Kirsti Kalimo

The patch test, skin prick test, and serum milk-specific IgE as diagnostic tools in cow's milk allergy in infants.

We evaluated the value of the patch test, skin prick test, and milk‐specific IgE by CAP RAST in 301 infants with suspected hypersensitivity to cows milk. The patch test was carried out with milk powder, and the skin prick test with cows milk‐based formula. Hypersensitivity to cows milk was determined with double‐blind, placebo‐controlled challenge. An immediate reaction to cows milk challenge was observed in 100 infants (33%), a delayed reaction in 76 (25%), and a negative result in 125 (42%). Skin prick test wheals were significantly greater in infants with immediate reactions than in infants with delayed or negative reactions. Milk‐specific IgE was correlated with the skin prick test (r=0.78, P<0.001, n=268) but did not contribute to further discrimination of immediate reactions from delayed or negative reactions compared to skin prick test alone. In our study population, the skin prick test (diameter ≥3 mm) showed a specificity and sensitivity of 91% and 69%; the results for milk‐specific IgE (≥0.7 kU/l) were 88% and 58%, respectively. The patch test did not distinguish subjects with immediate or delayed reactions from those with negative reactions.

Contact allergy to dental restorative materials in patients with oral lichenoid lesions

118 patients with oral lichenoid lesions (OLL) topographically related to dental fillings were patch tested (FT) to reveal contact allergy to restorative materials. 80 (67.8%) patients displayed positive PT reactions to metals of dental filling materials: 76 reactions were found to various mercury compounds. 4 to sodium aurothiosulphate, 3 to stannic chloride and 2 to silver nitrate. The positive patch lest reactions appeared more commonly in patients with restricted contact lesions (85.1%, type‐1 lesions) as compared to patients with lesions exceeding to the adjacent areas (38.6%, type‐2 lesions). The replacement of dental fillings was carried out in 62/80 PT‐positive and 15/38 PT‐negative patients. 28 out of 62 (45.2%) PT‐positive and 3/15(20%) PT‐negative patients showed complete healing of OLL after a mean follow‐up time of 16 months. Complete healing occurred in 29/54(54.0%) type‐1 and 2/23 (8.7%) type‐2 lesions. Topographical relation between the lesion and the filling material (restricted versus exceeding the contact area) indicated association of OLL lesion and the filling material, which could be further confirmed by patch testing in the majority of patients. The patch test series should include mercuric chloride (0.1%), mercury (0.5%) and mercury ammonium chloride (1.0%), each in pet.

Patch test reactions to cosmetic allergens in 1995–1997 and 2000–2002 in Finland – a multicentre study

Contact sensitivity to cosmetics is common, but the sensitizing chemicals vary between countries and study periods. The present survey aimed at revealing the recent trends in patch test sensitivity with cosmetic chemicals in Finland. We report a retrospective multicentre survey of patch test reactions focusing on cosmetic‐related substances and comparing the test results in 1995–97 with those in 2000–02. The most striking increases in the frequency of the patch test sensitivity were found with balsam of Peru and propolis from 4.0% to 6.2% (P < 0.001) and from 0.5% to 1.4% (P < 0.001), respectively, whereas the most prominent decreases were found with methylchloro/methylisothiazolinone and chlorhexidine diglugonate from 2.4% to 1.3% (P < 0.001) and from 1.2% to 0.5% (P < 0.001), respectively. The level of patch test sensitivity to methyldibromo glutaronitrile increased, although not significantly, from 1.0% to 1.5%. An increasing tendency was also found with hair dye chemicals 4‐aminophenol and toluene‐2,5‐diamine or toluene‐2,5‐diamine sulfate from 1.3% to 3.8% and from 1.4% to 5.2%, respectively, while such a tendency was not found among permanent wave chemicals. The sensitivity level of fragrance mix remained the same (6% − 7%). We conclude that surveys revealing the state of sensitivity to cosmetic chemicals should be performed periodically in different countries.

