Occupational protein contact dermatitis from coriander.
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Biomedical subjects
Publications and source records attributed to L Kanerva.
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The exposure of dental personnel to airborne methacrylates and natural rubber latex (NRL) allergens was studied during placing of composite resin restorations in six dental clinics in Finland. Both area and personal sampling were performed, and special attention was paid to measurement of short-term emissions from the patient's mouth. Methacrylates were collected onto thermal desorption tubes filled with Tenax TA and NRL allergens onto membrane filters. The methacrylate samples were thermally desorbed and analysed by gas chromatography with mass selective detection. The NRL allergen concentrations were determined by the allergen-specific IgE-ELISA-inhibition method. The median concentration of 2-hydroxyethylmethacrylate (2-HEMA) was 0.004 mg m-3 close to the dental nurse's work-desk and 0.003 mg m-3 in the breathing zone of the nurse with a maximum concentration of 0.033 mg m-3. Above the patient's mouth the concentration of 2-HEMA was about 0.01 mg m-3 during both working stages, i.e., during application of adhesive and composite resins and during finishing and polishing of the fillings. Maximum concentrations of 3-5 times higher than median concentrations were also measured. Triethyleneglycol dimethacrylate was released into the air mainly during the removal of old composite resin restorations (0.05 mg m-3) and only to a minor extent during finishing and polishing procedures. The median concentration of the NRL allergen was 0.12 au m-3 (au = arbitrary unit) with a maximum concentration of 1.1 au m-3. The results show that, except for short-term emissions from the patient's mouth, the exposure of dental personnel to methacrylates and NRL allergens is very low. Measures to reduce exposure are discussed, as the airborne concentrations of methacrylates should be kept as low as possible in order to reduce the risk of hypersensitivity.
BACKGROUND: Compositae mix and sesquiterpene-lactone (SL) mix are important patch test substances to show allergic contact dermatitis from various Compositae plants. OBJECTIVES: The aims of this study are to calculate the sensitization rates to Compositae mix and SL mix in an occupational dermatology clinic and to describe cases of active sensitization caused by patch testing with Compositae mix and SL mix. METHODS: Conventional patch testing was performed. SL mix (0.1%) and Compositae mix (6% in petrolatum) were tested in a modified European standard series and a plant allergen series. Testing with other appropriate patch test series was also performed. RESULTS: SL mix provoked 8 allergic patch test reactions (0.7%) in 1,076 patients, whereas Compositae mix was positive in 15 of 346 patients (4.2%). Three patients were actively sensitized to Compositae mix and 1 patient to SL mix. One patient was also sensitized to other plant allergens in a series of allergenic plant chemicals, namely to Mansonone A, an ortho-quinone; (R)-3,4-dimethoxydalbergione, a quinone; and Chlorophorin, a hydroxy stilbene. Allergic patch test reactions to laurel leaf were caused by cross-sensitization to SLs. CONCLUSION: Compositae mix seems to be a more important patch test substance than SL mix to detect allergic contact dermatitis to Compositae plants, but patch testing may sensitize. The concentration of the individual components of the Compositae mix should be adjusted so that the mix detects allergic patients but does not sensitize.
Dental acrylic monomers (that is, acrylates and methacrylates) are important occupational sensitizers. Acrylic monomers may also cause allergic reactions in dental care. Unfortunately, acrylic monomers cross-react--that is, allergic sensitization induced by one acrylic compound extends to one or more other acrylic compounds. Therefore, sensitized individuals are often multiallergic and, accordingly, cannot be exposed to any of the compounds. In the present review aspects of cross-reactivity in general and data from animal studies of cross-reactivity of multifunctional methacrylates and acrylates are summarized. A multitude of acrylic monomers is used in dentistry, and when patients or dental personnel become sensitized, it is of great importance to identify the dental acrylic preparations to which the sensitized individual can be exposed. Sensitized dental workers are known to have ceased working in dentistry owing to occupational allergic contact dermatitis or asthma, caused by dental acrylic monomers. Unfortunately, cross-reactivity of acrylic monomers used in dentistry is not sufficiently mapped to enable selection of an appropriate compound for the sensitized person. Another important aspect is that product declarations of dental acrylic materials should show all acrylic compounds present in the products--even acrylic monomers/impurities with lower concentrations than 1%. This could help to select a product that the sensitized individual could use.
