Dermatitis Reactions Research Articles

The CXCR3 Activating Chemokines IP-10, Mig, and IP-9 are Expressed in Allergic but not in Irritant Patch Test Reactions

Differentiation between allergic and irritant contact dermatitis reactions is difficult, as both inflammatory diseases are clinically, histologically, and immunohistologically very similar. Previous studies in mice revealed that the chemokine IP-10 is exclusively expressed in allergic contact dermatitis reactions. In the present study, we investigated whether the mRNA expression of IP-10 and the related CXCR3 activating chemokines, Mig and IP-9 are also differentially expressed in human allergic contact dermatitis and irritant contact dermatitis reactions. Skin biopsies from allergic (13 cases) and sodium lauryl sulfate-induced irritant patch test reactions (13 cases), obtained 1-72 h after patch testing, were studied by means of an in situ hybridization technique. Results of chemokine mRNA expression were correlated with clinical scoring, histology, and immunohistochemical data including the proportion of inflammatory cells expressing CXCR3, the receptor for IP-10, Mig, and IP-9, and ICAM-1 and HLA-DR expression on keratinocytes. IP-10, Mig, and IP-9 mRNA were detected in seven of nine allergic contact dermatitis reactions after 24-72 h, but not in sodium lauryl sulfate-induced irritant contact dermatitis reactions. ICAM-1 expression by keratinocytes was only found in allergic contact dermatitis reactions and correlated with chemokine expression. Moreover, up to 50% of the infiltrating cells in allergic contact dermatitis expressed CXCR3, in contrast to only 20% in irritant contact dermatitis reactions. In conclusion, we have demonstrated differences in chemokine expression between allergic contact dermatitis and irritant contact dermatitis reactions, which might reflect different regulatory mechanisms operating in these diseases and may be an important clue for differentiation between allergic contact dermatitis and irritant contact dermatitis reactions.

Atopic Dermatitis and Food Hypersensitivity Reactions

Eigenmenn PA, Sicherer SH, Borkowski TA, Cohen BA, Sampson HA. Pediatrics. 1998;101(3). URL: http://www.pediatrics.org/cgi/content/full/101/3/e8 #### Purpose of the Study Although it is clear that food allergy may play an important role in atopic dermatitis (AD) in selected populations, its overall prevalence in children with eczema is still not fully established. This study was designed to study the prevalence of immunoglobulin E (IgE)-mediated food allergy in children with atopic dermatitis being seen in a pediatric dermatology clinic. ##### Study Population Sixty-three patients with AD, ranging in age from 0.4 …

Atopic Dermatitis and Food Hypersensitivity Reactions

Wesley Burks A, James J, Heigel A, et alJ Pediatr.1321998132136The authors set out to determine the role and appropriate evaluation of food hypersensitivity in atopic dermatitis, using prick tests with a limited number of foods.One hundred sixty-five children, ages 4 months to 21.9 years, who met the criteria for a diagnosis of atopic dermatitis (AD), were enrolled in the study conducted in the pediatric allergy clinic of a teaching hospital.Precise histories were obtained as well as complete physical examinations. All patients underwent allergy prick tests with at least 12 common food antigens plus other foods that the parents thought caused symptoms. Food challenges were carried out on the basis of a positive skin test after the suspected food was eliminated for 2 to 3 weeks. A double-blind, placebo-controlled, food challenge (DBPCFC) was the method used. No child with a convincing history of a major anaphylactic reaction to a specific food was challenged with that food.A staggering 92% of these children had a family history of allergic rhinitis, asthma or AD! There were 2061 prick tests to foods performed with 323 (15.6%) read as positive. Ninety-eight patients had at least 1 positive test while 67 were completely negative. A total of 266 DBPCFC were performed and 88 were positive, plus an additional 22 were not performed because of a history of anaphylaxis. The results showed that a positive skin test had 100% sensitivity, 66% specificity, 65% positive predictive value, and 100% negative predictive value. The seven foods that accounted for 89% of the positive challenges were milk, egg, peanut, soy, wheat, cod/catfish, and cashew.Any child with significant AD who has been treated with the standard topical protocols plus systemic antihistamines and who fails to adequately respond should be considered for limited food prick skin testing, eg, the seven above. Elimination and challenge should be tried and if positive, an elimination diet should be instituted.We all encounter those children with tough to treat AD. The authors most convincingly present their case for a limited food skin test screening program. Your local friendly allergist may therefore be the best person to consult regarding your next troublesome AD patient. Rubbing “stuff” on and gulping pills does have it's limits, especially with the dramatic benefits that can be observed when food allergies are identified and appropriate diets are instituted.

