bluuebunny/crossref_metadata_2025 huggingface dataset:
FS03.2 Visual scoring of skin irritation reactions – what are the limits?
Authors: Basketter DA , Marriott Marie , Peters L , Cooper K
Published: August 2010

We have previously reported that, with suitable training and experience, skin irritation reactions can be graded visually with a high degree of sensitivity and precision. The objective of the work presented is to demonstrate the possibilities and limitations of the grading of skin irritation reactions by subjective visual assessment. In the present work, we have recorded a wide range of relatively minor skin irritation reactions using a high quality digital camera. The skin reactions recorded have then been graded by independent observers according to their appearance on a computer monitor. The results show that very subtle degrees of both erythema and skin dryness can be accurately described by trained skin graders in a reliable and reproducible manner. Examples of the grading scales and sensitivity of scoring will be shown. We conclude that visual scoring, when conducted well, represents a rapid and accurate method for the assessment of minor degrees of skin irritation. The present evidence, taken in combination with previously presented information on bioengineering techniques, leads us to the conclusion that visual assessment is both an adequate and a robust technique, delivering information of the quality necessary for safety assessment of consumer products.
FS04.1 Formaldehyde allergy – clinically relevant threshold reactions
Authors: Zachariae Claus , Hall B , Cottin M , Andersen KE , Menné T
Published: August 2010

The objective of the study was to establish eliciting threshold concentrations of diazolidinyl urea (Germall II)– derived formaldehyde in formaldehyde and/or in diazolidinyl urea – sensitive patients, using a leave‐on face cream formulation in a repeated open application test (ROAT) applied to different anatomical regions.

150 patients with known formaldehyde allergy were reviewed for inclusion in the study. 108 patients were contacted and in 65 patients the formaldehyde sensitisation was reconfirmed by a patch test. Four groups of 10 formaldehyde allergic subjects were exposed to 0.05%, 0.15%, 0.3% and 0.6% diazolidinyl urea, corresponding to approximately 50, 100, 200 and 400 ppm free formaldehyde, respectively.

Additional 10 individuals allergic to the formaldehyde donor – diazolidinyl urea itself – were exposed to 0.15% diazolidinylurea, corresponding to approximately 100 ppm free formaldehyde and 10 healthy non‐allergic individuals were exposed to 0.6% of diazolidinylurea (approximately 400 ppm free formaldehyde).

A ROAT was performed in a scheduled sequence: upper arm, neck and face.

Contact allergy reactions were elicited in 39 out of 58 formaldehyde‐sensitive and in 5 out of 7 diazolidinyl urea‐sensitive individuals.

Elicitation responses were dose‐ and anatomical region – dependent.

No reactions were observed at the lowest dose, suggesting that an elicitation threshold was attained in the study.
FS04.2 Immunotoxic effects of arylamine dyes
Authors: Skazik Claudia , Wilbers L , Breuer S , Merk HF , Kunz D , Blömeke B
Published: August 2010

Allergic reactions to arylamine dyes are well‐known causes for allergic contact dermatitis (ACD). These compounds are found in synthetic and natural materials, hair dyes, sun screen, photographic additives as well as temporary tattoos. Cross‐reactions between different para‐compounds have been frequently observed but the underlying mechanisms are not fully elucidated. We investigated the immunogenic capacities of p‐phenylendiamine (PPD), Bandrowski’s base (BB), 2‐methyl‐1,4‐phenylendiammoniumsulfat (PTD), 4‐aminoazobenzene (AAB), disperse orange (DO), disperse yellow (DY), 4–4‐diaminophenylmethan (DDM), bismarckbrown (BBY) and 2‐mercaptobenzothiazole (MBT) by measuring the proliferative responses of T‐cells on polyclonal and monoclonal level (thymidine incorporation). T cell responses were based on CD4+ and CD8+ T cells. Recently, we characterized PPD/BB T cell clones (TCC) as predominantly CD4+/CD45RO+ cells with a alpha/beta T cell receptor (Sieben et al., 2002). We isolated T cell lines (TCL, n = 16) and T cell clones (TCC, n = 20) from totally 11 PPD‐allergic persons and 5 exposed persons. We established TCLs and TCCs to 4 para‐amino compounds. We found some PPD and/or BB specific TCCs with no cross‐reactivity to the other compounds tested. Some TCCs showed a narrow range of cross‐reactions (BB, BBY, MBT), while others reacted to 6 different para‐amino compounds. We observed similiar patterns of crossreaction for the TCLs. The stimulation indices (SI) varied between 2.2 and 14.0. Our preliminary results on cross‐reactions between para‐amino compounds support recent findings in mice (Wulferink et al., 2002) demonstrating a limited discriminatory capacity of T cells carrying an alpha/beta T cell receptor. Further studies on the mechanisms of cross‐reactivities and the cytokine profiles are now under investigation. This study was supported by the Interdiciplinary Center for Clinical Research and Biomaterials (IZKF, Germany) and the Deutsche Forschungsgemeinschaft (Germany).
FS04.3 Hair dyes, prediction of sensitization potential with QSAR
Authors: Søsted Heidi , Patlewicz G , Estrada E , Basketter DA , Johansen J Duus
Published: August 2010

Objectives:  To identify substances and tonnage data for use for hair dyes registered in Europe. To predict the sensitization potential of each substance and to rank the substances due to their sensitization potential. Further to group the substances in clusters based on their physical chemical properties with a cluster analysis.

