Skin Patch Testing Research Articles

CLINICO-EPIDEMOLOGICAL STUDY OF FACIAL MELANOSIS

Introduction: Melanosis affecting face and neck occur from a myriad of conditions. The similar overlapping clinical, histological and dermoscopic features posses an intricate diagnostic problem for the clinician. Attempts to classify them have been partially successful. Methods: This was a prospective hospital based study conducted in a tertiary hospital over a period of one year involving 120 patients of facial melanosis. Relevant investigations including skin biopsy and patch testing were done wherever required. Results: Study sample ranged from nine to 60 years with maximum number of patients in 21-40 years of age. Females predominated in the study. Most common diagnosis was melasma followed by pigmented contact dermatitis, periorbital melanosis, lichen planus pigmentosus, erythema dyschromicum perstans, poikiloderma of civatte and eythromelanosis follicularis. Conclusion: There was considerable clinical, histological overlap between these clinical entities. UV exposure in melasma and lichen planus pigmentosus, exposure to allergens in pigmented contact dermatitis were the main etiological factors implicated. Key words: facial melanosis, melasma, pigmented contact dermatitis, lichen planus pigmentosus.

Skin pigmentation improvement with resveratrol microemulsion gel using polyoxyethylene hydrogenated castor oil

Objective To investigate the safety and efficacy of resveratrol microemulsion gel in improving pigmentation. Methods Resveratrol microemulsion gel was prepared by the microemulsion solubilization method, and its quality was evaluated. The transdermal and drug retention rates of resveratrol in vivo were assessed using a transdermal test. The inhibitory effects of resveratrol suspension and microemulsion on tyrosinase activity and melanin production of A375 human melanocytes and zebrafish embryos were compared. A skin patch test was used to investigate the safety of the gel on 15 volunteers. Results The microemulsion gel was homogeneous and stable. Compared with suspension and microemulsion, the drug penetration rate and skin retention in the microemulsion gel group were significantly increased. Compared with the suspension group, the activity of melanocyte tyrosinase in A375 human melanocyte was significantly inhibited in the microemulsion group, and the melanin production rate of A375 human melanocyte and the melanin area of zebrafish yolk was decreased. All 15 volunteers tested negative for the human skin patch. Conclusions The microemulsion gel could significantly enhance the ability of resveratrol to inhibit the formation of melanin without causing side effects. These data provide the experimental basis for developing and applying the preparation for improving pigmentation.

Mechanism and inhibitory effects of cactus (Opuntia dillenii) extract on melanocytes and its potential application for whitening cosmetics

Penghu cactus (Opuntia dillenii [Ker.] Haw) is a cactus plant that commonly grows in Penghu Island, Taiwan, Republic of China (ROC). However, still lack of scientific study on the Opuntia dillenii [Ker.] Haw extract on skin-whitening-associated tyrosinase activity and melanin production. The activities of its extract in melanogenesis were investigated in this article. In this experiment, we used an extract from the Penghu cactus (Opuntia dillenii [Ker.] Haw) to study its tyrosinase inhibition, anti-melanin generation, UV-protection effects and wound healing capacity in B16-F10 melanocytes. Without reducing cell growth greatly or causing cell death, 20 g/L cactus extract effectively inhibited the melanin production of B16-F10 cells, and melanogenesis was induced by 3-isobutyl-1-methylxanthine. The cactus extract could also promote cell proliferation. Cactus extract treatment decreased the mRNA expression of insulin-like growth factor 1 (IGF-1) and vascular endothelial growth factor (VEGF) and increased that of transforming growth factor β (TGF-β). Thus, it could reduce cell melanin production and promote cell growth but by also reducing IGF-1 and VEGF mRNA expression, may reduce wound scarring and prevent tumor proliferation and swelling. Increasing TGF-β mRNA expression can help increase collagen to remove wrinkles and help in wound healing. Skin patch test results agreed with in vitro results with B16-F10 melanoma cells. The cactus extract significantly inhibited tyrosinase activity and reduced melanin production, showing a whitening effect on skin tests. Cactus may be a good natural candidate for inhibiting melanin production and promoting cell proliferation.

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.

Poor Correlation Among Metal Hypersensitivity Testing Modalities and Inferior Patient-Reported Outcomes After Primary and Revision Total Knee Arthroplasties.

