Allergic contact dermatitis in veterinary surgeons

Thirty-six of 37 veterinary surgeons with incapacitating dermatitis had allergic contact dermatitis, mainly from antibiotics such as spiramycin, Penethamate BP and tylosin. Eight were sensitive to rubber materials. Twenty of 36 had positive prick or scratch tests, mainly to animal hair. The atopic sensitivities were relevant to the contact dermatitis since most of those who have them develop contact reactions from cows' hair and from obstetric work with cows. Protein contact dermatitis seems to be an important predisposing factor for the development of incapacitating allergic contact dermatitis in veterinary surgeons.     

Serum eosinophil chemotactic factor levels in patients with bullous pemphigoid, drug reactions and atopic eczema.

The sera of 4 patients with bullous pemphigoid, of 5 patients with drug reactions and of 13 patients with atopic eczema were examined for the occurrence of low molecular weight eosinophil chemotactic factor (ECF) by fractionation on a Sephadex G 25 column. Almost all patients had a peripheral eosinophilia, and many had raised total serum IgE levels. ECF was demonstrated in the sera of all 4 patients with bullous pemphigoid and in 4 of 5 patients with systemic drug reactions. In contrast, the sera of the 13 patients with atopic eczema did not contain any ECF activity, nor did the 13 control sera. These findings suggest that the ECF from phagocytosing polymorphonuclear leukocytes (PMN) and/or the mast cell derived ECF-A contribute to the elevated serum ECF levels in patients with bullous pemphigoid and drug reactions. A correlation between serum ECF and IgE levels and peripheral eosinophilia could not be established.     

Orange-induced skin lesions in patients with atopic eczema: evidence for a non-IgE-mediated mechanism

Oranges are suspected of inducing adverse skin reactions in patients with atopic eczema. We studied 21 adult patients with atopic eczema and a history of adverse reactions to oranges and 10 patients without. A dietary history, skin tests, serum IgE and oral provocation tests with oranges were obtained. Severity of eczema was monitored by SCORAD, and serum tryptase, eosinophil cationic protein and urinary methylhistamine were measured. No allergic reactions were found to orange in skin prick or patch tests. However, 23 patients (74%) had specific serum IgE to orange. Oral provocation testing resulted in pruritic eczematous or maculopapular skin lesions predominantly at the predilection sites in 16 patients (52%). The SCORAD increased significantly in patients positive to the oral provocation test (p <0.05). Specific IgE to orange did not correlate with the clinical outcome of the oral provocation test. No significant changes were found in serum mast cell tryptase, eosinophil cationic protein or in urinary methylhistamine excretion. The negative results in the skin tests and a lack of correlation between specific IgE and oral provocation tests indicate that non-IgE-mediated mechanisms are involved in cutaneous adverse reactions to oranges in patients with atopic eczema.     

IgE antibodies to Pityrosporum ovale in atopic dermatitis

An enzyme-linked immunosorbent assay (ELISA) was developed to assess serum IgE antibodies directed against Pityrosporum ovale in patients with atopic dermatitis (AD), atopic patients with allergic respiratory disease (ARD: rhinitis or asthma) but without eczema, and in healthy controls. IgE binding to P. ovale extract was demonstrated in 49% (35/72) of AD patients. In contrast, anti-P. ovale IgE was found in only one of 27 atopic controls without eczema; all healthy control sera (n = 17) were negative. Of 37 AD patients tested intracutaneously with P. ovale, 31 showed immediate-type reactivity, and 20 of these 31 patients had anti-P. ovale IgE detectable by ELISA, while sera from the six non-responders were all negative. Levels of anti-P. ovale IgE were highest in AD patients aged 20-30 years. No correlation was found with the severity of AD, but there was a non-significant tendency (P = 0.06) to higher levels in AD patients with concomittant respiratory allergy. Anti-P. ovale IgE was significantly correlated with total serum IgE, with specific IgE against various aeroallergens as measured by RAST, and with levels of anti-Candida albicans IgE, measured with a similar ELISA. Thus, production of IgE antibodies against P. ovale occurs very frequently in AD, and rarely in patients with atopic disease without skin involvement.     

