European Union policy on pesticides: implications for agriculture in Ireland.

European Community (EC) legislation has limited the availability of pesticide active substances used in effective plant protection products. The Pesticide Authorisation Directive 91/414/EEC introduced the principle of risk assessment for approval of pesticide active substances. This principle was modified by the introduction of Regulation (EC) 1107/2009, which applies hazard, the intrinsic toxicity of the active substance, rather than risk, the potential for hazard to occur, as the approval criterion. Potential impacts of EC pesticide legislation on agriculture in Ireland are summarised. While these will significantly impact on pesticide availability in the medium to long term, regulations associated with water quality (Water Framework Directive 2000/60/EC and Drinking Water Directive 1998/83/EC) have the potential to restrict pesticide use more immediately, as concerns regarding public health and economic costs associated with removing pesticides from water increase. This rationale will further reduce the availability of effective pesticide active substances, directly affecting crop protection and increasing pesticide resistance within pest and disease populations. In addition, water quality requirements may also impact on important active substances used in plant protection in Ireland. The future challenge for agriculture in Ireland is to sustain production and profitability using reduced pesticide inputs within a framework of integrated pest management.

Use of systemic glucocorticosteroids in pregnancy: be alert but not alarmed.

SUMMARY Concerns have been raised regarding the use of repeated courses of systemic glucocorticosteroids given to pregnant women with threatened premature labour to improve fetal lung maturity. Most worrying are animal studies showing detrimental effects on the developing brain, though human data to date are conflicting. Additional concerns relate to the fetal origins of adult diseases, particularly vascular diseases such as hypertension and atherosclerosis. It is currently recommended that obstetricians give only a single course of antenatal corticosteroids to pregnant women to enhance lung maturity instead of giving repeated doses, which was previously a common practice. Other clinicians including dermatologists, gastroenterologists and rheumatologists may have reason to provide systemic glucocorticosteroids to pregnant women. Although systemic glucocorticosteroids all cross the placenta to some degree, the extent to which they do so depends on the drug involved. The choice of systemic glucocorticosteroid for the pregnant women in light of this evolving literature is discussed.

Severe toxic epidermal necrolysis precipitated by amphetamine use.

A 48-year-old man presented with a maculopapular truncal rash 9 days following intravenous amphetamine use. He subsequently developed widespread bullae over his trunk and upper limbs. Treatment was initially commenced with intravenous hydrocortisone. A diagnosis of toxic epidermal necrolysis was made and the treatment was changed to intravenous immunoglobulin at a lower dose than requested. At the height of the reaction, there was 90% body surface area involvement with tri-mucosal involvement. His response to the intravenous immunoglobulin was poor and was complicated by infection with methicillin-resistant Staphylococcus aureus, Candida albicans and Pseudomonas aeruginosa. Gradual re-epithelialization took place over the next 6 weeks.

Skin prick testing to food allergens in breast-fed young infants with moderate to severe atopic dermatitis.

SUMMARY The role of food allergy in atopic dermatitis is controversial. This study presents results of skin prick tests to 31 different food allergens in a selected population of predominantly breast-fed young infants who had moderate to severe generalized atopic dermatitis. Of the 59 infants (22 female, mean age 26.5 weeks) tested, 54 infants (91.5%) had positive responses to one or more foods, 53 infants (90%) were positive to one or more of the five common food allergens (egg white, cow's milk, peanuts, wheat or soy) and 80% were positive to egg white, which was by far the most common positive test. A total of 37 infants had strongly positive responses to one or more foods, with 33 of these 37 having strongly positive responses to egg white. The significance of these responses is discussed. It is concluded that positive skin prick tests to foods, particularly to egg white, are very common in this selected population of breast-fed infants with moderate to severe atopic dermatitis.