Occupationally Related Contact Dermatitis in North American Food Service Workers Referred for Patch Testing, 1994 to 2010
ABSTRACT BACKGROUND: Contact dermatoses are common in food service workers (FSWs). OBJECTIVES: This study aims to (1) determine the prevalence of occupationally related contact dermatitis among FSWs patch tested by the North American Contact Dermatitis Group (NACDG) and (2) characterize responsible allergens and irritants as well as sources. METHODS: Cross-sectional analysis of patients patch tested by the NACDG, 1994 to 2010, was conducted. RESULTS: Of 35,872 patients patch tested, 1237 (3.4%) were FSWs. Occupationally related skin disease was significantly more common in FSWs when compared with employed non-FSWs. Food service workers were significantly more likely to have hand (P < 0.0001) and arm (P < 0.0006) involvement. The rates for irritant and allergic contact dermatitis in FSWs were 30.6% and 54.7%, respectively. Although the final diagnosis of irritant contact dermatitis was statistically higher in FSWs as compared with non-FSWs, allergic contact dermatitis was lower in FSWs as compared with non-FSWs. The most frequent currently relevant and occupationally related allergens were thiuram mix (32.5%) and carba mix (28.9%). Gloves were the most common source of responsible allergens. The NACDG standard tray missed at least 1 occupationally related allergen in 38 patients (4.3%). CONCLUSIONS: Among FSWs patch tested by the NACDG between 1994 and 2010, the most common allergens were thiuram mix and carba mix. Gloves were the most common source of responsible allergens.
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ABSTRACT: Allergic contact dermatitis is a significant cause of cutaneous disease affecting many individuals in the home and at the workplace. Patch testing is the most worthwhile diagnostic tool for the evaluation of patients with suspected allergic contact dermatitis. This study reports the results of patch testing from January 1, 2001, to December 31, 2002, by the North American Contact Dermatitis Group (NACDG). Patients were tested with an extended screening series of 65 allergens. A standardized patch-testing technique was used. Data from these patients were recorded on a standardized computer entry form and analyzed. Sixty-five allergens were tested on 4,913 patients. The top 10 allergens remain the same in this study period as in the 1999-2000 study period: nickel sulfate (16.7%), neomycin (11.6%), Myroxilon pereirae (balsam of Peru) (11.6%), fragrance mix (10.4%), thimerosal (10.2%), sodium gold thiosulfate (10.2%), quaternium-15 (9.3%), formaldehyde (8.4%), bacitracin (7.9%), and cobalt chloride (7.4%). Of the 4,913 patients tested, 69% had at least one positive allergic patch-test reaction. Of all patients, 15.8% had occupation-related dermatitis; 15.4% were determined to have irritant contact dermatitis, and 11.1% of the 15.4% had a relevant reaction to an occupational irritant. Of all patients tested, 16.7% had a relevant reaction to an allergen not in the NACDG standard series, and 5.5% had a relevant reaction to an occupational allergen not in the standard series. Our findings once again reinforce the need for a more comprehensive group of diagnostic allergens than those found in the standard screening kits. The usefulness of patch testing is enhanced when a greater number of allergens are tested, especially nonstandard allergens occupationally encountered.Dermatitis 01/2005; 15(4):176-83. DOI:10.2310/6620.2004.04038 · 1.36 Impact Factor
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ABSTRACT: To identify prognostic risk factors in patients with occupational hand eczema (OHE). Cohort study with 1-year follow-up. Danish National Board of Industrial Injuries Registry. All patients with newly recognized OHE (758 cases) from October 1, 2001, through November 10, 2002. Participants received a questionnaire covering self-rated severity, sick leave, loss of job, depression, and health-related quality of life. One year after the questionnaire was returned, all responders (N = 621) received a follow-up questionnaire, and 564 (91%) returned it. Persistently severe or aggravated OHE, prolonged sick leave, and loss of job after 1-year follow-up. During the follow-up period, 25% of all patients with OHE had persistently severe or aggravated disease, 41% improved, and 34% had unchanged minimal or mild to moderate disease. Patients with atopic dermatitis fared poorly compared with other patients. Patients younger than 25 years fared clearly better than older groups. Furthermore, severe OHE, age 40 years or greater, and severe impairment of quality of life at baseline appeared to be important predictors of prolonged sick leave and unemployment. Patients with lower socioeconomic status also had a high risk of prolonged sick leave, job change, and loss of job. Contact allergy was not found to be a risk factor for poor prognosis. Atopic dermatitis, greater age, and low socioeconomic status may be reliable prognostic factors in early OHE. Quality of life and standardized severity assessment may also be valuable tools to identify patients at high risk of prolonged sick leave and unemployment.Archives of Dermatology 04/2006; 142(3):305-11. DOI:10.1001/archderm.142.3.305 · 4.31 Impact Factor
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ABSTRACT: The impact of chronic hand dermatitis (ChHD) on patient-reported outcomes and economic costs has not been assessed in a US population. We sought to evaluate the quality of life, work productivity, activity impairment, and health care costs of patients with ChHD versus those without ChHD. A 13-item self-assessment questionnaire to identify ChHD was developed and validated. Skindex-29 and Work Productivity and Activity Impairment questionnaires were used to assess quality of life and work productivity for ChHD. The survey was mailed to a random sample of 1380 members of a Massachusetts managed care organization (N = 507, response rate = 36.74%). Univariate and multivariate analyses were conducted to determine the incremental effect of ChHD on quality of life, work productivity, and activity impairment. Health insurance claims were used to assess medical costs. Quality of life, along with work productivity and activity impairment, were significantly worse for patients with CHD than for those without ChHD; however, there was no significant difference in work time missed. After adjusting for significant covariates, a 25% cost increase in total medical costs was found attributable to ChHD, which translates to an incremental cost of $70 per patient per month. Survey response rate is not high; the survey respondents may not be completely representative of the nonrespondents. The cost burden of ChHD is underestimated because of the omission of over-the-counter drug and indirect costs. The multivariate models had a low goodness of fit indicated by the low R2 statistics. ChHD has a significant detrimental effect on quality of life, work productivity, activity impairment, and heath care costs. More awareness and treatment of this condition are needed to improve patient outcomes and decrease health care cost.Journal of the American Academy of Dermatology 04/2006; 54(3):448-57. DOI:10.1016/j.jaad.2005.11.1053 · 5.00 Impact Factor