香烟烟对变态反应性疾病的影响

为探讨香烟烟对变态反应性疾病的影响，以香烟烟作为变应原，采用特异性体内皮肤试验测定了１６０６例变态反应性疾病患者对香烟烟的反应，并对香烟烟呈阳性反应与各种变态反应性疾病的关系以及与性别和年龄的关系进行了多元回归分析。结果表明，对香烟烟的皮试阳性的反应率为３４．６％（５５６例患者对香烟烟呈阳性反应），香烟烟的阳性反应与变应性疾病的发病有关，而与性别、年龄、病程、外周血白细胞计数和嗜酸性粒细胞计数相关性不大。对５８例香烟烟呈阳性反应的支气管哮喘患者，用乙酰甲胆碱做了气道激发试验，其结果为，激发后的最大肺活量（ＦＶＣ）、一秒钟用力呼气量（ＦＥＶ１）、最大呼气流速（ＰＥＦＲ）低于激发前。对２２３例香烟烟阳性反应者（其中支气管哮喘患者１８４例、变应性鼻炎８７例、过敏性皮肤病５２例），采用ＥＬＩＳＡ方法测定血清总ＩｇＥ，并与正常对照组比较，香烟反应的病人组血清总ＩｇＥ显著增高。由此可见，香烟烟可以引起变态反应性疾病。     

镍接触性皮炎的斑贴试验及其组织病理学特征

目的 探讨斑贴试验在金属过敏等环境与职业性皮炎中的诊断价值,了解镍接触性皮炎的组织病理学特征。方法 应用欧洲标准抗原系列斑贴试验检测110例疑诊为接触性皮炎患者,并对13例硫酸镍(5％)斑贴试验不同时段阳性反应皮肤进行活检。结果 39例接触性皮炎患者对硫酸镍敏感(占35．5％),其中阳性反应皮肤组织学特征为：24h时表皮轻度海绵变性和灶状空泡变性,少许嗜酸性粒细胞外渗;48-72h时表皮和真皮炎症达高峰,主要是CD45RO^ T细胞和CD68^ 巨噬细胞分布于炎症表皮及真皮血管周围。916h-5d时表皮轻度增生,不同细胞成分参与修复过程。结论 硫酸镍是引起湿疹皮炎类疾病的主要接触变应原,镍皮炎病理学改变符合变应性接触性皮炎的特征。     

过敏性皮肤病患者斑贴试验的结果分析

目的：探讨过敏性皮肤病中斑贴试验的价值及常见变应原的特点,为疾病的防治提供参考。方法：选用包括了20项中国地区常见过敏原的斑贴试剂,对116例过敏性皮肤病患者进行斑贴试验。结果：116例过敏性皮肤病患者中91例斑贴试验阳性,总阳性率为78.45%。阳性率较高的前3位过敏原依次是：甲醛（36.26%）、芳香混合物（31.87%）和硫酸镍（28.57%）,其中芳香混合物和硫酸镍在女性中多见。结论：斑贴试验在过敏性皮肤病诊治中具有重要价值,试验提示甲醛、芳香混合物和硫酸镍是现今过敏性皮肤病的常见变应原。     

Allergy,Skin and Environment

The skin is very often the target organ of allergic reactions. This may be explained by many immunological competent cells in this organ such as the Langerhans cell, mast cells, lymphocytes, neutrophils and eosinophils. This is especially true for the antigen-presenting Langerhans cell. Therefore in many cases, the skin is a signalling organ for allergic reactions. Examples include food allergy which precipitates with signs and symptoms of skin diseases in about 45 % and drug allergy to β-lactam-antibiotics in about 90 %. Also the skin serves as a test organ in allergic diseases of other organs such as rhinitis allergica or asthma. Examples include Reibtest, prick-, intracutaneous-, scratch- and patch test. Therefore it is no surprise, that allergic diseases of the skin are the most often diagnosed skin diseases such as urticaria, angioedema, vasculitis, contact dermatitis and atopic dermatitis. At these diseases, their diagnose and therapy and especially the promissing progress in research with regard to these diseases which has been obtained during the last years will be focussed in this review.     

Tissue reaction to the nickel implants in the guinea pigs

Objectives

The aim of the study was the assessment of local tolerance to nickel implants during 9 months observation in guinea pigs sensitized to nickel before implantation and non-sensitized ones.

