title: UK rates of occupational skin disease attributed to rubber accelerators, 1996-2012.
abstract: BACKGROUND
  Natural and synthetic rubbers containing rubber accelerators are well-known causes of allergic contact dermatitis (ACD). Latex contact urticaria (CU) has been widely reported, especially when powdered latex glove use was commonplace. Consequently, interventions to reduce latex exposure by altering glove manufacture were introduced.
  
  
  OBJECTIVE
  This study aimed to analyse trends in UK-reported incidence of occupational skin disease associated with rubber accelerators.
  
  
  METHODS
  We analysed cases reported to EPIDERM (part of The Health and Occupation Research network) of occupational ACD caused by natural and synthetic rubber products, between 1996 and 2012.
  
  
  RESULTS
  For the studied period, a decreasing incidence of ACD associated with rubber products was found, with an average annual change of -1.2% [95% confidence interval (CI) -3.1 to 0.7]. The number of cases of latex CU (n = 580) significantly declined. The number of cases of ACD caused by mercapto mix and mercaptobenzothiazole (n = 177) and thiuram mix (n = 603) also declined. Reports of ACD associated with carba mix and its constituents (n = 219) increased significantly, by an average annual percentage of 10.1% (95%CI: 6.1-14.2). Twenty-six cases of ACD caused by rarer rubber compounds were identified, highlighting skin disease attributable to less widely recognized chemicals.
  
  
  CONCLUSIONS
  These data show a falling reported incidence of occupational ACD attributed to rubber chemicals, but within this a significant rise attributable to the constituents of the carba mix. Clinicians should recognize the changing diversity of chemicals used in rubber manufacturing, and consider including carba mix in their baseline series and testing beyond this in suspect cases to avoid false-negative results.
authors.affiliation: Department of Dermatology, Leeds Teaching Hospitals NHS Trust, Leeds, LS7 4SA, UK.
authors.forename: Katharine L
authors.initials: KL
authors.lastname: Warburton
authors.forename: Rachel
authors.initials: R
authors.lastname: Urwin
authors.forename: Melanie
authors.initials: M
authors.lastname: Carder
authors.forename: Susan
authors.initials: S
authors.lastname: Turner
authors.forename: Raymond
authors.initials: R
authors.lastname: Agius
authors.forename: S Mark
authors.initials: SM
authors.lastname: Wilkinson
mesh_terms: D052160:Benzothiazoles / Q000009:adverse effects; D017449:Dermatitis, Allergic Contact / Q000453:epidemiology* / Q000209:etiology*; D009783:Dermatitis, Occupational / Q000453:epidemiology* / Q000209:etiology*; D004050:Ditiocarb / Q000009:adverse effects; D006146:Guanidines / Q000009:adverse effects; D006801:Humans; D015994:Incidence; D020315:Latex Hypersensitivity / Q000453:epidemiology; D010655:Phenylenediamines / Q000009:adverse effects; D013438:Sulfhydryl Compounds / Q000009:adverse effects; D013893:Thiram / Q000009:adverse effects; D006113:United Kingdom / Q000453:epidemiology
chemical_list: D052160:Benzothiazoles; D006146:Guanidines; D010655:Phenylenediamines; D013438:Sulfhydryl Compounds; D013893:Thiram; C057051:carbamix; D004050:Ditiocarb; C014627:N-isopropyl-N-phenyl-4-phenylenediamine
keywords: allergic contact dermatitis; contact urticaria; epidemiology; latex; occupational; rubber; rubber accelerators