June 2020 additions to NERDB

June 2020 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 on the NERDB page

On the website we will publish from this month on regular updates on new disease – exposure combinations we added to the database. Currently, we have 242 entries. Ordered by year in which the abstract is published

unknown year6

Last new entries

Alexandri M, Spaeth KR. Nontransient third-degree heart block and persistent respiratory findings as sequelae of acute occupational exposure to pyrethroids insecticideAm J Ind Med. 2020;63(7):644‐648. doi:10.1002/ajim.23111.

The authors present the case of a worker with occupational exposure to a pyrethroid insecticide who acutely developed a nontransient third-degree heart block. In 2000, a 57-year-old male truck driver on his delivery route was accidentally exposed to pyrethroid insecticide being sprayed for West Nile virus containment. Both the driver and his vehicle were coated with the spray. The exposure was prolonged because he did not change his clothes until after his shift ended and he used the same contaminated truck for a week. Within days, he presented with a third-degree heart block, for which he was emergently treated, and a pacemaker was placed. He had no past history of arrhythmias.

In the weeks thereafter, he also developed reactive airway dysfunction syndrome (RADS). In the second decade following the exposure, the patient replaced his pacemaker, confirming the permanent nature of his heart block. In addition to the persistence of his exposure-related RADS, he developed restrictive lung disease and was diagnosed with pulmonary interstitial fibrosis in the absence of established risk factors. The patient died in October 2019 from respiratory illness. Most previous reports of pyrethroid-related disorders are limited to acute exposures, in which transient symptoms predominate. To the knowledge of the authors, this is the first report of an exposed worker experiencing permanent third-degree heart block, as well as persistent respiratory findings, as possible short- and long-term sequelae of pyrethroid exposure.

truck drivers
Photo by Bernd Dittrich on Unsplash

Jurakić Tončić R, Balić A, Pavičić B, et al. Occupational Airborne Contact Dermatitis Caused by OmeprazoleActa Dermatovenerol Croat. 2019;27(3):188‐189.

Airborne contact dermatitis (ACD) is a frequent condition, and there has been increasing recognition of the occupational origin of airborne contact dermatitis. ACD caused by drugs is often occupation-related and occurs mainly in healthcare workers who use the drugs for therapeutic aims and employees of pharmaceutical industries involved in the production of the drugs (1). Omeprazole (OM) is a proton pump inhibitor from the benzimidazole group used for the treatment of gastric acid-related disorders (2).

A 52-years-old female chemist had been working in a pharmaceutical company for 20 years. When working in the laboratory, she wore protective latex-free gloves, a mask, and glasses. Skin lesions started 6 months after she had started working in an analytic laboratory with omeprazole and azithromycin. Whenever omeprazole was being manufactured, the patient presented with eczema with scaling on the eyelids, face, and neck, with the hands subsequently being affected as well. The patient’s skin lesions cleared during holidays and sick leave and worsened when she was working in omeprazole production. Topical corticosteroids were applied, which resulted in temporally regression of skin symptoms. We performed patch tests with the baseline series (Chemotechnique Diagnostics, Vellinge, Sweden, and Imunološki zavod, Zagreb, Croatia) to materials in the patient’s workplace and a lymphocyte transformation test (LTT) to omeprazole. All tests were negative, except the patch test to OM which showed a positive reaction (+) to 0.1% OM in saline solution on day (D) 2 and D3 and positive reaction (+) to 0.5% OM in saline solution on D2 and ++ on D3 (Figure 1).

Hausen et al. performed experimental animal studies in which they concluded that OM and other proton pump inhibitors constitute a high-sensitizing-potential group (3). However, when administrated, orally or parenterally, the frequency of contact sensitization was low (3). Although direct contact with the skin was not always present, the distribution of the dust containing OM through the air and deposition on exposed areas may result in ACD.

The first two occupational cases of ACD caused by OM among pharmaceutical workers were reported in 1986 (4). Since then, ACD caused by OM in an occupational setting has been reported occasionally (2,4-6). Other proton pump inhibitors such as lansoprazole and pantoprazole have less pronounced potential to cause ACD (7,8). Ghatan et al. conducted a study in 2014 in an occupational setting with 97 workers and reported 31 positive LTT tests and 28 positive patch tests; these results confirm a high risk of sensitization to OM from occupational exposure (6).

Although direct contact with the skin is not always present, it is important to bear in mind that the distribution of dust containing OM through the air and deposition on exposed areas may result in ACD.

Visser AE, D’Ovidio F, Peters S, et al. Multicentre, population-based, case-control study of particulates, combustion products and amyotrophic lateral sclerosis riskJ Neurol Neurosurg Psychiatry. 2019;90(8):854‐860. doi:10.1136/jnnp-2018-319779

The objective of this study was to investigate whether exposure to particulates and combustion products may explain the association between certain occupations and amyotrophic lateral sclerosis (ALS) risk in a large, multicentre, population-based, case-control study, based on full job histories, using job-exposure matrices, with detailed information on possible confounders. Population-based patients with ALS and controls were recruited from five registries in the Netherlands, Ireland, and Italy. Demographics and data regarding educational level, smoking, alcohol habits, and lifetime occupational history were obtained using a validated questionnaire. Using job-exposure matrices, we assessed occupational exposure to silica, asbestos, organic dust, contact with animals or fresh animal products, endotoxins, polycyclic aromatic hydrocarbons, and diesel motor exhaust. Multivariate logistic regression models adjusting for confounding factors were used to determine the association between these exposures and ALS risk.

In this study were included 1557 patients and 2922 controls. Associations were positive for all seven occupational exposures (ORs ranging from 1.13 to 1.73 for high vs never exposed), and significant on the continuous scale for silica, organic dust, and diesel motor exhaust (p values for trend ≤0.03). Additional analyses, adding an exposure (one at a time) to the model in the single exposure analysis, revealed a stable OR for silica. We found similar results when patients with a C9orf72 mutation were excluded. The authors conclude that in a large, multicentre study, using harmonised methodology to objectively quantify occupational exposure to particulates and combustion products, we found an association between ALS risk and exposure to silica, independent of the other occupational exposures studied.



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