Cause Of Allergic Contact Dermatitis Research Articles

12-year data on dermatologic cases in the Finnish Register of Occupational Diseases I: Distribution of different diagnoses and main causes of allergic contact dermatitis.

Skin diseases are among the most common occupational diseases, but detailed analyses on their epidemiology, diagnoses, and causes are relatively scarce. To analyze data on skin disease in the Finnish Register of Occupational Diseases (FROD) for (1) different diagnoses and (2) main causes of allergic contact dermatitis (ACD). We retrieved data on recognized cases with occupational skin disease (OSD) in the FROD from a 12-year-period 2005-2016 and used national official labor force data of the year 2012. We analyzed a total of 5265 cases, of which 42% had irritant contact dermatitis (ICD), 35% ACD, 11% contact urticaria/protein contact dermatitis (CU/PCD), and 9% skin infections. The incidence rate of OSD in the total labor force was 18.8 cases/100 000 person years. Skin infections concerned mainly scabies in health care personnel. Twenty-nine per cent of the ACD cases were caused by plastics/resins-related allergens, mainly epoxy chemicals. Other important causes for ACD were rubber, preservatives, metals, acrylates, and hairdressing chemicals. Cases of occupational ACD due to isothiazolinones reached a peak in 2014. Our analysis confirms that epoxy products are gaining importance as causes of OSD and the isothiazolinone contact allergy epidemic has started to wane.

The value of pantomiming for allergic contact dermatitis

To the Editor: Pantomiming enables humans to communicate through mimicry in a context in which the physical tools of reference are not present.1Broadbent R. History of Pantomime. International Business Publications, Alexandria, VA2018Google Scholar,2Lausberg H. Kazzer P. Heekeren H.R. Wartenburger I. Pantomiming tool use with an imaginary tool in hand as compared to demonstration with tool in hand specifically modulates the left middle and superior temporal gyri.Cortex. 2015; 71: 1-14Crossref PubMed Scopus (7) Google Scholar Pantomime in dermatology can be useful to help understand the pattern of allergic contact dermatitis (ACD). For example, Alstroemeria, the Peruvian lily, is a well-documented occupational allergen for florists (Fig 1).3McGovern T.W. Alstroemeria L. (Peruvian lily).Am J Contact Dermat. 1999; 10: 172-176Crossref PubMed Scopus (10) Google Scholar The distribution of ACD can be clarified when a florist pantomimes how he or she places the hand on the flower to strip the stem.3McGovern T.W. Alstroemeria L. (Peruvian lily).Am J Contact Dermat. 1999; 10: 172-176Crossref PubMed Scopus (10) Google Scholar Garlic is another well-recognized cause of ACD; pantomime can help explain a distribution involving the nondominant thumb and index finger, which hold the garlic as the dominant hand cuts it (Fig 2).4Hughes T.M. Varma S. Stone N.M. Occupational contact dermatitis from a garlic and herb mixture.Contact Dermatitis. 2002; 47: 48Crossref PubMed Scopus (17) Google ScholarFig 2Allergic contact dermatitis. A classic distribution of a rash due to garlic allergen involving the nondominant hand.View Large Image Figure ViewerDownload Hi-res image Download (PPT) We present 3 cases for which pantomime was useful in diagnosing ACD. Case 1: Explaining rash distribution. A patient presented with sharply demarcated dermatitis of the left side of the neck. She had positive reactions on patch tests to gold, neomycin, and budesonide. Pantomiming the application of topical medications was helpful in understanding the distribution of her ACD (Fig 3). If the hands are spared (and, therefore, the relevance of topical medicament is questioned), it can be useful to ask what was used to apply the medication (eg, fingertips, cotton applicators, gauze, tissues). Sparing of fingertips may be explained if an applicator was used or if the hands were washed immediately after application. Case 2: Guiding selection of patch test allergens. An auto body shop worker presented with bilateral dorsal hand dermatitis. When pantomiming daily work tasks, the patient demonstrated using the dorsal aspect of his hands to put pressure on panels after applying an adhesive. Possible exposure to acrylate adhesive residue on the panels prompted testing an acrylate adhesive series. He showed allergy to ethylene glycol dimethacrylate and other acrylates that may have been missed on testing with only a standard screening series. Case 3: Identifying the primary source of relevance. A pipefitter presented with dermatitis of the left hand and periumbilical region. Overlying the rash were splotches of dried white material on his shirt, which prompted a request for him to pantomime how that substance got there. The patient pantomimed holding a paint tray with his left hand lodged against his periumbilical region while using a paintbrush to dip into the tray. The lubricant substance in the tray would splash over the edge onto his left hand and the clothing over his abdomen. The patch testing result was positive for lanolin, relevant to the lubricant and to the medicament used to treat the dermatitis. When using pantomime, prompt the patient by saying, “Let's pretend” or “Show me,” referring to the use of an object. Statements such as “How do you use this?” should be avoided because they may confuse the patient and make the process awkward. It may be helpful to hand any object to the patient that approximates the size of the item he or she is pretending to handle. Pantomiming can be very helpful in understanding unusual patterns of dermatitis. Pantomiming can be a powerful diagnostic modality that allows the physician to observe how patients may interact with various products to better diagnose ACD.