Skin and respiratory tract symptoms in veterinary surgeons

Chronic or relapsing irritant eczema of the hands was the main complaint in 34 veterinary surgeons. 9 had contact allergic eczema of occupational character. In 8 cases, the allergies were probably due to antibiotics contaminating the skin during the administration of treatment. Contact allergy to penicillin was observed in 5 cases, to neomycin in 2 and to streptomycin in 1 case. Sensitivities to other work-related substances such as rubber chemicals, antiseptics and local anaesthetics were found in 6 cases. Multiple contact allergies, in particular to different penicillins, were seen frequently. Obvious work-related immediate reactions of probable allergic type were present in 10 cases, but were confirmed with positive RAST or prick test in only 2 cases.     

IMMUNOGLOBULIN E IN "HEALED" ATOPIC DERMATITIS AND AFTER TREATMENT WITH CORTICOSTEROIDS AND AZATHIOPRINE

SUMMARY.— In patients with atopic dermatitis, eczema and urticaria, systemic treatment with prednisone had no effect on the serum immunoglobulin E level (IgE) but improved their clinical condition. Neither was there any effect on the IgE level after the immunosuppressive, azathioprine. The increased level of IgE found in patients with atopic dermatitis was not seen in those who had been free from symptoms for more than a year even if they had a persistent or recurring eczema of the hands or nummular eczema.     

特应性皮炎和湿疹患者血清金黄色葡萄球菌肠毒素B特异性抗体的检测及其意义

目的 探讨特应性皮炎(AD)和湿疹患者血清金黄色葡萄球菌肠毒素B(SEB)特异性抗体水平及其意义。方法 采用多中心、随机双盲、对照法,将118例AD和207例湿疹患者分为莫匹罗星治疗组和对照组,于治疗前和治疗28d取血清行间接酶联免疫吸附测定法测定抗SEB特异性IgG、IgM水平,采用链霉亲和素-生物素法检测抗SEBIgE水平。结果 治疗前,抗SEBIgE水平AD组显著高于正常人对照组(P=0.019)和湿疹组(P=0.048),湿疹组与正常人对照组之间差异无统计学意义(P=0.883);抗SEBIgM水平AD组(P=0.012)和湿疹组(P=0.000)均显著高于正常人对照组,AD组与湿疹组之间差异无统计学意义(P=0.088);抗SEBIgG水平各组间均差异无统计学意义(P=0.897)。临床症状评分与抗SEBIgE水平之间AD组(P=0.842)和湿疹组(P=0.134)均无显著相关性。治疗28d后,抗SEBIgM水平AD组显著下降(P=0.003),湿疹组亦显著下降(P=0.000),但治疗组与对照组间AD组(P=0.331)和湿疹组(P=0.815)差异均无统计学意义。结论 AD和湿疹患者血中抗SEBIgM、IgE升高,反映皮损处近期金黄色葡萄球菌定植并参与了皮肤变应性炎症性反应。     

SERUM IGE LEVEL AND WHITE DERMOGRAPHISM IN ATOPIC DERMATITIS,ATOPIC SKIN,AND INFANTILE ECZEMA

Serum IgE levels and white dermographism were evaluated in atopic dermatitis, atopic skin, and infantile eczema. Elevated serum IgE levels were found in some atopics. In atopic dermatitis there was an increase in serum IgE levels and a more constant presence of white dermagraphism in association with increased severity of dermatitis. Likewise, in atopic skin there was an association of increased serum IgE levels with white dermographism. In infantile eczema, IgE was not increased above normal adult levels nor was there white dermographism.     

Occurrence of IgE-bearing epidermal Langerhans cells in atopic eczema: a study of the time course of the lesions and with regard to the IgE serum level

Uninvolved and lesional skin of untreated and treated patients with atopic eczema has been investigated immunohistochemically to determine the conditions in which IgE-bearing CD1a+ Langerhans cells/indeterminate cells (LC/IC) occur in this disease. IgE-bearing epidermal dendritic cells were present in patients with elevated IgE serum level (greater than 300 UI/ml) and the staining pattern was stronger in lesional skin. On double immunostaining, a subpopulation of CD1a+ LC/IC was found not to bear IgE molecules as determined by the ratio IgE+/CD1a+ cells on serial sections as well. The ratio IgE+/CD1a+ cells decreased in patients who underwent a local therapy with glucocorticosteroids. These results suggest that the expression of IgE receptors and/or binding of IgE molecules on epidermal LC/IC in atopic eczema may be controlled by a complex network of mediators from the epidermis or the inflammatory infiltrate, or both, and that this phenomenon could be down regulated by glucocorticosteroids.     

