Ronald R. Brancaccio

Contact allergy to food

ABSTRACT:  Contact allergies to foods, spices, and food additives can occur to individuals in the workplace or at home. Seven different reaction types have been described. These include irritant contact dermatitis, allergic contact dermatitis, contact urticaria, protein contact dermatitis, phototoxic contact dermatitis, photo‐allergic contact dermatitis, and systemic contact dermatitis. The causes of each of these are reviewed and an approach to the diagnosis and management of contact allergy to foods, spices, and food additives is formulated.

Utility of a standard allergen series alone in the evaluation of allergic contact dermatitis: A retrospective study of 732 patients

BACKGROUND Patch testing remains the standard for the diagnosis of allergic contact dermatitis. The validity and usefulness of a standard patch test allergen series has not been addressed adequately by previous studies. OBJECTIVE We sought to examine the utility of the standard allergen series as a sole screening tool in the diagnosis of allergic contact dermatitis. METHODS The charts of 732 patients referred for patch testing were reviewed for positive patch test results. The group of patients with positive reactions was stratified into two groups based on the clinical relevance of their reactions. These groups were subsequently analyzed to determine whether the reactions were to part of the standard series of allergens or to part of a supplementary group. RESULTS Of patients tested, 50% had a positive patch test. Of those, 221 (30%) had reactions deemed clinically relevant. Only 23% of patients with positive patch tests reacted to an allergen(s) in the standard series exclusively. When adjusted for clinical relevance, only 15.7% of patients were completely evaluated with the standard series of 20 allergens. CONCLUSION The standard allergen series of 20 allergens available in the United States is limited as a screening tool when used alone in the evaluation of patients with allergic contact dermatitis.

Six-hour versus 48-hour patch testing with varying concentrations of potassium dichromate☆☆☆

This study examines the possibility of using patch contact times shorter in duration than the standard 48 hours. Using varying concentrations of potassium dichromate (K2Cr2O7), this study analyzed results from two sets of patches applied to the backs of 11 subjects for durations of 6 and 48 hours, respectively. Results showed that after the 48-hour application period, all subjects reacted to K2Cr2O7 at some concentration. For the patches applied for 6 hours, 7 of the 11 subjects (64%) reacted to K2Cr2O7 at some concentration. Minimum elicitation thresholds (METs), the lowest concentration at which a reaction was observed, were established for both the 6-hour and 48-hour application times. The ratio of an individuals 6-hour MET to their 48-hour MET was calculated to evaluate the feasibility of patch testing with a higher concentration of an allergen for a shorter time period. Although the results clearly indicated that a higher concentration of allergen is required in order to elicit a reaction at 6 versus 48 hours, a fair amount of interindividual variability is exhibited by these 6-hour to 48-hour MET ratios. This observed variability would seem to preclude the use of 6-hour duration patch contact times for routine patch testing with K2Cr2O7.

Cutaneous reactions to injectable corticosteroids.

Corticosteroids are used to treat a variety of medical conditions. While topical preparations are known to commonly cause allergic contact dermatits, systemic use of these drugs rarely causes cutaneous reactions. (This paper presents) Two cases of (systemic) injectable corticosteroid use resulting in delayed hypersensitivity reactions are presented.

Photocontact allergy to diallyl disulfide.

Although phototoxic reactions to plants are common, photoallergic contact dermatitis to plants and plant products rarely occurs. Our objective was to review the importance of including diallyl disulfide in the evaluation of patients with suspected photosensitivity. Phototests for ultraviolet B, ultraviolet A, and visible light as well as patch tests and photopatch tests for 49 allergens from the New York University Skin and Cancer Unit Photopatch Test Series were performed. Three patients had positive photopatch-test results to diallyl disulfide, which is the allergen in garlic. The authors conclude that although photocontact allergy to diallyl disulfide is rare, this allergen should be included in photopatch-test series.

Allergic contact dermatitis to pimecrolimus

Pimecrolimus suppresses the proinflammatory cytokine production of cutaneous T and mast cells (1) . It is used to treat atopic dermatitis and is the active ingredient in the topical formulation pimecrolimus 1.0% cream (Elidel®, Novartis Pharma AG, Basel, Switzerland).

WHAT IS NEW IN CLINICAL RESEARCH IN CONTACT DERMATITIS

The field of cutaneous allergy has enjoyed dynamic research advances in epidemiology and clinical contact dermatitis. Studies regarding outcomes analysis, validity, predictive value, and sensitivity have allowed clinicians to better understand the importance of patch test results. In the clinical arena, new and clinically relevant allergens are being discovered, such as corticosteroids, metals, preservatives, surfactants, and glues. Continued epidemiologic surveillance of new allergens will enable manufacturers to develop safer products for patients to use.

Allergic cutaneous reactions to systemic corticosteroids

Contact allergic reactions to topical corticosteroids are common. Cutaneous hypersensitivity reactions to systemically administered corticosteroids might occur though less frequently. The purpose of this literature review is to examine reported cases of cutaneous reactions to systemically administered corticosteroids. The data are presented considering route of administration, type of drug, type of reaction, and testing results. Corticosteroid classifications, cross-reactions, and allergy testing methods are also discussed.

Comparison of allergEAZE allergens to Chemotechnique Diagnostics allergens in the evaluation of contact allergy.

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