Analysis of Contact Allergens in Polyvinyl Chloride Examination Gloves in the United States

Background: Polyvinyl chloride (PVC) gloves are recommended as a safe alternative for patients with rubber accelerator allergy. However, allergic contact dermatitis to other chemicals in PVC gloves has been reported. Objective: To analyze single-use PVC medical examination gloves in the United States for the presence of potential contact allergens. Methods: Using liquid chromatography-mass spectrometry, 20 unique PVC gloves were analyzed in triplicate for 6 chemicals: benzisothiazolinone, bisphenol A, mono(2-ethylhexyl) maleate, tricresyl phosphate, triphenyl phosphate, and triphenyl phosphite. Results: All 20 PVC gloves contained detectable quantities of benzisothiazolinone (range, 0.001-1.48 parts per million [ppm]), bisphenol A (0.01-0.11 ppm), triphenyl phosphate (0.01-2.11 ppm), and triphenyl phosphite (0.001-0.22 ppm). Eighteen (90%) gloves contained mono(2-ethylhexyl) maleate (0.001-0.14 ppm) and 3 (15%) contained tricresyl phosphate (0.001-0.002 ppm). Conclusions: Known allergens were present in all 20 PVC gloves. However, the detected levels were mostly low and their relationship with sensitization and elicitation thresholds requires further study.

Occupational Hand Dermatitis

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.

Contact allergy to and allergic contact dermatitis from formaldehyde and -releasers: A clinical review and update

This review aims to provide a clinically useful update regarding the role of formaldehyde (FA) and its five main releasers (FRs) quaternium-15, diazolidinyl urea, DMDM hydantoin, imidazolidinyl urea and 2-bromo-2-nitropropane-1,3-diol (bronopol) in contact allergy and allergic contact dermatitis. These ubiquitous preservatives are still often, and sometimes undeclared, present in cosmetics, pharmaceuticals, medical devices, household detergents and chemical (industrial) products. In Europe, the use of free FA and quaternium-15 in cosmetics is forbidden and contact allergy rates have been found to be stable to decreasing. However, FA/FRs still readily provoke localized (e.g., facial/hand), airborne and generalized dermatitis, and may also complicate atopic and stasis dermatitis, or result in nummular dermatitis. Seborrheic-, rosacea- and impetigo-like dermatitis have recently been reported. For a correct diagnosis, FA 2% aq. (0.60 mg/cm² ) should be used, and particularly the FRs bronopol 0.5% pet. and diazolidinyl urea 2% should be patch tested separately in a baseline series. If sensitization to FA occurs, both FA and FRs should preferably be avoided, except perhaps for bronopol in case it tests negatively. If a patient reacts to one or more FRs (such as bronopol, or diazolidinyl/imidazolidinyl urea), but not to FA, then the specific FR(s) should be avoided. This article is protected by copyright. All rights reserved.

Novel insights into contact dermatitis

Contact dermatitis is a common disease, caused by repeated skin contact to contact allergens or irritants, resulting in allergic contact dermatitis (ACD) and/or irritant contact dermatitis. Attempts have been made to identify biomarkers to distinguish irritant and allergic patch test reactions, which could aid diagnosis. Some promising candidates have recently been identified, but verification and validation in clinical cases still need to be done. New causes of ACD are constantly recognized. In this review, 10 new contact allergens from recent years, were identified, several relating to anti-age products. Frequent allergens causing considerable morbidity in the population such as the preservative methylisothiazolinone (MI) have been regulated in EU. A significant drop in cases has been seen, while high rates are still occurring in other areas such as North America. Other frequent causes are fragrance allergens especially widely used terpenes and acrylates used in medical devises for control of diabetes. These represent unsolved problems. Recent advances in immunology have opened for a better understanding of the complexity of contact dermatitis, especially ACD. The disease may be more heterogenous that previous understood with several subtypes. With the rapidly evolving molecular understanding of the disease, the potential for development of new drugs for personalized treatment of contact dermatitis is considerable.

Occupational allergic contact dermatitis: A 24-year, retrospective cohort study from Turkey

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.

