Nystatin allergy. Petrolatum is not the optimal vehicle for patch testing

Testing with various bases in a case of contact allergy to nystatin showed that polyethylene glycol is preferable to petrolatum as a test vehicle. The literature on nystatin allergy is reviewed.

Batch variations

One of the basic principles in the investigation of suspected contact dermatitis is always to test with the patient's "own" product or chemical, the one to which he or she was actually exposed. An equally basic second principle is not to rely solely on a positive test reaction. The author discusses a case of contact dermatitis involving only certain batches of a particular branded product.

Long-lasting contact urticaria. Type I and type IV allergy from castor bean and a hypothesis of systemic IgE-mediated allergic dermatitis

A unique urticarial type I patch-test reaction to castor bean that persisted for more than 48 hours and was followed by a delayed type IV reaction is described. Immunohistochemical and electron microscopic observations indicated involvement of eosinophils and IgE receptors on Langerhans' cells. The authors present a scheme for the role of Langerhans' cells in skin allergy.

Production of hapten-specific T cell hybridomas and their use to study the effect of ultraviolet B irradiation on the development of contact hypersensitivity

We produced a series of T cell hybridomas that produce IL-2 when cultured with syngeneic APC coupled to FITC or TNP. These hybridomas are hapten specific and Ia restricted. The hybridomas were used to detect hapten-bearing APC in draining lymph nodes of mice sensitized with trinitrochlorobenzene or FITC in vivo. Hapten-bearing APC capable of stimulating the hybridomas were detectable in draining lymph nodes of hapten-painted mice within 3 h after sensitization. The ability of lymph node APC to stimulate the hybridomas peaked at 24 h and declined by 48 h. The dendritic cell subpopulation was the subpopulation of cells that were found in the regional lymph nodes of hapten-painted animals that were capable of stimulating the hybridomas to produce IL-2. Prior treatment of the skin with low dose UVB irradiation before epicutaneous application of contact sensitizers significantly reduced the capacity of hapten-bearing APC to stimulate the hybridomas. This observation was corroborated by results obtained from flow microfluorometry analysis of lymph node cells from FITC-sensitized mice. Lymph node dendritic cells obtained from FITC-painted mice contain a brightly staining group of cells by flow microfluorometry analysis. Lymph node dendritic cells from FITC-painted, UVB-irradiated mice did not contain this brightly staining population. These results indicate that low dose, local UVB irradiation may affect APC migration and/or function. We believe that these hybridomas will prove to be useful tools in the study of the development and regulation of contact hypersensitivity.

Dendritic cells in contact sensitivity

Bone-marrow-derived DC, passing through the skin or residing there as LC, acquire antigen following epicutaneous exposure to contact sensitizer. They move as veiled cells in the afferent lymphatics and migrate to draining lymph nodes, where they become interdigitating cells of the paracortex. Here they initiate T-cell responses; the cytotoxic T cells and antibody formation which develop may be able to target on DC as well as other antigen-bearing cells, so producing feed-back mechanisms to switch off immune responses. Additional features include a systemic effect which leads to movement of DC without antigen into lymph nodes. What are the signals leading to this movement and what is its significance? There is evidence for synergy between directly haptenated DC and DC not directly acquiring antigen. How does this occur and how important is this effect in ensuring the potency of DC in presenting contact sensitizer to T cells? What is the importance of antigen processing by LC? Finally, dendriform cells which may be of T-cell origin are also present in the skin. What is their role in modulating the development of contact sensitivity?

Aspects of the immune response to contact allergens: opportunities for the development and modification of predictive test methods

A variety of guinea-pig tests are currently employed to assess the skin-sensitizing potential of chemicals. Although some such tests, in particular the guinea-pig maximization test and the occluded patch test of Buehler, have become well established, widely applied and are of proven value in the safety evaluation of chemicals, they have certain limitations. It is the purpose of this review to examine various aspects of the immune response to contact allergens and the way in which an understanding of the molecular and cellular events that characterize the induction and elicitation of contact sensitivity may be applied to the development and modification of predictive test methods. Attention is focused on the role of dendritic cell migration and T lymphocyte activation during the induction phase of skin allergy and the association of acute-phase proteins and vasoactive amines with the elicitation reaction.

