Allergy at working places

Transcription

Allergy at working places
Rosemarie Braun
Skin Dep.
University Hospital Northern Norway
Rosemarie Braun, Skindep., Unn 2010
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Outline
Allergy - background / definitions
Allergic diseases/symptoms/evaluation/tests
Current allergies derived from occupation
Handle allergy:
Prevention
Initiatives when allergy occurs
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Immune System

normaly: immune system protects against
microorganisms

Cells and molecules from the immune system are
important weapons in defence against disease and
injuries.
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Allergy - Definition
Immune system reacts on ”wrong” (harmless) substances
(Allergens)
Once developed - after sensibilisation - allergy is usually
life-long
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Eczema= inflammation reaction in the
skin
Allergy related eczema:

Allergic contact dermatitis: caused by type IV
allergic reaction

Atopic eczema: can have relation to type I allergy
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Atopic eczema
”childhood eczema”
often first appearance in childhood
Failure in the defence system of the skin,
physically, chemically and immunologically,
genetic disposisjon
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Atopy

tendency to hypersensitivity of skin and mucosa of
eyes and airways

tendency to produce antibodies against allergens
(type I allergy)
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Skin cells
T-lymphocytes
Langerhans` cells
Other antigen-presenting cells
Keratinocytes (immunregulating)
High endothelian cells
Mastcells (IgE –receptor)
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Allergy - cause
Important predisposing factors

Inheritance (atopi, type I allergy)

Environment
contact with irritants and allergens
early contact with allergens protects against type I
allergy?
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Types of Allergy
Type I
IgE + mastcells or basophils
Type II
Antibody and Antigen on cell surface
Type III
Immun complex Antigen-Antibody activates
complement
TYPE IV
sensitized T - lymphocytes + macrophages
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Distribution
Scandinavia
30-40% gets an allergic disease/allergic symptoms?
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Is Allergy increasing ???
In case....what could be the cause?

Air pollution?

Smoking habits?

Diet?

Infection pattern?

Vaccination?

Contact with new and ”strange” substances?

More registration?
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Type I Allergic reactions
Rhino-conjunctivitis (Mucus conjunctiva and upper airways)
Hay-fever, Clear flux from nose and eyes, itch, red eyes, tight nose, sneeze
Urticaria, localized or generalized
Astma bronchialis (Mucus lower airways)
Tight lower airways, cough, wheezing, breezing difficulties
Anaphylactic reaction
Ev. eczema
These symptoms er not necessarily caused by an allergic reaction, can
be hypersensitivity
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Type I Allergic reactions
forts.
Atopic eczema?
Other ekczema-type reactions ?
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Rhinoconjunctivitis Symptoms
Tight nose
Water thin clear flux from the nose
Sneeze
Itching from both eyes and nose
Injection in conjunctiva (red eyes)
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Allergic Urticaria
rare, most urticaria is idiopatic
Itching rash, swelling
localized

face
eyelid
tounge
Generalized Urticaria (nettle rash)
After sensibilisation quick reaction on allergen contact, lesions come
and go, disappears during few hours
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Akutt urticaria
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Urticaria with varying morphology
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Urticaria with different morphology
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Allergic Asthma
Allergens are inhaled
Inflammation:
swelling
tight airways
production of mucus
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Asthma,contin.
Symptoms
attacs with chest tightness and breathing difficulty
cough
wheezing

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Allergic symptoms from the whole
body
Anaphylaxis
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Anaphylaxis
Acute allergic reaction with one or several life-threatening
characteristics
Common causes
food (peanuts, shellfish)
medicaments (antibiotics)
Bee, wasp bite
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Type IV allergic reaction
Allergic contact dermatitis

Constitute about 25% of all contact dermatitis

Often related to occupation
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Symptoms Type IV all. Reaction:
eczema
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Diagnosis: Contactallergy
Anamnesis, anamnesis, anamnesis !!!
Patchtest positiv AND clinical relevant
Demonstrate that pasient is exposed for material
tested positiv
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Allergic contact dermatitis, contin.
Chemicals used in laboratory work
Common allergens
Metals (nickel, chrome, cobolt)
rubber
various contents in cosmetics (lanolin, parfumes)

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Airborne Contactdermatitis
Not cloth-covered skin hud – face, neck, arms, hands:
Dvs. exposed skin regions incl. shadow locations
Obs. Powders, aerosols
D.D. Photodermatitis: shadow locations not/ little affected
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Id - reaction
Secundary spreeding of eczema to skin
localisations which er not directly in contact with
the allergen.
Sees espesially with :

Medicaments

Metals
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Obs !!!
Fingers/ hands can bring allergens to other
locations !!
especially face
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Endogene factors
Regional anatomy
Earlier/present skin disease/injury

