allergy at working places - uit on working place - laboratory...allergy at working places ......
TRANSCRIPT
Rosemarie Braun, Skindep., Unn 2010 1
Allergy at working places
Rosemarie BraunSkin Dep.University Hospital Northern Norway
Rosemarie Braun, Skindep., Unn 2010 2
Outline
Allergy - background / definitions
Allergic diseases/symptoms/evaluation/tests
Current allergies derived from occupation
Handle allergy:PreventionInitiatives when allergy occurs
Rosemarie Braun, Skindep., Unn 2010 3
Immune System
normaly: immune system protects against microorganisms
Cells and molecules from the immune system areimportant weapons in defence against disease and injuries.
Rosemarie Braun, Skindep., Unn 2010 4
Allergy - Definition
Immune system reacts on ”wrong” (harmless) substances(Allergens)
Once developed - after sensibilisation - allergy is usuallylife-long
Rosemarie Braun, Skindep., Unn 2010 5
Eczema= inflammation reaction in the skin
Allergy related eczema:
Allergic contact dermatitis: caused by type IV allergic reaction
Atopic eczema: can have relation to type I allergy
Rosemarie Braun, Skindep., Unn 2010 6
Atopic eczema
”childhood eczema”
often first appearance in childhood
Failure in the defence system of the skin, physically, chemically and immunologically, genetic disposisjon
Rosemarie Braun, Skindep., Unn 2010 7
Atopy
tendency to hypersensitivity of skin and mucosa ofeyes and airways
tendency to produce antibodies against allergens (type I allergy)
Rosemarie Braun, Skindep., Unn 2010 8
Skin cells
T-lymphocytes
Langerhans` cells
Other antigen-presenting cells
Keratinocytes (immunregulating)
High endothelian cells
Mastcells (IgE –receptor)
Rosemarie Braun, Skindep., Unn 2010 9
Allergy - cause
Important predisposing factors
Inheritance (atopi, type I allergy)
Environment
contact with irritants and allergens
early contact with allergens protects against type I allergy?
Rosemarie Braun, Skindep., Unn 2010 10
Types of AllergyType I IgE + mastcells or basophils
Type II Antibody and Antigen on cell surface
Type III Immun complex Antigen-Antibody activatescomplement
TYPE IV sensitized T - lymphocytes + macrophages
Rosemarie Braun, Skindep., Unn 2010 11
Distribution
Scandinavia30-40% gets an allergic disease/allergic symptoms?
Rosemarie Braun, Skindep., Unn 2010 12
Is Allergy increasing ???In case....what could be the cause?
Air pollution?
Smoking habits?
Diet?
Infection pattern?
Vaccination?
Contact with new and ”strange” substances?
More registration?
Rosemarie Braun, Skindep., Unn 2010 13
Type I Allergic reactionsRhino-conjunctivitis (Mucus conjunctiva and upper airways)
Hay-fever, Clear flux from nose and eyes, itch, red eyes, tight nose, sneeze
Urticaria, localized or generalized
Astma bronchialis (Mucus lower airways)Tight lower airways, cough, wheezing, breezing difficulties
Anaphylactic reaction
Ev. eczema
These symptoms er not necessarily caused by an allergic reaction, canbe hypersensitivity
Rosemarie Braun, Skindep., Unn 2010 14
Type I Allergic reactions forts.
Atopic eczema?
Other ekczema-type reactions ?
Rosemarie Braun, Skindep., Unn 2010 15
Rhinoconjunctivitis Symptoms
Tight nose
Water thin clear flux from the nose
Sneeze
Itching from both eyes and nose
Injection in conjunctiva (red eyes)
Rosemarie Braun, Skindep., Unn 2010 16
Allergic Urticariarare, most urticaria is idiopatic
Itching rash, swelling
localizedfaceeyelidtounge
Generalized Urticaria (nettle rash)
After sensibilisation quick reaction on allergen contact, lesions comeand go, disappears during few hours
Rosemarie Braun, Skindep., Unn 2010 20
Allergic Asthma
Allergens are inhaled
Inflammation:swellingtight airwaysproduction of mucus
Rosemarie Braun, Skindep., Unn 2010 21
Asthma,contin.
Symptomsattacs with chest tightness and breathing difficultycoughwheezing
Rosemarie Braun, Skindep., Unn 2010 23
Anaphylaxis
Acute allergic reaction with one or several life-threateningcharacteristics
Common causesfood (peanuts, shellfish)medicaments (antibiotics)Bee, wasp bite
Rosemarie Braun, Skindep., Unn 2010 24
Type IV allergic reaction
Allergic contact dermatitis
Constitute about 25% of all contact dermatitis
Often related to occupation
Rosemarie Braun, Skindep., Unn 2010 26
Diagnosis: Contactallergy
Anamnesis, anamnesis, anamnesis !!!
Patchtest positiv AND clinical relevant
Demonstrate that pasient is exposed for material tested positiv
Rosemarie Braun, Skindep., Unn 2010 27
Allergic contact dermatitis, contin.
Chemicals used in laboratory work
Common allergens
Metals (nickel, chrome, cobolt)rubbervarious contents in cosmetics (lanolin, parfumes)
Rosemarie Braun, Skindep., Unn 2010 28
Airborne ContactdermatitisNot cloth-covered skin hud – face, neck, arms, hands:
Dvs. exposed skin regions incl. shadow locations
Obs. Powders, aerosols
D.D. Photodermatitis: shadow locations not/ little affected
Rosemarie Braun, Skindep., Unn 2010 29
Id - reaction
Secundary spreeding of eczema to skinlocalisations which er not directly in contact withthe allergen.
Sees espesially with :
Medicaments
Metals
Rosemarie Braun, Skindep., Unn 2010 30
Obs !!!
