Paolo D. Pigatto

Chronic urticaria and Helicobacter pylori

Chronic urticaria can result from multiple causes. A number of factors have been identified that can appear to be important in the pathogenesis of individual cases, including intolerance to food, drugs, some internal diseases and some infections. Recently a possible relationship between chronic urticaria and Helicobacter pylori has been suggested. One hundred and twenty-five patients were investigated for Helicobacter pylori infection by means of ELISA assay and 13C urea-breath tests. When the two tests were positive, gastric biopsy was performed after informed consent. Patients with Helicobacter pylori infection were randomly assigned to receive triple therapy for the eradication of bacterium for one week, or no treatment. As controls, 25 patients with chronic urticaria and with negative results on ELISA and urea-breath tests were treated with the same triple therapy course. Forty-six unrelated blood donors of both sexes were examined for the presence of anti-Helicobacter pylori antibodies in the normal population. Seventy-eight patients had circulating specific IgG antibodies against the bacterium and positive urea-breath tests. Among these patients, 31 received eradication therapy, 34 were enrolled in the control group, and 13 patients neglected the study. Three patients in the eradication therapy group showed complete remission of urticaria after 12 months of follow-up as compared with 1 patient in the control group. Twenty blood donors out of 46 were IgG anti-Helicobacter pylori positive. In conclusion, our data show that the prevalence of Helicobacter pylori infection is high in chronic urticaria patients, but eradication of the bacterium does not appear to influence the skin disorders nor the symptoms.

Metal sensitivity in patients with orthopaedic implants: a prospective study

Background. Sensitization to orthopaedic implant materials is an unpredictable event that might affect implant performance.

Effectiveness of cyclosporine treatment in severe psoriasis: A clinical and immunologic study

The effectiveness of low doses of cyclosporine (3 to 5 mg/kg/day) for short-term treatment in 13 patients with severe psoriasis was studied. The psoriasis cleared in 12 of 13 patients within 3 to 4 weeks of treatment, and there was appreciable improvement in the thirteenth patient. No major side effects were observed: two patients showed biochemical evidence of slight transient renal dysfunction and three others had cutaneous infections (two viral and one mycotic). An immunohistologic study showed that the psoriatic plaques contained an infiltrate composed mainly of activated helper T lymphocytes. After 15 days of cyclosporine treatment, CD4+ cells were significantly fewer in the epidermis and dermis, and Langerhans cells were more regularly distributed in the epidermis. Our studies of neutrophil chemotaxis showed that it is not significantly influenced by cyclosporine in vitro but is decreased in vivo.

Photopatch testing: recommendations for a European photopatch test baseline series.

In order to establish a consensus recommendation for performing photopatch testing, a photopatch test taskforce group was established under the joint umbrella of the European Society for Contact Dermatitis and the European Society for Photodermatology in 2000. After proposing the most adequate methodology in 2004 and completing a European multicentre photopatch test study in 2011, this taskforce is recommending a list of photoallergens that should form part of a baseline series for photopatch testing in Europe. It contains mainly ultraviolet filters and drugs, mostly non‐steroidal anti‐inflammatory drugs. The choice of chemicals was based on the results of a recent multicentre study, previous published cases of photoallergy, and use of the substances in the European market.

Multicentre study of allergic contact cheilitis from toothpastes

The present work reports the results of a multicentre study of toothpaste allergic contact cheilitis (TACC) conducted by GIRDCA (Gruppo Italiano Ricerca Dermatiti da Contatto e Ambientali). The study examined 54 patients with eczematous lesions on the lips, the possible cause of which was suspected to be the use of toothpastes. Patch tests were conducted with a standard series, a specially‐targeted series (toothpaste cheilitis series, TCS), and with suspected toothpaste(s). A stop‐restart test (SRT) was carried out with these, together with a use test to identify possible alternative products. The TCS produced 17 positive reactions in 13 patients, the most frequent being to spearmint oil. Of the 54 patients, 5 displayed positive reactions only to the TCS. The patch tests with toothpaste produced positive reactions in 11/32 patients, the SRT a positive response in 10/12 cases. The diagnosis of TACC was confirmed in 15/54 patients. Alternative products were identified for 5 patients. In conclusion, the allergens most frequently responsible for TACC were the flavourings, and the additional series proved to be useful in many cases (together with patch tests with toothpastes and the SRT) for correct diagnosis and to initiate effective prevention.

