Occupational disease and allergic bronchial asthma are the main occupational disease in the food processing industry registered by the institution for statutory accident insurance and prevention in the foodstuffs industry and the catering trade (BGN). In the years 1999 and 2000, about 26 Mio Euro were spent on occupational disease. Most of the money went into occupational retraining (about 22 Mio Euro), but only a few trainees were able to get an employment after retraining, because of the worse situation on the labor market. To create an alternative to this depressing situation the skin disease prevention program in the baking, hotel and catering trades (SDPP) was developed by the BGN, regional office Erfurt, the Department ofDermatology and Allergology, Friedrich Schiller University, Jena, and the Research Centre for Applied System Safety and Industrial Medicine, Erfurt. The pilot phase was performed in Thuringia and Saxony. A detailed analysis of the occupational exposure of the employees and their personal occupational disease history was followed by the reevaluation of the patients' diagnosis and therapy. Individual care and protection regimes were provided and the application was practiced. Skin care and protection ointments were supplied during the program. Skin care and protection seminars as well as follow-up appointments were offered to the participants. From 1.10.1999 - 31.10.2001, 107 employees suffering from occupational hand dermatitis were included. Most of the employees (n = 84, 78%) showed signs and symptoms of irritant contact dermatitis. Follow-up date are available for 62 (58%) of the participants. In most of the cases, occupational hand dermatitis was caused by the ignorance of risk factors, the unawareness and unavailability of preventive measure. The interventions within the SDPP showed a significant advantage for long-term participants (> 6 months) of the program compared with a matched-control group. In 76% of the participants of the SDPP the lesions, cleared or improved substantially compared to 36% in the control group (p < 0.05). Moreover, costs for rehabilitation and retraining could be halved by the intervention compared to the control group. These results underline the medical and economical efficacy of the SDPP.

A 49-year-old woman presented with acute perianal vesicular/bullous contact dermatitis. Other areas were over the trunk, face, neck and wrists. She reported occasional application of an ointment (Mastu S) to treat her hemorrhoids.Patch tests (basic series, anal block, own ointment, local anesthetic, cosmetics) provoked strong vesicular and bullous reactions of persisting crescendo type, spreading far beyond the site of application, to Bufexamac, to a derivative of hydroxxamine acid, and to local applied ointment with mild or moderate antiinflammatory action.A week after the patch tests there was a flare-up of the previous foci of dermatitis. These reactions subsided two days later after intravenous injection of prednisolone. The skin lesions healed after rapid reduction of the systemic treatment and local application of corticosteroids, bathing with tanning substances and basic preparations.While Bufexamac is not absorbed when applied rectally, perianal contamination may not be avoidable on intra-anal application and can produce sensitization.

In food occupations, like in many other skin risk occupations, the regular use of personal protection equipment, i.e. of skin protection ointments and protective gloves, is recommended as well as regular skin care for the prevention of occupational hand dermatitis. We investigated the uptake and maintenance of different prevention strategies (instructions for skin protection and skin care, prevocational skin hardening with UV light) in food occupations and their efficacy in the primary prevention of vocationally caused hand dermatitis. We could show that the acceptance and regular use of skin protection and care measures could be significantly increased by theoretical and practical instructions in food industry trainees. The highest acceptance was seen with skin protection ointment (100%) and skin care (90%). Protective gloves (43.3%) were used to a lesser extent. The hand dermatitis point prevalence in the groups after 6 months was 13.3% (skin protection), 19.4% (UV hardening) and 29.1% (controls). These clinical trends were supported by statistically significant differences in the basal TEWL values. Adequate skin protection and regular skin care seem to be promising for the prevention of occupationally caused hand dermatitis. The experimental approach using UV hardening prevocationally did not fulfil the expectations.

Refinement in procedures to assess skin surface water loss (SSWL) dynamics of the vulvar skin on a large sample of subjects (60) is described and compared to another semi-occluded skin site, the inner thigh. Vulvar SSWL significantly decreased over a 30-min period from 46.2 ± 2.6 (SE) to 24.7 ± 1.6 g m–2 h (p < 0.001). The inner thigh, another semi-occluded region, showed no similar pattern for SSWL (6.2 ± 0.3 to 6.6 ± 0.5 g m–2 h), and the values were significantly less than those for vulvar skin. There was no significant effect of age, body mass index or atopic status on vulvar SSWL.

