European Surveillance System on Contact Allergies (ESSCA): results with the European baseline series, 2013/14.

BACKGROUND: Contact allergy is a common condition and can severely interfere with daily life or professional activities. Due to changes in exposures, such as introduction of new substances, new products or formulations and regulatory intervention, the spectrum of contact sensitization changes. OBJECTIVE: To evaluate the current spectrum of contact allergy to allergens present in the European baseline series (EBS) across Europe. METHODS: Retrospective analysis of data collected by the European Surveillance System on Contact Allergies (ESSCA, www.essca-dc.org) in consecutively patch-tested patients, 2013/14, in 46 departments in 12 European countries. RESULTS: Altogether, 31 689 patients were included in the analysis. Compared to a similar analysis in 2004, the prevalence of contact allergy to methylisothiazolinone went up to around 20% in several departments. In comparison, contact allergy to the metals nickel, cobalt and chromium remained largely stable, at 18.1%, 5.9% and 3.2%, respectively, similar to mostly unchanged prevalence with fragrance mix I, II and Myroxylon pereirae (balsam of Peru) at 7.3%, 3.8% and 5.3%, respectively. In the subgroup of departments diagnosing (mainly) patients with occupational contact dermatitis, the prevalence of work-related contact allergies such as epoxy resin or rubber additives was found to be increased, compared to general dermatology departments. CONCLUSION: Continuous surveillance of contact allergy based on network data offers the identification of time trends or persisting problems, and thus enables focussing in-depth research (subgroup analyses, exposure analysis) on areas where it is needed.

Occupational skin diseases: actual state analysis of patient management pathways in 28 European countries.

BACKGROUND: Work-related skin diseases (WSD) are caused or worsened by a professional activity. Occupational skin diseases (OSD) need to fulfil additional legal criteria which differ from country to country. OSD range amongst the five most frequently notified occupational diseases (musculoskeletal diseases, neurologic diseases, lung diseases, diseases of the sensory organs, skin diseases) in Europe. OBJECTIVE: To retrieve information and compare the current state of national frameworks and pathways to manage patients with occupational skin disease with regard to prevention, diagnosis, treatment and rehabilitation in different European countries. METHODS: A questionnaire-based survey of the current situation regarding OSD patient management pathways was carried out with experts on occupational dermatology and/or occupational medicine from 28 European countries contributing to the European Cooperation in Science and Technology (COST) Action TD 1206 (StanDerm) (www.standerm.eu). RESULTS: Besides a national health service or a statutory health insurance, most European member states implemented a second insurance scheme specifically geared at occupational diseases [insurance against occupational risks (synonyms: insurance against work accidents and occupational injuries; statutory social accident insurance)]. Legal standards for the assessment of occupationally triggered diseases with a genetic background differ between different countries, however, in most European member states recognition as OSD is possible. In one-third of the countries UV light-induced tumours can be recognized as OSD under specific conditions. CONCLUSION: OSD definitions vary between European countries and are not directly comparable, which hampers comparisons between statistics collected in different countries. Awareness of this fact and further efforts for standardization are necessary.

Occupational contact dermatitis to acrylates in a manicurist.

We report the case of a manicurist who developed an allergic skin reaction to acrylates, manifested by bullous lesions on fingertips and eczema of the hands and ears. Patch tests showed positive reactions to 2-hydroxyethyl methacrylate, 2-hydroxypropyl methacrylate, ethyleneglycol dimethacrylate, triethyleneglycol dimethacrylate, 1,6-hexandiol diacrylate, 2-hydroxyethyl acrylate and triethyleneglycol diacrylate. Because of her skin disorder, she had to give up her job. She was not correctly advised on retraining and started to work as a dental nurse. Soon after re-exposure to acrylates in dental materials, she experienced recurrence of the skin symptoms.

The European standard series in 9 European countries, 2002/2003 -- first results of the European Surveillance System on Contact Allergies.

Since January 2001, the European Surveillance System on Contact Allergies (ESSCA), supported by European Union funding (contract QLK4-CT-2001-00343), has started to collect patch-test data. This comprises a standardized clinical history and the patch-test results using the European standard series, from 17 centres in 9 European countries listed above. In 2002 and 2003, 10 511 patients' test results have been pooled and analysed. The anamnestic data partly reflect the subspecialties of some centres. The most common allergen was nickel sulfate (17.3%); however, large international variations were observed. The prevalence of contact allergy to Myroxylon pereirae resin (balsam of Peru) (5.8%) is coming close to the frequency found with the fragrance mix (6.4%). Regarding contact allergy to chromium compounds, different frequencies were noted in the 2 centres focused on occupational dermatitis (2.3% in the FIOH versus 7.4% in the Nofer Institute). These most likely reflect the beneficial effect of addition of ferrous sulfate in one, but not the other country. As differences may partly be due to different patch-test reading, standardization may need to be refined further. By providing post-marketing surveillance in the field of contact allergy, ESSCA will meet its objective of increased consumer safety across Europe.

[Photosensitivity induced skin diseases]. / Choroby skóry wywolane nadwrazliwoscia na swiatlo.

