Occupational Dermatology Research and Education Center

Melbourne, Australia

Occupational Dermatology Research and Education Center

Melbourne, Australia

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Christensson J.B.,Gothenburg University | Andersen K.E.,University of Southern Denmark | Bruze M.,Skåne University Hospital | Johansen J.D.,Copenhagen University | And 5 more authors.
Contact Dermatitis | Year: 2013

Background. Limonene is a common fragrance terpene that, in its pure form, is not allergenic or is a very weak allergen. However, limonene autoxidizes on air exposure, and the oxidation products can cause contact allergy. Oxidized R-limonene has previously been patch tested in multicentre studies, giving 2-3% positive patch test reactions in consecutive patients. Objectives. To investigate whether oxidized R-limonene 3.0% in petrolatum, with a stable concentration of the main haptens, limonene hydroperoxides (Lim-OOHs), could be a useful tool for the detection of contact allergy in an international setting. Methods. Oxidized R-limonene 3.0% (Lim-OOHs 0.33%) pet. was tested in 2900 consecutive dermatitis patients in Denmark, the United Kingdom, Singapore, Spain, Sweden, and Australia. Results. Overall, 5.2% (range 2.3-12.1%) of the patients showed a positive patch test reaction to oxidized R-limonene. Doubtful reactions were found in 7.0% of the patients (range 0-24%). Few irritant reactions were seen. Conclusions. Oxidized R-limonene at 3.0% pet. with a specified content of Lim-OOHs 0.33% is a standardized and useful tool for the detection of contact allergy in dermatitis patients. Many patients showing positive patch test reactions to oxidized R-limonene would not be informed of their fragrance allergy if this specific test had not been performed. © 2013 John Wiley & Sons A/S.


Keegel T.G.,Monash University | Keegel T.G.,University of Melbourne | Nixon R.L.,Occupational Dermatology Research and Education Center | Lamontagne A.D.,University of Melbourne
Contact Dermatitis | Year: 2012

Background. The Australian National Hazard Exposure Worker Surveillance (NHEWS) Survey 2008 was a cross-sectional survey undertaken by Safe Work Australia to inform the development of exposure prevention initiatives for occupational disease. This is a descriptive study of workplace exposures. Objectives. To assess the occupational and demographic characteristics of workers reporting exposure to wet work. Methods. Computer-assisted telephone interviews were conducted with 4500 workers. Two wet work exposure outcomes (frequent washing of hands and duration of time spent at work with the hands immersed in liquids) were analysed. Results. The response rate for the study was 42.3%. For hand-washing, 9.8% [95% confidence interval (CI) 8.9-10.7] reported washing their hands more than 20 times per day. For immersion of hands in liquids, 4.5% (95% CI 3.9-5.1) reported immersion for more than 2 hr per day. Females were more likely to report exposure to frequent hand-washing than males [odds ratio (OR) 1.97, 95% CI 1.49-2.61]. Workers in the lowest occupational skill level jobs were more likely to report increased exposure to hands immersed in liquids than those in the highest (OR 6.41, 95% CI 3.78-10.88). Workers reporting skin exposure to chemicals were more likely to report exposure to hand-washing (OR 3.68, 95% CI 2.91-4.66) and immersion of the hands in liquids (OR 4.09, 95% CI 2.92-5.74). Conclusions. Specific groups of workers reported high levels of exposure to wet work. There were differences between the profiles of workers reporting frequent hand-washing and workers reporting increased duration of exposure to hands immersed in liquids. We also found a high correlation between wet work and chemical exposure. © 2011 John Wiley & Sons A/S.


Lyons G.,Occupational Dermatology Research and Education Center | Keegel T.,Monash University | Keegel T.,University of Melbourne | Palmer A.,Occupational Dermatology Research and Education Center | Nixon R.,Occupational Dermatology Research and Education Center
Contact Dermatitis | Year: 2013

