Allergen Research Articles

Local allergic rhinitis: the issue and its significance

The article presents the pathogenetic mechanisms of allergic rhinitis and approaches to the allergic diagnosis of this pathology. The clinician has an opportunity to verify the presence of this particular form of rhinitis when using the following laboratory diagnostic methods: determining the level of IgE in the nasal secretion, using the basophil activation test, rhinocytogram, and other nasal cytology tests. The basophil activation test is a functional study in which flow cytometry is used to determine the expression of activation markers on basophils following the exposure to the relevant al lergen. The use of this test in diagnostics showed that it had 50% sensitivity and 93% specificity in the examination of patients with suspected sensitization to house dust allergens. Even higher sensitivity rates (66%) with equal specificity (91.7%) were found in patients with sensitization to pollen allergens.

Principles of allergy diagnostics

Allergies are frequent and approximately 30% of the general population in Germany are affected. The specific sensitization against an allergen is asymptomatic. On renewed allergen contact the symptoms are indicative of the underlying pathomechanism. A variety of different test procedures are available to identify allergic reactions. In this review article the typical clinical symptoms of allergic reactions are assigned to mechanisms and possible test methods are presented and discussed. Current developments in recombinant serum diagnostics and cellular testing methods are presented.

CD4+ T cells inhibit the generation of CD8+ epidermal-resident memory T cells directed against clinically relevant contact allergens.

CD8+ epidermal-resident memory T (TRM ) cells play central roles in local flare-up responses to experimental contact allergens by inducing massive influx of neutrophils to the epidermis upon allergen challenge. Whether similar immunopathogenic mechanisms are involved in the responses to clinically relevant contact allergens is unknown. The immune response to cinnamal, ρ-phenylenediamine (PPD) and methylisothiazolinone (MI) was studied in a well-established mouse model for allergic contact dermatitis that includes formation of TRM cells by ELISA, flow cytometry, fluorescence microscopy analyses and cell depletion protocols. We show that the formation of CD4+ and CD8+ epidermal TRM cells and the inflammatory response are highly allergen-dependent. However, the magnitude of the flare-up responses correlated with the number of epidermal CD8+ TRM cells, CXCL1/CXCL2 release and recruitment of neutrophils to the epidermis. Finally, depletion of CD4+ T cells strongly enhanced the number of epidermal CD8+ TRM cells, the flare-up response and the epidermal infiltration of neutrophils for all allergens. As the first, this study demonstrates that clinically relevant contact allergens have the ability to generate pathogenic, epidermal CD8+ TRM cells that recruit neutrophils following re-exposure to the allergen, but that this normally is counteracted by the simultaneous induction of anti-inflammatory CD4+ T cells.

Hazard identification and the prevalence of occupational skin disease in Indonesian Batik workers

Batik, a resist-dyeing technique to decorate a special cotton fabric, has been practiced for centuries in Indonesia. Unfortunately, as an informal enterprise, batik industry activities lack work safety and health regulations. This study aimed to identify potential health hazards, including inventorying the chemicals to which the workers are exposed, the PPE profile, and investigating the prevalence of occupational skin diseases (OSD) in the batik industry. A cross-sectional study and an inventory of exposure to the chemicals were done in traditional batik workplaces in 5 districts in Yogyakarta province, Indonesia. The chemicals were classified as potential sensitizers/irritants, and the workers were examined and interviewed using the Nordic Occupational Skin Questionnaire-2002/LONG. Of 222 traditional batik workers, OSD were diagnosed in 61 (27.5%) workers, with occupational contact dermatitis was the most common OSD encountered (n = 23/61; 37.7%) (allergic contact dermatitis n = 7/23; irritant contact dermatitis n = 16/23). A smaller portion of other OSD was also encountered including callus, miliaria, and nail disorder (9%, 6.3%, and 5.9%, respectively). During each step of the traditional batik manufacturing process, the workers are exposed to substances that act as irritants and/or as potential contact allergens. However, only one-fourth of the workers used PPE regularly, particularly during the coloring process and wax removal (wet processes). Traditional batik manufacturing process exposes the worker to various physical and chemical hazards, resulting in a high prevalence of occupational skin diseases, especially contact dermatitis among the employees.

Active sensitization to dimethylthiocarbamylbenzothiazol sulphide: An unexpectedly strong rubber contact allergen.

