Skin Patch Testing Research Articles

Allergic Contact Dermatitis in Pediatric Practice.

Allergic contact dermatitis (ACD) is prevalent among pediatric population, adolescent and young adults. Patients with ACD experience a lot of sociopsychological and qualityof- life (QoL) difficulties. Children and their caregivers alike are vulnerable to the burden of ACD. We have, in this paper, provided an overview of ACD and discussed common and unusual causes of ACD. We performed an up-to-date literature review in the English language on "allergic contact dermatitis" via PubMed Clinical Queries, using the keywords "allergic contact dermatitis" in August 2022. The search included meta-analyses, randomized controlled trials, clinical trials, casecontrol studies, cohort studies, observational studies, clinical guidelines, case series, case reports, and reviews. The search was restricted to English literature and children. ACD may be acute or chronic and it affects more than 20% of children and adults with significant quality-of-life impairments. ACD is manifested by varying degrees of cutaneous edema, vesiculation, and erythema. The hypersensitivity reaction is one of the most prevalent forms of immunotoxicity in humans. Localized acute ACD lesions can be managed with high-potency topical steroids; if ACD is severe or extensive, systemic corticosteroid therapy is often required to provide relief within 24 hours. In patients with more severe dermatitis, oral prednisone should be tapered over 2-3 weeks. Rapid discontinuation of corticosteroids can result in rebound dermatitis. Patch testing should be performed if treatment fails and the specific allergen or diagnosis remains unknown. ACD is common and can be a physically, psychologically, and economically burdensome disease. Diagnosis of ACD is primarily based on history (exposure to an allergen) and physical examination (morphology and location of the eruption). Skin patch test can help determine the causative allergen. Allergen avoidance is the cornerstone of management. Topical mid- or highpotency corticosteroids are the mainstay of treatment for lesions on less than 20% of the body area. Severe cases of ACD may require treatment with systemic corticosteroids.

Outbreak of contact allergy to dicyclohexylcarbodiimide in a biotechnology laboratory.

Dicyclohexylcarbodiimide (DCC) is known to cause occupational allergic contact dermatitis in biotechnology laboratory workers. This study aimed to assess the prevalence of DCC sensitization among workers of one biosynthesis laboratory and to determine the optimal DCC concentration for patch testing. 23 laboratory workers frequently exposed to DCC of whom 21 suffered from dermatitis and 11 controls were enrolled into the study. All participants underwent skin patch testing with different concentrations of DCC and other substances used in the work environment. Statistical analysis was conducted to compare results between active and control groups. Of the 23 workers tested, 56.5% showed positive reactions to DCC. All of them had dermatitis. Morpholine also elicited positive reactions in 26.1% of workers who were all sensitized to DCC. Dimethylformamide and chloroform yielded negative results. Dicyclohexylcarbodiimide was a major cause of contact dermatitis in the active group indicating an outbreak of contact allergy to DCC in the company necessitating preventive measures. Both DCC 0.1% ac. and DCC 0.05% pet. should both be used for patch testing.

Transcatheter patent foramen ovale closure in patients with and without documented nickel hypersensitivity

