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von Kobyletzki LB, Ulriksdotter J, Sukakul T, Aerts O, Agner T, Buhl T, Bruze M, Foti C, Gimenez-Arnau A, Gonçalo M, Hamnerius N, Johansen JD, Rustemeyer T, Stingeni L, Wilkinson M, Svedman C. Prevalence of dermatitis including allergic contact dermatitis from medical devices used by children and adults with Type 1 diabetes mellitus: A systematic review and questionnaire study. J Eur Acad Dermatol Venereol 2024. [PMID: 38400603 DOI: 10.1111/jdv.19908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 01/23/2024] [Indexed: 02/25/2024]
Abstract
Use of medical devices (MDs), that is, glucose sensors and insulin pumps, in patients with Type 1 diabetes mellitus (T1D) has proven an enormous advantage for disease control. Adverse skin reactions from these MDs may however hamper compliance. The objective of this study was to systematically review and analyse studies assessing the prevalence and incidence of dermatitis, including allergic contact dermatitis (ACD) related to MDs used in patients with T1D and to compare referral routes and the clinical investigation routines between clinics being part of the European Environmental and Contact Dermatitis Research Group (EECDRG). A systematic search of PubMed, EMBASE, CINAHL and Cochrane databases of full-text studies reporting incidence and prevalence of dermatitis in persons with T1D using MDs was conducted until December 2021. The Newcastle-Ottawa Scale was used to assess study quality. The inventory performed at EECRDG clinics focused on referral routes, patient numbers and the diagnostic process. Among the 3145 screened abstracts, 39 studies fulfilled the inclusion criteria. Sixteen studies included data on children only, 14 studies were on adults and nine studies reported data on both children and adults. Participants were exposed to a broad range of devices. Skin reactions were rarely specified. It was found that both the diagnostic process and referral routes differ in different centres. Further data on the prevalence of skin reactions related to MDs in individuals with T1D is needed and particularly studies where the skin reactions are correctly diagnosed. A correct diagnosis is delayed or hampered by the fact that, at present, the actual substances within the MDs are not declared, are changed without notice and the commercially available test materials are not adequately updated. Within Europe, routines for referral should be made more standardized to improve the diagnostic procedure when investigating patients with possible ACD from MDs.
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Affiliation(s)
- L B von Kobyletzki
- Department of Occupational and Environmental Dermatology, Lund University, Skåne University Hospital, Malmö, Sweden
- School of Medical Sciences, Örebro University, Örebro, Sweden
| | - J Ulriksdotter
- Department of Occupational and Environmental Dermatology, Lund University, Skåne University Hospital, Malmö, Sweden
| | - T Sukakul
- Department of Occupational and Environmental Dermatology, Lund University, Skåne University Hospital, Malmö, Sweden
| | - O Aerts
- Contact Allergy Unit, Department of Dermatology, University Hospital Antwerp (UZA) and Research Group Immunology, University of Antwerp, Antwerp, Belgium
| | - T Agner
- Department of Dermatology, Bispebjerg University Hospital, Copenhagen, Denmark
| | - T Buhl
- Department of Dermatology, Venereology and Allergology, University Medical Center Göttingen, Göttingen, Germany
| | - M Bruze
- Department of Occupational and Environmental Dermatology, Lund University, Skåne University Hospital, Malmö, Sweden
| | - C Foti
- Section of Dermatology, DIMEPREJ Department, University "Aldo Moro", Bari, Italy
| | - A Gimenez-Arnau
- Department of Dermatology, Hospital del Mar and Research Institute de Barcelona, Universitat Pompeu Fabra, Barcelona, Spain
| | - M Gonçalo
- Clinic of Dermatology, Coimbra University Hospital and Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - N Hamnerius
- Department of Occupational and Environmental Dermatology, Lund University, Skåne University Hospital, Malmö, Sweden
| | - J D Johansen
- Department of Dermatology, Herlev and Gentofte Hospital, Copenhagen, Denmark
| | - T Rustemeyer
- Dermato-Allergology and Occupational Dermatology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - L Stingeni
