Occupational protein contact dermatitis with type I allergy to different kinds of meat and vegetables

Objective: Even though occupational protein contact dermatitis is not an uncommon finding in occupational dermatology, reports about multiple sensitizations are rare. High-molecular-weight substances such as proteins can pass the epidermis only if it is damaged and cause a sensitization. In a high percentage of cases, atopic dermatitis might be the cause of this damage but cannot be regarded as the only cause. An interesting case is presented that was carefully worked up. Methods: Scratch, intracutaneous, and prick or prick-to-prick tests with native occupational allergens were performed as single tests. The patient was patch-tested with the European Standard Series. The determination of allergen-specific IgE was performed by ImmunoCAP. The results were subdivided into six classes. In addition, oral provocations with relevant allergens were performed. Results: The skin tests showed positive type I allergies to beef, lamb, horse, and pork meat, to pork and horse blood as well as to rye and wheat flour, raw potato, and pasta. Weak positive reactions could be found for fowl, duck, goose, and turkey in intracutaneous testing. The ImmunoCAP showed elevated specific IgE values for pork meat, raw potato, and rye and wheat flour. The oral provocation did not show any systemic or skin change. Conclusions: This case report demonstrates how an initial case of contact urticaria turns into protein contact dermatitis. It shows that the diagnosis can be made by means of scratch or prick tests with native occupational allergens. The determination of allergen-specific IgE by ImmunoCAP might be helpful, but a negative result does not exclude protein contact dermatitis. Received: 26 August 1997 / Accepted: 14 November 1997     

Skin-conditioning products in occupational dermatology

Moisturizers are frequently used in the prevention of occupational contact dermatitis. This review discusses their chemistry and mode of action. Methods to prove their preventive efficacy are presented. In addition to pharmacological efficacy, subjective factors that influence application of the products and compliance come into play. In conclusion, moisturizers are only one element of skin-disease prevention at the workplace that should be viewed as a complex, inter-dependent system. The efficacy of the complete, integrated system of occupational skin care has to be proven.Paper presented at the Occupational Skin Care Management State-of-the-Art Conference, 1–3 September 2000, Zurich     

Occupational issues of irritant contact dermatitis

Occupational irritant contact dermatitis (ICD), a non-immunological cutaneous inflammatory response to a workplace substance, comprises a major portion of occupational dermatoses in industrialized societies, resulting in considerable social and economic implications. The sheer morphological variety of ICD presents a diagnostic and classification challenge; ideotypes identified to date include acute, chronic and cumulative irritant dermatitis, delayed acute irritant dermatitis, irritant reaction, pustular irritant dermatitis, suberythematous irritation, sensory irritation, friction dermatitis and airborne dermatitis. Hand dermatitis is the most frequent manifestation of occupational ICD. This article reviews the various types of ICD, the epidemiological data available to date, risk factors, pathophysiology, diagnosis and management of ICD, emphasizing occupational issues.Paper presented at the Occupational Skin Care Management State-of-the-Art Conference, 1–3 September 2000, Zurich     

某锡冶炼厂工人职业性接触性皮炎患病情况

目的分析某锡冶炼厂工人职业性接触性皮炎的患病情况,为职业性皮肤病防治提供科学依据。方法对在2001—2010年健康检查中发现的接触性皮炎患者作回顾性分析。结果锡冶炼作业工人职业性接触性皮炎发病率与空气中砷浓度为正相关关系(r=0.956 1,P0.01),空气中砷浓度越大,发病率越高,且主要发生在粗炼、精炼、电解车间,发病率分别为5.35%、5.63%、5.88%;平均发病年龄为32.5岁,平均发病工龄为13.5 a。结论改善劳动条件,降低车间内含砷粉尘浓度,是减少职业性接触性皮炎发病的根本措施。     

Occupational skin disease in Finland An analysis of 10 years of statistics from an occupational dermatology clinic

Summary An analysis of 10 years (1974–1983) of statistics was carried out at the Institute of Occupational Health, Helsinki, Section of Dermatology, which is devoted to occupational dermatology. A total of 1,082 cases of occupational skin diseases were diagnosed during this period. Allergic (50.1%) and toxic eczema (47.1%) comprised the majority of occupational cases of dermatosis. The most frequent causes of allergic occupational eczemas were rubber chemicals (19.9%), chromates (18.8%), and epoxy resins (13.1%). If the metals (chromium, nickel and cobalt) were considered as a group, they formed the largest category (28.4%), followed by the plastic materials (27.7%). Detergents (37.8%), followed by organic solvents (16.1%), were responsible for most of the irritant (toxic) eczemas. Occupational skin diseases currently make up about 20% of all occupational diseases in Finland, but the percentage is decreasing.     

