新型斑贴试验的临床应用

斑贴试验是一种比较敏感和特异的检测过敏性皮肤病致敏原的手段,近年来在对斑贴试验的临床应用探索中,逐渐采用了检测光变应性皮肤病的光斑贴试验;应用于变态反应药疹的药物性斑贴试验以及应用于特应性皮炎的特应性斑贴试验等多种新方法,本文就新型斑贴试验的临床应用做一综述.     

177例皮炎湿疹类皮肤病斑贴试验结果分析

皮炎湿疹类皮肤病的发生和复发与外源性接触性致敏原有密切的关系.斑贴试验是公认的检测接触性变应原的一个简单易行的方法.我们对1997年～1999年在我科确诊为皮炎湿疹类皮肤病患者177例所做斑贴试验的结果进行分析,现将结果报道如下:     

317例斑贴试验结果分析

目的：探讨皮炎,湿疹类皮肤病接触性病因及发生规律。方法：用辨敏牌标准筛选斑贴试验试剂盒对患者做斑贴试验。结果：317例患者中阳性者218例,阳性率68．77％,其中湿疹,皮炎,荨麻疹的阳性率明显高于其他病种,痤疮,丘疹性荨麻疹,唇部色素沉着亦有阳性结果。结论：斑贴试验对皮炎,湿疹类皮肤病有确定的指导,防治意义,对某些不典型的皮肤病,如寻常痤疮,丘疹性荨麻疹,唇部色素沉着等应做斑试,以排除接触过敏的可能。     

402例过敏性皮肤病斑贴试验结果分析

目的分析过敏性皮肤病斑贴试验的结果及临床意义。方法对本科门诊确诊的402例过敏性皮肤病患者进行斑贴试验,并对结果作统计学分析。结果斑贴试验总阳性率57.5%,阳性率居前5位的变应原依次为:硫酸镍(33.1%)、白降汞(21.6%)、香料Ⅱ(10.2%)、重铬酸钾(5.7%)、橡胶Ⅳ(5.5%)。按照年龄分组,斑贴试验阳性数分布最高的是(31～40)岁组。结论硫酸镍、白降汞、香料Ⅱ、重铬酸钾、橡胶Ⅳ是本地区过敏性皮肤病的常见变应原,按年龄分组斑贴试验阳性数统计学差异有意义,斑贴试验对过敏性皮肤病寻找致敏原及防治具有重要的参考价值。     

湿疹皮炎类患者接触性变应原分析

目的探讨接触性变应原在湿疹皮炎类皮肤病的发生规律。方法采用瑞典进口“瑞敏牌”斑贴试验试剂盒对患者做斑贴试验,同时进行可疑因素评估:试验前医、患对可疑因素进行预估,并与试验后的结果进行对比。结果1 5 7例患者中,阳性9 6例,阳性率为6 1.1 5%,可疑因素评估显示患者预估符合率为1 0.0 0%,医生预估符合率为9.03%。结论湿疹皮炎类皮肤病临床表现多样,应做斑贴试验,以排除接触过敏的可能。医、患双方对可疑因素预估符合率都较低,说明接触性变应原致病临床表现复杂,仅凭印象判断是不准确的。     

林业工人中的职业性皮肤病

作者对印度尼西亚南苏门答腊的一家木材联合公司的林业工人的职业性皮肤病作了检查,并就调查结果及预防措施进行了讨论。该公司仅采伐二种木材,即Meranti(龙脑香科植物)和Jelutong(夹竹桃科植物)。所有的工作划分为调查、选择性砍伐、砍倒和锯断、堆存、运载等9个部分。在森林中心宿营的有60名工人,作者对其中45人作了调查,询问其工作过程、可能引起皮肤病的物质以及以往过敏史,检查了皮损的部位和表现,对怀疑由树汁、锯屑、树叶以及其他物质引起的接触性皮炎患者作了斑贴试验。调查结果:38人有皮肤病,由木材引起的接触性皮炎占很高的比例,各种皮肤病的发病率又和不     

遗传性皮肤病

941864 构经纤维瘤病患者染色体脆性部位的研究/郑丽芳…//中华皮肤科杂志。-1994,27(3).-141～143 采用低叶酸的培养条件,对20例神经纤维瘤病患者及正常人的外周血淋巴细胞染色体畸变及脆性部位研究发现,患者的染色体畸变率和脆性部位检出率均显著高于对照组(P<0.005),均携带两种以上的脆性部位;实验组平均细胞畸变率为15.90％,对照组为2.45％;实验组脆性部位检出率14.5％,对照组为2.4％。实     

906例皮炎湿疹类皮肤病斑贴试验抗原阳性率变化

皮炎湿疹类皮肤病的发生和复发与外源性接触性致敏原有密切关系.斑贴试验是公认的检测接触性变应原的一个简单易行的方法.我们对1990～1997年在我院皮肤科门诊确诊为皮炎湿疹类皮肤病患者906例所做斑贴试验的结果进行分析,同时比较了抗原阳性率变化情况,现将结果报道如下.     

