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Suojalehto H, Lindström I. Long-term outcome of occupational asthma with different etiology. Curr Opin Allergy Clin Immunol 2024; 24:64-68. [PMID: 38126800 DOI: 10.1097/aci.0000000000000962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
PURPOSE OF REVIEW This review summarizes the recent literature on the long-term outcome of sensitizer-induced and irritant-induced occupational asthma. RECENT FINDINGS Recent studies of sensitizer-induced occupational asthma show that after the offending exposure has ceased, most patients report at least partial relief of symptoms. However, in the long term, the diagnosis may negatively impact their careers, incomes, and quality of life. The studies also offer new insights into diisocyanate-induced occupational asthma phenotypes and asthma remission rates. One third of these cases were in remission in long-term after reduction or cessation of exposure. The long-term prognosis of irritant-induced occupational asthma was demonstrated to be poorer than sensitizer-induced occupational asthma. Older age, low fractional exhaled nitric oxide levels and uncontrolled asthma at the time of diagnosis predicted uncontrolled asthma in the long term in patients with irritant and low-molecular-weight sensitizer induced occupational asthma. SUMMARY Recent studies provide further evidence of the long-term outcome of different occupational asthma phenotypes and the factors that affect them. These findings help us identify patients at risk of poor asthma outcomes, who need close monitoring and support. It should also be borne in mind that occupational asthma diagnosis may have wider-ranging negative impacts on patients' lives.
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Affiliation(s)
- Hille Suojalehto
- Occupational Medicine, Finnish Institute of Occupational Health, Finland
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Sit G, Orsi L, Iwatsubo Y, Dananché B, Orsi F, Goldberg M, Leynaert B, Nadif R, Ribet C, Roche N, Roquelaure Y, Varraso R, Zins M, Pilorget C, Le Moual N, Dumas O. Chronic occupational exposures to irritants and asthma in the CONSTANCES cohort. Occup Environ Med 2024; 81:129-135. [PMID: 38418224 DOI: 10.1136/oemed-2023-109100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 02/12/2024] [Indexed: 03/01/2024]
Abstract
OBJECTIVES The impact of chronic occupational exposures to irritants on asthma remains discussed. We studied the associations between occupational exposures and asthma, with specific interest for chronic exposure to irritants, including disinfectants and cleaning products (DCPs) and solvents. METHODS Cross-sectional analyses included 115 540 adults (55% women, mean age 43 years, 10% current asthma) working at inclusion in the French population-based CONSTANCES cohort (2012-2020). Current asthma was defined by ever asthma with symptoms, medication or asthma attacks (past 12 months), and the asthma symptom score by the sum of 5 respiratory symptoms (past 12 months). Both lifetime and current occupational exposures were assessed by the Occupational Asthma-specific Job-Exposure Matrix. Associations were evaluated by gender using logistic and binomial negative regressions adjusted for age, smoking status and body mass index. RESULTS In women, associations were observed between current asthma and lifetime exposure to irritants (OR 1.05, 95% CI 1.00 to 1.11), DCPs (1.06, 95% CI 1.00 to 1.12) and solvents (1.06, 95% CI 0.98 to 1.14). In men, only lifetime exposure to DCPs (1.10, 95% CI 1.01 to 1.20) was associated with current asthma. Lifetime exposure to irritants was associated with higher asthma symptom score both in women (mean score ratio: 1.08, 95% CI 1.05 to 1.11) and men (1.11, 95% CI 1.07 to 1.15), especially for DCPs (women: 1.09, 95% CI 1.06 to 1.13, men: 1.21, 95% CI 1.15 to 1.27) and solvents (women 1.14, 95% CI 1.10 to 1.19, men: 1.10, 95% CI 1.05 to 1.15). For current exposures, no consistent associations were observed with current asthma and asthma symptom score. CONCLUSIONS Lifetime occupational exposures to irritants were associated with current asthma and higher asthma symptom score. These exposures should be carefully considered in asthma management.
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Affiliation(s)
- Guillaume Sit
- Université Paris-Saclay, UVSQ, Univ. Paris-Sud, Inserm, Équipe d'Épidémiologie respiratoire intégrative, CESP, Villejuif, France
| | - Laurent Orsi
- Université Paris-Saclay, UVSQ, Univ. Paris-Sud, Inserm, Équipe d'Épidémiologie respiratoire intégrative, CESP, Villejuif, France
| | - Yuriko Iwatsubo
- Santé Publique France, Direction Santé Environnement Travail, Saint-Maurice, France
| | - Brigitte Dananché
- Université Paris-Saclay, UVSQ, Univ. Paris-Sud, Inserm, Équipe d'Épidémiologie respiratoire intégrative, CESP, Villejuif, France
| | - Florence Orsi
- Université Paris-Saclay, UVSQ, Univ. Paris-Sud, Inserm, Équipe d'Épidémiologie respiratoire intégrative, CESP, Villejuif, France
| | - Marcel Goldberg
- Université Paris Cité, Université Paris-Saclay, UVSQ, Inserm, UMS 11, Cohortes Epidémiologiques en population, Villejuif, France
- Faculty of Medicine, Université de Paris, Paris, France
| | - Benedicte Leynaert
- Université Paris-Saclay, UVSQ, Univ. Paris-Sud, Inserm, Équipe d'Épidémiologie respiratoire intégrative, CESP, Villejuif, France
| | - Rachel Nadif
- Université Paris-Saclay, UVSQ, Univ. Paris-Sud, Inserm, Équipe d'Épidémiologie respiratoire intégrative, CESP, Villejuif, France
| | - Céline Ribet
- Université Paris Cité, Université Paris-Saclay, UVSQ, Inserm, UMS 11, Cohortes Epidémiologiques en population, Villejuif, France
- Faculty of Medicine, Université de Paris, Paris, France
| | - Nicolas Roche
- APHP Centre-Université de Paris, Hôpital et Institut Cochin, Service de Pneumologie, Paris, France
| | - Yves Roquelaure
- Université d'Angers, CHU Angers, Univ Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) UMR_S1085, Angers, France
| | - Raphäelle Varraso
- Université Paris-Saclay, UVSQ, Univ. Paris-Sud, Inserm, Équipe d'Épidémiologie respiratoire intégrative, CESP, Villejuif, France
| | - Marie Zins
- Université Paris Cité, Université Paris-Saclay, UVSQ, Inserm, UMS 11, Cohortes Epidémiologiques en population, Villejuif, France
- Faculty of Medicine, Université de Paris, Paris, France
| | - Corinne Pilorget
- Santé Publique France, Direction Santé Environnement Travail, Saint-Maurice, France
| | - Nicole Le Moual
- Université Paris-Saclay, UVSQ, Univ. Paris-Sud, Inserm, Équipe d'Épidémiologie respiratoire intégrative, CESP, Villejuif, France
| | - Orianne Dumas
- Université Paris-Saclay, UVSQ, Univ. Paris-Sud, Inserm, Équipe d'Épidémiologie respiratoire intégrative, CESP, Villejuif, France
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Mishra N, Kant R, Kandhari K, Ammar DA, Tewari-Singh N, Pantcheva MB, Petrash JM, Agarwal C, Agarwal R. Nitrogen Mustard-Induced Ex Vivo Human Cornea Injury Model and Therapeutic Intervention by Dexamethasone. J Pharmacol Exp Ther 2024; 388:484-494. [PMID: 37474260 PMCID: PMC10801761 DOI: 10.1124/jpet.123.001760] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 06/26/2023] [Accepted: 06/30/2023] [Indexed: 07/22/2023] Open
Abstract
Sulfur mustard (SM), a vesicating agent first used during World War I, remains a potent threat as a chemical weapon to cause intentional/accidental chemical emergencies. Eyes are extremely susceptible to SM toxicity. Nitrogen mustard (NM), a bifunctional alkylating agent and potent analog of SM, is used in laboratories to study mustard vesicant-induced ocular toxicity. Previously, we showed that SM-/NM-induced injuries (in vivo and ex vivo rabbit corneas) are reversed upon treatment with dexamethasone (DEX), a US Food and Drug Administration-approved, steroidal anti-inflammatory drug. Here, we optimized NM injuries in ex vivo human corneas and assessed DEX efficacy. For injury optimization, one cornea (randomly selected from paired eyes) was exposed to NM: 100 nmoles for 2 hours or 4 hours, and 200 nmoles for 2 hours, and the other cornea served as a control. Injuries were assessed 24 hours post NM-exposure. NM 100 nmoles exposure for 2 hours was found to cause optimal corneal injury (epithelial thinning [∼69%]; epithelial-stromal separation [6-fold increase]). In protein arrays studies, 24 proteins displayed ≥40% change in their expression in NM exposed corneas compared with controls. DEX administration initiated 2 hours post NM exposure and every 8 hours thereafter until 24 hours post-exposure reversed NM-induced corneal epithelial-stromal separation [2-fold decrease]). Of the 24 proteins dysregulated upon NM exposure, six proteins (delta-like canonical Notch ligand 1, FGFbasic, CD54, CCL7, endostatin, receptor tyrosine-protein kinase erbB-4) associated with angiogenesis, immune/inflammatory responses, and cell differentiation/proliferation, showed significant reversal upon DEX treatment (Student's t test; P ≤ 0.05). Complementing our animal model studies, DEX was shown to mitigate vesicant-induced toxicities in ex vivo human corneas. SIGNIFICANCE STATEMENT: Nitrogen mustard (NM) exposure-induced injuries were optimized in an ex vivo human cornea culture model and studies were carried out at 24 h post 100 nmoles NM exposure. Dexamethasone (DEX) administration (started 2 h post NM exposure and every 8 h thereafter) reversed NM-induced corneal injuries. Molecular mediators of DEX action were associated with angiogenesis, immune/inflammatory responses, and cell differentiation/proliferation, indicating DEX aids wound healing via reversing vesicant-induced neovascularization (delta-like canonical Notch ligand 1 and FGF basic) and leukocyte infiltration (CD54 and CCL7).
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Affiliation(s)
- Neha Mishra
- Department of Pharmaceutical Sciences, Skaggs School of Pharmacy and Pharmaceutical Sciences (N.M., R.K., K.K., C.A., R.A.) and Department of Ophthalmology, School of Medicine (M.B.P., J.M.P.) University of Colorado-Anschutz Medical Campus, Aurora, Colorado; Lions Eye Institute for Transplant and Research, Tampa, Florida (D.A.A.); and Department of Pharmacology and Toxicology, College of Osteopathic Medicine, Michigan State University, East Lansing, Michigan (N.T.-S.)
| | - Rama Kant
- Department of Pharmaceutical Sciences, Skaggs School of Pharmacy and Pharmaceutical Sciences (N.M., R.K., K.K., C.A., R.A.) and Department of Ophthalmology, School of Medicine (M.B.P., J.M.P.) University of Colorado-Anschutz Medical Campus, Aurora, Colorado; Lions Eye Institute for Transplant and Research, Tampa, Florida (D.A.A.); and Department of Pharmacology and Toxicology, College of Osteopathic Medicine, Michigan State University, East Lansing, Michigan (N.T.-S.)
| | - Kushal Kandhari
- Department of Pharmaceutical Sciences, Skaggs School of Pharmacy and Pharmaceutical Sciences (N.M., R.K., K.K., C.A., R.A.) and Department of Ophthalmology, School of Medicine (M.B.P., J.M.P.) University of Colorado-Anschutz Medical Campus, Aurora, Colorado; Lions Eye Institute for Transplant and Research, Tampa, Florida (D.A.A.); and Department of Pharmacology and Toxicology, College of Osteopathic Medicine, Michigan State University, East Lansing, Michigan (N.T.-S.)
| | - David A Ammar
- Department of Pharmaceutical Sciences, Skaggs School of Pharmacy and Pharmaceutical Sciences (N.M., R.K., K.K., C.A., R.A.) and Department of Ophthalmology, School of Medicine (M.B.P., J.M.P.) University of Colorado-Anschutz Medical Campus, Aurora, Colorado; Lions Eye Institute for Transplant and Research, Tampa, Florida (D.A.A.); and Department of Pharmacology and Toxicology, College of Osteopathic Medicine, Michigan State University, East Lansing, Michigan (N.T.-S.)
| | - Neera Tewari-Singh
- Department of Pharmaceutical Sciences, Skaggs School of Pharmacy and Pharmaceutical Sciences (N.M., R.K., K.K., C.A., R.A.) and Department of Ophthalmology, School of Medicine (M.B.P., J.M.P.) University of Colorado-Anschutz Medical Campus, Aurora, Colorado; Lions Eye Institute for Transplant and Research, Tampa, Florida (D.A.A.); and Department of Pharmacology and Toxicology, College of Osteopathic Medicine, Michigan State University, East Lansing, Michigan (N.T.-S.)
| | - Mina B Pantcheva
- Department of Pharmaceutical Sciences, Skaggs School of Pharmacy and Pharmaceutical Sciences (N.M., R.K., K.K., C.A., R.A.) and Department of Ophthalmology, School of Medicine (M.B.P., J.M.P.) University of Colorado-Anschutz Medical Campus, Aurora, Colorado; Lions Eye Institute for Transplant and Research, Tampa, Florida (D.A.A.); and Department of Pharmacology and Toxicology, College of Osteopathic Medicine, Michigan State University, East Lansing, Michigan (N.T.-S.)
| | - J Mark Petrash
- Department of Pharmaceutical Sciences, Skaggs School of Pharmacy and Pharmaceutical Sciences (N.M., R.K., K.K., C.A., R.A.) and Department of Ophthalmology, School of Medicine (M.B.P., J.M.P.) University of Colorado-Anschutz Medical Campus, Aurora, Colorado; Lions Eye Institute for Transplant and Research, Tampa, Florida (D.A.A.); and Department of Pharmacology and Toxicology, College of Osteopathic Medicine, Michigan State University, East Lansing, Michigan (N.T.-S.)
| | - Chapla Agarwal
- Department of Pharmaceutical Sciences, Skaggs School of Pharmacy and Pharmaceutical Sciences (N.M., R.K., K.K., C.A., R.A.) and Department of Ophthalmology, School of Medicine (M.B.P., J.M.P.) University of Colorado-Anschutz Medical Campus, Aurora, Colorado; Lions Eye Institute for Transplant and Research, Tampa, Florida (D.A.A.); and Department of Pharmacology and Toxicology, College of Osteopathic Medicine, Michigan State University, East Lansing, Michigan (N.T.-S.)
| | - Rajesh Agarwal
- Department of Pharmaceutical Sciences, Skaggs School of Pharmacy and Pharmaceutical Sciences (N.M., R.K., K.K., C.A., R.A.) and Department of Ophthalmology, School of Medicine (M.B.P., J.M.P.) University of Colorado-Anschutz Medical Campus, Aurora, Colorado; Lions Eye Institute for Transplant and Research, Tampa, Florida (D.A.A.); and Department of Pharmacology and Toxicology, College of Osteopathic Medicine, Michigan State University, East Lansing, Michigan (N.T.-S.)
