Allergic contact dermatitis from natural latex without contact urticaria

During the test decade, there have been many reports of immediate-type hypersensitivity to natural latex, resulting in contact urticaria, generalized allergic read ions such as urticaria and Quincke's edema, and asthmatic or anaphylactic reactions. Moreover, delayed-type hypersensitivity to rubber additives such as thiuram and carbamate derivatives is acknowledged to be the main cause of dermatitis in patients working with rubber gloves. We here report on a patient who developed severe dermatitis on his hands and forearms 3 months after he had started working with rubber gloves. Patch tests with rubber additives, skin prick tests and RAST to natural latex were negative. However, a delayed type of hypersensitivity to latex could be shown by a positive patch test. To our knowledge this is the 1st case reported of an isolated contact dermatitis from natural latex without contact urticaria to latex or hypersensitivity to rubber additives. We therefore propose that not only patch tests with rubber additives, hut also skin prick and patch tests with latex should be performed in contact dermatitis patients working with rubber gloves.     

Corn contact urticaria in a nurse

A 33-year-old nurse presented with persistent hand dermatitis. Radioallergosorbent tests showed moderate to strong reactions to latex, avocado and banana. Despite avoidance of latex gloves, she failed to improve. Patch testing was negative. Prick testing showed a negative reaction to latex, but a strong reaction to corn, with relevance to cornstarch powder present in many medical examination gloves. She was diagnosed with corn contact urticaria, irritant contact dermatitis and type I hypersensitivity to latex fruits.     

Contact dermatitis in hairdressers: the Italian experience

A multicenter study was performed in 9 Italian centers by members of the GIRDCA, to evaluate the frequency and source of contact sensitization in a group of 302 hairdressers with dermatitis. Occupational habits and use of preventive measures were specifically investigated both in these 302 hairdressers and in a further group of 240 hairdressers who answered a questionnaire. The results showed the presence of an occupationally relevant sensitization in 60.9% of the 302 hairdressers. This proportion included 52 hairdressers who had negative patch tests to the hairdressers' series but showed positive reactions to other allergens, such as nickel, rubber additives, preservatives and fragrances, which were judged relevant to their occupation. Among hair dyes, PPD caused 73 reactions (24.2%), PAP 32 reactions (10.6%), ONPPD 24 reactions (7.9%), and PTD 40 reactions (13.2%). A low incidence of sensitization was detected in our hairdressers to resorcinol and pyrogallol (1.3% for each substance). Among permanent wave allergens, positive reactions to GMTG were found in 11.3% of patients, while ATG gave a lower rate of positive reactions (5.0%). Allergic contact dermatitis due to APS was also relatively common (11.3%). 4 hairdressers in this study gave a positive reaction 30 min after a provocative test with latex gloves, patch testing to the rubber series being negative. Enquiry regarding preventive measures revealed that the majority of hairdressers use gloves when doing hair dyeing, but rarely use them for washing dyed hair or for doing permanent waving. The infrequent use of preventive measures by Italian hairdressers was confirmed by the results of the questionnaire, and possibly explains the high frequency of skin problems (12.5%) in the hairdressing population that was specifically interviewed.     

Allergic contact dermatitis from latex rubber

Summary Previously we have found occasional patients with delayed hypersensitivity to latex (in rubber gloves) in the absence of allergy to any chemicals in the rubber chemical screen. There are many reports of contact urticaria to latex and isolated reports of delayed hypersensitivity to latex, usually in the presence of contact urticaria. To establish if latex rubber is a more common cause of delayed hypersensitivity than is currently recognized, we patch tested all patients attending our contact dermatitis clinic, over a 6-month period, with latex. Of 822 patients, 16 (1.9%) demonstrated positive cutaneous reactions to latex. Six exhibited contact urticaria to latex, five contact urticaria and allergic contact dermatitis, and five allergic contact dermatitis alone. Of the five with delayed hypersensitivity to latex in the absence of contact urticaria, only one was atopic and the sensitivity was thought to be relevant or possibly relevant in four. Of our patients, 1.2% exhibited positive patch-test reactions to latex. Patch testing with latex should be considered where contact dermatitis to a latex rubber-containing product is suspected, e.g. gloves and footwear.     