The two dialkylthiocarbamyl benzothiazole sulphides, dimethyl-thiocarbamylbenzothiazole sulphide (DMTBS) and diethylthio-carbamylbenzothiazole sulphide (DETBS) were shown to be good markers of both thiuram and mercaptobenzothiazole sensitivity. To investigate if DMTBS and/or DETBS could be better markers of contact allergy to common rubber additives than the ones currently used. Sixty-eight dermatitis patients were patch tested with DMTBS and DETBS, both at 1% in petrolatum (pet). Because of late reactions in 10 patients, these were retested to DMTBS and DETBS in serial dilutions. Tetramethylthiuram monosulphide (TMTM) 1.0% pet was also tested. At the initial reading Days 3 and 7, no reactions were noted to DMTBS or DETBS. At retesting, 10 of the 68 (15%) patients reacted positively to lower concentrations of DMTBS than the initial test concentration. Seven of 8 also reacted to TMTM. Three of them had positive reactions to DEBTS. All 10 patients had reactions to more diluted solutions to DMBTS than to DEBTS (p = 0.0077; Mc-Nemar test, two-sided). Results speak for patch test sensitization to DMTBS with cross-reactivity to TMTM and also DEBTS. DMTBS and DEBTS could be new markers of rubber allergy but a safe test concentration must be found.

Use test with l-carvone in toothpaste on sensitized individuals.

The mint flavour carvone (l-carvone) is considered a weak contact allergen. However, contact allergy to carvone is more prevalent in patients with oral lichen planus or oral lichenoid lesions (OLP/OLL). Our aim was to investigate how carvone affects sensitized individuals through a use test with toothpaste containing carvone. Non-flavoured toothpaste served as control. Subjects were patch tested prior to the use test-14 subjects allergic to carvone (11 with OLP/OLL), 20 subjects with OLP/OLL and 3 healthy controls. The month-long use test comprised of using toothpaste twice daily. Subjects were examined fortnightly. Clinical signs were assessed with a mucosal scoring system. The subjects' oral health-related quality of life was measured with the oral health impact profile (OHIP-49). Local reactions to the carvone toothpaste presented as aggravated OLL (7/10) and peri-oral eczema (2/10) in allergic subjects. They also had significantly higher mucosal and OHIP scores compared with those receiving non-flavoured toothpaste. In sensitized individuals, oral exposure to carvone gives aggravated oral lesions and/or peri-oral eczema. The lesions mimic OLP and allergic individuals are therefore at risk of not being assessed with regard to flavour contact allergy.

Contact Allergy to Shellac. Retrospective Cross-Sectional Study With Data From the Spanish Registry of Research in Contact Dermatitis and Cutaneous Allergy (REIDAC)

IntroductionShellac is a known allergen present mainly in cosmetics used on the eyelids and lips, although new sources of exposure have recently been described. Our objective was to assess the use of shellac as a contact allergen in Spain and the clinical profile of patients allergic to shellac. MethodsThis retrospective cross-sectional study included patients patch tested for shellac between 2018 and 2021 from the Spanish Registry of Contact Dermatitis and Cutaneous Allergy (REIDAC). ResultsA total of 980 patients were patch tested for shellac (20% in ethanol), and 37 (3.77%, 95% confidence interval [CI], 2.58–3.97%) showed positive results. Most of these patients were tested for shellac due to a suspicion of cosmetic contact dermatitis. Seven patients with present relevance were found, five with relation to cosmetics, and the other two with an occupational background of food handling. The reaction index for shellac was 0.51 and the positivity ratio was 67.56% (95% CI, 52.48–82.65%). ConclusionsShellac appears to be a prevalent allergen in patients with suspected contact dermatitis related with cosmetics or foodstuff. However, further studies are needed to validate its use in other patients.

Occupational Hand Dermatitis.

Occupational hand dermatitis is a common work-related disorder of the skin. Prevention and management of this disease is critical to improving workers' quality of life and for occupation-specific retention. This is a critical review of the current literature on occupational hand dermatitis. Occupational dermatitis continues to have a high prevalence among workers although the overall incidence may be slowly decreasing. Irritant contact dermatitis due to wet work exposure is the most common cause of occupational hand dermatitis. Healthcare workers, hairdressers, and metal workers are at particularly high risk for this disease. While some prevention programs have been ineffective in mitigating occupational hand dermatitis, other more resource-intensive initiatives may have benefit. Continued research is needed on ways to manage wet work exposures and on scalable, effective prevention programs for occupational hand dermatitis. The spectrum of culprit contact allergens continues to evolve, and vigilance for potential occupation-specific allergens remains important.

Potential Allergens in Wound Care Products.

