Contact hypersensitivity in adolescents

BACKGROUND

Contact hypersensitivity is common in adolescents, but data in the literature are limited. Adolescents often use cosmetics, wear jewelry, and obtain tattoos, which can be sources of allergens.

METHODS

This was a retrospective, noninterventional cohort study of 100 adolescents (aged 13-18; 74 girls, 26 boys) who were consecutively patch tested.

RESULTS

We detected contact hypersensitivity in 51 of the 100 patch-tested patients (51%): 52.7% of the girls and 46.2% of the boys were sensitized. The most common allergens were nickel (17%), thimerosal (12%), para-phenylenediamine (8%), cobalt (7%), and fragrance mix I (6%). Thirteen percent of the reactions did not appear until the seventh day. The majority of clinical lesions affected the hands and face. The most common contact allergens were mercury derivatives, lanolin, and para-phenylenediamine in boys and nickel, thimerosal, para-phenylenediamine, cobalt, and fragrance mix I in girls. Of the 47 adolescents with atopic dermatitis 51.1% had contact hypersensitivity. In this group, skin care product ingredients were the typical allergens (25.5%). The most common contact allergens of those with atopic dermatitis were nickel (12.8%), lanolin (10.6%), and thimerosal (8.5%).

CONCLUSION

Contact hypersensitivity is common in adolescents. For patients with therapy-resistant skin lesions affecting the face and hands, patch testing with an evaluation for 7 days is recommended. Our results provide the first data on frequency of contact hypersensitivity in this age group in Hungary. Metals, fragrances, mercuric derivatives, dyeing materials, and skin care products were the most common allergens.

[Effect of diabetes on the relation between troponin T and inflammatory markers in patients on hemodialysis]

INTRODUCTION

Cardiac troponin T in renal failure is used for the assessment of cardiovascular risk and mortality. Elevated cardiac troponin T levels correlate with subclinical myocardial necrosis, coronary heart disease, several echocardiographic parameters, metastatic calcification, as well as the presence of diabetes and uremic toxins.

AIM

The aim of the authors was to examine the impact of factors, mainly the independent effects of inflammatory laboratory parameters, which may influence hypersensitive troponin T levels in hemodialysed patient groups with and without diabetes.

METHOD

Hemodialysed patient groups with (n = 44) and without diabetes (n = 76) were studied. Difference in serum hypersensitive troponin T values before and after dialysis were analysed by paired Wilcoxon test. Factors possibly affecting the level of hypersensitive troponin T (especially inflammatory markers) were evaluated by multiregression analysis.

RESULTS

Hypersensitive troponin T levels in patients without diabetes (p = 0.0003) and those with diabetes (p = 0.0032) significantly increased during hemodialysis. In patients without diabetes several factors had significant effect on hypersensitive troponin T including age (p = 0.025), duration of hemodialysis (p = 0.0002), presence of cardiovascular complications (p = 0.0002), high sensitivity C-reactive protein (p = 0.0021), white blood cell count (p = 0.038), and the monocyte ratio (p = 0.0202). However, in patients with diabetes only high sensitivity C-reactive protein (p = 0.0024) showed association with hypersensitive troponin T levels.

CONCLUSIONS

In hemodyalised patients with and without diabetes the hypersensitive troponin T levels are differently influenced by clinical and inflammatory laboratory parameters, which should be taken into consideration during clinical judgement.

Contact hypersensitivity to epoxy resin, methyldibromoglutaronitrile, tixocortol pivalate and budesonide in Hungary: a study in 1448 patients

AIM

In order to map the frequency of contact hypersensitivity (CH) to epoxy resin, methyldibromoglutaronitrile (MDBGN), tixocortol pivalate (TP) and budesonide patch tests were carried out.

METHODS

The tests were performed in 1448 patients. Most patients belong to the allergic and irritative contact dermatitis groups. The tests were administered with the allergens epoxy resin 1%, MDBGN 0.3%, TP 1% and budesonide 0.1%, applied on the back. Reactions were evaluated at 40 min, on day 2 (D2), day 3 (D3) and day 4 (D4). In the patients of the Dept. of Dermatology, Venerology and Dermatooncology of Semmelweis University (patients number =1073) reactions were evaluated on day 7 as well.

