Occupational contact dermatitis caused by aniline epoxy resins in the aircraft industry.

BACKGROUND: Tetraglycidyl-4,4'-methylenedianiline (TGMDA) is an aniline epoxy resin used in, for example, resin systems of pre-impregnated composite materials (prepregs) of the aircraft industry. Allergic contact dermatitis caused by TGMDA in prepregs has been described previously. OBJECTIVES: To report on 9 patients with occupational allergic contact dermatitis caused by TGMDA in epoxy glues used in helicopter assembly. METHODS: The patients were examined with patch testing at the Finnish Institute of Occupational Health in 2004-2009. The first patient was diagnosed by testing both components of two epoxy glues from the workplace, and was also tested with glue ingredients, including TGMDA. The following patients were tested with the glues and TGMDA. The resin parts of the glues were analysed for their epoxy compounds, including TGMDA. RESULTS: All of the patients had a patch test reaction to one or both of the resin parts of the TGMDA-containing glues. Eight of them had a strong allergic reaction to TGMDA, and one had a doubtful reaction to TGMDA. Two of the patients also had an allergic reaction to triglycidyl-p-aminophenol (TGPAP), another aniline epoxy resin, which was not present in the TGMDA-containing glues. CONCLUSIONS: In aircraft industry workers with suspected occupational dermatitis, aniline epoxy resins should be considered and patch tested as possible contact allergens.

Occupational respiratory and skin diseases among Finnish machinists: findings of a large clinical study.

PURPOSE: Machinists are exposed to many sensitizing and irritant substances, but no previous study has assessed the occurrence of clinically verified occupational diseases in an unselected large workforce of machinists. Our aim was to study the occurrence of clinically verified occupational respiratory and skin diseases cross-sectionally in a large sample of machinists in southern Finland. METHODS: A computer-assisted telephone interview on occupational exposures and health was carried out in a sample of 961 machining workers from 64 metalworking companies. Of these, 757 (79%) answered the interview. A total of 245 subjects reported work-related respiratory or skin symptoms and were invited to clinical examinations; 138 of these underwent a clinical interview and examination by an occupational health physician. On the basis of this examination, 32 subjects were further examined at the Finnish Institute of Occupational Health (FIOH) for occupational skin or respiratory diseases. RESULTS: One case of occupational asthma (OA) and seven cases of occupational dermatoses (OD) were diagnosed, giving a prevalence of 0.13% (95% CI 0-0.39) for OA, and 0.92% (95% CI 0.24-1.16) for OD. The OA was induced by the patient's own MWF. Additional five cases of newly diagnosed non-occupational asthma (0.79%, 95% CI = 0.16-1.42) were detected. No cases of occupational rhinitis or COPD were diagnosed. The dermatoses diagnoses consisted of four cases of allergic contact dermatitis and three cases of irritant contact dermatitis. The most common causes of the ODs were MWFs. CONCLUSION: This large clinical study of machinists representing metalworking in South Finland showed a prevalence of 0.13% of OA and 0.92% of OD. This relatively low occurrence of occupational diseases may reflect the strict Finnish criteria for the diagnosis of these occupational diseases and the relatively good level of occupational hygiene in machining workshops in Finland. Reported respiratory and skin symptoms were common, and these milder conditions may be linked to irritant rather than sensitizing exposures.

Clinical characterization and IgE profiling of birch (Betula verrucosa)--allergic individuals suffering from allergic reactions to raw fruits and vegetables.

BACKGROUND: Hypersensitivity to raw fruits and vegetables is often associated with respiratory allergy to birch (Betula verrucosa) pollen and is considered to be the most prevalent form of food allergy in adults sensitized to birch pollen. OBJECTIVE: The aim of the study was to investigate the association of clinical allergy and IgE profiles in individuals with birch pollen allergy and hypersensitivity to raw fruits and vegetables. METHODS: A total of 59 adults with clinical and skin prick test confirmed birch pollen allergy were included in the study. All the subjects were interviewed by using a structured questionnaire and were examined in vivo by the open test, with the appropriate fruits and vegetables. ImmunoCAP and ImmunoCAP ISAC were used as in vitro diagnostics to assess sensitization profiles for each individual, and principal components analysis was used to analyze the IgE data sets. RESULTS: Of 59 individuals, 54 (92%) had positive prick-prick test with raw potato, carrot, apple, and/or hazelnut, and the skin prick test was always positive when the corresponding skin challenge was defined as positive. Specific IgE in the ImmunoCAP and inhibition assays with rMal d 1 and rBet v 1 demonstrated that Bet v 1 is driving the sensitization against pathogenesis related-10 proteins. However, positive IgE in vitro results could not be used to predict clinical reactivity to raw fruits and vegetables. CONCLUSIONS: The present study showed that component-based IgE profiling does not enhance the diagnostic potential in case of pollen-food syndrome, which may be associated with other as yet unidentified components.

