Edvard S. Falk

Metal allergy in north Norwegian schoolchildren and its relationship with ear piercing and atopy.

In 424 schoolchildren (223 boys and 201 girls) aged 7–12 years undergoing routine patch tests, 21.0% (89 children), 38.8% (78/201) of girls and 4.9% (11/223) of boys, had had their ears pierced. 18.6% (79 children, 55 girls and 24 boys) gave a history of cutaneous reactions to metallic jewellery, and in 17.2% (73 children, 49 girls and 24 boys), sensitivity to one or more metals was confirmed. Metal allergy was confirmed by patch testing in only 34.2% of the children with a history of metal dermatitis, and 13.3% of those without a history of metal reactions had, in fact, positive patch tests to 1 or more metals. The low sensitivity (37.0%) and low positive predictive value (34.2%), together with high specificity (85.2%) and high negative predictive value (86.7%), seem to justify dermatological examination of individuals with a positive symptom‐based diagnosis only. Nickel sensitivity was found in 14.9% (63 children, 44 girls and 19 boys). There is clearly a relationship between ear piercing and induction of nickel allergy in girls, as nickel sensitivity in girls with pierced ears was 2 × (30.8%) that found in those without (16.3%) pierced ears. In boys, nickel sensitivity was much less frequent and few cases were related to ear piercing. Atopy appeared to influence the propensity for developing metal sensitivity in girls, as atopic girls showed positive metal tests 2xas frequently (30.8%) as non‐atopic (17.0%). No such differences were found in boys. Girls with a combination of atopy and ear piercing showed the highest frequency of positive metal tests (45.5%). The frequency of metal allergy increased with increasing number of holes in the ear lobes. Symptoms of nickel allergy were reported in 30.2% (19/63) of mothers whose children had nickel allergy, compared to 16.3% (59/361) of mothers whose children had negative nickel tests. Only 4 children reported symptoms of nickel allergy in their father. The high frequency of nickel sensitivity in all children tested may indicate an influence of sources other than ear piercing.

Dietary supplementation with very long-chain n-3 fatty acids in patients with atopic dermatitis. A double-blind, multicentre study.

The purpose of this study was to investigate whether fish oil and/or corn oil had a beneficial effect on the clinical state of atopic dermatitis, and to evaluate the dietary intake of nutrients in this group of patients. In a double‐blind, multicentre study lasting 4 months, during wintertime, 145 patients with moderate to severe atopic dermatitis were randomly assigned to receive either 6 g/day of concentrated n‐3 fatty acids, or an isoenergetic amount of corn oil. As local treatment, only an emollient cream or hydrocortisone cream was allowed. The fatty acid pattern in serum phospholipids, and the dietary intake of nutrients were monitored in a subgroup of patients, and the results were compared with a group of patients with psoriasis. The overall clinical score, as evaluated by the physicians, improved during the trial by 30% in the fish oil (P<0.001) and 24% in the corn oil group (P<0.001). This was also consistent with the results from a selected skin area, and it was further confirmed by the total subjective clinical score reported by the patients. There were no significant differences in the clinical scores between the two groups at baseline, and at the end of the study. In the fish oil group, the amount of n‐3 fatty acids in serum phospholipids was significantly increased at the end of the trial, compared with pretreatment values (P<0.001), whereas the level of n‐6 fatty acids was decreased (P<0.001). In the corn oil group, arachidonic acid, docosahexaenoic acid, and total n‐6 fatty acids, increased significantly (P<0.05), whereas the other fatty acids were similar after corn oil supplementation, compared with baseline. Clinical improvement was significantly correlated with an increase in the concentration of docosahexaenoic acid (22:6, n‐3) in serum phospholipids for the total group (P<0.05). Our patients with atopic dermatitis had significantly lower levels of both n‐6 (P<0.01) and n‐3 (P<0.001) fatty acids in serum phospholipids prior to the start of the trial compared with patients with psoriasis.

Serum immunoglobulin values in patients with scabies

Serum total IgE levels were found to be increased in thirty‐nine of ninety‐four patients with scabies investigated at the time of clinical presentation. One hundred and fifty‐four patients were found to have a significantly lower serum concentration of IgA during infection than when measured 6 weeks and 9 months following successful treatment (P <0.05). The serum concentration of IgA at 6 weeks and 9 months after treatment did not differ significantly. The serum concentration of IgG during infection was significantly higher than 6 weeks later (P <0.05), and than 9 months later P <0.001). The 6 weeks levels were significantly higher than the results at 9 months (P <0.01). The serum concentration of IgM during infection was higher than 6 weeks later (P <0.1). The 6 weeks levels were lower than those at 9 months (P <0.1), whereas there was no difference between the pretreatment and 9 months levels. No differences were noted in the concentration of C3 and C4. Antinuclear antibodies (ANA) and rheumatoid factor (RF) were not found in any of the patients. In thirty‐two patients with lichen planus no changes in immunoglobulins or complement were observed.

