Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Job Classification

In most duration tables, five job classifications are displayed. These job classifications are based on the amount of physical effort required to perform the work. The classifications correspond to the Strength Factor classifications described in the United States Department of Labor's Dictionary of Occupational Titles. The following definitions are quoted directly from that publication.

Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Allergic Dermatitis


Related Terms

  • Allergic Contact Dermatitis
  • Atopic Dermatitis
  • Drug Rash

Differential Diagnosis

Specialists

  • Allergist/Immunologist
  • Dermatologist

Factors Influencing Duration

Severity and extent of the allergic response and any complications affect the length of disability. Duration depends on job requirements, workplace exposure to allergen, and whether substitute, nonallergenic chemicals or substances may be used.

Medical Codes

ICD-9-CM:
693.0 - Dermatitis Due to Drugs and Medicines; Dermatitis Medicamentosa NOS
693.1 - Dermatitis Due to Food
693.8 - Dermatitis Due to Other Specified Substances Taken Internally
693.9 - Dermatitis Due to Unspecified Substance Taken Internally

Overview

Allergic dermatitis refers to skin inflammation caused by an allergic (hypersensitivity) reaction to a substance. Allergies are mediated by immune cells, not antibodies. Allergic reactions occur when an individual's immune system becomes sensitized to a substance (sensitization phase) and then reacts when again exposed to that substance (elicitation phase). In the case of allergic dermatitis, this immune response occurs in the skin and causes a rash.

When caused by a topical substance, allergic dermatitis is called allergic contact dermatitis. The hands and face are the most commonly affected areas. Ninety percent of all cases of allergic contact dermatitis are caused by toxic plants (poison ivy, oak, or sumac), formaldehyde, nickel, benzocaine, neomycin, preservatives (parabens), black dye (paraphenylenediamine), balsam of Peru, chromate, epoxy resins, antioxidants, permanent wave solutions, and fragrances.

Allergic dermatitis may arise from contact with airborne allergens. Topical drug application causes dermatitis more often than other routes of drug administration. The most common drug allergens are penicillin, sulfonamides, aspirin, local anesthetics (benzocaine), and topical antibiotics (neomycin and bacitracin).

Although uncommon, individuals who become sensitized to a substance by skin contact may have a generalized skin reaction to the substance when it is taken internally (contact dermatitis).

Incidence and Prevalence: Seven million visits to healthcare providers each year are due to dermatitis. The prevalence of contact dermatitis in the US is between 1% and 15% ("Ambulatory Care").

Latex hypersensitivity is an emerging health problem. Latex allergy is seen in 17% to 30% of all hospital employees (Marx 1624). Latex is a natural product and is processed in a manner that retains protein allergens and leaves residual chemicals on latex gloves.

Source: Medical Disability Advisor



Causation and Known Risk Factors

Susceptibility to skin irritation seems to be influenced by age, race, and genetic background, whereas sex-related differences do not seem to exist.

Source: Medical Disability Advisor



Diagnosis

History: Within minutes, hours, or days following exposure to the allergenic substance, skin eruption develops with or without itching, typically in the distribution of the skin area in contact with the allergen. Swelling or other symptoms such as fever and joint pain (arthralgia) may be present. A life-threatening generalized hypersensitivity reaction (anaphylaxis) characterized by hives, itching, angioedema, and breathing difficulties can occur. Individuals with a chronic condition complain of skin thickening (lichenification), scaling, fissures, and red, fluid-filled bumps (papulovesicles). The individual may report a recent change in detergent, soap, cosmetics, jewelry, or topical medication. The individual with poison oak, sumac, or ivy dermatitis often reports working or recreating outdoors.

Physical exam: Skin eruptions vary, but rash is most often seen. Hives and angioedema are also common. Allergic contact dermatitis appears as red, hardened (indurated) skin, and blisters. The pattern, shape, and location of the rash help identify the causative substance. Less common, potentially life-threatening forms of allergic dermatitis also have blistering (bullous) eruptions with peeling layers of skin (exfoliative dermatitis) or large blisters (erythema multiforme).

