Skin Patch Testing Research Articles

The role of nickel contact allergy in nummular dermatitis in Indonesia

In the recurrence of nummular dermatitis (ND) as a problem for patients, it is necessary to identify interferon-γ (IFN- γ), interleukin-4 (IL-4), interleukin-17 (IL-17), and stimulation of lymphocytes against nickel. This study aimed to investigate the role of nickel contact allergy in ND. Forty-two patients with ND were studied and 42 healthy subjects who were equal in age, sex and atopy history as control. All subjects underwent nickel skin patch test, detection of IFN-γ, IL-4, IL-17 in blood, and lymphocyte stimulation assays. To determine cut off point of the variables, receiver operator characteristic (ROC) curves were calculated. Bivariate and multivariate analyses were performed to measure the strength of association using odds ratio (ORs) and 95% confidence intervals (95% CI). Statistical analysis was performed using McNemar X2-square test and multiple conditional logistic regression. Nickel contact allergy was shown by nickel patch test (OR= 3.5; 95% CI = 1.09–14.60), stimulation index/SI (OR= 29; 95% CI = 4.81-1184.43), IFN-γ (OR= 4.25; 95% CI = 1.39–17.36). These results were supported after multivariate analysis with conditional logistic regression which showed nickel patch test (OR= 9.63; 95% CI= 1.02–109.38; p= 0.04), SI (OR= 42.19; 95% CI = 2.32–766.03; p= 0.01), IFN-γ (OR= 11.51; 95% CI = 1.08–122.63; p= 0.04). Nickel contact allergy is an important risk factor for ND. Patients with ND are recommended to be tested for nickel contact allergy.

Individual susceptibility to contact sensitization: the role of TNFα 308G>A polymorphism and atopy.

The significance of individual risk factors in the development of contact allergy, such as genetic variation in cytokine genes and atopy, is still not clearly defined. The aim of this study was to investigate the association between TNFα 308G>A polymorphism or atopy and contact sensitization (CS) in a cohort from the general Croatian population. The study involved 312 first-year students from the University of Zagreb (median age: 19 years). Methods included a questionnaire and skin prick and patch testing for common inhalable and contact allergens, respectively, as well as genotyping for TNFα 308G>A polymorphism based on buccal swabs. CS (positive patch test for ≥1 contact allergen) was reported in 32%, atopy (positive prick test for ≥1 inhalable allergen) in 38%, and TNFα 308G>A polymorphism in 23% of subjects. Based on multivariate analysis, atopy was confirmed as a predictor of CS, poly-sensitization, CS to p-phenylenediamine and cobalt chloride, and self-reported skin symptoms. TNFα 308G>A polymorphism was confirmed as a predictor of CS to p-phenylenediamine (OR: 5.72; 95%CI 1.20-27.28). These findings could be relevant for evaluation of individual susceptibility to developing a contact allergy, particularly among persons occupationally exposed to skin hazards.

Demographic, Clinical, and Allergic Characteristics of Children with Eosinophilic Esophagitis in Isfahan, Iran

Eosinophilic esophagitis (EoE) is a chronic immune-mediated disease isolated to the esophagus Food allergy is thought to play an important role in the pathophysiology of EOE. The aim of this study is to evaluate demographic features and sensitivity of patients with reference to common food allergens. Children with documented EoE were enlisted for this study. Skin prick test and patch test were done for all participants. Each test contained common food allergens. Other tests, such as evaluation of total IgE and eosinophil count, were also done. A total of 30 patients (the mean age of participants was 3±6 years) with 6 months to 15 years documented EoE participated in this study. The mean duration of symptoms was 2 years. Association with other allergic disorders was seen in 16 (32%) patients [Asthma in 8 (26.7%), allergic rhinitis in 5 (16.7%) and eczema in 3 (10%)]. The mean level of total IgE was 413.5±505.5 (IU/ML): total IgE level was above normal range for age in 17 children. The mean level of eosinophil was 372.2±305.2, and eosinophilia was seen in 11 patients (36.7%). The skin prick test and patch test findings showed that 28 patients (93%) and 17 of 30 patients (56.6%) tested positive to foods respectively. The most common positive skin prick test was for sesame and walnut. Patch test showed that the most common positive test was for fish. Evaluating the symptoms indicated that vomiting (70%) is the most prevalent symptom in patients; the less prevalent symptom was dysphagia (3.3%). Other prevalent symptoms were subsequent abdominal pain (33.3%), gaining weight failure (33.3%), heartburn (16.6%), cough (10%), fecal impaction (10%), and constipation (6.66%). Our series confirms the high degree of atopy in Iranian children with EoE. These patients seem to be polysensitized to several food allergens Because of different eating cultures in different countries, considering special food in selecting allergens for allergic tests is needed.

