Patient Workplace Research Articles

Role of Telerehabilitation in Patients With COPD: A Brief Review

Chronic obstructive pulmonary disease is a reversible lung disease that is characterised by persistent respiratory symptoms and airflow limitation. The airflow limitation may be due to alveolar and airway abnormalities, usually caused by significant exposure to noxious particles. India is estimated to have 30 million COPD patients at present. Chronic and progressive dyspnoea is the most common symptom of COPD. Dyspnoea is the major cause of anxiety and disability in COPD. There are various exercises for pulmonary rehabilitation for patients with COPD. Telerehabilitation is an approach in which rehabilitation is provided at the patient's work place, home, or other place through video-conferencing, video-based, or Gmail. Various physical exercises, such as strength exercise, endurance exercise, and breathing exercise, can help in the management of dyspnoea, quality of life, and exercise capacity. Studies have supported that telerehabilitation could result in better control of dyspnoea, quality of life, and exercise capacity in patients with COPD. Studies conducted till date have not reached a definitive conclusion for forming a definitive protocol for telerehabilitation exercise in patients with COPD. Hence, in order to establish a definitive telerehabilitation protocol for patients with COPD, further research needs to be conducted. Keywords: Telerehabilitation, Videoconferencing, Video-based, COPD, Quality of Life, Dyspnoea, Exercise Capacity

Allergic contact dermatitis to phenoxyethanol: A rare, but possible cause of hand dermatitis.

Phenoxyethanol (PE; Syn. 2-Phenyoxethanol; CAS no. 122-99-6) is one of the most commonly used preservatives in cosmetics and is also found in industrial products, including metalworking fluids. It is considered to have a low sensitization potential.1-3 A 59-year-old male toolmaker presented with therapy-resistant, 1-year lasting hand dermatitis suspected to be of occupational origin. Despite being on work leave and treatment with alitretinoin for the past 5 months, severe dermatitis of hands and lower arms was observed (Figure 1). We performed patch tests and readings according to the guidelines of the German Contact Dermatitis Research Group (DKG)4 using the DKG baseline series; the DKG series for topical preparations, preservatives, rubber, disinfectants, acrylates, industrial biocides, and metalworking fluids; and the patient's own metalworking fluid. Patch tests were removed at day (D) 2 with the exception of the metalworking fluid, which was removed already at D1 and reactions were evaluated at D2, D3, D4, and D7. Solely, a 2+ reaction to PE 1% pet. (SmartPractice, Greven, Germany) from D2 to D7 was noted (Figure 2A). PE was not found in any of the available safety datasheets of the patient's workplace products, including the metalworking fluid. However, according to the product labels, it was an ingredient of the patient's skin care products “Eucerin UreaRepair PLUS 5% Hand Creme” and “Nivea 3IN1 Repair Hand Creme” (both from Beiersdorf AG, Hamburg, Germany), which he had regularly applied on his hands and lower arms after the onset of dermatitis. Repeated open application test (ROAT) with “Eucerin UreaRepair PLUS 5% Hand Creme,” two times daily for 6 days on the inner sides of the patient's upper arm resulted in a positive reaction (Figure 2B). Dermatitis of hands and lower arms improved significantly after avoidance of these skin care products, indicating clinical relevance of the sensitization to PE as the contributing factor to the initially occupational irritant contact dermatitis. Despite its widespread use as preservative in cosmetic and pharmaceutical products as well as for other applications, only very few cases of allergic contact dermatitis and contact urticaria to PE have been reported.2, 5-7 Accordingly, a retrospective study of the Information Network of Departments of Dermatology (IVDK) revealed a very low sensitization rate of 0.24% among 6932 individuals patch tested in Germany, Austria, and Switzerland between 1996 and 2009.1 Similarly, in 681 cutting metalworkers patch tested with the DKG metalworking fluids series in IVDK centres from 2010 to 2018, sensitization to PE was rarely observed (0.3%).8 Although rare, allergic contact dermatitis to PE should be considered and if undiscovered may lead to longstanding disease and inefficient treatments. The present case illustrates the importance of performing early patch tests to avoid delays in diagnosis and prevention measures. Diagnostic workup of patients with suspected occupational hand dermatitis should include patch testing and in doubtful cases also ROAT with patient's own skin care products. The authors declare no conflicts of interest. Michaela Kolodziej: Conceptualization (equal); investigation (equal); writing – original draft (equal); writing – review and editing (equal). Alexander Kiewert: Investigation (supporting); writing – review and editing (equal). Christoph Skudlik: Investigation (supporting); writing – review and editing (equal). Richard Brans: Conceptualization (equal); investigation (equal); supervision (lead); writing – original draft (equal); writing – review and editing (equal).

