Occupational allergic contact dermatitis in construction workers

Occupational Contact Dermatitis in Construction Workers: A Retrospective Analysis of the North American Contact Dermatitis Group Data, 2001-2020

Background: Construction workers (CWs) are at risk for occupational contact dermatitis (CD) owing to workplace exposures. Objective: Determine the prevalence of occupational allergic CD and characterize common occupational allergens in CWs referred for patch testing in the United States and Canada. Methods: Retrospective cross-sectional analysis of patients patch tested by the North American Contact Dermatitis Group from 2001 to 2020. Results: Of 47,843 patch-tested patients, 681 (1.4%) were CWs. Compared with non-CWs, CWs were more likely to be male (91.0% vs 30.9%) have occupational skin disease (36.9% vs 11.4%) and have hand involvement (37.2% vs 22.5%) (all P < 0.0001). Of 681 CWs, 60.1% (411) had clinically relevant positive patch test reactions, and nearly 1/3 of CWs (128) had occupationally relevant reactions. Most common occupationally relevant allergens were potassium dichromate 0.25% pet. (30.5%, 39/128), bisphenol A epoxy resin 1% pet. (28.1%, 36/128), carba mix 3% pet. (14.8%, 19/128), cobalt (ii) chloride hexahydrate 1% pet. (14.1%, 18/128), and thiuram mix 1% pet. (14.1%, 18/128). Top sources of occupationally relevant allergens were cement/concrete/mortar (20.4%, 46/225), gloves (15.1%, 34/225), and coatings (paint/lacquer/shellac/varnish/stains) (9.8%, 22/225). Conclusions: Occupational CD in North American CWs is common. In this group, frequently identified etiological sources of occupational allergic CD included metals, epoxy resin, and rubber.

Patch Testing With Nickel, Cobalt, and Chromium in Patients With Suspected Allergic Contact Dermatitis

Background: Allergic contact dermatitis is frequently caused by metals, including multiple metals simultaneously. Objectives: To assess characteristics and associations of positive and clinically relevant patch test (PT) reactions with solitary and concurrent metal sensitization. Methods: A retrospective analysis of PT results for nickel, cobalt, and/or chromium from the North American Contact Dermatitis Group between 2001 and 2018 (n = 43,522). Results: 18.0% had a positive/allergic reaction to nickel sulfate hexahydrate, 7.3% to cobalt chloride hexahydrate, and 3.0% to potassium dichromate. 87.9% patients had a currently relevant reaction to 0, 9.4% to 1, and 2.7% to multiple metals tested. Patients with 1 versus no currently relevant reactions to metal were more likely to have a primary dermatitis site of trunk, feet, and ears; patients with currently relevant reactions to multiple metals had more dermatitis affecting the trunk and ears. Metal sources varied by co-reacting metal, especially for patients with cobalt and chromium allergy. Jewelry was the most commonly identified source of nickel and cobalt for both solitary and concurrent metal allergy. Conclusions: Sensitization to multiple metals occurred in 6% of patients. Allergen sources varied between patients with sensitivity to 1 metal versus those who had concurrent sensitivity to cobalt and/or chromium.

Patch Testing With Cobalt in Adults: A North American Contact Dermatitis Group Experience, 2001-2018

Background: Cobalt is a recognized cause of allergic contact dermatitis (ACD); however, detailed information on patient characteristics, sites, and sources is lacking. Objective: The aim of the study is to assess trends in patch test reactions to cobalt and associated patient characteristics, common sources, and body sites affected. Methods: The study used a retrospective analysis of adult patients who were patch tested to cobalt by the North American Contact Dermatitis Group between 2001 and 2018 (n = 41,730). Results: Overall, 2986 (7.2%) and 1362 (3.3%) had allergic or currently relevant patch test reaction to cobalt, respectively. Patients with versus without an allergic patch test reaction to cobalt were more likely to be female, employed, have a history of eczema or asthma, be Black, Hispanic, or Asian, and have occupational-related dermatitis. The most commonly identified sources of cobalt in allergic patients included jewelry, belts, and cement, concrete, and mortar. Affected body site(s) varied by cobalt source among patients with currently relevant reactions. Occupational relevance was found in 16.9% of patients with positive reactions. Conclusions: Positive patch test reactions to cobalt were common. The most common body sites were the hands, and affected site varied by the source of cobalt.

