Patch tests with Tactylon in patients with contact allergy to rubber.
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Dermatitis, Allergic Contact↗
Biomedical subjects
J M Lachapelle
Publications and source records attributed to J M Lachapelle.
Intraepidermal neutrophilic IgA dermatosis: pemphigus-like IgA deposits.
A case of intraepidermal neutrophilic IgA dermatosis with intercellular IgA deposit in the upper epidermis is reported. Indirect immunofluorescence was negative but immunoelectrophoresis showed a slight increase of IgA. The chemotactic activity of neutrophils was normal. Colchicine controlled the lesions.
Epidermis↗
Itraconazole compared with griseofulvin in the treatment of tinea corporis/cruris and tinea pedis/manus: an interpretation of the clinical results of all completed double-blind studies with respect to the pharmacokinetic profile.
Itraconazole is an orally active triazole antifungal which has been compared to griseofulvin in a number of double-blind trials. In dermatophytosis with a non-fixed treatment regimen for a maximum of 3 months, itraconazole 100 mg o.d. has produced a 100% mycological cure rate as compared with a 67% rate with griseofulvin 500 mg o.d. (p less than 0.01). Based on the pharmacokinetic profile, 100 mg itraconazole daily was then compared with 500 mg ultramicronized griseofulvin daily using a fixed treatment schedule of 15 days in tinea corporis and/or cruris and 30 days in tinea pedis and/or manus. In all studies in tinea corporis/cruris (n = 277), the superiority of itraconazole was shown for the clinical outcome at the last follow-up visit 2 weeks post-therapy (88 vs. 69%, p less than 0.01) and in the mycological outcome at the last follow-up visit (81 vs. 65%, p less than 0.05). In tinea pedis/manus (n = 210), the clinical response was virtually the same for the two treatment groups, but the most important finding was the mycological outcome with a significantly better result in favor of itraconazole at the end of treatment (77 vs. 61%, p less than 0.05) even more pronounced at the follow-up visit (85 vs. 48%, p less than 0.01). We conclude that itraconazole 100 mg daily in the treatment of tinea corporis/cruris and in tinea pedis/manus is significantly more effective than 500 mg griseofulvin daily when fixed treatment regimens are used. Furthermore, the best results are obtained with itraconazole 2-3 weeks after the end of treatment.(ABSTRACT TRUNCATED AT 250 WORDS)
Adolescent↗
Treatment of atopic dermatitis by allergen-antibody complexes: long-term clinical results and evolution of IgE antibodies.
This study describes the long-term follow-up of the clinical response of 10 adult patients suffering from atopic dermatitis (AD) who were treated by administration of complexes made of Dermatophagoides pteronyssinus (Dpt) allergens and autologous antibodies specific to that allergen. We have already described the clinical improvement observed after 1 year of treatment involving regular injections of complexes; this improvement was maintained throughout a second year, even though the number of injections was greatly reduced. At the end of the second year of treatment, 5 patients were completely free of disease, and 3 had had a short-lasting recurrence of low-severity dermatitis. Using a disease intensity index the mean improvement for these 8 patients was 83% compared to baseline values. One patient showed a significant recurrence of symptoms, and 1 patient left the study for personal reasons when she was in good clinical condition. A significant reduction of specific anti-Dpt IgE antibody titers was observed in 7 out of the 8 patients in clinical remission, while the level of total IgE antibodies was unchanged until the very end of the study. This study not only confirms that clinical benefit can be obtained from the treatment of AD patients hypersensitive to Dpt by injections of allergen-antibody complexes but also indicates that the therapy induces a suppression of IgE antibody production that is specific for the particular allergen.
Allergens↗
Allergen-antibody complexes in the treatment of atopic dermatitis: preliminary results of a double-blind placebo-controlled study.
Twenty-three adult patients suffering from chronic atopic dermatitis (AD) have been treated by regular injections of complexes made of D. pteronyssinus allergens and specific autologous antibodies. A double-blind placebo-controlled protocol was followed for 4 months, then the patients were treated openly to complete a full year on active therapy. Preliminary results are presented for the first 8 months. Seventy-three percent of patients improved when treated with complexes, showing a mean improvement of more than 70% after 4 months. This study suggests that injections of allergen-antibody complexes is an effective treatment of at least some forms of AD and confirms that airborne allergens are significant exacerbating factors of AD.
Adolescent↗
HIV infection and rape.
We report the case of a woman who was found to be HIV positive after a sexual assault, in the absence of other risk factors for HIV infection. This observation and the report of one similar case support the view that HIV may be transmitted to a victim of a single sexual assault. We believe that all victims of rape should be offered a test for HIV and offered counselling. In addition to the current recommendations, the semen obtained should be tested for HIV antibodies by Western blot analysis. In the absence of clear data on safety and efficacy, we should recommend neither routine application of virucidal agents nor systematic Zidovudine (AZT) prophylaxis.