RESULTS

Epoxy resin elicited immediate reactions in 1 patient at 40 min. Further evaluations showed no difference on D3, D4 and D7 with a frequency of CH of 1.03%. Patch testing for MDBGN did not provoke immediate reactions, evaluations showed an increasing hypersensitivity rate (D2: 0.93%; D7:1.77%). Patch tests with TP yielded no immediate reactions, the frequency of CH increased from 0.47% (D2) to 2.01% (D7). No immediate reactions were observed by budesonide; an increase was seen in frequency of CH (D2:0.93% to D7:3.84%). CH to the studied allergens was observed mostly in allergic contact dermatitis group, to budesonide in irritative contact dermatitis and in atopic dermatitis groups as well.

CONCLUSION

The data of the present study are the first results about this four allergens in Hungary and to our knowledge from our region as well.

Heme oxygenase-1 expression in premature and mature neonates during the first week of life

Newborns are exposed to mechanical and oxidative stress during labor and to relative hyperoxia thereafter during the course of adaptation to the extrauterine conditions. Part of the adaptation mechanism is the rapid degradation of fetal hemoglobin and the oxidation of its heme moiety by heme oxygenases (HOs). Heme oxygenase-1 enzyme (HO-1) is the inducible isoform, which is induced by and protective against oxidative stress. We hypothesized that HO-1 may play a role in the physiological adaptation of newborns. We therefore measured the HO-1 mRNA expression with cRT-PCR during the first week after birth in healthy mature and premature newborns. We found that HO-1 was induced until day 2 or 3 after birth, but its level had dropped below the birth HO-1 mRNA level by the end of the first week. HO-1 levels and inducibility were similar in mature newborns and premature newborns. The fact that HO-1 was inducible even in gestation week 26 suggests that HO-1 plays an important role in the early adaptation processes.

Simultaneous adeno- and squamous cell carcinoma with different phenotypic profiles in a rat model of chronic gastroesophageal reflux

The aim of our study was to investigate the incidence of duodeno-gastroesophageal reflux-induced malignant transformation in a series of duodeno-esophageal anastomosis operations in rats. This surgical method provides a model for reflux-induced esophageal pathologies, without carcinogen administration. The study design included the follow-up of 31 cases. Thirty weeks of duodeno-gastroesophageal reflux disease significantly increased the risk of the development of Barrett's esophagus, and reflux-induced esophageal adenocarcinoma formation was evident in four animals. In one of these particular cases, a superficial squamous cell cancer was noted in close vicinity to the adenocarcinoma formation. For further analysis, a detailed immunohistochemical staining protocol was used. The immunophenotypes revealed cyclin D1 expression (nuclear positivity in 35% of all the squamous cells), p53 protein accumulation (50% nuclear positivity), with a low expression of cox-2, and negative c-erbB2 staining in the squamous carcinoma cells. The specialized intestinal metaplasia and mucinous adenocarcinoma cells exhibited exclusively diffuse cox-2 positivity (90% of all glandular cells) and weak focal c-erbB2 (5%) staining, without cyclin D1 expression or p53 protein accumulation. Real-time polymerase chain reaction was applied to quantify the abundance of p53, cyclin D1 and cox-2 mRNAs in this biopsy. The most dramatic changes were observed in the level of expression of cyclin D1 (a 9.08-fold expression as compared with the non-treated esophagus samples), while the p53 and cox-2 gene expressions were increased by 1.61 and 2.45-fold, respectively, relative to the non-treated samples. The results afford evidence of the simultaneous activation of more than one possible carcinogenetic pathway in experimental gastroesophageal reflux disease. Synchronous neoplasm formation with different growth pattern characteristics is a rarity in humans, and this phenomenon suggests that the presented model is a suitable means of mimicking the whole spectrum of human gastroesophageal reflux disease pathology.

Endothelin-1 gene and endothelial nitric oxide synthase gene polymorphisms in adolescents with juvenile and obesity-associated hypertension

Hypertension is an increasing public health problem all over the world. Essential hypertension accounts for more than 90% of cases of hypertension. It is a complex genetic, environmental and demographic trait. New method in molecular biology has been proposed a number of candidate genes, but the linkage or association with hypertension has been problematic (lack of gene-gene and gene-environment interaction). It is well known that genetic influences are more important in younger hypertensives, because children are relatively free from the common environmental factors contributing to essential hypertension. The association studies compare genotype ferquencies of the candidate gene between patient groups and the controls, in pathways known to be involved in blood pressure regulation. This study examined three polymorphisms of these factors encoding genes (ET-1 G+5665T (Lys198Asn), endothelial nitric oxide synthase (eNOS) T-786C promoter polymorphism and 27-bp repeat polymorphism in intron 4) in adolescents with juvenile essential and obesity-associated hypertension. Significant differences were found in the G/T genotype of the ET-1 polymorphism in the hypertensive and obese+hypertensive patients (body mass index (BMI) > 30). A strong association was detected between the BMI and the polymorphism of the ET-1 gene. It seems that ET-1 gene polymorphism plays a role in the development of juvenile hypertension associated with obesity. Although no significant differences were seen in the case of the eNOS promoter polymorphism and the eNOS 4th intron 27-bp repeat polymorphism. It seems that eNOS may play a role, but this is not the main factor in the control of blood pressure; it is rather a fine regulator in this process. This study with adolescents facilitates an understanding of the genetic factors promoting juvenile hypertension and obesity.

