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Out of 923 female dental nurses in the Helsinki district, 799 were interviewed using a computer-assisted telephone interview. A structured questionnaire was used to inquire about skin, respiratory symptoms, atopy, work history and methods, and exposure at work. The 328 nurses, who reported work-related dermatitis on their hands, forearms or face, were invited to an interview by an occupational physician; 245 nurses participated. 31 nurses had previously been diagnosed with an occupational skin disease (OSD). 133 nurses with a suspected OSD were selected for further clinical examinations with prick and patch testing. Among the 107 nurses examined, 22 new cases of OSD were diagnosed. There were altogether 29 cases of allergic contact dermatitis, 15 of contact urticaria, 12 of irritant contact dermatitis, and 1 case of onychomycosis. Rubber chemicals and natural rubber latex (NRL) in protective gloves, as well as dental-restorative plastic materials [(meth)acrylates], were the most common causes of allergy. 42% of the OSD cases in the studied population had been missing from the statistics (Finnish Register of Occupational Diseases). Plastic gloves or NRL gloves with a low-protein content are recommended for dental work. Skin exposure to (meth)acrylates should be avoided.

Occupational skin diseases are among the most frequent work-related diseases in industrialized countries. Good occupational skin disease statistics exist in few countries. Questionnaire studies are needed to get more data on the epidemiology of occupational skin diseases. The Nordic Occupational Skin Questionnaire Group has developed a new questionnaire tool - Nordic Occupational Skin Questionnaire (NOSQ-2002) - for surveys on work-related skin disease and exposures to environmental factors. The 2 NOSQ-2002 questionnaires have been compiled by using existing questionnaires and experience. NOSQ-2002/SHORT is a ready-to-use 4-page questionnaire for screening and monitoring occupational skin diseases, e.g. in a population or workplace. All the questions in the short questionnaire (NOSQ-2002/SHORT) are included in the long version, NOSQ-2002/LONG, which contains a pool of questions to be chosen according to research needs and tailored to specific populations. The NOSQ-2002 report includes, in addition to the questionnaires, a comprehensive manual for researchers on planning and conducting a questionnaire survey on hand eczema and relevant exposures. NOSQ-2002 questionnaires have been compiled in English and translated into Danish, Swedish, Finnish and Icelandic. The use of NOSQ-2002 will benefit research on occupational skin diseases by providing more standardized data, which can be compared between studies and countries.

Objective: The aim was to study the causes of respiratory hypersensitivity in dental personnel based on the statistics of the Finnish Register of Occupational Diseases (FROD; 1975–1998) and the patient material of the Finnish Institute of Occupational Health (FIOH; 1990–1998). Methods: Details about the cases of respiratory hypersensitivity were compiled from the FROD. The occupational rhinitis diagnoses studied at the FIOH were based on work-related symptoms and a change in the status of the nasal mucosa during challenge testing; and the diagnosis of occupational asthma based on reactions in challenge testing, or on IgE positivity and peak flow monitoring at work and during days off. Results: A total of 64 cases of occupational respiratory diseases (ORDs) was diagnosed in dental personnel during 1975 to1998 according to the FROD; two cases in 1975 to 1989, and 62 in 1990 to 1998. Twenty-eight cases were of occupational asthma (18 caused by methacrylates), 28 occupational rhinitis (six caused by methacrylates), seven allergic alveolitis and one organic dust toxic syndrome (ODTS). The non-acrylate-material diagnosed in 1990–1998 at the FIOH comprised three cases of asthma and one of rhinitis caused by chloramine-T (sodium-N-chlorine-p-toluene sulphonamide); as well as one case of asthma, seven cases of rhinitis, and two cases of combined rhinitis and conjunctivitis caused by natural rubber latex (NRL). Furthermore, one case of occupational rhinitis caused by Nobetec containing colophony was diagnosed. The incidence rate (IR) of ORD increased from 0 in 1988 to a peak of 105.1 new cases per100,000 working years in 1995. During the last observation year, i.e. 1998, the IR was 55 new cases per 100,000 workers. The IR in dental personnel was lower than in the whole working population in Finland up until 1992, but since then has been greater than in the whole population, peaking in 1995 when the IR of dental personnel was 2.55 times greater than in the whole population. Conclusion: The present study shows the increasing frequency of respiratory hypersensitivity among dental personnel. Besides methacrylates, important causes of respiratory hypersensitivity are NRL and chloramine-T.

