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 employed to identify the cause of an irritant vesicular rash on the hands and fingers of a female office worker whose occupation entailed the day-long handling of significant quantities of CCP. The symptoms developed within 2 days of the subject's return to work after 18 months of leave. They resulted in the patient's stopping work after 3 weeks. Initial skin-patch tests to nickel sulfate, cobalt chloride, and fragrance mix gave positive results, but there was no reaction to the CCP. The patient improved during 3 months on sick leave, but the condition recurred severely as soon as she returned to work. Subsequent skin-patch tests to the five color formers supplied by the manufacturer of the CCP showed an allergic reaction to CVL at concentrations of 0.01% to 5%. The authors concluded that the patient was allergic to CVL and that CCP skin-patch tests with CCP only are not sufficient to detect allergies to color formers. They therefore suggested that the color formers themselves be used to test patients with hand eczema and regular contact with CCP.

LaMarte et al. 1988. Acute systemic reactions to CCP, including laryngeal edema, were reported in two U.S. office workers by LaMarte et al. [1988]. The first case was a 39-year-old woman with a 2-year history of recurring episodes of hoarseness, coughing, flushing, pruritus, and rash appearing within 30 min of topical exposure to CCP. She was a clerk/typist with frequent exposures to CCP during her working hours. Cutaneous application tests were performed using six chemical ingredients of CCP. Approximately 15 min after 1% alkylphenol novolac resin dispersion was rubbed onto her forearm, she was noted to develop hoarseness, wheezing, and angioedema of both arms. A subsequent challenge with the material was followed by hoarseness, wheezing, and angioedema at the challenge site. Video endoscopy of the larynx was interpreted as showing diffuse swelling and marked edema of the true vocal cords. Plasma histamine levels obtained at the onset and peak of symptoms were sixfold higher than the prechallenge level.

The second case described by LaMarte et al. [1988] was a coworker of the patient in the first case. This 45-year-old woman had a 6-month history of hoarseness, coughing, flushing, and localized angioedema subsequent to skin contact with CCP. She was challenged by rubbing 1% alkylphenol novolac resin onto one arm and was reported to have angioedema of the arm and hoarseness 30 min after the challenge. The authors concluded that the reaction was mast cell/basophil-mediated, that these cases demonstrate a connection to a specific component of CCP, and that they indicate a potentially life-threatening adverse reaction in susceptible patients.

Hammel 1990. Hammel [1990] reported the results of a NIOSH Health Hazard Evaluation of a U.S. consumer refrigeration manufacturer employing 2,600 workers, including 900 office personnel. CCP was used in all departments, but most users were in the export and purchasing departments. Medical interviews were performed for four workers who felt that their health problems were associated with CCP exposure. Two of four workers had developed recurrent episodes of hoarseness, coughing, flushing, pruritis, and rash, which would occur within 30 min of handling CCP. The third worker described having nausea and dizziness when handling one type of CCP form but not other types. The fourth worker developed redness and itching on the edges of both hands when handling CCP forms (a dermatitis that resolved during weekends). Symptoms improved in all four workers when they avoided exposure to CCP. Two of the four workers became so sensitized that they could not be in the vicinity of CCP without being hoarse. Medical evaluations confirmed acute systemic reactions to CCP (laryngeal edema and sixfold increases in plasma histamine levels) after