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Zafar I, Manzoor S, Mariappan N, Ahmad S, Athar M, Antony V, Ahmad A. A Murine Model of Vesicant-Induced Acute Lung Injury. J Pharmacol Exp Ther 2024; 388:568-575. [PMID: 38050084 PMCID: PMC10801773 DOI: 10.1124/jpet.123.001780] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Revised: 10/06/2023] [Accepted: 10/13/2023] [Indexed: 12/06/2023] Open
Abstract
Burn injuries including those caused by chemicals can result in systemic effects and acute lung injury (ALI). Cutaneous exposure to Lewisite, a warfare and chemical burn agent, also causes ALI. To overcome the limitations in conducting direct research on Lewisite-induced ALI in a laboratory setting, an animal model was developed using phenylarsine oxide (PAO) as a surrogate for Lewisite. Due to lack of a reliable animal model mimicking the effects of such exposures, development of effective therapies to treat such injuries is challenging. We demonstrated that a single cutaneous exposure to PAO resulted in disruption of the alveolar-capillary barrier as evidenced by elevated protein levels in the bronchoalveolar lavage fluid (BALF). BALF supernatant of PAO-exposed animals had increased levels of high mobility group box 1, a damage associated molecular pattern molecule. Arterial blood-gas measurements showed decreased pH, increased PaCO2, and decreased partial pressure of arterial O2, indicative of respiratory acidosis, hypercapnia, and hypoxemia. Increased protein levels of interleukin (IL)-6, CXCL-1, CXCL-2, CXCL-5, granulocyte-macrophage colony-stimulating factor, CXCL-10, leukemia inhibitory factor, leptin, IL-18, CCL-2, CCL-3, and CCL-7 were observed in the lung of PAO-exposed mice. Further, vascular endothelial growth factor levels were reduced in the lung. Pulmonary function evaluated using a flexiVent showed a downward shift in the pressure-volume loop, decreases in static compliance and inspiratory capacity, increases in respiratory elastance and tissue elastance. These changes are consistent with an ALI phenotype. These results demonstrate that cutaneous PAO exposure leads to ALI and that the model can be used as an effective surrogate to investigate vesicant-induced ALI. SIGNIFICANCE STATEMENT: This study presents a robust model for studying ALI resulting from cutaneous exposure to PAO, a surrogate for the toxic vesicating agent Lewisite. The findings in this study mimic the effects of cutaneous Lewisite exposure, providing a reliable model for investigating mechanisms underlying toxicity. The model can also be used to develop medical countermeasures to mitigate ALI associated with cutaneous Lewisite exposure.
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Affiliation(s)
- Iram Zafar
- Departments of Anesthesiology and Perioperative Medicine (I.Z., S.M., S.A., A.A.), Department of Dermatology (M.A.), and Department of Medicine (V.A.), University of Alabama at Birmingham, Birmingham, Alabama
| | - Shajer Manzoor
- Departments of Anesthesiology and Perioperative Medicine (I.Z., S.M., S.A., A.A.), Department of Dermatology (M.A.), and Department of Medicine (V.A.), University of Alabama at Birmingham, Birmingham, Alabama
| | - Nithya Mariappan
- Departments of Anesthesiology and Perioperative Medicine (I.Z., S.M., S.A., A.A.), Department of Dermatology (M.A.), and Department of Medicine (V.A.), University of Alabama at Birmingham, Birmingham, Alabama
| | - Shama Ahmad
- Departments of Anesthesiology and Perioperative Medicine (I.Z., S.M., S.A., A.A.), Department of Dermatology (M.A.), and Department of Medicine (V.A.), University of Alabama at Birmingham, Birmingham, Alabama
| | - Mohammad Athar
- Departments of Anesthesiology and Perioperative Medicine (I.Z., S.M., S.A., A.A.), Department of Dermatology (M.A.), and Department of Medicine (V.A.), University of Alabama at Birmingham, Birmingham, Alabama
| | - Veena Antony
- Departments of Anesthesiology and Perioperative Medicine (I.Z., S.M., S.A., A.A.), Department of Dermatology (M.A.), and Department of Medicine (V.A.), University of Alabama at Birmingham, Birmingham, Alabama
| | - Aftab Ahmad
- Departments of Anesthesiology and Perioperative Medicine (I.Z., S.M., S.A., A.A.), Department of Dermatology (M.A.), and Department of Medicine (V.A.), University of Alabama at Birmingham, Birmingham, Alabama
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Meshanni JA, Lee JM, Vayas KN, Sun R, Jiang C, Guo GL, Gow AJ, Laskin JD, Laskin DL. Suppression of Lung Oxidative Stress, Inflammation, and Fibrosis following Nitrogen Mustard Exposure by the Selective Farnesoid X Receptor Agonist Obeticholic Acid. J Pharmacol Exp Ther 2024; 388:586-595. [PMID: 37188530 PMCID: PMC10801770 DOI: 10.1124/jpet.123.001557] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 03/26/2023] [Accepted: 04/22/2023] [Indexed: 05/17/2023] Open
Abstract
Nitrogen mustard (NM) is a cytotoxic vesicant known to cause pulmonary injury that can progress to fibrosis. NM toxicity is associated with an influx of inflammatory macrophages in the lung. Farnesoid X receptor (FXR) is a nuclear receptor involved in bile acid and lipid homeostasis that has anti-inflammatory activity. In these studies, we analyzed the effects of FXR activation on lung injury, oxidative stress, and fibrosis induced by NM. Male Wistar rats were exposed to phosphate-buffered saline (vehicle control) or NM (0.125 mg/kg) by intratracheal Penncentury-MicroSprayer aerosolization; this was followed by treatment with the FXR synthetic agonist, obeticholic acid (OCA, 15 mg/kg), or vehicle control (0.13-0.18 g peanut butter) 2 hours later and then once per day, 5 days per week thereafter for 28 days. NM caused histopathological changes in the lung, including epithelial thickening, alveolar circularization, and pulmonary edema. Picrosirius red staining and lung hydroxyproline content were increased, indicative of fibrosis; foamy lipid-laden macrophages were also identified in the lung. This was associated with aberrations in pulmonary function, including increases in resistance and hysteresis. Following NM exposure, lung expression of HO-1 and iNOS, and the ratio of nitrates/nitrites in bronchoalveolar lavage fluid (BAL), markers of oxidative stress increased, along with BAL levels of inflammatory proteins, fibrinogen, and sRAGE. Administration of OCA attenuated NM-induced histopathology, oxidative stress, inflammation, and altered lung function. These findings demonstrate that FXR plays a role in limiting NM-induced lung injury and chronic disease, suggesting that activating FXR may represent an effective approach to limiting NM-induced toxicity. SIGNIFICANCE STATEMENT: In this study, the role of farnesoid-X-receptor (FXR) in mustard vesicant-induced pulmonary toxicity was analyzed using nitrogen mustard (NM) as a model. This study's findings that administration of obeticholic acid, an FXR agonist, to rats reduces NM-induced pulmonary injury, oxidative stress, and fibrosis provide novel mechanistic insights into vesicant toxicity, which may be useful in the development of efficacious therapeutics.
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Affiliation(s)
- Jaclynn A Meshanni
- Department of Pharmacology and Toxicology, Ernest Mario School of Pharmacy (J.A.M., J.M.L., K.N.V., R.S., C.J., G.L.G., A.J.G., D.L.L.) and Department of Environmental and Occupational Health and Justice, School of Public Health (J.D.L.), Rutgers University, Piscataway, New Jersey
| | - Jordan M Lee
- Department of Pharmacology and Toxicology, Ernest Mario School of Pharmacy (J.A.M., J.M.L., K.N.V., R.S., C.J., G.L.G., A.J.G., D.L.L.) and Department of Environmental and Occupational Health and Justice, School of Public Health (J.D.L.), Rutgers University, Piscataway, New Jersey
| | - Kinal N Vayas
- Department of Pharmacology and Toxicology, Ernest Mario School of Pharmacy (J.A.M., J.M.L., K.N.V., R.S., C.J., G.L.G., A.J.G., D.L.L.) and Department of Environmental and Occupational Health and Justice, School of Public Health (J.D.L.), Rutgers University, Piscataway, New Jersey
| | - Rachel Sun
- Department of Pharmacology and Toxicology, Ernest Mario School of Pharmacy (J.A.M., J.M.L., K.N.V., R.S., C.J., G.L.G., A.J.G., D.L.L.) and Department of Environmental and Occupational Health and Justice, School of Public Health (J.D.L.), Rutgers University, Piscataway, New Jersey
| | - Chenghui Jiang
- Department of Pharmacology and Toxicology, Ernest Mario School of Pharmacy (J.A.M., J.M.L., K.N.V., R.S., C.J., G.L.G., A.J.G., D.L.L.) and Department of Environmental and Occupational Health and Justice, School of Public Health (J.D.L.), Rutgers University, Piscataway, New Jersey
| | - Grace L Guo
- Department of Pharmacology and Toxicology, Ernest Mario School of Pharmacy (J.A.M., J.M.L., K.N.V., R.S., C.J., G.L.G., A.J.G., D.L.L.) and Department of Environmental and Occupational Health and Justice, School of Public Health (J.D.L.), Rutgers University, Piscataway, New Jersey
| | - Andrew J Gow
- Department of Pharmacology and Toxicology, Ernest Mario School of Pharmacy (J.A.M., J.M.L., K.N.V., R.S., C.J., G.L.G., A.J.G., D.L.L.) and Department of Environmental and Occupational Health and Justice, School of Public Health (J.D.L.), Rutgers University, Piscataway, New Jersey
| | - Jeffrey D Laskin
- Department of Pharmacology and Toxicology, Ernest Mario School of Pharmacy (J.A.M., J.M.L., K.N.V., R.S., C.J., G.L.G., A.J.G., D.L.L.) and Department of Environmental and Occupational Health and Justice, School of Public Health (J.D.L.), Rutgers University, Piscataway, New Jersey
| | - Debra L Laskin
- Department of Pharmacology and Toxicology, Ernest Mario School of Pharmacy (J.A.M., J.M.L., K.N.V., R.S., C.J., G.L.G., A.J.G., D.L.L.) and Department of Environmental and Occupational Health and Justice, School of Public Health (J.D.L.), Rutgers University, Piscataway, New Jersey
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Caré W, Delacour H, Vodovar D, Langrand J, Laborde-Castérot H. Occupational vesicant-induced skin lesions. Contact Dermatitis 2024; 90:91-93. [PMID: 37775955 DOI: 10.1111/cod.14432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 09/16/2023] [Accepted: 09/20/2023] [Indexed: 10/01/2023]
Affiliation(s)
- Weniko Caré
- Paris Poison Control Center, Toxicology Federation (FeTox), Hôpital Fernand Widal, AP-HP. Nord Université Paris Cité, Paris, France
- Department of Internal Medicine, Bégin Military Teaching Hospital, Saint-Mandé, France
- INSERM, UMR-S 1144, Paris, France
| | - Hervé Delacour
- Department of Medical Biology, Bégin Military Teaching Hospital, Saint-Mandé, France
- Val-de-Grâce School, Paris, France
| | - Dominique Vodovar
- Paris Poison Control Center, Toxicology Federation (FeTox), Hôpital Fernand Widal, AP-HP. Nord Université Paris Cité, Paris, France
- INSERM, UMR-S 1144, Paris, France
| | - Jérôme Langrand
- Paris Poison Control Center, Toxicology Federation (FeTox), Hôpital Fernand Widal, AP-HP. Nord Université Paris Cité, Paris, France
- INSERM, UMR-S 1144, Paris, France
| | - Hervé Laborde-Castérot
- Paris Poison Control Center, Toxicology Federation (FeTox), Hôpital Fernand Widal, AP-HP. Nord Université Paris Cité, Paris, France
- INSERM, UMR 1153, Paris, France
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Mishra N, Kant R, Goswami DG, Petrash JM, Agarwal C, Tewari-Singh N, Agarwal R. Metabolomics for identifying pathways involved in vesicating agent lewisite-induced corneal injury. Exp Eye Res 2023; 236:109672. [PMID: 37797797 PMCID: PMC10843384 DOI: 10.1016/j.exer.2023.109672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 09/11/2023] [Accepted: 10/02/2023] [Indexed: 10/07/2023]
Abstract
Lewisite (LEW) is an arsenical vesicant that can be a potentially dangerous chemical warfare agent (CWA). Eyes are particularly susceptible to vesicant induced injuries and ocular LEW exposure can act swiftly, causing burning of eyes, edema, inflammation, cell death and even blindness. In our previous studies, we developed a LEW exposure-induced corneal injury model in rabbit and showed increased inflammation, neovascularization, cell death, and structural damage to rabbit corneas upon LEW exposure. In the present study, we further assessed the metabolomic changes to delineate the possible mechanisms underlying the LEW-induced corneal injuries. This information is vital and could help in the development of effective targeted therapies against ocular LEW injuries. Thus, the metabolomic changes associated with LEW exposures in rabbit corneas were assessed as a function of time, to delineate pathways from molecular perturbations at the genomic and proteomic levels. New Zealand white rabbit corneas (n = 3-6) were exposed to LEW vapor (0.2 mg/L; flow rate: 300 ml/min) for 2.5 min (short exposure; low dose) or 7.5 min (long-exposure; high dose) and then collected at 1, 3, 7, or 14 days post LEW exposure. Samples were prepared using the automated MicroLab STAR® system, and proteins precipitated to recover the chemically diverse metabolites. Metabolomic analysis was carried out by reverse phase UPLC-MS/MS and gas chromatography (GC)-MS. The data obtained were analyzed using Metabolon's software. The results showed that LEW exposures at high doses were more toxic, particularly at the day 7 post exposure time point. LEW exposure was shown to dysregulate metabolites associated with all the integral functions of the cornea and cause increased inflammation and immune response, as well as generate oxidative stress. Additionally, all important metabolic functions of the cells were also affected: lipid and nucleotide metabolism, and energetics. The high dose LEW exposures were more toxic, particularly at day 7 post LEW exposure (>10-fold increased levels of histamine, quinolinate, N-acetyl-β-alanine, GMP, and UPM). LEW exposure dysregulated integral functions of the cornea, caused inflammation and heightened immune response, and generated oxidative stress. Lipid and nucleotide metabolism, and energetics were also affected. The novel information about altered metabolic profile of rabbit cornea following LEW exposure could assist in delineating complex molecular events; thus, aid in identifying therapeutic targets to effectively ameliorate ocular trauma.
