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Portugal&#44; Spain&#44; and Germany&#46; The materials used in their construction include carbon fiber and synthetic fiber &#40;aramids&#41;&#44; as well as epoxy resin and curing agents&#46; The manufacturing process varies according to needs&#44; and fiberglass is now replacing carbon fiber&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> An aerogenerator costs &#8364;2-3 million and has a half-life of 20 years&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">People who work in the manufacture of wind turbines must use special protective clothing&#44; gloves&#44; and goggles to prevent exposure to these substances&#44; which are irritants and sensitizing agents&#46; Few studies have examined skin diseases in the wind turbine industry&#46; Rasmusse et al&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> reported a prevalence of 10&#46;9&#37; for occupational allergic contact dermatitis&#59; the allergen was epoxy resin in 60&#46;6&#37; of cases and epoxy curing agents in 37&#46;9&#37;&#46; Our study aimed to describe the skin symptoms presented by these workers and the allergens causing occupational contact dermatitis in this industry&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Material and Methods</span><p id="par0020" class="elsevierStylePara elsevierViewall">We performed a descriptive observational study of patients working for companies that produced aerogenerators with suspected occupational contact dermatitis who were referred to the dermatology clinic of the National School of Occupational Medicine &#40;Escuela Nacional de Medicina del Trabajo&#41; in Madrid&#44; Spain between 2009 and 2011&#46; We took a general clinical history and occupational history&#44; and patients underwent a physical examination&#46; We studied the products to which the workers were exposed in their jobs by analyzing the product safety data sheets and conducting interviews with representatives of the company&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">The patch tests applied were the standard series of the Spanish Contact Dermatitis and Skin Allergy Research Group &#40;GEIDAC&#41; and the epoxy resin series of Chemotechnique Diagnostics &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; Other specific panels were used in some cases depending on the allergens specified on the product safety data sheet and in the clinical history&#46; The patches were placed on the patient&#39;s back&#44; where they remained under occlusion for 48<span class="elsevierStyleHsp" style=""></span>hours&#46; The results were read at 2&#44; 3&#44; and 6 days and reported according to the criteria of the International Contact Dermatitis Research Group &#40;&#43;&#44; &#43;&#43;&#44; and &#43;&#43;&#43;&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Results</span><p id="par0030" class="elsevierStylePara elsevierViewall">During the study period&#44; 10 patients from the aerogenerator manufacturing industry were seen &#40;8 men and 2 women&#59; mean age&#44; 33&#46;7 years &#91;range&#44; 25&#46;0-46&#46;0&#93; years&#41;&#46; They worked as painters&#44; laminators&#44; and gluers &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46; Four of the patients worked for Gamesa &#40;a Spanish company employing 7200 workers&#41; and 4 for Vestas &#40;a Danish company with 1600 workers in Spain&#41;&#46; The remaining 2 workers were employed by subsidiaries of Gamesa and Vestas&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">The product safety data sheets presented by the workers indicated the presence of lacquers&#44; form releasers&#44; adhesives&#44; and resins among the substances generally handled in the workplace&#46; These chemicals are usually referred to on the safety data sheet as bisphenol A&#44; 1&#44;6 hexanediol diglycidyl ether&#44; and sometimes more generically as synthetic resins&#44; epoxy resins&#44; or resin solutions&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">The workers had eczematous lesions affecting the face and eyebrows &#40;4 patients&#41;&#44; as well as the hands&#44; forearms&#44; or both &#40;7 patients&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; The patch tests revealed sensitization to epoxy resin from the standard series in 4 workers&#44; 1 of whom was also sensitized to the curing agents triethylenetetramine and diethylenetetramine&#46; One patient&#44; whose test result was negative with the standard series&#44; was sensitized to the epoxy resin bisphenol F from the epoxy resin series &#40;Chemotechnique Diagnostics&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46; Given the location of the lesions &#40;sites affected by airborne allergens&#41; and the allergens in the workplace&#44; patients who did not show sensitization in the standard series were diagnosed with irritant contact dermatitis induced by fiberglass&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">Consistent with our findings&#44; 5 workers were diagnosed with occupational allergic contact eczema and 5 with occupational irritant contact eczema&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Discussion</span><p id="par0050" class="elsevierStylePara elsevierViewall">The search for new sources of renewable energy has led to the production of wind farms&#46; Consequently&#44; aerogenerator manufacturers have been set up in Spain&#44; which is now the second largest producer of wind energy in Europe and the fourth largest in the world&#46; These companies provide employment to thousands of workers&#44; and occupational skin diseases have been recorded in this novel industry&#46; The blades of the turbines are manufactured using an outer coating of epoxy resin&#46; The structure is strengthened using fiberglass&#44; which may be previously impregnated with epoxy resin&#44; to which curing agents are added in order to catalyze the resins&#46; The coating and prepregs are hardened at high temperatures using autoclaves&#46; The production process consists of the following steps&#58; cutting of prepregs&#59; construction of blades&#44; beams&#44; and assembly parts&#59; and finishing&#46;<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6&#44;7</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">Epoxy resins are used as insulators and adhesives&#44; as well as coatings and paints&#46; These substances are potent allergens and the main cause of occupational allergic contact eczema&#44; as is the case in the aerospace industry&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> An epidemiologic study by Pont&#233; et al&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> in a Danish company specializing in the production of aerogenerators analyzed 603 workers and found that 10&#46;9&#37; had occupational allergic contact eczema&#44; indicating that the percentage of patients sensitized to epoxy resins was extremely high&#46; The main allergens were the epoxy resins bisphenol A &#40;10&#46;5&#37;&#41; and bisphenol F &#40;8&#37;&#41;&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">A study by Conde-Salazar et al&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> performed in the aeronautical industry&#44; where the manufacturing process is similar to that used in the wind turbine industry&#44; revealed that 6&#46;5&#37; of workers presented occupational allergic contact eczema due to sensitization to bisphenol A&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Our results show that half of the patients analyzed were sensitized to epoxy resins&#59; we consider this prevalence to be high for our population&#46; We must also remember that not all patients are sent to our reference center for patch testing&#44; because the skin manifestations are often very subtle&#44; because no disease is suspected&#44; or even because the patient shows little concern for his&#47;her condition&#46; As was the case in the study of Rasmusse