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Andre N, Usher A, Ofri M, Kilimnik V, Horev A. Examining the benefits of extended patch test series in children: a comprehensive analysis. Int J Dermatol 2024. [PMID: 38411217 DOI: 10.1111/ijd.17103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 02/03/2024] [Accepted: 02/07/2024] [Indexed: 02/28/2024]
Abstract
INTRODUCTION The growing presence of allergens in materials and scarce data on allergic contact dermatitis in children has increased our need to refine its diagnosis in this population. We aimed to analyze children's specific responsivity to highly reactive subcomponents of Fragrance mix I, Fragrance mix II, and Textile dye mix from the European baseline series. METHODS We retrospectively analyzed patch test records of children aged 2 to 18 who underwent patch testing with the European baseline series between 2014 and 2022 in Israel. RESULTS A total of 367 children were included in the study. In all, 160 children had positive results; 43 patients reacted to one of the mixes, and 20 performed further testing. Eleven of them completed the extended series at the exact same times as the regular European series, which benefited children. Farnesol was the most reactive compound (30.8%). CONCLUSIONS Performing the extended European series provides a more accurate and time-efficient allergic contact dermatitis diagnosis. Farnesol reactivity appears prominent in children and may justify tighter product regulations.
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Affiliation(s)
- Nicolas Andre
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Alisa Usher
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
- Pediatrics Department, Soroka University Medical Center, Beer Sheva, Israel
| | - Mai Ofri
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
- Clinical Research Center, Soroka University Medical Center, Beer-Sheva, Israel
| | | | - Amir Horev
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
- Pediatric Dermatology Service, Soroka University Medical Center, Beer Sheva, Israel
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Abstract
Significance: Healthy skin provides a barrier to contaminants. Breaches in skin integrity are often encountered in the patient health care journey, owing to intrinsic health issues or to various procedures and medical devices used. The time has come to move clinical practice beyond mere awareness of medical adhesive-related skin injury and toward improved care and outcomes. Recent Advances: Methods developed in research settings allow quantitative assessments of skin damage based on the measurement of baseline skin properties. These properties become altered by stress and over time. Assessment methods typically used by the cosmetic industry to compare product performance could offer new possibilities to improve clinical practice by providing better information on the status of patient skin. This review summarizes available skin assessment methods as well as specific patient risks for skin damage. Critical Issues: Patients in health care settings may be at risk for skin damage owing to predisposing medical conditions, health status, medications taken, and procedures or devices used in their treatment. Skin injuries come as an additional burden to these medical circumstances and could be prevented. Technology should be leveraged to improve care, help maintain patient skin health, and better characterize functional wound closure. Future Directions: Skin testing methods developed to evaluate cosmetic products or assess damage caused by occupational exposure can provide detailed, quantitative information on the integrity of skin. Such methods have the potential to guide prevention and treatment efforts to improve the care of patients suffering from skin integrity issues while in the health care system.
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Affiliation(s)
- Stéphanie F. Bernatchez
- 3M Health Care, St. Paul, Minnesota, USA.,Correspondence: 3M Health Care, St. Paul, MN 55144-1000, USA
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Incidence and risk factor of allergic contact dermatitis to 2-octyl cyanoacrylate and n-butyl cyanoacrylate topical skin adhesives. Sci Rep 2021; 11:23762. [PMID: 34887494 PMCID: PMC8660909 DOI: 10.1038/s41598-021-03319-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 11/22/2021] [Indexed: 01/18/2023] Open
Abstract
Although the use of topical skin adhesives has increased as an alternative to conventional skin closure methods, studies on the incidence and risk factors of allergic contact dermatitis (ACD) to topical skin adhesives have been limited. The purpose of this study was to investigate the incidence and risk factors of ACD after the use of 2-octyl cyanoacrylate and n-butyl cyanoacrylate topical skin adhesives. We retrospectively reviewed 1145 patients (739 patients with 2-octyl cyanoacrylate and 406 patients with n-butyl cyanoacrylate) who underwent skin closure with topical skin adhesives. Variables suspected to correlate with ACD were retrieved from medical records and analyzed to determine risk factors. The incidence of ACD from the use of 2-octyl cyanoacrylate and n-butyl cyanoacrylate topical skin adhesives was 2.7% and 2.2%, respectively. There was no statistically significant difference in the incidence between the two ingredients. In logistic regression analysis, none of the variables were found to increase the risk of ACD in both 2-octyl cyanoacrylate and n-butyl cyanoacrylate topical skin adhesives. As ACD occurs without risk factors in 2-3% of patients who used 2-octyl cyanoacrylate or n-butyl cyanoacrylate topical skin adhesives, clinicians and patients should be aware of these facts before using topical skin adhesives.
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Park J, Lee JW, Kim SH, Oh J, Roh WS, Kim SM, Park CO, Lee MG, Kim TG. Type 2 immunity plays an essential role for murine model of allergic contact dermatitis with mixed type 1/type 2 immune response. J Dermatol Sci 2021; 104:122-131. [PMID: 34763990 DOI: 10.1016/j.jdermsci.2021.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 09/24/2021] [Accepted: 10/03/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Both human and mouse allergic contact dermatitis (ACD) frequently demonstrates a combined type 1 and type 2 immune response. However, the relative importance of type 2 immunity in this setting has been incompletely understood yet. OBJECTIVE To explore an effector function of type 2 immunity in ACD with mixed type 1/type 2 immune response. METHODS Gene expression characteristics of contact hypersensitivity (CHS) model was examined by quantitative polymerase chain reaction. Cytokine profile of T cells was analyzed by flow cytometry. The involvement of type 2 immunity was assessed by antibody-mediated cytokine neutralization and cell depletion. The role of specific subset of cutaneous dendritic cells was evaluated using diphtheria toxin-induced cell-depleting mouse strains. RESULTS Oxazolone-induced CHS revealed a combination of type 1/type 2 gene expression. The severity of oxazolone-induced CHS was ameliorated by neutralization of IL-4 but not of IFN-γ, indicating that type 2 immunity plays a dominant effector function in this mixed type 1/type 2 model. Mechanistically, type 2 effector immunity was mounted by CD301b+Langeirn- dermal dendritic cells in part through thymic stromal lymphopoietin-interleukin 7 receptor alpha signaling-dependent manner. CONCLUSION Our findings suggest the clinical rationale for targeting type 2 immunity as a relevant therapeutic strategy for the mixed immune phenotype of ACD.
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Affiliation(s)
- Jeyun Park
- Department of Dermatology, Severance Hospital, Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea; Brain Korea 21 FOUR Project for Medical Science, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jae Won Lee
- Department of Dermatology, Severance Hospital, Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sung Hee Kim
- Department of Dermatology, Severance Hospital, Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jongwook Oh
- Department of Dermatology, Severance Hospital, Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Won Seok Roh
- Department of Dermatology, Severance Hospital, Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Soo Min Kim
- Department of Dermatology, National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea
| | - Chang Ook Park
- Department of Dermatology, Severance Hospital, Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea; Brain Korea 21 FOUR Project for Medical Science, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Min-Geol Lee
- Department of Dermatology, Severance Hospital, Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea.
| | - Tae-Gyun Kim
- Department of Dermatology, Severance Hospital, Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea; Institute for Immunology and Immunological Diseases, Yonsei University College of Medicine, Seoul, Republic of Korea.
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Artounian K, Hamann D. Handheld x-ray fluorescence spectroscopy evaluation of leather chromium and cobalt. Occup Med (Lond) 2021; 71:298-300. [PMID: 34455439 DOI: 10.1093/occmed/kqab122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
We present a 29-year-old non-atopic male apprentice power lineman and recreational cowboy with a case of allergic contact dermatitis due to both occupational and recreational exposure. He presented with a 4-month history of a pruritic, steroid-responsive, intermittent hand, foot and leg dermatitis. Patch testing was positive for chromium, cobalt and a piece of leather from his cowboy boots. His leather work gloves, inner lining of work harness, work boots and cowboy boots were assessed for chromium and cobalt content with handheld fluorescence x-ray spectrometry. Upon replacement of all leather items including the items tested and his leather cowboy saddle, the rash resolved. This case demonstrates the clinical relevance of using a handheld fluorescence x-ray spectrometer to assess for chromium and leather content.
