ABSTRACT
Fish, crustaceans, and mollusks are among the most potent allergenic foods of animal origin and are thus important triggers of work-related immediate-food allergies. In Germany, work-related seafood allergies are of great importance in the fishing and processing industries as well as in the areas of food preparation, food control, and food sales. There is no causal therapy of seafood allergy, only the strict and lifelong avoidance of allergens remains. The following recommendations serve to assess the impact of a seafood allergy with regard to the work opportunities ended by it for the assessment of the reduction of earning capacity (MdE (German for Minderung der Erwerbsfähigkeit)) in the context of the occupational disease number 5101 of the Annex to the German regulation for occupational diseases. As a special feature of work-related seafood allergy with regard to insurance law aspects, it must be taken into account that there is a potential risk of systemic reaction with subsequent multi-organ involvement. For the estimation of MdE in the general labor market, the impact of a seafood allergy can therefore be assessed, depending on its clinical severity, as generally "mild" to "severe" in justified individual cases.
ABSTRACT
HINTERGRUND: Die Synkanzerogenese am Hautorgan, wissenschaftlich unstrittig, spiegelt sich im monokausal geleiteten Berufskrankheiten (BK)-Recht nicht wider. Nichtmelanozytäre Hauttumoren und deren Vorläuferläsionen können nur nach Einzelprüfung der BK-Nrn. 5103 und 5102 anerkannt werden. METHODIK: Retrospektive Auswertung von 28 zwischen September 2012 und September 2015 begutachteten Fällen (Altersmedian 72,5 J.) mit nichtmelanozytären Hauttumoren und deren Vorläuferläsionen und arbeitsbedingter Exposition gegenüber natürlicher UV-Strahlung und polyzyklischen aromatischen Kohlenwasserstoffen. ERGEBNISSE: In allen 28 Fällen sahen wir die arbeitstechnischen Voraussetzungen nach den BK-Nrn. 5103 und 5102 als erfüllt an. In 26 Fällen (93 %) empfahlen wir die Hautkrebserkrankung als BK-Tatbestand nach den Nrn. 5103 und 5102 anzuerkennen. Dem folgte der Unfallversicherungsträger in vier Fällen. Achtmal wurde die Anerkennung nur nach BK-Nr. 5103, zehnmal nur nach BK-Nr. 5102 und viermal gar nicht ausgesprochen. SCHLUSSFOLGERUNGEN: Bei nichtmelanozytären Hauttumoren oder deren Vorläuferläsionen an UV-exponierten Hautarealen mit ausreichend kumulativer arbeitsbedingter natürlicher UV-Strahlenexposition und bei arbeitsbedingter Exposition gegenüber polyzyklischen aromatischen Kohlenwasserstoffen sollten mittels BK-Anzeige die "BK-Nrn. 5103 und 5102 im Sinne der Synkanzerogenese" gemeldet werden. Neben der gerechteren Wiedergabe der Arbeitsplatzrealitäten in einem solchen Feststellungsverfahren kann es dann im Konkreten auch zur Anerkennung von Basalzellkarzinomen kommen, die ansonsten, bei alleiniger Prüfung der BK-Nr. 5103, herausgerechnet würden.
ABSTRACT
BACKGROUND: Though scientifically undisputed, cutaneous syncarcinogenesis is not reflected in German occupational disease (OD) regulations, which tend to be guided by the tenet of monocausality. Recognition of nonmelanoma skin cancer (NMSC) and its precursor lesions as OD requires individual assessment as to whether the requirements pursuant to either OD 5103 (occupational exposure to natural UV radiation) or OD 5102 (occupational exposure to polycyclic aromatic hydrocarbons) are fulfilled. METHODS: Retrospective analysis of 28 patients (median age 72.5 years) with NMSC and respective precursor lesions who had been occupationally exposed to natural UV radiation and polycyclic aromatic hydrocarbons. All cases had undergone expert medical assessment between September 2012 and September 2015. RESULTS: According to our assessments, all 28 cases met the occupational requirements pursuant to OD 5103 and 5102. In 26 cases (93 %), we recommended recognition of skin cancer as occupational disease pursuant to both OD 5103 and OD 5102. The competent occupational insurance association (BG) followed our recommendation in four cases. In eight cases, recognition was solely based on OD 5103; in ten cases, only on OD 5102. Four cases were denied recognition. CONCLUSIONS: Following adequate cumulative occupational exposure to natural UV light as well as occupational exposure to polycyclic aromatic hydrocarbons, NMSC or its precursor lesions arising in UV-exposed areas should be reported to the competent occupational insurance association as "OD 5103 and 5102 in terms of syncarcinogenesis". Apart from the fact that the ensuing recognition proceedings will be able to more adequately reflect real-life workplace conditions, filing a report pursuant to both ODs also allows for recognition of basal cell carcinoma as occupational disease. According to current regulations, this would not be possible, if the assessment were solely based on OD 5103.
