Frequency of sensitivity to Grotan BK in Denmark.
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Biomedical subjects
Publications and source records attributed to J Roed-Petersen.
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In a search for contact sensitivity to antioxidants we patch tested consecutive patients referred with eczematous dermatitis. Six cases of allergic contact sensitivity to nordihydroguairetic acid (NDGA) were observed. Three had been sensitized by one brand of cream containing 0.1% NDGA, in three patients the source of sensitization could not be traced. In four patients we found positive patch tests to butylated hydroxyanisole and/or to butylated hydroxytoluene. In two cases the positive patch tests were relevant, since both patients remained asymptomatic when antioxidants were avoided in food. They both had acute flares of vesicular eczema on the fingers after oral administration of small amounts. Gallate esters and Vitamin E (d,l-alpha-tocopherol) each gave one unexplained positive patch test. The present data suggest that further search for hidden sensitizers in topical medicaments and cosmetics is warranted. A declaration of all ingredients in industrial products should be placed on the label.
American ragweed (Ambrosia) dermatitis has an airborne pattern and is caused by lipid soluble oleoresins of pollens. A similar weed dermatitis has been described in India and Australia. The weeds involved were all of the Compositae family and contain sesquiterpene lactones with one common antigenic determinant. This study reports seven Danish patients treated for many years under the diagnosis of photodermatitis, who eventually proved to suffer from Compsoitae oleoresin dermatitis. Probably, Compsitae dermatitis is a world-wide disease, although aften misdiagnosed as has happened in Scandinavia.
A 51-year-old woman, addicted to beer for several years, developed chronic zinc deficiency which caused severe mental impairment, a poor general condition with edema and diarrhea, widespread eczema craquelé and loss of hair. Laboratory tests showed a significantly lowered serum zinc concentration, microcytic anemia, an inversed serum albumin/gamma-globulin ratio and a decreased serum thyroxine. Two years earlier, her external pancreatic function had been found severely impaired. Following oral therapy with zinc sulfate 0.2 g X 3R, daily, the patient's mental and physical condition totally changed. In two weeks serum zinc was within the normal range, while hemoglobin concentration, serum proteins, serum thyroxine became normal in 4-8 weeks.
The preparation of food in restaurant kitchens carries a high risk of occupational dermatoses. Analysis of 33 cases revealed four different etiological types. Simple irritant dermatitis was rare (2 cases), plain contact dermatitis was more common (6 cases). Fifteen patients had relevant patch tests and scratch tests; ten had positive scratch tests only to explain the cause of their dermatitis. The last type was termed protein contact dermatitis. The major type IV allergens incriminated were metals, onion and garlic. The major proteinaceous allergens indicated by history and test results were fish and shell-fish. Open patch tests with the incriminated foods may cause erythema or oedema on normal skin after 20 minutes. Previously eczematous, now normal looking, skin often responds with a crop of dyshidrotic vesicles preceded by erythema and itching 30 minutes after the application of an open test. Examination for specific IgE is not always positive in such cases. Inhalant allergy was rare. The results indicate that food handlers are sensitized by the protein they touch, and then react to later contact with the proteins. Protein contact dermatitis is similarly common among veterinary surgeons, while the importance in other occupational groups remains to be studied.
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Patch tests with 24 Compositae species were performed on 81 patients suspected of having a plant dermatitis, of whom 16 had positive reactions to various species. When Compositae were included in the standard series, 10 of 488 consecutive patients (2%) were found to be sensitive to one or more species. Most of the positive test reactions were relevant. Fourteen of 16 sensitivities could have been detected by testing with two mixtures of Compositae. Alantolactone could not serve as a screening agent, since four of seven Compositae-sensitive patients had negative reactions to it. Concomitant reactions to balsams were found in four of 10 patients with unexpected sensitivy to Compositae. The clinical pattern of Compositae dermatitis may be that of a lichenified photo dermatitis. These cases are invariably missed, unless patch tests with Compositae are performed. Another group of patients have hadn eczema and also require patch tests with Compositae for etiological diagnosis. Because positive, relevant reactions are common, inclusion of a safe and reliable Compositae screening test in the standard series is urgently required. At the present stage, however, our test materials are sometimes irritant and they have occassionally caused active sensitization.
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Two persons had allergic contact dermatitis caused by Irgasan 0,2% in a deodorant foot-powder and 0,12% in a deodorant stick respectively. Both had positive patch test reactions to Irgasan 2% pet. One patient was further tested with Irgasan 1% pet. and 0,5% pet. She had positive reactions to these dilutions. In a blind half-sided usage test, a soap bar containing 0,5% Irgasan caused mild itching and a percepitble erythema, although the use of this soap was otherwise tolerated for one month. The soap bar without Irgasan caused no reactions. Although primary sensitization from Irgasan toilet soaps has not been reported, a previously sensitized person may react to the use of Irgasan in soaps.
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