Dermatitis caused by exposure to epoxy resin compounds was observed in the 1950s, shortly after epoxy resins were introduced. Following a description of the chemistry and the use of epoxy compounds, the authors discuss delayed and immediate allergic epoxy dermatitis and irritant epoxy dermatitis as well as factors such as exposure and skin testing.
Quaternary ammonium compounds are water-soluble antimicrobials which are widely used in disinfectants, sterilizers, skin cleansers and antiseptic creams. One quaternary ammonium compound, alkylammonium amidobenzoate (Osmaron B) has for decades been used in udder ointments. Here we present a ship technician with occupationally induced sensitization to alkylammonium amidobenzoate. The diagnosis was reached only when it emerged, after careful questioning, that the patient was exposed to a substance peculiar to his workplace but not to his occupation and was then patch tested for it. It turned out that an udder ointment had been used at the patient's workplace as a hand ointment. Patch testing was positive to the patient's hand ointment, and Osmaron B at 0.1-0.01% in petrolatum. Other sensitizing quaternary ammonium compounds, namely benzalkonium chloride, benzethonium chloride, benzoxonium chloride, N-benzyl-N,N-dihydroxyethyl-N-cocosalkyl-ammonium chloride, cetalkonium chloride, cetylpyridinium chloride, cetrimonium bromide, chloroallylhexaminium chloride, dequalinium chloride, domiphen bromide, methylbenzethonium chloride and 2,3-epoxypropyl trimethyl ammonium chloride are reviewed briefly. The importance of patch testing to all materials in use by the patient is emphasized. It is also important to select non-allergenic hand creams for use at work places.
A questionnaire survey was carried out among electron microscopy (EM) laboratory technicians in Finland. The questionnaire was returned by 18 out of the total of 45 to 50 EM workers, covering 13 laboratories. Epoxy resins, especially glycidyl ethers of glycerol, anhydride hardeners, amine accelerators, and propylene oxide, where used for embedding. On average, the technicians had been exposed to unpolymerized epoxy resins for 3 h a week over a 10-year period. Ten workers reported skin symptoms. Seventeen used protective gloves when working with unpolymerized resins. In gas chromatography, the epoxy resins were found to contain many skin sensitizing compounds, that is, diglycidyl ether of bisphenol A (molecular weight 340) and epoxy reactive diluents. This potential allergenic capacity of the epoxy resins emphasizes the importance of preventing skin contact. Selection of glove material for the handling of tissue specimens in electron microscopy laboratories was based on the results of permeation tests with propylene oxide, because the chemical construction of propylene oxide is similar to that of sensitizing epoxy compounds. Because it is a low viscosity compound, however, propylene oxide penetrates glove material more rapidly than the resin compounds. Thin polyethylene gloves provide better protection against propylene oxide, and thus also against embedding resins, than disposable polyvinyl chloride (PVC) or natural rubber gloves.
Plastics and glues are common causes of occupational dermatoses, but only few reports have dealt with patch-test reactions caused by plastic and glue allergens. Patients exposed to plastics and remitted to an occupational dermatology clinic, were patch-tested with 50-53 plastic and glue allergens during a 6-year period. Conventional patch-test techniques were used. The most common causes of allergic patch-test reactions in 360 patients were novolac epoxy resin (5.1%), phenol formaldehyde resin (3.1%), 4-tert-butylcatechol (2.6%), phenyl glycidyl ether (2.6%), diaminodiphenyl methane (2.2%), benzoyl peroxide (2.2%), hexamethylene tetramine (2.0%) and o-cresyl glycidyl ether (1.6%). The allergens that most often elicited irritant patch-test reactions were: benzoyl peroxide (9.5%), abitol alcohol (3.6%), hydroquinone (3.1%), acid-catalyzed phenol formaldehyde resin (2.5%) and toluene diisocyanate (1.9%). Twenty-six out of 53 chemicals caused no allergic reaction during the 6-year period. Plastic allergens in the standard series provoked allergic reactions with formaldehyde (5.8%), diglycidyl ether of bisphenol A (3.2%), 4-tert-butylphenol-formaldehyde-resin (1.1%), toluene sulphonamide formaldehyde-resin (1.1%) and triethylenglycol diacrylate (0.4%). Although half of the plastic chemicals gave no allergic patch-test reactions during a 6-year period, with unusual allergens this low yield needs to be accepted, because otherwise rare allergies will not be detected. Also a negative reaction has diagnostic value.
A dental assistant developed sensitivity to denial restorative materials within 3 months of starting to use them. They contained the epoxy acrylate BIS‐GMA, which is the most commonly used dimethacrylate monomer in dental composite restorations. She was positive to a patch test with BIS‐GMA, which was the probable allergen, and epoxy resin, but this substance was not present in the materials used, LIS shown by high performance liquid chromatography. The patient was also allergic to the disinfectant Desimex i® containing dodecyl diaminoethyl glycine.
Rubber chemicals are among the most common occupational contact sensitizers. The most common rubber sensitizers are thiurams, thiazoles, carbamates and paraphenylenediamine derivatives. Here we present data on a less‐well‐know rubber chemical, N‐(cyclohexylthio) phthalimide (CTP; CAS 17796‐82‐6). This chemical is currently the most widely used vulcanization retarder, but data on allergic contact dermatitis caused by CTP are lacking. We conducted a survey of 310 patients who had been patch tested with 30 rubber chemicals including CTP 11 (3.5%) showed an allergic patch test reaction provoked by CTP and 9.0% by thiurams. 4 of the patients reacted only to CTP and not to other rubber chemicals. Whereas the other 7 concomitantly reacted to other rubber chemicals. After analyzing the patch test data of these 11 patients, it was concluded that CTP probably did not cross‐react with the other rubber chemicals. Therefore the patch test results may indicate independent sensitization to CTP and other rubber chemicals. Because very little data on the components of rubber chemicals in rubber products are available, the source of the putative sensitization to the rubber vulcanization retarder CTP is unknown.
