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UK trends of allergic occupational skin disease attributed to fragrances 1996-2015: OCCUPATIONAL SKIN DISEASE ATTRIBUTED TO FRAGRANCE
Abstract
Background:
Fragrances are well known to cause allergic contact dermatitis (ACD). Occupationally related cases occur, with certain groups being at higher risk.
Objective:
To investigate the incidence of occupationally related cases of cutaneous fragrance allergy and to evaluate trends.
Method:
Data on incident cases of occupational ACD caused by fragrances between 1996 and 2015 (inclusive) reported to the EPIDERM surveillance scheme were analysed.
Results:
Of the cases reported to EPIDERM during the study period, 5.2% had ACD attributed to fragrances. The highest annual incidence rates were observed in women. Hairdressers, beauticians and people working in related occupations had a 47-fold higher incidence rate ratio than the reference category (the average of all other occupations combined). Trends analysis suggested a non-significant increase in fragrance allergy over the study period among all occupations, and beauty and food workers, and a slight decrease in healthcare workers.
Conclusions:
Fragrance allergy is a significant problem in an occupational setting. Although there was no significant change in the incidence of fragrance-related allergic occupational contact dermatitis (OCD) during the 20-year study period, this does not mirror the trend in OCD, which is falling. Fragrance allergy continues to be a major contributor to OCD, and contributes to a greater proportion of cases.
... A 20-year surveillance study from the United Kingdom revealed that occupational fragrance allergy was most frequently seen in beauty, health care, and food industries. 39 The same study reported the rate of fragrance-induced occupational ACD as 5.2% among all patients with occupational ACD. 39 The main limitations of our study were the low number of patients who were patch tested with a complete set of fragrance allergens, as some of the fragrance allergens were introduced at different time points into our patch test battery and the lack of patch testing with oxidized linalool and oxidized limonene. ...
... 39 The same study reported the rate of fragrance-induced occupational ACD as 5.2% among all patients with occupational ACD. 39 The main limitations of our study were the low number of patients who were patch tested with a complete set of fragrance allergens, as some of the fragrance allergens were introduced at different time points into our patch test battery and the lack of patch testing with oxidized linalool and oxidized limonene. ...
Background:
Limited data exist on fragrance contact allergy among Turkish population.
Objective:
The aim of this study was to investigate the frequency and characteristics of fragrance contact allergy in Turkey.
Methods:
A retrospective cohort study was conducted on 2566 patients consecutively patch tested with the European baseline series and additionally with a fragrance series (n = 358) at a tertiary referral center between 1996 and 2019.
Results:
One hundred sixty-three patients (6.4%) (male/female, 1.5:1) were sensitized with at least 1 fragrance allergen. Fragrance mix (FM) I was most frequently positive (3.9%), followed by Myroxylon pereirae (3.1%), FM II (2%), and hydroxyisohexyl 3-cyclohexene carboxaldehyde (0.5%), the latter exclusively positive in FM II-positive patients. Among 358 patients patch tested with a fragrance series, positive patch test reactions were observed in 38 patients, including 8 who did not react to baseline fragrance markers. Clinically relevant fragrance allergy was established in 128 patients (78.5%) from nonoccupational (72.4%) and occupational (6.1%) sources.
Conclusions:
The low prevalence, the middle-aged male preponderance, and the predominant involvement of hands were unusual findings. Rose/citrus-flavored perfumes and eau de cologne, which are traditionally preferred in our country, were important elicitors of fragrance contact allergy, especially among middle-aged and older men.
... Concerning patch testing with individual ingredients of FMs, citral, isoeugenol, and geraniol ranked as the highest prevalent causes of contact allergy in this group of patients (93). Hairdressers and beauticians were also at risk (94). Salespersons in cosmetic stores were reported as having multiple fragrance contact allergies due to bath bomb use demonstrations in the shop (95). ...
Fragrance materials are widely used in various types of products in daily life and many of them can be contact sensitizers. Contact allergy to fragrances has been reported to be common worldwide. Unlike other groups of contact allergens such as metals and preservatives, fragrance materials in consumer products can be present as single fragrance chemicals or in the form of mixtures known as natural complex substances. Due to the complexity of the fragrance materials and the high number of fragrance substances known to cause contact sensitization, selecting suitable materials for patch testing is challenging. Emerging fragrance markers have been additionally introduced in different baseline series for screening to enhance the rate of fragrance contact allergy detection. Moreover, there have been continual updates on basic knowledge, clinical perspectives, sources of exposure, and regulations on the use of fragrance materials. Avoiding pitfalls while performing patch testing with fragrance test materials is also crucial and should not be overlooked. Therefore, this review aims to update knowledge to provide a high-quality holistic approach to fragrance contact allergy diagnosis and management.
... 14 Occupational fragrance exposures are important to consider, and fragrance ACD is associated with hairdressers, beauticians, office workers exposed to aromatherapy diffusers, and food handlers. 15 Less-obvious professions that involve exposure to fragrances used to cover up unwanted odors-such as working with industrial and cleaning chemicals or even metalworking-also have been reported to be associated with ACD. 16 ...
Fragrances are found in abundance in everyday life—from obvious sources such as perfumes, colognes, and air fresheners, to not-so-common sources, such as workplace exposures. Problematically, even products labeled as “fragrance free” may contain covert fragrances. Patients and physicians alike should be aware that fragrances are a common cause of allergic contact dermatitis (ACD) and that patient education is critical to treatment success. In this review, we discuss the chemistry and epidemiology of fragrance ACD, patch test considerations, skillful patient education on avoidance, and potential pitfalls for patients with fragrance allergy—all to empower treating clinicians with the knowledge to effectively address patient needs.
... Fragrance allergy is taken as a major contributor to occupational contact dermatitis. A 47-fold higher incidence rate ratio of fragrance-related allergic occupational contact dermatitis for beauticians and related occupations than the reference category was supposed (14). Our results indicate even higher prevalence of contact sensitization to Fragrance mix I if compared with the findings cited above. ...
... The same holds true for ingredients of after-or at-work emollients, such as preservatives, emulsifiers, and fragrances. In a registry-based analysis of occupational dermatitis cases in the UK, a strikingly higher-thanaverage share of fragrance allergy had been noted among hairdressers [30] pointing to an increased risk of sensitization to these ubiquitous allergens. ...
Purpose of Review
This study aims to provide an overview on current knowledge on occupational allergic diseases in hairdressers and up-to-date perspectives of prevention.
Recent Findings
Hand eczema (dermatitis) is common in hairdressers, often caused by contact allergy to one or multiple small molecules (haptens) used, e.g., for dyeing, bleaching, and waving/relaxing or by ancillary substances such as preservatives. Hairdressers, compared to other patch-tested patients, have an up to fivefold increased risk to be found sensitized, e.g., against p-phenylenediamine, ammonium persulfate, and glyceryl thioglycolate. Some of these small molecules may induce respiratory sensitization causing allergic rhinitis and/or asthma, notably persulfate salts.
Summary
Occupational hazards in hairdressing are well described. This knowledge needs to be put into use for risk reduction, mainly by substitution of allergenic ingredients by less allergenic ones, education, and use of ventilation and suitable single-use gloves.
... While in the United Kingdom fragrance allergy seems to be on the decline, this was not the case with regard to occupational contact dermatitis related to fragrances, which remained stable, hairdressers and therapists being the occupations with the highest incidence rates [83]. In contrast, according to a Danish follow-up study involving 1496 patients with occupational hand eczema or contact urticaria, fragrances only ranked after rubber additives, biocides, hairdressing chemicals, nickel and epoxy resins regarding the share of sensitised patients [84]. ...
