Modified Plasma Cytokine Profile in Occupational Dermatitis.

BACKGROUND: Despite significant progress in the diagnosis of contact dermatitis, the identification by specific tests or biomarkers remains an unsolved issue, particularly when needed for the confirmation of the occupational origin of the disease. OBJECTIVE: To characterize the plasma proteome profile in occupational dermatitis in workers of paint industry. METHODS: The study has a case-control design, comparing exposed workers with and without occupational contact dermatitis, matched for age, gender, occupational history, and comorbidities. An immunological assay (Human XL Cytokine Array Kit - ARY022B, R&D Systems) was used to measure the plasma levels of 105 cytokines and chemokines in a pooled sample of the cases and a pooled sample of the controls. RESULTS: A 1.5-fold increase was noticed for interleukin 3, interleukin 10, and leptin in cases, as compared to controls. Fibroblast growth factor-7 and growth/differentiation factor-15 showed a 1.4-fold increase, while interleukin 19, interleukin 31, and macrophage inflammatory protein 3a.had only a 1.3- fold increase. The leukemia inhibitory factor was the only plasma cytokine that showed a 1.3-fold decrease. All other cytokines had a variation of less than 1.2-fold between cases and controls. CONCLUSION: The recognition of the molecular signatures is very important for an accurate and indisputable diagnosis of occupational contact dermatitis. In workers from the paint industry, plasma levels of interleukins 3, 10, 13 and 19, fibroblast growth factor-7, and growth/differentiation factor-15, together with leukemia inducible factor, may differentiate subjects with contact dermatitis from those without skin lesions.

Potential classification of chemical immunologic response based on gene expression profiles.

Occupational immune diseases are a serious public health burden and are often a result of exposure to low molecular weight (LMW) chemicals. The complete immunological mechanisms driving these responses are not fully understood which has made the classification of chemical allergens difficult. Antimicrobials are a large group of immunologically-diverse LMW agents. In these studies, mice were dermally exposed to representative antimicrobial chemicals (sensitizers: didecyldimethylammonium chloride (DDAC), ortho-phthalaldehyde (OPA), irritants: benzal-konium chloride (BAC), and adjuvant: triclosan (TCS)) and the mRNA expression of cytokines and cellular mediators was evaluated using real-time qPCR in various tissues over a 7-days period. All antimicrobials caused increases in the mRNA expression of the danger signals Tslp (skin), and S100a8 (skin, blood, lung). Expression of the TH2 cytokine Il4 peaked at different timepoints for the chemicals based on exposure duration. Unique expression profiles were identified for OPA (Il10 in lymph node, Il4 and Il13 in lung) and TCS (Tlr4 in skin). Additionally, all chemicals except OPA induced decreased expression of the cellular adhesion molecule Ecad. Overall, the results from these studies suggest that unique gene expression profiles are implicated following dermal exposure to various antimicrobial agents, warranting the need for additional studies. In order to advance the development of preventative and therapeutic strategies to combat immunological disease, underlying mechanisms of antimicrobial-induced immunomodulation must be fully understood. This understanding will aid in the development of more effective methods to screen for chemical toxicity, and may potentially lead to more effective treatment strategies for those suffering from immune diseases.

[Prediction of occupational allergic contact dermatitis induced by formaldehyde by IL17/IL22 secretion cell rest combined with patch test].