Abstract Background Transcatheter PFO closure has been established as a safe and feasible approach for secondary prevention in appropriately selected patients with previous cryptogenic stroke. The two FDA-approved devices, widely used, consist of a nitinol frame; a nickel-titanium alloy. Although nickel is recognized as the primary metal causing hypersensitivity reactions worldwide, the potential occurrence of nickel hypersensitivity following PFO closure remains a subject of debate. Purpose The aim of this study is to investigate whether patients with nickel hypersensitivity are more susceptible to experiencing adverse events after PFO closure and to explore the potential role of device selection. Methods We prospectively enrolled patients undergoing PFO closure at our tertiary hospital. Before the procedure, all patients underwent nickel skin patch tests, considered the gold standard for diagnosing nickel hypersensitivity. Subsequently, patients were randomized to receive one of the two FDA-approved devices. During a three-month follow-up period, we evaluated the primary endpoint, a composite outcome including patient-reported chest pain, palpitations, headaches, and rash. Blinding was maintained for the patients, the operator, and the assessor of endpoints regarding the results of the nickel skin patch tests. The chi-squared test was utilized to evaluate the primary endpoint. Results for continuous variables are expressed as mean ± standard deviation or, for non-normally distributed variables, as median (interquartile range). Results Between January 2021 and November 2023, a total of 63 patients were included in our analysis. The majority were men (n=33, 52.4%) with a mean age of 46.1 ± 10.1 years. The median RoPE score was 7 (6-8). Nickel hypersensitivity was documented in 30.8% of the patients. The primary endpoint was met in 37.7% (n=23) of the total sample, with a significantly higher incidence in patients with nickel hypersensitivity than in those without (61.1% versus 27.9%, p=0.015, OR: 4.060, 95% CI: 1.275 – 12.930). No significant difference was observed when analyzing the two devices separately (p=0.096 and p=0.078, respectively). No recurrent ischemic stroke, severe anaphylactic reaction, or requirement for device surgical removal was observed in any patient. Conclusions Our findings indicate that patients with documented nickel hypersensitivity are more likely to develop symptoms such as chest pain, palpitations, headaches, and rash following the procedure. However, these findings do not raise major safety concerns. The completion of our study is necessary to acquire more reliable and conclusive results.

Allergen Testing: A Review of the Indications, Procedures, and Limitations in Ocular Allergy.

Allergen-based diagnostics are essential in the management algorithm of allergic diseases. Unlike systemic allergy, where the indications and interpretation of these diagnostic modalities are well established, their utility in ocular allergy is not well-defined. With the rising prevalence of ocular allergies and the need for personalized treatment strategies, there is a growing demand for precision allergen diagnostics. This review describes the commonly used tests with their indications, procedures, and limitations. A review of the literature was carried out on articles on allergen diagnostics in ocular allergy, and after excluding articles that were not relevant, 82 papers were included in the current review. IgE-mediated pathways contribute significantly to seasonal and perennial ocular allergy and partly to vernal keratoconjunctivitis. Most diagnostic techniques aim to detect IgE sensitization. In vivo tests include skin prick (SPT), intradermal, and patch tests. SPT is considered the gold standard and directly evaluates the presence of allergen-specific IgE in the skin. In vitro tests measure total and specific IgE from either tears or sera. Tear IgE measurement is relatively specific for allergic conjunctivitis and can provide insight into the potential allergens responsible for local sensitization. The conjunctival provocation test can help establish true allergy, especially in patients with polysensitization. This review also provides an overview of evidence in literature segregated based on the test employed. This includes 17 studies on only SPT; 42 studies on IgE measured in serum, tears, or both; and 20 studies which have evaluated both SPT and IgE. The pattern of allergen sensitization can guide recommendations for avoidance measures and immunotherapy. Thus, this could create a corticosteroid-sparing therapy avenue in these patients, reducing disease severity and resulting visual morbidity.

53074 The usefulness of skin prick and patch testing for local anesthetics in clinical practice for patients with sulfite allergy

53074 The usefulness of skin prick and patch testing for local anesthetics in clinical practice for patients with sulfite allergy

Delayed Wound Healing in a Young Patient with TNXB Variants and the Role of WES

After decades of quality improvement efforts, surgical site infections and abnormal wound healing remain intermittent complications in surgery. In both cases, the complication and abnormality may be superficial, restricted to the skin, or deeper within the tissue. The synthesis of connective tissue proteins, critical for structural support as part of the extracellular matrix, is under the control of multiple genes, forming a complex adaptive network. We report an unusual case of delayed and abnormal wound healing with chronic infection in a 16-year-old patient following surgery for scoliosis. Skin patch test showed that he is allergic to cobalt, a component of fixation hardware used in his surgery. He underwent evaluation by clinical genetics with whole exome sequencing (WES) which showed two (maternally and paternally inherited) variants in the TNXB ( Tenasin XB) gene. These two variants are variants of uncertain significance (VUS). TNXB encodes tenascin-XB which is an extracellular matrix glycoprotein located primarily in the basement membrane. Autosomal recessive pathogenic and likely pathogenic variants in TNXB cause TNXB-related classical-like Ehlers-Danlos Syndrome. At present, there are no causal linkages of these VUSs in TNXB to abnormal wound healing. However, as WES becomes more affordable, its use will increase and therefore it is important that we start to document such associations.

