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Harbeck N, Gluz O, Kreipe HH, Christgen M, Svedman C, Shak S, Hofmann D, Kuemmel S, Nuding B, Rezai M, Schumacher C, Kusche M, Forstbauer H, Maass N, Kraemer S, Aktas B, Mohrmann S, Wuerstlein R, Kates RE, Nitz U. Abstract P6-05-11: Run-in phase of prospective WSG-ADAPT HR+/HER2- trial demonstrates feasibility of early endocrine sensitivity prediction by recurrence score and conventional parameters in clinical routine. Cancer Res 2013. [DOI: 10.1158/0008-5472.sabcs13-p6-05-11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Despite promising evidence regarding outcome prediction, endocrine sensitivity, as determined by proliferation response to short-term preoperative endocrine therapy, is currently not included in adjuvant chemotherapy decisions in early HR+/HER2- breast cancer (BC).
Methods: The prospective WSG-ADAPT HR+/HER2- trial includes early BC patients with 0-3 positive LN who are candidates for adjuvant chemotherapy based on clinical-pathological criteria alone; it aims to spare chemotherapy in a substantial proportion utilizing a combination of genomic assessment by Oncotype DX and endocrine sensitivity testing. All patients received 3-week preoperative endocrine induction therapy (ET): aromatase inhibitors (AI) if postmenopausal, tamoxifen if premenopausal. Patients with low (0-11) Recurrence Score (RS) or intermediate RS (12-25) and ET response (centrally tested, post-therapy Ki-67 <10%) are recommended to forego adjuvant chemotherapy (“low-risk” patients). Distribution of RS, responder percentages in each group, and impacts of RS, ET regimen, and initial Ki-67 on post-therapy Ki-67 are reported here.
Results: As of 6/2013, 380 patients from 30 study centers had been enrolled in the ADAPT HR+/HER2- trial. Median age was 54 years. At first pre-planned analysis (5/2013), paired Ki-67 measurements (pre-/post-therapy) were available in 241 patients; RS was available in 208 cases (201 with paired Ki-67). RS was low in 21.6%, intermediate in 57.7%, and high in 20.7%; the respective risk group responder percentages (post-treatment Ki 67 <10%) were 84.1%, 73.9%, and 40.0% (p<0.001 when comparing low/intermediate vs. high, chi-square). In particular, these percentages support the pre-trial estimate of >70% endocrine responders in the intermediate genomic risk group, who could potentially be spared adjuvant chemotherapy. Median Ki 67 level decreases (as percentage of pre-treatment value) were 25% in premenopausal patients (tamoxifen, n = 101) vs. 75% in postmenopausal patients (AI, n = 115) (p<0.001, Mann-Whitney); median decreases by RS group were similar, 61% (low), 53% (intermediate) and 56% (high), respectively (p = 0.81, Kruskal-Wallis). In linear regression, pre-treatment Ki-67, endocrine regimen/menopausal status, and RS were all independent predictors for post-treatment Ki 67. Final run-in-phase analysis and validation will be presented after completion of endocrine induction therapy in 400 patients.
Conclusions: The Run-In Phase of the WSG ADAPT HR+/HER2- trial confirms trial design estimates of RS and proliferation response to induction ET. It indicates that the multicenter prospective ADAPT concept combining static and dynamic biomarker assessment for individualized therapy decisions in early BC is feasible. Proliferation response was strongly associated with therapy group (AI/post-menopausal vs. tamoxifen/pre-menopausal). Survival non-inferiority of intermediate Recurrence Score proliferation responders vs. low Recurrence Score patients (active control) will be tested in the ADAPT main phase to determine if adjuvant chemotherapy can be spared in 70% of patients with 0-3 positive LN classified as “intermediate risk” by conventional factors.
Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P6-05-11.
