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INTERNATIONAL JOURNAL
OF CURRENT RESEARCH
International Journal of Current Research
Vol. 7, Issue, 01, pp.11538-11542, January, 2015

ISSN: 0975-833X

RESEARCH ARTICLE

ABOUT CASES OF OCCUPATIONAL ALLERGIES DETECTED IN WORKERS FOLLOWED BY THE

SERVICE OF MEDICINE OF WORK OF CHU TLEMCEN
*Zakia
Zakia Meziane,
Meziane Abdessalam Taleb and A. Benahmed
Service of Occupational Medicine, University Centre, Tlemcen, Laboratory Toxicomed, Algreria
ARTICLE INFO

ABSTRACT

Article History:

Allergic manifestations in the workplace, including allergic contact dermatitis, are increasingly
common. In addition, the association between skin and respiratory allergy is little reported in the
literature. We study this association through observations collected at the Service of Medicine of the
University centre of Tlemcen's work (CHUT). The aim of this work was to study dermatitis allergic
contact (DCA) and respiratory diseases of allergic allure as, as well as to propose a preventive
approach. This was
was a descriptive study that took place from January to July 2010. It includes an
analysis of working conditions and a medical survey (questionnaires, clinical examination, respiratory
functional explorations, allergy skin tests, and other paraclinical expl
exploration oriented depending on
symptomatology). The study population consists of patients having consulted in occupational
medicine service (CHUT) for which the diagnosis of occupational allergic contact dermatitis was
made at the end of this consultation, a total of 49 patients included in this study (57.1% of men,
42.9% of women) with a mean age of 37.2 10.4 years. Health and the BTP sector professionals are
the most represented (38.8% 20.5%, respectively). A history of personal atopy was found in 21% an
and
family in 14%. The proportion of the association of asthma, rhinitis, anaphylaxis to a DCA was
respectively 12.2, 61.2, 8.16%. Clinical responses were scored in 20.4% for chrome, 16.3% for latex,
in 8.1% to thiuram mix in 6% for Mercapto mix in 2% aldehyde
aldehyde and epoxy resins. There is therefore
a significant allergic risk and it is important to give attention to the identi
identication of risk and its
evaluation order to implement support and prevention strategies for this risk.

Received 15th October, 2014

Received in revised form
09th November, 2014
Accepted 08th December, 2014
Published online 23rd January, 2015

Key words:
Dermatitis of allergic contact dermatitis,
Occupational asthma,
Occupational allergens.

Copyright 2015 Zakia Meziane et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use,
distribution, and reproduction in any medium, provided the original work is properly cited.

INTRODUCTION
Occupational skin diseases are those whose cause may result in
whole or in part on the conditions under which the work is
exercised. They are one of the leading causes of illnesses at
work in many countries, they represent about nearly half of the
occupational
onal diseases and 10% of cutaneous pathology (Graut
C et Tripodi, 2001).. Indeed, according to the European
countries and the United States, 20-34%
34% of occupational
diseases are dermatoses. Their impact is estimated at 0.5-0.7
0.5
cases per 1000 workers per year (Constandt
Constandt et al., 2007). The
balance sheet of a unit of professional pathology, in the region
of Algiers (Rouiba), in 1998, reveals that occupational
dermatoses represent approximately 30% of occupational
diseases (Boumaza. I. Ghou, 2009),, thus reinforcing the trend
in industrialized countries (Constandt et al., 2007).
Occupational dermatoses (OD) represented predominantly by
(eczema contact and irritant dermatitis) contact dermatitis are
net increase due to the appearance of new allergens and the
diversification of individual processes. On the other hand, the
appearance of a superimposed allergic respiratory pathology
seems unusual and poorly understood mechanism.
*Corresponding author: Zakia Meziane
Service of Occupational Medicine, University Centre, Tlemcen, Laboratory
Toxicomed, Algreria.