Occupational skin disease and allergic bronchial asthma are the main occupational disease in the food processing industry registered by the institution for statutory accident insurance and prevention in the foodstuffs industry and the catering trade (BGN). In the years 1999 and 2000, about 26 Mio Euro were spent on occupational skin disease. Most of the money went into occupational retraining (about 22 Mio Euro), but only a few trainees were able to get an employment after retraining, because of the worse situation on the labor market. To create an alternative to this depressing situation the "skin disease prevention program in the baking, hotel and catering trades" (SDPP) was developed by the BGN, regional office Erfurt, the Department of Dermatology and Allergology, Friedrich Schiller University, Jena, and the Research Centre for Applied System Safety and Industrial Medicine, Erfurt. The pilot phase was performed in Thuringia and Saxony. A detailed analysis of the occupational exposure of the employees and their personal occupational disease history was followed by the reevaluation of the patients' diagnosis and therapy. Individual skin care and protection regimes were provided and the application was practiced. Skin care and protection ointments were supplied during the program. Skin care and protection seminars as well as follow-up appointments were offered to the participants. From 1.10.1999-31.10.2001, 107 employees suffering from occupational hand dermatitis were included. Most of the employees (n = 84, 78%) showed signs and symptoms of irritant contact dermatitis. Follow-up date are available for 62 (58%) of the participants. In most of the cases, occupational hand dermatitis was caused by the ignorance of risk factors, the unawareness and unavailability of preventive measure. The interventions within the SDPP showed a significant advantage for long-term participants (> 6 months) of the program compared with a matched-control group. In 76% of the participants of the SDPP the skin lesions, cleared or improved substantially compared to 36% in the control group (p < 0.05). Moreover, costs for rehabilitation and retraining could be halved by the intervention compared to the control group. These results underline the medical and economical efficacy of the SDPP.

Individual protection measures, i.e. the use of barrier creams and protective gloves as well as skin care, are recommended for employees in skin risk occupations like in food industry. We investigated the short- and long-term acceptance, maintenance and efficacy of different prevention strategies (skin protection and care measures (SP), prevocational UV hardening (UV)) in bakery trainees. Demographic profile and atopy criteria were equally distributed in the 2 intervention arms and the control group (C). Skin protection measures were accepted and taken up to a varying amount during the course of training in the groups. Barrier cream and skin care use in the SP group reached 100% and 90%, respectively, at the end of the observation period. The level of acceptance of glove use (43.3%) was considerably lower. Point prevalence of HD in the groups after 6 months was highest in the C (29.1%) followed by the UVB (19.4%) and the SP group (13.3%). UVB hardening and SP measures were associated with a reduction in HD prevalence by 9.7% (95% CI-8.5-28.1) and 15.8% (95% CI-2.4-33.9), respectively. Application of SP measures reduced the OR for HD 0.8 (95% CI0.17-3.70) and 0.33 (95% CI 0.09-1.23) fold compared to the UVB and C group, respectively. These clinical trends were underpinned by statistically significant differences in basal TEWL levels. Adequate and regular skin protection and care seem to be promising in the prevention of occupational hand dermatitis. The experimental concept of preoccupational UV induced skin hardening did not meet the expectations and cannot be recommended so far.

Individual protection measures, i.e. the use of barrier creams and protective gloves as well as skin care, are recommended for employees in skin risk occupations like in food industry. We investigated the short- and long-term acceptance, maintenance and efficacy of different prevention strategies (skin protection and care measures (SP), prevocational UV hardening (UV)) in bakery trainees. Demographic profile and atopy criteria were equally distributed in the 2 intervention arms and the control group (C). Skin protection measures were accepted and taken up to a varying amount during the course of training in the groups. Barrier cream and skin care use in the SP group reached 100% and 90%, respectively, at the end of the observation period. The level of acceptance of glove use (43.3%) was considerably lower. Point prevalence of HD in the groups after 6 months was highest in the C (29.1%) followed by the UVB (19.4%) and the SP group (13.3%). UVB hardening and SP measures were associated with a reduction in HD prevalence by 9.7% (95% CI -8.5 - 28.1) and 15.8% (95% CI -2.4 - 33.9), respectively. Application of SP measures reduced the OR for HD 0.8 (95% CI 0.17 - 3.70) and 0.33 (95 % CI 0.09 - 1.23) fold compared to the UVB and C group, respectively. These clinical trends were underpinned by statistically significant differences in basal TEWL levels. Adequate and regular skin protection and care seem to be promising in the prevention of occupational hand dermatitis. The experimental concept of preoccupational UV induced skin hardening did not meet the expectations and cannot be recommended so far.