Unsaturated polyester (UP) cement caused allergic contact dermatitis in car repair work. The resin was a condensate of polyols and maleic anhydride with reactive solvent, auxiliary substances, and inorganic reinforcement substances. To identify the causative chemicals, the cement was tested on a sensitized patient. For analysis, samples of the resin were eluted with acetone and eluted with hexane to precipitate inorganic material and large polyester molecules. The eluate was evaporated. The remainder, dissolved in acetone, was separated into fractions on silica plates by thin layer chromatography (TLC). On the developed (hexane/chloroform, 15/85) plates, 20 bands were obtained under UV-light at 254 nm. Samples of the bands were scraped and used for patch testing. The scraping at a retention factor (R f ) of 0.24 caused a skin reaction. The bands at this retention were removed from six plates, combined, eluted with acetone and purified again by TLC. The purified fraction mixed in petrolatum in the dilution series was used for conclusive patch testing on the patient. An allergic reaction was induced at down to 0.003% wt/wt. According to MS and IR analyses, the isolated compound was diethyleneglycol maleate (DEGM, MW204). In addition to the resin part, the sanding dust also contained this monomer.

Background: Occupational contact urticaria (CU) from plants is often reported, but it is less often attributed to decorative houseplants. We present an atopic gardener and caretaker of plants who developed CU when occupationall_y exposed to weeping fig, spathe flower, and yucca. Methods: Sensitization was evaluated by skin prick tests (SPT) and analyses for IgE antibodies. Results: SPT were positive to all_ three plants, and IgE antibodies were found to weeping fig and spathe flower. SPT were also performed with several decorative houseplants in more than 600 patients. Positive SPT was found to weeping fig (12%), African milk tree (8.3%), yucca (5.8%), Chinese rose (4.7%), massangana (4.6%), bird's nest fern (3.2%), and spathe flower (3.2%). Conclusions: Our study indicates that SPT and tests for IgE antibody are useful in detecting occupational CU caused by houseplants.

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.

Exposure to wood dusts may cause various skin and mucosal symptoms. Allergic dermatoses, caused by wood dusts, diagnosed at the Finnish Institute of Occupational Health during 1976-1999 are reported here. 16 had allergic contact dermatitis and, 2 had contact urticaria. 9 men (3 cabinet makers, 3 joiners, 1 carpenter, 1 knifemaker and 1 machinist) were mainly exposed to tropical hardwoods. 1 man had dermatitis caused by western red cedar. 5 patients, 3 men and 2 women, were exposed to Finnish pine or spruce dusts, and 1 man to aspen. 7 also had rhinitis, 4 asthma or dyspnoea and 3 conjunctivitis. On patch testing, 10 men reacted to 9 different wood dusts, including teak (5), palisander (3), jacaranda (2), mahogany (2), walnut (2) and obeche (1). Reactions to wood allergens, including lapachol (2), deoxylapachol (1), (R)-3,4-dimethoxydahlbergione (2), 2,6-dimethoxy-1,4-benzoquinone (1), mansonone A (2) and salicyl alcohol (1), were noted in 4 cases. All but 1 of 5 patients exposed to pine or spruce dusts reacted to the sawdusts, all 5 to colophonium, 3 to abietic acid, 2 to tall oil resin, 3 to wood tar mix and 4 to other wood gum resins. Of the 2 CU patients, 1 was prick and RAST positive to obeche, 1 reacted with urticarial dermatitis to punah wood dust on chamber exposure. Occupational allergic dermatoses are mainly caused by the dusts of hardwoods, mostly due to Type IV allergy, but may also be caused by softwood dusts. Patch tests can be done with wood dusts, but should be confirmed by patch testing with wood allergens if possible.

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.

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.

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: 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.

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 mg/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.

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.

Patch testing is the predominant method of establishing contact allergy. The present patch test technique is the result of a continuous process of development and improvement since its first application in the late 19th century. The perfect patch test should give no false-positive and no false-negative reactions. The ideal patch test should also cause as few adverse reactions as possible, particularly no patch test sensitization. Even though the history and examination of a patient with suspected allergic contact dermatitis will give clues to possible sensitizers, it is not sufficient to patch test only with initially suspected sensitizers; unsuspected sensitizers used for patch testing frequently turn out to be the real cause of the dermatitis. Fortunately, a small number of substances are considered to account for the majority of delayed hypersensitivity reactions. Therefore, generally 20-25 test preparations consisting of chemically defined compounds, mixes of allergens, and natural and synthetic compounds, are grouped into a standard test series. The requirements to be fulfilled by a sensitizer in a standard patch test series are discussed in this article. A procedure of investigations is proposed before a sensitizer is included in a standard series.