Contact and photocontact allergy to ketoprofen: clinical and experimental study

In the last 3 years, we have studied 10 patients with allergic reactions to topical ketoprofen. We have investigated the sensitization and irritant potential of the drug and the possibility of cross‐reactivity with other aryl‐propionic non‐steroidal anti‐inflammatory drugs (ibuproxam, ibuprofen, naproxen, fenoprofen, flubiprofen and tiaprofenic acid), 2 of our patients had contact dermatitis, and the other 8 photocontact dermatitis. One of our patients showed cross‐reactivity between ketoprofen and ibuproxam on patch testing. In the photopatch tests, we observed cross‐reactivity between ketoprofen and tiaprofenic acid in 2 patients, and cross‐reaction between ketoprofen and ibuproxam and flurbiprofen in another case. Experimental studies, including human maximization and photomaximization tests, performed in 20 healthy volunteers, showed a complete absence of sensitization. 3 volunteers showed a marked irritant reaction to ketoprofen (20% pet.) during either maximization (2 cases) or photomaximization (I case) tests. Although ketoprofen appears not to be a sensitizing agent in human volunteers, the fact that photosensitization to this drug seems to be quite common after topical use suggests that there are some local or individual factors, at present unknown, facilitating the development of allergy.

Contact dermatitis to cocamidopropylbetaine is caused by residual amines: Relevance, clinical characteristics, and review of the literature

Abstract Cocamidopropylbetaine (CAPE) is an amphoteric surfactant mainly sold as Tegobetaine L7; it is often included in shampoos, cleansing lotions, and disinfectants. In the last 2 years, this was responsible for 15 cases of allergic contact dermatitis seen in our clinics. The causes were shampoos, face cleansing lotions, gynecological antiseptic syndets, liquid shower soaps, and anal hygienic detergents. Although there are only a few cases of contact dermatitis reported in the literature from CAPB and detergents are generally considered rare sensitizing agents, the sensitizing potential of CAPB may be greater than previously thought. This seems to be because of a contaminant, dimethylaminopropylamine, found in some of the cosmetic products.

A multicentre study of contact sensitization in children

The results of 7 months of patch testing with a standard series of 26 allergens, in 323 children with eczerematous conditions or itching palmoplantar psoriasis under the age Of 14 years are reported. 114 (35.3%) of the children had 1 or more positive reactions to this standard series. 28 children (8,7%) were poly sensitive. On the basis of personal history, additional series of allergens and/or specific allergens were also tested, 61.7% (90/146) of positive reactions were considered relevant to the current dermatitis. Metals, medicaments, preservatives or fragrances, and shoe components were the major sources of contact sensitization. It is suggested that patch testing he done more frequently in evaluating dermatitis in children.

Disodium cromoglycate versus diet in the treatment and prevention of nickel‐positive pompholyx

In some cases that have been diagnosed as contact allergy to nickel, there are repeated cutaneous eruptions of pompholyx, even in areas with no direct contact with the metal. The possible alimentary origin of dyshidrotic eczema should be considered when deciding on therapy. We have collected the clinical data for 24 patients with dyshidrotic eczema caused by nickel, to evaluate the benefit of a low‐nickel diet versus treatment with oral disodium cromoglycate, comparing both objective and subjective symptoms. A low‐nickel diet does not improve these patients but those treated with DSCG reacted better, from both objective and subjective point of view, than either the controls or the patients treated by diet. We next did intestinal permeability tests before therapy and after 15 days of treatment. We found that nickel uptake diminishes simultaneously with the reduction of absorption through the smaller aqueous “pores”. This phenomenon was greatest alter DSCG. We suggest that DSCG can help selected cases of pompholyx.

Photopatch tests: an Italian multicentre study from 2004 to 2006

Background:  Evaluation of possible photoallergic contact dermatitis in at‐risk populations is often not undertaken, and an agreed methodology for investigation is uncommonly used.