American Journal of Contact Dermatitis最新文献

Background: Reports of textile dye allergic contact dermatitis are becoming frequent in the literature. Occupational exposure to textile dyes has been reported, but less frequently. Objective: To report 2 cases of allergic contact dermatitis to Disperse Blue dyes 106 and 124 occurring in airline personnel. Methods: The patients were patch tested to the European or North American standard series, a textile dye series, and 1 patient was tested with pieces of textile from an airplane seat. Results: Patch testing elicited in both patients a 2+ reaction to Disperse Blue dyes 106 and 124, and a 1+ reaction to paraphenylenediamine in one patient. Conclusion: We describe 2 cases of occupational textile dye allergy occurring in airline personnel. Both cases showed the utility of Disperse Blue dyes 106 and 124 to serve as the screening allergens for textile dermatitis. Mandatory uniforms might be an occupational hazard in certain professions.

Background: Patch testing with additional series (AS) of allergens may be a useful tool in diagnosing allergic contact dermatitis (ACD). Objective: Aim of the study was to verify the usefulness, to check the reliability in clinical practice and to evaluate the economic costs of AS previously built up. Methods: A total of 281 patients with suspicious ACD underwent patch test with the standard series (SS) and with one or more AS (51 among 71 built up). Results: A total of 170 patients (60.5%) showed positive reactions to SS; 116 (41.3%) to AS. Among 582 nonstandard allergens used, 113 (19.4%) elicited 1 or more positive reactions: out of 10,916 patch tests carried out, 260 (2.4%) positive reactions were observed. The correlation between SS and AS indicated that 8.2% patients resulted SS[minus ]/AS+, 27.7% SS+/AS[minus ], 32.7% SS+/AS+, 31.3% SS[minus ]/AS[minus ]. The most frequently used AS showed the following percentages of patients with 1 or more positive reactions: clothes 41.4%, building industry 51.8%, hairdressers 77.3%, textile industry 42.1%, shoes 36.8%. Positive reactions to the most frequently used nonstandard allergens resulted: propylene glycol 0.4%, cobalt chloride 12.6%, phenylmercuric nitrate 2.2%, p-aminophenol 4.5%. The approximate economic cost of patch testing with AS has been evaluated in 1.3 per single patch test. Conclusion: The cost of patch testing AS is not irrelevant, but it can be compensated by the advantages deriving from the increase of data concerning ACD etiology. A reduction in the number of allergens included in single AS should be performed. Cobalt chloride, taking into account the high percentage of positive reactions observed and its presence in a large number of AS, could be (re)introduced in the standard series.

Fragrance is the most common cosmetic allergen found when dermatitis patients are patch tested in the United States and in many places worldwide. Fragrances are ubiquitous in our daily lives and are present in items ranging from toiletries to toilet tissue. Although fragrances enhance the smell or mask unpleasant odors of various cosmetics and household items, it becomes very difficult for fragrance-allergic patients to find products they can use. Many items labeled unscented and fragrance-free contain esoteric fragrance chemicals that most consumers would not recognize. This article details some covert fragrance agents to help physicians better educate their fragrance-sensitive patients.

Background: Hand eczema can have complex causative or aggravating influences, and the pattern, history, and patch test data are helpful in identifying sources and antigen substitution. Objective: We studied our patients with hand eczema associated with exposure to baby wipes for pattern and sensitivities. Methods: Patient records over a 10-year period containing key words were reviewed for relevance of exposure, patch test data, and outcome. Results: A total of 6 women and 3 men with hand eczema were found to be allergic to (preservatives found in) different brands of moist towelettes used in diaper hygiene. Many were allergic to fragrance materials as well. The eruptions were mostly worse on the thumb and 2 adjacent fingers, with which the item was held. Five of the 9 were parents of infants, although no infant had a problem. Only 1 patient suspected the source. All improved with avoidance, although most had multiple other contact allergies, including corticosteroids. Conclusions: Hand eczema in a grip-like pattern is good reason to inquire about baby wipes as a possible source, as most patients do not recognize that source even after undergoing patch tests.

