Associations between tobacco smoking status and patch test results-A cross-sectional pilot study from the Information Network of Departments of Dermatology (IVDK).

BACKGROUND: Earlier studies suggested a potential association between tobacco smoking and nickel sensitization, but little is known about other contact allergens. OBJECTIVES: To investigate the association of smoking status and contact sensitizations as well as subtypes of dermatitis, and to analyse the sensitization profiles of tobacco smokers. PATIENTS AND METHODS: Within the Information Network of Departments of Dermatology (IVDK), we performed a cross-sectional multicentre pilot study comprising 1091 patch-tested patients from 9 departments, comparing 541 patients with a history of cigarette smoking (281 current and 260 former smokers) with 550 never-smokers. RESULTS: We could not confirm the previously reported association between nickel sensitization and tobacco smoking. Moreover, sensitizations to other allergens, including colophony, fragrance mix I, Myroxylon pereirae and formaldehyde, were not increased in cigarette smokers compared with never smokers. Hand dermatitis (50.6% vs. 33.6%) and occupational cause (36.2% vs. 22.5%) were significantly more frequent among cigarette smokers compared with never-smokers as shown by non-overlapping 95% confidence intervals. CONCLUSIONS: Although our study does not allow a firm conclusion on whether smoking status contributes to certain contact sensitizations, it confirms an association of smoking with hand dermatitis and occupational cause.

Contact allergies to dental materials in patients.

BACKGROUND: Concerns regarding contact allergies and intolerance reactions to dental materials are widespread among patients. Development of novel dental materials and less frequent amalgam use may alter sensitization profiles in patients with possible contact allergy. OBJECTIVES: To analyse current sensitization patterns to dental materials in patients with suspected contact allergy. METHODS: This retrospective, multicentre analysis from the Information Network of Departments of Dermatology (IVDK) selected participants from 169 834 people tested in 2005-2019 and registered with (i) an affected area of 'mouth' (and 'lips'/'perioral'), (ii) with the dental material in question belonging to one of three groups (dental filling materials, oral implants or dentures or equivalents) and (iii) with patch-testing done in parallel with the German baseline series, (dental) metal series and dental technician series. RESULTS: A total of 2730 of 169 834 tested patients met the inclusion criteria. The patients were predominantly women (81.2%) aged ≥ 40 years (92.8%). The sensitization rates with confirmed allergic contact stomatitis in women (n = 444) were highest for metals (nickel 28.6%, palladium 21.4%, amalgam 10.9%), (meth)acrylates [2-hydroxyethyl methacrylate (HEMA) 4.8%] and the substances propolis (6.8%) and 'balsam of Peru' (11.4%). The most relevant acrylates were HEMA, 2-hydroxypropyl methacrylate, methyl methacrylate, ethylene glycol dimethacrylate and pentaerythritol triacrylate. Few men were diagnosed with allergic contact stomatitis (n = 68); sensitization rates in men were highest for propolis (14.9%) and amalgam (13.6%). CONCLUSIONS: Allergic contact stomatitis to dental materials is rare. Patch testing should not only focus on metals such as nickel, palladium, amalgam and gold, but also (meth)acrylates and the natural substances propolis and 'balsam of Peru'.

Formaldehyde 2% is not a useful means of detecting allergy to formaldehyde releasers- results of the ESSCA network, 2015-2018.

