Collection of Blogs related to information about contact dermatitis

Contact allergens induce long lasting local skin memory and global immunologic memory

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‘[Contact allergens induce a strong, long-lasting local memory and a weaker, temporary global immunological memory response that is mediated skin-resident memory cells.]’

Schmidt JD1,2, Ahlström MG2, Johansen JD2, Dyring-Andersen B1,2, Agerbeck C1, Nielsen MM1, Poulsen SS3, Woetmann A1, Ødum N1, Thomsen AR1, Geisler C1, Bonefeld CM1.     Rapid allergen-induced interleukin-17 and interferon-γ secretion by skin-resident memory CD8+ T cells.     Contact Dermatitis. 2016 Nov 22. doi: 10.1111/cod.12715. [Epub ahead of print]

BACKGROUND:
Skin-resident memory T (TRM ) cells are associated with immunological memory in the skin. Whether immunological memory responses to allergens in the skin are solely localized to previously allergen-exposed sites or are present globally in the skin is not clear. Furthermore, the mechanisms whereby TRM cells induce rapid recall responses need further investigation.
OBJECTIVES:
To study whether contact allergens induce local and/or global memory, and to determine the mechanisms involved in memory responses in the skin.

METHODS:
To address these questions, we analysed responses to contact allergens in mice and humans sensitized to 2,4-dinitrofluorobenzene and nickel, respectively.

RESULTS:
Challenge responses in both mice and humans were dramatically increased at sites previously exposed to allergens as compared with previously unexposed sites. Importantly, the magnitude of the challenge response correlated with the epidermal accumulation of interleukin (IL)-17A-producing and interferon (IFN)-γ-producing TRM cells. Moreover, IL-17A and IFN-γ enhanced allergen-induced IL-1β production in keratinocytes.

CONCLUSIONS:
We show that sensitization with contact allergens induces a strong, long-lasting local memory and a weaker, temporary global immunological memory response to the allergen that is mediated by IL-17A-producing and IFN-γ-producing CD8+ TRM cells.

https://www.ncbi.nlm.nih.gov/pubmed/27873334

Pre-Emptive Avoidance Strategy Update

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Brankov N1, Jacob SE2.

Pre-Emptive Avoidance Strategy (P.E.A.S) 2016: Update on Pediatric Contact Dermatitis Allergens.

Expert Rev Clin Immunol. 2016 Nov 18. [Epub ahead of print]
The New Pre-Emptive Avoidance Strategy (P.E.A.S.) Update is published.
New PEAS:

1. Fragrance Mix 1 and 2/Balsam of Peru (and derivatives)
2. Neomycin/Bacitracin
3. Wool wax/Amerchol/lanolin
4. Formaldehyde/bronopol/Q15
5. MCI and MI
6. Propylene glycol
7. Cocamidopropyl betaine
8. Glucosides
9. Propolis
10. Compositae
Simple and Free is in the process of updating the products to reflect the new P.E.A.S.
https://www.dermatitisacademy.com/nickel-immediate-reactions/

Nickel reactions within minutes to hours – confirmed by prick testing.

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https://www.dermatitisacademy.com/nickel-immediate-reactions/

OLYMPUS DIGITAL CAMERA

This is a most important work by Dr. Doug Powell’s group, which highlights non-delayed type hypersensitivity immune activation to nickel (nickel immediate reactions).  In our practice we see patients with atopic dermatitis that flare in response to nickel exposure.  This is an area in need of further investigation.  Article will be in print this month!


Saluja SS1, Davis CL, Chong TA, Powell DL.  Contact Urticaria to Nickel: A Series of 11 Patients Who Were Prick Test Positive and Patch Test Negative to Nickel Sulfate 2.5% and 5.0. Dermatitis. 2016 Sep-Oct;27(5):282-7. doi: 10.1097/DER.0000000000000211.

