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Sessink P, Tans B, Devolder D, Schrijvers R, Spriet I. Evaluation of environmental antibiotic contamination by surface wipe sampling in a large care centre. J Antimicrob Chemother 2024; 79:1637-1644. [PMID: 38828950 DOI: 10.1093/jac/dkae159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Accepted: 04/13/2024] [Indexed: 06/05/2024] Open
Abstract
OBJECTIVES Exposure of healthcare workers to antibiotics may cause adverse health effects. Results of environmental contamination with antibiotics, obtained by taking surface wipe samples, can be used as an indicator for potential exposure to these sensitizing drugs. The objective was to describe the results of repeated measurements of contamination with antibiotics on multiple surfaces in hospital wards. Standardized needle and syringe preparation techniques and cleaning procedures were used. METHODS The preparation table and the floor around the waste bin in six wards were sampled and analysed for contamination with the antibiotics amoxicillin, benzylpenicillin, cefotaxime, ceftriaxone, flucloxacillin, meropenem, piperacillin and vancomycin. Sampling was performed in four trials during 8 months. Depending on the outcome of the trials, the cleaning procedure was adapted. Liquid chromatography with tandem mass spectrometry was used for the analysis of the drugs. RESULTS During the four trials, contamination with all eight antibiotics was omnipresent on all preparation tables and floors in the six wards. The highest contamination was found for amoxicillin (1291 ng/cm2). Changing the cleaning procedure did not reduce the level of contamination. CONCLUSIONS Surface contamination with the antibiotics was widespread and most probably caused by spillage during the preparation in combination with an ineffective cleaning procedure. Strategies should be developed and implemented by institutions for safe handling of antibiotics to reduce environmental contamination and potential exposure of healthcare workers to these sensitizing drugs.
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Affiliation(s)
- Paul Sessink
- Exposure Control Sweden AB, Bohus-Björkö, Sweden
| | - Birgit Tans
- Pharmacy Department, University Hospitals Leuven, Leuven, Belgium
| | - David Devolder
- Pharmacy Department, University Hospitals Leuven, Leuven, Belgium
| | - Rik Schrijvers
- Department of Microbiology, Immunology, and Transplantation, Allergy and Clinical Immunology Research Group, KU Leuven, Leuven, Belgium
- Department General Internal Medicine-Allergy and Clinical Immunology, University Hospitals Leuven, Leuven, Belgium
| | - Isabel Spriet
- Pharmacy Department, University Hospitals Leuven, Leuven, Belgium
- Department of Pharmaceutical and Pharmacological Sciences, University Leuven, Leuven, Belgium
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Karagounis TK, Cohen DE. Occupational Hand Dermatitis. Curr Allergy Asthma Rep 2023; 23:201-212. [PMID: 36749448 PMCID: PMC9903276 DOI: 10.1007/s11882-023-01070-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/25/2023] [Indexed: 02/08/2023]
Abstract
PURPOSE OF REVIEW Occupational hand dermatitis is a common work-related disorder of the skin. Prevention and management of this disease is critical to improving workers' quality of life and for occupation-specific retention. RECENT FINDINGS This is a critical review of the current literature on occupational hand dermatitis. Occupational dermatitis continues to have a high prevalence among workers although the overall incidence may be slowly decreasing. Irritant contact dermatitis due to wet work exposure is the most common cause of occupational hand dermatitis. Healthcare workers, hairdressers, and metal workers are at particularly high risk for this disease. While some prevention programs have been ineffective in mitigating occupational hand dermatitis, other more resource-intensive initiatives may have benefit. Continued research is needed on ways to manage wet work exposures and on scalable, effective prevention programs for occupational hand dermatitis. The spectrum of culprit contact allergens continues to evolve, and vigilance for potential occupation-specific allergens remains important.
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Affiliation(s)
- Theodora K. Karagounis
- The Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York, NY USA
| | - David E. Cohen
- The Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York, NY USA
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Mohr K, Nolff M, Zablotski Y, Dittus T, Korbel R, Meyer-Lindenberg A, Wolf G, Hiss K, Peters H, Schulz B. Einfluss der Verordnung über Tierärztliche Hausapotheken auf den Antibiotikaeinsatz bei Hund und Katze in Bayern. TIERÄRZTLICHE PRAXIS AUSGABE K: KLEINTIERE / HEIMTIERE 2022; 50:337-347. [DOI: 10.1055/a-1949-0407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Zusammenfassung
Gegenstand und Ziel Ziel der Studie war es, Daten über den Einsatz von Antibiotika (AB) bei Hunden und Katzen in Tierarztpraxen und -kliniken in Bayern zu erheben. Dabei sollte evaluiert werden, ob sich Änderungen hinsichtlich des Antibiotikaeinsatzes nach Novellierung der Verordnung über Tierärztliche Hausapotheken (TÄHAV) im März 2018 ergeben haben.
