Atopic dermatitis at preschool age and contact allergy in adolescence: a population-based cohort study.

BACKGROUND: Atopic dermatitis (AD) is characterized by an impaired skin barrier, which can allow enhanced penetration of allergens. It is not clear whether AD influences the risk of developing contact allergy. OBJECTIVES: To examine the association between AD at preschool age and contact allergy at 16 years of age. METHODS: At 16 years of age, 2215 adolescents from the population-based cohort BAMSE were included. These adolescents had been followed with repeated questionnaires regarding AD throughout childhood, and contact allergy was assessed by skin patch test at 16 years. RESULTS: AD at preschool age was associated with contact allergy to at least one of the tested substances at 16 years of age among boys [adjusted odds ratio (OR) 1·51, 95% confidence interval (CI) 1·03-2·20] but not among girls (adjusted OR 0·77, 95% CI 0·54-1·10). AD at preschool age was not associated with contact allergy to nickel in either boys or girls. In contrast, AD at preschool age was associated with contact allergy to fragrance mix I (adjusted OR 3·10, 95% CI 1·66-5·80). This association was observed especially for AD at preschool age in combination with IgE sensitization to airborne or food allergens (adjusted OR 3·80, 95% CI 1·67-8·61). CONCLUSIONS: The results suggest that AD in early childhood may be associated with contact allergy to fragrances, but not to nickel, in adolescence.

Short contact with nickel causes allergic contact dermatitis: an experimental study.

BACKGROUND: Knowledge about the required duration of exposure for elicitation of allergic nickel dermatitis in nickel-allergic individuals is limited. However, it often has been proposed that short skin contact is safe. OBJECTIVES: To examine whether repeated skin contact with nickel over short time periods (3 × 10 min) can elicit allergic nickel dermatitis. METHODS: Sixteen nickel-allergic adults and 10 controls were exposed to, respectively, nickel- and aluminium-containing discs on each volar forearm and on each earlobe for 3 × 10 min. One arm was pretreated for 24 h with sodium lauryl sulfate (SLS) 0·5% under occlusion before exposure. One aluminium and one nickel exposure site were clinically evaluated, and blood flow was measured with laser Doppler flowmetry at day 2 and day 4. RESULTS: Ten of 16 (63%) nickel-allergic participants developed allergic nickel dermatitis on SLS-pretreated arm skin and three of 16 (19%) developed it on normal skin on the earlobe. On the SLS-pretreated arms of nickel-allergic participants, blood flow increased significantly more on the nickel-exposed skin than on the aluminium-exposed skin on days 2 and 4. No change in clinical reactivity or blood flow was found on normal forearm skin in nickel-allergic participants or on any skin in controls. CONCLUSIONS: This experimental study showed that relatively short repeated skin contact (3 × 10 min) with metallic nickel elicits allergic nickel dermatitis in irritated skin and at sites with previous dermatitis. The results support the restrictions in current nickel regulation.

Methylisothiazolinone in rinse-off products causes allergic contact dermatitis: a repeated open-application study.

BACKGROUND: In recent years, the prevalence of contact allergy to the preservative methylisothiazolinone (MI) has increased dramatically. Cosmetic products are one of the major sources of exposure. OBJECTIVES: To examine whether allowed concentrations of MI in cosmetic rinse-off products have the potential to cause allergic contact dermatitis. METHODS: Nineteen MI-allergic subjects and 19 controls without MI allergy applied two liquid hand soaps five times per day on areas of 5 × 10 cm(2) on the ventral side of their forearms. One soap contained 100 ppm MI, the maximum allowed concentration in cosmetics, and was used by 10 allergic subjects and all controls. Another liquid soap with 50 ppm MI was used by nine allergic subjects. As the negative control, all subjects used a similar soap that did not contain MI. The repeated open applications proceeded until a positive reaction occurred or up to 21 days. The study was conducted in a randomized and blinded fashion. RESULTS: Ten out of 10 MI-allergic subjects developed positive reactions to the soap with 100 ppm and seven out of nine reacted to the 50 ppm soap, while none of the 19 controls had a positive reaction during 21 days of application. No reactivity was seen to the soap without MI. The difference in reactivity to MI between MI-allergic subjects and controls was statistically significant (Fisher's exact test, P ˂ 0.0001). CONCLUSIONS: Rinse-off products preserved with 50 ppm MI or more are not safe for consumers. No safe level has yet been identified.

