A. Sertoli

Anaphylactic shock from mustard after ingestion of pizza

A 27-year-old nurse came to us because of itching and the appearance of wheals on her forearms when she prepared injections containing analgesics (unspecified). In the past, from the age of 12 until her first pregnancy at age 23, she had taken analgesics containing phenazonic compounds regularly during her periods. At age 26 she took an unspecified analgesic for back pain and had an immediate reaction of diffuse itching. Approximately 1 year later a tablet of Nisidina® produced anaphylactic shock. Nisidina is a mixture of two antispastic drugs, adiphedrine and ethyl-N-diphenylaminoacetate, an antihistamine, diphenydramine, and the analgesic methamizole (4-methylamino-1.5dimethyl-2-phenyl-3-pyrazolone sodium methanesulfonate) which is sold in Italy under the name Novalgina®. Patch tests with 10 % aminophenazone gave negative immediate and delayed reactions. The prick test with aminophenazone (10 %) and an intradermal test with a 1 % concentration both provoked an immediate wheal reaction. A patch test with Nisidina (saturated solution) also provoked an immediate wheal reaction, but patch tests with the individual ingredients (10 % pet.) were all negative except for methamizole which gave an immediate wheal reaction. Prick tests with methamizole in concentrations of 1, 5, 25, and 50% all provoked immediate reactions. The structural formulas of methamizole and aminophenazone are: Methamizole (Novalgina)

Multicentre study of allergic contact cheilitis from toothpastes

The present work reports the results of a multicentre study of toothpaste allergic contact cheilitis (TACC) conducted by GIRDCA (Gruppo Italiano Ricerca Dermatiti da Contatto e Ambientali). The study examined 54 patients with eczematous lesions on the lips, the possible cause of which was suspected to be the use of toothpastes. Patch tests were conducted with a standard series, a specially‐targeted series (toothpaste cheilitis series, TCS), and with suspected toothpaste(s). A stop‐restart test (SRT) was carried out with these, together with a use test to identify possible alternative products. The TCS produced 17 positive reactions in 13 patients, the most frequent being to spearmint oil. Of the 54 patients, 5 displayed positive reactions only to the TCS. The patch tests with toothpaste produced positive reactions in 11/32 patients, the SRT a positive response in 10/12 cases. The diagnosis of TACC was confirmed in 15/54 patients. Alternative products were identified for 5 patients. In conclusion, the allergens most frequently responsible for TACC were the flavourings, and the additional series proved to be useful in many cases (together with patch tests with toothpastes and the SRT) for correct diagnosis and to initiate effective prevention.

Occupational contact dermatitis in 2 dental technicians.

2 dental technicians, both with chronic hand eczema, reported worsening from the use of 2 products containing methyl methacrylate, employed in manufacturing acryline prostheses. Patch tests in both patients gave positive reactions in methyl methacrylate, ethylene glycol dimethacrylate and products employed in manufacturing acrylic prostheses (2% and 5% pet.). On the basis of results subsequently obtained from patch tests carried out with pieces of glove interposed between the skin and the allergens (methyl methacrylate and products employed), we advised our patients still to use latex gloves during work. Follow‐up after 1 year showed complete regression of the dermatitis in I case and considerable improvement in the other.

Alantolactone sensitivity in chrysanthemum contact dermatitis

A case of occupational chrysanthemum contact dermatitis is reported. Patch tests showed the patienttobe sensitized to Chrysanthemum morifolium (Chr M) leaves, flowers, and stems (alcoholic extracts) and to alantolactone. An attempt at desensitizalion appears to have been successful.

Contact Dermatitis in the Textile and Garment Industry

Reports in the literature [1] indicate that dermatological risk is low in the textile and garment industry. To date, there have been reports of only individual cases of contact dermatitis, and the major risk has been shown to be for the workers who do the dyeing operations [2, 3, 6–8]. The causes of sensitization often remain unknown, but the substances most often cited as responsible are potassium bichromate [4], antiwrinkling resins with formaldehyde base [3], antispotting agents [2], antiinflammatory agents [2], optical whiteners [9], and biocidal agents [3, 5].