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Mowitz M, Zimerson E, Svedman C, Bruze M. Stability of fragrance patch test preparations applied in test chambers. Br J Dermatol 2013; 167:822-7. [PMID: 22803625 DOI: 10.1111/j.1365-2133.2012.11143.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Petrolatum patch test preparations are for practical reasons often applied in test chambers in advance, several hours or even days before the patient is tested. As many fragrance compounds are volatile it may be suspected that petrolatum preparations applied in test chambers are not stable over time. OBJECTIVES To investigate the stability of petrolatum preparations of the seven chemically defined components in the fragrance mix (FM I) when stored in test chambers. METHODS Samples of petrolatum preparations applied in test chambers stored at room temperature and in a refrigerator for between 4 and 144 h were analysed using liquid chromatographic methods. RESULTS The concentration decreased by ≥ 20% within 8 h in four of seven preparations stored in Finn chambers at room temperature. When stored in a refrigerator only the preparation of cinnamal had decreased by ≥ 20% within 24 h. The stability of preparations of cinnamal stored in IQ chambers with a plastic cover was slightly better, but like the preparations applied in Finn chambers, the concentration decreased by ≥ 20% within 4 h at room temperature and within 24 h in a refrigerator. Cinnamal and cinnamyl alcohol were found to be more stable when analysed as ingredients in FM I compared with when analysed in individual preparations. CONCLUSIONS Within a couple of hours several fragrance allergens evaporate from test chambers to an extent that may affect the outcome of the patch test. Application to the test chambers should be performed as close to the patch test occasion as possible and storage in a refrigerator is recommended.
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Albanell J, Holt S, Gligorov J, Eiermann W, Svedman C. Meta-Analysis of Prospective European Studies Assessing the Impact of Using The 21-Gene Recurrence Score Assay on Clinical Decision Making in Women With Er-Positive, Her2-Negative Early Stage Breast Cancer. Ann Oncol 2012. [DOI: 10.1016/s0923-7534(20)32871-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Wuerstlein R, Gluz O, Degenhardt T, Kreipe HH, Kates R, Liedtke C, Shak S, Schumann RV, Clemens M, Markmann S, Christgen M, Svedman C, Aktas B, Salem M, Uleer C, Augustin D, Thomssen C, Nitz U, Harbeck N. Welche Prognosefaktoren sind geeignet für den klinischen Einsatz beim Mammakarzinom? Prospektiver Vergleich von Recurrence Score, uPA/PAI-1, Grading und molekularen Subtypen und Korrelationen aus der WSG-Plan B Studie. Geburtshilfe Frauenheilkd 2012. [DOI: 10.1055/s-0032-1318581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Gluz O, Kreipe H, Degenhardt T, Salem M, Kates R, Shak S, Svedman C, Liedtke C, Nitz U, Harbeck N. 11O Prospective Comparison of Risk Assessment Tools in Early Breast Cancer: Correlation Analysis from the Phase III Wsg-Plan B Trial. Ann Oncol 2012. [DOI: 10.1016/s0923-7534(19)65683-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Ekqvist S, Lundh T, Svedman C, Björk J, Möller H, Nilsson L, Bruze M. Does gold concentration in the blood influence the result of patch testing to gold? Br J Dermatol 2009; 160:1016-21. [DOI: 10.1111/j.1365-2133.2009.09065.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Johansen JD, Rastogi SC, Andersen KE, Bernard G, Svedman C, Bruze M, Bossi R, Gimenez-Arnau E, Lepoittevin JP, Menné T. FS06.3
Chloroatranol - clinical studies and exposure analysis. Contact Dermatitis 2008. [DOI: 10.1111/j.0105-1873.2004.0309bl.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Ekqvist S, Svedman C, Möller H, Kehler M, Pripp CM, Björk J, Gruvberger B, Holmström E, Gustavsson CG, Bruze M. High frequency of contact allergy to gold in patients with endovascular coronary stents. Br J Dermatol 2007; 157:730-8. [PMID: 17711524 DOI: 10.1111/j.1365-2133.2007.08119.