Satisfaction des patients après réglage des orthèses mandibulaire par téléconsultation

Since the COVID-19 crisis, we have all had to apply telemedicine. As an example, we offered patients teleconsultations for titration of their mandibular advancement device for sleep apnea. The main objective of this study was to determine patient satisfaction with this new method of consultation.A cross-sectional survey using a satisfaction questionnaire was carried out in patients having been given an appliance adjustment teleconsultation by our establishment between March 2020 and February 2021.Adjustment of their orthosis by telemedicine was systematically proposed to seventy-five patients, of whom seventeen accepted (22.7%), with a mean age of 52.3 years. The consultations were short (mean duration: 5min), and more than a third were carried out at the patient's workplace; by and large, they were considered highly satisfactory (mean score 4.3/5).Although appliance adjustment by teleconsultation was not overwhelmingly accepted when offered, it gave great satisfaction after performance. This type of consultation is both technologically and administratively easy to organize, and it can be proposed as a supplementary service, suitable for all ages.

Occupational IgE‐mediated psyllium allergy in contemporary gluten‐free and vegan baking: A case of allergic rhinitis

Psyllium (from Plantago ovata; ispaghula) is used as a dietary supplement and is supplied in the form of husk, granules, capsules, or powder. Consumers using psyllium-containing laxatives, healthcare workers handling these, and pharmaceutical workers in laxative-manufacturing plants are known to be at risk of sensitization and subsequent rhinitis, asthma, contact urticaria, and even anaphylaxis. To our knowledge, the case we present here is the first of baker's immunoglobulin E (IgE)-mediated occupational allergy due to psyllium exposure. Our patient, a 24-year-old female baker with no previous allergies, was referred to our clinic with suspected occupational rhinitis. After 1 year of baking with cereal flour or gluten-free flour-mix, she began to suffer from rhino-conjunctival symptoms during workdays. Skin prick tests with agents from the patient's workplace revealed allergies not only to wheat and rye flours but also to psyllium, with a remarkable 10 mm wheal. Subsequently, nasal provocation tests confirmed occupational allergic rhinitis to psyllium. We also found work-related sensitization to buckwheat, which she used in gluten-free baking. Due to the increased prevalence of celiac disease and the popularity of gluten-free and vegan food, psyllium has recently become a common ingredient in baking, used as a substitute for gluten or eggs. Bakers handle allergens such as these in high concentrations and this may lie behind the emergence of respiratory and dermal symptoms. It is essential to consider new or recenlty introduced materials as possible allergens if it is suspected that a baker has work-related respiratory or allergic symptoms.

Information and legal background for remote outpatient care for patients with diabetes mellitus during COVID-19 pandemic

Objectives the in-depth analysis of the informational and legal base for organisation of remote medical care for patients with diabetes mellitus in the context of the COVID-19 pandemic.
 Material and methods. Official memoranda of the WHO and the International Labour Organization (ILO), decisions of the Government of the Russian Federation and foreign countries on the use of remote telemedicine counseling in the context of the COVID-19 pandemic were reviewed and analysed.
 Results.After reviewing the results of remote telemedicine counseling to provide specialized medical care to patients with diabetes during COVID-19 pandemic on various virtual platforms, we defined the factors limiting the widespread use of this technology. We collected metadata of the results of the original experience of remote consultation of patients with endocrine pathology using the automated workplace of an endocrinologist (AWPE).
 Conclusion.In the context of the COVID-19 pandemic, the development and implementation of new promising forms of outpatient work using digital telecommunication technologies is particularly relevant. The use of remote access telemedicine consulting techniques via Automated endocrinologist's workplace for patients with endocrine pathology during the period of self-isolation showed its effectiveness in a pilot study. Its widespread introduction into outpatient practice will not only significantly increase the availability of medical care for patients with diabetes, but also minimize the risk of infection with a new coronavirus for doctors.