A Comprehensive Artificial Sweat Study for Quantitation of Nickel and Other Inorganic Elements Released from Imitation Earrings Purchased in Istanbul Market.

Element sensitization is frequent cause of allergic contact dermatitis, and Ni is the main reason for this condition owing to daily use of different Ni-containing items. European Union established a limit of 0.2μg/cm2/week Ni release for the items by the Ni Directive in 2004.The aim of this study was to determine the amount of element release of imitation earrings sold in different points of Istanbul with different prices and consider the element release levels including 29 trace and toxic elements. After calculation of released nickel amounts, 31.80% of earrings (71 of 223) were observed over the limit of European Commission Directive's migration limit. Minimum and maximum nickel release amounts were found as 0.21 and 30.11μg/cm2/week, respectively, and mean level was found 3.24μg/cm2/week among 71 positive earrings. Results showed that essential part of imitation earrings used especially by women release nickel particles over the European Commission Directive's migration limit. In addition, other elements such as Cu, Cr, and Co were found to be in the structure of the imitation earrings, as well as high amounts of toxic element Pb.

Phytodermatitis: A Brief Review of Human Skin Reactions Caused by the Kingdom Plantae

Many organisms of the kingdom Plantae may cause skin reactions when contacted or ingested. Those involved in work and recreation in the great outdoors as well as gardeners and other plant enthusiasts are well aware of this. While Toxicodendron dermatitis from poison ivy, oak, and sumac is the most common cause of allergic contact dermatitis (ACD) in the United States, this is just the tip of the iceberg. Numerous other species of plants are also known causes of ACD, producing a multitude of molecular culprits.

Patch Testing Ingredients of Dermabond and Other Cyanoacrylate-Containing Adhesives.

Cyanoacrylates are strong adhesives used for a variety of medical, industrial, and cosmetic applications and have been implicated as a cause of allergic contact dermatitis. The aim of the study was to review our experience in patch testing with cyanoacrylates. We reviewed patch test results of 38 patients with a clinical history of contact dermatitis due to a cyanoacrylate-containing adhesive (mostly Dermabond). Testing used cyanoacrylates of >99% purity diluted to 10% to 30% in petrolatum (pet.), undiluted octyl cyanoacrylate, and/or Dermabond Mini or Advanced "as is." Patch tests were also performed with methacrylates, formaldehyde (a cyanoacrylate impurity), benzalkonium chloride, and cyanoacrylate polymerization inhibitors. Three patients were also tested with Dermabond Mini on abraded skin. Commercial cyanoacrylate patch testing material (ethyl cyanoacrylate 10% pet.) detected 29% of Dermabond-allergic patients, whereas patch testing with octyl cyanoacrylate 10% pet. increased detection to 50%. Testing with higher concentrations and/or on abraded skin further increased yield. Thirteen (37%) of our 35 cyanoacrylate-allergic patients were also allergic to methacrylates or acrylates. Octyl cyanoacrylate is the usual allergenic ingredient in Dermabond. Patch testing with high concentrations is often required. Testing Dermabond on abraded skin further improves diagnostic sensitivity by more closely simulating clinical use.

