Contact dermatitis and contact sensitization among enamellers and decorators in the ceramics industry

Identification of the pigments used in permanent makeup and their ability to elicit allergic contact dermatitis

BACKGROUND

Decorative tattoos are known to contain ingredients that may elicit allergic contact dermatitis; it is less well-known if permanent makeup pigments carry the same risk.

OBJECTIVE

Identify pigments used in permanent makeup inks sold in the United States and review cases of allergic contact dermatitis to these pigments.

METHODS

Using internet searches, permanent makeup inks sold in the United States were identified. Safety data sheets were used to catalog pigments used in permanent makeup. A subsequent literature search was performed to identify cases of allergic contact dermatitis to these pigments.

RESULTS

A total of 974 permanent makeup inks were reviewed, and 79 unique pigments were identified. The average product contained 4 pigments. Twenty of the pigments were inorganic metals, including carbon, iron, chromium, manganese, and molybdenum. Fifty-nine pigments were organic, of which most were azo, quinacridone, or anthraquinone dyes. A literature search revealed that 10 of the 79 pigments were associated with allergic contact dermatitis.

CONCLUSION

Permanent makeup primarily uses organic pigments, although some metallic pigments are still used. Physicians should also be aware that some of these pigments-both organic and inorganic-are known causes of allergic contact dermatitis. Of note, patch testing to these ingredients can be negative.

Contact sensitization to iron - a potentially underestimated metal allergen and elicitor of complications in patients with metal implants

BACKGROUND

Little is known about sensitization to iron (Fe) in private, working and medical settings, particulary implantology.

OBJECTIVES

To investigate sensitization to metals, particularly to Fe, both in pre-implant individuals with presumed metal allergy and in patients with suspected metal implant allergy. To further characterize Fe-sensitized individuals.

METHODS

Analysis of patch test reactions to an Fe (II)-sulfate-containing metal series in 183 consecutive patients (41 pre-implant, 142 metal implant-bearers). Test readings on D2, D3 and D6. Evaluation of questionnaire-aided history, of metal reactivity patterns, and demographics of Fe-reactors.

RESULTS

Metal reactivity in pre-implant/implant/total group was: to nickel 39%/30%/32%; to cobalt 17%/15%/15%; to chromium 7%/13%/11%. Co-sensitizations cobalt/nickel (19/58) and cobalt/chromium (11/21) were significant at P < .001; co-sensitizations Fe/Nickel (4/10) and chromium/knee arthroplasty (11/73) at P = .03. Ten of 183 (5.5%) reacted to Fe (2 of 41 pre-implant patients, 8 of 142 implant-bearers) with 10 only reacting on D6. Fe-reactivity was highest in complicated knee arthroplasty (7/73). Further peculiarities of Fe reactors included frequent isolated Fe reactivity (6/10), occupational metal exposure (7/10), previous (par)enteral Fe-substitution (6/10).

CONCLUSIONS

The 5.5% prevalence of Fe-reactions suggests a potentially underestimated role of this metal allergen in general and in implant-bearers. The latter also show a distinct metal sensitization pattern. This article is protected by copyright. All rights reserved.

Development of Membrane Hollow Fiber for Determination of Maleic Anhydride in Ambient Air as a Field Sampler

This research develops a rapid method for sampling and analysis of maleic anhydride (MA) in air using a one-step hollow fiber (HF) membrane in the liquid phase followed by high-performance liquid chromatography. A sampling chamber was prepared for sampling of MA with HF-supported de-ionized water absorbency. Several important parameters, such as sampling flow rate, sampling time, and breakthrough volume (BTV), were optimized at different concentrations using a central composite design. The results showed that sampling could be performed at the maximum period of 4 h with a flow rate of 1 mL min-1 for different concentrations (in the range of 0.05-2 mg m-3). The BTV was 240 mL. The relative standard deviations for the repeatability of interday and intraday were 7-10%, 10%, respectively, and the pooled standard deviation was 0.088. The limit of detection and limit of quantitation values were 0.033 and 0.060 mg m-3, respectively. Moreover, our findings revealed that the samples could be stored in sealed HF flexible plastic tubes in a cover at refrigerator temperature (4°C) for up to 7 days. The HF method was compared with method number 3512 National Institute Occupational Safety and Health for determination of MA. There was a good correlation (R2 = 0.99) between the two methods at a concentration of 0.05 to 2 mg m-3 in the laboratory and the average concentration of MA for both methods was 0.11 mg m-3 in the ambient air at an adhesive manufacturer. Our findings indicated that the proposed HF can act as a reliable, rapid, and effective approach for sampling of MA in workplaces.

