Current patch test results with the European baseline series and extensions to it from the ‘European Surveillance System on Contact Allergy’ network, 2007-2008

Immune response in adverse reactions to metal debris following metal-on-metal total hip arthroplasty

BACKGROUND

The purpose of the present study was to determine whether T cell-mediated type IV hypersensitivity reactions could be a major cause of adverse reaction to metal debris (ARMD) after metal-on-metal total hip arthroplasty (THA).

METHODS

Thirteen patients (1 man and 12 women; mean age 68 years, age range 60 to 83 years) with ARMD underwent revision surgery following metal-on-metal THA (15 hips). Lymphocyte stimulation testing was conducted. Periprosthetic tissue specimens underwent immunohistochemical studies.

RESULTS

Lymphocyte stimulation testing showed that five patients were nickel-sensitive, and one patient was also cobalt-sensitive. Immunohistochemical studies showed that T cells were dominant in five hips, and B cells were dominant in 10 hips. In four of the five patients with a positive lymphocyte stimulation test, the dominant lymphocytes were T cells, suggesting type IV hypersensitivity. The major cause of ARMD was not type IV hypersensitivity in the remaining nine patients.

CONCLUSION

Metal hypersensitivity does not appear to be the dominant biological reaction involved in the occurrence of ARMD.

Methylchloroisothiazolinone/Methylisothiazolinone and Methylisothiazolinone Sensitivity in Hungary

Background. Due to allowing of methylisothiazolinone (MI) in cosmetics, cleaning products, and paints, an epidemic of MI-hypersensitivity emerged. Patch testing Kathon CG® (3:1 mixture of methylchloroisothiazolinone and methylisothiazolinone, MCI/MI) does not correctly detect MI contact allergy, due to the low concentration of MI in the test material. Methods. A retrospective survey was performed to estimate the prevalence of MCI/MI hypersensitivity in 14693 patients tested consecutively between 1993 and 2014. Moreover, currently 314 patients were prospectively tested with the allergens MCI/MI and with MI during one year. Results. MCI/MI hypersensitivity increased retrospectively from 0.5% to 6.0%. By current prospective testing we detected 25 patients (8%) with MCI/MI and/or MI positive reactions. Out of the 25 patients 10 were only MCI/MI positive, 9 were only MI positive, and 6 were MCI/MI and MI positive. If MI had not been tested separately, MI contact allergy would have missed in 36% of all detected cases and in 2.8% of the total 314 patients. Conclusions. The frequency of MCI/MI hypersensitivity is increasing also in Hungary. We confirm that, in order to detect MI contact allergy, it needs to be tested separately. A further increase of MI hypersensitivity might be expected in the future as products containing MI are still widely available.

High prevalence of contact allergy in adolescence: results from the population-based BAMSE birth cohort

BACKGROUND

Contact allergy is common among adults. However, little is known about the prevalence in adolescents.

OBJECTIVES

To assess the prevalence of allergy to common contact allergens in Swedish adolescents in the general population.

PARTICIPANTS AND METHODS

The BAMSE cohort is a population-based birth cohort with the main aim of studying the risk factors for asthma, rhinitis, and atopic dermatitis. Patch testing was performed at the 16-year follow-up. The test (TRUE Test(®) ) was applied at home, and removed 2 days later by nurses, who recorded and photographed the results. Dermatologists made final assessments on the basis of photographs and protocols.

RESULTS

Two thousand two hundred and eighty-five participants (88% of all 16-year follow-up participants) were patch tested; 15.3% had at least one positive reaction. Contact allergy was more common in girls than in boys (17.0% versus 13.4%, p = 0.018). Sensitization to nickel was most common (7.5%), followed by sensitization to fragrance mix I (2.1%) and p-tert-butylphenol formaldehyde resin (1.9%). Nickel allergy was more frequent in girls (9.8% versus 4.9%, p < 0.001). Solitary sensitization to cobalt was more common than co-sensitization to nickel and cobalt.

CONCLUSIONS

The prevalence of contact allergy in adolescents is of almost the same high magnitude as in adults. The applied method was feasible in the population-based setting.

Patch test results in children and adolescents across Europe. Analysis of the ESSCA Network 2002-2010

BACKGROUND

Contact sensitization in children is more frequent than previously thought.

METHODS

The ESSCA collected patch test data from 11 European countries aggregated to 4 European regions.

