Delay in medical attention to hand eczema: a follow-up study.

BACKGROUND: Hand eczema often runs a chronic course but early medical intervention may be assumed to improve the prognosis. OBJECTIVES: To follow patients with hand eczema for 6 months after seeing a dermatologist to investigate if delay in medical attention would impair the prognosis. METHODS: Study participants were 333 patients with hand eczema from nine dermatological clinics in Denmark. Severity of hand eczema was assessed by the patients at baseline and at the 6-month follow up using a self-administered photographic guide. Additional information was obtained by self-administered questionnaires. RESULTS: Median patient delay (defined as the period from onset of symptoms until seeing a general practitioner) was 3 months [interquartile range (IQR) 1.5-8.0]. The median healthcare delay (defined as the period from the first visit to a general practitioner until seeing a dermatologist) was 3 months (IQR 1-8). In a logistic regression model, the odds ratio of a poor prognosis increased by a factor of 1.11 [95% confidence interval (CI) 1.02-1.21] per month of patient delay and by 1.05 (95% CI 1.00-1.10) per month of healthcare delay. CONCLUSIONS: A poorer prognosis of hand eczema was associated with longer delay before medical attention.

Clinical severity and prognosis of hand eczema.

BACKGROUND: Hand eczema (HE) is a frequent, long-lasting disease with both personal and societal repercussions. Consequently, more information is needed on factors that maintain symptoms. OBJECTIVES: In this study, patients with HE were followed for 6 months from the first visit to a dermatologist to identify factors associated with severe disease and a poor prognosis. METHODS: Study participants were 799 patients with HE from nine dermatological clinics in Denmark. Severity assessment of the HE was done at baseline and at the 6-month follow-up using the Hand Eczema Severity Index (HECSI) and by patients using a self-administered photographic guide. Additional information was obtained from a baseline questionnaire. RESULTS: At baseline, 60.3% assessed their HE as moderate to very severe using the self-administered photographic guide compared with 36.1% at follow-up. The mean HECSI value decreased from 19.9 points at baseline to 11.2 points at follow-up (P < 0.001). In a multivariable logistic regression analysis, statistically significant associations with severe HE at baseline were older age (P < 0.001), atopic dermatitis (P = 0.01) and > or = 1 positive patch test (P < 0.001). Being an unskilled worker was a predictor for a poor prognosis at follow-up (P = 0.04), and the presence of frequent symptoms during the previous 12 months was associated with severe initial disease (P = 0.02) and a poor prognosis (P = 0.04). CONCLUSIONS: Overall, the disease had improved 6 months after the dermatological examination: nevertheless, many patients continued to have significant symptoms. Dermatologists should pay special attention to patients with frequent eruptions and to unskilled workers.

Characterization of extract of dog hair and dandruff from six different dog breeds by quantitative immunoelectrophoresis. Identification of allergens by crossed radioimmunoelectrophoresis (CRIE).

An extract of mixed dog hair and dandruff from six different dog breeds (alsatian, boxer, collie, poodle, and long-haired and short-haired dachshund) was obtained by mild extraction, centrifugation, dialysis and freeze-drying. Extract of hair and dandruff from the individual dog breeds was obtained in the same way, but the material was not freeze-dried. Examination and characterization of the mixed extract by means of crossed immunoelectrophoresis revealed a precipitation pattern composed of 25 antigens, some of which were mutually partially identical, and a high content of dog serum proteins was found. Quantitative and qualitative differences between the individual dog breeds were demonstrated. Partial identity of the antigens of the mixed extract with antigens of serum, antigens of extracts of hair and dandruff from cat, cow, horse and guinea pig, and antigens from extract of house dust was also observed. By means of crossed radioimmunoelectrophoresis, using sera from 21 patients who were RAST-positive to dog hair and dandruff extract, the specific IgE-binding to antigens of the mixed extract was examined. On the basis of these results major and minor allergens were identified. Dog albumin was found to be a very important major allergen, but alpha1-antitrypsin and gamma-globulin were also identified. Furthermore, four non-serum proteins were shown to be allergens. No breed-specific allergens could be identified in the extracts from the individual dog breeds.

Flour allergy in bakers. I. Identification of allergenic fractions in flour and comparison of diagnostic methods.

Extract of wheat flour obtained by extraction, centrifugation and dialysis was immunochemically characterized by quantitative immunoelectrophoresis using rabbit antibodies. The analysis revealed wheat flour to be composed of 40 antigens, some of which were immunologically partially identical with antigens of rye flour and of common grass pollen. Furthermore, antigens of the gliadin fraction of wheat flour were identified. 25 bakers with allergic complaints working in and around Copenhagen were clinically tested with wheat flour and related extracts. Among 13 bakers with respiratory complaints (asthma and/or rhinitis), 11 showed positive reactions to wheat flour extract when tested in histamine release from basophil leukocytes radioallergosorbent test and skin test, whereas further 2 were positive in the basophil test only. The ability of the IgE of individual sera to adsorb to the individual antigens of wheat flour was examined by means of crossed radioimmunoelectrophoresis. On the basis of these results, individual allergenic components of wheat flour were identified, three of these with comparatively high affinity and frequency.