Objective: To investigate the possible role of IL17-and IL22-secreting cells combined with patch test for the prediction of formaldehyde-induced occupational allergic contact dermatitis(OACD). Methods: From October 2014 to October 2016, totally 131 formaldehyde-exposed workers(49 cases with inflammatory skin lesions,82 ones without inflammatory skin lesions)and 63 non-exposed health controls were recruited. Patch-test was performed in 49 cases of formaldehyde-exposed workers with inflammatory skin lesions. Circulating IL17+and IL22+Tcell subsets were assessed by flow cytometry(FCM). Results: Among 49 cases of formaldehyde-exposed workers with inflammatory skin lesions,32 cases were with positive patch-test while 17 cases with negative patch-test. The proportions of circulating CD3+CD8-IL17+ and CD3+CD8-IL22+ cells from patch-test(+) formaldehyde-exposed workers were significantly higher than that of patch-test(-)group, formaldehyde-exposed workers without skin lesions and non-exposed controls(P<0.05). The proportions of circulating CD3+CD8-IL17+ and CD3+CD8-IL22+cells from patch-test(-)group and formaldehyde-exposed workers without skin lesions were also higher than that of non-exposed controls(P<0.05). But there was no significant difference between patch-test(-)group and formaldehyde-exposed workers without skin lesions(P>0.05). Peripheral CD3+CD8+IL17+and CD3+CD8+IL22+cells were also detected in spite of small amounts. The percentages of CD3+CD8+IL17+and CD3+CD8+IL22+ cells inperipheral blood from patch-test(+)formaldehyde-exposed workers were enhanced significantly, compared to patch-test(-)group, formaldehyde-exposed workers without skin lesions and non-exposed controls(P<0.05). The proportions of circulating CD3+CD8+IL17+ and CD3+CD8+IL22+ cells from patch-test(-)group and formaldehyde-exposed workers without skin lesions were significantly higher than that of non-exposed controls(P<0.05). But there was no significant difference between patch-test(-) group and formaldehyde-exposed workers without skin lesions(P>0.05). Conclusion: The proportions of circulating IL17+ and IL22+T cells(both CD8-and CD8+)are enhanced in formaldehyde-exposed workers at proposed OEL, possibly involved in the development of formaldehyde-induced OACD.The detection of IL17-and IL22-secreting cells combined with formaldehyde patch test help to screen the workers with allergy property and prevent OACD.

[Information value of lipid peroxidation parameters in patients with occupational allergic dermatoses].

Evaluation of lipid peroxidation in patients with occupational allergic dermatoses revealed activation of free radical oxidation. Serum levels of diene conjugates and end products of free radical lipid peroxidation appeared to be informative parameters for assessing influences on body system and for estimating the disease severity and the individual protective means efficiency.

Skin symptoms in bakery and auto body shop workers: associations with exposure and respiratory symptoms.

PURPOSE: Despite the importance of skin exposure, studies of skin symptoms in relation to exposure and respiratory symptoms are rare. The goals of this study were to describe exposure-response relationships for skin symptoms, and to investigate associations between skin and respiratory symptoms in bakery and auto body shop workers. METHODS: Data from previous studies of bakery and auto body shop workers were analyzed. Average exposure estimates for wheat allergen and isocyanates were used. Generalized linear models were constructed to describe the relationships between exposure and skin symptoms, as well as between skin and respiratory symptoms. RESULTS: Data from 723 bakery and 473 auto body shop workers were analyzed. In total, 5.3% of bakery and 6.1% of auto body shop workers were female; subjects' mean age was 39 and 38 years, respectively. Exposure-response relationships were observed in auto body shop workers for itchy or dry skin (PR 1.55, 95% CI 1.2-2.0) and work-related itchy skin (PR 1.97, 95% CI 1.2-3.3). A possible exposure-response relationship for work-related itchy skin in bakery workers did not reach statistical significance. In both groups, reporting skin symptoms was strongly and significantly associated with reporting respiratory symptoms, both work-related and non-work-related. CONCLUSIONS: Exposure-response relationships were observed for skin symptoms in auto body shop workers. The lack of significant exposure-response associations in bakery workers should be interpreted cautiously. Workers who reported skin symptoms were up to four times more likely to report respiratory symptoms. Improved awareness of both skin and respiratory outcomes in exposed workers is needed.

[Prevalence of atopic conditions in patients with occupational contact allergic dermatitis: comparison between diagnostic tool]. / Prevalenza di atopia nella dermatite allergica da contatto professionale: confronto tra tecniche diagnostiche.