Patterns of positive patch test reactions to formaldehyde and formaldehyde releasers at the Finnish Institute of Occupational Health from 2007 to 2020

BACKGROUND

Formaldehyde is an important contact sensitizer. Formaldehyde releasing substances induce positive reactions in formaldehyde-allergic patients, but there are also reactions independent of formaldehyde allergy. In an earlier study, stronger formaldehyde reactions led to more positive reactions to quaternium-15.

OBJECTIVES

To analyze patterns of positive patch test reactions to formaldehyde and different formaldehyde releasers.

METHODS

Patch test files of 1497 patients investigated during the period November 2007-August 2020 were retrospectively reviewed for positive reactions to formaldehyde and its releasers. During the study period, almost all (≥99.3%) patients were tested with a formaldehyde dilution series and six formaldehyde releasers.

RESULTS

Ninety-three patients tested positive to formaldehyde; 80% of these had positive reactions to at least one formaldehyde releaser, most often benzylhemiformal. There were only nine independent contact allergies to formaldehyde releasers. There were only two reactions to 2-bromo-2-nitropropane-1,3-diol and they occurred in formaldehyde-negative patients. In patients with extreme (+++) reactions to formaldehyde, concomitant positive reactions to any of the other 11 investigated formaldehyde releasers were more common than in patients with milder formaldehyde reactions.

CONCLUSIONS

Strong formaldehyde reactions were associated with positive reactions to formaldehyde releasers.

Occupational contact dermatitis: Retrospective analysis of North American Contact Dermatitis Group Data, 2001 to 2016

BACKGROUND

Patch testing is an important diagnostic tool for suspected allergic contact dermatitis (ACD) in occupational settings.

OBJECTIVE

Provide an overview of occupational skin disease (OSD) and an analysis of occupational ACD in North American patients undergoing patch testing between 2001and 2016.

METHODS

Patients with OSD were analyzed for frequency of allergic reactions to a screening series of allergens, occupational relevance, location of skin disease, and exposure sources. Demographic, occupation, and industry information were recorded.

RESULTS

Of 38,614 patients evaluated, 4471 (11.6%) had OSD, of whom 3150 (70.5%) had ACD. The most common occupationally related allergens included rubber accelerators, preservatives, and bisphenol A epoxy resin. Hands (75.8%), arms (30.0%), and face (15.9%) were common sites of dermatitis. The occupations most affected were service workers and machine operators.

LIMITATIONS

Our cohort may not reflect the general working population.

CONCLUSION

This study identified common occupational allergens, exposure sources, and occupations/industries at risk. This information may help the clinician evaluate and manage patients with occupational contact dermatitis.

Occupational exposure to nickel, cobalt, and chromium in the Lithuanian hard metal industry

BACKGROUND

Metalworkers are said to have heavy exposure to metals, but the amount of released metal ions from alloys and deposition on the hands is unknown.

OBJECTIVE

To analyze nickel, cobalt, and chromium in vitro release to the artificial sweat from nails and wire made of different alloys, and to test metal deposition on the fingers of metalworkers.

MATERIAL AND METHODS

Six different samples of nails and wire were kept in artificial sweat for 24 hours and one week, respectively. The metal release was determined by atomic absorption spectrometry (AAS). Eighty-eight consecutive metal plant workers immersed their index fingers and thumbs in separate laboratory tubes filled with deionized water for 2 minutes. The sample analysis for metals was carried out with an inductively coupled plasma mass spectrometer (ICP-MS).

RESULTS

The average released concentration of Ni was 0.0012 μg/cm² , for Co it was 0.0007 μg/cm² , and for Cr 0.0037 μg/cm² after 24 hours and 0.0135, 0.0029, and 0.0042 μg/cm² , respectively, after 1 week. There was a statistically significant increase in released concentration of Ni during one week: 0.0012 μg/cm² vs 0.0135 μg/cm² (P = .04). Medians of the detected Co amount on fingers reflected a statistically significant difference between workplaces: 0.004 μg/cm² for metalworkers vs 0.001 μg/cm² for office staff (P = .04).

CONCLUSION

Nickel (Ni), cobalt (Co), and chromium (Cr) can be released in different concentrations from nails and wire. Detected Ni and Cr levels can elicit dermatitis in already sensitized patients. Co can be extracted from alloys even if not mentioned on material safety data sheets. The finger immersion technique was used for cobalt and chromium detection on fingers for the first time.