubmed. RESULTS Contact dermatitis from formaldehyde and glutaraldehyde were found in 11.5 and 13.5% of cases, respectively. In total 2.4-14.9% had latex allergy. The reported standardized incidence ratio of squamous cell carcinoma and melanoma was up to 2.15 [95% confidence interval (CI) 1.57-1.95] and 3.2 (95% CI 1.38-6.31). Transmission of human papilloma virus (HPV) particles during carbon dioxide laser wart ablation were found in 70% of samples collected from protective gloves and in 52% of samples from vapors. CONCLUSIONS The most frequently reported OSD in physicians is contact dermatitis from allergens in disinfectants and rubber gloves. There is also a risk of cutaneous reactions to latex. The incidence of skin cancer was higher in physicians than in the general population, and the reason for this remains unexplained and potentially biased. There are no reports of transmission of patient HPV to surgeons during wart ablation, possibly because of proper use of protective equipment.
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Affiliation(s)
- Mattias A S Henning
- Department of Dermatology, Zealand University Hospital, Faculty of Health and Medical Sciences, University of Copenhagen, Roskilde, Denmark
| | - Gregor B Jemec
- Department of Dermatology, Zealand University Hospital, Faculty of Health and Medical Sciences, University of Copenhagen, Roskilde, Denmark
| | - Kristina S Ibler
- Department of Dermatology, Zealand University Hospital, Faculty of Health and Medical Sciences, University of Copenhagen, Roskilde, Denmark
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Huang D, Tang Z, Qiu X, Liu X, Guo Z, Yang B, Guo Q, Xiong H. Hand eczema among healthcare workers in Guangzhou City: a cross-sectional study. ANNALS OF TRANSLATIONAL MEDICINE 2021; 8:1664. [PMID: 33490176 PMCID: PMC7812237 DOI: 10.21037/atm-20-7652] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background Healthcare workers are at high risk of developing hand eczema. This study aimed to investigate the association between occupational hygiene and self-reported hand eczema among nurses and doctors in Guangzhou. Methods A cross-sectional study using a self-administrated questionnaire sent to 740 health care workers in two tertiary hospitals between 1st April and 1st July 2019 was conducted. Results In total, 521 healthcare workers responded (70.4%). The prevalence of self-reported hand eczema was 9.6% [95% confidence interval (CI): 7.1-12.1%], with 10.8% in nurses and 6.9% in doctors. According to multivariable logistic regression analysis, the prevalence was higher in those who were excessively exposed to hair dye (OR: 3.871, 95% CI: 1.106-13.549) and those having a history of food allergy were at 3.013 (95% CI: 1.314-6.907) times greater risk of having hand eczema than those who did not. The odds of having hand eczema were 4.863 (95% CI: 1.037-22.803) times greater in those who hand washed more than 50 times daily in comparison to those who washed hands less than 10 times per day. The symptoms of hand eczema were mild during the investigation period. Conclusions Hand eczema is common among healthcare workers in Guangzhou. The prevention of hand eczema by educational programs is needed for Chinese healthcare workers.
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Affiliation(s)
- Danqi Huang
- Department of Dermatology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Zengqi Tang
- Department of Dermatology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xiaonan Qiu
- Department of Dermatology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xiuting Liu
- Department of Dermatology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Zhixuan Guo
- Department of Dermatology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Bin Yang
- Department of Dermatology, Dermatology Hospital of Southern Medical University, Southern Medical University, Guangzhou, China
| | - Qing Guo
- Department of Dermatology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Hui Xiong
- Department of Dermatology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
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14
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Silvestre Salvador JF, Heras Mendaza F, Hervella Garcés M, Palacios-Martínez D, Sánchez Camacho R, Senan Sanz R, Apellaniz González A, Giménez-Arnau AM. Guidelines for the Diagnosis, Treatment, and Prevention of Hand Eczema. ACTAS DERMO-SIFILIOGRAFICAS 2021; 111:26-40. [PMID: 32197684 DOI: 10.1016/j.ad.2019.04.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 04/11/2019] [Accepted: 04/21/2019] [Indexed: 12/28/2022] Open
Abstract
Hand eczema is a common condition associated with significantly impaired quality of life and high social and occupational costs. Managing hand eczema is particularly challenging for primary care and occupational health physicians as the condition has varying causes and both disease progression and response to treatment are difficult to predict. Early diagnosis and appropriate protective measures are essential to prevent progression to chronic eczema, which is much more difficult to treat. Appropriate referral to a specialist and opportune evaluation of the need for sick leave are crucial to the good management of these patients. These guidelines cover the diagnosis, prevention, and treatment of chronic hand eczema and highlight the role that primary care and occupational health physicians can play in the early management of this disease.
