Emmanuelle Amsler

A three-year-analysis of fixed drug eruptions in hospital settings in France

Fixed drug eruption (FDE) is one of the most typical cutaneous drug adverse reactions. This localized drug-induced reaction is characterized by its relapse at the same sites. Few large series of FDE are reported. The aim of this study was to retrospectively collect and analyse well informed cases observed in a hospital setting. This study involved 17 academic clinical centers. A French nation-wide retrospective multicentric study was carried out on a 3-year-period from 2005 to 2007 by collecting data in seventeen departments of dermatology in France. Diagnosis of FDE was based essentially on clinical findings, at times confirmed by pathological data and patch-testing. Records were reviewed for demographics, causative drugs, localization, severity, and patch-tests, when available. Fifty nine cases were analysed. Patients were 59-years-old on average, with a female predilection. The most common drug was paracetamol, followed by the non-steroidal anti inflammatory drugs. The time between drug intake and skin symptoms was, on average, two days. Beside these classical characteristics, some original findings were found including, a frequent non pigmentation course and a sex-dependent pattern of distribution. Women often had lesions on the hands and feet, and men on the genitalia. Given the fact that skin pigmentation is an inconstant feature of FDE, its French name (erythème pigmenté fixe) should be reconsidered. The sex-dependent distribution could help our understanding of the pathophysiology of fixed drug eruption.

Immediate hypersensitivity to iodinated contrast media: diagnostic accuracy of skin tests and intravenous provocation test with low dose

The diagnosis of HSR to iodinated contrast media (ICM) is challenging based on clinical history and skin tests.

Airborne allergic contact dermatitis caused by isothiazolinones in water-based paints: a retrospective study of 44 cases

Airborne allergic contact dermatitis caused by paints containing isothiazolinones has been recognized as a health hazard.

Étude de 19 cas d’allergie aux héparines prouvée par des tests cutanés

BACKGROUND Allergic hypersensitivity to unfractioned or low-molecular-weight heparins is uncommon but is known, and in particular the most common form is localized dermatitis, although such cases have seldom turned into maculopapular exanthema. Since cross-reactions with other heparins are frequent, identification of therapeutic alternatives is essential. PATIENTS AND METHODS This retrospective study included patients referred to the Department of Dermatology and Allergology at Tenon Hospital between 2000 and 2012 with suspicion of allergy to unfractionated heparin (UFH) or low-molecular-weight heparin (LMWH) and sensitized to at least one heparin (i.e. positive skin tests to at least one heparin). The heparins and hirudins used were tested in the forearm by means of intradermal skin tests. All patients were contacted in 2012 to establish whether they had used some form of heparin since the cutaneous allergy tests. RESULTS Nineteen patients had at least one positive skin test for heparin; 1 patient had presented anaphylactic shock, while 18 others had presented localized eczema (12) or generalized dermatitis (6). The heparin most often responsible for these adverse reactions was enoxaparin (13/19). An LMWH was responsible in most cases (18 vs. 1 with UFH). Of these 18 patients, 16 also presented positive skin tests for UFH, 9 for synthetic heparinoid and 1 for hirudin. 11/19 patients were tested for fondaparinux (a synthetic pentasaccharid) and all had negative skin tests. 5/7 patients with negative skin tests had taken fondaparinux without any visible reaction, whereas 2 who also tested negative experienced localized eruption at the injection site. DISCUSSION Our results underline the greater frequency of delayed hypersensitivity reactions compared with immediate reactions to heparins. Skin tests can help to identify substitution molecules. Fondaparinux might be an alternative but certain diagnosis relies on rechallenge.

Severe allergic contact dermatitis caused by octylisothiazolinone in a leather sofa: two new cases

Nadia Raison-Peyron1 , Emmanuelle Amsler2 , Catherine Pecquet2, Aurélie Du-Thanh1, Tania Naessens3, Sandra Apers3,† and Olivier Aerts4 1Department of Dermatology, Hôpital Saint-Eloi, CHU de Montpellier, 34295 Montpellier, France, 2Dermatology and Allergology Department, Tenon Hospital (AP-HP), Sorbonne Universities, UPMC University Paris 06, 75020 Paris, France, 3Research Group Natural Products and Food – Research and Analysis (NatuRA), Department of Pharmaceutical Sciences, University of Antwerp (UA), 2610 Antwerp, Belgium, and 4Department of Dermatology, University Hospital Antwerp (UZA) and University of Antwerp (UA), 2650 Antwerp, Belgium