et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> the sensitizing allergens were epoxy resins&#44; although in some cases&#44; the sensitizing agents were bisphenol F or curing agents such as triethylenetetramine and diethylenetetramine&#46; Bisphenol F was previously reported to be an allergen in patients working in the aeronautical industry<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> or in the manufacture of adhesives<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> and can go completely unnoticed if its involvement in specific types of eczema is not suspected&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Location on the face&#44; neck&#44; hands&#44; and forearms suggests the presence of an airborne mechanism&#44; as occurs in irritant and allergic contact eczema caused by epoxy resins&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> The association between eczema and physical presence in the workplace &#40;improvement during leave or vacation and recurrence on returning to work&#41; is an important indicator of the involvement of this resin in the disease&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Half of the workers referred to our department were diagnosed with occupational irritant contact eczema caused by exposure to fiberglass&#44; a material that is widely used in the manufacture of aerogenerators&#46; Fiberglass-induced skin disease is frequent in the construction industry&#44;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> as the small particles that penetrate the stratum corneum lead to irritation and have pruritus as their main and almost only manifestation&#46; Nogueira et al&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> published the case of a worker in the wind industry in whom sensitization to fiberglass &#40;not irritation&#41; was thought to be the cause of localized eczema on the face&#44; neck&#44; and forearms&#46; However&#44; the positive patch test result for epoxy resins found by those authors could also point to a diagnosis of occupational allergic contact eczema caused by epoxy resins&#44; together with occupational irritant contact eczema caused by fiberglass&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conclusion</span><p id="par0080" class="elsevierStylePara elsevierViewall">Epoxy resins are one of the most common allergens in industry in general and in the plastics industry in particular&#46; As a new high-technology activity&#44; the wind turbine industry uses these substances in the manufacture of aerogenerators&#59; therefore&#44; occupational skin diseases caused by contact with epoxy resins are likely to become increasingly common&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">We believe that workers in the wind turbine industry should undergo patch testing with epoxy resin series&#44; as well as the standard series&#44; to enable the detection of allergens that are common in this industry and that are not always indicated on the product safety data sheets&#46; Both allergic contact eczema caused by epoxy resins and irritant contact eczema caused by fiberglass are a frequent finding in these patients and usually present as diseases caused by airborne allergens&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conflicts of Interest</span><p id="par0090" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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    "fechaRecibido" => "2012-01-08"
    "fechaAceptado" => "2012-03-12"
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            0 => "Contact dermatitis"
            1 => "Professional"
            2 => "Wind energy industry"
            3 => "Epoxy resins"
            4 => "Fiberglass"
            5 => "Bisphenol F"
            6 => "Wind turbines"
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          "palabras" => array:7 [
            0 => "Dermatitis de contacto"
            1 => "Profesional"
            2 => "Industria e&#243;lica"
            3 => "Resinas epoxi"
            4 => "Fibra de vidrio"
            5 => "Bisfenol F"
            6 => "Molinos de viento"
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    "resumen" => array:2 [
      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<span class="elsevierStyleSectionTitle">Background and objectives</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">In 2010&#44; wind energy coverage in Spain increased by 16&#37;&#44; making the country the world&#39;s fourth largest producer in a fast-developing industry that is also a source of employment&#46; Occupational skin diseases in this field have received little attention&#46; The present study aims to describe the main characteristics of skin diseases affecting workers in the wind energy industry and the allergens involved&#46;</p> <span class="elsevierStyleSectionTitle">Material and methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">We performed a descriptive&#44; observational study of workers from the wind energy industry with suspected contact dermatitis who were referred to the occupational dermatology clinic of the National School of Occupational Medicine &#40;Escuela Nacional de Medicina del Trabajo&#41; between 2009 and 2011&#46; We took both a clinical history and an occupational history&#44; and patients underwent a physical examination and patch testing with the materials used in their work&#46;</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">We studied 10 workers &#40;8 men&#44; 2 women&#41;&#44; with a mean age of 33&#46;7 years&#46; The main finding was dermatitis&#44; which affected the face&#44; eyelids&#44; forearms&#44; and hands&#46; Sensitization to epoxy resins was detected in 4 workers&#44; 1 of whom was also sensitized to epoxy curing agents&#46; One worker was sensitized to bisphenol F resin but had a negative result with epoxy resin from the standard series&#46; In the 5 remaining cases&#44; the final diagnosis was irritant contact dermatitis due to fiberglass&#46;</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Occupational skin diseases are increasingly common in the wind energy industry&#46; The main allergens are epoxy resins&#46; Fiberglass tends to produce irritation&#46;</p>"
      ]
      "es" => array:2 [
        "titulo" => "Resumen"
        "resumen" => "<span class="elsevierStyleSectionTitle">Introducci&#243;n y objetivos</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">En el a&#241;o 2010 la energ&#237;a e&#243;lica en Espa&#241;a increment&#243; su capacidad de cobertura un 16&#37;&#44; lo que posiciona al pa&#237;s en el cuarto lugar del mundo en este sector industrial&#44; de gran desarrollo econ&#243;mico y fuente de empleo&#46; Las dermatosis profesionales en este campo han sido poco estudiadas&#46; Con el presente estudio se pretende describir las principales caracter&#237;sticas de la afectaci&#243;n cut&#225;nea en sus trabajadores y los al&#233;rgenos implicados&#46;</p> <span class="elsevierStyleSectionTitle">Material y m&#233;todo</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Se realiza un estudio descriptivo y observacional de trabajadores de la industria e&#243;lica con sospecha de dermatitis de contacto remitidos a consulta de Dermatolog&#237;a Laboral de la Escuela Nacional de Medicina del Trabajo entre 2009 y 2011&#46; Se realiz&#243; historia cl&#237;nica&#44; historia laboral&#44; exploraci&#243;n f&#237;sica y pruebas epicut&#225;neas seg&#250;n los materiales manipulados por estos trabajadores&#46;</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Se estudiaron 10 trabajadores &#40;8 hombres&#44; 2 mujeres&#41; pertenecientes a esta industria&#46; La media de edad fue de 33&#44;7 a&#241;os&#46; El cuadro principal fue eccema que afectaba a la cara&#44; a los p&#225;rpados&#44; a los antebrazos y a las manos&#46; En 4 trabajadores se encontr&#243; una sensibilizaci&#243;n a resinas epoxi&#44; uno de ellos present&#243;&#44; adem&#225;s&#44; sensibilizaci&#243;n a sus endurecedores&#46; Un paciente se encontraba sensibilizado a la resina de bisfenol F&#44; con negatividad de la resina epoxi de la bater&#237;a est&#225;ndar&#46; En los 5 casos restantes el diagn&#243;stico final fue el de dermatitis de contacto irritativa por fibra de vidrio&#46;</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Las dermatosis ocupacionales en la industria e&#243;lica son cada vez m&#225;s frecuentes&#46; Las resinas epoxi son sus principales al&#233;rgenos&#44; mientras que la fibra de vidrio suele producir cuadros irritativos&#46;</p>"
