Impact of soymilk consumption on 2,4-dinitrofluorobenzene-induced contact hypersensitivity and gut microbiota in mice.

Soymilk is rich in phytochemicals such as soy isoflavones (SIs) and soyasaponins (SSs). Dietary SIs and SSs display inhibitory effects on contact hypersensitivity (CHS), which was reported in a mouse model for allergic contact dermatitis (ACD); however, the beneficial effects of soymilk consumption on CHS remain unknown. Here, we studied the effects of drinking soymilk on CHS and gut microbiota. Soymilk consumption attenuated ear oedema and swelling, decreased the infiltration of Gr-1-positive cells into ear tissues, and reduced the production of chemokine (C-X-C motif) ligand 2 and triggering receptor expressed on myeloid cells-1 in ear tissues. The analysis of bacterial 16S ribosomal RNA gene sequences indicated that CHS caused changes in the gut microbiota structure and that consuming soymilk reduced these changes. These results suggest that soymilk consumption may be of therapeutic value for patients with ACD and may help control the balance of intestinal microbiota.

Systemic contact dermatitis--kids and ketchup.

Systemic manifestations of allergic contact dermatitis due to consumption of foods containing balsam of Peru (Myroxylon pereirae)-associated chemicals have recently been reported in children. We present seven children with widespread, recalcitrant dermatitis who experienced 60-80% clearance after initiating a diet low in balsam of Peru, specifically the tomato product ketchup. Furthermore, because we have observed a high prevalence of ketchup in our pediatric patients' diets, we recommend consideration of moderate consumption of this product in patients with recalcitrant widespread dermatitis.

Systemic contact dermatitis in children: how an avoidance diet can make a difference.

Systemic contact dermatitis is an under-recognized skin reaction that occurs secondary to systemic (oral, intravenous, intramuscular, inhaled, or subcutaneous) exposure to a hapten in a previously sensitized individual. Medicaments are the most common cause of SCD in the adult population, but other chemicals like nickel, cobalt, balsam of Peru, and formaldehyde have been implicated as well. Few reports in children exist to date. Dietary restriction has shown to be of some benefit in managing some adult patients. We present a case series of 8 pediatric patients diagnosed with SCD from the contact dermatology clinic, who showed marked improvement of their dermatitis after adequate dietary avoidance. We review common presentations of chemicals causing SCD in children and potential dietary modifications.

Role of intestinal Bifidobacterium pseudolongum in dietary fructo-oligosaccharide inhibition of 2,4-dinitrofluorobenzene-induced contact hypersensitivity in mice.

Strategies to manipulate the gut microbiota have been explored for preventing allergy development. We previously showed that dietary supplementation with fructo-oligosaccharide (FOS) reduced 2, 4-dinitrofluorobenzene (DNFB)-induced contact hypersensitivity (CHS) in BALB/c mice. Because the CHS response was negatively correlated with the number of faecal bifidobacteria, particularly Bifidobacterium pseudolongum, the present study aimed to examine whether oral administration of B. pseudolongum affects CHS response. Viable B. pseudolongum was successfully isolated from mouse faeces. Female BALB/c mice were fed a synthetic diet with or without FOS supplementation, and B. pseudolongum (2 x 10(7) cells) was administered daily throughout the experimental period. Two weeks after starting the test diets, mice received DNFB on the ear auricle twice at 7-d intervals. Conventional cultivation and molecular biological analyses based on 16S rRNA gene sequences showed that administration of FOS and B. pseudolongum resulted in higher excretion of viable bifidobacteria, mainly B. pseudolongum. Although dietary FOS reduced the CHS response as demonstrated by ear swelling, B. pseudolongum administration resulted in a reduction in the initial phase only of the CHS response. B. pseudolongum administration increased hapten-specific IgG1, while dietary FOS decreased IgG2a in sera. Administration of FOS and B. pseudolongum decreased interferon-gamma production and increased IL-10 production in cervical lymph node cells restimulated with hapten in vitro. We conclude that B. pseudolongum proliferation in the intestinal tract is partially responsible for the reduction in DNFB-induced CHS response by dietary supplementation with FOS in mice, which may be mediated by the modulation of antigen-induced cytokine production.

Cutaneous complications of improper leech application.