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Affiliation(s)
- K Artounian
- University of Arizona College of Medicine-Phoenix, Phoenix, AZ, USA
| | - D Hamann
- Contact Dermatitis Institute, Phoenix, AZ, USA
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Olusegun OA, Martincigh BS. Allergic contact dermatitis: a significant environmental and occupational skin disease. Int J Dermatol 2021; 60:1082-1091. [PMID: 33710640 DOI: 10.1111/ijd.15502] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 02/04/2021] [Accepted: 02/10/2021] [Indexed: 12/01/2022]
Abstract
This review article seeks to provide an overview of allergic contact dermatitis (ACD) as a significant environmental and occupational skin disease, the phases of ACD, its causes from the occupational and environmental perspectives, its detection, the effects of ACD with respect to the social, psychological, occupational, and financial perspectives, and its cure and/or prevention. Human skin is very sensitive and as the largest organ in the body, it is highly prone to direct and indirect contact with the substances from its environment. The skin reacts to these substances (xenobiotics) differently depending on the individual's tolerance level or threshold. Allergic contact dermatitis is a significant environmental and occupational skin disease that should not be ignored in our society because it can affect the quality of life of an affected individual. There are multiple causes of ACD, and these causes of ACD have been discussed from two perspectives: environmental and occupational. The effects of ACD can be psychological, social, financial, and occupational. There is need for more public enlightenment on the effects of ACD as well as a precise understanding that it is not a contagious disease so as to significantly reduce the psychological and social effects of ACD on these patients.
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Affiliation(s)
- Olufunmilayo A Olusegun
- School of Chemistry and Physics, University of KwaZulu-Natal, Westville Campus, Private Bag X54001, Durban, 4000, South Africa
| | - Bice S Martincigh
- School of Chemistry and Physics, University of KwaZulu-Natal, Westville Campus, Private Bag X54001, Durban, 4000, South Africa
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Olusegun OA, Martincigh BS. Understanding the Role of pH in Protein‐Haptenation Reaction: Kinetics and Mechanisms of the Protein‐Haptenation Reactions of Selected Quinones Present in the Environment. ChemistrySelect 2020. [DOI: 10.1002/slct.202003310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Olufunmilayo A. Olusegun
- School of Chemistry and Physics University of KwaZulu-Natal, Westville Campus Private Bag X54001, Durban 4000 South Africa
| | - Bice S. Martincigh
- School of Chemistry and Physics University of KwaZulu-Natal, Westville Campus Private Bag X54001, Durban 4000 South Africa
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Wagner F, Woitalla-Bruning J. Allergisches Kontaktekzem nach Anwendung eines grünen Permanentmarkers. PHLEBOLOGIE 2020. [DOI: 10.1055/a-1171-4952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
ZusammenfassungPräoperativ wird zur Vermeidung von Eingriffsverwechslungen die zu operierende Extremität mittels Farbmarkierungen detektiert. In der Phlebologie dient die Farbmarkierung darüber hinaus zum Auffinden der zu operierenden Varikose am Bein und gibt Hinweise darüber, welche Areale vor der Operation betäubt werden müssen. Das dabei verwendete Farbmaterial sollte der mehrmaligen gründlichen Desinfektion/Antisepsis der Haut des Operationsgebiets standhalten.In der Vergangenheit wurde bisher nur selten von Kontaktekzemen ausgelöst durch Permanentmarker berichtet. Wir präsentieren einen klinisch sehr beeindruckenden Fall einer Kontaktallergie auf einen grünen Permanentmarker.
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Affiliation(s)
- Felix Wagner
- Zentrum für Venen- und Dermatochirurgie, Krankenhaus Tabea GmbH & Co. KG
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Corrosion Susceptibility and Allergy Potential of Austenitic Stainless Steels. MATERIALS 2020; 13:ma13184187. [PMID: 32967138 PMCID: PMC7560466 DOI: 10.3390/ma13184187] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 09/05/2020] [Accepted: 09/14/2020] [Indexed: 11/16/2022]
Abstract
Although called stainless steels, austenitic steels are sensitive to localized corrosion, namely pitting, crevice, and intergranular form. Seventeen grades of steel were tested for localized corrosion. Steels were also tested in general corrosion and in galvanic couplings (steels-precious alloys) used in watchmaking applications. The evaluations have been carried out in accordance with the ASTM standards which specifically concern the forms of corrosion namely, general (B117-97, salt fog test), pitting (G48-11, FeCl3), crevice (F746-87) and intergranular (A262-15, Strauss chemical test and G108-94, Electrochemical potentiodynamic reactivation test). All tests revealed sensitivity to corrosion. We have noticed that the transverse face is clearly more sensitive than the longitudinal face, in the direction of rolling process. The same conclusion has been drawn from the tests of nickel release. It should be pointed out that, despite the fact that the grade of steel is in conformity with the classification standards, the behavior is very different from one manufacturer to another, due to parameters dependent on the production process, such as casting volume, alloying additions, and deoxidizing agents. The quantities of nickel released are related to the operations involved in the manufacturing process. Heat treatments reduce the quantities of nickel released. The surface state has little influence on the release. The hardening procedures increase the quantities of nickel released. The quantities of released nickel are influenced by the inclusionary state and the existence of the secondary phases in the steel structure. Another aspect is related to the strong dispersion of results concerning nickel release and corrosion behavior of raw materials.
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Abstract
PURPOSE OF REVIEW Allergic contact dermatitis (ACD) was once thought to be rare in children but recent studies have demonstrated that the prevalence of ACD is common and appears to be increasing in children. Current trends including toys, hobbies, and personal care products may play a role in potentially new allergen exposure or resurgence of certain allergens, making ACD a moving target in children. RECENT FINDINGS ACD and atopic dermatitis can coexist and certain clinical features can help differentiate ACD from endogenous atopic dermatitis in children. It is important to consider ACD in children with recalcitrant atopic dermatitis or dermatitis with atypical distribution. Patch testing has become a more common practice in children. In 2018, the first expert consensus-derived pediatric baseline series consisting of 38 allergens was proposed to aid in the diagnosis of ACD in children. Comparing recent patch testing data in the pediatric population, the top allergens ubiquitously identified were nickel, cobalt, neomycin, Myroxylon pereirae (balsam of Peru), fragrance mix I, fragrance mix II, methylisothiazolinone, methylchloroisothiazolinone/ methylisothiazolinone, formaldehyde, and lanolin. SUMMARY ACD is a common problem in children. Detection through patch testing, avoidance of offending allergens, and prevention of common allergens are the main focus of management of ACD in children.
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Sinha S, Singh S, Sardana K, Malhotra P. An uncommon case of systematized bullous contact dermatitis due to p-phenylenediamine healing with a "livedoid" pattern. Contact Dermatitis 2020; 83:235-237. [PMID: 32333394 DOI: 10.1111/cod.13573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 04/23/2020] [Indexed: 12/01/2022]
Affiliation(s)
- Surabhi Sinha
- Department of Dermatology & STD, Dr. Ram Manohar Lohia Hospital & ABVIMS, New Delhi, India
| | - Sweta Singh
- Department of Dermatology & STD, Dr. Ram Manohar Lohia Hospital & ABVIMS, New Delhi, India
| | - Kabir Sardana
- Department of Dermatology & STD, Dr. Ram Manohar Lohia Hospital & ABVIMS, New Delhi, India
| | - Purnima Malhotra
- Department of Pathology, Dr. Ram Manohar Lohia Hospital & ABVIMS, New Delhi, India
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Systemic contact dermatitis to inhaled and intranasal corticosteroids. Ann Allergy Asthma Immunol 2020; 125:103-105. [PMID: 32289523 DOI: 10.1016/j.anai.2020.04.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Revised: 03/22/2020] [Accepted: 04/02/2020] [Indexed: 11/23/2022]
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Hassan I, Akhtar S, Zeerak S, Rasool F, Rather PA, Bhat YJ, Latif I, Rather S, Mubashir S, Jeelani S, Devi R, Bashir Y, Nabi N, Batool S, Aleem S. Clinicoepidemiological and Patch Test Profile of Patients Attending the Contact Dermatitis Clinic of a Tertiary Care Hospital in North India: A 7-Year Retrospective Study. Indian Dermatol Online J 2019; 10:669-675. [PMID: 31807446 PMCID: PMC6859765 DOI: 10.4103/idoj.idoj_26_19] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Introduction: Allergic contact dermatitis (ACD) is a growing concern due to increased use of cosmetics and topical medications routinely and exposure to a large number of allergens on day-to-day basis. Patch testing is a reliable method for detecting the causative antigens in suspected cases. Aims and Objectives: To assess the demographic profile, pattern of ACD, and patch test profile of suspected cases of ACD attending contact dermatitis clinic of our department. Materials and Methods: It was a retrospective study in which all the data enrolled in the contact dermatitis clinic of our department over a 7-year period were analyzed. Patch testing was done using the Indian Standard Series of 20 antigens primarily, and other batteries were used depending on patient requirement and availability. Results: A total of 582 patients were enrolled in the contact dermatitis clinic over a period of 7 years. Hand eczema was the most common pattern seen in 268 cases followed by feet eczema, hand and foot eczema, facial eczema, forearm and leg eczema and photoallergic contact eczema. A total of 177 patients (30.4%) gave positive patch test results, with nickel sulfate being the most common allergen identified followed by potassium dichromate, cobalt sulfate, paraphenylenediamine, neomycin sulfate, and fragrance mix. Conclusion: Common allergens identified in our study were more or less similar to studies from other parts of India. However, due to the unique climate of the valley, the profile of parthenium sensitivity was low in our study when compared to the rest of the country.