Metal allergy testing may influence clinical decision-making for patients undergoing a total knee arthroplasty (TKA). Limited data were found to examine the consistency of available testing modalities. This study compares different metal allergy test results and clinical outcomes after primary and revision TKAs in patients with and without metal hypersensitivity. Primary (n= 28) and revision (n= 20) TKA patients receiving hypoallergenic implants for metal allergies diagnosed by skin patch testing (SPT), lymphocyte proliferation testing (LPT), or lymphocyte transformation testing (LTT) were retrospectively reviewed. The agreement between tests was assessed by percentage and kappa statistic within patients who used multiple testing modalities. Postoperative clinical outcomes of these patients were compared to those of patients without metal hypersensitivity matched by age (±5 years), body mass index (±5), gender, and follow-up duration (±2 years). SPT and LPT showed weak agreement for nickel and minimal agreement for cobalt. SPT and LTT showed minimal agreement for nickel; weak agreement for titanium, bone cement, vanadium, and zirconium; but strong agreement for chromium and cobalt. LPT and LTT agreement was weak. Compared to matched controls, metal hypersensitivity patients undergoing primary TKAs with hypoallergenic implants experienced less improvement in Knee Society Scores, Veterans RAND 12 physical component scores, and range of motion. Patients undergoing revision TKAs for multiple indications including metal hypersensitivity had worse clinical outcomes with significantly worse improvements in Knee Society functional scores compared to matched controls. Metal allergy tests produce conflicting results. Hypersensitivity patients may experience inferior clinical outcomes even with hypoallergenic implants. Clinician awareness may influence the choice of testing and improve preoperative counseling of this patient population.

Abstract 13109: Pacemaker Mediated Contact Allergy to Thiuram and Paraphenylenediamine

Introduction: Allergic contact dermatitis to cardiac rhythm devices (CRD) has been reported sporadically from the early 1980s to present. Most of these cases involve allergic reactions to direct contact agents such as nickel, silicone, titanium, cobalt, epoxy resin, mercury, polysulfone, polyurethane and polychloroparaxylene. Our case is unique in that the strongest allergic reaction was with thiuram and P-phenylenediamine (PPD), which has only been documented once since the advent of permanent pacemakers (PPM) Case: 58-year old male with history of hypertension and coronary artery disease presented with palpitations and fatigue. Holter monitoring demonstrated tachybrady syndrome and he underwent dual chamber PPM implantation (L331 Accolade TM MRI - Boston Scientific Inc). Eight weeks later he presented with new onset rash around his neck and the surgical site. PPM allergy was suspected, as patient did not respond to empiric antibiotics. He underwent PPM and lead extraction. Decision was made to observe patient without immediate re-implantation of PPM. Skin patch testing was strongly positive to thiuram and PPD. Final diagnosis of allergic contact dermatitis was made and patient’s condition improved. Discussion: Thiuram and PPD, the raw materials used in the production of silicone rubber, encase pacemaker headers and leads. Individuals typically get sensitized to PPD by using hair dyes or temporary henna tattooing. The device used in our patient contained the same compounds. No studies to date document the true incidence and/or prevalence of allergic reactions to pacemaker components. One non-randomized retrospective trial reported benefits of skin patch testing before CRD implantation in patients who had a history of allergy to metals. Future trials are warranted to further evaluate the efficacy and benefits of pre-implantation skin testing and if it would benefit the population as a whole.

