Contact Allergy Unit, Department of Dermatology, University Hospitals Leuven, Katholieke Universiteit Leuven, Leuven, B-3000, Belgium.
Contact Dermatitis. 2014 Apr;70(4):227-32. doi: 10.1111/cod.12166. Epub 2013 Nov 30.
Healthcare workers (or relatives) crushing drug tablets for patients with difficulties in swallowing are at risk of developing sensitization via airborne exposure. Tetrazepam, in particular, is increasingly being described as an important occupational allergen in this regard, although other drugs are also involved.
To identify the allergenic culprits in 4 patients, namely 2 nurses, 1 pharmacy assistant, and 1 spouse, who all regularly crushed tablets of systemic drugs and presented with severe airborne dermatitis.
The patients were patch tested with all of the drugs that they handled, as well as with potential cross-sensitizing molecules.
All 4 patients reacted to tetrazepam and other benzodiazepines, some of which they had not previously come into contact with, which favours cross-reactivity rather than concomitant sensitization. These patients also had positive reactions to several other non-structurally related drugs for which, in some cases, there was no history of exposure.
Subjects having to crush drugs, in either an occupational or a non-occupational context, and who present with dermatitis suspected of being airborne-induced, should be patch tested with all contacted medicaments, as well as with possible cross-reacting molecules. Prevention by the use of crushing devices and protective measures (gloves and masks) when medications are handled should be advised.
为吞咽困难的患者压碎药片的医护人员（或其亲属），存在经空气传播暴露而致敏的风险。在这方面，替扎尼定，特别是，越来越多地被描述为一种重要的职业性过敏原，尽管还有其他药物也涉及其中。
鉴定 4 名患者（2 名护士、1 名药剂师助理和 1 名配偶）的变应原罪魁祸首，他们都经常压碎全身用药物的片剂，并出现严重的空气传播性皮炎。
对这些患者进行斑贴试验，使用他们所接触的所有药物，以及潜在的交叉致敏分子。
所有 4 名患者对替扎尼定和其他苯二氮䓬类药物产生反应，其中一些药物他们以前从未接触过，这支持交叉反应而不是同时致敏。这些患者还对其他几种非结构相关药物产生阳性反应，其中一些药物没有接触史。
必须压碎药物的人员（无论是职业环境还是非职业环境），如果出现疑似空气传播诱导的皮炎，应进行斑贴试验，测试所有接触的药物以及可能的交叉反应分子。建议在处理药物时使用压碎设备和保护措施（手套和口罩）进行预防。