Im Nahrungsmittelgewerbe werden beruflich bedingte Kontaktekzeme der Hände auch in den nächsten Jahrzehnten eine wichtige Rolle spielen und große Anstrengungen in Diagnostik, Therapie und Prävention erforderlich machen. Wir haben Entstehungsdynamik, Prävalenz, Ursachen sowie Vorhersagemöglichkeiten von beruflich bedingten Handekzemen ausführlich untersucht und konnten zeigen, dass sich die Mehrzahl der beruflich bedingten Handekzeme im Nahrungsmittelgewerbe bereits in den ersten Monaten der Ausbildung manifestierten. In aller erster Linie traten irritative Kontaktekzeme auf. Nach 6 Monaten Ausbildung litten 29,1 % der Auszubildenden unter einem irritativen Kontaktekzem. 50 % der Atopiker und 30 % der Nichtatopiker waren erkrankt. Am Ende der Ausbildung wiesen 27,5 % ein irritatives Kontaktekzem auf. Die kumulative Prävalenz lag für die ersten drei Berufsjahre bei 41,3 %. Das Hautschutzverhalten der Auszubildenden war ungenügend. Endogene und exogene Risikofaktoren waren für die Entwicklung von Handekzemen verantwortlich. Bei den endogenen Risikofaktoren spielte die atopische Hautdiathese sowie anamnestische und aktuelle Hand- und Beugenekzeme eine wichtige Rolle. Geschlecht, respiratorische Atopie und Metallsensibilisierung waren nicht von Bedeutung. Bei den exogenen Risikofaktoren zeigte sich, dass berufliche Feuchtarbeit im Allgemeinen, die Kombination mehrerer Feuchtbelastungen sowie Hausbau und Renovierungsarbeiten im privaten Bereich mit einer Risikoerhöhung verbunden waren. Die Höhe der basalen TEWL-Werte ließ keine Vorhersage über das Risiko einer späteren Handekzementwicklung zu.

Unter den Verdachtsmeldungen zur Berufskrankheit (BK) machen die Hauterkrankungen einen großen Anteil aus. Das betrifft neben anderen Gewerben auch das Back-, Hotel- und Gaststättengewerbe. Um die Betreuung der Versicherten zu verbessern, wurde 1999 das „Präventionsprogramm Haut für das Back-, sowie Hotel und Gaststättengewerbe” von der Abteilung für Allergologie und Berufsdermatologie der Klinik für Hautkrankheiten der Friedrich-Schiller-Universität in Jena und dem arbeitsmedizinischen Präventionszentrum der Berufsgenossenschaft für Nahrungsmittel und Gaststätten (BGN) in Erfurt initiiert, in das bisher 23 Versicherte aufgenommen wurden. Nach einer detaillierten Expositionsanalyse am Arbeitsplatz sowie berufsdermatologischer Anamnese und Untersuchung werden bisherige Diagnosen und Therapiestrategien reevaluiert und falls notwendig ergänzt. Individuelle Hautschutz-, -reinigungs und -pflegeprogramme werden erarbeitet, dem Versicherten erklärt und mitgegeben. Durch die BGN werden die dazu nötigen Mittel zur Verfügung gestellt, Hautschutzseminare und Nachuntersuchungen initiiert. Seit Januar 1999 wurden 16 Versicherte in der berufsdermatologischen Sprechstunde der Klinik für Hautkrankheiten vorstellig. Die bisherigen Ergebnisse zeigen ein Defizit in der Aufklärung der Arbeitnehmer über die Entstehungsursachen und Verhinderungsmöglichkeiten berufsbedingter Hauterkrankungen sowie in der Bereitstellung und Anwendung adäquater Hautschutz-, Hautreinigungs- und -pflegemittel. Bei fast allen Versicherten (75 %) lag ein subtoxisch-kumulatives Handekzem als Erstdiagnose vor. In 7 Fällen (44 %) ist derzeit eine Verlaufsanalyse möglich. Bei 3 Versicherten (43 %) ist es im Beobachtungszeitraum zu einer Besserung bzw. Abheilung der Hautveränderungen gekommen. Bei weiteren 3 Versicherten (43 %) blieb der Hautbefund trotz Verbleib im Beruf stabil. Diese ersten Ergebnisse sind erfolgversprechend. Es ist geplant weitere Arbeitnehmer einzubeziehen und das Programm auf mehrere Zentren auszuweiten.

Der Zellantigenstimulationstest (CAST) stellt ein neues Verfahren in der In-vitro-Diagnostik von allergischen Reaktionen dar. Dieser Test beruht auf der Stimulierung von Blutleukozyten mit anschließender Bestimmung der produzierten Sulfidoleukotriene LTC4 und deren Metaboliten LTD4 und LTE4. Die Sulfidoleukotriene werden mittels ELISA-Technik (Enzyme Linked Immunosorbent Assay) gemessen. 84 Patienten mit Verdacht auf Hymenopterengiftallergie wurden mit Hilfe des CAST, des CAP-Systems und der klassischen Hauttests untersucht. Beim vorliegenden Untersuchungsmaterial wurden allergische Reaktionen aller Schweregrade (Grad I-IV nach Mueller) diagnostiziert. Die allergologische Abklärung umfasste nach einer gründlichen Anamnese den Hauttest (Schwellenwertbestimmung bis 1 µg/mL), die spezifische IgE-Antikörper-Bestimmung mit dem CAP-System und den zellulären Antigenstimulationstest. Der CAST wurde mit einer Konzentration von jeweils 0,2 µg/mL Bienen- und Wespengift (Apis mellifera et Vespula spec.) durchgeführt. Als Vergleich diente eine Kontrollgruppe von 10 nicht-allergischen CAP-negativen Personen. Zur Evaluation der diagnostischen Wertigkeiten des CAST wurden sowohl Vergleiche mit dem Hauttest als auch mit den Ergebnissen des CAP-Systems herangezogen. Die Sensitivität und Spezifität erreichten mit 93/67 % für Bienengift und 96/63 % für Wespengift sehr gute Werte und war den CAP-Ergebnissen überlegen. Durch Inkubation mit C 5a war es möglich, in einigen Fällen eine pseudoallergische Reaktion nachzuweisen.

