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Valbuena MC, Bravo C, Rolón-Cadena MC. Fixed Sunlight Eruption: A Series of 13 Cases in Bogotá, Columbia. ACTAS DERMO-SIFILIOGRAFICAS 2024; 115:288-292. [PMID: 37244395 DOI: 10.1016/j.ad.2023.04.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 03/09/2023] [Accepted: 04/02/2023] [Indexed: 05/29/2023] Open
Abstract
Few reports describing an association between UV radiation and fixed skin eruptions have been published since 1975. These reactions have received various names, including fixed sunlight eruption, fixed exanthema due to UV radiation, and broad-spectrum abnormal localized photosensitivity syndrome. We present a series of 13 patients (4 men [30.8%] and 9 women [69.2%]) aged between 28 and 56 years who were evaluated for fixed eruptions induced by UV radiation at a dermatology referral hospital in Bogotá, Colombia. The lesions were located on the inner thighs, buttocks, popliteal region, anterior and posterior axilla, and dorsum of the feet. Photoprovocation reproduced lesions in all the affected areas, and histopathology showed changes similar to those seen in fixed drug eruptions. While these UV-provoked reactions may be a type of fixed skin eruption, we cannot rule out that they may also be a distinct condition that simply shares a pathogenic mechanism with fixed eruptions.
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Affiliation(s)
- M C Valbuena
- Hospital Universitario, Centro Dermatológico Federico Lleras Acosta, Bogotá, Colombia.
| | - C Bravo
- Dermatología, Pontificia Universidad Javeriana, Bogotá, Colombia
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Valbuena MC, Bravo C, Rolón-Cadena MC. [Translated article] Fixed Sunlight Eruption: A Series of 13 Cases in Bogotá, Colombia. ACTAS DERMO-SIFILIOGRAFICAS 2024; 115:T288-T292. [PMID: 38219907 DOI: 10.1016/j.ad.2024.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 04/02/2023] [Indexed: 01/16/2024] Open
Abstract
Few reports describing an association between UV radiation and fixed skin eruptions have been published since 1975. These reactions have received various names, including fixed sunlight eruption, fixed exanthema due to UV radiation, and broad-spectrum abnormal localized photosensitivity syndrome. We present a series of 13 patients (4 men [30.8%] and 9 women [69.2%]) aged between 28 and 56 years who were evaluated for fixed eruptions induced by UV radiation at a dermatology referral hospital in Bogotá, Colombia. The lesions were located on the inner thighs, buttocks, popliteal region, anterior and posterior axilla, and dorsum of the feet. Photoprovocation reproduced lesions in all the affected areas, and histopathology showed changes similar to those seen in fixed drug eruptions. While these UV-provoked reactions may be a type of fixed skin eruption, we cannot rule out that they may also be a distinct condition that simply shares a pathogenic mechanism with fixed eruptions.
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Affiliation(s)
- M C Valbuena
- Dermatologist, Hospital Universitario Centro Dermatológico Federico Lleras Acosta, Bogotá, Colombia.
| | - C Bravo
- Dermatology resident, Pontificia Universidad Javeriana, Bogotá, Colombia
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Traineau H, Milpied B, Soria A, Assier H, Tetart F, Bernier C, Le Bouëdec MCF, Gener G, Kurihara F, Bauvin O, Delauney J, Amsler E, Bara C, Pelletier F, Valois A, Castelain F, de Risi Pugliese T, Hamelin A, Barbaud A. In Situ Patch Test and Repeated Open Application Test for Fixed Drug Eruption: A Multicenter Study. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2024; 12:460-468. [PMID: 37863314 DOI: 10.1016/j.jaip.2023.10.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 09/26/2023] [Accepted: 10/10/2023] [Indexed: 10/22/2023]
Abstract
BACKGROUND Few studies have evaluated allergy workup in fixed drug eruption (FDE) in a large population. OBJECTIVE To evaluate the sensitivity of a standardized allergy workup for diagnosing the cause of FDE, with a focus on in situ repeated open application tests (ROATs). METHODS In a retrospective multicenter study, we analyzed the practice of conducting a complete allergy workup for the etiological diagnosis of FDE. It consisted of 3 steps: in situ patch tests (PTs) for all cases except pure mucosal involvement, followed by in situ ROAT if in situ PT results were negative, and finally a drug challenge (DC). The in situ ROAT involved daily application of the suspected drug on a previously affected FDE site for 7 days. RESULTS Of 98 suspected FDE cases, 61 patients (median age 61 y; male-to-female ratio 1.8) with a complete allergy workup were included. In 4 cases, even the DC yielded negative results. Among the remaining 57 patients with a positive workup, implicated drugs included paracetamol (12 cases), β-lactams (11 cases), imidazoles (9 cases, including 5 with metronidazole), nonsteroidal anti-inflammatory drugs (8 cases), iodinated contrast media (4 cases), cotrimoxazole (3 cases), and various other drugs in 10 patients. The diagnosis was confirmed by in situ PT in 17 of 54 cases (31.5%), in situ ROAT in 14 of 40 cases (35%) (with 4 cases showing remote reactivation of FDE sites), and DC in 26 cases. CONCLUSIONS The sequential allergy workup involving successively in situ PT, in situ ROAT, and DC is a reliable and safe method for diagnosing the cause of FDE. In situ tests exhibited a sensitivity of over 50%.
