[Exceptional occupational allergies due to food of animal origin]. / Außergewöhnliche Berufsallergien durch Nahrungsmittel tierischen Ursprungs.

BACKGROUND: The food industry is a high-risk area for work-related allergic immediate skin reactions (contact urticaria, contact urticaria syndrome, protein contact dermatitis) with or without respiratory symptoms (allergic rhinitis, allergic asthma) due to proteins of animal origin. OBJECTIVES: The present work gives an overview of allergenic seafood and meat proteins and their clinical and occupational relevance in different work settings. METHODS: A review of current knowledge and a supplementary selective literature search were performed. RESULTS: Protein contact dermatitis is one of the more common occupational dermatoses in workers exposed to seafood and meat, after irritant hand eczema. Fishermen, cooks, and butchers are most commonly affected. Crustaceans and mollusks are more frequent triggers of food allergies than fish and can in individual cases also be life threatening. In contrast, primary meat allergy is rare. Beef among mammals and chicken among birds are the most common triggers. CONCLUSIONS: All employees with allergic immediate skin and/or respiratory reactions exposed to proteins of animal origin in the workplace should undergo a careful allergological workup at an early stage. Determination of the specific IgE plays a central role in confirming the diagnosis and it is of great importance in individual cases to include the suspected native material in the skin tests. The course of the disease is generally characterized by a poor prognosis and is commonly associated with a change in occupation.

[New allergens for occupational dermatology?] / Neue Allergene für die Berufsdermatologie?

BACKGROUND: The environment is continuously subject to change. Exposures in the work environment and therefore the importance of occupational type I and type IV allergens may change. OBJECTIVES: The most important trends concerning occupational allergens, new occupational allergens/allergen exposures, the diagnostic procedure to detect new allergens in practice and regulatory developments are presented. MATERIALS AND METHODS: Building on known relevant allergen exposures in occupational dermatology, published trends from clinical cohorts are evaluated and a systematic literature search (PubMed 2016-2021) for new occupational allergens is also performed RESULTS: Occupations with the highest incidence of occupational allergic contact urticaria and/or protein contact dermatitis include bakers, farmers and farm workers, veterinary technicians, veterinarians, cooks, dairy and livestock workers, gardeners, and hairdressers. The highest risk of developing occupational contact dermatitis is in health care, agriculture, metalworking occupations and machine operators, the food sector, service industries, and construction occupations. The search strategy "new occupational allerg*" yielded 603 hits and "novel occupational allerg*" 158 hits. A total of 25 papers included results relevant to the research question and were processed. New protein-based immediate-type allergens, as well as contact allergens (haptens) relevant for occupational dermatology, are presented. CONCLUSIONS: Current trends on known occupational allergens and new occupational allergens in the period 2016-2021 can be identified. Only a thorough individual workplace history and testing of patients' own materials can identify new allergens in occupational dermatology.

12-year data on dermatologic cases in the Finnish Register of Occupational Diseases I: Distribution of different diagnoses and main causes of allergic contact dermatitis.

BACKGROUND: Skin diseases are among the most common occupational diseases, but detailed analyses on their epidemiology, diagnoses, and causes are relatively scarce. OBJECTIVES: To analyze data on skin disease in the Finnish Register of Occupational Diseases (FROD) for (1) different diagnoses and (2) main causes of allergic contact dermatitis (ACD). METHODS: We retrieved data on recognized cases with occupational skin disease (OSD) in the FROD from a 12-year-period 2005-2016 and used national official labor force data of the year 2012. RESULTS: We analyzed a total of 5265 cases, of which 42% had irritant contact dermatitis (ICD), 35% ACD, 11% contact urticaria/protein contact dermatitis (CU/PCD), and 9% skin infections. The incidence rate of OSD in the total labor force was 18.8 cases/100 000 person years. Skin infections concerned mainly scabies in health care personnel. Twenty-nine per cent of the ACD cases were caused by plastics/resins-related allergens, mainly epoxy chemicals. Other important causes for ACD were rubber, preservatives, metals, acrylates, and hairdressing chemicals. Cases of occupational ACD due to isothiazolinones reached a peak in 2014. CONCLUSION: Our analysis confirms that epoxy products are gaining importance as causes of OSD and the isothiazolinone contact allergy epidemic has started to wane.

[Skin tests in chronic hand dermatitis]. / Place des tests allergologiques dans l'eczéma chronique des mains.

Chronic hand dermatitis is often multifactorial but allergic causes are frequent and can complicate atopic dermatitis or irritant dermatitis. The management of patients affected by hand dermatitis includes detailed interrogation and a complete examination of the skin. Allergologic tests must be systematically realized if examination is suggestive of contact dermatitis or protein contact dermatitis, if an occupational origin is suspected but also in all patients in which treatment is ineffective. Skin tests include patch tests with the European standard series, specialized or additional series if necessary. Skin tests may also include personal items used by patients on a daily basis. If protein contact dermatitis is suspected skin tests include prick tests. Only complete and definitive eviction of allergens can allow a complete and definitive cure of chronic hand dermatitis.

Contact Urticaria Syndrome: a Comprehensive Review.