Nature-Derived Epoxy Resin Monomers with Reduced Sensitizing Capacity─Isosorbide-Based Bis-Epoxides

Epoxy resin systems (ERSs) are a class of thermosetting resins that become thermostable and insoluble polymers upon curing. They are widely used as components of protective surfaces, adhesives, and paints and in the manufacturing of composites in the plastics industry. The diglycidyl ether of bisphenol A (DGEBA) is used in 75-90% of ERSs and is thus by far the most used epoxy resin monomer (ERM). Unfortunately, DGEBA is a strong skin sensitizer and it is one of the most common causes of occupational contact dermatitis. Furthermore, DGEBA is synthesized from bisphenol A (BPA), which is a petroleum-derived chemical with endocrine-disruptive properties. In this work, we have used isosorbide, a renewable and nontoxic sugar-based material, as an alternative to BPA in the design of ERMs. Three different bis-epoxide isosorbide derivatives were synthesized: the diglycidyl ether of isosorbide (1) and two novel isosorbide-based bis-epoxides containing either a benzoic ester (2) or a benzyl ether linkage (3). Assessment of the in vivo sensitizing potency of the isosorbide bis-epoxides in the murine local lymph node assay (LLNA) showed that all three compounds were significantly less sensitizing than DGEBA, especially 2 which was nonsensitizing up to 25% w/v. The peptide reactivity showed the same order of reactivity as the LLNA, i.e., 2 being the least reactive, followed by 3 and then 1, which displayed similar peptide reactivity as DGEBA. Skin permeation of 2 and 3 was compared to DGEBA using ex vivo pig skin and static Franz cells. The preliminary investigations of the technical properties of the polymers formed from 1-3 were promising. Although further investigations of the technical properties are needed, all isosorbide bis-epoxides have the potential to be less sensitizing renewable replacements of DGEBA, especially 2 that had the lowest sensitizing potency in vivo as well as the lowest peptide reactivity.

Epoxy allergy, investigation of a modern industry

BACKGROUND

Five workers from an industry manufacturing various articles from carbon fibre reinforced epoxy plastics were referred to our department because of suspected occupational allergic contact dermatitis (OACD). When patch tested, four of them had positive reactions to components of epoxy resin systems (ERSs) that could explain their current skin problems. All of them had been working at the same workstation at a specially designed pressing machine, with operations including manually mixing epoxy resin with hardener. Multiple cases of OACD in the plant prompted an investigation including all workers with possible risk exposures at the plant.

OBJECTIVES

To investigate the prevalence of occupational dermatoses and contact allergies among the workers at the plant.

MATERIALS AND METHODS

Totally 25 workers underwent investigation that included a brief consultation with a standardized anamnesis and clinical examination followed by patch testing.

RESULTS

ERSs-related reactions were found in 7 of the 25 investigated workers. None of the seven had a history of previous exposure to ERSs and they are regarded as sensitized through work.

CONCLUSIONS

Twenty-eight percent of investigated workers showed reactions to ERSs. Of these the majority would have been missed if supplementary testing would not have been added to testing with the Swedish base line series.

Urinary biomonitoring of occupational exposures to Bisphenol A Diglycidyl Ether (BADGE) - based epoxy resins among construction painters in metal structure coating