Sensitization from contact with ethyl alcohol

Numerous forms of contact dermatitis, both occupational and non-occupational, are attributed to the irritant and dehydrating properties of ethyl alcohol. In very few cases has sensitization been demonstrated, despite the frequent use of this substance as a disinfectant (1-7). A 49-year-old woman with a family history of atopy and an allergic contact dermatitis from cosmetics and topical drugs, developed a dermatitis following contact with denatured alcohol and with 2 ammonia-based disinfectants (Citrosil and Bialcool). Citrosil (containing benzalkonium chloride, lemon grass oil, bergamot, thyme, ethyl alcohol, nonyl-phenol-oxyethylate, tartrazine yellow, Blue E 131 and distilled water) was thought to be responsible for a scaly, erythematous eruption in the axilla following contact with a Citrosil-disinfected thermometer, and for a similar lesion in the right elbow flexure following contact with cotton wool soaked in Citrosil. Bialcool (containing dodecyl chloride benzyl ammonium-N-diethyl alcohol, ethyl alcohol, acetone, ethyl acetate, fragrance, pine oil, diethylene glycol mono-ethyl ether and deionized water) caused a papular eruption in the elbow flexure after a blood sample was taken. The next day, similar lesions appeared on the side of the neck and sternum. Denatured alcohol (ethyl alcohol to which adulterating substances have been added to render it unfit to drink and thus be tax free) was considered responsible for red papular lesions on the flexor surface of the left wrist, 24 h after she had given her husband an intramuscular injection, during the course of which her wrist came into contact with cotton wool soaked in it. In contrast to cases reported in the literature, the patient made no mention of skin eruptions after drinking alcohol. Patch tests with 70° denatured ethyl alcohol (10%, 50% and 100%) gave positive results, while the same tests were negative in 6 control subjects. Further patch tests performed using denaturant (1 %,10% and 50%) were negative. (Denaturants are mixtures of several substances, the exact formulae of which are kept secret and vary from one country to another.) There are a number of denaturants used in Italy, the principal ones being composed of various hydrocarbons, oil of acetone, pyridic bases, dyes, etc. There have been 6 other cases reported in the literature (2-7) of occupational and non-occupational contact dermatitis in subjects with sensitization to ethyl alcohol. In all of them, an eruption developed or was aggravated after alcoholic beverages (wine, gin, sherry, etc.) had been consumed. Our patient, however, showed no such reaction despite the fact that she drank wine daily.

Skin tests with fresh foods.

Benzoyl peroxide is a potent oxidizing agent widely used both as a topical medicament and as a curing agent in resin synthesis. Although allergic contact dermatitis due to benzoyl peroxide in orthopedic prostheses has not previously been fully documented, the patch test results indicate that this curing agent was the sensitizer of our patient. Jager & Balda (11) reported a 62-year-old patient with a total hip prosthesis who developed recurrent sterile fistulae and loosening of the prosthesis. Patch tests showed a positive reaction to benzoyl peroxide and contact allergy to benzoyl peroxide was suspected as the cause of the implant reaction. The positive patch test to quinolines resulted from the repeated application of topical medicaments containing chlorquinaldol as an active ingredient. Allergic contact dermatitis from topical medicaments is enhanced by trophic skin changes accompanying injured skin. The sensitive skin of leg ulcers is a· typical example. The skin at the site of amputations mimics this sensitivity and is likewise easily damaged.

girdca Data Bank for Occupational and Environmental Contact Dermatitis (1984 to 1988)

A multicenter study was performed in 12 Italian medical centers by members of Gruppo Italiano Ricerca Dermatiti da Contatto e Ambientali (GIRDCA) over 5 years (January 1984 to December 1988) to set up a computerized data bank on contact dermatitis. With a subsequent analytical study, the significanc

Systemic contact dermatitis from herbal and homeopathic preparations used for herpes virus treatment.

Systemic contact dermatitis may occur in contact-sensitized individuals when they are exposed to haptens orally, transcutaneously, intravenously or by inhalation. We report the case of a woman developing a diffuse skin eruption after the topical use of Rhus toxicodendron alcoholic extract and the oral introduction of a homeopathic preparation of the same substance for herpes treatment. An open test, performed with the Rhus toxicodendron tincture, showed an erythemato-oedematous response at 48 h and vesicular reaction at 96 h that was still present after 7 days. Patch test with 65% ethyl alcohol gave negative results. The open test performed, as control, in eight healthy informed subjects revealed negative responses to Rhus tincture application. The result is interesting because in Italy, allergic contact dermatitis to Rhus is uncommon and this case increases the understanding of the pathogenetic mechanism leading to systemic contact dermatitis development.

Prevention of allergic contact dermatitis with alternative products

In ACD from footwear, sensitization to chromium salts used in tanning is one of the most frequent causes. The alternative is leather (alternative Leather, AL) produced with vegetable tannins. The absence of chromium in AL provided by its manufacturer was checked by colorimetry and atomic absorption spectrophotometry; a series of tests (2) established (i) humidity, organic and inorganic substances; (ii) good resistance to traction, but decreased elasticity and waterproofing; (iii) lack of colour fastness to damp without seeping through. 12 patients sensitized to potassium dichromate and with ACD from leather shoes, who had used footwear made withAL (on average 5 days per week for 3-12 months), volunteered (without treatment): (a) considerable (8/ 12) or slight (4112) improvement clinically; (b) judgement on esthetic value, fit and protection as good-average in over ! the cases. All patients intended to continue wearing AL footwear.