EFFICACY OF HOUSE DUST MITE IMMUNOTHERAPY IN PATIENTS WITH ATOPIC AND CONTACT DERMATITIS OVERLAP SYNDROME

<h3>Introduction</h3> Allergen-specific immunotherapy may modify chronic inflammation in patients with allergic overlap syndrome, including atopic dermatitis and contact allergy. <h3>Methods</h3> A randomized, double-blind, placebo-controlled study was conducted. 81 patients aged 18 to 60 years with atopic and contact dermatitis were included. The main criterion for inclusion in the studies was confirmation of sensitization to house dust mites and contact allergy. Patients with a SCORAD index greater than/equal to 15 points were included. The primary endpoint of efficacy was a significant reduction in the SCORAD index between the active and placebo groups by more than 12 points after 6 months of treatment. Contact allergy was confirmed by skin patch tests. Specific IgE to Der p1 and Der p 2 were determined by ELISA. <h3>Results</h3> 71 patients completed the study, with 36 patients in the active group and 35 in the placebo group. Patients in both groups received standard treatment. Patients in the active group received subcutaneous allergen-specific immunotherapy with house dust mite extracts. In the active group, a decrease in the SCORAD index by 12 points was recorded in 30 of 36 patients, which significantly differed (chi squared 5.71, p<0.017) from the placebo group, where the decrease in the index occurred in 19 of 35 patients. The number of exacerbations of contact allergy in the active group was significantly less (p<0.05) compared with the placebo group. <h3>Conclusion</h3> This pilot study confirmed that allergen-specific immunotherapy may be effective in the overlap syndrome of atopic and contact dermatitis.

RECALL URTICARIA IN PATIENT WITH CELIAC DISEASE

<h3>Introduction</h3> Recall urticaria refers to an urticarial response localized to an area of prior antigen exposure and reactivated by various stimuli, typically allergy immunotherapy. Our case describes a patient, ultimately diagnosed with celiac disease, who experiences episodes of recall urticaria at site of previous allergy immunotherapy after ingestion of wheat. <h3>Case Description</h3> The patient is a 28-year-old female with allergic rhinitis previously on allergy immunotherapy from 2015-2016. In June 2020, she began to experience urticaria on the posterior region of her left arm. The episodes occurred in the evening, resolving within 20 minutes after diphenhydramine treatment. She described the location of hives to be consistent with area of prior immunotherapy injections. In July 2020, she started cetirizine 10mg every morning and diphenhydramine 25mg every evening, which controlled her hives outside of recurrence with missed antihistamines doses. She was later diagnosed with celiac disease and initiated a gluten-free diet. She discontinued oral antihistamines in February 2021 and remained free from frequent episodes of hives. However, with accidental ingestion of wheat, she reports a recurrence of localized hives 5-6 hours later. <h3>Discussion</h3> The patient's history of spontaneous localized hives where she previously received allergy immunotherapy is consistent with recall urticaria. Given the correlation between ingestion of wheat and episodes of urticaria, this appears to be her trigger for recall urticaria. Further investigations are underway, including skin prick and patch testing, with potential oral challenge to wheat. The mechanism by which the immune or inflammatory response to gluten triggers her recall urticaria remains to be elucidated.

Characterizations of a Cost-Effective Single Component Polymer for Stretchable and Flexible Microelectromechanical Systems Applications

Abstract Polymers like polydimethyl siloxane (PDMS) and polyethylene terephthalate (PET) have long been used as substrate materials for stretchable and flexible microelectromechanical systems (MEMS)-based applications. However, the ever-increasing demand of these materials and difficulty in frequent availability of such materials has also increased the cost. Thus, the study of alternate low-cost and easily available materials has become inevitable. Therefore, in this article, we have reported various research results related to BS-8599 V7 elastomer, a commonly available low-cost, silicone-based polymer alternative to PDMS and PET for stretchable and flexible MEMS applications. Mechanical properties were determined using tensile and compression tests according to ASTM-D412 Type C, Standard Test Methods for Vulcanized Rubbers and Thermoplastic Elastomers—Tension and ASTM-D575, Standard Test Methods for Rubber Properties in Compression, standards, respectively, thermal behavior was studied using thermal gravimetric analysis with hardness and elongation tests, chemical integrity of the polymer was observed by mass decomposition of the polymer in various chemical environments, and bio-compatibility of the polymer was studied by skin patch test to check its compatibility with the human epidermis. Finally, an adhesion test was performed by coating zinc oxide nanoparticle film on the polymer surface to demonstrate its application toward low-cost stretchable and flexible thin film devices. The analysis of the experimental data reveals that this material is highly stretchable and flexible, chemically inert, possesses good thermal stability, and can be used as a low-cost alternate substrate platform for various MEMS-based applications.