Improvement of human cell line activation test (h-CLAT) using short-time exposure methods for prevention of false-negative results

Recently, animal testing has been affected by increasing ethical, social, and political concerns regarding animal welfare. Several in vitro safety tests for evaluating skin sensitization, such as the human cell line activation test (h-CLAT), have been proposed. However, similar to other tests, the h-CLAT has produced false-negative results, including in tests for acid anhydride and water-insoluble chemicals. In a previous study, we demonstrated that the cause of false-negative results from phthalic anhydride was hydrolysis by an aqueous vehicle, with IL-8 release from THP-1 cells, and that short-time exposure to liquid paraffin (LP) dispersion medium could reduce false-negative results from acid anhydrides. In the present study, we modified the h-CLAT by applying this exposure method. We found that the modified h-CLAT is a promising method for reducing false-negative results obtained from acid anhydrides and chemicals with octanol-water partition coefficients (LogK_ow) greater than 3.5. Based on the outcomes from the present study, a combination of the original and the modified h-CLAT is suggested for reducing false-negative results. Notably, the combination method provided a sensitivity of 95% (overall chemicals) or 93% (chemicals with LogK_ow > 2.0), and an accuracy of 88% (overall chemicals) or 81% (chemicals with LogK_ow > 2.0). We found that the combined method is a promising evaluation scheme for reducing false-negative results seen in existing in vitro skin-sensitization tests. In the future, we expect a combination of original and modified h-CLAT to be applied in a newly developed in vitro test for evaluating skin sensitization.

Assessment of Industrial Antimony Exposure and Immunologic Function for Workers in Taiwan

This study investigated antimony exposure among employees in industries in Taiwan and evaluated whether their immunologic markers were associated with antimony exposure. We recruited 91 male workers and 42 male office administrators from 2 glass manufacturing plants, 1 antimony trioxide manufacturing plants, and 2 engineering plastic manufacturing plants. Air samples were collected at worksites and administrative offices, and each participant provided specimens of urine, blood, and hair to assay antimony levels. We also determined white blood cells, lymphocyte, and monocyte, IgA, IgE, and IgG in blood specimens. The mean antimony concentration in the air measured at worksites was much higher in the antimony trioxide plant (2.51 ± 0.57 mg/m³) than in plastic plants (0.21 ± 0.06 mg/m³) and glass plants (0.14 ± 0.01 mg/m³). Antimony levels in blood, urine, and hair measured for participants were correlated with worksites and were higher in workers than in administrators. The mean serum IgG, IgA, and IgE levels were lower in workers than in administrators (p < 0.001). Serum IgA and IgE levels in participants were negatively associated with antimony levels in air samples of workplaces, and in blood, urine, and hairs of participants. Serum IgG and IgE of all participants were also negatively associated with antimony levels in their hairs. In conclusion, the antimony exposure is greater for workers employed in the five industrial plants than for administrators. This study suggests serum IgG, IgA, and IgE levels are negatively associated with antimony exposure.

Evidence-based guidelines for the prevention, identification and management of occupational contact dermatitis and urticaria

BACKGROUND

Occupational contact dermatitis is the most frequently reported work-related skin disease in many countries. A systematic review was commissioned by the British Occupational Health Research Foundation in response to a House of Lords Science and Technology Committee recommendation.

OBJECTIVES

The systematic review aims to improve the prevention, identification and management of occupational contact dermatitis and urticaria by providing evidence-based recommendations.

METHODS

The literature was searched systematically using Medline and Embase for English-language articles published up to the end of September 2009. Evidence-based statements and recommendations were graded using the Royal College of General Practitioner's three-star system and the revised Scottish Intercollegiate Guidelines Network grading system.

RESULTS

Three thousand one hundred and fifty-five abstracts were identified and screened. From these, 786 full papers were obtained and appraised. One hundred and nineteen of these studies were used to produce 36 graded evidence statements and 10 key recommendations.

CONCLUSIONS

This evidence review and its recommendations focus on interventions and outcomes to provide a robust approach to the prevention, identification and occupational management of occupational contact dermatitis and urticaria, based on and using the best available medical evidence.