Background. Hairdressers are one of the largest occupational groups attending our Occupational Dermatology Clinic. However, few seek workers' compensation for their occupational dermatitis. Objectives. To retrospectively analyse and compare workers' compensation claims data and diagnosed disease data for occupational contact dermatitis in hairdressers from 1993 to 2009, for the state of Victoria, Australia. Patients/materials/methods. Data from the Occupational Dermatology Clinic database, the Compensation Research Database and the Australian Bureau of Statistics were used in this study. Results. The clinic database identified 157 hairdressers and apprentices with a confirmed diagnosis of occupational contact dermatitis assessed between 1993 and 2009. Forty-six unique claims for occupational contact dermatitis from 46 individuals were identified from the Compensation Research Database over the same time period. Hairdressers in the 15-24-year age group were significantly over-represented in the claims data relative to the diagnosed disease data (p < 0.01). The median cost per claim was AU$1421, and the median time off work per claim was 20 days. Conclusion. Increased efforts are needed to reduce the incidence of occupational contact dermatitis in hairdressers in Australia, and to ensure that hairdressers with occupational contact dermatitis are aware of their compensation entitlements. Reliance on workers' compensation data for disease surveillance may lead occupational health and safety regulators to underestimate the magnitude of the problem of occupational contact dermatitis in the hairdressing profession. © 2012 John Wiley & Sons A/S.


Chow E.T.,Liverpool Health Service | Chow E.T.,Skin and Cancer Foundation Australia | Avolio A.M.,Skin and Cancer Foundation Australia | Lee A.,Occupational Dermatology Research and Education Center | And 2 more authors.
Australasian Journal of Dermatology | Year: 2013

Background/Objectives Preservatives are important causes of allergic contact dermatitis. The frequency of allergy to preservatives in Australia has been unknown to date. Our objectives are to report the frequency of positive preservative patch test reactions in Australia, comparing them to the published international data, as well as exploring the current regulations in place for preservative use in Australia. Methods This was the first retrospective study of patch testing results, aggregated from four patch test clinics in three centres in Melbourne and Sydney. Results In all, 6845 patients were patch-tested during 1993-2006 and in this period the five most frequent preservative allergens were formaldehyde (4.6%), Euxyl K400 (containing methyldibromo glutaronitrile and phenoxyethanol) (3.3%), quaternium-15 (2.9%), diazolidinyl urea (2.4%), and methylchloroisothiazolinone/methylisothiazolinone (2.3%). These were followed by dimethylol dimethyl DMDM hydantoin (2.1%), chloroacetamide (2.1%) and imidazolidinyl urea (1.9%). The least frequent sensitisers were parabens (1.1%), 2-bromo-2-nitropropane-1, 3-diol (0.9%) and benzyl alcohol (0.4%). Conclusions Formaldehyde was the most prevalent preservative allergen. Chloroacetamide allergy was more commonly seen in Australia. Parabens, 2-bromo-2-nitropropane-1, 3-diol and benzyl alcohol were the least frequent sensitisers. Household products in Australia are not required to list all ingredients preventing sensitised individuals from properly assessing their exposure. © 2012 The Authors Australasian Journal of Dermatology © 2012 The Australasian College of Dermatologists.


Gamboni S.E.,Occupational Dermatology Research and Education Center | Allen K.J.,Murdoch Childrens Research Institute | Allen K.J.,University of Melbourne | Nixon R.L.,Occupational Dermatology Research and Education Center
Australasian Journal of Dermatology | Year: 2013

There is an increasing awareness of food allergies in the community. Dermatologists frequently see patients with atopic eczema, where parents are extremely concerned about the role of food allergy. Advice given to parents regarding the timing of introduction of solid foods has changed markedly over the past decade. Whereas previous advice advocated delaying the introduction of solid foods until the infant's gastrointestinal system had matured, recent studies suggest that the introduction of solids from around 4 to 6 months may actually prevent the development of allergies. Studies on maternal dietary restrictions during pregnancy and lactation have led researchers to believe that antigen avoidance does not play a significant role in the prevention of atopic disease. Breastfeeding exclusively for 4 to 6 months has multiple benefits for mother and child, however, it does not convincingly prevent food allergies or decrease atopic eczema. New evidence suggests that the use of hydrolysed formulas does not delay or prevent atopic eczema or food allergy. This article aims to highlight current evidence and provide an update for dermatologists on the role of food exposure in the development of atopic disease, namely atopic eczema. © 2012 The Authors. Australasian Journal of Dermatology © 2012 The Australasian College of Dermatologists.


