Clinico-statistical investigation about cement dermatitis in Italy]

To define the prevalence of cement dermatitis (allergic contact dermatitis-ACD-and irritant contact dermatitis-ICD), two retrospective studies have been carried out in Italy: the first one based on the analysis of dermatitis cases ascribable to cement as defined by INAIL (Italian Institute for Industrial Accidents Insurance) from 1984 to 1992; the second one by surveying cement dermatitis cases in workers in the building industry aged between 16 and 70 carried out by Istituto di Clinica Dermatologica dell'Università di Bari from 1988 to 1994. The survey on INAIL data showed that in the years take into account 5,290 dermatitis cases included in item 41 of the occupational diseases table have been defined. About 80% of these cases have been observed in workers working as bricklayers and floor-layers. Therefore, given the remarkable exposure to cement in these professions, the prevalence of cement dermatitis in Italy has been estimated to 6 cases/province/year, even though it has not been possible recognize the clinical form of cement dermatitis. Moreover, the study showed that disabling cutaneous after-effects eligible for compensation have been observed in 30% of the cases defined by INAIL. The allergologic study carried out by Clinica Dermatologica has not only defined the incidence of contact dermatitis (ACD and ICD), in building workers, but it has also extrapoled dermatitis cases due to cement. As a whole, in the years taken into account, 166 occupational or mixed ACD cases and 77 occupational or mixed ICD have been diagnosed. The incidence of contact dermatitis ascribable to cement has equalled 79% among ACD and 88% among ICD, with a ratio of about 2 to 1 in favour of allergic forms. Among the chemicals tested, potassium bichromate showed the highest frequency of cases positive to patch tests. The skin site the most affected by cement dermatitis is hand, followed by upper limbs, lower limbs and feet. In the province of Bari, in the years taken into account, an average incidence of 28.4 cases per year of the two forms of cement dermatitis has been observed.     

Acute sterile inflammation--correlation between cellular changes and extramedullary-produced regulators in vivo

During our first year of routine testing with Compositae allergens and extracts, contact allergy to Compositae was frequently found in eczema patients (4.5%), especially in middle-aged or elderly persons. Based on clinical patterns, patch test reactions and the long-term course of the disease, 4 groups of patients were recognized: (a) a small group with localized eczema; (b) another with classic Compositae dermatitis of exposed skin; (c) a 3rd group, the largest, with localized eczema that suddenly one summer turned into a widespread dermatitis; (d) a 4th group with a vesicular hand eczema and more-or-less widespread dermatitis with seasonal variation from the beginning. 65% of the patients had vesicular hand eczema at some time, partly reflecting the frequency of atopy (25%) and metal allergy (44%). 75% of the patients had contact allergy to > or = 1 compounds besides Compositae. Thus, Compositae allergy may be primary, e.g., in young patients with occupational plant contact, or secondary to other contact allergies, perhaps as a result of increased individual susceptibility. The clinical patterns in the latter patients were most often a widespread dermatitis with summer exacerbation. The variability in the clinical picture makes routine patch testing with Compositae allergens recommendable.     

Hypothalamic self-stimulation and operant activity in the mottled mutant mouse

Cell-mediated immunity to bacterial antigens was studied by intradermal testing, and to contact antigens (cosmetics, environmental chemicals and topical medicaments) by patch testing in 270 children with atopic dermatitis. The incidence of delayed-type immune cutaneous reactions in these patients was lower than in the controls. Contact allergy is a rare finding in the first 4 years of life but its incidence increases subsequently. In subjects with atopic dermatitis the incidence of sensitization by contact with allergens contained in topical medicaments proved to be lower than in subjects with eczema of other types. The data collected points to a reduced cell-mediated immune reactivity in a proportion of subjects with atopic dermatitis.     

