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Rivers JK, Arlette JP, DeKoven J, Guenther LC, Muhn C, Richer V, Rosen N, Tremblay JF, Wiseman MC, Zip C, Zloty D. Skin care and hygiene among healthcare professionals during and after the SARS-CoV-2 pandemic. SAGE Open Med 2021; 9:20503121211062795. [PMID: 34917384 PMCID: PMC8669117 DOI: 10.1177/20503121211062795] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 11/08/2021] [Indexed: 12/23/2022] Open
Abstract
The severe acute respiratory syndrome coronavirus 2 pandemic has necessitated enhanced protection against viral transmission among healthcare professionals, particularly relating to handwashing and personal protective equipment. Some of these requirements may persist for years to come. They bring associated concerns around skin hygiene and general care, with damage to the face and hands now a well-documented consequence among healthcare professionals. This review assesses optimal skin care during the severe acute respiratory syndrome coronavirus 2 pandemic and in the "new normal" that will follow, identifies current knowledge gaps, and provides practical advice for the clinical setting. Regular, systematic hand cleaning with soap and water or an alcohol-based hand rub (containing 60%-90% ethanol or isopropyl alcohol) remains essential, although the optimal quantity and duration is unclear. Gloves are a useful additional barrier; further studies are needed on preferred materials. Moisturization is typically helpful and has proven benefits in mitigating damage from frequent handwashing. It may be best practiced using an alcohol-based hand rub with added moisturizer and could be particularly important among individuals with pre-existing hand dermatoses, such as psoriasis and eczema. Face moisturization immediately prior to donning a mask, and the use of dressings under the mask to reduce friction, can be helpful dermatologically, but more work is required to prove that these actions do not affect seal integrity. Nonetheless, such measures could play a role in institutional plans for mitigating the dermatologic impact of transmission control measures as we exit the pandemic.
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Affiliation(s)
- Jason K Rivers
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, BC, Canada
- Pacific Derm, Vancouver, BC, Canada
| | - John P Arlette
- Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Joel DeKoven
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Lyn C Guenther
- Division of Dermatology, Western University, London, ON, Canada
- Guenther Research Inc., London, ON, Canada
| | - Channy Muhn
- Division of Dermatology, Department of Medicine, McMaster University, Hamilton, ON, Canada
- Dermetics, Burlington, ON, Canada
| | - Vincent Richer
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, BC, Canada
- Pacific Derm, Vancouver, BC, Canada
| | | | | | - Marni C Wiseman
- Section of Dermatology, Department of Medicine, University of Manitoba, Winnipeg, MB, Canada
- Skinwise Dermatology, Winnipeg, MB, Canada
| | | | - David Zloty
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, BC, Canada
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Shane HL, Lukomska E, Weatherly L, Baur R, Anderson SE. Prior Exposure to Ortho-Phthalaldehyde Augments IgE-Mediated Immune Responses to Didecyldimethylammonium Chloride: Potential for 2 Commonly Used Antimicrobials to Synergistically Enhance Allergic Disease. Toxicol Sci 2021; 178:127-137. [PMID: 32647894 DOI: 10.1093/toxsci/kfaa112] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Health-care workers have an increased incidence of allergic disease compared with the general public and are exposed to a variety of high-level disinfectants. Although exposure to these agents has been associated with allergic disease, findings between epidemiology and animal studies often conflict respecting immunological mechanisms. Therefore, we hypothesized that previous exposure to a representative IgE-mediated sensitizer (ortho-phthalaldehyde [OPA]) alters immune responses to a representative T-cell-mediated sensitizer (didecyldimethlyammonium chloride [DDAC]). Here, BALB/c mice were topically exposed to OPA (0.5%) for 3 days, rested, then topically exposed to DDAC (0.0625%, 0.125%, and 0.25%) for 14 days. Coexposure resulted in phenotypic changes in draining lymph node (dLN) cells, including a decreased frequency of CD8+ T cells and increased frequency and number of B cells compared with DDAC-only treated mice. The coexposed mice also had enhanced Th2 responses, including significant alterations in: dLN Il4 (increased), B-cell activation (increased), CD8+ T-cell activation (decreased), and local and systemic IgE production (increased). These changes were not observed if mice were exposed to DDAC prior to OPA. Exposure to OPA alone shows Th2 skewing, indicated by increased activation of skin type 2 innate lymphoid cells, increased frequency and activation of draining lymph node B cells, and increased levels of type 2 cytokines. These findings suggest that the OPA-induced immune environment may alter the response to DDAC, resulting in increased IgE-mediated immune responses. This data may partially explain the discordance between epidemiological and laboratory studies regarding disinfectants and provide insight into the potential immunological implications of mixed chemical exposures.