Trends of common contact sensitizers in tandem with increased hair dye dermatitis in Shimla, a sub-Himalayan region: a study of 521 patients

<p class="abstract"><strong>Background:</strong> Skin is exposed to a vast variety of chemicals, organic or biological products among fashion seeking community of today’s world. This put them at risk of contact sensitization. Rapid industrialization, westernization of the society and poor labeling laws of cosmetics put us to the threat of “contact sensitization explosion” in near future. To know the drift of common contact sensitizers in the region, patch testing provides an insight into the cause of allergic contact dermatitis. The objective of the study was to determine the commonest allergen responsible for allergic contact dermatitis among patients attending contact dermatitis clinic in a tertiary care hospital.</p><p class="abstract"><strong>Methods:</strong> This retrospective study was conducted in the Department of Dermatology of our institution. We reviewed the medical records of all patients who were patch tested over a period of 6 years, using Indian standard series.<strong></strong></p><p class="abstract"><strong>Results:</strong> A total of 521 patients who were patch tested in the contact dermatitis clinic were included in the study. Nine patients with angry back were excluded. There were 269 males and 243 females. The commonest provisional diagnosis was allergic contact dermatitis secondary to hair dye in 172 (33.3%) patients followed by air borne contact dermatitis to parthenium in 88 (17.3%) patients. The paraphenylenediamine (PPD) being the most common sensitizer in 92 (17.9%) patients was followed by nickel in 86 (16.7%) patients, potassium dichromate in 36 (7%), parthenium in 32 (6%) and fragrance mix in 31 (6%) patients.</p><p class="abstract"><strong>Conclusions:</strong> This study revealed higher prevalence of hair dye dermatitis. Paraphenylenediamine was the most common allergen.</p>

Allergic contact dermatitis of both eyes caused by alcaftadine 0.25%: a case report

BackgroundTo report the first case of allergic contact dermatitis (ACD) associated with alcaftadine 0.25% ophthalmic solution.Case presentationThe patient was a 51-year-old woman with no previous history of side effects to ophthalmic antihistamine agents. She had been prescribed alcaftadine 0.25% for allergic conjunctivitis. On first application of the medication, she did not experience any cutaneous reaction. One day later, after the second alcaftadine 0.25% application, both eyelids became swollen, and erythematous changes were evident. On slit-lamp examination, conjunctival injection was noted in the absence of conjunctival swelling or any other findings. Fundus examination was unremarkable. To evaluate the cause of ACD, a patch test was performed and 48 h later was noted to be positive for alcaftadine 0.25%. Based on the positive patch test, the patient was diagnosed with ACD caused by alcaftadine 0.25%. After 9 days of treatment, the swelling and erythema completely resolved.ConclusionsAlthough there have been no previous reports of alcaftadine 0.25%-associated ACD, it should be suspected in patients with swelling and erythematous change of both eyes after using alcaftadine 0.25%.

Delayed hypersensitivity to palladium dichloride: 15-year retrospective study in a skin allergy unit.

