Contact allergies to dental materials in patients.

BACKGROUND: Concerns regarding contact allergies and intolerance reactions to dental materials are widespread among patients. Development of novel dental materials and less frequent amalgam use may alter sensitization profiles in patients with possible contact allergy. OBJECTIVES: To analyse current sensitization patterns to dental materials in patients with suspected contact allergy. METHODS: This retrospective, multicentre analysis from the Information Network of Departments of Dermatology (IVDK) selected participants from 169 834 people tested in 2005-2019 and registered with (i) an affected area of 'mouth' (and 'lips'/'perioral'), (ii) with the dental material in question belonging to one of three groups (dental filling materials, oral implants or dentures or equivalents) and (iii) with patch-testing done in parallel with the German baseline series, (dental) metal series and dental technician series. RESULTS: A total of 2730 of 169 834 tested patients met the inclusion criteria. The patients were predominantly women (81.2%) aged ≥ 40 years (92.8%). The sensitization rates with confirmed allergic contact stomatitis in women (n = 444) were highest for metals (nickel 28.6%, palladium 21.4%, amalgam 10.9%), (meth)acrylates [2-hydroxyethyl methacrylate (HEMA) 4.8%] and the substances propolis (6.8%) and 'balsam of Peru' (11.4%). The most relevant acrylates were HEMA, 2-hydroxypropyl methacrylate, methyl methacrylate, ethylene glycol dimethacrylate and pentaerythritol triacrylate. Few men were diagnosed with allergic contact stomatitis (n = 68); sensitization rates in men were highest for propolis (14.9%) and amalgam (13.6%). CONCLUSIONS: Allergic contact stomatitis to dental materials is rare. Patch testing should not only focus on metals such as nickel, palladium, amalgam and gold, but also (meth)acrylates and the natural substances propolis and 'balsam of Peru'.

[Recurrent livedo-like skin lesions following a vector-based COVID-19 vaccine]. / Rezidivierende Livedo-artige Hautveränderungen nach einer Vektor-basierten COVID-19-Impfung.

Starting in 2020, the global health system faced unprecedent challenges due to the coronavirus disease 2019 (COVID-19) pandemic and the consequences are still felt. All the more fascinating and of particular importance for health policy was the development of potent vaccines within about one year by several research groups after the first reports of COVID-19 infections. To date, three types of COVID-19 vaccines are available, i.e., messenger RNA-based vaccines, adenoviral vector vaccines, and inactivated whole-virus vaccines. We report a woman who developed reddish, partially urticarial skin lesions on her right arm and flank shortly after the first dose with the corona vaccination from AstraZeneca/Oxford (ChAdOx1). The lesions were transient, however reoccurred in loco and at other locations over several days. The clinical presentation was unusual and was correctly assigned due to the clinical course.

Sexually transmitted pathogens causing urethritis: A mini-review and proposal of a clinically based diagnostic and therapeutic algorithm.

The purpose of this mini-review was to provide the latest information and concepts on diagnosis and treatment of the most common sexually transmitted pathogens causing urethritis. The incidence of several sexually transmitted infections that cause urethritis is increasing, and this genitourinary syndrome is among the most common reason young men see clinical care. The authors performed a literature search including the currently valid guidelines, and an overview of the most relevant pathogens is given. Moreover, the authors developed a clinically applicable diagnostic and therapeutic algorithm, because early diagnosis and correct treatment can sometimes prevent infected individuals from significant morbidity. Future research will focus on new methods to combat pathogens that cause urethritis, including vaccination.

First report of tamoxifen-induced baboon syndrome.

BACKGROUND: Baboon syndrome is a rare, type IV hypersensitivity reaction causing a maculopapular rash. Tamoxifen is an antineoplastic agent, working as an estrogen receptor antagonist, also called a selective estrogen receptor modulator. A variety of rashes were reported with Tamoxifen use to-date except baboon syndrome. The Tamoxifen-induced baboon syndrome seems to be reversible, as discontinuation of the drug improves clinical outcomes. AIM: Herein, we present the first case of Tamoxifen-induced baboon syndrome which occurred 8 years after initiation of Tamoxifen use. PATIENTS: A 44-year-old woman presented with papulovesicular eruption on her body and erythema on her face for a duration of 6 months. There was no evidence of ocular or mucosal involvement. She was diagnosed with breast cancer and treated with tamoxifen 10 mg twice daily over the past 8 years. She was not taking other medications or over-the-counter supplements at the time of presentation. The patient underwent urgent skin biopsies of two lesions on her buttock and thigh. No organisms were seen on Gram stain. The patient's skin biopsy revealed extensive hyperorthokeratosis, minimal parakeratosis, hypergranulosis, and lichenoid interface dermatitis in the irregularly acanthotic epidermis supporting diagnosis of fixed drug eruption. Following a multidisciplinary discussion, the patient was diagnosed with baboon syndrome or symmetrical drug-related intertriginous and flexural exanthema (SDRIFE) associated with Tamoxifen. RESULTS: Hence, Tamoxifen was immediately discontinued and treated with oral steroid along with topical agents. She showed improvement of clinical abnormalities within days after discontinuation of Tamoxifen. CONCLUSIONS: Given the widespread use of Tamoxifen in the management of patients with breast cancer, it is important that healthcare professionals monitor for rare, however clinically significant, and potentially life-threatening dermatological manifestations of Tamoxifen use, such as baboon syndrome.

