Threshold for occluded formaldehyde patch test in formaldehyde-sensitive patients

Our purpose was to investigate the eliciting threshold concentration of formaldehyde in formaldehyde-sensitive individuals in the occluded and non-occluded patch teat and to evaluate the relationship in repeated open application test (ROAT) with a product containing a formaldehyde releaser. 20 formaldehyde-sensitive patients and a control group of 20 healthy volunteer were included in the study. Occluded and non-occluded patch tests with formaldehyde solutions form 25 to 10,000 ppm. and ROAT for I week with a leave-on cosmetic product containing on average 300 ppm formaldehyde. Were carried out simultaneously on each subject. In the occluded patch test. 1/2 of the 20 patients only reacted to 10,000 ppm formaldehyde. 9 reacted to 5,000 ppm. 3 reacted to 1.000 ppm. 2 reacted to 500 ppm and I reacted to 25 ppm. No definite positive reactions were observed in the non-occluded patch test or in the ROAT No positive reactions were observed in the control group to any of the test procedures. We concluded that the threshold concentration for occluded patch test to formaldehyde in formaldehyde-sensitive patients was 250 ppm. The threshold in occluded patch test corresponded to the degree of sensitivity Definite positive reactions in the ROAT were not seen, either indicating that they are unlikely to happen with the type of product used or that the exposure time was too short.     

Self-reported occupational skin contact with cleaning agents and the risk of disability pension

Background:  Occupational skin diseases often affect the hands and can lead to consequences at both the individual and the social level.
Objectives:  To investigate and quantify the association between self-reported occupational skin contact with cleaning agents and subsequent transition to disability pension.
Methods:  A sample of 8337 employees between 18 and 59 years of age participated in the Danish Work Environment Cohort Study in 1990, 1995, or 2000. They were followed up regarding disability pension until 2006 using the DREAM register on social transfer payments for all inhabitants in Denmark. The Cox proportional hazards model was used to estimate the impact of occupational exposure to cleaning agents on subsequent disability pension.
Results:  Among women, 11% of the disability pension cases were attributable to exposure to cleaning agents and/or disinfectants.
Conclusions:  The study suggests a potential for prevention of work-related disabilities among job groups exposed to cleaning agents.     

Editorial

This is the second part of a review article on formaldehyde‐releasers used as durable press chemical finishes (DPCF) in textiles. The early finishes contained large amounts of free formaldehyde, which led to many cases of allergic contact dermatitis to clothes in the 1950s and 1960s. Currently, most finishes are based on modified dimethylol dihydroxyethyleneurea, which releases less formaldehyde. Nevertheless, recent studies in the United States and Israel have identified patients reacting to DPCF, considered to have allergic contact reactions to clothes, either from formaldehyde released by the DPCF therein or from the DPCF per se (in patients negative to formaldehyde). However, all studies had some weaknesses in design or interpretation and in not a single case has the clinical relevance been proven. The amount of free formaldehyde in most garments will likely be below the threshold for the elicitation of dermatitis for all but the most sensitive patients. The amount of free cyclized urea DPCF in clothes is unlikely to be high enough to cause sensitization. Patch test reactions to formaldehyde‐releasing DPCF will in most cases represent a reaction to formaldehyde released from the test material.     

Contact allergy to preservatives in patients with occupational contact dermatitis and exposure analysis of preservatives in registered chemical products for occupational use

Purpose

The aim of the study is to investigate risk factors for sensitization to preservatives and to examine to which extent different preservatives are registered in chemical products for occupational use in Denmark.

Methods

A retrospective epidemiological observational analysis of data from a university hospital was conducted. All patients had occupational contact dermatitis and were consecutively patch tested with 11 preservatives from the European baseline series and extended patch test series during a 5-year period: 2009–2013. Information regarding the same preservatives in chemical products for occupational use (‘substances and materials’) registered in the Danish Product Register Database (PROBAS) was obtained.

Results

The frequency of preservative contact allergy was 14.2% (n?=?141) in 995 patients with occupational contact dermatitis. Patients with preservative contact allergy had significantly more frequently facial dermatitis (19.9 versus 13.1%) and age?>?40 years (71.6 versus 45.8%) than patients without preservative contact allergy, whereas atopic dermatitis was less frequently observed (12.1 versus 19.8%). Preservative contact allergy was more frequent in painters with occupational contact dermatitis as compared to non-painters with occupational contact dermatitis (p?<?0.001). This was mainly caused by contact allergy to methylisothiazolinone and contact allergy to formaldehyde. Analysis of the registered substances and materials in PROBAS revealed that preservatives occurred in several product categories, e.g., ‘paints and varnishes’, ‘cleaning agents’, ‘cooling agents’, and ‘polishing agents’. Formaldehyde and isothiazolinones were extensively registered in PROBAS.