Understanding immune-mediated titanium allergy to in situ orthopaedic implants: a narrative review of the current literature.

Clinical recognition of potential immune-mediated allergic responses to implanted metal devices is increasing. For orthopaedic implants, while 'pure' compounds are used in specific circumstances, the majority of components are alloys - a combination of two or more distinct metals. Titanium is found commonly in many orthopaedic devices and is often championed as a 'hypoallergenic' option or inclusion. In the absence of a relevant previously published summary on the topic, this paper explores the current state-of-understanding of titanium allergy and proposes a patient management algorithm whereby such immune reactions are clinically-suggested. A structured, systematic literature review was performed following PRISMA search principles to provide a contemporary summary-of-understanding in this area and to highlight clinical and knowledge deficiencies. Thirty-five topic-related articles were identified, the majority reflecting small case series' or proof-of-concept studies. The general standard of scientific evidence available was poor. Justification for arthroplasty utilization of titanium as a 'hypoallergenic' option is largely extrapolated from non-orthopaedic domains. Both ionic and conjugated titanium particles released from implant surfaces have the potential to trigger innate immune responses and true allergy. There exists no simple, high-sensitivity, screening test for titanium allergy. Conventional skin-patch testing is unreliable due to poor dermal penetration. Given established lymphocyte and macrophage activation pathways for allergy responses, in vitro methods using both cell-types show diagnostic promise. Surgical biopsy analysis from host-implant interfaces remains the contemporary 'gold-standard', however this represents an invasive, costly and highly-specialized approach not readily available in most settings. Further research to establish reliable/accessible diagnostic methods are indicated.

Palmitoylethanolamide-Incorporated Elastic Nano-Liposomes for Enhanced Transdermal Delivery and Anti-Inflammation.

Palmitoylethanolamide (PEA) exhibits multiple skincare functions such as anti-nociceptive and anti-inflammatory effects. However, its topical application is limited due to its difficulty in bypassing the stratum corneum barrier, relatively low bioavailability, and low stability. Herein, elastic nano-liposomes (ENLs) with excellent deformability and elasticity were utilized as a novel drug delivery system to encapsulate PEA to overcome the abovementioned issues and enhance the biological effects on the skin. ENL was prepared with phosphatidylcholine, cholesterol, and cetyl-PG hydroxyethyl palmitamide with a molar ratio mimicking skin epidermal lipids, and PEA was loaded. The PEA-loaded ENL (PEA-ENL) demonstrated efficient transdermal delivery and enhanced skin retention, with negligible cytotoxicity toward HaCaT cells and no allergic reaction in the human skin patch test. Notably, PEA-ENL treatment increased cell migration and induced significant regulation in the expression of genes associated with anti-nociceptive, anti-inflammatory, and skin barrier repair. The mechanism of the anti-nociceptive and anti-inflammatory effects of PEA was further investigated and explained by molecular docking site analysis. This novel PEA-ENL, with efficient transdermal delivery efficiency and multiple skincare functionalities, is promising for topical application.

Exploring antibiotic safety: A prospective observational study from a tertiary care public sector hospital

BackgroundAntibiotics are the most commonly used drugs to treat bacterial infections; however, these life-saving drugs can also cause adverse drug reactions. In several pharmacovigilance studies, adverse drug reactions are a cause of prolonged hospitalization. The development of hypersensitivity reactions even after a negative skin test and patch test makes antibiotic-associated adverse reactions unpredictable. Owing to the scarcity of data on antibiotic desensitization, these drugs are important for pharmacovigilance. Most of the previous studies conducted were retrospective and lacked data regarding the duration of adverse drug reactions. AimThis study aimed to examine adverse drug reactions associated with antibiotics and to provide knowledge on the duration of these reactions. MethodA prospective observational study was conducted on patients receiving antibiotics at a tertiary care hospital. The patients were followed until discharge, and causality and severity assessments were performed. Descriptive statistical analyses were performed to summarize the data. ResultsThe study results show the median duration of adverse drug reactions was two days, with an interquartile range of two to four days. Most (21,3%) of the reactions were caused by cephalosporins. The majority (44.7%) of the reactions were skin and subcutaneous tissue disorders. The majority (78.7%) of the reactions were moderately severe and were not responsible for prolonged hospital stay. ConclusionThe patients receiving antibiotics require close monitoring for early detection and management of adverse reactions to reduce the duration of hospital stay and the duration of adverse drug reactions.