Contact dermatitis: relevant differential diagnoses, simulators, and variants.

Similar to all eczematous disorders, irritant and allergic contact dermatitis are primarily defined by their morphology. In addition, the diagnosis of this specific reaction pattern on the skin (and mucous membranes) also requires prior exposure (direct or indirect) to an allergen or irritant. While it is quite easy to give a textbook description of the typical features of eczema, its clinical manifestations in daily practice are diverse and frequently uncharacteristic. Contact reactions may present as lichenoid, lymphomatoid, granulomatous, pigmented, purpuric, and erythema multiforme-like lesions, thus lacking the typical eczematous appearance and broadening the spectrum of differential diagnoses to be considered. Moreover, a considerable number of agents, acting by mechanisms other than contact, may trigger adverse reactions mimicking the eczematic morphology and distribution pattern of contact dermatitis. Increasingly used in oncology, this is especially true for drugs such as kinase inhibitors. Knowledge of these associations is crucial for the adequate diagnostic and therapeutic care of patients with supposed or actual contact dermatitis.

Meteorological conditions and the diagnosis of occupationally related contact sensitizations.

OBJECTIVES: An accurate diagnosis of (occupational) contact sensitization by patch testing is a prerequisite for efficient preventive management. However, previously observed seasonal fluctuations in patch-test reactions indicate some influence of meteorological conditions. The present analysis aims at quantifying the possible impact of temperature and humidity on patch-test reactions to occupationally related allergens. METHODS: Clinical data from 61 780 patients tested with standard series allergens potentially related to occupational exposure from 1993 through 2001 were collected by a contact sensitization surveillance network.The association between the patch-test results and meteorological data (air temperature and humidity) collected at the time and the approximate location of the testing was analyzed in a multinomial logistic regression analysis. RESULTS: For three allergens (a dye and two biocides), the odds of irritant or doubtful allergic reactions increased during cold and arid conditions. Two of them (pphenylenediamine and formaldehyde) also showed an association between weak positive allergic reactions and such weather. In contrast, reactions to various adhesive, plastic, and rubber-related allergens were not associated with weather conditions. CONCLUSIONS: An overall increase in skin irritation, brought on by cold and dry conditions, may instigate an increase in positive reactions by leading doubtful allergic reactions to be (falsely) categorized as allergic for at least two of the considered allergens. For the most part, however, weather conditions were not associated with reactions to occupational allergens. Thus the validity of patch testing does not largely seem to be compromised by ambient meteorological conditions.

Occurrence of subacute cutaneous lupus erythematosus after treatment with fluorouracil and capecitabine.

Capecitabine, an oral fluoropyrimidine and 5-fluorouracil (FU) prodrug recently approved for the treatment of metastatic colon and breast cancer, is currently under investigation in patients with gastric cancer. It has the advantage of oral administration, and good tolerability with its activity being comparable with intravenous 5-FU. Lupus erythematosus and lupuslike drug eruptions have been observed after 5-FU treatment, but so far no cases of subacute cutaneous lupus erythematosus have been described in patients treated either with capecitabine or 5-FU. We report a patient who developed subacute cutaneous lupus erythematosus after administration of 5-FU and capecitabine.

Etiologic and causative factors in perianal dermatitis: results of a prospective study in 126 patients.

