Andrea Krautheim

Occupational contact allergy in the building trade in Germany: influence of preventive measures and changing exposure

PurposeSince 1993, assiduous efforts have been made in Germany to lower the incidence of allergic cement dermatitis by reducing the content of hexavalent chromium (Cr VI). Usage of epoxy resin systems has considerably increased in the building trade in the same period. We analysed data of the Information Network of Departments of Dermatology (IVDK) to evaluate the influence of these changing occupational exposures on frequencies of sensitization.MethodsIVDK data of 1,153 men working in the building trade (bricklayers, tile setters etc.) presenting with occupational skin disease in the years 1994–2008 were analysed, taking into consideration not only the year of patch testing, but also beginning and duration of work in the building trade.ResultsWhile contact sensitization to chromate decreased from 43.1 to 29.0%, sensitization to epoxy resin increased from 8.4 to 12.4%. Logistic regression analysis revealed that, compared to those who had already worked before 1994, patients having started to work in building trade after 1999 had a significantly decreased risk of chromate sensitization (odds ratio 0.42) and a significantly increased risk of sensitization to epoxy resin (odds ratio 2.79). Additionally, risk of thiuram sensitization increased with the duration of employment.ConclusionOur data confirm that reducing Cr VI content of cement is useful in preventing allergic cement eczema, as previously found in Scandinavia. In contrast, the increasing prevalence of contact sensitization to epoxy resin components in the building trade is alarming. Preventive measures, which have already been implemented, have to be enforced.

Patch testing with fragrance mix II: results of the IVDK 2005–2008

Background: The fragrance mix (FM I), established in 1977, detects the majority, but not all cases of contact allergy to fragrances. Based on European research 2002/2003, fragrance mix II (FM II) was developed to supplement FM I. In 2005, the German Contact Dermatitis Research Group (DKG) added FM II to their baseline series.

Nonradioactive technique to measure protein phosphatase 2A-like activity and its inhibition by drugs in cell extracts

A nonradioactive assay has been developed that can be used to measure serine/threonine protein phosphatase (PP) activity, especially PP2A, in crude extracts from different cell lines. For this technique commercially available casein is used as an already phosphorylated substrate. The prerequisite for reliable measurements is the removal of free phosphate from cell extracts and substrate preparations with desalting columns. The use of different nonspecific or specific inhibitors as well as inhibition characteristics observed after extract dilution suggests that in the absence of magnesium, PP2A-like activity in the extracts is measured by this technique. Inclusion of magnesium allowed the detection of a protein phosphatase activity that is activated by magnesium, which is presumably PP2C. The use of structurally different as well as structurally related inhibitors of PP2A gave results comparable to those of reports from the literature that were obtained with radioactive assays. Thus, our data supported our hypothesis that this nonradioactive assay can be used for the identification of newly synthesized PP inhibitors as well as for performing structure-activity analysis within groups of such new agents.

Michael Adducts of Ascorbic Acid as Inhibitors of Protein Phosphatase 2A and Inducers of Apoptosis

Michael adducts of ascorbic acid with alpha,beta-unsaturated carbonyl compounds have been shown to be potent inhibitors of protein phosphatase 1 (PP1) without affecting cell viability at the respective concentrations. Here we were able to show that higher concentrations can partially inhibit PP2A activity and concomitantly induce apoptotic cell death. A nitrostyrene adduct of ascorbic acid proved to be a more potent and effective inhibitor of PP2A as well as a stronger inducer of apoptosis. These adducts only slightly lost their cytotoxic potential in multidrug resistant cells that were 10-fold less sensitive to apoptosis induction by okadaic acid and vinblastine.

