A case study of dermatitis based on a collaborative approach between occupational physicians and industrial hygienists.

An example of interdisciplinary problem solving by occupational health professionals is presented. Approximately one dozen employees in an aircraft wire harness assembly line complained of dermatitis, alleging workplace exposures as causation. The plant's and consulting industrial hygienists prepared toxicology and exposure assessments for all process materials, manufacturing procedures, and protective equipment used. They identified no common elements in the work environment that may have caused the dermatitis, suggesting multiple causation and possible individual worker sensitivities. An investigative team composed of the industrial hygienists and physicians in outside practice, including dermatologists and occupational medicine physicians, conducted a review of plant operations and proposed that workers with dermatitis complaints receive diagnostic medical examinations. An initial examination medically documented each worker's complaint, and a follow-up included patch testing for selected process materials. The physicians diagnosed a variety of mainly nonoccupationally induced illnesses such as fungal infections, skin cancer (solar induced), acne, etc., confirming the industrial hygienists' original assessment. One case appeared directly work-related and to be a specific assembly component sensitivity. Although several cases with a nonoccupational origin could have been aggravated by working conditions, these workers showed no sensitivity to the component when patch tested.

Physicians' management of health effects related to industrial exposures: two case reports.

Although physicians play a vital role in diagnosing and treating health effects related to industrial exposures, most physicians have limited training in occupational and environmental medicine. Two cases of industrial exposure, one affecting an individual and the other, a community, are described to illustrate the need for physicians' awareness of such exposure and their need to know how to manage potential health effects. Resources to assist in identifying and managing these exposures and their related conditions are discussed.

Asbestos-associated disease: a review.

Asbestos and its potential for adversely affecting health remain a source of concern to several sectors of society. Since it rarely occurs in the absence of occupational exposure to asbestos, and because it is potentially preventable, asbestosis was recently defined as a reportable occupational disease in Texas. An overview of the cardinal characteristics of the asbestos minerals and their associated health effects is presented. The role of the primary physician in diagnosis and counseling of individuals with asbestos-associated diseases is addressed.

Possibilities of detecting health effects by studies of populations exposed to chemicals from waste disposal sites.

Factors affecting the design of an epidemiologic study assessing possible health effects from chemical waste disposal sites are reviewed. Such epidemiologic studies will most likely be prompted either by a known release of chemicals into the environment around the site, or by an unusual disease cluster in a population near the site. In the latter situation, a method for evaluating the health effects is needed, and one possible approach is discussed. In the former situation, it may not be obvious what health outcomes are relevant. Reported associations between health effects and chemicals in humans were reviewed. Studies from the occupational and environmental literature were classified by chemical and target organ affected and presented in tabular form. No attempt was made to critically evaluate the quality of evidence for each health effect, although bibliographic documentation was provided where possible. Episodes of chemical contamination of food, drinking water and other media were also reviewed and presented in a separate table. The organ sites likely to be affected by toxic chemicals from waste disposal sites depend heavily on the route of exposure and the dose that is received. Ingestion is the most frequently reported route of exposure in episodes of environmental contamination. These have affected the hepatic, renal, hematopoietic, reproductive, and central nervous systems. The type and severity of effects were dose-dependent. Direct skin contact is important in the occupational environment where dermal and central nervous system effects have been reported but seems less likely as a route of exposure for populations around waste disposal sites. Inhalation, unless at relative high concentrations or as a result of fire, is unlikely to be important, although hematopoietic, reproductive, and central nervous system effects have been reported in occupational studies.

Synthetic pyrethroid insecticides: a dermatological evaluation.

