Paresthesias and sensory neuropathy due to 1,1,1-trichloroethane.
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Adult↗
Biomedical subjects
D L Holness
Publications and source records attributed to D L Holness.
Work outcome in workers with occupational skin disease.
We carried out a follow-up study of employment outcome for 230 workers with a diagnosis of occupational skin disease who were at least 2 years postdiagnosis. Seventy-eight percent of the workers were working, but 57% of those working had changed jobs, 67% because of their skin problem. Thirty-one percent had lost no time from work because of their skin disease, while 35% had lost at least 1 month. Forty-three percent had applied for workers' compensation benefits, and 87% of those who had applied were successful in their claims. Older workers were more likely to be unemployed and to have applied for workers' compensation benefits. Women were less likely to have lost time from work and to have applied for workers' compensation. Those who had changed their jobs tended to have a better outcome with respect to active dermatitis, though they had lost more time from work and had more often applied for workers' compensation benefits.
Absenteeism↗
Exposure characteristics and cutaneous problems in operating room staff.
Health care personnel have exposure to a variety of cutaneous irritants and allergens and a high prevalence of cutaneous problems. The objectives of this exploratory study were to characterize the exposures and determine the prevalence of cutaneous symptoms and findings in operating room personnel, and to examine relationships between exposure characteristics and cutaneous outcomes. A questionnaire and standardized hand examination were used to assess the exposures and cutaneous status of operating room personnel. 184 operating room staff (90% of the eligible population) were assessed. Current skin problems were reported by 26%. Hand examination revealed that 9% had findings consistent with eczema and 10% changes of moderate dryness. A variety of preventive practices were being used by those with symptoms or findings. Cutaneous problems are common in operating room personnel. The use of preventive strategies (changing the type of gloves worn or the type of soap used for scrubbing, the use of glove liners and emollients) varied between different groups. These workers might benefit from more education regarding cutaneous hazards, preventive stategies and the importance of appropriate investigation of these problems.
Adult↗
Concomitant positive patch test results with standard screening tray in North America 1985-1989.
Responses to patch test substances may occur contemporaneously. Such simultaneous reactions may reflect concomitant sensitization to 2 dissimilar allergens to which concurrent exposure has taken place (e.g., ethylenediamine dihydrochloride and neomycin). It may occur when the individual has been exposed to only 1 of the substances and exhibits a response to other substances of similar chemical structure (i.e., cross-sensitization such as between para-phenylenediamine and benzocaine). Such simultaneous responses may also be chance occurrences, reflecting multiple sensitization or the result of altered response due to the "angry back syndrome". This investigation established that such concurrence of response is not uncommon and adds further documentation to the literature of these associations in patch test responses.
Adult↗
Disease outcome in workers with occupational skin disease.
BACKGROUND: Occupational contact dermatitis (OCD) contributes significantly to the burden of occupational disease, but there is little known about prognostic factors. OBJECTIVE: The study was designed to determine the health status of workers with OCD at least 2 years after diagnosis and to identify risk factors related to prognosis. METHODS: A questionnaire study was conducted of workers with a diagnosis of work-related skin disease. RESULTS: Of the 201 workers with OCD, 76% noted improvement and 40% reported that they were currently free of any eruption. Approximately one third noted that their skin disease interfered with household, work, or recreational activities. The key prognostic factor appeared to be sex because women reported a better outcome. Diagnosis and atopic status tended to be related to some outcomes, whereas age was not. CONCLUSION: Examination of other possible factors, some of which may be associated with sex, that might affect outcome should be undertaken to gain a better understanding of possible management strategies. A retrospective study has methodologic limitations and a prospective intervention trial should yield more information.
Adult↗
Lung function after a Halon 1301 discharge.
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Allied Health Personnel↗
The performance of specialized collections of bisphenol A epoxy resin system components in the evaluation of workers in an occupational health clinic population.
Epoxy resin of the bisphenol A type (ERBA) is a common cause of occupational contact dermatitis. 167 patients with a history of potential exposure were patch tested with epoxy resin (molecular weight 340) (ERBAM) 1% in pet. and with a number of other ingredients in ERBA systems. 18% of the test patients exhibited a positive response to ERBAM. Phenyl glycidyl ether was the most frequent system component other than ERBAM itself to elicit a positive response (6.1%). Approximately 80% of those tested were unresponsive to ERBAM or any other of the system components, while 20% exhibited a positive response to one or more of the test materials. Only a small % were positive to system materials, but negative to ERBAM, in keeping with previous studies. The study suggests that there is a marginal benefit to testing with other than ERBAM 1%, except in instances where there is known exposure to another ERBA system ingredient, in which event, the patient should also be tested with the specific material to which they have been exposed if there is no response to ERBAM.
