Current Allergy & Clinical Immunology

Introduction

Our understanding of auto-inflammation and the associated clinical syndromes is expanding rapidly – advances in genetic testing have revealed many monogenic autoinflammatory diseases. While classic auto-inflammatory conditions such as Familial Mediterranean Fever have been recognised as distinct diseases for centuries, the relatively recent concept of auto-inflammation has led to better insight being gained into many distinct immune disorders and their classification.

Occupational skin disease is a common condition globally, affecting men and women of all ages. The majority of cases are due to irritant and allergic contact dermatitis (ACD) of the hands and feet. Sanitation workers are an occupational group commonly affected by shoe dermatitis. The prevalence of shoe-allergic dermatitis varies from region to region and is between 1.5% to 25% of those attending specialist contact dermatitis clinics, depending on the types of shoe allergen commonly found in a region. The prevalence also varies depending on the nature of the work performed, the type and style of the shoes worn, pre-existing medical conditions, social disparity, and climatic and geographical conditions. Sanitation workers are exposed to a variety of hazards, including sun exposure, infective organisms, sewage, dirt and sharp objects, which necessitate the consistent use of impervious safety shoes. The prolonged use of these safety shoes creates an occlusive, moist environment, with the retention of perspiration from heat, physical activity and hyperhidrosis contributing to skin irritation, maceration and barrier dysfunction, which then facilitates exposure to shoe allergens present in leather, rubber, dyed fabric, plastic and adhesives. This article highlights a case of a non-atopic sanitation worker with shoe-allergic dermatitis and a fungal infection, and emphasises how to approach the diagnosis and management of shoe dermatitis.

Until recently, studies regarding allergic diseases were much more focused on asthma, rhinitis and other dermatological manifestations rather than ocular manifestations. It is now clear that the eye serves as one of the organs that exhibit early indications of an allergic condition but research is still rudimentary in terms of prevalence studies, environmental impact, genetics, pharmacological treatment implications and the economics of its control and treatment. This article highlights the apparent underestimation of ocular allergy and the prospect it holds in bringing perspective to both ocular and systemic diseases of clinical importance in order to inform action in the domain of public health.