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Affiliation(s)
- Hillary L Shane
- Allergy and Clinical Immunology Branch, Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Morgantown, West Virginia 26505
| | - Ewa Lukomska
- Allergy and Clinical Immunology Branch, Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Morgantown, West Virginia 26505
| | - Lisa Weatherly
- Allergy and Clinical Immunology Branch, Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Morgantown, West Virginia 26505
| | - Rachel Baur
- Allergy and Clinical Immunology Branch, Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Morgantown, West Virginia 26505
| | - Stacey E Anderson
- Allergy and Clinical Immunology Branch, Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Morgantown, West Virginia 26505
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Lee EB, Lobl M, Ford A, DeLeo V, Adler BL, Wysong A. What Is New in Occupational Allergic Contact Dermatitis in the Year of the COVID Pandemic? Curr Allergy Asthma Rep 2021; 21:26. [PMID: 33779825 PMCID: PMC8006117 DOI: 10.1007/s11882-021-01000-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2021] [Indexed: 12/17/2022]
Abstract
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. 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.
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Affiliation(s)
- Erica B Lee
- Department of Dermatology, University of Nebraska Medical Center, 985645 Nebraska Medical Center, Omaha, NE, 68198-5645, USA
| | - Marissa Lobl
- Department of Dermatology, University of Nebraska Medical Center, 985645 Nebraska Medical Center, Omaha, NE, 68198-5645, USA
| | - Aubree Ford
- Department of Dermatology, University of Nebraska Medical Center, 985645 Nebraska Medical Center, Omaha, NE, 68198-5645, USA
| | - Vincent DeLeo
- Department of Dermatology, Keck School of Medicine of University of Southern California, Los Angeles, CA, USA
| | - Brandon L Adler
- Department of Dermatology, Keck School of Medicine of University of Southern California, Los Angeles, CA, USA
| | - Ashley Wysong
- Department of Dermatology, University of Nebraska Medical Center, 985645 Nebraska Medical Center, Omaha, NE, 68198-5645, USA.
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Henning MAS, Jemec GB, Ibler KS. Occupational Skin Disease in Physicians: A Review of the Literature. Ann Work Expo Health 2021; 65:11-25. [PMID: 33009561 DOI: 10.1093/annweh/wxaa091] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 06/29/2020] [Accepted: 08/13/2020] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVES Occupational skin disease (OSD) arises from work-related activity. However, there is a paucity of literature on OSD in physicians. The aim of the this review was therefore to examine and summarize what types of symptomatic OSD physicians experience. METHODS We conducted a systematic literature search on Cochrane Library, Embase, and Pubmed. RESULTS Contact dermatitis from formaldehyde and glutaraldehyde were found in 11.5 and 13.5% of cases, respectively. In total 2.4-14.9% had latex allergy. The reported standardized incidence ratio of squamous cell carcinoma and melanoma was up to 2.15 [95% confidence interval (CI) 1.57-1.95] and 3.2 (95% CI 1.38-6.31). Transmission of human papilloma virus (HPV) particles during carbon dioxide laser wart ablation were found in 70% of samples collected from protective gloves and in 52% of samples from vapors. CONCLUSIONS The most frequently reported OSD in physicians is contact dermatitis from allergens in disinfectants and rubber gloves. There is also a risk of cutaneous reactions to latex. The incidence of skin cancer was higher in physicians than in the general population, and the reason for this remains unexplained and potentially biased. There are no reports of transmission of patient HPV to surgeons during wart ablation, possibly because of proper use of protective equipment.
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Affiliation(s)
- Mattias A S Henning
- Department of Dermatology, Zealand University Hospital, Faculty of Health and Medical Sciences, University of Copenhagen, Roskilde, Denmark
| | - Gregor B Jemec
- Department of Dermatology, Zealand University Hospital, Faculty of Health and Medical Sciences, University of Copenhagen, Roskilde, Denmark
| | - Kristina S Ibler
- Department of Dermatology, Zealand University Hospital, Faculty of Health and Medical Sciences, University of Copenhagen, Roskilde, Denmark
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Abstract
Health care workers may be at risk of occupational allergic contact dermatitis because of their frequent exposure to medical hand skin cleansers. We identified American Contact Dermatitis Society Core 80 Allergens found in medical hand skin cleansers (waterless skin soaps, water-needed skin soaps, and skin disinfectants) in the United States and developed a list of "low-allergen" medical hand skin cleansers. Waterless skin soaps most commonly contained fragrance, tocopherol, and sodium benzoate. Top allergens in water-needed skin soaps included fragrance, chloroxylenol, propylene glycol, and cocamidopropyl betaine. The most common allergens identified in skin disinfectants were chlorhexidine, cocamide diethanolamine, and fragrance. We identified 11 waterless skin soaps that were free of American Contact Dermatitis Society Core 80 Allergens. Low-allergen products were also identified for water-needed skin soaps (2 products) and skin disinfectants (4 products). This information is accurate as of the date of publication; product availability and ingredients may change over time.