Benzhydryl Compounds↗
Hypersensitivity pneumonitis and airways hyperreactivity induced by occupational exposure to penicillin.
A patient with penicillin-induced hyperreactive airways in association with hypersensitivity pneumonitis is described. Patch tests and intradermal tests to penicillin were positive. Bronchoalveolar lavage demonstrated a relative lymphocytosis and mild neutrophilia. Symptoms and physiologic abnormalities of pulmonary function and gas exchange resolved on cessation of exposure to penicillin.
Alveolitis, Extrinsic Allergic↗
Medical management of three workers following a radiation exposure incident.
The medical management of three individuals involved in an exposure incident to whole-body radiation at a nuclear generating plant of a Canadian electrical utility is described. The exposure incident resulted in the two highest whole-body radiation doses ever received in a single event by workers in a Canadian nuclear power plant. The individual whole-body doses (127.4 mSv, 92.0 mSv, 22.4 mSv) were below the threshold for acute radiation sickness but the exposures still presented medical management problems related to assessment and counseling. Serial blood counting and lymphocyte cytogenetic analysis to corroborate the physical dosimetry were performed. All three employees experienced somatic symptoms due to stress and one employee developed post-traumatic stress disorder. This incident indicates that there is a need in such radiation exposure accidents for early and continued counseling of exposed employees to minimize the risk of development of stress-related symptoms.
Acute Disease↗
Health effects of Halon 1301 exposure.
An accidental discharge of a Halon 1301 system is reported. Thirty-one workers were assessed, 22 who were present at the time of the discharge, and 9 who worked the next shift. The incident was complicated by a small Freon-22 leak several hours later. Throat, eye, and nasal irritation and lightheadedness were reported by the majority of workers. Workers present during the halon discharge reported significantly more lightheadedness, headache, voice change, cough, and a fast heartbeat than did those who worked the later shift. These differences were significant even after correcting for confounding factors such as age, sex, and sense of anxiety at the time of the incident. The possible causes for the irritant symptoms include breakdown products of Halon 1301 and Freon-22 or contaminants from the halon discharge system. Although these irritant effects may not be an effect of Halon 1301 alone, they may occur in these discharge situations, and workers should be advised of this possibility. The possible cardiac and central nervous system effects also should be considered. The importance of a clear-cut protocol to deal with such incidents as well as worker education are discussed.
Adult↗
Scabies in chronic health care institutions.
BACKGROUND: The diagnosis and management of outbreaks of scabies in health care facilities may be difficult. As there is little information available regarding the extent of this problem we conducted a questionnaire study to provide an indication of the occurrence of scabies in chronic health care facilities in the province of Ontario, Canada. It also documented the facilities' approach to the management of the disease. OBSERVATIONS: Two outbreaks of scabies in chronic health care facilities are described. The questionnaire study revealed that 25% of the institutions reported that they had problems with scabies over a 1-year period. A minority had a written policy with respect to dealing with the management of scabies, particularly in the setting of a mass outbreak. CONCLUSIONS: Scabies is a common problem in chronic health care facilities; however, diagnosis and management may be difficult. The development of a specific protocol for the management of such outbreaks by the appropriate public health agencies would be useful.
Adult↗
Work-related toxic epidermal necrolysis?
A case of toxic epidermal necrolysis is described in an employee of a company that carries out plastic extrusion using various resins, including cellulose acetate, co-polyester, polyvinyl chloride, acrylonitrile-butadienestyrene, and polyethylene. Air sampling during normal operating conditions indicated only trace amounts of hydrogen chloride and the plasticizer diethylphthalate. However, pyrolysis products of resin plugs could include compounds such as formaldehyde, acrylonitrile, and chlorinated hydrocarbons that have been associated with previous case reports of either erythema multiforme, Stevens-Johnson syndrome, or toxic epidermal necrolysis. The development of toxic epidermal necrolysis in this worker was directly preceded by exposure to a vapor from a machine used to dry cellulose acetate. The problems in determining work relatedness and advising about return to work are discussed.
Adult↗
Dermatologic problems of musicians.