SAT-210 Autoimmune Progesterone Dermatitis: A Rare Case Report in a Young Woman with Chronic Dermatitis

Back ground: Autoimmune progesterone dermatitis (APD) or progesterone hypersensitivity (PH) is a rare hypersensitivity reaction to progestogen that exclusively occur in women of childbearing age of which is the underlying mechanism remains not well understood. Clinical case: A 44 years old lady was referred to our endocrine outpatient clinic by her dermatologist for treatment of a recently diagnosed autoimmune progesterone dermatitis. She was initially evaluated for a skin rash that started during the second trimester of her second pregnancy in 2009. Her initial diagnosis was pregnancy induced eczema which was treated with topical steroid with no significant improvement. Her rash worsens after delivery and had persisted since then. She failed chronic systemic steroid treatment and multiple immunosuppressive medications over the years. She had regular menstrual period since her menarche at age of 11 years old. She was on oral contraceptive medication prior to her second pregnancy which she resumed after delivery. She then switched to IUD. Her rash typically gets worse 7-10 days before the onset of her menstrual period with some improvement after her period. Her initial clinical exam showed erythematous papules over her extensor elbows, thighs and genital area with scattered eczematous excoriated plaques over her extremities and trunk. She underwent skin patch test which showed that she is allergic to class A, B, and D1 steroids PH was suspected based on her history and confirmed by a positive progesterone skin test. She was referred to reproductive endocrinology for consideration of ovulation suppression using GnRH agonist. Conclusion: APD is a rare hypersensitivity reaction that can be triggered by endogenous progesterone (menses, pregnancy) or exogenous progestin (OCP, IUD, IVF) exposure. Women between menarche and menopause can be affected with the average age of onset to be in the third decade of life. The underlying mechanism is not well known with several hypotheses being postulated (e.g hypersensitivity reaction type I and IV, hormone cross reactivity and autoimmunity) Clinical presentation is variable and can range from mild dermatitis to life threatening anaphylaxis with some extra dermal manifestations have been described. Detailed history taking is the key to diagnosis as the most consistent features is the presentation of symptoms during the luteal phase of the menstrual cycle. The goal of treating APD is to suppress ovulation which can be achieved by the use of GnRH agonist, selective estrogen receptor modulator or oophorectomy. Progesterone desensitization has been tried in women desiring pregnancy.

Preschool atopic dermatitis and adolescent contact allergy

Atopic dermatitis is a common skin disease in children. The disease presents with red, itching and scaly skin, and results in a weakened skin barrier. When atopic dermatitis starts in early childhood, children may be treated with medical ointments and moisturizers for a long time. Such products often contain substances that can cause contact allergy. Contact allergy is caused by skin contact with chemical substances that are allergenic, e.g. contact allergens. Repeated contact with the allergen will result in dermatitis. This study investigated if atopic dermatitis in early childhood increases the risk for contact allergy in the teenage years. The study was performed among 2215 16‐year‐olds in Sweden. These 16‐year‐old participants had been followed since birth with questionnaires, clinical examinations and blood tests, to study environmental factors and allergies in children as part of a large population study called the BAMSE study. At 16 years, the participants were tested for contact allergy with a skin patch test. Nickel allergy was the most common contact allergy and fragrance (perfume) allergy was second most common. The results of this study indicate that atopic dermatitis in early childhood may increase the risk of having contact allergy to perfumes at 16 years, but not the risk of nickel allergy at 16 years. This study indicates that avoiding scented and perfume‐containing products is a good idea in children with atopic dermatitis in early childhood.

Exploring the Incidence, Implications, and Relevance of Metal Allergy to Orthopaedic Surgeons.

