SOM114
School of Materials Code of Practice and Guidance
regarding Skin and Respiratory Sensitisers.
Scope: This is for those who may be exposed to substances that could give
rise to skin or respiratory sensitisation. Many sensitising substances can
cause both, latex being an example. Such substances are common and can
be found in a wide range of work.
There are separate guidance notes on latex, laboratory animal allergens
(links), and on the COSHH regulations (link).
ALL PERSONS MUST HAVE ‘CERTIFICATE OF FITNESS’ TO WORK IN
AREAS USING SENSITISERS
INTRODUCTION
Respiratory Sensitisers can cause occupational asthma and in the worst cases, exposure can
be life threatening. Skin sensitisers can cause contact dermatitis, which is irritating and at times
unsightly, but not generally fatal.
Once someone is sensitised, continued exposure can result in permanent vulnerability and
increasingly severe symptoms. Once established, attacks can be triggered by exposure to
minute concentrations of the sensitiser or, in the case of respiratory sensitisation; symptoms
may be exacerbated by other triggers such as environmental tobacco smoke, general air
pollution, or even cold air. They can occur immediately upon exposure, or several hours later.
Individuals are seldom sensitised on their first exposure. Generally, it happens after months or
even years of breathing in the sensitiser. There is a significant degree of personal variation in
who may respond to a sensitiser and to what extent.
By its very nature, once established, sensitisation is often extremely difficult to treat except by
total avoidance of the substance, and prevention is therefore the key to effective control.
CODE OF PRACTICE
Sensitisers are subject to the Control of Substances Hazardous to Health Regulations 2002 as
amended. Exposure must be assessed, and avoided wherever this is reasonably practicable.
RESPONSIBILITIES
Heads of Schools and Heads of the Administration Directorates are responsible for ensuring
that:





COSHH assessments are carried out by those competent to do so (link to COSHH
guidance)
sensitisers are replaced by non-sensitisers wherever this is reasonably practicable
engineering controls are put in place and maintained
any necessary monitoring and health surveillance takes place, and
Staff and students are kept informed about the risks and control measures.
In practice, they will usually delegate this work to Principal Investigators, or other managers
responsible for laboratories, workshops and other workplaces where sensitisers may be used.
SOM114
All staff and students have a responsibility to act in accordance with the instructions given to
them, and to use any personal protective equipment provided.
Health and Safety Services staff provide information, advice and assistance to those carrying
out COSHH assessments and designing control measures. Occupational Health staff provides
expert advice on health effects and will be responsible for all necessary health surveillance.
GUIDANCE
Guidance is provided in 3 sections, on respiratory sensitisers, skin sensitisers, on matters
relevant to both and a Notification form for health surveillance
1.
Respiratory sensitisers
1.1 How to identify a respiratory sensitiser
Materials safety data sheets (msds) should always be consulted for information on risks.
Respiratory sensitisers will have the risk phrase R42 “May cause sensitisation by inhalation” or
H334 “May cause allergy or asthma symptoms of breathing difficulties if inhaled”.
The following table is a summary of the substances responsible for most cases of occupational
asthma.
Substance group
Isocyanates
Flour
Electronic soldering flux
Laboratory animals
Wood dusts
Some glues / resins
Common activities
Paint spraying, production of foams
Handling of grain, milling, baking etc
Soldering, electronic assembly
Laboratory work
Woodworking generally where dusts are
formed
Work with epoxy resins.
The tables in Appendix 1 will also assist in identifying respiratory sensitisers. These have been
assembled from HSE advice, and from materials safety data sheets (msds).
1.2 Symptoms to look for
Sufferers may report a variety of symptoms such as attacks of coughing, wheezing, tightness of
the chest, runny or stuffy nose, watery or prickly eyes.
If you suspect anyone might be suffering from sensitisation, ask them to report to Occupational
Health without delay, taking details of the substance(s) suspected of being the cause, if
possible.
1.3 Some do’s and don’ts
If respiratory sensitisers are in use, ensure all COSHH assessments take this into account. The
outcome of the COSHH assessment should be a conclusion either that exposure is insignificant
and unlikely to result in a risk to health, or that specified control measures must be adhered to.
SOM114
Consider the following control measures in the order given below:

Replace the sensitiser with another less harmful substance or use an alternative
procedure altogether. Avoidance is a key objective, because of the impact these
substances can have on future health

use a formulation that ensures the substance is less likely to become airborne (eg
granules instead of powder, pre-made solutions or gels)

segregate the work or totally enclose it – remember that people in the vicinity may also be
exposed

partially enclose the process, and provide local exhaust ventilation (which will need to be
examined every 14 months)
If the above measures do not adequately control exposure to as low as reasonably practicable,
provide suitable respiratory protective equipment.
If anyone reports symptoms, consult Occupational Health immediately. Check other guidance
documents on specific sensitisers such as latex (link). Review the COSHH assessment and if
appropriate make any necessary changes.
2.
Skin sensitisers
2.1 Types of skin sensitisers
There are 3 main types of skin reaction:

Irritant contact dermatitis (identified by the risk phrase R38 or H315 or H316).
A reversible non-allergic condition which may be caused by a variety of agents including
solvents (degreasers), acids and alkalis. The skin becomes dry, peeling and itchy. Once
the irritant agent has been identified and contact with it ceases, the symptoms disappear
and do not recur.