Occupational contact dermatitis among healthcare workers in the COVID-19 Isolation ward

Occupational skin disease due to intensified infection prevention procedures among healthcare workers has been reported since the outbreak of coronavirus disease-2019 (COVID-19). This study was to determine the cause of Occupational Contact Dermatitis (OCD) among healthcare workers in the COVID-19 isolation ward using a skin patch test to prevent the recurrence of the disease. The allergens for the patch test included thiuram-mix 1%, 2-mercaptobenzothiazole 2%, and tetramethyl thiuram disulfide 1% which were contained in gloves, cobalt chloride 1%, and colophony 20% which were contained in adhesives, as well as irigasan 2% and lanolin 100% which were contained in hand hygiene products. Thirty healthcare workers who were diagnosed with OCD were included and underwent patch tests. The participants were dominated by females (90%) and nurses (66.67%). Six participants got weak positive (+) results from thiuram-mix 1%. Meanwhile 1 weak positive (+), 6 strong positive (++) and 1 extreme positive (+++) were found in lanolin 100% patch test. There was clinical relevance to these results. The infection prevention measures among healthcare workers in the COVID-19 isolation ward increased the risk of OCD, including the use of PPE and hand hygiene products.

Novel human skin surface antimicrobial peptide quantification method using a skin patch test chamber: A pilot study.

Antimicrobial peptides (AMPs) on the skin surface are related to the innate immunity of the skin in preventing external infection. Skin rinsing and tape stripping (TS) are acceptable methods for analyzing AMPs on the skin surface but have limitations, such as causing skin damage. In this study, we proposed a noninvasive method to measure AMPs on the skin surface with minimal skin damage. Using the patch test assay, we aimed to analyze the skin surface human β-defensin (hBDs) levels without damaging the skin barrier. The concentrations of hBDs on the skin surface were evaluated through the skin patch testing of 13 healthy subjects, and hBD-1 concentrations were compared with those obtained using the TS method in this proof-of-concept study. In addition, changes in skin physiology and concentration of hBDs under 1% sodium lauryl sulfate stimulation were monitored in 14 healthy subjects (8 young and 6 elderly subjects) for 150 h. The correlation between the two methods had a Pearson's coefficient of 0.640, and skin patch analysis led to a relatively less impaired barrier with no significant increase in transepidermal water loss after analysis. Age-specific comparisons suggested that higher skin surface hBD-2 concentrations were present in the young group as compared with the elderly group. Skin surface expression of hBD-2 after skin barrier disruption was also higher in the young group. Our findings show that skin patch analysis is a convenient method to analyze hBDs on the skin surface. hBDs are factors of innate immunity that can be used as an index to predict a decreased chemical immune response of skin due to aging.

O100 The effect of nickel hypersensitivity on outcome of total knee arthroplasty and value of skin patch testing: a systematic review

Abstract Introduction Aims of the systematic review were to assess the sensitising potential of TKA, explore the relationship between Nickel hypersensitivity and clinical outcomes, and evaluate the utility of skin patch testing pre- and/or post-operatively. Methods A literature search was performed through EMBASE, Medline and PubMed databases. Articles were screened independently by two authors. Levels of Evidence were assessed using OCEBM criteria, and quality assessed using MINORS and Cochrane risk-of-bias tools. Results Twenty studies met the eligibility criteria, reporting on 1354 knee arthroplasties. Prevalence of Nickel hypersensitivity ranged from 0% to 87.5%. Only one study which compared prevalence of hypersensitivity in the same patient group before and after surgery noted newly positive patch test reactions in 4.1%. Three studies reported lower prevalence of hypersensitivity in post-operative patients compared to pre-operative patients. Seven studies suggested hypersensitivity might cause complications; six studies did not support any relationship. Seven studies recommended pre-operative patch testing in patients with history of metal allergy; nine studies concluded testing may be valuable post-operatively. Conclusion Patients undergoing TKA do not seem to be at increased risk of developing Nickel hypersensitivity, however there is conflicting evidence that patients with established hypersensitivity are more likely to experience adverse clinical outcomes. Patch testing remains the gold standard diagnostic method; evidence suggests performing this test pre-operatively in patients with history of metal allergy to aid selection of the most appropriate prosthesis, and postoperatively once common causes of implant failure have been excluded, since implant removal or revision with hypoallergenic implants may alleviate symptoms. Take-home message Patients undergoing total knee arthroplasty do not seem to be at an increased risk of developing nickel hypersensitivity, and there is mixed evidence that patients with hypersensitivity are more likely to experience adverse clinical outcomes. Evidence suggests performing patch testing preoperatively in patients with a history of metal allergy to aid selection of the most appropriate prosthesis, and post-operatively only once more common causes of implant failure have been excluded.

