¹Sofia Medical University, Sofia, Republic of Bulgaria
²Institute for Legal Studies, BAS, Sofia, Republic of Bulgaria
*Corresponding author: Maya Lyapina, MD, Department of Hygiene, Medical Ecology and Nutrition, Medical Faculty,
Medical University. 15 Blvd “Acad. Ivan Evstr. Geshov”, 1431 Sofia, Bulgaria. Phone: +359887161768. E-mail: firstname.lastname@example.org
Published: June 25, 2013
Background: In dental practice concomitant exposure to formaldehyde and glutaraldehyde is a common occurrence. The objective of the study is to evaluate the incidence of occupational contact dermatitis to formaldehyde and glutaraldehyde in dental professionals and the manifestation of co-reactivity.
Methods and Results: This study involved 78 participants (30 dental professionals and 48 referents). A questionnaire survey as well as skin patch testing with formaldehyde and glutaraldehyde was conducted. The incidence of occupational contact dermatitis to formaldehyde among the population investigated was 28.2%, and of glutaraldehyde, 24.4%. Occupational contact dermatitis to formaldehyde was found to be of a significantly higher incidence among dental professionals. A stronger irritant effect of the formaldehyde, with a significantly higher incidence and the relative risk of specifically the upper respiratory tract (р = 0.029) and respiratory system (р = 0.002) as well as skin (р = 0.019) symptoms among the subjects experiencing formaldehyde contact dermatitis was demonstrated. Allergic predisposition plays an important role as a risk factor of sensitization to glutaraldehyde and of co-reactivity.
Conclusions: The results indicate high rates of sensitization to formaldehyde and glutaraldehyde. Co-reactivity was found mainly among the non-occupationally exposed people. Atopy does not appear to be a risk factor for formaldehyde-specific allergic contact dermatitis, although it is so for glutaraldehyde-specific allergic contact dermatitis. Screening patch-testing for multiple dental compounds would be beneficial for early diagnosis, as well as for occupational risk assessment and management.
1. Bernstein RS, Stayner LT, Elliott LJ, Kimbrough R, Falk H, Blade L. Inhalation exposure to formaldehyde: an overview of its toxicology, epidemiology, monitoring, and control. Am Ind Hyg Assoc J 1984; 45(11):778-85.
2. Bostrom CE, Almen J, Steen B,Westerholm R. Human exposure to urban air pollution. Environ Health Perspect 1994; 102 (Suppl 4):39-47.
3. HSDB. Hazardous Substances Data Bank. National Library of Medicine 2009; http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?HSDB%20and%20search%20on%2.... Accessed 24 March 2013.
4. Flyvholm MA. Contact allergens in registered chemical products. Contact Dermatitis 1991; 25(1):49-56.
5. Aalto-Korte K, Kuuliala O, Suuronen K, Alanko K. Occupational contact allergy to formaldehyde and formaldehyde releasers. Contact Dermatitis 2008; 59(5):280-9.
6. Krecisz B, Kieć-Swierczyńska M. The role of formaldehyde in the occurrence of contact allergy. Med Pr 1998; 49(6):609-14.
7. Cockayne SE, McDonagh AJG, Gawkrodger DJ. Occupational allergic contact dermatitis from formaldehyde resin in clothing. Contact Dermatitis 2001; 44(2):109-10.
8. De Groot AC, Le Coz CJ, Lensen GJ, Flyvholm MA, Maibach HI, Coenraads PJ. Formaldehyde-releasers: relationship to formaldehyde contact allergy. Part 2. Formaldehyde-releasers in clothes: durable press chemical finishes. Contact Dermatitis 2010; 63(1):1-9.
9. Ezughah FI, Murdoch SR, Finch TM. Occupational airborne allergic contact dermatitis from medium-density fibreboard containing phenol-formaldehyde resin-2 (PFR-2). Contact Dermatitis 2001; 45(4):242.
10. García Bracamonte B, Ortiz de Frutos FJ, Iglesias Díez L. Occupational allergic contact dermatitis due to formaldehyde and textile finish resins. Contact Dermatitis 1995; 33(2):139-40.
11. Geier J, Lessmann H, Becker D, Bruze M, Frosch PJ, Fuchs T, et al. Patch testing with components of water-based metalworking fluids: results of a multicentre study with a second series. Contact Dermatitis 2006; 55(6):322-9.
12. Kiec-Swierczynska M. Occupational allergic contact dermatitis in Lodz: 1990-1994. Occup Med (Lond) 1996; 46(3):205-208.
13. Koch P. Occupational contact dermatitis from colophony and formaldehyde in banknote paper. Contact Dermatitis 1995; 32(6):371–2.
14. Rastogi SC. A survey of formaldehyde in shampoos and skin creams on the Danish market. Contact Dermatitis 1992; 27(4):235-40.