652例过敏性皮肤病斑贴试验变应原分析

目的:分析我院过敏性皮肤病患者常见的接触性变应原.方法:回顾性分析我院门诊652例行斑贴试验的过敏性皮肤病患者资料,包括接触性皮炎249例、面部皮炎158例、湿疹87例、激素依赖性皮炎64例、特应性皮炎51例、唇炎43例,并对斑贴试验结果及不同年龄、性别阳性率进行比较分析.结果:斑贴试验总阳性448例(68.71％)....     

香脂相关的接触性皮炎

秘鲁香脂 (ＢＯＰ)或混合香料 (ＦＭ )斑贴试验阳性提示食用含香脂的食物或调料可能会诱发系统性接触性皮炎。作者通过回顾性研究观察了避免食用含香脂的食物是否可改善与之相关的接触性皮炎。材料和方法 :研究对象为一个三级皮肤病中心1998年 7月 1日至 12月 31日间通过斑贴试验拟诊接触性皮炎的所有患者。斑贴试验所用过敏原5 0个 (北美接触性皮炎协作组提出和其他 )。所有患者均为ＢＯＰ ,ＦＭ ,桂皮醛 ,妥鲁香脂中一种或两种以上阳性。依据斑贴试验结果 ,将患者分为Ａ ,Ｂ ,Ｃ 3组 :Ａ组为仅对上述过敏原中一种或多种敏感 ;Ｂ组为除上述…     

Prevalence of natural rubber latex allergy (Type I and Type IV) in laboratory workers in The Netherlands

The objective of the study was to study the prevalence of Type IV and Type I allergy to natural rubber latex (NRL) in a population at risk in the Netherlands. Laboratory workers regularly using gloves were invited to complete a questionnaire and to be tested. We performed patch tests with standard contact allergens, rubber additives, glove powder and pieces of 4 gloves; prick tests with inhalant allergens, glove extracts, glove powder and fruit extracts; and RASTs. Glove-related hand dermatitis was reported in 36.9% of the individuals interviewed. A positive patch test result for rubber additives was seen in only 6.6%. Glove-related urticaria, rhinoconjunctivitis and/or asthma were reported in 24.6% of all cases. Confirmation of an IgE-mediated reaction was achieved in 8.3% by prick test with glove extracts and 5.0% by RAST No reaction to glove powder was noticed in patch testing or in prick testing. A high prevalence rate of glove-related symptoms and NRL Type I allergy was found in laboratory workers exposed to rubber gloves. Surprisingly, there was no co-existence of Type I and Type IV allergy in this population.     

橡胶工业职业性黑变病75例调查分析

作者等于1978-1979年对10家不同类型橡胶厂作了职业性黑变病调查,共发现75例.计男性33名,女性4E名.色素沉着以面部为主.耳、颈、前臂亦较多见,少数累及躯干80%的患者在发病前和病程中.局部有不同程度的皮炎或皮肤搔痒.75名患者的发病时工种主要是硫化及成型.少数为配料及炼胶.经现场及临床资料分析,认为本组职业性黑变病的致病因子,主要是促进剂及防老剂,尤与防老剂A,4010NA、促进剂D,M,DM等有关,而汽油并非导致黑变病的主要物质.此外,生产环境及卫生条件的优劣与发病亦有一定关系.     

链球菌相关检测在肾型过敏性紫癜诊治中的意义

目的探究链球菌感染和肾型过敏性紫癜的关系,提高临床医生对肾型过敏性紫癜的认识。方法以66例肾型过敏性紫癜患者为观察组,60例单纯型过敏性紫癜性患者为对照组,分别进行咽拭子培养和药敏试验,同时进行血抗溶血素O(ASO)和类风湿因子(RF)的检测,并进行对比分析。结果乙型溶血性链球菌观察组检出27例,检出率40.90%,对照组检出3例,检出率5.00%,两组比较χ2=22.34,P(0.05,差异具有显著性。ASO观察组阳性例数24例,阳性率36.36%,对照组阳性例数3例,阳性率5.00%,两组比较χ2=18.40,P(0.05,差异也有显著性。RF二组均为阴性。结论链球菌感染与肾型过敏性紫癜发病有一定关系,链球菌相关检测对肾型过敏性紫癜的治疗有重要指导意义。     