Allergologische Diagnostik und aktuelle Allergene in der Berufsdermatologie

ZusammenfassungDas beruflich bedingte allergische Kontaktekzem kann durch eine Vielzahl verschiedener Stoffe ausgelöst werden. Im individuellen Fall ist die Identifizierung der potenziellen oder tatsächlich relevanten Allergene am Arbeitsplatz oft schwierig. Daher ist es erforderlich, dass der Arzt, der entsprechende Patienten betreut, eine umfassende Kenntnis der in den verschiedenen beruflichen Bereichen häufigen und infrage kommenden Allergene hat. Nur so kann die Anamnese gezielt erhoben, die Diagnostik effizient durchgeführt und die Sekundärprävention durch Meidung des Allergenkontaktes sinnvoll eingeleitet werden. In dieser Übersicht werden zunächst praxisbezogene allgemeine Hinweise zur Epikutantestung bei Verdacht auf berufsbedingte Kontaktallergie gegeben. Anschließend werden die häufigsten Berufsallergene der am meisten betroffenen Berufsgruppen vorgestellt, und es werden berufsgruppenspezifische Empfehlungen für die Epikutantestung gegeben bzw. referiert.AbstractA broad spectrum of various substances may cause occupational allergic contact dermatitis. Often, it is difficult to identify potentially or truly relevant allergens at the workplace. Therefore, the consulting physician must have a comprehensive knowledge of possible allergens in different occupations to perform specific diagnostics and to initiate efficient secondary prevention by allergen avoidance. In this review, we give some practically relevant general comments on patch testing in occupational dermatitis, followed by a discussion of important occupational allergens in those occupational groups most frequently affected by occupational dermatitis. Finally, recommendations on which allergens should be tested in the respective occupational groups are given or reported from the literature.A broad spectrum of various substances may cause occupational allergic contact dermatitis. Often, it is difficult to identify potentially or truly relevant allergens at the workplace. Therefore, the consulting physician must have a comprehensive knowledge of possible allergens in different occupations to perform specific diagnostics and to initiate efficient secondary prevention by allergen avoidance. In this review, we give some practically relevant general comments on patch testing in occupational dermatitis, followed by a discussion of important occupational allergens in those occupational groups most frequently affected by occupational dermatitis. Finally, recommendations on which allergens should be tested in the respective occupational groups are given or reported from the literature.

Hamster pancreatic beta cell lines with altered sensitivity towards apoptotic signalling by phosphatase inhibitors.

Specific inhibitors of serine/threonine phosphatases like okadaic acid can induce apoptotic cell death in the pancreatic beta cell line HIT. Cultivation in stepwise increased concentrations of okadaic acid enabled the isolation of HIT100R cells which proliferate at 100 nM okadaic acid (8–10 times the initially lethal concentration). These two cell lines were used to characterize the events triggered by okadaic acid that led to apoptosis. Biochemical markers, e.g. cytochrome c release from mitochondria and increase of caspase‐3‐like activity, revealed that induction of apoptosis by 100 nM okadaic acid in parental HIT cells started with the release of cytochrome c. In HIT100R cells 500 nM okadaic acid were necessary to induce alterations comparable to those observed with 100 nM okadaic acid in non‐resistant HIT cells. In contrast to okadaic acid, the potency of the structurally different phosphatase inhibitor cantharidic acid to induce cytochrome c release, increase of caspase‐3‐like activity and DNA fragmentation was comparable in HIT and HIT100R cells. Thus, no cross‐resistance between these phosphatase inhibitors seemed to exist. Phosphatase activity in extracts from HIT and HIT100R cells did not differ in its total amount or in its sensitivity for okadaic acid. Since higher concentrations of okadaic acid were needed to induce apoptosis in HIT100R cells, a compromised intracellular accumulation of the toxin appeared likely. Functional and structural analysis revealed that this was achieved by the development of the multidrug resistance phenotype in HIT100R cells. The underlying mechanism appeared to be the enhanced expression of the pgp1 but not the pgp2 gene.

Airborne allergic contact dermatitis caused by didecyldimethylammonium chloride in a geriatric nurse

For surface disinfection in hospitals and nursing homes, preparations containing aldehydes such as formaldehyde, glutaral, or glyoxal, as well as quaternary ammonium compounds (QACs), are being used. Occupational allergic contact dermatitis (OACD), including airborne dermatitis, caused by these compounds is a well-known problem in nurses and hospital cleaners (1–6). For diagnostic purposes, only one QAC, namely benzalkonium chloride (BAC), is commercially available as a patch test preparation. We report a case of airborne OACD caused by a different QAC in a geriatric nurse.