Background: Patients with chronic wounds have an increased risk of developing allergic contact dermatitis (ACD). Reports of ACD to wound care products are not uncommon. To minimize contact sensitization in patients with chronic wounds, allergenic ingredients should be avoided when possible. Objective: With more than 5000 wound care products available in the United States, it is essential to understand which products can be chosen to minimize allergen exposures. Methods: Ingredients in wound care products in 5 wound care clinics across 2 institutions were cross-referenced with the American Contact Dermatitis Society core allergen series 2020. Results: Of the 267 wound care products included, 97 (36.3%) contained at least one allergen, including 31 dressings/wraps (22.3%), 25 medications (69.4%), 12 cleaning supplies (36.3%), 16 tapes/glues (80%), 2 instruments (14.3%), 8 emollients and vehicles (61.5%), 1 ostomy product (11.1%), and 2 odor-eliminating products (66.7%). Thirty-four different allergens were identified across all products. The most common allergens present in the included items were acrylates and propylene glycol, followed by parabens, cetyl stearyl alcohol, tocopherol, fragrance, and phenoxyethanol. Conclusions: Many wound care products contain at least one contact allergen, highlighting the importance of clinician education on ACD in the context of wound care product selection.

A 30-year Patch Testing Experience at Siriraj Dermatology

Objective: To identify trends of contact allergy and patch testing amendments at the Contact Dermatitis Clinic, Department of Dermatology, Siriraj Hospital.
 Materials and Methods: Medical records of 6,862 patients referred to our clinic between January 1992 and December 2021for patch testing were reviewed.
 Results: The number of patients patch tested increased and reached a peak of 600 patients/year in 2019 before the COVID-19 pandemic. The most frequently used series was baseline, while the most used specific series was cosmetics. The overall positivity rate was 69%. The highest positivity rate was in the cosmetics series (70.2%). Nickel sulfate was the most common contact allergen found (24.2%).
 Conclusion: Our patch test service has been growing in the last 30 years. The series of allergens used for patch testing has been amended every few years to be up-to-date with current global trends of contact allergies. Continual surveillance of contact prevalence and periodic updating of those series are necessary to enhance our ability to detect culprit contact allergens, which could help us improve care of our patients.

Popper's Dermatitis: A Unique Form of Contact Dermatitis In the MSM Community

Men who have sex with men have different contact allergen exposures compared to men who have sex with women due to cultural differences in the LGBTQ+ community. Poppers, a common name for volatile alkyl nitrates, are used more frequently in the MSM community as recreational inhalants. We aimed to identify common anatomic sites and contact allergens associated with popper's dermatitis in the MSM community.

ASSOCIATION BETWEEN ALLERGIC REACTIONS AND LIP INFLAMMATORY LESIONS (CHEILITIS).

The purpose of this study was to examine the possible association between cheilitis and allergic reactions, and to use allergy skin tests to identify the allergens that induce allergic reactions in cheilitis patients (type I and type IV). We included 50 patients with recurrent cheilitis (reversible cheilitis) who were dermatologically examined and agreed to undergo allergy skin tests, i.e., patch test and prick test. Additionally, clinical pictures and patient mental stress levels were examined using the Perceived Stress Scale (PSS). Positive prick tests (atopy) were recorded in 84% of patients with cheilitis. The most frequently found allergens were contact allergens (54%) (cobalt chloride, nickel sulfate and thimerosal) and inhalant allergens (46%). The patch test positive subjects who used cosmetic, hygiene, and decorative products were significantly more likely to have swollen and red lips than the patch test negative subjects. Also, low stress levels were recorded less frequently in patients with confirmed allergies than in non-allergic patients. The results indicated a higher incidence of cheilitis in the people prone to allergies (atopics) and confirmed an association between cheilitis and allergies. To our knowledge, this is the first study in patients with cheilitis, which simultaneously analyzed allergies, their clinical features and PSS in the same patients.

Screening for Allergic Contact Dermatitis Based on Pattern of Patch Test Results: A Retrospective Study