Occupational dermatoses caused by plastic composites based on polyester resins, epoxy resins and vinyl ester resins (epoxy diacrylates) were reviewed. Common causes of irritant contact dermatitis are glass-fibre reinforcement and dust from product-finishing processes. Irritant contact dermatoses are also caused by resins, styrene, acetone, benzoyl peroxide, etc. Diglycidyl ether of bisphenol A (DGEBA) epoxy resin, amine hardeners, dicarboxylic (phthalic) anhydride hardeners and reactive epoxy diluents are common causes of allergic contact dermatitis. Non-DGEBA epoxy resins, tetraglycidyl-4,4′-methylenedianiline (TGMDA) and triglycidyl-p-aminophenol (TGPAP) used in carbon fibre reinforced composites may cause sensitization from prepregs. Diethylene glycol maleate is a new allergen in polyester resin cement. Natural rubber latex in protective gloves, and low molecular weight chemicals such as the epoxy resin hardener methyl tetrahydrophthalic anhydride (MTHPA) are causes of immunologic contact urticaria. Patch-testing with materials used by the patients at work, together with chemical analysis, is often needed to find the causative allergen, in addition to patch testing with standard test trays. Avoidance of skin contact with resin compounds, use of protective gloves, local ventilation, proper working methods, and informing the workers, are needed to lower the prevalence of occupational dermatoses in the manufacture of plastic composites. Copyright © 1999 John Wiley & Sons, Ltd.

Background Allergic contact dermatitis caused by acrylate compounds is common in dental personnel; they also often complain of work-related respiratory or conjunctival symptoms. Objective The aim of the present study was to report the cases of acrylates induced respiratory hypersensitivity in dental personnel diagnosed in Finland during the last 6 years. Methods Occupational asthma, rhinitis, laryngitis and pharyngitis cases were diagnosed according to patient history, PEF monitoring, and a work-simulating provocation test. Results Twelve cases of respiratory hypersensitivity caused by acrylates diagnosed in dental personnel (six dentists and six dental nurses) in 1992–97 are reported. During this period one case of conjunctivitis and one of laryngitis have been published separately. Nine cases of occupational asthma, two rhinitis cases, and one laryngitis case were verified according to the challenge tests with dental acrylate compounds (acrylates, methacrylates and epoxy acrylates). Only three patients had positive skin-prick test reactions to common environmental allergens, and none reacted to acrylates in the skin-prick tests. Five patients had an elevated total IgE (>110 kU/L). PEF follow-up showed an occupational effect in all examined eight patients with diagnosed asthma. The mean duration of exposure to acrylates was 22 years, and the duration of respiratory symptoms 8 years. Conclusions The results indicate that acrylates constitute an important hazard for dental workers. The mechanism of respiratory hypersensitivity is still unknown, and it is probably not IgE-mediated.

Objectives The occurrence and causes of hairdressers' occupational skin and respiratory diseases were studied. Methods Of a random sample of 500 female hairdressers aged 15-54 years, 355 were available for study. Of the 189 reporting work-related skin and respiratory symptoms in a computer-aided telephone interview on exposure and health, 130 underwent a physical examination, lung function tests, prick and patch testing, and nasal and lung provocation tests. An occupational disease was diagnosed when the causality between exposure and disease was probable and the clinical tests supported the diagnosis. Results The telephone interview revealed a life-time prevalence of 16.9% for hand dermatoses, 16.9% for allergic rhinitis, and 4.5% for asthma among the hairdressers. In the clinical investigations, the prevalence was 2.8% for occupational dermatoses, 1.7% for occupational rhinitis, and 0.8% for occupational asthma. Ammonium persulfate caused 90% of the respiratory diseases and 27% of the hand dermatoses. Paraphenylenediamine, natural rubber latex, and skin irritation were also causes of hand dermatitis. Allergy to human dandruff (8.6%) and Pityrosporum ovale (12.1%) was common. Previously diagnosed atopic diseases increased the risk for occupational skin or respiratory disease 3-fold (odds ratio 2.9, 95% confidence interval 1.1-7.9). Of the cases, 37.5% (6 of 16 persons) had to change occupations during a 3-year follow-up. Conclusion Work-related skin and respiratory symptoms are common among hairdressers. Often a specific cause (eg, ammonium persulfate) can be found if occupational diseases are suspected and diagnosed. Hairdressers with atopic diseases are at risk of developing occupational skin and respiratory diseases.

