[Predictive factors of polysensitization to contact allergens: study conducted at the Dermato-Allergology Unit of the Farhat Hached University Hospital in Sousse, Tunisia]. / Facteurs prédictifs de la polysensibilisation aux allergènes de contact: étude comparative réalisée à l'Unité de Dermato-Allergologie du CHU Farhat Hached de Sousse, Tunisie.

Introduction: polysensitization is often defined as sensitization to three or more contact allergens. The objectives of our study were to determine the prevalence of polysensitization to allergens patch test and to analyze the factors associated with allergen polysensitization of the European Standard Battery in comparison with cases of oligosensitization. Methods: this is a retrospective descriptive cross-sectional study that included all patients who had undergone patch tests at the Department of Dermato-Allergology of the Department of Occupational Medicine of University Hospital Center Farhat Hached in Sousse spread over 10 years from January 1, 2009 to December 31, 2018. Results: in total, we collected 464 cases of contact dermatitis during the study period. The average age of patients was 38.93 ± 12.52 years with a slight female predominance (52.8% of cases). Among all the patients who consulted during the study period (832 patients), 133 patients had positive reactions to 3 or more allergens 16% of patients. Concerning, the associations of the most frequently noted allergens were those of triplet (chromium, cobalt, and nickel) in 15 patients and triplet (mercaptobenzothiazole, thiuram mix, and IPPD) in 7 cases. The predictive factors of polysensitivity were the personal history of leg ulcers; the site of the lesions in the thorax and the erythematous squamous and dyshidrotic appearance of the lesions. Conclusion: this phenomenon is frequent polysensitization, and close collaboration between dermatologists and occupational physicians to prevent this type of multiple allergies through better management of personal and also professional risk factors.

Effect of smoking on the clinical and allergological profile of contact dermatitis.

INTRODUCTION: Several clinical and epidemiological data point to a possible link between smoking exposure and contact dermatitis (CD). AIMS: To identify the clinical and epidemiological differences of CD in smoking and non-smoking subjects, and to determine the influence of smoking on the allergological profile of CD. METHODS: Retrospective descriptive study who consulted the Department of Occupational Medicine and Occupational Pathology of the Farhat Hached University Hospital of Sousse (Tunisia) during a period of 8 years for exploration of CD and who were tested with the European Standard Battery (ESB). RESULTS: A total of 767 patients were enrolled during the study period, 40% of whom were smokers. The group of smokers was characterized by a male predominance (p=10-3) and a greater professional seniority compared to non-smokers (p=0.01). Personal history of atopy was predominant in non-smokers (p=0.02). Among the ESB allergens, there was a significant association between smoking and CD due to metals (chromium, cobalt) and conservatives. After binary logistic regression, the variables associated with smoking exposure were male gender (OR=12.12 ; 95% CI=[6.07 - 24.21]; p=10-3), Kathon CG allergy (OR=3.69 ; 95% CI=[1.24 - 10.81]; p=0.018), and right hand involvement (OR= 2.83; 95% CI=[1.29 - 6.17]; p=0.005). CONCLUSION: Our study revealed an effect of smoking on the clinical and allergological characteristics of CD.

Critical study of the initial medical certificates of occupational accident declaration.

The drafting of the initial medical certificate (IMC) is an innocuous act that can engage the responsibility of the certifier. AIM: To evaluate the quality of the IMC and their compliance with the legal provisions and to develop good practice recommendations for the drafting of the occupational accident certificate. METHOD: An epidemiological, descriptive and retrospective study was conducted in the University Hospital Center Farhat Hached (Tunisia) based on the occupational accident certificates completed by physicians during a period of 12 months. RESULTS: In our study, 241 certificates were collected. The number of the patient's ID card was mentioned in 12% of cases. The date of the accident was noted in almost all cases (99.6%). The date of certification was indicated in all the cases. The average number of days of permanent work incapacity was significantly higher among male patients (p = 0.015), married patients (p≤10⁻³), and night workers (p = 0.05) and significantly lower among doctors (p ≤ 10⁻³). CONCLUSION: Our study showed that the quality of the initial medical certificate drafting suffered from several inadequacies. This may be related to the lack of training of doctors in forensic practice, hence the importance of reminding the rules of good practice.