An outbreak of contact allergy to cocamide diethanolamide

Keywords: allergic contact dermatitis; cocamide DEA; coconut diethanolamide; CAS no. 68603-42-9; eczema

What do we learn from a cohort of 219 French patients with chronic urticaria

The Urticaria Group of the French Society of Dermatology (GUS) conducted a prospective cohort study on chronic urticaria (CU), in which 10 departments of Dermatology or Clinical Immunology and Allergology in France took part. Study results are based on data collected using questionnaires between May and July 2012. The aims of this study were to:–Collect epidemiological data–Evaluate the existence of systemic symptoms associated with CU–Evaluate French prescription practices, including patients’ [...]

Is a specific eyelid patch test series useful? Results of a French prospective study

Eyelids are frequent sites of contact dermatitis. No prospective study focused on eyelid allergic contact dermatitis (EACD) has yet been published, and this topic has never been studied in French patients.

Eyelid allergic contact dermatitis after intravitreal injections of anti-vascular endothelial growth factor: What is the culprit? A report of 3 cases

AP-HP, Dermatology and Allergology Department, Hôpital Tenon, Paris, France Dermatology Department, Hôpital le Bocage, Dijon, France Faculty of Medicine, Sorbonne Université, Paris, France Immunology and Infectious Diseases Department (Cimi-Paris), Inserm 1135, Paris, France Correspondence Dr. Tullia de Risi-Pugliese, Service de Dermatologie et Allergologie, Hôpital Tenon 4 rue de la Chine, 75020 Paris, France. Email: tullia.derisi@gmail.com

Allergological work-up with half-dose challenge in iodinated contrast media hypersensitivity

To the Editor, The diagnosis of hypersensitivity reaction (HSR) to iodinated contrast media (ICM) is challenging when based on clinical history and skin tests. ICM re‐exposure is the gold standard. The ICM dose for intravenous provocation tests (IPTs) during allergological workup lacks consensus. Nine studies reported various modalities and doses for ICM challenge (10‐120 mL), with negative predictive value (NPV) of skin tests vs challenge ranging from 37.5% to 100% (Table 1). A cross‐reactivity classification of ICM in three subgroups was proposed by Lerondeau et al. The objective of this prospective study was to determine the NPV for skin tests as compared with IPT 50 mL, which is half the usual dose for radiologic explorations. In a bicenter study, during 12 consecutive months, all patients with suspected HSR to ICM were included. According to recommendations, skin tests (prick tests, intradermal tests [IDTs]) were performed with the culprit ICM whenever it was known and at least 3 other ICM, and when a delayed reaction was suspected, patch tests and IDT with readings after day 2 were performed. A single‐blind placebo‐controlled IPT was performed during a 1‐day hospital stay, with strict supervision up to 6 hours after the challenge. All injections were intravenous, with a 2‐minutes injection, beginning with the placebo (20 mL saline), followed successively with 20 and 30 mL ICM at 2‐ hour intervals (2‐step protocol). With Grade 3 HSR, the challenge involved three successive steps: 5, 15, and 30 mL with a 1.5‐hour interval. The IPT was reduced to 10 mL with glomerular filtration rate (GFR) < 30 mL/min and to 30 mL with GFR 60‐30 mL/min. One hundred and seventeen patients were included (mean age 58 years, range 20‐87 years; 71% women). For 75 patients, the culprit ICM was known and was skin‐tested with at least three other ICM; iomeprol, iodixanol, iohexol, and ioxitalamic acid for 112, 112, 109, and 102 patients, respectively (see Table S1). In all, 81 patients had an initial immediate HSR and 32 delayed HSR; in 4, the type of reaction was unknown. Sixteen patients reported Grade 3 HSR, and another had Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) syndrome (Figure 1A). Overall, 110 patients had a single‐blind IPT with the culprit ICM if the skin tests were negative or a substitutive ICM if positive. IPT was considered positive with saturation decreased < 90% and/or blood pressure decreased by >30% and/or a skin eruption