Introduction:Allergic reactions to metal implants are increasingly recognized, but its relevance to the orthopaedic surgeon remains unclear. We evaluate the prevalence of metal allergies in a subset of the population and review the significance through a survey of the current literature.Methods:Preoperative and postoperative patients referred for metal allergy testing were divided into two groups; those with a history of dermatitis and those without. Patients with a history of dermatitis were offered skin patch testing that included the North American Contact Dermatitis core allergen panels in addition to our metal screening series. Patients without dermatitis were tested to the more limited patch testing metal screening series. Some patients with dermatitis opted for the more limited screening, whereas some patients without dermatitis underwent more extensive testing at their request or at the request of the referring clinician. Patch tests were evaluated at 2 and 4 days after placement.Results:Hundred patients were referred for metal allergy testing, 46 of whom were for reasons related to planned orthopaedic surgery. Of those tested, 60 patients had a history of dermatitis and 40 did not. Some patients were nonreactive to all tested allergens, whereas others demonstrated one or more positive skin patch test reactions. The number of positive reactions to each metal in patients with a history of dermatitis was the following: nickel 19, amalgam 10, palladium 10, copper 8, cobalt 5, mercury 5, tin 2, gold 1, titanium 1, and vanadium 1. The number of positive reactions to metals in patients without a history of dermatitis was the following: nickel 4, amalgam 5, palladium 4, mercury 4, cobalt 4, tin 2, copper 2, gold 1, vanadium 1, and molybdenum 1.Discussion:Metal allergy was common in the individuals referred for testing, with reactions to nickel and amalgam being the most commonly encountered. Some individuals experience more notable allergic reactions to implanted devices than others. Localized and generalized skin reactions have been reported, along with implant failure and loosening. Surgeons should be aware of the incidence of metal allergies and the potential consequences.

Skin Biophysical Parameters and Patch Test Results in People Predisposing to Xiaotong Tiegao Induced Irritant Contact Dermatitis.

Background Xiaotong Tiegao (XTT) is an ancient topical Tibetan medicine plaster which is widely used in China. Irritant contact dermatitis (ICD) caused by XTT is very common. It is still unclear why some people are more prone to develop ICD. The aim of this study is to study the baseline skin biophysical parameters and patch test results in individuals predisposing to XTT induced ICD. Methods During a four-month period, 149 healthy volunteers with ICD and 50 volunteers without ICD after applying XTT were recruited. The skin biophysical parameters were measured, and contact allergy to 20 common allergens was patch tested, at two weeks after the ICD was recovered. Results There were no significant differences in age and sex between ICD and control groups. It was found that skin median melanin value (176.50 vs 189.50, P < 0.05, Mann-Whitney U-test) and erythema value (319.90 ± 70.49 vs 347.93 ± 84.55, P < 0.05, Independent-Samples T test) were much lower in ICD than control group. Overall patch test results were not different, but the positivity rate of nickel sulfate (15.44% vs 4.00%, P < 0.05, Fisher's exact test) was significantly higher in ICD group. Conclusions In conclusion, people with nickel allergy, lower values of skin melanin, and erythema are predisposing to develop ICD.

Clinical and immunological effects of a treatment with desentizating low-dose multicomponents in IgE mediated and non IgE mediated food allergies: observational retrospective pilot study.

Alimentary allergy has high impact on the quality of life (Qol) of patients and their families: it represents an economic burden for individuals and National Health System. The disease, particularly frequent in pediatric age, recognizes different pathogenetic mechanisms and expresses itself through the production of IgE (IgE mediated form) antibodies or through cell-mediated immunune responses (non IgE mediated forms). The aim of this clinical observational retrospective study is to evaluate the effect of a long-term treatment with Low Dose Medicine (LDM) drugs in pediatric patients affected by IgE and non IgE mediated food allergy. The purpose of the study is to determine the efficacy of the treatment with Allergy Plex (Guna Laboratory, Milan, Italy) to induce clinical and/or immunological tolerance both to IgE mediated and non IgE mediated food allergy; the secondary endpoint is to investigate the treatment tolerability, the reduction of positivity to Skin Prick test and Patch test to food allergens and the decrease on the peripheral blood of the specific IgE to food allergens. The treatment efficacy was measured through a clinical score. In this study the immunomodulant activity of Allergy Plex 13, Allergy Plex 7 and Allergy Plex 10 (Guna S.p.A., Milano, Italy) was evaluated. In every patient the state of allergical clinical responses and the immuno-allergological state were evaluated by means of specific parameters letting know the regulatory response to the allergical Th fenotype. Data about Clinical tolerance to food, Symptomatological clinical score, ECP, ACTH, Cortisol; IL-4, IL-10 was collected. There was evidence of improvement of clinical score, reduction of the diameter of cutaneous pomphus obtained through the Prick test and a decrease of IgE specifics values. The data issued from this study seem to confirm the efficacy of treatment with Allergy Plex in allowing the restoration of immune tolerance and the definite reduction of the clinical score.

