title: Occupational airborne contact dermatitis from benzodiazepines and other drugs.
abstract: BACKGROUND
  Healthcare workers (or relatives) crushing drug tablets for patients with difficulties in swallowing are at risk of developing sensitization via airborne exposure. Tetrazepam, in particular, is increasingly being described as an important occupational allergen in this regard, although other drugs are also involved.
  
  
  OBJECTIVE
  To identify the allergenic culprits in 4 patients, namely 2 nurses, 1 pharmacy assistant, and 1 spouse, who all regularly crushed tablets of systemic drugs and presented with severe airborne dermatitis.
  
  
  METHODS
  The patients were patch tested with all of the drugs that they handled, as well as with potential cross-sensitizing molecules.
  
  
  RESULTS
  All 4 patients reacted to tetrazepam and other benzodiazepines, some of which they had not previously come into contact with, which favours cross-reactivity rather than concomitant sensitization. These patients also had positive reactions to several other non-structurally related drugs for which, in some cases, there was no history of exposure.
  
  
  CONCLUSIONS
  Subjects having to crush drugs, in either an occupational or a non-occupational context, and who present with dermatitis suspected of being airborne-induced, should be patch tested with all contacted medicaments, as well as with possible cross-reacting molecules. Prevention by the use of crushing devices and protective measures (gloves and masks) when medications are handled should be advised.
authors.affiliation: Contact Allergy Unit, Department of Dermatology, University Hospitals Leuven, Katholieke Universiteit Leuven, Leuven, B-3000, Belgium.
authors.forename: Inge
authors.initials: I
authors.lastname: Swinnen
authors.forename: Katrien
authors.initials: K
authors.lastname: Ghys
authors.forename: Stefan
authors.initials: S
authors.lastname: Kerre
authors.forename: Lieve
authors.initials: L
authors.lastname: Constandt
authors.forename: An
authors.initials: A
authors.lastname: Goossens
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000633:toxicity; D000328:Adult; D000368:Aged; D000485:Allergens / Q000633:toxicity*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000633:toxicity; D001569:Benzodiazepines / Q000633:toxicity*; D017028:Caregivers; D003429:Cross Reactions; D017449:Dermatitis, Allergic Contact / Q000209:etiology*; D009783:Dermatitis, Occupational / Q000209:etiology*; D004339:Drug Compounding / Q000009:adverse effects; D005260:Female; D006801:Humans; D009726:Nurses; D052638:Particulate Matter / Q000633:toxicity*; D010328:Patch Tests; D010596:Pharmacy Technicians; D055815:Young Adult
chemical_list: D000319:Adrenergic beta-Antagonists; D000485:Allergens; D000806:Angiotensin-Converting Enzyme Inhibitors; D052638:Particulate Matter; D001569:Benzodiazepines; C005245:tetrazepam
keywords: ACE inhibitors; airborne; allergic contact dermatitis; benzodiazepines; cross-reactions; drugs; healthcare; occupational; tetrazepam; β-blocking agents