The causes of skin diseases associated with photosensitivity are presented. The combined effect of light and exogenous light sensitizing substances leads to the occurrence of phototoxic and photoallergic reactions, and what is more, UVA spectrum is most active in their pathogenesis. The light sensitizing compounds are contained in cosmetic preparations, drugs and certain plants. They are characterized by a tricyclic structure and the ability to absorb ultraviolet radiation. The light sensitizing properties are exhibited primarily by non-steroid anti-inflammatory drugs, preservatives, sun filters, phenothiazine derivatives and odorants. Photoallergic reactions may be of occupational nature. The majority of reports found in the literature concern farmers, gardeners, fruit-growers and breeders, as well as representatives of other occupations. They usually emerge after the contact with pesticides of the thiocarbamide group, tetrachloroisophthalonitryl and veterinary drugs. The cases of occupational eczema in farmers and gardeners induced by the effect of light sensitizing plants have also been reported. In addition, the photoallergy diagnostic methods are discussed.

[Natural history of occupational allergy to latex in health care workers]. / Historia naturalna alergii zawodowej na lateks u pracowników sluzby zdrowia.

The analysis of natural history of allergy to natural rubber latex (NRL) in health care workers, including the influence of exposure cessation on the clinical status and objective allergy markers was the objective of the study. The study covered 58 patients with recognised allergy to NRL. Of this number, 26 were followed up for 2 years after diagnosing NRL allergy. Medical examination, skin prick tests for common allergens and NRL, determination of total serum IgE and NRL-specific IgE antibodies, rest spirometry and non-specific bronchial hyperactivity test with histamine were performed. The retrospective analysis of clinical manifestation of NRL allergy revealed in 36% of patients progression of symptoms from local urticaria and rhinitis to systemic reactions. Two years after the cessation of exposure to NRL, symptoms became less severe in the majority of patients and even a clearance of allergic symptoms was observed, as well as the decrease in doses of inhalative glicocorticosteroids was noted. This was accompanied by the decline in non-specific bronchial hyperactivity. Although the skin prick tests showed the tendency to remain positive, the decrease in the level of specific anti-NRL IgE was found in 10 patients (including the RAST negativisation in one case). In conclusion, clinical progress from NRL-induced contact urticaria and allergic rhinitis to systemic reactions was observed only in part of patients with NRL allergy, which cannot be taken as a rule. Significant reduction of clinical symptoms or even total remission of NRL-allergic symptoms could be observed after exposure cessation.

Occupational skin diseases among the nurses in the region of Lódz.

We examined 223 nurses from the Lódz region, referred to the Nofer Institute of Occupational Medicine in 1995-99 because of suspected occupational dermatoses. The diagnosis of contact allergy was based on the positive results of patch tests, and immediate allergy to common allergens and latex on the results of prick tests, as well as on the determinations of specific IgE antibodies. Contact allergy was diagnosed in 66.4% of nurses. The most frequent sensitisers were quaternary ammonium compounds (benzalkonium) (23.8%), nickel (21.5%) and formaldehyde (20.6%); allergy was somewhat less frequently caused by thimerosal (14.3%), fragrances (12.1%), glutaraldehyde (10.8%), cobalt (9.9%), thiurams (6.7%) or glyoxal (4.9%). Allergy to rubber was diagnosed in 40 patients (17.9%), including 25 cases of immediate allergy to latex, 8 cases of contact dermatitis from thiuram rubber curing accelerators, and 7 cases of mixed allergy. It has been concluded that the contact with disinfectants (40.8% of allergic nurses), metals (30.9%) and rubber (17.9%) was the most frequent source of allergy in this group of medical personnel.

Occupational ceramic fibres dermatitis in Poland.

Recently, the use of asbestos has been considerably limited in Poland, with the simultaneous increase in the manufacture, processing and application of man-made mineral fibres, which includes ceramic fibres. The aims of this study were (1) to assess the type and frequency of dermal changes caused by the irritant activity of ceramic fibres among workers at the plants that manufacture packing and insulation products; and (2) to compare the irritant activity of Polish-made L-2 and L-3 ceramic fibres with that of the Thermowool ceramic fibres made in England. Workers (n = 226) who were exposed to ceramic fibres underwent dermatological examination. Patch tests with the standard allergen set, together with samples of the fibres L-2, L-3, and Thermowool fibres, were applied to all the workers. It has been shown that the Polish-made L-2 and L-3 fibres differed from Thermowool fibres in that the L-2 and L-3 fibres contained zirconium and were coarser. The proportion of filaments with diameters above 3 microns was 11.1% in the L-3 fibre and 6.3% in the L-2 fibre samples. The Thermowool fibre did not contain filaments thicker than 3 microns. Evident dermal changes, resulting from strong irritant activity of the fibres, were detected in 109 (48.2%) of the workers examined. Irritant contact dermatitis acuta (maculae, sometimes papulae and small crusts on the upper extremities, trunk, and lower extremities), disappearing after 2-3 days, was found in 50 (22.1%) workers. Irritant contact dermatitis chronica (diffuse permanent erythema with numerous telangiectasiae on the lateral portions of the face and neck, on the trunk, behind the auricles) was detected in 40 (17.7%) workers. The remaining 19 (8.4%) workers had both types of dermal change. All examined workers complained of very strong itching. The results of the patch tests confirmed the irritant activity of the ceramic fibres. Erythema without oedema, persisting for up to 96 h, appeared at the places where the fibres had been applied to the skin in 44 (19.5%) workers. In addition, the irritant activity of the fibres has been shown to be correlated with their thickness. The Thermowool fibre was the weakest irritant, because it did not contain filaments above 3 microns in diameter; the L-2 fibre containing 6.3% filaments above 3 microns caused somewhat stronger skin irritation; while the L-3 fibre, which contained 11.1% filaments thicker than 3 microns, was the strongest irritant. A few cases of allergy to nickel, chromium and colophony (rosin) were also detected.

