The prevalence of gross pathological damage in the livers of dairy cattle at processing plants in autumn in the North Island of New Zealand and an assessment of the gross liver pathology score as a method for estimating the prevalence of facial eczema.

AIM: To measure the prevalence of gross pathological damage in the livers of dairy cows at slaughter in the North Island of New Zealand in 2018 and 2019 and to determine, using Bayesian latent class analysis, the specificity and sensitivity of gross liver pathology score (GLS) as a method for detecting moderate to severe facial eczema (FE) at processing plants. METHOD: Meat inspectors at four processing plants located in the Northland, Waikato, Bay of Plenty and Taranaki regions of New Zealand graded all dairy cattle livers on particular days in April and May of 2018 and 2019 using a gross liver pathology score (GLS) from 0-5 (0 = no damage, 1= fatty liver, 2 = cholangitis and early cirrhosis, 3 = cirrhosis, 4 = extensive cirrhosis, 5 = regeneration). Forty livers from each grade were selected for histopathology. Sections from the apical margin of the right and the left lobes were scored using a histology biliary score (HBS; scored from 1-16) based on the classical histological lesions of FE focussing on changes that differentiate FE from fasciolosis. Mean HBS was collapsed into scores 2-6 (no and mild damage) and score 7-12 (moderate and severe) and GLS was collapsed into grades 0-2 (no or mild damage) and grades 3-5 (moderate, severe and chronic damage). A Bayesian latent class model was developed to estimate sensitivity and specificity of HBS and GLS. The diagnostic target was moderate or severe, gross and/or histological changes in the liver consistent with FE. RESULTS: A total of 2,899 dairy cow livers were graded at the four plants over the two study periods. There were 700/2,899 (24.1%) livers with at least some form of gross pathology damage (GLS≥1) and 130/2,899 (4.5%) livers with moderate, severe or chronic gross pathology damage (GLS≥3). The estimates (posterior median) for the sensitivity and specificity of GLS to liver damage were 0.844 (95% credible interval (CrI) = 0.757-0.905) and 0.932 (95% CrI = 0.866-0.973) respectively. Estimates for HBS were 0.834 (95% CrI = 0.765-0.892) and 0.778 (95% CrI = 0.707-0.854), respectively. CONCLUSION AND CLINICAL RELEVANCE: GLS is a useful means of estimating liver damage consistent with FE at slaughter. Increased use of liver scoring at slaughter could be useful for monitoring the likely impacts of FE at the country and regional levels.

Occupational autoeczematization or atopic eczema precipitated by occupational contact dermatitis?

Autoeczematization is characterized by the sudden dissemination of a previously localised form of eczema. While widely described, most cases reported have followed chronic, localized stasis dermatitis. In this study, we describe the clinical scenario of occupational contact dermatitis (OCD) triggering endogenous-like eczema in atopic individuals, who often have not had eczema since childhood, if at all. These cases appear similar to previously described cases of autoeczematization. To show this clinical scenario, a series of 6 patients is presented from the Occupational Dermatology Clinic in Melbourne, Australia. These workers initially developed OCD, usually affecting the hands, which then precipitated a flare of more generalized eczema. This appeared clinically consistent with atopic eczema (AE), and often became recurrent, and sometimes persistent. OCD can precipitate a flare of more generalized eczema, in a pattern consistent with AE, which may then persist. The clinical scenario is similar to that described for autoeczematization. It is possible that the pathophysiology, when clarified, will prove to be similar. Workers' compensation issues may become complicated for these patients, as the relationship between their generalized eczema and their occupational exposures may not be readily apparent. As a result, the work relatedness of their condition may not be recognized.

Comparison of 2 tests for clinical assessment of formaldehyde exposure.

