- Email: [email protected]
Combined skin prick and patch testing enhances identification of food allergy in infants with atopic dermatitis
LITERATURE
132
cal, and immunofluorescence testing was consistent with pemphigus vulgaris. Patch testing to 1:lO dilution of the fumigant yielded mild erythema; testing to 1:5 dilution yielded erythema, edema, and microvesiculation. Tzanck’s test of vesicles at the patch test site was positive for acantholytic cells. Treatment with prednisone and cyclophosphamide led to remission. At follow-up 4 years later, there were no stigmata of pemphigus, and repeat patch testing was negative. The authors conclude that the patient had allergic contact-induced pemphigus. Vozza A, Ruocco V, Brenner S, et al: Int J Dermato135: 199-20 1, 1996 Marti Jill Rothe, MD
Contact
Allergy to Topical Corticosteroids Systemic Contact Dermatitis From Prednisolone With Tolerance of Triamcinolone
and
A 27-year-old woman with a history of asthma, flexural dermatitis, and contact allergy to jewelry developed worsening facial dermatitis despite treatment with topical prednisolone-2 l-acetate and betamethasone valerate. Treatment with oral prednisolone led to constitutional symptoms, enanthem, angioedema of the face, erythematous patches in skin folds, and a truncal exanthem. Treatment with adrenocorticotropin hormone led to resolution of signs and symptoms. Testing showed positive patch tests to corticosteroids of group A, C, and D, including prednisolone-21-acetate and betamethasone valerate. Testing to group B corticosteroids was negative. Intradermal testing was positive at 20 minutes to hydrocortisone succinate, prednisolone hemisuccinate, and methylprednisolone; testing was negative to triamcinolone acetonide. Eight hours after intradermal testing, generalized itching developed along with a flare of the facial and flexural dermatitis; after 24 hours, a generalized exanthem was present, and the positive intradermal tests were infiltrated. This case highlights relevant issues in the emerging area of contact and delayed systemic allergy to corticosteroids. Patch and intraderma1 testing should be considered when trying to identify a corticosteroid safe for systemic administration to a patient with a history of contact corticosteroid allergy. Bircher AJ, Levy F, Langauer S, et al: Acta Derm Venereol (Stockh) 65:490-493,1995 Marti Jill Rothe, MD
Skin Hazards
of the Marine Industry
REVIEW
Aquarium
Marine aquaria are increasingly more popular in homes, offices, lounges, and waiting rooms. Stings and envenomation, skin infections, actinic damage, and irritant and allergic contact dermatitis are the major skin hazards of the marine aquarium industry. Ashing aquarium gravel by hand can result in frictional dermatitis and make the skin more vulnerable to other contactants and infection. Contact with dried sea salt crusts and prolonged, frequent immersions of the hands in water often lead to irritant dermatitis. Allergic contact dermatitis has been reported to proflavine, a disinfectant used to treat parasitic infestations of fish. Water chemistry test kits contain chemicals that can cause chemical burns, such as sodium hydroxide and sodium hypochlorite, and hydrazine, which is a contact sensitizer. Tong DW: Int J Dermato135: 153-158,1996 Marti Jill Rothe, MD Sensitization to Para-Tertiary-Butylphenolformaldehyde
Resin
Patients with positive patch test reactions to para-tertiary-butylphenolformaldehyde resin (PIBP-FR) underwent additional patch testing. Cross-reactions were observed to phenolformaldehyde resin (65.8% of patients), balsam of Peru (19.5%), urea formaldehyde resin (lo%), toluene sulfate/formaldehyde resin (lo%), and formaldehyde (7%). Dermatitis most commonly affected hands, lower limbs, and feet. Occupational sources of PTBP-FR included detergents, glues, insecticides, leather, bonding agents, paints, electric fittings, motor oils, hair dyes, and glazes. Patients with foot dermatitis did well with allergen avoidance. However, persistent or relapsing dermatitis was seen in nearly one third of patients and was attributed to numerous sources of occupational and nonoccupational exposures to the resin. Massone L, Anonide A, Borghi S, et al: Int J Dermato135: 177- 180, 1996 Marti Jill Rothe, MD Combined Skin Prick and Patch Testing Enhances Identification of Food Allergy in Infants with Atopic Dermatitis benefit
Early identification of patients who would from strict avoidance of dietary allergens
LITERATURE
133
REVIEW