- Dermatology Section, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - M Wilkinson
- Leeds Teaching Hospitals, NHS Trust, Leeds, UK
| | - C Svedman
- Department of Occupational and Environmental Dermatology, Lund University, Skåne University Hospital, Malmö, Sweden
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Gimenez-Arnau A, Bartra J, Ferrer M, Jauregui I, Borbujo J, Figueras I, Muñoz-Bellido FJ, Pedraz J, Serra-Baldrich E, Tejedor-Alonso MA, Velasco M, Terradas P, Labrador M. A Specialized Therapeutic Approach to Chronic Urticaria Refractory to H1-Antihistamines Improves Disease Burden: The Spanish AWARE Experience. J Investig Allergol Clin Immunol 2022; 32:191-199. [PMID: 33349612 DOI: 10.18176/jiaci.0661] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE During its first year, the AWARE study assessed disease activity, patient quality of life (QOL), and treatment patterns in chronic urticaria (CU) refractory to H1-antihistamines (H1-AH) in clinical practice. METHODS We performed an observational, prospective (24 months), international, multicenter study. The inclusion criteria were age ≥18 years and H1-AH-refractory CU (>2 months). At each visit, patients completed questionnaires to assess disease burden (Urticaria Control Test [UCT]), disease activity (7 day-Urticaria Activity Score [UAS7]), and QOL (Dermatology Life Quality index [DLQI], Chronic Urticaria Quality of Life Questionnaire [CU-Q2oL], and Angioedema Quality of Life Questionnaire [AE-QoL]). We present data for Spain. RESULTS The study population comprised 270 evaluable patients (73.3% female, mean [SD] age, 48.9 [14.7] years). At baseline, 89.3% were prescribed a CU treatment. After 1 year, first- and second-line treatments became less frequent and third-line treatments became more frequent. At baseline, 47.0% of patients experienced angioedema; at 1 year, this percentage had fallen to 11.8%. The mean (SD) AE-QoL score decreased from 45.2 (28.7) to 24.0 (25.8). The mean (SD) UCT score decreased from 7.0 (4.5) to 12.1 (4.1). According to UAS7, 38.2% of patients reported absence of wheals and itch in the previous 7 days at 1 year compared with 8.3% at baseline. The mean (SD) DLQI score decreased from 8.0 (7.4) to 2.8 (4.6). At the 1-year visit, the percentage of patients reporting a high or very high impact on QOL fell from 29.9% to 9.6%. CONCLUSION H1-AH-refractory CU in Spain is characterized by absence of control of symptoms and a considerable impact on QOL. Continuous follow-up of CU patients and third-line therapies reduce disease burden and improve patients' QOL.
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Affiliation(s)
| | - J Bartra
- Allergy Section, Pulmonology Department, Hospital Clínic, IDIBAPS, ARADyAL, Universitat de Barcelona, Barcelona, Spain
| | - M Ferrer
- Clínica Universidad de Navarra, ARADyAL, Pamplona, Spain
| | - I Jauregui
- Hospital Universitario Cruces, Vizcaya, Spain
| | - J Borbujo
- Hospital de Fuenlabrada, Madrid, Spain
| | - I Figueras
- Hospital de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | | | - J Pedraz
- Hospital Quirón, Pozuelo de Alarcón, Madrid, Spain
| | | | | | - M Velasco
- Hospital Arnau de Vilanova, Valencia, Spain
| | | | - M Labrador
- Hospital Vall d'Hebron, ARADyAL, Barcelona, Spain
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Balato A, Ayala F, Bruze M, Crepy MN, Gonçalo M, Johansen J, John SM, Pigatto P, Raimondo A, Rustemeyer T, Schuttelaar MLA, Svedman C, Aerts O, Uter W, Wilkinson M, Gimenez-Arnau A. European Task Force on Contact Dermatitis statement on coronavirus disease-19 (COVID-19) outbreak and the risk of adverse cutaneous reactions. J Eur Acad Dermatol Venereol 2020; 34:e353-e354. [PMID: 32356382 DOI: 10.1111/jdv.16557] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- A Balato
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - F Ayala
- Professor Emeritus of Dermatology, University of Naples Federico II, Naples, Italy
| | - M Bruze
- Department of Occupational and Environmental Dermatology, Skåne University Hospital, Lund University, Malmö, Sweden
| | - M-N Crepy
- Department of Occupational and Environmental Diseases, Hotel-Dieu Hospital, Paris, France.,Department of Dermatology, Cochin Hospital, Paris Descartes University, Paris, France
| | - M Gonçalo