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Affiliation(s)
| | - F Heras Mendaza
- Servicio de Dermatología, Hospital Universitario Fundación Jiménez Díaz, Madrid, España
| | - M Hervella Garcés
- Servicio de Dermatología, Complejo Hospitalario de Navarra, Pamplona, España
| | - D Palacios-Martínez
- Medicina de Atención Primaria, Centro de Salud Isabel II, Parla, Madrid, España
| | | | - R Senan Sanz
- Equipo de Atención Primaria el Clot, Instituto Catalán de la Salud, Barcelona, España
| | - A Apellaniz González
- Departamento de Estomatología, Facultad de Medicina y Enfermería, Euskal Herriko Unibertsitatea-Universidad del País Vasco, Leioa, Bizkaia, España
| | - A M Giménez-Arnau
- Departamento de Dermatología, Hospital del Mar, Universitat Autónoma de Barcelona, Barcelona, España
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15
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16
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Hamnerius N, Svedman C, Bergendorff O, Bruze M, Pontén A. Latex and chlorhexidine IgE levels in Swedish healthcare workers †. Contact Dermatitis 2020; 84:205-207. [PMID: 33002221 DOI: 10.1111/cod.13712] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 09/27/2020] [Indexed: 11/29/2022]
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
| | - Magnus Bruze
- 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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17
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França D, Sacadura-Leite E, Fernandes-Almeida C, Filipe P. Occupational dermatoses among healthcare workers in a hospital center in Portugal. Rev Bras Med Trab 2020; 17:285-291. [PMID: 32368662 PMCID: PMC7195876 DOI: 10.5327/z1679443520190393] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 07/08/2019] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Skin diseases account for more than 35% of occupational diseases, affecting 1/1,000 workers annually. OBJECTIVE To characterize occupational dermatoses affecting hospital workers and identify possible triggers and susceptibility factors. METHODS Cross-sectional study in which we analyzed information extracted from electronic medical records of workers who performed periodic examinations in the course of one year. RESULTS About 3.56% of 1,741 included workers had a diagnosis of occupational dermatosis, being mainly women (76.85%). Thirty-four (54.84%) of the affected workers had irritant contact dermatitis, 17 (27.42%) latex allergy, 6 (9.68%) allergic dermatitis, and 5 (8.06%) two concomitant conditions. We found significant difference in prevalence as a function of occupational group (p=0.008), being highest for nursing assistants (5.11%). Prevalence was also higher for employees allocated to surgery departments (8.47%, p=0.001). Main triggers were skin disinfectants, latex, nitrile gloves, and prolonged contact with water (4.84%). CONCLUSION The quality of the analyzed data depends on the quality of the analyzed medical records. Most subjects were nursing assistants, which fact hinders the generalization of the results. The prevalence of occupational dermatosis was just 3.56%, which might be explained by previously implemented preventive measures. The employees most frequently affected were those allocated to surgery departments and nursing assistants. Skin disinfectants were the most frequent triggers.