Die häufigsten Kontaktallergene der Jahre 2007–2009

ZusammenfassungHintergrundDie Ergebnisse epidemiologischer Untersuchungen zur Kontaktallergie mit Darstellung der häufigsten Kontaktallergene bei unselektierten Patienten sind für den Verbraucherschutz und die Routinediagnostik in der dermatologischen Praxis von Bedeutung.MethodenAnalyse von Daten des Informations-verbundes Dermatologischer Kliniken (IVDK) der Jahre 2007–2009.ErgebnisseIn den am IVDK beteiligten dermatologischen Abteilungen wurden im Untersuchungszeitraum 34.091 Patienten epikutan getestet. Im Jahr 2009 ergaben sich im Vergleich zu den beiden Vorjahren signifikant niedrigere Reaktionsquoten auf Nickelsulfat, Kobaltchlorid und Kaliumdichromat. Das Konservierungsmittel Methyldibromoglutaronitril (MDBGN, Dibromdicyanobutan) führte bereits seit 2008 zu signifikant weniger positiven Reaktionen. Auf den Duftstoff Hydroxyisohexyl-3-cyclohexencarboxaldehyd (HICC, Lyral®) wurden 2009 deutlich, jedoch nicht signifikant, weniger positive Reaktionen beobachtet als 2007 und 2008. Die Quote an Sensibilisierungen gegen Bufexamac ist seit Jahren mehr oder weniger konstant.SchlussfolgerungenTrotz der EU-Nickeldirektive stagnierte in den letzten Jahren die Quote der Sensibilisierungen gegen Nickel bei jungen Frauen auf hohem Niveau. MDBGN wurde 2008 EU-weit in Kosmetika und Körperpflegeprodukten verboten, was sich in sinkenden Sensibilisierungsquoten niederschlägt. Der Einsatz des Duftstoffs HICC in Kosmetika wurde reduziert; hier zeichnet sich bisher jedoch noch kein signifikanter Effekt auf die Sensibilisierungsquote ab. Wegen der Vielzahl von Sensibilisierungen gegen Bufexamac hat die EU-Kommision diesem Wirkstoff im Juli 2010 die Zulassung entzogen.SummaryBackgroundEpidemiological surveillance of contact sensitization with presentation of the most frequent contact allergens is important for consumer protection and the quality of routine diagnostics in dermatology.MethodsAnalysis of data of the Information Network of Departments of Dermatology (IVDK) of the years 2007 to 2009.ResultsDuring the study period, 34,091 patients have been patch tested in the departments of dermatology forming the IVDK. Compared to the years before, reactions to nickel sulphate, cobalt chloride and potassium dichromate were significantly less frequent in 2009 than before. The preservative methyldibromo glutaronitrile (MDBGN) elicited significantly less positive reactions already from 2008 on. The proportion of positive reactions to the fragrance hydroxyisohexyl 3-cyclohexene carboxaldehyde (HICC, Lyral®) was considerably, albeit not significantly, lower in 2009, when compared to 2007 and 2008. Sensitization frequency to bufexamac has been at a constant level for years.ConclusionsIn spite of the EU nickel directive, contact sensitization to nickel in young women hitherto remains on a high level. MDBGN has been banned from cosmetics and body care products by the EU commission in 2008. This measure resulted in decreasing sensitization rates. The use of HICC in cosmetics has been reduced; however, a substantial and significant reduction of the sensitization frequency could not yet be observed. Due to frequent sensitization, approval of bufexamac has been withdrawn by the EU Commission in July 2010.

Occupational allergic contact dermatitis caused by N-(3-aminopropyl)-N-dodecylpropane-1,3-diamine in a surface disinfectant

A 24-year-old woman developed hand eczema after 6 months of full-time cleaning of hospital operating theatres, using a surface disinfectant (Microbac® forte). The skin lesions healed during sick leave and application of topical corticosteroids, but recurred after she had returned to work, and then spread to the face. She was finally dismissed after 12 months, and her dermatitis cleared. She suffered from hay fever for years, but had never had any skin problems. She was patch tested with the baseline series, a series of disinfectants (including benzalkonium chloride), and fragrances, as recommended by the German Contact Dermatitis Group. Microbac forte 0.4% and 0.04% aq. Fig. 1. Patch test reactions to N-(3-aminopropyl)-N-dodecylpropane-1,3-diamine 0.1% aq. (above) and Microbac® forte 0.4% aq. (below) at D3.

Airborne allergic contact dermatitis in a parquet fitter

Contact allergy, including airborne allergic contact dermatitis caused by epoxy resin systems (ERSs), is an increasing problem in the building trade (1). Commercially available epoxy resin patch test series do not cover all allergologically relevant components of the ERSs currently used. Therefore, individual patch testing is essential (2). We report a case of severe airborne allergic contact dermatitis in a parquet fitter.