Adult↗
Contact sensitization to 5-chloro-2-methyl-4-isothiazolin-3-one and 2-methyl-4-isothiazolin-3-one (MCI/MI). A European multicentre study.
The frequency of positive reactions to 5-chloro-2-methyl-4-isothiazolin-3-one and 2-methyl-4-isothiazolin-3-one (MCI/MI) were studied at 22 European contact dermatitis clinics over a period of 1 year. A total of 4713 patients participated. All the patients were patch tested with nickel sulphate, formaldehyde, paraben-mix, and MCI/MI. 19.4% of the patients had positive patch tests to nickel, making this the most common allergen. 3% of the patients reacted to 100 ppm MCI/MI, while 2.6% reacted to formaldehyde and 1.1% to parabens. There was great variation in the frequency of MCI/MI sensitivity among the 22 centres. MCI/MI contact allergy was most common among women and in patients with facial dermatitis, while it was rarely seen in patients with dermatitis on the lower legs. There were no fluctuations in the number of positive patch tests to MCI/MI on a monthly basis when the results from all centres were combined. 117 of the 141 MCI/MI sensitized patients included in the study were retested. 88% had positive patch tests when retested. 101 of the MCI/MI-sensitive patients participated in a double-blind, placebo-controlled product use test. This test showed that 31% of the MCI/MI-sensitive patients had a positive reaction to a MCI/MI-preserved product. Only a few patients reacted to a control product. It is concluded that the preservative MCI/MI is an important new contact allergen.
Adolescent↗
Pharmacological modulation by cetirizine and ebastine of the cutaneous reactivity to histamine.
The peripheral H1-inhibiting effects of cetirizine 10 mg and ebastine 10 mg were compared at the skin level after single oral administration. The study was performed in 9 healthy subjects under double-blind randomized crossover conditions. Both drugs were significantly effective up to 24 h. The suppressive effect of cetirizine was significantly more rapid and more marked.
Administration, Cutaneous↗
Injection of allergen-antibody complexes is an effective treatment of atopic dermatitis.
Atopic dermatitis (AD) can be exacerbated by contact with airborne allergens, amongst which Dermatophagoides pteronyssinus (Dpt) appears to be potentially important. Specific IgE antibodies towards Dpt are often found in AD, and it can therefore be speculated that suppression of the production of anti-Dpt IgE might result in a significant clinical improvement. Complexes of antigen and specific antibodies have been shown to suppress the production of antibody in other systems; we report here the evaluation in an open trial of the capacity of such complexes to improve symptoms of AD. Ten adult patients were enrolled in this study. In addition to satisfying the criteria of AD, they all suffered from a severe disease (more than 20% of the body surface involved) that had been stable for at least the last 2 years. The patients had high titers of total IgE antibodies and specific anti-Dpt antibodies. Allergen-antibody complexes were prepared from Dpt allergens and an excess of autologous specific anti-Dpt antibodies obtained by immunoadsorption. The patients received regular injections of these complexes throughout 1 year, during which clinical parameters of disease intensity, percentage of body surface affected and intensity of pruritus were regularly monitored. A significant clinical improvement was obtained after 3-4 months of therapy and was maintained through the 9th month. After 1 year of treatment, 2 patients were completely free of disease, 4 had residual lesions which continued to improve and 4 patients had a partial recurrence of dermatitis.(ABSTRACT TRUNCATED AT 250 WORDS)
Adolescent↗
European multicenter study of TRUE Test, Panel 2.
Panel 2 of the standardized, ready-to-apply patch test, the TRUE Test, has been evaluated on 808 patients with suspected contact dermatitis. The patients were tested with 11 different allergens and the negative control, and compared with corresponding allergens in pet. (or aq.) in Finn Chambers fixed with Scanpor. The TRUE Test, Panel 2 and the control were applied symmetrically on the upper back. Left/right application of the respective test varied at random. Most tests were removed after 48 h and evaluated after 72 or 96 h, according to generally accepted recommendations. There were positive test reactions to all 11 allergens tested in the patient group. The concordance of positive reactions (1+, 2+, 3+) was 63% between TRUE Test, Panel 2 and the control method; 17% of positive reactions occurred only with TRUE Test, Panel 2 and 20% only with the compared method. Approximately 75% of all positive test reactions were explained by the patients' present or past history. Irritant/questionable reactions occurred in the same frequency for the 2 methods. Such reactions were recorded in less than 1% of all patches applied. No late reactions were recorded.
Allergens↗
Patch testing with the "sesquiterpene lactone mix": a marker for contact allergy to Compositae and other sesquiterpene-lactone-containing plants. A multicentre study of the EECDRG.