15. Kieć-Swierczyńska M, Krecisz B. Causes of occupational allergy in dental nurses. An analysis based on the material collected at The Institute of Occupational Medicine in Lódź. Med Pr 2000; 51(2):145-9. [Article in Polish].
16. Kieć-Swierczyńska M. Contact allergy caused by formaldehyde, based on materials from the Institute for medical occupations in Lodz. Med Pr 1993; 44(3):209-13. [Article in Polish].
17. Kieć-Swierczyńska M, Krecisz B, Krysiak B, Kuchowicz E, Rydzyński K. Occupational allergy to aldehydes in health care workers. Clinical observations. Experiments. Int J Occup Med Environ Health 1998; 11(4):349-58.
18. Hauman CHJ, Love RM. Biocompatibility of dental materials used in contemporary endodontic therapy: a review. Part 2. Root-canal-filling materials. Int Endod J 2003; 36(3):147-60.
19. Cohen BI, Pagnillo MK, Musikant BL, Deutsch AS. Formaldehyde evaluation from endodontic materials. Oral Health 1998; 88(12):37-9.
20. Lang I, Bruckner T, Triebig G. Formaldehyde and chemosensory irritation in humans: a controlled human exposure study. Regul Toxicol Pharmacol 2008; 50(1):23–36.
21. Liu KS, Huang FY, Hayward SB, Wesolowski J, Sexton K. Irritant effects of formaldehyde exposure in mobile homes. Environ Health Perspect 1991; 94:91–4.
22. Reich HC, Warshaw EM. Allergic contact dermatitis from formaldehyde textile resins. Dermatitis 2010; 21(2):65-76.
24. Fransway AF, Zug KA, Belsito DV, Deleo VA, Fowler JF Jr, Maibach HI, et al. North American Contact Dermatitis Group patch test results for 2007-2008. Dermatitis 2013; 24(1):10-21.
25. Ravis SM, Shaffer MP, Shaffer CL, Dehkhaghani S, Belsito DV. Glutaraldehyde-induced and formaldehyde-induced allergic contact dermatitis among dental hygienists and assistants. J Am Dent Assoc 2003; 134(8):1072-8.
26. Schnuch A, Uter W, Geier J, Frosch PJ, Rustemeyer T. Contact allergies in healthcare workers. Results from the IVDK. Acta Derm Venerol 1998; 78(5):358-63.
27. Kieć-Swierczyńska M, Krecisz B. Occupational skin diseases among the nurses in the region of Lódź. Int J Occup Med Environ Health 2000; 13(3):179-84.
28. Shaffer MP, Belsito DV. Allergic contact dermatitis from glutaraldehyde in health-care workers. Contact Dermatitis 2000; 43(3):150-6.
29. Sayed F, Seite-Bellezza D, Sans B, Bayle-Lebey P, Marguery MC, Bazex J. Contact urticaria from formaldehyde in a root-canal dental paste. Contact Dermatitis 1995; 33(5):353.
30. Fehr B, Huwyler T, Wüthrich B. Formaldehyde and paraformaldehyde allergy. Allergic reactions to formaldehyde and paraformaldehyde after tooth root treatments. Schweiz Monatsschr Zahnmed 1992; 102(1):94-7. [Article in French, German].
31. Gawkrodger DJ. Investigation of reactions to dental materials. Br J Dermatol 2005; 153(3):479-85.
32. Nosko M, Petrova E, Lyapinа M, et al. Occupational risk in formaldehyde exposure. Probl Hyg 2000; 1:16-21. [Article in Bulgarian].
33. Nosko M, Petrova E, Lyapinа M, et al. Toxic effects of formaldehyde on occupationally exposed. Hygiene and Public Health 2001; 2-3: 40-44. [Article in Bulgarian].
34. IARC Working Group on the Evaluation of Carcinogenic Risks to Humans. Formaldehyde, 2-Butoxyethanol, and 1-tert-Butoxypropan-2-ol. IARC Monogr Eval Carcinog Risks Hum. 2006; 88:1-478.
35. Doty RL, Cometto-Muňiz JE, Jalowayski AA, Dalton P, Kendal-Reed M, Hodgson M. Assessment of upper respiratory tract and ocular irritative effects of volatile chemicals in humans. Crit Rev Toxicol 2004; 34(2):85–142.
36. Takahashi S, Tsuji K, Fujii K, Okazaki F, Takigawa T, Ohtsuka A, et al. Prospective study of clinical symptoms and skin test reactions in medical students exposed to formaldehyde gas. J Dermatol 2007; 34(5):283–9.
37. Takigawa T, Usami M, Yamasaki Y, Wang B, Sakano N, Horike T, et al. Reduction of indoor formaldehyde concentrations and subjective symptoms in a gross anatomy laboratory. Bull Environ Contam Toxicol 2005; 74(6):1027–33.
38. Wilhelmsson B, Holmström M. Possible mechanisms of formaldehyde-induced discomfort in the upper airways. Scand J Work Environ Health 1992; 18(6):403–7.
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