Allergic contact hand dermatitis due to constituents of nitrile gloves

Purpose: This report of a case of allergic contact hand dermatitis due to constituents of nitrile gloves is to bring to the attention of practitioners four important practice points: 1) allergic contact dermatitis may occur due to exposure to chemicals in nitrile gloves; 2) skin patch testing is used to identify the causative allergens; 3) targeted allergens may be necessary in addition to the baseline European standard series if the standard series is unhelpful; and 4) there are potential interventions to manage nitrile glove dermatitis. Findings: A laboratory analyst had occupational exposure to several allergens and had worn latex gloves. She was exposed to laboratory chemicals and powdered ore dust, containing precious metals. She developed hand dermatitis and was relocated to administrative duties not requiring glove use. Her dermatitis cleared but recurred when she returned to the laboratory and started using nitrile gloves. On history, nitrile gloves and platinum group metal ore dust were consistently associated with her hand dermatitis, but laboratory chemicals were not. Latex-specific immunoglobulin E (IgE) was negative, as were skin patch tests for 13 allergens in the metal series, including salts of platinum group metals. She had positive allergic reactions to cobalt chloride, formaldehyde, nickel sulphate, and quaternium 15 in the European standard series patch tests. She did not react to the rubber chemicals in the European standard series, including thiuram mix. The patient was then tested with the rubber additives series because of the glove-relatedness of her hand dermatitis. She had positive reactions to three thiuram compounds used as accelerators in rubber gloves. The patient went on vacation during which time her dermatitis improved. She was relocated to a position without glove use or ore contact and her dermatitis did not recur. Conclusions: An analytic laboratory worker developed hand allergic contact dermatitis due to nitrile glove constituents. The diagnosis is supported by the improvement in her dermatitis after cessation of glove use, negative metal series patch tests, and positive patch tests to accelerators found in rubber gloves. Nevertheless, a contribution to the dermatitis by metals in the platinum group metal ore dust cannot be excluded. Recommendations: Nitrile glove constituents should be considered in wearers who develop hand dermatitis. Skin patch testing is recommended to investigate putative agents. Specific patch test series for more targeted testing may be required

Family Practitioners Perception of; Knowledge about and use of Peak Flow Meters in Lenasia; Lenasia South; and Soweto Community Health Clinics

Background : The purpose of this paper was to determine the availability of peak flow meters; perceptions about their usefulness and the perceptions of clinical indications for their use. Methods : A questionnaire was administered to private and public sector practitioners (n=72) working in three urban areas of greater Johannesburg. Data were collected concerning practice profiles; the characteristics of the practitioners; the extent of and indications for use; and the reasons for failure to use these meters. Results : The results showed that only 21 (29) of the practitioners advised their asthma patients to use peak flow meters for home monitoring. A scoring system (summary score); which was developed to summarise knowledge of both the indications for the use of the meters and the method of peak flow measurement; showed that only 33.3of the practitioners attained maximum or close to maximum scores (6 to 8 of an 8-point scale). Conclusion : Peak flow meters were underutilised by family practitioners. The cost of the peak flow meter was an important reported cause of underutilisation. It is recommended that the importance of the peak flow meter in the management of asthma be emphasised at the undergraduate and continuing medical education level. The findings of this study could also be used to guide the national campaign coordinators in South Africa in their strategy to improve asthma care among family practitioners. Since asthma may be under-diagnosed in the community; further research is needed to assess the effects of education in assisting people to recognise asthma. Early recognition and diagnosis of asthma; together with appropriate asthma education; may significantly reduce morbidity. The role of illiteracy and cost in limiting the use of peak flow meters warrants investigation; as does the possibility of developing suitable meters for populations with limited formal education. Doctors need to make more conscientious; concerted and informed efforts to monitor their asthma patients and to collaborate; where appropriate; with health educators to optimise the management of asthma. This could include workshops within the community and with fellow healthcare workers (doctors; primary healthcare sisters) on various aspects of asthma care; which will incorporate inhaler techniques and peak flow meter use

Increasing thyroxine requirements in primary hypothyroidism: don't forget the urinalysis!

Rising thyroid stimulating hormone (TSH) levels in patients being treated for primary hypothyroidism usually indicate poor compliance with thyroxine therapy. In rare instances, drugs or diseases affecting absorption of thyroxine or drugs that accelerate thyroxine metabolism can manifest in a similar fashion. Nephrotic syndrome is a rare cause of such a presentation though its presence can rapidly be suspected by dipstick urine testing. In this report we describe a patient with long-standing primary thyroid failure whose thyroxine dose requirements increased upon development of massive proteinuria. Biochemical testing and renal biopsy subsequently demonstrated nephrotic syndrome and amyloid deposition in association with myeloma. Dipstick urine testing should be considered in all hypothyroid patients with rising TSH levels, where good compliance with thyroxine therapy is likely.