Axel Schnuch

Contact allergies in healthcare workers. Results from the IVDK.

Healthcare workers often suffer from occupational skin disease frequently caused by allergic sensitization. Therefore the patch-test results and important patient history items of 31,849 patients recorded between 1992 and 1995 in the 24 allergy departments participating in the Information Network of Departments of Dermatology (IVDK) were evaluated. Significantly increased sensitization rates common to the healthcare sector as a whole were found for the vaccine preservative thiomersal (12.6% vs. 4.9%), the surface and instrument disinfectants glutardialdehyde (9.9% vs. 2.6%), formaldehyde (3.6% vs. 2.1%) and glyoxal (4.2% vs. 1.4%), and for the compounds of the thiuram mix (6.7% vs. 2.6%) present in protective gloves. Formaldehyde seems to lose its importance, but glyoxal must be added to the list of occupational allergens in the healthcare sector. In addition, occupation-specific sensitization was observed, with fragrances in massage therapists (16.1% vs. 10.6%) and nurses (13.8% vs. 11.4%), as well as with methacrylates in dental technicians. The often assumed importance of drugs as type-IV allergens was not confirmed, at least in terms of quantity. The identification of subgroups of increased risk and of occupation-specific allergens could be the basis of targeted preventive action in the healthcare sector.

The European standard series in 9 European countries, 2002/2003 - First results of the European Surveillance System on Contact Allergies

Since January 2001, the European Surveillance System on Contact Allergies (ESSCA), supported by European Union funding (contract QLK4‐CT‐2001‐00343), has started to collect patch‐test data. This comprises a standardized clinical history and the patch‐test results using the European standard series, from 17 centres in 9 European countries listed above. In 2002 and 2003, 10u2003511 patients test results have been pooled and analysed. The anamnestic data partly reflect the subspecialties of some centres. The most common allergen was nickel sulfate (17.3%); however, large international variations were observed. The prevalence of contact allergy to Myroxylon pereirae resin (balsam of Peru) (5.8%) is coming close to the frequency found with the fragrance mix (6.4%). Regarding contact allergy to chromium compounds, different frequencies were noted in the 2 centres focused on occupational dermatitis (2.3% in the FIOH versus 7.4% in the Nofer Institute). These most likely reflect the beneficial effect of addition of ferrous sulfate in one, but not the other country. As differences may partly be due to different patch‐test reading, standardization may need to be refined further. By providing post‐marketing surveillance in the field of contact allergy, ESSCA will meet its objective of increased consumer safety across Europe.

Association between occupation and contact allergy to the fragrance mix: a multifactorial analysis of national surveillance data

OBJECTIVES 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. METHODS Firstly, crude analyses of the prevalence of FCA in various occupational fields including all 57u2009779 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. RESULTS (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. CONCLUSIONS 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.

Nickel allergy following European Union regulation in Denmark, Germany, Italy and the U.K.

Nickel allergy is common worldwide. It is associated with hand dermatitis, and sensitization is often induced by nickel‐releasing jewellery. The European Union (EU) introduced legislation to control nickel content and release from jewellery and other consumer items through the EU Nickel Directive 1994, which came into force in 2001 and is now part of the REACH regulation.

Databases and Networks. The Benefit for Research and Quality Assurance in Patch Testing

The present chapter summarises several information technology (IT) applications in the research field of contact dermatitis intended to support the clinical management of patients and/or research. Today, due to the overwhelming speed of IT innovation, there seem to be few strictly technical problems. However, it seems to be an important issue to integrate IT into everyday work in such a way that it is not perceived as an intrusion, but rather as a support by its users. The starting point for a successful contact allergy research application is the implementation of user-friendly patch test software to document relevant parts of the patient’s history and patch test results. After an overview of the relevant issues, this presentation focuses on the usefulness of electronically collected data for quality control purposes within a patch test network. In this context, quality control is both an outcome and also a prerequisite for further use of this data for scientific purposes, e.g., surveillance of contact allergy or other dedicated analyses. The successful use of such databases generated by different networks is illustrated by several examples. As an aid in the daily management of contact dermatitis patients, a number of auxiliary sources of information are briefly outlined in the final section.

Contact allergy to topical antifungal agents

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Skin irritability to sodium lauryl sulfate is associated with increased positive patch test reactions

As previous observations have indicated an inter‐relationship between irritant and allergic skin reactions we analysed data of synchronous allergen and sodium lauryl sulfate (SLS) patch tests in terms of a relationship between SLS responsiveness and allergic patch test reactions.

Designation of substances as skin sensitizing chemicals : a reply

Sir A recent commentary in this journal1 addressed the rationale behind the classification and subsequent designation of substances as skin sensitizing chemicals proposed by the MAK Commissiont of the Deutsche Forschungsgemeinschaft.2 Although appreciating the standardization effort, Kimber et a]. disagree with a number of criteria the MAK Commission employs in the classification process and propose an alternative algorithm. We assume that the apparently different approaches of Kimber et a]. and our group are due to a

Kontaktallergien gegen ophthalmologische Lokaltherapeutika – eine epidemiologische Risikobewertung

BACKGROUNDnContact allergies (CA) against active agents of topical ophthalmological therapeutics, causing inflammation of the conjunctiva and/or the lid, are usually not life-threatening, but occur not infrequently. As yet, the assessment of the CA-eliciting risk has been based on clinical data alone, while a valid epidemiological risk assessment is lacking.nnnMATERIALS AND METHODSnThe Information Network of Departments of Dermatology supplied information on diagnostic results obtained in 4,102 patients patch-tested for suspected CA to ophthalmic drugs between 1995 and 2004. Clinical prevalences were extrapolated to incidences at the German population level. These estimates served as numerator for a relative incidence (RI), which included the nationwide frequency of prescriptions collected by the WIdO, Bonn, in terms of a standardised defined daily dose (DDD) as denominator.nnnRESULTSnThe estimated annual incidence of CA ranges from 155 (atropine sulphate) to 2077 (gentamicin sulphate) and can thus be regarded as moderate. If incidence estimates are related to prescription frequencies, the highest risk was found for kanamycin and neomycin sulphate (RI > 8 / 100,000 DDD). In contrast, the RI of pilocarpine-HCl (0.3) was virtually negligible.nnnCONCLUSIONSnThe substance-specific risk of CA has been evaluated for the first time and found to differ between therapeutics (with a similar spectrum of application). CA risk should be considered in differential therapeutic decision-making.

Computers in the Management of Contact Dermatitis

Nowadays it seems quite unnecessary to give reference to the unique features and advantages of computers, so indispensable have they become in both everyday and professional life. Not only has their sheer number increased, but also their quality, the mode of interaction between user and computer becoming increasingly intuitive and flexible. The scope of computer applications has also become much broader — including worldwide connectivity via the Internet.