April 2022 additions to NERDB

April 2022 additions to NERDB

NERDB is the New and emerging risks database. This bibliographic database is an initiative of Nicole Palmen and Annet Lenderink with the support of Modernet and is currently powered by Airtable.

More information on this database is on the NERDB page

On the website, we will publish regular updates on new disease-exposure combinations we added to the database. Currently, we have 334 entries. Ordered by year in which the abstract is published

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New entries:

Photo Pixabay.com

Dumas O. Cleaners and airway diseases. Curr Opin Allergy Clin Immunol. 2021 Apr 1;21(2):101-109. doi: 10.1097/ACI.0000000000000710. PMID: 33284160.

The purpose of the review was to gather evidence that adverse respiratory effects of occupational exposure to disinfectants and cleaning products (DCPs) have grown in the last two decades. The relationship between DCPs and asthma is well documented, but questions remain regarding specific causal agents. Beyond asthma, associations between DCPs and COPD or chronic rhinitis are plausible and have been examined recently. The purpose of this review is to summarize recent advances on the effect of occupational exposure to DCP and chronic airway diseases.

Recent epidemiological studies have often focused on healthcare workers and are characterized by efforts to improve assessment of exposure to specific DCPs. Despite increasing knowledge on the effect of DCPs on asthma, the burden of work-related asthma caused by DCPs has not decreased in the past decade, emphasizing the need to strengthen prevention efforts. Novel data suggest an association between occupational exposure to DCPs and other chronic airway diseases, such as rhinitis, COPD, and poor lung function.

Summarizing: Epidemiological and experimental data showed that many chemicals contained in DCPs are likely to cause airway damage, indicating that prevention strategies should target multiple products. Further research is needed to evaluate the impact of DCP exposure on occupational airway diseases beyond asthma.

Pelechas E, Voulgari PV, Drosos AA. Occupational mimics of rheumatoid arthritis: hair dye-induced arthritis. Rheumatol Int. 2021 Apr;41(4):795-797. doi: 10.1007/s00296-020-04748-5. Epub 2020 Nov 16. PMID: 33196874.

Hair dye (HD) and its component para-phenylenediamine (PPD) are commonly used to enhance beauty and youth. HD is associated with allergic contact reactions and the development of autoimmune phenomena. A 28-year-old woman presented to us complaining of pain and swelling affecting the small joints of the hands bilaterally, lasting for 7 weeks. Laboratory evaluation was remarkable only for an increase of acute-phase reactants, while the rest of the laboratory tests including serological tests for viruses, as well as immunological tests were negative or within normal limits. She noticed a close correlation between the onset of symmetrical polyarthritis and the use of HD products. Thus, after excluding other possibilities of inflammatory arthritis, the diagnosis of HD-induced arthritis was made. The patient was treated with naproxen, and after 3 weeks, she had a complete clinical response with a decrease in acute-phase reactants. Thus, we review and discuss the relevant literature on cases related to the use of HD and arthritis development. This is the first described case of HD-induced arthritis. Physicians must be aware and recognize these symptoms and signs of patients exposed to HD and treat them appropriately.

Rague J, Grush J, Buchanan J. A Case Series of Chemical Dermal Injury Requiring Operative Intervention after Prolonged Dermal Methylene Chloride Exposure. J Med Toxicol. 2021 Apr;17(2):222-226. doi: 10.1007/s13181-020-00818-z. Epub 2021 Jan 5. PMID: 33403570; PMCID: PMC8017058.

Methylene chloride, also known as dichloromethane, is a volatile hydrocarbon used in paint strippers and removers. Toxicity from methylene chloride may include narcosis and elevated carbon monoxide (CO) levels. Significant injury to the skin can occur after prolonged exposure to methylene chloride and other hydrocarbon-based solvents, causing a chemical dermal injury.

This case series describes three male patients with prolonged exposure to a methylene chloride-containing paint remover to the bilateral hands, with two of the three patients requiring transfer to a tertiary burn center and operative intervention. The clinical significance and impressive resolution of dermal injury from prolonged methylene chloride exposure are highlighted with detailed images and a literature review.

Chemical dermal injury, secondary to methylene chloride exposure, likely results from the destruction of lipids within the epidermis and dermis and direct chemical injury. Prolonged exposure to skin can result in clinically important injury that requires management by a burn specialist and may necessitate operative intervention. The severity of the dermal injury can range from severe to mild and should be considered by a clinician after skin exposure to hydrocarbons.

Nett RJ, Stanton M, Grimes GR. Occupational respiratory and skin diseases among workers exposed to metalworking fluids. Curr Opin Allergy Clin Immunol. 2021 Apr 1;21(2):121-127. doi: 10.1097/ACI.0000000000000717. PMID: 33394701.

The purpose of the review was to examine respiratory and skin diseases that occur among workers exposed to metalworking fluids (MWFs) used during machining processes.

Five cases of a severe and previously unrecognized lung disease characterized by B-cell bronchiolitis and alveolar ductitis with emphysema (BADE) were identified among workers at a machining facility that used MWFs, although MWF exposure could not be confirmed as the etiology. In the United Kingdom, MWF is now the predominant cause of occupational hypersensitivity pneumonitis (HP).

Under continuous conditions associated with respiratory disease outbreaks, over a working lifetime of 45 years, workers exposed to MWF at 0.1 mg/m3 are estimated to have a 45.3% risk of acquiring HP or occupational asthma under outbreak conditions and a 3.0% risk assuming outbreak conditions exist in 5% of MWF environments. In addition to respiratory outcomes, skin diseases such as allergic and irritant contact dermatitis persist as frequent causes of occupational disease following MWF exposure.

Healthcare providers need to consider MWF exposure as a potential cause for work-related respiratory and skin diseases. Additional work is necessary to more definitively characterize any potential association between MWF exposures and BADE. Medical surveillance should be implemented for workers regularly exposed to MWF.



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