BACKGROUND: Up to 5% of patients with dermatitis who are consecutively patch tested are allergic to one or more corticosteroids. However, few reports of allergic mucosal and skin symptoms in patients with asthma and rhinitis caused by inhaled corticosteroids exist. OBJECTIVE: Our purpose was to determine whether inhalation of budesonide would result in reactivation of patch test reactions caused by budesonide. METHODS: The study, which was randomized, double-blind, and placebo-controlled, was ethically reviewed by the Medical Faculty, University of Lund, Sweden. Fifteen nonasthmatic patients who were initially given a diagnosis of budesonide hypersensitivity on patch testing from less than 1 up to 8 years before the study were provoked with budesonide or placebo by inhalation 6 weeks after they had been patch tested with budesonide, its R and S diastereomers, and potentially cross-reacting substances. Lung function was studied by using spirometry and repeated peak expiratory flow measurements. RESULTS: In 4 of 7 patients who inhaled budesonide, reactivation of previously positive patch test reactions was noted within 24 hours, in contrast to 0 of 8 patients who inhaled placebo (P =.026). No adverse pulmonary responses could be detected. CONCLUSION: This study shows that allergic skin reactions may occur in patients with contact allergy to budesonide when inhaled forms of the drug are used.
Simultaneous contact allergies to epoxy resins based on diglycidyl ether of bisphenol A (DGEBA-R) or epoxy resins of the bisphenol F-type and the reactive diluent phenyl glycidyl ether (PGE) have been reported. The reason might be cross-reactivity, exposure to an epoxy resin system with PGE as a component, or contamination by PGE in the epoxy resin.
To study contamination by PGE, 20 commercial epoxy resins were analysed for the presence of PGE. To study contact allergy to PGE and its relation to epoxy resins by inserting PGE in the standard series.
Among 2227 patients, 7 reacted to PGE. Of 23 (30%) patients, 7 with contact allergy to DGEBA-R and 7/19 (37%) with contact allergy to an epoxy resin of the bisphenol F-type reacted to PGE. All 7 patients with contact allergy to PGE reacted both to the DGEBA-R and to the epoxy resin of the bisphenol F-type. PGE was found in 90% of the investigated resins. The amounts of PGE ranged between 0.004% w/w and 0.18% w/w.
Most probably, the presence of PGE as a contaminant in epoxy resins is of minor importance for the sensitization, but possibly the contamination of PGE might elicit contact dermatitis in individuals with a high reactivity to PGE.
Contact allergies to the preservatives formaldehyde and methylchloroisothiazolinone (MCI)/methylisothiazolinone (MI) have been reported to appear together at a statistically significant level. Recently, revisions concerning the patch test preparations of MCI/MI, MI and formaldehyde have been recommended for the European baseline series.
To investigate (i) the number of concomitant contact allergies to the preservatives, (ii) the number of concomitant contact allergies to the preservatives and the fragrance mixes (FM I and FM II) and (iii) gender differences.
Patients tested with the Swedish baseline series during the period 2012-2014 at the Department of Occupational and Environmental Dermatology in Malmö, Sweden were investigated.
2165 patients were patch tested with the baseline series (34% males and 66% females). Contact allergies to formaldehyde and MCI/MI and/or MI were significantly associated (p?
In a recent study we showed that all our dental personnel/patients were detected with 2-hydroxyethyl methacrylate (2-HEMA) and 2,2-bis[4-(2-hydroxy-3-methacryloxypropoxy)phenyl]propane (bis-GMA). We studied 90 patients tested to the acrylate and nail acrylics series at our department over a 10 year period to see whether screening allergens could be found. Patch testing with an acrylate and nail acrylics series was performed. Among the 10 acrylate/methacrylate-allergic occupational dermatitis patients tested to the acrylate series, the most common allergens were triethyleneglycol diacrylate (TREGDA, 8), diethyleneglycol diacrylate (5), and 1,4-butanediol diacrylate (BUDA, 5). All 10 of these patients would have been picked up by a short screening series combining TREGDA, 2-hydroxypropyl methacrylate (2-HPMA), and BUDA or 1,6-hexanediol diacrylate (HDDA). Among the 14 acrylate/methacrylate-allergic nail patients, the most common allergens were ethylene glycol dimethacrylate (EGDMA, 11), 2-HEMA, (9), and triethyleneglycol dimethacrylate (9). Screening for 3 allergens i.e. 2-HEMA plus EGDMA plus TREGDA, would have detected all 14 nail patients. A short screening series combining 2-HEMA, EGDMA, TREGDA, 2-HPMA, bis-GMA, and BUDA or HDDA would have picked up all our past study patients (dental, industrial, and nail) with suspected allergy to acrylate/methacrylate allergens.
p-Phenylenediamine (PPD) is the primary patch test screening agent for hair dye contact allergy, and approximately 100 different hair dye chemicals are allowed.
To examine whether PPD is an optimal screening agent for diagnosing hair dye allergy or whether other clinically important sensitizers exist.