Immediate Allergy to Rubber Gloves: A Questionnaire Study of Hospital Personnel

We conducted a questionnaire study of immediate allergy to natural rubber gloves among 2,408 medical workers who had used rubber gloves at Kumamoto University Hospital and allied hospitals. The response rate was 64.5% (1,321 workers). Among them, 8.5% (7.0–10.0% at 95% confidence limit) replied that they had experienced immediate allergy to rubber gloves. There were significant correlations among the frequency of rubber glove use, a history of atopic dermatitis or contact dermatitis, and the presence of skin lesions due to allergic reactions to rubber gloves. In 27 workers, skin lesions were associated with general symptoms. Of 59 workers who experienced immediate allergy and were tested for latex-specific IgE, 4 persons were positive. We conclude that the frequency of contact allergy to natural rubber products is substantially prevalent among Japanese hospital personnel and that education and awareness of this allergy are important.     

Comparative evaluation of Type 1 latex hypersensitivity in patients with chronic urticaria,rubber factory workers and healthy control subjects

Latex hypersensitivity manifests itself most commonly with contact urticaria. In this study, we investigated the frequency of latex hypersensitivity as a possible aetiological factor in patients with chronic urticaria (CU) and compared latex hypersensitivity of CU patients (n = 50) with that of rubber factory workers (n = 50) and healthy controls (n = 50). Prick test with latex and fruit extracts and determination of latex-specific immunoglobulin E (IgE) were performed. As a risk factor, contact dermatitis due to rubber additives was tested by patch test. Latex hypersensitivity was detected in 14% of CU patients, 12% of rubber factory workers and 12% of healthy controls (P > 0.05). Positive patch test with rubber additives was detected in 6% of CU and 4% of rubber factory workers. 3 of 7 CU patients had sensitivity to fruits in addition to latex hypersensitivity. In 1 patient with CU, the clinical complaints were found to be related to latex hypersensitivity. These findings suggest that the frequency of latex hypersensitivity in CU patients is no higher than that in healthy individuals. However, CU patients should be carefully asked about latex allergy, as we demonstrated that 1 of the CU patients had undiagnosed symptomatic latex allergy.     

Surveillance of occupational skin disease: EPIDERM and OPRA

Consultant dermatologists in the U.K. have been reporting to EPIDERM, a voluntary surveillance scheme for occupational skin disease, since February 1993; reporting by occupational physicians to the scheme began in May 1994 and was superseded in January 1996 by OPRA (Occupational Physicians Reporting Activity). Currently 244 dermatologists and 790 occupational physicians report incident cases to these schemes. During the 6 years to January 1999 a total of 12, 574 new cases of occupational skin disease was estimated from reports by consultant dermatologists and 10,136 cases estimated from occupational physicians (since May 1994). The annual incidence of occupational contact dermatitis using data from both schemes was 12. 9 per 100,000 workers. The incidence of contact dermatitis per 100, 000 workers increased with age in men from 4.9 (age 16-29 years) to 6.6 (age 45-60 years); in women a higher rate (9.5) was apparent in the younger age group, with lower rates in older female workers. High rates in young workers were associated with wet work and in older workers with exposure to oils. For men, high rates of contact dermatitis were seen in reports from both schemes for chemical operatives, machine tool setters and operatives, coach and spray painters and metal workers. For women, high rates were found for hairdressers, biological scientists and laboratory workers, nurses and those working in catering. The most frequent agents for contact dermatitis were rubber chemicals and materials (14.1% of cases reported by dermatologists), soaps and cleaners (12.7%), nickel (11. 9%), wet work (11.1%), personal protective equipment (6.2%), petroleum products (6.3%), cutting oils and coolants (5.6%), and epoxy and other resins (6.1%). In the 1608 estimated cases of skin cancer all but 4% were attributed to ultraviolet radiation. Cases of contact urticaria attributed to latex peaked in 1996, with a decline in cases since that time.     

