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Health Professionals• Guidelines for people with atopy |
| Example of patch tests used in clinic |
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Guidelines for people with atopy
What is atopy?
Atopy is referred to having a personal or family background of eczema, asthma or hayfever.
Atopy and dermatitis
Having a history of these conditions as a baby or in childhood, even when they have gone away, increases the risk of developing work-related dermatitis, particularly affecting the hands. In fact, those who have had eczema at any age anywhere on the skin are four times more likely to develop work-related dermatitis. A history of eczema affecting the hands but not elsewhere especially increases an individual’s susceptibility to develop occupational contact dermatitis.
People with atopy are more likely to have problems with their skin being able to repair itself; therefore the barrier function is often compromised, allowing greater opportunity for the development of irritation and allergy.
Work and atopy
People with a history of atopy, and that work in certain industries are at higher risk of developing skin problems at work. These include those working in:
- Construction
- Food handling
- Hair and beauty
- Healthcare and
- Mechanical and metal working
If you have an atopic background, you should avoid contact with skin irritants which are known to cause dermatitis, right from the beginning of your employment. These include:
- Wet work- frequent hand washing
- Soaps and detergents
- Oils and greases
- Heat and sweating (which can be caused from wearing occlusive/water proof style gloves for long periods)
- Dusts and fibre
- Solvents and thinners
Wearing appropriate gloves is also important- specific gloves are designed for specific tasks and chemicals. It is best that you avoid wearing powdered latex gloves, as people with an atopic background are at higher risk of developing an allergy to latex, and glove powder is known to facilitate the development of latex allergy.
Wearing cotton gloves under occlusive gloves can reduce sweating.
Teenagers entering the work force, even part-time, in areas such as hospitality involving frequent hand washing are vulnerable to developing hand dermatitis. So are young people who are working casually or are on work experience programs, who have not entered formal apprenticeship programs where they hopefully will learn about occupational health and safety.
Home life
It is important that you are aware of things at home that can also cause dermatitis, and flare eczema. These particularly include hand washing and dishwashing, cleaning and soaps and detergents. Use of appropriate gloves is essential for these tasks. Different jobs may require different gloves. Also avoid contact with irritants when performing house renovations, car maintenance or other hobbies or activities around the house.
Skin care
People with atopy need to be vigilant about looking after their skin at work and at home. Refer to our ‘Care of your hands’ brochure for more information. Essentially, treatment includes use of appropriate gloves, soap substitutes and use of moisturising creams to the hands, especially at night. The importance of keeping the skin well moisturised cannot be under-estimated. Moisturisers have a particular role to restore skin barrier function.
People at very high risk
International studies have identified those at the highest risk of developing occupational dermatitis. These are people with:
- Moderate to severe atopic eczema with hand involvement
- Chronic (long standing) hand eczema
- Previous change of work because of hand dermatitis
It is important that such individuals are counseled on appropriate skin care before starting work. It may mean that they are not suitable for some jobs.
Reference: Coenraads PJ Diepgen TL Risk for hand eczema in employees with past or present atopic dermatitis Int Arch Occup Environ Health 1998; 71: 7-13
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Contact Allergen Bank Australia
Introduction to Contact Allergen Bank Australia
Contact Allergen Bank Australia (CABA) is based on an idea which originated in Denmark and is a new initiative in Australia to assist dermatologists to diagnose allergic contact dermatitis (ACD). It involves the preparation of individualised patch tests which are sent out to dermatologists' practices.
Project aims:
- To provide Australian dermatologists, particularly those in regional centres, with access to comprehensive patch testing resources, available in a timely manner
- To improve the prognosis of patients with contact dermatitis, with the identification of allergens relevant to their skin condition
- To collect data on the results of patch testing nationally
- To enable dermatologists to develop experience and expertise in contact dermatitis, without the costs of purchasing allergens or paying for nursing staff
Dermatologists select patch test series that they would like to test on a particular patient. The patch tests are then prepared at the Foundation (SCF Victoria) and mailed to the dermatologist, together with a test sheet, prepared from our computerised patch testing program PatchCams© . Dermatologists can now order allergens online. Once registered for CABA, those registered will receive a password to access this online program. In addition, later on in the year patient information sheets for more than 70 allergens will be available to registered users.