The Role of Healthcare Providers in Return to Work

International research has generated strong evidence that healthcare providers (HCPs) play a key role in the return to work (RTW) process. However, pressure on consultation time, administrative challenges and limited knowledge about a patient's workplace can thwart meaningful engagement. Aim: Our study sought to understand how HCPs interact with workers compensation boards (WCBs), manage the treatment of workers compensation patients and navigate the RTW process. Method: The study involved in-depth interviews with 97 HCPs in British Columbia, Manitoba, Ontario and Newfoundland and Labrador and interviews with 34 case managers (CMs). An inductive, constant comparative analysis was employed to develop key themes. Findings: Most HCPs did not encounter significant problems with the workers compensation system or the RTW process when they treated patients who had visible, acute, physical injuries, but faced challenges when they encountered patients with multiple injuries, gradual-onset or complex illnesses, chronic pain and mental health conditions. In these circumstances, many experienced the workers compensation system as opaque and confusing. A number of systemic, process and administrative hurdles, disagreements about medical decisions and lack of role clarity impeded the meaningful engagement of HCPs in RTW. In turn, this has resulted in challenges for injured workers (IWs), as well as inefficiencies in the workers compensation system. Conclusion: This study raises questions about the appropriate role of HCPs in the RTW process. We offer suggestions about practices and policies that can clarify the role of HCPs and make workers compensation systems easier to navigate for all stakeholders.

Case of accelerated silicosis in a sandblaster

Sandblasting is traditionally known as a high-risk profession for potential development of lung silicosis. Reported is a case of a sandblaster with confirmed accelerated silicosis, a condition rather rarely diagnosed in the Czech Republic. Initially, the patient presented with progressive dry cough and exertional dyspnoea. In the early diagnostic process, a possible occupational aetiology was considered given his occupational history and known high-risk exposure to respirable silica particles confirmed by industrial hygiene assessment at the patient’s workplace. The condition was confirmed by clinical, histological and autopsy findings. The patient died during lung transplantation, less than five years from diagnosis.

Occupational Pulmonary Aluminosis: A Case Report

The authors present a case of occupational lung damage from exposure to dust containing aluminium. The first detected objective pathological finding was that of dispersed micronodules in the lungs seen in a chest radiograph. The final diagnosis of pulmonary aluminosis was established after three years of gradual exclusion of other interstitial lung diseases. The diagnosis was supported by the occupational history confirmed by hygiene assessment of the patient’s workplace and especially by histological examination with elemental analysis of the lung tissue. The possibility of development of this rare condition should not be underestimated in workers at high-risk jobs.

Diabetes Telehealth in the 21st Century: Log In to the Future of Medicine

The era of diabetes telehealth began with the first telephone call from a health care provider to a patient with diabetes, followed years later by a facsimile (fax) of patient-collected data (most likely urine glucose results and insulin doses) to a physician's office sent from a patient's workplace or home. The dates of those events have been long forgotten, but interacting with patients remotely via electronic means has exploded during the past 20 years with the establishment of personal computing, the Internet, and wireless communication technologies. The result has been an array of innovative modalities for diabetes health care teams to use for interacting with patients, whether they are located anywhere on the planet or just across the street. Diabetes care is largely a cognitive discipline. Providing timely education and self-management counseling to patients has always been a crucial element of successful outcomes. The archetypical example of a sustained application of telehealth was the Diabetes Control and Complications Trial (DCCT), which began more than 30 years ago. For more than a decade, subjects in the intensive treatment arm of the DCCT were contacted weekly by telephone to discuss progress and make adjustments to management.1 This was in the era before popular use of e-mail, webcams, cell phones, text messages, or the Internet. Now that we are well into the 21st century, it is time to recognize the increasing role of remote-access technologies today and the more prominent role they will play in the clinical arsenal of diabetes educators and health care providers and in health care population management systems in the future. The rising cost of health care delivery continues to be the primary driver of decision-making on the micro- and macroeconomic levels. Using remote communication, education, and training technologies to contain costs while maintaining quality are commonplace in …