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Affiliation(s)
- Hélène Traineau
- Médecine Sorbonne Universiy, Dermatology and allergology department, Hôpital Tenon, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris, France
| | - Brigitte Milpied
- Centre hospitalo-universitaire (CHU) de Bordeaux, Dermatology department, Saint André hospital, Bordeaux, France
| | - Angèle Soria
- Cimi-Paris Inserm 1135, AP-HP, Sorbonne University, Hôpital Tenon, Dermatology and allergology department, Paris, France
| | - Haudrey Assier
- Dermatology department, AP-HP, Henri Mondor hospital, Créteil, France
| | | | | | | | - Gwendeline Gener
- Dermatology department, AP-HP, Henri Mondor hospital, Créteil, France
| | - Flore Kurihara
- Médecine Sorbonne Universiy, Dermatology and allergology department, Hôpital Tenon, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris, France
| | | | - Juliette Delauney
- CHU d'Angers, Dermatology department, Centre hospitalier de Cholet, Angers, France
| | - Emmanuelle Amsler
- Médecine Sorbonne Universiy, Dermatology and allergology department, Hôpital Tenon, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris, France
| | - Corina Bara
- Dermatology department, Centre hospitalier du Mans, Le Mans, France
| | | | - Aude Valois
- Dermatology department, Hôpital d'instruction des armées Sainte Anne, Toulon, France
| | | | - Tullia de Risi Pugliese
- Médecine Sorbonne Universiy, Dermatology and allergology department, Hôpital Tenon, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris, France
| | - Aurore Hamelin
- Médecine Sorbonne Universiy, Dermatology and allergology department, Hôpital Tenon, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris, France
| | - Annick Barbaud
- Médecine Sorbonne Universiy, Dermatology and allergology department, Hôpital Tenon, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris, France.
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Krikeerati T, Rodsaward P, Nawiboonwong J, Pinyopornpanish K, Phusawang S, Sompornrattanaphan M. Revisiting Fruit Allergy: Prevalence across the Globe, Diagnosis, and Current Management. Foods 2023; 12:4083. [PMID: 38002141 PMCID: PMC10670478 DOI: 10.3390/foods12224083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 11/04/2023] [Accepted: 11/08/2023] [Indexed: 11/26/2023] Open
Abstract
Fruit allergies manifest with a diverse array of clinical presentations, ranging from localized contact allergies and oral allergy syndrome to the potential for severe systemic reactions including anaphylaxis. The scope of population-level prevalence studies remains limited, largely derived from single-center or hospital-based investigations. In this comprehensive review, we conducted a systematic literature search spanning the years 2009 to 2023, with full acknowledgment of potential analytical biases, to provide a global overview of fruit allergy prevalence. The primary mechanistic underpinning of fruit allergies stems from cross-reactivity between aeroallergens and food allergens, a consequence of structurally similar epitopes-a phenomenon recognized as pollen food allergy syndrome (PFAS). In the era of molecular allergology, numerous studies have dissected allergen components with substantial clinical relevance. Within this review, we explore important allergenic molecules found in plant-based foods, scrutinize pertinent cross-reactivity patterns, and offer insights into management recommendations. Additionally, we compare guideline recommendations to enhance clinical understanding and inform decision making.
