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'.

Systemic contact dermatitis related to alcoholic beverage consumption.

Systemic contact dermatitis is a rash secondary to systemic exposure to allergens after sensitization. Numerous agents are implicated including Balsam of Peru, a plant-derived compound often used for flavoring and fragrance. Alcoholic beverages can contain many possible allergens, including cinnamon, vanilla, citrus peels, and Balsam of Peru. Herein, we describe two patients presenting with recurrent, diffuse, erythematous, and pruritic cutaneous eruptions suspicious for contact dermatitis. Based on clinical history, exam, and formal and at-home patch testing results, we believe the most likely etiology was Balsam of Peru within the alcohol beverages leading to systemic contact dermatitis. Both patients markedly improved after avoidance of their alcoholic beverages. Overall, systemic contact dermatitis secondary to alcohol consumption is a rare phenomenon, whereas Balsam of Peru is a relatively common allergen. Suspicion must be high to identify possible allergens (including Balsam of Peru) exposure within alcoholic beverages such as artificial flavorings, aromas, and mixtures.

Contact Alopecia: Improvement of Alopecia with Discontinuation of Fluocinolone Oil in Individuals Allergic to Balsam Fragrance.

Inflammatory scalp dermatoses can be associated with alopecia, which is nonscarring and reversible in its early stages. This association has been described in seborrheic dermatitis, psoriasis, and atopic dermatitis. We describe three girls with alopecia aggravated by contact allergy to balsam fragrances. All three had complete resolution with avoidance of balsam of Peru and other balsam derivatives (including discontinuation of fluocinolone oil, which contains balsam of pine).

Pediatric Contact Dermatitis Registry Inaugural Case Data.

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.

Prevalencia y causas de ceguera en Perú: encuesta nacional / National survey on the prevalence and causes of blindness in Peru

OBJETIVO: Estimar la prevalencia de ceguera y deficiencia visual en adultos de Perú y precisar sus causas, evaluar la cobertura y la calidad de los servicios de cirugía de catarata y determinar las barreras que impiden acceder a esos servicios. MÉTODOS: Estudio poblacional transversal con muestreo aleatorio por conglomerado en dos pasos de personas de 50 años o más, representativo de todo el país, mediante la metodología estándar de la Evaluación Rápida de Ceguera Evitable. Se midió la agudeza visual y se examinó el cristalino y el polo posterior por oftalmoscopía directa. Se calculó la cobertura de cirugía de catarata y se evaluó su calidad, además de las causas de tener una agudeza visual < 20/60 y las barreras para acceder a ese tratamiento. RESULTADOS:Se examinaron 4 849 personas. La prevalencia de ceguera fue 2,0% (intervalo de confianza de 95%: 1,5-2,5%). La catarata fue la causa principal de ceguera (58,0%), seguida por el glaucoma (13,7%) y la degeneración macular relacionada con la edad (11,5%). Los errores de refracción no corregidos fueron la principal causa de deficiencia visual moderada (67,2%). La cobertura de cirugía de catarata fue de 66,9%, y 60,5% de los ojos operados de catarata logró una AV ≥ 20/60 con la corrección disponible. Las principales barreras para someterse a la cirugía de catarata fueron el alto costo (25,9%) y no saber que el tratamiento es posible (23,8%). CONCLUSIONES: La prevalencia de ceguera y deficiencia visual en Perú es similar a la de otros países latinoamericanos. La baja cobertura de cirugía de catarata y el envejecimiento poblacional indican que para aumentar el acceso a estos servicios se debe mejorar la educación de la población en salud ocular y la capacidad resolutiva de los servicios oftalmológicos y de cirugía de catarata, y reducir su costo.

OBJECTIVE: To estimate the prevalence of blindness and visual impairment among adults in Peru and to determine their causes, to evaluate the coverage and quality of the cataract surgical services and to investigate the barriers that inhibit access to these services. METHODS: A cross-sectional population study with two-stage random cluster sampling of individuals of ≥ 50 years old, representative of the entire country, using the standard methodology of the Rapid Assessment of Avoidable Blindness. Visual acuity was assessed and the condition of the lens and posterior pole examined by direct ophthalmoscopy. Cataract surgical coverage was calculated. Its quality, as well as the causes of visual acuity < 20/60 and the barriers to accessing surgical treatment were assessed. RESULTS: A total of 4 849 people were examined. Blindness prevalence was 2.0% (confidence interval of 95%: 1.5-2.5%). The main causes of blindness were cataract (58.0%), glaucoma (13.7%) and age-related macular degeneration (11.5%). Uncorrected refraction errors were the principal cause of moderate visual impairment (67.2%). Cataract surgical coverage was 66.9%. 60.5% of the eyes operated for cataracts achieved a visual acuity ≥ 20/60 with available correction. The main barriers to cataract surgery were the high cost (25.9%) and people being unaware that treatment was possible (23.8%). CONCLUSIONS: The prevalence of blindness and visual impairment in Peru is similar to that of other Latin American countries. Given the low cataract surgical coverage and the aging of the population, access to the services could be improved by increasing the population education on eye health and the response capacity of the ophthalmological and cataract surgical services, and by reducing the costs of the latter.

