Clinical outcome and component-specific antibody levels in egg allergic children after lightened oral immunotherapy

Objective: To evaluate the clinical outcome of lightened version of egg oral immunotherapy (OIT) and to analyze egg allergen component-specific antibody levels during short up-dosing with egg white powder and maintenance by egg in daily diet. Patients and methods: Eighteen egg-allergic children received egg powder with short up--dosing and they maintained tolerance using egg in daily diet. Seventeen egg-allergic children served as a control group. Component-resolved analysis of serum immunoglobulin E (IgE), IgA1, IgA2, and IgG4 levels were determined at inclusion, after up-dosing and after 1 year of immunotherapy. Skin-prick tests were performed at inclusion and after 1 year of therapy. Results: All 18 patients in the egg OIT group were successfully desensitized. Desensitization was achieved on average in 4.5 months. In the control group, only two children tolerated egg in oral food challenge after 1 year. Of the measured immune markers, smaller wheal diameters in skin-prick testing, reduction in component-specific IgE levels, and increase in component-specific IgA1, IgA2, and IgG4 levels were associated with desensitization. Conclusion: A lightened egg OIT is effective and safe in children with egg allergy. Increase in all egg component-specific IgA1, IgA2 and IgG4 levels and decrease in all egg component--specific IgE levels were observed after 12 months of OIT (AU)

Clinical outcome and component-specific antibody levels in egg allergic children after lightened oral immunotherapy.

OBJECTIVE: To evaluate the clinical outcome of lightened version of egg oral immunotherapy (OIT) and to analyze egg allergen component-specific antibody levels during short up-dosing with egg white powder and maintenance by egg in daily diet. PATIENTS AND METHODS: Eighteen egg-allergic children received egg powder with short up--dosing and they maintained tolerance using egg in daily diet. Seventeen egg-allergic children served as a control group. Component-resolved analysis of serum immunoglobulin E (IgE), IgA1, IgA2, and IgG4 levels were determined at inclusion, after up-dosing and after 1 year of immunotherapy. Skin-prick tests were performed at inclusion and after 1 year of therapy. RESULTS: All 18 patients in the egg OIT group were successfully desensitized. Desensitization was achieved on average in 4.5 months. In the control group, only two children tolerated egg in oral food challenge after 1 year. Of the measured immune markers, smaller wheal diameters in skin-prick testing, reduction in component-specific IgE levels, and increase in component-specific IgA1, IgA2, and IgG4 levels were associated with desensitization. CONCLUSION: A lightened egg OIT is effective and safe in children with egg allergy. Increase in all egg component-specific IgA1, IgA2 and IgG4 levels and decrease in all egg component--specific IgE levels were observed after 12 months of OIT.

Allergic contact dermatitis caused by glucose sensors in type 1 diabetes patients.

BACKGROUND: Allergic contact dermatitis caused by glucose sensors has become an increasing problem. Contact allergies to isobornyl acrylate, colophonium, ethyl cyanoacrylate and N,N-dimethylacrylamide have been reported. However, there is a paucity of information regarding the prevalence of sensor-related dermatitis and detailed patient histories. OBJECTIVES: To evaluate diabetes patients who have developed allergic contact dermatitis caused by glucose sensors. PATIENTS AND METHODS: Seventy patients with suspected contact allergy to glucose sensors referred to university hospital dermatology clinics in southern Finland were patch tested with the baseline series, an isobornyl acrylate dilution series, and a number of other acrylates. Atopic constitution, contact allergies, the severity of the dermatitis and the ability to continue with the same or another type of sensor were recorded. RESULTS: Positive patch test reactions to isobornyl acrylate were seen in 51 of 63 (81%) Freestyle Libre users. Colophonium or its derivatives gave positive reactions in five of seven Medtronic Enlite users. The median duration of sensor use before dermatitis was 6 months. The estimated prevalences of contact allergy to sensor adhesives were 0.7% for Freestyle Libre and 0.8% for Enlite. CONCLUSIONS: We suggest that patients who have difficulties in finding a tolerable glucose sensor or an insulin pump should be patch tested.

Patch testing and sensitization to multiple drugs.

BACKGROUND: Adverse drug reactions pose an increasing diagnostic challenge in hospitals and in outpatient clinics. When consecutive or repeated allergic drug eruptions are suspected, patch testing is a useful diagnostic tool for determining the causative drugs. OBJECTIVES: The aim of the study was to identify patient cases with multiple delayed-type drug sensitizations by using patch testing. METHODS: Eight hundred and eleven patients with suspected drug allergy were patch tested during a 9-year period. RESULTS: Multiple delayed drug sensitizations were found in 12% of those patients with positive results in drug patch testing. CONCLUSIONS: Drug patch testing is useful in cutaneous adverse drug reactions where multiple drugs are suspected. Multiple drug sensitizations can be found in a proportion of patients who have delayed drug allergies. In addition to drug reactions with eosinophilia and systemic symptoms, these patients may have repeated exanthemas or contact dermatitis.

Non-occupational contact sensitization to epoxy resin of bisphenol A among general dermatology patients.

