Jolanki R
Institute of Occupational Health, Helsinki, Finland.
Acta Derm Venereol Suppl (Stockh). 1991;159:1-80. doi: 10.2340/0001555555159180.
Of a total of 3731 patients investigated between 1974 and 1990, 1844 (49.4%) had an occupational skin disease. Of them 142 (7.7%) had an occupational skin disease caused by epoxy compounds--135 patients (95%) had allergic contact dermatitis, five had irritant contact dermatitis, and two had contact urticaria. Apart from dermatoses, two patients had IgE-mediated asthma from exposure to DGEBA epoxy resins. Thus epoxy compounds are one of the main causes of occupational allergic contact dermatoses and can be considered potential causes of occupational asthma. The most frequent causes were epoxy resin compounds, which together induced 93% (132 cases) of all epoxy compound dermatoses. The three most common causative products were epoxy paints and their raw materials (31%, 41 cases), epoxy resin compounds used in electrical insulation (29%, 38 cases) and epoxy glues (18%, 24 cases). Fewer cases were caused by products containing epoxy acrylate and EPTMAC. The present study found that, in addition to contact allergy to DGEBA epoxy resins, contact allergy to epoxy hardeners, non-DGEBA resins and reactive diluents is common. Polyamine hardeners, most frequently MDA, DETA and TETA, rarely IPDA, tris-DMP, EDA, TMD and XDA, were the second commonest causes of contact allergy induced by epoxy resin compounds, after DGEBA epoxy resins. Cycloaliphatic epoxy resins and other non-DGEBA epoxy resins, including heterocyclic dimethyl hydantoin, phenol novolak and brominated epoxy resins, were the third commonest causes, and reactive diluents the fourth commonest cause of allergic dermatitis due to epoxy resin compounds. Most patients sensitized to reactive diluents were allergic to PGE, ortho-CGE, HDDGE and BDDGE, whereas fewer patients were sensitized to AGE, NPGDGE and BGE. Cross-sensitization between reactive diluents was common. Cardura E 10 and Epoxide 8 provoked no reactions. The present study also indicated that DGEBA epoxy resins with a high average MW ought to be regarded as potential sensitizers, and organic solvents probably promote sensitization to DGEBA, even if the amount of DGEBA is low in the causative products. When contact dermatitis induced by epoxy compounds is suspected, an accurate diagnosis is made with the use of detailed data on the patient's exposure and extensive patch testing, including tests with the patient's own products. No chemical can be used alone to screen for sensitization to all different contact allergens of epoxy compounds.(ABSTRACT TRUNCATED AT 400 WORDS)
在1974年至1990年期间接受调查的3731名患者中，1844名（49.4%）患有职业性皮肤病。其中142名（7.7%）患有由环氧化合物引起的职业性皮肤病——135名患者（95%）患有过敏性接触性皮炎，5名患有刺激性接触性皮炎，2名患有接触性荨麻疹。除皮肤病外，有2名患者因接触二缩水甘油醚双酚A（DGEBA）环氧树脂而发生IgE介导的哮喘。因此，环氧化合物是职业性过敏性接触性皮炎的主要原因之一，可被视为职业性哮喘的潜在病因。最常见的病因是环氧树脂化合物，它们共同导致了所有环氧化合物皮肤病的93%（132例）。三种最常见的致病产品是环氧漆及其原材料（31%，41例）、用于电气绝缘的环氧树脂化合物（29%，38例）和环氧胶水（18%，24例）。由含环氧丙烯酸酯和环氧丙基三甲基氯化铵（EPTMAC）的产品引起的病例较少。本研究发现，除了对DGEBA环氧树脂的接触过敏外，对环氧固化剂、非DGEBA树脂和活性稀释剂的接触过敏也很常见。多胺固化剂，最常见的是4,4'-亚甲基双（2-氯苯胺）（MDA）、二亚乙基三胺（DETA）和三亚乙基四胺（TETA），很少见异佛尔酮二胺（IPDA）、三（2,4-二甲基苯基）膦（tris-DMP）、乙二胺（EDA）、三甲基二胺（TMD）和二甲苯二胺（XDA），是环氧树脂化合物引起接触过敏的第二常见原因，仅次于DGEBA环氧树脂。脂环族环氧树脂和其他非DGEBA环氧树脂，包括杂环二甲基乙内酰脲、酚醛清漆和溴化环氧树脂，是第三常见原因，而活性稀释剂是环氧树脂化合物引起过敏性皮炎的第四常见原因。大多数对活性稀释剂致敏的患者对苯基缩水甘油醚（PGE）、邻氯缩水甘油醚（ortho-CGE）、六氢邻苯二甲酸二缩水甘油酯（HDDGE）和溴化二缩水甘油醚（BDDGE）过敏，而对烯丙基缩水甘油醚（AGE）、新戊二醇二缩水甘油醚（NPGDGE）和丁基缩水甘油醚（BGE）过敏的患者较少。活性稀释剂之间的交叉致敏很常见。可的酯E10（Cardura E 10）和环氧化合物8（Epoxide 8）未引起反应。本研究还表明，平均分子量较高的DGEBA环氧树脂应被视为潜在的致敏剂，即使致病产品中DGEBA的含量较低，有机溶剂也可能促进对DGEBA的致敏。当怀疑由环氧化合物引起接触性皮炎时，应利用患者接触的详细数据和广泛的斑贴试验，包括用患者自己的产品进行试验，做出准确诊断。没有一种化学品可单独用于筛查对环氧化合物所有不同接触过敏原的致敏情况。（摘要截选至400字）