职业性三氯乙烯药疹样皮炎合并感染危险因素的病例-对照研究

目的探讨职业性三氯乙烯(TCE)药疹样皮炎患者合并感染的危险因素,为控制其并发感染提供依据,并为该病患者防止感染采取有针对性的预防措施。方法选择我院2000年1月至2006年12月职业性TCE药疹样皮炎合并感染的住院病例,按1∶1配对进行病例-对照研究,采用回顾性调查方法,对暴露因素进行单因素及多因素条件Logistic回归分析。结果单因素条件Logistic回归分析筛选出9个危险因素与医院感染发生有关(OR=0.006～26.806,P<0.05),多因素条件Logistic回归分析筛选出发热情况、皮肤黏膜破损程度、病情是否危重与合并感染相关(OR=5.621～23.280,P<0.05)。结论皮肤黏膜破损、病情危重、合并感染前发热患者发生感染的危险性明显增大。     

Enzymes as occupational and environmental respiratory sensitisers

A literature review shows that airborne enzymes occurring in the general environment and in purified form in industrial production have a high allergenic potential to the airways, causing rhinitis, conjunctivitis and asthma. It can be assumed that this also applies to the increasing number of enzymes manufactured by the cloning of fast-growing genetically engineered microorganisms. Cross-sectional studies demonstrate exposure–response relations for IgE-mediated sensitisation and airway disorders. Atopic individuals are more susceptible to enzyme allergy than non-atopic individuals. Skin prick testing and measurement of specific IgE antibodies have been shown to be useful diagnostic tools. Very high concentrations of proteases may lead to emphysema. There is also evidence for non-allergic airway inflammation by proteases, probably via protease-activated receptor-2 and intracellular Ca²⁺ release. It is recommended that all enzymes be classified with the risk phrase R42 (may cause sensitisation by inhalation) and that their inhalative uptake be totally avoided.     

广东150例职业性三氯乙烯药疹样皮炎病例的职业流行病学调查

目的阐明职业性三氯乙烯(TCE)药疹样皮炎职业流行病学特征,为其防治与研究提供资料。方法用专用调查表对广东省1988～2001年发病的150例职业性TCE药疹样皮炎病例进行回顾性调查,同时收集这些发病事故的调查资料,用Excel建立数据库,SPSS10.0进行统计处理。结果这组病例的临床表现和发病特点与药疹皮炎极其相似,表现为剥脱性皮炎、重症多形红斑、大疱性表皮坏死松解症或多形红斑。其发病均因接触TCE,但与接触浓度无明显关系;潜伏期均小于3个月;××市3年调查,接触TCE新工人的发病率仅为0.045%;激素治疗有效,病后再接触可再发病,斑贴试验阳性等。引起发病的TCE含量在95%以上,产地也不同,全分析未发现相同杂质;全部病例没有发现接触甲醛、甲胺磷等能引起药疹样皮炎的化学品;大部分病例发疹前2个月没有服过任何药物;美国和日本等地已有21例相似的病例报道。因接触TCE的新工人多和临床医师和管理人员提高了对本病的认识,使广东多发。结论本组病例都由职业性接触TCE引起,与药疹样皮炎相似,属免疫增强损伤。称为“职业性TCE药疹样皮炎”;其流行病学特点均与职业性TCE接触明显相关。     

农药生产企业职业病危害预评价风险评估法的应用

目的对某农药生产企业新建项目进行职业病危害预评价,识别、分析、评价其健康危害的风险。方法应用现场调查和风险评估法对职业病危害因素和防护措施进行分析评价。结果该项目有二氯苯酚、乙腈、氢氧化钾、六氟丙烯、硫酸、硝酸、盐酸、氯化亚锡、二氯乙烷、草酰氯、二氟苯甲酰胺、甲苯、粉尘、噪声等职业病危害因素;职业病危害因素风险级别属一般风险或低风险,风险级别最高为3.0,最低为1.4;该项目属于3级风险级别;定性为职业病危害一般的建设项目;需要实施和维持控制措施,每3年重新进行评价,进行空气监测,作业人员进行培训。结论采用风险评估法对农药生产企业进行职业病危害评价较为合适,评价可信程度较高;但是使用风险评估法进行职业病危害预评价尚在研究阶段,缺少可靠的系统的方法,评价暴露时要考虑大量的因素。     