Metal allergies are the most frequent causes of allergic contact dermatitis. Although the use of palladium is increasing, it is not included in any baseline series. To assess the prevalence of hypersensitivity to palladium and to describe the clinical and demographic characteristics of patients who are sensitized to palladium dichloride (PdCl2 ). A single-centre, retrospective study of 15 years of patch testing with the Spanish baseline series supplemented with PdCl2 2% pet. was performed. We collected clinical and demographic data and data on co-sensitization among the metals studied, and we compared patients who were sensitized to palladium, with or without co-sensitization to nickel, with the rest of the study population. Among the 3678 included patients, 730 (19.9%) were sensitized to nickel sulfate. The prevalence of sensitization to PdCl2 (n = 316, 8.6%) was higher than the prevalence of sensitization to potassium dichromate (n = 240, 6.5%) and similar to the prevalence of sensitization to cobalt chloride (n = 353, 9.6%). Only 26 (8.2%) of the patients sensitized to palladium were not co-sensitized to nickel. The percentage of men and patients aged ≥40 years was higher in this subgroup than in the patients with nickel co-sensitization. Given the high prevalence of hypersensitivity to PdCl2 , this metal salt should be included in the Spanish baseline series, notwithstanding the frequency of co-sensitization to nickel.

Recommendation to include hydroxyethyl (meth)acrylate in the British baseline patch test series.

(Meth)acrylates are potent sensitizers and a common cause of allergic contact dermatitis (ACD). The frequency of (meth)acrylate ACD has increased with soaring demand for acrylic nails. A preliminary audit has suggested a significant rate of positive patch tests to (meth)acrylates using aimed testing in patients providing a clear history of exposure. To date, (meth)acrylates have not been routinely tested in the baseline patch test series in the U.K. and Europe. To determine whether inclusion of 2-hydroxyethyl methacrylate (2-HEMA) 2% in petrolatum (pet.) in the baseline series detects cases of treatable (meth)acrylate ACD. During 2016-2017, 15 U.K. dermatology centres included 2-HEMA in the extended baseline patch test series. Patients with a history of (meth)acrylate exposure, or who tested positive to 2-HEMA, were selectively tested with a short series of eight (meth)acrylate allergens. In total 5920 patients were consecutively patch tested with the baseline series, of whom 669 were also tested with the (meth)acrylate series. Overall, 102 of 5920 (1·7%) tested positive to 2-HEMA and 140 (2·4%) to at least one (meth)acrylate. Had 2-HEMA been excluded from the baseline series, (meth)acrylate allergy would have been missed in 36 of 5920 (0·6% of all patients). The top (meth)acrylates eliciting a positive reaction were 2-HEMA (n = 102, 1·7%), 2-hydroxypropyl methacrylate (n = 61, 1·0%) and 2-hydroxyethyl acrylate (n = 57, 1·0%). We recommend that 2-HEMA 2% pet. be added to the British baseline patch test series. We also suggest a standardized short (meth)acrylate series, which is likely to detect most cases of (meth)acrylate allergy.

Contact allergy and allergic contact dermatitis caused by lavender: A retrospective study from an Australian clinic.

Lavender is commonly used in aromatherapy and in a broad range of personal and household products. It has been identified as a contact sensitizer, and has been reported to cause allergic contact dermatitis (ACD). To report our experience with contact allergy and ACD caused by lavender, and to raise awareness of lavender as a potential contact allergen. A retrospective database review was performed of patients attending patch testing clinics at the Skin and Cancer Foundation, Victoria, Australia, from January 1, 1993 to December 31, 2017. Among the 2178 patients patch tested with lavender over this period, a total of 58 positive reactions were recorded in 49 individuals, giving a positive patch test prevalence for patients tested with lavender of 2.2%. Twenty-seven patients were diagnosed with ACD. The most common sources of exposure to lavender were personal care products and essential oils. Of the patients with ACD, 74% were tested with lavender absolute, with positive results in 90% of cases. Lavender is an uncommon cause of ACD but is important to consider, given the potential for exposure through the use of personal care items and essential oils.

Oral Nickel Changes of Intestinal Microflora in Mice.

