An occupationally induced contact eczema can be of irritative, atopic and/or contact allergic nature. A decision concerning genesis is seldom easily to take. Because of that for each diagnostic review it has to be determined whether it is a matter of a contact allergy against an occupational contactant. The diagnostics of a occupationally induced contact allergy remains mainly on the examination of one for the particular occupational branch recommended, and commercially obtainable series of patch tests. As a rule the most important known allergens are covered by this, but in all branches there is a more or less high percentage of potentially allergenic occupational contactants which are not being taken into account. Moreover the change of the occupational exposition due to technological progress results in the recommendations becoming outdated after some time.
For this reason the supplemental patch testing with current occupational contactants and their ingredients of the patient’s workplace is an indispensable constituent of the diagnostic procedure in occupational dermatology. Regarding many of those substances there is no information available to dermatologists concerning testing modalities such as suitable concentration and carrier. This leads to these substances in many cases being tested in too high or low concentrations with the result of false positives, i.e. a reaction which is erroneously considered an allergic irritative reaction, or a false negative result, i.e. no reaction in spite of a sensitization. Likewise, the manufacturers of occupational contactants who are asked for supplying ready-for-testing single components often lack crucial information about the optimum preparation for testing. Perhaps testing has in many cases never been considered or not been pursued anymore because of the necessary information not being available and seemingly too difficult to obtain.
This is where the work of the KAB-Network starts. It is about a network of departments of occupational dermatology with a central office of information and documentation, which is supported by the German Statutory Accident Insurance (Deutsche Gesetzliche Unfallversicherung e.V., DGUV). The center of the KAB-Network is at the head office of the Information Network of Departments of Dermatology (IVDK) at the University of Göttingen. Job of the central office is to advise and support testing of occupational contactants and to centrally manage results of these tests. Thus it shall be guaranteed that tests with occupational contactants or single components of them are carried out adequately and in the same way by all clinics.
When an occupational contactant is to be tested the respective clinic makes contact with the KAB head office. The head office will get in touch with the concerning manufacturer to learn of the ingredients of the contactant and arrange a series of tests of the single components. Here it is particularly necessary to determine adequate testing preparations, and to critically assess the single components based on existing knowledge, also seen from a toxicological point of view. After determining a suitable testing preparation, the manufacturers are asked to make respective substances available and send them to the corresponding clinic. Simultaneously to the correspondence between the KAB head office and the manufacturer of the contactant, recommendations concerning the procedure of testing the respective product are given to the inquiring clinic.
Results of tests are wired to the KAB head office and from there with interpretation reported to the manufacturer.
Further details on the process:
Figure: Arbeitsweise des Netzwerks "Kontaktallergien durch Berufsstoffe"