INTRODUCTION: The medical leech (Hirudo medicinalis) has been used throughout the centuries and continues to be used today, mainly in reconstructive surgery and microsurgery. Easy access to these animals may entail an improper use of this therapeutic method by patients as a form of self-treatment. CASE REPORT: A man who presented with skin erythema and oedema due to the application of a medical leech. DISCUSSION: Infection is considered the most common complication of hirudotherapy, even though bacteriological examination of leech applied by the patient showed neither bacterial nor parasitic infection. The skin lesions were probably of allergic origin; whether this reaction was due to substances released from the leech or as a consequence of reusing the same leech, remains to be determined.

Pruritus ani as a manifestation of systemic contact dermatitis: resolution with dietary nickel restriction.

Pruritus ani is a common distressing problem with numerous possible causes. When locally applied agents trigger irritation or allergic response, skin changes of dermatitis usually accompany the itch. Focal pruritus in the absence of dermatitis is not generally considered to be a manifestation of contact allergy. Furthermore, focal pruritus is not listed among the possible diverse presentations of the systemic delivery of a proven contact allergen. We report a case of a gentleman with a 1.5-year history of treatment-resistant pruritus ani. When patch testing revealed a positive reaction to nickel sulfate, he admitted to daily peanut butter consumption. His symptoms resolved with dietary nickel restriction. Patch testing may be useful in patients with pruritus of the anogenital region, not only to elucidate potential contact exposures contributing to the symptom but also to suggest possible dietary precipitants.

Systemic contact dermatitis.

Systemic contact dermatitis is an inflammatory skin disease that may occur in persons with contact allergy when they are exposed to the hapten orally, transcutaneously, per rectum, intravesically, intravenously, or by inhalation. The most common causes of systemic contact dermatitis are drugs used both topically and systemically. Other causes are ubiquitously occurring haptens, such as the metals nickel, cobalt, gold, and chromate, and aromatic substances such as spices. Avoidance of the offending hapten is the most obvious treatment. For some haptens, such as nickel, diet treatment may be effective. Chelation therapy with disulfiram is another therapeutic option in nickel-allergic patients with systemic contact dermatitis. Hyposensitization therapy has been attempted with some success in systemic contact dermatitis caused by nickel and Parthenium hysterophorus.

Reduction of intake of balsams in patients sensitive to balsam of Peru.

64 patients participated in this study. 24 were patients who had positive patch tests to balsam of Peru. The dermatitis of 9 of the patients had flared after open oral challenge with balsam of Peru, and the dermatitis of 31 patients had flared after double-blind oral challenge. All 64 patients were asked to avoid food items suspected of containing balsams for 1 to 2 months. At the end of that time, an evaluation of the diet trial was made; the dermatitis of 37 had cleared or improved markedly. If an improvement had taken place, the patient was asked to continue to diet moderately. 6 months to 3 years after the diet was initiated, a questionnaire was mailed to those patients whose dermatitis had improved after the first trial. The patients were asked to evaluate the long-term benefit of following the diet. 30 felt there was a long-term effect, and 27 still followed the diet instructions to some degree.

[Food chemistry and technology aspects of nickel-deficient nutrition in endogenously-induced allergic contact eczemas]. / Lebensmittelchemische und -technologische Aspekte zur nickelarmen Ernährung bei endogen bedingten allergischen Kontaktekzemen.

With reference to endogenous nickel contact dermatitis, the quantity of nickel resorbed is dependent on the individual capacity for absorption, the element species of nickel in the food matrix and the total nickel content in the food. As the content of nickel varies widely in individual foods, it is difficult to make any definite dietary recommendations. The wide fluctuation in the nickel content of vegetable food stuffs is due to variations in the composition of soil. This means the availability of nickel to plants is not constant. The fluctuating content of nickel in the soil also has a heavy influence. Nickel contamination can be considerable when food is prepared in the usual way. The danger of nickel contamination during industrial preparation of food has not yet been fully explored. In tests for endogenous nickel contact eczema, organic nickel should be used. Another way is to administer a diet containing only defined minute amounts of nickel.

[Oral nickel provocation and a nickel-free diet. Indications and practical implementation]. / Orale Nickelprovokation und nickelarme Diät. Indikation und praktische Durchführung.

In spite of some unsolved questions, an influence of orally ingested nickel on some forms of chronic eczema is generally accepted. In cases of chronic relapsing dermatitis with typical location, positive nickel patch test and positive oral nickel challenge, a nickel-restricted diet may be recommended for a limited period of time. Regional nutritional habits should be considered in the design of diets. Indications, practice and evaluation criteria for oral nickel challenge and nickel-reduced diets are described.

Dietary treatment of nickel dermatitis.