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Stent implantation is an effective method for treatment of atherosclerotic disease. Factors predisposing to in-stent restenosis are still largely unknown. Contact allergy to metal ions eluted from the stent has been suggested to be a risk factor. OBJECTIVES To explore whether there is a possible induction of contact allergy to metals used in stents among patients with a stainless steel stent containing nickel (Ni stent) and patients with a gold-plated stent (Au stent). METHODS Adults (n = 484) treated with coronary stent implantation participated in the study with patch testing. The study design was retrospective and cross-sectional with no assessment of contact allergy before stenting. Age- and sex-matched patch-tested patients with dermatitis (n = 447) served as controls. RESULTS Of Au-stented patients, 54 of 146 (37%) were allergic to gold compared with 85 of 447 (19%) controls (P < 0.001). Within the stented population there were no statistically significant differences in contact allergy to gold or nickel between Ni-stented and Au-stented patients. In multivariate models where other risk factors for contact allergy to gold were considered, the Au stent showed a trend towards statistical significance (odds ratio 1.43, 95% confidence interval 0.95-2.16; P = 0.09). CONCLUSIONS As the frequency of contact allergy to gold is higher in stented patients independent of stent type it suggests a previous sensitization. However, several pieces of circumstantial evidence as well as statistical analysis indicate the possibility of sensitization in the coronary vessel by the Au stent. Ni stents and Au stents should not be ruled out as risk factors for induction of contact allergy to these metals.
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Jönsson B, Lichtenberg F, Lundkvist J, Svedman C, Wilking N. The utilization of new oncology drugs: A global perspective. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.6612] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
6612 Background: A number of new innovative cancer drugs have recently been approved or are in the process of being approved. We have analysed the access and uptake of 65 oncology drugs in 25 countries (19 European countries, Australia, Canada, Japan, New Zealand, South Africa and the USA) over a 10 year period based on sales data provided by IMS Health. Methods: We calculated an index of number of patients treated based on sales per inhabitant or per person who died from a specific cancer type. The age composition (vintage) of the drug arsenal used was calculated based on sales for cancer drugs introduced before 1995; between 1995–1999, 2000–2002 and after 2002 respectively. The vintage of the drug arsenal used was also analysed in relation to different economic and health care system characteristics. We performed three types of analysis of the effect of cancer drug vintage on cancer survival and mortality using difference-in-difference research designs. Results: Different patterns of uptake were seen in the countries studied, both with respect to speed of uptake and level of use. Fast uptake of most new drugs was seen in Austria, France, Switzerland, Spain and the USA, and slow uptake as well as low usage was seen in Poland, Hungary, New Zealand, South Africa and the UK. For some of the most recently approved drugs the variation in uptake is especially marked. The vintage of the cancer drug “arsenal” used also differs significantly between countries. Nearly half (44%) of the observed improvement in the two-year cancer survival rate between 1992 and 2000 at 50 USA cancer centres could be attributed to the use of newer cancer drugs. Around one sixth (14% − 19%) of the inter-country differences in 5-year cancer survival rates across 5 major European countries is due to differences in the uptake of newer drugs (post-1985) in each country. Nearly one third (30%) of the decline in cancer mortality rates seen during the period 1995 –2003, could be accounted for by the use of newer drugs. The observed decrease in mortality of 16% would have been only 11% if newer drugs had not been used. Conclusions: Patient access to innovative cancer drugs varies significantly between countries affecting mortality rates, and further research is needed into the determinants and consequences of these variations. No significant financial relationships to disclose.