Epoxy resin systems based on Bisphenol A Diglycidyl Ether (BADGE) monomer and its higher oligomers are important commercial formulations used widely in construction for protective coating of steel structures, such as bridges. The literature on occupational exposures and biomonitoring of BADGE-based epoxies among construction painters is remarkably limited. In this first occupational biomonitoring study of epoxies, 44 construction painters performing mid- and top-coating were recruited from 12 metal structure coating sites in New England. Cross-shift changes in the urinary levels of total BADGE and its three major hydrolysis derivatives - BADGE·2H₂O, BADGE·H₂O, BADGE·HCl·H₂O - were assessed. Results for 81 urine samples collected from coating workers were compared with 28 urine samples of a reference group of 14 spray polyurethane foam (SPF) insulation workers. The highest concentrations of all biomarkers were found in the urine samples of mid-coat applicators. The major urinary biomarker of BADGE in this cohort of workers, BADGE·2H₂O, was detected in 100% of urine samples. The post-shift BADGE·2H₂O (specific gravity normalized data) in mid-coat applicators had a geometric mean (GM) of 1.46 ng/mL and a geometric standard deviation (GSD) of 3.6 (range, 0.2-18.7 ng/mL). The second most abundant biomarker in urine, BADGE·HCl·H₂O, was measured in 84% of samples, and had a post-shift GM(GSD) of 0.17 (2.3) ng/mL (range, <0.025-0.59 ng/mL). BADGE·2H₂O was 8.6 times more abundant than BADGE·HCl·H₂O. BADGE·H₂O was quantified only in 10% of the samples (range, 0.11-0.41 ng/mL). Free BADGE in post-shift urine, corrected for background, had GM (GSD) of 0.04 (2.5) ng/mL (range, <0.025-0.16 ng/mL). Urinary BADGE·2H₂O were significantly higher (p = 0.01) in mid-coat applicators compared to top-coat and SPF workers. Post-shift urinary BADGE·2H₂O in mid-coat applicators increased by ~2.9× (p = 0.02) and 1.36× in top-coat applicators (p = 0.18) compared to pre-shift values, but not in SPF workers (0.95×; p = 0.40). In conclusion, we demonstrate that (i) significant BADGE uptake occurs via inhalation and skin exposures during application of epoxy-containing paintings (mid-coat), suggesting the need for improvements in hygiene practices and personal protective measures; (ii) BADGE·2H₂O is a robust and sensitive biomarker for biomonitoring of exposures to BADGE-based epoxies in occupational settings; and (iii) widespread occurrence of BADGE and BADGE·2H₂O in the urine of all workers, including SPF workers, suggest common exposures from non-occupational sources, such as ingestion or do-it-yourself consumer applications of epoxy resins. In light of this observation, establishing a reliable biological monitoring guidance value (BMGV) for BADGE·2H₂O will require more background biomonitoring and health effect data. An initial reference value for BADGE·2H₂O of 0.5 ng/mL (SG-normalized) or 180 nmol/mol creatinine is being proposed as the threshold to discriminate occupational from non-occupational exposures based on the maximum values observed in the reference SPF group.

Occupational contact allergy of construction workers in Greece: Trends during 2009-2018

BACKGROUND

Recent trends in the sensitization of construction workers show a decrease in potassium dichromate and an increase in epoxy resin sensitization.

OBJECTIVES

To present the trends of occupational contact allergy of construction workers in Greece from 2009 to 2018.

METHODS

We retrospectively reviewed the files of patients with eczema patch tested in our Contact Dermatitis Clinic who were construction workers.

RESULTS

A total of 191 construction workers initially reported contact dermatitis. Of these, 138 had occupation-relevant allergic contact dermatitis (ACD) or irritant contact dermatitis (ICD). All patients were men. After being patch tested, 98 (71.0%) were diagnosed with ACD and 40 with ICD. Median duration of occupation till onset of ACD was 2 years (interquartile range [IQR] 0.8-7). The hands were the most common location for ACD (73.5%), followed by the trunk (39.8%), the legs (38.8%), and the face (11.2%). Of the patients, 74.6% had lesions affecting multiple body sites. Potassium dichromate (67%) was the most frequent allergen, followed by thiuram mix (37.4%) and cobalt chloride (31.8%). Sensitization to epoxy resins was lower (12.1%).

CONCLUSION

The sensitization pattern of Greek construction workers does not follow the trends in Central or Northern Europe, rather sharing attributes with less industrialized countries.

Topical inflammasome inhibition with disulfiram prevents irritant contact dermatitis

BACKGROUND

The pathogenesis of contact dermatitis, a common inflammatory skin disease with limited treatment options, is held to be driven by inflammasome activation induced by allergens and irritants. We here aim to identify inflammasome-targeting treatment strategies for irritant contact dermatitis.

METHODS

A high content screen with 41,184 small molecules was performed using fluorescent Apoptosis associated speck-like protein containing a CARD (ASC) speck formation as a readout for inflammasome activation. Hit compounds were validated for inhibition of interleukin (IL)-1β secretion. Of these, the approved thiuramdisulfide derivative disulfiram was selected and tested in a patch test model of irritant contact dermatitis in 25 healthy volunteers. Topical application of disulfiram, mometasone or vehicle was followed by application of sodiumdodecylsulfate (SDS) for 24 h each. Eczema induction was quantified by mexameter and laser speckle imaging. Corneocyte sampling of lesional skin was performed to assess inflammasome-mediated cytokines IL-1β and IL-18.