ALLERGIC CONTACT DERMATITIS AND ATOPIC DERMATITIS: HIGHLIGHTS OF THE OVERLAP SYNDROME

Introduction. The combination of atopic dermatitis (AD) with allergic contact dermatitis (ACD) or the occurrence of ACD on the background of atopic dermatitis is called the overlap syndrome. Studies have demonstrated several reasons why patients with AD have a similar or even increased risk of developing ACD compared to those without AD. Allergens and haptens are trigger factors in a group of patients with AD and ACD overlap syndrome. The aim of the study. To confirm the diagnosis of ACD in a group of patients with AD – diagnose the overlap syndrome and analyze which allergens and haptens were the trigger factors in this group. Materials and methods. To confirm IgE-dependent sensitization in atopic dermatitis, skin prick tests or determination of specific IgE in blood serum were performed. Skin patch tests (European series S-1000) were performed to determine the mechanisms of delayed-type hypersensitivity. Results. It was found that the highest specific weight of positive allergic reactions has been recorded in response to the following allergens: ticks, ticks/ambrosia, birch and mold. The absolute majority of patients demonstrated positive specific IgE-dependent sensitization to Dermatophagoides pteronyssinus and Dermatophagoides farinae – 24 (50%), in turn, on Ambrósia – 14 (29.2%), and on Alternaria alternata – 8 (16.7%). Also, the reaction was most often recorded to haptens: cobalt, nickel, formaldehyde, PPD, textile dyes. Deterioration of the clinical course and shortening of AD remission periods were observed due to the formation of ACD against the background of impaired skin barrier function and the presence of chronic immune inflammation. Conclusions. Patients with AD are more often diagnosed with ACD, which predictably worsens the course of AD. Patients with confirmed overlap syndrome "AD + ACD" most often show reactions to haptens: Cobalt, Nikel, Formaldehyde, PPD, Textile dye mix – and in the vast majority to 2 haptens or more in one patient.

Gallates – toxicological data and a pilot study on the prevalence of contact sensitization

Propyl, octy- and dodecyl gallates are largely used in food, cosmetic and pharmaceutical industry as additives – preservatives. The main source of exposure non-related with food consumption is their use of cosmetic products. Gallates are classified as skin sensitization human health hazard. This research aims to evaluate the prevalence of contact sensitization to gallates and to estimate the possible cross/concomitant sensitization to gallate mix and other cosmetics ingredients among cosmeticians and cosmetology students. Skin patch testing with Gallate mix along with 19 other haptens was performed among 109 participants – 37 cosmetology students, 26 cosmeticians, and 46 controls. The study established high prevalence of contact sensitization to gallates, with higher risk for students (45.9%) and cosmeticians (38.5%). A significantly higher (р = 0.008) prevalence of co-sensitization to decyl glucoside was established for the control group. Proper risk information, with complex programs for prevention of occupational skin diseases should be provided.

Metal allergy and neurovascular stenting: A systematic review.

Intracranial stents and flow diverters contain significant amounts of metals, notably nickel, which can cause allergic reactions in a considerable portion of the population. These allergic responses may lead to complications like in-stent stenosis (ISS) and TIA/Stroke in patients receiving stents or flow diverters for intracranial aneurysms. We conducted a systematic review of studies from inception until July 2023, which reported outcomes of patients with metal allergy undergoing neurovascular stenting. The skin patch test was used to group patients into those with positive, negative, or absent patch test results but with a known history of metal allergy. Our review included seven studies with a total of 39 patients. Among them, 87% had a history of metal allergy before treatment. Most aneurysms (89%) were in the anterior circulation and the rest (11%) were in the posterior circulation. Skin patch tests were performed in 59% of patients, with 24% showing positive results and 33% negative. Incidental ISS was observed in 18% of patients, and the rate of TIA/Stroke was reported in 21%. The pooled rates of ISS and TIA/Stroke were higher in the first group (43% and 38%) compared to the second (18% and 9%) and third groups (15% and 15%), but these differences were not statistically significant. The current neurosurgical literature does not provide a conclusive association between metal allergy and increased complications among patients undergoing neurovascular stenting. Further studies are necessary to gain a more comprehensive understanding of this topic.