Methods:  The Inventory list of Cosmetics Ingredients (INCI), new regulation on cosmetics, tonnage data for use and Toxnet were used to identify and quantify the hair dyes. Salts were disregarded. A QSAR (Qualitative structure‐activity relationship) model called TOPS‐MODE, based on local lymph node assay (LLNA) data and physical chemical properties were used to predict the sensitization potential and make a cluster analysis.

Results:  Out of 315 hair dye substances 229 meet the inclusion criteria. Most of the hair dye substances 75% were predicted to be strong to moderate sensitizers. Less were predicted to be weak 22% and only a small part 3% were predicted to be extremely weak or non sensitizing. The 8 most used hair dye substances were predicted to be strong to moderate sensitizers. Ppd is the most used hair dye allergy marker but some azodyes were predicted to be more potent than para‐phenylenediamine (ppd).

Conclusions:  Most hair dye substances are predicted to be strong to moderate sensitizers, which explain why some people gets hair dye dermatitis. A patch test series with potent, much used azodyes, might prove useful in diagnosing ppd‐negative patients, with hair dye allergy. The cluster analysis grouped the substances which can be helpful choosing substances for clinical patch test.
FS04.4 Decreased MDBGN conc. in a product is counteracted by increased exposure
Authors: Jensen Charlotte Devantier , Menné T , Johansen Andersen J Duus, KE
Published: August 2010

Background:  Some types of cosmetic products such as creams and soaps are commonly used several times a day, especially in occupational use‐situations. Little is known about how the daily frequency of application of an allergen in a product influences the allergic response.

Objectives:  This study investigates the allergic responses elicited in pre‐sensitised individuals when exposed to a specific amount of allergen applied either in 1 application per day or distributed over 4 applications per day. As model allergen is used the cosmetic preservative methyldibromo glutaronitrile (MDBGN). Patients/Methods: 19 contact allergic individuals and 12 controls participated in a double‐blind, randomized repeated open application test (ROAT) using two coded aqua/ethanol (80:20) solutions preserved with 100 ppm and 400 ppm MDBGN, respectively. 12 cm2 areas on the lower arms were applied 2 drops either once daily of the 400 ppm solution or 4 times a day for the 100 ppm solution.

Results:  Most patients developed dermatitis following application of approximately equal amounts of MDBGN on both arms not distinguishing whether the allergen was applied as a 400 ppm solution once daily or a 100 ppm solution 4 times daily. Controls were negative.

Conclusions:  Applications with 400 ppm MDBGN once daily or 100 ppm MDBGN 4 times per day had, in a ROAT study, approximately equal capabilities of provoking allergic dermatitis in agreement with well‐known patch test data that dose per unit area is more important than concentration of allergen in the product. This may complicate risk assessment and regulation of cosmetic allergens. Further studies, however, are needed before more general conclusions can be made.
FS04.7 Atypic T‐cell infiltrate by isothiazolinone. Question to discuss
Authors: Giménez‐Arnau Ana , Toll A , Gallardo F , Roman J , Pujol‐Vallverdú RM
Published: August 2010

Methyl(chloro)isothiazolinone is an effective preservative and a major cause of cosmetic allergy in most European countries. On the face unusual clinical presentations are seborrhoeic dermatitis, lupus erythematosus, lymphocytic infiltrate, photodermatosis or atopic dermatitis. Three patients who suffered a chronic, recurrent, itchy and generalized cutaneous erytematous‐desquamative and eczematous eruption with a common pathologic event, an atypical lymphoid infiltrate, whose induction by a contact allergen can be discussed are presented. The first, a 59 years old man showed a biopsy with an atypical dermal‐epidermal T cell infiltrate of mycosis fungoides and monoclonal TCR‐rearrangement. The second, a 74 years old man showed an atypical lymphoid infiltration with polyclonal TCR‐rearrangement and a second biopsy showed an eczematous pattern. The third, a 50 year old man with pathology of plaque parapsoriasis with atypical lymphoid infiltrate. The three patients showed strong positive reaction to methyl(chloro)isothiazolinone (0.01%aq.) Trolab,,μ. Avoiding the allergen the cutaneous eruption disappeared and any recurrence has been observed yet. Pathologic criteria for mycosis fungoides remains controversial and could not be done only on the basis of cellular density or the percentage of atypical T‐cells. Autoinvolutive mycosis fungoides shows the unknowledge of its pathogenesis. How some allergens could affect on the cellular life needs further studies. We highly recommend to patch test all patients with atypical cutaneous T‐cell infiltrates.
FC01.4 Occupational skin diseases in different metal‐working industries
Authors: Bock M , Schmidt A , Bruckner T , Diepgen Thomas L
Published: August 2010

Objectives:  To analyse the yearly incidence rates and causes of occupational skin diseases (OSD) in different metal‐working industries.

Methods:  Between 1990 and 1999, all new cases of OSD and their causes were prospectively recorded in all metal‐working enterprises of Northern Bavaria. We calculated the incidence rates according to the average employed population. Furthermore, we analysed the different allergens, irritants and constitutional factors (e.g. atopy) in the affected metal workers.