Materials and Methods

Three groups of guinea pigs were included in the study: 10 sensitized to nickel by the guinea pig maximization test; 10 previously non-sensitized and 10 in control group. In 20 animals (except control group) the nickel implants were inserted in the muscle of the back. After 9 months of observation, the animals were patch-tested with 5% nickel sulfate. Also percentage of eosinophils in peripheral blood was examined. Next, the tissue surrounding the implant and skin from the area of patch tests were collected for the histological examination.

Results

In 70% of previously sensitized animals, the patch test confirmed the sensitivity to nickel. In 60% of previously non-sensitized animals, a positive reaction to nickel occurred. The results of patch tests in control group were negative. Percentage of eosinophils in peripheral blood was fourfold higher in animals sensitized to nickel than in control group. In histological examination, in the tissue surrounding the implant a dissimilarity concerning the intensity of cellular infiltration was observed between animals previously allergic and non-allergic to nickel. In the 2 of 10 previously sensitized guinea pigs quite severe inflammatory reactions in the inside of connective tissue capsule were noted which may indicate a local allergic reaction. The histological images of skin collected from the positive patch test site corresponded with the typical allergic contact dermatitis.

Conclusions

Nickel implants may cause primary sensitization to nickel. The nature of the histological changes in the tissues around the implants in guinea pigs sensitized to nickel may correspond to an allergic reaction. The examination of percentage of eosinophils in blood of guinea pigs may be useful in assessing the allergenic activity of metal alloys containing nickel.     

沈阳地区过敏原皮肤试验结果的城乡对比分析

为了解过敏原皮试在人群中的阳性率及城乡患者间差别,用皮肤针刺法,对２２８３ 人进行过敏原调查。发现螨的阳性率最高为２６８ ％ ,灰尘次之,在农村健康人、慢性气管炎及哮喘间皮试结果无显著差别。男性对灰尘和螨的皮试阳性率明显高于女性。城市１８８４ 例患者的皮试阳性率哮喘为７０８ ％ 、慢性气管炎５７７ ％ 、荨麻疹７５６ ％ 、过敏紫癜６９２ ％ 。慢性支气管炎及哮喘患者皮试阳性率城市明显高于农村。提示：清除环境中尘螨对预防变态反应疾病有重要意义。     

Skin and respiratory allergic disease caused by polyfunctional aziridine

BACKGROUND: Polyfunctional aziridine (PFA) hardener is increasingly used in water-based paints and inks as a replacement for organic solvents. Allergic contact dermatitis, contact urticaria, respiratory allergy in occupationally exposed patients with hypersensitivity to PFA are reported. OBJECTIVES: The aim was to study a population of adhesive tape printers for occupational respiratory and skin sensitisation to PFA hardener. Also 2 cases of occupational asthma in workers exposed to PFA in tanneries are reported. METHODS: A standard series prick and patch tests was carried out on 15 workers with skin symptoms out of 36 adhesive tape printers exposed to PFA. Prick tests with a 1% PFA water solution and patch tests with a dilution series (0.1-0.32-0.5-1%) of PFA in petrolatum were performed. Lung and nasal provocation tests with PFA hardener were also carried out on 4 subjects with skin and respiratory symptoms. RESULTS: Skin sensitivity to PFA prick tests was demonstrated in 8.3% of the exposed population; 22.2% of the exposed workers suffered from allergic contact dermatitis due to PFA with positive patch tests for this compound. One case of occupational rhinitis due to PFA was diagnosed. CONCLUSIONS: PFA is a strong sensitizer and the use of gloves and protective clothing appears to be insufficient to prevent occupational allergic diseases. Elimination of PFA from production processes is desirable.     