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Affiliation(s)
- Iffat Hassan
- Department of Dermatology, Sexually Transmitted Diseases and Leprosy, Government Medical College, University of Kashmir, Srinagar, J and K, India
| | - Saniya Akhtar
- Department of Dermatology, Sexually Transmitted Diseases and Leprosy, Government Medical College, University of Kashmir, Srinagar, J and K, India
| | - Sumaya Zeerak
- Department of Dermatology, Sexually Transmitted Diseases and Leprosy, Government Medical College, University of Kashmir, Srinagar, J and K, India
| | - Farhan Rasool
- Department of Dermatology, Sexually Transmitted Diseases and Leprosy, Government Medical College, University of Kashmir, Srinagar, J and K, India
| | - Parvaiz Anwar Rather
- Department of Dermatology, Sexually Transmitted Diseases and Leprosy, Government Medical College, University of Kashmir, Srinagar, J and K, India
| | - Yasmeen J Bhat
- Department of Dermatology, Sexually Transmitted Diseases and Leprosy, Government Medical College, University of Kashmir, Srinagar, J and K, India
| | - Insha Latif
- Department of Dermatology, Sexually Transmitted Diseases and Leprosy, Government Medical College, University of Kashmir, Srinagar, J and K, India
| | - Shagufta Rather
- Department of Dermatology, Sexually Transmitted Diseases and Leprosy, Government Medical College, University of Kashmir, Srinagar, J and K, India
| | - Syed Mubashir
- Department of Dermatology, Sexually Transmitted Diseases and Leprosy, Government Medical College, University of Kashmir, Srinagar, J and K, India
| | - Shazia Jeelani
- Department of Dermatology, Sexually Transmitted Diseases and Leprosy, Government Medical College, University of Kashmir, Srinagar, J and K, India
| | - Reeta Devi
- Department of Dermatology, Sexually Transmitted Diseases and Leprosy, Government Medical College, University of Kashmir, Srinagar, J and K, India
| | - Yakzata Bashir
- Department of Dermatology, Sexually Transmitted Diseases and Leprosy, Government Medical College, University of Kashmir, Srinagar, J and K, India
| | - Nahida Nabi
- Department of Dermatology, Sexually Transmitted Diseases and Leprosy, Government Medical College, University of Kashmir, Srinagar, J and K, India
| | - Samina Batool
- Department of Dermatology, Sexually Transmitted Diseases and Leprosy, Government Medical College, University of Kashmir, Srinagar, J and K, India
| | - Samia Aleem
- Department of Dermatology, Sexually Transmitted Diseases and Leprosy, Government Medical College, University of Kashmir, Srinagar, J and K, India
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Felmingham C, Davenport R, Bala H, Palmer A, Nixon R. Allergic contact dermatitis in children and proposal for an Australian Paediatric Baseline Series. Australas J Dermatol 2019; 61:33-38. [PMID: 31630402 DOI: 10.1111/ajd.13169] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 08/22/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND Allergic contact dermatitis (ACD) is an increasingly common diagnosis in children. The objectives of this study were to review our experience with ACD in children in tertiary settings, to ascertain the spectrum of allergens in this population and to subsequently propose the first Australian Paediatric Baseline Series for patch testing. METHODS We conducted a retrospective analysis of patch test data from 1993 to 2017 from two tertiary referral patch-testing centres in Melbourne, Victoria. RESULTS A total of 511 children were patch tested during the study period. Of these, 58.3% (298/511) of children tested had a positive patch test, and 65.1% (194/298, or 38.0% of the total) had a relevant positive patch test. The most common relevant patch test reactions were fragrance mix, methylchloroisothiazolinone/methylisothiazolinone (MCI/MI) and methylisothiazolinone (MI), Myroxylon pereirae, nickel sulphate, and colophonium. CONCLUSION Allergic contact dermatitis is not uncommon in children, and patch testing should be considered in children with suspected ACD or with recalcitrant atopic dermatitis. Based on our experience over 25 years, we propose the first Australian Paediatric Baseline Series.
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Affiliation(s)
- Claire Felmingham
- Occupational Dermatology Research and Education Centre, Skin and Cancer Foundation Inc., Carlton, Victoria, Australia
| | - Rachael Davenport
- Occupational Dermatology Research and Education Centre, Skin and Cancer Foundation Inc., Carlton, Victoria, Australia
| | - Harini Bala
- Occupational Dermatology Research and Education Centre, Skin and Cancer Foundation Inc., Carlton, Victoria, Australia
| | - Amanda Palmer
- Occupational Dermatology Research and Education Centre, Skin and Cancer Foundation Inc., Carlton, Victoria, Australia
| | - Rosemary Nixon
- Occupational Dermatology Research and Education Centre, Skin and Cancer Foundation Inc., Carlton, Victoria, Australia
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Bhat Y, Akhtar S, Hassan I. Contact dermatitis in pediatric age group: Indian scenario. INDIAN JOURNAL OF PAEDIATRIC DERMATOLOGY 2019. [DOI: 10.4103/ijpd.ijpd_17_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Gao YY, Jiang Y, Chen GC, Li SS, Yang F, Ma Q. A Sensitive and Rapid UPLC-MS/MS Method for Determination of Monosaccharides and Anti-Allergic Effect of the Polysaccharides Extracted from Saposhnikoviae Radix. Molecules 2018; 23:molecules23081924. [PMID: 30071672 PMCID: PMC6222413 DOI: 10.3390/molecules23081924] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2018] [Revised: 07/24/2018] [Accepted: 07/26/2018] [Indexed: 12/21/2022] Open
Abstract
Background: Allergic disease is a common clinical disease. Natural products provide an important source for a wide range of potential anti-allergic agents. This study was designed to evaluate the anti-allergic activities of the water-soluble polysaccharides extracted and purified from Saposhnikoviae Radix (SRPS). The composition and content of monosaccharides were determined to provide a material basis. Methods: An ultra-high-performance liquid chromatography-tandem mass spectrometry (UPLC-MS/MS) method was established to determine the composition and content of SRPS. 2,4-dinitrofluorobenzene (DNFB) induced a delayed-type hypersensitivity (DTH) mouse model orally administrated SRPS for seven consecutive days. Ear swelling, organ index, and serum IgE levels were observed to evaluate the anti-allergic activities. Results: The UPLC-MS/MS analysis showed that SRPS was consisted of eight monosaccharides including galacturonic acid, mannose, glucose, galactose, rhamnose, fucose, ribose, and arabinose with a relative molar ratio of 4.42%, 7.86%, 23.69%, 12.06%, 3.10%, 0.45%, 0.71%, and 47.70%, respectively. SRPS could effectively reduce ear swelling, a thymus index, and a serum IgE levels. Conclusions: The method was simple, rapid, sensitive, and reproducible, which could be used to analyze and determine the monosaccharide composition of SRPS. The vivo experiments demonstrated that SRPS may effectively inhibit development of DNFB-induced DTH. SRPS is a novel potential resource for natural anti-allergic drugs.