Atopic dermatitis at preschool age and contact allergy in adolescence: a population-based cohort study.

Atopic dermatitis (AD) is characterized by an impaired skin barrier, which can allow enhanced penetration of allergens. It is not clear whether AD influences the risk of developing contact allergy. To examine the association between AD at preschool age and contact allergy at 16 years of age. At 16 years of age, 2215 adolescents from the population-based cohort BAMSE were included. These adolescents had been followed with repeated questionnaires regarding AD throughout childhood, and contact allergy was assessed by skin patch test at 16 years. AD at preschool age was associated with contact allergy to at least one of the tested substances at 16 years of age among boys [adjusted odds ratio (OR) 1·51, 95% confidence interval (CI) 1·03-2·20] but not among girls (adjusted OR 0·77, 95% CI 0·54-1·10). AD at preschool age was not associated with contact allergy to nickel in either boys or girls. In contrast, AD at preschool age was associated with contact allergy to fragrance mix I (adjusted OR 3·10, 95% CI 1·66-5·80). This association was observed especially for AD at preschool age in combination with IgE sensitization to airborne or food allergens (adjusted OR 3·80, 95% CI 1·67-8·61). The results suggest that AD in early childhood may be associated with contact allergy to fragrances, but not to nickel, in adolescence.

Impaired resolution of wheals in the skin prick test and low diamine oxidase blood level in allergic patients.

IntroductionHistamine is the major mediator of IgE- and non-IgE-mediated allergic reactions upon allergen or hapten contact. Reduced histamine degradation capacity was associated with atopic eczema as well as with non-immunological histamine intolerance. Higher blood serum histamine level concomitant with decreased intestinal diamine oxidase activity were observed in patients with food allergy.AimTo evaluate the relationship between patients’ blood diamine oxidase (DAO) activity/histamine status and their reactivity to time-resolved histamine skin prick test in respect to vulnerability to allergic diseases.Material and methodsFifty-three patients were examined with skin prick tests (SPT) and patch tests for suspected presence of either IgE- or non-IgE-mediated allergy. All individuals were skin prick tested with histamine and the resolution of the wheal was monitored for 50 min. Blood DAO activity and histamine concentration were measured with a radio-extraction radioimmunoassay.ResultsTime-resolved histamine skin prick testing revealed presence of wheals which were 35% larger in diameter in 47% of examined subjects at 20 min of the test. These patients exhibited significantly compromised time-course wheal resolution (wheal ≥ 3 mm at 50 min) compared to a group of patients with the normal-rate of wheal resolution (wheal = 0 mm at 50 min). Within a group of subjects exhibiting impaired wheal resolution, 61% of patients were diagnosed allergic compared to 50% in a group of patients with a normal rate of wheal resolution. Finally, allergic patients were characterized by a significantly lower DAO activity and higher histamine content compared to healthy subjects.ConclusionsThe results of this study indicate that patients with IgE- or non-IgE-mediated allergy are likely to have low DAO blood activity and may concomitantly suffer from histamine intolerance. Furthermore, our results suggest that allergic patients are more likely to develop an excessive SPT reaction. Our results emphasize caution in interpretation of the SPT results in allergic patients with diagnosed histamine intolerance or histamine/DAO activity imbalance.

Oral Wheat Immunotherapy in a Patient with Anaphylaxis Despite Negative Sensitization Tests

Introduction: Wheat allergy can develop at any stage of life. The aim of this report was to demonstrate that skin testing and specific IgE have poor specificities and sensitivities for wheat allergy. Case Presentation: A 37-year-old female presented symptoms that were initiated immediately after consumption of bread and biscuits. She was well until two months prior to her recent admission. Her skin prick test, RIDA assay, and patch test for wheat showed negative results despite a history of two episodes of anaphylaxis. She underwent an oral food challenge, which confirmed wheat allergy. A desensitization procedure was recommended for her. At the end of the immunotherapy process, she had normal intake of wheat without any symptoms. Conclusions: Negative sIgE and SPT results do not rule out clinical food allergy. Oral food challenges are still the cornerstone of diagnosis of food allergy.

