Occupational allergic contact dermatitis diagnosed by a systematic stepwise exposure assessment of allergens in the work environment.
BACKGROUND
Information on the presence of contact allergens and irritants is crucial for the diagnosis of occupational contact dermatitis. Ingredient lists and Material Safety DataSheets (MSDSs) may be incomplete.


OBJECTIVE
To evaluate the workability of a systematic exposure assessment in consecutive patients with suspected occupational contact dermatitis, and to study how it could potentially aid correct diagnostic classification.


METHODS
A tool for systematic stepwise assessment of exposures in the work environment was developed, consisting of six steps spanning medical history and workplace visits. The programme included 228 consecutive patients diagnosed with occupational contact dermatitis; all patients underwent a clinical examination, the stepwise exposure assessment, and extensive patch and prick testing.


RESULTS
Of the participants, 48.2% were classified as having occupational allergic contact dermatitis. The diagnosis was made at the stepwise exposure assessment for 50.0% of patients at Step 1 (medical history) and for 34.5% at Step 2 (ingredient labelling/MSDS). We found 132 different occupational allergens of relevance to the patients' eczema, of these, 78.0% were allergens not included in the European baseline series.


CONCLUSIONS
Systematic stepwise exposure assessment provides information that results in the identification of occupational allergies caused by allergens not included in the European baseline series in a substantial number of patients.
Department of Dermato-Allergology, National Allergy Research Centre, Copenhagen University Hospital Gentofte, Hellerup, 2900, Denmark. ulrik.fischer.friis@regionh.dk
Ulrik F
UF
Friis
Torkil
T
Menné
Mari-Ann
MA
Flyvholm
Jens Peter E
JP
Bonde
Jeanne D
JD
Johansen
D000328:Adult; D000485:Allergens / Q000009:adverse effects*; D017449:Dermatitis, Allergic Contact / Q000175:diagnosis* / Q000209:etiology*; D017453:Dermatitis, Irritant / Q000175:diagnosis / Q000209:etiology; D009783:Dermatitis, Occupational / Q000175:diagnosis* / Q000209:etiology*; D005260:Female; D006801:Humans; D008297:Male; D016273:Occupational Exposure / Q000009:adverse effects*; D010328:Patch Tests; D012882:Skin Tests
D000485:Allergens
allergens; exposure analysis; occupational; occupational allergic contact dermatitis; occupational contact allergy; systematic exposure assessment; systematic stepwise exposure assessment