Abstract Background: Contact allergies are associated with morbidity worldwide. Purpose: To investigate the patterns of sensitization to contact allergens in a local population. Methods: A retrospective study investigated patch test reactivity among patients with a clinical diagnosis of contact dermatitis referred to the dermatology clinic at King Fahad Armed Forces Hospital, Jeddah, between January 2021 and January 2023. Pregnant women, immunosuppressed patients, and those receiving immunosuppressive therapy were excluded. Only 92 of 101 referred patients underwent patch testing after fulfilling requirements. The patch test was performed using a Thin-layer Rapid-Use Epicutaneous patch test containing 35 contact allergenic elements and one control (total = 36). Results: Among 92 patients, 35 (38%) were males, and 57 (62%) were females. Of these, 62 (67.4%) patients had a positive patch test and reacted to one or more allergens. The most common sensitizing allergens were p-phenylenediamine (PPD), gold sodium thiosulfate, and disperse blue 106, with equal positive reactions in 16 (25.8%) patients, followed by nickel sulfate in 13 (21%), p-tert-butylphenol formaldehyde resin in eight (13%), fragrance mix in 7 (10.8%), and epoxy resin in six (9.2%) patients. No significant sex differences were found among patients with contact dermatitis where notable patch test allergen reactivity was observed. Conclusion: Patch test reactivity to PPD, gold sodium thiosulfate, and disperse blue 106 was high. The pattern of contact allergy observed here highlights the need for large-scale investigations to identify local allergens for contact allergy and formulate policies for avoiding exposure.

Selection and significance of haptens in patch testing with contact allergens in patients with atopic eczema

Selection and significance of haptens in patch testing with contact allergens in patients with atopic eczema

A Retrospective Analysis to Investigate Contact Sensitization in Greek Population Using Classic and Machine Learning Techniques.

Allergic contact dermatitis (ACD) is an inflammatory reaction affecting all age groups and both sexes. ACD is characterized by a delayed-type hypersensitivity reaction IV caused by skin contact with haptens. Chronic exposure typically leads to a decrease in erythema accompanied by lichenification (thickening and hardening of the skin) and persistent itching. The current study aims to investigate the patterns of contact sensitization in the Greek population using patch test data analysis. Patch test data from 240 patients (120Males/120Females) with allergic contact dermatitis were collected at the Laboratory for Patch Testing, National Reference Center for Occupational Dermatoses "Andreas Syggros" Hospital in Athens Greece. The contact allergic reactions were caused by ethylenediamine dihydrochloride 1%, thimerosal 0.5%, and methyldibromo-glutaronitrile 0.1% from the European baseline series of allergens; information was also collected for ICDRG evaluation, an extended MOAHLFA index and patient-reported outcomes (daily routine questionnaire). The chi-square test for independence and Spearman's rank were used to evaluate the association and correlation, respectively, between patient characteristics and ACD-related factors. Multiple correspondence analysis (MCA), which is a data analysis approach, was used to find and depict underlying structures in the data collection for nominal categorical data. Statistically significant associations were found between the following pairs of characteristics: eczema triggers and gender and eczema triggers and hand dermatitis. The results from MCA showed that there is correlation between allergic contact dermatitis onset, allergens, and demographic variables.

Topikalne farmaceutske formulacije za negu kože izložene jonizujućem zračenju

Radiotherapy as the application of ionizing radiation is one of the main current therapeutic modalities for cancer. However, one of the most frequent adverse effects of this therapeutic strategy is radiodermatitis, which significantly affects quality of patients' lives. Nowadays, there is no consensus on the appropriate therapy of radiodermatitis, however there are basic recommendations that should be followed. The aim of this study was to make a review of current recommendations during radiotherapy for the prevention of radiodermatitis through application or avoidance of application of certain topical pharmaceutical formulations. Most studies proposed the adequate personal hygiene as a general preventive measure. Basic recommendations also include wearing loose-fitting clothing, using an electric shaver, sunscreens, moisturizers, and avoiding alcohol and cigarettes. According to the Multinational Association of Supportive Care in Cancer (MASCC), the only recommendation for the prevention and treatment of radiodermatitis is gentle washing using mild soap, as well as the use of topical steroids and silver sulfadiazine. Some studies report the possibility of using photobiomodulatory therapy in the prevention of radiodermatitis, as well as non-corticosteroid creams based on aloe, hyaluronic acid, calendula and comfrey. The use of comedogenic topical preparations, those containing alcohol, benzoyl peroxide and/or alpha-hydroxy acids, as well as those containing potential contact allergens and irritants, should be avoided. Adequate guidelines supported by strong evidence and consensus do not exist, and many recommendations were later refuted. Therefore, further research in this field is necessary to find a satisfying solution for an issue of radiation dermatitis.

A postulated model for photoimmunopathogenesis of chronic actinic dermatitis around adaptive immunity, including Th17 cells, Tregs, TRMs, cytotoxic T cells, and/or common-γ chain receptor+ cells.

