A.M. Giménez-Arnau

Epidemiología del eczema de contacto en España. Resultados de la Red Española de Vigilancia en Alergia de Contacto (REVAC) durante el año 2008

BACKGROUNDnThe epidemiology of contact dermatitis can be analyzed using clinical data from skin allergy units.nnnOBJECTIVESnThe aims of this study were to define the profile of patients attending a skin allergy unit and to determine the prevalence of the most common sensitizations in this population.nnnMATERIAL AND METHODSnThroughout 2008, a retrospective observational study was carried out in the 5 hospitals of the Spanish Surveillance System on Contact Allergies. All patients underwent skin patch tests with the Spanish standard series. The frequencies of sensitization were normalized for age and gender.nnnRESULTSnData were gathered on 1161 patients. The 5 allergens that gave the most frequent positive reactions were nickel sulfate (25.88%), potassium dichromate (5.31%), cobalt chloride (5.10%), fragrance blends (4.64%), and balsam of Peru (4.44%). The least frequently detected reactions were to quinolone-clioquinol mix and sesquiterpene lactone mix. There was a 35% prevalence of sensitization to nickel among women.nnnCONCLUSIONSnThe profile of sensitizations in Spain is similar to that of other Southern European countries. Nickel sulfate continues to be the most prevalent allergen, particularly in women. The low prevalence of sensitization to quinolone-clioquinol mix and sesquiterpene lactone mix supports their exclusion of the Spanish series.

Resultados y evaluación del fotoparche en España: hacia una nueva batería estándar de fotoalergenos

Resumen Introduccion Mientras que la estandarizacion de la exploracion con pruebas de fotoalergia o fotoparche (FTP) sigue su curso en Europa, hemos realizado un estudio epidemiologico sobre la situacion actual de la fotoalergia en nuestro pais. Material y metodos Hemos recogido los resultados del FTP en 7 centros hospitalarios de Madrid, Cataluna, Galicia y Comunidad Valenciana, durante los anos 2004 y 2005. La exploracion ha incluido, al menos, la bateria estandar del Grupo Espanol de Fotobiologia (GEF), con 16 (foto)alergenos, que se han irradiado con 10 julios/ cm 2 . Hemos valorado el numero total de pacientes explorados, su sexo, la relevancia presente, pasada o desconocida de los fotoparches positivos, las reacciones cruzadas y los alergenos responsables de la fotosensibilizacion. Resultados El 39,3 % de los 224 pacientes explorados mediante FTP presentaron uno o mas fotoparches positivos. Ciento tres (71 %) se consideraron relevantes respecto a la historia clinica, 14 (9,6 %) fueron reacciones cruzadas y 28 (19,3 %) se consideraron de relevancia desconocida. Los alergenos mas prevalentes fueron los antiinflamatorios no esteroideos, particularmente el ketoprofeno (43 pacientes), seguido a distancia de la bencidamina (7 pacientes) y el etofenamato (5 pacientes). La mezcla de 4 filtros solares de la bateria estandar del GEF solo detecto 10/16 pacientes con fotoalergia a filtros solares. Los fotoparches de relevancia desconocida fueron sobre todo por antisepticos (fenticlor) y antihistaminicos topicos. Conclusiones Proponemos modificar la bateria estandar de fotoalergenos del GEF, que deberia contemplar la mayoria de los antiinflamatorios no esteroideos y filtros solares que hay en el mercado espanol. El ketoprofeno sigue siendo el fotoalergeno mas frecuente en nuestro pais. Su importancia deriva tambien de las sensibilizaciones cruzadas que puede presentar. Los filtros solares deben explorarse por separado, y no en forma de una mezcla.

Principles and methodology for identification of fragrance allergens in consumer products.

Fragrances contain several hundreds of different chemicals, a few major and many minor, which are responsible for the complexity of the odour. Fragrances are a major cause of allergic contact dermatitis. As a diagnostic tool, the current fragrance mix is very useful though not ideal. A 50‐year‐old woman presented with a pruriginous, erythematous eruption, characterized by papules, vesicles, exudation and crusting over the neck and chest. With the suspicion of fragrance allergy, patch testing was performed. Initially, the only positive reaction observed was with her own eau de toilette named Woman®. The TRUE Test® fragrance mix patch test was negative. Chemical fractionation of Woman® perfume concentrate was combined with a sequenced patch testing procedure and with structure‐activity relationship studies. Ingredients supplied by the manufacturer were also included in the study. Benzophenone‐2, Lyral®, α‐hexyl cinnamic aldehyde and α‐damascone were found to be responsible for the patients contact allergy to the commercial product. These substances contain chemical structural alerts giving them antigenic ability. The common use of new chemicals to manufacture fragrances, and the increased number of patients sensitive to them but with negative fragrance mix reactions, makes it necessary to identify new potential fragrance sensitizers in commercial products.

Patch testing in children with hand eczema. A 5‐year multicentre study in Spain

Background. Hand eczema is common in children, but affected children are seldom patch tested. Relatively few studies have assessed patch testing in the paediatric population, and none has specifically evaluated its use in hand eczema in children.

Patch testing with formaldehyde and formaldehyde-releasers: multicentre study in Spain (2005–2009)

Background. Formaldehyde and formaldehyde‐releasers are common causes of allergic contact dermatitis.