BACKGROUND: Occupational allergic contact dermatitis (OACD), to which atopy contributes to a as yet unspecified degree, accounts for a considerable number of work-related diseases. OBJECTIVES: We studied the prevalence of atopy in OACD patients. We also compared the ability of prick tests and specific IgE assays to detect it. METHODS: In 329 patients diagnosed with OACD at the Occupational Medicine Unit of Cagliari University Hospital between 2000 and 2009, we aimed at detecting atopic conditions with prick tests and IgE assays specific for allergens most frequently responsible for atopic reaction. A kappa test was used to assess concordance between the two assays. The 2 test for trend was used in the analysis of prevalence of atopy by age at diagnosis. RESULTS: A positive response was more frequently detected with prick tests (35.9%) than the specific IgE assays (31%). IgE assays for all the allergens we tested were more frequently positive among males (p range = 0.001-0.037). With either test, the highest observed prevalence of a positive response was to Dermatophagoides pteronyssinus. A significantly inverse trend with increasing age in the prevalence ofpositive reaction to Dermatophagoides pteronyssinus, Phleum pratense and Olea europaea (olive) allergens was also observed. The concordance between the two tests ranged between good (Dermatophagoides pteronyssinus, Phleum pratense and Olea europaea and moderate Artemisia vulgaris (mugwort) and Parietaria judaica. CONCLUSIONS: Our results showed a prevalence of atopic conditions in 31-35.9% of OACD patients. RESULTS: with the two assays were largely consistent, indicating that both prick tests an specific IgE assays are valid diagnostic tools for atopy.

[Association between cytokines and trichloroethylene-induced hypersensitivity dermatitis].

OBJECTIVE: To detect the cytokines levels in serums of patients with trichloroethylene-induced hypersensitivity dermatitis and explore the effect biomarkers associated with this disease. METHODS: Twenty-two patients with TCE-induced hypersensitivity dermatitis, twenty-two healthy TCE-exposed workers from the same workshops with patients and twenty-two comparable unexposed controls were recruited in this study. Eight cytokines in serums from all subjects were detected using Liquid Suspended Biochip; the correlation among the eight cytokines including interleukin (IL)-1ß (IL-1ß), IL-5, IL-8, IL-10, interferon-γ (IFN-γ), tumor necrosis factor-α (TNF-α), macrophage chemoattractant protein-1 (MCP-1), macrophage inflammatory protein-1ß (MIP-1ß) and the correlation between IL-5 and eosinophil count were analyzed. RESULTS: The medians of levels of IL-1ß, IFN-γ, IL-5, IL-10, MCP-1, MIP-1ß, IL-8 among patients were 0.15, 80.13, 2.95, 6.45, 83.83, 1057.90, 440.22 pg/ml, respectively, which were higher than those among the TCE-exposed workers (0.09, 16.93, 0.11, 0.07, 28.75, 241.07, 28.26 pg/ml, respectively, all P values < 0.01) and unexposed controls (0.09, 3.14, 0.11, 0.07, 25.27, 209.64, 207.34 pg/ml, respectively, all P values < 0.01). The median of level of TNF-α among the patients was 13.26 pg/ml, which was significantly higher than that among TCE-exposed workers (4.87 pg/ml, P < 0.01) but not among unexposed controls; the median of level of IL-5 among the TCE-exposed workers was 0.11 pg/ml, which was significantly higher than that among the unexposed controls (0.11 pg/ml, P < 0.01). The median of levels of IL-8 among the unexposed controls was 207.34 pg/ml, which was significantly higher than that among the TCE-exposed workers (28.26 pg/ml, P < 0.01). In case group, except for correlation of TNF-α and IFN-γ, TNF-α and IL-5, the significant positive correlations were found among any two cytokines (r(IL-1ß,IFN-γ) = 0.500, r(IL-1ß,TNF-α) = 0.348, r(IL-1ß,MCP-1) = 0.537, r(IL-1ß,MIP-1ß) = 0.477, r(IL-1ß,IL-8) = 0.466, r(IL-1ß,IL-5) = 0.610, r(IL-1ß,IL-10) = 0.626, r(IFN-γ,MCP-1) = 0.460, r(IFN-γ,MIP-1ß) = 0.491, r(IFN-γ,IL-8) = 0.322, r(IFN-γ,IL-5) = 0.532, r(IFN-γ,IL-10) = 0.511, r(TNF-α,MCP-1) = 0.325, r(TNF-α,MIP-1ß) = 0.283, r(TNF-α,IL-8) = 0.430, r(TNF-α,IL-10) = 0.271, r(MCP-1,MIP-1ß) = 0.659, r(MCP-1,IL-8) = 0.526, r(MCP-1,IL-5) = 0.504, r(MCP-1,IL-10) = 0.614, r(MIP-1ß,IL-8) = 0.601, r(MIP-1ß,IL-5) = 0.451, r(MIP-1ß,IL-10) = 0.579, r(IL-8,IL-5) = 0.255, r(IL-8,IL-10) = 0.403, r(IL-5,IL-10) = 0.798, all P values < 0.05). The median of level of IL-5 among the patients with high eosinophils counts was 8.92 pg/ml, which was significantly higher than that among the patients with low eosinophils counts (1.04 pg/ml, P < 0.05). CONCLUSION: The abnormal production of IL-1ß, IFN-γ, TNF-α, IL-8, MCP-1, MIP-1ß, IL-5 and IL-10 was related with the pathogenesis of hypersensitivity dermatitis induced by TCE. These cytokines could be used as referential indexes in the early health surveillance and clinic disease treatment.

