Skin reactions due to the use of latex examination gloves occur frequently in dental practice. They consist of immediate type I allergy to natural latex protein, type IV delayed hypersensitivity to rubber additives and irritant dermatitis. Type I allergy to latex protein can cause contact urticaria, angioedema, rhinoconjunctivitis and asthma in the dentist, the dental assistant and also in the patient. Exceptionally, latex allergy can cause a life-threatening anaphylactic reaction. Cross reactions to tropical fruit can occur in the latex allergic patient. Type IV allergy causes allergic contact dermatitis. Rubber additives are also present in synthetic rubber. Glove advice for latex allergic patients are presented.

Anaphylaxis↗

PubMed1998

[Contact allergy to eyedrops containing beta-blockers].

In six patients (4 women aged 80, 62, 43 and 52 years and 2 men aged 58 and 51 years), who used eyedrops containing beta-blockers for the treatment of glaucoma, allergic contact dermatitis of the eyelids was diagnosed. Three were allergic to metipranolol, 2 to levobunolol and 1 to timolol. In literature, less than 50 cases of hypersensitivity to beta-blockers in eye medication have been reported. There are, however, reasons to assume that sensitization is more frequent: (a) not all patients are referred by the ophthalmologist to the dermatologist; (b) false-negative reactions to patch tests with the commercial preparations and with beta-blockers are not infrequent; (c) they are not routinely tested because beta-blockers are difficult to obtain in pure form; (d) cross-reactions with other beta-blockers are infrequent, and changing to another preparation therefore usually solves the clinical problem. Nevertheless it is advisable to test a battery of beta-blockers (befunolol, levobunolol, metipranolol, timolol) in allergic patients. A test preparation of 2% in water or 3%-10% in petrolatum may be suitable. Control testing in non-exposed individuals is necessary to exclude irritation reactions.

Adrenergic beta-Antagonists↗

PubMed1997

[Immunology in medical practice. V. Constitutional eczema].

Constitutional eczema (late atopic dermatitis) is a frequent condition: some 30% of the skin diseases seen by the GP involve constitutional eczema. A number of links with (external) factors have meanwhile been established. Patients with constitutional eczema often suffer from food allergy (over 60% of the children with the eczema) and many are allergic to airborne allergens (especially housedust mite allergen). The skin of patients with constitutional eczema has a diminished barrier function against irritants (soaps, acids, bases, water, detergents, biological juices (fruit, meat, fish, vegetables). In 90% of the patients with constitutional eczema the skin contains colonies of Staphylococcus aureus (in 5% of people without eczema). S. aureus can influence the eczema through exoantigens (so-called superantigens) and through conventional antigens that may evoke an IgE-mediated immune response. Emotional stress may influence the eczema. The close anatomical relationship between mast cells and nerve endings and between Langerhans cells and nerve endings suggest that the autonomous nervous system can modulate the immune system of the skin and consequently, the eczema. These factors should be taken into account in the treatment: reduction of exposure to food and airborne allergens and to irritants, treatment and prevention of S. aureus infections and psychological support. New therapies include cyclosporine, autologous IgG antigen complexes and phototherapy.

Adult↗

PubMed1997

[Statement of ingredients of cosmetics].

Since January 1st 1997 there is European legislation labelling that cosmetic products are supplied with a list of their ingredients. The ingredients are given in order of decreasing concentration using the nomenclature 'International nomenclature cosmetic ingredient' (INCI). This enables dermatologists to identify the allergenic components of cosmetic products in patients with allergic contact dermatitis caused by cosmetics, and enables allergic patients to purchase other cosmetic products without risking a recurrence of dermatitis.

Cosmetics↗

PubMed1997

[Contact allergy for corticosteroids].