Alpha-melanocyte stimulating hormone modulates contact hypersensitivity responsiveness in C57/BL6 mice

The neuropeptide alpha-melanocyte stimulating hormone (alpha-MSH) can act as an antagonist to interleukin 1 (IL-1) bioactivities such as inhibition of fever production, thymocyte proliferation, and inhibition of release of acute phase inflammatory molecules from the liver. In this report we have found that epicutaneous application of alpha-MSH suppresses both the sensitization and elicitation limbs of the cutaneous immune response (CIR) to potent contact sensitizers like dinitrofluorobenzene (DNFB) or oxazalone (OX) in mice. Further, the loss of contact hypersensitivity due to applications of alpha-MSH could be reconstituted by either intradermal or intravenous injections of epidermal thymocyte activating factor (ETAF)/interleukin-1. Topical application of alpha-MSH did not cause an alteration in Ia+ dendritic cells (i.e., Langerhans cells) but did produce a significant reduction in the expression of Thy1.2 marker on the Thyl+ dendritic epidermal cells (Thy1+DEC). It has no effects on the phenotypic expression of asialo GM-1 on these same cells. These observations suggest that alpha-MSH, a peptide classically isolated from the pituitary but found in many other tissues and cells of the body, may represent an additional biologic modifier than can modulate suppression of the contact hypersensitivity responses to various haptens. However, the mechanisms by which alpha-MSH or potentially other peptides found in the skin produce these suppressive effects have not been elucidated.

T lymphocytes, Langerhans cells and HLA-DR expression on keratinocytes in oral lesions associated with amalgam restorations

It has been shown recently that patients with mucosal lesions confined to areas opposing amalgam restorations (contact lesions) show a high rate of allergic reaction towards mercury. These lesions may, therefore, represent a contact hypersensitivity reaction. Contact lesions often have a lichenoid appearance. From a pathogenetic and differential diagnostic point of view we therefore evaluated the presence of lymphocyte subpopulations, Langerhans cells (LC) and the expression of HLA-DR antigens on mucosal keratinocytes in biopsies of contact lesions (Group 1) and in lichen planus lesions with (Group 2) and without (Group 3) partial contact with amalgam restorations. T lymphocytes dominated in all three groups and LC counts were similar. HLA-DR positive keratinocytes were found in 18-36% of lesions in all three groups. Thus, the immunologic parameters examined are not of value in discriminating between the types of lesions studied. Rather, it seems that the pattern observed is a common reaction of the oral mucosa to known (amalgam restorations) and unknown factors.

Antigen-presenting cells in the induction of contact hypersensitivity in mice: evidence that Langerhans cells are sufficient but not required

One explanation for the fact that certain genetically defined strains of mice prove to be resistant to effects of low dose ultraviolet B radiation on the induction of contact hypersensitivity is that ultraviolet B resistant mice possess a second pathway for antigen presentation through the skin--a pathway that is independent of epidermal Langerhans cells and beyond the reach of the damaging effects of ultraviolet B light. As a corollary, ultraviolet-B susceptible mice would be expected to be deficient in this pathway. Several experimental strategies were employed to determine whether Langerhans cells are required for the induction of contact hypersensitivity by epicutaneously applied hapten. The results reveal that tape-stripped skin supports the induction of contact hypersensitivity, whereas surgical excision of hapten-painted skin within 1 h of application fails to permit the development of contact hypersensitivity. Because the former selectively eliminates epidermal Langerhans cells while the latter deletes both Langerhans cells and dermal antigen-presenting cells, we conclude that either Langerhans cells or dermal cells are sufficient to provide antigen presentation in the induction of contact hypersensitivity. When large amounts of hapten are painted epicutaneously, or when hapten is injected subcutaneously or painted on sub-dermal tissues, contact hypersensitivity also results, indicating that induction of contact hypersensitivity does not require that antigen processing and presentation be provided by cutaneous cells. Reasons are presented for concluding that under physiologic circumstances induction of contact hypersensitivity by epicutaneous hapten application relies primarily upon the antigen-presenting capabilities of epidermal (Langerhans cells) and dermal cells.

