European Surveillance System on Contact Allergies (ESSCA): results with the European baseline series, 2013/14.

BACKGROUND: Contact allergy is a common condition and can severely interfere with daily life or professional activities. Due to changes in exposures, such as introduction of new substances, new products or formulations and regulatory intervention, the spectrum of contact sensitization changes. OBJECTIVE: To evaluate the current spectrum of contact allergy to allergens present in the European baseline series (EBS) across Europe. METHODS: Retrospective analysis of data collected by the European Surveillance System on Contact Allergies (ESSCA, www.essca-dc.org) in consecutively patch-tested patients, 2013/14, in 46 departments in 12 European countries. RESULTS: Altogether, 31 689 patients were included in the analysis. Compared to a similar analysis in 2004, the prevalence of contact allergy to methylisothiazolinone went up to around 20% in several departments. In comparison, contact allergy to the metals nickel, cobalt and chromium remained largely stable, at 18.1%, 5.9% and 3.2%, respectively, similar to mostly unchanged prevalence with fragrance mix I, II and Myroxylon pereirae (balsam of Peru) at 7.3%, 3.8% and 5.3%, respectively. In the subgroup of departments diagnosing (mainly) patients with occupational contact dermatitis, the prevalence of work-related contact allergies such as epoxy resin or rubber additives was found to be increased, compared to general dermatology departments. CONCLUSION: Continuous surveillance of contact allergy based on network data offers the identification of time trends or persisting problems, and thus enables focussing in-depth research (subgroup analyses, exposure analysis) on areas where it is needed.

Occupational skin diseases: actual state analysis of patient management pathways in 28 European countries.

BACKGROUND: Work-related skin diseases (WSD) are caused or worsened by a professional activity. Occupational skin diseases (OSD) need to fulfil additional legal criteria which differ from country to country. OSD range amongst the five most frequently notified occupational diseases (musculoskeletal diseases, neurologic diseases, lung diseases, diseases of the sensory organs, skin diseases) in Europe. OBJECTIVE: To retrieve information and compare the current state of national frameworks and pathways to manage patients with occupational skin disease with regard to prevention, diagnosis, treatment and rehabilitation in different European countries. METHODS: A questionnaire-based survey of the current situation regarding OSD patient management pathways was carried out with experts on occupational dermatology and/or occupational medicine from 28 European countries contributing to the European Cooperation in Science and Technology (COST) Action TD 1206 (StanDerm) (www.standerm.eu). RESULTS: Besides a national health service or a statutory health insurance, most European member states implemented a second insurance scheme specifically geared at occupational diseases [insurance against occupational risks (synonyms: insurance against work accidents and occupational injuries; statutory social accident insurance)]. Legal standards for the assessment of occupationally triggered diseases with a genetic background differ between different countries, however, in most European member states recognition as OSD is possible. In one-third of the countries UV light-induced tumours can be recognized as OSD under specific conditions. CONCLUSION: OSD definitions vary between European countries and are not directly comparable, which hampers comparisons between statistics collected in different countries. Awareness of this fact and further efforts for standardization are necessary.

Neutron star mass estimates from gamma-ray eclipses in spider millisecond pulsar binaries.

Reliable neutron star mass measurements are key to determining the equation of state of cold nuclear matter, but such measurements are rare. Black widows and redbacks are compact binaries consisting of millisecond pulsars and semi-degenerate companion stars. Spectroscopy of the optically bright companions can determine their radial velocities, providing inclination-dependent pulsar mass estimates. Although inclinations can be inferred from subtle features in optical light curves, such estimates may be systematically biased due to incomplete heating models and poorly understood variability. Using data from the Fermi Large Area Telescope, we have searched for gamma-ray eclipses from 49 spider systems, discovering significant eclipses in 7 systems, including the prototypical black widow PSR B1957+20. Gamma-ray eclipses require direct occultation of the pulsar by the companion, and so the detection, or significant exclusion, of a gamma-ray eclipse strictly limits the binary inclination angle, providing new robust, model-independent pulsar mass constraints. For PSR B1957+20, the eclipse implies a much lighter pulsar (1.81 ± 0.07 solar masses) than inferred from optical light curve modelling.

