bluuebunny/crossref_metadata_2025_split huggingface dataset:
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.
FS10.2 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.
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.
FS11.3 Contact allergy to the sesquiterpene lactone calocephalin
Authors: Hindsén Monica , Christensen LP , Paulsen E 
Published: August 2010

Background:  A 63‐year old female gardener developed eczema on her hands, arms and face. She suspected cushion bush, Calocephalus brownii F. Muell., a plant introduced in Sweden by her. This plant belongs to the Asteraceae family.Methods:  Patch testing with our standard series, plant series and acetone extract of cushion bush. The predominating sesquiterpene lactone (SL) calocephalin identified in the plant extract was patch tested in the patient and 20 controls. Calocephalin was isolated from the plant extract of cushion bush by column chromatography and preparative high‐performance liquid chromatography (HPLC) and identified by mass spectrometry and nuclear magnetic resonance (NMR) spectroscopy.Results:  The patient was negative to the standard series but positive to parthenolide and to the cushion bush extract. Likewise, positive reactions to cushion bush extracts were seen in SL‐mix positive but not in negative patients. Parthenolide was not present in the plant extract as shown by gas chromatography‐mass spectrometry (GC‐MS) analysis, while the guaianolide calocephalin was identified as the major SL. The patient tested positively to calocephalin while the controls tested negatively.Conclusion:  The plant cushion bush can cause occupational allergic contact dermatitis and the major contact sensitizer in the plant is the SL calocephalin.
FS13.2 Intervention on work‐related skin problems among gut cleaners
Authors: Flyvholm Mari‐Ann , Mygind K , Jensen A , Jepsen KF , Sell L , Villadsen E 
Published: August 2010

Work‐related skin problems are frequent in the food processing industry. A randomised intervention study with a one‐year follow up was carried out among gut cleaners in order to prevent work‐related skin problems due to wet work. The effects of the intervention were primarily measured by telephone interviews using questionnaires based on a standardized questionnaire for work‐related skin diseases and exposure (NOSQ‐2002).* The intervention activities included an evidence‐based prevention program and an evidence‐based method for implementation. Six of the 18 participating departments were randomly assigned to the intervention group and the remaining 12 departments to the comparison group. A total of 644 employees responded in the baseline interview and 622 in the follow‐up interview carried out a year later. The participation rates were 87,5% and 71,6% respectively. Among the 495 participants answering in both interviews the frequency of eczema on hands or forearms within the past 3 months was reduced significantly by more than 25% in the intervention departments. A minor increase was observed in the comparison departments. This study has shown that even in jobs without the possibility to reduce high exposure to wet work work‐related skin problems can be reduced by proper preventive measures.*) Susitaival P, Flyvholm M‐A, Meding B, Kanerva L, Lindberg M, Svensson Å, Ólafsson JH. Contact Dermatitis 2003;49:70–76.
PCS.05 Establishment of safe exposure limits for the induction of allergy. Practical examples
Authors: Menné Torkil 
Published: August 2010

The WHO criteria for drug allergy can be adapted as guidelines for primary sensitisation from consumer products or occupational exposures. In case a person with a formerly healthy skin, develops allergic contact dermatitis after a specific exposure (a product or occupational exposure) has a positive patch test to specific chemical present in the product and ideally a positive either patch test or use test to the product during re‐exposure primary sensitisation is likely.Allergic contact sensitisation is a unique toxicological event (e.g. compared to cancer) as there is a direct (time and skin area) correlation between exposure and disease and the basic damage on the individual can be identified by the diagnostic patch test. Primary sensitisation may occur after single exposure to potent allergens, experimental from DNCB, in the US poison ivy, occupational accidental exposure to isothiazolones (in%) or from hair dying with PPD and its derivatives as a flare‐up reaction occurring 1–2 weeks after the original exposure.The ongoing epidemic caused by methyldibromo glutaronitrile (MDGN) provides unique options for studying primary sensitisation from consumer products as the clinical reactions are often very severe and patch test reaction with the products often exceeds the strength of the standard patch test response. Chemical analysis of the products involved uniformly illustrates the presence of MDGN within the legal permitted concentration. At the start of the epidemic, primary sensitisation was mostly seen from leave on products. After EU actions in 2002 against the use of MDGN in leave on products primary sensitisation from this preservative is now caused by wash off products. This observation is significant as it underscores the effect of specific exposures for primary sensitisation from consumer products but also the fact that primary sensitisation from a moderate to strong hapten is possible from wash off products. The MDGN story has illustrated that human data are pivotal for the current risk assessment – risk management. No new chemical should be permanently permitted in consumer products before significant post marketing data, collected after stringent criteria, are public available and scrutinised by an independent scientific committee.Human sensitisation data has successfully been used to introduce regulation of nickel exposure from consumer items. The year 2000 EU regulation has been in use in Denmark for more than 10 years. A significant decline in both induction and elicitation of dermatitis from nickel releasing items has been observed. Health economists have calculated that the direct savings from the regulation amount to 1.2 bill Euro over a 20‐year period in a population of 5.2. mio individuals.Translated to the whole EU‐region substantial gains can be achieved by improving the contact allergy risk assessment – risk management process.
P20 Red tattoo reactions
Authors: Connolly Maureen , Archer CB , Dunnill GS , Kennedy CT , Sansom JE 
Published: August 2010

