Monica Hindsén

Individual variation in nickel patch test reactivity

BACKGROUND AND OBJECTIVE Various factors such as hormones, drugs, and ultraviolet (UV) radiation may influence patch test reactions. The aim was to study the individual variation in nickel reactivity, also in relation to the menstrual cycle. METHODS Thirty women allergic to nickel were studied for 7 months with patch tests with a serial dilution of nickel sulfate in water on four different test occasions. The patients belonged to two different eczema groups, one with nickel allergy, atopy, and pompholyx (12 patients); and the other with nickel allergy, but without both atopy and hand eczema. RESULTS None of the patients showed the same patch test reactivity on all four occasions, and the highest individual difference noticed was 250 times for the four test occasions. Furthermore, two of the patients had completely negative test reactions on at least one test occasion. CONCLUSION The variation in nickel reactivity as shown in this article is of great importance and should be kept in mind when a patient has a positive history of allergic contact dermatitis but negative patch test results to nickel.

Cross‐reactivity between nickel and palladium demonstrated by systemic administration of nickel

Concomitant patch test reactions to nickel and palladium have frequently been reported in patients undergoing investigation because of suspected allergic contact dermatitis. Theoretically, these reactions can be explained by multiple, concomitant, simultaneous sensitization as well as cross‐sensitization. We studied whether concomitant reactions to nickel and palladium could represent cross‐sensitization in females hypersensitive to combinations of nickel, palladium and cobalt. Females were patch tested with serial dilutions of nickel sulfate, cobalt chloride and palladium chloride on the upper back. 1 month later, when the patch test reactions were gone, the patients were randomized into 2 groups that were challenged orally with either nickel or placebo. 1 day later, the areas of previous positive patch test reactions were read in a blind way looking for flare‐up reactions. Nickel provocation but not placebo yielded flare‐up reactions on sites previously tested with nickel (P = 0.012) and palladium (P = 0.006), but were also observed on sites previously tested with cobalt, even though this was not statistically significant. Flare‐up reactions of previous patch test reactions to nickel and palladium after oral challenge with nickel speak in favour of a cross‐reactivity mechanism.

The significance of previous allergic contact dermatitis for elicitation of delayed hypersensitivity to nickel

Several factors, such as amount of allergen, vehicle, anatomic site, immunologic status and previous eczema, may influence delayed hypersensitivity reactions. In an extended model, we have studied the significance of previous allergic contact dermatitis for elicitation of delayed hypersensitivity to nickel in 25 nickel‐allergic females. On 3 occasions, 8, 4 and 1 months before the final challenge patch testing, an experimental allergic contact dermatitis from nickel was induced on the lower back. At the challenge patch testing, 4 identical dilution series of nickel were tested on 4 areas on the lower back 3 with previous but healed dermatitis and I control area. The tests were read in a blind way. A significantly higher test reactivity was found at the areas with a previous allergic contact dermatitis, the shorter the time interval between the previous provocation and the challenge, the stronger the reaction. These results may be of importance for the understanding of factors contributing to chronicity of allergic contact dermatitis.

Fixed drug eruption: an immunohistochemical investigation of the acute and healing phase

Five patients were each challenged orally with a drug which had previously induced a fixed drug eruption. A positive reaction occurred in all the patients. Punch biopsies were taken 6–12 h, 24h and 3 weeks after challenge. The specimens were tested with different mouse anti‐human monoclonal antibodies to identify T lymphocytes and phenotypic subsets, natural killer cells, B lymphocytes, OKT‐6 and HLA‐DR‐positive cells. T suppressor/cytotoxic cells seemed to play a major role in initiating the flare‐up reaction and preserving the cutaneous memory function of the fixed drug eruption.

Cobalt-containing alloys and their ability to release cobalt and cause dermatitis

Background:  Cobalt, nickel, and chromium are important skin sensitizers. However, knowledge about cobalt exposure and causes of cobalt sensitization is limited.

The significance of previous contact dermatitis for elicitation of contact allergy to nickel.

In 2 earlier studies, we found increased nickel re-test reactivity at earlier experimentally induced nickel eczema sites. The aim of this study was to investigate if earlier contact dermatitis caused by another allergen or earlier irritant contact dermatitis also influenced the reactivity when nickel was applied topically on earlier but healed dermatitis sites. Twenty-three females with contact allergy to both nickel and cobalt were involved in the study. Experimental contact dermatitis from nickel, cobalt and SLS was induced on the lower back. One month later, challenge patch testing with a serial dilution of nickel on the previous but healed dermatitis sites, and on a control area, was done. The tests were read blindly. Significantly higher test reactivity was found at the site with previous allergic contact dermatitis from nickel, and significantly lower test reactivity was observed at the previous SLS dermatitis site.

