Severely compromised supply of patch test allergens in Europe hampers adequate diagnosis of occupational and non-occupational contact allergy. A European Society of Contact Dermatitis (ESCD), European Academy of Allergy and Clinical Immunology (EAACI), European Academy of Dermatology and Venereology (EADV) task forces 'Contact Dermatitis' and 'Occupational Skin Disease' position paper.

Patch testing is the only clinically applicable diagnostic method for Type IV allergy. The availability of Type IV patch test (PT) allergens in Europe, however, is currently scarce. This severely compromises adequate diagnostics of contact allergy, leading to serious consequences for the affected patients. Against this background, the European Society of Contact Dermatitis (ESCD) has created a task force (TF) (i) to explore the current availability of PT substances in different member states, (ii) to highlight some of the unique characteristics of Type IV vs. other allergens and (iii) to suggest ways forward to promote and ensure availability of high-quality patch testing substances for the diagnosis of Type IV allergies throughout Europe. The suggestions of the TF on how to improve the availability of PT allergens are supported by the ESCD, the European Academy of Allergy and Clinical Immunology, and the European Academy of Dermatology and Venereology and intend to provide potential means to resolve the present medical crisis.

Need for new strategies to improve the recall and avoidance rates of contact allergens: A retrospective cohort study from Turkey.

BACKGROUND: Previous studies reported a low-to-moderate benefit from patch testing regarding allergen recall and avoidance. OBJECTIVES: To determine the allergen recall and avoidance rates of patients with allergic contact dermatitis (ACD) in Turkey. METHODS: This was a retrospective cohort study based on a phone questionnaire of 465 patients diagnosed with ACD from major allergen groups, that is, metals, preservatives, rubber, fragrances (ubiquitous allergens) and hair dye/black henna, topical drug and resins (nonubiquitous allergens), at our tertiary referral centre between 1996 and 2018. RESULTS: Among 176 responders, allergen groups were remembered better (53.4%) than the individual allergens (36.9%). Age <40 years and keeping the allergy pass had a significantly positive impact on the recall rate of methylchloroisothiazolinone/methylisothiazolinone and nickel, particularly non-occupational nickel allergy from metal jewellery in females, respectively. Exacerbations of ACD (56.3%) were mainly due to reexposures to ubiquitous allergens. 42.9% of patients with occupational ACD changed or quit their job, most of them being construction workers and hairdressers, showing a high share (83.3%) of benefit. CONCLUSIONS: The overall rates of allergen recall and avoidance were moderate. New strategies are needed to improve the recall and avoidance rates of contact allergens, such as increased use of allergy pass, smartphone applications and legal precautions.

Tobramycin and antiglaucoma agents as increasing culprits of periorbital allergic contact dermatitis from topical ophthalmic medications: A 24-year study from Turkey.

BACKGROUND: Allergic contact dermatitis (ACD) from topical ophthalmic medications (TOMs) poses an additional disease burden to patients who already suffer from eye problems. OBJECTIVES: To investigate the epidemiological/clinical profile of patients with periorbital ACD from TOMs in Turkey. PATIENTS AND METHODS: This was a retrospective, cross-sectional, single tertiary centre study based on files of 75 patch tested patients with suspected periorbital ACD from TOMs among a total of 2801 consecutively patch tested patients with suspected ACD of any origin between 1996 and 2019. RESULTS: Periorbital ACD was diagnosed in 25 of 75 (33.3%) patients (female:male = 1.8:1; age range: 6-85 years) with suspected ACD from TOMs showing an overall prevalence of 0.9% (25/2801) among the whole patch test population. Atopy was not present. Tobramycin-containing TOMs were the most frequent culprits, followed by antiglaucoma preparations. Their frequency increased, whereas no new cases of neomycin-induced ACD were observed after 2011. Positivities with thimerosal were of unknown clinical relevance, while benzalkonium chloride (BAC) caused ACD in two patients. The diagnosis would be missed in each 20% of patients without performing day (D) 4 and D7 readings and strip-patch testing. Ten culprits were identified only by testing with patients' own TOMs in eight (32%) patients. CONCLUSIONS: Aminoglycosides, particularly tobramycin, were the leading cause of ACD from TOMs. The frequency of ACD from tobramycin and antiglaucoma medications increased after 2011. BAC was a rare but important allergen. Additional D4 and D7 readings, strip-patch testing, and testing with patients' own TOMs seem essential when patch testing with eye medications.