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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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Occupationally Related Nickel Reactions: A Retrospective Analysis of the North American Contact Dermatitis Group Data 1998-2016. Dermatitis 2020; 30:306-313. [PMID: 31524759 DOI: 10.1097/der.0000000000000516] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND The epidemiology of nickel allergy in occupational settings is not well understood. OBJECTIVE The aim of the study was to characterize occupationally related nickel allergy (ORNA). METHODS This is a retrospective cross-sectional analysis of 44,378 patients patch tested by the North American Contact Dermatitis Group from 1998 to 2016. Characteristics of individuals with ORNA were compared with those with non-ORNA (NORNA). RESULTS A total of 7928 (18.2%) individuals were positive to nickel sulfate 2.5%. Two hundred sixty-eight (3.4%) had ORNA. As compared with NORNA, ORNA was statistically associated with the male sex (41.0% vs 12.9%, P < 0.001), a diagnosis of irritant contact dermatitis (22.4% vs 12.0%, P < 0.001), and no history of eczema (81.7% vs 75.7%, P = 0.0217). The most common sites of ORNA dermatitis were hand (39.9%) and arm (18.1%), which were significantly more common than in NORNA (P < 0.0001). Sixteen industry categories and 22 occupation categories were identified for ORNA; the most common industries were durable goods manufacturing (24.6%) and personal services (15.7%), and the most frequent occupations were hairdressers/cosmetologists/barbers (14.3%), machine operators (9.3%), and health care workers (7.1%). Overall 30% of ORNA occupations were in metalworking. Of 215 ORNA sources identified, instruments/phones/other equipment (16.3%), vehicles/machinery (15.8%), and tools (15.3%) were the most common. CONCLUSIONS Occupational nickel allergy is distinct from nonoccupational nickel allergy.
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Abstract
PURPOSE OF REVIEW The purpose of this review is to provide an update on occupational contact dermatitis including gaps in knowledge and practice. Occupational contact dermatitis is the most common occupational skin disease. RECENT FINDINGS New sources of exposure for known allergens and new allergens are continually being reported. Through clinical databases and surveillance systems, effects of prevention efforts or introduction of new allergens or new uses of known allergens can be monitored. Though the diagnostic process is clear, there are delays in workers seeking care. As early detection and intervention improves outcomes, screening should be implemented. Gaps in primary prevention in the workplace are identified and should be addressed to reduce the burden of disease. Surveillance systems support the prevention mandate. Understanding limitations of our knowledge and identifying gaps in practice can lead to initiatives to address research and practice needs and improve prevention of occupational dermatoses.
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Affiliation(s)
- Dorothy Linn Holness
- Dalla Lana School of Public Health and Department of Medicine, University of Toronto, Toronto, Canada. .,Division of Occupational Medicine, Department of Medicine, St Michael's Hospital, 30 Bond St., Toronto, ON, M5B 1W8, Canada. .,MAP Centre for Urban Health Solutions, St Michael's Hospital, Li Ka Shing Knowledge Institute, Toronto, Canada.
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Anderson SE, Weatherly L, Shane HL. Contribution of antimicrobials to the development of allergic disease. Curr Opin Immunol 2019; 60:91-95. [PMID: 31185370 DOI: 10.1016/j.coi.2019.05.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 05/07/2019] [Indexed: 12/26/2022]
Abstract
Antimicrobials represent a broad class of chemicals with the intended purpose of eliminating or controlling the growth of harmful microorganisms. Exposure can occur occupationally or through the use or consumption of consumer products. The use of antimicrobial agents has been associated with an increased incidence of allergic diseases, including asthma, atopic dermatitis, and less commonly, anaphylaxis. Very diverse immunological mechanisms and mediators have been identified in the sensitization response to antimicrobial chemicals and the importance of the local microenviroment in the response is increasingly being recognized. A complete understanding of the mechanisms of allergic diseases resulting from antimicrobial exposure will help to ensure safe environments and exposure limits.
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Affiliation(s)
- Stacey E Anderson
- National Institute of Occupational Safety and Health, Health Effects Laboratory Division, Allergy and Clinical Immunology Branch, Morgantown, WV, 26508, United States.