Knowledge of skin hazards and the use of gloves by Australian hairdressing students and practising hairdressers

Occupational contact dermatitis is common amongst hairdressers. In this population-based study, 193 trainee hairdressers and 184 practising hairdressers completed a questionnaire detailing their knowledge of skin hazards, the skills they practised and the frequency of glove use. Knowledge of skin hazards was poor in both groups. While up to 70% of participants correctly identified hairdressing chemicals as potential skin hazards, less than 15% correctly identified the role of wet work. Only a small proportion recognized that hairdressing chemicals could cause allergy. Contrary to findings elsewhere, less-experienced hairdressers often handled chemicals, particularly hair dyes containing p-phenylene diamine. The use of gloves was inadequate, particularly when performing work at the basin, which both junior and senior hairdressers did on a regular basis. Recommended strategies for the prevention of hand dermatitis in hairdressers include improved student education, appropriate glove use and the application of after-work moisturizing creams.     

Occupational contact dermatitis in nurses with hand eczema

Occupationally related dermatitis is a common problem in nurses, who are exposed to a wide variety of allergenic and irritant substances. In a group of 44 nurses with hand dermatitis (40 female, 4 male), 18 were thought to have a predominantly allergic contact dermatitis, 15 an irritant dermatitis, 7 other form of eczema, 3 atopic dermatitis and one pompholyx. 10 of the 15 irritant cases were diagnosed as occupational. Of the 18 patients with allergic contact dermatitis, the allergens were thought to be occupationally relevant in 8 cases. In 6 of these 8 the dermatitis was due to natural rubber latex (3) or other rubber chemicals (3). 2 had additional evidence of immediate-type hypersensitivity to natural rubber latex (one was patch test allergic to latex, the other to thiuram mix). Natural rubber latex allergy, both delayed and immediate, is a significant problem, and nurses at risk should be tested for both types of hypersensitivity, as well as being patch tested to standard, rubber and medicaments series.     

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.     

A survey of occupational hand eczema in Denmark

Occupational hand eczema (OHE) is the most frequently recognized work-related disease in Denmark and the annual cost to society is high. Understanding of the epidemiology of OHE is essential to be able to give appropriate recommendations for its prevention. The study comprised 758 persons, 490 females and 268 males with recognized OHE in the period October 2001 to November 2002. Data were obtained prospectively from the National Board of Industrial Industry Registry and from a self-administered questionnaire (response rate, 82%). The most frequently recognized diagnosis was irritant contact dermatitis (ICD), mainly caused by wet occupations. The proportion of occupational ICD was equal for males and females, 59.7% and 63.1%, respectively. The estimated rates of OHE were high for bakers, hairdressers and dental surgery assistants, and a high proportion of apprentices were found among hairdressers. The prevalence of atopic dermatitis was low (16.4%) compared to previous studies among hand eczema patients. The prevalence of occupational allergic contact dermatitis in the study population was substantially higher among males than females, and the most frequent causes among males were allergy to chromium (leather exposure), rubber additives (gloves) and nickel due to exposure from work tools and metalworking industry.     

FC01.6Hand dermatitis of hairdressers. Study of protective gloves permeation

Contact dermatitis among hairdressers is common and is one of the most frequent occupational dematoses due to continual exposure to water, detergents, hair dyes, permanent waves and metal equipment. Use of individual protection systems – as gloves – is considered a good measure of prevention. Few data exist about the real permeation resistance (PR) of gloves, also in term of time of PR. We tested two types of djsposable latex gloves different by thickness and density of the manufacture material. We used a permeation cell composed of two separated parts: in the upper part we introduced the hair colouring formulation and in the lower one the collection medium (NaHSO3 1% in water); the two parts were separated by a portion of the glove material. A 100 microL volume of the collection medium was collected and injected onto a HPLC apparatus after 1, 2, 4 and 24 hours. A diode array detector was utilised selecting two wavelengths in the UV range (240 and 275 nm) with a linear concentration gradient up to 60% of methanol/acetonitril mixture. We can simultaneously analyse 9 oxidation dyes and the detection limits were sufficient to determine these substances at very low concentrations. We obtained respectively a breakthrough time less than 24 hours for the lower thickness glove and of over 24 hours for the other one; the latex gloves are suitable for prevent the skin contamination during the preparation of the colourings mixture in the hairdresser activity. The obtained data show those latex gloves, of both thickness, have a very high PR. On the other hand, the use of latex gloves has been associated with the more frequent recognition of immediate‐type hypersensitivity responses related to latex products. The prosecution of the study will evaluate the PR of latex‐free gloves.     

