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Some not well-documented cases of occupational asthma or eczema occurred at high exposure levels.

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5 cases of occupational eczema, urticaria and respiratory disease from reactive dyes, occurring during 1977-1987, are reported. The patients, 4 men and 1 woman, were 24-52 years old when examined. They had been working in dye houses or textile plants, and had been exposed to reactive dyes for 8 months to 4 years before symptoms developed. Only 1 of the patients has been able to continue in the same occupation. On patch testing, the 4 patients with eczema reacted positively to 9 commercial dye powders. 2 patients reacted to the same dye, Remazol Schwarz B. On scratch and/or prick testing, the 2 patients who also had respiratory symptoms and/or urticaria reacted positively to the same dyes as on patch testing. The 5th patient, who had urticaria and respiratory symptoms, reacted positively to a dye, Remazol Gold Gelb RNL, but the patch test with that dye was negative. None of the patients was patch-test-positive to para-phenylenediamine (PPD) or to textile dye allergens in a series of organic dyes. Thus, the series of organic dyes has little value in the screening of allergy to reactive dyes. A 1% pet. dilution of commercial dye powder for patch testing and the same concentration in distilled water for prick testing seem to be suitable for the screening of allergy to reactive dyes.

A 56-year-old man with no history of atopy had worked since he was 30 years old in a small chemical company which manufactures a number of chemical products such as detergents, brake fluids, dental cream, etc. Some years ago the company started production of textile dyes containing different reactive dyes. He developed rhinitis and cough, and 1 year later eczema on his hands and the front of the neck. When he was on sick leave, the eczema and respiratory symptoms disappeared.

Patch testing with the ICDRG standard series was negative. Positive tests were obtained to several reactive dyes, Levafix brilliant blue E-BRA (+), Levafix marinblau E-2BA (+ +), and the different types of Levafix black, E-G, 5-GA, E-B; all 3 were positive (+ ). Immediate-type hypersensitivity to reactive dyes.

Prick tests with l0 common allergens gave a positive reaction (+ + +) to birch pollen, equal to the positive reference (10 mg of histamine hydrochloride/ml). 3 samples of reactive dyes from the “Levafix" series were chosen for prick tests. Conjugates of dyes and HSA (human serum albumin) were first used. The 3 Levafix dyes gave weakly (+) positive reactions. The Levafix black E-G and E-B and marinblau E-2BA, gave strong (+ + + +) prick test reactions when tested without HSA in a concentration of 10 mg/ml. RAST tests against the reactive dyes were negative. Total IgE was elevated at 380 kU/l. Metacholine bronchial challenge test was weakly positive. The patient now has a new job without exposure to reactive dyes; his eczema and respiratory symptoms have disappeared.

A case of occupational asthma in a wool and cotton dyer handling reactive dyes is described. The patient was skin positive, but asymptomatic to house dust mites. A bromoacrilamidic dye (Lanasol Yellow 4G) has been identified through chamber inhalation challenge as being responsible for the sensitization. A very short (4-minute) exposure produced a severe immediate obstructive ventilatory defect followed by arterial hypotension and urticaria. Bronchial hyperresponsiveness as tested through metacholine challenge was absent both in basal conditions and after the dye challenge. Both prick and patch test for the dye were positive in the absence of any sign of contact dermatitis.