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Adult↗
Is a worker's understanding of their diagnosis an important determinant of outcome in occupational contact dermatitis?
The possible effect of an individual's knowledge of their diagnosis on their disease outcome was examined in a group of 230 workers with occupational contact dermatitis. The workers were surveyed with an interviewer-administered questionnaire for an average of 5 years following a diagnosis of occupational contact dermatitis. 48% had allergic contact dermatitis and 52% had irritant contact dermatitis. There was a poor correlation between the workers' recalled diagnosis and the actual diagnosis, but better concordance with their recollection of patch test results. Only 33% correctly identified their diagnosis. Those who could not were approximately 2 x as likely to still have active dermatitis, to have more severe dermatitis and to note that their skin problem interfered with their work and home activities. Those who had no idea of their diagnosis were 3 x as likely to have these problems. These results raise the possibility that further efforts directed at the patient's education with respect to their condition might improve the outcome of their occupational skin disease.
Adult↗
Cutaneous nickel sensitivity in Toronto, Canada.
Patch tests were administered to 1074 subjects with suspected contact dermatitis by the method recommended by the International Contact Dermatitis Research Group. Of 629 subjects tested with 5% nickel sulfate in petrolatum, 10.5% had positive reactions (males, 5.1%; females, 16.7%). Of 447 subjects tested with 2.5% nickel sulfate in petrolatum, 11.9% reacted (males, 7.7%; females, 16.9%). In 447 subjects in whom the relationship between clinical findings and the patch test response was evaluated (i.e., relevance), more than 90% of the responses could be related to a past or present problem with contact dermatitis. The sites of involvement were not different between nickel-sensitive subjects and the overall population tested, except in the case of foot involvement, which was underrepresented in the nickel-sensitive group. Patients who had positive responses to nickel reacted more frequently to marginal irritants such as formaldehyde and benzoyl peroxide. This finding may suggest a reduction in the irritancy threshold in nickel-sensitive subjects. In most instances, domestic rather than occupational exposure was thought to account for the induction of nickel allergy.
Canada↗
Dermatitis in hairdressers.
Occupational contact dermatitis in hairdressers is a common clinical dermatologic problem. Apparently often secondary to irritant contact dermatitis caused by shampooing in Europe, in North America, allergic contact dermatitis related to the chemicals handled, especially oxidation dyes and permanent waving components, is not infrequently the problem. The preponderance of women in the clinical populations reported may well explain the relation noted between a positive patch-test response to nickel and the presence of contact dermatitis in hairdressers rather than nickel allergy predisposing to the disease. There is at present no convincing evidence for excluding persons with a medical or family history of atopy with the proviso that those with a history of hand eczema or atopic dermatitis would be wise to avoid the trade. Improved worker education about the cutaneous risks of the occupation and appropriate simple cutaneous industrial hygiene measures may offer some hope of modifying the risk of developing skin disease.
Adolescent↗
A review of 79 cases of eyelid dermatitis.
Seventy-nine patients with eyelid dermatitis and 1012 patients with dermatitis at other sites were assessed with patch tests. Eighty-nine percent of the eyelid cases involved women. Only the eyelids were involved in 78.5% of cases. Of the patients with eyelid dermatitis 46% had allergic contact dermatitis, 15% had irritant contact dermatitis, and 23% had atopic dermatitis. Only 13% were work related. Positive reactions to patch tests for cinnamic alcohol, diazolidinyl urea, and neomycin sulfate occurred more frequently, whereas those for cobalt and nickel occurred less frequently, in patients who had eyelid dermatitis when compared to the reactions of patients who did not have eyelid dermatitis.
Adult↗
Occupational dermatitis in food handlers and bakers.
Of 1346 patients with suspected contact dermatitis examined in Toronto, 10 bakers and 10 food handlers were found to have occupational contact dermatitis. Although not dissimilar in age, years in the trade, or length of illness, men were significantly overrepresented in the population of bakers (100% vs 40%, p less than 0.05). One baker had occupational asthma related to rye flour. Compared with the bakers, significantly more of the food handlers had allergic contact dermatitis (70% vs 20%, p less than 0.05). In addition to food components, cinnamates and rubber were found to be causes of allergic response. One food handler had contact urticaria caused by shellfish. The standard screening tests, combined with the use of contactants specific to occupational history, yielded a definitive determination of the existence of a contact allergy in our subjects.
Adult↗