Purpose of Review: Contact urticaria syndrome includes contact urticaria and protein contact dermatitis. Underreport, underdiagnosis, or misdiagnosis of entities within the contact urticaria syndrome is believed to be common, especially in the occupational setting. This review provides a structured overview of the entities comprised in this syndrome as well as the diagnostic work-up and management strategies. Recent Findings: Contact urticaria syndrome has been increasingly described due to personal protective equipment and hand sanitizers in the context of the COVID-19 pandemic. The use of legal cannabis products has led to a rise in occupational cases of contact urticaria to cannabis. A declining trend in the evolution of contact urticaria has been described for natural rubber latex allergy due to the use of synthetic gloves. Prick test has been proposed as a screening method, particularly if multiple products are to be tested, instead of the classical sequential scheme. Summary: Physicians should be aware of the growing number of culprit agents leading to contact urticaria syndrome. Clinical presentation may be challenging since it includes immediate urticaria and/or eczema and even more generalized reactions. Diagnosis requires a high degree of suspicion, detailed occupational history, and complementary tests, including skin testing. The best treatment is to avoid contact with the culprit agent and to implement preventive measures.

Protein Causes of Urticaria and Dermatitis.

Protein contact dermatitis is a cutaneous hypersensitivity reaction after chronic, recurrent exposure or chronic irritation to animal or plant protein. Although the pathophysiological mechanisms underlying protein contact dermatitis are not well characterized, protein contact dermatitis is thought to be caused by combined type I/IV-mediated, type-1 mediated, or a Langerhans cell immunoglobulin E-mediated delayed hypersensitivity reaction. This chapter reviews the epidemiology, pathogenesis, clinical features, common protein allergens, diagnostic process, treatment options, and prognosis of protein contact dermatitis.

Contact Urticaria.

This article discusses contact urticaria syndrome definition, history, epidemiology, occupational relevance, mechanisms, clinical manifestations, diagnostic tools, agents responsible, and how to prevent and treat the patients affected. Contact urticaria syndrome is often misdiagnosed because it is not well known or recognized by physicians. Commonly the patient recognizes the cause of the clinical symptom, but the cause can be exceptional or new. Triggers include proteins, chemical compounds, agricultural chemicals, metals, plants, foods, and other substances. The objective of this article is to help dermatologists, toxicologists, and immunologists by providing diagnostic tools to avoid the culprit agent and treat the patients.

Food Allergy Evaluation for Dermatologic Disorders.

Food allergy evaluation for dermatologic disorders is warranted when Type 1 allergy is suspected, and includes skin prick testing (SPT) or measurement of specific immunoglobulin E (IgE) levels. The utility of these tests for identifying triggers is improved with clinical correlation, especially for contact urticaria, and protein contact dermatitis, which are mixed mechanism diseases. In atopic dermatitis (AD), patients are at risk for development of food allergy, and screening with SPT or IgE may be considered in severe AD, especially to guide early food introduction. Management of food-related AD exacerbations should focus on modifications in skincare before evaluating for allergy.

Atopy patch tests may identify patients at risk for systemic contact dermatitis.

BACKGROUND: A subset of patients with positive patch tests demonstrates systemic contact dermatitis (SCD) upon ingestion or inhalation of the allergen. Concern has been raised about the use of patch tests for protein allergens (APTs) to detect SCD in atopic dermatitis (AD) patients. METHODS: We present atopy patch test (APT) data for 97 people. We reviewed APTs and tests for antigen-specific immunoglobulin E (IgE) to the same allergen in pediatric AD patients. We compared the frequency of APTs as a function of age in AD patients. To study the irritancy potential of APTs, we prospectively tested consenting non-AD dermatitis patients undergoing evaluation for allergic contact dermatitis and healthy controls to an APT panel. RESULTS: APT demonstrated fewer positive results than serum-specific IgE or skin prick tests to the same allergen. Positive APT to food was more common in children under 3 years, whereas positive APT to aeroallergens were more common in teens and adults. Only positive APTs to dust mite were significantly more common positive in subjects without AD. CONCLUSION: Our aggregate findings suggest that most APTs, but not dust mite, behave like conventional patch tests to low-potency allergens. They are more likely to be positive in patients with chronically inflamed skin and to identify allergens that cause SCD. The higher prevalence of APT positivity to foods in young children is consistent with food allergy as a trigger of AD (also known as SCD) being more common in children than adults. Positive APTs define patients who may have SCD; negative APTs may guide elimination diets.

Allergic Contact Sensitization in Healthy Skin Differs from Sensitization in Chronic Dermatitis: Atopic, Occupational Wet Work, and Stasis Dermatitis.

The duration of cutaneous inflammation preceding sensitization influences the resulting allergic response; the innate immune system instructs the adaptive immune response. Potent allergens that function as their own irritant cause classic T helper cell type 1 skewed dermatitis. Examples include poison ivy, epoxy resin, and methylchloroisothiazolinone. Less potent allergens, such as food proteins and propylene glycol, sensitize skin affected by chronic dermatitis resulting in a T helper cell type 2 skewed response, sometimes with associated systemic contact dermatitis. Systemic contact dermatitis should therefore be suspected in patients with positive patch tests to ingested allergens in the setting of chronic dermatitis.