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Affiliation(s)
- Yan-Yan Gao
- School of Chinese Materia Medica, Beijing University of Chinese Medicine, Beijing 102488, China.
| | - Yue Jiang
- School of Chinese Materia Medica, Beijing University of Chinese Medicine, Beijing 102488, China.
| | - Guo-Chao Chen
- School of Chinese Materia Medica, Beijing University of Chinese Medicine, Beijing 102488, China.
| | - Shuang-Shuang Li
- School of Chinese Materia Medica, Beijing University of Chinese Medicine, Beijing 102488, China.
| | - Fei Yang
- School of Chinese Materia Medica, Beijing University of Chinese Medicine, Beijing 102488, China.
| | - Qun Ma
- School of Chinese Materia Medica, Beijing University of Chinese Medicine, Beijing 102488, China.
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Poveda-Montoyo I, Álvarez-Chinchilla PJ, Silvestre JF. Allergic Contact Dermatitis: Therapeutic Management. CURRENT TREATMENT OPTIONS IN ALLERGY 2018. [DOI: 10.1007/s40521-018-0156-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Carossino AM, Carulli C, Ciuffi S, Carossino R, Zappoli Thyrion GD, Zonefrati R, Innocenti M, Brandi ML. Hypersensitivity reactions to metal implants: laboratory options. BMC Musculoskelet Disord 2016; 17:486. [PMID: 27881114 PMCID: PMC5120482 DOI: 10.1186/s12891-016-1342-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Accepted: 11/14/2016] [Indexed: 11/30/2022] Open
Abstract
Background All implant compounds undergo an electrochemical process when in contact with biological fluids, as well as mechanical corrosion due to abrasive wear, with production of metal debris that may inhibit repair processes. None of the commonly-used methods can diagnose implant allergies when used singly, therefore a panel of tests should be performed on allergic patients as pre-operative screening, or when a postoperative metal sensitisation is suspected. Methods We analysed patients with painful prostheses and subjects prone to allergies using the Patch Test in comparison with the Lymphocyte Transformation Test. Cytokine production was evaluated to identify prognostic markers for early diagnosis of aseptic loosening. Metal debris endocytosis and cytoskeletal rearrangement was visualised by confocal microscopy. Results Our results demonstrate that the Lymphocyte Transformation Test can identify patients who have a predisposition to develop allergic reactions and can confirm the diagnosis of hypersensitivity in patients with painful prostheses. The prevalence of a Th2-cytokine pattern may be used to identify predisposition to the development of allergic diseases, while the selective presence of osteoclastogenic cytokines may be used as predictor of a negative outcome in patients with painful prosthesis. The hypothesis of the prognostic value of these cytokines as early markers of aseptic loosening is attractive, but its confirmation would require extensive testing. Conclusions The Lymphocyte Transformation Test is the most suitable method for testing systemic allergies. We suggest that the combined use of the Patch Test and the Lymphocyte Transformation Test, associated with cytokine detection in selected patients, could provide a useful tool for preventive evaluation of immune reactivity in patients undergoing primary joint replacement surgery, and for clinical monitoring of the possible onset of a metal sensitization in patients with implanted devices.
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Affiliation(s)
- Anna Maria Carossino
- Department of Surgery and Translational Medicine, University of Florence, Viale Pieraccini 6, 50139, Florence, Italy
| | - Christian Carulli
- Department of Surgery and Translational Medicine, University of Florence, Viale Pieraccini 6, 50139, Florence, Italy
| | - Simone Ciuffi
- Department of Surgery and Translational Medicine, University of Florence, Viale Pieraccini 6, 50139, Florence, Italy
| | - Roberto Carossino
- Department of Surgery and Translational Medicine, University of Florence, Viale Pieraccini 6, 50139, Florence, Italy
| | | | - Roberto Zonefrati
- Department of Surgery and Translational Medicine, University of Florence, Viale Pieraccini 6, 50139, Florence, Italy
| | - Massimo Innocenti
- Department of Surgery and Translational Medicine, University of Florence, Viale Pieraccini 6, 50139, Florence, Italy
| | - Maria Luisa Brandi
- Department of Surgery and Translational Medicine, University of Florence, Viale Pieraccini 6, 50139, Florence, Italy.
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Roseotoxin B Improves Allergic Contact Dermatitis through a Unique Anti-Inflammatory Mechanism Involving Excessive Activation of Autophagy in Activated T Lymphocytes. J Invest Dermatol 2016; 136:1636-1646. [DOI: 10.1016/j.jid.2016.04.017] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Revised: 04/14/2016] [Accepted: 04/18/2016] [Indexed: 12/31/2022]
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Besonderheiten von Haptenen und Allergenen bei Spättypreaktionen. ALLERGOLOGIE 2016. [DOI: 10.1007/978-3-642-37203-2_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Weintraub GS, Lai IN, Kim CN. Review of allergic contact dermatitis: Scratching the surface. World J Dermatol 2015; 4:95-102. [DOI: 10.5314/wjd.v4.i2.95] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Revised: 12/28/2014] [Accepted: 01/20/2015] [Indexed: 02/06/2023] Open
Abstract
Contact dermatitis-including allergic contact dermatitis (ACD)-n and results in over four million lost work days per year in the United States alone. ACD is a classic example of a type IV delayed hypersensitivity reaction, and represents a significant burden on the health system, economy, and patient quality of life. Thorough history taking, clinical examination, histologic evaluation, and patch testing are keys to diagnosing contact dermatitis. Patch testing, especially with comprehensive and customized panels based on the patient’s exposure history, is particularly useful in identifying potential allergens in the case of allergic contact dermatitis. ACD management requires a combination of direct medical intervention, patient education, and appropriate environmental modification to prevent exposure to offending allergens in the home or workplace. Continuing advances in the study of ACD has led to an increased understanding of the disease processes, new methods for diagnosis, and improved management. This article reviews ACD-aiming to connect recent investigational data with the current clinical understanding of disease pathophysiology, diagnostic techniques, and management strategies.