[Drug-induced skin reactions]. / Lääkeaineiden aiheuttamat ihoreaktiot.

Antimicrobials and anti-inflammatories are the most common drugs causing skin reactions, but reactions are also brought about by ACE inhibitors, antiepileptics, many anticancer and certain other drugs. Exanthema and urticaria are the most common types of drug reactions. Urticaria may or may not be accompanied by angioedema or anaphylaxia. Possible life-threatening drug reactions include also toxic epidermal necrolysis, Stevens-Johnson syndrome and eosinophilia with systemic symptoms. A drug reaction resembles a typical allergic reaction. Diagnosis is based on the clinical picture and anamnesis.

Contact sensitization to methylisothiazolinone in Finland--a multicentre study.

BACKGROUND: Antimicrobials constitute the second most common cause of contact allergy to cosmetics. Methylisothiazolinone (MI), previously always used together with methylchloroisothiazolinone (MCI), has recently been approved in the EU for use on its own in cosmetics and also various industrial products. MCI has been classified as an extreme-strong and MI as a strong-moderate sensitizer. OBJECTIVES: To study the frequency of positive patch test reactions to MI, and its relevance and relation to MCI/MI sensitivity, in Finland. METHODS: Over a period of 3 years (2006-2008), MI 0.1% (1000 ppm) and 0.03% (300 ppm) were patch tested in 10,821 patients at eight Finnish dermatological clinics. During 2008, patients with positive reactions to MI were asked to take part in a repeated open application test (ROAT). RESULTS: Of the patients tested, 1.4% and 0.6% showed positive patch test reactions to 0.1% and 0.03% MI, respectively. Sixty-six per cent of those who were MI-positive were also positive to 100 ppm MCI/MI. Thirty-three agreed to undergo the use test, and 10 of these gave positive results (30%). CONCLUSIONS: Our data show that MI used alone also potentially induces contact allergy. Careful monitoring is needed to determine whether or not this antimicrobial is safe to use in cosmetics.

Contact allergy to aliphatic polyisocyanates based on hexamethylene-1,6-diisocyanate (HDI).

BACKGROUND: Aliphatic polyisocyanates based on hexamethylene 1,6-diisocyanate (HDI) are components of lacquers, coatings, and spray paints. They are mainly composed of HDI trimers, but also contain larger oligomers, and minute amounts of HDI monomers (<1%). HDI trimers occur as biuret, isocyanurate and asymmetrical types. OBJECTIVES: We report on 4 patients with allergic contact dermatitis/contact allergy resulting from HDI-based polyisocyanates in polyurethane paints. METHODS: The patients were examined at the Finnish Institute of Occupational Health in 2000-2009. The first two patients were diagnosed by testing with their own polyurethane hardeners and ingredients of the hardeners. In 2002, HDI isocyanurate (HDI-IC) trimer was added to our isocyanate series, and the last two patients were screened with the series. RESULTS: Patient no. 1 was exposed and sensitized to HDI biuret trimer, patient no. 2 to HDI-IC trimer, and patient no. 4 to HDI asymmetrical trimer. Patient no. 3 was positive with HDI-IC trimer. He had been handling several paint hardeners containing HDI-based polyisocyanates, but the subtypes of the trimers remained unidentified. All 4 patients were negative with HDI monomer. CONCLUSIONS: HDI trimers are novel contact allergens in workers who handle polyurethane paints. The allergic reactions cannot be explained by sensitization to HDI monomer.

A 6-month follow-up study of 1048 patients diagnosed with an occupational skin disease.

BACKGROUND: Occupational skin diseases (OSDs) often have considerable medical and occupational consequences. Previous data on prognostic factors have been derived from studies with fairly small sample sizes. OBJECTIVES: To determine the medical and occupational outcome in 1048 patients diagnosed with OSD at the Finnish Institute of Occupational Health and to identify the prognostic risk factors for the continuation of OSD. METHODS: Patients examined in 1994-2001 filled out a follow-up questionnaire 6 months after the diagnosis. Data on atopy, contact allergies, and occupation were analysed. RESULTS: Six months after the diagnosis the skin disease had healed in 27% of the patients. The OSD had cleared up in 17% of those with no changes at work, and in 34% of those who had changed their job/occupation. The best clearing had occurred in the patients with contact urticaria (35%), whereas the healing of allergic (27%) and irritant (23%) contact dermatitis was similar. The risk factors for continuing occupational contact dermatitis (OCD) were no changes in work, age > 45 years, food-related occupations, respiratory atopy, and male sex. CONCLUSIONS: The healing of OSD was associated with discontinuation of the causative exposure. A change in work and the presence of easily avoidable work-related allergies were associated with a good prognosis.