Systemic contact dermatitis to foods: nickel, BOP, and more.

Systemic contact dermatitis (SCD), a cutaneous reaction that is a direct manifestation of systemic exposure to a known allergen in a sensitized individual, has been increasingly recognized as a cause of persistent cutaneous contact dermatitis that is refractory to conventional therapies. While SCD in response to drugs has been described well in the literature, SCD to allergens in common foodstuffs is a less well-articulated phenomenon. Several foods that are universally consumed throughout the world contain potent allergens including nickel, balsam of Peru, trace metals, urushiol, and sesquiterpene lactones as well as a host of others that may cause a distinctive clinical picture. In this review article, the authors review the typical presentation and prevalence of SCD to foods, pathophysiology, the most common offensive ingestible food allergens, several appropriate diets, and effectiveness of dietary avoidance for situations in which SCD is suspected.

Acute allergic contact dermatitis of the lips from peppermint oil in a lip balm.

The etiology of cheilitis is often not readily apparent. We present a case series of four patients with allergic contact cheilitis (ACC) secondary to exposure to peppermint oil contained in a lip balm product. These patients developed eczematous dermatitis involving their lips and perioral skin. They were tested with the North American Contact Dermatitis Group standard series as well as with an expanded series of flavoring agents, sunscreens, plant and fragrance components, and their own products. The lip balm contained potential sensitizers such as propolis, lanolin, coconut oil, almond oil, peppermint oil, and vitamin E. Our patch-test results showed that peppermint oil was the most likely culprit in these patients' ACC. Peppermint oil is less commonly reported as causing ACC than are more common contactants such as balsam of Peru or nickel sulfate. However, with the widespread use of lip balms containing peppermint oil, more cases of peppermint oil-induced ACC may be expected.

[Patch testing and nickel allergy]. / Epikutantesting og nikkelallergi.

BACKGROUND: The prevalence of contact allergy varies between populations. MATERIAL AND METHODS: 857 patients were tested for contact allergy (epicutantest; patch test) at the Department of Dermatology, Stavanger University Hospital in 2001 and 2002. Finn Chambers were placed on the upper part of the back, removed after 48 hrs and read after an additional 24 hrs. Positive reactions and other variables were recorded and data were collected retrospectively from journals. RESULTS: The most common allergens were metals such as nickel (nickel chloride; 40% and nickel sulphate; 23%), cobolt (11%) and dichromate (6.5%), fragrance mix (10%) and fragrance indicators such as peru balsam (9.4%), compositae (6.1%) and colophonium 5.3%. 370 (67%) women versus 139 (45%) men were positive for at least one of the allergens in the standard series (odds ratio 2.5 CI 1.83-3.23). 149 of 341 (44%) nickel positive patients had isolated reactions to nickel chloride without reacting to nickel sulphate, while only 11 (3.2%) reacted to nickel sulphate alone. 61/93 (66%) of the cobolt sensitive patients were also sensitive for nickel sulphate (OR: 8.9 CI 5.54-14.12,), while 77 (82%) tested positive for nickel chloride (OR: 9.26 CI 5.29-16.21). INTERPRETATION: We detected a similar prevalence for common allergens as that reported from other skin departments in hospitals in Norway, but a higher average than that presented in other European studies.

[Systemic contact eczema against Balsam of Peru]. / Hämatogen-allergisches Kontaktekzem auf Perubalsam.

Balsam of Peru (PB; Myroxylon pereirae) is a natural product derived from resin of a tropical tree (MyroxyIon balsamum (L.) Harms var. pereirae (Royle) Baillon). Because of its antiseptic and aromatic properties PB or PB-components can be found worldwide not only in many health care and cosmetic products, but also in food items and semiluxury food. PB contains a wide variety of potent contact allergens leading to hypersensitivity reactions not only after topical application but also oral uptake. We report a 51-year-old brewer with chronic eczema of the hands who showed delayed-type patch test reactions against PB and fragrance-mix. Oral PB-challenge led to exacerbation of the eczema 5 and in a repeated test 2 days later. We here review this probably quite often overlooked disease and the therapeutic consequences which require profound knowledge about the wide distribution of PB when advising the patient about a PB-restricted diet. In addition, this unusual case report demonstrates that one has to consider marked delayed hypersensitivity reaction when investigating a systemic contact allergy.

Contact allergy to balsam of Peru. II. Patch test results in 102 patients with selected balsam of Peru constituents.