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Svedman C, Dunér K, Kehler M, Möller H, Gruvberger B, Bruze M. Lichenoid reactions to gold from dental restorations and exposure to gold through intracoronary implant of a gold-plated stent. Clin Res Cardiol 2006; 95:689-91. [PMID: 17066351 DOI: 10.1007/s00392-006-0448-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2006] [Accepted: 06/29/2006] [Indexed: 11/29/2022]
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Wilking NE, Svedman C, Jönsson B, Zethraeus N. The use of innovative oncology drugs in Europe. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.16020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
16020 Background: A number of new innovative cancer drugs have recently been approved or are in the process of being approved. Rapid patient access to new innovative drugs is important as it may lead to improved survival. Methods: We have analysed the access and uptake of new oncology drugs in 19 European countries over a 15 year period based on sales data provided by IMS Health. In the study we focus on select, “targeted” drugs that have been introduced over the last 10 years: rituximab, trastuzumab and imatinib. We have also analysed data to assess the composition of the drug “arsenal” used in the selected countries based on % of total sales for cancer drugs introduced before 1993; between1993–1998 and after 1999. Results: We see different patterns of uptake in countries studied, both with respect to speed and level of usage, in relation to use per person dying of the specific cancers.. Fast uptake is seen in Austria, Switzerland and Spain, and slow uptake as well as low usage is seen in Poland, Hungary, Norway and the UK. For example, trastuzumab uptake indicates that countries with the fastest uptake treat the majority of HER2 over expressing metastatic breast cancer patients within 2–3 years after introduction while countries with slow uptake still after 5 years seem to have a large proportion of patients not receiving trastuzumab treatment. On the other hand, for a drug like imatinib the uptake has been more rapid and uniform in most countries. The composition of the cancer drug “arsenal” used also differs significantly in between countries. Conclusions: Patient access to innovative cancer drugs varies significantly between European countries. [Table: see text]
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Svedman C, Tillman C, Gustavsson CG, Möller H, Frennby B, Bruze M. Contact allergy to gold in patients with gold-plated intracoronary stents. Contact Dermatitis 2006; 54:71. [PMID: 16426306 DOI: 10.1111/j.0105-1873.2006.00737.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Wersäll P, Blomgren H, Lax I, Kälkner KM, Linder C, Lundell G, Nilsson B, Nilsson S, Näslund I, Pisa P, Svedman C. 57 Extracranial Stereotactic Radiotherapy for Primary and Metastatic Renal Cell Carcinoma. Radiother Oncol 2005. [DOI: 10.1016/s0167-8140(05)81035-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Svedman C, Tillman C, Gustavsson CG, Möller H, Frennby B, Bruze M. Contact allergy to gold in patients with gold-plated intracoronary stents. Contact Dermatitis 2005; 52:192-6. [PMID: 15859991 DOI: 10.1111/j.0105-1873.2005.00522.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
An increasingly common and effective method for the treatment of atherosclerotic disease in the coronary arteries is percutaneous transluminal coronary angioplasty (PTCA) and stenting. The stents are made of different metals. An increased rate of restenosis when using gold-plated stents has been shown. Contact allergy to gold is common in many countries. Recently, a study has shown an increased rate of contact allergy to nickel among patients with restenosis and a nickel-containing stent. The aims of our study were to investigate whether there was an increased rate of contact allergy to gold among patients with gold-plated stents and if this increased the risk of restenosis. 22 patients who had received a gold-plated stent were patch tested. An age- and sex-matched population of 88 patients, previously patch tested because of a suspected contact dermatitis, served as controls. In the stent group, 10/22 (45.5%) had a contact allergy to gold, in the control group 18/88 (20.5%); the difference is statistically significant (P = 0.04). There was no significant difference regarding frequency of restenosis. Our study indicates that there is a risk of sensitizing the patient when implanting a gold-plated stent. Further studies are needed to confirm these results and to evaluate whether there is an increased risk of restenosis.
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Svedman C, Holst R, Johnsson A. Ulcus vulvae acutum, a rare diagnosis to keep in mind. Eur J Obstet Gynecol Reprod Biol 2004; 115:104-5. [PMID: 15223176 DOI: 10.1016/j.ejogrb.2003.09.045] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2002] [Revised: 07/02/2003] [Accepted: 09/10/2003] [Indexed: 11/25/2022]
Abstract
Genital ulceration is today often thought to be caused by herpes simplex. In this case report, a rare differential diagnosis, ulcus vulvae acutum is described, probably caused by Epstein-Barr virus (EB-virus).