Equipamento de Proteção Individual: Causa ou Consequência? Caso Clínico

Introduction Contact dermatitis comprises 70–90% of all occupational skin diseases, leading frequently to functional disability. If contact dermatitis is suspected, the patient’s occupational history can guide the clinical suspicion as well as the allergens to be tested. Case Report A 63-year-old male electrician, who went to a Dermatology Specialist with pruritic erythematous-scaly lesions on the hands and feet, two years after the onset of symptoms. An epicutaneous test was performed, and Potassium Dichromate, Paraphenylenediamine, Lanolin Alcohols and Textile Blends were found positive. Considering the characteristics of the lesions, their distribution, occupational exposure and the results of skin patch tests, the diagnosis of Allergic Contact Dermatitis was established. Discussion It was possible to establish a relationship between the Personal Protective Equipment used by the worker and the symptoms, as well as establish the presumptive diagnosis of Occupational Dermatitis. The best approach for treatment is to identify and remove the agent, since avoiding the allergens can improve the clinical condition. Workplace analysis, as well as the development of preventive strategies are essential for Occupational Health. It is important to encourage companies to reduce/eliminate exposure to risk factors, promoting the health and safety of workers. Conclusion Contact Dermatitis is associated with a high personal and professional impacts, which can result in absenteeism, reduced productivity and disability. The Occupational Health Care Physician plays an active role in informing workers, with regards to safe working practices and the correct use of Personal Protective Equipment, so that these are used for protection instead of the source of the illness. Keywords: Dermatitis, Allergic contact, Contact Dermatitis; Occupational Dermatitis; Occupational Health.

Anti-Inflammatory Effects of Psoralen Derivatives on RAW264.7 Cells via Regulation of the NF-κB and MAPK Signaling Pathways.

Using repositioning to find new indications for existing functional substances has become a global target of research. The objective of this study is to investigate the anti-inflammatory potential of psoralen derivatives (5-hydroxypsoralen, 5-methoxypsoralen, 8-hydroxypsoralen, and 8-methoxypsoralen) in macrophages cells. The results indicated that most psoralen derivatives exhibited significantly inhibited prostaglandin E2 (PGE2) production, particularly for 8-hydroxypsoralen (xanthotoxol) in lipopolysaccharide (LPS)-stimulated macrophage RAW 264.7 cells. In addition, xanthotoxol treatment decreased the PGE2, IL-6, and IL-1β production caused by LPS stimulation in a concentration-dependent manner. Moreover, Western blot results showed that the protein levels of inducible nitric oxide synthase (iNOS) and cyclooxygenase-2 (COX-2), which activated with LPS treatment, were decreased by xanthotoxol treatment. Mechanistic studies revealed that xanthotoxol also suppressed LPS-stimulated phosphorylation of the inhibitor of κBα (IκBα), p38 mitogen-activated protein kinase (MAPK), and c-Jun N-terminal kinase (JNK) in RAW 264.7 cells. The Western blot assay results show that xanthotoxol suppresses LPS-induced p65 translocation from cytosol to the nucleus in RAW 264.7 cells. Moreover, we tested the potential application of xanthotoxol as a cosmetic material by performing human skin patch tests. In these tests, xanthotoxol did not induce any adverse reactions at a 100 μΜ concentration. These results demonstrate that xanthotoxol is a potential therapeutic agent for topical application that inhibits inflammation via the MAPK and NF-κB pathways.

Doctor I Have an Iodine Allergy.

Ophthalmologists frequently face patients who refuse asepsis protocols involving povidone-iodine (PI) due to claims of an allergy to iodine. Such patients usually base this claim on previous reactions to shellfish consumption or to imaging procedures that used iodine-based contrast agents. Allergy to iodine, however, is biologically impossible, and iodine deficiency causes severe developmental problems, including mental retardation. Furthermore, shellfish allergy is due to tropomyosins in muscle tissue, and reactions to intravascular contrast dyes are due to hyperosmolar solutions; neither “allergy” is due to iodine. PI, which contains 9–12% iodine, is the preferred antiseptic for ophthalmic procedures. Experience shows that PI can be administered safely to patients claiming iodine allergy. True allergy to PI is rare and, if indicated, skin patch testing can be performed prior to surgery. Patients who react adversely to highly concentrated (5–10%) PI usually experience toxicity to the corneal and conjunctival epithelium after topical administration. Dilute (0.1–0.25%) PI kills microbes quicker than higher concentrations but for shorter periods of time because the total dose of iodine is smaller. Repeated administration (every 20–30 s) of dilute PI effectively kills microbes for as long as necessary with little risk of epithelial toxicity.