Tests: Skin patch tests, provocative challenges, and some immunological testing may be required, particularly if symptoms are persistent and the cause of the dermatitis remains unclear. Elevated total IgE suggests underlying allergy.

Source: Medical Disability Advisor



Treatment

The causative allergen is removed and avoided in the future, if possible. Mild itching is treated with wet dressings and astringent lotion. Baths with colloidal oatmeal preparations may be soothing. Topical corticosteroids, antihistamines, and tricyclic antidepressants can relieve moderate to severe itching. Oral steroids are reserved for individuals with extensive rash or rash that involves the face or genitals. Angioedema can be treated with topical corticosteroids or with oral steroids if necessary. Anaphylaxis is a life-threatening situation necessitating care in an emergency room, and injectable steroids are indicated for this condition.

Allergen immunotherapy, in which small amounts of an allergic substance are repeatedly injected over time until the individual builds up a tolerance to the substance, may be a good choice if symptoms are troublesome and the allergen cannot be avoided in the environment.

Source: Medical Disability Advisor



Prognosis

Symptoms usually subside within 10 to 20 days after removal of the offending substance. If the offending substance is not removed, the dermatitis may worsen and become chronic. Dermatitis may persist for years even with allergen avoidance.

Anaphylaxis and angioedema can occur upon exposure to the allergen, and are potentially fatal conditions for hypersensitive individuals.

Source: Medical Disability Advisor



Complications

Anaphylaxis, angioedema, secondary infection, inflammation of blood vessels (vasculitis), and involvement of other organs may complicate allergic dermatitis.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Because allergens may share common structural properties, the individual must avoid not only the known allergen, but also cross-reacting allergens (i.e., allergy to the anesthetic procaine may also include allergy to hair or textile dyes). Contact dermatitis may be avoided by removal (or replacement) of the allergenic substance or by wearing personal protective equipment (cotton-lined rubber gloves, aprons, sleeves, or face shield) and using barrier creams. Adequate ventilation is necessary if the allergen is airborne. Good housekeeping and personal hygiene practices are required. Personnel need to be educated in the safe handling of chemicals. Changes to the individual's position or duties may be required.

Source: Medical Disability Advisor



Failure to Recover

If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case.

Regarding diagnosis:

  • Does individual have symptoms of allergic dermatitis? Was there swelling, rash, itching, hives, or redness on the skin?
  • Was an exposure history and complete skin examination performed?
  • Was diagnosis confirmed with skin patch testing, provocative challenges, or immunological testing?
  • If diagnosis is uncertain, were other conditions with similar symptoms ruled out?
  • Would individual benefit by consulting with a dermatologist or allergist?

Regarding treatment:

  • Has causative agent been identified?
  • Have all possible causes of allergic dermatitis (both in workplace and at home) been considered?
  • Does dermatitis improve over weekends or while individual is on vacation?
  • Does individual work with or handle any known allergy-producing agents? If so, does individual use appropriate protective clothing?
  • If rash has failed to resolve or has worsened, is it possible that individual is reacting to medication used to treat rash?
  • Have additional treatments such as topical or oral corticosteroids relieved itching?

Regarding prognosis:

  • Was offending agent identified?
  • Has individual been compliant in avoiding offending agent?
  • Does individual have other skin conditions that may influence length of disability?
  • Did individual suffer any complications that may impact ability to recover?

Source: Medical Disability Advisor



References

Cited

"Ambulatory Care Visits to Physician Offices, Hospital Outpatient Departments, and Emergency Departments." Vital and Health Statistics 13 134 (1996): 1-45. Centers for Disease Control and Prevention. U.S. Department of Health and Human Services. 13 Jul. 2005 <http://www.cdc.gov/nchs/data/series/sr_13/sr13_134.pdf>.

Marx, J. A., et al., eds. Rosen’s Emergency Medicine: Concepts and Clinical Practice. 5th ed. St. Louis: Mosby, Inc., 2002.

Source: Medical Disability Advisor






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