Conclusions

The extensive use of formaldehyde and isothiazolinones in chemical products for occupational use may be problematic for the worker. Appropriate legislation, substitution, and employee education should be prioritized.

     

Preservatives in registered chemical products

Preservatives are common causes of contact allergy and contact dermatitis. Exposure to cosmetics, personal care products, consumer products and occupationally used products often involve contact with the same range of preservatives. The aim of this study is to provide an overview on the occurrence of preservatives in registered chemical products. The studied preservatives included substances from standard patch test series and other preservatives relevant for registered chemical products. Data obtained from the Danish Product Register Database (PROBAS) in January 2005 were compared to similar data from January 2002. Paints/lacquers, cleaning agents and printing inks were the most frequently registered product categories, and the studied preservatives were registered in most of the product categories included in the study. For most product categories the total number of registered products was stable during the study period. Butylated hydroxytoluene, benzoic acid, isothiazolinones, Bronopol and formaldehyde showed an increase from 2002 to 2005. Most of these changes occurred in the product category paints/lacquers, for which a doubling mainly due to a change in registration practice was observed. The frequent registration of isothiazolinones (MCI/MI and benzisothiazolinone) in paints/lacquers may be a possible explanation for the relative high and stable frequency of positive patch test reactions to MCI/MI.     

P55Nordic Occupational Skin Questionnaire (NOSQ‐2002)

Questionnaire‐tools for surveying occupational skin diseases and exposure are needed for comparable epidemiological research, workplace assessments, and evaluation of workplace interventions. The Nordic Occupational Skin Questionnaire Group supported by the Nordic Council of Ministers has developed a standardized questionnaire‐tool for surveys on work‐related skin diseases and skin exposures to environmental factors.
Nordic Occupational Skin Questionnaire (NOSQ‐2002) includes two questionnaires designed for separate purposes. NOSQ‐2002/short is a 4‐page questionnaire for screening skin problems at workplaces. NOSQ‐2002/long is an in‐depth survey tool for research purposes. The questionnaire covers occupational history, atopic symptoms, self‐reported hand or forearm eczema, exacerbating factors, consequences and life impact of dermatoses, self‐reported contact urticaria on hands or forearms, skin symptoms, skin tests, exposures, and protective glove use. For the time being, NOSQ‐2002 is available in English, Danish, Swedish, Finnish and Icelandic. Further translations are welcomed.
The NOSQ‐2002 report includes a review of pertinent literature on questionnaire methods for skin disease studies. Questions on work and exposure can be tailored to specific populations or occupational groups, according to the instructions and recommendations given in NOSQ‐2002/INFO version of the questionnaire.
The NOSQ‐2002 questionnaire files can be downloaded from http://www.ami.dk /NOSQ. The Nordic Council of Ministers has the copyright to the NOSQ‐2002 questionnaires. Use of the questionnaires is free of charge. The NOSQ‐2002 questionnaires and their present and possible future translations cannot be used commercially.     

Comparison of 2 tests for clinical assessment of formaldehyde exposure

The objective of the study was to obtain further experience on the applicability of 2 tests for clinical assessment of formaldehyde exposure. About 1300 products brought in by caosecutive formaldehyde-sensitive eczema patients during a 2-year period were tested with both the chromotropic acid test and the acetylacetone test. The chromotropic acid test was modified by including a 2nd reading after 2 days. The outcome was identical for about 90% of the products, and 74% of he products that were positive on day 2 were also positive on day 2. For products analyzed with both the chromotropic acid test (day 2 readings) and the acetylacetone test. About 80% gave identical results. Positive reactions were frequently found for hair shampoo, creams and lotions, soap and skin cleansers. Make-up and dishing liquids. The samples causing discolouration or problems in the tests were mostly concentrated in specific product categories. Very few products caused problems in both test methods. Thus, the most convenient test can be used as the 1st choice and, for product categories causing discolouration or problems with a specific test, the other test method can be used.