Community occupational structure, medical and economic resources, and coronary mortality among U.S. blacks and whites, 1980-1988

Through cooperation between the German Contact Dermatitis Research Group (DKG) and the Information Network of Departments of Dermatology (IVDK), results of standardized patch tests performed by the participating centres are centrally recorded in Germany. For this study, data from 24 departments of dermatology (19678 patients) were evaluated retrospectively and separately for 1995 and 1996. With decreasing frequency, nickel, fragrance mix, balsam of peru, and thimerosal yielded positive reactions most often; surprisingly high numbers of positive reactions were also seen with amerchol L-101 and palladium. Differentiated lists of allergens were compiled for 1995, referring to subgroups of patients (defined by gender, age, localization of eczema, geographical region, occupation, sensitization) and particular problems. In men, percentages of positive reactions were markedly lower for nickel, fragrance mix and balsam of peru than in women. Younger patients reacted more often to thimerosal and older ones to topical medical preparations. Medical allergens were also often positive in patients with leg eczema, whereas occupational allergens were found more frequently in patients with hand eczema. A comparison of positive reactions obtained in distinct geographical regions was problematic because of differences between test populations. The spectrum of allergens found in office workers was similar to that of the whole test population. Patients with positive reactions to nickel and fragrance mix had more positive reactions to unrelated allergens than the total test population. Sex- and age-adjusted frequencies of sensitization revealed a decrease in reactions to nickel and an increase in reactions to mercury allergens from 1995 to 1996. The clinical relevance of mercury reactions was often not apparent. Differentiated lists of allergens can be used to improve the quality of diagnostic and prophylactic procedures in allergic contact dermatitis.     

In vivo relevance of CD30 in atopic dermatitis

CD30 expression was evaluated by immunohistochemistry in lesional skin biopsies of eight patients with active atopic dermatitis (AD) and three patients with allergic contact (nickel-induced) dermatitis (ACD). CD30 expression was also assessed in a large panel of CD4+ and CD8+ T-cell clones generated from the skin biopsies of four patients with AD. Finally, the levels of soluble CD30 (sCD30) were measured in the serum of 41 patients with AD, 19 patients with ACD, and 60 healthy controls. In all specimens of lesional AD skin, where the great majority of infiltrating cells were CD4+ T cells, remarkable numbers of cells were CD30+, whereas virtually no CD30+ cells were found in the skin of patients with ACD. In CD4+ T-cell clones generated from the lesional AD skin, most of which produced both interleukin (IL)-4 and interferon-gamma (IFN-gamma) (Th0-like cells) or IL-4 and IL-5, but not IFN-gamma (Th2-like cells), CD30 expression directly correlated with the ability to produce IL-4 and IL-5, but was inversely related to IFN-gamma production. High levels of sCD30 (correlated with disease activity: r = 0.618) were detected in the serum of most AD patients, whereas there was no increase of sCD30 levels in the serum of patients with ACD. These data support the view that Th0/Th2-type responses predominate in the skin of patients with AD and suggest that the presence of CD30+ T cells in tissues and/or increased levels of sCD30 in biologic fluids are indicative of Th2-dominated responses.     

Apheresis platelets: emerging issues related to donor platelet count, apheresis platelet yield, and platelet transfusion dose

The prevalence of atopic dermatitis and other allergic diseases is increasing in industrialized countries. Today we know that atopy is conditioned genetically, but the development of the atopic phenotype requires environmental factors. It is believed that the genetic factors have not changed and that the increased prevalence is due to the increase in exposure to allergenic and non-specific environmental factors. The potential for sensitization is greater in the early years of life, so it is necessary to reduce harmful environmental exposure at these ages. Atopic clinical manifestations develop sequentially, in many cases beginning with atopic dermatitis in the early months of life. We know that children with atopic dermatitis present non-specific bronchial hyperreactivity (58 to 82%), which is a risk factor for the later development of asthma. The presence of specific bronchial hyperreactivity for mites in atopic dermatitis with mite sensitization also has been described, and it has been demonstrated that signs of eczema can develop or become exacerbated by airway exposure during bronchial challenge tests. The evolution from atopic dermatitis to asthma is a possibility that must be kept in mind. Patients should be followed-up and study of hyperreactivity and sensitization to allergens should be carried out in order to prevent the development of clinical symptoms. Prevention should include pneumoallergens, food allergens, and non-specific environmental risk factors, such as parental smoking (particularly mothers), pollution inside and outside the home, etc. Prevention is particularly important in children at risk of allergy, as determined by a family history among first-degree relatives, as well as the presence of atopic dermatitis, particularly of early onset, because these patient are most at risk of developing bronchial asthma in later years. At present, pharmacological prevention is being studied, without overlooking environmental prevention, in children at high risk of atopic disease for the purpose of preventing chronic inflammations that will condition their future as adults. In our daily clinical experience, atopic dermatitis is responsible for 8% of visits to a pediatric allergology unit. We emphasize that 62.5% of our patients with dermatitis are referred when they already have bronchial asthma, which represents an important delay in diagnosis with respect to the onset of symptoms.     