Identification of the molecular target for the suppression of contact hypersensitivity by ultraviolet radiation

This study was conducted to explore the involvement of DNA damage in the suppression of contact hypersensitivity (CHS) by UV irradiation. The opossum, Monodelphis domestica, was used because cells of these marsupials have an enzyme that is activated by visible light (photoreactivating enzyme) and repairs ultraviolet radiation (UVR)-induced pyrimidine dimers in DNA. A single dose of 1,500 J/m2 of UVB (280-320 nm) radiation, representing 2 minimal erythema doses, was administered to the dorsal skin of opossums. This treatment prevented the opossums from developing a CHS response to dinitrofluorobenze (DNFB) applied either at the site of irradiation or an unirradiated site. In addition, this dose of UVR decreased the number of ATPase+ epidermal Langerhans cells in the dorsal epidermis to approximately 3% of that in unirradiated skin at the time of DNFB application. Treatment of the animals with wavelengths that activate the repair enzyme (320-500 nm, photoreactivating light, PRL) for 120 min immediately after UV irradiation inhibited the UVR-induced suppression of CHS almost completely. Exposure to PRL before UVR did not prevent UVR-induced suppression of CHS. PRL treatment after UV irradiation also prevented the decrease in the number of ATPase+ Langerhans cells. Measurements of lesions in DNA indicated that PRL treatment removed around 85% of the UVR-induced pyrimidine dimers. These data provide direct evidence that DNA, and most likely, the pyrimidine dimer, is the primary molecular target for the UVB-induced suppression of contact hypersensitivity to haptens applied to irradiated or unexposed skin.

Antigen-specific inhibition of IL-2 and IL-3 production in contact sensitivity to TNP

The production of IL-2 and IL-3 by T cells from mice which had been contact sensitized to TNP and/or tolerized by intravenous injections of TNBS was assayed. Contact sensitization rapidly primes T cells, so that they respond to in vitro restimulation with haptenated syngeneic cells by producing IL-2 and IL-3. This production is strongly inhibited, in an antigen-specific manner, in tolerized mice. At least part of this inhibition can be attributed to the action of suppressor T cells that act by preventing the activation of lymphokine production in vitro. Lymphokine production thus closely parallels the in vivo delayed-type hypersensitivity (DTH) reaction in this system.

Role of the fourth complement component (C4) in the regulation of contact sensitivity. III. In vivo effect of purified C4

Lymph node cells obtained from CBA/J mice 4 days after painting with contact sensitizing agents such as picryl chloride or oxazolone ("4-day" cells), induce contact sensitivity into naive recipient mice by membrane-associated immunocomplexes. This immunizing capacity is abolished after incubation of the cells in serum from mice with high C4 levels (C4H), but not in serum from mice with low C4 levels (C4L), and the inhibitory activity of C4H serum is due to the activation of the early components of the classical complement pathway. The presence of 4-day cells depends on C4 levels: in fact, C4H mice lack these cells because they activate their own complement in vivo, whereas C4L mice fail to activate complement in vivo and possess 4-day cells. CBA/J (C4L) mice injected with purified C4 preparations from the C4H mice BALB/c, lose 4-day cells and show a short-term contact-sensitivity reaction, exactly as BALB/c mice, thus indicating that C4 levels play a role in the control of contact-sensitivity reaction to simple chemical haptens.

The role of contact allergy to aeroallergens in atopic dermatitis

In some patients with atopic dermatitis (AD), delayed-type allergy to aeroallergens, such as house dust mite, can be demonstrated by patch testing. Positive patch tests can be expected only in patients with AD and, in them, only to aeroallergens to which type 1 reactions have also been demonstrated. In an as yet unknown number of such cases, aeroallergens appear to play a role in AD. Studies to date have varied too widely in experimental method and design to allow more definite conclusions to be drawn. It is essential that future studies are standardised with regard to patch test system and designed to include adequate controls and assessment of relevance.

The immunologic basis of patch testing

During the past decade much has been learned about the cell-mediated immune responses that result in allergic contact dermatitis. The complex interaction between the hapten, the Langerhans cell, the specifically sensitized T cell, and the various soluble mediators of cellular immunity have begun to be delineated. This article reviews the pathophysiology of allergic contact dermatitis. Clinical and physicochemical modulators of this response, such as patient age, the anatomic site of antigenic challenge, and prior treatment with UVB, PUVA, glucocorticoids, or cyclosporine (Cyclosporin A), are stressed. The implications of these findings to the techniques of patch testing are summarized.