- Clinic of Dermatology, University Hospital and Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - J Johansen
- Department of Dermatology and Allergy, National Allergy Research Centre, Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
| | - S M John
- Department of Dermatology, Environmental Medicine, Health Theory, University of Osnabrueck, Osnabrueck, Germany.,Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm) at the University of Osnabrueck, Osnabrueck, Germany.,Rehabilitation (iDerm) at the University of Osnabrueck, Osnabrueck, Germany
| | - P Pigatto
- Department of Biomedical, Surgical and Dental Sciences, Clinical Dermatology, IRCCS Istituto Ortopedico Galeazzi, University of Milan, Milan, Italy
| | - A Raimondo
- Department of Medicine, Surgery and Dentistry, 'Scuola Medica Salernitana', University of Salerno, Salerno, Italy
| | - T Rustemeyer
- Department of Dermatology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - M-L A Schuttelaar
- Department of Dermatology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - C Svedman
- Department of Occupational and Environmental Dermatology, Skåne University Hospital, Lund University, Malmö, Sweden
| | - O Aerts
- University Hospital Antwerp (UZA) and University of Antwerp, Antwerp, Belgium
| | - W Uter
- Department of Medical Informatics, Biometry and Epidemiology, Friedrich-Alexander University Erlangen/Nürnberg, Erlangen, Germany
| | - M Wilkinson
- Dermatology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - A Gimenez-Arnau
- Department of Dermatology, Hospital del Mar. IMIM, Universitat Autònoma Barcelona, Barcelona, Spain
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Mahler V, Aalto-Korte K, Alfonso J, Bakker J, Bauer A, Bensefa-Colas L, Boman A, Bourke J, Bubaš M, Bulat P, Chaloupka J, Constandt L, Danielsen T, Darlenski R, Dugonik A, Ettler K, Gimenez-Arnau A, Gonçalo M, Johansen J, John S, Kiec-Swierczynska M, Koch P, Kohánka V, Krecisz B, Larese Filon F, Ljubojević S, Macan J, Marinović B, Matura M, Mihatsch P, Mijakoski D, Minov J, Pace J, Pesonen M, Ramada Rodilla J, Rast H, Reljic V, Salavastru C, Schuster C, Schuttelaar M, Simon D, Spiewak R, Jurakic Tončić R, Urbanček S, Valiukevičienė S, Weinert P, Wilkinson M, Uter W. Occupational skin diseases: actual state analysis of patient management pathways in 28 European countries. J Eur Acad Dermatol Venereol 2017; 31 Suppl 4:12-30. [DOI: 10.1111/jdv.14316] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Accepted: 03/24/2017] [Indexed: 11/27/2022]
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Maurer M, Metz M, Bindslev-Jensen C, Bousquet J, Canonica GW, Church MK, Godse KV, Grattan CE, Hide M, Kocatürk E, Magerl M, Makris M, Meshkova R, Saini SS, Sussman G, Toubi E, Zhao Z, Zuberbier T, Gimenez-Arnau A. Definition, aims, and implementation of GA(2) LEN Urticaria Centers of Reference and Excellence. Allergy 2016; 71:1210-8. [PMID: 27038243 DOI: 10.1111/all.12901] [Citation(s) in RCA: 92] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND GA²LEN, the Global Allergy and Asthma European Network, has recently launched a program for the development, interaction, and accreditation of centers of reference and excellence in special areas of allergy embedded in its overall quality management of allergy centers of excellence. The first area chosen is urticaria. Urticaria is a common and debilitating condition and can be a challenge for both patients and treating physicians, especially when chronic. Centers of reference and excellence in urticaria (UCAREs) can help to improve the management of hard-to-treat conditions such as urticaria. AIMS Here, we describe the aims, the requirements and deliverables, the application process, and the audit and accreditation protocol for GA²LEN UCAREs. RESULTS The main aims of GA²LEN UCAREs are to provide excellence in urticaria management, to increase the knowledge of urticaria by research and education, and to promote the awareness of urticaria by advocacy activities. To become a certified GA²LEN UCARE, urticaria centers have to apply and fulfill 32 requirements, defined by specific deliverables that are assessed during an audit visit. DISCUSSION AND CONCLUSION The GA²LEN UCARE program will result in a strong network of urticaria specialists, promote urticaria research, and harmonize and improve urticaria management globally.