Occupational allergy in health personnel

BACKGROUND: Health care workers are exposed to many agents that can cause irritant or allergic contact dermatitis. In nurses with eczema of the hands latex sensitivity can play an important role in the occurrence of urticaria, rhinitis and asthma. OBJECTIVES: To determine the prevalence of irritant and allergic contact dermatitis and contact urticaria and the role of skin sensitization to common and occupational haptens and allergens in a group of health care workers with skin problems. METHODS: Retrospective review of 204 health care workers assessed by prick and patch testing in an occupational health clinic. RESULTS: The diagnoses included 35.3% with irritant contact dermatitis, 64.7% with allergic contact dermatitis and 7.3% with contact urticaria to latex. Three workers complained of asthma and 5 complained of rhinitis related to latex sensitization. At present 12.9% of atopic subjects were sensitized to latex by skin prick against 21.9% in 1998, so sensitization showed a decline in the years considered. CONCLUSIONS: Contact dermatitis and sensitization to natural rubber latex is a significant problem and nurses should be tested for both types of hypersensitivity, as well as being patch tested to standard, rubber and disinfectants series. The need is stressed for preventive measures to prevent the onset of contact dermatitis and to avoid latex exposure.     

Occupational skin diseases in Czech healthcare workers from 1997 to 2009

Background

The healthcare sector ranked in second place among economic sectors in the Czech Republic, with about 11.4 % of all occupational diseases in 2009. Skin diseases constituted about 20 % of all occupational diseases.

Objectives

The aim of this study was to analyze the causes and trends in allergic and irritant-induced skin diseases in the healthcare sector.

Methods

The data concerning occupational skin diseases (Chapter IV of the Czech List of Occupational Diseases, non-infectious skin illnesses) in the healthcare sector were analyzed from the Czech National Registry of Occupational Diseases from 1997 until 2009. The trends in the total counts and most frequent causes were evaluated.

Results

During the past 13 years, a total of 545 skin diseases were acknowledged in healthcare workers. Allergic contact dermatitis was diagnosed in 464 (85 %), irritant contact dermatitis in 71 (13 %) and contact urticaria in 10 subjects (2 %). Ninety-five percent of the patients were females. The overall incidence in individual years varied between 1.0 and 2.9 cases per 10,000 full-time employees per year. Disinfectants were the most frequent chemical agents causing more than one third of all allergic skin diseases (38 %), followed by rubber components (32 %) and cleaning agents (10 %).

Conclusion

A general downward trend of diagnosed cases of occupational skin diseases in heath care workers in the Czech Republic over the past 13 years was demonstrated.     

常见变应性疾病吸入性变应原检测结果分析

目的研究沧州地区吸入性变应原在变应性疾病分布等方面的特点,为治疗和预防提供依据。方法 对2009-2010年诊断为慢性荨麻疹、变应性鼻炎、哮喘、变应性结膜炎患者共302例和对照组43例进行了18种吸入性变应原的皮肤点刺试验,对检测结果进行分析。结果 302例变应性疾病患者中192例变应原呈阳性反应,阳性率63.6%,变应原皮肤点刺试验阳性率前4位的变应原依次是尘螨、尘土、蒿属花粉、黑曲霉;慢性荨麻疹患者的变应原阳性率为42.9%低于变应性鼻炎、哮喘、变应性结膜炎患者的阳性率71.7%、79.6%、70.3%;儿童组变应原阳性率70.6%高于成人组60.0%。结论 尘螨、尘土、蒿属花粉是沧州地区主要变应原;对于慢性荨麻疹患者应注意变应原以外的其他原因;随年龄的增长变应原阳性率降低。     

Occupational asthma and rhinitis in workers from a lasamide production line

OBJECTIVES: A wide range of low-molecular-weight agents can cause occupational asthma. The chemical industry is an environment in which numerous hazardous substances are used. Lasamide (2,4-dichloro-5-sulfamoylbenzoic acid) is one of them (along with its precursors). METHODS: Five patients from a lasamide production line with suspected occupational asthma and rhinitis were examined. During the first visit, skin prick tests, total immunoglobulin E (IgE), a nonspecific bronchoprovocation test, and specific bronchoprovocation tests using occupational agents were performed to confirm the diagnosis of allergic diseases. During the follow-up visit (1-3 years after removal from exposure), all of the tests (except the specific bronchoprovocation test) were performed again. RESULTS: At the first hospitalization, the total IgE levels were increased in three patients. In addition, skin prick tests and the nonspecific bronchoprovocation test were positive for three patients. After the specific bronchoprovocation test, serious bronchoconstriction occurred in three patients; symptoms of rhinitis were present in all five patients. Several years after removal from exposure to the occupational agents, normalization (with respect to the parameters followed) was not yet complete for all of the patients. CONCLUSIONS: The process of lasamide production seems to be hazardous and is likely to cause allergic respiratory disease. The prognosis of allergic diseases caused by these products is not very favorable. Allergic symptoms (despite the removal from occupational allergen exposure) persisted even after several years.     