The objective of the study was to obtain further experience on the applicability of 2 tests for clinical assessment of formaldehyde exposure. About 1300 products brought in by consecutive formaldehyde-sensitive eczema patients during a 2-year period were tested with both the chromotropic acid test and the acetylacetone test. The chromotropic acid test was modified by including a 2nd reading after 2 days. The outcome was identical for about 90% of the products, and 74% of the products that were positive on day 2 were also positive on day 1. More than 1/2 of the tests that scored as traces or caused problems on day 1 became positive on day 2. For products analyzed with both the chromotropic acid test (day 2 readings) and the acetylacetone test, about 80% gave identical results. Positive reactions were frequently found for hair shampoo, creams and lotions, soap and skin cleansers, make-up and dishwashing liquids. The samples causing discolouration or problems in the tests were mostly concentrated in specific product categories. Very few products caused problems in both test methods. Thus, the most convenient test can be used as the 1st choice and, for product categories causing discolouration or problems with a specific test, the other test method can be used.

Side-chain-specific lymphocyte responses in workers with occupational allergy induced by penicillins.

Eight workers with clinically diagnosed or suspected occupational allergy caused by penicillins were studied by the lymphocyte transformation test (LTT) and by skin test. The majority of the workers handled bacampicillin, some of them had been in contact with benzylpenicillin and one worked with azidocillin only. Six workers had eczema and 2 workers suffered from rhinitis only. Lymphocytes from workers with bacampicillin-induced symptoms responded to this drug in vitro by an increased 3H-thymidine incorporation and by lymphoblastogenesis. Bacampicillin-specific allergy had been confirmed by positive patch test in 5 workers. Lymphocytes from bacampicillin-allergic workers did not respond to other penicillins such as benzylpenicillin or azidocillin in vitro. However, such penicillins were antigenic in vitro since lymphocytes from an azidocillin patch test positive worker proliferated on exposure to azidocillin in vitro. The findings at the cellular level were further supported by the specificity of the skin test. Thus, bacampicillin patch test positive workers had a negative skin reaction to benzylpenicillin. In conclusion, these data suggest the role of penicillin side chains in the sensitization process underlying occupational allergy to penicillins. LTT can be used as a tool for studying antigenic specificities involved in a sensitization process leading to penicillin allergy.

[Occupational allergy to antibiotics]. / Alergia zawodowa na antybiotyki.

Of 57 nurses suffering from dermatitis and having occupational contact with antibiotics 37 per cent exhibited positive tests with these drugs. Analogous figures for pharmaceutical industry workers were 34 subjects and 41 per cent and for veterinary surgeons 31 subjects and 29 per cent. A case of an ophthalmist sensitive to dethreomycin under occupational conditions was also recorded. Furthermore, six nurses exhibited inhalant allergy to penicillin manifested clinically by an anaphylactic shock or urticaria or, in two cases, by contact urticaria: one also due to penicillin and the other due to streptomycin.

[Delayed diagnosis of occupational dermatitis]. / Opóznienia w rozpoznawaniu wyprysku zawodowego.

Of 182 subjects affected by occupational eczema only in 15% the eczema was found to be developed in the first three months. In 21.8% the diagnosis of occupational eczema was delayed by over 5 years. The methodological and social outcome of the delayed diagnosis was analysed.

[Skin diseases and working disability in the Netherlands. II. Catamnestic study in 3 groups of patients with occupational contact eczema]. / Hautkrankheiten und Arbeitsunfähigkeit in den Niederlanden II. Eine katamnestische Untersuchung bei drei Gruppen von Patienten mit einem Berufskontaktekzem.

A follow-up study was performed of the medical and social condition of 164 patients with an occupational allergic contact dermatitis. A change of work did not always lead to an improvement of the dermatitis. A number of patients improved without changing their job. It is suggested that a change of occupation can only be advised to these patients if the causal allergen can be avoided completely by doing so and only by doing so; at the same time one must reckon with other aetiologic factors and the social situation after change of work. Moreover it is pointed out that patients who changed their occupation did hardly use the possibilities, created by the Dutch law, to obtain expert advice or to be retrained for another job at the expense of the community.