[Dynamic change study of dermatitis medicamentosa-like of trichloroethylene patients with liver damage].

OBJECTIVE: Observing the dynamic change characteristics of serum liver function indexes in occupational dermatitis medicamentosa-like of trichloroethylene patients with liver damage, we can underlie for guiding therapy, prognosis and mechanism of dermatitis medicamentosa-like of trichloroethylene patients with liver damage. METHODS: We collected serum of 10 cases of occupational dermatitis medicamentosa-like of trichloro-ethylene patients with liver damage from different time points since they were hospitalized, using automatic biochemistry analyzer to detect total protein (TP), albumin (ALB), total bilirubin (TBIL), direct bilirubin (DBIL), indirect bilirubin (IBIL), alanine aminotransferase (ALT), aspartate aminotransferase (AST), gamma-glutamyl transpeptidase (GGT), alkaline phosphatase (ALP), albumin/globulin ratio etc 11 liver function biochemical indicators. We used Excel to establish database, professional drawing software gnuplot to draw dynamic variation diagram of each index. RESULTS: The variation range of 11 liver function indexes of 10 cases was TP 43.2-74.2 g/L, ALB 24.6-44.6 g/L, A/G 0.77-2.10, TBIL 3.7-268.2 umol/L, DBIL 1.0-166.0 umol/L, IBIL 2.4 -167.5 umol/L, ALT 11-5985 U/L, AST 14-5586 U/L, GGT 15-1500 U/L, ALP 35-309 U/L, S/L 0.07-1.94, respectively. TBIL, DBIL, ALT, AST, GGT, ALP concentration significantly increased, especially ALT, AST, GGT, ALT topped 5985 U/L, AST topped 5586 U/L, GGT topped 1500 U/L. But TP, ALB and S/L significantly decreased, TP lowest to 43.2 g/L, S/L lowest to 0.07. A/G basically remained unchanged, but IBIL didn't change regularly. CONCLUSION: The early liver damage in dermatitis medicamentosa-like of trichloroethylene patients was serious, and repeatedly attacked, so we should lead to enough attention to the clinical work and prevention. This also provided the basis for studying the mechanism of trichloroethylene poisoning.