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Tanaka S, Royds C, Buckley D, Basketter DA, Goossens A, Bruze M, Svedman C, Menné T, Johansen JD, White IR, McFadden JP. Contact allergy to isoeugenol and its derivatives: problems with allergen substitution. Contact Dermatitis 2004; 51:288-91. [PMID: 15606655 DOI: 10.1111/j.0105-1873.2004.00446.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
A total of 2261 (808 male, 1453 female) consecutive patients attending contact dermatitis clinics were patch tested to isoeugenol and its derivatives listed in the EU Inventory of Fragrance Ingredients. Positive reactions were found to isoeugenol in 40, transisoeugenol in 40, isoeugenyl acetate in 19, isoeugenyl benzoate in 4, isoeugenyl phenylacetate in 16, isoeugenyl methyl ether in 6 and benzyl isoeugenyl ether in 2 patients. There was a concomitant reaction to isoeugenol in 36/40 of those positive to transisoeugenol, 13/19 of those to isoeugenyl acetate, 3/4 of those to isoeugenyl benzoate and 15/16 of those to isoeugenyl phenylacetate but in none of those 6 positive to isoeugenyl methyl ether and in neither of those 2 positive to benzyl isoeugenyl ether. Concomitant contact allergy between isoeugenol and its derivatives may occur through chemical cross-reactivity or local skin metabolism of the derivatives. It is more commonly observed with the esters rather than the ethers. Isoeugenyl acetate has been proposed as an alternative to isoeugenol, but there is a high degree of concomitant reactivity with isoeugenol.
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Heydorn S, Menné T, Andersen KE, Bruze M, Svedman C, White IR, Basketter DA. Citral a fragrance allergen and irritant. Contact Dermatitis 2003; 49:32-6. [PMID: 14641118 DOI: 10.1111/j.0105-1873.2003.00144.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Citral is a well known contact allergen and a contact irritant. Routine patch testing in the past may have been restricted because of possible irritant (IR) patch test responses. 586 consecutive patients, with hand eczema, were patch tested with a selection of fragrances including citral 2% petrolatum and the European standard series. 28 of the patients showed a positive patch test reaction (+ to +++) to citral and 82 at least 1 IR patch test reaction and no positive patch test reaction to citral. A statistically significant association between a positive patch test reaction to citral and positive patch test reactions to other fragrances compared with IR reactions (n = 82) was established. The difference regarding fragrance history found between those with IR and positive reactions to citral was not significant. Citral could be an allergen and/or irritant, worthy of further more extensive studies.
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Johansen JD, Frosch PJ, Svedman C, Andersen KE, Bruze M, Pirker C, Menné T. Hydroxyisohexyl 3-cyclohexene carboxaldehyde- known as Lyral®: quantitative aspects and risk assessment of an important fragrance allergen. Contact Dermatitis 2003; 48:310-6. [PMID: 14531869 DOI: 10.1034/j.1600-0536.2003.00126.x] [Citation(s) in RCA: 60] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Hydroxyisohexyl 3-cyclohexene carboxaldehyde, also known as Lyral, is a fragrance ingredient identified as the cause of contact allergic reactions in 2-3% of eczema patients undergoing patch testing. Lyral has been included in the standard patch test series in many clinics due to its importance as an allergen. It has been used without restrictions in cosmetic products, until now. In the present study, the dose-response relationship of Lyral contact allergy was studied with doses relevant for normal exposure in cosmetic products. 18 eczema patients, who previously had given a positive patch test to Lyral 5% petrolatum, were included along with 7 control subjects. All cases were tested with a serial dilution of Lyral in ethanol 6% to 6 p.p.m and subjected to a 2-week, repeated open application test with a low dose of Lyral in ethanol. In the case of no reaction, this was followed by another 2 weeks of testing with a higher dose. The test was performed at the volar aspect of the forearm. In 16 of 18 cases (89%), a positive use test developed, 11 reacting to the low and 5 to the high concentration. None reacted to the vehicle control of ethanol applied to the contralateral arm. All controls were negative to both the test solutions of Lyral and the ethanol control. The difference between the test and the control group was statistically significant (Fisher's test, P < 0.001). It is concluded that Lyral at the current usage levels is inducing sensitization in the community. The same levels were shown to elicit allergic contact dermatitis in almost all sensitized individuals. A significant reduction in usage concentrations is recommended to prevent contact allergic reactions.