A half of schoolchildren with 'ISAAC eczema' are ill with allergic contact dermatitis.

BACKGROUND: Similarity in clinical symptoms between atopic eczema (AE) and allergic contact dermatitis (ACD) may lead to misdiagnoses in both clinical practice and epidemiological studies. As patch testing for contact allergy does not seem popular among paediatric allergists, the resulting bias leads mainly to under diagnosing of ACD and over diagnosing of AE in children and adolescents. OBJECTIVES: To assess the frequency of AE and ACD among children and adolescents who answered affirmatively the eczema module of ISAAC questionnaire. METHODS: Of 9320 schoolchildren involved in an allergy screening programme, 143 consecutive participants were recruited for the present study. The inclusion criterion was affirmative answers to questions from the eczema module of the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire. The children were examined by two allergists: a paediatrician and a dermatologist, and the children underwent patch testing. RESULTS: We diagnosed AE in 46 (55.4%) children and 18 (30.0%) adolescents, whereas 32 (38.6%) children and 31 (51.7%) adolescents were diagnosed with ACD, with a considerable overlap of both diseases. Nine of 46 (19.6%) children and 13 of 25 (52.0%) adolescents with affirmative answers to the question about flexural eczema were diagnosed with ACD, while lacking features sufficient for the diagnosis of AE according to Hanifin and Rajka. Based on the indices from the whole population tested (9320 pupils), a rough estimate of the general ACD prevalence was 5.8% for adolescents, and 8.5% for children, which is close to the figure of 7.2% observed previously in Danish schoolchildren. CONCLUSIONS: Our data demonstrate that 'ISAAC eczema' is an epidemiological entity that embraces comparable portions of cases of atopic eczema and allergic contact dermatitis, and possibly also other less frequent pruritic dermatoses. Each case of chronic recurrent dermatitis in children requires differential diagnosis aimed at allergic contact dermatitis and inflammatory dermatoses other than atopic eczema, even when predominantly localized in flexural areas.

Excessive nickel release from earrings purchased from independent shops and street markets--a field study from Warsaw and London.

BACKGROUND: Nickel allergy is frequent and cause morbidity and increased health care costs. OBJECTIVE: The aim of this study was to determine the proportion of inexpensive earrings randomly purchased from stores and street markets in two capitals that gave positive dimethylglyoxime (DMG) test reactions and to determine whether the degree of nickel release was related to shop category. METHODS: Random inexpensive metallic earrings were purchased from stores and vendors in London and Warsaw. A qualitative investigation of nickel release by using the DMG test was performed. RESULTS: DMG testing revealed that respectively 15.1% (n=205) and 18.4% (n=206) of earrings purchased in London and Warsaw released nickel as indicated by positive test outcomes. Stratification by store category showed that DMG test-positive jewellery were mainly purchased from street markets and from stores that were not part of national or international chains. CONCLUSIONS: Despite the EU Nickel Directive having resulted in decreasing prevalence of nickel allergy, a large proportion of inexpensive earrings still release nickel in concentrations that may result in nickel allergy and dermatitis. Authorities should prioritize information campaigns and random inspections as a legislation that is not followed is of limited value.

Zoophilic and geophilic fungi as a cause of skin disease in farmers.