BACKGROUND: Studies suggest that patch testing with formaldehyde releasers (FRs) gives significant additional information to formaldehyde 1% aq. and should be considered for addition to the European baseline series (EBS). It is not known if this is also true for formaldehyde 2% aq. OBJECTIVES: To determine the frequency of sensitization to formaldehyde 2% aq. and co-reactivity with FRs. To establish whether there is justification for including FRs in the EBS. MATERIALS AND METHODS: A 4-year, multi-center retrospective analysis of patients with positive patch test reactions to formaldehyde 2% aq. and five FRs. RESULTS: A maximum of 15 067 patients were tested to formaldehyde 2% aq. and at least one FR. The percentage of isolated reactions to FR, without co-reactivity to, formaldehyde 2% aq. for each FR were: 46.8% for quarternium-15 1% pet.; 67.4% imidazolidinyl urea 2% pet.; 64% diazolidinyl urea 2% pet.; 83.3% 1,3-dimethylol-5, 5-dimethyl hydantoin (DMDM) hydantoin 2% pet. and 96.3% 2-bromo-2-nitropropane-1,3-diol 0.5% pet. This demonstrates that co-reactivity varies between FRs and formaldehyde, from being virtually non-existent in 2-bromo-2-nitropropane-1,3-diol 0.5% pet. (Cohen's kappa: 0, 95% confidence interval [CI] -0.02 to 0.02)], to only weak concordance for quaternium-15 [Cohen's kappa: 0.22, 95%CI 0.16 to 0.28)], where Cohen's kappa value of 1 would indicate full concordance. CONCLUSIONS: Formaldehyde 2% aq. is an inadequate screen for contact allergy to the formaldehyde releasers, which should be considered for inclusion in any series dependant on the frequency of reactions to and relevance of each individual allergen.

Effectiveness of secondary prevention in metalworkers with work-related skin diseases and comparison with participants of a tertiary prevention program: A prospective cohort study.

BACKGROUND: In Germany, a multistep approach has been established to prevent work-related skin diseases (WRSDs). OBJECTIVES: To evaluate the effect of a secondary individual prevention program (SIP) in metalworkers with WRSD and to compare their characteristics with those of participants of a tertiary individual prevention program (TIP). PATIENTS AND METHODS: In a prospective cohort study, metalworkers with WRSD of the hands participating either in the SIP (n = 114) or in the TIP (n = 83) were recruited. At baseline and at the respective follow-up 8-12 weeks after the SIP or at dismissal from the TIP (3-4 weeks later), questionnaires were completed and the severity of WRSD was assessed. Saliva samples were collected for assessment of filaggrin (FLG) mutations and an explorative genome-wide association study (GWAS). RESULTS: Ninety-three SIP patients (81.6%) attended the follow-up. Disease severity was significantly reduced, and knowledge and protective behavior were significantly improved compared to baseline. Significant differences between SIP and TIP patients were found regarding duration and severity of symptoms, work absenteeism, tobacco smoking, and presence of atopic dermatitis, but not regarding FLG mutations and by GWAS. CONCLUSIONS: The SIP was effective in metalworkers with WRSDs. Individual factors may influence the course of the disease and the need for the TIP.

Health education decreases incidence of hand eczema in metal work apprentices: Results of a controlled intervention study.

BACKGROUND: Metal work apprentices (MWAs) frequently develop work-related hand eczema (HE). OBJECTIVES: To evaluate the effect of health education on incidence of work-related HE in MWAs and to assess confounding factors. MATERIALS/METHODS: In a prospective controlled intervention study, 131 MWAs received educational training on prevention of HE, whereas 172 MWAs and 118 office work apprentices served as controls. At baseline and during three yearly follow-ups, questionnaires were completed and hands were examined. Saliva samples were collected for assessment of filaggrin (FLG) null mutations and an explorative genome-wide association study (GWAS), and levels of various cytokines were assessed from stratum corneum samples. RESULTS: The 2-year and 3-year incidence of HE in the metalwork control group was 20.9% and 32.6%, respectively, which was significantly higher than in the intervention group (odds ratio [OR] 2.63, 95% confidence interval [CI] 1.31 to 5.28, P < .01 and OR 3.47, 95% CI 1.88 to 6.40, P < .0001). The knowledge score was higher in unaffected MWAs (P < .05). Other factors significantly associated with developing HE in MWAs were smoking cigarettes (P < .01) and FLG mutations (P < .001). No significant associations were found regarding epidermal cytokine levels and GWAS. CONCLUSIONS: Health education is effective in primary prevention of HE in MWAs. Individual factors should be considered in targeted counseling.

Tertiary prevention of occupational skin diseases: Prevalence of allergic contact dermatitis and pattern of patch test results.