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Heydorn S, Menné T, Andersen KE, Bruze M, Svedman C, Basketter D, Johansen JD. The fragrance hand immersion study - an experimental model simulating real-life exposure for allergic contact dermatitis on the hands. Contact Dermatitis 2003; 48:324-30. [PMID: 14531871 DOI: 10.1034/j.1600-0536.2003.00145.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Recently, we showed that 10 x 2% of consecutively patch-tested hand eczema patients had a positive patch test to a selection of fragrances containing fragrances relevant to hand exposure. In this study, we used repeated skin exposure to a patch test-positive fragrance allergen in patients previously diagnosed with hand eczema to explore whether immersion of fingers in a solution with or without the patch-test-positive fragrance allergen would cause or exacerbate hand eczema on the exposed finger. The study was double blinded and randomized. All participants had a positive patch test to either hydroxycitronellal or Lyral (hydroxyisohexyl 3-cyclohexene carboxaldehyde). Each participant immersed a finger from each hand, once a day, in a solution containing the fragrance allergen or placebo. During the first 2 weeks, the concentration of fragrance allergen in the solution was low (approximately 10 p.p.m.), whilst during the following 2 weeks, the concentration was relatively high (approximately 250 p.p.m.), imitating real-life exposure to a household product like dishwashing liquid diluted in water and the undiluted product, respectively. Evaluation was made using a clinical scale and laser Doppler flow meter. 3 of 15 hand eczema patients developed eczema on the finger immersed in the fragrance-containing solution, 3 of 15 on the placebo finger and 3 of 15 on both fingers. Using this experimental exposure model simulating real-life exposure, we found no association between immersion of a finger in a solution containing fragrance and development of clinically visible eczema on the finger in 15 participants previously diagnosed with hand eczema and with a positive patch test to the fragrance in question.
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Svedman C, Bruze M, Johansen JD, Andersen KE, Goossens A, Frosch PJ, Lepoittevin JP, Rastogi S, White IR, Menné T. Deodorants: an experimental provocation study with hydroxycitronellal. Contact Dermatitis 2003; 48:217-23. [PMID: 12786728 DOI: 10.1034/j.1600-0536.2003.00094.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Axillary dermatitis is a common problem, particularly in individuals with contact allergy to fragrances. Many individuals suspect their deodorant to be the causal product of their fragrance allergy. It has been shown that deodorants containing cinnamic aldehyde (cinnamal) can elicit axillary dermatitis in patients sensitized to this substance. The aim of the present investigation was to evaluate the importance of hydroxycitronellal used in deodorants for the development of axillary dermatitis, when applied by individuals with and without contact allergy to this fragrance chemical. Patch tests with deodorants and ethanolic solutions containing hydroxycitronellal, as well as repeated open application tests (ROAT) with roll-on deodorants with and without hydroxycitronellal at different concentrations, were performed in 14 dermatitis patients, 7 with and 7 without contact allergy to hydroxycitronellal. A positive ROAT was noted only in the patients hypersensitive to hydroxycitronellal (P < 0.001) and only in the axilla to which the deodorants containing hydroxycitronellal had been applied (P < 0.001). Deodorants containing hydroxycitronellal in the concentration range of 0.032-0.32% used twice daily on healthy skin in individuals hypersensitive to hydroxycitronellal can elicit axillary dermatitis in a few weeks.