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Affiliation(s)
- Diana França
- Occupational Health Department, North Lisbon Hospital Center – Lisbon, Portugal
| | - Ema Sacadura-Leite
- Occupational Health Department, North Lisbon Hospital Center – Lisbon, Portugal
| | | | - Paulo Filipe
- Dermatology Department, North Lisbon Hospital Center – Lisbon, Portugal
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18
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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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19
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20
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Barnes S, Stuart R, Redley B. Health care worker sensitivity to chlorhexidine-based hand hygiene solutions: A cross-sectional survey. Am J Infect Control 2019; 47:933-937. [PMID: 30765146 DOI: 10.1016/j.ajic.2019.01.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 01/14/2019] [Accepted: 01/14/2019] [Indexed: 01/03/2023]
Abstract
BACKGROUND Health service hand hygiene programs have seen widespread use of chlorhexidine solutions. Reports of both immediate and delayed hypersensitivity to chlorhexidine are increasing among health care workers. This study examined the prevalence of self-reported symptoms of sensitivity to chlorhexidine solutions among health care workers. METHODS This study was a cross-sectional online anonymous survey of all workers at a single health service. RESULTS Of the 1,050 completed responses, 76.3% were female, 35.3% were nurses and midwives, 28% were medical staff, and 8.7% were working in nonclinical areas. Over 95% used chlorhexidine-based hand hygiene products in their workplace. Nurses and midwives most frequently reported asthma (13.7%), contact dermatitis (27.8%), and previous testing for allergy to chlorhexidine (4.9%). There was a correlation between both the presence of atopy, eczema, or dermatitis and the self-reporting of dry skin, eczema, or dermatitis attributed to chlorhexidine use. DISCUSSION Occupational chlorhexidine allergy is an important risk to health care workers. Self-reported symptoms of sensitivity to chlorhexidine solutions revealed high reported use and presence of skin symptoms among health care workers. CONCLUSIONS Screening programs need to identify nurses who develop chlorhexidine sensitivity due to occupational exposure. Strategies to mitigate risk should provide alternatives for those with sensitization.
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21
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de Groot AC. Myroxylon pereirae
resin (balsam of Peru) – A critical review of the literature and assessment of the significance of positive patch test reactions and the usefulness of restrictive diets. Contact Dermatitis 2019; 80:335-353. [DOI: 10.1111/cod.13263] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 03/02/2019] [Accepted: 03/04/2019] [Indexed: 11/30/2022]
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22
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Chlorhexidine allergy in the perioperative setting: a narrative review. Br J Anaesth 2019; 123:e95-e103. [PMID: 30955832 DOI: 10.1016/j.bja.2019.01.033] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 01/04/2019] [Accepted: 01/26/2019] [Indexed: 02/03/2023] Open
Abstract
Chlorhexidine is an antiseptic with a broad spectrum of activity and a persistent effect on skin. Consequently, it has become an ubiquitous antiseptic in healthcare and the community. As use has become widespread, increasing numbers of cases of allergy have been reported in the literature, including cases of anaphylaxis to chlorhexidine gels used on mucous membranes, chlorhexidine-impregnated devices such as central venous catheters, chlorhexidine preparations used on wounds and broken skin, and cases after dental procedures. Numerous governmental warnings have been issued over recent decades to warn of the risk of allergy to chlorhexidine on mucosal surfaces or in medical devices. Whilst the number of published cases likely underestimates the true prevalence of reactions, we retrospectively surveyed clinics with experience in investigating perioperative chlorhexidine allergy. Despite differences in investigation practice before the survey took place, 13 clinics responded which together had diagnosed 252 cases of anaphylaxis to chlorhexidine, and cases of delayed allergy. In eight of 13 clinics, chlorhexidine was within the top four most commonly diagnosed causes of perioperative anaphylaxis. Despite this, the incidence of anaphylaxis to chlorhexidine is low given that patients are very commonly exposed. Sensitisation of healthcare workers can occur, but is uncommon. Before exposing patients to this antiseptic, consideration of the potential risk vs benefit should be undertaken, particularly for higher risk exposures, such as mucosal exposure or i.v. exposure via impregnated lines. Difficulties exist in protecting patients with known allergies from re-exposure to chlorhexidine, which would be improved with uniform labelling and chlorhexidine product registers.