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Affiliation(s)
- M. Maurer
- Department of Dermatology and Allergy; Allergie-Centrum-Charité; Charité - Universitätsmedizin Berlin; Berlin Germany
| | - M. Metz
- Department of Dermatology and Allergy; Allergie-Centrum-Charité; Charité - Universitätsmedizin Berlin; Berlin Germany
| | - C. Bindslev-Jensen
- Department of Dermatology and Allergy Center; Odense Research Center for Anaphylaxis; Odense University Hospital; Odense Denmark
| | - J. Bousquet
- University Hospital; Montpellier France
- VIMA: Ageing and Chronic Diseases, Epidemiological and Public Health Approaches; INSERM; Paris France
- UVSQ; UMR-S 1168; Université Versailles St-Quentin-en-Yvelines; St-Quentin-en-Yvelines France
| | - G. W. Canonica
- IRCCS AOU San Martino-IST; University of Genoa; Genoa Italy
| | - M. K. Church
- Department of Dermatology and Allergy; Allergie-Centrum-Charité; Charité - Universitätsmedizin Berlin; Berlin Germany
| | - K. V. Godse
- Department of Dermatology; D.Y. Patil School of Medicine; Nerul Navi Mumbai India
| | | | - M. Hide
- Department of Dermatology; Institute of Biomedical and Health Sciences; Hiroshima University; Hiroshima Japan
| | - E. Kocatürk
- Department of Dermatology; Okmeydani Training and Research Hospital; Istanbul Turkey
| | - M. Magerl
- Department of Dermatology and Allergy; Allergie-Centrum-Charité; Charité - Universitätsmedizin Berlin; Berlin Germany
| | - M. Makris
- 2nd Department of Dermatology and Venereology; Attikon University Hospital; Athens Greece
| | - R. Meshkova
- Department of Clinical Immunology and Allergy; Smolensk State Medical University; Smolensk Russia
| | - S. S. Saini
- Department of Medicine; Johns Hopkins University; Baltimore MD USA
| | - G. Sussman
- Division Allergy and Immunology; University of Toronto; Toronto ON Canada
| | - E. Toubi
- Allergy and Clinical Immunology; Bnai-Zion Medical Center; The Technion; Haifa Israel
| | - Z. Zhao
- Department of Dermatology and Venereology; Peking University, First Hospital; Beijing China
| | - T. Zuberbier
- Department of Dermatology and Allergy; Allergie-Centrum-Charité; Charité - Universitätsmedizin Berlin; Berlin Germany
| | - A. Gimenez-Arnau
- Department of Dermatology; Hospital del Mar, IMIM; Universitat Autònoma; Barcelona Spain
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Stull DE, McBride D, Gimenez-Arnau A, Grattan C, Khalil S, Balp MM. Categorical Health States In Chronic Spontaneous Urticaria (Csu) Based On The Weekly Urticaria Activity Score (Uas7): Are They Distinct, Discriminative, And Reproducible? Value Health 2014; 17:A611. [PMID: 27202130 DOI: 10.1016/j.jval.2014.08.2140] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- D E Stull
- RTI Health Solutions, Manchester, UK
| | - D McBride
- RTI Health Solutions, Manchester, UK
| | | | - C Grattan
- Norfolk and Norwich University Hospital, Norfolk, UK
| | - S Khalil
- Novartis Pharma AG, Basel, Switzerland
| | - M M Balp
- Novartis Pharma AG, Basel, Switzerland
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Maurer M, Bindslev-Jensen C, Gimenez-Arnau A, Godse K, Grattan C, Hide M, Kaplan A, Makris M, Simons F, Zhao Z, Zuberbier T, Church M. Chronic idiopathic urticaria (CIU) is no longer idiopathic: time for an update. Br J Dermatol 2013; 168:455-6. [DOI: 10.1111/j.1365-2133.2012.11171.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Mullol J, Bousquet J, Bachert C, Canonica WG, Gimenez-Arnau A, Kowalski ML, Martí-Guadaño E, Maurer M, Picado C, Scadding G, Van Cauwenberge P. Rupatadine in allergic rhinitis and chronic urticaria. Allergy 2008; 63 Suppl 87:5-28. [PMID: 18339040 DOI: 10.1111/j.1398-9995.2008.01640.x] [Citation(s) in RCA: 94] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Histamine is the primary mediator involved the pathophysiology of allergic rhinitis and chronic urticaria, and this explains the prominent role that histamine H(1)-receptor antagonists have in the treatment of these disorders. However, histamine is clearly not the only mediator involved in the inflammatory cascade. There is an emerging view that drugs which can inhibit a broader range of inflammatory processes may prove to be more effective in providing symptomatic relief in both allergic rhinitis and chronic urticaria. This is an important consideration of the Allergic Rhinitis and its Impact on Asthma (ARIA) initiative which provides a scientific basis for defining what are the desirable properties of an 'ideal' antihistamine. In this review of rupatadine, a newer dual inhibitor of histamine H(1)- and PAF-receptors, we evaluate the evidence for a mechanism of action which includes anti-inflammatory effects in addition to a powerful inhibition of H(1)- and PAF-receptors. We assess this in relation to the clinical efficacy (particularly the speed of onset of action) and safety of rupatadine, and importantly its longer term utility in everyday life. In clinical trials, rupatadine has been shown to be an effective and well-tolerated treatment for allergic rhinitis and chronic idiopathic urticaria (CIU). It has a fast onset of action, producing rapid symptomatic relief, and it also has an extended duration of clinical activity which allows once-daily administration. In comparative clinical trials rupatadine was shown to be at least as effective as drugs such as loratadine, cetirizine, desloratadine and ebastine in reducing allergic symptoms in adult/adolescent patients with seasonal, perennial or persistent allergic rhinitis. Importantly, rupatadine demonstrated no adverse cardiovascular effects in preclinical or extensive clinical testing, nor negative significant effects on cognition or psychomotor performance (including a practical driving study). It improved the overall well-being of patients with allergic rhinitis or CIU based on findings from quality of life questionnaires and patient global rating scores in clinical trials. Thus, rupatadine is a recently introduced dual inhibitor of histamine H(1)- and PAF-receptors, which has been shown to be an effective and generally well-tolerated treatment for allergic rhinitis and chronic urticaria. It possesses a broader profile of anti-inflammatory properties inhibiting both inflammatory cells and a range of mediators involved in the early- and late-phase inflammatory response, but the clinical relevance of these effects remain to be clarified.