Feeding a soy formula to children with cow's milk allergy: The development of immunoglobulin E-mediated allergy to soy and peanuts

Peanut allergy has been associated with the intake of soy milk or a soy formula. We studied the development of immunoglobulin E antibodies specific to soy and peanuts and of allergic reactions caused by peanuts, in children with confirmed cows milk (CM) allergy fed either a soy formula or an extensively hydrolyzed formula (EHF). One hundred and seventy infants with documented CM allergy (CMA) were randomly assigned to receive either a soy formula or an EHF. The children were followed to the age of 4 yr. Peanut‐specific immunoglobulin E was measured at the age of 4. A detailed history of the occurrence of allergic reactions caused by peanuts was recorded by the parents. Soy‐specific immunoglobulin E antibodies were measured at the time of diagnosis and at the ages of 1, 2 and 4 yr. Immunoglobulin E antibodies to soy (≥0.35 kU/l) were found in 22 of 70 children fed the soy formula, and in 14 of 70 of the children fed the EHF (p = 0.082). In an open challenge with soy at the age of 4, no immediate reactions were observed. One of 72 children from the soy group had a delayed reaction. immunoglobulin E antibodies to peanuts (≥0.35 kU/l) were found in 21 of 70 children fed the soy formula and 17 of 69 infants fed the EHF (p = 0.717). The incidence of reported peanut allergy in the soy group was two of 72 (3%) and four of 76 (5%) in the EHF group (p = 0.68). Development of immunoglobulin E‐associated allergy to soy and peanuts was rare in our study group of milk allergic children. The use of a soy formula during the first 2 yr of life did not increase the risk of development of peanut‐specific immunoglobulin E antibodies or of clinical peanut allergy.

Rapid systemic valaciclovir reaction subsequent to aciclovir contact allergy

Keywords: aciclovir; valaciclovir; allergic contact dermatitis; famciclovir; cutaneous adverse drug reactions; antivirals; oral challenge; systemic contact dermatitis; cross-sensitivity; medicaments; cetearyl alcohol

Is it possible to improve the prognosis in nickel contact dermatitis

A questionnaire was sent to 143 patients who had shown a positive patch test reaction to nickel sulfate more than 10 years earlier. 91 patients returned the questionnaire, revealing that after the testing, 73 had suffered from dermatitis, 61 especially from hand dermatitis, 37 of these patients were clinically examined and patch tested with standard series and in addition, 12 patients were tested with nickel sulfate and nickel chloride with different occlusion times. At the clinic visit, 23 patients had dermatitis, 16 hand dermatitis, and 11 were symptom‐free, 26 of the patients had metal items close to their skin and 21 of them had current dermatitis, 14 hand dermatitis. Of the 11 patients who had no metal exposure, 9 were symptom‐free. The association of dermatitis with exposure to metal objects was statistically significant (p < 0.001). Those patients who had current dermatitis had also developed multiple allergies and reacted to nickel with shorter application times in patch tests, as compared to those who were symptom‐free. It seemed possible that the prognosis for nickel dermatitis could be improved if nickel‐allergic patients would strictly avoid metal contact, especially in clothing and jewelry.

Contact sensitivity and atopic dermatitis: association with prognosis, a follow-up study in 801 atopic patients.

The influence of contact sensitivities on the course of atopic dermatitis (AD) is not known. The objective of the study is to find the course of AD in atopic patients with and without contact sensitivities. A total of 801 atopic patients were studied and patch tested in 1983/84. A questionnaire focusing on the occurrence of dermatitis was sent to these patients 16 years later. During the follow up the number of symptom‐free patients increased from 36.7% to 40.7%. In patients with positive patch‐test reactions, 30.1% were symptom free in 1983/84 and 38.3% at the follow up (P= 0.001). Among those with positive patch‐test reactions to fragrance mix and/or balsam of Peru, the number of symptom‐free patients had increased the most: from 26.9% to 42.6% (P= 0.0095), and a similar tendency was seen among those with nickel allergy. The occurrence of dermatitis did not change among patients without contact sensitivities. Thus, the study concluded that contact allergy does not impair the prognosis of dermatitis in atopic patients.