Current Allergy and Clinical Immunology - March 2008

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Table II. Summary of exposure, clinical findings and patch test reactions for individual casesJob description Occupational exposure Clinical findings Patch testAllergenReaction1. Encapsulating Epoxy resin, thinners, mica Itchy, vesicular rash Epoxy resin (ESS) ?on arms, neck & Potassium dichromate (ESS) ?around eyes Clioquinol (ESS) 2+Fragrance mix (ESS) ?Epoxy resin (W) 1+2. Crane driver Epoxy resin, mica sheets Itchy rash on feet, Epoxy resin (ESS) 2+upper body & arms, Fragrance mix (ESS) 2+hyperpigmented areas Epoxy resin (W) 2+seen3. Process worker Epoxy resin, thinners, mica Itchy rash on dorsum Cobalt Chloride (ESS) 1–2+of hands, arms & neck Epoxy resin (ESS) ?Nickel sulphate (ESS) 1+4. Process worker Epoxy resin, thinners, Itchy rash on neck, ESS Negmica & greaseface & forearms,swelling of eyes & face5. Armature winder Epoxy resins, thinners, Itchy, red rash & dry, ESS Negvarnish, Bostik putty, scaly skin on inner Epoxylite (W) ?IRthermosetting tape forearm Hot potting resin (Part A) (W) ?IR6. Encapsulating Epoxy resin, thinners, mica, Itchy rash on dorsum Epoxy resin (ESS) 1+heavy-duty hand cleaner of hands, forearms, Epoxylite (W) 1+neck & eyelids,swelling of eyes7. Encapsulating Epoxy resin, thinners, Red, swollen eyes & Epoxy resin (ESS) 1+mica & greaseswollen lips, no visiblecontact dermatitis8. Core making Epoxy resins; powder coating, Itchy vesicular rash on Epoxy resin (ESS) ?Heavy-duty hand cleaner palmar & dorsal surfaceof hands, & web spaces9. Coil taping Epoxy resin, thinners, mica Depigmented areas Epoxy resin (ESS) 2+around eyes & neck Nickel sulphate (ESS) 2+(Contact leucoderma)10. Apprentice Epoxy resin, cold glue, Dry, scaly, cracked skin Wool alcohols (ESS) ?pattern maker wood, thinners on hands, starts as Paratertiary phenolitchy, vesicular rash formaldehyde resin (ESS) ?Reactions: Neg = negative; ? = questionable; 1+ = weak; 2+ = strong; 3+ = extreme; IR = irritant.Allergens: ESS = European Standard Series; W = substances from the workplace.Airborne contamination must be controlled through theintroduction of adequate ventilation such as localexhaust ventilation. 13 In addition personal protectiveequipment should include safety glasses, face shield,and full face respirators depending on the extent ofexposure.Appropriate hand and body protection is required. Theglove material should be appropriate for the type ofchemical exposure. Latex gloves give good protectionagainst epoxy resins but only fair protection against thehardeners and solvents encountered. Ethyl vinyl alcohollaminate gloves on the other hand provide excellentprotection if used within the limits of the breakthroughtime. They should be replaced if damaged. 14 Chemicalresistantclothing, including disposable aprons, coveralls,lab coats and sleeves, should also be used. 13SUMMARYEpoxy resins cause dermatitis, both true allergic andirritant, leucoderma and urticaria. Health care workersshould be alert to the problems caused by these chemicalsand should ensure that all possible cases are fullyassessed. It is important that optimum protectivemeasures should be instituted to protect all workersfrom these potentially dangerous substances.Declaration of conflict of interestThe authors declare no conflict of interest.REFERENCES1. Marks J, Elsner P, DeLeo V, eds. Contact & OccupationalDermatology. 3rd ed. Chapter 5 (Standard Allergens). St Louis:Mosby Inc, 2002.2. Rietschel R, Fowler J, eds. Fisher’s Contact Dermatitis. 4th ed.Chapter 29 [Plastic (Synthetic Resin) Dermatitis]. Baltimore:Williams & Wilkins, 1995.3. Bray PG. Epoxy resins. Occup Med 1999; 14: 743-758.4. Gawkrodger DJ. Patch testing in occupational dermatology. OccupEnviron Med 2001; 58: 823-828.5. Chew AL, Maibach HI. Occupational issues of irritant contact dermatitis.Int Arch Occup Environ Health 2003; 76: 339-346.6. Jappe U, Geier J, Hausen BM. Contact vitiligo following a strongpatch test reaction to triglycidyl-p-aminophenol in an aircraft indus-Current Allergy & Clinical Immunology, March 2008 Vol 21, No. 1 41