Solvent Induced Cumulative Insult Irritant Contact Dermatitis through Glove Permeation: A Case-Report on the Chronic Occupational Skin Lesion

A young female laboratory worker presented with chronic cumulative skin lesion over hands. The occupational exposure history supported the prolonged and frequent exposure to multiple solvents which are recognised as work irritants, improper work practice and wrong use of protective glove. The diagnosis of Irritant Contact Dermatitis (ICD) was supported by workplace dermatology risk factors, clinical features, negative skin patch test to rule out hypersensitivity reaction and fulfilment of all seven Mathias Criteria. The effective management of occupational contact dermatitis requires practices change and exposure control. The comprehensive Hand Care Programs must be individualised and incorporate several important elements namely the skin care screening and surveillance, early referral for Occupational Health assessment, effective education and training programs and provision of hand moisturising products. The support of return to work (RTW) among the affected workers is of paramount important in order to minimise the negative impacts on their quality of work as well as home life.

Delayed postoperative reactions to metamizole: a diagnostic challenge.

Background. Metamizole, a non-steroidal anti-inflammatory drug from the pyrazolone group, is a frequent cause of immediate hypersensitivity reactions and, more rarely, of delayed drug hypersensitivity reactions. Due to its favorable pharmacokinetic characteristics, metamizole is widely used in the postoperative period for pain control. Methods. Retrospective study of patients referred for allergological study between January 2012 and June2022 for postoperative hypersensitivity reactions. Clinical and diagnostic data were collected through review of patients' medical records. Twenty patients with postoperative hypersensitivity reactions were referred, of which 10 presented delayed reactions. We analyzed the results of skin prick, intradermal and patch tests performed with an intravenous metamizole solution as well as provocation tests performed with metamizole and acetylsalicylic acid. Cross-reactivity to non-steroidal anti-inflammatory drugs was excluded by confirmation of clinical tolerance to non-steroidal anti-inflammatory drugs or by acetylsalicylic acid provocation test. Results. In 7 of the 10 patients a delayed reaction to metamizole was diagnosed. These reactions were characterized as maculopapular exanthema, occurring in multiple postoperative settings. Skin tests were negative, except in one patient with late mild erythema in the ipsilateral upper limb and no reaction at the site of intradermal injection. Delayed hypersensitivity was demonstrated by late positive metamizole provocation tests. Conclusions. This study demonstrated that for a correct diagnosis a high degree of suspicion about possible delayed hypersensitivity drug reactions to metamizole in the postoperative setting is needed. In the investigation, provocation test with metamizole was decisive for diagnostic confirmation.

Abstract 14453: Patent Foramen Ovale Closure in Patients With and Without Nickel Hypersensitivity Using Two Different Devices

Background: Transcatheter PFO closure has been established as a safe and effective approach for secondary prevention in patients with ESUS. The Amplatzer® PFO occluder and Gore Helex® septal occluder are two FDA-approved devices, which consist of a nickel-titanium alloy frame. While nickel is the first cause of hypersensitivity reaction worldwide, the potential occurrence of nickel hypersensitivity following PFO closure is still under investigation. Aim: Our aim is to investigate whether patients with nickel allergy are more susceptible to experiencing adverse events after device implantation and to explore the potential role of device selection. Methods: We prospectively enrolled patients undergoing PFO closure. Before the procedure, nickel skin patch tests were performed in all the patients. The patients were randomized to receive either Amplatzer® or Gore® device. During a three-month follow-up period, we evaluated the primary endpoint, which was a composite outcome including patient-reported chest pain, palpitations, headaches, and rash. We used the chi-squared test to evaluate the primary endpoint and performed multivariate binary logistic regression analysis to assess the effect of device selection on the primary endpoint. Results: A total of 50 patients (50% female, 45.4±10.3 years old) completed the follow-up and were included in the present analysis. Among them, 29 patients received the Gore device, while the remaining 21 patients received the Amplatzer device. Fourteen patients were diagnosed with nickel hypersensitivity. The primary endpoint was reached in 40% of the analyzed patients. The occurrence of the primary endpoint was significantly higher in patients with nickel hypersensitivity compared to those without (50% vs. 13.3%, p=0.005). Additionally, multivariate binary logistic regression analysis demonstrated no association between device selection and the composite outcome (p=0.892). Conclusions: Our preliminary results indicate that patients with nickel hypersensitivity are more likely to develop symptoms such as chest pain, palpitations, headaches, and rash following the procedure. However, the completion of our study is necessary to obtain more reliable and conclusive results.