Cytochrome P450 1B1: a major P450 isoenzyme in human blood monocytes and macrophage subsets

In this study, cytochrome P450 ( CYP; EC 1.14.14.1)-dependent activities and P450 isoenzyme patterns were determined in human monocytes and macrophages, which play a major role in antigen processing including small molecular weight compounds which cause contact dermatitis or drug-allergic reactions. Using reverse transcriptase-polymerase chain reaction (RT-PCR) we determined the mRNA expression of eight CYPs (1A1, 1A2, 1B1, 2B6/7, 2E1, 3A3/4, 3A7 and 4B1) in human blood monocytes and macrophage subsets 27E10 and RM3/1. To study the influence of known P450 inducers, monocytes were incubated in vitro with ethanol, dexamethasone, cyclosporin A (CSA), benzanthracene (BA), phenobarbital (PB), lipopolysaccharide (LPS) and 12-O-tetradecanoyl-phorbol-13-acetat (TPA) for 24 hr. Percoll density gradient isolated monocytes as well as the pro-inflammatory macrophage subtype 27E10 expressed 1B1, 2E1 and 2B6/7. On the other hand, in the anti-inflammatory macrophage subtype RM3/1, predominantly 1B1 and to some extent 2B6/7 were found. Treatment with cyclosporin A, phenobarbital, benzanthracene or ethanol resulted in induction of the expression of 3A3/4. CYP1B1 was the predominant isoenzyme in all monocytes and macrophages. In monocytes purified by adherence or induced by benzanthracene, lipopolysaccharide or 12-O-tetradecanoyl-phorbol-13-acetat, 1A1 was also expressed. Northern blot analysis confirmed the presence of CYP1B1 in monocytes and macrophages, a presence which was also demonstrated on the protein level by immunoblot and by immunohistochemical staining of the cells. The expression of several CYPs in monocytes/macrophages suggests that these cells may be important in the metabolism of small molecular weight compounds, which play a role in allergic contact dermatitis and drug reactions. Of particular interest is the remarkably strong expression of the recently identified dioxin inducible CYP1B1, known to be present in a wide range of malignant tumors.

Contact dermatitis and sistemic reaction due to “Portuguese man of war” (Physalia physalis)

Contact dermatitis and sistemic reaction due to “Portuguese man of war” (Physalia physalis)

Contact allergens in patients with leg ulcers

Background Contact dermatitis can complicate the treatment of leg ulcers and is an acquired phenomenon resulting from the use of topical medications.Objective To show the incidence of contact dermatitis reactions to topical medications applied to leg ulcers and to evidence changing trends in such reactions through comparison of two case series about 20 years apart.Subjects and methods We studied two groups of patients with leg ulcers that were patch tested with contact allergens in 1973–1974 and in 1994–1995.Results One or more positive patch tests was present in 75% and 40% of the patients, respectively. A decrease in the incidence of positive reactions to neomycin, local anesthetics and parabens mix was seen in 1994–1995. The most important contact allergens in 1994–1995 were fragrance mix, colophony and the excipients wool alcohols and amerchol. Other relevant sensitizers were formaldehyde, neomycin and gentamycin.Conclusion The changing trends in contact allergens over the last 20 years may be explained by changes in the components of topical agents used for treatment.

Keratin 17 is expressed during the course of SLS-induced irritant contact dermatitis, but unlike keratin 16, the degree of expression is unrelated to the density of dividing keratinocytes.

The aims of this study were to utilize quantitative immunocytochemical techniques to determine the densities of keratin 16 (K16) and keratin 17 (K17) expressed by keratinocytes during the course of acute patch test reactions to sodium lauryl sulfate (SLS), and to relate these to the proliferative state of the epidermis, as assessed by Ki-67 immunolabelling. Significantly increased numbers of dividing keratinocytes were present in 48h and 96h reactions, concurrent with high levels of expression of K16 and more moderate expression of K17. Statistical analysis indicated a good correlation between K16 expression and the density of Ki-67+ keratinocytes present in the epidermis (r=0.843). This was not the case for K17 (r=0.396). The results demonstrate that both K16 and K17 expression are features of acute irritant contact dermatitis reactions, but suggest that the factors which influence and control their expression differ.