1990—2019年亚洲地区接触性皮炎疾病负担研究

目的 评估中国与亚洲其他国家和地区接触性皮炎的疾病负担,以便更好地促进人类健康。方法 从全球疾病负担数据库（GBD2019）中获取接触性皮炎病例的相关数据,采用伤残调整寿命年（disability-adjusted life years,DALY）和年龄标化患病率（/10万）来描述疾病负担,采用年估计变化百分比（estimated annual percentage changes,EAPC）（%）来评估1990—2019年疾病负担的变化趋势。结果 1990—2019年亚洲48个国家和地区接触性皮炎DALY率和患病率均呈上升趋势（均EAPC>0、95%UI>0）,中国大陆DALY率和患病率均逐年增加（均EAPC>0、95%UI>0）。亚洲DALY率和患病率较全球高,中国大陆DALY率和患病率较亚洲高。女性DALY率和患病率均高于男性。2019年DALY率和患病率最高的年龄段均为70~74岁, DALY率最高的国家是菲律宾（34.94/10万）、最低的是以色列（7.28/10万）,患病率最高的国家是菲律宾（1 406.92/10万）、最低的是以色列（289.63/10万）。结论 亚洲接触性皮炎的疾病负担呈增长趋势,各国家和地区要根据实际情况提高人们对接触性皮炎的认识,预防接触性皮炎的发生。     

常见环境接触因素在手部皮炎发病中的作用

通过问卷调查及斑贴试验对常见环境接触因素在48例手部皮炎患者发病中的作用进行了研究。结果确诊接触性皮炎7例(14．6％),其中5例为职业性接触性皮炎;其余41例为可疑接触性皮炎。手部皮炎患者斑贴阳性率偏低(51％);洗涤剂引起或加重患者病情的占41．7%。水引起或加重患者病情的占39．6％;说明刺激因素在手部皮炎中也很重要。可疑接触性皮炎患者斑贴阳性率为46．3％,接触过敏因素在这部分患者发病中的作用仍不能忽视。明确斑贴试验阳性结果与疾病的联系是进一步必须研究的课题。     

镍接触性皮炎的斑贴试验及其组织病理学特征

目的 探讨斑贴试验在金属过敏等环境与职业性皮炎中的诊断价值,了解镍接触性皮炎的组织病理学特征。方法 应用欧洲标准抗原系列斑贴试验检测110例疑诊为接触性皮炎患者,并对13例硫酸镍(5％)斑贴试验不同时段阳性反应皮肤进行活检。结果 39例接触性皮炎患者对硫酸镍敏感(占35．5％),其中阳性反应皮肤组织学特征为：24h时表皮轻度海绵变性和灶状空泡变性,少许嗜酸性粒细胞外渗;48-72h时表皮和真皮炎症达高峰,主要是CD45RO^ T细胞和CD68^ 巨噬细胞分布于炎症表皮及真皮血管周围。916h-5d时表皮轻度增生,不同细胞成分参与修复过程。结论 硫酸镍是引起湿疹皮炎类疾病的主要接触变应原,镍皮炎病理学改变符合变应性接触性皮炎的特征。     

Occupational contact dermatitis in a gender perspective: North East Italian data 1996-2016

Background:Occupational contact dermatitis (OCD) ranks high among occupational diseases in Europe, but little is known as regards OCD and jobs in a gender perspective.Objectives:To evaluate sex prevalence of OCD according to occupational sectors and agents involved. 27381 patients (1996–2016) with suspected irritant/allergic contact dermatitis (ICD-ACD) were evaluated in North-Eastern Italy. Each patient underwent: a standardized questionnaire, a dermatologist/occupational physician evaluation and a patch test.Results:Females were younger at diagnosis (35.2 ± 11.6 years vs 37.7 ± 12.6 in males, p< 0.001) and had a lower ICD prevalence (OR 0.58, C.I. 95% 0.51 - 0.66, p < 0.001). Job categories most involved differed between sexes, with highest rank for healthcare professionals in females and machinery mechanics and filters for males. In females ACD percentage was higher in all job categories.Conclusions:OCD characteristics differ between sexes, according to intrinsic and extrinsic factors. Use of personal care products, housekeeping products and outdoor work activities may account for different sensitization profiles.     