Contact allergy (sensitisation) and allergic contact dermatitis (ACD) resulting from it have a considerable public health impact. For the present review, all pertinent articles were systematically searched via Medline and Web of Science™; additionally, all available issues of the journals “Contact Dermatitis” and “Dermatitis” were manually searched, covering the years 2018–2019, thereby extending and re-focusing a previous similar review. New allergens, or previously described allergens found in a new exposure context or of other current importance, are described in sections according to substance classes, e.g., metals, preservatives, fragrances. As a common finding in many investigations, a lack of information on product composition has been noted, for instance, regarding a newly described allergen in canvas shoes (dimethylthiocarbamylbenzothiazole sulfide) and, most notably, absence of co-operation from manufacturers of glucose-monitoring devices and insulin pumps, respectively. These latter devices have been shown to cause severe ACD in a considerable number of diabetic patients caused by the liberation of isobornyl acrylate and N,N’-dimethylacrylamide, respectively, as demonstrated by an international collaboration between dermatologists and chemists. Improved and complete ingredient labelling for all types of products, and not just as we have with cosmetics at present (apart from full listing of fragrance substances) in Europe, must be put on the legislative agenda.
... -in the United Kingdom from 1996 -2015 among 1,776 patients: 4.2% had occupational allergic contact dermatitis that was attributable to fragrances, compared with 2% of the general population [19]. ...
Introduction and objective
Brittany is the leading agricultural production region of France where many workers are exposed to the local flora and fauna. The aim of the study is to describe the different skin diseases found among the workers occupationally exposed to the terrestrial fauna and flora in Brittany, and to assess the possible over-representation of some work environments.
Material and methods
This was a retrospective, descriptive study carried out between 1 October 2002 – 30 April 2017, based on the coding of files from a multi-disciplinary occupational dermatology clinic at the Brest University Hospital
Results
The study population of 84 patients was drawn from a total 788 patients seen during this period. Allergic contact dermatitis was the most frequently coded diagnosis with 35 cases (42%). There were 13 cases of irritant contact dermatitis (15%). Infectious diseases were poorly represented with only 5 cases (6%).The 6 most frequently represented occupations were packers in the agri-food industry (12.0%), cattle farmers and tomato greenhouse workers (both 10.7%), maintenance workers of parks and gardens (9.5%), agri-food factory cleaning operatives (8.3%) and pig farmers (7.1%).
Conclusions
There was a marked incidence of allergic contact dermatitis and irritative contact dermatitis, mostly occupational in origin. While no specific diseases were found among these workers, some of the allergens and irritants identified may be specific to certain work environments. Overall, there did not seem to be a major risk of occupational dermatoses among workers exposed to Brittany’s terrestrial fauna and flora in this population, compared with other professional sectors, such as hairdressing or care work. The incidence rate of the cases of occupational skin diseases in this population is assessed from 3 – 5 cases per 100,000 workers.
... In addition, although the studies of Loretz et al [11][12][13] are limited to consumer use data from women, it has been reported that allergic contact dermatitis from fragrances is more common in women. 19,20 It should be noted that Api et al 3 used the 90th percentile data presented by Loretz et al [11][12][13] for several products, including pump hair spray, shampoo, conditioner, facial cleanser, and body wash. In contrast, we used the 95th percentile data from Loretz et al [11][12][13] in our analysis. ...
Background:
Many chemicals used for fragrance purposes in a diversity of products have allergenic potential. Based on such concerns, industry groups developed concentration limits for use of fragrance chemicals in personal care and cosmetic products.
Objective:
The aim of this study was to use a quantitative risk assessment to evaluate the potential for skin sensitization induction resulting from daily exposure to fragrance chemicals present in personal care and cosmetic products.
Methods:
Product-specific dermal consumer exposure levels were calculated based on product use data in US adult females and benchmarked against acceptable exposure levels based on reported no expected sensitization induction levels to determine a margin of safety for each fragrance under evaluation.
Conclusions:
The results demonstrate an increased risk of skin sensitization induction for several leave-on products (lipstick, solid antiperspirant, eye shadow, face cream) for most of the evaluated fragrance chemicals, particularly under high-use exposure scenarios. In contrast, rinse-off products (shampoo, conditioner, facial cleanser) were not associated with risk of skin sensitization induction. Because the approach was based on maximum use limits for fragrance chemicals with skin sensitization concerns, the results suggest these limits may not be protective, particularly in the United States.
... In a UK study analyzing OCD 1996-2015, beauticians, hairdressers, and beauty industry workers had a 47 times higher incidence rate ratio of allergy to fragrance when compared to the average rate of all other occupations combined [47]. ...
Occupational skin disease is common. It affects workers more often than reported. Contact dermatitis, both irritant and allergic, accounts for the majority of occupational skin diagnoses. Occupational contact dermatitis (OCD) frequently affects the hands and may have a profound impact on an employee’s ability to perform a job. Severe OCD can affect a worker’s activities of daily living and can even lead to job loss. Numerous irritants have been described in the workplace, from the common (wet work) to the more obscure (warm, dry air). Several contact allergens may be work-related, and the majority of established occupational allergens are also known nonoccupational allergens. Emerging occupational allergens are continually described in the literature. Patch testing is the gold standard for the workup of allergic contact dermatitis. Patch testing in the setting of OCD may require extended or unique allergen trays, as well as a thorough occupational history and collection of workplace Material Safety Data Sheets (MSDS). These MSDS contain valuable information but may not be complete or accurate. Proof of occupational causation can be aided by employing the Mathias criteria. Certain industries and occupations are associated with higher rates of OCD, and as expected, the industries with direct contact with irritants and allergens are highly represented. The differential diagnosis for occupational dermatitis is broad and should be considered when evaluating an employee with suspected OCD. Some other diagnoses to consider include atopic dermatitis, psoriasis, and manifestations of internal disease, as well as an overlap syndrome of more than one diagnosis. OCD treatment should ideally follow the public health hazard controls’ stepwise approach. Prevention and early intervention are key to promoting occupational health and preventing OCD. Multidisciplinary teams have been successful in the treatment of OCD, and newly described topical treatments may provide additional modalities for use in the occupational setting.
Allergic contact dermatitis is considered to be a prototype of delayed hypersensitivity reactions requiring two phases – induction and elicitation. The amount of allergen per skin surface area is the key factor that determines the risk of induction. Exposure‐related factors that influence the elicitation phase include allergen concentration (dose), duration and frequency of exposure, the matrix, the presence of irritants and the region of application. A diagnosis of allergic contact dermatitis requires careful evaluation of a patient's clinical history when the suspicion is aroused, physical examination, and various types of skin testing (patch testing, photopatch testing and repeat open application tests. During the last few decades much effort has been put into standardisation of allergens, vehicles, test concentrations and the scoring of test reactions. This chapter provides information on the diagnosis and management of allergic contact dermatitis and information on the major allergens involved in regional dermatitis.
Background:
Hair cosmetic products contain several, partly potent contact allergens, including excipients like preservatives. Hand dermatitis in hairdressers is common, scalp and face dermatitis in clients or self-users (summarised here as 'consumers') may be severe.
Objective:
To compare frequencies of sensitization to hair cosmetic ingredients and other selected allergens between female patch tested patients working as hairdressers and consumers without professional background, respectively, who were tested for suspected allergic contact dermatitis to such products.
Methods:
Patch test and clinical data collected by the IVDK (https://www.ivdk.org) between 01/2013 and 12/2020 were descriptively analysed, focusing on age-adjusted sensitization prevalences in the two subgroups.