A Case of Tracheal Adenoid Cystic Carcinoma in a Worker Exposed to Rubber Fumes

BackgroundPrimary tracheal tumors occur infrequently, accounting for less than 0.1% of all tumors. Adenoid cystic carcinoma (ACC) is the second most common type of malignancy of the trachea after squamous cell carcinoma (SCC). Little has been reported on the risk factors for tracheal ACC. The purpose of this study is to describe a case of tracheal ACC in a patient who had been exposed to rubber fumes, and to review the relationship between tracheal ACC and rubber fumes.Case reportA 48-year-old man who had been experiencing aggravation of dyspnea for several months was diagnosed as having ACC of the trachea on the basis of a pathologic examination of a biopsy specimen obtained via laser microscopy-guided resection. The patient had been exposed to rubber fumes for 10 years at a tire manufacturing factory where he worked until ACC was diagnosed. His job involved preheating and changing rubber molds during the curing process.ConclusionACC of both the trachea and the salivary glands show very similar patterns with regard to histopathology and epidemiology and are therefore assumed to have a common etiology. Rubber manufacturing is an occupational risk factor for the development of salivary gland tumors. Further, rubber fumes have been reported to be mutagenic. The exposure level to rubber fumes during the curing process at the patient’s workplace was estimated to be close to or higher than British Occupational Exposure Limits. Therefore, tracheal ACC in this case might have been influenced by occupational exposure to rubber fumes.

Darbo aplinkos veiksnių poveikio sveikatai ekspertizė pulmonologijoje

Galimo etiologinio ar ligą skatinančio veiksnio (darbo, namų aplinkoje esančio rizikos veiksnio) išsiaiškinimas ir pašalinimas laiku sudaro sąlygas efektyvesniam gydymui ir gali užkirsti kelią tolesniam ligos progresavimui, lemiančiam ilgalaikį nedarbingumą, o ilgainiui ir neįgalumą. Yra tokių alerginių bei kvėpavimo takų ligų, kuriomis sergantis asmuo negali dirbti veikiamas cheminių veiksnių, pvz.: lėtinės obstrukcinės plaučių ligos, astma, lėtinis kvėpavimo nepakankamumas, viršutinių kvėpavimo takų atrofiniai pakitimai. Gydytojas, nustatęs alerginę ar lėtinę plaučių ligą ir įtaręs, kad ligos eigą gali bloginti paciento darbo sąlygos, turėtų siųsti jį darbo medicinos gydytojo konsultacijos.

A Case of Occupational Asthma in a Plastic Injection Process Worker

ObjectivesWe report a case of death due to asthma attack in a plastic injection process worker with a history of asthma.MethodsTo assess task relevance, personal history including occupational history and medical records were reviewed. Samples of the substances utilized in the injection process were collected by visiting the patient’s workplace. The work environment with the actual process was reproduced in the laboratory, and the released substances were evaluated.ResultsThe medical records confirmed that the patient’s conventional asthma was in remission. The analysis of the resins discharged from the injection process simulation revealed styrene, which causes occupational asthma, and benzenepropanoic acid, 3,5-bis(1,1-dimethylethyl)-4-hydroxy-, and octadecyl ester. Even though it was not the case in the present study, various harmful substances capable of inducing asthma such as formaldehyde, acrolein, and acetic acid are released during resin processing.ConclusionA worker was likely to occur occupational asthma as a result of the exposure to the harmful substances generated during the plastic injection process.

