Annick Barbaud

Skin testing and patch testing in non-IgE-mediated drug allergy.

Drug skin tests can reproduce delayed hypersensitivity to drugs and entail a moderate reexposure of patients to offending drugs. Drug patch tests (DPTs) and prick tests can be done with any commercialized form of a drug. In non-severe delayed non-IgE-mediated reactions to drugs, intradermal tests (IDT) with delayed readings have a greater value, but their techniques lack standardization. A negative drug skin test does not exclude the responsibility of a drug, and the drug must be rechallenged in non-severe cases. DPTs are useful in maculopapular rashes, flexural exanthemas, and if done in situ, also in fixed drug eruption. Their best indication is in acute generalized exanthematous pustulosis or drug reaction with eosinophilia and systemic symptoms (DRESS). They should be carried out cautiously, following strict guidelines. Prick tests have a low value but they can sometimes be positive on delayed readings. In non-severe delayed reactions to drugs, intradermal tests with delayed readings are the most sensitive skin tests especially for beta-lactam antibiotics, radiocontrast media, heparins but also some biological agents. The value of patch testing varies according to the implicated drug and the non-immediate adverse drug reaction. In DRESS, DPTs have a good value in testing carbamazepine or proton pump inhibitors but remain negative in testing with allopurinol or salazopyrin. In toxic epidermal necrolysis, DPTs are safe but positive in only 9 to 23xa0% of the reported cases.

Dermatose neutrophilique des mains

BACKGROUNDnIn 1964, based on eight cases, R. Sweet described a form of acute febrile neutrophilic dermatosis that was quickly renamed Sweets syndrome. Over time, other entities (pyoderma gangrenosum, erythema elevatum diutinum, etc.) came to be included in the same nosological group, giving rise to the concept of neutrophilic dermatosis. In addition to types of passage between these different diseases, neutrophilic dermatoses may have a variety of atypical presentations such as that described as neutrophilic dermatosis of the hands, of which we present a case herein.nnnPATIENTS AND METHODSnA 60-year-old woman with non-insulin-dependent diabetes and mild psoriasis was consulting for an eruption mainly on the hands. The lesions, of various shapes, comprised pustules and large bullous lesions on purple oedematous skin; these were painful and some were progressing to ulceration. They measured between 0.5 and 3 cm and were filled with an opaque liquid. These lesions were painful and some were progressing towards ulceration. The patient was also presenting inflammatory joint pain. The histopathology study revealed infiltration of the dermis, predominantly by neutrophils. A diagnosis of neutrophilic dermatosis was made without any clearly discernible distinction between Sweets syndrome, palmoplantar pustulosis or pyoderma gangrenosum.nnnDISCUSSIONnSince the initial description of Sweets syndrome in 1964, many unusual cases have been described in the literature (associated with neoplasias or systemic diseases, concomitant pustular or bullous lesions, etc.). In 1995, Strutton et al. described a new entity, pustular vasculitis of the hands, based on six cases, which is fairly similar to the present case. Understanding of this syndrome developed and Gallaria renamed it neutrophilic dermatosis of the dorsal hands. Walling and Duquia termed this form of dermatosis palmoplantar Sweet syndrome.nnnCONCLUSIONnThis case highlights the difficulties in clearly distinguishing forms of neutrophilic dermatosis, adding to the notion of a continuum in neutrophilic disease.

Is 500 ppm a better concentration than 200 ppm for diagnosing contact allergy to methylisothiazolinone

Two commercial products are available for peforming patch tests for sensitivity to methylisothiazolinone (MI): one diluted to 200ppm MI (Laboratory Chemotechnique, Velinge, Sweden) and the other to 500ppm (Laboratory Stallergene, Antony, France). The sensitivity and specificity of these tests are not known, and the authors discuss which one is best to use.

Allergy to betalactams and nucleotide-binding oligomerization domain (NOD) gene polymorphisms.

Polymorphisms of interleukin genes related to IgE production and inflammation are predictors of hypersensitivity to betalactam, but nothing is known on the influence of NOD genes, despite their association with inflammation and atopy.

Clinical approach on challenge and desensitization procedures with aspirin in patients with ischemic heart disease and nonsteroidal anti-inflammatory drug hypersensitivity

Hypersensitivity to acetylsalicylic acid (ASA) constitutes a serious problem for subjects with coronary artery disease. In such subjects, physicians have to choose the more appropriate procedure between challenge and desensitization. As the literature on this issue is sparse, this study aimed to establish in these subjects clinical criteria for eligibility for an ASA challenge and/or desensitization.

First evidence of occupational asthma to argan powder in a cosmetic factory.

Argan is used worldwide in numerous cosmetic products, as this fruit is supposed to have many beneficial properties on health. New cases of allergy can be expected with the growing use of argan. We investigated all workers (9) employed by a cosmetic factory and exposed to argan powder to identify possible allergies related to exposure to argan powder.

Occupational contact dermatitis caused by nickel in scratchcards

Keywords: n nairborne contact dermatitis; nlottery ticket; nnickel; noccupational contact dermatitis; nscratchcard

Occupational Asthma to Detergent Protease Associated With a Late-Phase Neutrophilic Cutaneous Response

Background: The relationships between asbestos exposure and colorectal cancer remain controversial. Objectives: We examined the association between asbestos exposure and colorectal cancer incidence. Methods: Volunteer retired workers previously exposed to asbestos were invited to participate in the French ARDCo screening program between 2003 and 2005. Additional data on risk factors for colorectal cancer were collected from the ARDCo-Nut subsample of 3,769 participants in 2011. Cases of colon and rectal cancer were ascertained each year through 2014 based on eligibility for free medical care following a cancer diagnosis. Survival regression based on the Cox model was used to estimate the relative risk of colon and rectal cancer separately, in relation to the time since first exposure (TSFE) and cumulative exposure index (CEI) to asbestos, and with adjustment for smoking in the overall cohort and for smoking, and certain risk factors for these cancers in the ARDCo-Nut subsample. Results: Mean follow-up was 10.2 years among 14,515 men, including 181 colon cancer and 62 rectal cancer cases (41 and 17, respectively, in the ARDCo-Nut subsample). In the overall cohort, after adjusting for smoking, colon cancer was significantly associated with cumulative exposure (HR = 1.14; 95% CI: 1.04, 1.26 for a 1-unit increase in ln-CEI) and ≥ 20–40 years since first exposure (HR = 4.67; 95% CI: 1.92, 11.46 vs. 0–20 years TSFE), and inversely associated with 60 years TSFE (HR = 0.26; 95% CI: 0.10, 0.70). Although rectal cancer was also associated with TSFE 20–40 years (HR = 4.57; 95% CI: 1.14, 18.27), it was not associated with ln-CEI, but these findings must be interpreted cautiously due to the small number of cases. Conclusions: Our findings provide support for an association between occupational exposure to asbestos and colon cancer incidence in men. Citation: Paris C, Thaon I, Herin F, Clin B, Lacourt A, Luc A, Coureau G, Brochard P, Chamming’s S, Gislard A, Galan P, Hercberg S, Wild P, Pairon JC, Andujar P. 2017. Occupational asbestos exposure and incidence of colon and rectal cancers in French men: the Asbestos-Related Diseases Cohort (ARDCo-Nut). Environ Health Perspect 125:409–415;u2002http://dx.doi.org/10.1289/EHP153