Allergy and skin diseases in musicians

In order to define a standard diagnostic protocol for managing allergic dis-eases in musicians, we conducted a literature search on this topic. The most frequent allergic disease in this special category of workers was contact dermatitis, always described in stringed and wind instruments players, involving the mouth and the hands. No other allergic disease directly related to musical instruments was reported. The most frequently reported culprit substances were: colophony, exotic woods, nickel sulphate, varnishes, and propolis (bee glue). Thus, being contact dermatitis the most frequent disease, a correct diagnostic approach to this problem in musicians should involve, in addition to clinical history and examination, the patch test with a specific panel of substances. Finally, allergy in musicians involves additional problems: the virtual impossibility to avoid the offending substance, and the poor adherence to therapy due to lifestyle. In general, this specific allergologic problem seems to be underestimated, underdiagnosed and, as a conquence, poorly managed.     

Cardiac involvement in collagen diseases

The purpose of this study is to evaluate the early morphologicaland functional abnormalities of the heart in patients with collagendisease. The study population was free of risk factors for coronaryartery disease and without any clinically evident cardiac manifestations.In 62 patients with collagen disease (25 with progressive systemicsclerosis, 19 with systemic lupus erythematosus, 15 with rheumatoidarthritis, three with dermatomyositis) and in 40 healthy subjectsan echocardiographic study was performed. Echocardiographicexamination from the apical four-chamber view was performedat rest and during the end of a 3 min isometric exercise withhandgrip. Global and regional ejection fraction of the leftventricle were calculated In the group with progressive systemicsclerosis the left ventricular mass index was significantlyhigher than in the control group (110.78 ± 48.61 vs 82.18± 28.46g. m^–2) and the ejection fraction (53.61± 7.95%) was the lowest of all groups (control: 61.47± 8.52%, systemic lupus erythematosus: 59.04 ±8.58%, rheumatoid arthritis: 62.38 ± 6.88%). Regionalejection fraction analysis revealed a major dysfunction of theproximal segment of the interventricular septum, in all groups.During isometric exercise, the global and regional ejectionfraction did not change significantly, although differencesbetween groups disappeared. In rheumatoid arthritis, mitraland aortic valve leaflet separation appeared to be reduced.In the group with systemic lupus erythematosus, mild abnormalitieswere noticed, although the mean age and duration of the diseasewere the smallest compared with the other groups. In conclusion,patients with progressive systemic sclerosis mainly presentleft ventricular hypertrophy with a reduced ejection fractionwhile rheumatoid arthritis patients show a predominant valvedysfunction. In patients with collagen disease, without clinicalsigns of heart disease or risk factors for coronary artery disease,there are early morphological and functional abnormalities probablydue to the primary disease.