Contact allergens in patients with leg ulcers

Contact dermatitis can complicate the treatment of leg ulcers and is an acquired phenomenon resulting from the use of topical medications. To show the incidence of contact dermatitis reactions to topical medications applied to leg ulcers and to evidence changing trends in such reactions through comparison of two case series about 20 years apart. We studied two groups of patients with leg ulcers that were patch tested with contact allergens in 1973-1974 and in 1994-1995. One or more positive patch tests was present in 75% and 40% of the patients, respectively. A decrease in the incidence of positive reactions to neomycin, local anesthetics and parabens mix was seen in 1994-1995. The most important contact allergens in 1994-1995 were fragrance mix, colophony and the excipients wool alcohols and amerchol. Other relevant sensitizers were formaldehyde, neomycin and gentamycin. The changing trends in contact allergens over the last 20 years may be explained by changes in the components of topical agents used for treatment.

Allergic contact dermatitis to preservatives in topical medicaments

Background: Textile dye dermatitis is frequently undiagnosed because clinical awareness is low and because of the absence of good screening allergens in standard patch test series for this type of contact dermatitis.Objectives: To determine the incidence of textile dye allergy in patients with problematic eczemas evaluated at a contact dermatitis clinic, and to determine the incidence of allergic contact dermatitis to disperse blue dyes in these patients.Methods: We conducted a retrospective study of 788 patients who were patch tested to either the North American Contact Dermatitis Group (NACDG) Standard Series or the European Standard Series, in addition to other relevant series. The Chemotechnique textile series was utilized in 271 patients (28%).Results: Forty patients reacted positively to 1 or more textile dyes, the majority reacting positively to Disperse Blue 106 (33 of 40; 82.5%) and to Disperse Blue 124 (32 of 40; 80%). Ten of 11 tested patients reacted to their own clothing, 9 of whom reacted to the blue/black 100% acetate or 100% polyester liners in their garments.Conclusions: Textile dye allergy is more common than previously reported. It can cause marked dermatitis and widespread autoeczematization reactions. The most frequent allergens are Disperse Blue 106 and 124, which are frequently found in the 100% acetate and 100% polyester liners of women's clothing. We recommend that Disperse Blue 106 or 124 serve as the screening allergen for textile dye dermatitis.

ASTHMA PHENOTYPES: Wheezy Infants and Wheezy Children

ASTHMA PHENOTYPES: Wheezy Infants and Wheezy Children

Atopic dermatitis and food hypersensitivity reactions

Objective: To determine the role of food hypersensitivity in atopic dermatitis and to determine whether patients with atopic dermatitis who had food hypersensitivity could be identified by screening prick skin tests using a limited number of food allergens. Study design: Patients with atopic dermatitis attending the Arkansas Children's Hospital Pediatric Allergy Clinic underwent allergy prick skin testing to a battery of food antigens. Patients with positive prick skin tests underwent double-blind, placebo-controlled food challenges. Results: One-hundred sixty-five patients were enrolled and completed the study. Patients ranged in age from 4 months to 21.9 years (mean 48.9 months). Ninety-eight (60%) patients had at least one positive prick skin test. A total of 266 double-blind, placebo-controlled food challenges were performed. Sixty-four patients (38.7% of total) were interpreted as having a positive challenge. Seven foods (milk, egg, peanut, soy, wheat, cod/catfish, cashew) accounted for 89% of the positive challenges. By use of screening prick skin tests for these seven foods we could identify 99% of the food allergic patients correctly. Conclusions: This study confirms that most children with atopic dermatitis have food allergy that can be diagnosed by a prick skin test for the seven foods. (J Pediatr 1998;132:132-6)

エンドトキシンおよびリポタイコ酸によるマウス皮膚炎症反応の比較

エンドトキシンおよびリポタイコ酸によるマウス皮膚炎症反応の比較

Evidence for altered cell-mediated immunity in postmastectomy lymphoedema

Patients with chronic lymphoedema are prone to develop chronic infections and various tumours in the lymphoedematous limb, suggesting that regional immune surveillance is impaired. To test the hypothesis that cutaneous cell-mediated immunity is impaired, 35 women with postmastectomy lymphoedema were investigated using dinitrochlorobenzene to test the afferent and efferent loops of the allergic contact immune response. The results support the role of lymphatics as an important component of the immune response to allergens by the demonstration of impairment of both the afferent and efferent loops of the allergic contact dermatitis reaction, and confirm that there is suppression of immune competence in a lymphoedematous limb.

