Occupational protein contact dermatitis

Abstract

Occupational contact dermatitis is generally caused by haptens but can also be induced by proteins causing mainly immunological contact urticaria (ICU); chronic hand eczema in the context of protein contact dermatitis (PCD). In a monocentric retrospective study, from our database, only 31 (0.41%) of patients with contact dermatitis had positive skin tests with proteins: 22 had occupational PCD, 3 had nonoccupational PCD, 5 occupational ICU and 1 cook had a neutrophilic fixed food eruption (NFFE) due to fish. From these results and analysis of literature, the characteristics of PCD can be summarized as follows. It is a chronic eczematous dermatitis, possibly exacerbated by work, suggestive if associated with inflammatory perionyxix and immediate erythema with pruritis, to be investigated when the patient resumes work after a period of interruption. Prick tests with the suspected protein-containing material are essential, as patch tests have negative results. In case of multisensitisation revealed by prick tests, it is advisable to analyse IgE against recombinant allergens. A history of atopy, found in 56 to 68% of the patients, has to be checked for. Most of the cases are observed among food-handlers but PCD can also be due to non-edible plants, latex, hydrolysed proteins or animal proteins. Occupational exposure to proteins can thus lead to the development of ICU. Reflecting hypersensitivity to very low concentrations of allergens, investigating ICU therefore requires caution and prick tests should be performed with a diluted form of the causative protein-containing product. Causes are food, especially fruit peel, non-edible plants, cosmetic products, latex, animals.Key words: protein contact dermatitis, chronic hand eczema, prick test, protein allergy, immunological contact urticaria, neutrophilic fixed food eruption O ccupational contact dermatitis is generally caused by haptens but it can also be induced by proteins causing immunological contact urticaria (ICU), chronic hand eczema in the context of protein contact dermatitis (PCD) or less common skin conditions. We report the results of a retrospective study on occupational protein dermatitis carried out in our dermatology and allergology department and provide an update on the characteristics of occupational skin diseases induced by proteins and on the causative factors found in our study and in a review of literature.

The role of skin barrier in occupational contact dermatitis

“…According to the pathophysiological mechanisms involved, CD can be classified as irritant contact dermatitis (ICD) and allergic contact dermatitis (ACD), with ICD being more prevalent in occupational settings. Moreover, protein contact dermatitis (PCD), common in workers handling food products, is a distinct clinical entity where immediate type skin reactions occur . However, in a clinical context, many patients suffer from a mixture of the above.…”

“…Moreover, protein contact dermatitis (PCD), common in workers handling food products, is a distinct clinical entity where immediate type skin reactions occur. [4] However, in a clinical context, many patients suffer from a mixture of the above.…”

Occupational rhinitis, asthma, and contact urticaria from IgE‐mediated allergy to pork

“…IgE‐mediated allergy to foodstuffs may cause allergic rhinitis, asthma, contact urticaria, and protein contact dermatitis in food handlers . Nasal provocation test has been established as an international standard for evaluating occupational rhinitis .…”

British Association of Dermatologists’ guidelines for the management of contact dermatitis 2017

“…The GDG also established a set of outcome measures of importance to patients (prevention and treatment), ranked according to the GRADE methodology, 4 data on which are extracted from included studies: (i) return to/remain in work (9); (ii) improvement in quality of life (8); (iii) improved or clearance of dermatitis (8); (iv) treatment tolerability (5); (v) prevention of dermatitis (5); (vi) side-effects of interventions (4).…”

“…Prick and radioallergosorbent tests to the offending protein allergen are positive, but patch tests are negative. The proteins may be vegetables (potato, garlic), meats, fish (in food handlers), flour, enzymes (in bakers and pharmaceutical manufacture), and animal dander and fluids (in veterinarians and abattoir workers) …”