A case of conjugal azathioprine-induced contact hypersensitivity

Consort Allergic Contact Dermatitis: A Systematic Review

ABSTRACT

Consort allergic contact dermatitis (CACD) develops following exposure to an allergen originating from another individual. The diagnosis is often not straightforward. We conducted a systematic review to characterize patient demographics, clinical features, consort types, responsible products, and associated allergens in CACD. A literature search was conducted in PubMed, EMBASE, Web of Science, and CINAHL Complete from inception to July 2020. In total, 183 articles describing 261 patients with CACD were included. Mean age was 40.9 years with female predominance (62.8%). The most common body sites involved were the face (48.6%), hand (30.4%), arm (20.9%), neck (17.8%), and genitals (11.5%). The most common consorts were partners/spouses (50.0%, of which 29.9% were related to sexual activity), children (19.4%), and healthcare providers (7.8%). Allergens were mainly encountered via direct contact with consorts (80.5% of cases). A caregiver relationship was involved in 27.6% of cases, and the consort's occupation in 14.6%. The most frequently implicated products were medications (35.6%), plants/botanicals (11.7%), and fragrances (8.7%). Patch testing identified 125 unique allergens in CACD. CACD can occur in relation to many individuals encountered throughout life. Caregivers may represent a high-risk group for developing CACD. Obtaining a holistic history encompassing social, sexual, and occupational factors can aid in the diagnosis.

The differential effect of maternal dietary patterns on quantiles of Birthweight

BACKGROUND

Maternal dietary habits during pregnancy are considered essential for development and growth of the fetus as well as maternal health. It has an effect on the birthweight of infants. However, little is known about the effect of dietary patterns on birthweight in urban South Africa. This study aimed to investigate differential effect of dietary patterns of pregnant women on quantiles of birthweight.

METHODS

Data for the study were obtained from a Mother and Child in the Environment birth cohort study in Durban South Africa. Quantile regression was used to investigate the effect of maternal dietary patterns on quantiles of birthweight. Data collection was conducted during the period of 2013 to 2017 in Durban South Africa. Using factor analysis, eight dietary groups were identified from 687 pregnant women in the cohort. Quantile regression analysis was employed to identify the differential effects of the seven dietary groups and demographic factors on the birthweight.

RESULTS

The quantile regression estimates at the 50th quantile and the ordinary regression estimates painted the same picture about the conditional mean effect of covariates on the birthweight. But unlike the quantile regression the ordinary regression fails to give insights about the covariates effect disparities at the low and/or upper birthweight quantiles. All the dietary groups show a significant differential effect at different birthweight quantiles. For instance, increased frequency of protein rich foods intake was associated with reduction in birthweight at lower and upper quantiles; increased frequency of junk foods intake has a slight increase in birthweight at the lower quantiles but significantly higher increase at the 95th quantile (p < 0.001); increase in consuming vegetable rich foods, reduced birthweight at 95th quantile (p < 0.001). The results further showed that employment (p = 0.006) and family size (p = 0.002) had differential effects across different birthweight quantiles.

CONCLUSIONS

Both maternal undernutrition and overnutrition of protein rich foods, junk foods, snack and energy foods and vegetable rich foods have shown a substantial varying effects on those infants with birthweights in the lower and upper birthweight quantiles.

Allergy and Sexual Behaviours: an Update

The exact prevalence of hypersensitivity reactions related to sexual behaviours is not known; however, they heavily impact on the quality of life and of sex life of affected patients. In fact, not only common respiratory and skin allergies, such as asthma, rhinitis, urticaria and atopic dermatitis, but also food and drug allergy have been found to negatively affect the quality of sex life. Allergic diseases impact on the sexual function in both physical and psychological ways, representing one of the main complaints of a considerable proportion of patients. Sexual behaviours may act as the triggers of allergic reactions or as the carriers of allergens. Food and drug allergens can be carried through human organic fluids, like saliva and semen. Latex in condoms and numerous substances in lubricants, spermicides, topical medications and cosmetics can cause allergic reactions or contact dermatitis. Sexual activity itself is also a potential trigger of symptoms in patients affected by respiratory allergies, like honeymoon asthma and rhinitis. In seminal plasma hypersensitivity, seminal fluid proteins are the culprit allergens. The present review aims at summarizing the state of the art about allergy and sexual behaviours. In clinical practice, the influence of common allergic diseases on the sexual quality of life should be taken carefully into account. Sexual behaviours need to be accounted in the differential diagnosis of hypersensitivity reactions, and awareness on those exposure routes should be raised between different specialists and general practitioners.

Intimate Contact Could Be Dangerous for Your Health

PURPOSE

To review evidence of hypersensitivity reactions to allergens and/or pathogens transmitted via intimate contact.

METHODS

We reviewed PubMed for publications in English between 1980 and 2018 using the terms allergy, drugs, foods, hypersensitivity, intercourse, kissing, Kounis syndrome, mast cells, and semen.

FINDINGS

In human RELATIONSHIPS, intimate contact can occasionally have disastrous or even fatal consequences because antigens and pathogens can be transmitted via the oral and vaginal mucosa. Hypersensitivity to semen is an underrecognized problem. Some individuals also developed acute coronary hypersensitivity, which mimics myocardial infarction, known as Kounis syndrome.

IMPLICATIONS

Hypersensitivity reactions to allergens and/or pathogens via intimate contact are common and should be recognized. Sensitive patients should be evaluated for atopic diathesis because such patients may be more susceptible and could also develop Kounis syndrome.

Erythema nodosum as azathioprine hypersensitivity reaction in a patient with bullous pemphigoid

A 65-year-old woman with bullous pemphigoid presented with fever and several red-purple nodular subcutaneous lesions on both lower legs 1 week after starting treatment with azathioprine (AZA). Biopsy of a skin nodule was compatible with erythema nodosum (EN) and hypersensitivity reaction to AZA was suspected. AZA was subsequently discontinued, observing complete remission of fever and EN within 2 weeks. This case highlights the importance of recognizing EN as a possible manifestation of hypersensitivity reaction to AZA.