RESULTS

Disulfiram induced a dose-dependent inhibition of ASC speck formation and IL-1β release in cellular assays in vitro. In vivo, treatment with disulfiram, but not with vehicle and less mometasone, inhibited SDS-induced eczema. This was demonstrated by significantly lower erythema and total perfusion values assessed by mexameter and laser speckle imaging for disulfiram compared to vehicle (p < 0.001) and/or mometasone (p < 0.001). Also, corneocyte IL-18 levels were significantly reduced after application of disulfiram compared to vehicle (p < 0.001).

CONCLUSION

We show that disulfiram is a dose-dependent inhibitor of inflammasome pathway activation in vitro and inhibitor of SDS-induced eczema in vivo. Topical application of disulfiram represents a potential treatment option for irritant contact dermatitis.

What Is New in Occupational Allergic Contact Dermatitis in the Year of the COVID Pandemic?

Purpose of Review

This article aims to summarize some recent trends in occupational allergic contact dermatitis (ACD), including dermatitis related to pandemic-level personal protective equipment in healthcare workers, hazards patients may experience when working from home, and occupational perspectives on the recent American Contact Dermatitis Society (ACDS) allergens of the year and ACDS Core Allergen Series updates.

Recent Findings

Recent ACDS Allergens of the Year may be particularly relevant to healthcare workers, including isobornyl acrylate, which is present in glucose sensors and propylene glycol present in hand cleansers and disinfectants. Lavender, limonene, and linalool, all of which are new additions to the ACDS Core Allergen Series, have been reported as causes for occupational ACD in massage therapists and aromatherapists. Isothiazolinone allergy continues to rise in both consumer and occupational settings. Finally, the COVID-19 pandemic has resulted in a wave of occupational ACD in healthcare workers to personal protective equipment, and revealed new potential allergens for individuals working from home.

Summary

Occupational allergic contact dermatitis continues to exert a significant occupational disease burden. Remaining aware of the current trends in allergens may allow for earlier recognition, diagnosis, and treatment, subsequently helping our patients to work in healthier and safer environments.

Allergic contact dermatitis: a significant environmental and occupational skin disease

This review article seeks to provide an overview of allergic contact dermatitis (ACD) as a significant environmental and occupational skin disease, the phases of ACD, its causes from the occupational and environmental perspectives, its detection, the effects of ACD with respect to the social, psychological, occupational, and financial perspectives, and its cure and/or prevention. Human skin is very sensitive and as the largest organ in the body, it is highly prone to direct and indirect contact with the substances from its environment. The skin reacts to these substances (xenobiotics) differently depending on the individual's tolerance level or threshold. Allergic contact dermatitis is a significant environmental and occupational skin disease that should not be ignored in our society because it can affect the quality of life of an affected individual. There are multiple causes of ACD, and these causes of ACD have been discussed from two perspectives: environmental and occupational. The effects of ACD can be psychological, social, financial, and occupational. There is need for more public enlightenment on the effects of ACD as well as a precise understanding that it is not a contagious disease so as to significantly reduce the psychological and social effects of ACD on these patients.

Patch Testing of Mercaptobenzothiazole and Mercapto Mix: The North American Contact Dermatitis Group Experience, 1994-2016

OBJECTIVES

Mercapto compounds are a category of rubber accelerators that may cause allergic contact dermatitis. This study characterizes patch test reactions to mercaptobenzothiazole (MBT) and mercapto mix (MM) in a large North American population.

METHODS

The 1994-2016 North American Contact Dermatitis Group screening series data were analyzed. Patients with allergic reactions to either MBT or MM (mercapto+) were included. The following characteristics were analyzed: strength of reaction, clinical and occupational relevance, coreactivity with other rubber accelerators, and sources of exposure.

RESULTS

A total of 49,795 patients were tested to mercapto compounds from 1994 to 2016; 633 (1.3%) had positive reactions to MBT and/or MM. The frequency to both MBT and MM significantly decreased over time (P < 0.0001). Mercapto+ patients were significantly more likely to be male, have occupationally related skin disease, and report involvement of the hands and/or feet (P < 0.0001). They were significantly less likely to have face, scalp/ears/neck, or trunk involvement (P ≤ 0.0001). There was significant coreactivity with carba mix (23.4%) and thiuram mix (32.5%). Mercaptobenzothiazole and MM reactions were frequently clinically (81.7% and 83.5%, respectively) and occupationally relevant (29.8% and 33.4%, respectively). Gloves were the most common source (31.3% and 30.9%, respectively).

CONCLUSIONS

Patch test positivity to mercapto compounds significantly decreased from 1994 to 2016 but remains clinically and occupationally relevant.