| | - Lisa Weatherly
- National Institute of Occupational Safety and Health, Health Effects Laboratory Division, Allergy and Clinical Immunology Branch, Morgantown, WV, 26508, United States
| | - Hillary L Shane
- National Institute of Occupational Safety and Health, Health Effects Laboratory Division, Allergy and Clinical Immunology Branch, Morgantown, WV, 26508, United States
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Hamnerius N, Svedman C, Bergendorff O, Björk J, Bruze M, Engfeldt M, Pontén A. Hand eczema and occupational contact allergies in healthcare workers with a focus on rubber additives. Contact Dermatitis 2018; 79:149-156. [PMID: 29923205 DOI: 10.1111/cod.13042] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 05/01/2018] [Accepted: 05/03/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Hand eczema (HE) in healthcare workers (HCWs) is common. Besides wet work, healthcare work also implies exposure to contact allergens. OBJECTIVES To assess HE and contact allergy related to occupational exposures in HCWs. METHODS In a cross-sectional study, 311 HCWs with HE within the preceding 12 months and a control group of 114 HCWs without HE were investigated with the baseline series and a special patch test series based on substances found in the gloves, soaps, alcoholic hand disinfectants and hand creams provided at the hospitals. RESULTS Contact allergy to rubber additives was significantly more common in HCWs with HE (6%) than in HCWs without HE (1%, P = .02). The corresponding percentages for fragrances were 11% and 3%, respectively (P = .004). Occupational HE was found in 193 of 311 (62%) HCWs. Of these, 22 of 193 (11%) had occupational allergic contact dermatitis, including 17 with glove-related rubber contact allergy. Contact allergy to diphenylguanidine was as common as contact allergy to thiurams. Occupational contact allergy to rubber additives was significantly associated with sick-leave related to HE. CONCLUSION Contact allergy to rubber additives in medical gloves is the most common cause of occupational allergic contact dermatitis in HCWs. Aimed patch testing with relevant rubber additives is mandatory when HE in HCWs is investigated.
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Affiliation(s)
- Nils Hamnerius
- Department of Occupational and Environmental Dermatology, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Cecilia Svedman
- Department of Occupational and Environmental Dermatology, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Ola Bergendorff
- Department of Occupational and Environmental Dermatology, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Jonas Björk
- Department of Occupational and Environmental Medicine, Lund University, Lund, Sweden
- Clinical Studies Sweden, Forum South, Skåne University Hospital, Lund, Sweden
| | - Magnus Bruze
- Department of Occupational and Environmental Dermatology, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Malin Engfeldt
- Department of Occupational and Environmental Dermatology, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Ann Pontén
- Department of Occupational and Environmental Dermatology, Lund University, Skåne University Hospital, Malmö, Sweden
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Patient Reported Improvement After Patch Testing and Allergen Avoidance Counseling: A Retrospective Analysis. Dermatol Ther (Heidelb) 2018; 8:435-440. [PMID: 29987683 PMCID: PMC6109020 DOI: 10.1007/s13555-018-0250-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Indexed: 11/08/2022] Open
Abstract
Introduction Our objectives were to assess patient-reported improvement after patch testing at the 2–3-month follow-up visit in patients referred for patch testing with relevant positive patch test reactions at the University of California, San Francisco. Methods Cross-sectional analyses of patients patch tested between 2013 and 2016 who returned for a follow-up visit approximately 2–3 months after patch testing. We examined positive patch test results considered of definite, probable or possible relevance to the patient’s eczematous eruptions. Patients reported improvement after patch testing as a percentage: 0–100%. Patients were categorized into four groups: (1) those that reported no improvement or worsened, (2) those that reported > 0% and ≤ 60% improvement, (3) those that reported > 60% but < 100% improvement and (4) those that reported 100% improvement. Secondary measures included the association of allergens, gender, age and location of the rash. Results The majority (81%) of patients seen at follow-up reported improvement after patch testing. Women reported more improvement than men with statistical significance. Notably, there does not appear to be a statistically significant relationship in patient-reported improvement and age, atopy, strength of a the patient’s positive reactions, number of positive reactions and follow-up time or with potential systemic contact allergens (i.e., balsam of Peru, nickel, chrome and cobalt). Conclusion We find the large percentage of patients that self-report global benefit from patch testing encouraging, as we believe this to be a powerful measure of disease and symptom activity, as well as quality of life. The gender differences we found contradict the previous literature.
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Shane HL, Lukomska E, Stefaniak AB, Anderson SE. Divergent hypersensitivity responses following topical application of the quaternary ammonium compound, didecyldimethylammonium bromide. J Immunotoxicol 2018; 14:204-214. [PMID: 29124973 PMCID: PMC6391722 DOI: 10.1080/1547691x.2017.1397826] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Didecyldimethylammonium bromide (DDAB) is a fourth generation dialkyl-quaternary ammonium compound (QAC) that is used in numerous products for its antimicrobial properties. While many QACs have been associated with allergic disease, the toxicity and sensitization of DDAB have not been thoroughly investigated. The purpose of these studies was to evaluate the irritancy and sensitization potential of DDAB following dermal application in a murine model. DDAB induced significant irritancy (0.0625-2%), evaluated by ear swelling in female BALB/c mice. Initial evaluation of the sensitization potential was conducted using the local lymph node assay (LLNA) at concentrations ranging from 0.0625% to 2%. A concentration-dependent increase in lymphocyte proliferation was observed with a calculated EC3 value of 0.057%. Immune cell phenotyping along with local and systemic IgE levels were evaluated following 4 and 14 days of dermal application. Phenotypic analyses revealed significant and dose-responsive increases in the absolute number of B-cells, CD4+ T-cells, CD8+ T-cells, and dendritic cells in the draining lymph nodes (DLNs) following 4 and 14 days of dermal exposure with significant increases in the number of activated B-cells and dendritic cells. However, increased activation of CD4+ T-cell and CD8+ T-cells was only observed following four days of DDAB exposure. Exposure to DDAB also induced increased production of IgE as evaluated by phenotypic analysis of DLN B-cells (IgE+ B-cells) and measurement of total serum IgE levels following 14 days but not four days of dermal application. Significant increases in gene expression were observed in the DLN (Il-4, Il-10, and ox40l) and ear (tslp) following 4 and 14 days of DDAB exposure. These results demonstrate the potential for development of irritation and hypersensitivity responses to DDAB following dermal exposure and raise concerns about the effects of exposure duration on hypersensitivity responses.