Para-tertiary-butylcatechol (PTBC) is a rare allergen which is used in the rubber, paint and petroleum industries. We present 9 patients who were sensitized to PTBC and examined at the Finnish Institute of Occupational Health (FIOH) between 1974 and 1995. 3 of the patients had been exposed to PTBC in their work. 2 of them also had allergic reactions to para-tertiary-butylphenol (PTBP)-formaldehyde resin and to PTBP. 5 of the patients became sensitized to PTBC from patch testing. PTBC was found to be one of the most common causes of active sensitization in our clinic. Accordingly, at the FIOH, the patch test concentration of PTBC was lowered to 0.25% and this lower concentration is recommended for general use.

Background : Allergic contact dermatitis from local amide anesthetics such as lidocaine (Xylocaine), bupivacaine (Marcaine, Bicain), mepivacaine (Carbocaine), etidocaine (Duranest), and prilocaine (Citanest) is rare. Allergic contact dermatitis from prilocaine has been reported only from EMLA cream. Objectives : We report on a patient sensitized from prilocaine used as a local infiltration anesthetic. Methods : Conventional patch testing with various local amide anesthetics as well as intracutaneous tests with amide anesthetics were performed. Results : Patch testing with EMLA cream (as is) (Astra, Sweden), containing prilocaine and lidocaine provoked an allergic patch test reaction, whereas patch testing with lidocaine was negative. Patch testing with Citanest containing 2% prilocaine and adrenaline was positive. Also articaine gave an allergic patch test reaction, whereas mepivacaine, benzocaine, and caine-mix were negative. Intracutaneous tests with prilocaine and articaine were positive. Conclusion : Our patient had been sensitized from prilocaine and cross-reacted to articaine, but not to other amide anesthetics. Cross-reactions between prilocaine and amide anesthetics were reviewed. As there seem to be no clear rules regarding cross-reactivity among various amide anesthetics, it is safest to test as many amide type anesthetics as possible in case of a delayed type allergy to any member of this family.

2,3-epoxypropyl trimethyl ammonium chloride (EPTMAC) is used in the production of cationic starch (CS) for the paper industry. It has been shown to be a sensitizer in guinea pigs, but cases of human sensitization are few. 4 workers were previously sensitized to the substance in a Finnish plant. This report describes 3 process men from another plant examined because of recurring dermatitis. 18 workers were involved in production, and had free access to all work sites. 3 process men, whose work involved drying the CS, had dermatitis, although they had only occasional contact with the cationizing chemical. 2 were already verified to be allergic to EPTMAC and had had variable dermatitis for 8-12 years. One had had dermatitis on his face for 1 year. Patch testing with a dilution series (1%, 0.5%, 0.2%, 0.1% pet.) confirmed their allergy to the cationizing chemical containing EPTMAC, but tests with CS were negative. In addition, 2 had contact allergy to Cl+ Me-isothiazolinone from contact with Kathon LX used as a slimicide in the process. In long-standing (years) recurrent dermatitis, re-examination of patients with verified exposure history and skin test is necessary. In line with our previous study, sampling the process materials, maintenance work and contamination of work sites and gloves caused sensitization. The results also confirm that EPTMAC is a strong human contact sensitizer. 0.2%-0.5% pure EPTMAC in pet. seems to be the optimal patch test concentration.

A worksite survey was conducted in all 38 Finnish electroplating plants. All workers (n = 163) who worked with nickel plating (bath workers, hangers and solution makers) were interviewed with a questionnaire about symptoms of nickel dermatitis, hand dermatitis, and about protective measures, atopy, etc. Patch testing with nickel sulfate was done with the TRUE TestTM method. All the workers, 94 men and 69 women, answered the questionnaire. The mean age of women was 41.1 years, and of men 43.1 years, respectively. Men had longer occupational exposure to nickel (14 years) than women (10 years). Most workers used protective gloves. 35% of women and 30% of men reported present or past hand dermatosis. 19% reported a history of atopic dermatitis. 15% of women (n = 8) and 4% (n = 2) of men had an allergic patch test reaction to nickel sulfate. 70% of those with an allergic patch test reaction to nickel reported past or present hand eczema. The prevalence of nickel allergy among the electroplaters was similar to that of patients in patch test clinics in Finland. An allergic patch test reaction to nickel sulfate does not necessarily oblige an electroplater to change jobs.