Type I allergy: immediate hypersensitivity reaction (identified by risk phrase R43 or
H317). An immunoglobulin E (IgE) mediated reaction. Response normally occurs 5 – 30
minutes after exposure and symptoms include a localised or more generalised rash plus
other more widespread symptoms including in severe cases anaphylactic shock.

Type IV allergy: delayed cell-mediated reaction (also identified by risk phrase R43 or
H334). In this case, the reaction may be delayed for 6 - 48 hours after exposure.
Response is confined to the area of contact although it can spread. A localised itchy
rash may develop. Subsequent reactions may include: slight redness, itching, swelling
and cracking of the skin, oozing red blisters.
2.2
Some do’s and don’ts
Avoidance of symptoms is the key objective. If skin sensitisers are to be used, COSHH
assessments should identify all necessary controls in the following order of preference:



Replace the sensitiser with another less harmful substance or use an alternative
procedure altogether.
Use a formulation that ensures the substance is less likely to come into contact with skin
or need handling (e.g. granules instead of powder, pre-made solutions or gels)
Reduce the number of people involved in handling the substances, and / or the times they
are exposed

SOM114
Provide suitable protective gloves, and other clothing if appropriate, and ensure that staff
and students know why it is important to wear it.
For those already affected, Occupational Health staff can provide advice on skin care
programmes, including the use of barrier and moisturising creams before and after work.
Hand washing facilities should be easily accessible to those using skin sensitisers (ie within the
laboratory or room).
3.
Matters relevant to both respiratory and skin sensitisers
3.1
Information to give to users
Regulation 12 of the COSHH Regulations 2002 as amended requires employers to give
information, instruction and training to persons who may be exposed to substances hazardous
to health. This includes staff and students, and clearly relates to the use of sensitisers.
The information given will need to be tailored to the individual(s) receiving it, and will need to be
more explanatory and detailed for undergraduate students than for experienced staff. In all
cases, however, it should include:






3.2
the nature and degree of risks to health, including any known factors that may increase
risk (e.g. smoking)
symptoms of sensitisation
the importance of reporting relatively minor symptoms at an early stage (sensitisation is
irreversible)
the proper use of any control measures needed to ensure exposure is insignificant, or
adequately controlled
the need to report any failures in the control systems (eg faults on fume cupboards)
if health surveillance is necessary, the reasons and arrangements for this.
Health surveillance
Under COSHH, health surveillance is required where:


certain substances are used in certain processes (mainly manufacturing), or
exposure gives rise to an identifiable disease or adverse health effect that may be related
to exposure and there are valid techniques for detecting the disease or effect.
Respiratory sensitisers which can cause occupational asthma, and skin sensitisers, both fall into
the second category.
Early detection improves the chances of a full recovery. Advice about programmes of health
surveillance are available from Occupational Health, and the detail will often depend on the
exact circumstances.
For respiratory sensitisers, the Employment Medical Advisory Service (EMAS) divides
substances into two tiers, those justifying “high level” health surveillance and those where a “low
level” surveillance is sufficient. High level surveillance involves annual assessments and lung
function tests, whilst low level surveillance can be carried out, for example, by annual
questionnaire. The decisions about what level of health surveillance is appropriate will be taken
by Occupational Health staff.
SOM114
Notification form for health surveillance
Where the substances used indicate a risk of skin or respiratory sensitisation, i.e. R42, R43,
H317 or H334 then the school’s “Chemicals – CMR Hazardous Chemicals User Form –
SOM029” needs to be completed.
Where the COSHH assessment indicates the exposure is significant, or a member of staff or a
student reports symptoms, Occupational Health must be informed. The additional notification
form in Appendix 2 must be used. The purpose of this notification is two fold:


Firstly, Health and Safety Services staff will assist the school in checking the COSHH
assessment, the effectiveness of measures to reduce exposure, and the validity of the
conclusion about significant exposure.
Secondly, occupational health staff will initiate their procedures about health surveillance.
TRAINING REQUIREMENTS
Those carrying out COSHH assessments should be competent to do so, and understand how to
identify sensitisers. Training courses are available from Staff Training and Development Unit
(link)
BIBLIOGRAPHY
University of Manchester Code of Practice and Guidance Note on working with animal allergens
University of Manchester Code of Practice and Guidance Note on latex
Preventing asthma at work: how to control respiratory sensitisers, HSE (1994). Available from
the library OHSIS CDs (link or explanation)
Breathe freely – a workers’ information card on respiratory sensitisers, HSE IND(G)172L
available at http://www.hse.gov.uk/pubns/indg95.pdf
Control of Substances Hazardous to Health Regulations 2002 as amended
http://www.legislation.hmso.gov.uk/si/si2002/20022677.htm and
http://www.legislation.hmso.gov.uk/si/si2003/20030978.htm
General COSHH Approved Code of Practice, L5, HSE (available from HSS, and on the John
Ryland’s Library Technical Indexes Database)
A matter of life and breath, HSE Video (available from HSS)
Rash Decisions, HSE Video (available from HSS)
Preventing Dermatitis at Work, advice for employers and employees, INDG233, reprinted 5/03
(available from the HSE website at http://www.hse.gov.uk/pubns/indg233.pdf
SOM114
Appendix 1
Respiratory sensitisers.
All substances classed under the Chemicals (Hazard Information and Packaging) Regulations
with the risk phrase R42 “may cause sensitisation by inhalation” or H334 “May cause
allergy or asthma symptoms of breathing difficulties if inhaled”
The following list comprises groups of substances or substances which may not be supplied
with a safety data sheet. All these substances should be regarded as respiratory sensitisers:
Carmine (red food colouring)
Chloroplatinates (and other halogenoplatinates)
Chromium (VI) compounds
Cobalt (metal and compounds)
Cow epithelium / urine
Diazonium salts
Flour dust
Grain dust
Hardwood dusts
Laboratory animal excreta
Latex
Penicillins
Reactive dyes
Rosin based solder flux
Softwood dusts
Storage mites
In addition, any newly synthesised substance or intermediate substance analogous to those
listed above or to substances with the R42 / H334 risk phrase (for example, a new substance
containing the isocyanates group) should be regarded as a potential sensitiser, until there is
substantive evidence to the contrary.
Substances under consideration by HSE as respiratory sensitisers
 amylase
acetic anhydride
ethyl cyanoacrylate
flour dust (chemical hazard alert notice issued March 98, MEL likely)
ethylamine
methyl cyanoacrylate
p-phenylenediamine
Substances also reported to cause sensitisation
Various antibiotics and enzymes
Cockroaches
Pancreatic extracts
Mist from oil in water cutting fluids (connected to Pseudomonas?)
Some food dusts such as tea, soy bean, castor bean, coffee bean dust,
Food proteins eg proteins in crustaceans, egg, fish
SOM114
Skin sensitisers
All substances classed under the Chemicals (Hazard Information and Packaging) Regulations
with the risk phrase R43 “May cause sensitisation by skin contact” or H317 “May cause an
allergic skin reaction”
Note: the risk phrase R38, H 315 or H316 “Irritating to skin” indicates that the substance can
cause a non-allergic skin reaction, i.e. it can damage the skin by physical means such as degreasing. Such substances do not trigger the need for health surveillance, but advice about
skin conditions caused by them, and skin care programmes, should be obtained from
Occupational Health.
Known Sensitisers used in the School of Materials
Chemical
Isocyanates
Epoxy compounds
Ethylene Diamine
Glutural
Nickel Sulphate
Trypsin
Formaldehyde
Some Acrylates
Respiratory Sensitiser
R42, H334
YES
YES
YES
YES
YES
YES
Skin Sensitiser
R43, H317
SOME
YES
YES
Reference Number:
SOM114
Appendix 2
Please send completed form to:
Ms. Polly Crook,
Room C3, Materials Science Centre, Grosvenor Street,
Manchester, M1 7HS
Notification form for use of respiratory or skin sensitiser
Risk Phrase R42 – May cause sensitisation by inhalation
Risk Phrase R43 – May cause sensitisation by skin contact
Name of User:
Email address:
Status:
Supervisor:
Start Date:
Finish Date:
School of Materials Unit:
Building:
Project Title:
Lab. No:
Sex: Male or Female
Date of Birth:
Home address:
National Insurance Number:
Name of Chemicals Used
Signed
Cas No.
Approx. Total
Quantity used:
Reference numbers of Risk
and COSHH safety
assessments:
Print Name:
(Principal Investigator)
Tel:
Email:
Review dates and comments
Use a separate form for each person and attach copies of relevant assessments and reports