This has motivated this study aims to describe the different

types of allergic contact dermatitis (DCA) observed among
workers who viewed in the service of Medicine of the work of
the University centre (CHU) Tlemcen, search for respiratory
sensitization associated in subjects with a DCA, and
recommend a preventive action.
Patients and methods
We conducted a descriptive study, allergic skin conditions
encountered during the consultation of profes
professional
Dermatology at the Department of Medicine of the work of the
University Centre of Tlemcen (CHUT) between January and
July 2010, patients working in this region. The study includes
an analysis of working conditions and a medical survey
(questionnaires,
s, clinical examination, explorations functional
respiratory allergy skin tests, and other paraclinical exploration
oriented depending on symptomatology).
The questionnaires
The collection of data is done by three questionnaires, the first
on the eczema contact, inspired by one established by health
McGill University Centre (Questionnaire
Questionnaire sur l'eczma 1982),
enriched with information from sociological and adapted to the

11539

Zakia Meziane et al. About cases of occupational allergies detected in workers followed by the service of medicine of work of chu tlemcen

circumstances and conditions of life in our society. The second

questionnaire standardized on bronchial symptoms, of the
Committee of respiratory diseases, the international union
against tuberculosis and lung disease (UNION 1986)
(www.truetest.ca/French/PDFs/Sasseville_questionnairefrench.pdf), and the third on allergic rhinitis (SFAR: Score for
Allergic Rhinitis) (Burney et al., 1989).
The questionnaires relate on civil status, curriculum laboris,
habits, atopic personal and family history and the ocular skin
clinical symptoms, ENT and respiratory with their evolution
on the basis of work, leave and triggers and allergic
investigated. Atopic field is evoked by history of asthma or
one of its counterparts (rhinitis, conjunctivitis, urticaria, atopic
eczema...) among the worker or his family. Symptoms
suggestive of asthma include chest whistling, breathing
difficulty, chest tightness or spasmodic cough caused by
various stimuli such as strong odours, smoke, and dust. These
recurrent symptoms can be isolated or associated with. Rhinitis
were clinically dened by sneezing in bursts, rhinorrhea, nasal
obstruction, nasal itching and the hyposmia. Sought to identify
conjunctivitis symptoms ocular itching, redness of the eyes
and tearing.

median peak expiratory flow (DEMM), Skin allergy test (patch

test, prick test), are made by a physician allergist. Reading
patch testing is standardized for both reading time (double
reading at 48 hours and 72 or 96 hours), and for the used score
based on the elementary lesion according to the criteria
proposed by the International Contact Dermatitis Research
Group (I.C.D.R.G.). The skin tests to immediate playback
(prick-tests) are designed to explore cases of allergies
immediate (proteins, asthma, rhinitis, urticaria contact
dermatitis..).
Other paraclinical explorations are requested on a case by case
basis, depending on the clinical context: biological assessment,
chest, face, determination of the specific immunoglobulin E
(IgE): asked for people with an allergy of type I (urticaria,
asthma, rhinitis anaphylactic reaction).
Statistical analysis
The seizure of data and descriptive analysis of results are
carried on the epi-info version 6 software.

RESULTS

Clinical examination

Socio-professional characteristics

Each patient has a clinical, especially Mucocutaneous, review

with the recourse to a dermatologist, and necessary
complementary examinations (Mycological collection, skin
biopsy) to confirm the diagnosis of eczema. Complemented by
a review focused on respiratory and ORL, with doubt the
advice of medical specialists use. To retain the professional
skin diagnosis at the time of the consultation, we relied on the
seven criteria of Mathias (Sherwood Burge, 2001):

A total of 49 patients included in this study. Among them, 19

are "lost to follow-up". The average age is 37.2 10.4 years
(extremes: 24-59 years). This population consisted of 28 men
(57.10%) and 21 women (42.90%). The notion of smoking is
absent in 77.6% of subjects, 14.3% subjects are smokers and
8.2% have quit smoking. 53% of patients have a length less
than 5 years (Table 1). Handled products are rubber-based
products in 34.4% (especially gloves in latex, but also probes,
catheter, bands, Withers, armbands,...), detergents (21%) come
in second place, followed by cement which represents 17% of
handled products.