Databases and Networks. The Benefit for Research and Quality Assurance in Patch Testing

The present chapter summarises several information technology (IT) applications in the research field of contact dermatitis intended to support the clinical management of patients and/or research. Today, due to the overwhelming speed of IT innovation, there seem to be few strictly technical problems. However, it seems to be an important issue to integrate IT into everyday work in such a way that it is not perceived as an intrusion, but rather as a support by its users. The starting point for a successful contact allergy research application is the implementation of user-friendly patch test software to document relevant parts of the patient’s history and patch test results. After an overview of the relevant issues, this presentation focuses on the usefulness of electronically collected data for quality control purposes within a patch test network. In this context, quality control is both an outcome and also a prerequisite for further use of this data for scientific purposes, e.g., surveillance of contact allergy or other dedicated analyses. The successful use of such databases generated by different networks is illustrated by several examples. As an aid in the daily management of contact dermatitis patients, a number of auxiliary sources of information are briefly outlined in the final section.

Results and Assessment of Photopatch Testing in Spain: Towards a New Standard Set of Photoallergens

INTRODUCTIONnWhile the standardization of exploration with photoallergy tests or photopatch testing runs its course in Europe, we have carried out an epidemiological study about the current situation of photoallergy in our country.nnnMATERIAL AND METHODSnWe have gathered the results of photopatch testing in seven hospital centres of Madrid, Cataluña, Galicia and Comunidad Valenciana during the years 2004 and 2005. The exploration has included, at least, the standard set of the Spanish Photobiology Group (GEF), with 16 (photo) allergens, that have been irradiated with 10 joules/cm(2). We have assessed the total number of explored patients, their sex, present, past or unknown relevance of positive photopatch testing, cross reactions, and allergens responsible for photosensitization.nnnRESULTSnOf 224 patients explored by photopatch testing, 39.3 % show one or more positive tests. Seventy-one percent (103) were considered relevant with respect to clinical history, 14 cases (9.6 %) were cross reactions, and 28 (19.3 %) were considered of unknown relevance. The most prevalent allergens were nonsteroidal antiinflammatory drugs, specially ketoprophen (43 patients), followed by bencydamine (7 patients) and etofenamate (5 patients). The mixture of four sunscreens from the standard set of the GEF only detected 10 of 16 patients with photoallergy to sunscreens. Photopatch testing of unknown relevance was mainly due to antiseptics (fenticlor) and topical antihistamines.nnnCONCLUSIONSnWe propose the modification of the standard set of photoallergens from the GEF, that should include the majority of nonsteroidal antiinflammatory drugs and sunscreens available in Spain. Ketoprophen continues to be the most frequent photoallergen in our country. It is also important for the cross sensitizations that may present. Sunscreens should be explored separately and not in form of a mixture.

Epidemiology of contact dermatitis in Spain. Results of the Spanish Surveillance System on Contact Allergies for the year 2008

Abstract Background The epidemiology of contact dermatitis can be analyzed using clinical data from skin allergy units. Objectives The aims of this study were to define the profile of patients attending a skin allergy unit and to determine the prevalence of the most common sensitizations in this population. Material and methods Throughout 2008, a retrospective observational study was carried out in the 5 hospitals of the Spanish Surveillance System on Contact Allergies. All patients underwent skin patch tests with the Spanish standard series. The frequencies of sensitization were normalized for age and gender. Results Data were gathered on 1161 patients. The 5 allergens that gave the most frequent positive reactions were nickel sulfate (25.88%), potassium dichromate (5.31%), cobalt chloride (5.10%), fragrance blends (4.64%), and balsam of Peru (4.44%). The least frequently detected reactions were to quinolone-clioquinol mix and sesquiterpene lactone mix. There was a 35% prevalence of sensitization to nickel among women. Conclusions The profile of sensitizations in Spain is similar to that of other Southern European countries. Nickel sulfate continues to be the most prevalent allergen, particularly in women. The low prevalence of sensitization to quinolone-clioquinol mix and sesquiterpene lactone mix supports their exclusion of the Spanish series.

Management of urticaria: not too complicated, not too simple.

In spite of being an old disease and apparently easy to diagnose, chronic spontaneous urticaria (CSU) is still perceived as an uncontrollable and difficult to manage disease. The perception of the patient is that his/her condition is not well understood and that is suffering from a disorder with hidden causes that doctors are not able to tackle. Sometimes patients go through a number of clinicians until they found some CSU expert who is familiar with the disease. It is surprising that myths and believes with no scientific support still persist. Guidelines are not widely implemented, and recent tools to assess severity are infrequently used. European and American recent guidelines do not agree in several key points related to diagnosis and treatment, which further contributes to confusion. With the aim to clarify some aspects of the CSU picture, a group of allergists and dermatologists from the Spanish Dermatology and Allergy societies developed a Frequent Asked Questions leaflet that could facilitate physicians work in daily practice and contribute to a better knowledge of common clinical scenarios related to patients with CSU.

A Summary of shoe allergic contact dermatitis caused by dimethyl fumarate in Spain

Juan Francisco Silvestre1, Fernando Toledo1, Pedro Mercader2 and Ana Marı́a Giménez-Arnau3, on behalf of the Spanish Research Group of Allergic Contact Dermatitis due to Dimethyl Fumarate in Spain 1Dermatology Department, Hospital General Universitario de Alicante, 03010 Alicante, Spain, 2Dermatology Department, Hospital General Universitario Morales Meseguer, 30008 Murcia, Spain, and 3Dermatology Department, Hospital del Mar, 08003 Barcelona, Spain.