Sickness certification as a complex professional and collaborative activity - a qualitative study

BackgroundPhysicians have an important but problematic task to issue sickness certifications. A manifold of studies have identified a wide spectrum of medical and insurance-related problems in sickness certification. Despite educational efforts aiming to improve physicians’ knowledge of social insurance medicine there are no signs of reduction of these problems. We hypothesised that the quality deficits is not only due to lack of knowledge among issuing physicians. The aim of the study was to explore physicians’ challenges when handling sickness certification in relation to their professional roles as physicians and to their interaction with different stakeholders.MethodsOne hundred seventy-seven physicians in Stockholm County, Sweden, participated in a sick-listing audit program. Participants identified challenges in handling sick-leave issues and formulated action plans for improvement. Challenges and responsible stakeholders were identified in the action plans. To deepen the understanding facilitators of the program were interviewed. A qualitative content analysis was performed exploring challenge categories and categories of stakeholders with responsibility to initiate actions to improve the quality of the sick-listing process. The challenge categories were then related by their content to professional competence roles in accord with the Canadian Medical Education Directions for Specialists (CanMEDS) framework and to the stakeholder categories.ResultsSeven categories of challenges were identified. Practitioner patient interaction, Work capacity assessment, Interaction with the Social Insurance Administration, The patient’s workplace and the labour market, Sick-listing practice, Collaboration and resource allocation within the Health Care System, Leadership and routines at the Health Care Unit. The challenges were related to all seven CanMEDS roles. Five categories of stakeholders were identified and several stakeholders were involved in each challenge category.ConclusionsPhysicians performing sickness certification tasks experience a complex variety of challenges. From physician perspective actions to handle these need to be initiated in interaction with both medical and non-medical stakeholders. The relation between the challenges and a well-established professional competence framework revealed a complex pattern. Thus, from a public health perspective, educational activities aimed to improve the sick-listing process should address all physician competences including identification and interaction with stakeholders, and not just knowledge of social insurance medicine.

Die Ergotherapie bei der rheumatoiden Arthritis – aktuelle Übersicht und Zusammenfassung der Literatur

Die ergotherapeutische Behandlung ist ein wichtiger Bestandteil in der Versorgung von Patienten mit rheumatoider Arthritis (RA). Neben der Befunderhebung werden ergotherapeutische Maßnahmen inkl. Beratung zum Gelenkschutz sowie die Möglichkeiten der funktionellen Therapie erläutert. Anhand einer fokussierten Literaturrecherche wird die Evidenz zur Ergotherapie bei der RA wiedergegeben. Demnach können intensive und umfassende Programme unter Einbeziehung von Schulungen und Beratungen signifikante Verbesserungen von Schmerz und Funktion erreichen. Orthesen und Schienen zeigen wenig Effektivität. Aufgrund der innovativen medikamentösen Behandlung stellt die Betreuung am Arbeitsplatz einen wesentlichen Schwerpunkt der Ergotherapie dar.

Exposure-Related Diffuse Lung Disease

Practicing pulmonologists are often faced with the question of whether a lung disease is related to something in the patient's workplace, home, or recreational environment. Recognizing a lung disease as exposure related creates both opportunities and obligations for clinicians. In addition to managing the patient, the obligation to consider risks to others and to prevent ongoing exposure is a challenge that requires diagnostic clarity and collaboration between multiple specialists. We present five illustrative case studies of patients with diffuse lung diseases from environmental and occupational exposures in which communication between the pulmonologist, radiologist, and pathologist was essential for both medical and public health management. Diagnostic and treatment strategies as well as social and preventive interventions are reviewed, with key points for the practicing pulmonologist.