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        "nota" => "<p class="elsevierStyleNotepara">Please cite this article as&#58; L&#225;rraga-Pi&#241;ones G&#44; et al&#46; Dermatitis de contacto profesional en la industria e&#243;lica&#46; Actas Dermosifiliogr&#46; 2012&#59;103&#58;905&#8211;9&#46;</p>"
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          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Modern aerogenerator&#46;</p>"
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          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Eczematous plaques on the face of a patient in the wind turbine industry&#46;</p>"
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          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Positive result for the epoxy resin bisphenol F&#46;</p>"
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                  \t\t\t\t">Hexamethylenetetramine 2&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Phenyl glycidyl ether 0&#46;25&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Diethylenetriamine 1&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Ethylenediamine dihydrochlorhydrate&#44; 1&#37; aq&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Dimethylaminopropylamine&#44; 1&#37; aq&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#44;4 Butanediol diglycidyl ether 0&#46;25&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">M-xylylenediamine 0&#46;1&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Trimethylpropane triglycidyl ether 0&#46;25&#37;&nbsp;\t\t\t\t\t\t\n
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        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Abbreviations&#58; OACE&#44; occupational allergic contact eczema&#59; OICE&#44; occupational irritant contact eczema&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Sex&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Age&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Position&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Site of Eczema&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Standard Test&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Specific Test&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Diagnosis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Male&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">27&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Gluer&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Face&#44; eyelids&#44; and neck&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Epoxy resin Thiomersal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Triethylenetetramine Diethylenetetramine&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">OACE&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Female&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Laminator&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Forearms&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Epoxy resin Nickel&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Negative&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">OACE&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Female&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">33&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Human resources&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hands&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Nickel&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Negative&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">OICE&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Male&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">38&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Laminator&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Face and neck&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Negative&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Negative&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">OICE&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Male&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">49&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Gluer&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Face&#44; eyelids&#44; and hands&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Epoxy resin&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Negative&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">OACE&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Male&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">31&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Laminator&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hands&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Negative&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Negative&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">OICE&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Male&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Painter&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Forearms&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Negative&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Negative&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">OICE&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Male&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">27&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Assembly&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Face&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Negative&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Bisphenol F epoxy resin&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">OACE&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Male&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">46&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Sander&#47;painter&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Face&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Negative&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Negative&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">OICE&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Male&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">31&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Laminator&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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              "identificador" => "bib0005"
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              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "Pitteloud JD&#46; General Situation&#46; World Wind Energy Report 2010&#59;1&#58;6&#46; &#91;Accessed 20 Sept 2011&#93;&#46; Available from&#58; <a class="elsevierStyleInterRef" href="http://www.wwindea.org/home/images/stories/pdfs/worldwindenergyreport2010_s.pdf">http&#58;&#47;&#47;www&#46;wwindea&#46;org&#47;home&#47;images&#47;stories&#47;pdfs&#47;worldwindenergyreport2010&#95;s&#46;pdf</a>"
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              "identificador" => "bib0010"
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                  "referenciaCompleta" => "El Sistema El&#233;ctrico Espa&#241;ol&#46; Red El&#233;ctrica de Espa&#241;a&#44; 2010&#59;1&#58;13&#46; &#91;Accessed 1 Oct 2011&#93;&#46; Available from&#58; <a class="elsevierStyleInterRef" href="http://www.%20ree.es/sistema%20electrico/pdf/infosis/sintesis%20REE%202010.pdf">http&#58;&#47;&#47;www&#46; ree&#46;es&#47;sistema electrico&#47;pdf&#47;infosis&#47;sintesis REE 2010&#46;pdf</a>"