Pilot Study of the Prevalence of Contact Sensitization to Preservatives as Cosmetic Ingredients in Occupational and Educational Exposures

Abstract Aim: To evaluate the prevalence of contact sensitization to selected preservatives as cosmetic ingredients among cosmeticians and cosmetology students and to identify the most common allergens in occupational and non-occupational exposures. Materials and methods: Skin patch testing with formaldehyde, quaternium-15, DMDM hydantoin, imidazolidinyl urea, methylisothiazolinone + methylchloro-isothiazolinone, iodopropynyl butylcarbamate, methyldibromoglutaronitrile, polyaminopropyl biguanide and paraben mix was performed among 109 participants – 37 cosmetology students, 26 cosmeticians, and 46 individuals – controls, occupationally unexposed to cosmetics. Fisher Exact Test and multiple binary logistic regression analysis were used. Results: Formaldehyde was the main contact sensitizer, with significantly higher prevalence of sensitization among the occupationally exposed cosmeticians and cosmetology students if compared to the controls (p = 0.005) [OR = 0.290 (95% CI: 0.092-0.916]). The positivity prevalence to DMDM hydantoin was 11%, with equal rates of sensitization to quaternium-15, methylisothiazolinone + methylchloroisothiazolinone and methyldibromo-glutaronitrile (9.2%). A significantly higher prevalence of co-sensitization to DMDM hydantoin and imidazolidinyl urea was revealed. The positivity rate to quaternium-15 was highest among cosmetology students – 13.5%. The frequency of positive reactions to imidazolidinyl urea was 2.7% for students and 11.5% for cosmeticians. Cosmetology students and cosmeticians were at risk of sensitization to DMDM hydantoin, and the cosmeticians – to methylisothiazolinone/methylchloro-isothiazolinone and methyldibromo glutaronitrile and parabens. Conclusions: This study established comparative high prevalence and risk of contact sensitization to the selected preservatives. Proper occupational risk information, developing and disseminating of practical tools for workplace risk assessment and management, with complex programs for prevention of occupational skin diseases should be provided.

The Preparation and Sensory Evaluation of Post-waxing Aftercare Lotion

In this study, we prepared a lotion containing <i>Gymnema sylvestre Leaf</i> Extract (GSLE) and evaluated its stability, safety, and usability. To assess stability, a series of scientific evaluations were conducted, including centrifugation testing and heat-cool cycling. Following the application of the Lycon, 5% GSLE lotion on the skin, a skin patch test was conducted to detect the presence of erythema in the designated patch area, in accordance with the established guidelines provided by the International Contact Dermatitis Research Group (ICDRG). Using a 10-point scale, the level of satisfaction resulting from actual usage was assessed. The stability of both the vehicle and the 5% GSLE lotion was found to be intact in terms of their physical and chemical properties. No adverse skin reactions were observed in any of the groups tested, which included the vehicle, Lycon lotion, and 5% GSLE lotion. Furthermore, when considering efficacy, functionality, and usability, the 5% GSLE lotion demonstrated the highest value. In terms of absorption, moisturization, smoothness, and calming effects, the Lycon lotion exhibited relatively lower performance compared to both the vehicle and the 5% GSLE lotion. Across all evaluation criteria, the 5% GSLE lotion was found to provide an excellent user experience.