We present a mechanism for agonist-promoted alpha(2A)-adrenergic receptor (alpha(2A)-AR) activation based on structural, pharmacological, and theoretical evidence of the interactions between phenethylamine ligands and alpha(2A)-AR. In this study, we have: 1) isolated enantiomerically pure phenethylamines that differ both in their chirality about the beta-carbon, and in the presence/absence of one or more hydroxyl groups: the beta-OH and the catecholic meta- and para-OH groups; 2) used [(3)H]UK-14,304 [5-bromo-N-(4,5-dihydro-1H-imidazol-2-yl)-6-quinoxalinamine; agonist] and [(3)H]RX821002 [2-(2-methoxy-1,4-benzodioxan-2-yl)-2-imidazoline; antagonist] competition binding assays to determine binding affinities of these ligands to the high- and low-affinity forms of alpha(2A)-AR; 3) tested the ability of the ligands to promote receptor activation by measuring agonist-induced stimulation of [(35)S]GTPgammaS binding in isolated cell membranes; and 4) used automated docking methods and our alpha(2A)-AR model to predict the binding modes of the ligands inside the alpha(2A)-AR binding site. The ligand molecules are sequentially missing different functional groups, and we have correlated the structural features of the ligands and ligand-receptor interactions with experimental ligand binding and receptor activation data. Based on the analysis, we show that structural rearrangements in transmembrane helix (TM) 5 could take place upon binding and subsequent activation of alpha(2A)-AR by phenethylamine agonists. We suggest that the following residues are important in phenethylamine interactions with alpha(2A)-AR: Asp113 (D(3.32)), Val114 (V(3.33)), and Thr118 (T(3.37)) in TM3; Ser200 (S(5.42)), Cys201 (C(5.43)), and Ser204 (S(5.46)) in TM5; Phe391 (F(6.52)) and Tyr394 (Y(6.55)) in TM6; and Phe411 (F(7.38)) and Phe412 (F(7.39)) in TM7.
The mechanism of occupational asthma from diisocyanates (DI)(1-10)(Fig. 1) is not fully known; only about 10%-30% of such patients have specific IgE antibodies to DI (3, 11, 12). A T-cell mediated response has been considered to be involved in DI asthma (13) and we therefore wondered whether patch testing might be of any help in its diagnosis.
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BACKGROUND: Dental products contain many allergens, and may cause problems both for patients undergoing dental treatment and for dental personnel because of occupational exposure. Individual patch test clinics may not study sufficient numbers of patients to collect reliable data on uncommon allergens. OBJECTIVE: To collect information on dental allergens based on a multicenter study. MATERIALS AND METHODS: The Finnish Contact Dermatitis Group tested more than 4,000 patients (for most allergens, 2,300 to 2,600 patients) with dental screening series. Conventional patch testing was performed. The total number and percentage of irritant (scored as irritant [IR] or doubtful [?]) and allergic (scored as +, ++, or +++) patch test reactions, respectively, were calculated, as well as the highest and lowest percentage of allergic patch test reactions recorded by the different patch test clinics. A reaction index (RI) was calculated, giving information on the irritancy of the patch test substances. RESULTS: The most frequent allergic patch test reactions were caused by nickel (14.6%), ammoniated mercury (13%), mercury (10.3%), gold (7.7%), benzoic acid (4.3%), palladium (4.2%) and cobalt (4.1%). 2-hydroxyethyl methacrylate (2.8%) provoked most of the reactions caused by (meth)acrylates. Menthol, peppermint oil, ammonium tetrachloroplatinate, and amalgam alloying metals provoked no (neither allergic nor irritant) patch test reactions. CONCLUSION: Patch testing with allergens in the dental screening series, including (meth)acrylates and mercury, needs to be performed to detect contact allergy to dental products.
