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"Cette fiche d'allergologie-pneumologie professionnelle annule et remplace l'ancienne fiche du même nom (TR 17). Elle fait le point sur les sulfites, sels de l'anhydride sulfureux (SO2), qui sont utilisés dans de nombreux secteurs d'activité, notamment pour leurs propriétés antiseptiques et anti-oxydantes. Si l'intolérance aux sulfites, notamment chez les sujets asthmatiques, est bien connue lors de l'ingestion d'aliments ou de boissons, ou lors de l'administration de produits pharmaceutiques en contenant, seuls quelques cas d'asthme induit par l'usage professionnel de sulfites ont été rapportés dans la littérature ces 25 dernières années. D'un point de vue physiopathologique, plusieurs hypothèses ont été proposées pour expliquer la genèse ou l'aggravation d'un asthme par les sulfites, mais aucune ne semble pouvoir expliquer à elle seule la diversité des manifestations cliniques observées, ni leur variabilité en terme de sévérité ou de sensibilité individuelle. Les éléments anamnestiques plaident parfois pour une origine purement irritative lorsque la manipulation de solutions de sulfites provoque des dégagements importants de SO2 dans l'environnement de travail. Dans d'autres cas, l'asthme apparaît après un long temps de latence et en dehors de toute exposition accidentelle, ce qui serait plutôt en faveur d'un mécanisme immuno-allergique. Le diagnostic étiologique repose sur l'histoire médicale, la mise en évidence d'une rythmicité professionnelle et, si possible, sur un test d'exposition réaliste positif. La prévention doit en particulier s'attacher à éviter la création de conditions favorables à la libération atmosphérique de fortes quantités de SO2."

Background Natural rubber latex (NRL) has become an important occupational health concern in recent years, particularly among health care workers. It has been suggested in some reports that the prevalence of latex sensitization among occupationally exposed groups is not different from that in the general population. Methods The findings of prevalence studies conducted among occupationally-exposed and general population groups were reviewed to determine whether there is evidence to support this suggestion. Results Numerous surveys of HCWs have demonstrated that the prevalence of sensitization to latex ranged in most studies from 5 to 12%; sensitization of HCWs may produce clinical effects including urticaria, rhinoconjunctivitis, occupational asthma, and potentially life-threatening anaphylactic shock. More than a decade ago, data from Finland indicated that the prevalence of latex allergy in the general population was less than 1%. Recent reports from Finland have confirmed this, with observations that 0.7-1.1% of large series of patients were NRL-allergic, while among 804 unselected patients, the prevalence of latex skin prick test (SPT) positivity was 0.12%. In contrast, other studies have suggested that from 4 to 6.4% of individuals tested were positive for serum latex-specific IgE antibodies. However, the specificity of these assays has been reported to be low. In three recent studies based on SPTs, published in 1997, the prevalence of positive reactions to latex was about 1% or less. The prevalence was 0.7% (95% CI 0.3-1.4) among 758 apprentices in Quebec, Canada; and 1.1% among more than 3,000 children tested in Finland (1.0% confirmed on latex use test). There were no first- and second-year dental students with positive latex SPTs in Ontario, Canada. Conclusions These recent investigations provide further evidence consistent with earlier studies based on skin testing that the prevalence of latex sensitization in occupationally-unexposed groups is quite low (<1%). The marked differences in the findings based on serological assays may relate to the nonspecificity of these assays and deserve further investigation.

The relationship between sensitization to natural rubber latex (NRL) and work disability was examined among health care workers. A questionnaire was completed by 32 female health care workers diagnosed with NRL allergy and 51 age, sex and occupation matched health care workers without NRL allergy. The Work Ability Index (WAI), based on the physical and mental demands of work and the worker's health status and resources, was used to determine the working capability of the workers. The usefulness of symptoms in screening for NRL allergy was also examined. The median WAI was lower among the latex allergic workers than among the nonsensitized workers. Among latex allergic workers, the mean WAI increased following the exclusion of allergic eczema from the calculations. In the control group, the mean WAI remained unchanged following the exclusion of allergic eczema from the calculations. The median difference between sensitized and nonsensitized workers was 1.0 point greater among workers performing both physically and mentally demanding work than among workers performing mentally demanding work only. Work ability was categorized as poor, moderate, and good in 9, 56, and 34% of the sensitized workers and 2, 45, and 53% of the nonsensitized workers, respectively. Of the sensitized subjects, 44% experienced dry skin, 97% experienced itchy hands, and 56% experienced hand eczema. Of the controls, 25%, 22%, and 8% reported dry skin, itchy hands, and hand eczema, respectively. Symptoms such as watery or itchy eyes, rhinorrhea, and lip edema were reported almost exclusively by sensitized workers. The reporting of at least one skin condition with one mucosal symptom served as a sensitive and specific indicator of NRL allergy. The authors conclude that latex allergy is clearly associated with decreased work ability in health care workers. A self administered questionnaire may be useful for quick latex allergy screening.

"Les dermatoses professionnelles au caoutchouc sont essentiellement des dermatites de contact d'irritation et/ou allergiques et des urticaires de contact. Les équipements de protection individuelle (EPI) sont principalement impliqués, par exemple les gants chez les personnels de santé ou les gants, bottes et chaussures de sécurité chez les salariés du Bâtiment et travaux publics (BTP). La plupart des EPI en caoutchouc sont irritants, surtout en cas de port prolongé.
Les principaux allergènes responsables de dermatite de contact allergique sont les additifs du caoutchouc (accélérateurs de vulcanisation et anti-oxydants).
Le latex est de loin la principale cause d'allergie immédiate IgE dépendante au caoutchouc."

"Concerns have been raised regarding toxic chemicals found in tire crumb used as infill in artificial turf and other play surfaces. A hazard-based analysis was conducted, comparing tire crumb with other materials marketed as alternative infills. These include other synthetic polymers as well as plant- and mineral-based materials. The comparison focused on the presence, absence, number, and concentration of chemicals of concern. No infill material was clearly free of concerns, but several are likely to be somewhat safer than tire crumb. Some alternative materials contain some of the same chemicals of concern as those found in tire crumb; however, they may contain a smaller number of these chemicals, and the chemicals may be present in lower quantities. Communities making choices about playing surfaces are encouraged to examine the full range of options, including the option of organically managed natural grass."