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Affiliation(s)
- Neha Mishra
- Department of Pharmaceutical Sciences, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado-Anschutz Medical Campus, Aurora, CO, USA
| | - Rama Kant
- Department of Pharmaceutical Sciences, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado-Anschutz Medical Campus, Aurora, CO, USA
| | - Dinesh G Goswami
- Department of Pharmaceutical Sciences, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado-Anschutz Medical Campus, Aurora, CO, USA
| | - J Mark Petrash
- Department of Ophthalmology, School of Medicine, University of Colorado-Anschutz Medical Campus, Aurora, CO, USA
| | - Chapla Agarwal
- Department of Pharmaceutical Sciences, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado-Anschutz Medical Campus, Aurora, CO, USA
| | - Neera Tewari-Singh
- Department of Pharmaceutical Sciences, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado-Anschutz Medical Campus, Aurora, CO, USA
| | - Rajesh Agarwal
- Department of Pharmaceutical Sciences, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado-Anschutz Medical Campus, Aurora, CO, USA.
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8
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Fishwick D, Carder M, Iskandar I, Fishwick BC, van Tongeren M. Irritant asthma and work: cases from the UK SWORD reporting scheme from 1999 to 2018. Occup Environ Med 2023; 80:553-557. [PMID: 37770178 PMCID: PMC10579497 DOI: 10.1136/oemed-2023-108884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 07/03/2023] [Indexed: 10/03/2023]
Abstract
BACKGROUND Acute irritant asthma is a preventable health consequence of a workplace exposure and has a number of adverse outcomes. While cases and case series are reported, little is known about the causes and incidence of this condition over prolonged periods of time. AIMS We aimed to estimate the reported incidence of irritant asthma referred to a national reporting scheme, and how this has changed over time. METHODS Cases of irritant asthma reported to SWORD, the UK-based Surveillance of Work-related Occupational Respiratory Diseases scheme, were grouped into four 5-year time periods from 1999 onwards. Likely causative exposures, job, work sector and incidence rates were analysed over time. RESULTS 307 actual cases equated to 1066 estimated cases; actual cases had a mean age of 46 years (SD 17.8); 70.7% were male. The annual incidence fell from 1.98 per million employed in the first 5-year period, to 0.56 in the most recent. Eleven occupational codes were associated with six or more attributed cases, and between them accounted for 38% of all cases. Thirteen exposure categories were associated with five or more cases. These were formaldehyde (n=5), cutting oils and coolants (n=6), isocyanates (n=6), pesticides and herbicides (n=6), welding fumes (n=7), paints (n=7), solder and colophony (n=7), solvents (n=9), fuel oil, diesel and ill-defined fumes (n=10), chlorine and hypochlorites (n=15), acids (n=23), smoke (n=25) and cleaning products and sterilising agents (n=39). CONCLUSIONS While the incidence of irritant asthma may have fallen, cases are persistently attributed to well-described causes. A persistence of cases attributed to cleaning agents was seen.
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Affiliation(s)
- David Fishwick
- Science Division, Health and Safety Executive Bootle Headquarters, Bootle, Sefton, UK
- Centre for Occupational and Environmental Health, The University of Manchester, Manchester, UK
| | - Melanie Carder
- Centre for Occupational and Environmental Health, The University of Manchester, Manchester, UK
| | - Ireny Iskandar
- Centre for Occupational and Environmental Health, The University of Manchester, Manchester, UK
| | | | - Martie van Tongeren
- Centre for Occupational and Environmental Health, The University of Manchester, Manchester, UK
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9
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Umejiego E, Paramo R, Zafiris A, Mullane E, Bargagna-Mohan P, Mohan R. A corneo-retinal hypercitrullination axis underlies ocular injury to nitrogen mustard. Exp Eye Res 2023; 231:109485. [PMID: 37080381 PMCID: PMC10214858 DOI: 10.1016/j.exer.2023.109485] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 04/12/2023] [Accepted: 04/18/2023] [Indexed: 04/22/2023]
Abstract
The vesicant sulfur mustard (SM) is a chemical warfare agent that causes acute and chronic injury to the cornea and proximal anterior segment structures. Despite clinical evidence of SM-exposure causing unexplained retinal deficits, there have been no animal studies conducted to examine the retinal toxicity of this vesciant. The cardinal hallmark of retinal response to stressors or injury is the activation of reactive gliosis, a cellular process largely governed by Müller glia. Previously we showed that corneal exposure to sodium hydroxide elicits rapid induction of reactive gliosis and results in retinal degeneration in a dose-related manner. Based on this evidence, we hypothesized that the vesicant nitrogen mustard (NM), an analog of SM, may also elicit reactive gliosis. To test this idea, we developed a mouse model of NM ocular injury and investigated corneal and retinal effects focusing on citrullination, a posttranslational modification (PTM) of proteins. This PTM was recently linked to alkali injury and has also been shown to occur in retinal degenerative conditions. Here, we demonstrate that corneal exposure to 1% NM causes a synchronous activation of citrullination in both the cornea and retina with hypercitrullination becoming apparent temporally and manifesting with altered cellular expression characteristics. A key finding is that ocular citrullination occurs acutely as early as 1-h post-injury in both the cornea and retina, which underscores a need for expeditious interception of this acute corneal and retinal response. Moreover, exploiting dose response and temporal studies, we uncoupled NM-induced retinal citrullination from its induction of retinal gliosis. Our findings demonstrate that hypercitrullination is a common corneo-retinal mechanism that sensitizes the eye to NM injury and suggests that counteracting hypercitrullination may provide a suitable countermeasure to vesicant injury.
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Affiliation(s)
- Ezigbobiara Umejiego
- Department of Neuroscience, University of Connecticut Health Center, Farmington, CT, USA
| | - Ricky Paramo
- Department of Neuroscience, University of Connecticut Health Center, Farmington, CT, USA
| | - Alexander Zafiris
- Department of Neuroscience, University of Connecticut Health Center, Farmington, CT, USA
| | - Elias Mullane
- Department of Neuroscience, University of Connecticut Health Center, Farmington, CT, USA
| | - Paola Bargagna-Mohan
- Department of Neuroscience, University of Connecticut Health Center, Farmington, CT, USA
| | - Royce Mohan
- Department of Neuroscience, University of Connecticut Health Center, Farmington, CT, USA.
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10
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Ronsmans S, Le Moual N, Dumas O. Update on irritant-induced occupational asthma. Curr Opin Allergy Clin Immunol 2023; 23:63-69. [PMID: 36729951 DOI: 10.1097/aci.0000000000000884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
PURPOSE OF REVIEW In this narrative review, we aim to highlight novel research findings on both acute/subacute irritant-induced asthma (IIA) and chronic exposure IIA (also called 'low dose' IIA). RECENT FINDINGS Novel case series showed that acute and subacute IIA cases had similar causal agents (e.g., acid or base aerosols/fumes, dusts, mixtures) but had occurred in different circumstances (accidents vs. regular work). Acute and subacute IIA cases had similar clinical characteristics but poorer short-term outcomes than sensitizer-induced occupational asthma patients. Novel large epidemiological studies reported associations between chronic occupational exposure to irritants and current adult-onset asthma and poor asthma control, and with a specific asthma endotype characterized by neutrophilic inflammation and oxidative stress. Recent studies reconfirmed the association of the use of disinfectants and cleaning products (especially sprays) with IIA. A role for genetic susceptibility has been suggested. SUMMARY Recent literature provided further understanding of both acute/subacute and chronic exposure IIA, in terms of causes, possible mechanisms, and consequences such as poor asthma control. Research is needed to clarify several aspects of IIA, including its frequency (still likely underestimated), modulating factors, and mechanisms. Research aiming at improving irritant exposure assessment, including intensity/duration, and determining relevant exposure windows would be welcome.
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Affiliation(s)
- Steven Ronsmans
- KU Leuven, Centre for Environment and Health, Department of Public Health and Primary Care, Leuven, Belgium
| | - Nicole Le Moual
- Université Paris-Saclay, UVSQ, Univ. Paris-Sud, Inserm, Équipe d'Épidémiologie respiratoire intégrative, CESP, 94807, Villejuif, France
| | - Orianne Dumas
- Université Paris-Saclay, UVSQ, Univ. Paris-Sud, Inserm, Équipe d'Épidémiologie respiratoire intégrative, CESP, 94807, Villejuif, France
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11
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Lemiere C, Lavoie G, Doyen V, Vandenplas O. Irritant-Induced Asthma. J Allergy Clin Immunol Pract 2022; 10:2799-2806. [PMID: 35820617 DOI: 10.1016/j.jaip.2022.06.045] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 06/30/2022] [Accepted: 06/30/2022] [Indexed: 06/15/2023]
Abstract
Irritant-induced asthma (IIA) is a phenotype of asthma caused by the inhalation of irritant agents. Definite, probable, or possible IIA have been described, depending on the concentration of the inhaled irritants and the onset of respiratory symptoms respective to the time of exposure. Definite IIA represents approximately 4% to 14% of all cases of new-onset work-related asthma. Agents responsible for IIA can be encountered as fumes, gases, aerosols, or dusts. The most frequent are chlorine, nitrogen oxides, sulfur dioxide, ammonia, acetic acid, solvents, and cleaning materials. Although the diagnosis of definite IIA is based on a suggestive clinical history along with evidence of reversible airflow limitation and/or nonspecific bronchial hyperresponsiveness, possible IIA cannot be diagnosed with certainty because the relationship between exposure and the onset of symptoms is difficult to establish. This article reviews the epidemiology, pathophysiology, diagnostic approach, and management of IIA.