Roles of Paraoxonase and Oxidative Stress in Adolescents with Uraemic, Essential or Obesity-Induced Hypertension

BACKGROUND/AIMS

Paraoxonase 1 (PON1) is associated with high-density lipoproteins in the plasma, and is capable of hydrolysing oxidized lipids and preventing the oxidation of low-density lipoproteins. Oxidative stress and the PON1 (activity and Q192R polymorphism) were analysed in adolescent patients with essential (n = 49) or obesity-induced hypertension (n = 79), uraemic patients (n = 20), and also in obese normotensive patients (n = 60) and age-matched controls (n = 57).

METHODS

The PON1 activity was measured via paraoxon hydrolysis. The PON1 genotype was determined by real-time PCR. The levels of oxidized and reduced glutathione, the end-products of nitric oxide, cysteine, homocysteine and lipid peroxidation in the plasma were measured and related to the PON1 status.

RESULTS

There were no significant differences between the patient groups and the control group in the genotype distributions and the allele frequencies of the Q192R polymorphism. The PON activity was significantly lower (p < 0.001) in the uraemic hypertensive group than in the controls. The MDA concentration was significantly higher in the uraemic hypertensive (p < 0.001) and obese hypertensive (p < 0.05) patients. The plasma NOx concentrations were significantly lower (p < 0.001) and the ratio MDA/NOx were significantly higher in all four patient groups. The GSH levels were significantly lower in the patients with hypertension (p < 0.001) and obesity-induced hypertension (p < 0.05) than in the controls, while the GSSG level (p < 0.01) and the ratio GSSG/GSH (p < 0.05) was significantly higher in the uraemic hypertensive group. The plasma homocysteine level was significantly higher (p < 0.001) in the uraemic hypertensive patients as compared with the controls.

CONCLUSIONS

We found no significant correlation between the biochemical parameters and neither genotypes nor enzyme activities. The PON1 status and the levels of certain biochemical parameters are independently associated with the hypertension in hypertensive and obese hypertensive patients, and the elevated levels of lipid peroxides and plasma homocysteine may contribute to the increased risk of cardiovascular complications in patients on haemodialysis.

Different pathomechanisms of essential and obesity-associated hypertension in adolescents

Obesity-induced hypertension and essential hypertension in lean patients are two different forms of hypertension. The main goal of this study was to test whether there are differences in biochemical parameters between subjects with obesity-associated hypertension and those with essential hypertension. We examined whether the biochemical responses to angiotensin-converting enzyme inhibitor (ACEI) ramipril therapy reveal properties of these two conditions that might explain the differences in clinical outcome. Before ramipril therapy, the hypertensive group exhibited increases in ACE activity (p<0.05), plasma malondialdehyde (MDA) concentration and the malondialdehyde/nitric oxide end-product ratio (MDA/NO(x)) (p<0.05), and decreases in xanthine oxidase (XO) activity (p<0.05) and plasma nitric oxide end-product (NO(x)) level (p<0.01). Before medication, plasma endothelin-1 (ET-1), plasma leptin, and leptin receptor levels were normal. Following ramipril treatment, ACE activity normalized. Before ACE inhibitor treatment, the obese-hypertensive group exhibited elevated levels of plasma ET-1 (p<0.05), plasma leptin (p<0.01), XO activity (p<0.05), plasma MDA and MDA/NO(x) (p<0.05), and reduced levels of plasma NO(x)(p<0.01) and leptin receptors (p<0.001). Following medication, the plasma NO(x) level, MDA/NO(x), and XO activity returned to normal while ACE activity decreased (p<0.001). In patients with essential hypertension, NO availability and ACE activity, and in those with obesity-associated hypertension, hyperleptinemic effects, NO level, endothelin-1 concentration and XO activity, may be important factors in the pathology.