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Febriana S, Soebono H, Coenraads P, Schuttelaar M. Contact allergy in Indonesian patients with foot eczema attributed to shoes. J Eur Acad Dermatol Venereol 2015; 29:1582-9. [DOI: 10.1111/jdv.12951] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2014] [Accepted: 12/04/2014] [Indexed: 11/29/2022]
Affiliation(s)
- S.A. Febriana
- Department of Dermatology & Venereology; Gadjah Mada University; Yogyakarta Indonesia
| | - H. Soebono
- Department of Dermatology & Venereology; Gadjah Mada University; Yogyakarta Indonesia
| | - P.J. Coenraads
- Department of Dermatology; University of Groningen; University Medical Center Groningen; Groningen The Netherlands
| | - M.L.A. Schuttelaar
- Department of Dermatology; University of Groningen; University Medical Center Groningen; Groningen The Netherlands
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Toholka R, Wang YS, Tate B, Tam M, Cahill J, Palmer A, Nixon R. The first Australian Baseline Series: Recommendations for patch testing in suspected contact dermatitis. Australas J Dermatol 2014; 56:107-15. [DOI: 10.1111/ajd.12186] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Accepted: 04/30/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Ryan Toholka
- Occupational Dermatology Research and Education Centre; Skin and Cancer Foundation Inc; Melbourne Victoria Australia
| | - Yi-Shi Wang
- Occupational Dermatology Research and Education Centre; Skin and Cancer Foundation Inc; Melbourne Victoria Australia
- W Skin and Laser Clinic; Mount Elizabeth Novena Specialist Centre; Singapore
| | - Bruce Tate
- Occupational Dermatology Research and Education Centre; Skin and Cancer Foundation Inc; Melbourne Victoria Australia
| | - Mei Tam
- Occupational Dermatology Research and Education Centre; Skin and Cancer Foundation Inc; Melbourne Victoria Australia
| | - Jennifer Cahill
- Occupational Dermatology Research and Education Centre; Skin and Cancer Foundation Inc; Melbourne Victoria Australia
| | - Amanda Palmer
- Occupational Dermatology Research and Education Centre; Skin and Cancer Foundation Inc; Melbourne Victoria Australia
| | - Rosemary Nixon
- Occupational Dermatology Research and Education Centre; Skin and Cancer Foundation Inc; Melbourne Victoria Australia
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Coman G, Blickenstaff N, Edwards A, Maibach H. Dermatotoxicologic clinical solutions: textile dye dermatitis patch testing. Cutan Ocul Toxicol 2014; 34:68-71. [DOI: 10.3109/15569527.2014.883403] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Vocanson M, Hennino A, Chavagnac C, Saint-Mezard P, Dubois B, Kaiserlian D, Nicolas JF. Contribution of CD4+and CD8+T-cells in contact hypersensitivity and allergic contact dermatitis. Expert Rev Clin Immunol 2014; 1:75-86. [DOI: 10.1586/1744666x.1.1.75] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Chong SZ, Tan KW, Wong FHS, Chua YL, Tang Y, Ng LG, Angeli V, Kemeny DM. CD8 T cells regulate allergic contact dermatitis by modulating CCR2-dependent TNF/iNOS-expressing Ly6C+ CD11b+ monocytic cells. J Invest Dermatol 2013; 134:666-676. [PMID: 24061165 DOI: 10.1038/jid.2013.403] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Revised: 08/25/2013] [Accepted: 09/08/2013] [Indexed: 12/23/2022]
Abstract
Monocytes and their derived cells have critical roles in inflammation and immune defense. However, their function in skin diseases such as allergic contact dermatitis remains poorly defined. Using a model of contact hypersensitivity (CHS) toward 2,4-dinitrochlorobenzene, we show that Ly6C+ CD11b+ monocytic cells participate in the pathophysiology of CHS and their accumulation is regulated by effector CD8 T cells. These Ly6C+ CD11b+ monocytic cells are the primary contributors of tumor necrosis factor-α (TNF-α) and inducible nitric oxide synthase (iNOS) and derive from Ly6C(hi)CCR2+ monocytes, as they were absent in non-inflamed skin and accumulate as a consequence of inflammation in a C-C chemokine receptor type 2 (CCR2)-dependent manner. Importantly, CCR2(-/-) mice, or wild-type mice depleted of monocytes via clodronate liposomes, display a marked decrease in TNF-α and iNOS expression accompanied by attenuated skin inflammation. Using transgenic mice and antibody depletion, we show that effector CD8 T cells regulate the accumulation of Ly6C+ CD11b+ monocytic cells through IL-17 and activate them for TNF-α and iNOS through IFN-γ. CD8 T cell-derived IFN-γ was also critical for the accumulation of the major histocompatibility complex II-expressing Ly6C+ CD11b+ subset, which expressed intermediate levels of CD11c and costimulatory molecules. Taken together, our findings provide further insight into the pathophysiology of allergic contact dermatitis by showing that CD8 T cells regulate the inflammatory cascade through TNF/iNOS-expressing Ly6C+ CD11b+ monocytic cells.
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Affiliation(s)
- Shu Zhen Chong
- Immunology Programme, Life Sciences Institute, National University of Singapore, Singapore; NUS Graduate School for Integrative Sciences and Engineering (NGS), National University of Singapore, Singapore; Singapore Immunology Network, Agency for Science, Technology and Research (A*STAR), Biopolis, Singapore.
| | - Kar Wai Tan
- Singapore Immunology Network, Agency for Science, Technology and Research (A*STAR), Biopolis, Singapore
| | - Fiona H S Wong
- Immunology Programme, Life Sciences Institute, National University of Singapore, Singapore
| | - Yen Leong Chua
- Immunology Programme, Life Sciences Institute, National University of Singapore, Singapore
| | - Yafang Tang
- Immunology Programme, Life Sciences Institute, National University of Singapore, Singapore; NUS Graduate School for Integrative Sciences and Engineering (NGS), National University of Singapore, Singapore
| | - Lai Guan Ng
- Singapore Immunology Network, Agency for Science, Technology and Research (A*STAR), Biopolis, Singapore
| | - Veronique Angeli
- Immunology Programme, Life Sciences Institute, National University of Singapore, Singapore
| | - David M Kemeny
- Immunology Programme, Life Sciences Institute, National University of Singapore, Singapore; NUS Graduate School for Integrative Sciences and Engineering (NGS), National University of Singapore, Singapore
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Tian J, Che H, Ha D, Wei Y, Zheng S. Characterization and anti-allergic effect of a polysaccharide from the flower buds of Lonicera japonica. Carbohydr Polym 2012; 90:1642-7. [DOI: 10.1016/j.carbpol.2012.07.044] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2012] [Revised: 07/01/2012] [Accepted: 07/16/2012] [Indexed: 10/28/2022]
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Silva EA, Bosco MRM, Mozer É. Study of the frequency of allergens in cosmetics components in patients with suspected allergic contact dermatitis. An Bras Dermatol 2012; 87:263-8. [DOI: 10.1590/s0365-05962012000200011] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2011] [Accepted: 04/25/2011] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND: Contact dermatitis to cosmetics is a common dermatosis, especially in adults and professionals who handle them. OBJECTIVE: The objective of this study was to evaluate the frequency of sensitization to cosmetics' components in patients with suspected allergic contact dermatitis and to identify the main sensitizers related to occupational contact dermatitis. METHODS: During the period of January 2008 to June 2010, all the patients with a presumptive diagnosis of allergic contact dermatitis to cosmetics were selected. The patients were submitted to the patch tests of cosmetics series, composed by ten substances. RESULTS: Among the 147 patients studied sensitization to cosmetics components occurred in 31,29% of the cases, 14 of those (19,18%) equally corresponding to BHT and triethanolamine substances, 13 (17,81%) to ammonium thioglycolate, 09 to sorbic acid (12,33%), 08 to tosilamida (10,95%), 06 to germall (8,22%). The other elements tested showed indices of 5% or less. A higher frequency of contact dermatitis to cosmetics was observed in women and the age most affected was concordant with the age range of greatest professional activity of the population. CONCLUSION: Allergic contact dermatitis was more frequently associated with Triethanolamine, BHT and ammonium thioglycolate, and the relation with occupational contact dermatitis was discreet.
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Patel UO, Fox SR, Moy JN, Korbet SM. Pruritic Rash and Eosinophilia in a Patient Receiving Peritoneal Dialysis. Semin Dial 2011; 24:338-40. [DOI: 10.1111/j.1525-139x.2011.00937.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Lee MK, Lee WY, Yong SJ, Shin KC, Lee SN, Lee SJ, Lee JH, Kim SH. A case of autoimmune progesterone dermatitis misdiagnosed as allergic contact dermatitis. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2011; 3:141-4. [PMID: 21461257 PMCID: PMC3062796 DOI: 10.4168/aair.2011.3.2.141] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/16/2010] [Accepted: 11/22/2010] [Indexed: 11/20/2022]
Abstract
Autoimmune progesterone dermatitis is a rare autoimmune response to endogenous progesterone that usually occurs in fertile females. Cutaneous or mucosal lesions develop cyclically during the luteal phase of the menstrual cycle when progesterone levels are elevated. Symptoms usually start 3-10 days before menstruation and resolve 1-2 days after menstruation ceases. We report the case of a 48-year-old woman with intermittent eczematous skin lesions of the legs, forearms, and buttocks. She was diagnosed with allergic contact dermatitis, and topical steroids were prescribed. Her skin eruptions waxed and waned for 6 years and were associated with her menstrual cycle. We performed an intradermal test using progesterone, which was positive, and prescribed gonadotropin-releasing hormone analogues monthly for 3 months. The patient's skin lesions improved, confirming the diagnosis. Autoimmune progesterone dermatitis should be included in the differential diagnosis of recurrent eczema that is refractory to treatment in women of child-bearing age.