Results:  In metal workers, a total of 700 OSDs were registered which comprise 18.8% of all OSDs in our register. They were classified into metal‐surface processors (260 OSDs, yearly incidence per 10,000 employees = 10.4), metal processors (129 OSDs, 5.9), locksmiths and automobile mechanics (119 OSDs, 2.5), electrical industry (69 OSDs, 1.4), machinists (47 OSDs, 11.6), mechanics (40 OSDs, 6.6), electroplaters (22 OSDs, 20.6) and solderers (14 OSDs, 13.4). The proportion between allergic (ACD) and irritant contact dermatitis (ICD) varies conspicuously. While electroplaters and solderers predominantly suffer from ACD (82% resp. 71%), in other occupational groups ICD is more common: mechanics (60%), locksmiths and automobile mechanics (59%) or metal‐surface processors (53%). The type IV allergens differ widely depending on the occupational exposure. The most important allergen in solderers is colophony, in electroplaters nickel sulphate and potassium dichromate. There is a wide range of allergens in metal working fluids and it is mandatory to patch test patient‘s own working materials due to the fact that important allergens are not yet included in the screening series.
FC01.6 Hand dermatitis of hairdressers. Study of protective gloves permeation
Authors: Arcangeli Giulio , Bavazzano P , Perico A , Montalti M , Guarducci L , Cupelli V
Published: August 2010

Contact dermatitis among hairdressers is common and is one of the most frequent occupational dematoses due to continual exposure to water, detergents, hair dyes, permanent waves and metal equipment. Use of individual protection systems – as gloves – is considered a good measure of prevention. Few data exist about the real permeation resistance (PR) of gloves, also in term of time of PR. We tested two types of djsposable latex gloves different by thickness and density of the manufacture material. We used a permeation cell composed of two separated parts: in the upper part we introduced the hair colouring formulation and in the lower one the collection medium (NaHSO3 1% in water); the two parts were separated by a portion of the glove material. A 100 microL volume of the collection medium was collected and injected onto a HPLC apparatus after 1, 2, 4 and 24 hours. A diode array detector was utilised selecting two wavelengths in the UV range (240 and 275 nm) with a linear concentration gradient up to 60% of methanol/acetonitril mixture. We can simultaneously analyse 9 oxidation dyes and the detection limits were sufficient to determine these substances at very low concentrations. We obtained respectively a breakthrough time less than 24 hours for the lower thickness glove and of over 24 hours for the other one; the latex gloves are suitable for prevent the skin contamination during the preparation of the colourings mixture in the hairdresser activity. The obtained data show those latex gloves, of both thickness, have a very high PR. On the other hand, the use of latex gloves has been associated with the more frequent recognition of immediate‐type hypersensitivity responses related to latex products. The prosecution of the study will evaluate the PR of latex‐free gloves.
FC02.4 Meteorological factors and standard series patch test reactions
Authors: Hegewald Janice , Pfahlberg A , Schnuch A , Kränke B , Uter W
Published: August 2010

The existence of seasonal patterns to patch test reactions has been described, but with conflicting causal interpretations. The potential seasonality of patch tests may be due to irritation, changes to skin barrier or changes to immunological functions caused by meteorological fluctuations. For example, increased skin irritability due to cold winter weather and low humidity may cause an increase in irritative/doubtful and weak positive (false positive) reactions. To investigate the extent of the association between weather and patch test results, consecutive patients (N = 73691) patch tested with the standard series of the German Contact Dermatitis Research Group (DKG) at German or Austrian IVDK (http://www.ivdk.de) centres were matched with weather data collected at a nearby (30 km radius) weather station. Temperature and absolute humidity (AH) on the day of patch test application and the two preceding days were averaged to represent the environment most likely to have influenced the skin condition at the time of testing. The results of 24 standard series substances were analyzed with multivariate logistic regression. Half of the standard series substances examined, including fragrance mix, nickel sulphate, and formaldehyde, exhibited evidence of a relationship with meteorological conditions. Fragrance mix and p‐Phenylene diamine exhibited the strongest evidence of an association to weather, with the odds of the reactions in all three reaction categories (ir/?, +, ++/+++) increasing during winter conditions. Due to the association between weather and patch test reactivity, the potential effect of meteorological conditions should be considered in the interpretation of patch test reactions.
FC02.5 Investigation of reactions to dental materials
Authors: Gawkrodger David J
Published: August 2010

In dentistry there are many potential allergens and irritants. Patients may have an adverse reaction in minutes, hours or days after dental procedures. Dentists use many metals e.g. mercury in amalgam restorations, which may give an oral lichenoid eruption, and gold, and platinum group metals for inlays, crowns or bridges, which may give allergic reactions. Dentists, for dentures, use acrylate resins extensively and traces of which can give rise to allergic symptoms, though most cases are not ‘allergic’ in origin. Dental personnel have a high frequency of occupational skin problems and may complain of hand dermatitis or itching, facial eruptions or respiratory symptoms. With regard to oral lichenoid lesions, the proportion of patients allergic to mercury on patch testing varies according to series, from 67% down to 8%. In some cases, the mechanism can be irritant as well as allergic. Gold can cause lichenoid eruption or other changes. The role of palladium is still very difficult to judge. Cheilitis is particularly difficult to investigate, as there are many causes. The aetiology is irritant in 33%, allergic contact dermatitis in 25% and atopic eczema in 20%. Benzoates, antioxidants or flavourings in foods sometimes cause lip swelling. Hand dermatitis is common in dental personnel. Common causes are irritancy, latex contact urticaria, and allergic contact dermatitis to acrylates, Myroxolon, fragrance, thiuram and colophonium. In the investigation of reactions in dental patients many things need to be considered and often the cause is not related to the dental materials suspected.
FS05.3 New characterization and chemistry of Germall 115 and Germall II
Authors: Lehmann Søren Vig , Hoeck U , Breinholdt J , Olsen CE
Published: August 2010