RESULTS

Six thousand and eight patients aged 1-16 years old with suspected allergic contact dermatitis were analyzed during a period of 8 years (2002-2010). The overall prevalence of at least one positive reaction to a hapten was 36.9%. The 10 most frequent haptens were as follows: nickel sulfate, cobalt chloride and potassium dichromate, neomycin sulfate, Myroxylon pereirae resin (balsam of Peru), para-phenylenediamine, chloromethylisothiazolinone/methylisothiazolinone 3:1, fragrance mix, lanolin alcohols, and colophony. No difference was found in the prevalence of at least one positive reaction to at least one hapten between boys and girls and between children with atopic dermatitis and children without. Children without atopic dermatitis, when compared with those with, had a significantly higher prevalence of contact sensitization for nickel sulfate (20.91% vs 16.87%, respectively), 4-tert. butylphenol formaldehyde resin (1.61% vs. 0.7%), and para-phenylenediamine (2.49% vs. 1.3%).

LIMITATIONS OF THE STUDY

Chamber loading is not an exact science and variation may occur between staff and departments. Interinstitution variations in readings can occur. A possible geographic confounder is that the southern regions tested more children in the younger age group. Relevance was not addressed due to difficulties in the application of a set of uniform definitions.

CONCLUSIONS

Our study adds information on the most common contact allergens detected in children which could help to define a Standard European Pediatric Baseline Series.

The association between metal allergy, total knee arthroplasty, and revision: study based on the Danish Knee Arthroplasty Register

BACKGROUND AND PURPOSE

It is unclear whether delayed-type hypersensitivity reactions against implanted metals play a role in the etiopathogenesis of malfunctioning total knee arthroplasties. We therefore evaluated the association between metal allergy, defined as a positive patch test reaction to common metal allergens, and revision surgery in patients who underwent knee arthroplasty.

PATIENTS AND METHODS

The nationwide Danish Knee Arthroplasty Register, including all knee-implanted patients and revisions in Denmark after 1997 (n = 46,407), was crosslinked with a contact allergy patch test database from the greater Copenhagen area (n = 27,020).

RESULTS

327 patients were registered in both databases. The prevalence of contact allergy to nickel, chromium, and cobalt was comparable in patients with and without revision surgery. However, in patients with 2 or more episodes of revision surgery, the prevalence of cobalt and chromium allergy was markedly higher. Metal allergy that was diagnosed before implant surgery appeared not to increase the risk of implant failure and revision surgery.

INTERPRETATION

While we could not confirm that a positive patch test reaction to common metals is associated with complications and revision surgery after knee arthroplasty, metal allergy may be a contributor to the multifactorial pathogenesis of implant failure in some cases. In cases with multiple revisions, cobalt and chromium allergies appear to be more frequent.

Detection of nickel and palladium contact hypersensitivity by a flow cytometric lymphocyte proliferation test

We established a flow cytometric lymphocyte proliferation test (LPT) for the detection of nickel (Ni) and palladium (Pd) sensitization. Eighty-one consecutive patients with an indication for patch test (PT) were tested by LPT with Ni (NiSO4 ) and Pd (Na2 PdCl4 and PdCl2 ) salts. The imprecision of the LPT was low (coefficient of variation 7.2%). Using PT as a diagnostic reference, the sensitivity and specificity of LPT were 74.4% and 80% for NiSO4 , 74.4% and 78.3% for Na2 PdCl4 , and 57.2% and 85.4% for PdCl2 , respectively. For both Ni and Pd, the likelihood ratio for a positive PT markedly increased with increasing LPT value. With medical history as a reference, the sensitivity and specificity were 40.6% and 82.1% for LPT and 59.4% and 89.7% for PT, respectively. Combination of LPT and PT resulted in a higher specificity of 95%, albeit lower sensitivity of 34.4%. In conclusion, flow cytometric LPT represents a reliable and useful method for the detection of Ni and Pd sensitization. LPT values correlate with PT results and, when used in combination with PT, increase test specificity.

Air-oxidized linalool elicits eczema in allergic patients - a repeated open application test study

BACKGROUND

Linalool is a commonly used fragrance terpene that forms potent sensitizers upon oxidation. In a recent multicentre study, we found that 7% of 2900 patients showed positive patch test reactions to oxidized linalool at 6.0%. No elicitation studies have been performed.

OBJECTIVE

To identify threshold concentrations for elicitation of allergic contact dermatitis caused by oxidized linalool in allergic individuals with repeated exposures.

METHODS

Repeated open application tests were performed in 6 participants previously diagnosed with contact allergy to oxidized linalool. Creams containing 3.0%, 1.0% and 0.30% oxidized linalool (corresponding to 0.56%, 0.19% and 0.056% linalool hydroperoxides, respectively) and 'fine fragrance' containing 1.0%, 0.30% and 0.10% oxidized linalool (corresponding to 0.19%, 0.056% and 0.019% linalool hydroperoxides, respectively) were used twice daily for up to 3 weeks. Patch testing with a dilution series of oxidized linalool was performed.

RESULTS

Five of 6 participants reacted to the cream containing 3% oxidized linalool. With 1% oxidized linalool, a reaction was seen in 3 (cream) and 4 (fine fragrance) participants, respectively. With 0.3% oxidized linalool, 2 (cream) and 1 (fine fragrance) participants reacted.