Gamboni S.E.,Occupational Dermatology Research and Education Center | Palmer A.M.,Occupational Dermatology Research and Education Center | Nixon R.L.,Occupational Dermatology Research and Education Center
Australasian Journal of Dermatology | Year: 2013

Gallic acid esters or gallates are antioxidants used as preservatives in food and cosmetics. Few cases of gallates causing allergic contact dermatitis (ACD) have been reported in the literature. We present a case report of a 42-year-old beauty therapist who presented with a swollen tongue. Patch testing was positive to dodecyl gallate, commonly reported as being present in edible oil and oily foods such as margarine. Our patient avoided foods presumed to contain gallates and at the 6-week review reported a substantial improvement in her tongue symptoms. We reviewed our database and found 16 (7%) definitely or possibly relevant reactions to dodecyl gallate, seven (15%) definitely or possibly relevant reactions to propyl gallate and six (3%) definitely or possibly relevant reactions to octyl gallate. Most reactions were attributed to margarine, moisturising cream and lipstick. These products are often mentioned in the literature as containing gallates; however, ingredient labelling and discussions with manufacturers made it difficult to establish whether they are currently present in foods. Ascertaining relevance for these reactions is not always possible. © 2012 The Australasian College of Dermatologists.


Lyons G.,St Vincents Hospital | Nixon R.,Occupational Dermatology Research and Education Center
Australasian Journal of Dermatology | Year: 2013

Acrylates are used widely in acrylic nails, dental restorative materials, paint, varnish, printing ink, adhesives, glue, orthopaedic prostheses, bone cement and diathermy pads. This is the first case of allergic contact dermatitis to methacrylates in electrocardiogram electrode dots reported in the literature. © 2012 The Authors Australasian Journal of Dermatology © 2012 The Australasian College of Dermatologists.


Toholka R.,Occupational Dermatology Research and Education Center | Nixon R.,Occupational Dermatology Research and Education Center
Australasian Journal of Dermatology | Year: 2013

Chlorhexidine is a commonly used antiseptic agent in the health-care setting. Although exposure to chlorhexidine is very common, allergic contact dermatitis (ACD) is rarely reported. We report a case series of ACD to chlorhexidine in health-care workers and discuss our rates of allergy to chlorhexidine, from patch-testing performed at the Skin and Cancer Foundation, Melbourne, Australia. Of 7890 patients patch-tested, 840 patients were tested to 0.5% chlorhexidine diacetate with 28 (3%) positive reactions, 13 (2%) of which relevant to their presenting dermatitis. Altogether 1565 patients were tested to 0.5% chlorhexidine digluconate, with 47 (3%) positive reactions, 16 (1%) of which were relevant. We estimate our rate of relevant chlorhexidine ACD from our total clinic patients, non-occupational and occupational, to be at least 19/7890 (0.24%). Our rate of relevant chlorhexidine ACD in health-care workers is 10/541 (2%). Interestingly, our rates of chlorhexidine allergy are slightly higher than documented elsewhere. This raises the possibility that chlorhexidine is underestimated as an allergen worldwide, and should be tested for in health-care workers where there is a history of exposure. © 2013 The Authors. Australasian Journal of Dermatology © 2013 The Australasian College of Dermatologists.


Toholka R.,Occupational Dermatology Research and Education Center | Nixon R.,Occupational Dermatology Research and Education Center
Australasian Journal of Dermatology | Year: 2014

We report a case of suspected allergic contact dermatitis to the preservative and uncommon allergen iodopropynyl butylcarbamate, found in Microshield Angel hand gel, a skin cleanser commonly used in Australian health-care settings. © 2013 The Australasian College of Dermatologists.


Palmer M.J.,Occupational Dermatology Research and Education Center | Nixon R.,Occupational Dermatology Research and Education Center
Australasian Journal of Dermatology | Year: 2015

Polysensitisation refers to reactivity to three or more allergens on epicutaneous patch testing, and is likely to affect a distinct subgroup of individuals with allergic contact dermatitis (ACD). Methylisothiazolinone (MIT) is an increasingly prevalent allergen, recently having been described as occurring in epidemic proportions. We report a patient with ACD to 12 allergens, including MIT, and discuss the implications of polysensitisation and the likely need for repeat patch testing in such patients if they subsequently re-present with dermatitis. © 2014 The Australasian College of Dermatologists.

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