Mechanical trauma and urticaria

Link between TRPV channels and mast cell function

Mast cells are tissue-resident immune effector cells. They respond to diverse stimuli by releasing potent biological mediators into the surrounding tissue, and initiating inflammatory responses that promote wound healing and infection clearance. In addition to stimulation via immunological routes, mast cells also respond to polybasic secretagogues and physical stimuli. Each mechanism for mast cell activation relies on the influx of calcium through specific ion channels in the plasma membrane. Recent reports suggest that several calcium-permeant cation channels of the TRPV family are expressed in mast cells. TRPV channels are a family of sensors that receive and react to chemical messengers and physical environmental cues, including thermal, osmotic, and mechanical stimuli. The central premise of this review is that TRPVs transduce physiological and pathophysiological cues that are functionally coupled to calcium signaling and mediator release in mast cells. Inappropriate mast cell activation is at the core of numerous inflammatory pathologies, rendering the mast cell TRPV channels potentially important therapeutic targets.

Occupational skin diseases

Primary care physicians will likely see a wide variety of occupational skin diseases in their practices, including allergic contact dermatitis, irritant contact dermatitis, contact urticaria, a variety of infectious diseases, and skin cancers. The ideal role of a medical practitioner involved in occupational dermatology is not only to diagnose and treat patients, but also to determine the cause of the occupational skin disease and to make recommendations for its prevention. Making the diagnosis and offering treatment, determining the cause, and recommending measures can be difficult undertakings.

Symptoms of hand-arm vibration syndrome in gas distribution operatives

OBJECTIVES

To survey the prevalence and severity of hand-arm vibration syndrome symptoms (HAVS), and to estimate past and current exposure to hand held vibrating tools in a sample of gas distribution operatives breaking and re-instating road surfaces.

METHODS

153 gas distribution operatives (participation rate 81%) from three company districts were assessed by an administered questionnaire, a clinical examination, and a simple cold challenge test to the hands. Exposure histories were taken aided by a picture album of past and current tools. Information was obtained from several sources on the likely vibratory characteristics of those tools. Estimates were thus obtained of the frequency of blanching and neurological complaints in operatives, and of their lifetime hours of exposure and lifetime dose of vibration.

RESULTS

On average, the sample had spent 16 years in employment involving use of vibratory tools. 24% had symptoms or signs of blanching after use of tools in the industry; 46% had troublesome persistent complaints of paraesthesiae or numbness, and these symptoms extended into the hands or arms in 18% of workers. In 5.9% the distribution of symptoms was suggestive of carpal tunnel syndrome; and of ulnar nerve entrapment in a further 3.9%. The risks of blanching and neurological complaints rose significantly with lifetime hours of use of vibrating tools and lifetime dose of vibration. Symptoms were generally mild and apparent only after a prolonged interval, but there were exceptions, and cases had occurred after lower recent exposures.

CONCLUSIONS

It has been suggested that aspects of the gas distribution operative's work mitigate against the risk normally anticipated from use of pneumatic road breaking tools. By contrast our data suggest that symptoms of HAVS do occur, given sufficient exposure, a finding relevant not only to gas supply workers, but also to workers from other industries who break and repair road surfaces.