BACKGROUND: Allergic contact dermatitis (ACD) is one of the most common occupational skin diseases (OSDs). Its prevalence and the causative allergens differ between occupations. OBJECTIVES: To evaluate the prevalence of ACD and the pattern of patch test results of patients taking part in a tertiary individual prevention programme (TIP) for OSD in Germany. PATIENTS AND METHODS: In a retrospective cohort study, the data of 3411 TIP patients patch tested between 2007 and 2016 were analysed. RESULTS: In 2687 (78.8%) patients, work-related skin disease was diagnosed, mostly hand dermatitis. The highest proportion of face dermatitis was seen in painters (8.1%). ACD was most common in painters (56.8%), hairdressers (45.8%), construction workers (31.5%), gardeners/florists (26.7%), and metalworkers (26.5%). On average, hairdressers had the youngest age (31.4 ± 12.6 years, P < 0.0001) and the shortest time in the profession prior to the TIP (mean 13.7 years). The pattern of patch test reactivity showed occupation-specific differences related to work exposures. CONCLUSIONS: Identification of occupational groups at risk for ACD and relevant allergens may help in the development and implementation of targeted prevention strategies. Our data suggest that there should be a particular focus on hairdressers and painters.

[Current trends in occupational dermatology]. / Aktuelle Trends in der Berufsdermatologie.

In clinical practice occupational skin diseases usually present as hand dermatitis. Occupationally acquired contact allergies are of eminent relevance in many work place products e.g. skin care products, dyes and paints, epoxy resins or protective gloves. However, not infrequently, a range of other dermatoses of different etiology and localization can be occupationally induced and, at least in Germany, thus be medically treated and--if necessary--compensated for with full coverage by the statutory employers' liability insurance. Examples regarding non-eczematous skin diseases triggered by external factors are psoriatic lesions, cutaneous type-1-allergies, occupationally acquired infections, and dermatoses in other localizations which are occupationally exposed to irritant influences (e.g. feet in workers wearing occlusive safety boots). Moreover, outdoor workers deserve specific attention by the dermatologist if squamous cell carcinomas including precursor lesions like actinic keratoses or Bowen disease have occurred. In Germany, recently the scientific advisory committee to the Ministry of Labor has recommended including these skin cancers caused by occupational solar UV exposure in the national list of occupational diseases. The framework for dermatological preventive care of occupationally-induced inflammatory dermatoses has been continuously improved in the last years. The aim is to reach a similar level of care and preventive measures for patients with occupational skin cancer, including primary preventive workers' education.

Is cocamidopropyl betaine a contact allergen? Analysis of network data and short review of the literature.

BACKGROUND: There is no general agreement on whether cocamidopropyl betaine (CAPB) is a skin sensitizer. OBJECTIVE: To examine the evidence for CAPB being a (non-)sensitizer. METHODS: This was a retrospective analysis of data on patch testing with CAPB 1% aqua collected by the Information Network of Departments of Dermatology from 1996 to 2009, with a focus on the patch test reaction profile, and demographic and clinical features of CAPB positives, supplemented by a literature review. RESULTS: Eighty-three thousand eight hundred and sixty-four patients were patch tested with CAPB 1% aqua, yielding 2.16% [95% confidence interval (CI) 2.06-2.26%] positive (2.03% + and 0.13% + + /+ + + ) and 4.6% non-allergic reactions. Thus, the reaction index was-0.368 and the positivity ratio was 94.2%. Reproducibility on synchronous patch testing (n = 6534) was poor [Cohen's kappa: 0.29 (95% CI 0.25-0.32)] and results upon retesting (n = 1157) were almost non-reproducible [kappa: 0.12 (95% CI 0.05-0.19]. Multifactorial logistic regression analysis revealed an increased risk associated with being male and aged ≥40 years, with atopic dermatitis, with scalp dermatitis, with being a hairdresser, and with a 48-hr patch test application. When only + + or + + + reactions were used as a conservative outcome, only the elevated risk in males and in patients with atopic dermatitis remained significant. CONCLUSION: The vast majority of positive reactions to CAPB are presumably false positive. Allergic reactions are very rare. This would support the notion of CAPB being 'not a significant skin sensitizer', in line with current classification systems.