What is the problem with high transporters?

Mercury exanthem can be considered as a systemic contact dermatitis following exposure to mercury vapor in patients with a prior sensitization to mercurials. It is characterized by a symmetrically distributed erythematous eruption appearing predominantly in the major flexural areas, in the neck, the lower portion of the abdomen and the upper anteromedial part of the thighs. In some cases, small pustules develop over the erythematous surfaces. We report our observations of two patients with mercury exanthem after exposure to mercury vapor caused by a broken thermometer. One of these patients presented with an unusual bullous form of mercury exanthem. Although diagnosis of mercury exanthem can be essentially based on clinical features, confirmation of the patient's exposure to mercury should be obtained. Cutaneous patch tests often prove the sensitization to mercurials.     

Cilostazol has beneficial effects in treatment of intermittent claudication: results from a multicenter, randomized, prospective, double-blind trial

BACKGROUND: Cilostazol is a new phosphodiesterase inhibitor that suppresses platelet aggregation and also acts as a direct arterial vasodilator. This prospective, randomized, placebo-controlled, parallel-group clinical trial evaluated the efficacy of cilostazol for treatment of stable, moderately severe intermittent claudication. METHODS AND RESULTS: Study inclusion criteria included age > or =40 years, initial claudication distance (ICD) on treadmill (12.5% incline, 3.2 km/h) between 30 and 200 m, and confirmation of diagnosis of chronic lower-extremity arterial occlusive disease. After stabilization and single-blind placebo lead-in, 81 subjects (62 male, 19 female) from 3 centers were randomized unequally (2:1) to 12 weeks of treatment with cilostazol 100 mg PO BID or placebo. Primary outcome measures included ICD and maximum distance walked (absolute claudication distance, or ACD). Secondary outcome measures included ankle pressures, subjective assessments of benefit by patients and physicians, and safety. Treatment and control groups were similar with respect to age, severity of symptoms, ankle pressures, and smoking status. Statistical analyses used intention-to-treat analyses for each of 77 subjects who had > or =1 treadmill test after initiation of therapy. Comparisons between groups were based on logarithms of ratios of ICD and ACD changes from baseline using ANOVA test at last treatment visit. The estimated treatment effect showed a 35% increase in ICD (P<0.01) and a 41% increase in ACD (P<0.01). There was no significant change in resting or postexercise ankle/brachial indexes. Patients' and physicians' subjective assessments corroborated the measured improvements in walking performance observed in the cilostazol-treated group. CONCLUSIONS: Cilostazol improved walking distances, significantly increasing ICD and ACD. The data suggest cilostazol is safe and well tolerated for the treatment of intermittent claudication.     

Hepatic subcapsular extension of pelvic lymphocele after radical retropubic prostatectomy

We determined the cyclic adenosine monophosphate phosphodiesterase (cAMP-PDE) activity in peripheral blood mononuclear leucocytes from 100 patients with atopic dermatitis (AD) aged 13-57 years (mean +/- SD, 29.8 +/- 17.7 years). The correlation between cAMP-PDE activity and clinical parameters such as the severity of eczema and a personal or family predisposition to atopic respiratory diseases (ARD) (asthma or allergic rhinitis) was examined. Although the enzymic activity varied from normal to very high in the AD patients, cAMP-PDE activity was significantly (P < 0.005) elevated in AD patients (42.1 +/- 22.0 units) as compared with the normal controls (12.4 +/- 5.6) and clinical control subjects (13.4 +/- 9.5). In contrast, we found no correlation between cAMP-PDE activity and the severity of eczema when AD patients were classified into four categories (remission, mild, moderate and severe) according to the extent of their skin involvement. Furthermore, we found that systemic corticosteroid therapy in severe AD patients did not alter the cAMP-PDE activity. cAMP-PDE activity was significantly (P < 0.01) higher in those AD patients who had a personal history of ARD (47.2 +/- 11.2) than in AD patients with a family history of ARD (37.2 +/- 17.4) and those without a personal or family history ('pure' AD) (34.4 +/- 19.8). Nevertheless, the cAMP-PDE activity was significantly higher even in 'pure' AD patients than in the controls. These results suggest that an elevation of cAMP-PDE activity is closely related to a predisposition to respiratory atopy, and does not follow inflammation in AD patients.     