Fingers/ hands can bring allergens to otherlocations !!
especially face
Rosemarie Braun, Skindep., Unn 2010 31
Endogene factors
Regional anatomy
Earlier/present skin disease/injury
Any process which damages the skin affects thebarriere function:
Skin injury, skin disease (atop.dermatitt) raises disposition for irritative Contactdermatitis
Rosemarie Braun, Skindep., Unn 2010 42
If you suspect allergy
Anamnesis: Symptoms and correlation to work
Clinical examination
Allergy Tests
Rosemarie Braun, Skindep., Unn 2010 43
Anamnesis allways most important
Skin or Blood Test:
Just supplementary !!!!!!!!!!!!
Provocation test sjeldom necessary
Rosemarie Braun, Skindep., Unn 2010 45
Test Procedures
standardised
Read testInterprete – evaluate relevance
Rosemarie Braun, Skindep., Unn 2010 46
Test can be good diagnostic help, but
You cannot always trust it !!!! espesially :
Rosemarie Braun, Skindep., Unn 2010 47
Test for Type I allergy
Pricktest
Prick-pricktest
Scratchtest
Spesifikk serum-IgE
Rosemarie Braun, Skindep., Unn 2010 49
PRIST
Measuring total amount serum IgE
Not allways coincident with spesific type I allergy
Often high in atopic persons
Rosemarie Braun, Skindep., Unn 2010 51
Test for TYPE IV ALLERGY
Test done on target organ
BUT:Use test only when positiv anamnesis
Rosemarie Braun, Skindep., Unn 2010 52
Patch test = Epikutantest
Dermatolog with experience to select relevante allergens
Rosemarie Braun, Skindep., Unn 2010 61
Indication for patchtest
Suspiscion that patient has contact allergy
Rosemarie Braun, Skindep., Unn 2010 62
Interprete and judje relevance
NOT an EASY task
False positivFalse negativAdverse reaction
Relevance to work ????
Rosemarie Braun, Skindep., Unn 2010 63
False positiv reaction
Excited skin reactionActive dermatitisStrong test reaction
Irritative reaction
Rosemarie Braun, Skindep., Unn 2010 64
Irritative reaction
can imitate allergic reaction:
Anamnesis
Repeat test
Rosemarie Braun, Skindep., Unn 2010 65
Allergy Testing demandsexperience
Easy to å mount test
Difficult to read test
Nearly impossible to evaluate relevans
Rosemarie Braun, Skindep., Unn 2010 66
Relevant Positiv test
Evidence for exposisjon to antigen (Product declarations)
Can exposisjon explain the clinical picture?
Rosemarie Braun, Skindep., Unn 2010 67
Allergy tested products
Nearly nonsense ???
Every substans is a potentialallergen
Rosemarie Braun, Skindep., Unn 2010 69
Relevant occupational allergies in laboratorys
Type I Allergies
Laboratory animals
Natural Rubber Latex
Proteins e.g. collagenase, albumin
Medicaments e.g. antibiotics
Rosemarie Braun, Skindep., Unn 2010 70
Relevant occupational allergies in laboratorys
Type IV AllergiesChemicals used at working place
don`t forget airborne allergy !!!
don`t forget transport of allergens byfingers (gloves!) to other skin-lokations
Rosemarie Braun, Skindep., Unn 2010 71
Laboratory animal allergy: type I allegy
10-30% of exposed people develope allergy
mouse and rat allergen (obs. proteins in the urine)
symptomsrhinoconjunctivitisurticariaasthma
Rosemarie Braun, Skindep., Unn 2010 72
Plant proteins from natural rubber latex (plant syrup)
Type I allergi
Cross over allergy with many fruits (kiwi, bananas)
gloves, ballons, condoms, rubber band, swimming goggles, comforter and so on
Occurrence of allergy:approx. 1 % in general populationup to 30 % among eager glove users
Rosemarie Braun, Skindep., Unn 2010 74
Symptoms
Whole spectre from rhinoconjunctivitis , asthma, urticaria to anaphylaxis
Cross over allergy with several fruits, e.g. kiwi and banana
Rosemarie Braun, Skindep., Unn 2010 76
Chemicals added when processingrubber products
Type IV allergy
Rosemarie Braun, Skindep., Unn 2010 79
Powder on glovesPowder from gloves binds easily to latex particle. Leads to increased dispersion.
Powder used in intraabdominal sugery and evenexamination through body openings can provoceadherences
Rosemarie Braun, Skindep., Unn 2010 80
Intolerances
”idiopatic environmental intolerance”
Unknown causes
Not allergy
Rosemarie Braun, Skindep., Unn 2010 81
How to handle allergy at an laboratoryPrevention
Initiatives when allergy arises
Rosemarie Braun, Skindep., Unn 2010 82
Prevention...How?Avoid any direct contact with allergens - skin and airways
Knowledge about substances one is working with (HMS data sheet)
Reduce spreading over large areas (ventilation, weigh rooms)
As little as possible maintain in dangerous/straining jobs
Protective equipment
Awareness around use of gloves, especially latex
Rosemarie Braun, Skindep., Unn 2010 83
If Occupational Allergy is confirmed
Changes at your working place, adapt working procedures if possible:
Avoid/reduce contact with allergensChange to equipment made of other material Change proceduresprotective equipment
Rosemarie Braun, Skindep., Unn 2010 84
If Occupational Allergy is confirmed cont.
Change working place if necessary
Yrkesrettet attføring = vocational rehabilitation
Apply for approval as occupational disease
Pensjon if the above solutions do not work
Rosemarie Braun, Skindep., Unn 2010 85
Approval of occupational disease
The worker bring forward the demands to the welfareoffice (Trygdekontoret)
Evaluation by spesialist, often more than one
Takes long time, several months
Offers special rights + eventually compensation