HAND DERMATITIS IN A SURGEON: A DIFFICULT PROBLEM AND A THREE-PRONGED SOLUTION

Introduction Hand dermatitis is a common problem affecting up to 25% of health workers, it can be caused by contact dermatitis (CD). CD is categorized as irritant in 80% of patients and allergic in 20%. Case Description A 42-year old male surgeon with a history of recurrent eczematous lesions on hands and trunk presented with a recurrence of pruritic rash. The rash had persisted despite using OTC hydrocortisone, triamcinolone and OTC moisturizers. Hand dermatitis interfered with his work as a surgeon. Patch testing for allergic contact dermatitis was positive for 1, 3-diphenylguanidine, ammonium persulfate, carba mix, cinnamic aldehyde, cocamidopropyl betaine, coconut diethanolamide (cocamide DEA), colophony, formaldehyde, fragrance mix, hydrocortisone-17-butyrate, Iodopropynyl butylcarbamate, lidocaine-HCl and propylene glycol. The glove materials (1, 3-diphenylguanidine, carba mix), fragrances, preservatives (propylene glycol) and topical steroids were correlated with the patient's symptoms. After contact dermatitis was confirmed with patch testing, a targeted avoidance was recommended. Treatment modalities were adjusted. Triamcinolone and hydrocortisone were eliminated based on patch test results (triamcinolone 0.1% cream contained propylene glycol). Symptoms improved with: 1. topical calcineurin inhibitor (tacrolimus); 2. avoidance of irritants and allergens based on skin patch test; 3. use of barrier protection such as cotton undergloves. Discussion Hand dermatitis can have a potentially devastating effect on a surgeon's career based on the limitations it imposes on the ability to practice. The three-pronged approach described above can offer a clinical solution to a difficult problem.

IMMEDIATE HYPERSENSITIVITY TO A DENTAL APPLIANCE CONTAINING NICKEL AND METHYL METHACRYLATE

Introduction Type IV delayed hypersensitivity reactions causing allergic contact dermatitis secondary to nickel and acrylates are commonly reported. Immediate hypersensitivity from both of these materials is a rare presentation that should be taken into consideration from allergic reactions to dental appliances. Case Description A 50-year old man with obstructive sleep apnea was referred by his dentist after an acute allergic reaction resulted in an emergency room (ER) visit after wearing a dental appliance for the first time. The patient describes symptoms began within 2 hours of wearing a mandibular advancement oral device. He developed redness and burning sensation in his legs, angioedema involving his face and tongue, metallic taste, and palpitations. In the ER, he was treated with epinephrine, as well as diphenhydramine, famotidine and methylprednisolone. His symptoms resolved within minutes of epinephrine administration. Upon further investigation, it was determined that the mandibular advancement device contained both alloy containing nickel and a mixture of acrylates. Both skin prick testing and patch testing are scheduled to be performed to determine either immediate or delayed hypersensitivity to nickel and acrylates. Discussion While nickel and acrylates have previously been reported to cause delayed hypersensitivity reactions manifesting as allergic contact dermatitis, there are only a few published cases of type I hypersensitivity to nickel allergy manifesting as urticaria or angioedema. This case is a rare example of either nickel or acrylate potentially causing an immediate hypersensitivity reaction and should be further investigated as a cause of angioedema after initial use of a dental appliance.

Case Report: A nine year follow-up for a pacemaker generator poly-tetra-fluoro-ethylene coating for allergic reactions to pacemaker compounds

Background: Allergic reaction to pacemaker compounds is a rare complication of cardiac pacing. Initial management is difficult because accurate diagnosis is often delayed. The tendency is to initially suspect a bacterial infection, rather than to quickly rule out an allergy to the pacemaker components. Management of this condition is difficult and not well established. Case presentation: A 75-year-old man underwent a dual chamber pacemaker implantation. The patient needed two generator re-implantations because of sterile skin necrosis. Pace maker allergic reaction was suspected despite non-conclusive skin patch testing. The patient underwent pacemaker system removal and re-implantation of poly-tetra-fluoro-ethylene sheet coated generator in a retropectoral position. Subsequently, there has been no externalization or recurrence in nine years of follow-up. Take-away lesson: Contact allergy to pacemakers is often unrecognized. Once infection has been excluded, allergy testing must be performed. The only valuable treatment is the removal of all the system components, followed by a replacement with hypoallergenic material. Polytetrafluoroethylene coated materials can be effective to prevent recurrence.