Dermatitis in hairdressers

Hand dermatitis in hairdressers is caused by a variety of factors. Important are the sensitizing and irritant capacities of some hair-cosmetic ingredients, unsafe packaging which causes contamination of the hands, work tables and instruments with hazardous chemicals, absence of protection with adequate gloves and ignorance of safe handling of these chemicals. A strategy is proposed, based on improvement of the safety of ingredients and packaging, use of vinyl gloves and introduction of safe hairdressing procedures. Introduction of this strategy in hairdressing salons with 16 cases of moderate to severe contact dermatitis reduced the number of cases of active dermatitis to 3 in 4 months. The value of pre-employment screening is discussed and the necessity of cooperation of centers of occupational dermatology is emphasized.     

Dermatitis in hairdressers

Contact dermatitis among hairdressers is common. In The Netherlands, registered sick leave for hand dermatitis among hairdressers rose from 21,050 days in 1986 to 54,293 in 1991. In a survey among 45 hairdressers in 5 different salons, 12 had a history of hand dermatitis and 16 showed moderate to severe hand dermatitis. After extensive investigations, 13 were classified as having allergic contact dermatitis and 3 cumulative irritant contact dermatitis, fn the past 4 years, 103 hairdressers were extensively patch tested and glyceryl thioglycolate (GTG), ammonium persulfate and nickel sulfate were responsible for the majority of positive reactions. Hair dyes and preservatives were responsible for a moderate % of the positive reactions. Positive reactions were also found to cocamidopropyl betaine and sodium coco hydrolyzed animal protein. These 2 allergens show a rather capricious patch test reaction pattern and irritant reactions may easily be confused with allergic. The relevance of positive patch test reactions to these chemicals should always be questioned. Atopy was not a frequent cause of hand dermatitis in this study. Chemicals with a thiol group can be demonstrated with a chemical spot test. With this test, contamination of the hairdressing salon with thioglycolates was demonstrated. It is emphasized that contamination of hairdressing salons with GTG is probably a significant factor in explaining the severe flare-ups in GTG-sensitized hairdressers who no longer use GTG permanent-waving solutions.     

Contact urticaria due to rubber chemicals?

Contact urticaria due to gloves is mostly related to immediate-type allergy to natural rubber latex (NRL), and rarely due to rubber chemicals. We report the results of prick tests with rubber chemicals curried out on 75 latex-allergic patients. Clinically relevant hypersensitivity was not observed in our patient collection. Thus, we conclude that contact urticaria due to rubber chemicals is a very rare finding in latex-allergic patients, but has to be considered in patients with contact urticaria due to synthetic rubber gloves, as well as in patients with contact urticaria due to NRL gloves but no latex, allergy. Therefore prick tests with rubber chemicals are unnecessary in the routine diagnostic assessment of latex-allergic patients.     