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BACKGROUND: We report on IgE-mediated allergy in a worker caused by Tribolium confusum (confused flour beetle). These beetles lived in the "old" flour to which he was exposed in his work. CASE REPORT: A 35-year-old, nonatopic mechanic in a rye crispbread factory developed rhinitis, conjunctivitis, and asthmatic symptoms, as well as urticaria on his wrists, lower arms, hands, neck, and face, during the maintenance and repair of machines contaminated by flour. This flour had been in and on the machines for a long time, and it contained small beetles. The patient did not suffer any symptoms when handling fresh, clean flour. RESULTS: Skin prick tests with standard environmental allergens, storage mites, enzymes, flours, and molds were negative. A prick test with flour from the machines gave a 10-mm reaction. An open application of the same flour caused urticarial whealing on the exposed skin. Prick tests with fresh flour from the factory were negative. A prick test with minced T. confusum from the flour in the machines gave a 7-mm reaction. Histamine hydrochloride 10 mg/ml gave a 7-mm reaction. Specific serum IgE antibodies to T. confusum were elevated at 17.2 kU/l. Prick tests with the flour from the machines were negative in five control patients. CONCLUSIONS: The patient had occupational contact urticaria, rhinitis, conjunctivitis, and asthmatic symptoms from exposure to flour. His symptoms were caused by immediate allergy to the beetle T. confusum. Immediate allergy to this beetle has rarely been reported in connection with respiratory symptoms, but it may be more common. Contact urticaria from this source has not been reported before.
The regulations relating to cosmetic products give no limit values for toxic elements such as metals or arsenic occurring as impurities in cosmetic products. The present study of metals (lead, cobalt, nickel, chromium) and arsenic in eye shadows in 88 colors of 25 brands and 49 products provides a basis for assessing the safety of eye shadow. 66 out of 88 (75%) of the colors contained more than 5 ppm of at least one of the elements, and all 49 products contained more than one 1 ppm of at least 1 of the elements. In one color, the amount of all elements was less than 1 ppm. The highest levels of cobalt and nickel were 41 and 49 ppm, respectively. These levels were high enough to cause allergic symptoms in those previously sensitized. Furthermore, long-term exposure to such levels may probably sensitize. The concentrations of arsenic were extremely low, 2.3 ppm at most. The level of lead was less than 20 ppm in all products. Accordingly, the concentrations of arsenic and lead seemed to be safe. 9 colors had concentrations of water-soluble chromium exceeding 2 ppm, and a very high level, 318 ppm, was encountered in 1 case. The overall results indicate that eye-shadows probably have no significant systemic toxicological effects. The groups at greatest risk are those already sensitized to the allergenic elements. Such consumers will have difficulties in choosing suitable products, since these elements in the form of impurities are not declared in the list of ingredients. Manufacturers should demand certification that the raw materials they buy contain no toxic elements. Although some of the products studied were acceptable, many had excessive levels of the elements from the consumer's viewpoint.
Protein contact dermatitis (PCD) is a chronic recurrent dermatitis caused by contact with a proteinaceous material. PCD may also present as paronychia. Here a case of PCD and paronychia from natural rubber latex (NRL) is presented. The correct diagnosis would not have been established if prick testing with NRL had not been performed. This case shows that contact allergy presenting as dermatitis may occur despite negative patch test results. PCD from NRL may be relatively common, although very few cases have been published. This is probably due to the fact that the term contact urticaria is so closely connected to NRL that automatically all cases of type I allergy to NRL are considered contact urticaria, although the clinical picture is a dermatitis, i.e. PCD.
BACKGROUND: Data on the incidence rates (IR) of occupational dermatoses are scarce. MATERIAL AND METHODS: We calculated the IR of occupational allergic contact dermatitis (ACD) caused by chromium, nickel and cobalt by occupation, during a 7-year period (1991-1997) from the data of the Finnish Register of Occupational Diseases and from the statistics on the working population in different occupations. RESULTS: A total of 2543 cases of occupational ACD were reported during 1991-1997. Cr caused 143 (5.6%) cases of ACD, Ni 176 cases (6.9%) and Co 41 cases (1.6%) of ACD. Women had greater number of occupational ACD from nickel, whereas occupational ACD from chromate and cobalt was more frequent in men. The ranking list of the IR of occupational ACD caused by Cr per 10,000 working years was (incidence rate in parenthesis) (1) tanners, fellmongers, and pelt dressers (12.20); (2) cast concrete product workers (6.94); (3) leather goods workers (4.71), (4) metal plating and coating workers (3.66); (5) bricklayers (3.44); (6) reinforcement concreters (2.79); and (7) building workers (1.32). The corresponding ranking list for Ni was (1) footwear workers (2.55); (2) machine and metal product assemblers (2.40); (3) electrical and teletechnical equipment assemblers (2.03); (4) precision instrument mechanics (1.73); (5) postal officials (1.48); (6) hairdressers, beauticians, and bath attendants (1.24); (7) industrial tailors and seamstresses (1.08); and (8) waiters in cafes and snack bars (1.04). The corresponding ranking list for Co was (1) printers (0.80); (2) turners, machinists, and toolmakers (0.36); and (3) machine and engine mechanics (0.17). CONCLUSION: The Finnish Register of Occupational Diseases forms a good basis for calculating IR. As IR illustrates the risk to become sensitized, preventive measures should be directed at occupations with the highest IR.