Tattoos are becoming increasingly popular, although reactions to tattoos remain relatively uncommon. We describe 4 patients with a variety of red tattoo reactions, one responding well to intralesional steroid therapy.Case 1:  A 50‐year‐old man presented with a florid, inflammatory reaction confined to the red area of his forearm tattoo. Biopsy showed a dense lymphocytic and focal macrophage response to tattoo pigment. Mass spectrometry of biopsy tissue revealed high concentrations of titanium and iron. Patch testing was negative. Intralesional steroid injection has produced a marked improvement.Case 2:  A 42‐year‐old man presented with an inflammatory reaction affecting the red area of his leg tattoo. Biopsy revealed a florid lymphoid reaction.Case 3:  A 30‐year‐old man presented with an eczematous reaction within the red/brown pigmented areas of his tattoos, which was exacerbated by sun exposure. Patch testing showed a (+) positive reaction to cadmium after 96 hours. Photo patch testing was negative. The reaction settled spontaneously within 12 months.Case 4:  A 37‐year‐old woman presented with a florid, indurated inflammatory reaction involving the red area of a shoulder tattoo. Patch testing revealed a (++) and (+) positive reaction to nickel and cobalt respectively with a doubtful (?+) reaction to mercury 0.5% in petrolatum after 96 hours. Tattoo reactions, especially red tattoo reactions can present with a spectrum of histological changes, including lichenoid, granulomatous, hypersensitivity, nodular, pseudolymphomatous or sarcoidal reactions. One of our cases responded well to intralesional steroid injection and one case resolved spontaneously.
P22 Patch testing with p‐toluene diamine (PTD) preparations of different ages
Authors: Geier Johannes , Lessmann H , Uter W , Hildebrandt S , Schnuch A 
Published: August 2010

Background:  PTD, a component of oxidative hair dyes, is a frequent sensitizer in hairdressers. Investigations on the stability of the patch test preparation PTD 1% pet. revealed a decline of the PTD concentration to 0.1% within 6 months, possibly due to a reaction of PTD molecules to dye complexes. This raises the question if the long‐term diagnostic quality of the PTD preparation is hampered by chemical changes.Objective:  To systematically compare intra‐individually patch test results obtained with three PTD patch test preparations of different age, tested synchronously in a multicenter study of the German Contact Dermatitis Research Group (DKG).Methods:  3 PTD preparations, produced in January 2002 (batch A), August 2001 (batch B), and April 2001 (batch C), were patch tested in 177 patients from March to December 2002. Patch testing was performed blinded, with respect to the production date.Results:  There were 150 concordant reactions to batch A, B, and C, i.e. 133 negative, 1 doubtful (?), 11 weak positive (+), 3 strong positive (++ and +++), and 2 irritant reactions. In 27 patients, discordant reactions to batch A, B, and C had been observed. Altogether, 22 positive reactions were noted to batch A, and 19 to batch B and C, respectively (difference not significant). There was no clear cut time trend concerning the occurrence of positive or discordant reactions.Conclusions:  Reproducibility of patch test reactions was within a normal range. The chemical changes mentioned above apparently do not affect the diagnostic quality of the PTD patch test preparation.
P23 Allergic contact sensitization in Spanish patch‐tested patients in 2001
Authors: Sanchez‐Perez Javier , De Frutos J Ortiz , Bravo B García , Salazar L Conde , Muntañola A Alomar , De la Cuadra Oyanguren J , Fernandez‐Redondo V , Juanena D Guimaraens , Vozmediano JM Fernandez , Manrique P , Romero A Miranda , Alvarez B Piñeiro , Serna M Rodriguez , Sagrera C Romaguera , Pedreño P Sanchez , Baldrich E Serra , Silvestre JF , Vilaplana J Vilaplana 
Published: August 2010