Background: To make a correct diagnosis of allergic contact dermatitis, patch testing needs to be performed, and the patch test substances need to be pure. Objective: We wanted to study how pure commercial (meth)acrylic patch test substances are. Methods: The purity of (meth)acrylic patch test substances (diacrylates, dimethacrylates, and triacrylates) dissolved in acetone was determined by gas chromatography. The impurities were identified by mass spectrometry in both electron impact and chemical ionization mode. Results: The analyzed dimethacrylates were very pure (97% to 99%). The purity of the three studied diacrylates were 81% to 91%, but tripropyleneglycol diacrylate (81% pure) contained as much as 13% of tripropyleneglycol monoacrylate. The purities of the triacrylates were 82% to 86%. All diacrylates and triacrylates contained 1% to 13% of the corresponding hydroxyacrylates. Conclusion: The impurities may result in false interpretation of the patch test results, and accordingly in wrong diagnosis. If the patch test substance is impure, at least, the chemical impurities that can be detected by gas chromatography should be measured and reported in a certificate of analysis, preferably from each batch.

Background. Epoxy resin compounds (ERG) include a large number of sensitizing chemicals such as epoxy resins (ER), hardeners (curing agents), and reactive diluents. Allergic contact dermatitis (ACD) caused by ERCS is often occupational. Materials and Methods. We report a patient, sensitized to a hardener of a two-component epoxy paint. Three conventional patch test sessions were performed to diagnose the causative chemical. We also review the literature on sensitizing epoxy-resin hardeners. Results. A 47-year-old nonatopic woman developed dermatitis from a two-component epoxy paint. Patch testing with epoxy resin was negative, but 2,4,6–tris(dimethylaminomethyl)phenol (tris-DMP), used in the paint hardener, induced an allergic patch test reaction. We also review briefly other epoxy hardeners that have caused allergic dermatitis, including: (1) aliphatic polyamines, e.g., ethylenediamine, diethylenetriamine, triethylenetetramine, 3-dimethylaminopropylamine, and trimethylhexamethylenediamine; (2) cycloaliphatic polyamines, e.g., isophoronediamine and 3,3′-dimethyl-4,4-diaminodicyclohexylmethane; (3) aromatic amines, such as 4,4′-diaminodiphenylmethane, m-phenylene diamine, and 1,3-xylylene diamine; (4) dicyanodiamide; (5) triglycidyl isocyanurate, an epoxy compound that may be used as an epoxy-resin hardener; and (6) additives in epoxy accelerators, such as hexavalent chromate. Conclusions. No one chemical can be used to screen for sensitization to the many different epoxy hardeners. Extensive patch testing may be required to reveal the hardener that has caused the allergy. The hardener, 2,4,6-tris-dimethylaminomethyDphenol (tris-DMP), is a new sensitizer. To verify ACD caused by tris-DMP, patch-testing at 1% in petrolatum is suggested.

Data on occupational contact urticaria (protein contact dermatitis included) in Finland during 1990-1994 were analyzed. Altogether 815 cases were reported to the Finnish Register of Occupational Diseases during this period, compared with 1944 cases of occupational allergic contact dermatitis. Accordingly, the total number of occupational allergic contact dermatoses was 2759, 29.5% being contact urticaria and 70.5% being allergic contact dermatitis. Occupational contact urticaria was much more common in women (70%) than in men (30%). The 6 most common causes of contact urticaria were (1) cow dander (362 cases = 44.4%), (2) natural rubber latex (193 cases = 23.7%), (3) flour, grains and feed (92 cases = 11.3%), (4) handling of foodstuffs (25 cases = 3.1%), (5) industrial enzymes (14 cases = 1.7%) and (6) decorative plants (13 cases = 1.6%). The occupations with the highest numbers of occupational contact urticaria were farmers (341 cases), domestic animal attendants (61), bakers (53), nurses (42), chefs (40) and dental assistants (28). The ranking list of the most common occupations with occupational contact urticaria per 100,000 employed workers was as follows: (1) bakers (140.5 cases per 100,000 employed persons), (2) preparers of processed food, (3) dental assistants, (4) veterinary surgeons, (5) domestic animal attendants, (6) farmers and silviculturalists, (7) chefs, cooks and cold buffet managers, (8) dairy workers, (9) horticultural supervisors, (10) laboratory technicians and radiographers, (11) physicians, (12) butchers and sausage makers, (13) laboratory assistants, (14) dentists and (15) nurses (21.2 cases per 100,000 employed person). Low-molecular-weight chemicals caused very few cases of occupational contact urticaria, the most common being 2-ethylhexyl acrylate (5 cases). To summarize, occupational contact urticaria forms a large group of occupational contact dermatoses, and dermatologists need to be able to diagnose IgE-mediated immediate skin allergic diseases.