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Affiliation(s)
- Hillary L Shane
- a Health Effects Laboratory Division , National Institute for Occupational Safety and Health , Morgantown , WV , USA
| | - Ewa Lukomska
- a Health Effects Laboratory Division , National Institute for Occupational Safety and Health , Morgantown , WV , USA
| | - Aleksandr B Stefaniak
- b Respiratory Health Division , National Institute for Occupational Safety and Health , Morgantown , WV , USA
| | - Stacey E Anderson
- a Health Effects Laboratory Division , National Institute for Occupational Safety and Health , Morgantown , WV , USA
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Contact Dermatitis Associated With Skin Cleansers: Retrospective Analysis of North American Contact Dermatitis Group Data 2000–2014. Dermatitis 2018; 29:32-42. [DOI: 10.1097/der.0000000000000330] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Burnett CL. Glutaral. Int J Toxicol 2017; 36:28S-30S. [PMID: 29025344 DOI: 10.1177/1091581817716646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Christina L Burnett
- 1 Senior Scientific Writer/Analyst, Cosmetic Ingredient Review, Washington, DC, USA
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Anderson S, Long C, Dotson GS. Occupational Allergy. EUROPEAN MEDICAL JOURNAL 2017. [DOI: 10.33590/emj/10311285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
An estimated 11 million workers in the USA are potentially exposed to agents that can become a cause of allergic diseases such as occupational asthma and allergic contact dermatitis, which can adversely affect health and well-being. Hundreds of chemicals (e.g. metals, epoxy and acrylic resins, rubber additives, and chemical intermediates) and proteins (e.g. natural rubber latex, plant proteins, mould, animal dander) present in virtually every industry have been identified as causes of allergic disease. In general, allergens can be classified as low molecular weight (chemical) allergens and high molecular weight (protein) allergens. These agents are capable of inducing immunological responses that are both immunoglobulin E and non-immunoglobulin E-mediated. Interestingly, the same chemical can induce diverse immune responses in different individuals. As new hazards continue to emerge, it is critical to understand the immunological mechanisms of occupational allergic disease. Specific understanding of these mechanisms has direct implications in hazard identification, hazard communication, and risk assessment. Such efforts will ultimately assist in the development of risk management strategies capable of controlling workplace exposures to allergens to prevent the induction of sensitisation in naïve individuals and inhibit elicitation of allergic responses. The purpose of this short review is to give a brief synopsis of the incidence, agents, mechanisms, and research needs related to occupational allergy.
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Affiliation(s)
- Stacey Anderson
- Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Morgantown, West Virginia, USA
| | - Carrie Long
- Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Morgantown, West Virginia, USA
| | - G. Scott Dotson
- Education and Information Division, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Cincinnati, Ohio, USA
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Higgins CL, Palmer AM, Cahill JL, Nixon RL. Occupational skin disease among Australian healthcare workers: a retrospective analysis from an occupational dermatology clinic, 1993-2014. Contact Dermatitis 2016; 75:213-22. [PMID: 27436328 DOI: 10.1111/cod.12616] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Revised: 04/17/2016] [Accepted: 04/19/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Healthcare workers (HCWs) are at risk of developing occupational skin disease (OSD). OBJECTIVES To ascertain the causes of OSD in Australian HCWs in a tertiary referral clinic. METHODS A retrospective review was performed of patients assessed at the Occupational Dermatology Clinic in Melbourne from 1993 to 2014. RESULTS Of 685 HCWs assessed in the clinic over a period of 22 years, 555 (81.0%) were diagnosed with OSD. The most common diagnosis was irritant contact dermatitis (ICD) (79.1%), followed by allergic contact dermatitis (ACD) (49.7%). Natural rubber latex allergy was also relatively frequent (13.0%). The major substances causing ACD were rubber glove chemicals (thiuram mix and tetraethylthiuram disulfide), preservatives (formaldehyde, formaldehyde releasers, and isothiazolinones), excipients in hand cleansers, which are hard-to-avoid weak allergens, and antiseptics. ACD caused by commercial hand cleansers occurred more frequently than ACD caused by alcohol-based hand rubs (ABHRs). Occupational ICD was mostly caused by water/wet work and hand cleansers, and environmental irritants such as heat and sweating. CONCLUSIONS Understanding the causes of OSD in HCWs is important in order to develop strategies for prevention. We suggest that skin care advice should be incorporated into hand hygiene education. The use of ABHRs should be encouraged, weak allergens in skin cleansers should be substituted, and accelerator-free gloves should be recommended for HCWs with OSD.