Inhibition of parathyroid hormone-stimulated resorption in cultured fetal rat long bones by the main metabolites of ipriflavone

Among 1619 patients suspected of occupational contact dermatitis examined during the years 1990-1994, sensitivity to acrylates was diagnosed in 9 persons (4 dental technicians, 4 dentists, 1 textile printer). Ethyleneglycol dimethacrylate (5 positive patch tests), methyl methacrylate (4), 2-hydroxyethyl methacrylate (4) and triethyleneglycol dimethacrylate (4) were the most common sensitizers. Comparison of patch test results in dental technicians and dentists indicated that dentists were sensitive to a greater number of (meth)acrylate (acrylate and methacrylate) allergens and also to certain other allergens (metals and rubber additives). Dental technicians were sensitive almost exclusively to methacrylates, while the textile printer only to acrylates.     

Bronchial and cutaneous responses in atopic dermatitis patients after allergen inhalation challenge

BACKGROUND: Atopic dermatitis (AD) is often associated with allergic asthma (AA). Inhalation of allergens influences the activity of AA but the effect on the skin in AD is unclear. OBJECTIVES: We evaluated the degree of bronchial hyperresponsiveness to methacholine in eight AD patients with AA (AD+) and eight AD patients without AA (AD-) and studied bronchial and cutaneous responses after allergen inhalation challenge. METHODS: All patients were treated in hospital for their eczema with tar ointment (pix liquida) and orally administered antihistamines (mean hospital stay 37 days). After clearing of the skin lesions allergen inhalation challenge was performed. Cutaneous responses were studied by measuring the 'Costa' score before and 24 h after allergen inhalation challenge. RESULTS: The median value of the provocative concentration of methacholine causing a 20% fall (PC20 Mch) in forced expiratory volume in 1 second (FEV1) was significantly higher in the AD- group compared to the AD+ group with median values of 10.70 and 0.60 mg/mL, respectively. These values did not change significantly in both groups during hospital stay. After challenge all AD+ patients showed early and late asthmatic responses whereas only four AD patients showed early asthmatic responses (mean values of the maximal fall in FEV1 during the EAR 37%/16% and in PEF during the LAR 27%/4% for AD+ and AD-patients, respectively). The 'Costa' score increased in both groups (mean score before 19.1/24.4 and after challenge 26.8/26.9 for AD+ and AD- patients, respectively). The increase in the AD+ group was significantly higher compared with the AD- group (P=0.016). CONCLUSION: We conclude that allergen inhalation challenge causes a flare up of the skin lesions in atopic dermatitis patients. This was more prominent in atopic dermatitis patients who already suffered from an IgE-mediated allergic inflammation in the lung.     

Sensitization and development of allergic contact dermatitis caused by a single contact with an electrosurgical grounding plate containing acrylates

Acrylates are known as potent sensitizers which can cause sensitization even during patch testing. A single exposure to concentrated acrylates can induce primary sensitization and contact dermatitis. Here we describe a 50-year-old man who developed contact dermatitis at the site of an electrosurgical grounding plate 2 weeks after orthopedic surgery. Patch testing revealed positive reactions to the electrosurgical plate and its components hydroxyethyl acrylate and hydroxyethyl methacrylate. As the patient has never had contact with acrylate-containing materials before, there is a high probability of primary sensitization by a single contact with the grounding plate during surgery.     