A pilot study on the content and the release of Ni and other allergenic metals from cheap earrings available on the Italian market

The capability of alloys used in cheap jewellery to release metal ions on contact with the skin causing allergic contact dermatitis (ACD) is generally acknowledged. To reduce the diffusion of the Ni-induced ACD the Council Directive 94/27/EC [Council Directive 94/27/EC of 30 June 1994. Official Journal L 188, 22/07/1994, 1.] limited the total Ni content in alloys and its release rate in artificial sweat. In this work, three different aspects were explored: i) the frequency of skin sensitization to Ni-containing earrings in patients before and after the introduction of the Directive's limit; ii) metal composition of alloys by X-ray analysis; iii) metal leaching in artificial sweat followed by Sector Field Inductively Coupled Plasma Mass Spectrometry (SF-ICP-MS) quantification. Well-known allergenic metals, as Ni, Cr and Co, and possible emergent allergens, as Al, Ag, Au, Cd, Cu, Fe, Ir, Mn, Pb, Pd, Pt, Rh, Sn, V and Zn, were studied. Results showed that the frequency of allergy due to earrings did not decrease after the introduction of the Ni limit: in 1994 and in 2005 patients positive to Ni patch tests were 54.3% and 53.5%, respectively. The earring components analyzed were Fe-based or alloys of Cu/Zn or Fe/Cr/Ni, plated with a thin film of precious metal (Ag, Au) which, in several cases, was combined with a Ni layer beneath. Five out of 10 items were not in compliance with the Ni Directive 94/27/EC having a total Ni content >0.05%. In three cases the release of Ni concentrations was higher than the safe sensitizing limit given by the above mentioned Regulation (i.e., <0.5 microg/cm(2)/week). The release of Cu and Zn was very variable among the different pieces (Cu: 0.134-30.9 microg/cm(2)/week; Zn: 0.141-160 microg/cm(2)/week); two objects released high amounts of Fe (358 and 586 microg/cm(2)/week) and one released considerable Mn (21 microg/cm(2)/week). Lead was released from 70% of the objects, while Ag, Al, Cd, Co, Cr and Sn from ca. 30% of the items and concentrations of these elements were well below 0.5 microg/cm(2)/week. Vanadium was released by only one item whereas Au, Ir, Pd, Pt and Rh were never leached.

Levels of nickel and other potentially allergenic metals in Ni-tested commercial body creams

It is extensively well-known that Ni and other metals occurring as impurities in cosmetic products might give rise to contact dermatitis in subjects with pre-existing allergy. The present study on the content of 13 metals (Cd, Co, Cr, Cu, Hg, Ir, Mn, Ni, Pb, Pd, Pt, Rh, and V) in moisturizing creams, labelled as "Ni-tested" (i.e., Ni content <100 ng g(-1)) and available on the Italian market, provides a basis for assessing their safety for consumers. Quantification of metals was performed by sector field inductively coupled plasma mass spectrometry after microwave-assisted acid digestion of products. The developed method had limits of quantification less than 0.8 ng g(-1) for all the elements; recovery was in the interval 88% (Cd, Co) to 110% (Hg), and precision was always under 7%. Nickel was present in all the products with levels between 17.5 and 153 ng g(-1); three skin creams were slightly above the concentration reported on the label. The other elements were at levels below 1 microg g(-1). The highest concentrations, in ng g(-1), of Co, Cr, Cu, and Mn were 222, 303, 51.2, and 59.9, respectively. Mean Cd, Pb, and V were below 5 ng g(-1), while Hg was absent in all the samples. Among the new emergent allergens, Ir and Rh were in traces or even undetectable, while Pt had levels of 2.65 and 6.28 ng g(-1) in two creams and Pd was equal to 1.07 ng g(-1) in one product. The overall results are below the sensitizing limit proposed for consumer products and, thus, probably have no significant toxicological effects. Nevertheless, some creams presented amounts of Co and Cr comparable to those of Ni and therefore they have to be monitored in consideration of their cross-reactivity as well.

Cadmium concentration in maternal and cord blood and infant birth weight: a study on healthy non-smoking women

The aim of our study was to measure, at delivery, maternal and cord blood cadmium levels (by means of atomic absorption spectrometry) in 45 healthy non-smoking pregnant women exposed to a low cadmium challenge, and to evaluate the relationship between these cadmium levels and the birth weight of the infants. Our results showed fairly low cadmium levels in maternal blood, in accordance with the fact that all women enrolled in this study lived in areas with low toxic metal contamination and that they did not smoke during their pregnancy. Furthermore, a highly significant direct correlation was found between maternal and cord blood cadmium concentrations. Since cadmium concentration appeared of the same order of magnitudine both in cord and maternal serum, one could speculate that cadmium is transferred easily from the mother to the fetus through the placenta. Finally, we found that birth weight is inversely correlated with maternal and cord blood cadmium concentrations; thus birth weight might be negatively influenced by cadmium levels as a result of the toxic effects of the metal on the placenta. Although preliminary, our data show that (also not-predictable) prenatal exposure to even low cadmium levels might be a risk factor for developmental impairment in infants.