Contact dermatitis in the construction industry: the role of filaggrin loss-of-function mutations

Background A high prevalence of contact dermatitis (CD) and respiratory symptoms has been observed in the construction industry, probably due to widespread exposure to irritants and allergens. It is unknown whether carriers of loss-of-function mutations in the gene encoding filaggrin (FLG), a known risk gene for eczema and asthma, are at increased risk. Objectives To investigate associations of FLG mutations with CD and respiratory symptoms in Dutch construction workers. Methods A questionnaire including items on dermal and respiratory symptoms such as wheeze, shortness of breath and asthma was administered to construction workers. Total and specific serum IgE was analysed by enzyme immunoassays. Four FLG loss-of-function mutations were genotyped. CD was diagnosed by a team of a dermatologist and a clinical occupational medicine specialist using photographs of the subjects' hands and self-reported questionnaire data. Results Of the 506 participating workers, 6.3% carried at least one FLG mutation. Mild CD was diagnosed by the specialists in 34.0%, and severe CD in an additional 24.3%. CD was considered work related in 282 of 295 subjects (95.6%). Carriers of FLG variants had an increased risk of CD compared with subjects carrying wild-type alleles [mild CD: odds ratio (OR) 5.71, 95% confidence interval (CI) 1.63-20.06; severe CD: OR 8.26, 95% CI 2.32-29.39]. FLG variants and the presence of CD were not associated with respiratory symptoms and atopy. Conclusions Contact dermatitis prevalence in construction workers is high. FLG loss-of-function mutations increase the risk of CD even further. FLG mutations were not associated with respiratory symptoms or atopy.