Contact allergy to corticosteroids is not rare. In some studies prevalence rates up to 6% have been observed among patients suspected of allergic contact dermatitis. Hypersensitivity occurs especially in individuals who have been suffering for years from atopic dermatitis, contact dermatitis of the hands and feet, or stasis dermatitis caused by chronic venous insufficiency. The clinical picture is rarely that of acute allergic contact dermatitis, because the reaction is mitigated by the anti-inflammatory properties of the corticosteroid itself; the diagnosis must be suspected when eczema does not improve or spreads during topical corticosteroid therapy. Application to the mucous membranes less frequently leads to sensitisation. Most such cases are caused by nasal sprays containing tixocortol pivalate or budesonide. Oral or parenteral administration of corticosteroids to sensitive individuals causes exacerbation of pre-existing contact dermatitis or widespread allergic cutaneous drug reactions. Allergological investigation with corticosteroids presents some specific problems, the most important being occurrence of false-negative reactions. Nevertheless, most sensitive patients can be identified by testing the 'indicator' allergens, budesonide and tixocortol pivalate, which should be added to the routine series of contact allergens. Cross-reactions to other corticosteroids occur frequently. This should be taken into account when prescribing alternative corticosteroid preparations.

Administration, Topical↗

PubMed1997

[Allergy to Ficus benjamina: at the workplace and at home].

In four patients, two women aged 40 and 42 years and two men aged 49 and 37 years, type I allergy to Ficus benjamina was established. Two patients had been sensitized by contact with these pot plants at their homes. The other two patients were plant growers. F. benjamina is a non-flowering, currently very popular pot plant to be found in both private houses and public buildings. The symptoms comprise itching and swelling of the eyelids, tears, running nose, wheezing and dyspnoea. In one plant grower contact urticaria progressing to dermatitis of the hand was the main symptom. Only one patient had a clear-cut atopy. Both plant growers showed a cross-allergy to other Ficus species. Two patients had a cross-allergy to latex and the associated cluster of tropical fruit (banana, kiwi, avocado, and chestnut). Removal of the ficus plants from the homes and change to another crop or to another occupation completely resolved the complaints of these patients.

Adult↗

PubMed1997

Allergic contact dermatitis from a boxwood recorder.

Explore the source record for details and available documents.

Aged↗

PubMed1996

Methyldibromoglutaronitrile (Euxyl K 400): an important "new" allergen in cosmetics.

Euxyl K 400 is a preservative system for cosmetics and toiletries that contains phenoxyethanol and methyldibromoglutaronitrile in a 4:1 ratio. In The Netherlands, Italy, and Germany, the prevalence of allergy to Euxyl K 400 has risen in the past 4 years and is currently 2% to 4% in patients suspected of having contact dermatitis. The allergenic ingredient is nearly always methyldibromoglutaronitrile. Causative products include both stay-on and rinse-off cosmetics and moistened toilet tissue. Because the causative products usually give false-negative reactions, the allergen, methyldibromoglutaronitrile, should be tested in all patients suspected of having cosmetic dermatitis and in those with perianal dermatitis. We suggest a test concentration of 0.3% to 0.5% in petrolatum.

Allergens↗

PubMed1996

Methyldibromoglutaronitrile is an important contact allergen in The Netherlands.

From 15 May to 15 December 1994, 2943 patients suspected of having contact dermatitis (1955 women, 988 men) were patch tested with methyldibromoglutaronitrile 0.3%, 0.1% and 0.05% pet. 119 patients (4.0%; women 4.1%, men 3.8%) proved to be allergic. 71% of the reactions were considered to be relevant. In 2/3 of the patients, causative products were cosmetics, in 1/3 moistened toilet tissues. Testing with methyldibromoglutaronitrile at lower concentrations (0.05% and 0.1%) and with commercial allergens (Euxyl K 400 and methyldibromoglutaronitrile, both containing methyldibromoglutaronitrile 0.1%), resulted in a number of false-negative reactions. All preservatives in the European standard series had lower scores than the 4% positive reactions to methyldibromoglutaronitrile (formaldehyde 2.0%, MCI/MI (Kathon CG) 3.2%, parabens 1.0%, quaternium-15 1.3%). It is concluded that methyldibromoglutaronitrile (present in the commercial preservative Euxyl K 400) is an important contact allergen in the Netherlands in cosmetics and moistened toilet tissues. It should be added to cosmetics series and to proctological series. The optimal test concentration is unknow, but may be 0.3% pet. The concentration of 0.1% methyldibromoglutaronitrile in the currently available commercial allergens appears to be too low, resulting in a number of false-negative reactions.

Adolescent↗