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Affiliation(s)
- Claire L Higgins
- Occupational Dermatology Research and Education Centre, Skin and Cancer Foundation Inc., Carlton, Victoria, 3053, Australia.
| | - Amanda M Palmer
- Occupational Dermatology Research and Education Centre, Skin and Cancer Foundation Inc., Carlton, Victoria, 3053, Australia
| | - Jennifer L Cahill
- Occupational Dermatology Research and Education Centre, Skin and Cancer Foundation Inc., Carlton, Victoria, 3053, Australia
| | - Rosemary L Nixon
- Occupational Dermatology Research and Education Centre, Skin and Cancer Foundation Inc., Carlton, Victoria, 3053, Australia
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Anderson SE, Shane H, Long C, Lukomska E, Meade BJ, Marshall NB. Evaluation of the irritancy and hypersensitivity potential following topical application of didecyldimethylammonium chloride. J Immunotoxicol 2016; 13:557-66. [PMID: 27216637 DOI: 10.3109/1547691x.2016.1140854] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Didecyldimethylammonium chloride (DDAC) is a dialkyl-quaternary ammonium compound that is used in numerous products for its bactericidal, virucidal and fungicidal properties. There have been clinical reports of immediate and delayed hypersensitivity reactions in exposed individuals; however, the sensitization potential of DDAC has not been thoroughly investigated. The purpose of these studies was to evaluate the irritancy and sensitization potential of DDAC following dermal exposure in a murine model. DDAC induced significant irritancy (0.5 and 1%), evaluated by ear swelling in female Balb/c mice. Initial evaluation of the sensitization potential was conducted using the local lymph node assay (LLNA) at concentrations ranging from 0.0625-1%. A concentration-dependent increase in lymphocyte proliferation was observed with a calculated EC3 value of 0.17%. Dermal exposure to DDAC did not induce increased production of IgE as evaluated by phenotypic analysis of draining lymph node B-cells (IgE (+) B220(+)) and measurement of total serum IgE levels. Additional phenotypic analyses revealed significant and dose-responsive increases in the absolute number of B-cells, CD4 (+) T-cells, CD8 (+) T-cells and dendritic cells in the draining lymph nodes, along with significant increases in the percentage of B-cells (0.25% and 1% DDAC) at Day 10 following 4 days of dermal exposure. There was also a significant and dose-responsive increase in the number of activated CD44 (+) CD4 (+) and CD8 (+) T-cells and CD86 (+) B-cells and dendritic cells following exposure to all concentrations of DDAC. These results demonstrate the potential for development of irritation and hypersensitivity responses to DDAC following dermal exposure and raise concerns about the use of this chemical and other quaternary ammonium compounds that may elicit similar effects.
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Affiliation(s)
- Stacey E Anderson
- a Health Effects Laboratory Division , National Institute for Occupational Safety and Health , Morgantown , WV , USA
| | - Hillary Shane
- a Health Effects Laboratory Division , National Institute for Occupational Safety and Health , Morgantown , WV , USA
| | - Carrie Long
- a Health Effects Laboratory Division , National Institute for Occupational Safety and Health , Morgantown , WV , USA
| | - Ewa Lukomska
- a Health Effects Laboratory Division , National Institute for Occupational Safety and Health , Morgantown , WV , USA
| | - B Jean Meade
- a Health Effects Laboratory Division , National Institute for Occupational Safety and Health , Morgantown , WV , USA
| | - Nikki B Marshall
- a Health Effects Laboratory Division , National Institute for Occupational Safety and Health , Morgantown , WV , USA
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Occupational dermatitis in health care workers evaluated for suspected allergic contact dermatitis. Dermatitis 2015; 26:177-83. [PMID: 26172487 DOI: 10.1097/der.0000000000000124] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Contact dermatitides occur commonly among health care workers (HCWs). OBJECTIVE To contrast the atopic status and incidence, location, and final diagnosis of skin diseases afflicting HCWs versus non-HCWs (NHCWs) evaluated for suspicion of allergic contact dermatitis (ACD); and among the population diagnosed with ACD, to compare the incidence and occupational relatedness of allergens found in HCWs with the rates observed in NHCWs. METHODS Between July 1, 1994, and May 30, 2014, 2611 patients underwent patch testing by the senior author. Of these, 165 were classified as HCWs based on their primary occupation. Statistical analysis was done using a χ test. RESULTS Health care workers were more likely than NHCWs to be women and to have hand dermatitis. Women, but not men, HCWs suffered more irritant contact dermatitis. Health care workers had significantly more work-related ACD, especially to formaldehyde, quaternium-15, 2-bromo-2-nitropropane-1,3-diol, cocamide diethanolamine (DEA), thiuram mix, carba mix, thimerosal, benzalkonium chloride, glutaraldehyde, and bacitracin. LIMITATIONS Only patients suspected of having ACD were tested. Our population was geographically limited to metropolitan Kansas City, MO and metropolitan New York, NY. CONCLUSIONS Health care workers suffer more from occupational ACD, especially of the hands, than do NHCWs, including to allergens not present on available standard allergen series.