Contact allergy to textile dyes in southern Sweden

Contact allergy to disperse dyes in textiles is documented in prevalence studies from southern Europe. To evaluate the prevalence of allergic patch test reactions to different textile dyes in southern Sweden, and to look at the sites of dermatitis in individuals hypersensitive to textile dyes, we retrospectively investigated 3325 consecutively patch‐tested patients. They had all been patch tested with the standard test series supplemented with a textile dye mix (TDM) consisting of 8 disperse dyes, i.e. Disperse (D) Blue 35, 106 and 124, D Yellow 3, D Orange 1 and 3 and D Red 1 and 17. All but 3 of the TDM‐positive patients were additionally tested with the separate dyes included in the mix. The frequency of contact allergy to TDM was 1.5%, which is comparable with studies from southern Europe. The most common dye allergen was D Orange 1. The high prevalence of allergic reactions to D Orange 1 was unexpected, whereas test reactions to D Blue 106 and 124 were lower than expected from other studies. Compared to all tested patients, the TDM‐positive patients more often had dermatitis on their arms, face, neck and axillary folds, and women also had a higher frequency of hand dermatitis.

Photoallergic contact dermatitis from ketoprofen in southern Sweden.

The non‐steroidal anti‐inflammatory drug ketoprofen is widely used for topical treatment. In Sweden, ketoprofen has been available for topical application since 1995. Photoallergic contact dermatitis from ketoprofen‐containing topical preparations usually includes severe eczematous reactions. Ketoprofen is derived from propionic acid, and it is also a substituted benzophenone and therefore structurally similar to fenofibrate and sunscreen agents based on benzophenones. During the last 2 years, 35 patients have been refereed to our department with suspected photoallergic or allergic reactions after having used ketoprofen‐containing gels. Photopatch testing with the photopatch standard series, the ketoprofen‐containing gels and their ingredients, fenofibrate, benzophenone‐3, benzophenone‐10 and benzophenone‐4, was performed. Photoallergic reactions to ketoprofen were noted in 35 patients and a simultaneous contact allergy to ketoprofen in 2 patients. Simultaneous photoallergy to fentichlor, tetrachlorosalicylanilide and fenofibrate was registered in 74%, 40% and 73% of the patients, respectively.

Occupational allergic contact dermatitis in a company manufacturing boards coated with isocyanate lacquer.

Over a short period of time, there was an outbreak of work‐related skin lesions among workers at a company producing flooring laminate boards, after the introduction of a water‐repellent lacquer based on diphenylmethane‐4,4′‐diisocyanate (MDI). In 5 workers, patch testing was performed with a standard series, an isocyanate series and work‐environmental products when indicated. 3 of the workers were tested with the lacquer, and contact allergy was found with concurrent reactions to 4,4′‐diaminodiphenylmethane (MDA). 1 of the 3 workers also showed a simultaneous reaction to MDI, whereas 1 showed a positive reaction to dicyclohexylmethane‐4,4′‐diisocyanate (HMDI). Of the 2 individuals not tested with the lacquer, 1 reacted to both MDI and MDA, whereas the other reacted to a soap used at work. In 3 of 4 cases, the isocyanate reactions appeared after D3. Occupational contact with isocyanates should not exclusively be focused upon respiratory hazards, as this report shows that skin contamination probably increases the risk of developing contact allergy to isocyanates and isocyanate‐related substances. When aiming at diagnosing contact allergy to isocyanates, it is desirable to perform a late reading, as positive reactions appear late. MDA appears to be a good marker for isocyanate hypersensitivity.

Natural history of dermatitis herpetiformis in southern Sweden.

A retrospective clinical survey of 96 patients with dermatitis herpetiformis (DH) was performed in two defined populations of 425,000 in southern Sweden. The incidence of DH was 1.05-1.13/100,000 inhabitants/year and the prevalence was approximately 20-25/100,000 inhabitants. In one-third of DH patients the age at onset was greater than 60 years. In women with DH a strong connection to thyroid dysfunction was observed, but also other conditions of probable autoimmune pathogenesis were found in both sexes. No connection to malignant disease was observed. DH seems to be less active the later in life it starts. Several patients with DH manage without dapsone or need dapsone just occasionally in connection with bouts. This is the case even without a gluten-free diet. Many mild cases of DH were observed without a gluten-free diet; therefore, this restricting regimen should be prescribed only in more active cases of DH.