Germall 115 and Germall II are well known cosmetic preservatives, widely used as such since the early 1970’s and 1980’s, respectively. This investigation reveals that they have mistakenly been regarded as pure chemical entities with specific structures by the majority of the chemical society. In fact Germall 115 and Germall II both consist of complex mixtures of numerous and fast degradable allantoin‐formaldehyde condensation products and may not even contain the conventionally assigned chemical structures of imidazolidinyl urea (Germall 115) and diazolidinyl urea (Germall II). Equilibrium between different structures may be formed in different cosmetic formulations/test materials. This may have led to the discrepancies in the literature: Are the Germalls themselves sensitizers or are the allergic reactions caused by formaldehyde release? The identification and structure assignment of (4‐hydroxymethyl‐2,5‐dioxo‐imidazolidin‐4‐yl)‐urea (HU) will be presented, as it is the major and chemically stable degradation product of both Diazolidinyl urea and Imidazolidinyl urea. A guinea pig maximization test has been performed to determine the potential of HU to induce delayed contact hypersensibility in guinea pigs. Separate chemically stable TRUE Test patches containing the mixtures have shown clinical efficacy.
FS05.4 Contact sensitization in Italian children over a 7 year period
Authors: Seidenari Stefania , Giusti F , Mondino M , Massone F , Pepe P , Pellacani G
Published: August 2010

Our aim was to investigate contact sensitization in children over a 7 year period and to compare these data to our previous findings. From January 1995 to December 2001, 1094 children with suspected allergic contact dermatitis were patch tested with our paediatric series of 30 substances. 404 were affected by atopic dermatitis. 570 children (52.1%), 300 girls and 270 boys, proved to be sensitized. Among them, 291 (51%) were polysensitized. Neomycin, nickel sulfate, wool alcohols, thimerosal, ammoniated mercury, and propolis gave the highest number of positive responses. No significant differences were observed in the prevalence of contact sensitization among the patients with atopic dermatitis and non atopics. However, in the latter the frequency of positive responses to nickel sulfate and Kathon CG was significantly lower than in the former. The face (25%), the hands (23%), and the flexural areas of the limbs (18%) were most frequently affected in children with positive patch tests. In this study population the frequency of sensitized children was significantly higher than the one found from 1988 to 1994, in particular for neomycin, nickel sulfate, wool alcohols, ammoniated mercury, propolis, potassium dichromate, mercaptobenzothiazole and thiuram mix. Our data demonstrate that contact sensitization is more and more frequent in children referring to our department and that the importance of some allergens, such as neomycin, wool alcohols, propolis and potassium dichromate, is increasing in the paediatric age with respect to previous results.
FS05.5 The European Standard Series in 8 European countries – first results of the ESSCA network
Authors: Uter Wolfgang , Hegewald J , Aberer W , Bircher A , Brasch J , Coenraads PJ , Elsner P , Fartasch M , Frosch P , Fuchs T , Menné T , Jolanki R , Krêcisz B , Orton D , Perrenoud D , Schnuch A
Published: August 2010

Since January 2001, the European surveillance system on contact allergies (ESSCA) has developed a suitable infrastructure with the financial support of EU funding (QLK4‐CT‐2001–00343 and –2001–2812), and has started to collect patch test data. These comprise a standardized clinical history and patch test results with the European standard series, contributed by the 12 centres in 8 European countries listed above. So far, with the 2003 data collection not yet completed, 7636 patients’ test results have been pooled and analysed; current data pertaining to 2002 and 2003 will be presented. Anamnestic data reflect partly the specialties of some centres (e.g., the % of occupational and hand dermatitis ranging between 6 and 29% and 18 and 56%), partly different selection criteria or possibly also definitions (e.g., 7–32% with underlying atopic dermatitis, 40–69% of patients age 40+). The leading allergen was nickel sulfate (15.7%, age‐ and sex‐standardized), with however, large inter‐national variation (the lowest standardized prevalence, 9.7%, was observed in Gentofte, Denmark, where nickel regulation had long been introduced). The prevalence of contact allergy to Myroxylon Pereirae resin (7.8%) has almost reached the frequency found with the fragrance mix (8.3%). In the two centres using the True Test™, both percentages were even lower, which may be indicative of a systematic effect. Within a few years, ESSCA is expected to meet its objective of increased consumer safety by post‐marketing surveillance by continuously monitoring contact allergy across Europe.
FS06.4 Milia as sequelae to allergic contact dermatitis, a case report
Authors: Thormann Henrik , Andersen KE
Published: August 2010