环境接触性因素在面部皮炎发病中的作用分析

目的研究环境接触性因素在面部皮炎发病中的作用。方法通过常见环境过敏原斑贴试验及问卷调查,对60例面部皮炎患者进行了研究。结果28例（46．7％）确诊为接触性皮炎,其中1例职业性接触性皮炎;10例其他原因皮炎;22例不能排除环境接触因素的作用,为可疑接触性皮炎。这些患者斑贴阳性率为60％,仍不能忽视接触过敏因素的作用。结论斑贴试验阳性结果与疾病的联系是寻找病因或加重因素的关键。     

180例皮炎湿疹类患者斑贴试验结果分析

目的探讨溧水地区常见变应原种类,以更好地预防和治疗过敏性皮肤病。方法应用"瑞敏"牌斑贴试剂盒对180例(面部皮炎106例,手部湿疹47例,外阴湿疹27例)过敏性皮肤病患者进行皮肤斑贴试验,并以36例健康者为对照。结果过敏组斑贴试验阳性率74.44%,高于对照组(2.78%)(χ2=66.58,P0.01),3组病例间差别无统计学意义。常见过敏原依次为硫酸镍(23.89%)、卡巴混合物(20.00%)、芳香混合物(19.44%)、重铬酸钾(17.22%)、对苯二胺基质(13.89%);3组病例中均有超过半数的病例存在2种及以上的阳性变应原;男女性患者斑贴试验阳性率差异有统计学意义的变应原,分别为卡巴混合物(33.33%,13.82%)、芳香混合物(12.28%,22.76%)。结论硫酸镍、卡巴混合物、芳香混合物、重铬酸钾、对苯二胺基质是引起溧水地区皮炎湿疹类患者的主要变应原。     

Dermal testing of vaccines for children at high risk of allergies

Vaccinations for children with allergic diseases often need to be postponed or terminated because of the presumed risk of an immediate-type allergic reaction such as anaphylaxis. A new skin test protocol for predicting allergic reactions using the vaccine itself and the following stepwise vaccination method were developed and tested. Intradermal tests using 1:10 and 1:100 diluted measles vaccine indicated that the former was superior to the latter because a positive reaction against 1:10 diluted vaccine was found in 28.6% of 49 patients with severe allergic diseases including bronchial asthma, atopic dermatitis, food allergies and allergies to two or more allergens with high levels of IgE, as compared with the reaction against 1:100 diluted vaccine in 10.2% of the patients. Patients negative for 1:10 skin tests were safe from the following full-dose vaccine shots. Three patients showed very strong local reactions against measles vaccine, and avoided receiving the following full-dose shot. Positive reactions to skin tests of 1:10 diluted vaccine were found in 11 patients, who were given stepwise vaccinations. Three patients had adverse reactions, and two of them had been negative for 1:100 skin tests. In the case of influenza vaccine, skin tests were again more sensitive to 1:10 than to 1:100 diluted vaccine, because 3 out of 14 patients with positive reactions showed immediate-type adverse reactions against the following stepwise vaccinations, and 1 of them was negative for the 1:100 skin test. Moreover, the results of the skin prick test (undiluted vaccine) and the intradermal skin test (1:10 diluted vaccine) indicated that the latter was more useful in both cases of measles (54 patients) and influenza vaccine (69 patients). Overall, the skin test using 1:10 diluted vaccine was the more suitable for predicting an immediate-type reaction to measles and influenza vaccinations. Patients having negative 1:10 skin tests can be expected to show no adverse reactions to the remaining injections and even the positive subjects will complete the course of vaccine doses by the stepwise method.     