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23
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Opstrup MS, Jemec GBE, Garvey LH. Chlorhexidine Allergy: On the Rise and Often Overlooked. Curr Allergy Asthma Rep 2019; 19:23. [PMID: 30874959 DOI: 10.1007/s11882-019-0858-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
PURPOSE OF REVIEW In recent years, the risk of allergy to chlorhexidine is increasingly recognised. In this review, we discuss why the allergy is so easily overlooked and point out several preventative initiatives that can minimise the risk of both chlorhexidine sensitisation and allergy development and accidental re-exposure in patients with chlorhexidine allergy. Testing for chlorhexidine allergy is also discussed. RECENT FINDINGS Numerous reports have been published from many different specialties. Symptoms range from mild skin symptoms to life-threatening anaphylaxis. Testing for chlorhexidine allergy is based on skin testing and in vitro testing. Recently, it was found that both skin prick testing and specific IgE have high sensitivities and specificities. This review gives an overview of chlorhexidine allergy with a special focus on preventative initiatives and testing.
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Affiliation(s)
- Morten Schjørring Opstrup
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark. .,Danish Anaesthesia Allergy Centre, Allergy Clinic, Department of Dermatology and Allergy, Copenhagen University Hospital Gentofte, Kildegårdsvej 28, 2900, Hellerup, Denmark.
| | - Gregor Borut Ernst Jemec
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Lene Heise Garvey
- Danish Anaesthesia Allergy Centre, Allergy Clinic, Department of Dermatology and Allergy, Copenhagen University Hospital Gentofte, Kildegårdsvej 28, 2900, Hellerup, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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24
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Mauro M, Fortina AB, Corradin T, Marino A, Bovenzi M, Filon FL. Sensitization to, and allergic contact dermatitis caused by, colophonium in north-eastern Italy in 1996 to 2016 with a focus on occupational exposures. Contact Dermatitis 2018; 79:303-309. [PMID: 30182476 DOI: 10.1111/cod.13089] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 06/29/2018] [Accepted: 07/01/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND Colophonium is a natural substance derived from Pineaceae trees. It is used in a wide range of consumer and occupational products because of its tackiness, and is a known sensitizer. OBJECTIVES To analyse the temporal trend of contact allergy to colophonium in north-eastern Italy, and to evaluate the associations with occupations in our geographical area. METHODOLOGY From 1996 to 2016, 27 381 patients with suspected allergic contact dermatitis were patch tested in north-eastern Italy. Individual characteristics were documented by use of a standardized questionnaire in 6 departments of dermatology or occupational medicine. RESULTS The overall prevalence of colophonium sensitization was 1.67%; the prevalence was significantly higher in women (1.75%) than in men (1.49%). No significant differences among departments were observed. We found significant associations between colophonium sensitization and being a student (odds ratio [OR] 4.64; 95% confidence interval [CI]: 1.04-20.6), being a farmer or fishermen (OR 3.63; 95%CI: 1.21-10.84), being a housekeeper (OR 2.02; 95%CI: 1.08-3.77), and being retired (OR 2.06; 95%CI: 1.08-3.92). CONCLUSION Our study showed that contact allergy to colophonium is still relevant in north-eastern Italy. The frequency of sensitization has dropped significantly over a period of 10 years, but students and farmers/fishermen still have sensitization prevalences above 3.5%. Our results are in line with European data.