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Affiliation(s)
- Catherine Lemiere
- Department of Chest Medicine, CIUSSS du Nord de l' Île de Montréal, Hôpital du Sacré-Cœur de Montréal, Montréal, Québec, Canada.
| | - Gabriel Lavoie
- Department of Chest Medicine, CIUSSS du Nord de l' Île de Montréal, Hôpital du Sacré-Cœur de Montréal, Montréal, Québec, Canada
| | - Virginie Doyen
- Department of Chest Medicine, Centre Hospitalier Universitaire UCL Namur, Université Catholique de Louvain, Yvoir, Belgium
| | - Olivier Vandenplas
- Department of Chest Medicine, Centre Hospitalier Universitaire UCL Namur, Université Catholique de Louvain, Yvoir, Belgium
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12
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Mishra N, Agarwal R. Research models of sulfur mustard- and nitrogen mustard-induced ocular injuries and potential therapeutics. Exp Eye Res 2022; 223:109209. [PMID: 35961426 DOI: 10.1016/j.exer.2022.109209] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 07/27/2022] [Accepted: 08/02/2022] [Indexed: 11/20/2022]
Abstract
Sulfur mustard (SM) is a notorious, bifunctional alkylating vesicant that was first used in warfare during World War I in 1917 and since then has been deployed in numerous skirmishes with its most recent documented use being during the Middle Eastern conflicts. Apart from its use in combat and terrorist activities, continual threat of accidental exposure from old stockpiles and improperly discarded munitions is ever present, especially to the innocent and unassuming civilian populations. SM can cause devastating injuries, depending on the dosage of SM exposure, route of exposure, as well as the physiological conditions of the individuals exposed. The most common routes of exposure are ocular, dermal, and exposure to the lungs and respiratory tissues through inhalation. Eyes are the most susceptible organ to SM-induced toxicities owing to their high moisture content and rapidly dividing cells. Additionally, ocular injury causes the most expeditious disablement of individuals even upon whole-body exposures. Therefore, it is imperative to understand the mechanisms underlying SM-induced ocular toxicity and design therapeutic interventions to prevent/mitigate ocular injuries. Ocular SM exposure may cause a wide range of symptoms such as inflammation, lacrimation, itching, dryness, photophobia, edema of the cornea/sclera/retina/iris, conjunctivitis, degradation of the corneal layer, fusion of two or more ocular layers, neovascularization, fibrosis, and temporary or permanent structural damage to one or more ocular layers. These symptoms may lead to vision impairments, resulting in partial or complete blindness that may be permanent. The highly toxic and exceedingly notorious nature of SM makes it a highly regulated chemical, requiring very expensive licensing, security, and safety requirements; thus, the more easily accessible analogue, nitrogen mustard (NM) that mimics SM-induced toxicity and injuries is employed in plethora of studies conducted in different animal models and culture systems. This review provides a comprehensive account of the injuries and symptoms that occur upon ocular SM exposures in human patients as well as studies in animal (in vivo, ex vivo) and cell (in vitro) models of SM and NM ocular exposures. Special emphasis has been laid on highlighting the strengths and lacunae in the research as well as the possible unexplored avenues of mechanisms underlying mustard-induced ocular injury that can be explored in future research endeavors. Furthermore, development of therapeutic interventions and targets of interest in the ocular system exposed to SM and NM, based on studies in human patients as well as in vivo, ex vivo, and in vitro models has been discussed in great depth, providing a valuable knowledge database to delineate pathways associated with vesicant-induced toxicity, and strategies/diagnostic tools against SM-induced toxicity.
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Affiliation(s)
- Neha Mishra
- Department of Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045, USA
| | - Rajesh Agarwal
- Department of Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045, USA.
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13
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Sockrider M. Managing Your Asthma: Avoiding Irritants. Am J Respir Crit Care Med 2022; 206:P1-P2. [PMID: 35776846 DOI: 10.1164/rccm.20601p1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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14
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Lantto J, Suojalehto H, Karvala K, Remes J, Soini S, Suuronen K, Lindström I. Clinical Characteristics of Irritant-Induced Occupational Asthma. J Allergy Clin Immunol Pract 2022; 10:1554-1561.e7. [PMID: 35259533 DOI: 10.1016/j.jaip.2022.02.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 01/25/2022] [Accepted: 02/04/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Work is a substantial contributing factor of adult-onset asthma. A subtype of occupational asthma (OA) is caused by irritant agents, but knowledge of the clinical outcomes of irritant-induced asthma (IIA) is incomplete. OBJECTIVES To evaluate whether the clinical picture of IIA differs from that of sensitizer-induced OA. METHODS This retrospective study analyzed acute and subacute IIA patients diagnosed in an occupational medicine clinic during 2004 to 2018. Sixty-nine patients fulfilled the inclusion criteria, and their characteristics were analyzed at the time of the diagnosis and 6 months later. The results were compared with those of 2 subgroups of sensitizer-induced OA: 69 high-molecular-weight (HMW) and 89 low-molecular-weight (LMW) agent-induced OA patients. RESULTS Six months after the diagnosis, 30% of the patients with IIA needed daily short-acting β-agonists (SABA), 68% were treated with Global Initiative for Asthma, 2020 report (GINA) step 4-5 medication, and 24% of the patients had asthma exacerbation after the first appointment. IIA depicted inferiority to LMW-induced OA in daily need for SABA (odds ratio [OR]: 3.80, 95% confidence interval [CI]: 1.38-10.46), treatment with GINA step 4-5 medication (OR: 2.22, 95% CI: 1.08-4.57), and exacerbation (OR: 3.85, 95% CI: 1.35-11.04). IIA showed poorer results than HMW-induced OA in the latter 2 of these features (OR: 2.49, 95% CI: 1.07-5.79 and OR: 6.29, 95% CI: 1.53-25.83, respectively). CONCLUSIONS Six months after the OA diagnosis, a significant proportion of the patients with IIA remain symptomatic and the majority of these patients use asthma medications extensively suggesting uncontrolled asthma. The short-term outcomes of IIA appear poorer than that of sensitizer-induced OA.
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Affiliation(s)
- Jussi Lantto
- Doctoral Program in Clinical Research, University of Helsinki, Helsinki, Finland; Finnish Institute of Occupational Health, Occupational Medicine, Helsinki, Finland.
| | - Hille Suojalehto
- Finnish Institute of Occupational Health, Occupational Medicine, Helsinki, Finland
| | - Kirsi Karvala
- Finnish Institute of Occupational Health, Occupational Medicine, Helsinki, Finland; Varma Mutual Pension Insurance Company, Consultant Physicians, Helsinki, Finland
| | - Jouko Remes
- Finnish Institute of Occupational Health, Occupational Medicine, Oulu, Finland
| | - Satu Soini
- Finnish Institute of Occupational Health, Occupational Medicine, Oulu, Finland
| | - Katri Suuronen
- Finnish Institute of Occupational Health, Occupational Medicine, Helsinki, Finland
| | - Irmeli Lindström
- Finnish Institute of Occupational Health, Occupational Medicine, Helsinki, Finland
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15
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Jacobsen G, Rasmussen K, Bregnhøj A, Isaksson M, Diepgen TL, Carstensen O. Causes of irritant contact dermatitis after occupational skin exposure: a systematic review. Int Arch Occup Environ Health 2022; 95:35-65. [PMID: 34665298 PMCID: PMC8755674 DOI: 10.1007/s00420-021-01781-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 07/11/2021] [Indexed: 01/15/2023]
Abstract
PURPOSE Irritant contact dermatitis (ICD) is a major cause of occupational disease. The aim was to review the relation between exposure to occupational irritants and ICD and the prognosis of ICD. METHODS Through a systematic search, 1516 titles were identified, and 48 studies were included in the systematic review. RESULTS We found that the evidence for an association between ICD and occupational irritants was strong for wet work, moderate for detergents and non-alcoholic disinfectants, and strong for a combination. The highest quality studies provided limited evidence for an association with use of occlusive gloves without other exposures and moderate evidence with simultaneous exposure to other wet work irritants. The evidence for an association between minor ICD and exposure to metalworking fluids was moderate. Regarding mechanical exposures, the literature was scarce and the evidence limited. We found that the prognosis for complete healing of ICD is poor, but improves after decrease of exposure through change of occupation or work tasks. There was no substantial evidence for an influence of gender, age, or household exposures. Inclusion of atopic dermatitis in the analysis did not alter the risk of ICD. Studies were at risk of bias, mainly due to selection and misclassification of exposure and outcome. This may have attenuated the results. CONCLUSION This review reports strong evidence for an association between ICD and a combination of exposure to wet work and non-alcoholic disinfectants, moderate for metalworking fluids, limited for mechanical and glove exposure, and a strong evidence for a poor prognosis of ICD.
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Affiliation(s)
- Gitte Jacobsen
- Department of Occupational Medicine, Danish Ramazzini Centre, Regional Hospital West Jutland, University Research Clinic, Herning, Denmark.
- Department of Occupational Medicine, Hospital South West Jutland, University Hospital of Southern Denmark, Esbjerg, Denmark.
| | - Kurt Rasmussen
- Department of Occupational Medicine, Danish Ramazzini Centre, Regional Hospital West Jutland, University Research Clinic, Herning, Denmark
| | - Anne Bregnhøj
- Department of Dermatology, Aarhus University Hospital, Aarhus, Denmark
| | - Marléne Isaksson
- Department of Occupational and Environmental Dermatology, Skåne University Hospital, Lund University, Malmö, Sweden
| | - Thomas L Diepgen
- Department of Clinical Social Medicine, Occupational and Environmental Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Ole Carstensen
- Department of Occupational Medicine, Danish Ramazzini Centre, Regional Hospital West Jutland, University Research Clinic, Herning, Denmark
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16
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Martin WK, Padilla S, Kim YH, Hunter DL, Hays MD, DeMarini DM, Hazari MS, Gilmour MI, Farraj AK. Zebrafish irritant responses to wildland fire-related biomass smoke are influenced by fuel type, combustion phase, and byproduct chemistry. J Toxicol Environ Health A 2021; 84:674-688. [PMID: 34006202 PMCID: PMC8237130 DOI: 10.1080/15287394.2021.1925608] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Human exposure to wildfire-derived particulate matter (PM) is linked to adverse health outcomes; however, little is known regarding the influence of biomass fuel type and burn conditions on toxicity. The aim of this study was to assess the irritant potential of extractable organic material (EOM) of biomass smoke condensates from five fuels (eucalyptus, pine, pine needle, peat, or red oak), representing various fire-prone regions of the USA, burned at two temperatures each [flaming (approximately 640°C) or (smoldering approximately 500°C)] using a locomotor assay in zebrafish (Danio rerio) larvae. It was postulated that locomotor responses, as measures of irritant effects, might be dependent upon fuel type and burn conditions and that these differences relate to combustion byproduct chemistry. To test this, locomotor activity was tracked for 60 min in 6-day-old zebrafish larvae (25-32/group) immediately after exposure to 0.4% dimethyl sulfoxide (DMSO) vehicle or EOM from the biomass smoke condensates (0.3-30 µg EOM/ml; half-log intervals). All EOM samples produced concentration-dependent irritant responses. Linear regression analysis to derive rank-order potency indicated that on a µg PM basis, flaming pine and eucalyptus were the most irritating. In contrast, on an emission-factor basis, which normalizes responses to the amount of PM produced/kg of fuel burned, smoldering smoke condensates induced greater irritant responses (>100-fold) than flaming smoke condensates, with smoldering pine being the most potent. Importantly, irritant responses significantly correlated with polycyclic aromatic hydrocarbon (PAH) content, but not with organic carbon or methoxyphenols. Data indicate that fuel type and burn condition influence the quantity and chemical composition of PM as well as toxicity.
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Affiliation(s)
- W Kyle Martin
- Curriculum in Toxicology and Environmental Medicine, UNC-Chapel Hill, USA
| | - S Padilla
- Biomolecular and Computational Toxicology Division, Us Epa, Rtp, NC, US
| | - Y H Kim
- Center for Environmental Medicine, Asthma and Lung Biology, University of North Carolina, Chapel Hill, NC, US
| | - D L Hunter
- Biomolecular and Computational Toxicology Division, Us Epa, Rtp, NC, US
| | - M D Hays
- Air Methods & Characterization Division, Us Epa, Rtp, NC, US
| | - D M DeMarini
- Biomolecular and Computational Toxicology Division, Us Epa, Rtp, NC, US
| | - M S Hazari
- Public Health and Integrated Toxicology Division, Us Epa, Rtp, NC, US
| | - M I Gilmour
- Public Health and Integrated Toxicology Division, Us Epa, Rtp, NC, US
| | - A K Farraj
- Public Health and Integrated Toxicology Division, Us Epa, Rtp, NC, US
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Niazi S, Brabec B, Anschutz L, Willson C, Davidson M, Burnett P. A Phase 2 Open-Label Study to Evaluate VP-102 for the Treatment of Molluscum Contagiosum. J Drugs Dermatol 2021; 20:70-75. [PMID: 33400412 DOI: 10.36849/jdd.5626] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND This Phase 2, open-label study evaluated the safety, efficacy, systemic exposure, and impact on quality of life (QoL) with treatment using VP-102, a drug-device combination containing cantharidin (0.7% w/v) in subjects with molluscum contagiosum (MC). STUDY DESIGN Pediatric subjects with MC (2–15 years of age) were eligible to enroll in this 12-week study. MC lesions were treated topically with VP-102 every 21 days until clearance (maximum of 4 treatments). Adverse events (AEs) and QoL outcomes (using the Children's Quality of Life Index, CDLQI) were documented at each visit. Rate of complete clearance and the percent reduction in lesions were measured at each visit on days 21, 42, 63, and 84 (end of study [EOS] visit). A group of 17 subjects with at least 21 MC lesions was evaluated for systemic cantharidin exposure via plasma samples obtained before the first application of VP-102, and at 2 hours, 6 hours, and 24 hours post-application. RESULTS A total of 33 subjects enrolled in the study (n=17 systemic exposure group, n=16 standard group). There were an equal number of male and female subjects. Subject mean (SD, range) age was 6.7 (3.3, 2–15) years, with a mean lesion count of 30 (26.1, 3–113). Complete lesion clearance was achieved in 48.5% of subjects, with a 90.4% reduction in lesions from baseline to the EOS visit. Mean CDLQI score decreased from 2.6 at baseline to 0.38 at the EOS visit. AEs were mild to moderate in severity and expected due to the pharmacodynamic action of cantharidin. There were no serious treatment-related adverse events and no study discontinuations due to treatment. In the systemic exposure group plasma cantharidin levels were below the lower limit of quantitation (LLOQ, 2.5 ng/mL) in 65 of 66 samples. CONCLUSIONS VP-102 treatment resulted in a reduction in lesion counts and improved QoL. Treated subjects had a 48.5% rate of complete clearance of molluscum lesions. Negligible systemic cantharidin exposure was observed in the systemic exposure group. This data demonstrates safety and efficacy of treatment with VP-102 in MC; a widespread viral infection that does not have any current FDA-approved treatments. Significant Finding: Treatment of subjects with MC using VP-102 resulted in negligible systemic cantharidin exposure, as well as a reduction in lesion counts, improved QoL, and a demonstrated efficacy in clearance of new and baseline MC lesions. Meaning: Results of this Phase 2 study demonstrate efficacy and safety outcomes in using VP-102 in MC subjects, and large randomized clinical trials are warranted to compare topical VP-102 with a vehicle control in order to fully evaluate the use of the medication. ClinicalTrials.gov identifier: NCT03186378 J Drugs Dermatol. 2021;20(1):70-75. doi:10.36849/JDD.5626.