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Affiliation(s)
- Thanachit Krikeerati
- Division of Allergy and Clinical Immunology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand;
- Faculty of Medicine Siriraj Hospital, Center of Research Excellence in Allergy and Immunology, Mahidol University, Bangkok 10700, Thailand
| | - Pongsawat Rodsaward
- Division of Immunology, Department of Microbiology, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand;
- Division of Allergy and Clinical Immunology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
| | - Jutamard Nawiboonwong
- Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand;
| | - Kanokkarn Pinyopornpanish
- Division of Allergy and Clinical Immunology, Department of Medicine, Faculty of Medicine, Chiangmai University, Chiangmai 50200, Thailand;
| | - Songwut Phusawang
- Division of Allergy, Immunology and Rheumatology, Department of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand;
| | - Mongkhon Sompornrattanaphan
- Division of Allergy and Clinical Immunology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand;
- Faculty of Medicine Siriraj Hospital, Center of Research Excellence in Allergy and Immunology, Mahidol University, Bangkok 10700, Thailand
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Vander Does A, Ju T, Yosipovitch G. When Foods Cause Itch: Clinical Characteristics, Pathophysiology, and Recommendations for Food-Induced Skin and Mucosal Pruritus. Dermatitis 2023; 34:13-20. [PMID: 36705658 DOI: 10.1089/derm.0000000000000916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Itch occurs in various dermatologic and systemic conditions. Many patients report that certain foods instigate itch, although there is limited published information in dermatology on food-induced pruritus. In addition, itch severity is rarely mentioned. Food can induce pruritus through either ingestion or direct contact with skin or mucosal membranes. The most common type of itch provoked by food is acute urticaria, often through the classical immunoglobulin E (IgE)-mediated pathway. Other mechanisms include non-IgE-mediated, mixed (IgE-mediated and non-IgE-mediated), T-cell-mediated, and nonimmune reactions. For patients presenting with urticaria, generalized pruritus, oral pruritus, or dermatitis, a thorough history is warranted, and possible food associations should be considered and assessed. Although any food seems to have the potential to elicit an immune response, certain foods are especially immunogenic. Treatment includes avoidance of the trigger and symptom management. Careful consideration should be used as to avoid unnecessarily restrictive elimination diets.
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Affiliation(s)
- Ashley Vander Does
- From the Dr Phillip Frost Department of Dermatology and Miami Itch Center, University of Miami, FL
| | - Teresa Ju
- From the Dr Phillip Frost Department of Dermatology and Miami Itch Center, University of Miami, FL
| | - Gil Yosipovitch
- From the Dr Phillip Frost Department of Dermatology and Miami Itch Center, University of Miami, FL
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Vander Does A, Ju T, Yosipovitch G. When Foods Cause Itch: Clinical Characteristics, Pathophysiology, and Recommendations for Food-Induced Skin and Mucosal Pruritus. Dermatitis 2022; Publish Ahead of Print:01206501-990000000-00036. [PMID: 35839419 DOI: 10.1097/der.0000000000000916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Itch occurs in various dermatologic and systemic conditions. Many patients report that certain foods instigate itch, although there is limited published information in dermatology on food-induced pruritus. In addition, itch severity is rarely mentioned. Food can induce pruritus through either ingestion or direct contact with skin or mucosal membranes. The most common type of itch provoked by food is acute urticaria, often through the classical immunoglobulin E (IgE)-mediated pathway. Other mechanisms include non-IgE-mediated, mixed (IgE-mediated and non-IgE-mediated), T-cell-mediated, and nonimmune reactions. For patients presenting with urticaria, generalized pruritus, oral pruritus, or dermatitis, a thorough history is warranted, and possible food associations should be considered and assessed. Although any food seems to have the potential to elicit an immune response, certain foods are especially immunogenic. Treatment includes avoidance of the trigger and symptom management. Careful consideration should be used as to avoid unnecessarily restrictive elimination diets.