Milia are small sub epidermal keratin cysts. They may be seen following bullous diseases disrupting the dermo‐epidermal junction. They may occur rarely as a complication to contact allergic reactions. An oak moss allergic patient participated in a dose response ROAT with chloratranol, shown to be a potent allergen in oak moss. The patient reacted to choratranol at patch testing down to 0.0063 ppm, and started a ROAT by application of 2 drops of a 5 ppm solution to an area of 3 × 3 centimetres on the volar aspect of one forearm. After 1 day severe oedematous dermatitis was observed and blistering was seen at day 2. The test was stopped and the patient treated with systemic prednisolone. At a 3 month control visit milia were seen at the application site on the forearm but not on the back where the patch tests were applied. The patient had no subjective symptoms and the milia were easily removed with a sterile needle. The presence of milia as sequelae seems to reflect the depth and severity of the allergic contact dermatitis developed months earlier. This observation underlines the potency of chloratranol as a very strong allergen.
FS06.5 Fragrance sensitization in geriatric nurses
Authors: Schürer Nanna , Schwanitz HJ
Published: August 2010

Objective:  The incidence of occupational hand dermatitis in geriatric nurses (GN) is increasing. 102 GN were involved in a program of secondary individual prevention at the University of Osnabrück. Prior to participation a patch test was performed in 99 of 102 IG by the dermatologist in charge. Sensitization to the fragrance mix was noted in 16% of cases. However, not once the fragrance mix was splitted. One of the GN was presented for further work up, revealing sensitizations to cinnamic alcohol and aldehyde, hydroxycitronellal, isoeugenol, lyral as well as ylang‐ylang oil.

Method:  Patch tests according to the DKG guidelines were performed. To reveal the composition, fragrance oils were submitted to gas chromatography.

Results:  Additional patch tests to various ylang‐ylang oils employing various concentrations reveal different patch test reactions. Further work up employing gas chromatography of different ylang‐ylang oils will be presented and relevance of patch test will be discussed. Hence cinnamic alcohol is frequently employed by the perfume and cosmetic industry, further patch tests of cinnamic alcohol in petrolatum at various concentrations as well as given cinnamic‐alcohol‐containing‐products are performed. Relevance of patch test results will be presented and discussed with respect to the current discussion of labelling skin sensitizers.

Conclusion:  At present the fragrance mix is not commonly splitted. Dermatologist in practice test the fragrance mix. When patch testing naturally occurring fragrance oils, origins and extracts thereof must be considered, because they may contain different allergens relevant for sensitization.
FS06.6 Mucosal symptoms elicited by fragrances; a population‐based study
Authors: Elberling Jesper , Linneberg A , Mosbech H , Dirksen A , Frølund L , Madsen F , Nielsen N Henrik , Johansen J Duus
Published: August 2010

Objectives:  To investigate symptoms from the eyes and airways, elicited by perfume and fragrance products and associations between such symptoms and skin prick test reactivity, metacholine bronchial hyperreactivity (BHR), contact allergy, and eczema in a population based sample.

Methods:  A questionnaire on mucosal symptoms elicited by fragrance products was mailed to 1189 persons who had participated in a Danish population‐based study of allergic diseases in 1997/98. The study included measurement of BHR, skin prick testing, patch testing and history of hand eczema.

Results:  The response rate to the questionnaire was 80%. Symptoms from the eyes or airways elicited by fragrance products were reported by 42%. There were no significant associations between these symptoms and skin prick test reactivity. Positive and independent statistical significant associations were found between BHR, perfume contact allergy and hand eczema, and symptoms from the eyes and airways elicited by fragrance products, also when adjusting for nickel contact allergy, age, gender psychological vulnerability, educational level and social class.

Conclusions:  Individuals with BHR, hand eczema and/or perfume contact allergy, as opposed to those without, are more frequently and more severely bothered from the eyes or airways after volatile exposure to fragrance products. The lack of association with skin prick test reactivity indicates that IgE mediated allergic mechanisms do not play a major role in the development of these symptoms. Having hand eczema has the greatest impact on reporting mucosal symptoms elicited by fragrance products.
FS07.6 Efficacy of UVB radiation versus skin protection in the prevention of hand dermatitis in baker apprentices
Authors: Bauer Andrea , Kelterer D , Bartsch R , Stadeler M , Kleesz P , Grieshaber R , Elsner P
Published: August 2010

In‐vitro and in‐vivo data suggest the efficacy of various skin protection measures in the prevention of hand dermatitis (HD). The aims and objectives of this intervention study was to quantify the efficacy of skin protection (SP) measures and UVB hardening in the prevention of HD. SP measures were compared against UVB hardening in a controlled clinical trial of 94 apprentices. The apprentices were assigned to the intervention arms class‐wise. Baker apprentices involved in a previous follow‐up study served as an additional historic control group representing no intervention. The apprentices were interviewed and examined in a standardised way at the beginning of the vocational training and at four follow‐ups. Transepidermal water loss (TEWL) was measured at the back of the hands. Point prevalence of HD in the groups after 6 months was highest in the controls (C)(29.1%) followed by the UVB‐group (19.4%) and the SP group (13.3%). UVB hardening and SP measures were associated with a reduction in HD prevalence by 9.7%(95%CI −8.5 to 28.1) and 15.8%(95%CI −2.4 to 33.9), respectively. Unadjusted logistic regression analysis showed atopy (OR = 4.74, 95%CI 1.12–20.11, p = 0.035) and skin care (OR 0.39, 95%CI 0.16–0.86, p = 0.023) to be independent risk factors. Application of SP measures reduced the OR for HD 0.8 (95%CI 0.17–3.70) and 0.33 (95%CI 0.09–1.23) fold compared to the UVB and C group, respectively. The trends in the clinical results were confirmed by statistically significant differences in TEWL values. Apprentices in the SP group consistently had a lower prevalence of HD compared to the apprentices in the UVB and C group. These trends were reinforced by statistically significant differences in TEWL levels. A multi‐centre trial is recommended to confirm the efficacy of SP measures in a larger randomised study.
FS08.4 Prognosis of hand eczema – a 15‐year follow‐up
Authors: Wrangsjö Karin , Järvholm B , Meding B
Published: August 2010

Aims:
To study long‐term prognosis of hand eczema and to identify factors of importance for the prognosis.