Two thousand nine hundred and thirty-nine consecutive patients in 12 dermatology clinics were patch tested with five hair dyes available from patch test suppliers. Furthermore, 22 frequently used hair dye ingredients not available from patch test suppliers were tested in subgroups of ~500 patients each.
A positive reaction to PPD was found in 4.5% of patients, and 2.8% reacted to toluene-2,5-diamine (PTD), 1.8% to p-aminophenol, 1% to m-aminophenol, and 0.1% to resorcinol; all together, 5.3% (n = 156). Dying hair was the most frequently reported cause of the allergy (55.4%); so-called 'temporary henna' tattoos were the cause in 8.5% of the cases. p-Methylaminophenol gave a reaction in 20 patients (2.2%), 3 of them with clinical relevance, and no co-reaction with the above five well-known hair dyes.
Hair dyes are the prime cause of PPD allergy. PPD identifies the majority of positive reactions to PTD, p-aminophenol and m-aminophenol, but not all, which justifies additional testing with hair dye ingredients from the used product.
Questionnaire studies have indicated that patients with dental gold will more frequently have contact allergy to gold. This study aimed at investigating the relationship between contact allergy to gold and the presence and amount of dental gold alloys. A total of 102 patients were referred for patch testing because of suspicion of contact allergy. Patch tests were performed with gold sodium thiosulphate 2% and 5%. The patients underwent an oral clinical and radiological examination. Contact allergy to gold was recorded in 30.4% of the patients, and of these 74.2% had dental gold (p=0.009). A significant correlation was found between the amount of gold surfaces and contact allergy to gold (p=0.008), but there was no statistical relationship to oral lesions. It is concluded that there is a positive relationship between contact allergy to gold and presence and amount of dental gold alloys.
Contact allergy to dental allergens is a well-studied subject, more so among dental professionals than dental patients. 1632 subjects had been patch tested to either the dental patient series or dental personnel series at the department of Occupational and Environmental Dermatology, Malmö, Sweden. Positive patch tests to (meth)acrylate allergens were seen in 2.3% (30/1322) of the dental patients and 5.8% (18/310) of the dental personnel. The most common allergen for both groups was 2-hydroxyethyl methacrylate (2-HEMA), followed by ethyleneglycol dimethacrylate (EGDMA), triethyleneglycol dimethacrylate, and methyl methacrylate. 47 (29 dental patients and 18 dental personnel) out of these 48 had positive patch tests to 2-HEMA. All 30 subjects who had a positive reaction to EGDMA had a simultaneous positive reaction to 2-HEMA. One dental patient reacted only to 2,2-bis[4-(2-hydroxy-3-methacryloxypropoxy) phenyl]propane (bis-GMA). From our data, screening for (meth)acrylate contact allergy with 2-HEMA alone would have picked up 96.7% (29/30) of our (meth)acrylate-allergic dental patients and 100% (18/18) of our (meth)acrylate-allergic dental personnel. The addition of bis-GMA in dental patients would increase the pick-up rate to 100%.
Geraniol is a widely used fragrance terpene, and is included in fragrance mix I. Geraniol is prone to autoxidation, forming the skin sensitizers geranial, neral, and geraniol-7-hydroperoxide. Oxidized geraniol has previously been patch tested in 1 clinic, giving 1% to 4.6% positive reactions in consecutive patients when tested at 2% to 11%.
To compare test reactions to pure and oxidized geraniol, to compare 2 different test concentrations of oxidized geraniol and to investigate the pattern of concomitant reactions to fragrance markers of the baseline series in a multicentre setting.
One thousand four hundred and seventy-six consecutive patients referred for patch testing were patch tested with geraniol 6% pet. and oxidized geraniol 6% and 11% pet.
Pure geraniol 6% pet., oxidized geraniol 6% pet. and oxidized geraniol 11% pet. gave 1%, 3% and 8% positive patch test reactions and 0.7%, 3% and 5% doubtful reactions, respectively. Approximately 50% of the patients with doubtful reactions to oxidized geraniol 6% pet. had positive reactions to oxidized geraniol 11% pet.
Oxidized geraniol 11% pet. provides better detection than oxidized geraniol 6% pet. As most patients reacted only to oxidized geraniol, it is important to explore further whether oxidized geraniol should be included in a baseline patch test series.
Ambrosia artemisiifolia L. a classical cause of ragweed dermatitis in North America, is also found in Europe. 17 patients with contact allergy to sesquiterpene lactone (SL) mix were recalled for patch testing with extracts of North American and Swedish ragweed, the latter harvested in summer and autumn. 8/17 patients were test-positive to the American extract, 14/17 to the Swedish summer extract and 15/17 to the autumn extract. All patients except 1 were found to have a chronic hand eczema of the pompholyx type. 5/16 hand eczema patients had a flare-up of their pompholyx at patch testing. We concluded that patients with SL mix allergy are allergic to American as well as to Swedish ragweed. Pompholyx seems to be a frequent clinical picture in patients with SL mix allergy.