title: Contact allergy and respiratory/mucosal complaints from heroin (diacetylmorphine).
abstract: After the start of heroin (diacetylmorphine)-assisted treatment to a selected group of chronic treatment-resistant heroin-dependent patients in the Netherlands, we reported about work-related eczema and positive patch tests to heroin in some nurses and nasal and respiratory complaints. To investigate the prevalence of heroin contact allergy, we started a questionnaire-based study with follow-up by allergological examinations. Of 120 questionnaires sent, 101 (84%) was returned: 67 from nurses and 34 from other employees. Of 101 workers, 38 (38%) had reported work-related complaints: 33 of 67 (49%) nurses and 5 of 34 (15%) other employees. Patch tests to heroin were performed in 24 nurses and were positive in 8 (33%). All the 8 had eyelid or facial eczema and, in 6, accompanied by mucosal or respiratory complaints. The prevalence of heroin contact allergy in this study was 8% (8/101) among all employees and 12% (8/67) among nurses. Respiratory and mucosal complaints could not be ascribed to a contact allergy, and in these cases, serum was analysed for specific immunoglobulin E to heroin. A type 1 allergy to heroin could not be shown. These complaints are possibly due to the histamine-liberating effect of heroin, to atopic constitution, to a combination of these factors or - less likely - to other non-allergic factors.
authors.affiliation: University Medical Center Groningen, University of Groningen, The Netherlands.
authors.forename: A J
authors.initials: AJ
authors.lastname: Hogen Esch
authors.forename: S
authors.initials: S
authors.lastname: van der Heide
authors.forename: W
authors.initials: W
authors.lastname: van den Brink
authors.forename: J M
authors.initials: JM
authors.lastname: van Ree
authors.forename: D P
authors.initials: DP
authors.lastname: Bruynzeel
authors.forename: P J
authors.initials: PJ
authors.lastname: Coenraads
mesh_terms: D000485:Allergens / Q000009:adverse effects*; D017449:Dermatitis, Allergic Contact / Q000097:blood / Q000453:epidemiology* / Q000209:etiology / Q000473:pathology; D009783:Dermatitis, Occupational / Q000097:blood / Q000453:epidemiology* / Q000209:etiology / Q000473:pathology; D005148:Facial Dermatoses / Q000097:blood / Q000139:chemically induced / Q000453:epidemiology / Q000473:pathology; D006282:Health Personnel; D003932:Heroin / Q000009:adverse effects*; D006801:Humans; D007073:Immunoglobulin E / Q000097:blood; D009426:Netherlands / Q000453:epidemiology; D010328:Patch Tests; D015995:Prevalence; D012140:Respiratory Tract Diseases / Q000097:blood / Q000139:chemically induced / Q000453:epidemiology* / Q000473:pathology; D016320:Substance Abuse Treatment Centers; D011795:Surveys and Questionnaires
chemical_list: D000485:Allergens; D007073:Immunoglobulin E; D003932:Heroin