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Sandage MJ, Ostwalt ES, Allison LH, Cutchin GM, Morton ME, Odom SC. Irritant-Induced Chronic Cough Triggers: A Scoping Review and Clinical Checklist. Am J Speech Lang Pathol 2021; 30:1261-1291. [PMID: 33989029 DOI: 10.1044/2021_ajslp-20-00362] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Purpose The primary aim of this review was to identify environmental irritants known to trigger chronic cough through the life span and develop a comprehensive clinically useful irritant checklist. Method A scoping review was conducted using the Preferred Reporting Items for Systematic Review and Meta-Analysis Extension for Scoping Reviews, checklist, and explanation. English-language, full-text resources were identified through Medline, PsycINFO, SPORTDiscus, Web of Science, and ProQuest Dissertations and Theses Global. Results A total of 1,072 sources were retrieved; of these, 109 were duplicates. Titles of abstracts of 963 articles were screened, with 295 selected for full-text review. Using the exclusion and inclusion criteria listed, 236 articles were considered eligible and 214 different triggers were identified. Triggers were identified from North America, Europe, Africa, Asia, and Australia. Occupational exposures were also delineated. Conclusions A clinically useful checklist of both frequently encountered triggers and idiosyncratic or rare triggers was developed. The clinical checklist provides a unique contribution to streamline and standardize clinical assessment of irritant-induced chronic cough. The international scope of this review extends the usefulness of the clinical checklist to clinicians on most continents.
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Affiliation(s)
- Mary J Sandage
- Department of Speech, Language, and Hearing Sciences, Auburn University, AL
| | | | - Lauren H Allison
- Department of Speech, Language, and Hearing Sciences, Auburn University, AL
| | - Grace M Cutchin
- Department of Speech, Language, and Hearing Sciences, Auburn University, AL
| | | | - Shelby C Odom
- Department of Speech, Language, and Hearing Sciences, Auburn University, AL
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Tamagawa-Mineoka R, Katoh N. Atopic Dermatitis: Identification and Management of Complicating Factors. Int J Mol Sci 2020; 21:ijms21082671. [PMID: 32290423 PMCID: PMC7215488 DOI: 10.3390/ijms21082671] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 04/09/2020] [Accepted: 04/10/2020] [Indexed: 12/23/2022] Open
Abstract
Atopic dermatitis (AD) is a chronic relapsing inflammatory skin disease, associated with impaired skin barrier function and an atopic background. Various complicating factors, such as irritants, aeroallergens, food, microbial organisms, contact allergens, sweat, and scratching can induce the development of AD symptoms. Irritants, including soap/shampoo and clothes, can cause itching and eczematous lesions. In addition, young children with AD tend to become sensitized to eggs, milk, or peanuts, while older children and adults more often become sensitized to environmental allergens, such as house dust mites (HDM), animal dander, or pollen. Serum-specific IgE levels and skin prick test reactions to food tend to show high negative predictive values and low specificity and positive predictive values for diagnosing food allergy. On the other hand, AD adult patients tend to have severe skin symptoms and exhibit high HDM-specific IgE levels. Microbial organisms, e.g., Staphylococcus aureus and Malassezia furfur, might contribute to the pathogenetic mechanisms of AD. While sweat plays a major role in maintaining skin homeostasis, it can become an aggravating factor in patients with AD. Furthermore, scratching often exacerbates eczematous lesions. Several patient-specific complicating factors are seen in most cases. The identification and management of complicating factors are important for controlling AD.
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Yin X, Wu H, Zhang B, Zhu N, Chen T, Ma X, Zhang L, Lv L, Zhang M, Wang F, Tang X. Tojapride prevents CaSR-mediated NLRP3 inflammasome activation in oesophageal epithelium irritated by acidic bile salts. J Cell Mol Med 2020; 24:1208-1219. [PMID: 31859410 PMCID: PMC6991659 DOI: 10.1111/jcmm.14631] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Revised: 06/23/2019] [Accepted: 08/06/2019] [Indexed: 12/11/2022] Open
Abstract
Impairment of the oesophageal epithelium in patients with reflux oesophagitis (RE) is a cytokine-mediated injury rather than a chemical burn. The present study was conducted to explore CaSR/NLRP3 inflammasome pathway activation and cytokines IL-1β and IL-18 release in oesophageal epithelia injured by refluxates and the effects of Tojapride on that signal regulation. Using a modified RE rat model with Tojapride administration and Tojapride-pretreated SV40-immortalized human oesophageal epithelial cells (HET-1A) exposed to acidic bile salts pretreated with Tojapride, we evaluated the therapeutic effects of Tojapride on oesophageal epithelial barrier function, the expression of CaSR/NLRP3 inflammasome pathway-related proteins and the release of downstream cytokines in response to acidic bile salt irritation. In vivo, Tojapride treatment ameliorated the general condition and pathological lesions of the oesophageal epithelium in modified RE rats. In addition, Tojapride effectively blocked the CaSR-mediated NLRP3 inflammasome activation in modified RE rats. In vitro, Tojapride treatment can reverse the harmful effect of acidic bile salts, which reduced transepithelial electrical resistance (TEER), up-regulated the CaSR-mediated NLRP3 inflammasome pathway and increased caspase-1 activity, LDH release and cytokines secretion. Taken together, these data show that Tojapride can prevent CaSR-mediated NLRP3 inflammasome activation and alleviate oesophageal epithelial injury induced by acidic bile salt exposure.
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Affiliation(s)
- Xiao‐Lan Yin
- Department of GastroenterologyChina Academy of Chinese Medical SciencesXiyuan HospitalBeijingChina
| | - Hao‐Meng Wu
- Department of Gastroenterology, Guangzhou Higher Education Mega CenterThe Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Xiao‐gu‐wei JieGuangzhouChina
| | - Bei‐Huang Zhang
- Department of GastroenterologyChina Academy of Chinese Medical SciencesXiyuan HospitalBeijingChina
| | - Ning‐Wei Zhu
- Department of PharmacyZhejiang Pharmaceutical CollegeNingboChina
| | - Ting Chen
- Department of GastroenterologyChina Academy of Chinese Medical SciencesXiyuan HospitalBeijingChina
| | - Xiang‐Xue Ma
- Department of GastroenterologyChina Academy of Chinese Medical SciencesXiyuan HospitalBeijingChina
| | - Li‐Ying Zhang
- Department of GastroenterologyChina Academy of Chinese Medical SciencesXiyuan HospitalBeijingChina
| | - Lin Lv
- Department of GastroenterologyChina Academy of Chinese Medical SciencesXiyuan HospitalBeijingChina
| | - Min Zhang
- Department of GastroenterologyChina Academy of Chinese Medical SciencesXiyuan HospitalBeijingChina
| | - Feng‐Yun Wang
- Department of GastroenterologyChina Academy of Chinese Medical SciencesXiyuan HospitalBeijingChina
| | - Xu‐Dong Tang
- Department of GastroenterologyChina Academy of Chinese Medical SciencesXiyuan HospitalBeijingChina
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Abstract
BACKGROUND The hospital departments for occupational medicine and the National Institute of Occupational Health (STAMI) established a shared, anonymous patient register in 2009. This report describes the diagnoses, occupations and exposure factors that occur most frequently in the youngest patient group. This will reflect exposures in modern working life in particular, and thus produce important knowledge with regard to targeted prevention efforts. MATERIAL AND METHOD We have undertaken a descriptive analysis of 910 examinations of patients in the age group 20-29 years, performed in occupational medicine departments in Norway during the period 2010-17. RESULTS Examinations of patients aged 20-29 years accounted for 914 (8 %) of a total of 11 969 recorded patient examinations. We excluded four participants for whom information on their sex was missing. This age group encompassed 498 (55 %) men, compared to 75 % men in the total dataset. The most frequent diagnoses were asthma (187/910, 21 %), contact eczema (184/910, 20 %) and rhinitis (73/910, 8 %). The most frequent exposure factors were irritants/allergens (469/910, 52 %). The most common occupations were hairdresser (159/910, 17 %) and painter/varnisher (46/910, 5 %). Hairdresser was the predominant occupation among women (154/412, 37 %), while painter/varnisher (35/498, 7 %) and electrician (25/498, 5 %) predominated among men. INTERPRETATION Young patients who are examined in occupational medicine departments in Norway are most frequently registered with asthma or hand eczema. Hairdressers are especially exposed, indicating a special need for primary prevention in this occupation to prevent development of illness. In cases of asthma and hand eczema, doctors should be aware of the possibility that this might be occupationally related.
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LaCour M, Meaux T. Hand Dermatitis: Pathology, Diagnosis, and Management. Skinmed 2019; 17:30-34. [PMID: 30888945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Hand dermatitis is a common skin disorder that can negatively impact a patient's daily life and occupation. The necessity and frequency of hand use can expose the overlying skin to irritation, trauma, and observation from others. This can make hand dermatitis irritating to active hands and difficult to treat, as irritant exposure is often difficult to avoid. Due to the variable degrees of presentations of hand dermatitis, it is essential for dermatologists to adequately recognize the variable presentation, establish a definitive diagnosis, and develop an appropriate treatment. This review explores the pathogenesis, clinical types, diagnosis methods, treatment, and prognosis of hand dermatitis. (SKINmed. 2019;17:30-34).
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Affiliation(s)
- Matthew LaCour
- School of Medicine, University of Texas Medical Branch, Galveston, TX
| | - Tyson Meaux
- Department of Dermatology, Louisiana State University, School of Medicine, New Orleans, LA
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Melo MDGM, Villarinho ALCF, Leite IDC. Sociodemographic and clinical profile of patients with occupational contact dermatitis seen at a work-related dermatology service, 2000 - 2014. An Bras Dermatol 2019; 94:147-156. [PMID: 31090819 PMCID: PMC6486076 DOI: 10.1590/abd1806-4841.20197235] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 11/30/2017] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Occupational dermatoses are common, especially contact dermatitis. Epidemiological studies on these dermatoses are scarce in Brazil and they are necessary as part of the public policy to protect workers' health. OBJECTIVES To identify sociodemographic and clinical profile of patients with occupational contact dermatitis seen between 2000 and 2014 at an occupational dermatology service. METHODS It is a cross-sectional and retrospective study, based on information obtained from the service's database. RESULTS Of 560 patients with conclusive patch test, 289 (46.9%) presented occupational dermatoses and 213 occupational contact dermatitis with predominance of the allergic type in relation to the irritative type (149:64 respectively). The odds of occupational dermatoses were higher among men and lower among patients aged 50 years or older and with higher level of education. Regarding the possibility of presenting occupational allergic contact dermatitis, only the gender variable was statistically significant. The professions most seen were cleaners, construction workers, painters, mechanics/metallurgists and cooks. The commonest allergens were nickel sulfate, potassium dichromate, cobalt chloride, carba-mix and formaldehyde. STUDY LIMITATIONS The main limitations of this study are the fact that it was carried out in a tertiary service of occupational dermatoses and the lack of access to some allergens outside the patch test baseline series. CONCLUSIONS It was possible to identify the sociodemographic and clinical profile of patients with suspected occupational contact dermatitis seen at the Service, beyond the professional groups and allergens related to a high risk of occupational contact dermatitis in this population.