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Affiliation(s)
- Marcella Mauro
- Department of Medical Sciences, Clinical Unit of Occupational Medicine, University of Trieste, Trieste, Italy
| | - Anna Belloni Fortina
- Padua Hospital Internal Medicine Department - DIMED, Paediatric Dermatology Unit, University of Padua, Padova, Italy
| | - Teresa Corradin
- Pordenone Hospital - Internal and Specialistic Department, Ospedale Santa Maria degli Angeli, Pordenone, Italy
| | - Alessandro Marino
- Department of Medical Sciences, Clinical Unit of Occupational Medicine, University of Trieste, Trieste, Italy
| | - Massimo Bovenzi
- Department of Medical Sciences, Clinical Unit of Occupational Medicine, University of Trieste, Trieste, Italy
| | - Francesca Larese Filon
- Department of Medical Sciences, Clinical Unit of Occupational Medicine, University of Trieste, Trieste, Italy
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25
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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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Uter W, Werfel T, White IR, Johansen JD. Contact Allergy: A Review of Current Problems from a Clinical Perspective. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15061108. [PMID: 29844295 PMCID: PMC6025382 DOI: 10.3390/ijerph15061108] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 05/20/2018] [Accepted: 05/26/2018] [Indexed: 12/17/2022]
Abstract
Contact allergy is common, affecting 27% of the general population in Europe. Original publications, including case reports, published since 2016 (inclusive) were identified with the aim of collating a full review of current problems in the field. To this end, a literature search employing methods of systematic reviewing was performed in the Medline® and Web of Science™ databases on 28 January 2018, using the search terms (“contact sensitization” or “contact allergy”). Of 446 non-duplicate publications identified by above search, 147 were excluded based on scrutiny of title, abstract and key words. Of the remaining 299 examined in full text, 291 were deemed appropriate for inclusion, and main findings were summarised in topic sections. In conclusion, diverse sources of exposures to chemicals of widely-differing types and structures, continue to induce sensitisation in man and may result in allergic contact dermatitis. Many of the chemicals are “evergreen” but others are “newcomers”. Vigilance and proper investigation (patch testing) are required to detect and inform of the presence of these haptens to which our populations remain exposed.
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Affiliation(s)
- Wolfgang Uter
- Department of Medical Informatics, Biometry and Epidemiology, University of Erlangen/Nürnberg, 91054 Erlangen, Germany.
| | - Thomas Werfel
- Division of Immunodermatology and Allergy Research, Department of Dermatology and Allergy, Hannover Medical School, 30625 Hannover, Germany.
| | - Ian R White
- St John's Institute of Dermatology, Guy's Hospital, London SE1 9RT, UK.
| | - Jeanne D Johansen
- Department of Dermatology and Allergy, National Allergy Research Centre, Copenhagen University Hospital Herlev and Gentofte, 2900 Hellerup, Denmark.
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27
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Toletone A, Dini G, Massa E, Bragazzi NL, Pignatti P, Voltolini S, Durando P. Chlorhexidine-induced anaphylaxis occurring in the workplace in a health-care worker: case report and review of the literature. LA MEDICINA DEL LAVORO 2018; 109:68-76. [PMID: 29411737 PMCID: PMC7682154 DOI: 10.23749/mdl.v109i1.6618] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 12/18/2017] [Accepted: 12/22/2017] [Indexed: 12/23/2022]
Abstract
BACKGROUND Chlorhexidine has been widely used in the occupational field as an effective antiseptic and disinfectant, especially in the health-care services. Several cases of allergic reactions to chlorhexidine have been reported, both in the general population and in workers. OBJECTIVES To describe a case of occupational chlorhexidine-induced severe anaphylaxis that occurred in the workplace in a health-care worker (HCW) and to update the literature on chlorhexidine as a possible occupational allergen. METHODS We report a case of a severe anaphylactic reaction that occurred in the workplace in a 63-year-old man, who had worked as a dentist for over 20 years. We also carried out a systematic review of the literature according to the PRISMA guidelines. No time or language filters were applied. Only occupational case-reports and case-series were included. RESULTS The causative role of chlorhexidine was suspected owing to the presence of chlorhexidine-containing products in the workplace. Positive results on the Basophil Activation Test confirmed the diagnosis of immediate chlorhexidine-induced hypersensitivity reaction and excluded a role of other disinfectants. No other causes of anaphylaxis were suspected. Our systematic literature review identified 14 cases of occupational chlorhexidine-induced allergy among HCWs; in these cases, the clinical presentation was mild and the symptoms resolved. No cases of systemic reactions in the workplace were reported. CONCLUSIONS This is the first report of chlorhexidine-induced severe anaphylaxis occurring in the workplace. This case report underlines the importance of investigating and being aware of individual and environmental risk factors in the occupational field, which can cause, albeit infrequently, severe reactions with serious consequences.
