The problem of the sensitization to dithiocarbamates in thiuram-allergic patients

Making Glove Decision Less of a White Knuckling Experience: A Systematic Review and Inventory of Glove Accelerator Contents

Background

Accelerators in medical gloves are a common cause of allergic contact dermatitis among healthcare workers.

Objective

A systematic review of medical and nursing literature, patch testing reports, and chemical analyses of gloves was conducted to assess accelerator contents reported in the literature and to identify accelerator-free gloves.

Methods

A systematic literature search was performed in OVID Medline and OVID EMBASE. Hand-searching of reference lists of articles in the field and author input generated the remainder of articles assessed.

Results

We present an inventory of accelerator contents of gloves and accelerator-free glove options as reported in the literature as a clinical reference tool to assist allergen-free glove selection for individuals suffering from allergic contact dermatitis due to rubber accelerators.

Limitations

Pertinent limitations of our review include lack of predefined study exclusion criteria and screening of the studies identified in the search by 1 review author only.

Conclusion

The glove inventory we provide summarizes the available literature regarding medical and surgical glove accelerator content, describing gloves both by brand and manufacturer as well as by accelerators.

Contact allergy and exposure patterns to thiurams and carbamates in consecutive patients

Sensitization to rubber is most often due to sensitization to thiurams. Positive patch test reactions to carbamates are less frequent, and usually only diagnosed in patients with positive patch test reactions to thiurams as well. The aim of the present study was to describe the relative frequency of sensitization to thiuram mix (TH mix) and zinc diethyldithiocarbamate (ZDC) in a population where the exposure to these chemicals from rubber gloves was previously studied and considered to be of approximately the same order of magnitude. The thiuram derivatives seemed to be the most important sensitized (frequency 2.8%) compared to ZDC (frequency 0.5%), which has been the most frequently reported sensitizer among the carbamates in rubber gloves. An interesting observation was that the probability that the patient was reacting to ZDC was strongly associated with the strength of the patch test reaction to TH mix. This observation may add a new aspect to the discussion about cross-reactivity versus concomitant sensitization of thiurams and carbamates.

Occupational allergic contact dermatitis and airborne contact dermatitis from 5 fungicides in a vineyard worker. Cross-reactions between fungicides of the dithiocarbamate group?

We report a patient with occupational contact dermatitis due to sensitization to mancozeb and perhaps metiram used in a vineyard. Patch testing showed strong allergic patch test reactions to 2 of the commercially available preparations used (Dithane Ultra and Polyram WG). Further patch tests showed allergic patch test reactions to mancozeb (0.5 and 1% pet.), a weak reaction to metiram (1% pet.) as well as to 4 other fungicides of the dithiocarbamate group (maneb, nabam, propineb and zineb), which had never been used in the vineyard.

Type IV allergy to rubber additives: a 10-year study of 686 cases

BACKGROUND

Rubber additives, mainly vulcanizers and antioxidants, are increasingly a cause of contact dermatitis.

OBJECTIVE

The aim of the present study was to determine the frequency of type IV allergy to rubber additives.

METHODS

Seven thousand patients seen during a 10-year period were evaluated. Of them, 4680 were patch tested with the standard series recommended by the Spanish Group for Research of Contact Dermatitis (GEIDC) and a series of individual rubber additives.

RESULTS

A total of 686 patients (14.7% of those patch tested) had one or more positive reactions to rubber additives. Of these, 582 (84.8%) were men and 104 (15.2%) were women. The incidence of rubber sensitization was especially high among construction workers (47.0%).

CONCLUSION

Rubber additives are a common cause of occupational contact dermatitis, particularly in construction workers. We postulate that rubber gloves and boots (utilized to avoid contact with sensitizing substances) themselves may be a common cause of contact dermatitis. The high incidence of allergy to some rubber additives, such as thiurams and carbas, indicates that their replacement by other less sensitizing vulcanizers is advisable.

Frequency, spectrum and occupational relevance of type IV allergies to rubber chemicals

3851 consecutive patients patch tested between January 1985 and March 1990 have been analysed for rubber allergies. The incidence of rubber allergy was 3.8% (n = 145). In 80/145 patients (55%), the source of rubber sensitization was occupational, 67 of whom (84%) had acquired allergy from wearing rubber gloves at work. Most of them (36%) were employed in the health services. The most commonly positive rubber-mix in this group was thiuram-mix (72%) followed by carba-mix (25%). 13/80 patients (16%) had occupational rubber allergy from industrial rubber products other than gloves. Patch tests revealed thiuram-mix (62%) as the most commonly positive rubber-mix but, in contrast to the group with glove-induced rubber allergy, black-rubber-mix came second (38%). In 47/145 patients (32%), the source of rubber sensitization was non-occupational; in 18/145 (13%) the origin remained unknown.

Contact dermatoses from disposable glove use: a review

Contact dermatoses from disposable gloves are being reported with greater frequency. A variety of eruptions can occur. These have become increasingly relevant for dermatologists, who for most procedures now use disposable gloves. This article represents a review of the relevant issues about the use of disposable gloves by dermatologists. Methods of management and prevention of morbidity associated with disposable glove use will also be discussed.

Environmental and biological monitoring of exposure to ethylenebisdithiocarbamate fungicides and ethylenethiourea

Exposure of workers to ethylenebisdithiocarbamates (EBDCs; maneb or mancozeb) in 29 potato farms was evaluated during the control of potato late blight. Concentrations of EBDCs and ethylenethiourea (ETU), an impurity and degradation product in EBDC formulations, in ambient air were evaluated during pesticide application. Biological monitoring of exposure to EBDCs was carried out by measuring the concentrations of ETU, a metabolite of EBDCs, in urine for 22 days after the end of the exposure. The estimated inhaled doses of ETU and EBDCs during the average four hour application period were 0.07 and 1.8 micrograms/kg, respectively. Only 1-10% of ETU on the clothes reached the skin. The creatinine corrected concentrations of ETU in urine were 0.1-2.5 micrograms/mmol creatinine 24 hours after exposure ended. The estimated half life for eliminating ETU through the kidneys was close to 100 hours. These results indicate that the measurement of ETU in urine is suitable for biological monitoring of exposure to EBDCs.

Irritation and sensitization potential of pesticides

A pesticide series of 36 substances was patch tested in 652 subjects to establish the optimal test concentration, and the frequency of irritant and allergic reactions. Allergic reactions to fungicides were found in 46: thiophthalimides (captan, folpet and difolatan) were the most common. Irritant and allergic reactions to other pesticides (insecticides, herbicides, etc.) were rare. Sensitivity to pesticides was significant in patients who work, or have worked on the land. Cross sensitivity to bisdithiocarbamates or thiophthalimides is possible.