PEARLS & ZEBRA
Contact Dermatitis to Epoxy Resins Presenting as Conjunctivitis Agnessa Goodson, MD and Doug Powell, MD
PRECI´S Epoxy resins are a common cause of airborne contact dermatitis of the skin, but we present a novel example of conjunctivitis without skin involvement caused by epoxy resins.
DISCUSSION A 45-year-old Asian woman who worked in a factory assembling airplane components presented with a several-month history of stinging and burning of her eyes within minutes to hours of entering her workplace. She had been working at the factory for 10 years. On initial examination, her conjunctivae were noted to be injected, but her skin (including her eyelids and periorbital areas) was clear. An open use test using cleaners from the patient’s work and prick testing to solvents methyl ethyl ketone and isopropyl alcohol were negative. Patch testing was performed using the American Contact Dermatitis Society standard series, epoxy series, and oil and cooling fluid series, which were read at 48 and 96 hours. The patient was positive to chrome (1+ reaction) and epoxy resins (2+ reaction). Initially, the patient had a reaction to the standard epoxy resin (a combination of bisphenol A and epichlorohydrin) but later also reacted to bisphenol F (an additional component of epoxy resins). Further probing into her work history revealed that she was exposed to epoxy resins in areas where she worked with airplane components. She was noted to have flaring of her eyes when being patch tested with epoxy resins, which was thought to represent a recall reaction. She never developed an allergic reaction anywhere else on her skin. An airborne contact conjunctivitis to epoxy resins was diagnosed, and the patient was instructed to avoid any environment From the University of Utah School of Medicine, Salt Lake City, UT. Address reprint requests to Agnessa Goodson, MD, 30 N 1900 E, 4A330 School of Medicine, Salt Lake City, UT 84132. E-mail: [email protected]. The authors have no funding or conflicts of interest to declare. DOI: 10.1097/DER.0000000000000015 * 2014 American Contact Dermatitis Society. All Rights Reserved.
34
that had epoxy resins. When she avoided areas where epoxy resins were used, her eyes remained clear. However, when she was placed back in the building where airplane components were assembled, she once again developed redness and irritation of her eyes. Eventually, the patient was moved to work in a building where she was not exposed to epoxy resins and remained free of eye irritation. Airborne allergens are known to cause an allergic contact dermatitis, with most cases found to be caused by occupational agents.1 The upper eyelids are more susceptible to developing an allergic reaction because the skin in this area is very thin. However, the mucosa of the eyes can also be rarely involved, as demonstrated by type I allergy to latex and type IV allergy from occupational exposure to methacrylates as well as trimethylolpropane triacrylate.2Y4 Allergic reactions to epoxy resins commonly present as eyelid dermatitis,2 but conjunctivitis without dermatitis has not been previously reported. The likely explanation for the paucity of allergic reactions involving the eye itself resides in the fact that it is considered an ‘‘immune-privileged site,’’ where the risk of losing sight due to inflammation outweighs the risk that foreign pathogens may pose.5 Multiple studies have shown that when T cells encounter retinal pigment epithelium and pigmented epithelial cells cultured from the iris and ciliary body in vitro, their activation is inhibited. In addition, when aqueous humor is harvested from normal eyes and tested in vitro, it has been shown to suppress activation of a wide variety of cells (including T cells, neutrophils, and macrophages) involved in inflammation and destructive immunity.5
ZEBRA This was a unique example of occupational airborne allergic contact dermatitis to epoxy resins presenting as conjunctivitis without any skin involvement.
REFERENCES 1. Swinnen I, Goossens A. An update on airborne contact dermatitis: 2007Y2011. Contact Dermatitis 2013;68(4):232Y238. 2. Goossens A. Contact allergic reactions on the eyes and eyelids. Bull Soc Belge Ophtalmol 2004;(292):11Y17. 3. Estlander T, Kanerva L, Kari O, et al. Occupational conjunctivitis associated with type IV allergy to methacrylates. Allergy 1996;51(1):56Y59. 4. Mancuso G, Berdondini RM. Occupational conjunctivitis as the sole manifestation of airborne contact allergy to trimethylolpropane triacrylate contained in a UV-cured paint. Contact Dermatitis 2008;59:372Y373. 5. Streilein JW. Ocular immune privilege: the eye takes a dim but practical view of immunity and inflammation. J Leukoc Biol 2003;74(2):179Y185.
DERMATITIS, Vol 25 ¡ No 1 ¡ January/February, 2014
Copyright © 2014 American Contact Dermatitis Society. Unauthorized reproduction of this article is prohibited.