[Analysis of subgroups of lymphocyte in peripheral blood among dermatitis medicamentosa-like of trichloroethylene patients and healthy exposed workers].

OBJECTIVE: To study the effects of trichloroethylene (TCE) to lymphocyte subsets among exposed workers, and explore the early immunological effect biomarkers for prevention of hypersensitivity dermatitis induced by TCE. METHODS: Twenty-eight patients with TCE-induced hypersensitivity dermatitis, 56 healthy TCE-exposed workers from the same workshops with patients, and 28 comparable unexposed controls were recruited in this study. The total lymphocyte count and the major lymphocyte subsets including T cell, CD4(+) T cell, CD8(+) T cell, B cell, NK cell in peripheral blood were measured by Flow Cytometer analysis and Standard blood count analysis. RESULTS: The total lymphocyte count and T cell, CD4(+) T cell, CD8(+) T cell among patients (median at 2810.00, 1846.17, 831.87, 904.05 cell counts/µl blood) were significantly increased compared with TCE-exposed workers (median at 2101.00, 1218.59, 643.87, 482.81 cell counts/µl blood, Z = -3.19, -4.96, -3.22, -4.99, P < 0.001) and unexposed controls (median at 1900.00, 1223.60, 558.60, 325.80 cell counts/µl blood, Z = -3.30, -4.46, -3.45, -5.03, P < 0.001), the NK cell and CD3(+)CD4(+)/CD3(+)CD8(+) ratio among patients (median at 255.50 cell counts/µl blood and 1.11) were significantly decreased compared with the unexposed controls (median at 642.60 cell counts/µl blood and 1.96, Z = -3.56 and -3.11, P < 0.01). Meanwhile, for the exposed workers, the CD8(+) T cell (median at 482.81 cell counts/µl blood) was significantly increased and the NK cell and CD3(+)CD4(+)/CD3(+)CD8(+) ratio (median at 318.76 cell counts/µl blood and 1.27) were significantly decreased compared with unexposed controls (median at 325.80 and 642.60 cell counts/µl blood and 1.96, Z = -2.63, -3.52, -2.29, P < 0.05). CONCLUSION: Occupational exposure to TCE could affect the lymphocyte subsets, especially T cell and NK cell. The total lymphocyte count, T cell and CD4(+) T cell might be effect biomarkers for subjects with hypersensitivity dermatitis among TCE-exposed workers.

[Screening and identification of differential serum proteins related to dermatitis medicamentosa-like of trichloroethylene].

OBJECTIVE: To screen and identify differential serum proteins which might be involved in dermatitis medicamentosa-like of trichloroethylene (DMLT). METHODS: Three groups of sera were collected from population exposed to trichloroethylene (TCE) (group I), patients suffering from DMLT (group II), and the healed cases (group III). After removing albumin and IgG in the three pools of sera, a comparative proteomic analysis was carried out. The images were analyzed using ImageMaster Platinum 2D 5.0 to screen the differentially expressed proteins. The protein spots were then subjected to matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF-MS) and tandem mass spectrometry sequencing of tryptic peptides for further identification. RESULTS: The depletion of albumin and IgG greatly increased the number of protein spots to 300 ± 12.Five differential spots were identified, which were complement component C4b, apolipoprotein A-I, apolipoprotein C-III apolipoprotein C-II and transthyretin. Compared with group I, the expression levels of complement component C4b in group III and apolipoprotein C-II in group II were up-regulated (1.352 88-fold, 1.512 14-fold, respectively); compared with group I, the expression levels of apolipoprotein A-I, apolipoprotein C-III and transthyretin in group II were down-regulated (1.601 17-fold, 1.034 49-fold, 1.313 35-fold, respectively). CONCLUSION: The findings of this study show that most of the identified differential proteins are closely related to immunity and liver dysfunction, which provides some evidence on elucidating the mechanisms and screening of biomarkers of TCE intoxication.