Allergy to betalactams: myth and realities

Allergic reactions to penicillins have been reported since the 1950s, shortly after their introduction as therapeutic agents. An increasing number of reported anaphylactic reactions and other adverse effects proved this to be a serious public health problem. Fifty years later, betalactam-induced hypersensitivity is the most frequent cause of drug reaction and has been the source of a great number of publications. Clinically, betalactam-induced allergic reactions may be immediate or non-immediate according to the time interval between drug intake and the occurrence of symptoms. The diagnosis of betalactam hypersensitivity is based on skin tests methods, in vitro tests and drug provocation test. There are three classical methods for skin testing: prick, intradermal, and patch. These tests are still the most sensitive techniques. In vitro tests, mainly based on the quantification of IgE antibodies to betalactams by immunoassay (Fluorescent Enzyme Immunoassay [FEIA]), may sometimes yield useful complementary information. Drug provocation tests must be performed with the required caution and the adequate indication. Algorithms are available for both immediate and non-immediate reactions to provide a practical approach for patient evaluation. They are based on the following data: clinical history, skin tests, FEIA, and drug provocation tests. Finally, cross reactivity between betalactams has been reported, especially between penicillins and cephalosporins. Their frequency was long over-estimated, but recent evidence, indicates that cross reactivity between betalactams has become rare. Administration of cephalosporins in patients with a history of penicillin allergy requires performing skin testing with penicillin, the probably allergenic drug, and the cephalosporin to be prescribed.     

Allergic cutaneous diseases in hairdressers

BACKGROUND: Hairdressers are commonly exposed to water, irritants, sensitizers, and are at risk of occupational skin diseases. Several cases of allergic contact dermatitis and contact urticaria in hairdressers have been described over the last few years. OBJECTIVES AND METHODS: The paper aims to report occupational agents which can induce allergic cutaneous diseases in hairdressers; moreover an analysis of the literature was carried out to review data concerning epidemiology, clinical evaluation, management and prevention. RESULTS AND CONCLUSIONS: Hairdressing carries a high risk of skin damage, especially for the hands. Allergic contact dermatitis is the most common disorder. Training represents a risk factor, while the role of atopy and nickel sensitivity as etiological agents is controversial. A great number of chemicals may induce allergic cutaneous diseases in hairdressers, such as nickel, thioglycolate, p-phenylendiamine (and other dye-related substances), persulphates, quaternary ammonium compounds, protein hydrolysates, surfactants, cyanoacrylates, latex, rubber haptens and others. Avoidance of further contact with the identified causal sensitizer(s) is the most important measure for management and prevention; to this end, a number of specific preventive strategies should be implemented.     

Possible Improved Technique of Skin Patch Testing

A patient with quinine-induced thrombocytopenic purpura was skin tested with a saturated solution of quinine hydrochloride by an occlusive patch test method which, to our knowledge, has not been described in the literature. The method evoked a definite positive skin reaction to quinine at 48 hours. In light of previous experience indicating the spurious results obtained with skin patch testing, it is believed that this simple occlusive technique may have application in patch testing individuals to other suspected contact or systemic allergens.     

Allergic contact dermatitis

Allergic contact dermatitis is a common skin condition that can be difficult to diagnose without the aid of a specific diagnostic tool called patch testing. The pathophysiology, clinical features, diagnosis, and treatment of allergic contact dermatitis are summarized in this review. The process of patch testing, the gold standard for diagnosing allergic contact dermatitis, is discussed in detail.     

对农药引起敏感性疾病的综合、系统预防体系

由于职业原因，农业从业人员会在劳动中接触大量、不同种类的农药，关于农药对农业从业人员的健康危害已经有大量的报道。因为缺乏适当的预防措施，在这些危害健康的疾病中，呼吸道和皮肤的过敏性疾病，尤其是接触性皮肤炎，已成为最严重的问题。但目前这种系统的、综合的预防体系还没有建立。为此，我们研究农药引起过敏性疾病的病因学和预防医学，主要的研究方法是使用吸入激惹试验对速发性过敏性疾病进行研究，使用贴附试验和豚鼠最大量实验对迟发性过敏性疾病进行研究，现在发展到使用细胞培养。目前，我们试图建立一种系统、综合和连续的预防体系对于发现农药对农业从业人员致敏因素和建立适当的控制措施。根据我们的研究结果，我们的预防体系包括以下6个步骤：通过专业采样调查发现可疑的致敏化学物质和工作环境因素；对致敏化学物质进行文献检索，查找有无致敏作用的相关报道；对致敏因素的可靠性进行证实；如果没有可疑化学物质致敏的相关文献报道，就通过实验研究证实可疑化学物质的致敏作用和机制；建立对农业从业人员工作环境的保护体系。最后，我们希望通过建立区域性的过敏和免疫中心，以便能有效地管理上述的预防体系。