Results:
Amongst the 920 hairdressers (median age: 28 years, 84% hand dermatitis) and 2321 consumers (median age: 49 years, 71.8% head/face dermatitis), sensitization to p-phenylenediamine (age-standardised prevalence: 19.7% and 31.6%, respectively) and toluene-2,5-diamine (20 and 30.8%) were most common. Contact allergy to other oxidative hair dye ingredients was also more commonly diagnosed in consumers, whereas ammonium persulphate (14.4% vs. 2.3%) and glyceryl thioglycolate (3.9 vs. 1.2%) as well as most notably methylisothiazolinone (10.5% vs. 3.1%) were more frequent allergens in hairdressers.
Conclusions:
Hair dyes were the most frequent sensitizers both in hairdressers and in consumers; however, as indication for patch testing may differ, prevalences cannot directly be compared. The importance of hair dye allergy is evident, often with marked coupled reactivity. Workplace and product safety need to be further improved.
The service (tertiary) sector involves heterogeneous activities producing short-lasting, non-material benefits that cannot be stored or owned as a property, and are inseparable from the individual that provides them. We hereby discuss the occupational dermatoses (OD) regarding a choice of occupations within the service sector (e.g., athletes, musicians, stage artists, ballet dancers, kitchen workers, flight staff, military personnel, healthcare workers, dental professionals, veterinarians, hairdressers, and nail technicians).In many of these, patients initially develop irritant contact dermatitis (ICD) related to several factors (trauma, moist, heat, friction, etc.). Subsequently, allergic contact dermatitis (ACD), protein contact dermatitis (PCD) and/or CU (chronic urticaria) can also be observed. Chronic Inducible Urticaria (CIndU) has also been described within this sector in relation to a variety of physical stimuli.The typical management strategy for patients, with OD within the service sector, relies on an accurate etiological diagnosis. Since the potential etiological factors and sources of exposure are multiple and varied, it is essential to apply individualized specific diagnostic tests (e.g., patch tests or prick tests) according to the clinical history, to rule out delayed or immediate allergic reactions, respectively. Secondary prevention involves avoiding the exposure to the culprit agents or switching them over to allergen-free alternatives. Regulations are urgently needed to compel manufacturers to cooperate in the patch test investigations and to provide transparent information regarding the composition of the products. Finally, effective treatments are crucial to lessen the impairment that the disease may have on the professional performance and quality of life of patients.KeywordsIrritant contact dermatitis (ICD)Benzoyl peroxideEtiological diagnosisSwimmer’s itch
Kontaktallergie (Sensibilisierung) und daraus resultierende allergische Kontaktdermatitis (ACD) sind von erheblicher Tragweite aus Sicht des Gesundheitswesens. Für die vorliegende Übersichtsarbeit hierzu wurden alle passenden Artikel aus dem Zeitraum 2018–2019 per systematischer Suche in Medline und Web of ScienceTM ermittelt; außerdem wurden alle verfügbaren Ausgaben der Fachzeitschriften „Contact Dermatitis“ und „Dermatitis“ manuell durchsucht und so eine frühere, ähnliche Übersichtsarbeit fortgeschrieben und neu fokussiert. Neue Allergene ebenso wie bekannte Allergene, die in neuem Expositionskontext gefunden wurden oder deren Bedeutung in sonstiger Hinsicht neu bewertet wurde, werden in Abschnitten nach Substanzklasse gegliedert beschrieben (z. B. Metalle, Konservierungsmittel, Duftstoffe). Als gemeinsames Ergebnis zahlreicher Untersuchungen fällt sowohl ein Mangel an Informationen über die Produktzusammensetzung auf, z. B. in Bezug auf ein neu beschriebenes Allergen in Leinenturnschuhen (Dimethylthiocarbamylbenzothiazolsulfid), als auch vor allem die mangelnde Kooperativität von Herstellern von Blutzuckermessgeräten bzw. Insulinpumpen. Zu den letztgenannten Geräten hat eine internationale Zusammenarbeit zwischen Dermatologen und Chemikern gezeigt, dass sie bei zahlreichen Diabetikern schwere ACD verursachen, indem sie Isobornylacrylat bzw. N,N’-Dimethylacrylamid freisetzen. Eine verbesserte und vollständige Deklaration der Inhaltsstoffe für Produkte alle Art – und nicht nur, wie wir es derzeit in Europa haben, bei Kosmetika (abgesehen von der vollständigen Auflistung der Duftstoffe) – muss auf die legislative Agenda gesetzt werden.
Occupation contact dermatitis (CD) is a common inflammatory skin condition impacting every professional industry in the United States. It is associated with significant personal and professional distress, loss of revenue, and decreased productivity. Occupational CD is further subdivided into irritant CD and allergic CD. Frequently, workers may suffer from a combination of both types. Numerous workplace exposures are implicated, but there are several themes across professions, such as CD related to frequent handwashing and wet work. A detailed occupational history, physical examination, and patch testing can help to make the diagnosis. Treatment includes identification of the substance and avoidance, which often is quite challenging.
Contact dermatitis and contact allergy are common medical conditions. But how common are they? Are certain populations, e.g., certain occupations, more affected than others? Are reactions to specific contact allergens more prevalent than to other allergens or more common in a particular subgroup? This chapter presents some basic epidemiologic principles which are important in population-based or clinic-based studies on contact dermatitis. The chapter deals with methodological issues in the analysis of clinical epidemiological studies, i.e., among patients undergoing patch testing. Common pitfalls are addressed, and factors important for the occurrence of contact dermatitis and/or contact allergy are discussed. Examples of studies on contact allergy as well as contact dermatitis in general are presented.
Occupational contact dermatitis is the most frequent type of skin diseases caused by occupational factors. The frequency varies considerably among professions and is highest in hairdressers, chefs, food handlers, and healthcare workers. Numerous irritants and contact allergens have to be considered in the pathogenesis and are often highly specific for a particular profession. Therefore, in-depth information on the working environment must be obtained for the diagnostic work-up. Careful patch testing, particularly with the worker’s own materials, must be performed to identify relevant contact allergens. The prognosis depends on the diagnosis: slight forms of irritant contact dermatitis can usually be well improved with gloves and avoidance of major irritants. If an occupational contact allergen cannot be eliminated, or exposure to it be reduced, the worker frequently has to give up this occupation. Combined forms of allergic and irritant contact dermatitis, which are not rare, are the most difficult to treat. A multidisciplinary approach including dermatologists, allergists, technicians, and patient education is necessary.
Fragrances are used in many types of products. They are composed of 10–300 individual fragrance ingredients, many of which may be allergens. Fragrance allergy is frequent, also in adolescents. In this chapter, an overview is given of the epidemiology of fragrance allergy, the causative allergens, the chemicals and naturals, and the exposures. The diagnosis of fragrance allergy can be difficult, but the three current diagnostic preparations, fragrance mix I and II (FM I and FM II) and Myroxylon pereirae (balsam of Peru) are helpful. Further individual substances of relevance for testing will be commented upon, and advice on how to inform the patient will be given.
Allergic contact dermatitis to fragrance is common. The prevalence of fragrance allergy in the general population is between 0.7% and 2.6%. In patch-test populations, the positive reaction rate to fragrances ranges from 5% to 11%. The most common fragrance screeners in most baseline series include fragrance mix 1, fragrance mix 2, and Balsam of Peru. The addition of hydroxyisohexyl 3-cyclohexene carboxaldehyde, hydroperoxides of limonene, and hydroperoxides of linalool to screening series can further aid in the diagnosis of fragrance allergy. In the proper clinical setting, supplemental patch testing with an additional fragrance or essential oil series should be considered.