About 1000 patients were investigated at our clinic during 1991-1995 for occupational skin disease, and 5 had occupational allergic contact dermatitis from spices. The patients were chefs, or kitchen, coffee room, and restaurant workers. All patients had hand (or finger) dermatitis. The causative spices were: garlic, cinnamon, ginger, allspice and clove. The same patients also had allergic patch test reactions to foods: tomato, lettuce and carrot. Paprika elicited a weak allergic patch test reaction in 2 patients. Occupational allergic contact dermatitis from spices is relatively rare, but needs to be taken into consideration in patients who have hand dermatitis, and work with spices and foods. Patch testing with spices as is is useful, but testing with dilutions in pet, may be needed to confirm that the patch test reactions are allergic. Patients also need to be prick tested with spices and foods.

Background: Mono(meth)acrylates (monoacrylates and monomethacrylates) are moderate to strong sensitizers. They are used in the production of a great variety of polymers, including nail cosmetics. Objective: A patient who became occupationally sensitized to photobonded sculptured nails is reported. Detailed patch testing and analyses of the patient's nail cosmetics containing mono(meth)acrylates clarified the cause of her hand and face dermatitis. The current knowledge on mono(meth)acrylates in nail cosmetics is also reviewed. Methods: Patch testings with conventional methods, including patch testing with the patient's own substances, were performed. The patient's nail cosmetics suspected of containing mono(meth)acrylates were analyzed with gas chromatography/mass spectrometry analysis. Results: In the (meth)acrylate series, 15 of the 31 (meth)acrylate compounds tested gave an allergic reaction: 2 acrylates, 5 methacrylates, 3 dimethacrylates, and 5 diacrylates. Epoxy diacrylates, cyanoacrylate, triacrylates, and methacrylic acid were negative. Three of seven of her own nail cosmetic preparations contained mono(meth)acrylates as revealed by the gas chromatography/mass spectrometry analysis, and these also gave allergic patch test reactions, namely, the nail liquid, nail hardener, and UV-cured nail gel. Conclusion: The patient probably had been sensitized to the following (meth)acrylate compounds from her nail cosmetics: tripropylene glycol diacrylate and methyl acrylate from her photobonded nail gel; ethyl methacrylate, triethylene glycol dimethacrylate, and methyl methacrylate from her nail liquid; and butyl methacrylate from her nail hardener. She was probably also sensitized to the rare sensitizer aliphatic urethane diacrylate, but the source was not verified. Because nail cosmetics containing mono(meth)acrylates are strong sensitizers, both the workers and the customers should be aware of their sensitizing capacity; they should use no-touch techniques regarding the skin before the mono(meth)acrylates are polymerized.

Of 22 workers in a ski factory, occupational allergic contact dermatitis was found in 8. 6 were sensitive to epoxy resin compounds, i.e., epoxy resins, hardeners or diluents, 1 to cobalt in glass-fiber reinforcements, and 1 to formaldehyde in a urea-formaldehyde glue and a lacquer. 4 workers had irritant contact dermatitis from epoxy resin compounds, lacquers, sanding dust, or glass-fiber dust. 3 had contact allergy from a new sensitizer, diethyleneglycol diglycidyl ether, in a reactive diluent. Immediate transfer of workers sensitized to epoxy resin from epoxy exposure prevents aggravation of their dermatitis and broadening of the sensitization to epoxy hardeners, diluents and other compounds.