Synthetic pyrethroids are lipophilic insecticides whose biological activity seems to be directly related to their chemical structure. In this investigation differences in cutaneous sensation were detected by human participants between synthetic pyrethroids with a cyano group in the (S)-configuration of the 3-phenoxybenzyl alcohol of their molecular structure (fenvalerate) and those that do not (permethrin). A strong relation was noted between insecticidal potency and degree of induced cutaneous sensation for the alpha-cyano and non-cyano pyrethroids, with a prominent difference between the two. No sensation was observed by any of the same participants on topical exposure to the inert ingredients of these agents. A linear correlation between concentration and degree of induced dysaethesia was observed for both pyrethroids. Regressing the cutaneous sensation on the common logarithm of concentration resulted in a regression equation of Y = 84.0 + 31.0X1 for fenvalerate and Y = 27.5 + 15.8X1 for permethrin. A highly efficacious therapeutic agent for pyrethroid exposure was noted to be dl-alpha tocopherol acetate. An impressive degree of inhibition of paraesthesia resulted from the topical application of vitamin E acetate, with a therapeutic index of almost 100%.

Primary irritant contact dermatitis from synthetic pyrethroid insecticide exposure.

Synthetic pyrethroids are widely used insecticides with numerous applications, varying from food protection to general pest control. Humans are capable of tolerating greater acute and chronic exposures to the pyrethroids than to many other insecticides. An abnormal cutaneous sensation (paresthesia) is known to occur after dermal contact with the pyrethroids. Recent field studies have indicated that a primary irritant contact dermatitis may also develop. This investigation evaluated dermal irritancy from cutaneous synthetic pyrethroid application to albino rabbits. Through repeated daily applications of either fenvalerate or permethrin, a slight erythema was noted visually which correlated with increased cutaneous blood flow measured by laser Doppler velocimetry. Histopathological changes were also documented, but no significant differences were detected in edema or thermal variation.

Alteration of in vitro immunoglobulin secretion by amosite asbestos.

We investigated the in vitro effects of amosite asbestos on immunoglobulin (Ig) secretion by human peripheral blood mononuclear leukocytes (MNL). Concentrations of 100 to 300 micrograms/ml of amosite asbestos reduced the number of Ig-secreting cells recovered from 6-day cultures of unstimulated MNL or MNL stimulated with Epstein Barr virus. By contrast, the Ig secretory response to pokeweed mitogen was enhanced by 10 to 100 micrograms/ml concentrations of amosite asbestos; however, amosite asbestos no longer enhanced the response to pokeweed mitogen when MNL were first partially depleted of monocytes (to less than 2%) esterase-positive cells remaining). These results indicate that amosite asbestos has multiple effects on the cells involved in Ig secretion: 1) amosite asbestos inhibits unstimulated B cell function; 2) amosite asbestos inhibits the function of B cells stimulated with the direct B cell activator Epstein Barr virus; and 3) amosite asbestos may alter regulator monocyte function allowing enhanced Ig secretion in the presence of monocyte-dependent B cell triggers such as pokeweed mitogen.

Industrial hygiene in the world arena of occupational health and safety.

The professional industrial hygienist is a "man (or woman) for all seasons," with the ability to cope with a wide variety of problems affecting the health and safety of workers. The development of this profession, for which we in the United States can take credit, had its beginnings about the time of WWI when our chemical industry was beginning to expand and munitions had to be produced for the war effort. Today this professional expertise that is industrial hygiene is in demand in every industrialized country, and even the developing countries are realizing its potential benefit in prevention of occupational disease. In the last decade, which some call the OSHA decade, we have seen several important trends in this profession. The industrial hygienist has become a manager. He must be able to supervise industrial hygiene technologists and technicians. He has become an allied health professional in that he is doing the biologic monitoring heretofore done exclusively by physicians and nurses. In many companies he has been given organization status equal to that of the corporate medical director, and in some instances he has even been given corporate responsibility for overall health and safety. Industrial hygiene is truly a rewarding field for young people with backgrounds in engineering or one of the chemical, physical, or biological sciences. Several hundred are currently in training at the graduate level, but still the demand far exceeds the supply. The decade of the 80's should see even further advances in the field of industrial hygiene, especially in the development of more sophisticated instrumentation and the increased use of the computer in managing environmental and biological data and programming epidemiologic studies. To the academic institutions responsible for postgraduate training in this field, these rapid and profound changes in the professional requirements pose a real challenge, and continuing education courses will assume an even more important role.