Inhibition of cutaneous contact hypersensitivity by calcium transport inhibitors lanthanum and diltiazem

Epidermal Langerhans cells (ELC) are bone marrow-derived immune cells that are important in allergic contact dermatitis. We examined the influence of calcium transport inhibitors, lanthanum and diltiazem hydrochloride, on allergic contact dermatitis induced by 1-chloro-2,4-dinitrobenzene (DNCB) in BALB/c mice. Systemic lanthanum at a dose of 0.08 mg/kg and topical lanthanum (50 microliters of 10% solution) were given 5 d before DNCB sensitization. Systemic diltiazem (30 mg/kg per dy) was given for 3 d during sensitization with DNCB. In all animals, challenge with topical DNCB to the ear skin was performed 5 d after sensitization and ear swelling was measured. Twenty four hours post-DNCB challenge, animals receiving systemic lanthanum demonstrated a 56% decrease in contact hypersensitivity (ear swelling) compared with non-lanthanum-treated animals (0.08 +/- 0.03 mm vs 0.18 mm +/- 0.02 mm, p less than 0.01). Topical lanthanum produced a 58% decrease in contact hypersensitivity (0.20 +/- 0.02 mm vs 0.41 +/- 0.03 mm, p less than 0.01). The DNCB-induced ear swelling also resolved more quickly in animals treated with lanthanum. Systemic diltiazem produced a 67% decrease in ear swelling (0.05 +/- 0.01 mm vs 0.15 +/- 0.02 mm, p less than 0.001). A decrease in epidermal Langerhans cell density of 13 to 14% was produced by systemic lanthanum, detected by both ATPase staining and Ia staining, respectively (p less than 0.05). Approximately 20% of the Langerhans cells were morphologically abnormal, having become "rounded," and lacking normal dendritic processes. From these results, we infer that calcium transport across the cell membrane of ELC may be important in the regulation of their function. Lanthanides and other calcium-channel blockers may be useful pharmacologic agents to probe these phenomena.

[Antigen presenting cells and T lymphocytes in the induction phase of contact hypersensitivity]

When a sensitizing substance that induces contact hypersensitivity, fluorescein isothiocyanate (FITC), was painted on abdominal skin of mice, FITC+ cells appeared in the inguinal lymph node after 24 hours. The FITC+ cell in the lymph node was relatively large in size, and it did not appear to be a T lymphocyte. When FITC was painted on either murine tail skin or skin pre-treated by tape stripping, the number of FITC+ cells in the inguinal lymph node was significantly less than that in the positive control. In the mesenteric lymph nodes, which have a different lymph flow from that of the skin regional lymph node, FITC+ cells did not increase in number, and the few FITC+ cells were not significantly different in number among above-mentioned experimental systems. In the inguinal lymph nodes on the 4th day after painting of picryl chloride (PCl) on the abdominal skin of mice, L3T4+ cells, which expressed an interleukin 2 receptor (IL-2R), increased in number. On the other hand, when PCl was painted on either tail skin or skin treated by tape stripping, L3T4+ IL-2R+ cells did not increase in the skin regional lymph nodes. The number of L3T4+ IL-2R+ cells in the mesenteric lymph nodes did not increase in any of the experimental systems mentioned above. These results suggest some relationship between antigen presenting cells and T lymphocytes, as well as one between the skin and the regional lymph nodes, in an induction phase of sensitization in contact hypersensitivity.

Calgranulin expression in inflammatory dermatoses

We have used monoclonal antibodies to study the expression of calgranulins by keratinocytes in inflammatory dermatoses. Calgranulins are intracellular calcium binding proteins which have inflammatory cytokine activity and are composed of at least two different chains, calgranulin A and B. Antibody CF 145 and CF 557 identify calgranulin A and B, respectively. MAC 387 recognizes a molecule probably containing both calgranulins. Keratinocytes in normal skin did not contain these molecules. The keratinocytes in 52 cases of different inflammatory dermatoses showed expression of both calgranulin chains in lesional but not in non-lesional skin. Keratinocytes in inflammatory dermatoses therefore express an intracellular calcium binding protein which has cytokine activity.