Occupational hypersensitivity pneumonitis due to molds in an onion and potato sorter

A 42-year-old female non-smoking onion and potato sorter developed work-related shortness of breath, cough, fatigue and flu-like symptoms. The diagnosis of hypersensitivity pneumonitis was based on patchy infiltrates in both lungs on high resolution computed tomography and lymphocytosis of 71% in a bronchoalveolar lavage sample with a CD4/CD8 ratio of 0.4. Exposure cessation and initial corticosteroid therapy resulted in complete recovery. IgG antibodies to Penicillium species and Fusarium solani cultivated from samples from the patient's workplace were detected in the patient's serum and cross-reactivity was demonstrated within Penicillium species, but also between Penicillium species and Aspergillus fumigatus. We conclude that occupational hypersensitivity pneumonitis due to molds may develop in onion and potato sorters.

Occupational Medicine Tutorial (Out of Print)

OPEN ACCESSDecember 19, 2007Occupational Medicine Tutorial (Out of Print) Lynn Kosowicz, MD, Franklyn Farrell, MD, MPH, Anton Alerte, MD, Anne Bracker, MPH, CIH, Marc Croteau, MD, MPH, Eileen Storey, MD, MPH Lynn Kosowicz, MD University of Connecticut School of Medicine Google Scholar More articles by this author , Franklyn Farrell, MD, MPH Texas A&M Health Science Center College of Medicine Google Scholar More articles by this author , Anton Alerte, MD University of Connecticut School of Medicine Google Scholar More articles by this author , Anne Bracker, MPH, CIH University of Connecticut School of Medicine Google Scholar More articles by this author , Marc Croteau, MD, MPH University of Connecticut School of Medicine Google Scholar More articles by this author , Eileen Storey, MD, MPH University of Connecticut School of Medicine Google Scholar More articles by this author https://doi.org/10.15766/mep_2374-8265.701 SectionsAbout ToolsDownload Citations ShareFacebookTwitterEmail AbstractAbstract Introduction: The online Occupational Medicine Tutorial prepares students to diagnose occupational diseases in their patients. The material is comprehensive enough to allow faculty who do not specialize in occupational medicine to run this activity. Methods: The tutorial is broken into three sections and is designed to take approximately 30-minutes to complete. The first section includes an overview of the importance of taking an occupational history, a list of common occupations, exposures and resultant diseases, and a methodology for obtaining a problem-focused occupational history. The second section asks the students to complete their own personal occupational history using the framework outlined in the previous section. The third section allows the student to work through one of two clinical vignettes. Results: Both students and faculty graded the online tutorial favorably. Eighty-one percent of students rated the relevance of the online tutorial as good to excellent. Seventy-four percent thought the quality of the material is good to excellent and seventy percent rated the quality of the presentation as good to excellent. Faculty respondents were much more enthusiastic with 92.8% judging the relevance, quality of content, and presentation within the good to excellent range. Discussion: After completing the tutorial students appreciated the range of occupational exposures and the importance of taking an occupational history. Because the tutorial encourages the students to take their own occupational histories, they are more familiar with the tools available to determine if a patient's workplace exposures could be associated with their presenting symptoms and illness. Educational Objectives By the end of the module, the learner will be able to: Understand the scope of work-related disorders, its components, and the importance of the occupational history.Obtain an occupational history in different clinical settings, and recognize that occupational diseases are reportable to public health agencies. Sign up for the latest publications from MedEdPORTAL Add your email below FILES INCLUDEDReferencesRelatedDetails FILES INCLUDED Included in this publication: Web Link Access_701.pdf To view all publication components, extract (i.e., unzip) them from the downloaded .zip file. Download editor’s noteThis publication may contain technology or a display format that is no longer in use. Copyright & Permissions© 2007 Kosowicz et al. This is an open-access publication distributed under the terms of the Creative Commons Attribution-NonCommercial license.KeywordsAllergic ContactMSDSGlutaraldehydeCarpal Tunnel SyndromeMaterial Safety Data Sheet Disclosures None to report. Funding/Support None to report. Loading ...

