Contact allergy to thiurams multifactorial analys

Authors: Wolfgang Uter Janice Hegewald Annette Pfahlberg Holger Lessmann Axel Schnuch Olaf Gefeller

Publish Date: 2009/12/30

Volume: 83, Issue: 6, Pages: 675-681

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Abstract

Clinical demographic and allergy patch test data of all patients tested between 1992 and 2006 with the thiuram mix 1 in petrolatum as part of the baseline series was analysed n = 121051 Poisson regression analysis was used to quantify the association between different occupations and other relevant factors and a positive patch test reaction to the thiuram mix Furthermore the time trend of sensitisation prevalence was analysed in highrisk occupational subgroups identifiedIn comparison to a largely unexposed reference group office workers and teachers rubber manufacturers had a significantly elevated risk prevalence ratio PR 51 95 confidence interval CI 20–105 However health care workers such as physicians and dentists PR 38 95 CI 30–48 or nursing staff PR 30 95 CI 25–36 as well as meat and fish processors PR 35 95 CI 22–53 and cleaners PR 31 95 CI 25–38 were found to have a high sensitisation risk as well In case of health care workers a significant downward trend during the study period was observed while in food processors and cleaners sensitisation prevalence remained largely stableThe adjusted multifactorial analysis identified occupations yet unknown to be associated with elevated thiuram contact allergy risk eg food processors and cleaners Thus i further indepth research can be targeted and ii efforts to prevent sensitisation to thiurams focussed eg by limiting thiuram concentrations in products to a residual level which is technically inevitableAmong the various substances known to cause occupational allergic contact dermatitis additives to rubber comprise a conspicuous and meaningful subgroup The additives are either remnants from the production process eg vulcanisation accelerators or added to enhance the technical properties of the final product such as plasticisers colours antioxidants or antiozonants Belsito 2000 The thiurams are regarded as the most important class of contact allergens among the vulcanizers partly due to crossreactivity allergy with corresponding dithiocarbamates which are used for similar purposes Patch testing is performed with a screening mix of tetraethylthiuram disulphide CAS 97778 tetramethylthiuram monosulfide CAS 97745 tetramethylthiuram disulphide CAS 137268 and dipentamethylenethiuram disulphide CAS 94371 at 025 each ie a total concentration of 1 incorporated into petrolatum as carrier The thiuram mix is part of all national and international standard series known to us Hence virtually all patients who are patch tested are exposed to the thiuram mixSuch general diagnostic application enables the analysis of occupational and other risk factor not biased by selective application of the allergen to certain subgroups of patients undergoing patch testing––notwithstanding the issue of selection from the working population into the group of patients patch tested see “Discussion” Data collected by the Information Network of Departments of Dermatology IVDK wwwivdkorg was retrospectively analysed regarding the association between contact allergy to the thiuram mix and occupational exposure and other important factors respectivelyThe IVDK a contact allergy surveillance network in Germany Switzerland and Austria has been described elsewhere Briefly results of all patients patch tested in the participating departments are electronically recorded along with important demographic and clinical data The diagnostic procedure follows international guidelines Wahlberg and Lindberg 2006 further refined by the German Contact Dermatitis Research Group Schnuch et al 2008 of which all IVDK participants are members All data are transmitted to the data centre in Göttingen in an anonymous format twice yearly where it is checked and if satisfying internal quality control criteria Uter et al 2005 analysed according to international guidelines Uter et al 2004b using SAS™ software version 92 SAS Institute Cary NC

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