Material und Methoden Mittels zweier anonymisierter Online-Umfragen wurden 2017 und 2020 Tierärzte/-innen (TÄ) in Bayern, zu deren Patienten Hunde und Katzen zählen, zur Anwendung von AB sowie zur Einschätzung der Resistenzsituation befragt. Die Ergebnisse der beiden Umfragen wurden anschließend miteinander verglichen.
Ergebnisse Für 2017 konnten 238 Fragebögen ausgewertet werden; 2020 waren es 160. Die 3 am häufigsten zur systemischen Therapie beim Kleintier angewendeten AB waren 2017 Amoxicillin/Clavulansäure (74,8 % der TÄ), Enrofloxacin (56,7 %) und Amoxicillin (53,4 %). 2020 wurden Amoxicillin/Clavulansäure (88,8 %), Amoxicillin (67,5 %) und Metronidazol (33,8 %) genannt. Die teilnehmenden TÄ gaben an, signifikant weniger Cephalosporine der 3. und 4. Generation (von 20,2 % der teilnehmenden TÄ in 2017 auf 9,4 % in 2020, p = 0,005) und Fluorchinolone (von 80,3 % auf 33,1 %, p < 0,001) einzusetzen. Die Wahl eines AB wurde 2020 bei 83,8 % der befragten TÄ durch rechtliche Vorgaben beeinflusst; weitere Einflussfaktoren waren Verträglichkeit (81,3 %), Applikationsart (76,9 %), Akzeptanz durch den Patienten (70,0 %) und Häufigkeit der Anwendung (64,4 %), wobei letzterer von TÄ aus der Praxis (83,8 %, p = 0,004) signifikant häufiger genannt wurden als von TÄ aus Kliniken.
Schlussfolgerung Im Vergleich zu 2017 gaben TÄ 2020 einen signifikant geringeren Einsatz von Fluorchinolonen und Cephalosporinen der 3. und 4. Generation bei Hund und Katze an. Diese Änderungen im Verschreibungsverhalten könnten Folgen der Novellierung der TÄHAV sein, die ein Umwidmungsverbot sowie eine Antibiogrammpflicht dieser AB-Klassen vorgibt.
Klinische Relevanz Rechtliche Vorgaben können möglicherweise einen positiven Einfluss auf die Menge und Art der in der Kleintiermedizin eingesetzten Antibiotika haben und somit bei der Vermeidung von Antibiotikaresistenzen helfen.
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Affiliation(s)
- Kaye Mohr
- Medizinische Kleintierklinik der Ludwig-Maximilians-Universität, München
| | - Mirja Nolff
- Klinik für Kleintierchirurgie, Tierspital Universität Zürich
| | - Yury Zablotski
- Medizinische Kleintierklinik der Ludwig-Maximilians-Universität, München
| | | | - Rüdiger Korbel
- Klinik für Vögel, Kleinsäuger, Reptilien und Zierfische der Ludwig-Maximilians-Universität, München
| | | | - Georg Wolf
- Institut für Infektionsmedizin und Zoonosen der Ludwig-Maximilians-Universität, München
| | - Katrin Hiss
- Bayerisches Landesamt für Gesundheit und Lebensmittelsicherheit, Erlangen
| | - Hannah Peters
- Bayerisches Landesamt für Gesundheit und Lebensmittelsicherheit, Erlangen
| | - Bianka Schulz
- Medizinische Kleintierklinik der Ludwig-Maximilians-Universität, München
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de Groot AC. Patch testing in Drug reaction with eosinophilia and systemic symptoms (DRESS): a literature review. Contact Dermatitis 2022; 86:443-479. [PMID: 35233782 DOI: 10.1111/cod.14090] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 02/15/2022] [Accepted: 02/24/2022] [Indexed: 11/27/2022]
Abstract
The literature on positive patch test results in drug reaction with eosinophilia and systemic symptoms (DRESS) is reviewed. 105 drugs were identified that have together caused 536 positive patch tests in 437 patients suffering from DRESS. By far most reactions (n=145) were caused by carbamazepine, followed by amoxicillin, isoniazid, phenytoin, ethambutol, fluindione, phenobarbital, rifampicin, and ceftriaxone; 43 drugs each caused a single case only. The drug classes causing the highest number of reactions are anticonvulsants (39%), beta-lactam antibiotics (20%), antituberculosis agents (11%), non-beta-lactam antibiotics (6%) and iodinated contrast media (5%). The sensitivity of patch testing (percentage of positive reactions) is high for anticonvulsants (notably carbamazepine), beta-lactam antibiotics (notably amoxicillin) and possibly iodinated contrast media. Allopurinol and sulfasalazine frequently cause DRESS, but never give positive patch tests. Patch testing in DRESS appears to be safe, although mild recurrence of DRESS symptoms, mostly skin reactions, may not be rare. Multiple drug hypersensitivity was found to occur in 16% of all patients, but it is argued that the true frequency is (far) higher. Clinical aspects of DRESS, including diagnosing the disease and identifying culprit drugs (patch tests, intradermal tests, in vitro tests, challenge tests) are also provided, emphasizing the role of patch testing. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Anton C de Groot
- dermatologist np Schipslootweg 5, 8351, HV, Wapserveen, The Netherlands
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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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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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Contact Allergy to Topical Drugs. Contact Dermatitis 2021. [DOI: 10.1007/978-3-030-36335-2_38] [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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8