BACKGROUND: In Switzerland, Germany, and Austria, allergic reactions to balsam of Peru (BP) have now made it the third most common contact allergen. OBJECTIVE: A series of 20 single BP constituents (including resorcinol monobenzoate), established in 1995, was used for patch tests in patients with a positive reaction to BP in the standard series. MATERIALS AND METHODS: Between 1995 and 1998, 2,273 patients were tested with the standard series, including BP, fragrance mix (FM), and propolis. Patients positive for BP were requested to participate in a further test using the 19 compounds of the BP constituents and resorcin monobenzoate (BP series); 102 patients agreed and were patch tested. The results of the 72-hour reading were used for the evaluation. RESULTS: A total of 93 patients reacted to 1 or more of the BP series compounds. Positive reactions were seen, in decreasing order, to cinnamic alcohol, cinnamic acid, coniferyl benzoate, benzoic acid, cinnamyl cinnamate, eugenol, resorcinol monobenzoate, coniferyl alcohol, and benzyl alcohol. There were no positive reactions to vanillin or ferulic acid. A correlation between skin lesions and frequent consumption of sweets was found in 7 patients with major positive test reactions to coniferyl benzoate and benzyl alcohol. Most of the reactions to eugenol and isoeugenol had less to do with BP itself than with a primary sensitization to fragrances. Although resorcin monobenzoate (RMB) has up to now not been detected in BP, 16 patients reacted distinctly to this compound. Eleven were strong smokers; the remaining ones had contact with plastic materials that have been reported to contain RMB. RMB is used frequently as an antioxidant in synthetic material. When these patients stopped smoking, the skin lesions cleared. However, consumption of sweets caused recurrences. CONCLUSION: The evaluation of reactions to single constituents of BP by testing with the special BP series facilitates understanding how sensitization may be acquired. The allergen may prove to be BP itself or 1 or more of its constituents. Testing for the constituents of this series may provide patients with a more specific allergen diagnosis and may facilitate improved therapy. BP may function as an important indicator for contact allergy to RMB.

Estudo preliminar da compatibilidade biológica dos cimentos de óxido de zinco e copaíba e óxido de zinco e eugenol: avaliaçäo histológica de implantes subcutâneos em ratos / Preliminary study of the biological compatibility of a zinc oxide-copaiba and zinc oxide-eugenol cements: histological evaluation of subcutaneous implants in rats

No tecido conjuntivo subcutâneo de 20 ratos foram implantados tubos de polietileno preenchidos com o cimento do óxido de zinco e copaíba (Grupo I) e óxido de zinco e eugneol (Grupo Controle II). Decorridos os períodos de 7, 15, 30 e 60 dias, biópsias foram realizadas e as peças cirúrgicas foram cortadas seriadamente e coradas com hematoxilina e eosina. Aos 7 dias para o Grupo I, houve discreta presença de células inflamatórias, necrose de contato e degradaçäo de fibras colágenas, näo sendo observada a presença de neutrófilos ou de células gigantes. O cone capsular formado junto à abertura tubular apresentou discreta amplitude. Todos estes eventos histopatológicos foram ligeiramente superiores para o Grupo II nos primeiros períodos. Com o decorrer dos períodos, para os dois grupos, todos os eventos analisados reduziram em quantidade, e no último período o tecido conjuntivo da área principal de análise apresentava características histológicas de normalidade, permanecendo o tubo de polietileno totalmente envolto por um tecido fibroso denso. Estes achados sugeriram que o material do Grupo I (OZ copaíba) foi menos irritante que o material do Grupo II (Controle), quando implantados no tecido conjuntivo subcutâneo do rato

Usage test of four endodontic sealers in Macaca fascicularis monkeys.

Root canals with vital pulps in four Macaca fascicularis monkeys were subjected to pulp extirpation and root filling with gutta-percha and sealer, either AH26, Endomethasone, Kloroperka N-phi, or ProcoSol. Observation periods were 1 and 6 months. The results of treatment were evaluated by radiographic analysis (periapical index scores) and by histopathologic assessment of the remaining pulp and periapical tissues. Sixty roots with acceptable termination (between 0.5 and 3 mm from apex) of the root fillings and adequate histopathologic specimens were available for analysis. These roots were equally distributed in each observation period group and among the four material groups. Radiography indicated periapical pathosis in 6 of the 60 roots--4 at 1 month and 2 at 6 months. Periapical inflammation was observed on histopathologic examination in 17 roots--11 after 1 month and 6 after 6 months. Histologic and radiographic assessment of periapical inflammation was significantly correlated (p less than 0.01, chi 2) at the 6-month observation period. No granuloma or cyst formation was evident on histologic examination. The magnitude of the inflammatory response appeared unrelated to the endodontic sealer used, and several inflammatory foci were not related to foreign bodies in the tissues. Bacteriologic sampling showed growth in thioglycollate broth cultures in 9 of the 60 roots, but the presence of cultivable bacteria by this technique was unrelated to inflammatory changes. Histologic demonstration of bacteria was positive in 4 roots, all of which were associated with inflammatory periapical reactions. The method applied in the present study did not provide a sensitive discrimination among endodontic materials of widely different chemical composition.

Contact dermatitis to estradiol benzoate.

Three patients developed facial dermatitis after contact with preparations containing estradiol benzoate. Patch tests were positive to estradiol benzoate 0.1% in MEK but negative to other related estrogens including estradiol. All three patients also had positive tests to resorcinol monobenzoate and two out of three to balsam of Peru. Most likely estradiol benzoate was the primary sensitizer.