Background: Diisocyanates are widely used in industry, for example at hospitals as a constituent of Scotch Cast soft casts (3M, Glostrup, Denmark). They are a cause of occupational asthma and have been described as causing cutaneous problems both as irritants and as sensitizers. Objective: The sensitizing potential of diisocyanates has previously only sporadically been described, predominantly in case reports. Therefore, we conducted this study to investigate eventual work-related skin sensitization to diisocyanates in a regularly exposed population. Methods: The nursing staff of an orthopaedic outpatient clinic, consisting of 10 persons, were interviewed and subjected to patch testing using 5 types of diisocyanates and the TRUE Test (ECDRG Standard Series) to elucidate possible other type IV allergies with similar symptoms. Patch test results were evaluated according to the guidelines of the International Contact Dermatitis Group. Results: We found no relationship between exposure time and severity of symptoms. Symptoms were mild, consisting of redness, itching, or both, lasting about 30 minutes. There was no suggestion that they result in any chronic skin problems. One nurse presented a doubtful reaction towards diaminophenylmethane (MDA) and isophorene diisocyanate (IPDI). Nine persons had no reactions to the 5 diisocyanates used in the patch test. Positive reactions were seen to nickel (4/10), thiomersal (2/10), and perfume mix (1/10). Conclusion: Our observations suggest that diisocyanates are primarily irritants rather than sensitizers in the professional setting studied. The skin symptoms of irritation were all mild and temporary.

Background: Patients using topically applied corticosteroids are at risk of developing allergic contact hypersensitivity. Objective: To assess prevalence of allergic contact hypersensitivity reactions to inhaled or intranasal corticosteroids. Methods: A prospective study of 30 adult patients using inhaled or intranasal corticosteroids for conditions such as allergic rhinitis was performed. We used epicutaneous patch testing to determine the prevalence of allergic contact hypersensitivity to corticosteroids and common additives (propylene glycol and benzalkonium chloride) in inhaled and nasal corticosteroid preparations in this population. Results: Of 30 patients, 4 (13%) had positive patch test results. 3 (10%) were allergic reactions and 1 (3%) was an irritant reaction. Half of the reactions were to a corticosteroid (budesonide) and half were to a common preservative in nasal preparations (benzalkonium chloride). Conclusion: This study supports other clinical evidence that contact dermatitis/mucositis from inhaled or intranasal corticosteroid products can occur. The corticosteroids or added agents such as preservatives can be causative and may result in allergic or irritant reactions, which can be relevant to clinical symptoms.

Insect-pollinated members of the plant family Compositae (Asteraceae) rarely cause immediate-type hypersensitivity disease; however, this may have quite disabling consequences, which is shown by the case of a 42-year-old female florist. She developed contact urticaria later accompanied by rhinoconjunctivitis and bronchial asthma with maximum obstruction occurring some hours after the end of occupational exposure to the causative Compositae pollens of, for example, dandelions, blazing star, golden rod, yarrow, Aster ssp, chrysanthemums, and marguerite. Skin testing revealed immediate-type hypersensitivity to several members of the above-mentioned plant family confirmed by demonstration of specific IgE antibodies. Bronchial provocation testing yielded a positive response with all 4 pollen extracts tested. The patient had to give up work in a flower shop, because sufficient avoidance of airborne inhalant exposure was not considered practical.

Background: Budesonide, a marker for corticosteroid allergy, is a 1:1 mixture of 2 diastereomers, the R and S, present in all commercial formulations. Budesonide is said to cross-react with group B substances through the R and S diastereomer and some group D substances only through the S diastereomer. Objective: To investigate the cross-reactivity pattern between the R and S diastereomers and 4 potentially cross-reacting substances, 2 from group B and 2 from group D. Methods: By patch testing 10 patients hypersensitive to budesonide with a serial dilution of budesonide, the R and S diastereomer, triamcinolone acetonide, amcinonide, prednicarbate, and hydrocortisone-17-butyrate. Results: Nine of 10 patients reacted to budesonide and the S diastereomer. Seven of 9 to the R diastereomer. Each of the 9 patients with S diastereomer allergy reacted to the group B and/or group D substances. Five patients reacted to triamcinolone acetonide, not to 1.0% but only to 0.0010% and 0.00010%. Conclusion: The R and S diastereomers can induce positive patch test reactions in budesonide-hypersensitive individuals. The potential of budesonide to cross-react with substances from group B and D might be explained by the presence of the 2 diastereomers. When patch testing with triamcinolone acetonide, much lower concentrations than recommended should be used.