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Affiliation(s)
- Myoung Kyu Lee
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
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Kasper-Sonnenberg M, Sugiri D, Wurzler S, Ranft U, Dickel H, Wittsiepe J, Hölzer J, Lemm F, Eberwein G, Altmeyer P, Kraft M, Krämer U, Wilhelm M. Prevalence of nickel sensitization and urinary nickel content of children are increased by nickel in ambient air. ENVIRONMENTAL RESEARCH 2011; 111:266-273. [PMID: 21168833 DOI: 10.1016/j.envres.2010.11.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2010] [Revised: 11/01/2010] [Accepted: 11/10/2010] [Indexed: 05/30/2023]
Abstract
In a cross-sectional study performed in 2000, an unexpected positive association between nickel (Ni) in ambient air, urinary Ni content and the prevalence of Ni sensitization in a subgroup of 6-yr-old children living near a steel mill was observed. Between 2005 and 2006, in a different and larger study population, we examined if Ni from ambient air or urinary Ni concentration was related to Ni sensitization in children living next to Ni-emitting steel mills. We studied 749 school beginners living in four Ni-polluted industrial areas of North Rhine-Westphalia, Germany. We assessed Ni in ambient air, Ni in urine from children and mothers, and Ni in tap water, conducted patch tests in children (including the NiSO(4)-dilution test) and collected questionnaire data. Statistics were done by linear and logistic regression analyses, adjusted for covariates. At increased Ni concentration in ambient air (unit of increase: 10 ng/m(3)), urinary Ni concentrations rose in both mothers (9.1%; 95% CI: 6.8-11.4%) and children (2.4%; 95% CI: 0.4-4.4%). The prevalence of Ni sensitization in children was associated with increased Ni from ambient air (unit of increase: 18 ng/m(3); odds ratio 1.28; 95% CI: 1.25-1.32) and urinary Ni concentration (unit of increase: 7.1 μg/L; odds ratio 2.4; 95% CI: 1.20-4.48). Ni in ambient air of areas with Ni-emitting factories contributes to internal Ni exposure in residents via inhalation and, furthermore, is a risk factor for the development of Ni sensitization in children.
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Affiliation(s)
- Monika Kasper-Sonnenberg
- Department of Hygiene, Social and Environmental Medicine, Ruhr-University Bochum, Universitaetsstr. 150, 44780 Bochum, Germany.
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Helsing P, Gjersvik P, Holm JØ, Steinkjer B, Holsen D, Johnsson M, Braun R, Vårdal M, Austad J. Variability in patch test reactions - first report from the Norwegian Patch Test Registry*. Contact Dermatitis 2010; 62:309-13. [DOI: 10.1111/j.1600-0536.2010.01711.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Vocanson M, Hennino A, Rozières A, Poyet G, Nicolas JF. Effector and regulatory mechanisms in allergic contact dermatitis. Allergy 2009; 64:1699-714. [PMID: 19839974 DOI: 10.1111/j.1398-9995.2009.02082.x] [Citation(s) in RCA: 236] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Allergic contact dermatitis (ACD), one of the commonest occupational diseases, is a T-cell-mediated skin inflammation caused by repeated skin exposure to contact allergens, i.e. nonprotein chemicals called haptens. Allergic contact dermatitis, also referred to as contact hypersensitivity, is mediated by CD8+ T cells, which are primed in lymphoid organs during the sensitization phase and are recruited in the skin upon re-exposure to the hapten. Subsets of CD4+ T cells endowed with suppressive activity are responsible for both the down-regulation of eczema in allergic patients and the prevention of priming to haptens in nonallergic individuals. Therefore, ACD should be considered as a breakdown of the skin immune tolerance to haptens. Recent advances in the pathophysiology of ACD have demonstrated the important role of skin innate immunity in the sensitization process and have revisited the dogma that Langerhans cells are mandatory for CD8+ T-cell priming. They have also introduced mast cells as a pivotal actor in the magnitude of the inflammatory reaction. Finally, the most recent studies address the nature, the mode and the site of action of the regulatory T cells that control the skin inflammation with the aim of developing new strategies of tolerance induction in allergic patients.
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Affiliation(s)
- M Vocanson
- Faculté de Médecine Lyon Sud, Université Lyon1, Lyon, France
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Blömeke B, Brans R, Coenraads PJ, Dickel H, Bruckner T, Hein DW, Heesen M, Merk HF, Kawakubo Y. Para-phenylenediamine and allergic sensitization: risk modification by N-acetyltransferase 1 and 2 genotypes. Br J Dermatol 2009; 161:1130-5. [PMID: 19663877 DOI: 10.1111/j.1365-2133.2009.09352.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Para-phenylenediamine (PPD) is a common contact sensitizer causing allergic contact dermatitis, a major skin problem. As PPD may need activation to become immunogenic, the balance between activation and/or detoxification processes may influence an individual's susceptibility. PPD is acetylated and the metabolites do not activate dendritic-like cells and T cells of PPD-sensitized individuals. OBJECTIVES To investigate whether PPD can be acetylated in vitro by the two N-acetyltransferases 1 (NAT1) and 2 (NAT2). Based on the assumption that N-acetylation by NAT1 or NAT2 is a detoxification reaction with respect to sensitization, we examined whether NAT1 and NAT2 genotypes are different between PPD-sensitized individuals and matched controls. METHODS Genotyping for NAT1 and NAT2 polymorphisms was performed in 147 PPD-sensitized individuals and 200 age- and gender-matched controls. Results Both PPD and monoacetyl-PPD were N-acetylated in vitro by recombinant human NAT1 and to a lesser extent by NAT2. Genotyping for NAT1*3, NAT1*4, NAT1*10, NAT1*11 and NAT1*14 showed that genotypes containing the rapid acetylator NAT1*10 allele were under-represented in PPD-sensitized cases (adjusted odds ratio 0.72, 95% confidence interval 0.45-1.16). For NAT2, NAT2*4, NAT2*5AB, NAT2*5C, NAT2*6A and NAT2*7B alleles were genotyped. Individuals homozygous for the rapid acetylator allele NAT2*4 were under-represented in cases compared with controls (4.3% vs. 9.4%), but this trend was not significant. CONCLUSIONS With respect to data indicating that NAT1 but not NAT2 is present in human skin, we conclude that NAT1 genotypes containing the rapid acetylator NAT1*10 allele are potentially associated with reduced susceptibility to PPD sensitization.
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Affiliation(s)
- B Blömeke
- Department of Environmental Toxicology, University Trier, 54296 Trier, Germany.
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Blömeke B, Brans R, Dickel H, Bruckner T, Erdmann S, Heesen M, Merk HF, Coenraads PJ. Association between TNFA-308 G/A polymorphism and sensitization to para-phenylenediamine: a case-control study. Allergy 2009; 64:279-83. [PMID: 18384449 DOI: 10.1111/j.1398-9995.2008.01704.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Para-phenylenediamine (PPD) and related chemicals are common contact sensitizers, frequently causing allergic contact dermatitis (ACD). The cytokine tumor necrosis factor-alpha (TNF-alpha) plays a key role in contact sensitization. METHODS In this case-control study, we evaluated the distribution of variations in the regulatory region of the gene for TNF-alpha (TNFA-308 G/A) in 181 Caucasian individuals with a history of ACD and sensitization to PPD and 161 individuals with no history of sensitization to PPD. RESULTS The frequency of GA or AA TNFA genotypes was significantly higher in individuals sensitized to PPD than in age- and gender-matched controls giving an odds ratio (OR) of 2.16 (95% confidence interval, CI: 1.35-3.47; P = 0.0016). This relation was even more pronounced when restricting cases to females over 45 years (OR = 3.71; 95% CI: 1.65-8.31; P = 0.0017) vs younger females (less than or equal to 45 years; OR = 2.41; 95% CI: 1.03-5.65; P = 0.044) or males (OR = 1.05; 95% CI: 0.449-2.47; P = 1.0). In addition, a logistic regression model revealed a significant effect for TNFA-308 AA and AG vs GG genotype (point estimate = 2.152; 95% Wald CI: 1.332-3.477). CONCLUSIONS These findings suggest a possible role for the TNFA-308 genetic polymorphism as a susceptibility factor for chemically induced ACD.
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Affiliation(s)
- B Blömeke
- Department of Ecotoxicology and Toxicology, University of Trier, Trier, Germany
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Blömeke B, Pietzsch T, Merk HF. Elicitation response characteristics to mono- and to N,N'-diacetyl-para-phenylenediamine. Contact Dermatitis 2008; 58:355-8. [DOI: 10.1111/j.1600-0536.2008.01347.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Fernandes MFM, de Mello JF, Pires MC, Vizeu MCM. Comparative study of patch test using traditional method vs. prior skin abrading. J Eur Acad Dermatol Venereol 2007; 21:1351-9. [DOI: 10.1111/j.1468-3083.2007.02276.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Abstract
Hexavalent chromium causes two types of dermatological toxicities: allergic contact dermatitis (ACD) and skin ulcers. This report reviews the etiology, prevalence, pathology, dose-response, and prognosis of both of these reactions. Reports in the literature indicate that repeated exposure to hexavalent chromium in concentrations of 4-25 ppm can both induce sensitization and elicit chromium ACD. Exposure to 20 ppm hexavalent chromium can cause skin ulcers in nonsensitized people. The prevalence of chromium sensitivity in cement workers, exposed to 10-20 ppm hexavalent chromium for years, is approximately 4-5%. Chromium ACD can be a chronic debilitating disease, perhaps because chromium is ubiquitous in foods and in the environment and is difficult to avoid. Due to the high rates of sensitization in populations chronically exposed to chromium and the chronic nature of chromium ACD, some investigators recommend reducing the hexavalent chromiumconcentrations in consumer products, such as detergents, to less than 5 ppm.