Heme oxygenase 1 expression in young uremic patients on hemodialysis

Oxidative stress plays an important role in the cardiovascular complications in end-stage renal disease (ESRD) patients on long-term hemodialysis (HD). Heme oxygenase-1 (HO-1) inhibits inflammatory events and protects against oxidative stress and endothelial injury. Therefore, we followed the effects of single HD sessions on HO-1 expression. A competitive reverse transcriptase PCR method was used to estimate HO-1 induction before and immediately after HD and 48 h later in 17 young uremic patients. We also measured the concentrations of plasma hemoglobin and bilirubin as indicators of hemolysis, the ferroxidase activity, and the erythrocyte-derived reduced and oxidized glutathione levels as oxidative stress markers, and the homocysteine levels as an independent risk factor. We found significant differences in HO-1 expression patterns in the patients, depending on the duration of HD treatment. Short-term HD [ n=7, median 19 months (9, 29 quartiles)] resulted in an elevated HO-1 expression, which was not further upregulated during HD. Long-term HD [ n=10, median 97 months (53, 150 quartiles)] led to downregulation of baseline HO-1 expression in ESRD patients. In these patients, a single HD session results in erythrocyte injury and a transient one- to five-fold elevation of HO-1 expression. The chronic downregulation of the baseline expression of HO-1 in long-term HD patients resulted in recurring oxidative stress during each HD session, which may contribute to accelerate the progression of atherosclerosis.

Platelet aggregation, blood viscosity and serum lipids in hypertensive and obese children

A group of 35 patients (median age 15.5 years, range 8-17 years) with juvenile essential hypertension, 15 with body mass index (BMI kg/m(2)) <25 and 20 with BMI >25, as well as 35 age and sex matched controls (BMI <25 n=20; BMI >25 n=15) were investigated to study the role of hypertension and obesity, separately and in combination, on in vitro platelet aggregation, blood and plasma viscosity, plasma lipid concentrations and lipid peroxidation as well as nitric oxide (NO) production. Obese children (hypertensive and controls) had significantly higher concentrations of total cholesterol and triglycerides. The levels of high density lipoprotein (HDL)-cholesterol were lower in obese hypertensive children than their non-obese counterparts. There was a significant increase in platelet aggregation and a decrease in NO levels in hypertensive patients (obese and non-obese) reflecting a significant negative correlation (r=-0.553 and -0.530, n=35; P<0.01, respectively). However, an increased tendency to aggregation was also evident in obese normotensive patients. A significant positive correlation was observed between the platelet aggregation and BMI (r=0.501, n=35; P<0.01). Plasma free thiols were decreased in hypertensive children independent of their BMI. An increased lipid peroxidation and higher blood and plasma viscosity were found only in obese patients with hypertension. Multivariate analysis revealed significant interactions in the effects of obesity and hypertension on platelet aggregation and thiol oxidation.

CONCLUSION

in obese children an increased platelet aggregation and oxidative insult contribute to the development of hypertension and to the promotion of vascular damage.

Oxidative stress in juvenile essential hypertension

OBJECTIVE

Oxidative stress, an antioxidant/pro-oxidant imbalance, in patients with juvenile essential hypertension was measured via several biochemical parameters. As the blood pressure is associated with the body mass index (BMI), results were compared with those on BMI-matched controls.

DESIGN AND SETTING

A prospective observational study at a university teaching hospital.

PATIENTS

Children and adolescents with essential hypertension (mean standard deviation: age 14.4 +/- 3.1 years, BMI 25.0 +/- 6.9 kg/m(2), n = 52) before any treatment, and controls with a similar BMI distribution (age 14.3 +/- 4.3 years, BMI 24.4 +/- 6.6 kg/m(2), n = 48).

METHODS

Measurements were made of the plasma levels of (1) nitrites + nitrates, an indirect measure of available nitric oxide; (2) lipid peroxidation end-products, as malondialdehydes and free thiols; and (3) the redox status of the red blood cell glutathione, as a new oxidative stress parameter.

RESULTS

There were decreased plasma levels of nitrates and increased levels of lipid peroxidation end-products in the hypertensive patients, resulting in a consistent increase in the plasma lipid peroxidation/nitric oxide ratio as compared with the controls with the same BMI (P <0.01). This ratio additionally correlated directly with both the systolic and diastolic blood pressures for the overall patient population (P <0.001). A significant glutathione depletion in the red blood cells resulted in an elevated ratio of oxidized/reduced forms with a reduced antioxidant protective capacity in the hypertensive patients versus the BMI-matched controls (P <0.001).

CONCLUSIONS

The presence of systemic oxidative stress was proven in hypertensive children and adolescents, irrespective of their BMI.