In vitro demonstration of specific immunological hypersensitivity to scabies mite

An extract prepared from 200 adult female scabies mites was used for prick and intracutaneous testing in twelve patients with previous scabies infestation, as well as in six healthy controls and three persons with skin sensitivity to Dermatophagoides pteronyssinus who had never had scabies before. Seven individuals who had had scabies less than a year prior to the testing had positive intracutaneous (immediate type) reactions, whereas all the five who had had scabies more than a year before had negative reactions. The prick tests were negative in all cases. No skin reactions could be evoked in the controls. The passive transfer, or Prausnitz‐Küstner, test was positive with the scabies mite extract and serum from three of five patients tested on one healthy individual, and with both of two sera tested on a second healthy individual. These findings indicate that immediate type hypersensitivity reactions may occur with scabies infection.

IgE antibodies to house dust mite in patients with scabies.

Of 135 patients with scabies, forty‐seven (35%) had a positive (Classes 1–4) radioallergosorbent test (RAST) to Dermatophagoides pteronyssinus (DP). Elevated serum IgE concentrations were found in sixty‐one (45%) of the patients. Atopic disease was confirmed in twenty‐eight (23%) of the 120 patients who completed a medical questionnaire satisfactorily.

Antigens Common to Scabies and House Dust Mites

Twenty‐five antigens were demonstrated in a crude Dermatophagoides farinae (DF) extract by means of crossed immunoelectrophoresis (CIE), using a rabbit anti‐DF serum. With the same antiserum, four antigens were demonstrated in a scabies mite preparation, indicating an immunological relationship between these scabies antigens and some of the DF antigens. In tandem CIE experiments the DF antigens were found to be partly identical to three of the scabies antigens. No IgE activity against any of these scabies antigens was evident in pooled sera from patients with house dust mite allergy by crossed radioimmunoelectrophoresis. However, one such patient had IgE antibodies to a DF antigen and a partial identical scabies antigen.

Parapoxvirus infections of Reindeer and Musk Ox associated with unusual human infections

This report concerns five cases of human infection resulting in lesions morphologically similar to human orf. Parapoxvirus infection in reindeer was the probable source of infection in four cases. The fifth case involved musk ox. Two of the cases involving reindeer are particularly interesting as transmission of infection occurred indirectly. Viral particles were not seen by electron microscopy of human tissues, due probably to the late stage of the illness at the time of examination. However, electron microscopy of negatively stained suspensions prepared from biopsy material collected from reindeer calves at the outbreak of the illness and of post‐mortem material from the musk ox revealed characteristic parapoxvirus particles. In one patient the infection was accompanied by fever, lymphadenopathy and nausea, which cleared following a few days of treatment with doxycycline chloride. 4 cases were curetted after 4, 6, 12 and 20 weeks and healed without scarring whereas the fifth patient was by request left alone. This resulted in localized dark pigmentation following completion of the healing process after 26 weeks.

The effect of UVB radiation on skin microbiota in patients with atopic dermatitis and healthy controls

OBJECTIVES: To investigate Staphylococcus aureus and Staphylococcus epidermidis quantitatively in adult patients with atopic dermatitis and in healthy controls treated with UVB radiation. STUDY DESIGN: Twenty-three adult patients (of these, 3 were excluded) with flexural atopic dermatitis and 20 healthy controls were randomly selected at the outpatient clinic of the Dermatological Department, University Hospital, North Norway. METHODS: Adult patients with atopic dermatitis (n = 20) and healthy controls (n = 20) were given 20 UVB treatments. Bacterial samples were collected before treatment, after 4 weeks of treatment, and finally after 2 weeks follow-up. RESULTS: The main bacteria found were Staphylococcus aureus and Staphylococcus epidermidis. 16 of the 20 patients with atopic dermatitis had Staphylococcus aureus in lesional skin and 12 in non-lesional skin. None of the healthy controls had Staphylococcus aureus in the sample from the flexural elbow. The Staphylococcus aureus counts decreased (not significant) in lesional skin after 4 weeks of treatment and Staphylococcus aureus counts were slightly higher after 2 weeks follow up. The same figures were also seen in non-lesional skin and forehead. CONCLUSIONS: Staphylococcus aureus is widely colonised in the skin of atopic dermatitis patients, but is rare in healthy adults. UVB treatment decreases the Staphylococcus aureus count in patients with atopic dermatitis.

Serum IgE before and after Treatment for Scabies

In 120 patients, treated for scabies infection, the serum IgE concentrations fell from high levels in 54 and normal levels in 66 to lower levels 12 months after treatment. The specific IgE antibodies to Dermatophagoides pteronyssinus (RAST) were also reduced 12 months after treatment. The decrease in both IgE concentrations and IgE antibodies was most conspicuous in non‐atopic patients. These findings confirm previous observations of specific immunological hypersensitivity to scabies mite, and that scabies infection stimulates the production of IgE antibodies.

Skin and respiratory tract symptoms in veterinary surgeons

Chronic or relapsing irritant eczema of the hands was the main complaint in 34 veterinary surgeons. 9 had contact allergic eczema of occupational character. In 8 cases, the allergies were probably due to antibiotics contaminating the skin during the administration of treatment. Contact allergy to penicillin was observed in 5 cases, to neomycin in 2 and to streptomycin in 1 case. Sensitivities to other work‐related substances such as rubber chemicals, antiseptics and local anaesthetics were found in 6 cases. Multiple contact allergies, in particular to different penicillins, were seen frequently. Obvious work‐related immediate reactions of probable allergic type were present in 10 cases, but were confirmed with positive RAST or prick test in only 2 cases.