Cobalt toxicity in humans-A review of the potential sources and systemic health effects

Cobalt (Co) and its compounds are widely distributed in nature and are part of numerous anthropogenic activities. Although cobalt has a biologically necessary role as metal constituent of vitamin B₁₂, excessive exposure has been shown to induce various adverse health effects. This review provides an extended overview of the possible Co sources and related intake routes, the detection and quantification methods for Co intake and the interpretation thereof, and the reported health effects. The Co sources were allocated to four exposure settings: occupational, environmental, dietary and medical exposure. Oral intake of Co supplements and internal exposure through metal-on-metal (MoM) hip implants deliver the highest systemic Co concentrations. The systemic health effects are characterized by a complex clinical syndrome, mainly including neurological (e.g. hearing and visual impairment), cardiovascular and endocrine deficits. Recently, a biokinetic model has been proposed to characterize the dose-response relationship and effects of chronic exposure. According to the model, health effects are unlikely to occur at blood Co concentrations under 300μg/l (100μg/l respecting a safety factor of 3) in healthy individuals, hematological and endocrine dysfunctions are the primary health endpoints, and chronic exposure to acceptable doses is not expected to pose considerable health hazards. However, toxic reactions at lower doses have been described in several cases of malfunctioning MoM hip implants, which may be explained by certain underlying pathologies that increase the individual susceptibility for Co-induced systemic toxicity. This may be associated with a decrease in Co bound to serum proteins and an increase in free ionic Co²⁺. As the latter is believed to be the primary toxic form, monitoring of the free fraction of Co²⁺ might be advisable for future risk assessment. Furthermore, future research should focus on longitudinal studies in the clinical setting of MoM hip implant patients to further elucidate the dose-response discrepancies.

Allergic contact dermatitis among construction workers detected in a clinic that did not specialize in occupational dermatitis

BACKGROUND: Contact dermatitis is one of the common work-related dermatoses. Among bricklayers, cement can cause both allergic contact dermatitis and primary contact irritative dermatitis. The personal protective equipment (rubber gloves) may favor the development of allergic contact dermatitis. OBJECTIVES: 1) to evaluate the frequency of allergic contact dermatitis among construction workers between January 2005 and December 2009; 2) to determine the major sensitizing agents in the study group; and 3) to compare the data obtained from the construction workers to that of a group of patients who were not construction workers. METHODS: A retrospective analysis of patch tests. Patients were separated into two groups: 1) bricklayers and 2) non-bricklayers. RESULTS: Of the 525 patch tests analyzed, 466 (90%) were from non-bricklayers and 53 (10%) from bricklayers. The hands were affected in 38 (61%) of them. 13 patients (24%) had irritative contact dermatitis and 40 (76%) had allergic contact dermatitis. The group of construction workers had a high frequency of sensitization to cement, and 29 (54.7%) had sensitization to rubber vulcanizing agents. 23 patients (43.4%) had sensitization to both cement and rubber. CONCLUSIONS: Among the bricklayers the presence of allergic contact dermatitis to rubber and cement in the same patient is common and demonstrates the importance of the patch test.

Evaluation of cadmium, chromium, nickel, and zinc in biological samples of psoriasis patients living in Pakistani cement factory area

Psoriasis is a noncontiguous common and chronic skin disorder. The aim of the present study was to compare the level of trace elements cadmium (Cd), chromium (Cr), Nickel (Ni), and zinc (Zn) in biological samples (whole blood, urine, and scalp hair) of psoriasis patients of both gender age ranged (25-55 years) at mild, moderate severe, and more severe stage (n = 418) living in the vicinity of cement factory. For comparison purposes, healthy age-matched referent subjects, residents of industrial and non-industrial area, of both gender were also selected (n = 241). The concentrations of trace and toxic elements were measured by atomic absorption spectrophotometer prior to microwave-assisted acid digestion. The validity and accuracy of methodology was checked by using certified reference materials (CRMs) and conventional wet acid digestion method on same CRMs and real samples. The results of this study showed that the mean values of Cd, Cr, Ni, and Pb were significantly higher in scalp hair, blood, and urine samples of mild and severe psoriasis patients as compared to referents (p < 0.001), while the concentration of Zn was lower in the scalp hair and blood, but higher in the urine samples of psoriasis patients. The deficiency of Zn in psoriasis patients may be undoubtedly caused by the toxic element exposures via cement factory.

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.