Occupational allergic contact dermatitis from cinnamon including one case from airborne exposure.

BACKGROUND: The bark of the cinnamon tree is used as a spice; its flavour is from an essential oil containing mainly cinnamal. OBJECTIVE: To report new cases of occupational allergic contact dermatitis (ACD) from cinnamon and a novel case of airborne cinnamon contact allergy. METHODS: We examined the patient material of two dermatological clinics in Helsinki to find cinnamon contact allergic patients and review their clinical records. RESULTS: We found six patients with delayed contact allergy to cinnamon. In four patients, cinnamon was the main cause of occupational ACD. Three of them had dermatitis on their hands and one patient on the face and neck. In the latter case, the exposure was shown to be airborne. In addition, the fifth patient was occupationally sensitized to cinnamon, but it was not the main cause of his hand dermatitis. In the sixth patient, cinnamon allergy was considered to derive from cross-allergy to fragrances. Five of the patients reacted to cinnamal separately and in fragrance mix I. None of the six patients had immediate-type cinnamon allergy. CONCLUSIONS: Occupational contact allergy to cinnamon is rare but needs to be considered in workers handling foods. Cinnamal is possibly the main allergen in cinnamon.

Respiratory symptoms and conditions related to occupational exposures in machine shops.

OBJECTIVES: Since there are few data on the effects of metalworking in populations representing a variety of metal companies or on dose-response relationships concerning metalworking, this study investigated the relationship between occupational exposures in machine shops and the occurrence of upper and lower respiratory symptoms, asthma, and chronic bronchitis. METHODS: A cross-sectional study of 726 male machine workers and 84 male office workers from 64 companies was conducted in southern Finland. All of the participants filled out a questionnaire, and aerosol measurements were performed in 57 companies. RESULTS: Exposure to metalworking fluids (MWF) showed a greater risk [odds ratio (OR)>or=2) for upper-airway symptoms, cough, breathlessness, and current asthma than exposures in office work did. Exposure to aerosol levels above the median (>or=0.17 mg/m3 in the general workshop air) was related to an increased risk (OR>or=2) of nasal and throat symptoms, cough, wheezing, breathlessness, chronic bronchitis, and current asthma. Machine workers with a job history of >or=15 years experienced increased throat symptoms, cough, and chronic bronchitis. CONCLUSIONS: This large study representing machine shops in southern Finland showed that machine workers experience increased nasal and throat symptoms, cough, wheezing, breathlessness, and asthma even in environments with exposure levels below the current occupational exposure limit for oil mists. The study suggests that improving machine shop environments could benefit the health of this workforce. It also suggests that it is time to consider reducing the current Finnish occupational exposure limit for oil mist or introducing the use of other health-relevant indicators of exposure.

IgE-mediated occupational asthma from epoxy resin.

BACKGROUND: Epoxy resins (ERs) are used in paints and other protective coatings, including flooring materials. Bisphenol A diglycidyl ether (BADGE) ERs (BADGE ERs) account for about 75% of the ERs used world-wide. ERs can cause both immediate and delayed allergic reactions, but immediate reactions are rare. METHODS: Occupational asthma (OA) was diagnosed on the basis of a specific challenge test combined with the patient's history of occupational exposure and respiratory symptoms. RESULTS: A 39-year-old nonsmoking construction worker experienced dyspnea when laying ER-containing floors, but not in other situations. He also presented skin symptoms. IgE-mediated allergy to BADGE ER could be verified with both serum IgE antibodies and skin prick tests. The specific bronchial challenge test with BADGE ER caused an immediate asthmatic reaction. On patch testing, a positive reaction was provoked by BADGE ER. CONCLUSIONS: This is the first study on a patient exposed to BADGE ER with IgE-mediated immediate OA, based on a positive inhalation challenge test. If work-related respiratory symptoms develop when handling ERs, the possibility of OA should be recognized.

Occupational asthma caused by sculptured nails containing methacrylates.

BACKGROUND: In recent decades, the use of artificial nails including methacrylates (MAs) has increased. This study presents the first two clinical cases of occupational asthma (OA) caused by sculptured nails containing MAs. METHODS: In both cases, OA was diagnosed on the basis of a work simulation test combined with the patient's history of occupational exposure and respiratory symptoms. RESULTS: Both patients developed work-related respiratory symptoms 4-5 years before the current examinations. Previously, the first patient (a 30-year-old female) was diagnosed as having allergic contact dermatitis (ACD) to MAs; the second patient (a 27-year-old female) had no skin symptoms. In both cases, a dual asthmatic reaction was observed in the bronchial provocation test, in which the patients simulated their work using their own products including MAs. CONCLUSIONS: Sculptured nails containing MAs can induce OA in nail technicians. Products not containing MAs should be used to prevent OA and ACD. If MAs are used, they should be handled with appropriate safety measures.