The impact of microscopic fungi on the farmers' health seems to be underestimated. In the present article an overview of fungi as pathogens is presented with reference to occupational hygiene in agriculture and related areas. The infection may be transmitted from infected humans, animals, plants or soil. To date, little epidemiological data on fungal skin disease in farmers is available. Epidemiological studies from Poland suggest that mycoses are the most prevalent skin diseases in farmers, and may be present even in over 20% of the population. Working conditions on farms greatly enhance the development of fungal infections. Farmers spend most of their working time in humid conditions, wearing rubber boots for long hours, etc. Another professional groups at higher risk for developing a fungal disease are animal feeders, foresters, grave-diggers and veterinarians as well as employees working in the food industry. Besides infection, fungi may also cause non-invasive forms of skin disease, as dermato-mycotoxicosis professionalis or alternariosis. Criteria for classifying a case of mycosis as occupational disease are also discussed.

Occupational dermatoses in farmers - a proposal for diagnostic procedure.

The article presents a proposal for diagnostic procedures in cases of suspected occupational dermatosis in farmers. The process of certifying a disease as occupational is difficult because of lack of the monitoring of occupational risks in private farms; moreover, there is no compulsory medical assessment before one starts work as a farmer. Many patients meet an occupational health professional for the first time when the disease is already advanced and legal action towards obtaining an occupational rent has already been issued. In these circumstances, confirming or rejecting the possible occupational etiology of a given dermatosis is very difficult. This article presents a diagnostic procedure which has been devised by the author and used with some success for two years at the Institute of Agricultural Medicine, Lublin, Poland.

Pesticides as a cause of occupational skin diseases in farmers.

Pesticides are chemical substances used in agricultural production to protect crops against pests. They help to achieve better quality and quantity of crops; however, they also are capable of causing occupational diseases in farmers. Skin is the most exposed organ while spraying the pesticide on fields. Farmers are also exposed to pesticides while mixing, loading the pesticide as well as while cleaning the equipment and disposing of empty containers. Other activities associated with exposure are sowing pesticide-preserved seeds, weeding and harvesting previously sprayed crops. During the first decades of using pesticides the main problem was the risk of acute intoxication among people occupationally exposed. With decrease in the toxicity of improved pesticides, attention was turned to chronic intoxication and environmental contamination. Nowadays, the problem of diseases not immediately related to the toxic potential of pesticides gains increasing interest. The majority of these non-toxic diseases are dermatoses. Most pesticide-related dermatoses are contact dermatitis, both allergic or irritant. Rare clinical forms also occur, including urticaria, erythema multiforme, ashy dermatosis, parakeratosis variegata, porphyria cutanea tarda, chloracne, skin hypopigmentation, nail and hair disorders. Farmers exposed to arsenic pesticides are at risk of occupational skin cancer, mostly morbus Bowen (carcinoma in situ), multiple basal cell carcinomas and squamous cell carcinomas. Non-arsenic pesticides, e.g. paraquat, are also potentially carcinogenic.

Zoophilic and geophilic dermatophytoses among farmers and non-farmers in Eastern Poland.

The study was aimed at assessing the frequency of zoophilic and geophilic fungal infections among farmers compared to non-farmers in eastern Poland. The study was carried out on adult patients with a suspicion of fungal infection of skin or its appendages. Skin scrapings or nail fragments were cultured on Sabouraud agar with chloramphenicol and cycloheximide for at least 3 weeks, and then identified based on macroscopic and microscopic morphology. In total, 116 subjects were included into the farmers group, 67 females and 49 males, aged 18-88 (median 53) years. Dermatophyte infection was found in 64 farmers (55.2%). Anthropophilic dermatophytes were identified in 61 farmers (52.6%), whereas zoophilic or geophilic dermatophytes - in only 5 farmers (4.3%). Trichophyton verrucosum was found in 3 cases, while T. terrestrae and Microsporum gypseum - 1 case each. The control group comprised 74 non-farmers, 40 females and 34 males, aged 18-93 (median 47) years. Among them, dermatophyte infection was found in 35 (47.3%) patients. Anthropophilic dermatophytes were identified in 30 (40.5%), whereas zoophilic or geophilic dermatophytes in 6 persons (8.1%): M. canis in 2 patients, and T. verrucosum, T. mentagrophytes var. mentagrophytes (granulosum), M. nanum, and T. terrestrae - 1 case each. There were no significant differences between farmers and non-farmers. Zoophilic and geophilic fungi identified in our study were responsible either for superficial mycosis and/or onychomycosis, no case of deep mycoses or scalp infections were found. Our data suggest that zoophilic and geophilic dermatophytoses are not frequent among eastern-Polish farmers.

