Allergy at working places

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Allergy at working places
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
Rosemarie Braun, Skindep., Unn 2010
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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
ƒ contact with irritants and allergens
ƒ 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
ƒ rhinoconjunctivitis
ƒ urticaria
ƒ asthma
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Plant proteins from natural rubber latex (plant syrup)
„ Type I allergi
„ Cross over allergy with many fruits (kiwi, bananas)
ƒ gloves, ballons, condoms, rubber band, swimming goggles,
comforter and so on
ƒ Occurrence of allergy:
ƒ approx. 1 % in general population
ƒ 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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