CONTACT ALLERGIES IN MEDICAL AND PARAMEDI CAL PROFESSIONS

Based on reports in the literature, data from the information network of German dermatology centres (Informationsverbund Dermatologischer Kl iniken) and the authors own findings, a review is presented on prevale nce, clinical picture and causative agents of contact allergic dermato ses in health care professions. In 1991 the proportion of suspected oc cupational diseases in the health care professions (including hairdres sers) represented by cases of dermatitis, as reported to the responsib le insurance institution, reached 72% of the total for the year (7287 out of 10127). Every 20th to 40th case was recognized as an occupation al dermatosis according to German law, Accurate figures on incidence a re scarce; for dentists an incidence of 0.11 parts per thousand has be en calculated. The risk of developing occupational hand eczema has bee n shown to be at least three times higher for nurses than for other so -called dry professions. For persons engaged in the personal care of t he ill and the elderly, relevant occupational allergens were found to be benzalkonium chloride and aldehydes in disinfectants, as well as ru bber accelerators such as thiuram mix. Latex contact urticaria has inc reasing significance for medical personnel, with prevalence rates of s ensitization between 4.5% and 10.7%. Among physicians, contact allergi es to thiuram mix were found to be dominant (12.9%). For surgeons and orthopaedic surgeons, methyl methacrylate as a constituent of bone cem ent is of great importance. Various esters of acrylic acid and methacr ylic acid are important sensitizers in the dental professions, particu larly in heavily exposed dental laboratory technicians, Only a few glo ves protect against these types of sensitizers. Sensitizations by medi caments can be avoided in most cases by reducing direct skin contact, as practiced with penicillin or ispaghula powder. Strategies of preven tion include information of atopics regarding the increase in occupati onal dermatitis, the regular use of barrier creams, intensive skin car e after work and avoidance of irritants and allergens wherever possibl e.