Occupational contact dermatitis caused by opioids: A case series

Abstract

Background: Opioid-manufacturing facility workers are at risk of developing occupational contact dermatitis.Objectives: To describe the causes of occupational allergic contact dermatitis caused by opioids in an opioid-manufacturing facility. Materials and Methods:A retrospective review was performed of patients assessed at the Occupational Dermatology Clinic in Melbourne, Australia from 2004 to 2017.Results: Fifteen workers from an opioid-manufacturing facility were assessed in our clinic over a period of 14 years. Of these, 11 individuals were diagnosed with occupational allergic contact dermatitis caused by opioids, with seven reacting to thebaine, five to morphine, four to norhydroxymorphinone, two to codeine, and two to oripavine. Two people were suspected of having immediate hypersensitivity reactions to opioids, including one who also had allergic contact dermatitis. Two patients were diagnosed with urticaria, aggravated at work. One patient was diagnosed with a non-occupational rash. Conclusions:We report a case series of workers with allergic contact dermatitis caused by opioids in a manufacturing facility. With greater awareness, including implementation of an educational programme and improved skin protection, the number of cases declined over time. Interestingly, norhydroxymorphinone had not been reported as an allergen before. Further testing is required to establish optimal patch test concentrations of all opiates. K E Y W O R D Scontact allergy, occupational allergic contact dermatitis, opioids, opioid-manufacturing facility, patch test, urticaria

Occupational allergic contact dermatitis caused by nalmefene

“…There are reports of sensitization and contact dermatitis following occupational exposure to phenanthrene alkaloid opiates and their derivatives 4 . Reactions have been reported to formulations of: codeine, codeine dihydrophosphate, ethylmorphine, morphine, diacetylmorphine, naloxone, oxycodone, thebaine, oripavine and norhydroxymorphinone 4‐9 . To our knowledge this is the first reported case of contact allergy to nalmefene.…”

Opioidergic Signaling—A Neglected, Yet Potentially Important Player in Atopic Dermatitis

“…However, the fact that certain widely used opioids exert relevant antibacterial activity against Staphylococcus and Candida albicans strains raises the possibility that they could be used as adjuvant treatment of AD-accompanying cutaneous dysbiosis (obviously only in appropriate topical formulations that could prevent their systemic adverse effects). However, in the course of clinical investigation of such opioid-containing formulations, special caution will be needed, since, according to a recent case report, certain opioids (thebaine, morphine, norhydroxymorphinone, codein, and oripavine) can cause occupational allergic contact dermatitis [182]. Finally, the putative role of endogenous opioids (not only the already investigated β-endorphin and Met-enkephalin (OGF), but all the other keratinocyte-derived endogenous opioids as well) in shaping cutaneous microbiota should also be investigated.…”

Kontaktallergien – Neu aufkommende Allergene und Auswirkungen für das Gesundheitswesen

“…Die Anwendung in dieser Indikation hat in nur wenigen Tagen eine perianale ACD verursacht [191]. Von Opioiden ist berichtet worden, dass sie berufsbedingte ACD hervorrufen können – zuletzt im Rahmen einer Fallserie aus Australien, wo bei 11 Personen berufsbedingte allergische Kontaktdermatitis mit Opioiden als Auslöser diagnostiziert wurde: 7 reagierten auf Thebain, 5 auf Morphin, 4 auf Norhydroxymorphinon, 2 auf Codein und 2 auf Oripavin [192].…”