Methods:
A cohort of 1238 individuals with verified hand eczema diagnosis was established by a population‐based prevalence study in Gothenburg, Sweden, in 1982–83. In 1998 a questionnaire was mailed to all individuals with available addresses (n = 1115). The response ratio was 78%(868/1115).

Results:
66% reported periods of hand eczema since 1983, and 44% during the past year. 12% stated continuous symptoms. No significant difference was found between the sexes. 74% of those who reported symptoms after 1983 considered that their hand eczema had improved. Significant differences in the persistence of hand eczema were related to the age at onset of hand eczema, skin atopy, and the extension of eczema at examination. Contact allergy related significantly to occurrence of hand eczema during the year before follow‐up. 32% had visited a doctor, 7% reported sick leave periods, 2% sick pension and 3% change of occupation due to hand eczema.

Conclusions:
In this population‐based study, a majority of individuals with hand eczema reported periods of eczema during a 15‐year follow‐up, implying that hand eczema is a longstanding disease. Young age at onset, history of childhood eczema and extension of the hand eczema were prognostic factors. Hand eczema did entail consequences like change of occupation, sick leave or pension in more than 10% during a 15‐year period.
PCS.03 Risk assessment in practice – clinical problems in ACD. Occupational perspectives
Authors: Isaksson Marlene
Published: August 2010

This lecture will focus on consequences for the affected labour force following contact with well‐known allergens in new technical applications, or when the risk assessment of chemicals has been done by persons without sufficient knowledge of factors significant for the induction and elicitation of contact allergy and allergic contact dermatitis. When chemicals with noxious characteristics to both the airways and the skin are handled, the focus is by far and foremost on protection of the airways. However, one must consider the difference of dose needed for airway diseases compared to skin diseases with regard to allergic contact dermatitis. For contact allergy, it is not the total dose that is the culprit but the dose/unit area, i.e. a high concentration of a chemical on a limited skin area may be deleterious. This implies that contamination outside the working operation (e.g. on handles and doors) may lead to sensitisation and allergic contact dermatitis.

Examples will be given from the dental profession ((meth)acrylates), the manufacture of resol resins based on phenol and formaldehyde in the production of laminate, and from manual labour including contact with isocyanates and epoxy resins in the manufacture of water‐repelling surfaces on floor boards and in the production of wings for wind mills, respectively.
Dose response aspects of contact allergy
Authors: Johansen Jeanne Duus
Published: August 2010

It has been shown by series of experiments that the induction of contact allergy depends on the concentration of allergen per unit skin rather than the total dose delivered. This means that a high concentration of allergen delivered to a small area of the skin comprise a higher risk of induction than if the same total amount is applied to a larger skin area. Attempts have been made to exploit this knowledge in risk assessment models for induction of contact allergy. The concentration (dose per unit skin) applied at induction also determines the sensitivity of the individual at elicitation. It also seems that smaller concentrations of allergen are required to sensitise individuals with pre‐existing contact allergy than those without.Once a person is sensitised to a substance, the sensitivity of the individual in combination with the level of exposure to the allergen, determines whether clinical symptoms will occur. These dose‐response relationships can be studied in sensitised individuals by re‐application of a serial dilution of the relevant allergen either under patch test conditions or by repeated open applications. Thresholds for no‐response or minimum effect levels may be determined for different allergens and used systematically for preventive purposes. Practical examples of such successful prevention exist regarding nickel and chromium allergy, providing both primary and secondary preventive effects. Further understanding of the dose‐ response relationships is important in diagnosing contact allergy and advising the patient relevantly.
FS09.3 Can Flutivate® cream be safely used in formaldehyde‐allergic patients?
Authors: Isaksson Marléne , Gruvberger B , Goon A T‐J , Bruze M
Published: August 2010

Objectives:  To study the healing time of an experimental eczema treated with Flutivate® cream, a potent corticosteroid containing a formaldehyde releasing preservative, in patients allergic to formaldehyde and controls not allergic to formaldehyde.

Methods:  24 individuals allergic to nickel, 7 of whom were also allergic to formaldehyde, had a nickel‐allergic contact dermatitis experimentally induced on both upper arms. The dermatitis was treated twice daily for a maximum of 3 weeks or until healing with either Flutivate® cream or Betnovate® cream, a corticosteroid with the same potency but containing another preservative, which was tolerated by all 24 study persons. The study was double‐blind and randomized.

Results:  In 12/17 controls (71%) the nickel‐allergic contact dermatitis healed completely when treated with Flutivate® cream compared to 2/7 formaldehyde‐allergic patients (29%)(p < 0.05).

Conclusion:  Flutivate® cream should not be used by individuals allergic to formaldehyde.
FS09.4 Methyldibromo glutaronitrile in leave‐on products
Authors: Pedersen Line Kynemund , Agner T , Held E , Duus J Johansen
Published: August 2010

The rapidly increasing frequency of contact allergy to methyldibromo glutaronitrile (MDBGN) is of concern. This study investigates the allergic response elicited in pre‐sensitised individuals from exposure to a leave‐on product preserved with 50 or 100 ppm MDBGN.

