Erzsébet Temesvári

Contact and aeroallergens in adulthood atopic dermatitis

Background  Atopic dermatitis (AD) is a clinically well‐defined, chronic‐intermittant, genetically predisposed skin disease. The increasing number of adult cases observed in the last years has turned the attention to ascertaining factors eliciting skin symptoms. Studies have revealed numerous environmental components (e.g. contact and aeroallergens) that may play an important role in sustaining the symptoms.

Correlation between T-Cell and Mast Cell Activity in Patients with Chronic Urticaria

Background: The presence of autoantibodies reacting with the high affinity IgE receptor (FcΕRIα) usually indicates a more severe form of chronic urticaria (CU). Previously, we showed an increased lymphocyte reactivity in CU patients; however, the relation between enhanced cellular immunity and the presence of anti-FcΕRIα-specific autoantibodies has not been investigated. Methods: Cellular and humoral immune reactivity of 50 CU patients and 28 healthy controls was studied.Serum sIL-2R, neopterin, and tryptase levels were measured to assess T-cell, monocyte/macrophage and mast cell activity, respectively. Helicobacter pylori (HP)-specific IgG antibody, and IgE levels were also tested. Anti-FcΕRIα-specific autoantibody was determined by Western blotting. In vivo histamine-releasing activity of patients’ sera was assessed by the autologous serum skin test (AST). Results: 17/50 CU patients, who both had IgG-type anti-FcΕRIα-antibodies by Western blotting and a positive AST response, were classified as autoimmune CU. All patients with CU had significantly higher serum sIL-2R and tryptase levels than healthy controls (p = 0.000257, p = 0.000166, respectively), indicating T-cell and mast cell activation. Patients with higher sIL-2R levels also had higher tryptase levels; the strongest correlation was shown in the autoimmune subgroup of patients (ρ = 0.688, p = 0.002). There was a tendency towards higher tryptase levels in the autoimmune subgroup, as compared to the nonautoimmune CU patients. While the serum IgE was significantly lower in autoimmune than in nonautoimmune CU (p = 0.000836), there was no significant difference in their sIL-2R, neopterin and HP-specific IgG antibody levels. CU patients with a positive AST response (38/50) had significantly higher tryptase levels (p = 0.0107) when compared to the negative skin test group. Conclusions: The significant correlation between sIL-2R and tryptase levels in patients with CU indicates that T cell activation is proportional to mast cell degranulation in these patients. The increased level of tryptase in autoimmune CU may suggest more severe disease.

Patch testing with fragrance mix and its constituents in a Hungarian population

propylene glycol, but this could be due to multiple sensitization as he had used several topical agents containing propylene glycol or PEG. Although few contact allergies are found in relation to the widespread use of PEGs, some patients are perhaps more susceptible to developing contact dermatitis from PEGs. The use of topical preparations containing PEG on damaged skin, such as leg ulcers, seems to predispose (2, 5, 6). The older German literature (2, 5) advises incorporation of PEG in test series for topical preparations, as does a recent publication from India (6). Our own results, I out of 314 patients positive, do not really support this advice. Local customs in the prescription of various topical preparations containing PEG might be important in deciding whether to incorporate PEG in a vehicle series. PEG 400 and 1540 can be tested as is; in case of a positive allergic reaction, dilution down to 3% or 1% pet. or aq. may confirm a positive reaction. PEG is not subject to bacterial deterioration. Peroxidases may however be formed during storage, especially at higher temperatures or in daylight (3), so storage Contact Dermatitis 1994: 30: 185

Reduced inflammatory threshold indicates skin barrier defect in transglutaminase 3 knockout mice