Palmar skin is not involved in severe atopic eczema.

Irritant hand eczema is a well-known risk in adults, who have suffered from severe atopic dermatitis during childhood. We therefore studied the involvement of the skin on the hands in 29 consecutive patients admitted for severe atopic dermatitis. Only 5 of the 29 patients had eczema in the palmar skin (p less than 0.01; sign test). There was no correlation with the existence of hyperlinearity, extent of disease, concomitant asthma, total serum IgE or work.     

House dust mite allergy and atopic eczema:a case report

Sequential measurements were made of total and specific serum IgE concentrations in an adult patient with severe atopic eczema. Initially, the total serum IgE concentration and the concentration of IgE antibody to house dust mite were very high. These concentrations decreased over the next 3 years, following amelioration of her eczema. However, they rose again when her eczema worsened as a result of marital problems and fell once again with amelioration of her eczema after separation from her husband. The IgE concentrations to other common allergens, however, remained stable during this period. These results suggest that large amounts of house dust mite antigen may be scratched into the skin during clinical exacerbations of the eczema, this in turn aggravating the state of the skin because of hypersensitivity to the mite.     

Protective and curative effects of topically applied CX-659S,a novel diaminouracil derivative,on chronic picryl chloride-induced contact hypersensitivity responses

BACKGROUND: CX-659S, a newly discovered anti-inflammatory compound, exerts inhibitory effects against acute contact hypersensitivity responses (CHRs) induced by picryl chloride (PC), oxazolone and dinitrochlorobenzene. The murine model of chronic CHR induced by repeated application of PC is known to mimic many, if not all, events occurring within the lesional skin of patients with atopic dermatitis (AD). OBJECTIVES: To investigate the ability of CX-659S to inhibit PC-induced chronic CHR in mice. METHODS: The protective and curative effects of CX-659S were tested on PC-treated ears of BALB/c mice, and were compared with those of prednisolone. Effects were quantified by measurements of ear thickness, serum IgE and cytokine mRNA expression. RESULTS: Both protectively applied and curatively applied CX-659S significantly inhibited increases in ear thickness and total serum IgE. Inhibition was dose-dependent. Although protectively applied prednisolone showed similar activities to CX-659S against chronic CHR, curatively applied prednisolone did not affect the serum IgE level despite inhibiting increases in ear thickness and inflammatory cell infiltration. Consistent with these results, CX-659S reduced mRNA expression of interleukin (IL)-4 and IL-10 but not of interferon (IFN)-gamma, whereas prednisolone inhibited not only mRNA expression of IL-4 and IL-10 but also that of IFN-gamma in the ear lesion. In contrast to prednisolone, CX-659S did not show any side-effect such as atrophy, alopecia or telangiectasia. CONCLUSIONS: CX-659S is the first promising compound having inhibitory activities against chronic CHR accompanied by a diminishing effect on elevated serum IgE, without any other side-effect. Therefore, CX-659S may be a promising candidate for management of patients with recurring AD who require long-term therapy.     

Factors influencing prognosis for occupational hand eczema: new trends

Hand eczema is a common skin disease causing itchy skin patches on the hands, which can have a significant impact on the quality of life of affected individuals. Occupational hand eczema is when the condition is caused or made worse by factors in the workplace. Occupational hand eczema affects up to 30% of people in ‘high risk’ occupations, such as jobs like hairdressing in which the hands stay wet for prolonged periods (known as wet work) or where the hands come into contact with irritants or allergens. In this study the authors, based in Copenhagen, Denmark, looked at factors influencing the prognosis (likely outcome, such as whether or not it will improve) for occupational hand eczema. By using files from the Danish Labor Market Insurance, patients with occupational hand eczema in the period January 2010 to December 2011 were identified and included in the study. Information on gender, age, occupation, wet work, atopic eczema (a common type of eczema in childhood) and contact allergy (skin allergy caused by contact with an allergen) was obtained from the files. In 2015, participants received a questionnaire about lifestyle factors, occupation and persistence of hand eczema. A total of 1491 out of 2703 patients responded to the question regarding persistence of hand eczema and were included in the study. A total of 19.3% of patients reported that their hand eczema had completely healed. Current tobacco smoking and a high level of stress were factors associated with persistence of hand eczema, while a high level of exercise was significantly related to healing of eczema. Change of profession was a favorable prognostic factor (meaning it led to improvement), while age, gender, atopic eczema, contact allergy and education did not significantly influence the prognosis. The study showed that traditionally important risk factors such as atopic eczema and contact allergy had no marked influence on prognosis, while lifestyle factors were of major importance. The findings indicate that risk factors may vary over time, allowing for new perspectives on prevention, with increased focus on lifestyle factors.     

