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     

The epidemiology of occupational contact dermatitis

Occupational contact dermatitis (OCD) ranks first of all occupational diseases in many countries. The incidence rate is believed to be around 0.5–1.9 cases per 1000 full-time workers per year. Epidemiological studies play an important role in observing disease trends, analysing risk factors, and monitoring the effect of preventive measures. In this review article the lack of truly epidemiologic data on OCD and the difficulties of those studies are illustrated. The following issues are highlighted: case ascertainment and bias, the distribution of allergic and irritant contact dermatitis in the working population, the interrelationship between exogenous (allergens, irritants) and endogenous factors, the prognosis, the social and economic impact, and the need for intervention studies. Received: 26 January 1999 / Accepted: 24 April 1999     

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 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.     

职业性药疹型皮炎

职业接触某些化学物可致剥脱性皮炎、大疱性表皮坏死松解、重症多形红斑和多形红斑, 常伴发热和粘膜损害, 严重时累及内脏, 类似药疹。本文就其职业性致病化学物、发病机制、临床表现、诊断、预后及命名等作一综述。     

Occupational issues of allergic contact dermatitis

Occupational contact dermatitis is often of multifactorial origin, and it is difficult to determine the relative significance of the various contributing factors. Contact allergies are relevant in 20-50% of recognised occupational contact dermatitis cases. The reported frequency in different studies varies, depending on differences in how occupational diseases are notified and recognised, in types of occupation in a geographical area, and the "quality" of the dermatological examination, including the accuracy of the diagnostic patch-test investigation. However, the clinical relevance of the reported contact allergies is often uncertain. Many occupational contact dermatitis patients with documented contact allergies develop chronic eczema, in spite of work changes and attempted allergen avoidance. Recognition/non-recognition of a notified case may be based on circumstantial evidence, because of difficulties in the establishing of a firm proof of work exposure and subsequent development of skin disease. Reliable quantitative exposure measuring techniques are needed. Methods are developed for the measurement of exposure to allergens such as nickel and acrylates, which makes it possible for exposure-effect relationships to be established with increased certainty. For prevention of allergic contact dermatitis it was a major step forward, with mandatory ingredient labelling of cosmetic products. However, improved labelling of the presence of contact allergens in household and industrial products is needed. For the identification of hazardous contact allergenic compounds, guinea pig or mice assays are still required. The local lymph node assay (LLNA), which is an objective and sensitive mouse assay has now been internationally validated and accepted.     

Occupational allergic and irritant contact dermatitis in workers exposed to polyurethane foam

Objectives

To evaluate sensitization to chemicals present in work environment after an outbreak of contact dermatitis in workers of vehicle equipment factory, exposed to polyurethane foam, based on 4,4′-diphenylmethane diisocyanate (MDI).

Material and Methods

From among 300 employees, 21 individuals reporting work-related skin and/or respiratory tract symptoms underwent clinical examination, patch testing, skin prick tests, spirometry and MDI sIgE measurement in serum. Patch tests included isocyanates series, selected rubber additives, metals, fragrances, preservatives, and an antiadhesive agent.

Results

Clinical examination revealed current eczema in the area of hands and/or forearms in 10 workers. Positive patch test reactions were found in 10 individuals, the most frequent to diaminodiphenylmethane and 4-phenylenediamine (7 persons). Reactions to an antiadhesive agent were assessed as irritant (5 workers). Except for sensitization to common aeroallergens, no significant abnormalities were found in the remaining tests. Occupational allergic contact dermatitis was diagnosed in 7 workers, irritant contact dermatitis in 10 and coexisiting allergic and irritant contact dermatitis in 3 workers.

Conclusions

In workers manufacturing products from polyurethane foam, attention should be paid to the risk of developing contact dermatitis. Skin problems in our study group were attributable probably to insufficient protection of the skin.     

