Klaus-Peter Peters

Allergic and irritant reactions to rubber gloves in medical health services: Spectrum, diagnostic approach, and therapy

Delayed-type allergies account for most reactions to gloves. These have been found in 32 of 39 patients (82%) attending our department with occupationally induced contact dermatitis to gloves. Accelerators, mainly of the thiuram group, antioxidants, vulcanizers, organic pigments, and, presumably, glove powder ingredients are known responsible allergens. In contrast, immediate-type allergies to rubber gloves were less frequent (13 of 39 patients [33%] with occupationally induced glove allergies). They usually present as contact urticaria. Responsible allergens are latex, glove powder, and accelerators. On the basis of the numerous glove-related allergens, a comprehensive schedule of diagnostic tests is proposed. In addition, we introduce a new classification of hypoallergenic gloves according to their basic materials and ingredients and thus provide a guideline for individual therapy.

Frequency, spectrum and occupational relevance of type IV allergies to rubber chemicals

3851 consecutive patients patch tested between January 1985 and March 1990 have been analysed for rubber allergies. The incidence of rubber allergy was 3.8% (n=145) In 80/145 patients (55%). the source of rubber sensitization was occupational, 67 of whom (84%) had acquired allergy from wearing rubber gloves a work. Most of them (36%) were employed in the health services. The most commonly positive rubber‐mix in this group was thiuram‐mix (72%) Followed by carba‐mix (25%.) 13/80 patients (16%) had occupational rubber allergy from industrial rubber products other than gloves. Patch tests revealed thiuram‐mix (62%) as the most commonly positive rubber‐mix but, in contrast to the group with glove‐induced rubber allergy, black‐rubber‐mix came second (38%) In 47/145 patients (32%) the source of rubber sensitization W8S non‐occupational; in 18/145 (13%) the origin remained unknown.

Yellow nail syndrome in a patient with mycosis fungoides

5. Wilson L. The dissociation of topical from systemic effect in corticosteroids. Postgrad Med J 1974;50(suppl 4):7-9. 6. Topert M. Perspectives in corticosteroid research. Drugs 1988;36(suppI5):1-8. 7. Eriksen K. Comparison of clobetasol propionate and betamethasone-17,21, dipropionate with reference to adrenal suppression. Acta Derm Venereol (Stockh) 1978;59:372-4. 8. Ohnman EM, Rogers S, Meenan FO, et al. Adrenal suppression following low-dose topical clobetasol propionate. J R Soc Med 1987;80:422-4. 9. Neumann RA, Schmidt J, Spona J. Einfluss topischer Glukokortikoide auf die korpereigene Cortisolproduktion. Z Hautkr 1987;63:302-8. 10. Carruthers JA, August PJ, Stoughton RCD. Observations Journal of the American Academy of Dermatology May 1993

Effects of lnterferon-Alpha-2b on the Clinical Course, Inflammatory Skin Infiltrates and Peripheral Blood Lymphocytes in Patients with Severe Atopic Eczema

Increased serum IgE and enhanced susceptibility to viral infections, decreased levels of interferons, lymphocytic skin infiltrates and IgE-bearing epidermal Langerhans cells are striking features in patients with atopic eczema (AE). Since the hyper-IgE syndrome is known to improve under alpha-interferon (alpha-IFN) therapy, we treated 7 patients with severe AE and high serum IgE exclusively with 3 x 10(6) units IFN alpha 2b thrice weekly for 3 months. Before treatment the skin infiltrates mainly consisted of CD3+/CD4+/TcR alpha/beta + lymphocytes, whereas the CD3+/CD8+ phenotype was limited to about 10% of cells. After 6 weeks of therapy, epidermal inflammation with CD4+ and CD8+ cells was reduced but dense infiltrates remained in papillary perivascular areas. Expression of TcR gamma/delta, HLA-DR and CD25 showed no significant changes. Initially high serum IgE and soluble CD23 as well as cell-bound IgE dropped under therapy, whereas a short-term elevation in serum IL-2 receptor was observed. On peripheral blood lymphocytes slightly reduced expression of HLA-DR, LFA-1, CD23 and ICAM-1 was seen after 100 days. LFA-3 expression became reduced in 4 patients, the CD4/CD8 ratio decreased in all cases. After an initial therapeutic response of all patients, significant longer-lasting improvement of the skin lesions could only be observed in 2 of 7 patients. The data of our long-term study suggest that systemic IFN alpha 2b treatment leads to a remarkable reduction in epidermal inflammation but does not significantly influence cutaneous cell subsets. Immunomodulatory effects became obvious by reduced peripheral cell subsets expressing TcR alpha/beta, MHC class II and adhesion molecules.

