Allergic contact dermatitis and conjunctivitis from epinephrine

A patient with chronic open-angle glaucoma was suspected of having allergic dermatitis and conjunctivitis to epinephrine. He was tested with epinephrine and other active substances, the preservatives and antioxidants usually used in the preparation of eye drops. He was also tested with other possible contactants with which he had had contact. The patient showed positive allergic patch test reactions to the chloride solution of epinephrine. The patient showed an unexpected positive reaction when tested with di-isopropyl fluorophosphate (DFP). The importance of routine patch testing in ophthalmic practice to detect sensitizers in cases of contact allergy is stressed.     

Allergic contact eczema from topical corticosteroids

Eptcutaneous tests with topical steroids in therapeutic and ten-fold therapeutic concentrations in ethanol were performed in 105 patients selected on the basis of unresponsiveness of their eczema to topical corticosteroids or because topical steroids had provoked eczema around treated psoriatic lesions. Five patients showed allergic test reactions to one or several steroids. One of the two clobctasol-17-propionate sensitive patients reacted to the weak concentration only. The problem related to the instability of many steroids in ethanolic solution is discussed. After one month of storage in u refrigerator, the chromatographic purity of several test substances fell to 95–75%.     

Allergic contact dermatitis from topical corticosteroids

22 cases of allergic contact dermatitis from topical corticosteroids were observed in Strasbourg and previously published. 7 further cases are reported here and the vehicle and concentration of corticosteroids for patch tests are discussed. A 0.1% concentration in petrolatum seemed adequate for testing the 4 molecules (triamcinolone acetonide, dexamethasone, desonide and amcinonide) responsible for the 7 new cases. In 1 case, several cross-reactions were seen. A corticosteroid screening series permits patch testing of the suspected molecule(s) in a selective way. Without this series, long delays are required to make the correct diagnosis by patch testing. We have reviewed more than 60 papers on corticosteroid allergy published up to now.     

Allergic contact dermatitis due to rubber chemicals in haemodialysis equipment

6 of 80 haemodialysed patients developed a sub-acute eczematous dermatitis of the area surrounding the arteriovenous shunt in the forearm. Patch tests were positive to rubber chemicals: 6 patients reacted to the thiuram group, 4 of them also to carba compounds. Since the equipment contained only small pieces of rubber, the cause of the allergy remains obscure. It is possible that allergy was caused by short and intermittent contact of the skin with the rubber gloves used by the nursing personnel.     

Allergic contact dermatitis to cow's hair

A 32-year-old farmer woman with delayed type of allergy to cow's hair is described in this study. She had the 5-year history of erythematous, desquamative lesions on the dorsal side of the hands and forearms. Shortly after entering the cowshed, she showed relapse of skin symptoms and total regression when she was away from the farm. The patch test to European standard series, hair of the cow from the patient's cowshed, hay, and stable hay was performed. Additionally, prick tests were performed on inhalant allergens such as hair of the cow from the patient's cowshed, hay, stable hay and cow's milk, total immunoglobulin class E (IgE) together and specific IgE to cow dander and milk. Patch test showed positive reaction to cow's hair, cobalt chloride, nickel sulfate, and thimerosal. All other tests were negative.     

Allergic contact dermatitis in venous leg ulcer patients

Our aim was to determine the frequency and nature of contact sensitivity in venous leg ulcer patients in Lanarkshire. We performed patch testing with the European standard series, antimicrobials and medicaments on 200 patients referred to our leg ulcer clinics. Positive patch tests were found in 136 (68%) patients. Multiple allergies occurred in 102 (51%). The most frequent allergen groups were fragrances (30.5%), antimicrobials (19.5%), topical excipients (19.5%), rubber accelerators (13.5%) and topical corticosteroids (8%). We also found a high prevalence of positive patch tests to Intrasite gel (9.5%) and Hioxyl cream (8.5%), medicaments which are commonly used to treat leg ulcers in our area. Contact sensitivity is common in venous leg ulcer patients and has important implications for patient management. The allergens involved vary depending on local nursing practice. We suggest that all venous leg ulcer patients be patch tested with a locally relevant patch test series.