Occupational contact dermatitis to Phaseolus vulgaris in a farmer - a case report.

A case of occupational contact dermatitis in a farmer is described, caused among others by Phaseolus vulgaris. The patient's history of eczematous and vesicular and bullous skin reactions occurring after exposure to Phaseolus was confirmed by skin tests with native leaves of the plant. To the best of our knowledge, this is the first description of occupational contact dermatitis caused by leaves of Phaseolus plant.

Detection of specific IgE as a screening tool for cow and swine breeders' occupational allergic dermatoses.

The study aimed at assessing whether detection of IgE specific to cow and swine allergens can be used as a screening tool for farmers' occupational eczema. Serum samples were taken from 51 farmers. The farmers were questioned about work-related skin symptoms using a nurse-administered questionnaire, verified by a dermatologist. Sera of 29 cow breeders were tested for IgE antibodies specific to cow dander and bovine serum albumin. Sera of 22 swine breeders were tested for IgE specific to swine epithelium, swine serum albumin, and swine urine proteins. Among cow breeders, IgE specific to cow dander was found in one farmer. Among swine breeders, IgE specific to swine epithelium was found also in one subject. On first examination, the cow breeder complained of slight itching of the conjunctivae while working in a cow barn and had no other allergic symptoms. One year later, however, he noticed episodes of hand eczema after contact with cows. In the IgE-positive swine breeder, only mild stationary psoriasis, and no work-related symptoms were found. Among the remaining 28 IgE-negative cow breeders, 11 complained of skin symptoms, but these were not related to working with cows; among 21 IgE-negative swine breeders, 7 subjects had skin diseases, none of which were related to working with swine. We conclude that detection of animal antigen-specific IgE may be an useful screening tool, although an exact assessment of sensitivity and specificity of the method in a larger population of exposed farmers will be required.

Work-related skin symptoms and type I allergy among eastern-Polish farmers growing hops and other crops.

UNLABELLED: 73 eastern-Polish farmers growing hops and other crops were examined. They were questioned by a dermatologist and subsequently skin prick-tested with allergens of hops, grain dust, straw dust, hay dust, storage mites, and antigens of microorganisms typical for farm environment. RESULTS: 14 farmers (19.2%) complained of work-related skin symptoms, caused most often by hops (11%), followed by grain (5.6%), hay (5.5%) and straw (4.1%). Five farmers (6.8%) complained of hand dermatitis, four (5.5%) of airborne dermatitis, and eight (11.0%) of pruritus. In two farmers, two skin diseases co-existed. The skin symptoms were mostly mild, however, one case of severe invalidating airborne dermatitis to hops was found. On skin prick tests, 14 farmers (19.2%) showed positive skin reaction to at least one allergen; 5.5% of farmers reacted to grain dust, 5.5% to straw dust, 11% to hay dust, and 8.2% to hops. Tests with storage mites showed positive reactions to Acarus siro in 9.6%, Lepidoglyphus destructor in 17.8%, and to Tyrophagus putrescentiae in 13.7%. Tests with microbial allergens elicited positive reactions to Pantoea agglomerans in 4.1%, Saccharopolyspora rectivirgula in 4.1%, Aspergillus fumigatus in 4.1% and to Streptomyces albus in 1.4% of farmers. Although results of skin prick tests in general did not correlate well with the work- related skin symptoms, in three of 14 farmers with skin symptoms the tests results played a crucial role in identifying the cause of their work-related skin disease.

Atopy, allergic diseases and work-related symptoms among students of agricultural schools: first results of the Lublin study.