BACKGROUND:
Nickel is the most common allergen found by patch testing; however, not all cases of nickel allergy are type 4 (delayed) allergies. Contact urticaria (CU) to nickel (immediate reaction) has been reported; however, few seem to evaluate it as per a recent published survey of American Contact Dermatitis Society members.
OBJECTIVE:
The aim of the study was to present a series of patients who had clinical histories suggestive of nickel allergy and yet were patch test negative but prick test positive to nickel, thus demonstrating CU.
METHODS:
We reviewed the charts of 11 patients who were patch test negative but prick test positive.
RESULTS:
All 11 patients demonstrated evidence of CU by prick testing (or closed chamber test in 1). None were patch test positive to nickel 2.5% or 5.0%. Four patients’ histories mentioned reactions to various jewelry/earrings within minutes, whereas 2 histories mentioned reacting within a few hours. These histories are consistent with CU. Others (except 1 patient) recalled reacting to jewelry/earrings but did not recall a time frame.
CONCLUSIONS:
Our series suggests that CU to nickel may be far more common than anticipated and should be evaluated with prick testing when patients’ history suggests nickel allergy and yet they are patch test negative.

 

Learn more about nickel immediate reactions this month!!!

pediatric patch test

Free Access for 30d! Inaugural Pediatric Contact Dermatitis Registry Data.

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New Today – 10 years in collaborative effort!  The inaugural data paper from the Pediatric Contact Dermatitis Registry (PCDR).   In the not too distant past it was believed that contact dermatitis (allergic) in children was rare, we now know that not to be the case as in fact it is an common in patch tested children as adults.  This study discusses the evaluation of more than 1000 US children who presented for evaluation of contact dermatitis.  The  reported here through a collaborative effort of more than 80 providers!  65% of the cases had a positive allergen and 48% were able to find at least on relevant source – remove the allergen and improve the dermatitis!!!

Goldenberg A1, Mousdicas N, Silverberg N, Powell D, Pelletier JL, Silverberg JI, Zippin J, Fonacier L, Tosti A, Lawley L, Wu Chang M, Scheman A, Kleiner G, Williams J, Watsky K, Dunnick CA, Frederickson R, Matiz C, Chaney K, Estes TS, Botto N, Draper M, Kircik L, Lugo-Somolinos A, Machler B, Jacob SE.  Pediatric Contact Dermatitis Registry Inaugural Case Data.  Dermatitis. 2016 Sep-Oct;27(5):293-302.

Abstract
BACKGROUND:
Little is known about the epidemiology of allergic contact dermatitis (ACD) in US children. More widespread diagnostic confirmation through epicutaneous patch testing is needed.
OBJECTIVE:
The aim was to quantify patch test results from providers evaluating US children.
METHODS:
The study is a retrospective analysis of deidentified patch test results of children aged 18 years or younger, entered by participating providers in the Pediatric Contact Dermatitis Registry, during the first year of data collection (2015-2016).
RESULTS:
One thousand one hundred forty-two cases from 34 US states, entered by 84 providers, were analyzed. Sixty-five percent of cases had one or more positive patch test (PPT), with 48% of cases having 1 or more relevant positive patch test (RPPT). The most common PPT allergens were nickel (22%), fragrance mix I (11%), cobalt (9.1%), balsam of Peru (8.4%), neomycin (7.2%), propylene glycol (6.8%), cocamidopropyl betaine (6.4%), bacitracin (6.2%), formaldehyde (5.7%), and gold (5.7%).
CONCLUSIONS:
This US database provides multidisciplinary information on pediatric ACD, rates of PPT, and relevant RPPT reactions, validating the high rates of pediatric ACD previously reported in the literature. The registry database is the largest comprehensive collection of US-only pediatric patch test cases on which future research can be built. Continued collaboration between patients, health care providers, manufacturers, and policy makers is needed to decrease the most common allergens in pediatric consumer products.

Full free access to the article for 30 days:

http://journals.lww.com/dermatitis/Abstract/2016/09000/Pediatric_Contact_Dermatitis_Registry_Inaugural.10.aspx

Free Article- Cosmetic Contact Allergens by An Goossens!

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This is a FREE open access article that discusses common and not so common allergens in cosmetics.  Section  3.2.2. discusses preservatives:

“Shifts in frequency of positive patch-test reactions have occurred over the years [6 ], but more

recently methylisothiazolinone (MI), in particular … weaker sensitizer… less efficient …

hence larger use concentrations … severe skin lesions and atypical clinical

symptoms, leading to a delay in the correct diagnosis (e.g., [8 ]), and respiratory …”

“The incidence of positive reactions to formaldehyde—”

3.21. discusses fragrances:

“Myroxylon pereirae (balsam of Peru), colophonium, hydroperoxides of limonene and linalool, terpene compounds that act as prehaptens…”

 