Peripheral lymph node helper T-cell recovery after syngeneic bone marrow transplantation in mice prepared with either gamma-irradiation or busulfan

The optimum marrow ablative regimen for preparing recipients of bone marrow transplantation (BMT) has not been established. gamma-Irradiation, but not busulfan, produces a characteristic microvascular injury pattern which results in depressed capacity of normal lymphocytes to localize into the lymph nodes of syngeneic murine BMT recipients. Since peripheral lymph nodes are important sites for initiation and amplification of immune responses, the preparative regimen might delay recovery of regionally compartmentalized immune functions after BMT. We evaluated the effects of busulfan and gamma-irradiation on the phenotypic and functional reconstitution of helper T-cell function within the peripheral lymph nodes of BMT recipients. Both marrow ablative regimens caused a protracted delay in regeneration of peripheral lymph node CD4+ T cells. Specific helper T-cell functions, such as contact hypersensitivity and alloantigen responses, remained significantly depressed in the lymph nodes of irradiated mice for prolonged periods (up to 60 weeks). These responses recovered more rapidly in busulfan-treated BMT recipients. In contrast, the capacity of peripheral lymph node T cells to provide "help" for antigen-specific immunoglobulin production was only transiently depressed by either preparative regimen. Our experiments confirm the hypothesis that the marrow ablative regimen, particularly gamma-irradiation, may contribute to the period of immunodeficiency which follows BMT. The pattern of immune recovery observed suggests that preparative total body irradiation (TBI) may selectively depress the regional recovery of the TH1 [interleukin-2 (IL-2) and gamma-interferon (gamma-IFN) secreting] lymphocyte subset.

Increased contact hypersensitivity response in mice by topical application of 1 alpha,25-dihydroxyvitamin D3 to elicitation site

Recent evidence indicates that the biologically active metabolite of vitamin D3, 1 alpha,25-dihydroxyvitamin D3 [1 alpha,25(OH)2D3], has an effect on the regulation of the immune response. We investigated whether topical treatment of mice with 1 alpha,25(OH)2D3 influences the contact hypersensitivity (CHS) response to trinitrochlorobenzene (TNCB). 1 alpha,25(OH)2D3 was applied to the dorsal trunk of A/J mice on days 0-3, and on day 4 topical application of 5% TNCB on the 1 alpha,25(OH)2D3-treated site was performed. The mice were tested for CHS on day 10 by applying 1% TNCB to the ears. No effect on induction of CHS response to TNCB was observed in 1 alpha,25(OH)2D3-treated mice compared with 24,25-dihydroxyvitamin D3[24,25(OH)2D3]-treated mice as control. In a second experiment, the dorsal trunk of A/J mice was treated with 5% TNCB on day 0. The topical application of 1 alpha,25(OH)2D3 on the ears was performed from days 2 to 5. On day 6, the mice were tested for CHS by applying 1% TNCB to the 1 alpha,25(OH)2D3-treated ears. When 1 alpha,25(OH)2D3 was administered to the elicitation site prior to the challenge, pretreatment of mice with 1 alpha,25(OH)2D3 increased their response to TNCB by 40% compared with 24,25(OH)2D3-treated mice as control (P less than 0.01). There were no findings suggesting that the pretreatment of the challenge site with 1 alpha,25(OH)2D3 induced an irritant dermatitis that was superimposed on a subsequent CHS reaction. The 1 alpha,25(OH)2D3 modulation of CHS response to TNCB in mice suggests that the hormone may play a role in the regulation of the immune response in vivo.

Allergic contact dermatitis resulting from sensitivity to citrus peel, geraniol, and citral

A bartender with hand dermatitis had allergic contact sensitivity to the skin of lemon, lime, and orange but not to their juices. Although most reported cases of citrus peel allergy are due to d-limonene, for our patient, reactions to patch tests for geraniol and citral, two minor components of citrus peel oil, were positive, whereas those for d-limonene were negative. Contact allergy to citrus peel oil should be considered in patients with hand dermatitis who are occupationally exposed to citrus fruits.