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Affiliation(s)
- Susan R Shelnutt
- Center for Toxicology and Environmental Health, North Little Rock, Arkansas, USA
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Escandell JM, Recio MC, Máñez S, Giner RM, Cerdá-Nicolás M, Gil-Benso R, Ríos JL. Dihydrocucurbitacin B inhibits delayed type hypersensitivity reactions by suppressing lymphocyte proliferation. J Pharmacol Exp Ther 2007; 322:1261-8. [PMID: 17562851 DOI: 10.1124/jpet.107.122671] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
We have studied the effects of dihydrocucurbitacin B, a triterpene isolated from Cayaponia tayuya roots, on different models of delayed type hypersensitivity (DTH) in mice, as well as on T-lymphocyte proliferation and the mediators involved. In experiments with mice, dihydrocucurbitacin B inhibited the inflammatory reactions induced by oxazolone, dinitrofluorobenzene, and sheep red blood cells, reducing both the edema and cell infiltration. Moreover, the analysis of inflamed tissues showed that dihydrocucurbitacin B reduced the presence of the most relevant cytokines implicated in these processes, including interleukin-1 beta, interleukin-4, and tumor necrosis factor-alpha. Dihydrocucurbitacin B was also found to inhibit the proliferation of phytohemagglutinin-stimulated human T lymphocytes (IC(50) = 1.48 microM), halting the cell cycle in the G(0) phase. In addition, the triterpene reduced the production of interleukin-2, interleukin-4, interleukin-10, and interferon-gamma in human T lymphocytes, and it hampered the induction of the principal cyclins involved in the cell cycle, including A(1), B(1), D(2), and E(1). Finally, dihydrocucurbitacin B was found to exert a selective inhibition on the nuclear factor of activated T cells (NFAT) in human lymphocytes without affecting the calcium influx. Taken together, these results suggest that dihydrocucurbitacin B curbs DTH reactions by inhibiting NFAT, which in turn suppresses the proliferation of the most relevant cells involved in DTH reactions, namely the T cells.
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Affiliation(s)
- José M Escandell
- Departament de Farmacologia, Facultat de Farmàcia, Universitat de València, Av. Vicent Andrés Estellés s/n, 46100 Burjassot, Spain
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42
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Abstract
PURPOSE OF REVIEW Contact dermatitis is a common disease process that includes allergic and irritant contact dermatitis. The gold standard for diagnosing allergic contact dermatitis, a type IV delayed hypersensitivity reaction, is patch testing. Patch testing is not a difficult procedure, however, there are several critical components that determine the success of the test: having an appropriate level of suspicion for the diagnosis of allergic contact dermatitis, an adequate threshold for patch testing, the necessary experience to properly interpret the results and to determine their relevance, and the ability to thoroughly educate the patient about the condition. RECENT FINDINGS Research shows that patch testing practices differ among individuals and specialties. The level of patch testing education, interest in, and experience with, the procedure can affect the results of the test. Some of these practice differences and how they affect the outcome of patch testing are highlighted. SUMMARY Physicians' knowledge and experience with patch testing, their level of interest and access to allergens will determine the performance of this test, the reliability of the results and the benefits gained from this procedure.
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Vocanson M, Goujon C, Chabeau G, Castelain M, Valeyrie M, Floc'h F, Maliverney C, Gard A, Nicolas JF. The skin allergenic properties of chemicals may depend on contaminants--evidence from studies on coumarin. Int Arch Allergy Immunol 2006; 140:231-8. [PMID: 16685137 DOI: 10.1159/000093248] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2005] [Accepted: 01/10/2006] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS Positive patch tests are considered representative of a contact allergy to the tested chemical. However, contaminants and derivatives rather than the suspected chemical itself could be responsible for the allergic skin reactions. Here, we tested the importance of contaminants in the sensitizing and allergenic properties of coumarin in mice and humans. Coumarin, an ingredient in cosmetics and fragrances, was chosen as the reference chemical since conflicting results have been obtained regarding its ability to induce contact allergy. In some chemical preparations, this could be explained by the presence of coumarin derivatives endowed with allergenic properties. METHODS In mice, three different coumarin preparations were tested in the local lymph node assay. In humans, we assessed the irritant and allergenic properties of highly pure coumarin in nonallergic and fragrance-allergic patients. RESULTS Pure coumarin did not exhibit irritant or sensitizing properties in the local lymph node assay. In contrast, two other commercially available coumarins and three contaminants that were detected in these coumarin preparations were identified as weak and moderate sensitizers, respectively. In humans, pure coumarin was extremely well tolerated since only 1 out of 512 patients exhibited a positive patch test to the chemical. CONCLUSIONS These results indicate that coumarin cannot be considered as a common contact allergen and further emphasize that purity of chemicals is mandatory for the assessment of their allergenicity.
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Affiliation(s)
- M Vocanson
- INSERM U 503, IFR 128 BioSciences Lyon-Gerland, Lyon, France
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44
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Abstract
A survey of patients attending an occupational dermatology clinic with suspected occupational contact dermatitis affecting the hands was undertaken to determine if optimal skin care treatment had been instituted prior to referral for patch testing. Appropriate treatment for contact dermatitis of the hands was defined as concurrent use of a soap substitute, use of a lipid-rich moisturizer, and if appropriate, use of a topical corticosteroid in an ointment vehicle. Patients were asked about the use of a particular soap substitute, the name and type of any moisturizer used and the name and type of topical corticosteroids currently used. The products were examined where possible. Only one-third of all patients were using the complete package at the time of their clinic appointment. Nearly all of these patients had seen a dermatologist prior to this appointment. Of the group of patients with work-related diseases who reported having seen a dermatologist prior to the clinic appointment, only 38% were using the complete skin care routine.
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Affiliation(s)
- Mignon Moyle
- Occupational Dermatology Research and Education Centre, Skin and Cancer Foundation, Melbourne, Victoria, Australia.
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45
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Vocanson M, Hennino A, Chavagnac C, Rozières A, Saint-Mezard P, Akiba H, Satoh M, Kaiserlian D, Nicolas JF. Eczéma allergique de contact : Comment ré-induire une tolérance ? Med Sci (Paris) 2006; 22:158-63. [PMID: 16457756 DOI: 10.1051/medsci/2006222158] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Allergic contact dermatitis (ACD) is a skin inflammatory disease mediated by activation of CD8+ cytotoxic T cells specific for haptens in contact with the skin. CD4+ T cells behave as both regulatory and tolerogenic cells since they down-regulate the skin inflammation in patients with ACD (regulation) and prevent the development of eczema (tolerance) in normal individuals. Thus, ACD corresponds to a breakdown of immune tolerance to haptens in contact with the skin. Several regulatory CD4+ T cell subsets (Treg), especially CD4+CD25+ natural Treg cells, are involved in immunological tolerance and regulation to haptens through the production of the immunosuppressive cytokines IL-10 and TGF-beta. Ongoing strategies to re-induce immune tolerance to haptens in patients with eczema include improvement of existing methods of tolerance induction (oral tolerance, low dose tolerance, allergen-specific immunotherapy, UV-induced tolerance) as well as development of new drugs able to activate IL-10 producing Treg cells in vivo. Ongoing and future progress in this area will open up new avenues for treatment of eczema and more generally autoimmune and allergic diseases resulting from a breakdown of tolerance to autoantigens and allergens, respectively.
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Affiliation(s)
- Marc Vocanson
- Inserm U.503 et U.404, IFR 128 BioSciences Lyon-Gerland, 21, avenue Tony Garnier, 69375 Lyon Cedex 7, France
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46
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Abstract
The pathophysiology of ACD follows an intricate design and results in the characteristic, delayed inflammatory response. Although the astute physician may correctly diagnose ACD from its initial, classic history and presentation, alternative diagnoses should be considered and excluded. Patch testing performed with a relevant panel of contact allergens is the ultimate confirmatory test of ACD. Correctly identifying the inciting allergen permits appropriate personal avoidance. Corticosteroids remain the principal treatment options.