Material and methods:  Eighteen volunteers with contact allergy to MDBGN and 10 healthy controls were exposed to repeated open allication tests (ROAT) with two moisturisers with a high and a low lipid content, respectively, both containing MDBGN in a concentration of 50 ppm. The ROATs were performed on the left and the right side of the neck for 14 days, or until a positive reaction was seen. If a positive reaction did not develop within the first 14 days the application with analogous moisturisers containing 100 ppm MDBGN continued for further 14 days.

Results:  Eleven (61.1%) developed dermatitis on the test area, and 10 (55.5%) developed a positive reaction to 50 ppm moisturiser. Reactions to the low‐ moisturiser were the most frequent. the controls all had negative ROATs.

Conclusion:  A concentration of 50 ppm MDBGN in a leave‐on product was found to elicit an allergic reaction in more than half of sensitised individuals when applied on the neck.
FS09.7 Standardisation of the “strip” patch test: a multicentre study
Authors: Dickel Heinrich , Brasch J , Bruckner T , Erdmann S , Fluhr J , Frosch P , Grabbe J , Löffler H , Merk HF , Pirker C , Schwanitz H , Weisshaar E
Published: August 2010

Objectives:  The strip patch test (SPT), proposed by Spier and Sixt (Hautarzt 1955;6:152–9), is a modification of the patch test (PT). This technique is used to enhance penetration through the stratum corneum for poorly penetrating substances such as medicaments. So far, a standardised procedure is lacking. This multicentre study aims at standardising the SPT procedure.

Methods:  A total of 83 healthy volunteers participated. In each subject, we determined the number of strips (A) until the surface became glistening and then calculated the median number of strips in the sample (Ā = 26). We ascertained the median number of strips in the sample (ā = 11) that was necessary to achieve a first statistically significant and medically relevant increase of the TEWL revealing a critical stratum corneum strip depth. For the finally calculated number of strips for each subject (a/A = (ā/Ā)⇔a = A × (ā/Ā)), the actual increase in test sensitivity was substantiated employing SLS 0.125% aqueous.

Standardisation results:  Perform stripping at one upper part of the back until the surface becomes glistening: gently press a 25 mm diameter adhesive tape downward vertically for about 2 seconds and then remove it in one quick movement at the angle in direction of adherence; continue stripping with a new tape cut on exactly the same skin area. Multiply number of strips by the correction factor (cf = ā/Ā = 11/26 = 0.4). Perform calculated number of strips likewise on the contralateral site and then apply there the test preparation for 24 hours.

Conclusions:  If clinically an allergic contact dermatitis is expected but PT is negative, the SPT might reveal the potential allergen.
FS10.1 Current spectrum of contact allergens in metalworking fluids
Authors: Geier Johannes , Lessmann H , Uter W , Schnuch A
Published: August 2010

The current spectrum of contact allergens in metalworking fluids (MWF) is illustrated based on (I) recent patch test data from the Information Network of Departments of Dermatology (IVDK) concerning metalworkers tested in 2002/2003 due to suspected MWF dermatitis, (II) a study on occupational contact allergies performed in the IVDK 1999–2001 (FaSt study), (III) a patch test study in five centres of the German Contact Dermatitis Research Group (DKG) with components of MWF not routinely tested, and (IV) information from the interdisciplinary task force on allergy diagnostics in the metal branch. Potential allergens are found in various MWF components, mainly in emulsifiers, rust preventing agents, preservatives, and anti‐wear‐additives. Various special additives also may contain potential allergens. Currently, the most important MWF allergens are: – oxidation products from resin acids, e.g. abietic acid, in distilled tall oil, a frequently used base material of MWF. Contact allergy to these is detected by patch testing with colophony. – monoethanolamine, diglycolamine – used as rust preventing agents and emulsifiers. – formaldehyde and various formaldehyde releasers, mainly oxazolidine derivatives – used as biocides. Other biocides, e.g. Methylchloroisothiazolinone/Methylisothiazolinone (MCI/MI), Benzisothiazolinone (BIT) or Iodopropynyl butylcarbamate (IPBC) are also used in MWF and should hence be tested routinely. While odour masks for MWF are available, little is known about the extent of their usage. However, this allergen source should be considered in cases of fragrance allergy. Cobalt apparently is a relevant MWF allergen only in carbid metal processing.
FS10.2 Occupational contact dermatitis in health care workers
Authors: Mahler Vera , Bruckner T , Schmidt A , Diepgen T L
Published: August 2010

Objectives:  Occupational skin diseases (OSDs) account for a large number of occupational diseases in Europe. Population‐based epidemiological studies concerning certain occupations (e.g. Health care workers), however, are missing.

Aim of our study was to analyse the reports of OSD in Health care workers (HCW) in the register of OSDs of Northern Bavaria and to assess the annual incidence in this occupational group in relationship to the total employed population in Northern Bavaria. Further, we investigated the spectrum of sensitizations with and without occupational relevance in this group.

Methods:  A total of 5285 cases of OSD were assessed prospectively and registered from 1990–1999. Data of total employment were provided by the German Federal Employment office.