Any process which damages the skin affects the
barriere function:
Skin injury, skin disease (atop.dermatitt)
raises disposition for irritative Contact
dermatitis
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If you suspect allergy
Anamnesis: Symptoms and correlation to work
Clinical examination
Allergy Tests
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Anamnesis allways most important
Skin or Blood Test:
Just supplementary !!!!!!!!!!!!
Provocation test sjeldom necessary
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Blind screening allways
Contraindicated !!!
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Test Procedures
standardised
Read test
Interprete – evaluate relevance
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Test can be good diagnostic help, but
You cannot always trust it !!!!
espesially :
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Test for Type I allergy
Pricktest
Prick-pricktest
Scratchtest
Spesifikk serum-IgE
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Prikktest
Intracutan
test
Positiv prikk/
intracutantest
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PRIST
Measuring total amount serum IgE
Not allways coincident with spesific type I
allergy
Often high in atopic persons
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When testresults come:
Shoot your cat !
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Test for TYPE IV ALLERGY
Test done on target organ
BUT:
Use test only when positiv
anamnesis
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Patch test = Epikutantest
Dermatolog with experience to select relevante
allergens
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Patch test, variant
ROAT
Repeated open application test
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Indication for patchtest
Suspiscion that patient has contact allergy
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Interprete and judje relevance
NOT an EASY task
False positiv
False negativ
Adverse reaction
Relevance to work ????
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False positiv reaction
Excited skin reaction
Active dermatitis
Strong test reaction
Irritative reaction
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Irritative reaction
can imitate allergic reaction:
Anamnesis
Repeat test
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Allergy Testing demands
experience
Easy to å mount test
Difficult to read test
Nearly impossible to evaluate relevans
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Relevant Positiv test
Evidence for exposisjon to antigen (Product declarations)
Can exposisjon explain the clinical picture?
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Allergy tested products
Nearly nonsense ???
Every substans is a potential
allergen
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Allergi – en vanskelig diagnose
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Relevant occupational allergies in laboratorys
Type I Allergies

Laboratory animals

Natural Rubber Latex

Proteins e.g. collagenase, albumin

Medicaments e.g. antibiotics
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Relevant occupational allergies in laboratorys
Type IV Allergies
Chemicals used at working place
don`t forget airborne allergy !!!
don`t forget transport of allergens by
fingers (gloves!) to other skin-lokations
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Laboratory animal allergy: type I allegy
10-30% of exposed people develope allergy
mouse and rat allergen (obs. proteins in the urine)

symptoms
rhinoconjunctivitis
urticaria
asthma
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Plant proteins from natural rubber latex (plant syrup)
Type I allergi
Cross over allergy with many fruits (kiwi, bananas)
gloves, ballons, condoms, rubber band, swimming goggles,
comforter and so on
Occurrence of allergy:
approx. 1 % in general population
up to 30 % among eager glove users
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Hevea brasiliensis
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Symptoms
Whole spectre from rhinoconjunctivitis , asthma,
urticaria to anaphylaxis
Cross over allergy with several fruits, e.g. kiwi and
banana
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Surgeon must change occupation
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Chemicals added when processing
rubber products
Type IV allergy
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Powder on gloves
Powder from gloves binds easily to latex particle.
Leads to increased dispersion.
Powder used in intraabdominal sugery and even
examination through body openings can provoce
adherences
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Intolerances
”idiopatic environmental intolerance”
Unknown causes
Not allergy
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How to handle allergy at an laboratory
Prevention
Initiatives when allergy arises
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Prevention...How?
Avoid any direct contact with allergens - skin and airways
Knowledge about substances one is working with (HMS data
sheet)
Reduce spreading over large areas (ventilation, weigh rooms)
As little as possible maintain in dangerous/straining jobs
Protective equipment
Awareness around use of gloves, especially latex
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If Occupational Allergy is confirmed
Changes at your working place, adapt working procedures if possible:

Avoid/reduce contact with allergens
Change to equipment made of other material
Change procedures
protective equipment
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If Occupational Allergy is confirmed cont.
Change working place if necessary
Yrkesrettet attføring = vocational rehabilitation
Apply for approval as occupational disease
Pensjon if the above solutions do not work
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Approval of occupational disease
The worker bring forward the demands to the welfare
office (Trygdekontoret)
Evaluation by spesialist, often more than one
Takes long time, several months
Offers special rights + eventually compensation
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Educate the patient and the employer
Allergen source
How avoid allergen
Product compensation
Change work is not easy. Demands a good
reason !!!
Pension (uføretrygd) only if you do not find
another solution
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