[Causes of occupational allergy in dental nurses. An analysis based on the material collected at The Institute of Occupational Medicine in Lódz]. / Przyczyny uczulenia zawodowego u pomocy dentystycznych, na podstawie materialu Instytutu Medycyny Pracy w Lodzi.

The causes of occupational dermatosis were analysed in 27 dental nurses examined at The Nofer Institute of Occupational Medicine during the years 1995-99. Contact sensitisation (at least one positive epidermal test) was found in 18 subjects (66.7%). Occupational allergic dermatitis was induced most frequently by: glutaraldehyde (7 positive patch tests), nickel (7), benzalkonium (4), formaldehyde (4), fragrances (4), chromium compounds (3), glyoxal (3), and thiuram (3). In the authors' opinion, dental nurses are nowadays sensitised to other chemical compounds than it used to be in the past. The present components of disinfectants (aldehydes, quaternary ammonium bases), metals and rubber are the major etiologic agents that induce occupational allergy.

[Irritating effect and dermal toxicity of virkon, a disinfectant widely used in Poland]. / Ocena dzialania drazniacego i toksycznosci dermalnej Virkonu, preparatu dezynfekujacego szeroko stosowanego w Polsce.

The aim of the study was to define the threshold irritating effect of Virkon, a disinfectant widely used in Poland, on the rabbit's skin and eye, and its dermal toxicity in single exposure. The studies were carried out according to the OECD guidelines, modified by Krysiak. A 10% aqueous solution of Virkon in the conditions of multiple open exposure was defined as the threshold concentration evoking small inflammatory reaction. After a single administration of Virkon in aqueous solutions into the rabbit's eye, the value of sensitising effect index was 1.5 for 1% solution of the disinfectant in question which indicates weak inflammatory reaction. The study of dermal toxicity in a single exposure revealed neither animal death nor morphological changes in internal organs which suggests non-cutaneous absorption of Virkon. The present study may provide the basis for assessing dermatological changes in people exposed to disinfectants.

[Evaluation of allergic sensitivity to the virkon disinfectant preparation widely used in Poland]. / Ocena dzialania uczulajacego Virkonu preparatu dezynfekujacego, szeroko stosowanego w Polsce.

The aim of the study was to define the sensitising effect of Virkon, a disinfectant widely used in Poland, especially in hospitals. The study was carried out on guinea pigs, using the maximisation test according to Magnusson and Kligman, modified by Krysiak. The assessment of dermal changes presented in the percentage of sensitised animals, being thus far the criterion adopted by Magnusson and Kligman, has been expanded to include our own criteria covering the intensity of reactions of testing samples and the results of eosinophilic and basophilic tests in peripheral blood. Using these parameters and applying pathomorphological examinations it was possible to indicate the difference in the intensity of sensitising effect of Virkon, depending on the concentration used. The results of the study showed that 1% aqueous solution of Virkon is the optimum concentration for monitoring its sensitising effects in people having contact with this substance.

[Contact allergy to nickel]. / Alergia kontaktowa na nikiel.

The authors present data on allergy to nickel. They highlight the necessity to evaluate the incidence of allergy in young people who begin vocational training that entails their contact with metal lead-containing objects.

[The evaluation of the irritating and sensitizing effects of benzalkonium chloride]. / Ocena dzialania drazniacego i uczulajacego chlorku benzalkonium.

The aim of the study was to determine the threshold irritating effect of benzalkonium chloride on the rabbit's skin and eye, and its sensitizing effect on guinea pigs. The study was performed according to the OECD guidelines modified by Krysiak. As a threshold concentration of benzalkonium evoking slight inflammatory reaction on the skin in a single, closed exposure and in multiple, open exposure, the following values were adopted for its aqueous solutions: > 0.5-1%, and 05% respectively. Following the eye administration of 0.01% and 0.05% of benzalkonium aqueous solution a weak irritating and rapidly reversible effect was revealed. The study performed on guinea pigs indicated a sensitizing effect of 0.5%, 0.1% and 0.05% benzalkonium aqueous solutions. The effect differed depending on the concentration used. The evaluation covered the proportion of sensitized animals, the nature and intensity of dermal reaction, as well as peripheral blood eosinophil and basophil tests. The results showed that 0.1% benzalkonium aqueous solution is an optimum concentration for monitoring the sensitizing effect in humans being in contact with this substance.