In vitro “skin patch tests” for the detection of sensitization, allergy and relative potency assessment

Organ-on-a-chip is a microfluidic cell culture model that replicates key organ-specific microarchitecture and pathophysiology in vitro. The current methods to fabricate these devices rely on softlithography, which is usually tedious, laborious, and requires adroit users as well as cleanroom facilities. Recently, the use of 3D-printing technologies for the rapid fabrication of molds for polydimethylsiloxane (PDMS) casting is on the rise. However, most of the 3D-printed materials are unsuitable for PDMS casting. To address this issue, we have improved the existing techniques and introduced a modified protocol for the surface treatment of 3D-printed molds, making them ideal for repeated long-term PDMS casting. Using this protocol, we have fabricated a simple open well lung-on-a-chip model to simulate the in vivo environment of airway at air-liquid interface under dynamic condition. To validate the functionality of the developed chip, Calu-3 cells were cultured in the chip and maintained at an air-liquid interface. The model demonstrated that the cultured cells replicated the 3D culture-specific-morphology, maintained excellent barrier integrity, secreted mucus, and expressed cell surface functional P-glycoprotein; all indicative of a promising in vitro model for permeability assays, toxicological tests, and pulmonary drug delivery studies. To validate the suitability of this lung-on-a-chip in vitro model, the effects of cigarette smoke extract (CSE) on Interleukin-6 (IL-6) and Interleukin-8 (IL-8) release from cultured Calu-3 cells were examined. CSE treated cells showed significantly higher secretion of IL-6 and IL-8 over 24 h compared to the cells treated with both CSE and Budesonide, an anti-inflammatory drug. Moreover, our results illustrated that CSE reduced the expression of E-cadherin as an adherent junctional protein. In conclusion, the proposed protocol demonstrated an easy and low-cost fabrication technique which will allow a biologist with minimal technical skills to rapidly prototype molds for different/versatile organ-on-a-chip models.

PROSPECTIVE CLINICAL STUDY TO ASSESS THE SAFETY AND EFFICACY OF DRAVANTI BEEJ LEPA (LOCAL APPLICATION OF CROTON TIGLIUM) IN INDRALUPTA W. S. R. TO ALOPECIA AREATA

Indralupta (Alopecia Areata) is not life threatening disorder but it definitely affects the quality of life like impairing psychological well-being thus affecting mental and social status of person due to bald patch. It is characterized by smooth, circumscribed bald patch on the hair bearing area. The risk of allopathic treatment outweighs their benefits. Indralupta is considered under Kshudraroga by most of the authors of classical Ayurvedic texts. Safety and efficacy of Dravanti beeja lepa in regeneration of hair in Indralupta is assessed through present study. Prospective open randomized single-arm clinical trial was carried out on 30 patients showing classical symptoms of Indralupta. A Skin patch test has been done prior to apply the lepa for safety assessment. The Dravanti beeja lepa was given for local application twice a day over a period of 28 day. Indralupta was found to be more prevelant in males. Intake of Amla, Katu and lavana Rasa, non-vegetarian diet, stress factor and use of cosmetics could be considered as etiological factor of Indralupta. On regular use of Dravanti beeja lepa, regeneration of hair was also observed to significant level. Thus, Dravanti beeja lepa proved its safety and efficacy for topical application.

Utility of Food Patch Testing in the Evaluation and Management of Irritable Bowel Syndrome

BackgroundIrritable Bowel Syndrome (IBS) is a functional gastrointestinal (GI) disorder of unknown etiology.ObjectiveWe sought to investigate whether specific type 4 food allergens identified by skin patch testing, when eliminated from the diet, alleviate symptoms of IBS.MethodsIn this case series, skin patch testing was performed on 60 IBS patients using an extensive panel of type 4 food allergens after which food avoidance diets directed by the patch test results were implemented. Questionnaires assessing abdominal pain/discomfort and global improvement in IBS symptoms were used to assess one month and three or more month outcomes. ResultsThere were statistically significant improvements in abdominal pain/discomfort and in global IBS symptoms after one month and again at an average of 7.6 months of patch test-guided food avoidance.ConclusionsSustained improvement with avoidance of type 4 food allergens identified by skin patch testing suggests a role for delayed-type food hypersensitivities in the pathogenesis of some cases of IBS. A subset of patients whose IBS symptoms resolve completely may be better characterized as having a newly proposed disease, allergic contact enteritis (ACE).