is the appearance of lesions compatible with contact

dermatitis?
are there occupational exposure to irritants or potential
allergens?
is the anatomical distribution of dermatitis compatible
with the task and exposure?
is the temporal relationship between exposure and the
onset of dermatitis compatible with a professional
background?
non-occupational exposure was excluded?
the cessation of exposure improves Dermatitis?
examinations further conrm - they occupational in origin

A positive response to four of these issues during the

consultation was to a professional etiology.
Paraclinical exploration
Spirometry is performed using a device, regularly calibrated,
type Essilor HI 801. For all subjects, spirometry examination
comprising three successive tests is performed. The best of the
three is chosen taking into account the degree of cooperation
of the subject, and the aspect of the flow/volume curve. The
measured parameters are the forced vital capacity (FVC),
forced expiratory volume in one second (FEVS), advanced
(DEP) (VEMS/FVC), forced expiratory flow report, the

Table 1. Socio-professional characteristics

Specifications
extreme
Age (Year)
GENDER (%): Male
woman
Smoking N (%)
Smoking
Ex-smokers
No Smoking
Products handled (%):

rubber

detergents

cement

disinfectants

other
Gloves: Men
PPE use:
women
Masks: men
women

Subjects (n = 49) (Mean SD)

24 59 years
10.4 years
57.10 %
42.90 %
7 (14.3 %)
4 (8.2 %)
38 (77.6 %
34.4%
21%
17%
13%
24.6%
38.8%
8.2%
20.4%
4%

Health care professionals are the most represented (38.8%),

this group included 19 patients: nine nurse s (18.36%), six
doctors (12.24%), two laboratory technicians and two orderlies
(4.08% for each). In second place, workers in the construction

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International Journal of Current Research, Vol. 7, Issue, 01, pp.11538-11542, January, 2015

sector (20.5%): six Masons (12.24%), and six labourers BTP

(12.24%), then six women's household (12.24%) (Figure 1
and 2).

through recruitment of consultant mainly for allergic disorders

patients.

Figure n 3, skin lesions

Paraclinical exploration

Figure 1. Distribution of subjects by occupational category

Figure 2. distribution of the population by branch of activity

The notion of atopy is found in more than one-third of the

population (35%), it is, especially personal (21%). The
appearance of acute eczema is the most common 40%,
followed by the chronic aspect (23%) which includes the
erythemato-squamous appearance, the AK aspect, lichenified
appearance, fissuraire,... then hives representing only 9%, and
other aspects (Figure 3). However, there may exist in the same
subjects two aspects, or even several. hands, only (66.88%) or
associated to other locations, was more concerned topography
by allergic contact dermatitis (84.74%), discovery areas
achieving is found in 14.26% cases and eczema of the face
alone is found in 7.26% cases and translated, which is
conventionally described in the form of airborne eczema. The
association of a DCA allergic disease. Rhinitis is found in 30
patients with a DCA (is 61.2% cases), while asthma is found in
6 patients (or 12.2% of cases). This finding is explained in part

Potassium dichromate is the most frequently updated

offending allergen (20.40%). Then come the latex (16.30%),
thiuram mix (8.10%), Mercapto mix (6.10%), epoxy resins and
aldehyde (2% each).
At the pulmonary level, 49 subjects benefited from the
pulmonary function tests. These EFR revealed anomalies for
08 patients: 3 subjects of obstructive ventilatory disorder, 5
individuals harbouring a restrictive ventilatory disorder. Only
30 chest x-rays have been recovered on the requested 49, they
have revealed normal for all except two, an x-ray showed in a
Mason with a contact associated with asthma eczema
interstitial syndrome. Confirmed by a chest CT scan, which
revealed an interstitial syndrome with emphysematous lesions.
4 subjects among the 6 with a presumed asthma linked to the
work had a serial measurement of the DEP whose three
showed abnormalities and a DEP was unrepresentative. The
other two did not have the DEP for the following reasons: a
nurse who refused to do (patient landscaped stationed) and a
maneuver off work for his altered state of health.
Professional recommendations
After the diagnosis of allergic contact dermatitis, associated or
not with a respiratory allergy has increased; the problem of the
ability to position arises for the majority of the consultants. On
49 patients, there are 20 skills with reserve to the position, 12
demerit and 17 folders without recommendations about the
suitability to the position ("lost to follow-up" patients). All
abilities with reserve, recommendations for the management of
workstations have been issued. Among the demerit to the post,
04 conclusions recommended a retraining and 06 a change in
position at the breast or not of the same company when it
seemed that the adaptation of the post or the environment
would not allow the total suppression of nuisances and
therefore generated symptoms. 02 final demerit have spoken
for two doctors (Neurosurgery and reanimation) residents who
have been forced to start over in a non-surgical industry.