Occupational contact allergy in the building trade in Germany: influence of preventive measures and changing exposure

PURPOSE

Since 1993, assiduous efforts have been made in Germany to lower the incidence of allergic cement dermatitis by reducing the content of hexavalent chromium (Cr VI). Usage of epoxy resin systems has considerably increased in the building trade in the same period. We analysed data of the Information Network of Departments of Dermatology (IVDK) to evaluate the influence of these changing occupational exposures on frequencies of sensitization.

METHODS

IVDK data of 1,153 men working in the building trade (bricklayers, tile setters etc.) presenting with occupational skin disease in the years 1994-2008 were analysed, taking into consideration not only the year of patch testing, but also beginning and duration of work in the building trade.

RESULTS

While contact sensitization to chromate decreased from 43.1 to 29.0%, sensitization to epoxy resin increased from 8.4 to 12.4%. Logistic regression analysis revealed that, compared to those who had already worked before 1994, patients having started to work in building trade after 1999 had a significantly decreased risk of chromate sensitization (odds ratio 0.42) and a significantly increased risk of sensitization to epoxy resin (odds ratio 2.79). Additionally, risk of thiuram sensitization increased with the duration of employment.

CONCLUSION

Our data confirm that reducing Cr VI content of cement is useful in preventing allergic cement eczema, as previously found in Scandinavia. In contrast, the increasing prevalence of contact sensitization to epoxy resin components in the building trade is alarming. Preventive measures, which have already been implemented, have to be enforced.

Contact allergy in male construction workers in Sao Paulo, Brazil, 2000?2005

There are no recent data on allergens in the construction industry in Brazil; apparently there were no changes in allergenic substances. The objective of this study was to identify sensitization to allergens in adult males working in the construction industry. A cross-sectional study with adult males submitted to patch tests from May 2000 to December 2005. Out of 169 male patients, 83 were construction workers. The five most frequent allergens among the construction workers were potassium dichromate (57%), carba-mix (34.9%), cobalt chloride (30.2%), thiuram-mix (27.9%) and neomycin (19.8%). There is a significant sensitization to potassium dichromate, cobalt, carba-mix, and thiuram-mix, demonstrating that cement and rubber gloves of personal protection equipment still account for allergic contact dermatitis in construction industry workers.

Chemical exposure and symptoms of hand dermatitis in construction painters

Studies on the prevalence of hand dermatitis in construction painting are rare. Our aim was to study the painters' chemical exposure and the prevalence of self-reported skin symptoms on hands and forearms. A cross-sectional questionnaire survey was conducted on 1000 Finnish male construction painters and 1000 carpenters (response rates 60.6% and 60.4%, respectively). We used 2 definitions for symptom-based hand dermatitis (liberal > or = 2 symptoms and strict criteria > or = 3) and logistic regression analysis, adjusted with age and atopy. Painters reported more symptoms of hand dermatitis than carpenters (12-month prevalence 22.5% and 14.2%, P < 0.05; strict criteria 13.3% and 6.4%, P < 0.05). A dose-response relationship was found for reporting symptoms and exposure to several solvent-based (SB) and water-based (WB) products. When exposure was combined into 1 variable, daily use of SB epoxy/urethane paints (OR 5.3, 95% CI 2.2-12.9; strict criteria 6.8, 2.3-19.9) and WB putties/plasters (1.9, 1.2-3.0; strict criteria 2.0, 1.1-3.9) were associated with hand dermatitis, whereas using only WB paints was not a risk factor. In conclusion, painters reported significantly more symptoms of hand dermatitis than carpenters. Putties/plasters emerged as a risk factor for dermatitis in construction painting.

Contact sensitivity to standard series allergens in 1038 patients with contact dermatitis in Turkey

We planned to determine the frequency of sensitivity to European standard patch test allergens in 1038 patients with contact dermatitis. From 1992 to 2004, 1038 patients with the diagnosis of contact dermatitis were patch tested with the European standard series. Seven hundred and five patients were female (67.9%) and 333 patients were male (32.1%). A total of 336 patients (32.3%) had one or more positive patch test reactions. The most common allergens were nickel (17.6%), cobalt chloride (5.3%), potassium dichromate (4.6%), neomycin (2.4%), fragrance mix (2.1%) and balsam of Peru (2.1%). Contact sensitivity to potassium dichromate and thiuram was significantly more frequent in male patients, whereas nickel and primin sensitivity was significantly more frequent in female patients. Higher sensitivity rates for potassium dichromate, neomycin, balsam of Peru, wool alcohol, fragrance mix and primin were noted in patients over 40 years of age. Sensitivity rates of the standard series allergens were all similar in atopic patients and in non-atopic patients. Metals, neomycin and fragrances are the leading allergens in Turkey. Although fragrances are among the most important sensitizers, sensitivity rates to fragrances and also to preservatives are much lower than the rates in Europe and the US.

