May 2022 additions to NERDB

May 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 338 entries. Ordered by year in which the abstract is published

unknown year620224

New entries:


Hansen, A., Buse, A. S., Wilke, A., Skudlik, C., John, S. M., & Brans, R. (2021). Sensitization to 1, 3‐diphenylguanidine: An underestimated problem in physicians and nurses using surgical gloves?Contact Dermatitis84(3), 207-208.

A 55-year-old male anesthesiologist with hand eczema was patch tested in our department in 2016 revealing sensitization to1,3-diphenylguanidine [DPG, day (D) 3: +] and cetyl pyridinium chloride (CPC, D3: +).

In 2020, we saw a 45-year-old female surgeon with hand eczema who presented with a patch test protocol from 2018 indicating that she was sensitized to DPG (D3: ++) and CPC (D3: ++).

In the same year, a 56-year-old female surgical nurse and a 59-year-old male surgeon, both suffering from hand eczema, had positive reactions to DPG (D3: ++ and D3: +, respectively) in patch tests performed in our department. In the latter two cases, patch testing with CPC was not possible as the test substance previously produced by Smart Practice Europe (Greven, Germany) wasn’t available.

All patients reported that, at work, they had used polyisoprene sterile surgical gloves from the Protexis PI product line (Cardinal Health, Waukegan, Illinois). Upon request, the manufacturer revealed that the glove line contains DPG and has a CPC inner coating. Patch testing of the glove was done in three of the patients and revealed no positive reaction. In all four cases, occupational allergic contact dermatitis of the hands was diagnosed, and the surgical gloves were replaced by alternative gloves free of DPG or CPC, according to the manufacturer’s information.

Three of the patients were able to continue their occupations with markedly improved skin conditions. No follow-up information was available for the female surgeon.

The researchers discuss these results and conclude that DPG and, if possible, CPC should be patch tested in healthcare workers with suspected allergic contact dermatitis who use sterile surgical gloves.

Kolodziej M, Kiewert A, Skudlik C, Brans R. Allergic contact dermatitis caused by polyhexamethylene biguanide may contribute to work-related hand eczema. Contact Dermatitis. 2021 Jul;85(1):97-98. doi: 10.1111/cod.13792. Epub 2021 Feb 9. PMID: 33486772.

Polyaminopropyl biguanide (PAPB) and polyhexamethylene biguanide(PHMB) are polymeric biguanides. They are widely used as a disinfectant or preservative in wound care, cleansing, or cosmetic products.

A 52-year-old male kitchen aid presented to our department with a 3-year history of work-related hand eczema. Patch tests were performed and read according to the guidelines of the German Contact Dermatitis Research Group. A positive reaction to PHMB (2.5% aq., Chemotechnique Diagnostics, Vellinge, Sweden) was observed at D3 (+), D4 (++), and D7 (++). The skincare product “Excipial Repair Sensitive”(Galderma Laboratorium, Düsseldorf, Germany), which contains PAPB according to product labeling, caused a doubtful reaction at D3 with a slight increase (+) until D7. The patient had applied this product (now marketed under the name “Cetaphil Pro Itch Control Repair sensitive”), on his hands several times a day for >1 year.

To further explore the clinical relevance, we performed a repeated open application test (ROAT) with “Excipial Repair Sensitive/Cetaphil Pro Itch Control Repair sensitive”, twice daily for 7 days on the inner sides of both forearms, causing erythema at D4 and a papulovesicular reaction at D7 in both test areas (Figure 2).

We diagnosed work-related hand eczema consisting of both irritant contact dermatitis and allergic contact dermatitis caused by sensitization to PHMB.

Tjalvin, G., Svanes, Ø., Igland, J., Bertelsen, R. J., Benediktsdóttir, B., Dharmage, S., … & Svanes, C. (2022). Maternal preconception occupational exposure to cleaning products and disinfectants and offspring asthma. Journal of Allergy and Clinical Immunology149(1), 422-431.

Emerging research suggests health effects in offspring after parental chemical exposures before conception. Many future mothers are exposed to potent chemicals at work, but potential offspring health effects are hardly investigated. The researchers sought to investigate childhood asthma in relation to the mother’s occupational exposure to cleaning products and disinfectants before conception.

The multicenter Respiratory Health In Northern Europe/Respiratory Health In Northern Europe, Spain and Australia generation study investigated asthma and wheeze starting at age less than 10 years in 3318 mother-offspring pairs.

From an asthma-specific Job-Exposure Matrix and mothers’ occupational history, we defined maternal occupational exposure to indoor cleaning agents (cleaning products/detergents and disinfectants) starting before conception, in the 2-year period around conception and pregnancy, or after birth.

Never-employed mothers were excluded. Exposed groups include cleaners, health care workers, cooks, and so forth. Associations were analyzed using mixed-effects logistic
regression and ordinary logistic regression with clustered robust SEs and adjustment for maternal education.

Maternal occupational exposure to indoor cleaning starting preconception and continuing (n 5 610) was associated with offspring’s childhood asthma: odds ratio 1.56 (95% CI, 1.05-2.31), childhood asthma with nasal allergies: 1.77 (1.13-2.77), and childhood wheeze and/or asthma: 1.71 (95% CI, 1.19-2.44).

Exposure starting around conception and pregnancy (n 5 77) was associated with increased childhood wheeze and/or asthma: 2.25 (95% CI, 1.03-4.91).

Exposure starting after birth was not associated with asthma outcomes (1.13 [95% CI, 0.71-1.80], 1.15 [95% CI, 0.67-1.97], 1.08 [95% CI, 0.69-1.67]).

Conclusions: Mother’s occupational exposure to indoor cleaning agents starting before conception, or around conception and pregnancy, was associated with more childhood asthma and wheeze in offspring. Considering potential implications for vast numbers of women of childbearing age using cleaning agents, and their children, further research is imperative.

Pesonen, M., Koskela, K., & Aalto‐Korte, K. (2021). Hairdressers’ occupational skin diseases in the Finnish Register of Occupational Diseases in a period of 14 yearsContact Dermatitis84(4), 236-239.

Hairdressers have a high risk of occupational contact dermatitis caused by exposure to wet work and allergens in hairdressing chemicals. The objective of the researchers is to examine the distribution of diagnoses of occupational skin diseases (OSDs) and their main causes in hairdressers based on a national register data on occupational diseases.

They retrieved cases of recognized OSDs in hairdressers from the Finnish Register of Occupational Diseases (FROD) in years 2005-2018. During the 14-year period, a total of 290 cases of recognized OSD in hairdressers were registered in the FROD. Allergic contact dermatitis (ACD) was diagnosed in 54%, irritant contact dermatitis in 44%, and contact urticaria (CU) in 5% of them.

ACD was most commonly caused by hair dye products and their ingredients (N = 57), persulfates (N = 35), and preservatives (N = 35; mainly isothiazolinones). Acrylates emerged as hairdressers’ occupational contact allergens (N = 8) probably due to the introduction of structure nails into hair salons. Persulfates were the most common cause of CU.

The researchers conclude that ACD was the most common OSD in hairdressers. Their analysis confirms that preservatives are important causes of ACD in hairdressers in addition to hair dye products and persulfates. Acrylates emerged as hairdressers’ occupational contact allergens, but contact allergy to perming agents remained rare.



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