Allergic contact dermatitis caused by fragrances and formaldehyde is common (1,2), but pustular dermatitis as a manifestation of contact allergy is rare (3). We report a case of therapy‐resistant rosacea for which (occupational) contact allergy to fragrances, and to a lesser extent formaldehyde, was identified as an aggravating factor. This article is protected by copyright. All rights reserved.
Purpose of review:
The purpose was to highlight recent findings especially concerning new and old allergens, trends, diagnosis and causes of contact allergy.
Recent findings:
Nickel is still the most frequent cause of contact allergy in women and piercings remain an important risk factor. Countries with a long history of regulation of contact allergens have the lowest level of contact allergy to nickel and chromium in Europe. Among the most frequent causes of fragrance contact allergy is terpenes, which are oxidized such as limonene, linalool and in some countries: geraniol. Methylisothiazolinone is still causing considerable problems due to hidden exposures. Acrylates are emerging allergens and 2-hydroxyethyl methacrylate has been included in the 2019 update of the baseline series, as many new cases are seen due to long-lasting nail polish based on acrylates and glue (isobornyl acrylate) in insulin pumps. More than 10 new allergens have been described, which need to be considered in diagnosing contact allergy.
Summary:
Allergic contact dermatitis is a frequent problem, it also constitutes a challenge to diagnose due to many potential contact allergens. The main culprit allergens remain the same, new significant causes are found especially within acrylates.
Introduction
Les parfums sont des produits d’usage quotidien, qu’il soit cosmétique ou d’entretien. Ils représentent la première cause de dermatite de contact (DC) aux produits cosmétiques et dont la prévalence ne cesse d’augmenter.
Objectifs
Identifier la part des parfums dans la survenue des DC dues aux cosmétiques ainsi que les allergènes les plus incriminés.
Méthodes
Étude transversale descriptive réalisée sur 10 ans et portant sur les sujets ayant consulté à l’Unité de dermato-allergologie du Service de médecine du travail du CHU Farhat Hached de Sousse pour exploration d’une DC et présentant un patch test positif à la Batterie standard européenne à un ou plusieurs allergènes aux parfums.
Résultats
Au total, 90 cas de sensibilisation aux allergènes des parfums ont été recensés, représentant 63,8 % des cas de DC aux cosmétiques. La sensibilisation aux parfums était isolée chez 64 patients (71,1 %) alors qu’elle était associée aux conservateurs, à la PPD et à la lanoline dans 23,3 %, 3,3 % et 2,4 % des cas respectivement. Les allergènes des parfums les plus fréquemment rencontrés étaient le Fragrance mix I et le baume de Pérou avec soit 48,9 % des allergies aux parfums pour chacun.
Discussion
Nos résultats corroborent ceux de l’étude de Johansan JD où les ingrédients des parfums étaient responsables de 30 à 45 % des DC aux cosmétiques [1]. Rastogi et al. ont étudié les composants de parfum dans 59 produits domestiques et professionnels. Les parfums les plus couramment utilisés dans ces produits incluent le limonène (78 %), le linalol (61 %), le citronellol (47 %), l’eucalyptol (41 %), le géraniol (41 %) et l’α-pinène (39 %) [2].
Conclusion
L’éviction indispensable des molécules parfumantes chez un patient sensibilisé est toujours délicate et incomplète. Toutefois, des actions à la source du problème incluant l’élimination ou le remplacement du produit en cause permettront dans l’avenir une limitation des réactions cutanées.
The toxicology of fragrance materials is largely well understood. Although most are benign, a minority have the potential to cause adverse health effects, notably allergic contact dermatitis resulting from skin sensitization. As a consequence, industry guidelines have banned certain materials and strictly limited the use of others. Recently, data have been published that have been interpreted to suggest that inhalation of fragrances is associated with the occurrence of a variety of health effects, ranging from headaches to asthma attacks. In this review, the evidence basis for these assertions is examined critically and the biological basis and mechanistic plausibility for causation by fragranced products of these health effects is explored. This review concludes that respiratory effects, including irritation and allergy appear highly unlikely to occur by this route. While some sensory/psychosomatic effects are possible, this does not explain the very high rates of adverse effects reported in the recently published questionnaire studies, which this review concludes are more likely to be attributed to methodological weaknesses. Ultimately, it is concluded that adverse health effects arising from fragrance inhalation are uncommon and remain to be identified and confirmed by methodologically rigorous epidemiological investigations supported by a convincing biological and mechanistic basis.
Résumé
Introduction
La Bretagne est la première région de production agricole française. Beaucoup de travailleurs sont exposés à la faune et à la flore locales.
Objectifs
Décrire les atteintes dermatologiques de ces travailleurs exposés professionnellement à la faune et à la flore terrestres bretonnes et évaluer l’éventuelle surreprésentation de certains postes de travail.
Méthode
Il s’agit d’une étude descriptive rétrospective, issue des dossiers des consultations bidisciplinaires de dermatologie professionnelle réalisées au CHRU de Brest du premier octobre 2002 au 30 avril 2017.
Résultats
Sur les 788 patients vus durant la période, notre population d’étude comprend 84 patients. Les dermites allergiques de contact sont les dermites les plus représentées avec 35 cas soit 42 %, les dermites irritatives de contact arrivent juste derrière avec 13 cas soit 15 %, et les maladies infectieuses sont peu représentées avec 5 cas soit 6 %. Les six postes les plus retrouvés sont les ouvriers de conditionnement dans l’industrie agro-alimentaire (12,0 %), suivis de près par les exploitants de bovins et les ouvriers en serre de tomates (chacun 10,7 %), puis les ouvriers s’occupant d’espaces verts (9,5 %), les agents de nettoyage dans des usines agro alimentaires (8,3 %) puis l’élevage porcin (7,1 %).
Conclusion
Les dermites allergiques de contact et les dermites irritatives de contact, majoritairement d’origine professionnelle, apparaissent au premier plan. Aucune affection spécifique de ces travailleurs n’a été rencontrée, mais les allergènes ou les irritants retrouvés peuvent parfois être spécifiques de certains postes de travail.
Reducing healthcare-associated infections (HCAI) has been a priority in the UK over recent decades and this has been reflected in interventions focussing on improving hygiene procedures.
to evaluate whether these interventions coincided with an increased incidence of work-related irritant contact dermatitis (ICD) attributed to hand hygiene or/and other hygiene measures in healthcare workers (HCW).
A quasi-experimental (interrupted time series) design was used to compare trends in incidence of ICD in HCW attributed to hygiene before and after interventions to reduce HCAI with trends in the same periods in control groups (ICD in other workers). Cases of ICD reported to a UK surveillance scheme from 1996 to 2012 were analysed. The time periods compared were defined objectively based on the dates of the publication of National evidence-based guidelines, the UK health act 2006 and the Cleanyourhands campaign.
The reported incidence of ICD in HCW attributed to hygiene has increased steadily from 1996 to 2012 (annual incidence rate ratio; 95% confidence interval: hand hygiene only 1.10; 1.07 to 1.12, all hygiene 1.05; 1.03 to 1.07) whereas the incidence in other workers is declining. An increase in incidence of ICD in HCW attributed to hand hygiene was observed at the beginning of the Cleanyourhands campaign.
The increasing incidence of ICD in HCWs combined with the popularity of interventions to reduce HCAI warrants increased effort towards identifying products and implementing practices posing the least risk of ICD. This article is protected by copyright. All rights reserved.