Lesional skin vascular endothelial growth factor levels correlate with clinical severity in patients with cement allergic contact dermatitis.

Allergic contact dermatitis to cement is a delayed-type hypersensitivity reaction in which cytokines interferon-gamma (IEN-y) and vascular endothelial growth factor(VEGF) may be involved in persisting erythema and oedema. VEGF and IFN-gamma levels in serum and skin lesions were measured in 32 Egyptian building workers with chronic allergic contact dermatitis due to occupational exposure to cement and 20 healthy controls. Dermatitis patients had significantly higher levels of serum and lesional skin VEGF and IFN-gamma than controls. A significant positive correlation was found between tissue VEGF and the eczema area and severity index (EASI) score in dermatitis patients (r = 0.86). VEGF and IFN-gamma may play a role in the pathogenesis of cement allergic contact dermatitis.

Identification of IgE-reactive proteins in patients with wheat protein contact dermatitis.

BACKGROUND: Wheat protein and its derivatives can cause protein contact dermatitis (PCD), which mainly occurs in bakers. Few studies have attempted to identify the allergens responsible for wheat PCD. OBJECTIVES: The aim of this study was to identify allergenic wheat proteins in patients with wheat PCD. METHODS: Water-soluble and water-insoluble wheat flour proteins were separated by 1- or 2-dimensional gel electrophoresis. IgE-binding proteins were detected by immunoblotting with sera from 3 wheat PCD patients and identified by N-terminal amino acid sequence analysis. The IgE-binding proteins were recombinantly expressed in Escherichia coli and tested against patients' sera. RESULTS: IgE antibodies from the patients' sera reacted with water-soluble proteins rather than water-insoluble proteins, and the 2-dimensional electrophoresis and immunoblotting produced individual IgE-binding patterns. Analysis of the N-terminal amino acid sequence of the IgE-binding proteins from the 2-dimensional gel led to the identification of three glycoproteins, wheat 27-kDa allergen, peroxidase, and purple acid phosphatase. No specific IgE antibodies to their non-glycosylated recombinant proteins were observed. CONCLUSIONS: We identified wheat 27-kDa allergen, peroxidase and purple acid phosphatase as candidate allergens for wheat PCD. Our results suggest that glycan moieties in these proteins are involved in IgE binding.

Occupational contact urticaria caused by cyclic acid anhydrides.

BACKGROUND: Cyclic acid anhydrides often cause allergic respiratory diseases, but contact urticaria because of these anhydrides has been considered rare. OBJECTIVE: We describe 21 patients diagnosed with occupational contact urticaria at the Finnish Institute of Occupational Health during the period 1990-2006. METHOD: Prick test with human serum albumin (HSA)-acid anhydride conjugates, determination of specific immunoglobulin E (IgE), and open application were used in the diagnosis. RESULTS: The majority of the patients worked in the manufacture of electrical machines and were exposed to an epoxy hardener containing methyl hexahydrophthalic anhydride. The largest prick test reaction was often noted for the acid anhydride the patient had been exposed to. The specific IgE results were mostly in line with the prick test reactions. Phthalic anhydride IgE was determined in 20 patients and was found positive in 19 patients. In open application, a positive test result often required the use of the undiluted hardener. CONCLUSIONS: Contact urticaria may be more common than previously believed. Prick tests with HSA-acid anhydride conjugates were a useful test method for detecting immediate sensitization to acid anhydrides. The determination of the specific IgE gave almost equal results. The open application test often had to be performed with the undiluted anhydride product to obtain a positive test result.

Tumour necrotizing factor-alpha promoter and GST-T1 genotype predict skin allergy to chromate in cement workers in Taiwan.