Mono(meth)acrylates (monoacrylates and monomethacrylates) are moderate to strong sensitizers. They are used in the production of a great variety of polymers, including nail cosmetics.A patient who became occupationally sensitized to photobonded sculptured nails is reported. Detailed patch testing and analyses of the patient's nail cosmetics containing mono(meth)acrylates clarified the cause of her hand and face dermatitis. The current knowledge on mono(meth)acrylates in nail cosmetics is also reviewed.Patch testings with conventional methods, including patch testing with the patient's own substances, were performed. The patient's nail cosmetics suspected of containing mono(meth)acrylates were analyzed with gas chromatography/mass spectrometry analysis.In the (meth)acrylate series, 15 of the 31 (meth)acrylate compounds tested gave an allergic reaction: 2 acrylates, 5 methacrylates, 3 dimethacrylates, and 5 diacrylates. Epoxy diacrylates, cyanoacrylate, triacrylates, and methacrylic acid were negative. Three of seven of her own nail cosmetic preparations contained mono(meth)acrylates as revealed by the gas chromatography/mass spectrometry analysis, and these also gave allergic patch test reactions, namely, the nail liquid, nail hardener, and UV-cured nail gel.The patient probably had been sensitized to the following (meth)acrylate compounds from her nail cosmetics: tripropylene glycol diacrylate and methyl acrylate from her photobonded nail gel; ethyl methacrylate, triethylene glycol dimethacrylate, and methyl methacrylate from her nail liquid; and butyl methacrylate from her nail hardener. She was probably also sensitized to the rare sensitizer aliphatic urethane diacrylate, but the source was not verified. Because nail cosmetics containing mono(meth)acrylates are strong sensitizers, both the workers and the customers should be aware of their sensitizing capacity; they should use no-touch techniques regarding the skin before the mono(meth)acrylates are polymerized.

12 cases of occupational allergic contact dermatitis caused by decorative plants were diagnosed in a 14-year period. The patients were middle-aged, and their average exposure time was 13 years. The plant families and plants causing occupational contact dermatitis were Compositae (5 patients: chrysanthemum, elecampane, gerbera, feverfew), Alstroemeriaceae (5 patients, Alstroemeria), Liliaceae (4 patients; tulip, hyacinth). Amaryllidaceae (2 patients: narcissus) and Caryophyllaceae (2 patients; carnation, cauzeflower). The known chemical allergens causing dermatitis were tuliposide-A and sesquiterepene lactones, such as alantolactones and parthenolide, in the Liliaceae and Compositae families. 7 of the 12 patients were able to continue their work; 5 were not because of severe relapses of skin symptoms. The plant allergen and extract series currently available are of great help in the diagnosis.

Rubber chemicals are among the most common occupational contact sensitizers. The most common rubber sensitizers are thiurams, thiazoles, carbamates and paraphenylenediamine derivatives. Here we present data on a less-well-known rubber chemical, N-(cyclohexylthio)phthalimide (CTP; CAS 17796-82-6). This chemical is currently the most widely used vulcanization retarder, but data on allergic contact dermatitis caused by CTP are lacking. We conducted a survey of 310 patients who had been patch tested with 30 rubber chemicals including CTP. 11 (3.5%) showed an allergic patch test reaction provoked by CTP, and 9.0% by thiurams. 4 of the patients reacted only to CTP and not to other rubber chemicals, whereas the other 7 concomitantly reacted to other rubber chemicals. After analyzing the patch test data of these 11 patients, it was concluded that CTP probably did not cross-react with the other rubber chemicals. Therefore the patch test results may indicate independent sensitization to CTP and other rubber chemicals. Because very little data on the components of rubber chemicals in rubber products are available, the source of the putative sensitization to the rubber vulcanization retarder CTP is unknown.

Polyfunctional aziridine (PFA) is increasingly used as a water-based cross-linker in 2-component paints, paint primers, lacquers, topcoats and other protective coatings. The cross-linker (PFA hardener) is made by reacting multifunctional acrylic monomer with a highly reactive aziridine compound. During 1992-1993, we came across 2 patients with allergic patch test reactions provoked by PFA hardener. One of the patients was a parquet layer, and the other a printer. Allergic contact dermatitis (ACD) was diagnosed by positive allergic patch test reactions to PFA hardener in a dilution series in pet.:0.3%-1% gave ++ to allergic reactions in both patients, whereas 0.1% gave a weak (+) or questionable reaction (?+), respectively. The methacrylate patch test series was negative in both patients, although gas chromatography/mass spectrometry analysis showed that PFA hardener contained 0.3% of trimethylolpropane triacrylate (TMPTA), a multifunctional acrylic monomer. One of the patients also had symptoms of contact urticaria, and a prick test with PFA hardener (1% aq.) induced a histamine-sized prick test reaction. The positive reactions with the PFA hardener and the negative reactions with the starting chemicals and additives in PFA, namely acrylates, propyleneimine and dimethylethanolamine, indicate that PFA caused ACD. This is in accordance with our previous observations, but differs from the reports of others, whose patients had been sensitized to acrylates present as remnants in the PFA hardener. As test substance, 0.5% PFA hardener in pet. is recommended for patch testing. Testing should be performed in patients with contact dermatitis if exposure to PFA has occurred. Skin prick tests may be of help to detect contact urticaria.