This article is protected by copyright. All rights reserved.
The European Union (EU) strategy for health and safety at work underlines the need to reduce the incidence of occupational diseases (OD), but European statistics to evaluate this common goal are scarce. We aim to estimate and compare changes in incidence over time for occupational asthma, contact dermatitis, noise-induced hearing loss (NIHL), carpal tunnel syndrome (CTS) and upper limb musculoskeletal disorders across 10 European countries.
OD surveillance systems that potentially reflected nationally representative trends in incidence within Belgium, the Czech Republic, Finland, France, Italy, the Netherlands, Norway, Spain, Switzerland and the UK provided data. Case counts were analysed using a negative binomial regression model with year as the main covariate. Many systems collected data from networks of 'centres', requiring the use of a multilevel negative binomial model. Some models made allowance for changes in compensation or reporting rules.
Reports of contact dermatitis and asthma, conditions with shorter time between exposure to causal substances and OD, were consistently declining with only a few exceptions. For OD with physical causal exposures there was more variation between countries. Reported NIHL was increasing in Belgium, Spain, Switzerland and the Netherlands and decreasing elsewhere. Trends in CTS and upper limb musculoskeletal disorders varied widely within and between countries.
This is the first direct comparison of trends in OD within Europe and is consistent with a positive impact of European initiatives addressing exposures relevant to asthma and contact dermatitis. Taking a more flexible approach allowed comparisons of surveillance data between and within countries without harmonisation of data collection methods.
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Work-related skin and respiratory disease still constitute an important part of the work-related ill-health (WRIH) burden of Great Britain (GB). It is therefore important to be able to accurately quantify the true incidence of these two groups of disease.
To improve the accuracy of the methodology to estimate clinical specialist incidence rates, with a focus on skin and respiratory disease. Specifically, we sought to estimate the number of additional cases not captured by voluntary surveillance through The Health and Occupation Reporting (THOR) network and provide a better estimation of the true incidence of work-related skin and respiratory disease in GB.
Cases not captured by THOR in 2005-2007 due to non-participation of eligible clinical specialists and due to <100% response rates by THOR participants were estimated, and the numerator adjusted accordingly. Adjusted incidence rates were calculated using Labour Force Survey data as the denominator.
During 2005-2007, 62% of skin cases and 60% of GB respiratory cases were likely to have been captured by THOR. After adjustment, dermatologist-derived incidence rates for skin disease were raised from 9 to 14 per 100,000 employed, while those for respiratory disease were raised from 10 to 17 per 100,000 employed.
We have provided a significant improvement in the surveillance-based methodology used to estimate the number of cases of WRIH captured by THOR and hence enabled more accurate estimations of GB incidence rates for clinical specialist-reported WRIH.
Self-reported work-related ill-health (WRI) statistics suggest that agricultural workers in the UK are at an increased risk of musculoskeletal disorders (MSD), skin and respiratory disease. However, there is little comprehensive medically reported information on WRI in the UK agricultural sector.
Cases of WRI within the UK from 2002 to 2008, as reported to The Health and Occupation Reporting (THOR) network by occupational physicians, clinical specialists and general practitioners, were analysed. Directly standardized incidence rate ratios (SRRs) for the agricultural sector versus all other sectors were calculated for dermatological, musculoskeletal, respiratory and psychological illness, using as the standard population the UK working population as estimated from the Labour Force Survey.
During 2002-08, 471 cases within the agricultural sector were reported to THOR (2% of all cases). Based on reports by clinical specialists, male agricultural workers aged <65 years had significantly raised SRRs for MSD (2.3, 95% CI 1.6-3.3), allergic alveolitis (32, 95% CI 19-51), asthma (1.9, 95% CI 1.2-3.0) and skin neoplasia (7.9, 95% CI 5.8-10.9) and a significantly reduced SRR for asbestos-related respiratory disease (0.4, 95% CI 0.2-0.7). Reports of mental ill-health in agricultural workers were low.
These medically reported incidence data provide information on WRI in the UK agricultural sector. Consistent with other sources, there are increased risks for asthma, allergic alveolitis and MSD and a reduced risk for mental ill-health. The raised incidence of skin cancer requires confirmation and further comparison with reliable estimates of the incidence in the UK workforce.
To assess the role of potential (occupational) risk factors for fragrance contact allergy (FCA). Most studies assessing the range of contact sensitisation in various clinical populations found the fragrance mix, a good screening tool for the detection of FCA in general, to be one of the leading allergens. The role of occupational exposure to fragrances is, however, yet unclear.
Firstly, crude analyses of the prevalence of FCA in various occupational fields including all 57,779 patients patch tested in the participating centres of the Information Network of Departments of Dermatology (IVDK) between January 1992 and December 1998. Secondly, a multifactorial Poisson regression analysis of these patients, including several potential risk factors.
(a) The proportion of patients with FCA varied greatly between different occupational groups from 2.5% to 17.4%, (b) the highest occupational risk of FCA was associated with work as a masseur or physiotherapist, metal furnace operator, potter or glass maker etc, or geriatric nurse, (c) non-occupational factors that influenced risk of FCA included atopy, female sex, several sites, in particular the axillae, and increasing age.
Occupations with a high risk of FCA were identified as targets of preventive action--that is, the substitution of scented products with fragrance free materials with which to work (skin disinfectants, cleaning solutions, personal care products) wherever possible.
Sensitization to fragrance is believed to occur mainly outside the workplace. This study addresses the frequency of fragrance allergy in patch test patients of differing occupations during a 15 year period. The occupation most strongly associated with fragrance allergy in both sexes was health care work (positive tests in 11.7% of males and 10.4% of females). Retired individuals also had high rates of fragrance allergy (11.6% of males and 14.5% of females), and the prevalence of sensitization increased with advancing age. Health care workers and metal workers had statistically significantly higher rates of allergy to eugenol than did workers in other occupations. Food handlers had significantly higher rates of allergy to cinnamal and cinnamic alcohol. These findings suggest that sensitization to fragrance occurs more frequently in an occupational setting than is generally understood and could have implications for preventive measures.
The currently used fragrance mix in the European baseline patch test series (baseline series) fails to detect a substantial number of clinically relevant fragrance allergies.
To investigate whether it is justified to include hydroxyisohexyl 3-cyclohexene carboxaldehyde (Lyral) and fragrance mix 2 containing hydroxyisohexyl 3-cyclohexene carboxaldehyde, citral, farnesol, coumarin, citronellol, and alpha-hexyl cinnamal in the European baseline patch test series.
Survey of the literature on reported frequencies of contact allergy and allergic contact dermatitis from fragrance mix 2 and hydroxyisohexyl 3-cyclohexene carboxaldehyde (Lyral) as well as reported results of experimental provocation test.
Fragrance mix 2 has been demonstrated to be a useful additional marker of fragrance allergy with contact allergy rates up to 5% when included in various national baseline patch test series. Of the fragrance substances present in fragrance mix 2, hydroxyisohexyl 3-cyclohexene carboxaldehyde is the most common sensitizer. Contact allergy rates between 1.5% and 3% have been reported for hydroxyisohexyl 3-cyclohexene carboxaldehyde in petrolatum (pet.) at 5% from various European centres when tested in consecutive dermatitis patients.
From 2008, pet. preparations of fragrance mix 2 at 14% w/w (5.6 mg/cm(2)) and hydroxyisohexyl 3-cyclohexene carboxaldehyde at 5% w/w (2.0 mg/cm(2)) are recommended for inclusion in the baseline series. With the Finn Chamber technique, a dose of 20 mg pet. preparation is recommended. Whenever there is a positive reaction to fragrance mix 2, additional patch testing with the 6 ingredients, 5 if there are simultaneous positive reactions to hydroxyisohexyl 3-cyclohexene carboxaldehyde and fragrance mix 2, is recommended.