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Affiliation(s)
- J Mullol
- Unitat de Rinologia, Servei d'ORL, Hospital Clinic, IDIBAPS, Barcelona, Spain
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Gimenez-Arnau A, Pujol RM, Ianosi S, Kaszuba A, Malbran A, Poop G, Donado E, Perez I, Izquierdo I, Arnaiz E. Rupatadine in the treatment of chronic idiopathic urticaria: a double-blind, randomized, placebo-controlled multicentre study. Allergy 2007; 62:539-46. [PMID: 17441794 DOI: 10.1111/j.1398-9995.2007.01330.x] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Chronic urticaria is one of the most common and disturbing cutaneous condition. The treatment of chronic idiopathic urticaria (CIU) is still a challenge. Antihistamines are recommended as first-line treatment. Rupatadine is a new potent nonsedative anti-H1. OBJECTIVE To study rupatadine efficacy and safety for moderate to severe CIU treatment. METHODS This randomized, double-blind, placebo-controlled, parallel-group, multicentre, study was designed to assess primarily mean pruritus score (MPS) reduction with rupatadine, 10 and 20 mg, administered once daily for 4 weeks. Three hundred and thirty-three patients with active episodes of moderate-to-severe CIU were included. RESULTS A 57.5% (P < 0.005) and 63.3% (P = 0.0001) significative MPS reduction from baseline, was observed at week 4 with 10 and 20 mg rupatadine, respectively, compared with placebo (44.9%). Both doses of rupatadine were not significantly different at any time point, with respect to their effects on pruritus severity, number of wheals and total symptoms scores. Rupatadine 10 mg had an overall better adverse event profile. CONCLUSION Rupatadine 10 mg is a fast, long-acting, efficacious and safe treatment option for the management of patients with moderate-to-severe CIU.
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Gimenez-Arnau A, Gimenez-Arnau E, Serra-Baldrich E, Lepoittevin JP, Camarasa JG. Principles and methodology for identification of fragrance allergens in consumer products. Contact Dermatitis 2002; 47:345-52. [PMID: 12581281 DOI: 10.1034/j.1600-0536.2002.470606.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Fragrances contain several hundreds of different chemicals, a few major and many minor, which are responsible for the complexity of the odour. Fragrances are a major cause of allergic contact dermatitis. As a diagnostic tool, the current fragrance mix is very useful though not ideal. A 50-year-old woman presented with a pruriginous, erythematous eruption, characterized by papules, vesicles, exudation and crusting over the neck and chest. With the suspicion of fragrance allergy, patch testing was performed. Initially, the only positive reaction observed was with her own eau de toilette named Woman. The TRUE Test fragrance mix patch test was negative. Chemical fractionation of Woman perfume concentrate was combined with a sequenced patch testing procedure and with structure-activity relationship studies. Ingredients supplied by the manufacturer were also included in the study. Benzophenone-2, Lyral, alpha-hexyl cinnamic aldehyde and alpha-damascone were found to be responsible for the patient's contact allergy to the commercial product. These substances contain chemical structural alerts giving them antigenic ability. The common use of new chemicals to manufacture fragrances, and the increased number of patients sensitive to them but with negative fragrance mix reactions, makes it necessary to identify new potential fragrance sensitizers in commercial products.
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Affiliation(s)
- A Gimenez-Arnau
- Department of Dermatology, CAP Barceloneta, Hospital del Mar, Universitat Autónoma de Barcelona, Spain
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