Patch testing with metalworking fluids from the patient's workplace

In view of the wide variety of components currently used in metalworking fluids (MWF), relevant contact sensitizations may be overlooked, because commercially available MWF test series cannot cover the full spectrum. Hence, patch testing with MWF from the patient's workplace is an important additional diagnostic tool. However, recommendations on how to perform such patch tests vary. We retrospectively analyzed patch test data of the Department of Dermatology in Dortmund, 1992-2003. In 141 metalworkers tested because of suspected occupational contact dermatitis due to MWF, 829 patch tests with 306 samples of MWF were performed. Water-based MWF (wb MWF) were mainly tested in 2 dilution series, i.e. pure (workplace concentration), 10% aq. and 1% aq., and pure, 50% aq. and 10% aq. Positive reactions to wb MWF occurred in 27 patients. Patch testing with wb MWF at workplace concentration resulted in 16.1% (39/242) positive reactions, with a positivity ratio of 69% and a reaction index of 0. From the analysis of reaction patterns and concomitant reactions, we conclude that most of these positive reactions indicated true contact allergy. With lower concentrations, relevant allergic reactions may be missed. Neat oils were tested as is or diluted from 1 to 50% in olive oil, but no reactions at all were observed. For optimum benefit of patch testing with MWF from the patient's workplace, breakdown testing is recommended. To overcome the time-consuming difficulties associated with this procedure, we propose a centre for information and documentation of contact allergies due to occupational exposure. Furthermore, full declaration of MWF ingredients is desirable.

Occupational rhinitis.

This article aims to define occupational rhinitis, classify its various causes, review the steps in its diagnosis, and describe its nonpharmacologic and pharmacologic principles of management. Occupational rhinitis frequently coexists with asthma but also occurs alone. Although it does not have the same impact as occupational asthma, occupational rhinitis causes distress, discomfort, and work inefficiency. By concentrating on the patient's workplace, the clinician has an opportunity to practice preventive medicine: to recognize substances in the patient's micro- and macroenvironment that are causing the problems and then to intervene by altering the environment or removing the patient from the environment.

Kontaktekzeme durch Kühlschmierstoffe in der Metallindustrie

In dieser Übersicht werden zunächst wassermischbare (wm), wassergemischte (wg) und nichtwassermischbare (nw) Kühlschmierstoffe (KSS) mit ihren Einsatzbereichen und Komponenten, sowie betriebsbedingte Veränderungen von wg-KSS skizzenhaft vorgestellt. Insbesondere durch wg-KSS können irritative und allergische Kontaktekzeme bei exponierten Metallbearbeitern verursacht werden. Irritative Schädigungen der Haut entstehen dabei durch Feuchtarbeit, den alkalischen pH-Wert, Emulgatoren und Eintrocknung von KSS-Spritzern auf der Haut. Unter den Allergenen sind die Oxidationsprodukte von Harzsäuren, die bei der Produktion über Tallöl-Destillate in den KSS gelangen, von großer Bedeutung. Weitere wichtige Allergene sind vor allem Mono- und Diethanolamin, Formaldehyd (FA) und FA-Depotstoffe sowie (Chlor)Methylisothiazolinon, aber auch Benzisothiazolinon, Octylisothiazolinon, Iodpropinylbutylcarbamat und wahrscheinlich auch Diglykolamin. Die Relevanz der bei wg-KSS-exponierten Ekzempatienten häufig beobachteten allergischen Reaktionen auf Kobalt, Duftstoffe und p-Phenylendiamin bzw. p-Aminoazobenzol ist noch nicht abschließend geklärt; mögliche Expositionen werden aufgezeigt. Die Exposition ist in jedem Einzelfall genau aufzuklären, wobei selbstverständlich auch außerberufliche Allergenquellen zu berücksichtigen sind. Die aktuell von der Deutschen Kontaktallergie-Gruppe (DKG) empfohlenen Testungen bei Verdacht auf allergisches Kontaktekzem durch KSS werden ebenso wie die Hinweise der Arbeitsgruppe „Allergiediagnostik in der Metallbranche” zur Testung von KSS vom Arbeitsplatz des Patienten vorgestellt. Abschließend wird auf präventive Maßnahmen hingewiesen.