Localized and Generalized Skin Adverse Drug Reactions to Nadroparin Calcium Injection in 6 Cases of Pregnant Women

Background Despite the increasing number of skin adverse drug reactions caused by nadroparin calcium have been reported, mostly, little is known regarding of their details of clinical characteristics, especially for generalized skin adverse drug reactions. We sought to evaluate localized and generalized characteristics of the skin adverse drug reaction to nadroparin calcium injection in pregnant women. Methods A retrospective study was conducted on 6 pregnant women, who experienced localized and generalized skin adverse drug reactions during long-term nadroparin calcium injection. The patients' clinical and imaging information were retrieved from medical records. The skin prick test, patch test, and intradermal test were performed after they stopped lactation. Causality assessment of suspected adverse drug reactions was performed on these cases. Results The average total dose of nadroparin calcium injection in the 6 cases was 64.17 ± 22.66. Localized skin adverse drug reaction, manifested as erythema at the injection point, appeared after 47.5 ± 17.4 days of subcutaneous injection of nadroparin calcium. Generalized urticaria-like lesions, progressing from the injection site on the abdomen, appeared in 5.17 ± 3.60 days after the first appearance of localized reaction, while laboratory test results revealed essential peripheral blood eosinophilia. All rashes in the 6 cases subsided in 2–5 weeks after drug withdrawal. After delivery, 5 of 6 cases received complete skin tests to evaluate drug hypersensitivity. Results presented positive in the intradermal test within 7 days. Both the skin prick test and skin patch test were negative. Localized skin reactions and generalized urticaria-like adverse drug reactions were considered as definitely and probably caused by nadroparin calcium injection, respectively. Conclusion Subcutaneous injection of nadroparin calcium in pregnant women appears to be at risk of localized and generalized urticaria-like adverse drug reaction. It is important to follow up the pregnant woman during nadroparin calcium injection for evaluating adverse drug reactions. Timely detection of symptoms is pivotal in early diagnosis and treatment of adverse drug reactions.

Contributions of nurse specialists in the allergy and immunology service and patient care.

Specialist nurses have a crucial role within the allergy and immunology specialty that reflects their competence in an increasingly complex area of work and ability to use advanced diagnostic testing and therapeutic modalities. A specialist nurse in Qatar follows the local Hamad Medical Cooperation (HMC) guidelines and the competency published by the British Society for Allergy and Clinical Immunology (BSACI).Specialist Allergy NursesLearning domain: Learn and review the written standard operating procedure (SOP) and protocols for all diagnostic and therapeutic allergy procedures, including skin prick testing (inhaled, food, and others), intradermal testing, skin patch testing, penicillin testing, food and drug challenges, different desensitization protocols, and biologics and other medication administration. In addition, learn the protocol for immunotherapy administration and maintain an updated knowledge of trends and developments in the field by reading relevant articles, journals, and related material and attending seminars and conferences, as needed.Maintain a safe work environment: Perform all the above procedures and medication administration with a high grade of competency under physician supervision. Apply quality measures to ensure safety. Furthermore, perform stocktaking by regularly checking procedure requirements, availability of items and consumables, date of expiry of items, and medications. Monitor the patients closely during drug and food allergy challenge procedures and record and report patients’ vitals and reactions to treating physicians. Ensure that a patient stays the required observation time after injection(s).General care: Assess patient needs and suggest solutions to patient care problems. Provide education and resources for the patient and family support as needed. React appropriately and on time during patient reaction situations to mitigate early adverse reactions. Maintain patient, employee, and clinic confidentiality.Specialist Immunology Nurses• Develop specialist knowledge and experience in immunology.• Develop nurse-led clinics for administering immunoglobulin replacement therapy safely and effectively based on patients’ preferences (IV vs. SC and in-hospital vs. home programs).• Coordinate communication between members of the multidisciplinary team to facilitate the appropriate delivery of care.• Provide education and resources for the patient and family support (insurance issues, resources for vaccination recommendations, concerns regarding traveling and vacations, pregnancy, and any other lifecycle changes).