Recently, a transglutaminase 3 knockout (TGM3/KO) mouse was generated that showed impaired hair development, but no gross defects in the epidermal barrier, although increased fragility of isolated corneocytes was demonstrated. Here we investigated the functionality of skin barrier in vivo by percutaneous sensitization to FITC in TGM3/KO (n=64) and C57BL/6 wild-type (WT) mice (n=36). Cutaneous inflammation was evaluated by mouse ear swelling test (MEST), histology, serum IgE levels, and by flow cytometry from draining lymph nodes. Inflammation-induced significant MEST difference (P<0.0001) was detected between KO and WT mice and was supported also by histopathology. A significant increase of CD4+ CD25+-activated T cells (P<0.01) and elevated serum IgE levels (P<0.05) in KO mice indicated more the development of FITC sensitization than an irritative reaction. Propionibacter acnes-induced intracutaneous inflammation showed no difference (P=0.2254) between the reactivity of WT and KO immune system. As in vivo tracer, FITC penetration from skin surface followed by two-photon microscopy demonstrated a more invasive percutaneous penetration in KO mice. The clinically uninvolved skin in TGM3/KO mice showed impaired barrier function and higher susceptibility to FITC sensitization indicating that TGM3 has a significant contribution to the functionally intact cutaneous barrier.

Periocular dermatitis: a report of 401 patients

Background  Periocular contact dermatitis may appear as contact conjunctivitis, contact allergic and/or irritative eyelid and periorbital dermatitis, or a combination of these symptoms. The clinical symptoms may be induced by several environmental and therapeutic contact allergens.

Multicentre study of fragrance allergy in Hungary. Immediate and late type reactions.

The authors followed the frequency of fragrance contact sensitization in Hungary in a multicentre study in the years 1998 and 1999. A total of 3604 patients were tested with fragrance mix (FM), and positive reactions were observed in 294 (8.2%). In 160 FM hypersensitive patients, the study was continued with patch testing of the mix constituents (cinnamic alcohol, cinnamic aldehyde, eugenol, amyl cinnamic aldehyde, hydroxycitronellal, geraniol, isoeugenol, oak moss absolute). Of the patients tested, 70.6% produced positive reactions to the constituents. FM contact sensitization was mainly observed in female patients (74.4%). The incidence of contact urticaria in FM hypersensitive patients was 6.1%. Simultaneous patch test trials of other environmental contact allergens, in both early and late evaluations, mainly confirmed hypersensitivity reactions to balsams. Female dominance of hypersensitivity reactions observed during testing the individual components of the mix was striking (82.4%). In positive skin reactions, cinnamic alcohol, isoeugenol and oak moss provoked skin symptoms most frequently. We also tested the 104 patients who produced negative reactions to FM with the constituent individual allergens, with 11.9% positive incidence. The clinical symptoms of the patients were above all manifest in the form of contact eczema, located on the hands, face, eyelids and axillae. With this study, the authors, members of the Hungarian Contact Dermatitis Research Group, call attention to one of the most frequent allergens in the environment.

The Effect of Heat-Inactivated Helicobacter pylori on the Blastogenic Response of Peripheral Blood Mononuclear Cells of Patients with Chronic Urticaria

Background:Helicobacter pylori, the most important etiologic factor of gastritis and peptic ulcer, has recently been associated with several extradigestive diseases. Previous studies reported conflicting results on H. pylori eradication in chronic urticaria, in that some studies showed a benefit, while others found no effect. Methods: Peripheral blood mononuclear cells of 24 chronic urticaria patients (13 seropositive/11 seronegative for H. pylori) and 18 healthy controls (9 seropositive/9 seronegative) were stimulated with whole heat-inactivated H. pylori (8 × 105, 8 × 106 and 8 × 107 bacteria/well), phytohemagglutinin (2 µg/ml) and pokeweed mitogen (5 µg/ml). The proliferative response was determined by 3H-thymidine incorporation. Helicobacter-specific IgG antibody response was determined by ELISA. Results: There were significantly higher proliferative responses to various concentrations of whole heat-inactivated H. pylori antigen in 6- to 7-day cultures of peripheral blood mononuclear cells of chronic urticaria patients compared to healthy controls. We found a tendency to exhibit a higher proliferative response to either Helicobacter antigens or mitogens in seropositive compared to seronegative patients. Conclusion: Our results support the hypothesis that there is an increased lymphocyte reactivity in chronic urticaria, perhaps further enhanced by the presence of H. pylori which, therefore, may be involved as a trigger in the pathogenesis of chronic urticaria.