                ]
              ]
            ]
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              "identificador" => "bib0015"
              "etiqueta" => "3"
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                0 => array:1 [
                  "referenciaCompleta" => "De Otto&#44; P&#233;rez&#44; editores&#46; Potencia Instalada en Espa&#241;a&#46; Eolica&#8217;11 2011&#59;1&#58;24-35&#46; &#91;Accessed 14 Oct 2011&#93;&#46; 1-129&#46; Available from&#58; <a class="elsevierStyleInterRef" href="http://www.aeeolica.%20org/uploads/documents/Anuario%2011%20completo.pdf">http&#58;&#47;&#47;www&#46;aeeolica&#46; org&#47;uploads&#47;documents&#47;Anuario&#37;2011&#37;20completo&#46;pdf</a>"
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                      "titulo" => "Electricity without Carbon"
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                            0 => "Q&#46; Schiermeier"
                            1 => "J&#46; Tollefson"
                            2 => "T&#46; Scully"
                            3 => "A&#46; Witze"
                            4 => "O&#46; Morton"
                          ]
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                    0 => array:2 [
                      "doi" => "10.1038/454816a"
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                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18704061"
                            "web" => "Medline"
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                            5 => "M&#46; Bruze"
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                    0 => array:2 [
                      "doi" => "10.1111/j.0105-1873.2004.00346.x"
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                        "fecha" => "2004"
                        "volumen" => "50"
                        "paginaInicial" => "329"
                        "paginaFinal" => "338"
                        "link" => array:1 [
                          0 => array:2 [
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                            5 => "M&#46; Bruze"
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                    0 => array:2 [
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                        "tituloSerie" => "Int Arch Occup Environ Health"
                        "fecha" => "2005"
                        "volumen" => "78"
                        "paginaInicial" => "211"
                        "paginaFinal" => "217"
                        "link" => array:1 [
                          0 => array:2 [
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                      ]
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                  ]
                ]
              ]
            ]
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              "identificador" => "bib0035"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Dermatosis Profesionales por pl&#225;sticos y resinas"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "L&#46; Conde-Salazar G&#243;mez"
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                  ]
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                            3 => "C&#46;M&#46; Galera"
                            4 => "R&#46; Valverde"
                            5 => "F&#46; Vanaclocha"
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                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
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                        "link" => array:1 [
                          0 => array:2 [
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                          "etal" => false
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                            3 => "M&#46;A&#46; Gonzalez"
                            4 => "P&#46; Fenoy"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
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                        "tituloSerie" => "Actas Dermosifiliogr"
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                        "volumen" => "81"
                        "paginaInicial" => "23"
                        "paginaFinal" => "28"
                      ]
                    ]
                  ]
                ]
              ]
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            9 => array:3 [
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              "etiqueta" => "10"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Contact allergy to epoxy resin base on diglycidyl ether of bisphenol F"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "A&#46; Pont&#233;n"
                            1 => "M&#46; Bruze"
                          ]
                        ]
                      ]
                    ]
                  ]
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                        "volumen" => "44"
                        "paginaInicial" => "98"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11205414"
                            "web" => "Medline"
                          ]
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                          "pii" => "S0161642008012736"
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                      "titulo" => "Occupational allergic contact dermatitis to bisphenol F epoxy resin"
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                          "etal" => false
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                            0 => "S&#46; Sakata"
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                            2 => "D&#46; Barton"
                            3 => "R&#46; Nixon"
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                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1440-0960.2005.00149.x"
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                        "tituloSerie" => "Australas J Dermatol"
                        "fecha" => "2005"
                        "volumen" => "46"
                        "paginaInicial" => "90"
                        "paginaFinal" => "92"
                        "link" => array:1 [
                          0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Dermatosis aerotransportadas profesionales"
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                          "autores" => array:2 [
                            0 => "A&#46; Goossens"
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                    0 => array:2 [
                      "titulo" => "Fiberglass dermatitis&#58; a report of 2 cases"
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                      ]
                    ]
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                  "host" => array:1 [
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                        "paginaFinal" => "122"
                        "link" => array:1 [
                          0 => array:2 [
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              "etiqueta" => "14"
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                    0 => array:2 [
                      "titulo" => "Systemic allergic contact dermatitis to fiberglass in a factory worker of wind turbine blades"
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Información de la revista
Vol. 103. Núm. 10.
Páginas 905-909 (diciembre 2012)
Visitas
8429
Vol. 103. Núm. 10.
Páginas 905-909 (diciembre 2012)
Original article
Acceso a texto completo
Occupational Contact Dermatitis in the Wind Energy Industry
Dermatitis de contacto profesional en la industria eólica
Visitas
8429
G. Lárraga-Piñonesa,
Autor para correspondencia
gabi_larraga@hotmail.com