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Svedman C, Petersen CS. [Increased occurrence of gonorrhea in Copenhagen]. Ugeskr Laeger 2000; 162:3472. [PMID: 10918834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
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Svedman C, Samra JS, Clark ML, Levy JC, Frayn KN. Skin mini-erosion technique for monitoring metabolites in interstitial fluid: its feasibility demonstrated by OGTT results in diabetic and non-diabetic subjects. Scand J Clin Lab Invest 1999; 59:115-23. [PMID: 10353325 DOI: 10.1080/00365519950185841] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
The aim of this study was to evaluate a new interstitial fluid (IF) sampling technique and its application in diabetology. IF and venous whole blood were sampled serially during an oral glucose tolerance test (OGTT) on days 1 and 3 after formation of a mini-erosion in eight non-diabetic controls and eight Type 2 diabetic subjects. Glucose, lactate, glycerol, 3-hydroxybutyrate and insulin were assayed in IF and plasma. With solitary exceptions, the IF sample volumes were in excess of those required for measurement of all five substances. However, mean IF sampling rates differed significantly both between the non-diabetic and diabetic groups and between days 1 and 3 (p < 0.001 in all cases). In both groups, the OGTT curves of glucose, glycerol and 3-hydroxybutyrate were similar to the respective curves for plasma, whereas for lactate concentrations they were markedly greater in IF than in plasma (40% and 93% in the control group and 57% and 100% greater in the diabetic group on days 1 and 3, respectively). The reverse was true of insulin concentrations in the non-diabetic group, which were 57% and 74% lower in IF than in plasma on days 1 and 3, respectively. In the non-diabetic group, the baseline (pre-OGTT) insulin level in IF increased from 49 +/- 22% (SD) of that in plasma on day 1 to 74 +/- 19% of that in plasma on day 3 (p=0.005). Sampling site re-epithelialization was rapid. In conclusion, the feasibility of transdermal sampling of IF via a skin mini-erosion has been demonstrated in both diabetic and non-diabetic subjects.
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Svedman C, Cherry GW, Ryan TJ. The veno-arteriolar reflex in venous leg ulcer patients studied by laser Doppler imaging. Acta Derm Venereol 1998; 78:258-61. [PMID: 9689291 DOI: 10.1080/000155598441819] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Posture-induced microcirculatory changes in the lower leg were studied in venous leg ulcer patients and in control subjects by means of laser Doppler imaging (LDI), a technique which allows almost real-time mapping of the perfusion from a distance, each perfusion value constituting the mean of a number of measurements at separate sites. LDI values for intact skin with the subject supine were 0.39 (0.32, 0.47) V [geometric mean (gm -SD, gm +SD)] and 0.32 (0.15, 0.70) V in two age groups of controls and 0.91 (0.66, 1.24) V in patients (NS). Values were 2.04 (1.25, 3.35) V for skin at the ulcer margin, and 1.44 (0.72, 2.88) V in the ulcer proper. With the lower leg passively dependent, lower LDI values were obtained at all sites in all groups, the reduction in intact skin value being 62 +/- 11% (arithmetic mean +/- SD) (p < 0.01) in the younger controls, 43 +/- 24% (p < 0.01) in the older controls and 62 +/- 19% (p < 0.001) in the patient group, and the reduction in ulcer values being 45 +/- 27% (p < 0.05) for the margin and 52 +/- 23% (p < 0.001) for the ulcer proper. Thus, a high degree of postural vasoconstriction was present overall, even in the ulcer itself. Vasomotor tone in the skin of the lower leg was assessed by topical application of methyl nicotinate, a vasodilator. The skin perfusion value (supine position, no stimulus) was 71 +/- 31% (p < 0.01) of the drug-induced (assumed peak) hyperaemia value [0.60 (0.30, 1.10) V] in patients and 24 +/- 25% (p < 0.001) of the hyperaemia value (1.30 (0.64, 2.62) V] in the controls. It would appear that in ulcer patients the veno-arteriolar reflex, despite being comparable in magnitude to that in controls, may nonetheless be insufficient to reduce tone during dependency to a level similar to that in healthy controls.