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Abstract
BACKGROUND Health care workers (HCWs) are at increased risk of irritant contact dermatitis due to frequent hand washing and use of alcohol gel. This has increased the incidence of occupational skin diseases. AIMS To evaluate hand dermatitis in HCWs in our hospital by means of a survey which also examined trends of exposure and the utility of patch testing. METHODS HCWs diagnosed with hand dermatitis in our contact dermatitis clinic from January 2011 to July 2012 were included. Information was collected retrospectively from medical notes, computer records and the database of the British Cutaneous Allergy Society. RESULTS A total of 69 HCWs were diagnosed with hand dermatitis, with a prevalence of ~4%. The majority were female and the clinical areas in which they worked were diverse. About 98% (68) had irritant contact dermatitis, and hand washing was the commonest cause of symptoms. About 75% (51) had irritant dermatitis exclusively. Patch test was positive in 42% with the commonest reaction to nickel, followed by formaldehyde. Associated atopy was found in less than half of the cases. CONCLUSIONS Irritant hand dermatitis is prevalent in HCWs in this setting. Patch testing is useful to identify any additional allergic element in such cases.
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Affiliation(s)
- M Malik
- Derby Teaching Hospitals NHS Foundation Trust, London Road Community Hospital, London Road, Derby DE1 2QY, UK,
| | - J English
- Circle, NHS Treatment Centre, Nottingham NG7 2FT, UK
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Abstract
Fragrances are a common cause of allergic contact dermatitis in Europe and in North America. They can affect individuals at any age and elicit a spectrum of reactions from contact urticaria to systemic contact dermatitis. Growing recognition of the widespread use of fragrances in modern society has fueled attempts to prevent sensitization through improved allergen identification, labeling, and consumer education. This review provides an overview and update on fragrance allergy. Part 1 discusses the epidemiology and evaluation of suspected fragrance allergy. Part 2 reviews screening methods, emerging fragrance allergens, and management of patients with fragrance contact allergy. This review concludes by examining recent legislation on fragrances and suggesting potential additions to screening series to help prevent and detect fragrance allergy.
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Anderson SE, Meade BJ. Potential health effects associated with dermal exposure to occupational chemicals. ENVIRONMENTAL HEALTH INSIGHTS 2014; 8:51-62. [PMID: 25574139 PMCID: PMC4270264 DOI: 10.4137/ehi.s15258] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Revised: 11/03/2014] [Accepted: 11/04/2014] [Indexed: 05/14/2023]
Abstract
There are a large number of workers in the United States, spanning a variety of occupational industries and sectors, who are potentially exposed to chemicals that can be absorbed through the skin. Occupational skin exposures can result in numerous diseases that can adversely affect an individual's health and capacity to perform at work. In general, there are three types of chemical-skin interactions of concern: direct skin effects, immune-mediated skin effects, and systemic effects. While hundreds of chemicals (metals, epoxy and acrylic resins, rubber additives, and chemical intermediates) present in virtually every industry have been identified to cause direct and immune-mediated effects such as contact dermatitis or urticaria, less is known about the number and types of chemicals contributing to systemic effects. In an attempt to raise awareness, skin notation assignments communicate the potential for dermal absorption; however, there is a need for standardization among agencies to communicate an accurate description of occupational hazards. Studies have suggested that exposure to complex mixtures, excessive hand washing, use of hand sanitizers, high frequency of wet work, and environmental or other factors may enhance penetration and stimulate other biological responses altering the outcomes of dermal chemical exposure. Understanding the hazards of dermal exposure is essential for the proper implementation of protective measures to ensure worker safety and health.
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Affiliation(s)
- Stacey E Anderson
- National Institute for Occupational Safety and Health, Morgantown, WV, USA
| | - B Jean Meade
- National Institute for Occupational Safety and Health, Morgantown, WV, USA
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Occupationally related contact dermatitis in North American food service workers referred for patch testing, 1994 to 2010. Dermatitis 2013; 24:22-8. [PMID: 23340395 DOI: 10.1097/der.0b013e31827b14e1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Contact dermatoses are common in food service workers (FSWs). OBJECTIVES This study aims to (1) determine the prevalence of occupationally related contact dermatitis among FSWs patch tested by the North American Contact Dermatitis Group (NACDG) and (2) characterize responsible allergens and irritants as well as sources. METHODS Cross-sectional analysis of patients patch tested by the NACDG, 1994 to 2010, was conducted. RESULTS Of 35,872 patients patch tested, 1237 (3.4%) were FSWs. Occupationally related skin disease was significantly more common in FSWs when compared with employed non-FSWs. Food service workers were significantly more likely to have hand (P < 0.0001) and arm (P < 0.0006) involvement. The rates for irritant and allergic contact dermatitis in FSWs were 30.6% and 54.7%, respectively. Although the final diagnosis of irritant contact dermatitis was statistically higher in FSWs as compared with non-FSWs, allergic contact dermatitis was lower in FSWs as compared with non-FSWs. The most frequent currently relevant and occupationally related allergens were thiuram mix (32.5%) and carba mix (28.9%). Gloves were the most common source of responsible allergens. The NACDG standard tray missed at least 1 occupationally related allergen in 38 patients (4.3%). CONCLUSIONS Among FSWs patch tested by the NACDG between 1994 and 2010, the most common allergens were thiuram mix and carba mix. Gloves were the most common source of responsible allergens.
