Radiographic and respiratory functional findings are reported for a series of 133 Finnish patients with asbestosis. Of these patients, 65 (49%) were found to have radiographically mild diffuse pulmonary fibrosis (profusion 0/1, 1/0 or 1/1), 48 (36%) moderate fibrosis (1/2, 2/1 or 2/2) and 20 (15%) diffuse fibrosis in an advanced stage (2/3 or more). The type of fibrosis was mostly irregular (110 = 83%). Fibrosis was typically the most advanced in the lower zones of the lungs. Of the 133 patients, 88 (66%) showed pleural changes and 78 (59%) pleural calcifications. The more severe the fibrosis, as seen in the radiographs, the greater the decrease in vital capacity (VC) and expiratory volume in 1 s (FEV1.0). Transfer factor was generally impaired only in advanced cases of asbestosis (fibrosis 2/3 or more). In general, obstruction was not observed in this series. Pleural changes seemed to decrease VC and FEV1.0 when the fibrosis was mild (0/1, 1/0 or 1/1). They had no effect on diffusion capacity (TLco).
Long-term follow-up studies on the prognosis and consequences of occupational hand eczema (OHE) and the prognostic risk factors for persistent OHE are sparse.To determine the medical and occupational outcome after a follow-up of 7-14 years in 605 patients diagnosed with OHE and to identify the prognostic risk factors for the continuation of hand eczema.Patients examined at the Finnish Institute of Occupational Health in 1994-2001 completed a follow-up questionnaire 7-14 years after diagnosis.The hand eczema had healed (no eczema during the last year) in 40% of patients with OHE. The duration of hand eczema before diagnosis was strongly associated with the continuation of eczema. Age, sex and diagnosis (allergic or irritant contact dermatitis) were not associated with the prognosis, but skin atopy, and especially respiratory atopy, were correlated with the continuation of hand eczema. Contact allergies in general were not risk factors for persistent OHE, but the presence of a work-related chromate allergy was associated with poor healing. A total of 34% of patients had changed their occupation due to OHE, and their long-term prognosis was better than those who had not. The hand eczema of patients originally in food-related occupations continued on an unfavourable course.In the logistic model, risk factors for the continuation of OHE were a long duration of hand eczema before diagnosis, respiratory atopy, skin atopy, and continuation in the same occupation. Those who ended up changing occupation due to their OHE had a better medical and economic prognosis.
Three cases of allergic alveolitis due to indoor humdification systems are described. Thermoactinomyces vulgaris precipitins were detected in the serum of a 37-year-old female patient who had typical febrile attacks during exposure to cool-mist from a home humidifier. When the cause was detected and eliminated, the symptoms and signs disappeared and the woman's gas transfer factor improved from 56% to normal within six months. In a printing office a 60-year-old woman had had febrile attacks with cough for more than a year. The patient herself associated the respiratory disease with a cool-mist humidifier sometimes used at work. The water reservoir was heavily contaminated with amoebas (Amoeba proteus), which might have been the causative organisms in this case. Aspergillus fumigatus precipitins were found in the serum of a 53-year-old female printer with the clinical picture of occupational allergic alveolitis. The same organism was detected in the ambient air of the printing office.
Contact allergy to plastic gloves is rare. Benzisothiazolinone is a biocide that is mainly used in industrial settings. We first suspected delayed-type contact allergy to benzisothiazolinone from polyvinyl chloride (PVC) gloves in 2004. We looked through our medical records from 1991 to 2005 to find similar cases.
Observations
We found a total of 8 patients who are allergic to benzisothiazolinone and who had had exacerbations of their hand dermatitis while using PVC gloves. Patch testing revealed that 3 of them had weak allergic or doubtful reactions to the glove materials. Six of them had used Evercare Soft, Medi-Point, or Derma Grip PVC gloves, which in chemical analysis were shown to contain 9 to 32 ppm of benzisothiazolinone. Seven of the patients worked in dentistry or health care and 1 in farming. All of them had had hand dermatitis for many years.
Conclusions
To our knowledge, there have been no previous reports of contact allergy to antimicrobial agents in plastic gloves. Benzisothiazolinone is widely used as a biocide in the manufacture of disposable PVC gloves. Small amounts of benzisothiazolinone in the gloves may sensitize those who already have hand dermatitis. We recommend that all patients with hand dermatitis while using PVC gloves should be patch tested with benzisothiazolinone.
The rôle of contact allergies in oral mucosal diseases was studied. The subjects were 24 patients out of 479 tested, who had oral mucosal symptoms and positive patch test reactions in a dental series during 1987–1994 at the Department of Dermatology. Helsinki University Hospital. The clinical diagnoses were oral lichen planus (LPO, 13 patients), leukoplakia (2), glossodynia, i.e., ‘burning mouth syndrome’ (4), stomatitis (3) and recurrent angioedema (2), Only 1 patient had symptoms in relation to dental care. All but 2 patients had allergic reactions to mercury (Hg) (12 patients), gold sodium thiosulfate (Au) (13 patients) or both. A clinical connection between oral symptoms and contact allergy was seen in 10 patients, 9 patients (7 LPO, 2 leukoplakia) had Hg allergy in these cases, the oral lesions disappeared after the amalgam fillings had been removed. 1 patient had recurrent stomatitis and perioral eczema after dental care and 2,2‐bis(4‐(2‐hydroxy 3‐methacryloxypropoxy)phenyl)propane (BIS‐GMA) allergy. Her symptoms were caused by drilling of acrylic fillings. In addition, a connection between localized stomatitis and contact allergy was considered probable in 2 cases. 1 patient had stomatitis from contact with an orthodontic device and nickel allergy. The other had stomatitis from contact with a dental gold crown and gold allergy. No clinical connection was found between gold allergy and the oral symptoms of other patients.