BACKGROUND: Sensitization to epoxy resins often results from occupational exposure in various fields of construction and industry. Non-occupational sensitization sources and environments have remained overlooked. OBJECTIVES: To analyse non-occupational and occupational contact sensitization to epoxy resin of bisphenol A among general dermatology patients. Special attention was paid to patients sensitized from non-occupational sources. PATIENTS AND METHODS: During a 10-year period, 6042 general dermatology patients were patch tested with epoxy resin (bisphenol A) in the Dermatology Clinic of Turku University Hospital. The clinical data and the sources of occupational and non-occupational exposure to epoxy resin were analysed in sensitized patients. RESULTS: Epoxy resin sensitization was found in 59 patients. Non-occupational sensitization was found in 21 (35%) patients, whereas the number of occupational cases was 38 (65%). The most common sources of non-occupational epoxy resin sensitization were materials used in domestic renovation and construction projects and in boat repair. CONCLUSIONS: Non-occupational sensitization sources account for approximately one-third of epoxy resin sensitization cases, and therefore represent an important risk among hobbies and leisure activities.

The relevance of chlorhexidine contact allergy.

BACKGROUND: Chlorhexidine is used for disinfection of skin and mucosae in medicine and dentistry. Prolonged exposure may lead to contact sensitization and allergic contact dermatitis or stomatitis. OBJECTIVES: The purpose of this study was to analyse the sources of chlorhexidine exposure and sensitization, and to obtain data on the prevalence of sensitization and chlorhexidine-related contact allergy. PATIENTS AND METHODS: From 1999, patch testing was performed with chlorhexidine digluconate (0.5% aq.) on 7610 general dermatology patients with suspected contact allergy at the Turku University Hospital Dermatology Department. The medical records were reviewed concerning the patients' exposure to chlorhexidine. RESULTS: A positive patch reaction to chlorhexidine was seen in 36 patients (0.47%). Current dermatitis or stomatitis caused by chlorhexidine-containing topical medicaments was seen in 5 patients. Chlorhexidine sensitization contributed to the current dermatitis in 11 patients. A history of earlier exposure to chlorhexidine-containing products was recalled by only 16 sensitized patients, whereas no exposure was revealed in 4 cases. CONCLUSIONS: Chlorhexidine-containing corticosteroid creams, skin disinfectants and oral hygiene products are principal sources of chlorhexidine contact sensitization. Exposure to chlorhexidine in cosmetics may lead to delayed improvement of eczema in sensitized patients, emphasizing the importance of identifying the potential cosmetic sources.

Contact sensitization to methylisothiazolinone in Finland--a multicentre study.

BACKGROUND: Antimicrobials constitute the second most common cause of contact allergy to cosmetics. Methylisothiazolinone (MI), previously always used together with methylchloroisothiazolinone (MCI), has recently been approved in the EU for use on its own in cosmetics and also various industrial products. MCI has been classified as an extreme-strong and MI as a strong-moderate sensitizer. OBJECTIVES: To study the frequency of positive patch test reactions to MI, and its relevance and relation to MCI/MI sensitivity, in Finland. METHODS: Over a period of 3 years (2006-2008), MI 0.1% (1000 ppm) and 0.03% (300 ppm) were patch tested in 10,821 patients at eight Finnish dermatological clinics. During 2008, patients with positive reactions to MI were asked to take part in a repeated open application test (ROAT). RESULTS: Of the patients tested, 1.4% and 0.6% showed positive patch test reactions to 0.1% and 0.03% MI, respectively. Sixty-six per cent of those who were MI-positive were also positive to 100 ppm MCI/MI. Thirty-three agreed to undergo the use test, and 10 of these gave positive results (30%). CONCLUSIONS: Our data show that MI used alone also potentially induces contact allergy. Careful monitoring is needed to determine whether or not this antimicrobial is safe to use in cosmetics.

Sensitization to thiourea derivatives among Finnish patients with suspected contact dermatitis.

BACKGROUND: Thiourea derivatives in rubber products may induce contact sensitization and allergic contact dermatitis. Sensitization is most often from neoprene rubber, but the multitude of possible sensitizing products has remained poorly characterized. OBJECTIVE: The aim of this study was to collect information on the occurrence of thiourea-related contact allergy and to show novel sources of sensitization. PATIENTS AND METHODS: A mixture of dibutyl-, diethyl-, and diphenylthiourea was included in patch test baseline series in five Finnish dermatology clinics during 2002-2007. In addition, an extended series of rubber chemicals was tested in patients with suspected rubber allergy. Sources of sensitization to thioureas were analysed in sensitized patients. RESULTS: Thiourea mix yielded positive patch test reactions in 59 of 15,100 patients (0.39%); 33/59 patients were also tested with individual rubber chemicals. Diethylthiourea was positive in 24/33, diphenylthiourea in 5, and dibutylthiourea in 1 patient. The most common sources of sensitization included various neoprene-containing orthopaedic braces, sports equipment, and foot wear. CONCLUSIONS: The sources of sensitization to thiourea chemicals were detected in most cases. These sources comprise a heterogenous group of products extending from orthopaedic materials to sports equipment.

