American Journal of Contact Dermatitis最新文献

Background: Both irritant and allergic contact dermatitis can be influenced by occupational and nonoccupational environmental exposures. Objective: The aim of this study is to compare the occupations and allergens of occupational contact dermatitis cases with nonoccupational contact dermatitis cases. Methods: Diagnostic patch testing was conducted with the 50 screening allergens of the North American Contact Dermatitis Group and occupational coding by the Surveillance Branch of the National Institute of Occupational Safety and Health. Results: Of the 5,839 patients patch tested for contact dermatitis, 1,097 (19%) were deemed to be occupationally related. Of the occupational cases, 60% were of allergic and 32% were of irritant origin. The hands were the primary body part affected in 64% of allergic occupational cases and 80% of irritant occupational cases. Epoxy resin was the only allergen tested that was associated more with an occupational exposure than nonoccupational exposure. The allergens encountered most frequently in the occupational cases were carba mix, thiuram mix, epoxy resin, formaldehyde, and nickel. The medical field is overrepresented in the data compared with other occupations. Conclusions: Occupational contact dermatitis frequently was found to be multifactorial and associated with several specific allergens and occupations.

Background: Natural rubber latex allergy is a potentially life-threatening, Type I, immediate allergic reaction. Despite great strides in identification of high-risk groups, methods for diagnosis remain limited in the United States. Objective: The objective of this study was to estimate the prevalence of evaluation for latex allergy and methodologies used by allergists in the United States. Methods: A cross-sectional survey of all US Fellows of the American Academy of Allergy, Asthma and Immunology was conducted. Results: Of 1,239 questionnaires mailed, 519 (42%) were returned. Ninety-five percent of responding allergists reported evaluating patients for latex allergy. RAST and skin prick testing were the most commonly used tests. Sixty-two percent of respondents reported performing prick testing for latex allergy, with those in academic practices significantly more likely to do so. Whereas respondents practicing in the Northern United States were significantly more likely to evaluate for latex allergy than those in the Southern United States, no associations were found between practice location and prick testing for latex allergy. There was no association between practice type and evaluation for latex allergy. Only 6% of allergists reported ever witnessing a patient with anaphylaxis during latex allergy testing. Conclusions: Almost all responding allergists evaluated patients for latex allergy, with approximately two thirds utilizing prick testing.

Background: p-tert-Butylphenol-formaldehyde resin (PTBPFR) is a contact allergen that is included in most standard patch test series. This resin consists of a large number of substances most of which are unknown. Objective: The aim of this study was to investigate if allergens in PTBPFR are molecules mainly of low (MW [lt ] 250), medium, or high molecular weight (MW [gt ] 1,000); to isolate and identify some of the low molecular weight components of the resin; and for new substances to determine if these were allergens. Methods: Gel permeation chromatography, patch testing, high-pressure liquid chromatography, mass spectrometry, and nuclear magnetic resonance spectrometry were used. Results: Patch test reactions indicated allergens in low-, medium-, and high-molecular-weights fractions. The strongest patch test reactivity was seen to a medium molecular weight fraction constituting only 6% wt/wt of the resin for 4 of the patients. Two patients reacted positively to low molecular weight fractions, and one of these patients reacted only to these fractions. The following substances were isolated: 4-tert-butyl-[1,2]benzoquinone, 4-tert-butyl-2,6-bis-hydroxymethyl-phenol, 4-tert-butylbenzene-1,2-diol, 4-tert-butyl-2-hydroxymethyl-phenol, 5-tert-butyl-2-hydroxy-3-hydroxymethyl-benzaldehyde, 4-tert-butyl-2-hydroxymethyl-6-methoxymethyl-phenol, and p-tert-butylphenol. Patients reacted positively to 5-tert-butyl-2-hydroxy-3-hydroxymethyl-benzaldehyde and 4-tert-butyl-2-hydroxymethyl-6-methoxymethyl-phenol but not to 4-tert-butyl-[1,2]benzoquinone. Conclusion: Two new allergens in PTBPFR were found: 5-tert-butyl-2-hydroxy-3-hydroxymethyl-benzaldehyde and 4-tert-butyl-2-hydroxymethyl-6-methoxymethyl-phenol.

