Gail,
For an occupational contact allergy or irritant problem as the name suggests
there must be contact. So the first question should be is there contact
between the ear plug and the affected area. If there is no contact between
the ear plug and the area affected I fail to see how it can be allergic
contact dermatitis to the earplug. As Alan so rightly said Nickel is a very
common sensitizer, however for an allergic skin reaction to occur the
causative substance must pass through the stratum Corneum (outer skin layer)
and reach the immune cells of the skin, langerhans cell in allergic contact
dermatitis or the mast cell in contact urticaria. What this means is that if
the substance causing the reaction is not bioavailable, i.e. not in a form
that can pass through the stratum Corneum, there will be no reaction even if
the individual is sensitized to that substance. As no patch test has been
done on your worker yet we still don’t know if it is in fact a contact
allergic dermatitis problem.
If the problem is irritant it is likely to be multifactoral and will most
probably also be influenced not just by the earplugs but by any other
substance or physical damage that may be occurring on that area of skin,
e.g. the shampoo she is using may be a factor. However, that said the
problem will only be visible where there is contact with irritant substances
or physical damage.
If the GP is being unhelpful there is always the option of sending her to a
dermatologist privately.
Best regards
Helen
Helen Taylor (neé Packham)
Enviroderm Services
2 Amery Lodge Farm
North Littleton
Evesham
WR11 8QY
Tel: +44 (0) 1386 832 311
Fax: +44 (0) 1386 830 163
_____
From: [log in to unmask] [mailto:[log in to unmask]] On Behalf
Of Gail Collins
Sent: 07 May 2008 07:43
To: [log in to unmask]
Subject: Re: [OCC-HEALTH] Allergy to metal in detectable ear plugs
Yes I should have said where her eczema is - not IN her ear but on the
pinnar, side of her face down her neck and into her hairline - she also has
excessively dry hands too
I have tried a friendly letter to her GP but so far nothing - 9 weeks later
- cant get to speak to him as he's too busy but my messages will be passed
on - they now consider me a pest or worse a rep!
By the way I know several GP's and they're very friendly and helpful but
none around my employees current area !
Kind regards
Gail
Alan <[log in to unmask]>
Sent by: [log in to unmask]
07/05/2008 01:30
Please respond to Occupational Health mailing list
To: [log in to unmask]
cc:
Subject: Re: [OCC-HEALTH] Allergy to metal in detectable ear
plugs
Where is the eczema?
Some people develop a recurrent ( infective) otitis externa which is often
labelled as "eczema" - I'm not familiar with the ear plugs that you
describe, but if she's trapping moisture in the ear canal, that can
predispose to infection. If the eczema is on her neck, then she could have a
contact dermatitis - and I'm sure you're aware that Nickel is a common
culprit.
I'd suggest a nice letter to the GP saying that your patient has this
problem, that PPE is essential for her to continue in her current job and a
dermatologist's opinion would be most helpful. Apologise for the the scrappy
data sheet that you enclose and say that you feel that if the GP decides to
refer, the dermatologist might find this helpful. A phone call might be even
more helpful if you think that there's a good chance that the employee is
playing each of you off against the other..... and by the way, my eczema is
really bad at the moment, can I have a new car too? ( apologies for
combining two threads!)
Alan
Gail Collins wrote:
Hi All
Many thanks for the answers so far
in response:
Chris I will give you a call later
Personally I think that she just doesn't want to wear them and while I am
not dismissing the possibility of an allergic reaction I will very
surprised. ear defenders only became compulsory about two years ago and its
only now that anyone has taken much notice of whether they wear them or not!
The ear plug is detectable in that it has metal on the string leading into
the actual plug itself and we have two types =- the foam ones (lazertrak)
that need to be rolled and the blue ones that don't (Uvex whisper)
I agree that this is a disciplinary problem unless there is a good medical
reason why she cant wear them then it becomes an employable problem - cant
wear ear defenders cant work here. Unfortunately there are inherited
problems that are going to take some time to untangle!