Studies in the Scandinavian countries have shown that orthodontists run an equal or even greater risk of contracting dermatitis compared to other dental personnel. The aim of the study was to find out whether the self-reported occupation-related health problems of general dental practitioners and orthodontists differ from those of office employees in Finland. The subjects were 147 general dentists, 81 orthodontists and 99 office employees (77% women and 23% men). The data were collected using a mailed questionnaire. Within the past year, 42% of the subjects had had occupational health problems, while 51% had experienced symptoms in the previous year or earlier. The complaints of hand dermatoses, musculoskeletal, as well as respiratory symptoms were significantly more common among women than among men. Musculoskeletal complaints were the most common symptoms in all occupational groups, but the odds ratio of having them were significantly higher for dental professionals compared to office employees. The frequency of self-reported hand dermatoses was 42% for dental professionals and 26% for office employees, but the difference did not reach statistical significance. The odds of having hand dermatoses were higher for atopic subjects and for women. Orthodontists did not differ from general practitioners in respect of any of the complaints reported. Materials used in dentistry were mentioned as the cause of symptoms by 49 (21.5%) of the dental professionals. The present results show an increased risk of self-reported musculoskeletal symptoms for the dental professionals. Also, a tendency towards increased occurrence of skin symptoms was noted for the dental professionals compared to office employees of this study.
BACKGROUND: Very little is known about allergic contact dermatitis (ACD) from preimpregnated epoxy products (prepregs). OBJECTIVE: To describe a patient with occupational ACD from prepregs, and report new quantitative data on the content of prepregs. METHODS AND RESULTS: A laminator developed work-related vesicular hand dermatitis. He worked in an aircraft plant assembling aircraft parts, being exposed to preimpregnated carbon fiber and fiberglass sheets (prepregs), and epoxy adhesive tapes and foams. Triglycidyl-p-aminophenol (TGPAP; 1-0.25%, 2+; 0.05%, 1+) and tetraglycidyl-4,4'-methylene dianiline (TGMDA; 1%, 3+; 0.5-0.05%, 2+) provoked allergic patch test reactions, whereas o-diglycidyl phthalate was negative (1-0.05% pet) and standard epoxy provoked a weak (?+) reaction. Six prepreg products provoking allergic patch test reactions were analyzed for their TGPAP, TGMDA and diglycidyl ether of bisphenol A (DGEBA) content using gas and liquid chromatographic methods, showing up to 10% of TGPAP, 19% of TGMDA and 5% of DGEBA in the prepregs. An epoxy primer contained 61% of TGPAP. CONCLUSION: TGPAP and TGMDA caused occupational ACD. These chemicals need to be used when patch testing patients are exposed to prepregs, because patch testing with DGEBA may be negative.
OBJECTIVES: This study attempted to develop and evaluate a challenge test for diagnosing allergic asthma and rhinitis due to cellulase. METHODS: Challenge tests in a chamber were performed on 11 persons sensitized to cellulase. Four different enzyme-lactose mixtures, starting from a 0.03% mixture, were used. The enzyme dust was generated from a dry enzyme preparation mixed with lactose powder, using pressurized air. The cellulase concentration in the air was measured with an immunochemical method. RESULTS: Nasal, pharyngeal, or bronchial symptoms could be elicited at cellulase air concentrations of 1 to 1300 microg/m3. A dose-response relationship was observed for symptoms in repeated challenge tests with increasing concentrations of cellulase. For 2 persons skin symptoms could also be reproduced. CONCLUSION: The challenge method proved to be a practical means with which to simulate conditions at the worksite and elicit the specific respiratory symptoms of the patients.
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