136 eastern-Polish farming students (51 females and 85 males, aged 16-23 years) underwent clinical examination, skin prick tests with common and farm-specific allergens, total IgE measurement and Phadiatop test. Atopy was found in 35.3% (95% CI: 27.3-43.3%) of students. For allergic skin diseases, the point prevalence was 5.9%, the lifetime prevalence 28.7%; for allergic rhinitis 12.7% and 16.4%; for asthma 2.2% and 8.8% respectively. 56 students (41.2%) complained of work-related symptoms; most often of pruritus (30.9%), erythema of the skin (16.9%), sneezing (16.2%), rhinorrhea (15.4%), cough (9.6%) and dyspnea (8.1%). The students reported as causative factors of work-related symptoms: grain dust (71.4% of the 56 symptomatic students), hay dust (57.1%), straw dust (17.9%), green parts of plants (5.4%), fertilisers, diesel fuel and farm animals (3.6% each). Prick tests were positive in 30.9% of students, most frequently to Lepidoglyphus destructor (18.4% of all students), Tyrophagus putrescentiae (15.4%), Dermatophagoides pteronyssinus (14.0%), Acarus siro (13.2%) and weed pollens (5.1%). The only statistically significant difference between males and females found in the study was that in the lifetime prevalence of allergic skin diseases (males 17.6% versus females 47.1%, p<0.001). Students reporting work-related symptoms had significantly more present and past allergic skin diseases and allergic rhinitis (for each feature p<0.01), and past obstructive lung disease (p=0.001). In 12 farming students (8.8%, 95% CI: 4.1-13.6%), employment as a farmer was strongly contraindicated due to health status.

Young farmers with cellular reactivity to airborne microbes suffer more frequently from work-related skin symptoms and allergic dermatitis.

UNLABELLED: 75 farming students (49 males and 26 females aged 16-23 years) underwent dermatological, laryngological and pulmonary examination, skin prick tests with common and farm allergens, Phadiatop and total IgE measurement. After that, the migration inhibition tests with antigens of airborne microbes typical for farm environment (Saccharopolyspora rectivirgula, Pantoea agglomerans, and Aspergillus fumigatus) were carried out. Possible differences between students with positive results and those non-reactive were sought. RESULTS: 10 students reacted to at least one microbial antigen in the migration inhibition test. There were no significant differences in distribution of atopy, prick test results, total IgE, and Phadiatop between the reactive students and their classmates. Only one case of asthma was found, hence a further statistical analysis was not feasible. Allergic rhinitis has been found in 30% of the reactive and in 9.2% of non-reactive students; the difference, however, was not statistically significant (p=0.06). Significant differences were found with respect to the frequency of allergic skin diseases (40% reactive versus 9.2% non-reactive, p = 0.009); no other triggering factors than microbial antigens could be identified in 2 out of 4 reactive students with dermatitis. Work-related symptoms were present in all reactive students (100% versus 27.7%, p=0.001); 8 out of 10 reactive students did not show any other specific sensitisation. Antigens of airborne microbes are commonly associated with lung diseases. Our results, however, suggest that the skin may be affected as well. Relatively strong association between cellular reactivity to airborne microbes and skin diseases deserves further studies.

[Sensitization to cow and pig allergens among farmers in Eastern Poland]. / Uczulenie na alergeny krów i swin wsród rolników Polski wschodniej.