Occupational methacrylate and acrylate allergy from glues.

BACKGROUND: Glues and sealants are important causes of methacrylate and acrylate allergy. AIM: This study aimed to analyse patterns of allergic patch test reactions to acrylic monomers in relation to exposure in patients sensitized from glues. PATIENTS/METHODS: We screened the patch test files at the Finnish Institute of Occupational Health from 1994 to 2006 for allergic reactions in the 'Methacrylate series' and analysed the clinical records of sensitized patients. Only patients who had handled acrylic glues at work were included. RESULTS: 10 patients had allergic reactions to acrylic monomers and had been sensitized from glues at work. 9 of them had used anaerobic sealants, 3 cyanoacrylate-based instant adhesives, and 1 patient a bi-component instant adhesive. All the patients reacted to 2-hydroxyethyl methacrylate (2-HEMA) and ethyleneglycol dimethacrylate (EGDMA); reactions to 2-hydroxypropyl methacrylate, triethyleneglycol dimethacrylate, and tetrahydrofurfuryl methacrylate were also common. The first 4 methacrylates were found in the glues used by the patients. Ethyl cyanoacrylate (ECA) gave no reactions, but 1 patient reacted weakly to her own ECA-based glue. CONCLUSION: 2-HEMA and EGDMA are good screeners for contact allergy to anaerobic sealants and also detected a single case deriving from bi-component acrylic glue.

Methacrylate and acrylate allergy in dental personnel.

BACKGROUND: Methacrylates are important allergens in dentistry. OBJECTIVE: The study aimed to analyse patch test reactivity to 36 acrylic monomers in dental personnel in relation to exposure. METHODS: We reviewed the test files at the Finnish Institute of Occupational Health from 1994 to 2006 for allergic reactions to acrylic monomers in dental personnel and analysed the clinical records of the sensitized patients. RESULTS: 32 patients had allergic reactions to acrylic monomers: 15 dental nurses, 9 dentists, and 8 dental technicians. The dentists and dental nurses were most commonly exposed to 2-hydroxyethyl methacrylate (2-HEMA), triethyleneglycol dimethacrylate (TREGDMA), and 2,2-bis[4-(2-hydroxy-3-methacryloxypropoxy) phenyl]propane (bis-GMA). 8 dentists and 12 dental nurses were allergic to 2-HEMA. The remaining dentist was positive to bis-GMA and other epoxy acrylates. The remaining 3 dental nurses reacted to diethyleneglycol diacrylate (DEGDA) or triethyleneglycol diacrylate (TREGDA), but not to monofunctional and multifunctional methacrylates. Our dental technicians were mainly exposed and sensitized to methyl methacrylate (MMA) and ethyleneglycol dimethacrylate (EGDMA). 1 technician reacted only to 2-HEMA, and another to ethyl methacrylate (EMA) and ethyl acrylate (EA). CONCLUSIONS: 2-HEMA was the most important allergen in dentists and dental nurses, and MMA and EGDMA in dental technicians. Reactions to bis-GMA, DEGDA, TREGDA, EMA and EA were relevant in some patients.

How to improve skin notation. Position paper from a workshop.

The ICOH Scientific Committee on Occupational and Environmental Dermatoses organized an International Workshop on "Dermal risk assessment at workplace" with the aim of focussing on the different ways of approaching the concept of skin notation (S) for chemicals. The Workshop participants presented their ideas on several aspects of S such as the problems related to the absorption through the compromised skin, the different approaches to S and models that can be used as alternatives to S. Participants agreed to produce a position paper with the goal of exploring the actions needed to improve the S system towards international harmonization. They consider that further discussions are needed to obtain an international consensus, but at the same time they believe that by improving and harmonizing systems for setting S we can make an important contribution to improving health of people with potential dermal exposure to chemicals at work.

Self-reported skin symptoms in metal workers.

Machinists and machine maintenance men working in the metal industry use metal-working fluids capable of causing irritant and allergic contact dermatitis. The objectives of this study were to find out the frequency of skin symptoms in machinists and machine maintenance men (metal workers) and to compare the risk of their skin symptoms to that in office workers (controls). A total of 726 male metal workers and 84 controls answered a structured telephone questionnaire enquiring about work, atopy, skin symptoms, their impact on life, etc. The risk of skin symptoms compared with that in the controls was estimated using a logistic regression analysis. Of the metal workers, 20% reported recurring or prolonged dermatitis on their hands or forearms during the past 12 months. The hand or forearm dermatitis (HD) affected mostly the metal workers' mood and their activities at work. Recurring dermatitis elsewhere (DE) than in the hands and in connection with work was reported by 10%. The risk of HD was about twofold and the risk of DE was about fourfold compared with that in the controls. The HD of machinists may be severe and affect their ability to work. DE may have clinical significance in machinists.