Analysis of Hexavalent Chromium in Cement Samples From Countries Within and Outside the EU: A Study From the International Contact Dermatitis Research Group.

Background: Allergic contact dermatitis (ACD) caused by hexavalent chromium (Cr(VI)) is often severe and difficult to treat. The content of Cr(VI) in cement can be reduced by, for example, addition of iron(II) sulfate. Since 2005 the content of Cr(VI) in cement is regulated in the EU Directive 2003/53/EC and must not exceed 2 ppm. Since this regulation came into force, ACD caused by cement has markedly been reduced. Objective: To investigate Cr(VI) and total chromium content in samples of cement from countries within and outside the EU. Methods: The members of the International Contact Dermatitis Research Group (ICDRG) were invited to participate in the study with the aim to collect cement samples from geographically different areas. The content of Cr(VI) in the samples was estimated by the diphenyl carbazide spot test, atomic absorption spectroscopy was used to assess the total chromium content. Results: Forty-five cement samples were analyzed, containing amounts of Cr(VI) from <0.1 to >70 ppm. Twenty-one samples contained >2 ppm Cr(VI), 24 contained less. Four of 17 samples from within the EU contained >2 ppm Cr(VI), that is, higher amounts than stipulated in the EU directive, as compared with 17 samples from countries outside the EU. Conclusion: In countries outside the EU, significantly more cement samples contained >2 ppm Cr(VI).

Long-term dupilumab therapy in Netherton syndrome with severe atopic manifestations: Case report and review of the literature.

We herein present a unique patient of Netherton syndrome (NS) with ichthyosis linearis circumflexa (ILC) lesions associated with severe atopic manifestations since infancy, showing different responses of atopic and ILC lesions to a 2-year dupilumab therapy. The atopic eczematous lesions and pruritus healed remarkably, dramatically improving the patient's quality of life, whilst the scalp hair showed a clinical and light microscopic improvement. The additional recovery in axillary/pubic/extremity hair growth, sweating and nail growth in the presented case was not previously reported in NS patients treated with dupilumab. However, dupilumab had no therapeutic effect on ILC lesions which were not pruritic and showed a treatment-independent wax and waned course.

Sorbitan sesquioleate: a rare contact allergen that is also an important indicator of allergic contact dermatitis from crossreacting compounds as well as for false-positive fragrance allergy.

BACKGROUND: Controversy exists about the addition of sorbitan sesquioleate (SSO) to the European baseline series for concomitant patch testing, particularly with fragrance mix (FM) I and Myroxylone pereirae (MP), which both contain SSO as an emulsifier. AIM: To investigate SSO contact sensitization and concomitant positive patch test reactions to FM I or MP in Turkey. METHODS: This was a retrospective analysis of 840 patients consecutively patch tested with SSO 20% petrolatum between 1996 and 2020. RESULTS: The prevalence of SSO sensitization was 0.6% (5 of 840). In four of the five patients, clinical relevance could be established from SSO crossreactants, mainly in moisturizers and topical pharmaceuticals other than corticosteroids. Positive patch test reactions with unknown clinical relevance were observed to FM I or MP (both containing 5% SSO) in 71.4% of patients with a positive/questionable positive reaction to SSO (P < 0.001) and to other patch test allergens containing 1-5% SSO. CONCLUSIONS: SSO was a very good indicator for positive patch test reaction with unknown clinical relevance to fragrances and other allergens containing 1-5% SSO. We suggest that SSO should be tested as a negative control with any commercially available patch test allergen containing SSO at any concentration. Moreover, clinicians should be alert for SSO synonyms and for other sorbitan derivatives in product labels, as SSO itself might not be the culprit but an indicator for crossreacting allergens.

