Györgyi Pónyai

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.

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.

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.

para-Phenylenediamine Hypersensitivity: A Report From Budapest, Hungary, 2007-2014.

Backgroundpara-Phenylenediamine (PPD) is a potent allergen with frequent exposure through use of hair dyes or henna tattoos. ObjectivesWe wished to determine if prevalence of PPD sensitivity is changing through time as trends in its use change. PatientsA total of 3631 patients were patch tested consecutively with the environmental standard series between 2007 and 2014 to map the prevalence of PPD sensitivity and its distribution according to age, sex, and diagnosis. ResultsTwo hundred nine patients (5.75%) were proven to be PPD sensitive. Most PPD-sensitive patients were approximately in their 60s in 2007, whereas in 2014, they were in their 20s and 30s. In 2014, 61.1% of the patients were younger than 35 years and 50% were younger than 25 years. Of 209 PPD-sensitive patients, 32.5% had present relevance related to hair dyeing and eyebrow or eyelash coloring procedures. All affected male patients were hairdressers. Adverse reaction to henna was detected in only 1 case after henna hair dye use. ConclusionsThe 5.75% prevalence of PPD sensitization in our study was higher compared with that in the European data. It is alarming that PPD hypersensitivity occurred even among teenagers. This may be mainly explained by hair dyeing at an early age.

Contact hypersensitivity in rosacea – a study in 82 patients

Editor There are only few data concerning the frequency of contact hypersensitivity (CH) in rosacea, although it in fact can play an important role in the therapy or in the daily life of the patients. The aim of this study was to map the ratio of CH in 82 unselected rosacea patients (68 women, 14 men, over all 18 years, mean age: 54.4) tested in the Department of Dermatology, Venerology and Dermato-oncology of the Semmelweis University between January 2004 and December 2009. The patch tests were performed with Brial GmbH D-Greven series, and the reactions were evaluated (with 48 h occlusion) at 48, 72 and 96 h and on the 7th day. The patients did not take any antihistamine or immunosuppressive agents, and used only indifferent topical treatment 1 week before the tests and at the time of testing. Pregnancy, breast feeding, acute skin symptoms and UV radiation within 6 weeks before testing were drop-out criteria. CH was detected in 29 cases (35.4%). Most common allergens were nickel, balsam of Peru and fragrance mix I (Table 1). Among the relevant allergens, balsam of Peru (5 ⁄ 5), fragrance mix I (4 ⁄ 4), lanalcolum and PPD (3 ⁄ 3) were the most common. Relevant CH can rather be related to cosmetics (46.1%) and washing agents (38.4%). 38.8% of women face creams and make-ups and 20% lotions and gels were in connection with the CH. 27.8% showed CH as a component of therapeutic medical creams. At the time of testing, 80.5% of the patients were over 41 years. In 24 patients, the clinical symptoms had been present for 1–2 years, and in six cases, it was present for over 10 years. Two women had atopic dermatitis. The rosacea symptoms did not show correlation with the occupation of the patients. There is only few data about the ratio of CH in rosacea. In this study, the ratio of CH to nickel (7.3%) meets previous data (3.4–15.5%), to that of balsam of Peru (6.1%) is lower than previous data (6.9–10.4%),and to that of fragrance mix I (4.9%) is lower than previous results (5.2–10.3%). Rosacea patients are very susceptible to adverse reactions caused by external formulations, and so the choice of local treatment and cosmetics is difficult. The presence of CH must be kept in mind. According to our results, relevant CH associate mostly with cosmetics in rosacea patients.

Methylchloroisothiazolinone/Methylisothiazolinone and Methylisothiazolinone Sensitivity in Hungary

Background. Due to allowing of methylisothiazolinone (MI) in cosmetics, cleaning products, and paints, an epidemic of MI-hypersensitivity emerged. Patch testing Kathon CG® (3:1 mixture of methylchloroisothiazolinone and methylisothiazolinone, MCI/MI) does not correctly detect MI contact allergy, due to the low concentration of MI in the test material. Methods. A retrospective survey was performed to estimate the prevalence of MCI/MI hypersensitivity in 14693 patients tested consecutively between 1993 and 2014. Moreover, currently 314 patients were prospectively tested with the allergens MCI/MI and with MI during one year. Results. MCI/MI hypersensitivity increased retrospectively from 0.5% to 6.0%. By current prospective testing we detected 25 patients (8%) with MCI/MI and/or MI positive reactions. Out of the 25 patients 10 were only MCI/MI positive, 9 were only MI positive, and 6 were MCI/MI and MI positive. If MI had not been tested separately, MI contact allergy would have missed in 36% of all detected cases and in 2.8% of the total 314 patients. Conclusions. The frequency of MCI/MI hypersensitivity is increasing also in Hungary. We confirm that, in order to detect MI contact allergy, it needs to be tested separately. A further increase of MI hypersensitivity might be expected in the future as products containing MI are still widely available.

Association of collagenous colitis with prurigo nodularis

The etiology and pathogenesis of collagenous colitis (CC) is poorly understood and probably multifactorial; many potential pathophysiological mechanisms have been described, although none have been conclusively proved. Circumstantial evidence suggests that CC appears as an autoimmune response to a luminal or epithelial antigen of unknown origin. Infections and certain drugs (e.g. NSAID, lansoprazole) may act as triggers for an immune-mediated process. CC is characterized clinically by chronic watery, nonbloody diarrhea with normal endoscopic appearance and without radiological abnormalities, but specific microscopic changes in the colon. Histopathology is featured by the presence of a thickened subepithelial collagen band adjacent to the basal membrane. Up to 40% of patients with CC have associated diseases of autoimmune or inflammatory origin, such as thyroid disease, coeliac disease, rheumatoid arthritis, diabetes mellitus, Sjögrens syndrome, CREST syndrome, scleroderma, pernicious anemia, and sarcoidosis. Prurigo nodularis is a chronic condition characterized by intensely pruritic, lichenified, or excoriated papules and nodules of unknown etiology. It is assumed to represent a cutaneous reaction pattern to repeated scrubbing or scratching caused by pruritus. We report a case of CC and prurigo nodularis. To our knowledge, this association has not been reported earlier.

Contact hypersensitivity in adolescents

Contact hypersensitivity is common in adolescents, but data in the literature are limited. Adolescents often use cosmetics, wear jewelry, and obtain tattoos, which can be sources of allergens.