Strategies for prevention: occupational contact dermatitis

The economic consequence of occupational contact dermatitis (OCD) is considerable and impacts on an individual's quality of life. There are a range of prevention strategies, which include: elimination or substitution of harmful exposures; technical control measures; personal protection; identification of susceptible individuals; and education, training and health surveillance. Each one has been shown to have varying degrees of success in reducing OCD, but further work is required to evaluate the effectiveness of preventive measures in the workplace. OCD is not considered a high priority in most affected industries and therefore the development of health and safety policies to reduce its prevalence should be encouraged, although guidance and assistance would be required, because all employees are entitled to a safe working environment.     

医务人员职业暴露和防护状况调查及对策

目的了解医院工作人员职业安全防护状况,探讨增强防护意识,完善防护措施的举措。方法采用问卷调查法对本院工作人员,包括医生、护士、工勤人员,对关于职业暴露的防护意识及防护措施等项目进行调查分析。结果 308名被调查的医务人员中,锐器刺伤≤5次者168人,占职业暴露人数的54.55%;5~10次者50人,占职业暴露人数的16.23%;11~20次者20人,占职业暴露人数的6.49%;≥20次者70人,占22.73%。其中医务人员被刺伤环节最高发于收集、清洗器械时刺伤,其次为配药、加药时匆忙、粗心。锐器刺伤发生率与自我防护意识强弱有关,防护意识强者,刺伤发生率低,防护意识弱者,刺伤发生率高,两者之间差异显著(P<0.001)。多数医务人员表示其安全防护意识多来源于院内学习培训,工作经验及同事间交流。结论临床医务人员职业暴露的发生率很高,应完善管理制度强化防护意识,加强职业安全防护教育,规范医院工作人员的操作行为,使用安全性能好的医疗护理器材。     

Variability in transepidermal water loss of the skin: evaluation of a method to assess susceptibility to contact dermatitis in epidemiological studies

Summary Transepidermal water loss (TEWL) has been suggested to be a measure which can be used to identify subjects at risk for the development of contact dermatitis. Transepidermal water loss is high when the barrier function of the skin is impaired. It is assumed that subjects with a high TEWL have skin which is more permeable to substances causing contact dermatitis. The inter-individual and intra-individual variability of simultaneous TEWL measurements and TEWL measurements over a period of three weeks were estimated in healthy individuals. The intra-individual coefficient of variation (CV) of simultaneous measurements was 13.5%. The intra-individual coefficient of variation of the measurements on consecutive days was somewhat higher (15.1%). The intra-individual coefficients of variation were low compared to the inter-individual coefficients of variation. The results indicate that transepidermal water loss is a stable personal characteristic, which can be studied as a risk factor in epidemiologie studies on contact dermatitis.     

The effects of long-term occupational exposure to dust from herbs

Introduction: Herbs are a heterogeneous group of many species with several thousand plants, which are used in large quantities in the pharmaceutical and food industries. The aim of the study was to analyse the health effects of long-term occupational exposure to dust from herbs. Methods: A group of 150 people occupationally exposed to dust from herbs, consisting of farmers and workers from herbs processing industry, was examined. As a reference group, 50 urban dwellers not exposed to any kind of organic dust were examined. Examined people were interviewed with the help of the ATS questionnaire compiled by Ferris and by the questionnaire developed in the Institute of Agricultural Medicine in Lublin, Poland for examination of work-related symptoms caused by organic dust. The lung function examination (vital capacity (VC), forced expiratory volume in the first second (FEV₁), and FEV₁/VC (%) of normal ranges) and allergological tests (skin prick test, precipitin test and inhibition of leukocyte migration (MIF) test) with microbial antigens were conducted. Results: 71.3% (95% CI 64.1–78.6%) of the exposed people reported occurrence of work-related symptoms. A post-shift decrease of spirometric values (VC, VC%) was observed in the exposed group (mean decrease 2.6%, P<0.01). A significant relationship was found between the number of work-related symptoms and decrease of FEV₁ values, both before (Spearman correlation coefficient r=−0.21, P<0.05) and after work (r=−0.31, P<0.01). In allergological tests, the frequencies of positive reactions in the exposed group were significantly higher than in the reference group. Precipitins specific to Pantoea agglomerans were found in 30.6% (95% CI 23.2–38.1%) of exposed, compared to 12.0% among unexposed (P=0.01). The frequency of positive results in the migration inhibition test was significantly higher among exposed workers for all antigens tested. Conclusion: Long-term exposure to dust from herbs causes work-related symptoms and decrease of lung function parameters, which, finally, may lead to occupational disease.     