Prognosis of contact dermatitis in epoxy resin workers

Between January 1993 and February 2002, 40 of 1354 (3%) workers who attended a tertiary referral occupational dermatology clinic were diagnosed with allergic contact dermatitis (ACD) from epoxy resin systems (ER). 20 of these patients were followed up at least 2 years post-diagnosis to establish prognosis. Characteristics collected at diagnosis, including age, atopic status and severity, were compared between the follow-up and not followed-up groups. No significant differences were observed. A clinician contacted patients and administered a telephone questionnaire based on variables identified from the literature, which were considered of importance for prognosis. All patients reported improvement of their skin condition since diagnosis. 12 of the 20 {60%[95% confidence interval (CI) 56-94%]} patients had applied for workers' compensation; all of these claims were successful. 16 had ceased working with ER. Of these, 9 [56% (95% CI 29-80%)] reported complete healing and 7 [44% (95% CI 19-70%)] reported ongoing dermatitis. Although no conclusions could be drawn because of the small sample size, factors that may be associated with a poor prognosis were age, atopy, duration of symptoms and severity at diagnosis. The prognosis of ACD from ER is not always favourable, even if a worker ceases exposure.

Allergic contact urticaria from natural rubber latex in healthcare and non-healthcare workers

To compare the prevalence of natural rubber latex (NRL) sensitization and allergic contact urticaria from NRL in healthcare and non-healthcare workers, we studied all 1171 patients who attended our clinic during 2001 and 2002. Prick testing for NRL and patch testing with European standard series were performed in all patients and an additional rubber series in those who had contact with rubber. Specific immunoglobulin E (IgE) levels against NRL and tropical fruits were measured when prick testing was positive. Sensitization to NRL (positive prick test and specific IgE levels) was much more common in healthcare workers than that in non-healthcare workers, 16.7 versus 2.3%. Among the non-healthcare workers, sensitization to NRL was more common in food handlers (17.1%), construction workers (6.6%), painters (6.2%), hairdressers (5.1%) and cleaners (3.8%). The difference in the prevalence of specific IgE to tropical fruits was not significant. Allergic contact urticaria from NRL was also much more frequent in healthcare workers, 71.4 versus 28.6%. In conclusion, sensitization to NRL and allergic contact urticaria from NRL are more common in healthcare workers, but this is a growing problem in non-healthcare workers and should be investigated in all workers with a history of NRL intolerance or who have contact with NRL.

Occupational skin disease in the construction industry

BACKGROUND

Construction workers have a substantial risk of developing irritant and/or allergic contact dermatitis. Unfortunately, however, there is little population-based epidemiological data relating to occupational skin diseases (OSD) in the European construction industry that allow assessment of preventive measures.

OBJECTIVES

In this investigation, the yearly incidence rates and causes of OSD in the construction industry were analysed on the basis of our register in Northern Bavaria.

METHODS

From 1990 until 1999, all incidences of OSD in the construction industry were recorded prospectively. This enables the calculation of incidence rates of OSD in relation to the employed population in Northern Bavaria as recorded by the German Federal Employment Office.

RESULTS

In the construction industry, a total of 335 OSD were registered. These comprise 9.0% of all OSD in the register. We classified them into four relevant groups: (A) tile setters and terrazzo workers (incidence per 10 000 employees = 19.9); (B) painters (7.8); (C) construction and cement workers (5.2); and (D) wood processors (2.6). The overall incidence was 5.1 per 10 000 employees over 10 years, which is a little below average for the entire register (6.7). Of these, 43.6% were at least 40 years old. Allergic contact dermatitis (61.5%) occurred more often than irritant contact dermatitis (44.5%). Potassium dichromate caused roughly half of all cases of sensitization found to be occupationally relevant in the construction industry (152 cases) followed by epoxy resin (40) and cobalt chloride (32).