Alteration of cell surface carbohydrates associated with ordered and disordered proliferation of oral epithelia: a lectin histochemical study in oral leukoplakias, papillomas and carcinomas.

Abstract. Cell surface carbohydrates in healthy oral mucosa (n = 15), leukoplakias without (n= 48) and with (n = 62) dysplasia, oral papillomas (n= 6) and squamous cell carcinomas (SCCs) (n – 40) were examined using the lectins peanut agglutinin (PNA), Ulex europaeus agglutinin I (UEA I), soybean agglutinin (SBA), Helix pomatia agglutinin (HPA), and Griffonia simplicifolia agglutinin I (GS I‐B4). Binding of these lectins in formalin‐fixed, paraffin‐embedded tissues was demonstrated using either the peroxidase‐anti‐peroxidase (PAP) method or the avidin‐biotin method. Healthy oral epithelia revealed binding sites for these lectins mostly in the suprabasal keratinocytes with occasional PNA binding also in their basal cells. Unlike healthy mucosa, a number of leukoplakias without and with dysplasia revealed receptor sites for UEA I also in their basal layer. Only those keratinocytes undergoing squamoidal differentiation exhibited SBA binding. Staining patterns of UEA I and SBA did not vary significantly between either leukoplakias without and with dysplasia or papillomas and SCCs. Conversely, a reduction or lack of binding sites for PNA (Galβl‐3GalNAc), HPA (D‐GalNAcα) and GS I‐B4 (αD‐Gal) was observed more frequently in leukoplakias with dysplasia and SCCs contrasting their counterparts lacking epithelial dysplasia.

Frequency of type I allergy to rubber gloves in dental students

Zusammenfassung. In der vorliegenden Studie wurde mittels Fragebogen, Prick-Testungen und Bestimmung spezifischer IgE-Antikörper die Prävalenz einer Typ-I-Allergie gegen Latex bei Zahnmedizinstudenten untersucht. Bei 18 (8,7%) von 206 Studenten zeigten sich positive Prick-Teste auf unterschiedliche Latexmilchen, für die in 11 Fällen eine klinische Relevanz bestand. Unter Berücksichtigung der jeweiligen Gesamtzahl an Studenten pro Semester konnte eine Zunahme der minimalen Prävalenzen einer klinisch relevanten Latexallergie von 2% im 7. Semester auf 10,4% im 10. Semester ermittelt werden. Die Anamnese einer Handschuhintoleranz mit Urtikaria, Erythem und Juckreiz war nur in 50% der Fälle mit dem Vorliegen einer Typ-I-Allergie gegen Latex assoziiert. Als Risikofaktoren erwiesen sich atopische Erkrankungen und Handekzeme unterschiedlicher Genese bei 16 bzw. 5 der 18 Latexallergiker. In der Diagnostik zeigte sich eine hochammoniakalische, akzeleratorfreie Latexmilch als geeignetes Testmedium im Gegensatz zu der weniger sensitiven Bestimmung spezifischer IgE-Antikörper gegen Latex.Abstract. The prevalence of type I allergy against latex was investigated in dental students by questionnaire, prick tests and the determination of specific IgE antibodies. Positive prick tests against different latex fluids were found in 18 (8.7%) of 206 students, with clinical relevance in 11 cases. When the total number of students in each semester was taken into account an increase in the minimal prevalence of clinically relevant latex allergy from 2% in the second semester to 10.4% in the tenth semester was seen. A history of glove intolerance presenting as a wheal-and-flare reaction was associated with a type I allergy against latex in only 50% of the affected subjects. Atopic diseases and hand eczema of different causes proved to be risk factors in 16 and 5 of 18 students with latex allergy, respectively. A high-ammonia accelerator-free latex fluid proved to be a very reliable test medium compared to the less sensitive determination of specific IgE antibodies to latex.

Extensive linear epidermal nevus associated with hemangiomas of bones and vitamin-D-resistant rickets.

The association of connate, left-sided, extensive epidermal verrucous nevus, multiple isolated bone tumors and vitamin-D-resistant rickets since childhood seen in a 20-year-old male patient corresponded to an epidermal nevus syndrome (ENS). However, other organ involvement occasionally associated with ENS could not be found in this patient, and his intraosseous tumors represented histologically benign hemangiomas. Serum analysis revealed hypophosphatemia (together with phosphaturia), decreased levels of 1,25-dihydroxycholecalciferol and elevated levels of alkaline phosphatase indicating hypophosphatemic osteomalacia. Therefore we suppose that vitamin-D-resistant rickets combined with skeletal tumors represents a peculiar type of osteomalacia caused by unilateral mesenchymomas.