In statistical models of dependence, the effect of a categorical variable is typically described by contrasts among parameters. For reporting such effects, quasi-variances provide an economical and intuitive method which permits approximate inference on any contrast by subsequent readers. Applications include generalised linear models, generalised additive models and hazard models. The present paper exposes the generality of quasi-variances, emphasises the need to control relative errors of approximation, gives simple methods for
obtaining quasi-variances and bounds on the approximation error involved, and explores the domain of accuracy of the method. Conditions are identified under which the quasi-variance approximation is exact, and numerical work indicates high accuracy in a variety of settings.
Background:
There is a significant rate of sensitisation worldwide to the oxidised fragrance terpenes limonene and linalool. Patch testing to oxidised terpenes is not routinely carried out; the ideal patch test concentration is unknown.
Objectives:
To determine the best test concentrations for limonene and linalool hydroperoxides, added to the British baseline patch test series, to optimise detection of true allergy and minimise irritant reactions.
Methods:
During 2013-2014, 4563 consecutive patients in 12 UK centres were tested to hydroperoxides of limonene in petrolatum (pet.) 0.3%, 0.2% and 0.1%, and hydroperoxides of linalool 1.0%, 0.5% and 0.25% pet. Irritant (IR) reactions were recorded separately from doubtful (?+) reactions. Concomitant reactions to other fragrance markers and clinical relevance were documented.
Results:
Limonene hydroperoxide 0.3% gave positive reactions in 241 (5.3%) patients, irritant reactions in 93 (2.0%) and doubtful reactions in 110 (2.4%). Linalool hydroperoxide 1.0% gave positive reactions in 352 (7.7%), irritant reactions in 178 (3.9%), and doubtful reactions in 132 (2.9%). 119 patients with crescendo reactions to 0.3% limonene would have been missed if only tested with 0.1%. 131 patients with crescendo reactions to 1.0% linalool would have been missed if only tested with 0.25%. In almost two-thirds of patients with positive patch tests to limonene and linalool the reaction was clinically relevant. The majority of patients did not react to any fragrance marker in the baseline series.
Conclusions:
We recommend that limonene hydroperoxides be tested at 0.3% and linalool hydroperoxides at 1.0% in the British baseline patch test series. This article is protected by copyright. All rights reserved.
Background:
Geriatric nurses (GN) have a high risk of occupational contact dermatitis (OCD), with chronic irritant contact dermatitis predominating. However, allergic contact dermatitis is an important issue as well. Little is known whether the relevant occupational allergen spectrum reported in the 1990s, including fragrances, preservatives, rubber chemicals and ingredients of surface disinfectants to be the most common sensitizers in GN, is still valid.
Objectives:
To monitor the current allergen spectrum in GN with OCD and verify the validity of the patch test recommendations (baseline-, preservative-, ointment base-, rubber-, disinfectant, series and fragrances) in GN with suspected OCD given by the German Contact Dermatitis Research Group (DKG).
Methods:
Retrospective analysis of IVDK data (2005-2014) of 743 female GN with OCD, in comparison to 695 GN without OCD.
Results:
GN with OCD reacted significantly more frequently to both fragrance mixes, hydroxyisohexyl 3-cyclohexene carboxaldehyde (HICC), thiuram mix, zinc diethyldithiocarbamate and mercaptobenzothiazole than GN without OCD. Reactions to MDBGN, methylchloroisothiazolinone/methylisothiazolinone and oil of turpentine occurred substantially, but not significantly more frequently among GN with OCD. The latter may be due to former use of a special alcoholic liniment in geriatric care. Among material from the patients' workplaces, tetrazepam was a frequent allergen, due to dust exposure from pill crushing. Furthermore, occupationally used protective gloves, body care products as well as surface disinfectants were often tested positively.
Conclusions:
The general allergen spectrum in GN with OCD is unchanged, so the DKG patch test recommendations are still valid. Prevention of occupational sensitization should focus on fragrance-free hygiene and body care products, usage of accelerator-free protective gloves and avoidance of drug dust exposure.
Background
Population-based studies about contact allergy are scarce.Objectives: To obtain reliable estimates of prevalence of contact allergy in the general population in Europe.Methods
Cross-sectional study of a random sample from the general population, aged 18 to 74 years, in 5 different European countries (Sweden, The Netherlands, Germany, Italy, Portugal). In total 12,377 subjects were interviewed and a random sample (n=3,119) patch tested to TRUE-test panel 1, 2 and 3 plus fragrance mix II, HICC, and sesquiterpene lactone mix. A positive patch test reaction is considered as contact allergy.ResultsIn total, 27.0% (95% CI 25.5-28.5) had at least one positive reaction to an allergen of the European baseline series with a significant higher prevalence in females compared to males. The highest age-standardized prevalences (≥ 1%) were found for nickel (14.5%; 95% CI 13.2-15.8), thimerosal (5.0%; 95% CI 4.2-5.8), cobalt (2.2%; 95% CI 1.7-2.7), fragrance mix II (1.9%, 95% CI 1.5-2.5), fragrance mix I (1.8% 95% CI 1.4-2.3), hydroxyisohexyl-3-cyclohexene carboxaldehyde (HICC)(1.4%, 95% CI 1.0-1.9), p-tert-butylphenol- formaldehyde-resin (1.3%; 95% CI 0.9-1.7), and p-phenylenediamine (1.0%; 95% CI 0.6-1.3). Only Nickel and Thimerosal showed a statistically significant different prevalence for contact allergy amongst the different European populations. Subjects that reported contact dermatitis in lifetime (age-standardized prevalence 15.1%, 95%CI 13.8-16.3) had an increased risk for contact allergy (OR 1.9, 95% CI 1.5-2.5) the risk of having a contact allergy was not increase in those with atopic dermatitis (prevalence 7.6%, 95% CI 6.7-8.6; OR 1.0, 95% CI 0.7-1.4).Conclusions
Contact allergy to at least one allergen of the European baseline series was diagnosed in more than one quarter of the general European population. Therefore measures to improve the primary prevention of contact allergy have to be enforced.This article is protected by copyright. All rights reserved.
Sensitization to fragrance is believed to occur mainly outside the workplace. This study addresses the frequency of fragrance allergy in patch test patients of differing occupations during a 15 year period. The occupation most strongly associated with fragrance allergy in both sexes was health care work (positive tests in 11.7% of males and 10.4% of females). Retired individuals also had high rates of fragrance allergy (11.6% of males and 14.5% of females), and the prevalence of sensitization increased with advancing age. Health care workers and metalworkers had statistically significantly higher rates of allergy to eugenol than did workers in other occupations. Food handlers had significantly higher rates of allergy to cinnamal and cinnamic alcohol. These findings suggest that sensitization to fragrance occurs more frequently in an occupational setting than is generally understood and could have implications for preventive measures.