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Affiliation(s)
- Alessandra Toletone
- Department of Health Sciences (DISSAL), Postgraduate School in Occupational Medicine, University of Genoa, Italy.
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28
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Crepy MN, Lecuen J, Ratour-Bigot C, Stocks J, Bensefa-Colas L. Accelerator-free gloves as alternatives in cases of glove allergy in healthcare workers. Contact Dermatitis 2018; 78:28-32. [PMID: 28748553 DOI: 10.1111/cod.12860] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 06/15/2017] [Accepted: 06/18/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Accelerators in rubber gloves constitute an important group of contact allergens, particularly in healthcare workers. OBJECTIVES To assess the efficacy of accelerator-free medical gloves in the secondary prevention of allergic contact dermatitis caused by rubber accelerators in healthcare workers. METHODS Nine healthcare workers with hand eczema were advised to use accelerator-free rubber gloves after a diagnosis of allergic contact dermatitis caused by rubber accelerators. RESULTS Switching from conventional medical single-use gloves containing accelerators to accelerator-free medical gloves led to improvement in all cases, and more than two-thirds of the patients were completely free of symptoms. CONCLUSION The use of accelerator-free medical gloves can be an effective alternative in healthcare workers who are allergic to rubber accelerators.
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Affiliation(s)
- Marie-Noëlle Crepy
- Department of Occupational and Environmental Diseases, University Hospital of Centre of Paris, Hotel-Dieu Hospital, AP-HP, 75004 Paris, France
| | - Jérome Lecuen
- Department of Occupational and Environmental Diseases, University Hospital of Centre of Paris, Hotel-Dieu Hospital, AP-HP, 75004 Paris, France
| | - Carole Ratour-Bigot
- Department of Dermatology, University Hospital of Centre of Paris, Cochin Hospital, AP-HP, 75014 Paris, France
| | - Jill Stocks
- NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre, Centre for Primary Care, Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, University of Manchester, Manchester M13 9PL, UK
| | - Lynda Bensefa-Colas
- Department of Occupational and Environmental Diseases, University Hospital of Centre of Paris, Hotel-Dieu Hospital, AP-HP, 75004 Paris, France.,Paris Descartes University, Sorbonne Paris Cité, EA 4064, Laboratoire Santé Publique et Environnement, 75006 Paris, France
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29
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Paula H, Hübner NO, Assadian O, Bransmöller K, Baguhl R, Löffler H, Kramer A. Effect of hand lotion on the effectiveness of hygienic hand antisepsis: Implications for practicing hand hygiene. Am J Infect Control 2017; 45:835-838. [PMID: 28768592 DOI: 10.1016/j.ajic.2017.05.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Revised: 05/24/2017] [Accepted: 05/24/2017] [Indexed: 11/20/2022]
Abstract
BACKGROUND Skin protection products should be used after washing hands with soap, during breaks, after work, and during leisure time. Aside from their beneficial effects, skin care products may also interact with alcohol-based hand disinfectants by reducing their efficacy. The aim of this study was to investigate the effect of a hand lotion on the effectiveness of hygienic hand antisepsis using an alcohol-based handrub. METHODS The effect of a protective hand lotion against an isopropyl alcohol-based handrub was investigated in 20 healthy volunteers according to the European standard test procedure EN 1500 in the following combinations: handwashing and application of hand lotion, only application of hand lotion, and no washing and no hand lotion (control), each for 5 minutes or 1 hour before hand antisepsis. The difference in microbiologic before-and-after values were expressed as log reduction factor. RESULTS The effectiveness of hand antisepsis was not significantly affected in any of the groups using the tested hand lotion. CONCLUSIONS Hand antisepsis may be delayed for 5 minutes after hand lotion application. Shorter time intervals might be possible but were not tested.