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Zakia Meziane et al. About cases of occupational allergies detected in workers followed by the service of medicine of work of chu tlemcen

Medico-legal aspect
In total, twelve patients have been reported to the national
health insurance (CNAS) in respect of compensable
occupational diseases (MPI) tables, they are distributed as
shown in Table 5.

DISCUSSION
The study population consists of all patients for which the
diagnosis to the outcome of the consultation was occupational
allergic contact dermatitis. A total of 49 patients included in
this study, average age of 37.2 years (10.4), a little younger
than in some studies such as Haby and collar, made in Algeria,
which reported an average age of 41 years ( 11.4) (Toby
Mathias, 1989). Men are more represented than women
(57.1%).

which consolidates the erythemato-squamous appearance, the

AK aspect, lichenified appearance, fissuraire,... (23%), and
urticaria (9%), eczema airborne and Photoallergic (8% each),
Dyshidrotic eczema, the acropulpite and protein contact
dermatitis. However, there may exist in the same subject two,
or even several aspects. This diversity has already been found
in other studies: Dwight and col reported the erythematovesicular appearance (31%) is the most common, chronic
eczema is represented by 19% (Toby Mathias, 1989). Paul and
col have found follows, in descending order: allergic contact
dermatitis isolated from ten patients (25,6 %); allergic contact
dermatitis associated with dermatitis of irritation in eight
patients (20.5%); Dermatitis to latex proteins associated with
eczema of contact in two patients (5.1%);a boost of atopic
dermatitis favored by irritants in a patient (2.5%); and a patient
(2.5%) contact urticaria (Mahfoudh et al., 2009).

Table 5. Summary table of the medico-legal aspects in patients reported in MPI

Cases
01
02
03
04
05
06
07
08

Age
42
58
40
57
26
29
30
31

Gender
M
M
M
M
M
W
M
W

Industry
building public works
building public works
building public works
building public works
building public works
health
health
health

Work station
mason
Mason-coffreur
Mason-coffreur
maneuver
aide mason
resident physician
resident physician
Caregiver

09

54

health

Lab

ailment
Eczema, asthma
Eczema, asthma
Arorport eczema, rhinoconjunctivitis
Arorport eczema, rhinoconjunctivitis
Eczema, rhinitis, asthma
Eczema, asthma, anaphylaxis
Eczema, spasmodic cough, anaphylaxis
Eczema, rhinoconjunctivitis, breathing,
anaphylaxis
Arorport eczema, rhinoconjunctivitis

10
11

32
54

W
M

health
health

nurse
male nurse

Eczema, asthma
Urticaria, anaphylaxis

12
13

32
54

W
W

health
maintenance sector

nurse
Maid

Eczema, rhinitis, asthma

Photoallergic eczema, rhinitis

14

56

maintenance sector

Maid

Eczema, rhinoconjunctivitis

15

31

plastics industry

technician

16

24

food sector

cook

Eczema (acropulpite),
rhinoconjunctivitis, asthma Equivalent
Protein contact dermatitis,
rhinoconjunctivitis