The present study summarizes information on toothpaste composition as supplied by the manufacturers. The survey covered 48 items, virtually all toothpastes offered for sale in Finland. It was concluded that the toothpastes are not entirely safe to use, because almost 50% of the products studied contained a total of some 30 compounds widely recognized as allergens. According to the literature, the most common allergens in toothpastes are flavours (e.g., cinnamic aldehyde, cinnamon oil and peppermint) and preservatives. Symptoms include stomatitis, cheilitis, glossitis, gingivitis, perioral dermatitis and immediate hypersensitivity.

Acid anhydrides are low-molecular-weight chemicals known to cause respiratory irritancy and allergy. Skin allergy has on rare occasions been reported. 2 workers contracted hives and itching on uncovered skin after 2 months exposure to methyltetrahydrophthalic anhydride (MTHPA) and methylhexahydrophthalic anhydride (MHHPA), to which they had airborne exposure. Later, the patients also developed conjunctivitis, rhinitis, sore throat, cough or asthma. In addition to MTHPA, 1 worker was also exposed to unsaturated polyester resin (UP). Both patients' immediate allergy to MTHPA and MHHPA was verified by positive prick tests to MTHPA and MHHPA, conjugated with human serum albumin (HSA), and positive radioallergosorbent tests (RASTs) to these anhydrides. On prick testing, both patients also reacted to a phthalic anhydride (PA)-HSA-conjugate and 1 of the patients to UP-HSA-conjugate. Specific immediate allergy to UP was shown by RAST. RAST inhibition with MTHPA, MHHPA and UP-resin conjugates confirmed IgE-mediated allergy and cross-reactivity between anhydrides. Our patients had developed airborne contact urticaria caused by phthalic anhydrides, in addition to respiratory allergy. Phthalic anhydride contained in the UP resin was possibly responsible for the immediate reaction of the skin.

Background: Most dental prostheses are currently made of acrylate compounds. Therefore, patients sensitized to acrylate compounds may have difficulties in finding prostheses. Objective: A patient with allergic prosthesisinduced stomatitis who was able to use the prosthesis after her allergenic acrylate-based dental prosthesis had been coated with a UV light—cured acrylate lacquer is reported. Methods: The patient was patch tested with the standard series, the dental screening series, the (meth)acrylate series, the plastics and glues series, and commercial prosthesis materials. Patch testing was performed with a 48-hour occlusion time and readings after 2 days and 3 or 4 days. Results: On patch testing, the patient had allergic patch test reactions to methyl methacrylate (MMA), 2-hydroxyethyl methacrylate, 1, 4-butanedioldiacrylate, and ethylene glycol dimethacrylate. Her prosthesis was then coated using a UV light—cured acrylate lacquer containing MMA, and she could wear the prosthesis without adverse side effects. Conclusions: Evidently, the surface of the UV light—cured, acrylate-based prosthesis polymerized so completely that residual MMA caused no clinical symptoms. UV light—cured coating of allergenic acrylate prostheses is recommended for patients with allergic problems from acrylate compounds.

It is known from experimental studies that antigenic potency and the concentration of antigen determine whether exposure to an antigen will result in sensitization. A single accidental exposure to concentrated antigen may therefore induce primary sensitization. The purpose of this report was to collect clinical cases in which a single exposure had resulted in contact dermatitis suspected to be allergic. Only patients without previous relevant skin symptoms were included. Patch testing was used to demonstrate sensitization. 6 patients developed occupational allergic contact dermatitis from accidental exposure. Patch testing revealed allergy to diglycidylether of bisphenol A epoxy resin, polyfunctional aziridine hardener, methyl acrylate, phenol-formaldehyde resin, and methylchloroisothiazolinone/methylisothiazolinone (Kathon LX), respectively. Furthermore, 2 patients developed allergic contact dermatitis from their first exposure to tear gas chemicals, namely omega-chloroacetophenone and ortho-chlorobenzylidene malonitrile. A single exposure can therefore induce both sensitization and subsequent allergic contact dermatitis without further exposure. The allergens described must be considered strong allergens. The skin should immediately be cleaned if an accidental splash with such an allergen has taken place. Language: en