Hand eczema and atopic dermatitis in adolescents: a prospective cohort study from the BAMSE project.

BACKGROUND: There is a well-known association between atopic dermatitis (AD) and hand eczema but less is known about how age at onset, persistence and severity of AD influence the risk of developing hand eczema. OBJECTIVES: To examine the role of AD in the occurrence of hand eczema in adolescence. In addition, associations between asthma and rhinoconjunctivitis, sensitization to common airborne and food allergens, and hand eczema were studied. METHODS: From the population-based birth cohort BAMSE, 2927 adolescents who had been followed up repeatedly concerning allergy-related disease were included. Questionnaires identified adolescents with hand eczema at 16 years, and their blood was analysed for specific IgE. RESULTS: A total of 152 (5·2%) adolescents had hand eczema at the age of 16 years. Many of these adolescents had a history of AD (n = 111; 73·0%) and asthma and/or rhinitis (n = 83; 54·6%), respectively. Children with AD (aged 0-16 years) had more than threefold increased odds ratios (OR) for having hand eczema; those with persistent or severe AD had a crude OR of 6·1 [95% confidence interval (CI) 4·0-9·1] and 5·3 (95% CI 2·9-9·6), respectively. CONCLUSIONS: We confirm a strong association between AD during childhood and hand eczema in adolescence. Children with persistent or more severe AD are at greater risk of developing hand eczema. Asthma and/or rhinoconjunctivitis, positive specific IgE or age at onset of AD are not associated with hand eczema in adolescence.

Prevalence and incidence of hand eczema in adolescence: report from BAMSE--a population-based birth cohort.

BACKGROUND: BAMSE is a Swedish population-based birth cohort. OBJECTIVES: To estimate prevalence proportions and the incidence rate of hand eczema in Swedish adolescents, and to compare information given by adolescents and parents. Further aims were to study sex distribution, age at onset and extension of hand eczema. METHODS: At 16 years of age, 2927 adolescents were included in this study; both adolescent and parental questionnaires were used, as well as clinical examination. RESULTS: The 1-year prevalence of hand eczema was 5·2% (n = 152) and 4·0% (n = 116) (P < 0·03), and lifetime prevalence was 9·7% (n = 284) and 7·0% (n = 206) (P < 0·01), respectively, when adolescents and parents reported. The incidence rate was 573/100 000 person-years according to the adolescent report. The level of agreement between adolescents and parents was fair for 1-year and lifetime prevalence (κ = 0·56 and κ = 0·49, respectively). According to the Hand Eczema Extent Score, 27·0% (n = 36) had moderate-to-severe hand eczema. CONCLUSIONS: At the age of 16 years, the 1-year prevalence of hand eczema was substantial, with an incidence rate of the same magnitude as in adults. Female predominance was seen in adolescence. It is preferable that the occurrence of hand eczema is reported by adolescents themselves, as they are the ones most aware of their symptoms.

Excessive nickel release from earrings purchased from independent shops and street markets--a field study from Warsaw and London.

BACKGROUND: Nickel allergy is frequent and cause morbidity and increased health care costs. OBJECTIVE: The aim of this study was to determine the proportion of inexpensive earrings randomly purchased from stores and street markets in two capitals that gave positive dimethylglyoxime (DMG) test reactions and to determine whether the degree of nickel release was related to shop category. METHODS: Random inexpensive metallic earrings were purchased from stores and vendors in London and Warsaw. A qualitative investigation of nickel release by using the DMG test was performed. RESULTS: DMG testing revealed that respectively 15.1% (n=205) and 18.4% (n=206) of earrings purchased in London and Warsaw released nickel as indicated by positive test outcomes. Stratification by store category showed that DMG test-positive jewellery were mainly purchased from street markets and from stores that were not part of national or international chains. CONCLUSIONS: Despite the EU Nickel Directive having resulted in decreasing prevalence of nickel allergy, a large proportion of inexpensive earrings still release nickel in concentrations that may result in nickel allergy and dermatitis. Authorities should prioritize information campaigns and random inspections as a legislation that is not followed is of limited value.

