title: Has European Union legislation to reduce exposure to chromate in cement been effective in reducing the incidence of allergic contact dermatitis attributed to chromate in the UK?
abstract: OBJECTIVE
  Hexavalent chromate (chromate) in cement is a well-recognised cause of allergic contact dermatitis (ACD). Consequently in January 2005, following European Union legislation (EU Directive 2003/53/EC), the use or supply of cement containing >2 ppm of chromate was prohibited in the UK (COSHH 2004). This analysis of work-related ill-health surveillance aims to evaluate the effectiveness of this legislation.
  
  
  METHODS
  Changes in the incidence of work-related ACD cases returned to The Health and Occupation Reporting network by dermatologists were analysed taking in to account attribution to chromate and occupation.
  
  
  RESULTS
  There was a significant decline in the incidence of both ACD attributed to chromate (incidence rate ratio 0.48, 95% CI 0.36 to 0.64) and ACD not-attributed chromate (0.76, 95% CI 0.69 to 0.85) between the time period preceding the EU legislation (2002-2004) and the postlegislation period (2005-2009). However, the decline in ACD attributed to chromate was significantly greater (p=0.006). This decline was further increased in workers potentially exposed to cement (incidence rate ratio 0.37, p=0.001). The majority of the decline in incidence occurred during 2005.
  
  
  CONCLUSIONS
  The timing of this significant decline in the UK incidence of chromate attributed ACD, and the greater decline in workers potentially exposed to cement strongly suggests that the EU Directive2003/53/EC was successful in reducing exposure to chromate in cement in the UK.
authors.affiliation: Centre for Occupational and Environmental Health, Health Sciences Group, School of Community-Based Medicine, Faculty of Medical and Human Sciences, The University of Manchester, Manchester, UK. jill.stocks@manchester.ac.uk
authors.forename: S J
authors.initials: SJ
authors.lastname: Stocks
authors.forename: R
authors.initials: R
authors.lastname: McNamee
authors.forename: S
authors.initials: S
authors.lastname: Turner
authors.forename: M
authors.initials: M
authors.lastname: Carder
authors.forename: R M
authors.initials: RM
authors.lastname: Agius
mesh_terms: D000293:Adolescent; D000328:Adult; D002840:Chromates / Q000009:adverse effects*; D002857:Chromium / Q000009:adverse effects*; D003252:Construction Materials / Q000009:adverse effects*; D017449:Dermatitis, Allergic Contact / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D009783:Dermatitis, Occupational / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D005062:European Union; D005260:Female; D033161:Government Regulation; D006801:Humans; D015994:Incidence; D008297:Male; D019216:Metals, Heavy / Q000009:adverse effects; D016273:Occupational Exposure / Q000009:adverse effects / Q000331:legislation & jurisprudence*; D006113:United Kingdom / Q000453:epidemiology
chemical_list: D002840:Chromates; D019216:Metals, Heavy; D002857:Chromium