Background
Occupational contact dermatitis is one of the most common occupational diseases in Europe. In order to develop effective preventive measures, detailed and up-to-date data on the incidence, main causes and professions at risk of occupational contact dermatitis are needed.Objectives
To describe the pattern of patch test reactivity to allergens in the European baseline series of patients with occupational contact dermatitis in different occupations.Methods
We analysed data collected by the European Surveillance System on Contact Allergy (ESSCA) network from 2002 to 2010, from 11 European countries.ResultsAllergens in the European baseline series associated with an at least doubled risk of occupational contact dermatitis include: thiuram rubber chemical accelerators, epoxy resin, and the antimicrobials methylchloroisothiazolinone/methylisothiazolinone, methyldibromo glutaronitrile, and formaldehyde. The highest risk of occupational contact dermatitis was found in occupations classified as ‘other personal services workers’, which includes hairdressers, nursing and other healthcare professionals, precision workers in metal and related materials, and blacksmiths, tool-makers and related trades workers.Conclusions
In the planning and implementation of measures aimed at preventing occupational contact dermatitis, the focus should be on the identified high-risk occupational groups and the most common occupational allergies.
Healthcare workers are occupationally exposed to various allergens in protective gloves, surface or instrument disinfectants, drugs, and skin care products. An increased prevalence of sensitization to thiurams, glutaraldehyde, formaldehyde and glyoxal in nurses with occupational contact dermatitis (OCD) has been known since the 1990s.
To update the range of occupational allergens in healthcare professionals.
We retrospectively analysed patch test data from the Information Network of Departments of Dermatology (IVDK), 2003-2012. Patch test results from 2248 nurses with OCD were compared with those of 2138 nurses without OCD.
Significantly increased sensitization rates were found for thiuram mix (6.7%), potassium dichromate (5.7%), methylchloroisothiazolinone/methylisothiazolinone (4.4%), colophonium (3.4%), 2-bromo-2-nitropropane-1,3-diol (1.7%), and zinc diethyldithiocarbamate (1.7%). Patch testing with products from the patients' workplaces gave additional clues to further allergens, for example tetrazepam.
The known range of contact sensitization in nurses with OCD has been confirmed. Formaldehyde allergy seems to be less important today. Drugs such as tetrazepam are occupational sensitizers in nurses. The increase in chromium sensitization remains unexplained.
© 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
Background
Limonene is widely used as a fragrance substance and solvent in cleansing products. Oxidized limonene is a frequent contact allergen among consumers of cosmetics, personal care products, and scented household cleaning products. Less is known about the sources of occupational exposure and occupational contact dermatitis caused by limonene.Objective
To report 14 patients with occupational contact allergy to limonene.Methods
The patients were examined in 2008–2013. An in-house preparation of oxidized limonene was patch tested as 3% and 5% in petrolatum from 2008 to August 2010, and after this as 3%, 1% and 0.3% pet. From 2012 onwards, a commercial test substance of limonene hydroperoxides was also used. We assessed the patients' occupational and domestic exposure to limonene.ResultsOccupational limonene allergy was observed in workers who used limonene-containing machine-cleaning detergents and hand cleansers, and in workers who used limonene-containing surface cleaners and dishwashing liquids similar to those used by consumers. In 3 cases, the occupational limonene allergy resulted from work-related use of limonene-containing, leave-on cosmetic products.Conclusions
Limonene is a frequent occupational sensitizer in hand cleansers and cleaning products. Occupational limonene contact allergy may also be caused by exposure to cosmetic products scented with limonene.
Background:
Beauticians are exposed to many potential allergens in their occupation.
Aim:
To identify the sources of occupational skin and respiratory disease reported in beauticians, with an emphasis on acrylate chemicals, and to investigate the trends over time.
Methods:
We used the Health and Occupation Research (THOR) database to identify occupational disease in beauticians between 1996 and 2011. Trend analysis was carried out to look for any change in the allergens reported over this period.
Results:
In total, 257 cases of contact dermatitis (CD) in beauticians were identified, which were associated with 502 suspected agents. The most frequently cited source of allergic CD was acrylate chemicals. The trend analysis showed a small average annual percentage increase in work-related CD in beauticians for all agents (1.1%; 95% CI -2.5 to 4.9). There was a small decrease in cases in which acrylates were not cited (-1.7%; 95% CI -5.9 to 2.7), and a statistically significant increase when acrylates were cited (7.4%; 95% CI 0.9 to 14.4). There were 11 cases of occupational asthma.
Conclusion:
We found an increase in cases of occupational dermatitis associated with acrylates in beauticians over a 15-year period, and describe other causes of occupational dermatitis.
Experimental and clinical studies have shown that fragrance substances can act as prehaptens or prohaptens. They form allergens that are more potent than the parent substance by activation outside or in the skin via abiotic (chemical and physical factors) and/or biotic activation, thus, increasing the risk of sensitization.
In the present review a series of fragrance substances with well documented abiotic and/or biotic activation are given as indicative and illustrative examples of the general problem.
Commonly used fragrance substances, also found in essential oils, autoxidize on contact with air, forming potent sensitizers that can be an important source for contact allergy to fragrances and fragranced products. Some of them can act as prohaptens and be activated in the skin as well. The experimental findings are confirmed in large clinical studies.
When substances with structural alerts for acting as prohaptens and/or prehaptens are identified, the possibility of generating new potent allergens should be considered. Predictive testing should include activation steps. Further experimental and clinical research regarding activation of fragrance substances is needed to increase consumer safety.
Chefs and food handlers are at high risk of developing occupational skin diseases. Incidence rates per 10,000 workers per
year range from 2.9 (butchers/food processing industries) and 6.6 (cooks) to 23.9 (pastry cooks) and 33.2 (bakers). Irritant
contact dermatitis is the most prevalent occupational disease in chefs and food handlers, followed by allergic contact dermatitis
(most frequently due to compositae (food), thiurams (gloves) and formaldehyde (detergents and disinfectants)). Food handling
occupations are also prone to IgE-mediated protein contact dermatitis and immunological (IgE-mediated) and non-immunological
occupational contact urticaria. Some food and food additives can trigger several of these mechanisms independently and may
induce different clinical pictures. The prerequisite for a successful treatment is the individual identification and exclusion
of the disease eliciting allergen(s), as well as implementation of skin protection.
Background. Healthcare workers are at increased risk of developing hand eczema.
Objectives. To investigate the prevalence and severity of self-reported hand eczema, and to relate the findings to demographic data, occupation, medical speciality, wards, shifts, and working hours.
Patients/materials/methods. A survey of 3181 healthcare workers was performed. Data were analysed with logistic regression. Data on sick leave and notification to the authorities were obtained.
Results. The response rate was 71% (2274 of 3181). The 1-year prevalence of hand eczema was 21%, and was positively associated with atopic dermatitis, younger age, male sex (male doctors), and working hours. Eighty nine per cent of subjects reported mild/moderate lesions. Atopic dermatitis was the only factor significantly related to severity. Sick leave was reported by 8% of subjects, and notification to the authorities by 12%.
Conclusions. The 21% prevalence of hand eczema in healthcare workers is double the prevalence in the background population. Eleven per cent of hand eczema patients reported severe/very severe eczema. No significant differences were found between professions or medical specialities with respect to prevalence or severity, but cultural differences between professions with respect to coping with the eczema were significant. Atopic dermatitis was related to increased prevalence and severity, and preventive efforts should be made for healthcare workers with atopic dermatitis.
The composition of water-based metalworking fluids (wb MWF) is complex, and various admixtures may be added before or during usage. Wb MWF may cause irritant as well as allergic contact dermatitis. While several current case reports point towards allergens particularly related to wb MWF, systematic studies have not been performed for several years. From 1999 to 2001, a study on contact allergies among patients with occupational dermatitis (OD) called "Fruhzeitige Erkennung allergener Stoffe bei beruflicher und nicht-beruflicher Exposition" (German acronym: FaSt) was conducted by the Information Network of Departments of Dermatology (IVDK), funded by the employers' liability insurances in Germany (HVBG).