Human group C rotavirus in children with diarrhea in the Federal District, Brazil

BACKGROUND: A family history of atopy is a poor predictor of sensitization to inhalant allergens and allergic disease during childhood. We recently identified early sensitization to food allergens, especially hen's egg, as a valuable predictor of subsequent sensitization to inhalant allergens. OBJECTIVE: (1) Whether prediction will be improved by in vitro allergy tests at 1 year of age in combination with family history and medical history data. (2) Comparison with the capacities of in vitro tests to predict sensitization to aeroallergens. METHODS: Of an observational birth cohort study (MAS) 49 children who were sensitized to inhalant allergens at 5 years of age and 116 non-sensitized controls were included in the present study. For the prediction of sensitization to inhalant allergens the following prognostic factors were evaluated: atopic family history (FH), atopic dermatitis (AD) during the first year of life, two in vitro allergy tests for specific IgE to common food allergens at 1 year of age (fx5 [Pharmacia] and single allergen specific tests (sIgE) for four allergens) and 'high' total serum IgE, defined by three different cut off points. RESULTS: The combination of medical history data and laboratory tests resulted in the best predictive discrimination. The positive predictive values (PPV) were higher if sensitization to food was detected by single allergen specific tests (PPV: 66%/75%/100% corresponding to the three evaluated risk groups) than by the qualitative fx5 (PPV: 46%/65%/100%). The negative predictive values were equal for both tests (69 and 92% for the two low risk groups). High total serum IgE had low predictive capacity. CONCLUSION: During infancy the prediction of sensitization to inhalant allergens should be based on medical history data and allergy tests determining sensitization to food allergens. The in vitro tests improve the predictive discrimination, but the individual risk profile of the child must be considered for a reliable and valid prediction.     

The millennium criteria for the diagnosis of atopic dermatitis

Atopic dermatitis forms an active area of basic and clinical research, where important new knowledge about genetics and immunopathogenesis has surfaced over the past years, and where simultaneous development of new and innovative therapies is under way. However, the inclusion of any patient in an atopic dermatitis study, whether it is on its genetics, pathogenesis or therapy, requires a diagnosis which is irrefutable. Since there is no simple and also no complicated laboratory procedure to reach a diagnosis of atopic dermatitis, different sets of clinical criteria have been developed for the purpose of making the diagnosis uniformly in different studies as well as in different study centers. The most commonly used are Hanifin and Rajka's set of diagnostic features, which have major and minor clinical criteria to be fulfilled in order to establish a diagnosis of atopic dermatitis. Recent developments in the immunology of atopy have clearly established the major abnormality in this syndrome, the preferential production of allergen-specific IgE. In this contribution, it is suggested that the presence of such antibodies in a given patient should be a mandatory criterium for the diagnosis of atopic dermatitis. Such a diagnostic test however establishes a diagnosis of atopic syndrome, not atopic dermatitis. Thus, for atopic dermatitis we have to rely, for the time being, on additional clinical criteria. The clinical features described in the literature are critically evaluated, and it is suggested that in addition to the mandatory presence of allergen-specific IgE, 2 of 3 principal criteria (pruritus, typical morphology and distribution, chronic or chronically relapsing) should be present for such a diagnosis. Finally, the minor features originally described by Hanifin and Rajka and later evaluated by others are revised and divided over 4 subcategories; a) related to subclinical eczema; b) related to dry skin; c) extra skin folds; and d) ophthalmological pathology. They are suggested to be used as additional criteria only, needed when clinical suspicion is high but the new mandatory and principal diagnostic criteria described here are inconclusive. For study purposes, we suggest that the mandatory and principal criteria are sufficient. They are now evaluated and validated in ongoing atopic dermatitis treatment studies.     

Patch migration: a serious late complication of thoracotomy lead systems

Thoracotomy patch leads used for implantable cardioverter defibrillators (ICDs) are generally safe and effective. We describe two patients in whom a late complication of patch lead migration occurred years after the original implants, causing a bronchopleural fistula in one and lingular lobe collapse in the other patient. We conclude that patch migration is a late but possible complication of extrapericardial ICD leads, and should be suspected in patients who present with hemoptysis, atypical pneumonia, or lung collapse after the initial ICD surgery.     