BACKGROUND: Perianal dermatitis is probably the most common cutaneous disorder of the genitoanal area. Studies on the epidemiology of causative factors are rare. METHODS: Over a 4-year period we prospectively studied 126 patients with a presumptive diagnosis of anal eczema. The diagnostic algorithm comprised medical history, inspection, microbiology, laboratory chemistry, patch tests, proctoscopy, and biopsy if appropriate. RESULTS: The age range was 7-82 years and the majority of patients were male (57.1%). Periods of anal symptomatology ranged from 6 days to 120 months and most of the patients (51.6%) had complaints for more than 12 months. The clinical diagnosis in 68 patients (54%) was: intertrigo/candidiasis (42.9%), atopic dermatitis (6.3%), pruritus ani (5.6%), psoriasis (3.2%), skin atrophy from steroid use (2.4%), lichen sclerosus et atrophicus (n = 2), herpes simplex (n = 1), and condylomata acuminata (n = 1). Contact eczema was suspected in 58 patients (46%), but 25 of these (43.1%) showed no contact sensitization. CONCLUSION: The majority of patients with symptoms of anal eczema suffer from intertrigo/candidiasis, and relevant, causative contact sensitization may be found in only some of them. Patch-testing is a valuable investigative tool only when the patients' own products are included in the test series. Most patients suffer from their perianal complaints for more than 12 months, therefore diligent evaluation is warranted.

Cytokine gene polymorphisms in allergic contact dermatitis.

Susceptibility to contact allergy may be influenced by genetically determined alterations in the production of pro- and anti-inflammatory cytokines. This report focuses on functional polymorphisms in the genes encoding for several cytokines involved in the pathogenesis of contact allergic responses, including tumour necrosis factor (TNF)-alpha (G-238 A, G-308 A), interleukin (IL)-1beta (C-511G, T+ 3953C), its natural antagonist, the IL-1 receptor antagonist (VNTR intron 2), and IL-6 (G-174C). Polymorphisms were investigated by PCR techniques among polysensitized individuals, defined as individuals with confirmed contact sensitization to para-substituted aryl compounds and at least one other structurally unrelated allergen (n = 86), and healthy control individuals without a history of eczema (n = 310). The distribution of TNFA-308 genotypes was significantly different in these groups (Padjusted= 0.0378). Compared with carriers of 2 wild-type alleles (TNFA-308*1/1 (*G/G)), carriers of the TNFA-308*1/2 (*G/A) and TNFA-308*2/2 (*A/A) genotypes tended to be more common among polysensitized individuals [OR = 1.54, 95% CI (0.92-2.55) and OR = 2.36 (0.84-6.51), respectively]. No significantly different distribution of genotypes was detected at any other polymorphic loci among control individuals without eczema and polysensitized subjects. These findings suggest a possible relationship between the TNFA-308 polymorphism and contact allergy. The results need to be confirmed in future studies.

Measurement of IgE antibodies using liquid allergens--an inter-method and inter-laboratory quality assessment.

BACKGROUND: The determination of IgE antibodies is important for the in vitro diagnosis of allergic diseases. However, not all systems currently available in the market fulfill essential quality criteria, e.g. regarding characteristics such as sensitivity and specificity, and the data do not always reflect true clinical relevance in the required fashion. Recent innovations may reduce the workload for the technician, and thus help save time and money. More importantly, they might reduce potential sources of error. OBJECTIVE: Two allergy systems, the well established Pharmacia CAP system that uses the allergens conventionally in a solid phase and the ALLERgen system that employs liquid allergens, were compared with regard to quality criteria and practicability. METHODS: Defined serum pools were checked for within-run and between-days imprecision of IgE antibody detection in two independent laboratories. Serum specimens from allergic patients and controls were tested in parallel using both methods for total and antigen-specific IgE antibody detection under standardized conditions. In addition, one laboratory working exclusively with the ALLERgen system participated in the Austrian inter-laboratory quality assessment program. RESULTS: The two systems were comparable in terms of sensitivity and specificity, and also showed good correlation. Within-run evaluations were excellent for total IgE and antigen-specific IgE, and the between-days imprecision was satisfactory. Coefficients of variation were within an acceptable range for the different groups of allergens. In the external quality control program the data obtained with the ALLERgen system showed good concordance with other systems in use; up to 94% of the results were identical when considering clinically relevant sensitizations. Regarding practicability, both systems were most satisfactory for the operator. The ALLERgen system offered a certain advantage in terms of automated operation, which resulted in shorter fixed and variable phases of personnel time. CONCLUSION: Both the Pharmacia CAP system and the ALLERgen system belong to an advanced generation of allergy test systems and are easy to handle. The reproducibility of results is good with both methods, and the imprecision data fall within an acceptable range. Thus, the ALLERgen system is a reliable in vitro system for evaluating specific and total IgE in serum, providing data equivalent to those obtained with the CAP system.