Contact sensitivity and urticaria in "wet" work

A selected group of 142 hospital “wet” workers with hand eczema was studied. 91% were female. Atopy (58%), metal dermatitis (41%), and hand eczema prior to the current wet work (67%) were more common than in the total cohort to which these patients belonged. Patch tests were carried out on 120 patients and prick tests on 41 with a history of contact urticaria. Water, cleaning agents, hand disinfectants, the wearing of gloves and other trivial irritant factors were claimed to have elicited the current episodes of hand eczema in 92.3% of cases. In 35%, a considerable part of the exposure to irritant factors look place at home or during leisure time. Delayed contact sensitivity was found in 45 patients, nickel, cobalt, balsam of Peru and rubber chemicals being the most common allergens. Nickel and/or cobalt allergy was found in approximately half of the patients with contact allergy. Positive prick tests relevant for contact urticaria were found in 22 patients, and were most often obtained with various foods or rubber gloves. Although contact sensitivity and contact urticaria were common, they seemed to play a minor rôle in the etiology of the current hand eczema compared to endogenous factors and trivial irritants.     

Allergic contact urticaria from natural rubber latex in healthcare and non-healthcare workers

To compare the prevalence of natural rubber latex (NRL) sensitization and allergic contact urticaria from NRL in healthcare and non-healthcare workers, we studied all 1171 patients who attended our clinic during 2001 and 2002. Prick testing for NRL and patch testing with European standard series were performed in all patients and an additional rubber series in those who had contact with rubber. Specific immunoglobulin E (IgE) levels against NRL and tropical fruits were measured when prick testing was positive. Sensitization to NRL (positive prick test and specific IgE levels) was much more common in healthcare workers than that in non-healthcare workers, 16.7 versus 2.3%. Among the non-healthcare workers, sensitization to NRL was more common in food handlers (17.1%), construction workers (6.6%), painters (6.2%), hairdressers (5.1%) and cleaners (3.8%). The difference in the prevalence of specific IgE to tropical fruits was not significant. Allergic contact urticaria from NRL was also much more frequent in healthcare workers, 71.4 versus 28.6%. In conclusion, sensitization to NRL and allergic contact urticaria from NRL are more common in healthcare workers, but this is a growing problem in non-healthcare workers and should be investigated in all workers with a history of NRL intolerance or who have contact with NRL.     

Epidemiology of occupational dermatoses in the Potsdam district (V)

An epidemiological study focusing on the 1981 to 1985 occupational-dermatosis incidence was carried out, based on the medical-opinion data at the Potsdam County Council Occupational Hygiene Board, and comparisons were made with the results of previous studies. Occupational skin diseases accounted for 46 per cent of all cases and cases of BK 80 (BK stands for occupational disease recognised by GDR law) for 34.7 per cent, which is a 13.6 per cent increase over against the previous study covering the 1976 to 1980 period. A steady increase was found in the percentage of women with an occupational eczema (1981-1985: 66.2 per cent). Of all the eczema cases recognised as occupational diseases, 8.6 per cent had no allergic etiology. Among the various branches of occupation, the health service ranked first for the first time, accounting for 26.1 per cent. With regard to individual occupations too, the medical staff showed the highest incidence (20.8 per cent), followed by bricklayers and concrete workers (8.6 per cent), electroplating workers (6.7 per cent) and milkers (6.4 per cent). The allergens most frequently responsible for the occupational-eczema cases were formaldehyd (24.6 per cent), chromium compounds (15.7 per cent), nickel (15.6 per cent) and rubber ingredients (10.6 per cent). As compared with previous studies, there was an increase in terms of formaldehyde and nickel and a decrease in terms of turpentine oil, chromates and rubber ingredients. While one in five occupational contact eczema patients had to put up with occupational and social drawbacks in the course of their rehabilitation in the past, a substantial improvement has now been achieved by comprehensive organising measures taken by the Potsdam County Council Occupational-Hygiene Board.     

Latex allergy among construction workers

To assess the incidence of latex allergy in construction workers, we studied all the 230 construction workers who attended our clinic between 1996 and 2000. In the 54 (23.5%) patients who reported any kind of intolerance to rubber gloves or boots, we performed both patch testing with the TRUE Test standard series and a rubber series and prick testing for latex. Latex-specific IgE levels were measured when prick testing was positive. 16 patients (7.0%) had a positive prick test to latex, of whom 14 had allergic contact urticaria from latex (ACUL). All of these 14 patients (6.1%) showed 1 or more positive reactions to the True Test series, which included 1 or more rubber chemicals in 9 of them. The level of specific Ig E to latex was greater than 0.35 kU/L in 15 of the 16 patients. In conclusion, our data suggest that the incidence of latex allergic contact urticaria among construction workers may be as high as that among health care workers. Most of these construction workers with Type I latex hypersensitivity had a concurrent Type IV hypersensitivity to chromate or rubber chemicals, presenting as occupational allergic contact dermatitis, which could have facilitated sensitization to latex.