CONCLUSIONS

The results indicate that potassium dichromate is still the most important allergen in the construction industry of Northern Bavaria; there has been no significant decline during the 1990s. This contrasts with the Scandinavian countries, where the prevalence of potassium dichromate sensitization declined following the reduction of chromium VI levels resulting from the addition of ferrous sulphate to cement. Within the construction industry, tile setters and terrazzo workers have a strikingly high incidence of OSD.

Latex allergy among construction workers

To assess the incidence of latex allergy in construction workers, we studied all the 230 construction workers who attended our clinic between 1996 and 2000. In the 54 (23.5%) patients who reported any kind of intolerance to rubber gloves or boots, we performed both patch testing with the TRUE Test standard series and a rubber series and prick testing for latex. Latex-specific IgE levels were measured when prick testing was positive. 16 patients (7.0%) had a positive prick test to latex, of whom 14 had allergic contact urticaria from latex (ACUL). All of these 14 patients (6.1%) showed 1 or more positive reactions to the True Test series, which included 1 or more rubber chemicals in 9 of them. The level of specific Ig E to latex was greater than 0.35 kU/L in 15 of the 16 patients. In conclusion, our data suggest that the incidence of latex allergic contact urticaria among construction workers may be as high as that among health care workers. Most of these construction workers with Type I latex hypersensitivity had a concurrent Type IV hypersensitivity to chromate or rubber chemicals, presenting as occupational allergic contact dermatitis, which could have facilitated sensitization to latex.

Diaminodiphenylmethane (DDM): frequency of sensitization, clinical relevance and concomitant positive reactions

Diaminodiphenylmethane (DDM) is an aromatic diamine used in the manufacture of rubber, plastics, diisocyanates, dyes and adhesives. It may cross-react with para-(amino)compounds. Allergic patch test reactions to DDM are relatively frequent, but their relevance is often difficult to detect. We report our experience in 6809 patients (4589 female, 2220 male, mean age 39.9+/-17.8 years) with suspected contact dermatitis patch tested during the period 1997-1999 by the North-East Italy Contact Dermatitis Group (NEICDG). A positive patch test to DDM was detected in 132 (1.9%) patients (88 female, 44 male, mean age 49.5+/-16.2 years). Eczema was mostly localized on the hands. The relevance was detected in 31 patients. A logistic regression analysis showed an association with patient's age (odds ratio 5.4 for age 30-59 years), absence of atopic diseases (odds ratio 3.1) and presence of leg ulcer (odds ratio 5). We found a highly significant correlation (p<0.001) between sensitivity to DDM and to para-phenylenediamine, Disperse Yellow 3, cobalt chloride, fragrance mix, benzocaine, paraben mix and primin. Positive patch test results to DDM were relatively frequent. The difficulty in detecting the relevance of these sensitizations may be related to the surprisingly high frequency of concomitant positive reactions to other allergens.

Occupational epoxy resin allergic contact dermatitis

Sixteen cases of occupational contact dermatitis to epoxy resins were seen over a 5-year period. All were men. Six cases worked in the construction industry, two worked as painters, two as engineers, two as car windscreen repairers, and one each worked in a timber yard, a car yard, on a farm and as a cane-furniture salesman. Most presented with rashes on their faces (56%), hands (50%) or arms (37%). Two patients were allergic to the reactive diluent phenyl glycidyl ether, and one was allergic to the epoxy hardener isophorone diamine. The rest were allergic to the epoxy resin itself. Outcome in this series was poor because most continued to be exposed to epoxy resins in their workplace environment.

Chromium allergy in consecutive patients in a country where ferrous sulfate has been added to cement since 1981

Cement eczema used to be a common occupational disease in Denmark. Since 1981, ferrous sulfate has been added to all cement produced in Denmark to reduce the amount of soluble hexavalent chromate to below 2 mg/kg (2 ppm). The aim of the study was to analyse a material of consecutive chromate-sensitive patients in an urban tertiary referral centre with respect to primary cause of sensitization, in a geographical area where the risk of chromate exposure from cement had been reduced. In the 6-year period January 1989 to December 1994, a total of 4511 patients were patch tested with the European standard series, including chromate. 79 patients, 31 male and 48 female, were diagnosed as chromate sensitive. Relevant chromate exposure was established in 34 of these 79 patients. Leather was the most frequent source of chromate sensitization (19 out of 34) (47%). Chromate sensitization from cement was considered likely in 10 out of 34 subjects. Of these, 7 had been sensitized before 1981, 2 had been sensitized by non-occupational exposure to cement, and only 1 had been sensitized from occupational cement exposure in the 6-year period.