would be ideal to (1) avoid unnecessary restricted diets, which might lead to growth retardation during early childhood, (2) improve the clinical course of atopic dermatitis, and (3) prevent secondary development of multiple food allergies. One hundred eighty-three patients aged 2 to 36 months with atopic dermatitis were evaluated for cow milk allergy. Oral cow milk challenge was positive in 54% of patients, eliciting rapid onset of pruritus, urticaria, or exanthem versus delayed-onset eczematous lesions in approximately equal numbers. Skin prick tests to cow milk were positive in 67% of cases with acute onset reactions and usually negative in cases with delayed reactions. Patch tests to cow milk were positive in 89% of delayed reactions and usually negative in acute-onset reactions. Isolauri E, Turjanmaa K: J Allergy Clin Immuno1 97:9-15, 1996 Marti Jill Rothe, MD
False Negative Patch Test Reaction Caused by Testing With Dental Composite Acrylic Resin Sensitization to acrylics has been previously described by the authors in testing to workplace acrylic products; therefore, 1% dilutions of workplace acrylics have been recommended for patch testing. A 60-year-old dentist with fingertip dermatitis classic for acrylic allergy underwent patch
testing to standardized acrylic allergens and to 1% dilutions of workplace acrylic products. Falsenegative results to the workplace acrylics occurred because the relevant allergen components were diluted to less than the concentrations needed to detect contact allergy. The authors suggest testing to higher concentrations of workplace acrylics if initial testing with 1% dilutions is negative. Estlander T, Jolanki R: Int J Dermato135: 189192,1996 Marti Jill Rothe, MD
Prevalence of Latex-specific IgE Antibodies Hospital Personnel
in
Three hundred eighty-one hospital personnel who completed questionnaires regarding exposures to latex and allergy symptoms were tested for total and latex-specific immunoglobulin (Ig)E. Twentyone (5.5%) of the participants had latex-specific IgE antibodies. Positive latex-specific antibodies were more prevalent in personnel who reported tachycardia, palpitation, flushing, or wheezing associated with latex gloves. Most patients with complaints of skin irritation were negative for antibodies. Kaczmarek RG, Silverman BG, Gross TP, et al: Ann Allergy Asthma Immunol76:5 l-56, 1996 Marti Jill Rothe, MD
132
cal, and immunofluorescence testing was consistent with pemphigus vulgaris. Patch testing to 1:lO dilution of the fumigant yielded mild erythema; testing to 1:5 dilution yielded erythema, edema, and microvesiculation. Tzanck’s test of vesicles at the patch test site was positive for acantholytic cells. Treatment with prednisone and cyclophosphamide led to remission. At follow-up 4 years later, there were no stigmata of pemphigus, and repeat patch testing was negative. The authors conclude that the patient had allergic contact-induced pemphigus. Vozza A, Ruocco V, Brenner S, et al: Int J Dermato135: 199-20 1, 1996 Marti Jill Rothe, MD
Contact
Allergy to Topical Corticosteroids Systemic Contact Dermatitis From Prednisolone With Tolerance of Triamcinolone
and
A 27-year-old woman with a history of asthma, flexural dermatitis, and contact allergy to jewelry developed worsening facial dermatitis despite treatment with topical prednisolone-2 l-acetate and betamethasone valerate. Treatment with oral prednisolone led to constitutional symptoms, enanthem, angioedema of the face, erythematous patches in skin folds, and a truncal exanthem. Treatment with adrenocorticotropin hormone led to resolution of signs and symptoms. Testing showed positive patch tests to corticosteroids of group A, C, and D, including prednisolone-21-acetate and betamethasone valerate. Testing to group B corticosteroids was negative. Intradermal testing was positive at 20 minutes to hydrocortisone succinate, prednisolone hemisuccinate, and methylprednisolone; testing was negative to triamcinolone acetonide. Eight hours after intradermal testing, generalized itching developed along with a flare of the facial and flexural dermatitis; after 24 hours, a generalized exanthem was present, and the positive intradermal tests were infiltrated. This case highlights relevant issues in the emerging area of contact and delayed systemic allergy to corticosteroids. Patch and intraderma1 testing should be considered when trying to identify a corticosteroid safe for systemic administration to a patient with a history of contact corticosteroid allergy. Bircher AJ, Levy F, Langauer S, et al: Acta Derm Venereol (Stockh) 65:490-493,1995 Marti Jill Rothe, MD