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Giménez-Arnau AM, Skudlik C. Occupational Contact Dermatitis: Health Personnel. Contact Dermatitis 2021. [DOI: 10.1007/978-3-030-36335-2_43] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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9
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Patch Testing in Adverse Drug Reactions. Contact Dermatitis 2021. [DOI: 10.1007/978-3-030-36335-2_26] [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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10
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Abstract
BACKGROUND Both surgical personnel and patients undergoing procedures are exposed regularly to different antiseptic chemicals in various forms. Little is known about the ingredients in these antiseptics and the risk these products may provoke allergic contact dermatitis. OBJECTIVE The aim of the study was to identify and characterize common allergens in surgical scrubs and patient surgical cleansers that health care workers and surgical patients may encounter in the perioperative period. METHODS DailyMed website was searched using numerous terms for surgical disinfectants. Products used for health care worker handwashing/scrubbing or patient surgical cleansing/disinfecting were included. Each product's ingredients were recorded; those found on the 2017 American Contact Dermatitis Society (ACDS) Core Allergen Series were noted from each product. CONCLUSIONS A total of 1940 products were identified, of which 267 were included in the analysis. A total of 66.3% contained iodine, 25.8% contained chlorhexidine digluconate, and 2.6% contained chloroxylenol. Within the group analyzed, 1586 ingredients were identified. Of these, 241 were ACDS Core Series allergens. Most products contained a single ACDS allergen. There were significant differences in allergens based on product type and active ingredient, with iodine-containing products having the fewest number of allergens. The most common ACDS allergens found were cocamide diethanolamide (22.5%), fragrance (21.7%), lanolin (19.5%), propylene glycol (6.7%), alkyl glucosides (6.0%), and sorbic acid derivatives (5.6%).
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Affiliation(s)
- Jamie P Schlarbaum
- From the Park Nicollet Contact Dermatitis Clinic
- University of Minnesota Medical School
| | - Sara A Hylwa
- From the Park Nicollet Contact Dermatitis Clinic
- Department of Dermatology, University of Minnesota, Minneapolis
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Sessink PJM, Nyulasi T, Haraldsson ELM, Rebic B. Reduction of Contamination with Antibiotics on Surfaces and in Environmental Air in Three European Hospitals Following Implementation of a Closed-System Drug Transfer Device. Ann Work Expo Health 2020; 63:459-467. [PMID: 30852616 DOI: 10.1093/annweh/wxz010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 01/07/2019] [Accepted: 01/29/2019] [Indexed: 11/15/2022] Open
Abstract
PURPOSE Occupational exposure of nurses to antibiotics may result in adverse health effects such as hypersensitivity, allergic reactions, resistance, and anaphylactic shock. The purpose of this study was to measure surface and air contamination with antibiotics in three hospitals during the preparation of the drugs using conventional techniques or using the Tevadaptor® closed-system drug transfer device (CSTD). METHODS Surface contamination was measured by taking wipe samples. Stationary air samples were collected in preparation areas and personal air samples were collected in the working environment of the nurses. Contamination was reassessed after several weeks following implementation of the CSTD. Surface contamination was compared before and after CSTD introduction. Vancomycin, meronem, augmentin, ceftriaxone, cefotaxime, piperacillin, and benzylpenicillin were monitored. Wipe and air samples were analyzed using liquid chromatographytandem mass spectrometry (LC-MS/MS). RESULTS Using conventional preparation techniques, widespread contamination with antibiotics up to 767 ng cm-2 was detected. After implementation of the CSTD, contamination levels significantly decreased for the most frequently prepared antibiotics in the three hospitals.Using the conventional preparation technique, three antibiotics were detected in environmental air of seven nurses in two hospitals (0.01-5 µg m-3), and one antibiotic was found in environmental air above a preparation surface (0.02 µg m-3). After implementation of the CSTD, the same antibiotic was detected in environmental air above the same preparation surface (1.39 µg m-3) but no antibiotics were detected in environmental air of the nurses in the three hospitals. CONCLUSIONS Using the conventional preparation techniques, surfaces and air were widely contaminated with antibiotics whereas the use of the CSTD significantly reduced contamination. Systematic use of a CSTD significantly reduces exposure to hazardous antibiotics and consequently reduces potential adverse health effects for healthcare providers.