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Affiliation(s)
- Maria das Graças Mota Melo
- Sector of Occupational Dermatology, Centro de Estudos da
Saúde do Trabalhador e Ecologia Humana, Escola Nacional de Saúde
Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro
(RJ), Brazil
| | - Ana Luiza Castro Fernandes Villarinho
- Sector of Occupational Dermatology, Centro de Estudos da
Saúde do Trabalhador e Ecologia Humana, Escola Nacional de Saúde
Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro
(RJ), Brazil
| | - Iuri da Costa Leite
- Department of Epidemiology and Health Quantitative
Methods, Escola Nacional de Saúde Pública Sergio Arouca,
Fundação Oswaldo Cruz, Rio de Janeiro (RJ), Brazil
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Gilmour N, Kimber I, Williams J, Maxwell G. Skin sensitization: Uncertainties, challenges, and opportunities for improved risk assessment. Contact Dermatitis 2019; 80:195-200. [PMID: 30525211 PMCID: PMC6587935 DOI: 10.1111/cod.13167] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 10/23/2018] [Indexed: 02/01/2023]
Abstract
At the ESCD congress held in Manchester in 2016, a session was organized to encourage more dialogue between clinicians with expertise in skin sensitization and toxicologists seeking to provide effective risk assessment to prevent human health issues. That session focused on the remaining uncertainties regarding the induction and regulation of skin sensitization in humans, and the opportunities and challenges associated with the refinement and improvement of risk assessment methodologies. This short article, prompted by those discussions, debates what the authors regard as being among the most important and most intriguing uncertainties about skin sensitization and allergic contact dermatitis in humans, and the most significant opportunities for improving risk assessment. The aim has been to provide a basis for mapping out the areas that might benefit from a closer alignment between the relevant clinical community and toxicologists charged with the responsibility of ensuring that skin sensitization risks are understood and managed.
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Affiliation(s)
- Nicola Gilmour
- Unilever Safety and Environmental Assurance CentreBedfordUK
| | - Ian Kimber
- Faculty of Biology, Medicine and HealthUniversity of ManchesterManchesterUK
| | - Jason Williams
- Contact Dermatitis Investigation Unit, Salford NHS Foundation TrustSalfordUK
| | - Gavin Maxwell
- Unilever Safety and Environmental Assurance CentreBedfordUK
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Girijala RL, Siddiqi I, Kwak Y, Wright D, Patel DB, Goldberg LH. Pustular DRESS Syndrome Secondary to Hydroxychloroquine With EBV Reactivation. J Drugs Dermatol 2019; 18:207-209. [PMID: 30811149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Background: Drug reaction with eosinophilia and systemic symptoms (DRESS syndrome) or drug-induced hypersensitivity (DIHS) is a rare and feared complication of frequently used medications such as anticonvulsants, sulfonamides, and allopurinol. To date, no reports of hydroxychloroquine-induced pustular DRESS syndrome have been associated with Epstein-Barr virus (EBV) reactivation nor imitated other cutaneous adverse drug reactions as in our patient. Observation: A 56-year-old female presented with a diffuse cutaneous eruption involving the face, trunk, extremities, and palms approximately two weeks after the initiation of hydroxychloroquine therapy for a suspected Sjögren's-like process with inflammatory cervical lymphadenopathy. Skin examination demonstrated diffuse erythematous and edematous papules and pustules on her dorsal and volar hands and fingers, arms, legs, chest, abdomen, back, scalp, and face. In many areas, lesions coalesced into plaques with overlying pustules, scale, and crust. Additional notable exam findings included centralized facial edema, edema of the hands, and cervical lymphadenopathy. Laboratory workup revealed leukocytosis, peripheral eosinophilia, elevated transaminases, and a negative autoimmune workup; however, serology demonstrated EBV reactivation. Histologic assessment displayed a spongiotic dermatitis with eosinophils, superficial perivascular dermatitis, as well as corneal, subcorneal, and intraepidermal neutrophilic microabscesses, mimicking acute generalized exanthematous pustulosis or pustular psoriasis, even though clinical evaluation suggested DRESS syndrome. Conclusion: To our knowledge, this is the first reported case of hydroxychloroquine-induced pustular DRESS syndrome in the context of EBV reactivation. Given hydroxychloroquine’s immunomodulatory function and association with other cutaneous manifestations, our patient represents a significant diagnostic challenge. Therefore, this case highlights the importance of knowledge regarding overlapping features, histologically and clinically, among acute generalized exanthematous pustulosis, pustular psoriasis, and DRESS syndrome. J Drugs Dermatol. 2019;18(2):207-209.
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Abstract
Peripheral infiltration is defined as the inadvertent delivery of nonvesicant fluid or medication into surrounding tissue that has the potential to harm the patient. Vesicant fluid that has leaked into the tissue space is called extravasation. At present, there is no agreement in the literature on the best practice for managing these injuries in pediatric patients. The purpose of this study was to identify occurrences of peripheral infiltration injuries and examine treatment modalities used to treat pediatric patients who suffered such an injury.
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Affiliation(s)
- Brian Odom
- Arkansas Children's Hospital, Little Rock, Arkansas (Dr Yates, Mr Odom); Harding University Physical Therapy Program, Searcy, Arkansas (Mr Odom); University of Central Arkansas, Conway, Arkansas (Drs Yates and Lowe, Mr Odom); and Center for Translational Neuroscience, University of Arkansas for Medical Sciences, Little Rock, Arkansas (Dr Yates). Brian Odom, MS, PT, CWS, is an assistant professor in the physical therapy program at Harding University, where he teaches integumentary, cardiopulmonary, and clinical reasoning. Board certified in wound care, he practices at Arkansas Children's Hospital. His emphasis in wound care focuses on acute trauma, pressure ulcers, and wounds in intensive care units. He is also a PhD student at the University of Central Arkansas. Leah Lowe, PhD, DPT, PT, PCS, is an assistant professor of physical therapy at the University of Central Arkansas. She teaches in the pediatrics course work and is the course director for Physical Therapy Research 1-2. She is a board-certified pediatric clinical specialist and practices at Pediatrics Plus, a specialized pediatric health care provider. Charlotte Yates, PhD, PT, PCS, is an associate professor at the University of Central Arkansas, where she teaches neuroscience, pediatrics, and integumentary. She is a research faculty member at the Center for Translational Neuroscience. A board-certified clinical specialist in pediatrics, Dr Yates practices at Arkansas Children's Hospital. Her emphasis on wound care is acute trauma
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Xie D, Choudhary V, Seremwe M, Edwards JG, Wang A, Emmons AC, Bollag KA, Johnson MH, Bollag WB. Soy Phosphatidylglycerol Reduces Inflammation in a Contact Irritant Ear Edema Mouse Model In Vivo. J Pharmacol Exp Ther 2018; 366:1-8. [PMID: 29695409 PMCID: PMC5988020 DOI: 10.1124/jpet.117.244756] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2017] [Accepted: 04/17/2018] [Indexed: 01/05/2023] Open
Abstract
We have previously shown that phosphatidylglycerol (PG) regulates the function of keratinocytes, the predominant cells that compose the epidermis, inhibiting the proliferation of rapidly dividing keratinocytes. In particular, soy PG, a PG mixture with a high proportion of polyunsaturated fatty acids, is efficacious at inhibiting these proliferating keratinocytes. Psoriasis is a skin disorder characterized by hyperproliferation of keratinocytes and inflammation. Data in the lung suggest that PG in pulmonary surfactant inhibits inflammation. To investigate the possibility of using PG containing polyunsaturated fatty acids for the treatment of psoriasis, we examined the effect of soy PG on inflammation induced by the application of 12-O-tetradecanoylphorbol 13-acetate (TPA), a contact irritant, to mouse ears in vivo. We monitored ear thickness and weight as a measure of ear edema, as well as CD45-positive immune cell infiltration. Our results indicate that soy PG when applied together with 1,25-dihydroxyvitamin D3 (vitamin D), an agent known to acutely disrupt the skin barrier, suppressed ear edema and inhibited the infiltration of CD45-positive immune cells. On the other hand, neither PG nor vitamin D alone was effective. The combination also decreased tumor necrosis factor-α (TNFα) levels. This result suggested the possibility that PG was not permeating the skin barrier efficiently. Therefore, in a further study we applied PG in a penetration-enhancing vehicle and found that it inhibited inflammation induced by the phorbol ester and decreased CD45-positive immune cell infiltration. Our results suggest the possibility of using soy PG as a topical treatment option for psoriasis.
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Affiliation(s)
- Ding Xie
- Charlie Norwood VA Medical Center, Augusta, Georgia (V.C., W.B.B.); Institute of Molecular Medicine and Genetics, Department of Medicine (D.X., M.S., W.B.B.), Department of Physiology (D.X., V.C., M.S., A.W., A.C.E., K.A.B., W.B.B.), Department of Family Medicine (D.X.), Department of Neuroscience and Regenerative Medicine (M.H.J.), and Division of Dermatology, Department of Medicine (W.B.B.), Medical College of Georgia, Augusta University, Augusta, Georgia; and Apeliotus Technologies, Inc., Philadelphia, Pennsylvania (J.G.E., W.B.B.)
| | - Vivek Choudhary
- Charlie Norwood VA Medical Center, Augusta, Georgia (V.C., W.B.B.); Institute of Molecular Medicine and Genetics, Department of Medicine (D.X., M.S., W.B.B.), Department of Physiology (D.X., V.C., M.S., A.W., A.C.E., K.A.B., W.B.B.), Department of Family Medicine (D.X.), Department of Neuroscience and Regenerative Medicine (M.H.J.), and Division of Dermatology, Department of Medicine (W.B.B.), Medical College of Georgia, Augusta University, Augusta, Georgia; and Apeliotus Technologies, Inc., Philadelphia, Pennsylvania (J.G.E., W.B.B.)
| | - Mutsa Seremwe
- Charlie Norwood VA Medical Center, Augusta, Georgia (V.C., W.B.B.); Institute of Molecular Medicine and Genetics, Department of Medicine (D.X., M.S., W.B.B.), Department of Physiology (D.X., V.C., M.S., A.W., A.C.E., K.A.B., W.B.B.), Department of Family Medicine (D.X.), Department of Neuroscience and Regenerative Medicine (M.H.J.), and Division of Dermatology, Department of Medicine (W.B.B.), Medical College of Georgia, Augusta University, Augusta, Georgia; and Apeliotus Technologies, Inc., Philadelphia, Pennsylvania (J.G.E., W.B.B.)
| | - John G Edwards
- Charlie Norwood VA Medical Center, Augusta, Georgia (V.C., W.B.B.); Institute of Molecular Medicine and Genetics, Department of Medicine (D.X., M.S., W.B.B.), Department of Physiology (D.X., V.C., M.S., A.W., A.C.E., K.A.B., W.B.B.), Department of Family Medicine (D.X.), Department of Neuroscience and Regenerative Medicine (M.H.J.), and Division of Dermatology, Department of Medicine (W.B.B.), Medical College of Georgia, Augusta University, Augusta, Georgia; and Apeliotus Technologies, Inc., Philadelphia, Pennsylvania (J.G.E., W.B.B.)
| | - Angela Wang
- Charlie Norwood VA Medical Center, Augusta, Georgia (V.C., W.B.B.); Institute of Molecular Medicine and Genetics, Department of Medicine (D.X., M.S., W.B.B.), Department of Physiology (D.X., V.C., M.S., A.W., A.C.E., K.A.B., W.B.B.), Department of Family Medicine (D.X.), Department of Neuroscience and Regenerative Medicine (M.H.J.), and Division of Dermatology, Department of Medicine (W.B.B.), Medical College of Georgia, Augusta University, Augusta, Georgia; and Apeliotus Technologies, Inc., Philadelphia, Pennsylvania (J.G.E., W.B.B.)
| | - Aaron C Emmons
- Charlie Norwood VA Medical Center, Augusta, Georgia (V.C., W.B.B.); Institute of Molecular Medicine and Genetics, Department of Medicine (D.X., M.S., W.B.B.), Department of Physiology (D.X., V.C., M.S., A.W., A.C.E., K.A.B., W.B.B.), Department of Family Medicine (D.X.), Department of Neuroscience and Regenerative Medicine (M.H.J.), and Division of Dermatology, Department of Medicine (W.B.B.), Medical College of Georgia, Augusta University, Augusta, Georgia; and Apeliotus Technologies, Inc., Philadelphia, Pennsylvania (J.G.E., W.B.B.)
| | - Katherine A Bollag
- Charlie Norwood VA Medical Center, Augusta, Georgia (V.C., W.B.B.); Institute of Molecular Medicine and Genetics, Department of Medicine (D.X., M.S., W.B.B.), Department of Physiology (D.X., V.C., M.S., A.W., A.C.E., K.A.B., W.B.B.), Department of Family Medicine (D.X.), Department of Neuroscience and Regenerative Medicine (M.H.J.), and Division of Dermatology, Department of Medicine (W.B.B.), Medical College of Georgia, Augusta University, Augusta, Georgia; and Apeliotus Technologies, Inc., Philadelphia, Pennsylvania (J.G.E., W.B.B.)
| | - Maribeth H Johnson
- Charlie Norwood VA Medical Center, Augusta, Georgia (V.C., W.B.B.); Institute of Molecular Medicine and Genetics, Department of Medicine (D.X., M.S., W.B.B.), Department of Physiology (D.X., V.C., M.S., A.W., A.C.E., K.A.B., W.B.B.), Department of Family Medicine (D.X.), Department of Neuroscience and Regenerative Medicine (M.H.J.), and Division of Dermatology, Department of Medicine (W.B.B.), Medical College of Georgia, Augusta University, Augusta, Georgia; and Apeliotus Technologies, Inc., Philadelphia, Pennsylvania (J.G.E., W.B.B.)
| | - Wendy B Bollag
- Charlie Norwood VA Medical Center, Augusta, Georgia (V.C., W.B.B.); Institute of Molecular Medicine and Genetics, Department of Medicine (D.X., M.S., W.B.B.), Department of Physiology (D.X., V.C., M.S., A.W., A.C.E., K.A.B., W.B.B.), Department of Family Medicine (D.X.), Department of Neuroscience and Regenerative Medicine (M.H.J.), and Division of Dermatology, Department of Medicine (W.B.B.), Medical College of Georgia, Augusta University, Augusta, Georgia; and Apeliotus Technologies, Inc., Philadelphia, Pennsylvania (J.G.E., W.B.B.)