Occupational skin diseases (OSD) are among the most frequent occupational diseases (OD). Compared to other occupations, bakers, confectioners and employees in the catering trades are at a high risk of developing OSD. In January 1999, the interdisciplinary Skin Disease Prevention Program in the Baking, Hotel and Catering Industries (SDPP) conducted by the Department of Dermatology and Allergology at the Friedrich Schiller University, Jena, in cooperation with the Research Center for Applied System Safety and Industrial Medicine, Erfurt, and the technical experts at the Social Insurance for the Food Industry and Related Professions (Berufsgenossenschaft für Nahrungsmittel und Gaststätten– (BGN)), Erfurt, was initiated. Following detailed analysis of the occupational exposure of the employees and their personal occupational disease history, the patients’ diagnosis and therapy was re‐evaluated and supplemented if necessary. Individual skin care and protection regimes were demonstrated and practically trained. Skin care and protection products were supplied. Skin‐care and protection seminars were offered to volunteering participants. From January to December 1999, 29 affected employees were examined in the OSD clinic. 22 employees (76%) suffered from irritant contact dermatitis. The follow‐up data of 11 employees are available. In 8 employees (73%), the skin disease improved or disappeared. Moreover, in 1 employee (9%), the skin condition was stabilized even though he continued working. In only 2 employees (18%) did the skin condition worsen. These preliminary results showed that most of the OSD were due to lack of or unsuitable skin care and protection. The program will be extended to cover a larger number of food industry employees with OSD.

Objective: The aim of this prospective follow-up study was to quantify the impact of hand dermatitis (HD) in bakers, confectioners and bakery shop assistants, and to investigate related risk factors. Method: Bakers', confectioners' and bakery-shop assistants were included in a prospective follow-up study in the region of East Thuringia starting in August 1996. At the beginning of their vocational training 91 apprentices were interviewed and examined in a standardised way. Follow-up examinations and interviews were done after 6 months (n=79), 12 months (n=63) and at the end of the training (n=69) after 36 months. Results: In their case histories 3.3% (n=3) of the apprentices reported previous HD in childhood and adolescence. The first assessment after 2 to 4 weeks of vocational training revealed HD in 17.5% (n=16) of the individuals. At the follow-up examination after 6 months, point prevalence of HD was 29.1% (n=23), after 12 months 27.0% (n=17) and after 36 months 27.5% (n=19). Mild to moderate irritant contact dermatitis was the most frequent finding. Finally, an atopic skin diathesis (>10 points, “atopy score”) (OR=4.89; CI 95% 1.15–20.79), previous HD (OR=41.1; CI 95% 4.99–339.13) as well as flexural dermatitis (OR=6.8; CI 95% 1.72–27.22) proved to be predictive factors for the development of HD. No association was found to respiratory atopy (OR=1.29; CI 95% 0.35–4.7) and metal sensitisation (OR=1.1; CI 95% 0.29–4.35). Exogenous irritant factors did not show a strong association towards a risk increase. Wet work in general, as well as distinct occupational tasks showed only a tendency for being a risk factor for HD. However, leisure time activities, especially house building and rebuilding (OR=5.4; CI 95% 1.05–27.81), were associated with an elevated risk. Conclusions: Endogenous and exogenous factors contribute to the development of HD in bakers' and confectioners' apprentices.

Anaphylactic reactions to food containing allergens in the consumption or preparation of food are well known. However, allergy in the preparation of sausages have rarely been described. In the present study a 26-year-old butcher was investigated who had a severe anaphylactic reaction developing sneezing, rhinitis, conjunctivitis, generalised pruritus, followed by widespread urticaria, Quincke's oedema and dyspnoe after starting to prepare sausages containing red yield rice. Red yield rice is produced from polished and washed rice by means of the fungus Monascus purpureus. It was the first time that Monascus purpureus could be shown as allergic agent by means of prick-to-prick test, Cellular Antigen Stimulation Test (CAST) and different other immunoblots.