O. Justesen

Oral challenge with balsam of Peru

A placebo‐controlled, double‐blind, Oral challenge with balsam of Peru was carried out in 221 patients with various types of dermatitis. 210 patients completed the study, and 45 of them experienced a flare of their symptoms after challenge with balsam of Peru but not after placebo. 15 patients reacted to the placebo, and 5 reacted to both balsam and placebo. Specific reactivity to balsam of Peru was seen particularly in patients with positive patch tests to this compound and in some patch‐test‐negative patients with vesicular hand eczema, ano‐genital and axillary eczema.

Oral challenge with metal salts. (I). Vesicular patch‐test‐negative hand eczema

202 patients, 68 males and 134 females, with patch‐test‐negative, symmetrical vesicular hand eczema were challenged orally in a controlled study with 2.5 mg nickel, 2.5 mg chromium and 1 mg cobalt given as salts of the respective metals. Initially a mixture of the 3 metal salts was given, and if this produced a flare of the eczema, the salts were administered individually at 1 week intervals.

Reduction of intake of balsams in patients sensitive to balsam of Peru.

64 patients participated in this study 24 were positive who had positive patch teststobalsam or Peru. The dermatitis of 9 of the patients had flared after open oral challenge with balsam of Peru, and the dermatitis of 31 patients had flared after double‐blind oral challenge. All 64 patients were asked to avoid food items suspected of containing balsams for 1 to 2 months. At the end of that time, an evaluation of the diet trial was made; the dermatitis of 37 had cleared or improved markedly. If an improvement taken place, the patient was asked to continue to diet moderately. 6 months in 3 years after the diet was initiated, a questionnaire was mailed to those patients whose dermatitis had improved after the first trial. The patients were asked to evaluate the long‐term benefit of fallowing the diet. 30 felt there was a long‐term effect, and 27 still followed the diet instructions to some degree.

Occupational contact dermatitis due to spiramycin and/or tylosin among farmers

Nine farmers suspected of having occupational contact dermatitis had positive patch tests in spiramycin and/or tylosin. After diagnosis the dermatitis cleared or improved markedly in seven patients; five of these stopped using the antibiotics in question, and two began to wear gloves while handling the drugs. The two patients who continued use of the drugs and look no precautionary measures had link change in the activity of the dermatitis.

Dietary restrictions in the treatment of adult patients with eczema

Improvement was seen in the dermatitis of 262 of 675 patients who followed a restrictive diet for approximately I month. Patients included in the study were sensitive to metal salts, balsams or classical food allergens or reacted to oral challenge with fond additives. Also included were patients who did not react to diagnostic tests but who experienced improvement of their dermatitis while maintaining an elimination diet. A follow‐up study was carried out 1–3 years after diet treatment was instituted. Each of the 262 patients was asked to complete a questionnaire to describe the long‐term course of the dermatitis. 262 responded to the questionnaire, and for 144 of them (70%: 95% confidence limits 64–76%). there was long‐term improvement of the dermatitis. Long‐term improvement was more common among a topic patients than among non‐atopics. Symptoms of contact urticaria were more common among patients with hand eczema than those with other types of eczema.

Oral challenge with metal salts. (II). Various types of eczema.

299 patients with chronic dermatitis of obscure origin were challenged orally in a controlled study with 2.5 mg nickel, 2.5 mg chromium, and 1 mg cobalt given as salts of the respective metals.

Why do young girls become nickel sensitive

ming that light had played a part in this mans sensitivity, although there was no evidence of clinical photosensitivity. Since ethylenediamine is a common contact allergen comparable in its sensitising abilities to topical antihistamines which in my experience have mostly been discarded, it may be playing a larger part in the initiation of photosensitivity than is at present understood. It is surprising that this chemical, which has been known for a considerable period of time to be a sensitiser, is still incorporated into topical medicaments. References

Oral challenge with balsam of Peru in patients with eczema: a preliminary study

A 22-year-old woman was first seen on November 30, 1981, complaining of dry, cracking, and painful lips for the past year. Her cheilitis became worse after the application of various lipsticks and lip creams. She tried many new lipsticks and lip creams to find an innocuous product, but the result of her effort was disappointing. Examination revealed the vermillion border of the upper and lower lips to be dry, scaly, and erythematous. The patient was patch tested 3 times. We tested her own lipsticks and lip creams and obtained 2 plus positive reactions to most of the 15 products. She was then tested with the standard series of cosmetic allergens. Except for the coloring matter and perfumes, the ingredients of lipsticks are thought to be relatively innocuous. So, at the start we suspected the allergen to be tar dyes or perfumes. However, all results were negative and these results reminded us of her stating that she had never noticed skin abnormality after using any cosmetics other than lipsticks and lip creams. We prepared the base cosmetic ingredients, which are selectively used in the lipsticks and lip creams. The results are shown below:

Patch testing with substances not included in the standard series.

During a 5‐year period, 3664 consecutive patients were patch tested in a private dermatology practice with the Standard Series of the International Contact Dermatitis Research Group (ICDRG). 454 of these were tested with one or more additional substances which were suspected of having caused their dermatitis. 194 of the 454 patients had positive reactions to one or more of the additional substances. Most of these reactions were of current relevance, and in only 25% of the patients could the allergies have been predicted by the use of the Standard Series alone.

Diagnostic procedures for eczema patients

Of 7887 patients with eczema seen in a private dermatological practice over a period of 2 year and 4 months, a specific final diagnosis was found in 5376 (68%), white a final diagnosis of non‐specific eczema was made in 2511 cases (32%). The most common final diagnoses were seborrhoeic dermatitis (1351), contact dermatitis (1357), atopic dermatitis (1009) and nummular eczema (822), Battery patch testing was the initial diagnostic procedure performed, and 897 of the 3164 patients who were patch tested had one or more positive patch tests. In 545 eases, the reactions were considered of relevance to the current dermatitis. Tests for immediate‐type allergy were carried out in 618 patients, and 284 of these had one or more positive tests. In 86 patients, these test results were of diagnostic significance 257 patients, with positive patch tests were challenged orally with the relevant substance, and 53 of 156 reacted to metal salts, most commonly nickel, while 25 of 101 reacted to orally invested balsam of Peru. Among patch‐test‐negative patients, 66 of 408 had positive reactions to one or more metal salts; 41 of 180 reacted to balsam of Peru, while 15 of 41 reacted to various food additives.