Contact Dermatitis to Epoxy Resins Presenting as Conjunctivitis Agnessa Goodson, MD and Doug Powell, MD
PRECI´S Epoxy resins are a common cause of airborne contact dermatitis of the skin, but we present a novel example of conjunctivitis without skin involvement caused by epoxy resins.
DISCUSSION A 45-year-old Asian woman who worked in a factory assembling airplane components presented with a several-month history of stinging and burning of her eyes within minutes to hours of entering her workplace. She had been working at the factory for 10 years. On initial examination, her conjunctivae were noted to be injected, but her skin (including her eyelids and periorbital areas) was clear. An open use test using cleaners from the patient’s work and prick testing to solvents methyl ethyl ketone and isopropyl alcohol were negative. Patch testing was performed using the American Contact Dermatitis Society standard series, epoxy series, and oil and cooling fluid series, which were read at 48 and 96 hours. The patient was positive to chrome (1+ reaction) and epoxy resins (2+ reaction). Initially, the patient had a reaction to the standard epoxy resin (a combination of bisphenol A and epichlorohydrin) but later also reacted to bisphenol F (an additional component of epoxy resins). Further probing into her work history revealed that she was exposed to epoxy resins in areas where she worked with airplane components. She was noted to have flaring of her eyes when being patch tested with epoxy resins, which was thought to represent a recall reaction. She never developed an allergic reaction anywhere else on her skin. An airborne contact conjunctivitis to epoxy resins was diagnosed, and the patient was instructed to avoid any environment From the University of Utah School of Medicine, Salt Lake City, UT. Address reprint requests to Agnessa Goodson, MD, 30 N 1900 E, 4A330 School of Medicine, Salt Lake City, UT 84132. E-mail: [email protected]. The authors have no funding or conflicts of interest to declare. DOI: 10.1097/DER.0000000000000015 * 2014 American Contact Dermatitis Society. All Rights Reserved.
34
that had epoxy resins. When she avoided areas where epoxy resins were used, her eyes remained clear. However, when she was placed back in the building where airplane components were assembled, she once again developed redness and irritation of her eyes. Eventually, the patient was moved to work in a building where she was not exposed to epoxy resins and remained free of eye irritation. Airborne allergens are known to cause an allergic contact dermatitis, with most cases found to be caused by occupational agents.1 The upper eyelids are more susceptible to developing an allergic reaction because the skin in this area is very thin. However, the mucosa of the eyes can also be rarely involved, as demonstrated by type I allergy to latex and type IV allergy from occupational exposure to methacrylates as well as trimethylolpropane triacrylate.2Y4 Allergic reactions to epoxy resins commonly present as eyelid dermatitis,2 but conjunctivitis without dermatitis has not been previously reported. The likely explanation for the paucity of allergic reactions involving the eye itself resides in the fact that it is considered an ‘‘immune-privileged site,’’ where the risk of losing sight due to inflammation outweighs the risk that foreign pathogens may pose.5 Multiple studies have shown that when T cells encounter retinal pigment epithelium and pigmented epithelial cells cultured from the iris and ciliary body in vitro, their activation is inhibited. In addition, when aqueous humor is harvested from normal eyes and tested in vitro, it has been shown to suppress activation of a wide variety of cells (including T cells, neutrophils, and macrophages) involved in inflammation and destructive immunity.5
ZEBRA This was a unique example of occupational airborne allergic contact dermatitis to epoxy resins presenting as conjunctivitis without any skin involvement.
REFERENCES 1. Swinnen I, Goossens A. An update on airborne contact dermatitis: 2007Y2011. Contact Dermatitis 2013;68(4):232Y238. 2. Goossens A. Contact allergic reactions on the eyes and eyelids. Bull Soc Belge Ophtalmol 2004;(292):11Y17. 3. Estlander T, Kanerva L, Kari O, et al. Occupational conjunctivitis associated with type IV allergy to methacrylates. Allergy 1996;51(1):56Y59. 4. Mancuso G, Berdondini RM. Occupational conjunctivitis as the sole manifestation of airborne contact allergy to trimethylolpropane triacrylate contained in a UV-cured paint. Contact Dermatitis 2008;59:372Y373. 5. Streilein JW. Ocular immune privilege: the eye takes a dim but practical view of immunity and inflammation. J Leukoc Biol 2003;74(2):179Y185.
DERMATITIS, Vol 25 ¡ No 1 ¡ January/February, 2014
Copyright © 2014 American Contact Dermatitis Society. Unauthorized reproduction of this article is prohibited.