The objective of FaSt was to detect sensitization patterns related to particular occupational exposures.
Anamnestic and clinical data were gathered using a standardised questionnaire. Patch test results were recorded by computer within the IVDK routine procedure. In addition to descriptive statistical analyses, logistic regression analysis was performed to control the effect of potential confounders.
Among the 1842 OD patients in the FaSt study, there were 160 metalworkers exposed to wb MWF, whose data is presented in this paper. A specific allergen pattern of these patients can be described: most frequently, sensitizations to monoethanolamine (MEA), colophony/abietic acid, and fragrance mix were observed. Additionally, cobalt, formaldehyde, formaldehyde releasers and other biocides are important allergens in these patients.
Preventive measures and aimed in-depth research may be based on these results. The special MWF test series have to be kept up to date based on exposure information from the MWF industry and on continuous surveillance of the target group.
The bark of the cinnamon tree is used as a spice; its flavour is from an essential oil containing mainly cinnamal.
To report new cases of occupational allergic contact dermatitis (ACD) from cinnamon and a novel case of airborne cinnamon contact allergy.
We examined the patient material of two dermatological clinics in Helsinki to find cinnamon contact allergic patients and review their clinical records.
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.
Occupational contact allergy to cinnamon is rare but needs to be considered in workers handling foods. Cinnamal is possibly the main allergen in cinnamon.
Contact and systemic contact-type dermatitis reactions to spices such as nutmeg, mace, cardamom, curry, cinnamon, and laurel may be rare but may well be overlooked. In our experience, patch testing with these spices "as is" is very useful; if there is a positive reaction, testing with dilutions is helpful. Scratch-chamber testing often leads to false-positive irritant reactions. As Hjorth and Niinimäki have pointed out, a positive test to balsam of Peru may indicate a spice allergy, but the absence of such a reaction does not rule it out. In all the cases in our experience, the careful drafting of the anamnesis or case history was critical in the diagnosis.
Allergy to fragrance is the most common cause of cosmetic contact dermatitis and therefore constitutes a significant clinical problem. The widespread use of fragranced materials in skin care and household products is probably the most important reason for the high incidence of fragrance sensitization.
This report will summarize the history of fragrance, review how to detect and evaluate fragrance allergy, discuss the problems inherent in patch testing with the fragrance mix and its constituents, describe systemic contact dermatitis from ingestion of certain flavors, and give suggestions for fragrance-sensitive patients.
The use of fragrance mix in patch testing has been invaluable in detecting fragrance allergy. Continued investigation into positive patch test responses to fragrance in scented products is essential in helping to identify new fragrance allergens. Additionally, more cooperation is necessary between industry and dermatologists in assisting patients to avoid proven allergens.
Hand hygiene is one of the basic components of any infection control program and is frequently considered synonymous with
hand washing. However, health care workers frequently do not wash their hands, and compliance rarely exceeds 40%. Hand rubbing
with a waterless, alcohol-based rub-in cleanser is commonly used in many European countries instead of hand washing. Scientific
evidence and ease of use support employment of a hand rub for routine hand hygiene. It is microbiologically more effective
in vitro and in vivo, it saves time, and preliminary data demonstrate better compliance than with hand washing. Therefore,
a task force comprising experts from the Centers for Disease Control and Prevention and from professional societies is designing
guidelines for the use of a hand rub in the United States. Today, most countries of Northern Europe recommend a hand rub for
hand hygiene unless the hands are visibly soiled. Side effects are rare and are mainly related to dryness of the skin. This
review evaluates the scientific and clinical evidence that support the use of alcohol-based hand rubs in health care facilities
as a new option for hand hygiene.
Epidemiological studies have described an increasing prevalence of fragrance allergy and indicated an association with hand eczema. 59 domestic and occupational products intended for hand exposure were subjected to gas chromatography-mass spectrometric (GC-MS) analyses to test the hypothesis that fragrance chemicals known to have the potential to cause contact allergy but not included in fragrance mix (FM) may be common ingredients in these products. A quantitative analysis of 19 selected fragrances was performed by GC-MS. Further analysis of GC-MS data revealed the presence of 43 other fragrance chemicals/groups of fragrance chemicals in the products investigated. Among the 19 target substances the most commonly detected were limonene in 78%, linalool in 61% and citronellol in 47% of the products investigated. The FM ingredients were present in these products with the following frequencies: oak moss (evernic acid methylester) 2%, cinnamic alcohol 2%, cinnamic aldehyde (cinnamal) 3%, isoeugenol 5%, alpha-amylcinnamic aldehyde (amyl cinnamal) 8%, hydroxycitronellal 12%, eugenol 27%, and geraniol 41%. Thus, the chemical analyses of domestic and occupational products indicates that investigation of potential contact allergy related to these products types should consider fragrance allergens additional to those in the FM, since these may occur with high frequency.
Allergic contact dermatitis induced by the occupational use of products containing essential oils has not been studied comprehensively.
The aim of the present report was to describe the characteristics, diagnosis, and outcome of 5 patients with occupational contact dermatitis because of essential oils attending our outpatient dermatology clinics over a 2-year period.
These patients are added to the 11 cases reported thus far in the literature.
The research shows that for proper diagnosis, patch tests with the standard series and the fragrance series should be performed, in addition to tests with the specific oils to which the patients were exposed.
Patients should be instructed to avoid the allergens identified. Sensitization to essential oils has important implications for the occupational future of affected individuals.
The ability to measure temporal trends in disease incidence is important, but valid methods are needed. This study investigates UK trends during 1996-2005 in work-related skin and respiratory diseases including non-malignant pleural disease, asthma, mesothelioma and pneumoconiosis and the potential for bias when using surveillance systems for this purpose.
The volunteer reporters in three surveillance schemes were specialist physicians for skin diseases, specialist physicians for respiratory diseases and occupational physicians, respectively, who provided monthly reports of new cases of disease which they considered work related. Poisson regression models were used to investigate variation by calendar year (trend), season and reporter characteristics. Separately, temporal patterns in the probabilities of non-response and zero reports were investigated. Annual changes in disease incidences were compared between reporter groups.
There was little evidence of change in incidences of non-malignant pleural disease, mesothelioma, skin neoplasia and urticaria, but falls were seen for contact dermatitis and pneumoconiosis. Although the directions of change were similar across reporter groups, the magnitude of annual change in incidence was often inconsistent: for occupational asthma, it was -1.9% (95% CI -5.2 to 1.4) and -12.1% (95% CI-19.5 to -4.1) using respiratory and occupational physician reports, respectively. Response rates were high (approximately 85%), but non-response increased slightly with membership time, as did the probability of a zero return in some groups. Adjustment of results for presumed reporting fatigue led to an upward correction in some calendar trends.
As some estimated changes in incidence based on volunteer reporting may be biased by reporting fatigue, apparent downward trends need to be interpreted cautiously. Differences in the population bases of the surveillance schemes and UK health service capacity constraints may also explain the differences in trends found here.
In statistical models of dependence, the effect of a categorical variable is typically described by contrasts among parameters. For reporting such effects, quasi-variances provide an economical and intuitive method which permits approximate inference on any contrast by subsequent readers. Applications include generalised linear models, generalised additive models and hazard models. The present paper exposes the generality of quasi-variances, emphasises the need to control relative errors of approximation, gives simple methods for obtaining quasi-variances and bounds on the approximation error involved, and explores the domain of accuracy of the method. Conditions are identified under which the quasi-variance approximation is exact, and numerical work indicates high accuracy in a variety of settings. Copyright Biometrika Trust 2004, Oxford University Press.
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