Occupational hand dermatitis in food industry apprentices: results of a 3-year follow-up cohort study

Objective: The aim of this prospective follow-up study was to quantify the impact of hand dermatitis (HD) in bakers, confectioners and bakery shop assistants, and to investigate related risk factors. Method: Bakers', confectioners' and bakery-shop assistants were included in a prospective follow-up study in the region of East Thuringia starting in August 1996. At the beginning of their vocational training 91 apprentices were interviewed and examined in a standardised way. Follow-up examinations and interviews were done after 6 months (n=79), 12 months (n=63) and at the end of the training (n=69) after 36 months. Results: In their case histories 3.3% (n=3) of the apprentices reported previous HD in childhood and adolescence. The first assessment after 2 to 4 weeks of vocational training revealed HD in 17.5% (n=16) of the individuals. At the follow-up examination after 6 months, point prevalence of HD was 29.1% (n=23), after 12 months 27.0% (n=17) and after 36 months 27.5% (n=19). Mild to moderate irritant contact dermatitis was the most frequent finding. Finally, an atopic skin diathesis (>10 points, “atopy score”) (OR=4.89; CI 95% 1.15–20.79), previous HD (OR=41.1; CI 95% 4.99–339.13) as well as flexural dermatitis (OR=6.8; CI 95% 1.72–27.22) proved to be predictive factors for the development of HD. No association was found to respiratory atopy (OR=1.29; CI 95% 0.35–4.7) and metal sensitisation (OR=1.1; CI 95% 0.29–4.35). Exogenous irritant factors did not show a strong association towards a risk increase. Wet work in general, as well as distinct occupational tasks showed only a tendency for being a risk factor for HD. However, leisure time activities, especially house building and rebuilding (OR=5.4; CI 95% 1.05–27.81), were associated with an elevated risk. Conclusions: Endogenous and exogenous factors contribute to the development of HD in bakers' and confectioners' apprentices. Received: 25 September 2000 / Accepted: 20 February 2001     

刺激性接触性皮炎的研究进展

接触性皮炎（contact dermatitis，CD）是指接触外源化合物而导致的皮肤炎性疾患，根据发病机制的不同通常将其分为刺激性接触性皮炎（irritant contact dermatitis，ICD）和变应性接触性皮炎（allergic contact dermatitis，ACD）。ICD是一种不产生特异性抗体的皮肤炎症，而ACD属于T细胞介导的Ⅳ型超敏反应，需要预先致敏才能发生。另外，ICD形态变化广泛，在急性期主要表现为皮肤红斑、水肿、脱屑和角质形成细胞囊泡化样变，在慢性期主要表现为皮肤裂隙、苔藓化和角化过度。由于这些变化都是非特异性表现，使得ICD通常很难与ACD以及内源性皮炎相区别。     

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。     

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.     

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.     

Airborne irritant contact dermatitis due to sewage sludge

An outbreaks of cases of airborne irritant contact dermatitis developed among incinerator workers employed in a sewage treatment facility. Contamination of the workplace and workers' clothing by sludge from the interstices of an incinerator exhaust fan proved to be the cause of the problem. The irritancy of the sludge was determined by tests in rabbits. There was no recurrence of the problem after the institution of hygienic measures designed to control contact with the sludge during subsequent fan maintenance procedures.     

职业性光接触性皮炎

简述了职业性光接触性皮炎的致病因素与机制、发病与危害、临床表现、治疗与预防。     

Occupational contact dermatitis in women

In work in which women predominate, the highest rate of the occupational contact dermatitis is seen among hairdressers and medical nursing staffs. Twelve such cases are presented and several points regarding the diagnosis and treatments are discussed. The patients were five hairdressers, two dental technicians, two nurses and three woman divers. A patch test was useful in identifying the allergens or irritants in most cases.     

急性刺激性气体中毒防治研究现状

刺激性气体种类繁多,理化性质各不相同。近年来我国刺激性气体中毒事件频发,危害较大。为了给刺激性气体中毒的救治提供理论参考,对刺激性气体的毒性作用、临床表现、诊断原则、治疗原则和具体措施等方面的研究进展作一综述。     

电镀工人职业性接触性皮炎1例报告

电镀工人经常接触金属、电镀液及橡胶手套等,金属镍、电镀液中的香料及橡胶添加剂是常见的接触过敏原。本科收治的1例患者,经斑贴试验证实为镍、香料及橡胶添加剂过敏,现报告如下。