R. Valsecchi

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.

Eyelid dermatitis: an evaluation of 150 patients

This study was performed to evaluate eyelid dermatitis in a group of patients of our Allergy Unit between January 1990 and April 1991, Among the 1158 patients seen during this period. 150 had eyelid dermatitis: 135 females: and 15 males, with a mean age of 35 years. Of the 150 patients with eyelid dermatitis, 54 had eczema localized to the eyelids only, 49 to the eyelids and face, 19 to the eyelids and hands, and 28 to the eyelids and other sites. 98 patients (65,3%) were diagnosed as having allergic Contact dermatitis, 25 (16.6%) irritant contact dermatitis, 21 (14%) atopic dermatitis, and 6 (4%) seborrhoeic dermatitis. Patch lest Ructions to nickel sulphate. Kathon CG and fragrance‐mix occurred more frequently in patients with eyelid dermatitis then in those without.

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.

Cutaneous lesions in Blastocystis hominis infection

Sir, The first paper clearly defining the genus Blastocystis as a distinct organism was presented by Alexeieff (1) in 1911, who proposed the name Blastocystis enterocola. The name Blastocystis hominis was proposed by Brumpt (2), and this is the name utilized in the current literature. B. hominis is now regarded as an intestinal protozoan that seems not merely to be a commensal organism, but should be considered as a potential pathogen (3). Symptoms commonly attributed to infection with B. hominis include diarrhoea, abdominal pain, cramps, nausea, discomfort, anorexia, fatigue, flatulence and profuse watery diarrhoea (4 – 6). During the past few years an association between B. hominis infection and some skin disorders such as urticaria (7, 8) and palmoplantar pruritus (9) have been reported. We present here our experience of this association.

Eyelid dermatitis: an evaluation of 447 patients.

BACKGROUND Eyelids can be affected by various types of dermatitis that are often difficult to diagnose. OBJECTIVE The aim of the study was to establish some guidelines for a correct diagnosis. METHODS A total of 447 patients treated at 12 research units for eczema or other inflammatory dermatitis located on the eyelids were invited to complete a questionnaire. When necessary, patch tests with haptens of the standard series from Gruppo Italiano di Ricerca sulle Dermatiti da Contatto e Ambientali della Società Italiana di Dermatologia e Venereologia (SIDEV-GIRDCA) were performed. RESULTS Of the subjects studied, 50.2 % were diagnosed with allergic contact dermatitis (ACD); 20.9% were affected by irritant contact dermatitis (ICD), 13.5% by atopic dermatitis, 6.3% by seborrheic dermatitis, 6.5% by aspecific xerotic dermatitis, and 2.3% by psoriasis. Approximately 91% of all subjects reported an absence of familial atopy. A significant statistical association between diagnosis type and a personal history of atopy was evident (p <.000001, chi-square test). The results of gradual logistic regression models showed four-eyelid involvement as the main risk factor for ACD (odds ratio [OR] = 3.0; 95% CI, 1.1-8.1); with ICD, the main risk factor was the onset of symptoms at between 2 and 6 months (OR = 2.1; 95% CI, 1.1-4.0), whereas for atopic dermatitis, the main risk factors were the onset of symptoms later than 6 months and a personal history of atopy (OR = 4.9 and 3.6, respectively). CONCLUSION Results suggest that many characteristics of the patients examined can be used for the differential diagnosis of palpebral eczematous dermatitis.

Tiaprofenic acid photodermatitis

I. Wilkinson J D, Hambly E M, Wilkinson D S. Comparison of patch test results in two adjacent areas of England (II). Medicaments. Acta Dermato-venereologica 1980: 60: 245-249. 2. North American Contact Dermatitis Group. Epidemiology of contact dermatitis in North America, 1972. Arch Dermatol 1973: 108: 537-554. 3. Rietschel R L, Adams R M, Maibach HI, Storrs F J, Rosenthal L E. The case for patch test readings beyond day 2. J Am Acad Dermatol 1988: 18: 42-45. 4. MacFarlane A W, Curley R K, Graham R M, Lewis-Jones S, King C M. Delayed patch test Contact Dermatitis 1989: 21: 345

Allergic contact dermatitis of the eyelids and conjunctivitis from diclofenac.

where RCOrepresents the fatty acids derived from coconut oil (1 ). It is marketed by Mona (USA) under the trade name of Phospholipid PTC. According to the manufacturers data sheet, this tensioactive has minimal irritant properties and can be safely utilized on sensitive mucous membranes. Besides being tensioactive, cocamidopropyl PG-dimonium chloride phosphate has skinconditioning properties and broad-spectrum antimicrobial activities at low concentrations against Gram positive and negative bacteria, molds and yeasts, its performance not being adversely affected by pH, anionic or nonionic surfactants, or contaminants that commonly deactivate preservatives. According to the manufacturer, possible uses for cocamidopropyl PG-dimonium chloride phosphate include baby products, feminine washes, ophthalmic preparations, antiseptic cleansers and many other applications (2). We are aware of other unpublished cases of contact sensitization to cocamidopropyl PG-dimonium chloride phosphate in Europe (G. Ducombs, personal communication; La Roche-Posay, personal communication). All SHORT COMMUNICATIONS

The loss of contact sensitization in man

Little is yet known about the duration of contact sensitivity, but frequent exposure of a target lo allergen seems to reduce skin reactivity The aim of this study was to study the persistence of a specific contact sensitivity in 66 patients with alopecia areata, previously sensitized in DNCB (31 patients) and SADBF, (35 patients) between 1978–1985. Patch tests were performed with 0.020 ml of different concentrations of DNCB or SADBE in acetone (0.05%, 0.10%. 0.20% 1%). The results were read in a standardized manner. Of 66 patients, 47 (71%) had positive reactions and 19 (29%) negative. 8 of the 19 negative patients had been treated with DNCB, 11 with SADBE, Approximately 1/3 of the patients previously sensitized had lost their original sensitivity, und this did not seem to be time‐dependent. This phenomenon seemed to be clinically correlated because the majority of the patients were from the “low responders” group. We think that acquired unresponsiveness to topical antigen in man to a possible phenomenon, but that it occurs more rarely than in mice and guinea pigs.

Cross-reactions in patch testing and photopatch testing with ketoprofen, thiaprophenic acid, and cinnamic aldehyde.

In the last 7 years, we have studied 123 patients with allergic reactions to topical arylpropionic anti-inflammatory drugs. We have investigated the rate of sensitization and the irritant potential of one of them, ketoprofen, and its cross-reactivity with such other derivatives as ibuproxam, ibuprofen, naproxen, fenoprofen, flurbiprofen, and thiaprofenic acid. Sensitization was single in most cases, and ketoprofen was the drug most often involved. The combination most frequently found was ketoprofen plus ibuproxam. The most frequent cross-reactions were to fragrance mix, especially cinnamic aldehyde and balsam of Peru, both contact and photocontact sensitizers. Because there is a ketonic group in the molecule of ketoprofen and cinnamic aldehyde and after conversion of thiaprofenic acid, this could be the trigger for this particular allergy and cross-reactivity.

Erythema-multiforme-like lesions from triamcinolone acetonide

Triamcinolone acetonide is a class B corticosteroid of Coopman et al. (1), characterized by a C16, C17‐cis ketal or diol structure. To the best of our knowledge, only 3 cases of contact allergy to it have been reported (2, 3).