Skin Hazards
of the Marine Industry
REVIEW
Aquarium
Marine aquaria are increasingly more popular in homes, offices, lounges, and waiting rooms. Stings and envenomation, skin infections, actinic damage, and irritant and allergic contact dermatitis are the major skin hazards of the marine aquarium industry. Ashing aquarium gravel by hand can result in frictional dermatitis and make the skin more vulnerable to other contactants and infection. Contact with dried sea salt crusts and prolonged, frequent immersions of the hands in water often lead to irritant dermatitis. Allergic contact dermatitis has been reported to proflavine, a disinfectant used to treat parasitic infestations of fish. Water chemistry test kits contain chemicals that can cause chemical burns, such as sodium hydroxide and sodium hypochlorite, and hydrazine, which is a contact sensitizer. Tong DW: Int J Dermato135: 153-158,1996 Marti Jill Rothe, MD Sensitization to Para-Tertiary-Butylphenolformaldehyde
Resin
Patients with positive patch test reactions to para-tertiary-butylphenolformaldehyde resin (PIBP-FR) underwent additional patch testing. Cross-reactions were observed to phenolformaldehyde resin (65.8% of patients), balsam of Peru (19.5%), urea formaldehyde resin (lo%), toluene sulfate/formaldehyde resin (lo%), and formaldehyde (7%). Dermatitis most commonly affected hands, lower limbs, and feet. Occupational sources of PTBP-FR included detergents, glues, insecticides, leather, bonding agents, paints, electric fittings, motor oils, hair dyes, and glazes. Patients with foot dermatitis did well with allergen avoidance. However, persistent or relapsing dermatitis was seen in nearly one third of patients and was attributed to numerous sources of occupational and nonoccupational exposures to the resin. Massone L, Anonide A, Borghi S, et al: Int J Dermato135: 177- 180, 1996 Marti Jill Rothe, MD Combined Skin Prick and Patch Testing Enhances Identification of Food Allergy in Infants with Atopic Dermatitis benefit
Early identification of patients who would from strict avoidance of dietary allergens
LITERATURE
133
REVIEW
would be ideal to (1) avoid unnecessary restricted diets, which might lead to growth retardation during early childhood, (2) improve the clinical course of atopic dermatitis, and (3) prevent secondary development of multiple food allergies. One hundred eighty-three patients aged 2 to 36 months with atopic dermatitis were evaluated for cow milk allergy. Oral cow milk challenge was positive in 54% of patients, eliciting rapid onset of pruritus, urticaria, or exanthem versus delayed-onset eczematous lesions in approximately equal numbers. Skin prick tests to cow milk were positive in 67% of cases with acute onset reactions and usually negative in cases with delayed reactions. Patch tests to cow milk were positive in 89% of delayed reactions and usually negative in acute-onset reactions. Isolauri E, Turjanmaa K: J Allergy Clin Immuno1 97:9-15, 1996 Marti Jill Rothe, MD
False Negative Patch Test Reaction Caused by Testing With Dental Composite Acrylic Resin Sensitization to acrylics has been previously described by the authors in testing to workplace acrylic products; therefore, 1% dilutions of workplace acrylics have been recommended for patch testing. A 60-year-old dentist with fingertip dermatitis classic for acrylic allergy underwent patch
testing to standardized acrylic allergens and to 1% dilutions of workplace acrylic products. Falsenegative results to the workplace acrylics occurred because the relevant allergen components were diluted to less than the concentrations needed to detect contact allergy. The authors suggest testing to higher concentrations of workplace acrylics if initial testing with 1% dilutions is negative. Estlander T, Jolanki R: Int J Dermato135: 189192,1996 Marti Jill Rothe, MD
Prevalence of Latex-specific IgE Antibodies Hospital Personnel
in
Three hundred eighty-one hospital personnel who completed questionnaires regarding exposures to latex and allergy symptoms were tested for total and latex-specific immunoglobulin (Ig)E. Twentyone (5.5%) of the participants had latex-specific IgE antibodies. Positive latex-specific antibodies were more prevalent in personnel who reported tachycardia, palpitation, flushing, or wheezing associated with latex gloves. Most patients with complaints of skin irritation were negative for antibodies. Kaczmarek RG, Silverman BG, Gross TP, et al: Ann Allergy Asthma Immunol76:5 l-56, 1996 Marti Jill Rothe, MD