Occupational skin exposure to water: a population-based study.

BACKGROUND: Occupational exposure to skin irritants, in particular to water, is an important risk factor for hand eczema. OBJECTIVES: To assess occupational skin exposure to water in the general population. METHODS: As part of a public health survey in Stockholm, Sweden, 18,267 gainfully employed individuals aged 18-64 years completed a questionnaire with previously validated questions regarding occupational skin exposure to water. RESULTS: Altogether 16% reported exposure to water for (1/2) h or more a day, and 13% reported exposure to water more than 10 times a day. Furthermore, 7% reported water exposure of more than 2 h and 6% of more than 20 times a day. Women reported more water exposure than men and many female-dominated occupations were seen to comprise water exposure. Women were also more exposed than men within the same jobs. Young adults were more exposed than older. A total of 18% were employed in high-risk occupations for hand eczema. Fifty-nine per cent of individuals employed in high-risk occupations reported water exposure at work, compared with 11% in low-risk occupations. CONCLUSIONS: A total of 20% of the population of working age acknowledged occupational skin exposure to water, which was found to be more common in young adults and women. Using job title as a proxy for water exposure gives an underestimation due to misclassification. In assessing occupational skin exposure to water, both exposure time and frequency should be considered.

Intellectual, neuropsychological, and achievement outcomes in children six to eight years after recovery from Haemophilus influenzae meningitis.

Twenty-four grade school children who had sustained an earlier episode of Haemophilus influenzae type b meningitis were tested, along with a group of 24 school-aged siblings. Evaluations consisted of tests of IQ, academic achievement, and neuropsychological skills. Parents completed forms rating each child's behavioral adjustment and temperament. Available school-administered standardized achievement tests were also obtained. Information relating to the episode of meningitis was extracted from the medical charts of each child who had had meningitis in order to investigate the relationship of these parameters to developmental outcome. Results showed that, compared with nearest-age siblings, children who had had meningitis scored lower on performance IQ and full-scale IQ. The group that had had meningitis also performed more poorly on several neuropsychological tasks. However, the groups did not differ in verbal IQ, and they performed comparably on all academic measures. Significant behavioral adjustment problems were absent from both groups, and there were no notable differences in temperament. Although findings support the existence of postmeningitis sequelae, the selective nature of the deficiencies observed indicate that prognosis for children in the age range examined may be better than that suggested by earlier studies.

TRANSACT--a model for integrating clinical practice and longitudinal research.

To effectively deal with the high-risk infant and his outcome, it would appear that clinicians and researchers must, in a sense, place themselves "at-risk." They must recognize the limitations of a reductionistic, biomedical model when applied to this population and its problems. They must move beyond this traditional model to a so-called "biopsychosocial model" which acknowledges the uncertainties of human development and its transactional character. To do so, they must also seek to break down many traditional "boundaries" that have served to inhibit a better understanding of the high-risk infant. These boundaries include those between disciplines, between clinicians and researchers, between assessment and treatment, between cost efficiency and comprehensiveness, and those between quantitative and qualitative methodologies to name a few. This process must not be one of all or none exclusion, where a uniform perspective is adopted in isolation and applied to all aspects of the problem. Rather it must be a combination and synthesis of many perspectives. In essence, the construct used to understand and study the high-risk infant and his outcome should be consistent with the transactional and multifactorial nature of the problem. These tasks are formidable and threatening to undertake, particularly when they do not always yield the type of outcomes we have been conditioned to expect: "hard" data; narrow etiologies; and successful cures. However, failure to take such "risks" would seem to impede a further understanding of the at-risk infant. The T.R.A.N.S.A.C.T. model presented here is offered as a working construct which has yet to be fully operationalized. Its perceived limitations will reflect the background, biases and perspectives of the reader. Hopefully, it will serve to stimulate those interested and involved in the high-risk infant and his outcome to modify, refine or build upon their current approaches.