Cosmetic Contact Allergens

By An Goossens

“This article presents trends in the frequency of cosmetics as causal factors of allergic contact dermatitis during a 26-year period in 14,911 patients patch-tested between 1990 and 2014, and discusses the cosmetic allergens identified during the last six years (2010–2015) in 603 patients out of 3105 tested. The data were retrieved from, and evaluated with, a patient database developed in-house. The results show the increasing importance of cosmetic allergies, up to 25% of the patients tested during the last five-year period. As expected, fragrance materials, preservatives, and hair dyes were the most frequent culprits, but a great variety of other allergenic ingredients were involved as well. This underlines the need of additional and extensive patch testing with the patient’s products used and their ingredients.”

 

To read more click on this link:

http://www.mdpi.com/2079-9284/3/1/5

and download FREE pdf.
To learn more about contact dermatitis visit us at:

 http://www.dermatitisacademy.com

The conifer – balsam of Peru connection discussed – Systemic Contact Dermatitis

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Systemic contact dermatitis is a systemic response to an allergen in a previously sensitized individual.  This article presents a case of a woman with ‘dyshidrotic hand eczema’ who developed blisters after eating chocolate.  She also had fever and an elevated immune cell count.  This patient benefited from a BOP-reduced diet.

…”many of the components of BP can be present as unrecognized, ‘‘hidden’’ allergens in different food items.” … ” Patients with BP contact allergy are often allergic to colophonium, balsam of Tolu, wood tar, turpentine, styrax or propolis, all of which can contain similar or related allergens.”

Conifers (evergreens, pine trees) are sources of colophonium.

http://medicaljournals.se/acta/content/download.php?doi=10.1080/00015550310016599

For more information on the balsam of Peru diet visit us at:

https://www.dermatitisacademy.com/bop-diet/

 

Test your Uroshiol Savvy

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Test your knowledge of common items containing the allergen Uroshiol

Read more

FDA data on the TRUE Test

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This article updated in Nov 2015 on the Thin-layer Rapid Use Epicutaneous (T.R.U.E.) test discusses Indications and Usage, Dosage and Administration, and Contraindications, Timing of the Reads, Interpretation Instructions — use in specific populations (pregnancy, nursing, pediatric) — detailed allergen composition and the ten clinical studies were conducted in North America and Europe evaluating sensitivity and specificity, and/or agreement with a reference allergen…

 

To read full article: http://www.fda.gov/downloads/BiologicsBloodVaccines/Allergenics/UCM294327.pdf

High concentrations of isothiazolinone and mislabeling – Belgium

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This article discusses the evaluation of MI in products in Belgium and the verification of accurate labeling and regulatory compliance.  They found that concentrations of MI may be “(too) high” and labelling may be incorrect.

“Aerts O1, Meert H2, Goossens A3, Janssens S2, Lambert J1, Apers S2.  Methylisothiazolinone in selected consumer products in Belgium: Adding fuel to the fire?  Contact Dermatitis. 2015 Sep;73(3):142-9. doi: 10.1111/cod.12449.

Methylisothiazolinone (MI) contact allergy is severely affecting consumers with allergic contact dermatitis, owing to its presence in cosmetics, household detergents, and water-based paints, in particular. Data on the true isothiazolinone concentrations in these products are scarce, and labelling may be incorrect.”
“OBJECTIVES:
To report on the MI concentrations in such products marketed in Belgium, in order to verify the accuracy of labelling (when applicable) and compliance with EU regulations.
MATERIALS AND METHODS:
Thirty cosmetics (18 leave-on and 12 rinse-off), eight detergents and four paints were analysed for MI by the use of high-performance liquid chromatography with ultraviolet detection.
RESULTS:
The analysed leave-on, and to a lesser extent the rinse-off, cosmetics, contained MI at concentrations far exceeding the permitted 100 ppm use concentration. Household detergents contained high concentrations of MI, and mislabelling occurred for both cosmetics and detergents. The (limited) data on paints are in line with the existing literature.
CONCLUSION:
Cosmetics and detergents may facilitate contact sensitization because of a (too) high MI concentration, and mislabelling may make its avoidance extremely difficult. Safer use concentrations and correct labelling should be ensured by adequate quality control.”

This is not an OPEN ACCESS article.  The article can be rented at: http://onlinelibrary.wiley.com/wol1/doi/10.1111/cod.12449/full