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Shoimer I, Pratt M. Allergic contact dermatitis to medical equipment in a non-health care worker caring for a disabled spouse. J Cutan Med Surg 2013; 17:207-11. [PMID: 23673305 DOI: 10.2310/7750.2013.12113] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Allergic contact dermatitis (ACD) to rubber accelerators is a common occurrence, especially in health care workers, but the risks in family caregivers are not as well documented. OBJECTIVE To document a case of a 66-year-old woman who developed recurrent, extensive flares of ACD from contact with rubber accelerators through caregiving. METHOD AND RESULTS Patch testing revealed a positive reaction to two common rubber accelerators: carba mix (3+) and thiuram mix (3+). The patient described caring for her disabled husband, which involved handling rubberized medical equipment. CONCLUSION Physicians should appreciate ACD in non-health care workers caused by rubber accelerators found in medical equipment. Individuals providing care for sick or elderly relatives should be further questioned on exposure to a hospital environment and contact with medical equipment.
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Geier J, Lessmann H, Krautheim A, Fuchs T. Airborne allergic contact dermatitis caused by didecyldimethylammonium chloride in a geriatric nurse. Contact Dermatitis 2013; 68:123-5. [DOI: 10.1111/cod.12013] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Pontén A, Hamnerius N, Bruze M, Hansson C, Persson C, Svedman C, Thörneby Andersson K, Bergendorff O. Occupational allergic contact dermatitis caused by sterile non-latex protective gloves: clinical investigation and chemical analyses. Contact Dermatitis 2012. [DOI: 10.1111/cod.12010] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Arrandale VH, Kudla I, Kraut AG, Scott JA, Tarlo SM, Redlich CA, Holness DL. Skin and respiratory symptoms among workers with suspected work-related disease. Occup Med (Lond) 2012; 62:420-6. [DOI: 10.1093/occmed/kqs133] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Bernier M, Bernal-Ruiz A, Rivas-Ruiz F, Fernández-Morano M, de Troya-Martín M. Sensibilización de contacto a alérgenos de la serie estándar en el Hospital Costa del Sol: Estudio retrospectivo (2005-2010). ACTAS DERMO-SIFILIOGRAFICAS 2012; 103:223-8. [DOI: 10.1016/j.ad.2011.07.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2011] [Revised: 06/29/2011] [Accepted: 07/10/2011] [Indexed: 11/27/2022] Open
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32
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Contact Sensitization to Allergens in the Spanish Standard Series at Hospital Costa del Sol in Marbella, Spain: A Retrospective Study (2005–2010). ACTAS DERMO-SIFILIOGRAFICAS 2012. [DOI: 10.1016/j.adengl.2011.07.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Ni C, Dou X, Chen J, Zhu X, Liu L. Contact Sensitization in Chinese Patients with Hand Eczema. Dermatitis 2011. [DOI: 10.2310/6620.2011.10123] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Ngo MA, Maibach HI. Dermatotoxicology: Historical perspective and advances. Toxicol Appl Pharmacol 2010; 243:225-38. [DOI: 10.1016/j.taap.2009.12.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2009] [Revised: 12/04/2009] [Accepted: 12/07/2009] [Indexed: 10/20/2022]
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Abstract
Hand dermatitis is a common disease of the skin resulting in significantly decreased quality of life. Allergic contact dermatitis is a frequent cause of hand dermatitis. Recent studies have revealed that biocides used as preservatives are frequent allergens affecting the hands. This article reviews common biocides implicated in hand dermatitis.
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Current World Literature. Curr Opin Allergy Clin Immunol 2009; 9:574-8. [DOI: 10.1097/aci.0b013e328333c13c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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38
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Zug KA, Warshaw EM, Fowler JF, Maibach HI, Belsito DL, Pratt MD, Sasseville D, Storrs FJ, Taylor JS, Mathias TC, DeLeo VA, Rietschel RL. Patch-Test Results of the North American Contact Dermatitis Group 2005-2006. Dermatitis 2009. [DOI: 10.2310/6620.2009.08097] [Citation(s) in RCA: 212] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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