In the present study, only 2 of 27 tasks performed by
the cleaners were significantly associated with a rash: spot
cleaning for men and polishing furniture for females. Spot
cleaning carpets involves spraying the carpet with a chemical
and then rubbing the stain. A rash associated with this
task may be due to chemical exposure to the hands of
male cleaners performing the task. Although harsh chemicals
are used to spot clean carpets and polish furniture,
these are not unique as many of the other tasks also involved
the use of irritating solvents. Although the relationship
between tasks and rash may be spurious, it may
deserve further investigation. Small numbers of subjects
may have limited our ability to detect additional statistically
significant differences.
We observed a strong association in this study between
rash and WRAS among cleaners. This was especially true
for male and female cleaners with a rash in the past 12
months.Previous studies in large groups examining an associationbetweencontactdermatitisandwork-
relatedasthma,
in any work environment, are lacking. Small case series and
case reports have been published regarding patients with
contact dermatitis also developing occupational asthma.
These include florists, cosmeticians, workers exposed to
latex and to polyurethane chemicals [24–27]. Our study
is noteworthy as it demonstrates a strong relationship betweenWRASanddermatitis
in cleaners in alargequestionnaire
study. Additionally, our findings are important
because cleaners represent a large occupational group.
The exact mechanisms underlying both contact dermatitis
and asthma are not clear. Whether individuals
who are prone to developing allergic contact dermatitis
are more susceptible to developing work-related asthma
remains to be determined. One possible mechanism
may be an association due to underlying atopy. Although
cleaners reported few symptoms of previous atopic dermatitis
generally, cleaners with a work-related rash and
those with WRAS were more likely to report a history
of symptoms of previous atopic dermatitis. This suggests
an association with atopy, implying that cleaners with underlying
atopy, if identified early in theirwork, could benefit
from additional workplace training and safety measures.
One limitation is the small sample size of female
cleaners in the questionnaire survey and the low response
rate. The questionnaire was administered during the
summer months and this could have contributed to the
low response rate. The low response rate may have also
related to a low English literacy rate in a multicultural city.
Cleaners on temporary leave could not be included, possibly
underestimating the magnitude of the association.
The outcomes (rashes) were self-reported and were not
clinically confirmed.
This study highlights the importance of effective preventive
measures in this population, including safety and
skin care training, protective skin and respiratory equipment
and emollient cream use.