BACKGROUND: Construction workers exposed to cement are known to suffer from occupational contact dermatitis because of chromate sensitization. It is not clear whether certain genotypes are associated with increased susceptibility of chromate sensitization in those workers regularly exposed to cement. OBJECTIVE: The objective of this study was to determine the genotypes predisposing workers to cement-induced contact dermatitis. METHODS: A total of 153 current cement workers who had regular contact with cement were telephone interviewed for skin problems in the past 12 months, work exposure, and personal protection. A dermatologist examined their skin and conducted patch test with common skin allergens. Blood samples were donated for genotypic determination by polymerase chain reaction-based assays for GST-T1, GST-M1 (null/non-null), tumour necrosis factor (TNF) alpha promoter-308G/A, and interleukin (IL) 4-590C/T. RESULT: High percentage of dermatitis was noted in the 153 workers examined, which was correlated with reported skin problems. By patch testing, construction workers had a high-prevalence rate (12%) of sensitivity to chromate. Sensitivity to chromate was significantly associated with TNF alpha promoter-308 heterozygous (GA) as compared with GG genotype (odds ratio 3.9, 95% confidence interval 1.1-13.2), as well as with GST-T1 null genotype (odds ratio 5.5, 95% confidence interval 1.4-36.2), but neither the GST-M1 nor the IL-4 genotypes. CONCLUSION: It is concluded that among workers frequently exposed to cement in Southern Taiwan, those with TNF alpha promoter-308 heterozygous (GA) genotype or GST-T1 null genotype had increased risk of chromate sensitization.

Lactase-induced occupational protein contact dermatitis and allergic rhinoconjunctivitis.

Enzymes are high-molecular-weight proteins and highly sensitizing occupational allergens used widely in industrial processes. Lactase has been described to cause work-related respiratory and conjunctival immunoglobulin (Ig)-E-mediated sensitizations in workers in the pharmaceutical industry. In these previous reports, allergic rhinoconjunctivitis or asthma was confirmed with prick tests but not by challenge tests. Lactase previously has not been described as a cause of immediate or delayed contact skin reaction. Furthermore, there are no previous reports of lactase-specific IgE. We report a case of protein contact dermatitis and allergic rhinoconjunctivitis from occupational exposure to lactase in a pharmaceutical worker. The patient exhibited strong positive responses to lactase in prick tests. In an open application test, lactase elicited whealing, and in patch testing, lactase elicited an eczematous reaction. Serum lactase-specific IgE antibodies were demonstrated in immunospot and radioallergosorbent test assays, and lactase-IgE-binding fractions and their specificities were examined in immunoblot and immunoblot inhibition assays. The chamber challenge test was performed to detect the association between lactase sensitization and rhinoconjunctival symptoms. Our results have confirmed the previous observations that lactase can induce occupational IgE-mediated respiratory and conjunctival sensitizations, but they show that contact skin reactions caused by lactase may also occur.

Occupational allergic contact dermatitis from azithromycin in pharmaceutical workers: a case series.

BACKGROUND: Reports on hypersensitivity reactions to azithromycin associated with therapy or occupational exposure have been rare. OBJECTIVES: A case series describing clinical characteristics, diagnostic pathways and risk factors in occupational allergic contact dermatitis (ACD) caused by azithromycin in pharmaceutical workers is presented. PATIENTS/METHODS: 7 out of 21 pharmaceutical workers exposed to powdered intermediate and final substances in azithromycin synthesis were referred with workplace-related skin and respiratory symptoms. They all underwent diagnostic procedure involving medical history and examination, patch testing with standard allergens and azithromycin, prick testing with inhalatory allergens and total immunoglobulin E measurement. RESULTS: Airborne ACD caused by azithromycin was established in 4 examined workers with positive patch test to azithromycin. 2 workers additionally had positive patch test to intermediate substances. Occupation-related symptoms of urticaria, rhinoconjunctivitis, laryngitis and/or dyspnoea were described in additional 2 workers without clearly positive patch test to azithromycin. 2 atopic workers had a shorter asymptomatic period between the beginning of the exposure to azithromycin and occurrence of skin symptoms than non-atopics (2-3 months versus 1-3 years, respectively). CONCLUSIONS: Our results suggest that daily manipulation with powdered azithromycin and intermediates is a main route of sensitization. Besides contact sensitization, other possible workplace-related azithromycin hypersensitivity reactions are indicated.

