Torkel Fischer

False-positive, follicular and irritant patch teat reactions to metal salts

853 hard metal workers were patch tested with nicked nickel sulphate 5%, potassium dichromate 0.5% and cobalt chloride 1% each in petrolatum. Non‐allergic reactions appeared in 6.5% of the nickel tests, 13% of the chromium tests and 18.3% of the cobalt tests. Most of the individuals with positive, poral or pustular reactions were retested with serial dilutions of metal salts in pet, and in water. The accuracy of a positive initial nickel reaction was 83%, a chromium reaction 40% and a cobalt reaction 62%. The nonallergic reactions were partly reproducible and correlated with both the type of patch test material and with individual factors. Weak and moderately strong positive patch test reactions to metal salts may be irritant and should be checked with serial dilution tests ot at least be tested. A reduction of the cobalt chloride concentration from 1% to 0.5% in the standard test material is discussed.

Fragrance contact dermatitis: A worldwide multicenter investigation (Part I)☆

OBJECTIVE The aim of this study was to determine the prevalence of responses to selected fragrance materials in patients with suspect fragrance allergy and to evaluate risk factors and associations with such responses. The validity of using specific fragrance ingredients versus a mixture of fragrances was evaluated in terms of predicting allergy to different fragrance ingredients. METHODS One hundred sixty-seven subjects were evaluated in seven centers worldwide with a fragrance mix, the eight ingredients in the fragrance mixture, six other well-known fragrance allergens, balsam of Peru, and 15 lesser studied fragrance materials. RESULTS The age of the patients was 44.9 +/- 17.5 years (mean +/- SD). More than 85% were women. A relatively high proportion gave a past history of atopic disease. Facial eruptions (40%) and hand involvement (26.7%) were the most common topographic sites. All but 4 of the 35 fragrance materials produced a positive response in > 1%. A reaction to fragrance mix occurred in 47.3%. Seven of the 34 ingredients tested produced an allergic response in more than 10% of those tested. Men were more likely than women to exhibit a positive response to five fragrance ingredients. White persons were more likely to react to perfume mix (52.8% versus 25.3%) and certain ingredients in the mix than Asian persons. Allergy to benzyl salicylate was more common in Japan than in Europe or the United States. CONCLUSION The age at which patients with perfume allergy present for evaluation is similar to that of other contactants. Atopic individuals may be overrepresented in this group of patients. Face involvement is likely. White persons are more likely to react to fragrance mix, whereas in Asian patients benzyl salicylate was a more frequent allergen. Fragrance mix corrected with 85.6% of positive responses to fragrance ingredients. The addition of ylang ylang oil, narcissus oil, and sandalwood oil to fragrance mix would be expected to pick up 94.2% with positive responses to fragrance materials; adding balsam of Peru increases this to 96%.

Relationship between nickel and cobalt sensitization in hard metal workers

853 hard metal workers were examined and patch tested with 20 substances from their environment, including nickel and cobalt. Nickel sensitivity was found in 2 men and 38 women. 88% of the nickel‐sensitive individuals had developed a jewellery dermatitis prior to employment in the hard metal industry or before the appearance of hand eczema. 29% of the hard metal workers gave a history of slight irrifant dermatitis. In the nickel sensitized group, 40% had had severe hand eczema which generally appeared 6–12 months after starting employment. In 25% of the cases, nickel sensitive individuals developed cobalt allergy, compared with 5% in the total population investigated. Most facts indicate that nickel sensitivity and irritant hand eczema precede cobalt sensitization. Hard metal workers with simultaneous nickel and cobalt sensitivity had a more severe hand eczema than those with isolated cobalt or nickel sensitivity or only irritant dermatitis. 64% of the female population had pierced ear lobes. Among the nickel allergic women, 95% had pierced ear lobes. The use of earrings containing nickel after piercing is strongly suspected of being the major cause of nickel sensitivity. Piercing at an early age seems to increase the risk of incurring nickel sensitivity.

Nickel release from ear piercing kits and earrings

Ear piercing with nickel‐alloyed studs/clasps involves considerable risk of nickel sensitisation. Stainless steel studs/clasps for ear piercing and different types of earring were stored in synthetic sweat for 1 week. The nickel release was determined. One “hypoallergenic” stud/clasp released 0.005 μg Ni; 21 unused studs/clasps and earrings released 0.05–3 μg Ni, and 11 unused studs/clasps and earrings released 6–25 μg Ni. 6 earrings which caused dermatitis released 14–442 μg Ni. Thus, all studs/clasps and earrings released nickel. Neither gold nor silver plating prevented the nickel release. Nickel‐sensitive women were asked to wear studs/clasps releasing various amounts of nickel. The most sensitive of them showed eczematous reactions to studs/clasps releasing nickel down to 0.05 μg. The dimethylglyoxime test was positive only when more than 10 μg Ni was released.

Time trends in Swedish patch test data from 1992 to 2000. A multi-centre study based on age- and sex-adjusted results of the Swedish standard series.