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Svedman P, Svedman C. Skin mini-erosion sampling technique: feasibility study with regard to serial glucose measurement. Pharm Res 1998; 15:883-8. [PMID: 9647354 DOI: 10.1023/a:1011924631680] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PURPOSE To describe a dermally non-invasive serial sampling technique and to test its clinical feasibility with regard to glucose measurement. METHODS A standardized skin mini-erosion devoid of the epidermal barrier, and covered by an artificial one, was formed by a suctioning technique. Interstitial fluid (IF) was extracted serially by brief application of negative pressure, and its glucose content compared with that in capillary or venous blood samples. RESULTS The procedure caused no discomfort. The epidermis regenerated rapidly after experimentation. There were no complications. In non-diabetic subjects (n = 13) the mean of all IF values measured daily for 6 days was 6.2 +/- 0.1 mmol/l (+/-SE). The corresponding capillary blood glucose value was 5.6 +/- 0.1 mmol/l, and the venous glucose value was 5.4 +/- 0.1 mmol/l. The differences between IF glucose values and invasive control values remained within narrow limits throughout. The 2SD limits of agreement for the differences were 1.44 mmol/l (IF vs. capillary blood samples) and 1.76 mmol/l (IF vs venous samples) respectively. The OGTT curves suggested glucose kinetics to be similar in IF and in capillary blood. In diabetic subjects, the mean of IF values determined serially during one day was 15.3 +/- 1.0 mmol/l (range, 6.7-21.8 mmol/l), and the corresponding mean capillary value was 12.0 +/- 0.9 mmol/l (range, 3.3-17.2 mmol/l). The ICC for all paired photometric observations was 0.948. CONCLUSIONS The results suggest the new sampling technique to be a feasible approach for clinical and experimental purposes. A functionally integrated sampling patch is entering the clinical testing stage.
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Svedman C, Cherry GW, Strigini E, Ryan TJ. Laser Doppler imaging of skin microcirculation. Acta Derm Venereol 1998; 78:114-8. [PMID: 9534888 DOI: 10.1080/000155598433430] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Laser Doppler imaging (LDI), a new technique which allows measurement of skin blood perfusion at a distance from the skin surface, was assessed methodologically in healthy volunteers. Each skin LDI value was based on virtually real-time measurements obtained from a number of discrete measuring sites. In scans made along the circumference of the lower arm, valid figures for LDI (as distinct from no output at all) were obtained in 8/8 measurements at 0 degrees inclination, and in 16/16 measurements at 7 degrees, 14 degrees, 22 degrees, 30 degrees and 38 degrees, respectively. Beyond this inclination a numerical output was obtained in only 9/16 of measurements at an inclination of 48 degrees, in 7/16 at 69 degrees, and in no more than 1/16 at 90 degrees. Values obtained at angles of inclination greater than 38 degrees fell within the relatively narrow range of values obtained at lesser angles of inclination. The findings are of interest since measuring sites of clinical importance may not be flat. Variability of measurement (coefficient of variation in per cent) was studied in the lower leg by performing LDI and conventional laser Doppler flowmetry (LDF) concomitantly. The coefficient of variation for measurements in one subject at rest was 13% for LDI vs. 19% for LDF, the corresponding interindividual coefficient of variation values being 25% vs. 28%. In response to heating, finger pulp perfusion increased by 55% as measured by LDI (p = 0.0051) and by 44% (p = 0.0756) as measured by LDF. In summary, the findings contribute to the validation of LDI for skin perfusion measurement.
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