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Le Moual N, Zock JP, Dumas O, Lytras T, Andersson E, Lillienberg L, Schlünssen V, Benke G, Kromhout H. Update of an occupational asthma-specific job exposure matrix to assess exposure to 30 specific agents. Occup Environ Med 2018; 75:507-514. [PMID: 29650699 DOI: 10.1136/oemed-2017-104866] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 02/09/2018] [Accepted: 03/15/2018] [Indexed: 01/26/2023]
Abstract
OBJECTIVES We aimed to update an asthmagen job exposure matrix (JEM) developed in the late 1990s. Main reasons were: the number of suspected and recognised asthmagens has since tripled; understanding of the aetiological role of irritants in asthma and methodological insights in application of JEMs have emerged in the period. METHODS For each agent of the new occupational asthma-specific JEM (OAsJEM), a working group of three experts out of eight evaluated exposure for each International Standard Classification of Occupations, 1988 (ISCO-88) job code into three categories: 'high' (high probability of exposure and moderate-to-high intensity), 'medium' (low-to-moderate probability or low intensity) and 'unexposed'. Within a working group, experts evaluated exposures independently from each other. If expert assessments were inconsistent the final decision was taken by consensus. Specificity was favoured over sensitivity, that is, jobs were classified with high exposure only if the probability of exposure was high and the intensity moderate-to-high. In the final review, all experts checked assigned exposures and proposed/improved recommendations for expert re-evaluation after default application of the JEM. RESULTS The OAsJEM covers exposures to 30 sensitisers/irritants, including 12 newly recognised, classified into seven broad groups. Initial agreement between the three experts was mostly fair to moderate (κ values 0.2-0.5). Out of 506 ISCO-88 codes, the majority was classified as unexposed (from 82.6% (organic solvents) to 99.8% (persulfates)) and a minority as 'high-exposed' (0.2% (persulfates) to 2.6% (organic solvents)). CONCLUSIONS The OAsJEM developed to improve occupational exposure assessment may improve evaluations of associations with asthma in epidemiological studies and contribute to assessment of the burden of work-related asthma.
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Affiliation(s)
- Nicole Le Moual
- Univ Versailles St-Quentin-en-Yvelines, UMR-S 1168, F-78180, Montigny le Bretonneux, France
- Inserm, U1168, VIMA: Aging and chronic diseases. Epidemiological and public health approaches, Inserm, F-94807, Villejuif, France
| | - Jan-Paul Zock
- Barcelona Institute of Global Health (ISGlobal), Barcelona, Spain
- University Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Orianne Dumas
- Univ Versailles St-Quentin-en-Yvelines, UMR-S 1168, F-78180, Montigny le Bretonneux, France
- Inserm, U1168, VIMA: Aging and chronic diseases. Epidemiological and public health approaches, Inserm, F-94807, Villejuif, France
| | - Theodore Lytras
- Barcelona Institute of Global Health (ISGlobal), Barcelona, Spain
- University Pompeu Fabra (UPF), Barcelona, Spain
| | - Eva Andersson
- Department of Occupational and Environmental Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Linnéa Lillienberg
- Department of Occupational and Environmental Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Vivi Schlünssen
- Department of Public Health, Danish Ramazzini Centre, Aarhus University and National Research Center for the Working Environment, Copenhagen, Denmark
| | - Geza Benke
- Monash Centre for Occupation and Environmental Health, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Hans Kromhout
- Department of Environmental Epidemiology, Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
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Keller SC, Dzintars K, Gorski LA, Williams D, Cosgrove SE. Antimicrobial Agents and Catheter Complications in Outpatient Parenteral Antimicrobial Therapy. Pharmacotherapy 2018; 38:476-481. [PMID: 29493791 PMCID: PMC5902416 DOI: 10.1002/phar.2099] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVES Debate about whether certain antimicrobial agents traditionally considered vesicants increase the risk of catheter complications has led to uncertainty in venous catheter placement protocols. To understand whether patients requiring home-based outpatient parenteral antimicrobial therapy (OPAT) should receive peripheral catheters (e.g., midline catheters) versus central venous catheters, and to understand whether certain antimicrobial agents place home-based OPAT patients at higher risk for catheter complications, we investigated associations between antimicrobial agent(s) and catheter complications. METHODS We performed a prospective cohort study of patients requiring home-based OPAT discharged from two urban tertiary care academic medical centers, including telephone surveys and chart abstractions. Multivariable Poisson regressions were used to evaluate: (i) associations between antimicrobial agents traditionally considered vesicants, based on pH or osmolarity, and catheter complication rates, and (ii) associations between antimicrobial agent and rates of catheter complications. RESULTS Vesicant antimicrobials defined using pH or osmolarity criteria were not associated with an increased rate of catheter complications (adjusted incidence rate ratio [aIRR]: 1.63, 95% confidence interval [CI]: 0.89-2.96). Vancomycin was associated with an increased rate of catheter complications, as was daptomycin (aIRR: 2.32 [95% CI: 1.20-4.46] and 4.45 [95% CI: 1.02-19.41], respectively). Staphylococcus aureus infections were also associated with an increased rate of catheter complications (aIRR: 2.13, 95% CI: 1.09-4.19), as were midline catheters (aIRR: 9.44, 95% CI: 2.12-41.97). CONCLUSIONS Our study supports recent guidance identifying vancomycin as a vesicant, among a subset of antimicrobial agents, and removal of pH criteria for identification of vesicants.
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Affiliation(s)
- Sara C Keller
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Kathryn Dzintars
- Department of Pharmacy, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Lisa A Gorski
- Wheaton Franciscan Home Health, Milwaukee, Wisconsin
| | | | - Sara E Cosgrove
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Abstract
A 70-year-old man with malignant lymphoma was subjected to a fourth course of chemotherapy using gemcitabine and cisplatin. During the intravenous infusion of anticancer agents, pain and redness was observed at the site of insertion. The patient was subsequently treated with the strongest topical steroids and topical cooling agents. However, 2 weeks later, the affected area turned yellow, and the histopathological findings revealed skin necrosis of the entire dermis layer. It took two and a half months to cure the lesion. Close attention should be paid to the development of skin necrosis even when irritant anticancer agents such as gemcitabine and cisplatin are administered.
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Affiliation(s)
- Hiroto Okuda
- Division of Dermatology, Saiseikai Izuo Hospital, Japan
- School of Pharmacy and Pharmaceutical Sciences, Mukogawa Women's University, Japan
| | | | | | - Rie Arai
- Division of Dermatology, Saiseikai Izuo Hospital, Japan
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Fowler JF, J Zirwas MJZ, Napolitano L, Russell M, Coope-Epstein J. A Novel Multifactorial Approach to Developing Mild Laundry Detergents and Assessing Their Relative Mildness. J Drugs Dermatol 2017; 16:1235-1239. [PMID: 29240858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
INTRODUCTION: Dermatologists are becoming more aware of the irritant and allergic potential of laundry detergents that incorporate harsh surfactants and potentially sensitizing ingredients. It is difficult however for the physician to distinguish one laundry detergent from another because the only distinguishing feature advertised tends to be the lack of dyes and fragrances. DESIGN: A new objective method was developed for measuring the harshness of laundry detergents using a three-pronged laboratory testing approach consisting of zein, corneosurfametry, and cytokine testing. Combing these methods, a Detergent Mildness Index was created which conveniently provides a single value by which products can be compared. RESULTS: A new mild laundry detergent was formulated with ingredients carefully selected by dermatologists who are experts in con-tact dermatitis. The irritancy potential of the formula was measured using the Detergent mildness index score. Compared to 11 other commercial laundry detergents marketed for sensitive skin, the new formula is measurably the mildest formula. DISCUSSION: The Detergent Mildness Index provides dermatologists with an objective method to compare commercial laundry deter-gents. Currently the only method available is patch testing, this new test is able to more finely differentiate between products and thus enables more informed recommendations on laundry detergent choices for their patients with sensitive skin.
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Aarhus L, Mehlum IS. Occupational health examinations of patients in Norway. Tidsskr Nor Laegeforen 2017; 137:16-0652. [PMID: 28828846 DOI: 10.4045/tidsskr.16.0652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND In 2009, the hospital departments of occupational medicine and the National Institute of Occupational Health established a joint, anonymous examination register. The objective was to achieve a better overview of occupational health examinations of patients in Norway, including changes in occupationally related exposure and illness over time. MATERIAL AND METHOD After the patient consultation the examining doctor completes a form, which is subsequently registered electronically. This article is based on analyses of patient examinations registered in the period 2010 – 2015. RESULTS A total of 8 775 patient examinations had been recorded. The majority of those examined were men (75 %) and the most commonly occurring age group was 50 – 69 years (52 %). The most frequent exposures involved irritants/allergens (18 %) and organic solvents (15 %), which were recorded in a slightly increasing and slightly declining frequency respectively through the period. Manufacturing and mining were the top industries (30 %). The most common symptom organs were the lungs/respiratory tract (57 %), with asthma, COPD and lung cancer as the most frequent diagnoses. The proportion of cases that were deemed to be likely or possibly related to work remained stable at 40 % and 23 % respectively. At the time of the examination altogether 16 % of the patients were receiving sickness benefit, 10 % were receiving work assessment allowance and 13 % disability benefit. INTERPRETATION Occupationally related illness entails significant consequences for individuals as well as society. The examination register provides a good overview of the patient examinations in the occupational health departments in Norway and may reveal changes in occupationally related exposure over time. In this way, the register may contribute to targeted preventive efforts.
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Koppes SA, Ljubojević Hadžavdić S, Jakasa I, Franceschi N, Riethmüller C, Jurakić Tončic R, Marinovic B, Raj N, Rawlings AV, Voegeli R, Lane ME, Haftek M, Frings‐Dresen MH, Rustemeyer T, Kezic S. Effect of allergens and irritants on levels of natural moisturizing factor and corneocyte morphology. Contact Dermatitis 2017; 76:287-295. [PMID: 28295421 PMCID: PMC5836858 DOI: 10.1111/cod.12770] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Revised: 01/04/2017] [Accepted: 01/05/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND The irritant sodium lauryl sulfate (SLS) is known to cause a decrease in the stratum corneum level of natural moisturizing factor (NMF), which in itself is associated with changes in corneocyte surface topography. OBJECTIVE To explore this phenomenon in allergic contact dermatitis. METHODS Patch testing was performed on patients with previously positive patch test reactions to potassium dichromate (Cr), nickel sulfate (Ni), methylchloroisothiazolinone (MCI)/methylisothiazolinone (MI), or p-phenylenediamine. Moreover, a control (pet.) patch and an irritant (SLS) patch were applied. After 3 days, the stratum corneum from tested sites was collected, and NMF levels and corneocyte morphology, expressed as the amount of circular nanosize objects, quantified according to the Dermal Texture Index (DTI), were determined. RESULTS Among allergens, only MCI/MI reduced NMF levels significantly, as did SLS. Furthermore, only MCI/MI caused remarkable changes at the microscopic level; the corneocytes were hexagonal-shaped with pronounced cell borders and a smoother surface. The DTI was increased after SLS exposure but not after allergen exposure. CONCLUSIONS MCI/MI significantly decreased NMF levels, similarly to SLS. The altered corneocyte morphology suggests that skin barrier damage plays a role in the pathogenesis of MCI/MI contact allergy. The DTI seems to differentiate reactions to SLS from those to the allergens tested, as SLS was the only agent that caused a DTI increase.