try worker: case report and review of the literature. ContactDermatitis 2005; 53: 89-92.7. Geier J, Lessmann H, Hillen U, et al. An attempt to improve diagnosticsof contact allergy due to epoxy resin systems. First resultsof the multicentre study EPOX 2002. Contact Dermatitis 2004; 51:263-272.8. Kanerva L, Pelttari M, Jolanki R, Alanko K, Estlander T, Suhonen R.Occupational contact urticaria from diglycidyl ether of bisphenol Aepoxy resin. Allergy 2002; 57: 1205-1207.9. Jolanki R, Kanerva L, Estlander T, Tarvainen K, Keskinen H, Henriks-Eckerman ML. Occupational dermatoses from epoxy resin compounds.Contact Dermatitis 1990; 23: 172-83.10. Jonker MJ, Bruynzeel DP. The outcome of an additional patch-testreading on days 6 or 7. Contact Dermatitis 2000; 42: 330-335.11. Ormond P, Hazelwood E, Bourke B, Lyons JP, Bourke JF. Theimportance of a dedicated patch test clinic. Br J Dermatol 2002;146: 304-307.12. Kanerva L, Jolanki R, Tupasela O, et al. Immediate and delayedallergy from epoxy resins based on diglycidyl ether of bisphenol A.Scand J Work Environ Health 1991; 17: 208-215.13. Epoxy Resin Systems Safe Handling Guide 1997 [cited 2007/05/25]; Available from: http://www.plasticsindustry.org/about/epoxy/epoxy_guide.htm.14. Health and Safety Executive. An Assessment of Skin Sensitisationby the Use of Epoxy Resin in the Construction Industry. ResearchReport 079, 2003. Granta Park, Cambridge [cited 2007/05/25];Available from: http://www.hse.gov.uk/research/rrpdf/rr079.pdfManaging the Allergic PatientJohn H. Krouse, MD, PhD, M. Jennifer Derebery, MD and Stephen J. Chadwick, MD2008, hardcover, 400 pp, 300 illus., 265 x 195 mm, R1 800This new reference provides up-to-date, disease-specific diagnostic and treatmentprotocols in a new, full-colour, heavily illustrated reference. This is the most currentallergy management information at your fingertips – regardless of your medicalspecialty.Key Features Get the most up-to-date guidance from the most trusted experts in the field. Quickly locate key anatomy, tests, and management protocols in the clinicalsetting. Find everything you need in one place with diagnosis and managementincluded in each chapter. Compare common presentations and quickly reference the latest in diagnosisand treatment options with over 300 clinical and diagnostic algorithms, photographs,charts, and tables.Contents1 – Introduction to Allergy. 2 – Principles of Allergy Management. 3 – Management of the Patient withRhinitis. 4 – Management of the Patient with Rhinosinusitis. 5 – Management of the Patient with Asthma.6 – Management of the patient with Ocular Allergy. 7 – Otitis Media: Background and Science. 8 – Managementof the Child with Otitis Media. 9 – Management of the Patient with Inner Ear Allergy. 10 – Managementof the Patient withLaryngitis. 11 – Management of the Patient with Drug Allergy. 12 – Management of thePatient with Occupational Allergy. 13 – Management of the Patient with Atopic Skin Disease. 14 – Managingthe Allergic Child.15 – Management of the Patient with Anaphylaxis.Allergy 3/eStephen T. Holgate and Lawrence M. LichtensteinAugust 2006, hardback, 448 pp, 450 illustrations, Mosby, R1 700This comprehensive, clinically oriented full-colour resource offers you a wealth ofdetailed information on the diagnosis, treatment, and management of allergic diseases—fromasthma to urticaria. Thoroughly updated to reflect today’s knowledge,this edition features all of the latest developments in allergy and immunology. Plus, aconsistent, logical organization puts vital information at your fingertips.Features Features abundant algorithms that provide at-a-glance assistance in identifyingthe allergic conditions. Offers in-depth information in a chapter dedicated entirely to asthma. Valuable treatment protocols assist in prescribing appropriate therapies andeffective management Includes extensive references that point the way to the key works in the literature. Features a new detailed chapter on pediatric allergy, an increasingly common condition. Includes a CD-ROM containing all of the illustrations from the book downloadable into PowerPoint.Orders: Medical Book Seller, PO Box 3784, Tygervalley 7536Tel Jackie: 083 303 8500, fax (021) 975-1970,E-mail: jackie@medbookseller.co.za42 Current Allergy & Clinical Immunology, March 2008 Vol 21, No. 1
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