Hand dermatitis and allergic patch test reactions caused by nickel in electroplaters.

A worksite survey was conducted in all 38 Finnish electroplating plants. All workers (n = 163) who worked with nickel plating (bath workers, hangers and solution makers) were interviewed with a questionnaire about symptoms of nickel dermatitis, hand dermatitis, and about protective measures, atopy, etc. Patch testing with nickel sulfate was done with the TRUE TestTM method. All the workers, 94 men and 69 women, answered the questionnaire. The mean age of women was 41.1 years, and of men 43.1 years, respectively. Men had longer occupational exposure to nickel (14 years) than women (10 years). Most workers used protective gloves. 35% of women and 30% of men reported present or past hand dermatosis. 19% reported a history of atopic dermatitis. 15% of women (n = 8) and 4% (n = 2) of men had an allergic patch test reaction to nickel sulfate. 70% of those with an allergic patch test reaction to nickel reported past or present hand eczema. The prevalence of nickel allergy among the electroplaters was similar to that of patients in patch test clinics in Finland. An allergic patch test reaction to nickel sulfate does not necessarily oblige an electroplater to change jobs.

Potential dangers from topical preparations containing methyl salicylate.

Methyl salicylate (oil of wintergreen) is widely available in many over-the-counter liniments, ointments, lotions or medicated oils for the relief of musculoskeletal aches and pains. Ingestion of methyl salicylate poses the threat of severe, rapid-onset salicylate poisoning because of its liquid, concentrated form and lipid solubility. Excessive usage of these preparations in patients receiving warfarin may result in adverse interactions and bleedings. Methyl salicylate in topical analgesic preparations may cause irritant or allergic contact dermatitis and anaphylactic reactions. Physicians should fully appreciate the potential dangers from topical preparations containing methyl salicylate.

Allergy versus asthma as the focus of the subspecialty

The current subspecialty of allergy and clinical immunology has a central mechanistic focus on broad aspects of immunology, both beneficial and pathologic. However, 90% of our practice concerns diseases caused by immediate hypersensitivity responses. Indeed, skin testing, education, and immunotherapy dominate the medical activity in our clinics. The description of skin tests dates to 1873; that of immunotherapy dates to 19!1; and the description of the association of rhinitis, asthma, and atopic dermatitis with immediate skin tests to common inhalant allergens was fully established before 1950. From 1960 to 1980 there was a dramatic increase in our scientific understanding of the immunology of allergy, purification of pollen allergens, IgE and specific IgE antibodies, basophils, mast cells, and T cells. This increased understanding was paralleled by a retrenchment of the subspecialty to focus on those conditions whose causes and mechanisms we could be certain that we understood. Since 1975 major advances have occurred in our understanding of the role of hypersensitivity in other diseases, particularly perennial asthma, atopic dermatitis, venom allergy, and drug reactions. In addition, it is increasingly clear that a real change has occurred in the pattern of disease, the most important of which is the increase in the prevalence and morbidity of asthma. The magnitude of the increase in the United States is not well documented, but today asthma is present in 5% to 10% of children (although up to 18% have had symptoms as judged by the prescription of an inhaler); asthma is the most common cause of hospital admission for children. Whether asthma has increased among adults is less clear; however, sales of asthma medicine, hospital admissions, and clinic load suggest that such an increase has taken place. During the past 10 years, evidence has been published to show that asthma is an inflammatory disease of the bronchi characterized by eosinophils and that the most common cause of this inflammation is indoor allergens. During the same period, the investigation and management of asthma have become major foci of our clinics, and many allergy clinics have added asthma to their name. Asthma will become an increasingly important source of patients for the allergist. Quality-of-care measures suggest that specialist care is more cost effective for moderate-to-severe asthma than generalist care. Thus managed care organizations may divert patients with asthma to the allergist for management as a cost-saving device~ The cost saved will largely reflect reduced hospitalization and emergency room visits, which far outweigh the cost of a specialist visit. In addition, it !s likely that allergic rhinitis will become less important in the referral base for the allergist during the next two decades. This belief is based on the effectiveness of current agents and the promise of new ones to manage most patients with rhinitis. Thus the allergist may become a consultant in the management of allergic rhinitis: making the diagnosis, establishing allergy avoidance regimens, and occasionally initiating immunotherapy, but passing patient management and administration of therapy to the primary care physician. In many respects, this division of labor makes sense by permitting the allergist to serve a much larger population of patients at a lower cost. It is expected that patients with urticaria, eczema, anaphylaxis, stinging insect hypersensitivity, and drug allergy will continue to be cared for by both the academic allergist and the practicing allergist. Another disease that may become more important for the allergist !s sinusitis. Currently patients with acute sinusitis are cared for by the primary care physician, and those with chronic sinusitis are referred to the otolaryngologist. Data suggest that patients with sinusitis who are managed by allergist s have fewer treatment failures and require less surgery. The question now is whether we need to change the focus of the subspecialty either in fact or in name. The reality is that we have far more to offer in the management of asthma than any other