Undesirable effects from latex gloves in hospital health-care personnel

The high incidence of occupational hand dermatitis in hospital employees and the increased number of reports on cutaneous, mucosal and systemic reactions connected with a widespread USE: OF GLOVES induced us to investigate the prevalence of undesirable effects caused by latex gloves and the possible risk factors. We distributed a self-administered questionnaire, elaborated by us. to 1030 Perugia Monteluce Hospital employees who usually used latex gloves at work. The questionnaire was returned by 922 (476 females and 446 males; mean age. 38.7 years). The subjects who reported atopy and/or undesirable glove reactions were interviewed and clinically examined. Of these, 128 (13.9%) had presented or still had glove problems and therefore were submitted to skin tests (patch and prick tests) and when negative, to use test. Our results showed that the large majority of skin complaints from gloves was caused by irritation rather than by allergy. Predisposing factors of irritant contact dermatitis (CD), which was present in 13.1% of the subjects investigated, were female sex. age under 31 years, cleaning activity mainly when carried out in the Held of internal medicine, and atopie constitution. The most common causative factors, investigated with two substitute latex gloves in 64 of the 120 patients affected by irritant CD, were cornstarch powder and perhaps latex proteins. Even if allergic skin disorders from latex gloves were rare in our unselected group (allergic CD: 0.5%-, contact urticaria: 0.3%), more attention should be given to IgE-mediated disorders since they may be a life threatening problem.     

Investigation of reactions to dental materials

Patients undergoing dental treatment can be exposed to a wide range of potential allergens, but adverse events seem infrequent. Patients with symptoms or signs of stomatitis, burning, tingling, cheilitis, oral lichenoid lesions, lip and facial swelling may relate their problems to dental treatment or to the use of dental products. Investigation for immediate type or delayed type hypersensitivity is indicated using patch testing, prick testing and blood tests for allergen-specific IgE. The main allergic reactions found in patients include contact allergy to metals, cosmetics, food additives, flavours and acrylates, and immediate type allergy to latex. Adverse reactions following the administration of local anaesthetics are seen in about 0.5% of cases, but immediate type allergy to these agents is rare. In dental staff, occupationally related problems are common and usually take the form of hand or facial dermatitis or respiratory disease. The most common allergic reactions in dental staff are immediate type allergy to latex, and contact allergy to rubber additives, fragrances, acrylates and formaldehyde. Occupational irritant problems causing hand dermatitis are probably more common in dental personnel than is dermatitis caused by contact allergy. Patch testing and tests for immediate type allergy are useful investigative methods in the investigation of patients who present with oral or facial symptoms possibly related to dental treatments and are also beneficial in dental personnel who present with hand or facial dermatitis or respiratory symptoms.     

Hairdressers with dermatitis should always be patch tested regardless of atopy status

Background: Allergic contact dermatitis is common in hairdressers because of their exposure to chemicals used in hair dyes and permanent wave solutions. Atopic individuals are known to have a higher prevalence of leaving the profession due to morbidity associated with hand eczema. Objectives: To assess which chemicals are responsible for allergic contact dermatitis in hairdressers and whether the prevalence is the same according to atopy status. Methods: A total of 729 hairdressers who had been patch tested were retrospectively identified. Allergic reactions to relevant allergens from the extended European baseline series and hairdressing series were analysed against history of atopic eczema. Results: Of the total, 29.9% of patients had a current or past history of atopic eczema. The most frequent positive allergens from the European baseline series were nickel sulfate (32.1%) and p‐phenylenediamine (19.0%) and from the hairdressing series were glyceryl monothioglycolate (21.4%) and ammonium persulfate (10.6%). There was no significant difference between people with or without a history of atopic eczema, except for fragrance mix I and nickel sulfate. Conclusions: We present findings from the largest cohort of hairdressers patch tested from a single centre. It is necessary to patch test hairdressers with dermatitis, regardless of a history of atopy. Strategies to reduce prevalence of allergic contact dermatitis are required.     

What do trainee hairdressers know about hand dermatitis?

Hand dermatitis is an important cause of morbidity in hairdressers. We conducted a questionnaire survey of 121 trainee hairdressers from 2 hairdressing colleges in Burnley (UK). The questionnaire concerned the number and types of hairdressing procedures performed, previous and current medical history, awareness of risks to the skin from hairdressing, and knowledge of hand dermatitis prevention. 17% of the trainees suffered currently from hand dermatitis. This is likely to be due to the large amount of wet work done by apprentice hairdressers, particularly those who worked in salons. 2/3 of trainees were not aware that atopic eczema predisposed to hand dermatitis. Formal pre-school and pre-employment counselling was limited. Knowledge on hand care among trainees was not often translated into practice, with gloves being worn by only 9% when shampooing and 58% when perming. Prevention of hand dermatitis by education and pre-employment counselling is of fundamental importance.     