Allergy to carmine red (E120) is not dependent on concurrent mite allergy.

BACKGROUND: Positive skin prick test (SPT) reactions to carmine red (E120) have been reported to occur concurrently with reactions to mites. The relationships between positive SPT reactions to carmine, carmine allergy and concurrent mite reactions are unknown. The aim of this study was to analyse the prevalence of carmine sensitization and its clinical importance among patients with suspected allergy to food additives. METHODS: The occurrence of positive SPT reactions to mites was studied in 6,464 patients: 3,164 were tested with carmine and 2,837 with shrimp. Carmine ingestion-associated symptoms were registered at the time of testing. Patients with positive SPT to carmine received a follow-up questionnaire on their symptoms 1-5 years later. RESULTS: Positive SPT reactions to carmine were seen in 94 patients (3.0%) of whom 74% also had positive SPT reactions to mites and 22% to shrimp. Carmine ingestion-associated symptoms were not dependent on concurrent mite reactivity in 39/94 (42%) patients. CONCLUSIONS: Carmine sensitization without sensitization to mites is seen in one fourth of the patients. Allergic reactions to carmine are not dependent on concurrent reactivity to mites.

Positive patch test reactions to gentamicin show sensitization to aminoglycosides from topical therapies, bone cements, and from systemic medication.

BACKGROUND: A history of prolonged use of topical antimicrobials is common among patients with positive patch test reactions to gentamicin and to aminoglycosides. OBJECTIVES: The aim of this study was to show sources of gentamicin sensitization in patients with positive patch test reactions to gentamicin. PATIENTS AND METHODS: About 7814 patients were patch tested with a baseline patch test series and 620 of them were further tested with gentamicin. The clinical histories, concurrent contact sensitivities, and sources of sensitization are analysed among these patients. RESULTS: Positive patch test reactions to gentamicin were seen in 29/620 patients, most of whom (18/29) also reacted to neomycin and to kanamycin (7/29). Mean age of the gentamicin-positive patients was 62 years, but three young operating room nurses with hand dermatitis had a history of gentamicin exposure from bone cement. Among the 11/29 neomycin-negative patients, a history of exposure to different aminoglycosides was apparent, and one patient had a history of systemic netilmicin-medication-associated exanthema. CONCLUSIONS: Positive patch test reactions to gentamicin reflect sensitization to different aminoglycosides for which gentamicin seems to represent a sensitive indicator. Gentamicin sensitization may result from occupational exposure to gentamicin containing bone cements or from systemic medication with aminoglycosides.

Contact sensitization to 4,4'-diaminodiphenylmethane and to isocyanates among general dermatology patients.

BACKGROUND: Diisocyanates and 4,4'-diaminodiphenylmethane (MDA) are industrial sensitizers. Occupational asthma is a risk among workers exposed to diisocyanates. Exposure may also lead to contact sensitization and allergic contact dermatitis. OBJECTIVE: The aim of this study was to determine the occurrence of contact sensitization to MDA and to diisocyanates among general dermatology patients. PATIENTS AND METHODS: Patch testing with MDA was carried out in 1595 patients. Diphenylmethane-4,4'-diisocyanate (MDI) and toluene-2,4-diisocyanate (TDI) were tested in 1023 patients and isophorone diisocyanate (IPDI) and 1,6-hexamethylene diisocyanate (HDI) in 433 patients. The clinical data and sources of exposure are analysed. RESULTS: MDA reactions were seen in 17 (1.1%) patients and MDI reactions in 4 patients. Six MDA-positive patients reacted to p-phenylenediamine and two to epoxy chemicals. 5/10 of the TDI reactions were seen concurrently with reactions to MDI, MDA, HDI, or to IPDI. IPDI reactions were seen in eight patients and HDI reactions in two patients. Possible sources of exposure were traced in most patients, although the association with the current dermatitis was not apparent in all cases. CONCLUSION: (Di)isocyanates may induce contact sensitization with or without allergic contact dermatitis.

Quantification of human Aiolos splice variants by real-time PCR.

Aiolos is a transcriptional regulator of B cell development and belongs to the Ikaros family of chromatin remodelling transcription factors. All the members of Ikaros family produce multiple isoforms via alternative mRNA splicing. Altered expression of Ikaros isoforms has been found in patients with acute lymphoblastic leukemia but it is not studied whether the altered expression of Aiolos isoforms also has a role in the development of leukemias or lymphomas. We developed a quantitative real-time PCR application to detect the relative expression of Aiolos splice variants. The method is based on fluorescence resonance energy transfer (FRET)-labelled isoform specific hybridisation probes used with the LightCycler instrument. The isoform specificity is obtained by targeting the probes at the edges of chosen exons. The probes are here shown to represent a rapid, high throughput, specific and reproducible quantification method. We designed and optimised the analysis for a dominant negative Aiolos isoform, but the described method is applicable to any isoform-forming gene. This study shows that the real-time PCR with exon edge spanning probe pairs can be applied generally to reveal the importance of alternative splicing and the role of isoforms in normal development and diseases.