Studies on safety and efficacy of particles containing a mixture of hydroxyapatite–argentum–titanium oxide (HAT) and sheets coated with HAT particles to be used in masks to improve nasal allergy: II. Cellular, in vivo, and clinical studies

PurposeWe report the manufacture of particles containing a mixture of hydroxyapatite–argentum–titanium oxide (HAT), followed by attachment to nonwoven polyester fabrics to produce HAT-coated sheets (HATS) for use in masks. The purpose of the present study was to perform cellular, in vivo, and clinical studies to further examine the safety of HATS for use in masks to improve nasal allergy.MethodsReverse mutation tests for HAT were performed using five bacterial strains. A cellular toxicity test was performed using a Chinese hamster cell line incubated with the HATS extracts. Skin reactions after intradermal administration were examined in rabbits. Skin sensitization tests in guinea pigs were performed using the HATS extracts. HAT was administered to the nasal cavity and conjunctival sac of the rabbits. An oral administration study was performed in rats. Finally, a human skin patch test was performed using the HATS.ResultsReverse mutation tests showed negative results. The cellular toxicity test showed that the HATS extract had moderate cytotoxicity. The intradermal skin reaction and skin sensitization tests were all negative. The administration of HAT to the nasal cavity and intraocular administration showed negative results. No toxicity was observed after oral administration of HAT powder up to a dose of 2000 mg/kg. Finally, the skin patch test result was negative.ConclusionAlthough HAT showed moderate cytotoxicity, in vivo results indicated that HAT is safe because it does not come in direct contact with cells in normal usage, and HATS is safe when used in masks.

Frequency of positive allergy tests in children, adults and seniors

Summary Background Among allergists, it is often assumed that allergies primarily affect children and young adults and are “lost” during life. Methods To challenge this assumption, we analysed skin prick tests and patch tests from a large patient cohort of 5857 consecutive patients seen by the same physician in 2018 in a large allergy outpatient clinic in Vienna. Results We observed a clustering of patients suffering from inhalant allergy between the ages of 5 and 59 years (44.6% = 2155/4828), although inhalant allergies were still frequent beyond the age of 60 years with 20.2% (167/826). Food allergies were most relevant in infants under 5 years of age, at 16.3% (33/203). The proportion of contact allergies was low in childhood, but steadily increased over the age and affected more often women (women: 5.28% = 187/3544, men: 1.99% = 46/2313). Conclusion Inhalant allergies play a relevant role until old age. Food allergies are mainly a disease of infancy, and contact allergies predominantly affect adult women.

Prevalence and Patterns of Latex Glove Allergy among Healthcare Workers in a Tertiary Care Center In South India - A Cross-Sectional Study.

Background:Latex glove allergy and its impact on healthcare workers (HCWs) have been studied in many countries, but the data is scarce from developing countries.Objectives:We wanted to estimate the prevalence and patterns of latex glove allergy among HCWs and to study the factors associated with it.Materials and Methods:We conducted a cross-sectional study among 1088 HCWs of a tertiary care center in South India with the screening questionnaire adopted from “Allergy and Asthma network.” Skin prick test, patch test, and serum total immunoglobulin E (IgE) were performed only in consenting symptomatic HCWs.Results:The prevalence of latex glove allergy in our study subjects was 9.1% (99/1088). This includes latex protein allergy and contact dermatitis to rubber glove allergens. The most common manifestation of latex glove allergy was irritant contact dermatitis observed in 68 HCWs (68.6%). Other presentations were allergic rhinitis (40.4%), allergic contact dermatitis (17.1%), contact urticaria (11.1%), allergic conjunctivitis (6.06%), and asthma (3.03%). The risk factors associated with latex glove allergy in our study were atopy (OR = 20.51), working in both ward and operation theater (OR = 26.6), auxiliary staff (OR = 4.75), and more than ten years of hospital work experience (OR = 3.85).Conclusion:Our study reported a high prevalence of latex glove allergy. With irritant contact dermatitis being the most common manifestation in our study, HCWs at risk shall be educated on the appropriate use of gloves and hand moisturizer to prevent occupational irritant contact dermatitis (ICD). We recommend further research to address the gaps in our knowledge around latex allergy in a healthcare setting.