Berndt Stenberg

Methotrexate vs. ciclosporin in psoriasis: effectiveness, quality of life and safety. A randomized controlled trial

Summary Background  When this study was initiated, no previous studies comparing methotrexate and ciclosporin for moderate to severe plaque psoriasis had been performed.

Does vitamin d intake during infancy promote the development of atopic allergy

The active metabolite of vitamin D, 1,25-(OH)2D3, has immunomodulatory properties in addition to its more established action on bone and calcium metabolism. Recently vitamin D has been proposed as one of several environmental factors responsible for the increase in atopic diseases during the last decades. The objective of this study was to determine whether the estimated dose of dietary vitamin D3 during the first year of life is associated with atopic diseases up to the age of 6 years. In a prospective birth cohort study 123 six-year-old children were investigated for the cumulative incidence of atopic dermatitis, allergic rhinitis or asthma by means of a postal questionnaire. Their vitamin D3 intake during infancy was recorded in a previous study and the relationship between lower or higher vitamin D3 intake and atopic illness later in childhood was assessed. Atopic manifestations were more prevalent in the group with higher intake of vitamin D3. Although small, this study supports previous investigations suggesting a role of vitamin D intake during infancy in the development of atopic allergy later in childhood. If these findings are confirmed in prospective controlled clinical trials, prevention through modified vitamin D3 supplementation in infancy could be discussed to reduce the burden of atopic illnesses.

Time trends in Swedish patch test data from 1992 to 2000. A multi-centre study based on age- and sex-adjusted results of the Swedish standard series.

Allergic contact dermatitis is recognized as a public health problem and some major allergens have been subject to intervention aiming at lowering skin exposure. There is an obvious interest in evaluating the effect of such interventions. Population studies are difficult to perform and epidemiological studies based on clinical data from testing patients with contact dermatitis are common surrogates. Our objective was to gather Swedish clinical standard series test data on two occasions in order to monitor trends in sensitization rates. Consecutive patch test results from the Swedish standard series were collected from 9 centres from 1991 to 1993 and from 1999 to 2001. In total, 3680 and 3790 patients, respectively, were included. Crude, age‐adjusted and age‐stratified prevalence are given separately for women and men. Our top 10 allergens are much in line with newly published European test data. Significant changes among those allergens are increasing sensitization rates for Myroxylon pereirae and decreasing rates for colophony, 5‐chloro‐2‐methyl‐4‐isothiazolin‐3‐one, Amerchol L 101 and thiuram mix. Nickel allergy is decreasing among young women. Among less common allergens, a noteworthy increase of sensitization to 4‐phenylendiamine is found. In conclusion, significant trends in sensitization rates of important allergen, reflecting changes in exposure, have been found.

A double-blind study comparing the effect of glycerin and urea on dry, eczematous skin in atopic patients.

Moisturizing creams have beneficial effects in the treatment of dry, scaly skin, but they may induce adverse skin reactions. In a randomized double-blind study, 197 patients with atopic dermatitis were treated with one of the following: a new moisturizing cream with 20% glycerin, its cream base without glycerin as placebo, or a cream with 4% urea and 4% sodium chloride. The patients were asked to apply the cream at least once daily for 30 days. Adverse skin reactions and changes in skin dryness were assessed by the patient and a dermatologist. Adverse skin reactions such as smarting (a sharp local superficial sensation) were felt significantly less among patients using the 20% glycerin cream compared with the urea-saline cream, because 10% of the patients judged the smarting as severe or moderate when using glycerin cream, whereas 24% did so using urea-saline cream (p < 0.0006). No differences were found regarding skin reactions such as stinging, itching and dryness/irritation. The study showed equal effects on skin dryness as judged by the patients and the dermatologist. In conclusion, a glycerin containing cream appears to be a suitable alternative to urea/sodium chloride in the treatment of atopic dry skin.

Associations between type of ventilation and air flow rates in office buildings and the risk of SBS-symptoms among occupants

Abstract The association between type of ventilation and outdoor-air flow rates and Sick Building Syndrome (SBS) and SBS symptoms was studied in a cross-sectional questionnaire and field study comprising 160 office buildings, and 260–2649 respondents with case-controls as well as prevalence comparisons. Measured ventilation rates were higher than required by most building codes and consisted of fresh-air (outdoor-air) inflow of 17±14 L/p and 2.0±1.3 air changes/h. Increased risk of SBS and elevated prevalence of general SBS symptoms were associated with low outdoor-air flow rates, presence of copying machines in office rooms, and ventilation operating hours was less than 10 h/d. There was a suspected association between SBS and air humidification, recirculation of exhaust air at high outdoor-air flow rates but not at low outdoor-air flow rates, and with natural or mechanical exhaust ventilation systems. SBS was not associated with the presence of a rotary heat exchanger or with the supply air temperature higher than the room air temperature.