Contact allergy and respiratory/mucosal complaints from heroin (diacetylmorphine).

After the start of heroin (diacetylmorphine)-assisted treatment to a selected group of chronic treatment-resistant heroin-dependent patients in the Netherlands, we reported about work-related eczema and positive patch tests to heroin in some nurses and nasal and respiratory complaints. To investigate the prevalence of heroin contact allergy, we started a questionnaire-based study with follow-up by allergological examinations. Of 120 questionnaires sent, 101 (84%) was returned: 67 from nurses and 34 from other employees. Of 101 workers, 38 (38%) had reported work-related complaints: 33 of 67 (49%) nurses and 5 of 34 (15%) other employees. Patch tests to heroin were performed in 24 nurses and were positive in 8 (33%). All the 8 had eyelid or facial eczema and, in 6, accompanied by mucosal or respiratory complaints. The prevalence of heroin contact allergy in this study was 8% (8/101) among all employees and 12% (8/67) among nurses. Respiratory and mucosal complaints could not be ascribed to a contact allergy, and in these cases, serum was analysed for specific immunoglobulin E to heroin. A type 1 allergy to heroin could not be shown. These complaints are possibly due to the histamine-liberating effect of heroin, to atopic constitution, to a combination of these factors or - less likely - to other non-allergic factors.

DNA damage and TNFalpha cytokine production in hairdressers with contact dermatitis.

The present work was undertaken to study in hairdressers exposed to several irritants and allergens (prevalently hair-dyeing) and affected by hand contact dermatitis the possible correlation between exposure and direct-oxidative DNA damage, production of tumour necrosis factor alpha (TNFalpha) and allergic inflammatory disease. We evaluated in 19 hairdressers with hand contact dermatitis, 14 allergic contact dermatitis (ACD) and 5 irritant contact dermatitis (ICD) and in a selected control group TNFalpha serum levels by ELISA and direct-oxidative DNA damage by Fpg (formamido-pyrimidine-glycosylase)-modified Comet test on blood. Hairdressers were divided on the basis of number of hair-dyeing carried out weekly into 2 groups: low-exposure (<60 hair-dyeing/week) and high-exposure hairdressers (>or=60 hair-dyeing/week) that reflect also the exposure to other allergens and irritants and 2 different tasks (hairdressers and apprentice hairdressers, respectively). Serum levels of TNFalpha in hairdressers with ACD were significantly higher than controls with a correlation to exposure level. Significant DNA damage in ICD hairdressers with higher exposure as compared to controls was found. These findings suggest that occupational exposure can induce in hairdressers, particularly ICD, DNA damage, increase the TNFa levels particularly in ACD and induce allergic sensitization, suggesting a relationship between direct-oxidative DNA damage, TNFalpha production and allergic inflammatory disease.

Occupational generalised urticaria and allergic airborne asthma due to anisakis simplex.

Anisakis simplex (AS), a fish and cephalopodes parasite, may cause allergic reactions in humans on eating and/or handling contaminated fish. We present a case of occupational hypersensitivity to AS in a woman employed in a frozen-fish factory. She showed both generalised urticarial rash and asthmatic symptoms after work place exposure. All these symptoms immediately disappeared after work place exposure was ceased. The presence of a positive skin prick test and high specific IgE values confirmed a hypersensitivity to anisakis. This is the first case reported of both occupational generalised urticaria and allergic airborne asthma due to AS in the same patient. We suggest that AS could be an important cause of occupational asthma and/or urticaria in the fish industry.