Multiple physical urticarias.

Physical urticarias are a group of mucocutaneous disorders characterised by the appearance of whealing and/or angioedema and induced by physical stimuli. A 24-year-old Caucasian male affected by ultraviolet A-induced solar urticaria, specific food-dependent exercise-induced anaphylaxis, symptomatic dermographism and allergic rhinoconjunctivitis is described.

Patch testing by additional series of allergens: results of further experiences.

BACKGROUND: Patch testing with additional series (AS) of allergens may be a useful tool in diagnosing allergic contact dermatitis (ACD). OBJECTIVE: Aim of the study was to verify the usefulness, to check the reliability in clinical practice and to evaluate the economic costs of AS previously built up. METHODS: A total of 281 patients with suspicious ACD underwent patch test with the standard series (SS) and with one or more AS (51 among 71 built up). RESULTS: A total of 170 patients (60.5%) showed positive reactions to SS; 116 (41.3%) to AS. Among 582 nonstandard allergens used, 113 (19.4%) elicited 1 or more positive reactions: out of 10,916 patch tests carried out, 260 (2.4%) positive reactions were observed. The correlation between SS and AS indicated that 8.2% patients resulted SS-/AS+, 27.7% SS+/AS-, 32.7% SS+/AS+, 31.3% SS-/AS-. The most frequently used AS showed the following percentages of patients with 1 or more positive reactions: clothes 41.4%, building industry 51.8%, hairdressers 77.3%, textile industry 42.1%, shoes 36.8%. Positive reactions to the most frequently used nonstandard allergens resulted: propylene glycol 0.4%, cobalt chloride 12.6%, phenylmercuric nitrate 2.2%, p-aminophenol 4.5%. The approximate economic cost of patch testing with AS has been evaluated in 1.3 euro per single patch test. CONCLUSION: The cost of patch testing AS is not irrelevant, but it can be compensated by the advantages deriving from the increase of data concerning ACD etiology. A reduction in the number of allergens included in single AS should be performed. Cobalt chloride, taking into account the high percentage of positive reactions observed and its presence in a large number of AS, could be (re)introduced in the standard series.

Multicentre study of allergic contact cheilitis from toothpastes.

The present work reports the results of a multicentre study of toothpaste allergic contact cheilitis (TACC) conducted by GIRDCA (Gruppo Italiano Ricerca Dermatiti da Contatto e Ambientali). The study examined 54 patients with eczematous lesions on the lips, the possible cause of which was suspected to be the use of toothpastes. Patch tests were conducted with a standard series, a specially-targeted series (toothpaste cheilitis series, TCS), and with suspected toothpaste(s). A stop-restart test (SRT) was carried out with these, together with a use test to identify possible alternative products. The TCS produced 17 positive reactions in 13 patients, the most frequent being to spearmint oil. Of the 54 patients, 5 displayed positive reactions only to the TCS. The patch tests with toothpaste produced positive reactions in 11/32 patients, the SRT a positive response in 10/12 cases. The diagnosis of TACC was confirmed in 15/54 patients. Alternative products were identified for 5 patients. In conclusion, the allergens most frequently responsible for TACC were the flavourings, and the additional series proved to be useful in many cases (together with patch tests with toothpastes and the SRT) for correct diagnosis and to initiate effective prevention.

Epidemiological survey of contact dermatitis in Italy (1984-1993) by GIRDCA (Gruppo Italiano Ricerca Dermatiti da Contatto e Ambientali).

BACKGROUND: The Gruppo Italiano Ricerca Dermatiti da Contatto e Ambientali (GIRDCA) resolved to obtain the most relevant data regarding contact dermatitis (CD) in Italy by means of a multicenter epidemiological study, involving research units (RU) throughout the country. The survey was performed with the collaboration of Generale Per l'Informatica, Rome (GEPIN) over the periods 1984 to 1988 and 1989 to 1993. The analytical study (of a transverse kind) was aimed at supplying prevalence measures. MATERIALS AND METHODS: The number of subjects taking part in the survey was 42,839. All patients underwent patch testing with the GIRDCA standard series and were included in the survey only if the final diagnosis was either CD or eczematous dermatitis caused by contact. The main anamnestic, clinical data, and allergological test results of all patients were codified into a chart, and subsequently transcribed into a data bank. The data were then processed cumulatively and were statistically analysed by a chi-square for trend test. RESULTS: The four most frequent diagnoses (which, when considered together, make up 39,496 cases, or about 92% of all cases) proved to be nonoccupational allergic contact dermatitis (ACD), nonoccupational irritant contact dermatitis (ICD), occupational ACD, and occupational ICD. The haptens most frequently causing positive reactions in the total number of cases over the first 5 years were, in order of frequency: nickel sulphate, potassium dichromate, cobalt chloride, fragrance mix, balsam of Peru, and, in the second 5-year period, nickel sulphate, cobalt chloride, potassium dichromate, fragrance mix, and thimerosal. Occupational CD (ACD and ICD) was present in 11,694 cases overall, corresponding to approximately 27% of the total number of cases examined, and approximately 29% of all CD (including forms of nonoccupational CD). Regarding distribution by sex, a substantial equivalence of males and females for ACD, and a prevalence of females with ICD can be observed. Five occupations were reputed to be responsible for over 60% of total cases of occupational CD (housewives, bricklayers, workers in the metallurgic and mechanical industries, hairdressers, and healthcare personnel). Regarding the pathogenesis, a clearly dominant percentage of ACD may be observed among bricklayers and hairdressers, and of ICD among housewives. The haptens most frequently noted over the entire decade as the cause of positive reaction in occupational ACD were, in order of frequency, potassium dichromate, nickel sulphate, cobalt chloride, p-phenylenediamine and thiuram mix. Nonoccupational CD (ACD and ICD) was present in 27,802 cases overall, corresponding to about 65% of all cases under examination and over 70% of all CD (also including forms of occupational CD). In regard to distribution by sex, a clear dominance of females, as opposed to males, can be noted for ACD and also (although to a lesser extent) for ICD. The main products and materials (ie, components and relative substances) that are pinpointed as being responsible for nonoccupational ACD, were, in order of frequency, clothing accessories, cosmetics, topical pharmaceuticals, and clothing. The haptens most frequently recognized as the cause of positive reactions were, in order of frequency, nickel sulphate, fragrance mix, cobalt chloride, balsam of Peru, potassium dichromate, ethylenediamine, and diaminodiphenylmethane.

[Contact dermatitis of the hands in housewives: the results of a multicenter study]. / Indagine sulla dermatite da contatto delle mani delle casalinghe: risultato di uno studio multicentrico.

The survey was carried out between January 1988 and June 1990. It consisted in a clinical and allergological study of 1489 housewives, 880 of which had contact dermatitis at their hands. (group of "cases"). The other 609 represented the control group. The anamnesis was gathered with a guided questionnaire: the questions concerned familiar and personnel pathology, use of detergents and cosmetics, use of means of prevention and therapies. Patch tests with haptens of GIRDCA series and with the most common detergent components were performed. In 98% of cases hands were the lace of beginning of symptoms; in the group of "cases" 46% were positive to at least one patch test. Nickel sulphate gave positivities in the 28% of cases. Results of the search of this metal (and of chrome and cobalt) in detergents are described. Other possible occasions of contact are described. Other causes of sensitization are represented by rubber additives, by perfumes and by preservatives. Cutipositivities for detergents are very really limited. Means of protection, in particular barrier creams, are described as scarcely used.