Any questions or to Register for CABA, please ph. 03 9623 9402 or email apalmer@occderm.asn.au
Information for dermatologists
Costs of CABA
Less than 10 allergens = $30
Less than 30 allergens = $60
Less than 60 allergens = $120
Less than 80 allergens = $180
Less than 100 allergens = $240
More than 100 allergens = To be advised at time of ordering
Postage and handling = $20.00 + GST
Time of receiving allergen order:
Please allow up to two weeks for order. When ordering allergens please specify what date you plan on using the tests, so they can be prepared and sent accordingly (write the date you require the patches on the 'Patients detail' screen, in the notes section at the bottom of the screen). If this request can’t be met, you will be notified.
Storage of patches
Stores patches in fridge or in a dry, cool place, away from direct sunlight.
What to order:
Generally we recommend that all patients are tested with our Australian Baseline Series. These contain the most common causes of allergy seen in Australia and worldwide. These series contain a wide range of allergens including, nickel, fragrances, preservatives, rubber ingredients, ingredients from medicaments and cosmetics, dyes, hair dyes and bleach.
In addition, we recommend you add tests that are relevant to the patients’ rash or occupation. We have almost 50 additional series that you can choose from.. For full lists of individual allergens you must be registered with CABA. To assist you when dealing with occupational cases, we have developed a list of occupational groups we commonly see, and have suggested recommended test allergens and series. Similarly, we have a comprehensive list of recommended tests for general causes of contact dermatitis.
Limitations of CABA
Plant extract series- We are unable to mail these as they are in an alcohol base, therefore we cannot send due to difficulty in finding suitable containers for alcohol based allergens.
Methyl methacrylate- Is thought to be unstable, so therefore may not be reliably tested.
Placement of patches
The patches are most commonly positioned on the patients back, in 2-3 rows across the top of the shoulder, down to mid back line. See below for suggested positioning. Place Micropore over the top to hold patches in place.
Reading of patches
Reading of patches is performed on day 3 and 5. The reading is performed 10-15 minutes after patches have been removed. Once patches are removed, the purple marks are re-touched, then the patches are numbered with thin pieces of tape.
An example of positive reactions, from doubtful/weak to strong are listed below.
Please record results on patient chart, and state their relevance.
U= Unknown relevance
R= Relevant reaction
O= Old or past relevant reaction
Patient information
About patch testing- patch brochure
Patch testing instruction sheet- Instruction sheet
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Information sheets
We have a range of information sheets now available.- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
Training
The Skin and Cancer Foundation, Melbourne, runs two different contact dermatitis patch test clinics, a general clinic and a specialised occupational contact dermatitis clinic. There are usually 2 general and 2 occupational clinics conducted on a monthly basis.
Each clinic is run over a period of 5 days, with patients attending on Monday, Wednesday and Friday consecutively.
On the first appointment, patients have full consultation with specialist dermatologist, who will decide what needs to be tested. The clinic nurse will then make the patches up and apply them to the patients back.
On the second appointment, the patches are removed and the back will be looked at to see if there have been any reactions or 'red spots' showing up where the patches were.
On the third appointment, the dermatologist will have another look at the back to see if there have been any other reactions. The dermatologist will then discuss results and management of the condition.
If you are a dermatologist, or dermatology registrar interested in attending either clinic please email admin@occderm.asn.au or phone 03 9623 9402.
Example of positive patch test reactions
Interesting Cases CD
The Occupational Dermatology Research and Education Centre, Skin and Cancer Foundation, Victoria, have released a CD ROM. The CD is titled 'Interesting Cases from the Occupational Dermatology Clinic,' and is designed to be an educational tool for dermatologists, occupational physicians and occupational hygienists and others who may treat patients or workers with occupational skin disease.
Occupational skin disease is an important cause of work-related disease. By far the most cause of occupational skin disease is occupational contact dermatitis, with irritant contact dermatitis significantly more common than allergic contact dermatitis. There is often a delay in making the exact diagnosis, which may adversely affect the prognosis. Sometimes, the occupational nature of disease is not suspected by the treating practitioner, leading to a delay in referral for assessment. There is evidence that shows the earlier the diagnosis is made, the better the prognosis.
This CD contains 60 de-identified clinical cases. For each case there is a summary of clinical information including history, examination of findings, patch test results and blood test results, final diagnosis, advice given to patient and photographs. Key teaching points are also presented for each case, along with relevant references.
This CD was produced with support from the Australasian College of Dermatologists and the Skin and Cancer Foundation, Victoria.
For more information or to order a copy ph. 03 9623 9402 or email admin@occderm.asn.au Cost is $50 plus postage and handling.
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