Allergic contact dermatitis from dyes in wigs following diphencyprone treatment

Objectives:  To investigate symptoms from the eyes and airways, elicited by perfume and fragrance products and associations between such symptoms and skin prick test reactivity, metacholine bronchial hyperreactivity (BHR), contact allergy, and eczema in a population based sample.
Methods:  A questionnaire on mucosal symptoms elicited by fragrance products was mailed to 1189 persons who had participated in a Danish population‐based study of allergic diseases in 1997/98. The study included measurement of BHR, skin prick testing, patch testing and history of hand eczema.
Results:  The response rate to the questionnaire was 80%. Symptoms from the eyes or airways elicited by fragrance products were reported by 42%. There were no significant associations between these symptoms and skin prick test reactivity. Positive and independent statistical significant associations were found between BHR, perfume contact allergy and hand eczema, and symptoms from the eyes and airways elicited by fragrance products, also when adjusting for nickel contact allergy, age, gender psychological vulnerability, educational level and social class.
Conclusions:  Individuals with BHR, hand eczema and/or perfume contact allergy, as opposed to those without, are more frequently and more severely bothered from the eyes or airways after volatile exposure to fragrance products. The lack of association with skin prick test reactivity indicates that IgE mediated allergic mechanisms do not play a major role in the development of these symptoms. Having hand eczema has the greatest impact on reporting mucosal symptoms elicited by fragrance products.     

湿疹皮炎患者过敏原特异性IgE检测阳性结果的多中心研究

目的 探讨湿疹皮炎患者血清过敏原检测常见的阳性过敏原及其临床意义。 方法 回顾性分析中国10家医院皮肤科就诊并进行了血清变应原特异性IgE检测且至少一项阳性的湿疹皮炎患者。 结果 458例患者纳入研究,其中男209例（45.63%）,女249例（54.37%）,年龄（28.13 ± 23.11）岁。前3位常见阳性过敏原为蟑螂（180/458,占39.30%）、尘螨组合（152/458,占33.19%）、花生（116/458,占25.33%）。89.66%（26/29）特应性皮炎患者及86.84%（33/38）面部湿疹患者存在多种过敏原。皮损相对泛发者过敏率（88/110,占80%）较皮损相对局限者（245/348,占70.40%）高,差异有统计学意义（χ2 = 3.880,P = 0.049）。吸入变应原阳性率在11 ~ 20岁年龄组最高（39/43,占90.70%）;牛奶（26/98,占26.53%）、牛肉（19/98,占19.39%）,特异性IgE 阳性多见于3岁以下婴幼儿。北方与南方常见变应原不同,艾蒿、蟑螂、牛奶、黄豆、牛肉、淡水鱼特异性IgE阳性率（10.35%、42.42%、14.39%、13.89%、11.36%、13.38%）均分别高于南方（1.61%、19.35%、3.23%、3.23%、1.61%、3.23%）,差异有统计学意义（?字2 = 4.917、11.959、5.958、5.594、5.641、5.235,均P < 0.05）。 结论 蟑螂是湿疹皮炎患者致敏率较高的变应原,临床意义值得研究。面部湿疹及特应性皮炎更容易多发过敏。年龄是影响变应原致敏的较重要因素。不同地域常见变应原不同。     

Thymosin-inducible ''null'' cells in atopic eczema

Thirty children with atopic eczema were compared with an equal number of age-matched healthy children. The mean peripheral blood T-lymphocyte level was lower in the eczema group (mean 1,197/mm2 as against 1,702/mm3; P = 0 . 003). This difference was abolished in vitro by thymosin, a thymic hormone extract. Positive correlations were found between eczema severity and: eosinophilia; hyperimmunoglobulinaemia E; but not T lymphopaenia. Thymosin-inducible T-cell (Ti) counts correlated with plasma IgE levels, suggesting that these Ti cells may be immature suppressor T cells. If this T-cell deficiency represents inadequate suppression of IgE responses, then a trial of treatment with thymosin appears to be warranted.     

