Severe anaphylactic reaction to cisatracurium during anesthesia with cross-reactivity to atracurium.

A case of a severe anaphylactic reaction during general anesthesia was reported. Despite the high suspicion for cefuroxime as a trigger of the anaphylactic reaction, cisatracurium emerged being the culprit drug. This case illustrates the importance of testing all drugs used during procedures/operations, trying to find a culprit of anaphylaxis.

Skin testing with bendamustine: what concentration should be used?

We present a case of the patient, who developed hypersensitivity reaction during the treatment of chronic lymphocytic leukemia. Bendamustine was suspected as a culprit agent. The patient as well as 3 controls underwent skin testing with the concentrations of the bendamustine described in earlier studies. We doubted the testing recommendations as all the controls developed serious local reactions. The clinical meaning of the positive skin test reaction in the patient remained unclear and questioned the safeness of recommended testing concentrations as in certain situations wrong diagnosis could be made or even harm could be done. Future investigations are needed when allergy to bendamustine is suspected.

Metals Are Important Contact Sensitizers: An Experience from Lithuania.

Background. Metals are very frequent sensitizers causing contact allergy and allergic contact dermatitis worldwide; up-to-date data based on patch test results has proved useful for the identification of a problem. Objectives. In this retrospective study prevalence of contact allergy to metals (nickel, chromium, palladium, gold, cobalt, and titanium) in Lithuania is analysed. Patients/Methods. Clinical and patch test data of 546 patients patch tested in 2014-2016, in Vilnius University Hospital Santariskiu Klinikos, was analysed and compared with previously published data. Results. Almost third of tested patients (29.56%) were sensitized to nickel. Younger women were more often sensitized to nickel than older ones (36% versus 22.8%, p = 0.0011). Women were significantly more often sensitized to nickel than men (33% versus 6.1%, p < 0.0001). Younger patients were more often sensitized to cobalt (11.6% versus 5.7%, p = 0.0183). Sensitization to cobalt was related to sensitization to nickel (p < 0.0001). Face dermatitis and oral discomfort were related to gold allergy (28% versus 6.9% dermatitis of other parts, p < 0.0001). Older patients were patch test positive to gold(I) sodium thiosulfate statistically significantly more often than younger ones (44.44% versus 21.21%, p = 0.0281). Conclusions. Nickel, gold, cobalt, and chromium are leading metal sensitizers in Lithuania. Cobalt sensitization is often accompanied by sensitization to nickel. Sensitivity rate to palladium and nickel indicates possible cross-reactivity. No sensitization to titanium was found.

Time trends of contact allergy to the European baseline series in Lithuania.

BACKGROUND: Monitoring trends of positive patch test reactions is useful for epidemiological surveillance and contact allergy prevention, and has not previously been reported in Lithuania. OBJECTIVES: To examine and compare changes in the prevalence of contact allergy to European baseline series allergens in adults with suspected contact dermatitis during a 9-year period. METHODS: In this retrospective study, patch test results of 297 consecutive patients, tested with the European baseline series in 2014-2015, were analysed and compared with the data published earlier in Lithuania. RESULTS: The most common allergens were nickel sulfate (30.6%), methylisothiazolinone (MI) (13.5%), methylchloroisothiazolinone (MCI)/MI (7.4%), potassium dichromate (6.1%), cobalt chloride (6.1%), Myroxylon pereirae resin (5.4%), p-phenylenediamine (5.4%), fragrance mix I (4.7%), formaldehyde (4.4%), and methyldibromo glutaronitrile (3.7%). Increases in the prevalence of sensitization to MCI/MI (2.3% in 2006-2008 and 7.4% in 2014-2015; p < 0.0001) and nickel sulfate (16.4% in 2006-2008 and 30.6% in 2014-2015; p < 0.0001) and decreases in the prevalence of sensitization to paraben mix (3.2% in 2006-2008 and 0.3% in 2014-2015; p = 0.006) were observed. Prevalences for the other allergens remained stable or showed a decreasing trend (Myroxylon pereirae resin; p = 0.06). CONCLUSION: This study provides current information on the prevalence of contact allergy in Lithuania. Changing trends in sensitivity to some allergens probably reflect changes in exposure.

Formaldehyde may be found in cosmetic products even when unlabelled.

Concomitant contact allergy to formaldehyde and formaldehyde-releasers remains common among patients with allergic contact dermatitis. Concentration of free formaldehyde in cosmetic products within allowed limits have been shown to induce dermatitis from short-term use on normal skin. The aim of this study was to investigate the formaldehyde content of cosmetic products made in Lithuania. 42 samples were analysed with the chromotropic acid (CA) method for semi-quantitative formaldehyde determination. These included 24 leave-on (e.g., creams, lotions) and 18 rinse-off (e.g., shampoos, soaps) products. Formaldehyde releasers were declared on the labels of 10 products. No formaldehyde releaser was declared on the label of the only face cream investigated, but levels of free formaldehyde with the CA method was >40 mg/ml and when analysed with a high-performance liquid chromatographic method - 532 ppm. According to the EU Cosmetic directive, if the concentration of formaldehyde is above 0.05% a cosmetic product must be labelled "contains formaldehyde". It could be difficult for patients allergic to formaldehyde to avoid contact with products containing it as its presence cannot be determined from the ingredient labelling with certainty. The CA method is a simple and reliable method for detecting formaldehyde presence in cosmetic products.

[Study of apoptosis in normal skin tissues]. / Apoptozes tyrimas normalios odos audiniuose.

UNLABELLED: The aim of the study was to investigate the apoptosis in normal human skin by examination of all epidermal layers. MATERIAL AND METHODS: The normal skin epidermis of 15 healthy subjects was investigated by TUNEL (terminal deoxynucleotidyl transferase-mediated dUTP-X nick end labeling) technique. Apoptotic cells were evaluated in the germinative and differential compartments and stratum corneum. Only highly TUNEL-positive cells with typical morphological DNA fragmentation signs were calculated. RESULTS: In vital strata (except stratum corneum) of normal skin epidermis, 37.5% of all TUNEL-positive cells were observed in the germinative compartment and 41.7% in the granular layer of differential compartment. CONCLUSIONS: The study showed that apoptosis occurs in all layers of normal skin epidermis. It demonstrates that apoptosis is highly important in the renewal of cells and formation of epidermal structure within all compartments.

[Consensus on asthma diagnosis and treatment in children and adults]. / Vaiku ir suaugusiuju astmos diagnostikos ir gydymo sutarimas.

Asthma is a chronic airway disease that is a growing problem of public health. The current consensus is based on the Global Initiative for Asthma (GINA) and other guidelines for asthma, and adapted for Lithuania. This Consensus provides physicians with recommendations for asthma management in children and adults.