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Affiliation(s)
- Barry J Mark
- Division of Allergy and Immunology, Saint Louis University School of Medicine, St. Louis, MO 63104, USA.
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47
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Mohammad AH, Cohen S, Hadi S. Patch testing: a retrospective analysis of 103 patients with emphasis on practical aspects for the clinician. Skinmed 2005; 4:340-4. [PMID: 16276148 DOI: 10.1111/j.1540-9740.2005.03677.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
BACKGROUND Allergic contact dermatitis is a common dermatologic disorder caused by small chemical molecules that can penetrate the skin barrier. Thousands of chemicals capable of inducing allergic contact dermatitis have been identified. To cure allergic contact dermatitis, the allergen should be identified and eliminated from the environment of the patient. Patch testing, utilizing a variety of standard panels of the most frequent allergens, is used to identify the allergen in question. Patch testing is still the gold standard tool used to identify one or more substances that may contribute to the etiology of allergic contact dermatitis. OBJECTIVE To determine the frequency of patch test positivity and to identify the most common allergens in patients with suspected allergic contact dermatitis. METHODS A retrospective analysis of files of 103 patients who have been clinically diagnosed to have allergic contact dermatitis and have been patch tested using a standard technique with a Northern American Contact Dermatitis Group series. RESULTS Sixty-two patients (60.2%) showed positive reactions to one or more substance. The most common allergens were nickel sulfate, fragrance mix, and neomycin sulfate. There was an increased frequency of positive reactions to fragrance mix and a significant decrease of frequency of thimerosal positive reactions. CONCLUSIONS Increased awareness of allergens and their potential sources may help to limit the usage of these chemicals in manufacturing consumer products. This may have contributed to decreased prevalence rates of certain allergens such as thimerosal and paraphenylenediamine.
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Affiliation(s)
- Al-Helalat Mohammad
- Department of Dermatology, Mount Sinai Medical Center, New York, NY 10029-6574, USA.
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48
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Nardelli A, Taveirne M, Drieghe J, Carbonez A, Degreef H, Goossens A. The relation between the localization of foot dermatitis and the causative allergens in shoes: a 13-year retrospective study. Contact Dermatitis 2005; 53:201-6. [PMID: 16191015 DOI: 10.1111/j.0105-1873.2005.00692.x] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The purpose of this retrospective study was to test whether the initial pattern of clinical presentation of shoe dermatitis could indicate the causative allergen(s) and to estimate the odds on foot dermatitis in patients with a positive patch test versus those with a negative patch-test result. Between 1990 and 2002, 8543 patients were patch tested with the standard series (and additional allergens, if appropriate). Of them, 1168 (14%) had been referred because of foot dermatitis and 474 of these patients (5.5% of the total group) presented a positive reaction to one or more substances related to shoes. We found that 6 standard allergens in the male group and 8 standard allergens in the female group were statistically significant for the shoe dermatitis group. The data showed a relationship between the distribution pattern of the foot lesions and most of the allergens. These results have clinical applications since the gender of the patients and the localization of the foot eruptions can, indeed, indicate what allergen is involved.
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Affiliation(s)
- A Nardelli
- Department of Dermatology, University Hospital, Katholieke Universiteit Leuven, Leuven, Belgium
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49
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Hennino A, Vocanson M, Chavagnac C, Saint-Mezard P, Dubois B, Kaiserlian D, Nicolas JF. Fisiopatologia da dermatite de contato alérgica: papel das células T CD8 efetoras e das células T CD4 regulatórias. An Bras Dermatol 2005. [DOI: 10.1590/s0365-05962005000400003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
A dermatite de contato alérgica (DCA), também conhecida como hipersensibilidade de contato (HSC) é uma das dermatoses inflamatórias mais freqüentes, sendo caracterizada por eritema, pápulas e vesículas, seguidas de ressecamento e descamação. A DCA é induzida pelo contato da pele com substâncias químicas não protéicas denominadas haptenos, e corresponde a uma reação de hipersensibilidade cutânea do tipo tardio, mediada por células T hapteno-específicas. Durante a fase de sensibilização, tanto os precursores de células T CD4+ quanto os de CD8+ são ativados nos linfonodos de drenagem através da apresentação de peptídeos conjugados a haptenos pelas células dendríticas (CD) da pele. A subseqüente exposição de pele ao hapteno em um local a distância induz o recrutamento e ativação de células T específicas no local de provocação, levando à apoptose dos queratinócitos, recrutamento de células inflamatórias e desenvolvimento de sintomas clínicos. Estudos experimentais dos últimos 10 anos demonstraram que, em respostas normais de HSC a haptenos fortes, as células T CD8+ do tipo 1 são efetoras da HSC através de citotoxicidade e produção de IFNgama, enquanto que as células T CD4+ são dotadas de funções de regulação negativa. Estas últimas podem corresponder à população de células T regulatórias CD4+ CD25+ recentemente descritas. Entretanto, em algumas situações, especialmente naquelas em que há um pool deficiente de células T CD8, as células T CD4+ podem ser efetoras da HSC. Estudos em andamento deverão confirmar que a fisiopatologia da DCA em humanos é semelhante à HSC em camundongos, e que a resposta de HSC a haptenos fracos comuns, mais freqüentemente envolvidos na DCA em humanos, é semelhante à descrita para haptenos fortes.
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Affiliation(s)
- Ana Hennino
- Institut National de la Santé et de la Recherche Médicale, França
| | - Marc Vocanson
- Institut National de la Santé et de la Recherche Médicale, França
| | - Cyril Chavagnac
- Institut National de la Santé et de la Recherche Médicale, França
| | | | - Bertrand Dubois
- Institut National de la Santé et de la Recherche Médicale, França
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50
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Dickel H, Bruckner TM, Erdmann SM, Fluhr JW, Frosch PJ, Grabbe J, Löffler H, Merk HF, Pirker C, Schwanitz HJ, Weisshaar E, Brasch J. The "strip" patch test: results of a multicentre study towards a standardization. Arch Dermatol Res 2004; 296:212-9. [PMID: 15293061 DOI: 10.1007/s00403-004-0496-x] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2004] [Revised: 06/28/2004] [Accepted: 07/09/2004] [Indexed: 11/27/2022]
Abstract
BACKGROUND The "strip" patch test (SPT) is a variant of patch testing which is used for substances with a poor percutaneous penetration. Penetration of the substances is enhanced by repeated applications of adhesive tape prior to their application to the skin. However, no guidelines exist for standardized performance of the SPT. OBJECTIVES The aim of this multicentre study was to obtain a first practical approach towards a standardized SPT procedure. METHODS Intact noninflamed skin of the upper back of 83 healthy volunteers was tape-stripped. For sequential strips, a 25-mm diameter 3M Blenderm surgical tape was vertically applied and gently pressed downward using the fingertips for about 2 s. The tape was removed in one quick movement at an angle of 45 degrees in the direction of adherence. Each strip was performed with a new piece of tape on exactly the same skin area. RESULTS. In each subject, we first determined the number of strips (A) until the skin surface started to glisten and calculated the median number of strips (A) in the sample (A=26 strips). We then ascertained the median number of strips (a) in the sample that was necessary to achieve a statistically significant and twofold increase in TEWL (a=11 strips), revealing a "critical" stratum corneum strip depth. The unknown number of strips (a) for each subject was finally calculated from the formula a/A=a/A, i.e. the individual number of strips (A) until the skin surface started to glisten was multiplied by a derived tape-specific correction factor (cf=a/A=11/26=0.4). The increase in percutaneous penetration in strip patch testing by performing "a" strips versus conventional patch testing was shown by scoring of clinical and subjective SLS irritant reactions. CONCLUSIONS The present multicentre study outlines an experimentally derived approach for a uniform SPT procedure, which does not require the use of complex technical equipment. This first approach now requires validation by a study involving the application of allergens to obtain evidence of enhancement in the sensitivity of patch testing.
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Affiliation(s)
- Heinrich Dickel
- Department of Dermatology, Environmental Medicine, and Health Theory, University of Osnabrück, Sedanstr. 115, 49090 Osnabrück, Germany.
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