The pathogenesis of chronic actinic dermatitis (CAD) is more complicated than other photodermatoses. However, the relationship between the clinical severity of CAD and the offending photocontact or contact allergens or both, and the correlations of CAD immunopathogenesis with the immunoregulatory molecules involved in adaptive immunity are yet to be investigated. We performed phototesting with broad-spectrum ultraviolet (UV) B, UVA, and visible light to establish the presence of photosensitivity in 121 patients with CAD, together with photopatch and contact patch testing. Nine patients with CAD were selected according to their clinical severity score for CAD (CSS-CAD), and triple direct immunofluorescence analysis was performed with paraffin-embedded skin biopsy samples. As CSS-CAD was closely correlated with the multiplicity of photo(contact) allergens, particularly photoallergens, three or more photoallergens were detected in the severe CAD group (52.5%); less in the moderate group (32.8%); and only one in the mild group (14.8%; P=.025). In the groups showing greater severity of disease, the absolute numbers of IFN-γ+ , IL-17+ , CD4+, CD8+, common-γ chain receptor (common-γCR)+ , and CD69+ tissue-resident memory cells increased on average; there was also an increase in the CD4+/CD8+ cell ratio, with the more severely affected groups. However, the levels of TNF-α+ and FoxP3+ regulatory T (Treg) cells and the mean IL-17/IFN-γ cell ratio decreased in the more severely affected CSS-CAD subgroups. Based on the clinical analysis and immunopathogenic results, avoidance of excessive sun exposure, and topical and systemic blocking agents for photo(contact) allergens are recommended. Additionally, conventional immunomodulators and emerging agents including JAK-STAT inhibitors may be administered for CAD treatment in the future.

A Survey of Allergic Contact Dermatitis Among Hairdressers

Summary The study aimed to investigate the relationship between the professional environment and hypersensitivity reactions to various contact allergens, the features of the clinical course, and the type of allergic contact dermatitis (ACD) in 35 hairdressers. The analysis was based on data on length of professional experience, localization of rashes, clinical diagnosis and allergens, and the cause of positive reactions in patch testing. Skin changes most often affect the hands, palms, face, and neck. The frequency of ACD diagnosed was 46%, followed by dyshidrotic eczema (DE) - 34%. The highest percentage of contact dermatitis (68%) was seen in the upper extremities, followed by dermatitis of the face and hands (26%). Of the patients investigated, 34% had a history of illness up to 3 years. A negative correlation was found between professional experience and “hand eczema” (p=0.005). Patch tests showed that the most frequent positive reactions were to Nickel (II) sulfate hexahydrate (Nickel, 15 times) and p-Phenylenediamine (PPD, 14 times). These contact allergens are directly correlated with hand eczema. We compared the results with those published in the literature.

A cross-sectional study of contact allergens in feminine hygiene wipes: a possible cause of vulvar contact dermatitis.

The present study aims to investigate the presence and prevalence of potential allergens in the most used feminine hygiene wipes. An internet-based search was performed to identify best-selling name brand and generic feminine hygiene wipes. Each unique wipe was analyzed and compared to the North American Contact Dermatitis Group 80 allergens. We found contact allergens are frequently present in feminine hygiene wipes, most commonly fragrances, other scented botanicals in the form of essences, oils, and fruit juices, and vitamin E (tocopherol). All wipes analyzed in this study contained potential allergens. The inability to eliminate commercial names from analysis could have introduced bias. Vaginal and vulvar epithelia are highly susceptible to contact allergens, often found in products marketed for feminine hygiene and cleanliness. Providers should caution patients against trusting product labeling claims to avoid incidental contact allergy and encourage simply cleansing the vulva with water.

The use of carvone in consecutive patch testing.

Carvone (l-carvone) is a mint-tasting flavour additive that most of us is exposed to and can cause allergic contact reactions. To analyse the frequency and the relevance of positive carvone reactions in a dermatitis population. A retrospective analysis of dermatitis patients consecutively tested with carvone from 2017 to 2021. Data were retrieved from the department's patch-test database. Of 3554 patients tested with carvone, 28 (0.79%) had a positive reaction. Carvone-positive patients had higher mean age, were significantly more likely female (p< 0.001) and had often an intraoral/lip involvement (p< 0.001). In the carvone-positive group, 50% (n= 14) had a relevant reaction, and in 4 of 14, the relevance was first revealed after test reading. Of the carvone-positive patients, 18 of 28 did not have a coexisting allergy to a fragrance/flavour allergen and of these 44% had a relevant allergy. The study suggests that a significant fraction of relevant carvone contact allergies may be overlooked if the allergen is not tested. Furthermore, as the exposure is widespread, inclusion of carvone in the Swedish baseline series may be justified even if the contact allergy prevalence is below 1%.