Chris,

 

Thanks for your input. I was hoping that you would have some pointers. I knew that this one was going to be difficult. I doubt that the employer will be willing to fork out for the relevant testing (as I mentioned a V small company). I am concerned that this individual is still at work - but they have been for 17 months although it was undiagnosed until recently. Financial reasons are keeping this person at work at present and I feel unable to make any recommendations with so little knowledge and prior to receiving the specialist report. My instinct is to send them home but I don’t want to over react so I have recommended a common sense approach until I know more ie. no contact with chemicals inc cleaning products and increased cleaning to keep dust levels down.

 

Looks like I have some bedtime reading to do!

 

 

In the fourth edition of the Textbook of Dermatology (Rook, Wilkinson, et. al) there is a section dedicated to multiple sensitivities. Chapter 14 by Wilkinson and Rycroft write of concomitant sensitivities, and divide these into four groups:

Multiple non-specific reactivity sensitivity

Multiple primary specific sensitivities

Multiple secondary specific sensitivities, i.e. cross-sensitization

Multiple reactions to several compounds containing an identical allergen, i.e. false cross reaction.

This condition is described also in other dermatological books and journals and is not that uncommon. However, caution is needed in assuming that this is what you are dealing with.

 

It may be that this person is atopic and simply suffering from an irritant reaction at a lower level of exposure that would normally be required. Alternatively it could be a combination of irritant and allergic reactions, possibly combined with other factors, e.g. stress, sub-clinical constitutional conditions, etc.

 

From the information so far available it does not appear that any detailed clinical testing has been done, i.e. patch/prick test or RAST. This is a prerequisite for being able to manage the condition. So referral for proper investigation is essential. In addition to investigating the respiratory symptoms I would wish to see appropriate testing done by a suitably experienced dermatologist. Once the clinical diagnosis is known, then a plan can be formulated to (hopefully) allow that person to continue at their current work.

 

Regards

Chris

 

Chris Packham

EnviroDerm Services

Unit 10, The Mews, Mitcheldean, GL17 0SN

Tel: 01386 832 311