During a 5-year period, 61 patch-test-negative patients whose dermatitis flared after oral challenge with 2.5 mg nickel and 143 patients with positive patch tests to nickel who were not challenged orally adhered to a diet intended to reduce the daily intake of nickel for at least one month. After 1 to 2 months of dieting the dermatitis in 121 of the 204 patients had cleared or was markedly improved. One to 5 years after the initial diet treatment a questionnaire was sent to the 204 patients to inquire about the long-term results of the diet treatment. 150 patients responded to the questionnaire. 90 of these patients had continued to diet constantly or intermittently for a year or more. 88 patients felt that there was a long-term improvement as a result of diet treatment.

Low nickel diet in the treatment of patients with chronic nickel dermatitis.

Of 28 patients with chronic nickel dermatitis 17 experienced aggravation following oral ingestion of 2.5 mg nickel, but not a placebo tablet. The dermatitis of 9 of the 17 patients improved during a period of 6 weeks on a low nickel diet. The dermatitis of 7 of the 9 patients flared again when a normal diet was resumed. Nickel excretion over a 24-h period was measured for 14 of the 17 patients by atomic absorption spectrophotometry before, during, and after the diet. Reduced excretion was seen during the diet with no statistically significant difference between patients whose dermatitis improved during the diet and those whose dermatitis showed no change.

Nickel dermatitis and diet: clinical improvement and a reduction in blood and urine nickel levels with a low-nickel diet.

A 27-year-old nickel-sensitive female who had had continuous spontaneous flare-ups of eczema, including at sites of previous metal contact, experienced a clearing of her eruption after commencing a low-nickel diet. When on the diet, whole-blood and urinary nickel levels fell to half or less of pre-diet values and this coincided with the clinical improvement. Low-nickel diets should be considered for patients who are highly nickel sensitive.

Dermatitis induced or aggravated by selected foodstuffs.

The eczema of 113 patients with dermatitis other than classical urticaria or typical atopic dermatitis cleared or showed marked improvement after one to two months of dietary restriction. In their response to a questionnaire completed at least 6 months after the initiation of the diet, 61 (54%) of these patients said that diet restriction was effective in reducing the activity of or preventing recurrence of their dermatitis. Their most common symptoms were recurrent symmetrical hand eczema, anogenital eczema, pruritic papules and excoriations of the trunk as well as a "fixed" type of eczema. Forty-nine of the 113 patients were able to reproduce their symptoms at least 3 times with certain food items, most commonly eggs, milk, tomato, cheese and fish. It is likely that both the classical food allergens and foods containing or producing histamine or other vasoactive substances could be the cause of such dermatoses or act as a non-specific aggravating factor. This type of reactivity was most common among patients with a personal and/or family history of atopic diseases (asthma, hay fever and/or atopic dermatitis). Symptoms corresponding to those of contact urticaria to food items were commonly seen among the patients.

Can oral challenge with balsam of Peru predict possible benefit from a low-balsam diet?

BACKGROUND: Previous studies have shown that some patients sensitive to balsams and/or fragrances obtain long-term benefits by following a low-balsam diet, whereas others do not. OBJECTIVE: This study was performed to determine whether a low-balsam diet was a helpful long-term treatment for selected patients sensitive to balsam of Peru and/or a perfume mixture and to determine whether oral challenge with balsam of Peru could predict which balsam-sensitive patients might benefit from a reduction in balsam intake. METHODS: Questionnaires were sent to 46 patients with positive patch test results to balsam of Peru and/or a perfume mixture and chronic dermatitis of a morphology consistent with endogenous dermatitis who had experienced improvement after 1 to 2 months on a diet intended to reduce the intake of balsams. The questionnaires were mailed 1 to 3 years after the initiation of the diet treatment to inquire about a possible long-term benefit of the diet. RESULTS: Twenty-eight of the 46 patients stated in the questionnaire that they had long-term benefits from the diet treatment. These included 16 of 22 patients who had reacted to a placebo-controlled oral challenge with 1 g balsam of Peru, 3 of 10 who had no reaction or a placebo reaction to the oral challenge, and 9 of 14 who had not been challenged orally. The efficacy of the diet treatment was not correlated to whether the patient had patch test reactivity to either balsam of Peru, the perfume mixture, or both substances. Food items most commonly mentioned by patients as causing aggravation of their symptoms on at least three different occasions were wine, candy, chocolate, cinnamon, curry, citrus fruit, and flavorings. CONCLUSIONS: In its present form, the oral challenge procedure with balsam of Peru offers only limited assistance in selecting patients who are likely to benefit from diet treatment.