Allergy versus asthma as the focus of the subspecialty

Allergy versus asthma as the focus of the subspecialty

Occupational hand dermatitis in hospital environments

Health care personnel form the 5th category at major occupational risk of skin disease in Italy. The aim of this study was to assess the prevalence and clinical relevance of contact dermatitis in a group of 1301 employees of the Perugia Monteluce Hospital (658 females and 643 males; mean age 39.8 years) who answered a self-administered questionnaire elaborated by the authors. The subjects with anamnestic hand dermatitis and/or atopic mucosal reactions were clinically examined and submitted to skin tests (patch and/or prick tests). Contact dermatitis of the hands and/or forearms occurred in 21.2% and was significantly more frequent (p < 0.001) in women, subjects under 31 years of age, workers in internistic and surgical fields, cleaners and nurses. In the majority of cases (94.9%), the lesions were irritant in origin and mainly related to disinfectants (especially, chlorhexidine gluconate and glutaraldehyde) and gloves (latex proteins and starch glove powder, rather than accelerators and additives of rubber). Finally, atopy seemed to favour the onset of hand dermatitis. The importance of these results for preventive measures of contact dermatitis in hospital employees is discussed.

A Subset of Macrophages Located along the Basement Membrane (“Lining Cells”) Is a Characteristic Histopathological Feature of Psoriasis

In this paper, we describe the immunophenotype and ultrastructure of a new macrophage subpopulation present in inflamed but not in normal human skin. In biopsy material from patients with psoriasis (n = 4), atopic dermatitis (n = 4), and positive patch test reactions (n = 4), spindle-shaped macrophages located along the basement membrane were detected staining positive for CD11c (LeuM5 high, Ki-M1 low), CD68 (Ki-M6 low), and Ki-M8 (low). This subpopulation was most prominent in psoriasis, where a median of 34 macrophages neighbored 100 basal keratinocytes, thus covering about 80% of the dermoepidermal junction. The numbers of atopic and positive patch test reactions were 11 and 13, respectively, accounting for about 20% of the dermoepidermal junction. Transmission electron microscopy revealed an electron-lucent nucleus with dense deposits of chromatin along the nuclear membrane. Interruptions of the integrity of the basement membrane neighboring these cells were also seen. We repeatedly observed parts of basal keratinocytes merging through these openings and macrophages exhibiting cytoplasmic extentions directed toward the porus. Our observations suggest vigorous interactions between macrophages and basal keratinocytes and support the hypothesis that these interactions are an important regulatory event in the pathogenesis of psoriasis.

Contact dermatitis and adverse oral mucous membrane reactions related to the use of dental prostheses.

The latest trends in the use and composition of dental prostheses have been reviewed, and 66 patients referred by dermatologists and odontologists patch tested. The allergen series used were: TRUE Test standard series; Chemotechnique dental screening series; specially prepared metals series. The allergens found to be positive, in order of frequency, were: nickel, cobalt, potassium dichromate, rhodium, palladium, mercury, beryllium, methyl methacrylate, copper and zinc.