Corresponding author.
, F. Heras-Mendazab, L. Conde-Salazarb
a Departamento Dermatología, Hospital Central Dr. Ignacio Morones Prieto, Universidad Autónoma de San Luis Potosí, Mexico
b Servicio de Dermatología Laboral, Escuela Nacional de Medicina del Trabajo, Madrid, Spain
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Tablas (2)
Table 1. Epoxy Resin Series of Chemotechnique Diagnostics.
Table 2. General Characteristics of the Patients.
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Abstract
Background and objectives

In 2010, wind energy coverage in Spain increased by 16%, making the country the world's fourth largest producer in a fast-developing industry that is also a source of employment. Occupational skin diseases in this field have received little attention. The present study aims to describe the main characteristics of skin diseases affecting workers in the wind energy industry and the allergens involved.

Material and methods

We performed a descriptive, observational study of workers from the wind energy industry with suspected contact dermatitis who were referred to the occupational dermatology clinic of the National School of Occupational Medicine (Escuela Nacional de Medicina del Trabajo) between 2009 and 2011. We took both a clinical history and an occupational history, and patients underwent a physical examination and patch testing with the materials used in their work.

Results

We studied 10 workers (8 men, 2 women), with a mean age of 33.7 years. The main finding was dermatitis, which affected the face, eyelids, forearms, and hands. Sensitization to epoxy resins was detected in 4 workers, 1 of whom was also sensitized to epoxy curing agents. One worker was sensitized to bisphenol F resin but had a negative result with epoxy resin from the standard series. In the 5 remaining cases, the final diagnosis was irritant contact dermatitis due to fiberglass.

Conclusions

Occupational skin diseases are increasingly common in the wind energy industry. The main allergens are epoxy resins. Fiberglass tends to produce irritation.

Keywords:
Contact dermatitis
Professional
Wind energy industry
Epoxy resins
Fiberglass
Bisphenol F
Wind turbines
Resumen
Introducción y objetivos

En el año 2010 la energía eólica en España incrementó su capacidad de cobertura un 16%, lo que posiciona al país en el cuarto lugar del mundo en este sector industrial, de gran desarrollo económico y fuente de empleo. Las dermatosis profesionales en este campo han sido poco estudiadas. Con el presente estudio se pretende describir las principales características de la afectación cutánea en sus trabajadores y los alérgenos implicados.

Material y método

Se realiza un estudio descriptivo y observacional de trabajadores de la industria eólica con sospecha de dermatitis de contacto remitidos a consulta de Dermatología Laboral de la Escuela Nacional de Medicina del Trabajo entre 2009 y 2011. Se realizó historia clínica, historia laboral, exploración física y pruebas epicutáneas según los materiales manipulados por estos trabajadores.