Nickel, a silver-colored metal found in nature, is a common cause of allergic contact dermatitis. Nevertheless, the existence of inflammatory reaction to oral nickel exposure remains controversial. The following study investigates whether oral nickel can change the intestinal microflora in mice. A total of 20 female ICR mice were randomly divided into two groups: the oral nickel group (Group O) and the control group (Group C). Group O received water containing 400 µM NiSO4·6H2O, while group C was given pure water for 21 days. The content of nickel in the kidneys was determined by atomic absorption spectrophotometry, while the composition of bacterial community in the cecum was detected by 16S rDNA sequencing. The results were subsequently validated by real-time quantitative PCR with genus and species specific primers. Compared to Group C, significantly higher nickel levels were observed in Group O (P = 0.016); however, our data suggested that oral administration of 400 µM NiSO4·6H2O was nontoxic to the animals. (No statistical difference in body animal weight was found between Group O and Group C, before and after oral administration of nickel.) At the genus level, significantly higher relative abundance of Bacteroides (P = 0.016) and Intestinimonas (P = 0.018), and significantly lower relative abundance of Lachnospiraceae_NK4A136_group (P = 0.002) and Lachnospiraceae_UCG-001_group (P = 0.042) were observed in the oral nickel group compared to the control group. In addition, Group O had significantly lower ratio of Firmicutes/Bacteroides (P = 0.008). The results of real-time quantitative PCR further confirmed that the amplicon mass of Bacteroides and B. fragilis in the Group O was significantly higher compared to C group (P = 0.034 and P = 0.02). Oral nickel could change the intestinal microflora in mice, thus suggesting that oral nickel alters the interaction between the host and the intestinal flora.

IL-24 contributes to skin inflammation in Para-Phenylenediamine-induced contact hypersensitivity

Para-Phenylenediamine (PPD) is an aromatic amine used in hair dyes and in temporary black henna tattoos, which is a frequent cause of allergic contact dermatitis (ACD). ACD is a skin inflammatory reaction characterized by modifications such as spongiosis, exocytosis and acanthosis. The aim of this study is to characterize the expression and the role of IL-20-related cytokines, including IL-19, IL-20, IL-22 and IL-24, in ACD. The expression of IL19, IL20, IL22 and IL24 is increased in affected skin from PPD allergic patients compared with uninvolved skin. In addition, the expression of these cytokines positively correlates with clinical symptoms. To assess their role in ACD, we set up a mouse model of PPD-induced allergic contact dermatitis and we showed that, in contrast to Il22-deficient mice, Il22ra1-, Il20rb- and Il24-deficient mice are partially protected against development of PPD-induced contact hypersensitivity. These mice have decreased ear thickening and less acanthosis compared with WT mice after PPD treatment. In addition, the absence of IL-22R, IL-20R2 or IL-24 affects the recruitment of neutrophils into the skin but not the total IgE production. Taken together, these results demonstrate the implication of IL-24 via the IL-20R type II receptor in the inflammatory process of ACD.

Temporal changes in chromium allergy in Denmark between 2002 and 2017.

In 2012, Danish authorities submitted a proposal to the European Chemical Agency restricting the content of hexavalent chromium to a maximum of 3 ppm in leather goods. Following its adoption, this proposal was implemented in 2015 as a directive in the EU. To examine the temporal trend of chromium contact allergy in adult dermatitis patients patch tested between 2002 and 2017, and to determine clinical characteristics and causative exposures in these patients. All adult dermatitis patients patch tested between 2002 and 2017 were included. Patch test data were reviewed retrospectively. Comparisons were performed with the χ 2 test and logistic regression analysis. A total of 13 379 adults aged 18 to 99 years were patch tested between 2002 and 2017. The overall prevalence of chromium allergy was 2.2%. An overall decreasing trend was found for the prevalence of chromium allergy (Ptrend = 0.00002). Specifically, a significant difference was found for the study periods 2010 to 2013 (Ptrend = 0.002) and 2014 to 2017 (Ptrend < 0.0001) as compared with 2002 to 2005. Leather remained the most important single cause of allergic contact dermatitis caused by chromium. The proportion of clinically relevant leather exposures increased from 42.3% during 2002 to 2009 to 54.8% during 2010 to 2017 (P = 0.04). The prevalence of chromium allergy is decreasing. The EU Directive restricting the use of hexavalent chromium in leather goods is thought to be playing a central role in this change.