The study aimed at assessing the frequency of sensitization to cow and pig allergens among farmers in Eastern Poland. Sixty eight farmers from 17 randomly selected family farms were examined. The study group included 30 females and 38 males, aged 18-84 years (median, 47 years), with exposure duration ranging from 1 to 80 years (median, 30 years). The farmers were interviewed and subsequently skin prick-tested with cow and swine epithelia. Blood samples were examined for the presence of IgE antibodies, specific to cow dander and swine epithelium, using enzyme immunoassay (UniCAP). None of the farmers complained of any symptoms when working with cows or pigs. In 13 farmers (19.1%) either positive skin pick test and/or the presence of IgE specific to cow and/or pig were found. Seven farmers (10.3%) reacted to skin prick tests: 2 to cow epithelium; 2 to pig epithelium; and 3 to both allergens. Specific IgE was also found in 7 farmers (10.3%): in 4 to cow dander; in 1 to cow epithelium; and in 2 to both allergens. There was a very weak correlation between skin tests and IgE determination; only one farmer showed positive reaction to cow allergens in both skin tests and IgE. Following the results of the previous and the present studies, it was concluded that in Poland the farm animal allergens are less important causes of work-related diseases than plant allergens.

[Clinical and rhino-manometric evaluation of flunisolide in treatment of seasonal allergic rhinitis]. / Kliniczna i rinomanometryczna ocena skutecznosci flunizolidu w leczeniu alergicznego sezonowego niezytu nosa.

24 patients with seasonal allergic rhinitis (SAR) were observed. Persons with nasal obstruction caused by other mechanisms than allergy to pollens were excluded. The increase of nasal resistance and complaints after begin of pollen season was statistically significant. The clinical efficacy of topical flunisolide in patients with SAR was evaluated. The significant building of symptoms scores and increase of rhinomanometric measured nasal patency were noted.

[Correlation between symptoms and results of rhinomanometric measurements of nasal patency in patients with seasonal allergic rhinitis]. / Zwiazek miedzy samopoczuciem a wynikami rinomanometrycznych pomiarów droznosci nosa u chorych na sezonowy niezyt nosa.

The aim of presented study were to assess the usefulness of rhinomanometry in monitoring course of disease and effectivity of treatment in seasonal allergic rhinitis (SAR) through answering the question whether and eventually which relationship exists between patient's general feeling and results of rhinomanometric measurements of nasal patency (NP). The study involved 114 subjects with SAR divided into 3 groups dependent on phase of disease and severity of complaints and 30 healthy volunteers. For results see table I. Nasal flow and resistance measured at differential pressure 75 Pa in groups I, III and IV did not differ significantly. In group II nasal flow values were lower (alpha < 0.001) and resistance values higher (alpha < 0.001) as compared with remaining groups. Thus, the beginning of symptoms is related to lowering of NP as compared with symptom-free phase of SAR. In the symptom-free period NP do not differ from healthy population. The results of rhinomanometric measurements of NP are useful in monitoring of course of SAR in assessment of effectivity of treatment.

[Debates on the role of rhinomanometry in modern functional diagnosis of the upper airway]. / Spór o miejsce rynomanometrii we wspólczesnej diagnostyce czynnosciowej górnych dróg oddechowych.

In presented paper a review of recent articles regarding applicability of computerized rhinomanometry in modern rhinological diagnostics was done. A conclusion of discussed opinions is that at the time it is no agreement about clinical value of rhinomanometry. There are however some applications, in which rhinomanometry seems to have proved its usefulness.

[Comparison of rhinomanometry results and selected subjective and objective symptoms in patients with seasonal allergic rhinitis]. / Porównanie wyników badania rynomanometrycznego z wybranymi objawami subiektywnymi i obiektywnymi u chorych na alergiczny niezyt nosa.

The aim of this study was to compare rhinomanometric results with patient's assessment of nasal patency, frequency of sneezing, nasal secretion, and results of anterior rhinoscopy, 34 patients with seasonal allergic rhinitis were examined. Correlations of medium degree were found between the rhinomanometric results and both the patient's assessment of nasal patency and the results of anterior rhinoscopy. No correlations were found between rhinomanometric results and either sneezing or nasal secretion. This might suggest that values measured by rhinomanometry are not closely enough connected with those measured by other methods and thus rhinomanometry can neither replace nor be replaced with any other of the analysed methods for assessing upper airway status.