Resultados

Se estudiaron 10 trabajadores (8 hombres, 2 mujeres) pertenecientes a esta industria. La media de edad fue de 33,7 años. El cuadro principal fue eccema que afectaba a la cara, a los párpados, a los antebrazos y a las manos. En 4 trabajadores se encontró una sensibilización a resinas epoxi, uno de ellos presentó, además, sensibilización a sus endurecedores. Un paciente se encontraba sensibilizado a la resina de bisfenol F, con negatividad de la resina epoxi de la batería estándar. En los 5 casos restantes el diagnóstico final fue el de dermatitis de contacto irritativa por fibra de vidrio.

Conclusiones

Las dermatosis ocupacionales en la industria eólica son cada vez más frecuentes. Las resinas epoxi son sus principales alérgenos, mientras que la fibra de vidrio suele producir cuadros irritativos.

Palabras clave:
Dermatitis de contacto
Profesional
Industria eólica
Resinas epoxi
Fibra de vidrio
Bisfenol F
Molinos de viento
Texto completo
Introduction

Wind has been used as an energy source since ancient times, when people began to apply it to pump water, propel boats, and grind grains. The modern wind industry came into being in 1979 with the mass production of turbines moved by large blades, which have increased in diameter over time from 20-30m to the 90m currently used by the highest-output turbines (Fig. 1). During the last 10 years, world wind energy production has increased considerably, with the result that production now stands at 196 630 MW.1 In 2010, China was the world's leading wind energy producer, with Spain in fourth place after the United States and Germany.2 Spain has 889 wind farms with 18 933 turbines distributed throughout the country; the farms are located mainly in Castile and Leon, Castile-La Mancha, Galicia, and Andalusia. The highest installed capacity is in Castile and Leon.3

Figure 1.

Modern aerogenerator.

(0.15MB).

The advantages of wind energy are that it is renewable, nonpolluting, and easily obtained if the turbines are installed in a suitable location. Its main disadvantages, however, are the high cost of the aerogenerators, in which production of energy is intermittent, and the fact that the energy cannot be stored.4 Aerogenerators are manufactured mainly in Denmark, Portugal, Spain, and Germany. The materials used in their construction include carbon fiber and synthetic fiber (aramids), as well as epoxy resin and curing agents. The manufacturing process varies according to needs, and fiberglass is now replacing carbon fiber.5 An aerogenerator costs €2-3 million and has a half-life of 20 years.

People who work in the manufacture of wind turbines must use special protective clothing, gloves, and goggles to prevent exposure to these substances, which are irritants and sensitizing agents. Few studies have examined skin diseases in the wind turbine industry. Rasmusse et al.6 reported a prevalence of 10.9% for occupational allergic contact dermatitis; the allergen was epoxy resin in 60.6% of cases and epoxy curing agents in 37.9%. Our study aimed to describe the skin symptoms presented by these workers and the allergens causing occupational contact dermatitis in this industry.

Material and Methods

We performed a descriptive observational study of patients working for companies that produced aerogenerators with suspected occupational contact dermatitis who were referred to the dermatology clinic of the National School of Occupational Medicine (Escuela Nacional de Medicina del Trabajo) in Madrid, Spain between 2009 and 2011. We took a general clinical history and occupational history, and patients underwent a physical examination. We studied the products to which the workers were exposed in their jobs by analyzing the product safety data sheets and conducting interviews with representatives of the company.

The patch tests applied were the standard series of the Spanish Contact Dermatitis and Skin Allergy Research Group (GEIDAC) and the epoxy resin series of Chemotechnique Diagnostics (Table 1). Other specific panels were used in some cases depending on the allergens specified on the product safety data sheet and in the clinical history. The patches were placed on the patient's back, where they remained under occlusion for 48hours. The results were read at 2, 3, and 6 days and reported according to the criteria of the International Contact Dermatitis Research Group (+, ++, and +++).

Table 1.

Epoxy Resin Series of Chemotechnique Diagnostics.

Hexamethylenetetramine 2% 
Diaminodiphenylmethane 0.5% 
Triethylenetetramine 0.5% 
Phenyl glycidyl ether 0.25% 
Diethylenetriamine 1% 
Isophorone diamine 0.1% 
Epoxy resin, cycloaliphatic 0.5% 
Ethylenediamine dihydrochlorhydrate, 1% aq 
Dimethylaminopropylamine, 1% aq 
Bisphenol F 
1,6 Hexanediol diglycidyl ether 0.25% 
1,4 Butanediol diglycidyl ether 0.25% 
M-xylylenediamine 0.1% 
Trimethylpropane triglycidyl ether 0.25% 
Results

During the study period, 10 patients from the aerogenerator manufacturing industry were seen (8 men and 2 women; mean age, 33.7 years [range, 25.0-46.0] years). They worked as painters, laminators, and gluers (Table 2). Four of the patients worked for Gamesa (a Spanish company employing 7200 workers) and 4 for Vestas (a Danish company with 1600 workers in Spain). The remaining 2 workers were employed by subsidiaries of Gamesa and Vestas.