Results:  A total of 3097 cases were confirmed as OSD in 24 occupational groups, of which 482 were confirmed in the group of HCW. The average annual incidence of OSD in this group accounted for 7.3 per 10,000 workers. In 1990 the incidences in this occupational group accounted for 11.4%, in 1999 for 5.0% per 10,000 workers with highest incidences in younger age groups. In the evaluated health care workers from the register of OSD in Northern Bavaria 54%(n = 260) had irritant and 51%(n = 244) had allergic contact dermatitis including 19%(n = 89) who suffered from both. Of the 482 HCW 13% had occupational relevant Type IV allergy to glutaraldehyde, 12% to thiurams, 6% to nickel (II) sulfate, 4% to formaldehyde or fragances, respectively, 2% to thimerosal, potassium (II) chloride, chloromethyl‐isothiazolone and p‐phenylendiamine (free base) each.

Conclusions:  HCW belong to the occupational groups at exceedingly high risk for OSD. Higher frequencies of OSD occur in younger age groups. Irritant and allergic contact dermatitis are equally common causes of OSD in HCW. Sensitization to certain allergens (e.g. glutaraldehyde, thiurams and latex) are most often of occupational relevance, whereas others although frequently found (e.g. sensitization to nickel‐II‐sulfate, cobalt‐II‐chloride, fragance‐mix) rarely are of occupational relevance.
FS10.7 A surveillance network for occupational contact dermatitis utilizing general practitioners
Authors: Nixon Rosemary , Keegel T , Noonan A , Saunders H , Frowen K
Published: August 2010

Objectives:  The Surveillance by General Practitioners of Occupational Contact Dermatitis Project (Spot) has been designed to provide disease estimates for occupational contact dermatitis within a defined geographic area in Melbourne, Australia.

Method:  Spot collected reports of occupational contact dermatitis from four separate sources: general practitioners, dermatologists, a Dermatology Outpatient clinic, and an Occupational Dermatology Clinic. Case definition was stratified into two levels, suspected and confirmed. All cases of suspected occupational contact dermatitis reported to Spot were assessed and required to undergo diagnostic confirmation, including appropriate patch testing by an occupational dermatologist. The rates generated by Spot were compared to the rates generated by Victorian workers’ compensation data (Victorian Work Cover Authority) for “Contact dermatitis and other and unspecified dermatitis.”

Results:  To date, a total of 125 suspected cases have been reported to Spot. 56 cases of occupational contact dermatitis have been confirmed with an incidence rate of 12.5 per 100,000 full‐time workers and a prevalence rate of 28 per 100,000. This can be compared to the rate from Victorian WorkCover Authority of 4 per 100,000 (with information not available for incidence or prevalence).

Conclusions:  Although limited by resources, clinician and worker participation rates, Spot provides a better estimate for occupational contact dermatitis in an Australian urban setting than that currently available through workers’ compensation statistics. The information generated by Spot will provide an important contribution towards the characterisation of occupational contact dermatitis in Australia.
The value of skin testing in the study of drug eruptions
Authors: Gonçalo Margarida
Published: August 2010

Abstract not available at the time of printing.
FS11.1 Primula obconica – a falling allergen
Authors: Connolly Maureen , Mc Cune J , Dauncey E , Lovell C
Published: August 2010

Objective:  We believe the incidence of primula contact allergic dermatitis has fallen since the introduction of primin‐free primula onto the European market and thus our study aims were twofold. Firstly to see if the incidence of primula contact allergic dermatitis was truly on the decline and secondly to confirm the presence and document retailers’ knowledge and awareness of primin‐free primula in the UK.

Methods:  A questionnaire was sent to 22 contact dermatitis departments throughout the UK and Ireland looking at the number of primin positive patch tests in the years 1995/96, 1998, 2000 and 2002 compared with the total number of patch tests. 10 seed suppliers and 12 plant retailers were asked to complete a telephone survey.

Results:  We showed a significant fall in the yearly incidence of contact allergy to primin from 0.785% in 1995/96 to 0.457% in 2002. This downward trend was statistically significant (p = 0.001). The telephone survey showed 90% of seed suppliers were aware that the older varieties of P. obconica could cause an allergic reaction whereas only 60% of them were aware that new primin‐free varieties were now being bred. 50% of suppliers were in fact selling these primin‐free varieties with 60% of them stocking a primin‐free variety exclusively. 90% of retailers were not currently selling any variety of P. obconica.

Conclusion:  Our study shows that the incidence of primula contact dermatitis is falling. The overall trend is moving towards primin‐free varieties provided they continue to be horticulturally viable long term.
FS11.2 Contact allergy to herbal teas from Asteraceae plants
Authors: Mårtensson Kerstin , Hindsén M , Gruvberger B , Möller H , Svensson Å , Bruze M
Published: August 2010

Objective:  A possible contact allergy to herbal teas, in particular those derived from the Asteraceae plant family, was investigated in patients allergic to sesquiterpene lactones (SL).

Method:  Twenty patients with a contact allergy to SL were recalled and patch‐tested with aqueous, ethanol and acetone extracts of 8 different herbal teas based on Asteraceae plants as well as with parthenolide and other SL.

Results:  In 18/20 patients with SL allergy there were positive test reactions to the Asteraceae teas, mainly to those based on German chamomile, dandelion and milfoil. Among the SL, parthenolide was the most frequent co‐reactor.

Conclusion:  Most patients with a contact allergy to SL are allergic to commercial teas derived from the Asteraceae plant family as well.