CONCLUSION

Repeated exposure to low concentrations of oxidized linalool can elicit allergic contact dermatitis in previously sensitized individuals.

Fragrance allergy and quality of life - a case-control study

BACKGROUND

Fragrance ingredients can cause contact allergy, which may affect quality of life (QoL). However, few studies have investigated this topic.

OBJECTIVES

To investigate QoL life among subjects with a fragrance allergy as compared with other eczema patients.

METHODS

A case-control survey was sent to subjects with a positive patch test reaction to a fragrance ingredient/marker (n = 550) and to a control group (n = 1100). It contained questions on eczema and the newly developed fragrance QoL index. Participants had been consecutively patch tested at Gentofte University Hospital (2000-2010). The response rate was 65.7%. Information on patch test data was retrieved from the National Contact Dermatitis Database.

RESULTS

An increase in impairment of QoL was observed in women with fragrance allergy as compared with the control group (p = 0.042), which was not found among men. Several factors played a significant role in impairment of QoL in women: (i) number of fragrance allergies, (ii) severity of the patch test reaction, (iii) age combined with recent diagnosis; and (iv) allergy to specific fragrance ingredients/markers.

CONCLUSION

Fragrance-allergic subjects are just as affected in their QoL as other eczema patients. However, women, and in particular recently diagnosed young women, seem to be more impaired in their QoL than other eczema patients.

Propolis: a review of properties, applications, chemical composition, contact allergy, and other adverse effects

Propolis (bee glue) is the resinous substance that bees collect from living plants for the construction and adaptation of their nests. It has antibacterial, antifungal, and antiviral properties and may have a wide range of other beneficial biological activities. Propolis is available as a dietary supplement, in products for the protection of health and prevention of diseases, in biopharmaceuticals, and as a constituent of (bio)cosmetics. In this article, the following aspects of propolis are reviewed: the nature and chemical composition, its biological properties and applications, contact allergy and allergic contact dermatitis (sensitizing potential, products causing contact allergy, clinical picture, frequency of sensitization, coreactivity and cross-reactivity, the allergens in propolis), and other adverse effects.

Monitoring immune modulation by nutrition in the general population: identifying and substantiating effects on human health

Optimal functioning of the immune system is crucial to human health, and nutrition is one of the major exogenous factors modulating different aspects of immune function. Currently, no single marker is available to predict the effect of a dietary intervention on different aspects of immune function. To provide further guidance on the assessment and interpretation of the modulation of immune functions due to nutrition in the general population, International Life Sciences Institute Europe commissioned a group of experts from academia, government and the food industry to prepare a guidance document. A draft of this paper was refined at a workshop involving additional experts. First, the expert group defined criteria to evaluate the usefulness of immune function markers. Over seventy-five markers were scored within the context of three distinct immune system functions: defence against pathogens; avoidance or mitigation of allergy; control of low-grade (metabolic) inflammation. The most useful markers were subsequently classified depending on whether they by themselves signify clinical relevance and/or involvement of immune function. Next, five theoretical scenarios were drafted describing potential changes in the values of markers compared with a relevant reference range. Finally, all elements were combined, providing a framework to aid the design and interpretation of studies assessing the effects of nutrition on immune function. This stepwise approach offers a clear rationale for selecting markers for future trials and provides a framework for the interpretation of outcomes. A similar stepwise approach may also be useful to rationalise the selection and interpretation of markers for other physiological processes critical to the maintenance of health and well-being.

Cytokine detection for the diagnosis of chromium allergy

BACKGROUND

Patch testing remains the gold standard method for the identification of the etiologic agent of allergic contact dermatitis. However, it is a subjective, time-consuming exam whose technique demands special care and which presents some contraindications, which hamper its use. In a recent study, we showed that the proliferation assay can suitably replace patch testing for the diagnosis of chromium allergy, which had been previously demonstrated only for nickel allergy. In this study, we try to refine the method by reducing the incubation period of cultures for lymphocyte proliferation assays in response to chromium.

OBJECTIVE

Develop an alternative or complementary diagnostic test for chromium allergic contact dermatitis.

METHODS

We compared the production of 9 cytokines (IFN-γ, IL-2, IL-4, IL-5, IL-10, IL-12, IL-13, IL-17 and RANTES) between 18 chromium-allergic patients and 19 controls.

RESULTS

Chromium increased the production of IFN-y, IL-5, IL-2 and IL-13 in allergic patients, but only IL-2 and especially IL-13 helped discriminate allergic patients from controls. The sensitivity, specificity and accuracy found with IL-13 were about 80%.

CONCLUSIONS

IL-13 and IL-2 detection may be used to diagnose chromium allergy in 2-day cultures. However, in general, the 6-day cultures seem to be superior for this purpose.