Low Prevalence of Fragrance Contact Allergy Among Turkish Population: A 24-Year, Cross-Sectional, Tertiary Single-Center, Retrospective Study.

BACKGROUND: Limited data exist on fragrance contact allergy among Turkish population. OBJECTIVE: The aim of this study was to investigate the frequency and characteristics of fragrance contact allergy in Turkey. METHODS: A retrospective cohort study was conducted on 2566 patients consecutively patch tested with the European baseline series and additionally with a fragrance series (n = 358) at a tertiary referral center between 1996 and 2019. RESULTS: One hundred sixty-three patients (6.4%) (male/female, 1.5:1) were sensitized with at least 1 fragrance allergen. Fragrance mix (FM) I was most frequently positive (3.9%), followed by Myroxylon pereirae (3.1%), FM II (2%), and hydroxyisohexyl 3-cyclohexene carboxaldehyde (0.5%), the latter exclusively positive in FM II-positive patients. Among 358 patients patch tested with a fragrance series, positive patch test reactions were observed in 38 patients, including 8 who did not react to baseline fragrance markers. Clinically relevant fragrance allergy was established in 128 patients (78.5%) from nonoccupational (72.4%) and occupational (6.1%) sources. CONCLUSIONS: The low prevalence, the middle-aged male preponderance, and the predominant involvement of hands were unusual findings. Rose/citrus-flavored perfumes and eau de cologne, which are traditionally preferred in our country, were important elicitors of fragrance contact allergy, especially among middle-aged and older men.

Occupational allergic contact dermatitis: A 24-year, retrospective cohort study from Turkey.

BACKGROUND: Limited data exist on occupational allergic contact dermatitis (OACD) in Turkey. OBJECTIVES: To investigate the epidemiologic profile of OACD in Turkey. METHODS: A retrospective cohort study on 294 patients with OACD among 2801 consecutively patch-tested patients in the Allergy Unit of the Dermatology Department of Istanbul Faculty of Medicine between 1996 and 2019. RESULTS: The overall prevalence of OACD was 10.5%, showing a male predominance. OACD was most frequently seen in construction workers (45.2%), followed by hairdressers, metalworkers, health care workers, and miscellaneous. The main relevant allergens were chromium in cement, thiurams in rubber gloves, hairdressing chemicals, resins/glues/plastics, metals, isothiazolinones, and fragrances. Hands were the mainly involved site (95.6%). Airborne eczema was observed in 21.4%. Hand and foot eczema and co-sensitizations to chrome and thiuram and chrome and cobalt were significantly associated with being a construction worker. Sensitizations to isothiazolinones in house painters, ammonium persulfate and p-phenylenediamine in hairdressers, and colophonium increased after 2010. CONCLUSION: This was the largest group of data on OACD from Turkey, reflecting the importance of rubber glove allergy in all occupations and the striking increase in ammonium persulfate allergy among hairdressers. Chrome and cobalt were still the main cement allergens in Turkey, where the cement directive is not yet in force.

How does working in pandemic units affect the risk of occupational hand eczema in healthcare workers during the coronavirus disease-2019 (COVID-19) pandemic: A comparative analysis with nonpandemic units.