Overlap in prevalence between various types of environmental intolerance.

Environmental intolerance (EI) is characterized by attribution of several, multisystem symptoms to specific environmental exposures, such as exposure to odorous/pungent chemicals, certain buildings, electromagnetic fields (EMFs) and everyday sounds. The symptoms are medically unexplained, non-specific and the symptoms overlap between different types of EI. To approach the issue of underlying mechanisms the matter of overlap in prevalence between intolerances can provide valuable information. The aim of the study was to examine if the overlap between intolerance to odorous/pungent chemicals, certain buildings, EMFs and sounds is larger than the expected overlap if no association would exist between them. The study was using cross-sectional data from the Västerbotten Environmental Health Study in Sweden; a large questionnaire-based survey. 8520 adults (18-79 years) were randomly selected after stratification for age and sex, of whom 3406 (40%) participated. Individuals with the four types of intolerance were identified either through self-report, or by having been physician-diagnosed with a specific EI. The overlaps between the four EIs were greater than predictions based on coincidence for both self-reported and diagnosed cases (except for the overlap between diagnosed intolerance to sounds and EMFs). The results raise the question whether different types of EI share similar underlying mechanisms, or at least that the sufferers of EI share some predisposition to acquire the conditions.

Self-reported hand eczema: symptom-based reports do not increase the validity of diagnosis.

Summary Background Hand eczema is a common skin disease that affects about 10% of the general population of working age in Sweden. The resulting long sick‐leave periods and need for changes of work and re‐training put an economic burden on society, and there is an interest indeveloping cost‐effective epidemiological surveillance instruments such as a screening questionnaire.

Nickel allergy : prevalence in a population of Swedish youths from patch test and questionnaire data

Background:  The prevalence of body piercing and orthodontic treatment has increased during recent decades. Such changes in lifestyle may influence the occurrence of nickel allergy.

Dermatology in public health - a model for surveillance of common skin diseases

Aims: The aim was to establish a baseline prevalence of skin conditions of public health importance in the general population and taking the validity of the questions into account. Our model is intended for future surveillance of skin conditions. Methods: The suggested questions have for the first time been used in Swedish population surveys. A random sample was taken from the general population aged 16 to 84 years of the participating areas. Results: During the past 12 months, hand eczema was reported by 9.4%, childhood eczema by 15.7% and nickel allergy by 13.7% of the population. Hand and childhood eczema questions have previously been validated. Taking the validity into account, the actual population prevalence of hand eczema (11.7%) is underestimated, and the prevalence of atopic childhood eczema (10.0%) is overestimated based on the results of the questionnaire. In addition to presenting prevalence, population survey results can be used for risk analyses. A 10-fold risk of hand eczema in individuals with childhood eczema and self-reported nickel sensitivity is shown in our study. Conclusions: Questionnaires can be used for epidemiologic surveillance so long as the questions are validated and that the validity is taken into account when estimating the occurrence of the conditions. Public health surveys such as this one lay the basis for future epidemiological surveillance of skin conditions that can be subject to interventions. We propose that these, or similar, questions should be used regularly in population surveys and supplemented by questions on skin exposure.

Is the question 'Have you had childhood eczema?' useful for assessing childhood atopic eczema in adult population surveys?

Atopic eczema (AE) is a major risk factor for hand eczema. In Scandinavian population‐based studies, the occurrence of AE in childhood has often been assessed by the question ‘Have you had childhood eczema?’ In the present study, this question was validated. A questionnaire was sent to 600 cases with AE and 600 controls without eczema or allergic disease, identified in school medical records from the 1960s. The response rate was 70.5%, and the mean age of the respondents was 36.7 years. The specificity of the question was 70.7% and the sensitivity 89.9%. The sensitivity was higher and the specificity lower in a subgroup with current hand eczema compared with a group without hand eczema. The results showed that the question overestimated the prevalence of AE in childhood by a factor of 1.6. When used for risk assessment, the question provided a better estimate of the risk of current hand eczema as compared with the lifetime risk of hand eczema. In conclusion, the validated question overestimated prevalence of childhood AE and may overestimate AE as a risk factor for hand eczema in adult population surveys.