Survey of sulfur-containing rubber accelerator levels in latex and nitrile exam gloves

2-Mercaptobenzothiazole and zinc dialkyldithiocarbamates are commonly used sulfur-containing rubber vulcanization accelerators known to cause allergic contact dermatitis. Exposure to these agents occurs through clothing such as undergarments and shoes, latex medical devices and latex and nitrile gloves. A simple, inexpensive screening method for total sulfur accelerator and a high performance liquid chromatographic speciation method were developed in the present study. These methods were applied to screen and quantify the sulfur accelerator content from 38 brands of 'off-the-shelf' latex and nitrile gloves obtained from commercial vendors. It was found that accelerator levels ranged from not detectable to 7.35 mg/g in the gloves analysed. Brands were found to contain single and multiple accelerator species within the glove. Powdered gloves had significantly higher accelerator levels than powder-free gloves from the same manufacturer; however, these chemical accelerators do not preferentially partition to the powder. The present analytical methodology is suitable for both manufacturing quality validation purposes, as well as for accelerator allergy research.     

Use of protective gloves by hairdressers: A review of efficacy and potential adverse effects

Occupational hand eczema is common among hairdressers, and protective gloves are important in limiting exposure to irritants and allergens. Various glove types may differ in their protective ability, and their use may lead to hand eczema due to skin irritancy and allergy. MEDLINE was searched for studies investigating permeation of gloves to irritants and allergens used in the hairdressing trade, as well as adverse effects of glove use affecting hairdressers. Forty-four studies were identified; nine reported on permeation. Of those, two in vitro studies found nitrile rubber (NR) gloves to give the best protection when handling hair dyes. Polyethylene (PE) gloves had the lowest reported break-through time. The prevalence of sensitization to rubber materials in European hairdressers was as follows: thiuram mix, median 2.5% (range 0%-8.2%), weighted average 3.0% (95% confidence interval [CI] 3.0%-3.1%); mercapto mix, median 0.4% (range 0%-3.3%), weighted average 0.5% (95% CI 0.47%-0.50%), mercaptobenzothiazole, median 0.6% (range 0%-6.6%), weighted average 0.7% (95% CI 0.6%-0.7%), NRL-type I allergy, median 1.3% (range 1%-16.4%), weighted average 4.0% (95% CI 3.6%-4.5%). In conclusion, NR gloves provide the best skin protection for hairdressers, although natural rubber latex (NRL) and polyvinylchloride (PVC) gloves may be sufficient in most cases. PE gloves are not recommended. Synthetic rubber gloves with low or no levels of accelerators are preferred.     

Contact dermatitis from cetyl pyridinium chloride in latex surgical gloves

Surgical and household gloves, both latex and non-latex, all contain potential allergens (1). Cetyl pyridinium chloride (CPC), found in Biogel ® latex gloves, has been reported to cause allergic contact dermatitis (2).     

Occupational skin diseases among dental nurses

Out of 923 female dental nurses in the Helsinki district, 799 were interviewed using a computer-assisted telephone interview. A structured questionnaire was used to inquire about skin, respiratory symptoms, atopy, work history and methods, and exposure at work. The 328 nurses, who reported work-related dermatitis on their hands, forearms or face, were invited to an interview by an occupational physician; 245 nurses participated. 31 nurses had previously been diagnosed with an occupational skin disease (OSD). 133 nurses with a suspected OSD were selected for further clinical examinations with prick and patch testing. Among the 107 nurses examined, 22 new cases of OSD were diagnosed. There were altogether 29 cases of allergic contact dermatitis, 15 of contact urticaria, 12 of irritant contact dermatitis, and 1 case of onychomycosis. Rubber chemicals and natural rubber latex (NRL) in protective gloves, as well as dental-restorative plastic materials [(meth)acrylates], were the most common causes of allergy. 42% of the OSD cases in the studied population had been missing from the statistics (Finnish Register of Occupational Diseases). Plastic gloves or NRL gloves with a low-protein content are recommended for dental work. Skin exposure to (meth)acrylates should be avoided.