Databases for monitoring patients with contact dermatitis have become indispensable for managing a constantly increasing variety of products which cause allergic and toxic dermatitis. As a result of collaboration between the Department of Dermatology and Department of Information Technology, Ullevål Hospital, we now have developed a database for registering patients with occupational dermatitis. The programming tool is DataEase, which contains files for the patients' personal data, site of the dermatitis, results of tests and diagnosis.
In Sweden, a cosmetic control system was introduced in 1989 at the Medical Products Agency (MPA). It consists of a register of importers, manufacturers and their products, and a voluntary adverse reaction reporting system identical to that concerning drugs. Between 1989 and 1994, MPA evaluated 191 reports concerning adverse effects of 253 cosmetics and toiletries. 90% of the reports concerned women and the top-ranking product category was moisturizers, followed by hair care products and nail products. The majority of the adverse effects reported involved only the skin, and 90% were eczematous reactions. 70% of the eczemas were classified as contact allergic, as patch tests were positive to the product as is, and in 1/2 of these products, 1 or more relevant allergens could be identified when tests were made with individual cosmetic ingredients. The most common offending ingredients were fragrances, toluenesulfonamide-formaldehyde resin and preservatives. The number of reports is small in relation to the expected number of cosmetic adverse effects, which can be explained by under-reporting. Efforts are being made to persuade Swedish physicians to report more often.
In a search for vehicles that might enhance the sensitivity of human skin tests for nonimmunological immediate contact reactions, benzoic acid was tested in 17 liquid vehicles on 16 medical students using the open application test method on the upper back. The results were read visually and the change in blood flow was measured using a laser-Doppler flowmeter 20, 40 and 60 min after application of the test substances. 2-propyl alcohol (isopropanol), ethyl alcohol (ethanol), 1,2-propylene glycol and water were mixed to form alcohol, alcohol/water, alcohol/alcohol, alcohol/propylene glycol and propylene glycol/water vehicles. The reactions were stronger in the alcohol/water vehicles than in the alcohols as such. The addition of 25% propylene glycol to isopropanol and ethanol had the greatest enhancing effect on the reactions. Ethanol has been the most popular liquid vehicle in tests for non-immunological immediate contact reactions, but at least with benzoic acid, stronger reactions can be elicited if alcohol/propylene glycol or alcohol/water mixture are used.
BACKGROUND: Dermatitis of and around the eye is common. Allergic contact reactions from phenylephrine are rare despite extensive use by ophthalmologists. Previous reports do not indicate crossreactivity between phenylephrine and other sympathomimetic drugs in patch testing. METHODS: We report three cases of allergic contact reactions (dermato-conjunctivitis) after eyedrops. Skin prick tests, epicutaneous testing with the implicated drugs, additives, and a complete patch test battery, TRUE test (Upjohn-Pharmacia, Sweden), were performed in each patient. RESULTS: All skin prick tests were negative. The three patients showed positive patch tests to phenylephrine and one of them also to ephedrine. Tolerance of the other eyedrops without phenylephrine was verified by challenge. CONCLUSION: Phenylephrine was the responsible agent for the reactions in our patients as confirmed by clinical findings and positive patch tests. Our findings suggest the central structure as the sensitizing part of drug in the second patient. Patch testing is essential for diagnosis of allergic contact reactions of and around the eye.
During a 10-year period 1,050 medical students were questioned regarding allergy and allergy-like symptoms and 612 of them underwent skin prick tests with dog, cat, timothy and birch allergens. Symptoms of eczema, asthma or non-infectious rhinitis, past or current, or current reactions to pollen, furred animals, dust, mould or food were reported by 46% of the students. Three per cent reported present eczema of the flexure type and a further 8% reported past symptoms of the same kind. Current contact e zema was reported by 7% and past contact eczema by a further 3%. Daily treatment with ointments was reported by 52% of the students with current flexure eczema and by 17% with current contact eczema. Current asthma was reported by 5% and past asthma by a further 3%. Of those with current asthma, 88% were allergic to pollens and/or furred animals and 57% used anti-asthmatic drugs for at least 2 weeks/year. Current allergic symptoms in the nose and/or eyes were reported by 29% and a further 2% reported past symptoms. Of those with current symptoms 64% were allergic to pollens and/or furred animals, as judged by the history and skin tests. Almost 60% of the students with pollen allergy used anti-allergic drugs for at least 2 weeks/year. Allergy to pollens was reported by 17%, to animals by 12%, to house dust by 10%, to moulds by 2% and to foods by 15%. Allergy reported and confirmed by a prick test was found in 8% against birch, 6% against timothy, 10% against cat and 5% against dog.(ABSTRACT TRUNCATED AT 250 WORDS)