Table 2.

General Characteristics of the Patients.

Sex  Age  Position  Site of Eczema  Standard Test  Specific Test  Diagnosis 
Male  27  Gluer  Face, eyelids, and neck  Epoxy resin Thiomersal  Triethylenetetramine Diethylenetetramine  OACE 
Female  30  Laminator  Forearms  Epoxy resin Nickel  Negative  OACE 
Female  33  Human resources  Hands  Nickel  Negative  OICE 
Male  38  Laminator  Face and neck  Negative  Negative  OICE 
Male  49  Gluer  Face, eyelids, and hands  Epoxy resin  Negative  OACE 
Male  31  Laminator  Hands  Negative  Negative  OICE 
Male  25  Painter  Forearms  Negative  Negative  OICE 
Male  27  Assembly  Face  Negative  Bisphenol F epoxy resin  OACE 
Male  46  Sander/painter  Face  Negative  Negative  OICE 
Male  31  Laminator  Hands and forearms  Epoxy resin Nickel  Negative  OACE 

Abbreviations: OACE, occupational allergic contact eczema; OICE, occupational irritant contact eczema.

The product safety data sheets presented by the workers indicated the presence of lacquers, form releasers, adhesives, and resins among the substances generally handled in the workplace. These chemicals are usually referred to on the safety data sheet as bisphenol A, 1,6 hexanediol diglycidyl ether, and sometimes more generically as synthetic resins, epoxy resins, or resin solutions.

The workers had eczematous lesions affecting the face and eyebrows (4 patients), as well as the hands, forearms, or both (7 patients) (Fig. 2). The patch tests revealed sensitization to epoxy resin from the standard series in 4 workers, 1 of whom was also sensitized to the curing agents triethylenetetramine and diethylenetetramine. One patient, whose test result was negative with the standard series, was sensitized to the epoxy resin bisphenol F from the epoxy resin series (Chemotechnique Diagnostics) (Fig. 3). Given the location of the lesions (sites affected by airborne allergens) and the allergens in the workplace, patients who did not show sensitization in the standard series were diagnosed with irritant contact dermatitis induced by fiberglass.

Figure 2.

Eczematous plaques on the face of a patient in the wind turbine industry.

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Figure 3.

Positive result for the epoxy resin bisphenol F.

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Consistent with our findings, 5 workers were diagnosed with occupational allergic contact eczema and 5 with occupational irritant contact eczema.

Discussion

The search for new sources of renewable energy has led to the production of wind farms. Consequently, aerogenerator manufacturers have been set up in Spain, which is now the second largest producer of wind energy in Europe and the fourth largest in the world. These companies provide employment to thousands of workers, and occupational skin diseases have been recorded in this novel industry. The blades of the turbines are manufactured using an outer coating of epoxy resin. The structure is strengthened using fiberglass, which may be previously impregnated with epoxy resin, to which curing agents are added in order to catalyze the resins. The coating and prepregs are hardened at high temperatures using autoclaves. The production process consists of the following steps: cutting of prepregs; construction of blades, beams, and assembly parts; and finishing.6,7

Epoxy resins are used as insulators and adhesives, as well as coatings and paints. These substances are potent allergens and the main cause of occupational allergic contact eczema, as is the case in the aerospace industry.8 An epidemiologic study by Ponté et al.5 in a Danish company specializing in the production of aerogenerators analyzed 603 workers and found that 10.9% had occupational allergic contact eczema, indicating that the percentage of patients sensitized to epoxy resins was extremely high. The main allergens were the epoxy resins bisphenol A (10.5%) and bisphenol F (8%).

A study by Conde-Salazar et al.9 performed in the aeronautical industry, where the manufacturing process is similar to that used in the wind turbine industry, revealed that 6.5% of workers presented occupational allergic contact eczema due to sensitization to bisphenol A.

Our results show that half of the patients analyzed were sensitized to epoxy resins; we consider this prevalence to be high for our population. We must also remember that not all patients are sent to our reference center for patch testing, because the skin manifestations are often very subtle, because no disease is suspected, or even because the patient shows little concern for his/her condition. As was the case in the study of Rasmusse et al.,6 the sensitizing allergens were epoxy resins, although in some cases, the sensitizing agents were bisphenol F or curing agents such as triethylenetetramine and diethylenetetramine. Bisphenol F was previously reported to be an allergen in patients working in the aeronautical industry10 or in the manufacture of adhesives11 and can go completely unnoticed if its involvement in specific types of eczema is not suspected.

Location on the face, neck, hands, and forearms suggests the presence of an airborne mechanism, as occurs in irritant and allergic contact eczema caused by epoxy resins.12 The association between eczema and physical presence in the workplace (improvement during leave or vacation and recurrence on returning to work) is an important indicator of the involvement of this resin in the disease.