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Affiliation(s)
- Helga Paula
- Department of Hospital Epidemiology & Infection Control, Medical University of Vienna, Vienna, Austria.
| | - Nils-Olaf Hübner
- Institute for Hygiene and Environmental Medicine, Ernst-Moritz-Arndt University, Greifswald, Germany
| | - Ojan Assadian
- Department of Hospital Epidemiology & Infection Control, Medical University of Vienna, Vienna, Austria; Institute for Skin Integrity and Infection Prevention, School of Human & Health Sciences, University of Huddersfield, United Kingdom
| | - Katja Bransmöller
- Institute for Hygiene and Environmental Medicine, Ernst-Moritz-Arndt University, Greifswald, Germany
| | - Romy Baguhl
- Institute for Hygiene and Environmental Medicine, Ernst-Moritz-Arndt University, Greifswald, Germany
| | - Harald Löffler
- SLK-Kliniken GmbH, Am Gesundbrunnen 20-26, Heilbronn, Germany
| | - Axel Kramer
- Institute for Hygiene and Environmental Medicine, Ernst-Moritz-Arndt University, Greifswald, Germany
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Hamann CR, Hamann D, Egeberg A, Johansen JD, Silverberg J, Thyssen JP. Association between atopic dermatitis and contact sensitization: A systematic review and meta-analysis. J Am Acad Dermatol 2017; 77:70-78. [DOI: 10.1016/j.jaad.2017.02.001] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Revised: 01/31/2017] [Accepted: 02/01/2017] [Indexed: 01/11/2023]
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Nickel Sulfate Promotes IL-17A Producing CD4+ T Cells by an IL-23-Dependent Mechanism Regulated by TLR4 and Jak-STAT Pathways. J Invest Dermatol 2017. [PMID: 28634033 DOI: 10.1016/j.jid.2017.05.025] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Allergic contact dermatitis, caused by nickel, is a delayed-type hypersensitivity reaction, and 14.5% of the general population may be affected in Europe. Among a wide range of cytokines, the IL-12 family has unique structural and immunological characteristics. Whereas IL-12p70 promotes T helper (Th) 1 cell polarization, IL-23 promotes Th17 cell development and both have been isolated from nickel-allergic patients. In this work, we were interested in understanding the mechanism behind nickel-induced Th17 cell development. We showed that nickel induced an early production of IL-23 in human monocyte-derived dendritic cells along with an increase in the expression of il-23p19 and il-12p40 mRNA. However, the production of a significant level of IL-12p70 required an additional signal such as IFN-γ. Moreover, nickel-treated monocyte-derived dendritic cells induced an increase in the percentage of IL-17A+ CD4+ T cells, an effect reduced by IL-23 neutralization. We then investigated the molecular mechanism of IL-23 production. Our results showed that toll-like receptor 4, p38 mitogen-activated protein kinase, and NF-κB were involved in IL-23 production induced by nickel. However, Jak-signal transducer and activator of transcription activation seems to maintain the IL-23/IL-12p70 balance by limiting IL-23 production and promoting Th1 polarization. These results indicate that nickel-induced Th17 cell development is dependent on the production of IL-23 by human monocyte-derived dendritic cells via toll-like receptor 4, p38 mitogen-activated protein kinase, NF-κB, and Jak-signal transducer and activator of transcription pathways.
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