Bacteriophages induced by ciprofloxacin in a Borrelia burgdorferi skin isolate

A retrospective study of 25,448 new cases of patients with various types of eczemas seen over a two-year period (1989-1990) was conducted. This represented 34.1% of new cases (74,589) seen at the Centre. The M:F ratio was 1:1. Occupational and ethnic distribution did not differ from that of the total outpatient population. 67% were endogenous eczema. Among the endogenous eczema, the majority (70%) were either non-specified endogenous eczema, hand and feet eczema or atopic dermatitis. 13.7% were contact dermatitis. Of these, 50% were non-specified contact dermatitis, 39% were irritant contact dermatitis and 11% were allergic contact dermatitis. Unskilled workers (19.1%) and housewives (12%) had the highest proportion for contact dermatitis. Exfoliative dermatitis (0.5% of all eczemas) was commonest among the elderly (68.3%) and Malays (19.7%). The prevalence of endogenous eczema had increased sharply from 31% in 1973 to 67% in 1989/90. In contrast, the proportion of exogenous eczemas over all eczemas seen has decreased from 48% to 15.4% (1973 to 1989/90).     

Occupational skin and respiratory diseases among hairdressers

OBJECTIVES: The occurrence and causes of hairdressers' occupational skin and respiratory diseases were studied. METHODS: Of a random sample of 500 female hairdressers aged 15-54 years, 355 were available for study. Of the 189 reporting work-related skin and respiratory symptoms in a computer-aided telephone interview on exposure and health, 130 underwent a physical examination, lung function tests, prick and patch testing, and nasal and lung provocation tests. An occupational disease was diagnosed when the causality between exposure and disease was probable and the clinical tests supported the diagnosis. RESULTS: The telephone interview revealed a life-time prevalence of 16.9% for hand dermatoses, 16.9% for allergic rhinitis, and 4.5% for asthma among the hairdressers. In the clinical investigations, the prevalence was 2.8% for occupational dermatoses, 1.7% for occupational rhinitis, and 0.8% for occupational asthma. Ammonium persulfate caused 90% of the respiratory diseases and 27% of the hand dermatoses. Paraphenylenediamine, natural rubber latex, and skin irritation were also causes of hand dermatitis. Allergy to human dandruff (8.6%) and Pityrosporum ovale (12.1%) was common. Previously diagnosed atopic diseases increased the risk for occupational skin or respiratory disease 3-fold (odds ratio 2.9, 95% confidence interval 1.1-7.9). Of the cases, 37.5% (6 of 16 persons) had to change occupations during a 3-year follow-up. CONCLUSIONS: Work-related skin and respiratory symptoms are common among hairdressers. Often a specific cause (eg, ammonium persulfate) can be found if occupational diseases are suspected and diagnosed. Hairdressers with atopic diseases are at risk of developing occupational skin and respiratory diseases.     

The pediatrician and care of chronic illness

Serum antibodies to a variety of dietary proteins were investigated in 26 patients with adult coeliac disease (ACD, 14 untreated and 17 treated with a gluten-free diet) and 38 patients with dermatitis herpetiformis (DH) with varying small bowel abnormalities. The incidence of one or more positive tests was highest in untreated ACD (73.4%) and DH with subtotal villous atrophy (57.4%). This incidence fell with morphological improvement, being 56.4% in treated ACD patients with partial villous atrophy (PVA), and 33.4% in DH with PVA, and 0% in DH with normal biopsies. The height of the serum antibody titre also fell with morphological improvement. These results show that there is an abnormally high incidence of dietary antibodies in patients with DH, and this correlates with the degree of small bowel damage.     

Occupational eczema in gardeners and greenhouse workers in the county of Funen

The aims of the study were to assess the prevalence of and association between occupational dermatitis and possible risk factors in gardeners and greenhouse workers living on Funen, describe the distribution of different types of eczema and detect the allergens most commonly involved. A cross-sectional study, based on a postal questionnaire and subsequent patch testing of selected persons was carried out in 1958 gardeners. The response rate was 84.6%, and among 250 persons patch tested the most frequently sensitizing occupational allergens were plants of the Compositae family and the fungicide captan. Allergic occupational contact dermatitis was suspected in 43 persons (17%). Irritant eczemas outnumbered allergic eczemas and both were most often caused by plants. The lifetime prevalence of occupational dermatitis was 19.6%. Occupational mucosal symptoms, working with Compositae and training as a gardener in females were significantly associated with an increased prevalence of occupational eczema, whereas sex, age and personal atopy seemed to be of less importance.