Benign familial chronic pemphigus (Hailey-Hailey) provoked by contact sensitivity in 2 patients.

7. Estlander T, Kanerva L, Jolanki R. Allergic dermatoses in chemical laboratory work. In: Jadassohn Centenary Congress, 9–12 Oct, 1996, London, UK, abstract no. 251: 1996: 64. 8. Foussereau J, Lantz J P, Grosshans E. Allergic eczema from vinyl-4-pyridine. Contact Dermatitis Newsletter 1972: 11: 261. 9. Sonnex T S, Rycroft R J G. Allergic contact dermatitis from chloromethyl heterocyclic intermediates in the synthesis of a histamine antagonist. Contact Dermatitis 1986: 14: 265–267. 10. Dooms-Goossens A, De Boulle K, Snauwaert J, Degreef H. Sensitization to 3,4,6-trichloropyridazine. Contact Dermatitis 1986: 14: 64–65. 11. Rothe A. Contact dermatitis from N-(a-chlorlbenzylidene) phenylhydrazine. Contact Dermatitis 1988: 18: 16–19. 12. Sasseville D, Balbul A, Kwong P, Yu K. Contact sensitization to pyridine derivatives. Contact Dermatitis 1996: 35: 100–101. 13. Tarvainen K, Kanerva L, Tupasela O, Grenquist-Nordén B, Jolanki R, Estlander T, Keskinen H. Allergy from cellulase and xylanase enzymes. Clin Exp All 1991: 21: 609— 615.

[Adulthood atopic dermatitis: epidemiology, clinical symptoms, provoking and prognostic factors].

The prevalence of atopic diseases, including allergic rhinitis, asthma bronchiale and atopic dermatitis is increasing both in children and adults at different parts of the world. Atopic dermatitis is a chronic inflammatory skin disease affecting mostly children, but the atopic trait continues, not only for later respiratory allergies, but also for skin symptoms in adulthood. In this form dry skin, flexural lichenification, head and neck dermatitis, hand dermatitis are typical. The exact etiology of atopic dermatitis is unknown, in the background interactions of genetical predisposition, skin barrier defects and immunological and environmental factors can be verified. In the complex approach of atopic dermatitis, a pivotal role is ascribed to the evaluation and possibly the elimination of provoking factors, like gender, family structure, clothing, aero-, alimentary and contact allergens, psychosocial stress, migration, infections, and personal home environment. Authors review clinical manifestations, triggering and prognostic factors of the adulthood atopic dermatitis.

Patch tests with fragrance mix II and its components.

BackgroundFragrance mix II (FM II) was initiated to detect contact hypersenstitivity (CH) to fragrances that could not have been identified previously. ObjectiveThe aim of this multicenter study was to map the frequency of CH to FM II and its components in Hungary. MethodsSix centers participated in the survey from 2009 to 2010. A total off 565 patients (434 women and 131 men) with former skin symptoms provoked by scented products were patch tested. The tests were performed with Brial GmbH D-Greven allergens. In the environmental patch test series, FM II, FM I, Myroxylon pereirae, colophonium, wood-tar mix, propolis, and sesquiterpene lactone mix were tested as fragrance allergens. The FM II components (citral, farnesol, coumarin, citronellol, &agr;-hexyl-cinnamaldehyde, and hydroxy-isohexyl-3-cyclohexene-carboxaldehyde [Lyral]) were also tested. ResultsContact hypersenstitivity to any fragrances was detected in 28.8%, to FM II in 17.2% of the patients. Contact hypersenstitivity to hydroxy-isohexyl-3-cyclohexene-carboxaldehyde was observed in 7.3%, to coumarin in 5.1%, to &agr;-hexyl-cinnamaldehyde in 3.5%, to citral in 3.4%, to farnesol in 2.5%, and to citronellol in 1.2%. Of the FM II–positive cases, 48.4% showed isolated CH reaction. ConclusionsThe frequency of CH to FM II is 17.2% in the tested, selected Hungarian population. The CH to FM II and its components could not have been revealed without the present test materials.