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Affiliation(s)
- Sjors A. Koppes
- Academic Medical Center, Department: Coronel institute of Occupational HealthAmsterdam Public Health Research Institute1105 AZ AmsterdamThe Netherlands
- Department of Dermatology‐AllergologyVU University Medical Centre1081 HV AmsterdamThe Netherlands
| | - Suzana Ljubojević Hadžavdić
- Department of Dermatology and VenereologyUniversity Hospital Centre Zagreb and University of Zagreb School of Medicine10000ZagrebCroatia
| | - Ivone Jakasa
- Faculty of Food Technology and Biotechnology, Laboratory for Analytical Chemistry, Department of Chemistry and BiochemistryUniversity of Zagreb10000ZagrebCroatia
| | - Nika Franceschi
- Department of Dermatology and Venereology, University Clinical Hospital Centre ‘Sestre Milosrdnice’10000ZagrebCroatia
| | - Christoph Riethmüller
- Centre for Nanotechnology, Serend‐ip GmbHCentre for Nanotechnology48149MünsterGermany
| | - Ružica Jurakić Tončic
- Department of Dermatology and VenereologyUniversity Hospital Centre Zagreb and University of Zagreb School of Medicine10000ZagrebCroatia
| | - Branka Marinovic
- Department of Dermatology and VenereologyUniversity Hospital Centre Zagreb and University of Zagreb School of Medicine10000ZagrebCroatia
| | - Nidhin Raj
- Skin Research Laboratory, Department of PharmaceuticsUniversity College LondonWC1N 1AXLondonUK
| | - Anthony V. Rawlings
- Skin Research Laboratory, Department of PharmaceuticsUniversity College LondonWC1N 1AXLondonUK
| | | | - Majella E. Lane
- Skin Research Laboratory, Department of PharmaceuticsUniversity College LondonWC1N 1AXLondonUK
| | - Marek Haftek
- Laboratory of Tissue Biology and Therapeutic EngineeringCNRS and University of LyonUMR 5305LyonFrance
| | - Monique H.W. Frings‐Dresen
- Academic Medical Center, Department: Coronel institute of Occupational HealthAmsterdam Public Health Research Institute1105 AZ AmsterdamThe Netherlands
| | - Thomas Rustemeyer
- Department of Dermatology‐AllergologyVU University Medical Centre1081 HV AmsterdamThe Netherlands
| | - Sanja Kezic
- Academic Medical Center, Department: Coronel institute of Occupational HealthAmsterdam Public Health Research Institute1105 AZ AmsterdamThe Netherlands
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Wolfe MK, Wells E, Mitro B, Desmarais AM, Scheinman P, Lantagne D. Seeking Clearer Recommendations for Hand Hygiene in Communities Facing Ebola: A Randomized Trial Investigating the Impact of Six Handwashing Methods on Skin Irritation and Dermatitis. PLoS One 2016; 11:e0167378. [PMID: 28030544 PMCID: PMC5193384 DOI: 10.1371/journal.pone.0167378] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Accepted: 11/09/2016] [Indexed: 11/19/2022] Open
Abstract
To prevent disease transmission, 0.05% chlorine solution is commonly recommended for handwashing in Ebola Treatment Units. In the 2014 West Africa outbreak this recommendation was widely extended to community settings, although many organizations recommend soap and hand sanitizer over chlorine. To evaluate skin irritation caused by frequent handwashing that may increase transmission risk in Ebola-affected communities, we conducted a randomized trial with 91 subjects who washed their hands 10 times a day for 28 days. Subjects used soap and water, sanitizer, or one of four chlorine solutions used by Ebola responders (calcium hypochlorite (HTH), sodium dichloroisocyanurate (NaDCC), and generated or pH-stabilized sodium hypochlorite (NaOCl)). Outcomes were self-reported hand feel, irritation as measured by the Hand Eczema Score Index (HECSI) (range 0-360), signs of transmission risk (e.g., cracking), and dermatitis diagnosis. All groups experienced statistically significant increases in HECSI score. Subjects using sanitizer had the smallest increases, followed by higher pH chlorine solutions (HTH and stabilized NaOCl), and soap and water. The greatest increases were among neutral pH chlorine solutions (NaDCC and generated NaOCl). Signs of irritation related to higher transmission risk were observed most frequently in subjects using soap and least frequently by those using sanitizer or HTH. Despite these irritation increases, all methods represented minor changes in HECSI score. Average HECSI score was only 9.10 at endline (range 1-33) and 4% (4/91) of subjects were diagnosed with dermatitis, one each in four groups. Each handwashing method has benefits and drawbacks: soap is widely available and inexpensive, but requires water and does not inactivate the virus; sanitizer is easy-to use and effective but expensive and unacceptable to many communities, and chlorine is easy-to-use but difficult to produce properly and distribute. Overall, we recommend Ebola responders and communities use whichever handwashing method(s) are most acceptable, available, and sustainable for community handwashing. TRIAL REGISTRATION International Standard Randomized Controlled Trial Registry ISRCTN89815514.
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Affiliation(s)
- Marlene K. Wolfe
- Department of Civil and Environmental Engineering, Tuft University, Medford, Massachusetts, United States of America
| | - Emma Wells
- Department of Civil and Environmental Engineering, Tuft University, Medford, Massachusetts, United States of America
| | - Brittany Mitro
- Department of Civil and Environmental Engineering, Tuft University, Medford, Massachusetts, United States of America
| | - Anne Marie Desmarais
- Department of Civil and Environmental Engineering, Tuft University, Medford, Massachusetts, United States of America
| | - Pamela Scheinman
- Department of Dermatology, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
| | - Daniele Lantagne
- Department of Civil and Environmental Engineering, Tuft University, Medford, Massachusetts, United States of America
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Angelova-Fischer I, Stilla T, Kezic S, Fischer TW, Zillikens D. Barrier Function and Natural Moisturizing Factor Levels After Cumula-tive Exposure to Short-chain Aliphatic Alcohols and Detergents: Results of Occlusion-modified Tandem Repeated Irritation Test. Acta Derm Venereol 2016; 96:880-884. [PMID: 26864715 DOI: 10.2340/00015555-2363] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Alcohol-based disinfectants and detergents are common workplace factors for irritant contact dermatitis (ICD). Though occlusion and water are relevant co-exposures, the tandem effects of occlusion and sequential exposure to alcohols and detergents have not been studied. We therefore investigated the combined effects of occlusion with water and repeated exposure to n-propanol and/or sodium lauryl sulphate (SLS) in an occlusion-modified tandem irritation test. The outcomes included visual scoring, measurement of erythema, transepidermal water loss, capacitance and natural moisturizing factor (NMF) levels. Occlusion abrogated the skin barrier function and significantly enhanced the irritant-induced barrier damaging effects. The NMF levels of all irritant-exposed fields decreased significantly compared with the non-exposed fields; occlusion enhanced the decrease in NMF. Although SLS exerted more pronounced effects on the measured parameters, the barrier function impairment and NMF decrease after exposure to n-propanol in workplace-relevant concentrations, found in the study, confirm the significance of short-chain aliphatic alcohols for occupational ICD.
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Abstract
Contact dermatitis is an umbrella term that describes the skin's reaction to contacted noxious or allergenic substances. The two main categories of contact dermatitis are irritant type and allergic type. This review discusses the signs, symptoms, causes, and complications of contact dermatitis. It addresses the testing, treatment, and prevention of contact dermatitis. Proper management of contact dermatitis includes avoidance measures for susceptible children. Implementation of a nickel directive (regulating the use of nickel in jewelry and other products that come into contact with the skin) could further reduce exposure to the most common allergens in the pediatric population. [Pediatr Ann. 2016;45(8):e287-e292.].
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Wise K. Response to: 'Domestic use of bleach and infections in children: a multicentre cross-sectional study'. Occup Environ Med 2016; 73:215. [PMID: 26838029 PMCID: PMC4789820 DOI: 10.1136/oemed-2015-103133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Accepted: 07/03/2015] [Indexed: 11/17/2022]
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Arshad AI, Khan SHM, Akhtar N, Mahmood A, Sarfraz RM. IN VIVO EVALUATION OF SKIN IRRITATION POTENTIAL, MELASMA AND SEBUM CONTENT FOLLOWING LONG TERM APPLICATION OF SKIN CARE CREAM IN HEALTHY ADULTS, USING NON-INVASIVE BIOMETROLOGICAL TECHNIQUES. Acta Pol Pharm 2016; 73:219-227. [PMID: 27008816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The present investigation was conducted to evaluate non-invasively, various functional skin parameters i.e., irritation potential, melasma and sebum contents following long term application of topical cream (w/o) loaded with 2% methanolic extract of Ananas comosus L. versus placebo control (base) in healthy adults. Healthy human volunteers (n = 11, aged 20-30 years) were recruited for investigation and written informed consent was taken from each volunteer. In this single blinded study every volunteer applied formulation on one side of face and placebo on the other side of face twice daily for a period of 12 weeks (three months). Different skin parameters i.e., skin irritancy, melasma, and sebum contents were measured on both sides of face at baseline and after two weeks interval, using photometric device Mexameter and Sebumeter in a draught free room with modulated conditions of temperature (22-25°C) and humidity (55-60%). It was evident from the results that no primary skin irritancy was observed with patch test. Besides, statistical interpretation indicates that treatment with formulation is superior to placebo because it significantly (p ≤ 0.05) reduced the skin irritancy, melasma and sebum secretions throughout the study and reaching maximum -20.76 ± 0.89, -54.2 ± 0.37 and -40.71 ± 0.75%, respectively, at the end of study period. Antioxidant activity of extract was 92% compared to standard antioxidant. Conclusively, active cream loaded with fruit extract was well tolerated by all the volunteers and suitable to treat contact dermatitis, greasy skin, acne and seborrheic dermatitis and augmenting beauty and attraction by depigmentation of human skin. So, in the future, there is need to clinically evaluate these formulations in patients with compromised skin functions i.e., contact dermatitis, melasma, and acne vulgaris in order to explore the actual potential of this fruit.
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Maier A, Vincent MJ, Parker A, Gadagbui BK, Jayjock M. A tiered asthma hazard characterization and exposure assessment approach for evaluation of consumer product ingredients. Regul Toxicol Pharmacol 2015; 73:903-13. [PMID: 26416168 DOI: 10.1016/j.yrtph.2015.09.028] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Revised: 09/21/2015] [Accepted: 09/22/2015] [Indexed: 11/19/2022]
Abstract
Asthma is a complex syndrome with significant consequences for those affected. The number of individuals affected is growing, although the reasons for the increase are uncertain. Ensuring the effective management of potential exposures follows from substantial evidence that exposure to some chemicals can increase the likelihood of asthma responses. We have developed a safety assessment approach tailored to the screening of asthma risks from residential consumer product ingredients as a proactive risk management tool. Several key features of the proposed approach advance the assessment resources often used for asthma issues. First, a quantitative health benchmark for asthma or related endpoints (irritation and sensitization) is provided that extends qualitative hazard classification methods. Second, a parallel structure is employed to include dose-response methods for asthma endpoints and methods for scenario specific exposure estimation. The two parallel tracks are integrated in a risk characterization step. Third, a tiered assessment structure is provided to accommodate different amounts of data for both the dose-response assessment (i.e., use of existing benchmarks, hazard banding, or the threshold of toxicological concern) and exposure estimation (i.e., use of empirical data, model estimates, or exposure categories). Tools building from traditional methods and resources have been adapted to address specific issues pertinent to asthma toxicology (e.g., mode-of-action and dose-response features) and the nature of residential consumer product use scenarios (e.g., product use patterns and exposure durations). A case study for acetic acid as used in various sentinel products and residential cleaning scenarios was developed to test the safety assessment methodology. In particular, the results were used to refine and verify relationships among tiered approaches such that each lower data tier in the approach provides a similar or greater margin of safety for a given scenario.
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Affiliation(s)
- Andrew Maier
- Department of Environmental Health, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
| | - Melissa J Vincent
- Department of Environmental Health, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Ann Parker
- Department of Environmental Health, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Bernard K Gadagbui
- Department of Environmental Health, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Michael Jayjock
- The LifeLine Group, 4610 Quarter Charge Dr, Annandale, VA, 22003, USA
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Affiliation(s)
- U Hinnen
- Department of Dermatology, University of Zurich, Switzerland
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41
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Affiliation(s)
- K P Wilhelm
- Department of Dermatology, Medical University of Lübeck, Germany
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42
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Affiliation(s)
- A M Grunewald
- Dermatological Clinic of Karlsruhe Municipal Hospital, Germany
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Krasteva M, Moulon C, Péguet-Navarro J, Courtellemont P, Redziniak G, Schmitt D. In vitro sensitization of human T cells with hapten-treated Langerhans cells: a screening test for the identification of contact allergens. Curr Probl Dermatol 2015; 25:28-36. [PMID: 8787586 DOI: 10.1159/000425512] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- M Krasteva
- Laboratoire Peau Humaine et Immunité, INSERM U346, Hôpital Edouard-Herriot, Lyon, France
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Affiliation(s)
- J E Wahlberg
- Department of Occupational Dermatology, Karolinska Hospital Stockholm, Sweden
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45
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Le M, Cals S, Schalkwijk J, van der Valk P. An immunohistochemical study on mild skin irritation induced by a single application of a low-molarity sodium dodecyl sulfate solution: keys to the prevention of irritant contact dermatitis. Curr Probl Dermatol 2015; 25:67-77. [PMID: 8787590 DOI: 10.1159/000425516] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- M Le
- Department of Dermatology, University Hospital Nijmegen, The Netherland
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MESH Headings
- Adult
- Allergens/adverse effects
- Chronic Disease
- Dermatitis, Allergic Contact/epidemiology
- Dermatitis, Allergic Contact/prevention & control
- Dermatitis, Allergic Contact/therapy
- Dermatitis, Contact/epidemiology
- Dermatitis, Contact/prevention & control
- Dermatitis, Contact/therapy
- Dermatitis, Occupational/epidemiology
- Dermatitis, Occupational/prevention & control
- Dermatitis, Occupational/therapy
- Disease Susceptibility
- Female
- Humans
- Hypersensitivity, Immediate/epidemiology
- Irritants/adverse effects
- Male
- Middle Aged
- Occupations
- Prognosis
- Prospective Studies
- Retrospective Studies
- Treatment Outcome
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Affiliation(s)
- C L Goh
- Institute of Dermatology, Singapore National Skin Centre
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47
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Affiliation(s)
- K P Wilhelm
- proDERM Institute for Applied Dermatological Research, Schenefeld/Hamburg, Germany
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48
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Affiliation(s)
- T L Diepgen
- Department of Dermatology, Friedrich-Alexander University Erlangen-Nuremberg, Germany
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49
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Affiliation(s)
- M A Flyvholm
- Department of Occupational Medicine, National Institute of Occupational Health, Copenhagen, Denmark
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50
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Affiliation(s)
- H C Williams
- Dermatoepidemiology Unit, Queen's Medical Center, University Hospital, Nottingham, UK
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