Is the skin affected by work at visual display terminals?

According to some reports, mainly from Norway and Sweden, visual display terminal work is suspected of causing skin rashes. In three different studies, we have tried to elucidate the question, and the results indicate that there might be a relation between VDT work and aggravation of some common skin diseases such as rosacea, seborrheic and atopic dermatitis, and acne. Whether this depends on physical, chemical, or psychological factors is still unknown.

Audiologic aspects of learning and behavior.

To effectively deal with learning and behavioral problems, physicians must acquire a new knowledge base and interact meaningfully with professionals from a variety of disciplines. They must be aware that audiologic factors are only one part of a complex matrix of components contributing to learning and behavior. Although the exact nature of these components is still being defined, their interrelationship can be hypothesized. An individual can overcome the uncertainties and avoid inappropriate diagnoses in this field by applying a comprehensive, descriptive diagnostic process. With a broad understanding of the transactional model of learning and behavior, physicians can ensure that audiologic problems are defined and addressed appropriately. By acknowledging this approach in the identification, assessment and management of children with learning and behavioral dysfunction, the physician can become a powerful advocate for these children.

Work with video display terminals among office employees. V. Dermatologic factors.

According to some reports, mainly from Norway, work with a video display terminal (VDT) has been suspected to cause skin rashes. In conjunction with an epidemiologic study of some 550 office employees, 74 persons, who complained of skin symptoms, were examined by occupational dermatologists. The objective was to see whether the findings from earlier reports could be confirmed, whether any type of rash could be suspected to depend on VDT work, and whether positive findings might be explained by means of physical data. Many different diagnoses were made, but no case demonstrated the clinical picture described among VDT operators from Norway. Subjects with seborrheic dermatitis, acne, and rosacea were overrepresented in the exposed group. Whether this occurrence was due to physical factors, psychological factors, or pure chance is still unclear. This study and observations from our clinic imply that a relationship might exist between VDT work and aggravation of seborrheic dermatitis, acne, and rosacea and probably poikiloderma of Civatte.

Occupational contact dermatitis due to nickel allergy.

Contact allergy to nickel is a large dermatological problem affecting 10-15% of women and 1% of men in the general population. The aim of this study was to illustrate the significance of occupational nickel exposure in men. Patch testing was carried out to identify patients with nickel allergy and the dimethylglyoxime test was used to identify sources of nickel exposure. 8% of the men and 30% of the women were patch-test positive to nickel. Most of the patients had hand eczema, and a few had facial eczema. Tools and equipment used in different jobs by workers such as carpenters, electricians, painters, and plumbers were often found to cause nickel release. Black-nickel plating is used for optical equipment while cold-sealing of aluminium with nickel is a method of treating anodized aluminium. Both black-nickel and cold-sealed aluminium were found to be unexpected causes of dermatitis due to nickel release. Sources of occupational nickel exposure are often missed by dermatologists, due to lack of knowledge. Occupational nickel exposure is however important to identify, and the dimethylglyoxime test is a helpful tool.

Experiences from long-term research cooperation between Costa Rican, Nicaraguan, and Swedish institutions.

This paper summarizes experiences from long-term ongoing cooperation between Swedish research institutions and institutions at the National Universities in Nicaragua and Costa Rica. 24 researchers and teachers from the Central American institutions and ten Swedish research students have been trained. In addition to three full doctoral and three licentiate (two-year PhD program) theses, the two programs have so far published 15 articles in English-language, international, refereed journals and about three times as many abstracts for conferences in more than ten countries. A "sandwich" model for training is recommended, where the southern researchers come to the wealthier partner for collaborative analyses and write-ups of the publications, while spending 50-75% of their time in their home countries for data collection. Such collaboration should be planned for a time span of at least eight years and include substantial numbers of researchers and students. Means to minimize the risk of brain drain are suggested. The collaboration has been important for the globalization of the research cultures at the participating institutions and has trained international experts.