6278 patients were patch tested with a sesquiterpene lactone mix (SL-mix) in 10 European clinics. 4011 patients were tested only with 0.1% SL-mix, 63 (approximately 1.5%) of whom were positive, with 26 (41%) of these cases being considered clinically relevant. There were no cases of active sensitization, though 5 cases of irritation were reported. 22 irritant reactions and 22 cases of active sensitization occurred when testing also with 1% and 0.33% concentrations of SL-mix. SL-mix 0.1% pet. is shown to be an important patch test and many relevant sensitizations will be missed without routine screening with such a mix. Most patients with SL-mix sensitivity presented with hand and/or face dermatitis, apparent photodermatitis or more generalised eczema.
Dermatitis, Contact↗
The patch test dilution of glyceryl thioglycolate.
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Dermatitis, Occupational↗
Comparative effects of loratadine and terfenadine in the treatment of chronic idiopathic urticaria.
Loratadine is a new selective peripheral histamine H1-receptor antagonist, that is orally effective, long-acting, and devoid of significant central and autonomic nervous system activity. Its safety and efficacy were evaluated in a 28-day study conducted in patients with chronic idiopathic urticaria. Patients were randomly assigned to one of three treatment groups (loratadine, 10 mg OD; terfenadine, 60 mg BID; or placebo). Evaluation of efficacy included weekly assessments of the individual disease signs and symptoms, the overall disease condition, and therapeutic response to treatment. Throughout the 28-day treatment period progressive improvement was observed in the loratadine and terfenadine treatment groups; however, at each evaluation, loratadine was significantly more effective than placebo (P less than .01) and clinically more effective than terfenadine in reducing disease signs and symptoms. Terfenadine was significantly more effective than placebo at day 7 and endpoint (last valid visit). The overall therapeutic response at the endpoint of treatment was rated as marked or complete relief of symptoms in 64%, 52%, and 25% of the patients in the loratadine, terfenadine, and placebo treatment groups, respectively. Loratadine was well tolerated and comparable to terfenadine and placebo in incidence of adverse experiences. Sedation was reported in one patient each in the terfenadine and placebo treatment groups and an anticholinergic side effect (dry mouth) in one terfenadine-treated patient. No sedative or anticholinergic side effects were observed in patients receiving loratadine. We concluded that loratadine, 10 mg, once daily is a safe and effective treatment for symptomatic relief of chronic idiopathic urticaria.
Adolescent↗
[Juvenile plantar dermatosis: when are epicutaneous tests indicated?].
The aetiology of juvenile plantar dermatosis (JPD) is probably multifactorial. Atopy, frictional factors and the frequent alternation between a hot and wet microclimate and a dry one seem to favour the dermatosis. An allergic contact dermatitis does not only involve a difficult differential diagnosis; it can also cause secondary deterioration of existing JPD. For these reasons, an attempt is made in this paper to specify the situations in which patch tests are indicated.
Child↗
Allergic contact dermatitis to colophony included in the formulation of flexible collodion BP, the vehicle of a salicylic and lactic acid wart paint.
The authors describe two cases of allergic contact dermatitis to colophony included in the formulation of flexible collodion BP, the vehicle of a wart paint. Patch and repeated open application tests confirmed absence of contact allergy to other constituents. The patients were known to be allergic to various adhesive plasters. The use of flexible collodion USP, which does not contain colophony, is highly advisable whenever possible.
Adult↗
Contact sensitivity to nonoxynols as a cause of intolerance to antiseptic preparations.
Twelve cases of allergic contact dermatitis caused by antiseptic preparations are presented. The reactions resulted not from the active principles but rather from nonoxynols used in the offending substances as nonionic surface-active agents. Nonoxynols are ethoxylated alkyl phenols or nonylphenylethers that conform in general to the formula C9H19C6H4(OCH2CH2)nOH. They have emulsifying, wetting, foaming, and solubilizing properties and are used in a large number of industrial, household, agricultural, cosmetic, and pharmaceutical products. They also are used as spermicides. There are very few reports in the literature of skin problems caused by nonoxynols.
Adult↗
Problems raised by the simultaneous reproducibility of positive allergic patch test reactions in man.
The dose of petrolatum patch test material applied with the Leukotest or the Finn Chamber method varies significantly and is one important factor in the lack of reproducibility with present patch test methods. Ready-to-apply methods such as Epiquick and TRUE Test avoid this problem. In a right-side versus left-side comparative study of 19 Epiquick patches on 100 consecutive patients, the reproducibility was 95%. This is a much higher correlation than with previous comparative tests with both identical and different patch test systems.
Allergens↗
Multiple lesions of molluscum contagiosum with metaplastic ossification.
A 30-year-old woman, suffering from systemic lupus erythematosus and treated with azathioprine and methyl-prednisolone, developed seven molluscum contagiosum lesions of the upper part of her left calf. Histological examination revealed metaplastic ossification in the upper dermis, in close relation to each molluscum contagiosum lesion. Such an association has not been reported before; its occurrence in this case is discussed.
Adult↗