Occupational Allergic Contact Dermatitis Diagnosed by a Systematic Stepwise Exposure Assessment of Allergens in the Work Environment
abstract
This abstract is available on the publisher's site.
Access this abstract nowBackground: Information on the presence of contact allergens and irritants is crucial for the diagnosis of occupational contact dermatitis. Ingredient lists and Material Safety DataSheets (MSDSs) may be incomplete.
Objectives: To evaluate the workability of a systematic exposure assessment in consecutive patients with suspected occupational contact dermatitis, and to study how it could potentially aid correct diagnostic classification.
Methods: A tool for systematic stepwise assessment of exposures in the work environment was developed, consisting of six steps spanning medical history and workplace visits. The programme included 228 consecutive patients diagnosed with occupational contact dermatitis; all patients underwent a clinical examination, the stepwise exposure assessment, and extensive patch and prick testing.
Results: Of the participants, 48.2% were classified as having occupational allergic contact dermatitis. The diagnosis was made at the stepwise exposure assessment for 50.0% of patients at Step 1 (medical history) and for 34.5% at Step 2 (ingredient labeling/MSDS). We found 132 different occupational allergens of relevance to the patients' eczema, of these, 78.0% were allergens not included in the European baseline series.
Conclusions: Systematic stepwise exposure assessment provides information that results in the identification of occupational allergies caused by allergens not included in the European baseline series in a substantial number of patients.
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Occupational Allergic Contact Dermatitis Diagnosed by a Systematic Stepwise Exposure Assessment of Allergens in the Work Environment
Contact Derm 2013 Sep 01;69(3)153-163, UF Friis, T Menné, MA Flyvholm, JP Bonde, JD JohansenFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
This article by Friis et al reinforces the fact that an evaluation for any contact dermatitis but, specifically, occupational contact dermatitis necessitates a systematic approach. Patch testing cannot be performed in a vacuum. The physician must query numerous aspects of the patient’s history in order to find the causative agents. This includes a complete exposure assessment of home and work, along with review of ingredients, MSDS forms, and workplace visits on occasion. The systematic approach will enhance the effectiveness of patch testing and lead to a more accurate and complete diagnosis.