The Role of Cleaning Products in Epidemic Allergic Contact Dermatitis to Methylchloroisothiazolinone/Methylisothiazolinone.

Sensitivity to methylchloroisothiazolinone (MCI)/methylisothiazolinone (MI) has increased rapidly over recent years. This increase is mainly related to the extensive use of high concentrations of MI in cosmetic products, although a growing number of cases of occupational allergic contact dermatitis are caused by MCI/MI. The aim of this study was to examine the association between the increase in MCI/MI sensitization and the work performed by the patients in our area. A retrospective study was undertaken of the records of a total of 1179 patients who had undergone contact skin patch tests for MCI/MI from January 2005 to December 2015. A multivariate logistic regression analysis was performed to identify the factors independently associated with sensitivity to MCI/MI. A constant increase in MCI/MI sensitization was observed over the observation period. The only work associated with a significant increase in the prevalence of MCI/MI sensitization was cleaning, with 38.5% of the cleaning professionals with MCI/MI sensitization consulting for cosmetics-related dermatitis. Occupational sensitization to MCI/MI in cleaning professionals is worryingly increasing. This, in turn, could possibly account for many cases of cosmetics-associated contact dermatitis. Our findings suggest that a review of the regulations with regard to isothiazolinone concentrations in industrial and household detergents is necessary.

Food allergy in children: recommendations for diagnosis and treatment

Food allergy arises from a specific immune response induced by food exposure. It is the first cause of anaphylaxis in childhood. Its prevalence increased exponentially in western countries. The proteins most frequently involved in infants are cow's milk and hen's egg; and in adults, seafood. Peanuts have the same frequency in both groups. The clinical manifestations and methodology of study are directly related to the pathophysiology of the disease. Clinical history, skin prick test, patch test, and food oral challenge are essential to arrive at a correct diagnosis, that will avoid unnecessary exclusions or exposures that carry life risk. The treatment is based on the correct avoidance of responsible food (considering hidden allergens), besides patient and their care giver's education, to maintain a good quality of life.

Brazilian experience with atopy patch tests for Dermatophagoides pteronyssinus, Dermatophagoides farinae and Blomia tropicalis

Background The aim of this study was to evaluate the positivity rates of atopy patch tests for Dermatophagoides pteronyssinus, Dermatophagoides farinae and Blomia tropicalis in patients with respiratory diseases such as asthma and allergic rhinitis with or without atopic dermatitis.Methods The patients’ clinical histories were collected, and the patients were subjected to skin prick and patch tests with the three different house dust mites on the same day. The patch tests were examined 48 hours later, and then patients were divided into two groups: I- patients with respiratory diseases, such as asthma and/or rhinitis, and atopic dermatitis and II-patients with only respiratory diseases. A total of 74 patients ranging in age from 2 to 60 years were included in this study; 16 patients were included in group I and 58 were included in group II. This study was approved by the human ethics committee of the Faculty of Medical Science and Health SUPREMA (number 2.007.135), and written informed consent was collected from each patient or their parents prior to enrollment.Results In the skin prick tests, the most prevalent mite that evoked a reaction was Dermatophagoides pteronyssinus, followed by Dermatophagoides farinae and Blomia tropicalis. Regarding the atopy patch tests, the mite that most frequently induced a positive reaction was Dermatophagoides farinae (78.4%), followed by Dermatophagoides pteronyssinus (77%) and Blomia tropicalis (52.7%). A comparison of the skin prick and atopy patch tests revealed that 53 patients (71.6%) were positive on both tests, and 30 (56.6%) patients were positivite for the same mite. We found six patients (8%) who had a positive clinical history of allergy and only exhibited positivity on the atopy patch test.Discussion Most studies have been performed with atopic dermatitis patients, but in this study, most of the patients had respiratory conditions. Blomia tropicalis is a mite that is prevalent in tropical areas, such as Brazil, and only two publications include these three mites, wich are present in Brazil. The APT may produce positive results in concordance with the SPT resuts, but may also be the only positive test ( 8%) as we observed in our study. These results suggest that the mite atopy patch test is relevant and should be considered as an additional test for patients with clinical histories of allergic respiratory disease who have negative prick test results.Conclusion The APT should be considered as an additional test when the SPT and specific serum IgE tests are negative in patients with clinical histories of allergies.