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Affiliation(s)
| | - Tibor Nyulasi
- Intensive Care Department, Szent János Hospital, Budapest, Hungary
| | | | - Branislava Rebic
- Pharmacy Department, University Children's Hospital, Belgrade, Serbia
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Contact Allergy-Emerging Allergens and Public Health Impact. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17072404. [PMID: 32244763 PMCID: PMC7177224 DOI: 10.3390/ijerph17072404] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 03/17/2020] [Accepted: 03/30/2020] [Indexed: 02/07/2023]
Abstract
Contact allergy (sensitisation) and allergic contact dermatitis (ACD) resulting from it have a considerable public health impact. For the present review, all pertinent articles were systematically searched via Medline and Web of Science™; additionally, all available issues of the journals "Contact Dermatitis" and "Dermatitis" were manually searched, covering the years 2018-2019, thereby extending and re-focusing a previous similar review. New allergens, or previously described allergens found in a new exposure context or of other current importance, are described in sections according to substance classes, e.g., metals, preservatives, fragrances. As a common finding in many investigations, a lack of information on product composition has been noted, for instance, regarding a newly described allergen in canvas shoes (dimethylthiocarbamylbenzothiazole sulfide) and, most notably, absence of co-operation from manufacturers of glucose-monitoring devices and insulin pumps, respectively. These latter devices have been shown to cause severe ACD in a considerable number of diabetic patients caused by the liberation of isobornyl acrylate and N,N'-dimethylacrylamide, respectively, as demonstrated by an international collaboration between dermatologists and chemists. Improved and complete ingredient labelling for all types of products, and not just cosmetics, must be put on the legislative agenda.
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Topical Drugs. Contact Dermatitis 2020. [DOI: 10.1007/978-3-319-72451-5_38-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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14
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Goossens A, Gonçalo M. Contact Allergy to Topical Drugs. Contact Dermatitis 2020. [DOI: 10.1007/978-3-319-72451-5_38-2] [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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Blanca-Lopez N, Jimenez-Rodriguez TW, Somoza ML, Gomez E, Al-Ahmad M, Perez-Sala D, Blanca M. Allergic reactions to penicillins and cephalosporins: diagnosis, assessment of cross-reactivity and management. Expert Rev Clin Immunol 2019; 15:707-721. [DOI: 10.1080/1744666x.2019.1619548] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
| | | | - Maria L. Somoza
- Allergy Service, Infanta Leonor University Hospital, Madrid, Spain
| | - Enrique Gomez
- Roche Innovation Center Basel, F Hoffmann-La Roche AG, Basel, Switzerland
| | - Mona Al-Ahmad
- Department of Microbiology, Faculty of Medicine, Kuwait University, Kuwait City, Kuwait
| | - Dolores Perez-Sala
- Department of Structural and Chemical Biology, Centro de Investigaciones Biológicas, C.S.I.C, Madrid, Spain
| | - Miguel Blanca
- Allergy Service, Infanta Leonor University Hospital, Madrid, Spain
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Usefulness of Cutaneous Provocation Tests to Study Drugs Responsible for Cutaneous Adverse Drug Reactions. CURRENT TREATMENT OPTIONS IN ALLERGY 2019. [DOI: 10.1007/s40521-019-0198-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Occupational Contact Dermatitis: Health Personnel. Contact Dermatitis 2019. [DOI: 10.1007/978-3-319-72451-5_43-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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