Allergic contact dermatitis is recognized as a public health problem and some major allergens have been subject to intervention aiming at lowering skin exposure. There is an obvious interest in evaluating the effect of such interventions. Population studies are difficult to perform and epidemiological studies based on clinical data from testing patients with contact dermatitis are common surrogates. Our objective was to gather Swedish clinical standard series test data on two occasions in order to monitor trends in sensitization rates. Consecutive patch test results from the Swedish standard series were collected from 9 centres from 1991 to 1993 and from 1999 to 2001. In total, 3680 and 3790 patients, respectively, were included. Crude, age‐adjusted and age‐stratified prevalence are given separately for women and men. Our top 10 allergens are much in line with newly published European test data. Significant changes among those allergens are increasing sensitization rates for Myroxylon pereirae and decreasing rates for colophony, 5‐chloro‐2‐methyl‐4‐isothiazolin‐3‐one, Amerchol L 101 and thiuram mix. Nickel allergy is decreasing among young women. Among less common allergens, a noteworthy increase of sensitization to 4‐phenylendiamine is found. In conclusion, significant trends in sensitization rates of important allergen, reflecting changes in exposure, have been found.

The thin layer rapid use epicutaneous test (TRUE‐test), a new patch test method with high accuracy

The thin layer rapid use epicutaneous test (TRUE‐test) is a new patch test, in which the allergens are incorporated in a thin, flexible solid vehicle on a water impermeable backing. The vehicle shows good stability for allergens, which are crystallized, micronized or emulsified into a gel. The TRUE‐test produces an exact dosage, even surface spread and high bioavailability for the allergens. This solves the problems of low bioavailability, uncertain dosage and uneven surface distribution which are commonly seen when petrolatum is used as the vehicle.

Guidelines for visualization of cutaneous blood flow by laser Doppler perfusion imaging. A report from the Standardization Group of the European Society of Contact Dermatitis based upon the HIRELADO European community project.

This report reviews how to set up a laser Doppler perfusion imaging system intended for visualization of skin blood perfusion, capture images and evaluate the results obtained. A brief summary of related papers published in the literature within the areas of skin irritant and allergy patch testing, microdialysis and skin tumour circulation is presented, as well as early applications within other fields such as diabetology, wound healing and microvascular research.

A study of new fragrance mixtures.

OBJECTIVE To determine the frequency of responses to four mixtures of fragrance materials in routine clinic patients undergoing patch testing for suspect allergic contact dermatitis. The validity of using fragrance mixtures alone, or in combination, was evaluated in terms of predicting allergy to fragrance judged on the basis of finding a response to at least one of the fragrance mixtures. METHODS A total of 752 subjects were patch tested in five centers worldwide with (1) fragrance mix 8% (FM), (2) balsam of Peru 25%, (3) a mixture of seven of the eight FM 8% ingredients and other fragrance ingredients including jasmine absolute (jasmine/FM mix), and (4) a mixture of five selected natural fragrance ingredients (NM). RESULTS Of 752 subjects, 100 (13%) had positive patch tests to at least one of the four fragrance mixtures. The age of the patients was 45.2 +/- 18.3 years (mean +/- SD). Ninety-six percent were Caucasian. Facial eruptions and hand involvement were the most common topographic sites. Of subjects exhibiting a positive response, 67% reacted to FM, 63% to the jasmine/FM mix, 47% to the NM, and 38% to balsam of Peru. Testing with FM and NM identified 84% of the perfume-allergic patients. FM 8% tested simultaneously with the jasmine/FM mix identified 86% of the perfume-allergic patients. Testing simultaneously with three test materials combining either the NM or the jasmine/FM mix with balsam of Peru and FM identified 95% of the perfume-sensitive patients. CONCLUSIONS The simultaneous testing of NM or jasmine/FM mix, in addition to the conventional use of FM 8% and balsam of Peru, increases the sensitivity of testing for fragrance allergy from 81% to 95%.

Easier patch testing with TRUE Test

TRUE Test, a standardized, ready-to-apply patch test system, is made from polyester covered with a film of allergens incorporated in a hydrophilic polymer. The patches are mounted on nonwoven cellulose tape with acrylic adhesive, covered with siliconized plastic, and packed in an air-tight and light-impermeable envelope. When the test strip is taped on the skin, perspiration hydrates the film and transforms it to a gel, which causes the allergen to be released. The first panel of 12 allergens and allergen mixes is standardized and tested for stability in vitro and in vivo. The accuracy of the test panel has been certified in international multicenter studies by comparing it with present patch test techniques. A second panel of 11 more allergens was completed in 1988. The two test panels include the full standard panel of the North American Contact Dermatitis Group.

The scandinavian multicenter photopatch study. Preliminary results

The Scandinavian photopatch test procedure has been applied to 745 patients with suspected photodermatoses during the years 1980‐1981. Our experience has been encouraging with the recording of several relevant reactions. A total of 132 positive photocontact reactions and 120 ordinary contact reactions Were seen. Photocontact reactions to musk ambrette (19 cases) and PABA (19 cases) were surprisingly frequent. The next most common photocontact reactions were to promethazine (24). chlorpromazine (22 cases and fentichlor (12). Ordinary contact reactions were observed to balsam of Peru (30). PABA (23), lichen mix (21), wood mix (14) and to perfume mix (10).