Allergic contact dermatitis related to homemade slime: a case and review of the literature

Slime has become extremely popular as a children's toy in recent years and is typically made with various household substances. Although reports of slime causing skin irritation are not uncommon, case reports of slime-induced allergic contact dermatitis have only recently surfaced. We present a case of a child with hand dermatitis, history of exposure to slime, and positive allergen patch testing to two ingredients found in slime. The case underscores the need for clinicians to be aware of slime as a possible cause of allergic contact dermatitis in children. Given the trend of newly-reported cases, we briefly review the current literature to date.

Contact dermatitis in pediatric age group: Indian scenario

Contact dermatitis was previously considered to be rare in children except some forms of irritant contact dermatitis which were seen commonly in children. However, nowadays, there are an increasing number of cases of allergic contact dermatitis (ACD) being reported in children due to increased exposure to a variety of allergens at an earlier age. Various predisposing factors which influence the occurrence of contact dermatitis include age, sex, atopy, and presence of any concomitant skin disease. Nickel has been identified as leading cause of ACD in children. Other common allergens reported are cobalt, fragrance mix, rubber, lanolin, thiomersal, neomycin, gold, mercapto mix, balsam of Peru, and colophony. Clinical presentation in children is similar to that in adults with eczema of the hands, feet, wrists, face, forehead, scalp, eyelids, earlobes, neck, axilla, trunk, thighs, and anogenital area being seen. Disseminated lesions can as well be seen. When ACD is suspected, patch testing is the gold standard diagnostic procedure. However, patch testing in children differs from adults as some technical difficulties are encountered in children due to their smaller test area and frequent movements. However, the general opinion stands that children can be patch tested with the same methods and patch test concentrations as adults. For the prevention of recurrence, allergen elimination should be the aim of treatment; however, in many cases, it is not possible to completely eliminate the allergen from the patients environment. Topical steroids and calcineurin inhibitors form the mainstay of treatment in most cases.

A study of profile of contact dermatitis in housewives with reference to vegetables, soaps and detergents

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Contact dermatitis in housewives is a common dermatological problem as almost all housewives have to handle vegetables, fruits, soaps and detergents. The purpose of this project was to study etiologic profile of contact dermatitis occurring in housewives.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; One hundred housewives, clinically diagnosed as having contact dermatitis, were randomly selected for the study. Each patient was then subjected to patch testing using the Indian standard battery and certain indigenously prepared antigens i.e. vegetables, soaps and detergents. The first reading was taken 60 minutes with second reading at 96 hours. Reading equal to or more than 1+ was considered to be a positive test.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Majority patients were in the age group of 20-30 years. Morphological diagnosis was wear and tear dermatitis in 43%, discoid eczema (19%), fingertip eczema (16%), hyperkeratotic (15%) and pompholyx (7%). Nickel sulphate was found to be the commonest allergen (19%) followed by para-phenylenediamine (8%), fragnance mix (7%), Balsam of Peru (6%), parthenium (6%) and cobalt (5%). Amongst vegetables, the commonest culprit was garlic. Allergic reaction to detergents was positive in 13% patients. Forty-four percent of the cases tested positive to the suspected allergen whereas 31% patients tested positive for allergens not initially suspected of causing contact dermatitis in them.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Thus patch testing is an important tool in establishing the cause of allergic contact dermatitis of the hands in housewives in whom the hand eczema is multifactorial. This enables the correct etiological diagnosis and proper management of housewives with hand dermatitis.&lt;/p&gt;&lt;p&gt; &lt;/p&gt;

Urushiol Patch Test Using the T.R.U.E. TEST System.