Half of the workers referred to our department were diagnosed with occupational irritant contact eczema caused by exposure to fiberglass, a material that is widely used in the manufacture of aerogenerators. Fiberglass-induced skin disease is frequent in the construction industry,13 as the small particles that penetrate the stratum corneum lead to irritation and have pruritus as their main and almost only manifestation. Nogueira et al.14 published the case of a worker in the wind industry in whom sensitization to fiberglass (not irritation) was thought to be the cause of localized eczema on the face, neck, and forearms. However, the positive patch test result for epoxy resins found by those authors could also point to a diagnosis of occupational allergic contact eczema caused by epoxy resins, together with occupational irritant contact eczema caused by fiberglass.

Conclusion

Epoxy resins are one of the most common allergens in industry in general and in the plastics industry in particular. As a new high-technology activity, the wind turbine industry uses these substances in the manufacture of aerogenerators; therefore, occupational skin diseases caused by contact with epoxy resins are likely to become increasingly common.

We believe that workers in the wind turbine industry should undergo patch testing with epoxy resin series, as well as the standard series, to enable the detection of allergens that are common in this industry and that are not always indicated on the product safety data sheets. Both allergic contact eczema caused by epoxy resins and irritant contact eczema caused by fiberglass are a frequent finding in these patients and usually present as diseases caused by airborne allergens.

Conflicts of Interest

The authors declare that they have no conflicts of interest.

References
[1]
Pitteloud JD. General Situation. World Wind Energy Report 2010;1:6. [Accessed 20 Sept 2011]. Available from: http://www.wwindea.org/home/images/stories/pdfs/worldwindenergyreport2010_s.pdf
[2]
El Sistema Eléctrico Español. Red Eléctrica de España, 2010;1:13. [Accessed 1 Oct 2011]. Available from: http://www. ree.es/sistema electrico/pdf/infosis/sintesis REE 2010.pdf
[3]
De Otto, Pérez, editores. Potencia Instalada en España. Eolica’11 2011;1:24-35. [Accessed 14 Oct 2011]. 1-129. Available from: http://www.aeeolica. org/uploads/documents/Anuario%2011%20completo.pdf
[4]
Q. Schiermeier, J. Tollefson, T. Scully, A. Witze, O. Morton.
Electricity without Carbon.
Nature, 454 (2008), pp. 816-823
[5]
A. Ponté, O. Carstensen, K. Rasmussen, B. Gruvberger, M. Isaksson, M. Bruze.
Epoxy-based production of wind turbine rotor blades: occupational dermatoses.
Contact Dermatitis, 50 (2004), pp. 329-338
[6]
K. Rasmusse, O. Carstensen, A. Ponten, B. Gruvberger, M. Isaksson, M. Bruze.
Risk of contact allergy and dermatitis at a wind turbine plant using epoxy resin-based plastics.
Int Arch Occup Environ Health, 78 (2005), pp. 211-217
[7]
L. Conde-Salazar Gómez, R. Valks.
Dermatosis Profesionales por plásticos y resinas.
Dermatología Profesional, pp. 134-146
[8]
L. Calzado, F.J. Ortiz-de Frutos, M.P. Sánchez-Caminero, C.M. Galera, R. Valverde, F. Vanaclocha.
Eczema de contacto alérgico por resina epoxi.
Actas Dermosifiliogr, 96 (2005), pp. 616-618
[9]
L. Conde-Salazar, S. Palacios, D. Guimaraens, M.A. Gonzalez, P. Fenoy.
Dermatitis de Contacto Profesional en la Industria Aeronáutica.
Actas Dermosifiliogr, 81 (1990), pp. 23-28
[10]
A. Pontén, M. Bruze.
Contact allergy to epoxy resin base on diglycidyl ether of bisphenol F.
Contact Dermatitis, 44 (2001), pp. 98
[11]
S. Sakata, J. Cahill, D. Barton, R. Nixon.
Occupational allergic contact dermatitis to bisphenol F epoxy resin.
Australas J Dermatol, 46 (2005), pp. 90-92
[12]
A. Goossens, S. Huygens.
Dermatosis aerotransportadas profesionales.
Dermatología Profesional, pp. 289-295
[13]
M.T. Bordel-Gómez, A. Miranda-Romero.
Fiberglass dermatitis: a report of 2 cases.
Contact Dermatitis, 59 (2008), pp. 120-122
[14]
A. Nogueira, P. Morais, A.P. Cunha, F. Azevedo.
Systemic allergic contact dermatitis to fiberglass in a factory worker of wind turbine blades.
Cutan Ocul Toxicol, 30 (2011), pp. 228-230

Please cite this article as: Lárraga-Piñones G, et al. Dermatitis de contacto profesional en la industria eólica. Actas Dermosifiliogr. 2012;103:905–9.

Copyright © 2012. Elsevier España, S.L. and AEDV
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