BACKGROUND: Hand eczema (HE) has increased among healthcare workers (HCWs) working in coronavirus disease-2019 (COVID-19) units, and was associated with increased hand hygiene practices. OBJECTIVES: To compare the prevalence and clinical characteristics of HE, and hand hygiene practices in HCWs working in COVID-19 and non-COVID-19 units. METHODS: A total of 244 HCWs working in COVID-19 (n = 118) and non-COVID-19 patient care units (n = 126) were examined by dermatologists with regard to demographic parameters and hand hygiene practices. The COVID-19 and non-COVID-19 groups were matched at a 1:1 ratio according to age, atopy, and generalized dry skin. RESULTS: HE was more frequent in the COVID-19 group (48.3% vs 12.7%, P < .001), whereas working years (P < .05) and additional housework at home (P < .001) were longer in the non-COVID-19 group. After the development of HE, moisturizing creams were reported to be more frequently used in the COVID group (P < .001). Topical corticosteroids were used in a minority (40% in the COVID group and 26.7% in the non-COVID group). CONCLUSIONS: HCWs in COVID-19 units developed HE more frequently. A majority increased the frequency of moisturizer use, instead of using topical corticosteroids, after the development of HE for the purpose of treating eczema. New approaches are needed for the prevention and management of HE in HCWs, especially by facilitating access to dermatologists.

Patch-test results in terms of the recently recommended allergens in children and adolescents: A retrospective cohort study over 22 years from Turkey.

BACKGROUND: A European pediatric patch-test series was suggested recently. OBJECTIVES: To evaluate the patch-test results in children (<10-years-old) and adolescents (10- to 18-years-old) in Turkey, focusing on the clinical/occupational relevance and the diagnostic value of the recently suggested series. PATIENTS AND METHODS: A retrospective cohort study on 317 consecutively patch-tested patients ≤18 years of age, between 1996 and 2017. RESULTS: The contact sensitization rate was 46.1%. Allergic contact dermatitis (ACD) was diagnosed in 30.9%, comprising non-occupational (84.7%) and occupational (15.3%) ACD. Nickel was the leading allergen in almost every age group. Methylchloroisothiazolinone/methylisothiazolinone (MCI/MI) was the clinically most relevant allergen, followed by p-phenylenediamine (PPD), ammonium persulfate, fragrance mix I, nickel sulfate, and mercury/mercury(II)amidochloride. Occupational ACD was most frequently seen in hairdresser apprentices (adolescents only) who were sensitized with PPD ± ammonium persulfate. ACD from MCI/MI increased to 5-fold, ammonium persulfate and mercurial compounds to 2-fold, and PPD to 1.7-fold after 2007. Almost one third of patients would be missed by testing only with the recommended allergens. CONCLUSIONS: For patch testing in Turkish children and adolescents, we suggest additionally testing with ammonium persulfate, mercury/mercury(II)amidochloride, toluenesulfonamide formaldehyde resin, and polyethylene glycol, the latter as a marker for nitrofurazone allergy, in appropriate patients.

The impact of COVID-19 pandemic on the management of patients with chronic urticaria: An observational two-center study from Turkey.

The Coronavirus Disease 2019 (COVID-19) outbreak significantly affected the clinical practice in hospitals and the management of many diseases. The aim of this study was to evaluate the effect of pandemic-related factors on the severity and course of chronic urticaria (CU). A total of 194 CU patients who were on regular follow-up, were enrolled in the study. The disease activity was assessed by means of the weekly urticaria activity score (UAS7) and urticaria control test (UCT). Patients were divided into two subgroups according to their disease aggravation as "aggravated" and "non-aggravated". Two groups were compared in terms of demographic, clinical, COVID-19-associated parameters, and parameters related with the effect of COVID-19 pandemic on CU management. The omalizumab use was statistically higher (P = .017), and the systemic corticosteroid use was statistically lower (P = .025) in the "aggravated" group. Adherence to quarantine was significantly lower in the "aggravated" group (P = .027). 173 patients (89.2%) were unable to contact a dermatologist during the pandemic. Among 186 patients who received treatment for CU before the pandemic, 48 (25.8%) did not continue the existing treatment during the pandemic. CU aggravated in one patient with COVID-19 and remained stable in the other. This study showed that CU patients, especially those on omalizumab therapy, had difficulties in attending medical care and even in the maintenance of their existing therapies during the pandemic. Creating novel follow-up and treatment models as well as the increased use of teledermatology might be beneficial in the management of this life-disturbing condition.