Poison ivy, poison oak, and poison sumac are the most common causes of allergic contact dermatitis in North America. Although extensive efforts have been made to develop therapies that prevent and treat allergic contact dermatitis to these plants, there lacks an entirely effective method, besides complete avoidance. Efforts to develop a more effective preventive therapy, such as a vaccine, are ongoing. To accurately evaluate the efficacy of these new therapies, an appropriate assessment tool is needed. The aim of this study was to evaluate the safety and appropriate doses of urushiol required for a patch test based on the hydrogel delivery system of the Thin-Layer Rapid Use Epicutaneous Patch Test. Nine subjects were patch tested with various doses of urushiol and a negative control on day 0. Patch test sites were inspected for any local reaction on days 2, 4, 7, 14, and 21 after the initial exposure and graded by standard morphology. All 9 subjects did not have any significant adverse effects. The urushiol patch test using the hydrogel delivery method demonstrated urushiol sensitivity. All doses of urushiol resulted in a local reaction, and severity of reactions was correlated with dosage of urushiol used in the patch test.

OCCUPATIONAL ALLERGIC CONTACT DERMATITIS IN HEALTHCARE WORKERS

INTRODUCTIONOccupational allergic contact dermatitis (ACD) is frequent among health care workers (HCW) and culprit allergens may vary with time, occupational setting and exposure hazards. OBJECTIVES AND METHODSIn order to characterize the main contact allergens in HCW with dermatitis and its occupational relevance, we performed a retrospective analysis of clinical data and patch test (PT) results from HCW who were studied in the Department of Dermatology of Coimbra Hospital and University Centre (CHUC) between 2010-2015. All patients were tested with a Baseline and additional series, according to the tasks developed. RESULTSAmong 1858 patch tested patients, 125 (6.7%) were HCW, 114 females/11 males, mean age 39.26±12.5 years, mainly nurses (56), technical assistants (48) and doctors (21), 71 with hand dermatitis (56.8%), 22 with atopic dermatitis and/or other atopic symptoms (17.6%).Ninety patients (72%) had at least one positive PT, 47 (37.6%) with occupational relevance. Patients with hand dermatitis were significantly more likely to have positive PT (76.1%). We observed 51 positive PT to metals (Ni-41, most with past relevance, Co-8; Cr -2), 30 to fragrances (FM-I-10; Myroxylon pereirae-8; lyral-5; FM-II-4; citronellol-3), 29 to preservatives (mostly methylisothiazolinone (MI) and/or chloromethylisothiazolinone (MCI)-20), 24 to rubber chemicals (P-phenylenediamine (PPD)/Isopropyl-PPD-9), and 14 to topical medicaments (iodopovidone - 5; caine mix - 4). The main occupational causes of ACD were hand soaps/disinfectants and patients’ hygiene products (15), protective gloves/shoes-9 and topical or systemic drugs (antiseptics-8 and parenteral antibiotics-3). Main allergens with occupational relevance were MI and/or MCI/MI (15), although isolated MI was tested only after mid 2012, lanolin and/or amerchol L101 (9), formaldehyde and/or formaldehyde releasers (7), iodopovidone (5), thiuram mix (5), carbamates (4), FM-I (3), cephalosporins (3) and (meth)acrylates (3 dentists/dental technicians).In 37 out of 42 evaluated cases there was marked improvement/resolution of the dermatitis, namely after eviction of the hospital hand soap which contains MCI/MI under the designation of Acticide® MV. CONCLUSIONSHand dermatitis was the main presentation of ACD in HCW with no apparent relation with atopy. Isothiazolinones and formaldehyde releasers induced more positive PT and were more frequent among HCW than in the whole population studied very probably due to the cumulative exposure to these preservatives in personal and occupational hand soaps and hygiene products. PT was important to orient eviction in each individual case but also for the hospital community to understand the presence of moderate or potent sensitizers in the work place and, therefore, establish the most adequate preventive measures.