Nickel allergy is still frequent in young German females - probably because of insufficient protection from nickel-releasing objects.

BACKGROUND: Nickel contact allergy is still frequent both in patch-tested patients and in the general population. Objectives. To explain this observation by relating clinical epidemiological data with recent chemical analyses of nickel release from costume jewellery. METHODS: (i) The trend of nickel allergy was analysed using data registered between January 1994 and December 2009 in the Information Network of Departments of Dermatology. (ii) In 2008, different parts of items of costume jewellery purchased at random on the German market (n = 609) were analysed for nickel release according to EN 1811:1998 + A1:2008 in five official German laboratories of food and non-food INVESTIGATION. RESULTS: (i) Between 1994 and 2009, nickel allergy decreased in men (18-30 years) and in women (1-17 and 18-30 years); however, after 2000, there was no significant decrease in nickel allergy in the women aged 1-17 years. (ii) Of the post-assemblies, 28.0% exceeded the migration limit of ≥0.2 µg/cm(2) per week, and 5% released ≥26.8 µg/cm(2) per week. In articles with direct and prolonged contact with the skin, 12.8% of decorative parts and 17.1% of clasps exceeded the migration limit. If an adjustment factor was applied, according to the above norm, about half of the items otherwise rejected became acceptable. CONCLUSION: Exposure to nickel-containing products exceeding the (unnecessarily relaxed) permitted limit may explain why nickel contact allergy remains a problem.

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

PURPOSE: Since 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. METHODS: IVDK 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. RESULTS: While 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. CONCLUSION: Our 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.

Formaldehyde-releasers: relationship to formaldehyde contact allergy. Part 2: Metalworking fluids and remainder.

We have reviewed formaldehyde-releasers used in metalworking fluids (MWFs) in this and a previous part of a two-part article. These biocides do not appear to be frequent or important sensitizers. Even in highly selected patient groups of metalworkers, mean prevalence rates of sensitivity are low: 0.2% for Tris(hydroxymethyl)nitromethane, 1.6% for tris(N-hydroxyethyl)hexahydrotriazine, 1.9% for Bioban P-1487 and Bioban CS-1246, and 2.8% for Bioban CS-1135. In the case of the Biobans, many reactions may have been irritant. Only N,N'-methylenebis(5-methyloxazolidine) has a fairly high mean score of 4.0% in metalworkers. With the exception of Bioban P-1487, there is a clear relationship between positive patch test reactions to the releasers and formaldehyde sensitivity: 40-70% of reactions to releasers occur in patients sensitive to formaldehyde and may therefore be caused by formaldehyde allergy. There is a lack of reliable data on the clinical relevance of contact allergy to the formaldehyde releasers in MWF. In most studies, no data on relevance were provided and in those that did, relevance was often found for a (very small) minority of the reactions only. Also discussed here are the formaldehyde-releasers MDM hydantoin, methenamine, N-methylolchloracetamide, paraformaldehyde, and Preventol D2.

Formaldehyde-releasers: relationship to formaldehyde contact allergy. Metalworking fluids and remainder. Part 1.

This is part of a series of review articles on formaldehyde-releasers and their relationship to formaldehyde contact allergy. Formaldehyde-releasers used in metalworking fluids (MWF) and a group of releasers not presented in previous articles are discussed. Here, in Part 1 of the article, there is a short overview of the composition and functions of MWF, the function of biocides in them, and adverse reactions to MWF. In addition, the releasers in MWF that have caused contact allergy are presented with CAS, synonyms, molecular formula, chemical structure, applications, patch test studies, and amount of formaldehyde released by them. In Part 2 of the article, the relationship between formaldehyde-releasers used in MWF and formaldehyde contact allergy is discussed as are data on miscellaneous releasers not previously presented, followed by a discussion of Parts 1 and 2 of the article.