Evaluation of Toxicological Risks of Nail Coatings Containing Acrylate Monomer HEMA

Individuals working in nail salons are exposed to 2-hydroxyethyl methacrylate (HEMA). HEMA has been found to have several effects on the skin: skin itching, peeling, redness and allergic contact dermatitis. The purpose of the study was to compare the effects of nail coatings containing HEMA and 2-hydroxypropyl methacrylate (HPMA) on the skin. In this study we explored the irritation properties of HEMA and HPMA containing nail coatings in cell cultures in-vitro and in skin PATCH tests under dermatological control. The cytotoxicity of coatings was tested in BALB/c3T3 and HaCaT cell lines by a neutral red uptake assay. Cytotoxicity was expressed as a concentration-dependent reduction of the uptake of neutral red, compared to the untreated controls. Open patch tests were supervised by a certified dermatologist. Polymerized coating extracts have little effect on Balb/c 3T3 cell viability, while having mild cytotoxic effects on HaCaT keratinocytes. Among two tested samples, extracts of HEMA containing coating exhibited higher cytotoxicity – reduction of keratinocyte viability by 28.29 % in case of undiluted 24 h extract and even by 48.26 % in case of 50 % extract was observed. Coating cytotoxiaty observed on HaCaT showed that the keratinocyte cell line was more sensitive to HEMA than to HPMA containing coating.

Immune-Mediated Organ-Specific Reactions to COVID-19 Vaccines: A Retrospective Descriptive Study.

Severe acute respiratory syndrome coronavirus 2 caused the global COVID-19 pandemic and public health crisis, and it led to the rapid development of COVID-19 vaccines, which can cause rare and typically mild hypersensitivity reactions (HRs). Delayed HRs to COVID-19 vaccines have been reported, and the excipients polyethylene glycol (PEG)2000 and polysorbate 80 (P80) are the suspected culprits. Skin patch tests do not help in diagnosing delayed reactions. We aimed to perform lymphocyte transformation tests (LTT) with PEG2000 and P80 in 23 patients with suspected delayed HRs. Neurological reactions (n = 10) and myopericarditis reactions (n = 6) were the most frequent complications. Seventy-eight percent (18/23) of the study patients were admitted to a hospital ward, and the median time to discharge was 5.5 (IQR, 3-8) days. Some 73.9% of the patients returned to baseline condition after 25 (IQR, 3-80) days. LTT was positive in 8/23 patients (5/10 neurological reactions, 2/4 hepatitis reactions and 1/2 rheumatologic reactions). All myopericarditis cases had a negative LTT. These preliminary results indicate that LTT with PEGs and polysorbates is a useful tool for identifying excipients as causal agents in HRs to COVID-19 vaccines and can play an important role in risk stratification in patients with HRs.

Metal Hypersensitivity Following Total Ankle Arthroplasty: Case Series and Literature Review

Metal hypersensitivity following total ankle arthroplasty (TAA) is an underreported complication that can manifest as dermal, systematic, and orthopaedic-specific symptoms. It is critical to recognize that metal hypersensitivity is a diagnosis of exclusion; only after all other potential sources of failure, such as loosening or infection are ruled out, can this diagnosis be considered. Aside from imaging and common laboratory analysis, skin patch testing, leukocyte migration inhibition test (LMIT), and lymphocyte transformation test (LTT) are the testing options available for metal allergy. With regards to management of metal hypersensitivity, nonoperative modalities involving topical dermatological management are generally preferred. Severe cases of metal allergy may necessitate operative management consisting of explantation of the implant and either revision TAA with a custom hypoallergenic implant or conversion to an ankle fusion. We present 3 cases of presumed metal hypersensitivity following TAA. In all 3 cases, other forms of TAA failure were carefully ruled out. One patient underwent explantation and conversion to hypoallergenic implant, 1 patient underwent explantation and ankle arthrodesis with hypoallergenic hardware, and 1 patient elected for conservative care. In patients who underwent explantation and conversion to hypoallergenic hardware, no further symptoms associated with metal allergy were noted. Additional research is necessary to improve diagnostic accuracy of metal allergy and make treatment options more effective and accessible.Level of Evidence: Retrospective case series, IV.