Objective:  The first Spanish patch‐test study of patients with contact dermatitis was performed in 1977. We aimed to determine the prevalence of hypersensitivity for Spanish standard allergens in patients suspected of contact dermatitis in 2001.Methods:  A total of 3832 patients of 13 dermatological centers were patch‐tested with Spanish standard series. Age, gender, occupation, dermatitis site and type, and positive patch test were tabulated.Results:  2300 female and 1532 male patients, aged 0 to 70 years were observed with contact dermatitis. Origin of eczema was occupational in 16.66% of patients. Eczema was located on hands in 54.34% of cases. Allergic contact dermatitis in 31.02% and irritative contact dermatitis in 15.88% were the most frequent diagnosis. Positive patch tests was observed in 55.11% of patients. Prevalence of positives reaction was obtained with nickel (26.64%), cobalt (9.89%), chrome (8.66%), PPDA (5.27%), thimerosal (5.21%), fragance mix (5.03%), Kathon CG (4.04%) and thiuram mix (2.87%).Conclusions:  The results emphasize that nickel, cobalt, chrome are by far the most common allergens. A increase in the frequency of allergic patch test reactions to nickel has been noted (18,78 in 1977; 26,64 in 2001). However the contact sensitivity to cobalt, chrome and thiuram mix has decreased. Currently, allergy to cosmetics constitutes a significant portion of the cases of contact dermatitis.
P25 Accuracy of serial dilution concentrations for intradermal skin testing: a neglectable problem?
Authors: Bircher Andreas , Figueiredo V , Scherer K , Surber C 
Published: August 2010

Skin tests are important diagnostic tools. To establish reactivity, a single allergen test concentration is considered to be sufficient. To diagnose sensitivity serial dilution or endpoint titration is recommended. Skin testing in drug allergy is complex, since pathogenetic mechanisms are diverse, and for many drugs cut‐off skin test concentrations have not been established. Therefore, after a negative prick/puncture test with the stock solution, intradermal tests with serial (ten‐fold) dilutions are recommended. Surprisingly in most publications dealing with serial skin test dilution, the technique is not described in detail.Aim:  Comparison of the variability of test substance concentrations produced with two serial dilution techniques conducted by experienced allergy nurses.Methods:  Two allergy nurses produced dilution series. Isosulfane blue was chosen as test substance, since it enabled easy and sensitive detection. Dilution series of isosulfan blue (aqueous solution of 10 mg/ml) from 1:10 to 1:10’000 were produced under sterile conditions by two dilution techniques: 1) Dilution in vials: 0.5 ml isosulfane blue solution was serially transferred with 1 ml tuberculine syringes to vials containing exactly 4.5 ml NaCl 0.9% 2) Dilution in syringes: 0.1 ml isosulfane blue solution with the higher concentration was aspirated into 1 ml tuberculine syringes followed by 0.9 ml NaCl 0.9%. These procedures were compared with a controlled experiment carried out using piston‐stroke pipettes. The concentrations of isosulfan blue in all dilutions were determined by UV/VIS‐spectroscopy and external standard calibration.Results:  In almost all samples the concentrations were higher than expected. In vials the concentrations varied from 83 to 360%, in syringes from 83 to 711% of the expected values. The dilution in vials gave consistently better results than dilution in syringes. A considerable interindividual variability was observed between the conducting nurses, however variability over time was smaller.Conclusions:  In routinely performed serial dilutions of allergen test preparation considerable deviations from the expected allergen test concentration have been observed. This might be of minor importance for an individual patient, however, in establishing e.g. cut‐off concentrations for non‐irritant drug concentrations or in multicenter studies such variations may result in major errors. Quality management of skin testing should not only include the recording, injection technique and test reactivity evaluation, but also the exact description of the preparation of test dilutions. In clinical routine dilution techniques should be applied, which give more accurate results.