Background: The patch test is an important tool for the diagnosis of contact dermatitis. In the past few years, allergists have shown increased interest in the diagnosis of contact dermatitis and the use of patch testing. Objective: The aim of this study was to determine (1) the frequency of usage of the patch test among allergists, (2) the factors that affect the decision to patch test, and (3) the need for training the allergist to perform patch testing. Method: A single mailing survey was sent to all the members of the American College of Allergy, Asthma and Immunology (ACAAI). Results: Fifty-seven percent of responding allergists performed patch testing but did so infrequently. Those who were fellowship trained in patch testing or attended a sponsored workshop performed the test more frequently than those with no training. Those who perceived the patch test as useful also were more likely to perform the test. Fellowship-trained members felt more confident than workshop-trained members in performing the test, and both, in turn, were more confident than members with no training. Trained physicians also were more likely to find the test useful compared with those with no training in patch testing. Conclusions: Education through fellowship training and workshop was associated with greater self-confidence of the allergist in his/her ability to perform patch testing. Education also was associated with increased perception of patch test utility and increased usage of the test.

Background: In patients hypersensitive to phenol formaldehyde resin (PFR) it is, for therapeutic and preventive reasons, important to know the identity of the primary sensitizing substances, their sensitizing capacity, as well as their cross-reaction patterns. When elucidating the issue of cross reactivity in patients with contact allergy to simple methylol phenols (MP), o-cresol was shown to be a contact sensitizer. Besides cross reactivity, contamination of one or more MP(s) in o-cresol as well as o-cresol being a sensitizer of its own in PFR were possible explanations of the simultaneous positive patch test reactions to MP and o-cresol. Objective: The aim of this study was to investigate if the simultaneous allergic reactions to PFR and o-cresol could be explained by the presence of this substance in PFR. Methods: Patch testing, high-pressure liquid chromatography (HPLC), nuclear magnetic resonance spectrometry (NMR), gas chromatography (GC), and mass spectrometry (MS) were used. Results: o-Cresol was isolated from the specific PFR used in our standard patch test series and identified. The concentration in the resin was 0.066% wt/wt. Conclusion: The current study establishes o-cresol as a contact sensitizer in a PFR. The observed reactions to o-cresol could be on the basis of cross reactivity or primary sensitization.

Nitromethane has wide industrial and commercial application as a polar solvent for adhesives and acrylics as well as explosive fuel. Allergic contact dermatitis to this chemical has not been described previously. The authors documented allergic contact hand dermatitis in 4 coworkers who similarly handled an adhesive solvent containing nitromethane. All 4 cases were confirmed by patch testing and resolved after allergen avoidance.

Background: Patch testing is considered the gold standard for the diagnosis of allergic contact dermatitis. Whereas previous surveys have evaluated the patch testing practices of dermatologists, little information is available on the use of patch testing by allergists. Objective: The objective of this study was to examine the prevalence of patch testing and associated methodologies used by allergists in the United States. Methods: A cross-sectional survey of all US Fellows of the American Academy of Allergy, Asthma and Immunology was conducted. Results: Of 1,239 questionnaires mailed, 519 (42%) were returned. Fifty-three percent of allergists reported performing patch testing. The majority (89%) patch tested 5 or fewer patients per month. Allergists who evaluated for latex allergy were twice as likely to patch test than those who did not. The most common patch test reading schedule was at both 48 and 72 hours (48%). Thirty-three percent of respondents performed only a single patch test reading. The majority (72%) used TRUE Test. Only 4% patch tested for Type IV allergy to dust mites. Conclusion: Many more allergists patch test than initially hypothesized. The patch testing methodologies used by allergists are similar to those of dermatologists.

Background: The authors report a case of a 47-year-old woman who suffered a severe allergic contact dermatitis (ACD) in the vulvar area after using Poise thin incontinency pads. She had a past history of ACD after the use of sculptured acrylic nails and after the installation of a dental crown. Objective: The aim of this report is to show the spectrum of (meth)acrylate allergy in one individual. Methods: Patch testing of moistened inner and outer aspect of the pad was performed. We also patch tested with the North American Contact Dermatitis Group series of 50 allergens, the dentistry series, various catalysts and inhibitors used in acrylic resin systems, and some epoxy acrylates. Results: Positive ACD reaction occurred to both sides of the pad, with the inner aspect being stronger than the outer aspect. There were also multiple (meth)acrylate allergies. Conclusion: This case shows a new potential source of allergy to (meth)acrylates.

Plant material occasionally is used in patch testing to diagnose contact dermatitis. Serious adverse reactions to this practice are extremely uncommon. The authors report on a 68-year-old non[ndash ]insulin-dependent diabetic gentleman with hand dermatitis in whom severe necrotizing cellulitis developed caused by Apophysomyces elegans, a subtype of mucormycosis, at the site of a patch test to a snapdragon plant from his garden.