Immune status in atopic eczema: a survey

We have searched the literature for data on the in vitro assessment of immune status in atopic eczema patients, and have found much confusion. The major findings are tabulated. It is concluded that atopic eczema is a form of immune deficiency, although it is unclear whether this is a primary or secondary defect. Most authors find a T-lymphocyte deficit while eosinophils, B lymphocytes and serum IgE are increased. Serum IgE levels appear to correlated with severity of eczema symptoms. We have previously suggested that T-lymphocyte levels are overestimated in eczema when fetal calf serum is used in the E-rosette assay. Analysis of the literature for the effect of this serum in the assay confirms that there is a T-lymphocyte deficit in atopic eczema, but that the serum masks it. Thus, much of the confusion surrounding this issue can be resolved.     

Unclassified endogenous eczema

Patients with intractable eczema are often referred for patch testing to exclude contact dermatitis. If this is excluded, then a diagnosis of endogenous eczema is made. At our clinic, we find a sizeable proportion of these patients do not fit any of the known patterns of endogenous eczema. These patients are given the diagnosis of unclassified endogenous eczema and make up 8% of the patients seen at our Occupational and Contact Dermatitis Clinic. There is little information available on this group of patients, with no mention of this problem in the recent dermatological literature. Since March 1996, we have further investigated these patients, to develop some understanding of this category. 12 of 34 patients reviewed over this period had an elevated IgE level above 100 IU/ ml. Thus, despite no past history or family history of eczema, asthma or hayfever, at least 1/3 of these patients are probably suffering from atypical, late onset atopic dermatitis. Patients were later contacted by telephone (average 2 years) to assess the natural history of this condition. In 20 of the 31 patients contacted, their eczema had either improved or resolved. We think that this important category of eczema needs to be recognized and further investigated.     

牛乳蛋白敏感的婴儿湿疹患者生长发育过程中体内牛乳蛋白sIgE及血清总IgE的变化

目的:分析对牛乳蛋白过敏的婴儿湿疹患者在生长发育过程中特异性牛乳蛋白sIgE、血清总IgE和皮损表现的变化.方法:回顾性分析2015年7月至2020年7月57例严重婴儿湿疹患儿,观察期间(30个月)食用乳蛋白配方奶粉(氨基酸配方),严格规避牛乳蛋白及其制品,于入组开始和结束时评估患儿皮损积分,检测患儿血清牛乳蛋白sIg...     

Sensitization to the yeast Malassezia sympodialis is specific for extrinsic and intrinsic atopic eczema

The opportunistic yeast Malassezia sympodialis belongs to the normal cutaneous flora but can also cause IgE-mediated sensitization in patients suffering from atopic eczema (AE). We investigated 706 individuals by ImmunoCAPm70 and skin-prick tests with a crude M. sympodialis extract. In AE patients, we further performed skin prick tests, atopy patch tests, ELISA, and peripheral blood mononuclear cells proliferation assays with recombinant M. sympodialis allergens (rMala s 1 and 5-9). In 52/97 patients with AE-specific IgE against M. sympodialis was detectable. Almost no reactivity to M. sympodialis was seen in patients suffering from other allergic diseases (4/571) and no reactivity at all was seen in healthy controls (0/38). Skin tests showed variable recognition patterns against the different molecular structures with a predominant sensitization to rMala s 1, 5, 6, and 9, confirmed also by specific serum IgE to these allergens. Interestingly, IgE- and T-cell-mediated reactivity against M. sympodialis was also found in patients with the intrinsic form of AE. Thus, sensitization to M. sympodialis is specific for AE patients and occurs in both the extrinsic and intrinsic variant of eczema. Recombinant yeast allergens represent a useful tool to study molecular structures and differential sensitization patterns in the pathogenesis of AE.