The risk management of occupational stress

In Europe, occupational stress is considered as a risk-assessable disease. Recent high-profile litigation cases have raised awareness of the risk posed by workplace stress. Whilst legislation provides guidelines for the risk assessment of physical hazards, there remains little guidance for employers concerning occupational stress. This article proposes a risk management methodology that might be used to identify hazards and assess the level of risk associated with those hazards, using well-validated stress audit instruments, for example the Occupational Stress Indicator. It is suggested that a risk management approach is both informative and cost-effective. High risks, which may require more expensive organisational development solutions, can be differentiated and prioritised from lower risks, which may be effectively controlled through stress management or Employee Assistance Programmes.     

产科护士血源性病原体职业暴露的影响因素及预防措施

目的 了解产科护士血源性病原体职业暴露的现状及影响因素,并探讨预防措施.方法 采用回顾性调查方法,对宁波市3所医院90名产科护士进行调查,分析产科护士血源性病原体职业暴露的现状及影响因素.结果 84份调查问卷中58名产科护士存在经皮损伤的职业暴露史,暴露率为69.1％;44名产科护士存在黏膜接触的职业暴露史,暴露率为52.4％;大部分产科护士对职业暴露相关知识掌握较好,但仍有较大的提高空间;工作年限、职称、职业暴露相关知识掌握水平、参加职业暴露预防相关培训,积极穿戴护具等是产科护士血源性病原体职业暴露的影响因素.结论 产科护士血源性病原体职业暴露的影响因素较多,可从提高护理人员自身水平、加大社会支持、加强有效行政干预等方面预防产科护士职业暴露的发生.     

Effectiveness of skin protection creams in the prevention of occupational dermatitis: results of a randomized,controlled trial

Objectives  The aim of the trial was to investigate whether the publicized effects of skin protection creams can be replicated in a real occupational setting during activities that expose the skin. Methods  A prospective, randomized, four-tailed controlled pilot trial was performed to compare the effect of skin protection and skin care alone or in combination with cleansing against a control group (only cleansing). Two branches were selected for the investigation: the building industry and the timber industry. A total of 1,006 workers from these two branches were recruited, and out of these 485 workers were examined longitudinally for at least three time points over 1 year (lost for follow-up: 430 workers, exclusion: 91 workers). At each time point, as a primary outcome measure, we assessed the condition of the skin at both hands in a blinded manner and the individual was assigned to one of the following categories: no eczema, mild, moderate and severe eczema. As a secondary outcome measure, the worker’s transepidermal water loss (TEWL) was measured under standardized conditions at the back of both hands. In addition, the workers were asked to evaluate their skin condition during the study. Results  With regard to differences in the occurrence of eczemas, we found only in workers in building industry without application of skin protection or skin care creams a statistical significant increase in the incidence between the first and the second visit and a statistical significant decrease in the incidence between the second and third visit. When evaluating the secondary outcome-measurement changes in the TEWL values, an improvement was found for the group skin protection and skin care in combination and by skin care alone. Females in the timber industry started with better TEWL values than males, which may be due to better overall skin care. In this group we found an improvement for the group skin protection and skin care in combination and by skin protection alone. For skin protection alone, we noted a slight, but not significant improvement in all other groups. The subjective improvement of skin condition was reported from the participants who used skin protection and skin care in combination. Conclusions  Taking all these secondary-outcome measurements together, the main result of this study was that skin protection creams alone have a small effect on the skin barrier in workers in the building and timber industries compared with skin care alone or in combination with skin protection. Supported by the General Austrian Accident Insurance Institution.