Matti Hannuksela

Extraction and Properties of Apple Allergens

It is shown that apple allergens are probably proteins and that they can be extracted in an active form only if reactions with phenolic compounds present in apple are inhibited. This is accomplished by incorporating chelators and solid polyvinylpolypyrrolidone in the extraction medium. Phenol, commonly used as a preservative, should not be added. With the RAST, serum‐IgE antibodies capable of reacting with apple allergens were detected in 90% of patients with clinical apple allergy, in 44% of patients with clinical birch‐pollen allergy and in 5—10% of patients with other atopic allergies. RAST inhibition indicated that apple and birch‐pollen allergens cross‐react.

The repeated open application test (ROAT)

Repeated open application tests (ROATs) were performed with common ingredients of vehicles in 86 patients with contact dermatitis. The substances were applied twice daily for 7 days to the flexor aspect of the forearm near the cubital fossa, unless dermatitis appeared earlier. Of the patients with a questionable (?+) patch test result, 44% were positive in ROATs. The corresponding figure was 80% in the patients with B positive (+ or ++) response in the patch lest, when the results of ROAT with propylene glycol were excluded. Only 5 of 14 patients reacting lo 30% or to 10% propylene glycol but not in 15 in water in patch testing, showed a positive result to a cream containing 5% propylene glycol in ROAT. All 5 patients with a positive patch test reaction to 1% propylene glycol reacted to 5% propylene glycol in ROAT.

Immediate reactions to fruits and vegetables

Common fruits and vegetables were tested as such with the “scratch‐chamber” method in 388 patients with various atopic disorders. Of the patients with hypersensitivity to birch pollen, 36% showed immediate positive responses to these natural, fresh materials. Apple, carrot, parsnip and potato elicited reactions more often than, e.g. swede, tomato, onion and parsley. On the basis of clinical data, the relevancy of the results of the skin tests was 80–90%. Both “false positive” and “false negative” responses were seen.

Finnish Allergy Programme 2008–2018 – time to act and change the course

Background:  The prevalence of allergic diseases has grown in Finland, similarly to many other western countries. Although the origin of allergy remains unresolved, increasing body of evidence indicates that the modern man living in urban built environment is deprived from environmental protective factors (e.g. soil microorganisms) that are fundamental for normal tolerance development. The current dogma of allergen avoidance has not proved effective in halting the ‘epidemic’, and it is the Finnish consensus that restoring and strengthening tolerance should more be in focus.

Allergy to Birch Pollen and Apple, and Gross-Reactivity of the Allergens Studied with the RAST

Apple‐pulp allergens arc unstable, but fresh material can be used for skin testing. In this study stable allergens, probably of a protein nature, were extracted from apple seed and used in radioallergosorbent tests (RAST). Apple‐seed allergens were shown by RAST inhibition to cross‐react with birch pollen allergen(s). Cross‐reactivity may explain the frequent co‐occurrence of birch pollen and apple allergy. Approximately 50% of patients in a group with immediate hypersensitivity to birch pollen were also sensitive to apple as judged by a history of symptoms, skin tests with apple‐pulp and apple‐seed preparations, and apple‐seed RAST.

Trioxsalen bath PUVA did not increase the risk of squamous cell skin carcinoma and cutaneous malignant melanoma in a joint analysis of 944 Swedish and Finnish patients with psoriasis.

It has been suggested that trioxsalen bath and ultraviolet (UV) A (PUVA) is associated with a very low or no risk of non‐melanoma skin cancer, but the numbers of patients in individual studies have been limited. In order to attain statistically relevant information about the cancer risk associated with trioxsalen bath PUVA, two follow‐up studies were combined and the joined cancer incidence was analysed among 944 Swedish and Finnish patients with psoriasis. The mean follow‐up time for skin cancer was 14.7 years. Standardized incidence ratios (SIR) were calculated as a ratio of observed and expected numbers of cases. The expected numbers of cases were based on the national cancer incidence rates in the respective countries. There was no excess of squamous cell skin carcinoma [SIR 1.1, 95% confidence interval (CI) 0.2–3.2] or malignant melanoma (SIR 0.9, 95% CI 0.1–3.2) in the combined cohort. Basal cell skin carcinoma was not studied. The incidence of all non‐cutaneous cancers was not increased (SIR 1.1, 95% CI 0.8–1.4). A threefold excess risk of squamous cell skin carcinoma after trioxsalen bath PUVA could therefore be excluded, which is a markedly lower risk than that associated with oral 8‐methoxypsoralen PUVA. The result needs to be confirmed in a future follow‐up, however, as the number of patients with high PUVA exposures was low.

Corticosteroid contact allergy: an EECDRG multicentre study

This article describes the results of an EECDRG multicentre study on contact allergy to corticosteroids. A total of 7238 patients were investigated: 6238 in 13 centres in the course of 1993, and 1000 patients in 1 centre in 1993 and 1994. The 5 corticosteroids tested were budesonide 0.1% pet., betamethasone‐17‐valerate 1% pet., clobetasol‐17‐propionate 1% pet., hydrocortisone‐17‐butyrate 1% eth., and tixoeortol‐21‐pivalate 1%., pet.; 189 (2.6%) gave a positive patehtest reaction (+, ++, +++)to at least 1 of the corticosieroids. The data regarding the corticosteroid‐sensitive patients, as well as the patchtest results, were recorded on a standardized form.

Allergy to ingredients of vehicles

Common ingredients of vehicles such as perfumes, antibacterial agents, emulsifiers and other surface active agents, propytene glycol, lanolin and wool alcohols were tested in eczema patients over a three‐year period. Perfume allergy was detected in 3.6 % of the cases, sensitivity to thiomersal in 2 %, to sorbic acid in 0.8 %, to parabens in only 0.3 %, and to wool alcohols in 1.2%. Reactions to emulsifiers were seen in over 1 % of those tested.

European Multicenter Study of the True Test

A new, standardized, ready‐to‐apply patch test, the TRUE Test™, has been evaluated on 698 consecutive patients with suspected contact dermatitis. The patients were tested with 12 different allergens. Simultaneously, the same 12 allergens in pet. (Trolab®) were applied symmetrically to the opposite side of the upper back using the conventional Finn Chamber® technique. There were positive test reactions to all 12 allergens lusted in the patient group. The concordance of positive reactions between the TRUE Test™ and the Finn Chamber® test was 67%; 13% of all positive reactions were recorded only for the TRUE Test™ and 20% only for the Finn Chamber® method. The frequency of questionable and irritant reactions was of the same low order of magnitude for both tests methods; such reactions were recorded an around 2% of all test patches.

Trioxsalen bath plus UVA effective and safe in the treatment of psoriasis

Seventy‐four patients with psoriasis were treated using a trioxsalen bath (50 mg/150 1 of water) and long wave ultraviolet light (UVA) given in an ordinary PUVA‐cabin. Good or excellent results were observed in 92% of the patients in the initial phase and in 63% during the maintenance treatment. Because of local side‐effects the therapy was discontinued in two patients. One of them developed contact hypersensitivity to trioxsalen and the other developed blisters with such low doses of UVA that it was difficult to maintain the proper dose. The therapy was started with 0‐28 J/cm2 of UVA and after an average of 18 treatments, when the average dose was 1.70 J/cm2, the patients were moved to maintenance treatment which took place at 1‐4 week intervals. The therapy was well tolerated and cosmetically very acceptable. The final tan was even on all but the face, which remained untanned.