Dermatite de Contacto Alérgica em Idade Pediátrica: Estudo Retrospectivo

Introdução: A dermatite de contacto alérgica em idade pediátrica, habitualmente considerada pouco frequente, tem sido recentemente objecto de numerosas publicações associadas a um aparente aumento da sua prevalência. Tal pode ser devido a exposição e sensibilização mais precoce a alergénios de contacto ou à mais ampla utilização de testes epicutâneos, cruciais ao diagnóstico desta patologia.Métodos: Com o objectivo de avaliar as características e causas da dermatite de contacto alérgica em idade pediátrica, foram analisados os processos clínicos dos doentes com &lt; 18 anos que efetuaram testes epicutâneos entre Janeiro de 2005 e Dezembro de 2014 na Unidade de Alergologia de Contacto do Serviço de Dermatologia dos HUC. Avaliaram- -se os seguintes parâmetros: sexo, idade, história pessoal e familiar de atopia, localização principal da dermatose, testes positivos a alergénios da série básica ou outros e respectiva relevância, hipótese de diagnóstico e diagnóstico final.Resultados: Foram estudados 106 doentes em idade pediátrica (3,6% do total), 68 do sexo feminino (64,2%) e 38 do sexo masculino (35,8%), quatro com idades compreendidas entre os 3 e 5 anos (3,8%), 28 entre os 6 e 11 anos (26,4%) e 74 entre os 12 e 17 anos (69,8%), 52,8% com antecedentes de atopia e 36,8% com lesões localizadas na face e/ou pescoço. Dos 106 doentes, 51 tiveram pelo menos um teste positivo (48,1%), mais frequentemente no sexo feminino por alergia ao níquel (18,9%). Seguiram-se o cobalto, a p-fenilenodiamina e a mistura de caínas (4,7%) entre os alergénios de série básica e, fora dela, o paládio positivo em cinco crianças. De notar que não observámos testes positivos ao níquel nos últimos dois anos. Doze doentes reagiram apenas a alergénios não incluídos na série básica, sobretudo medicamentos.Discussão: A alergia de contacto e dermatite de contacto alérgica antes dos 18 anos revelaram-se relativamente comuns. O diagnóstico etiológico precoce é importante para evitar a cronicidade das lesões e prevenir possíveis repercussões futuras a nível pessoal e profissional. O conhecimento dos principais alergénios nesta faixa etária poderá orientar medidas preventivas de futuras sensibilizações.

Using DR52c/Ni2+ mimotope tetramers to detect Ni2+ reactive CD4+ T cells in patients with joint replacement failure

T cell mediated hypersensitivity to nickel (Ni2+) is one of the most common causes of allergic contact dermatitis. Ni2+ sensitization may also contribute to the failure of Ni2+ containing joint implants, and revision to non-Ni2+ containing hardware can be costly and debilitating. Previously, we identified Ni2+ mimotope peptides, which are reactive to a CD4+ T cell clone, ANi2.3 (Vα1, Vβ17), isolated from a Ni2+ hypersensitive patient with contact dermatitis. This T cell is restricted to the major histocompatibility complex class II (MHCII) molecule, Human Leukocyte Antigen (HLA)-DR52c (DRA, DRB3*0301). However, it is not known if Ni2+ induced T cell responses in sensitized joint replacement failure patients are similar to subjects with Ni2+ induced contact dermatitis. Here, we generated DR52c/Ni2+ mimotope tetramers, and used them to test if the same Ni2+ T cell activation mechanism could be generalized to Ni2+ sensitized patients with associated joint implant failure. We confirmed the specificity of these tetramers by staining of ANi2.3T cell transfectomas. The DR52c/Ni2+ mimotope tetramer detected Ni2+ reactive CD4+ T cells in the peripheral blood mononuclear cells (PBMC) of patients identified as Ni2+ sensitized by patch testing and a positive Ni2+ LPT. When HLA-typed by a DR52 specific antibody, three out of four patients were DR52 positive. In one patient, Ni2+ stimulation induced the expansion of Vβ17 positive CD4+ T cells from 0.8% to 13.3%. We found that the percentage of DR52 positivity and Vβ17 usage in Ni2+ sensitized joint failure patients are similar to Ni sensitized skin allergy patients. Ni2+ independent mimotope tetramers may be a useful tool to identify the Ni2+ reactive CD4+ T cells.