As some of you may have noticed from previous posts I do not find our local
GPs very helpful on the whole and they obviously don't connect what they say
to their patients with any impact on their patients work place and certainly
don't enter into helpful dialogue (except once) written or otherwise!
Kind regards
Gail
Helen Packham <mailto:[log in to unmask]>
<[log in to unmask]>
Sent by: <mailto:[log in to unmask]> [log in to unmask]
06/05/2008 11:05
Please respond to Occupational Health mailing list
To: <mailto:[log in to unmask]>
[log in to unmask]
cc:
Subject: Re: [OCC-HEALTH] Allergy to metal in detectable ear
plugs
Dear Gail,
My father, Chris, has already replied but I have a couple of other things.
How is she putting the earplugs in her ears? If they are the type of ear
plugs that require rolling between fingers before placing in the ear it is
also possible that they are becoming contaminated prior to use in the ear.
That could also be a source of problems, if for example hands were not being
rinsed thoroughly residue of cleanser would be left on the hands and could
be deposited on the earplug and inserted into the ear, equally this could be
dirt if hands were not clean. This could lead to irritant damage,
particularly with the occlusion from wearing the earplugs, which in turn
could lead to eczema/dermatitis.
Have you observed her wearing the earplugs in the workplace? If she is not
wearing them then the problem should go away. I would also be interested to
know why she is so against wearing an alternative hearing protection as if
the eczema is due to the earplugs an alternative that did not involve
placing anything in the ear would resolve the problem. Most individuals
suffering from a skin problem will do a great deal to resolve it, in her
position I would be only to happy to wear an alternative form of hearing
protection if it meant I did not have the skin problem. With the earplugs
the metal has been mentioned, but what is the rest of the earplug made out
of? Is the metal completely encased in the other material?
As my father has already said the steroid cream should not be used for any
length of time, it is normally considered acceptable to use a topical
steroid for 1 or 2 weeks maximum, but no longer. Topical steroids can thin
the skin and inhibit the immune system amongst other things.
When she said the eczema started at the same time as wearing the earplugs,
is that on the same day or a week or so later, or longer than that?
Best regards
Helen
Helen Taylor (neé Packham)
Enviroderm Services
2 Amery Lodge Farm
North Littleton
Evesham
WR11 8QY
Tel: +44 (0) 1386 832 311
Fax: +44 (0) 1386 830 163
_____
From: <mailto:[log in to unmask]> [log in to unmask] [
<mailto:[log in to unmask]> mailto:[log in to unmask]] On
Behalf Of Gail Collins
Sent: 06 May 2008 09:57
To: <mailto:[log in to unmask]> [log in to unmask]
Subject: [OCC-HEALTH] Allergy to metal in detectable ear plugs
Your advice please?
I have an employee who insists she is allergic to detectable ear plugs. She
tells me her ezcema started at the same time as the ear plugs were
introduced and her GP agrees with her (she says). She has no other forms of
allergies/medical problems. She continues to wear the plugs even though I
have offered her alternatives, I rather suspect that she doesnt actually
wear anything but came in wearing them because she knew she should.
I contacted the company that make the plugs to find out what metal is used
in the plug (as it doesnt say ) and after three months they came up with a
faxed sheet from the steel company that they get the metal from - its all
gibberish to me
If anyone has the time to open the attachment and make sense of it I would
be very grateful.
In the meantime I have established that this lady has not been referred to a
dermatologist as she says her GP says there's little point. She also claims
her GP told her not to wear the plugs, continues to use the steroidal cream
prescribed and this is available on a repeat prescription
I have documented the advise I have given this lady - use alternative ear
muffs and that she chooses not to - that steroid cream should be used
sparingly and not continuously - what else should I do?
Kind regards
Gail
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contain alterations), is intended solely for the addressee, is strictly
confidential and may also be legally privileged. If you are not the
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