This male is a little lower than that found in the study of

Habyarimana and collar which male is 85% (Toby Mathias,
1989). Concerning the different branches of activity and
occupational categories, they are very diverse and almost all
represented. It is mainly the health sector (38.8%). In second
place, the building trades (20.4%): consisted of 12 cases and
then maintenance and cleaning, the metallurgy professions
sector (16.30%, 8.2%, respectively), then the textile and
leather, services such as personal food and restaurant trades.
In most studies, the same areas at risk are found, mainly the
building, maintenance and cleaning, mechanics and metallurgy,
health, hairdressing and industry of plastics (Toby Mathias,
1989; Haddar et al., 2003; Dickel et al., 2001) The wearing of
individual protection (gloves) is reported from 29.6% of
subjects; However, it is more common among women (gloves
38.8%, masks: 20.4%) than men (8.2%, 4%, respectively),
these figures are close to those reported by Dwight and col
(24% of the subjects wore gloves) (Toby Mathias, 1989).
Concerning the different clinical aspects of allergic contact
dermatitis are varied. It is mainly contact dermatitis acute
which is most frequent in 40%, followed by the chronic aspect

causative allergen
chrome
chrome
chrome
chrome
chrome
latex
latex
latex

what to do medical and legal

Statement TMP n 08 et 10bis
Statement TMP n 08 et 10bis
Statement TMP n 10
Statement TMP n08
Statement TMP n08
Statement MCP
Statement MCP
Statement MCP

Latex, Thiuram
mix
latex
Latex, Thiuram
mix
latex
Chrome, Additifs
caoutchouc
Chrome, Additifs
caoutch, aldhyde
Rsine poxy

Statement MCP

Latex, protines
(tomate, sardine)

Unfit with a change of position

Statement MCP
Statement MCP
Statement MCP
change of position
change of position
Statement TMP n50

In our study, the hands, only (66.88%) or associated to other

locations, have formed the most relevant topography by
allergic contact dermatitis (84.74%), discovery areas achieving
is found in 14.26% cases and eczema of the face alone is found
in 7.26% cases and translated, which is conventionally
described in the form of airborne eczema. Personal history of
atopy were found in 20% of cases, family atopy is reported in
14% of cases. These figures are close to those reported by
Dwight and col (personal atopy: atopy family 17%: 12%)
(Toby Mathias, 1989). In our series, potassium dichromate
(20.40%) is more offending to be at the origin of chronic,
airborne and Photoallergic contact eczema. This allergen is
more represented among the building trades (chromium is
present in the cement), and the cleaning products (impurity of
salts of chromium in bleach), on the other hand, latex 16.30%
is the most represented allergen among responsible allergens
of acute contact eczema, and urticaria contact.il is most found
in the health professionals when using latex gloves products
(medical equipment,...). These results can be explained by the
high percentage of health personnel that remains more aware
of the professional problems in relation to the rest of the
population. These classical allergens are also the most cited in

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International Journal of Current Research, Vol. 7, Issue, 01, pp.11538-11542, January, 2015

previous studies (Toby Mathias, 1989). On the other hand, all

subjects performed an EFR that objectified abnormalities for
16.3% of subjects: disorder obstructive ventilatory for 3
subjects, and restrictive ventilatory disorders to 5 subjects. In
our study, where research associated impairment (respiratory
ENT,...) is part of our goals, rhinitis is found in 30 patients
with a DCA (is 61.2% of cases), while asthma is found in 6
patients (is 12.2% cases) ana reactions
The professional recommendations
On 49 patients, there are 20 skills to the position, 12 demerit
and 17 folders without recommendations about the suitability
to the position ("lost to follow-up" patients). All abilities with
reserve, recommendations for the management of workstations
have been issued to avoid nuisance involved in the onset of
their symptoms.
Conclusion
The results of this study did a high proportion of respiratory
allergies among employees with a DCA. Indeed, the sociooccupational impact of the presence of an occupational
dermatitis is often catastrophic, especially with the risk of
developing respiratory allergy, with at best a reclassification to
a post non or most often less exposed, even when the
reclassification is impossible, a measure of redundancy. The
forensic impact translates into a rate of occupational disease
recognition requests relatively high in our study, probably
explained by large number of tables that can be called upon in
case of dermatitis eczematous.
Primary prevention, screening early of the disease by the
medical surveillance of exposed populations, the information
and the improvement of working conditions constitute the
basic elements of support for the allergic risk in the workplace.

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