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Affiliation(s)
- Ashley Vander Does
- From the Dr Phillip Frost Department of Dermatology and Miami Itch Center, University of Miami, FL
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Gil-Pallares P, Alvarez-Garcia O, González-Moure C, Castro-Murga M, Monteagudo-Sánchez B. Fixed food eruption caused by Maja squinado (European spider crab) in a child. Contact Dermatitis 2020; 83:510-512. [PMID: 32548887 DOI: 10.1111/cod.13642] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 06/11/2020] [Accepted: 06/13/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Pedro Gil-Pallares
- Department of Dermatology, Complejo Hospitalario Universitario de Ferrol, Ferrol, Spain
| | - Olaya Alvarez-Garcia
- Department of Allergy, Complejo Hospitalario Universitario de Ferrol, Ferrol, Spain
| | | | - Mónica Castro-Murga
- Department of Allergy, Complejo Hospitalario Universitario de Ferrol, Ferrol, Spain
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Sharma L, Agarwal R, Chopra A, Mitra B. A Cross-Sectional Observational Study of Clinical Spectrum and Prevalence of Fixed Food Eruption in a Tertiary Care Hospital. Indian Dermatol Online J 2020; 11:361-366. [PMID: 32695694 PMCID: PMC7367575 DOI: 10.4103/idoj.idoj_340_19] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Revised: 09/28/2019] [Accepted: 09/28/2019] [Indexed: 11/04/2022] Open
Abstract
Background Fixed food eruption (FFE) is a rare type of hypersensitivity reaction occurring after ingestion of some food items in the form of recurrent erythematous patches, bullae, vesicle, or pustule at the same site after ingestion of same or related food products. Various items listed responsible for causing FFE include tree nuts, groundnuts, legumes, lentils, eggs, fruits like kiwi, strawberry, tonic water, and tartrazine. Its more commonly reported in developed countries with no Indian studies as of yet. We studied the clinical spectrum and prevalence of FFE in a tertiary care hospital. Objective To study the prevalence and pattern of FFE after eliminating all other possible causes including drug rash. Materials and Methods A cross-section observational study of 27 consecutive patients suspected to have fixed food eruption after eliminating all possibilities of any drug reaction to the best of our knowledge. Informed consent was obtained from the patients, and ethical clearance was taken from the hospital ethical committee. Results A total of 27 patients were studied out of which 18 (66.66%) were females and 9 (33.33%) were males. The prevalence of fixed food eruption was calculated to be 0.072%.Fixed food eruption was noted secondary to cashew nuts (14.8%), almonds (7.4%), walnut (7.4%), pistachio (3.7%), strawberry (3.7%), kiwi (3.7%), and cheese crisps (3.7%). Conclusion This observational study highlights the varied patterns of fixed food eruptions as well as the burden of disease in population secondary to certain diets.
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Affiliation(s)
- Loknandini Sharma
- Department of Dermatology, Base Hospital Delhi Cantt, New Delhi, India
| | - Reetu Agarwal
- Department of Dermatology, Base Hospital Delhi Cantt, New Delhi, India
| | - Ajay Chopra
- Department of Dermatology, Base Hospital Delhi Cantt, New Delhi, India
| | - Barnali Mitra
- Department of Paediatrics, Base Hospital Delhi Cantt, New Delhi, India
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Patel S, John AM, Handler MZ, Schwartz RA. Fixed Drug Eruptions: An Update, Emphasizing the Potentially Lethal Generalized Bullous Fixed Drug Eruption. Am J Clin Dermatol 2020; 21:393-399. [PMID: 32002848 DOI: 10.1007/s40257-020-00505-3] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
A fixed drug eruption (FDE) is a relatively common reaction associated with more than 100 medications. It is defined as a same-site recurrence with exposure to a particular medication. The primary approach and treatment for all types of FDEs are to identify and remove the causative agent, often accomplished by a thorough history of medication and other chemical exposures, and possibly prior episodes. The most common category of FDE, localized FDE, whether bullous or non-bullous, is self-limited. Although one can confirm the causative agent using oral challenge testing, it is not recommended due to the risk of severe exacerbation or possible generalization; patch testing is now preferred. Bullous FDE may resemble erythema multiforme. Treatment of localized FDE includes medication removal, patient counseling, and symptomatic relief. Failure to remove the causative agent in localized FDE can lead to recurrence, which is associated with increased inflammation, hyperpigmentation, and risk of a potentially lethal generalized bullous FDE (GBFDE), which may resemble Stevens-Johnson syndrome (SJS) or toxic epidermal necrolysis (TEN). Distinguishing GBFDE from SJS and TEN is salient and will be stressed: GBFDE has more rapid onset in 1-24 h rather than in weeks, less or no mucosal involvement, less or no systemic involvement, and a tendency for a more favorable prognosis; however, recent experience suggests it may be just as life-threatening. This review will provide a comprehensive update and approach to diagnosis and management.
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Affiliation(s)
- Shreya Patel
- Dermatology, Rutgers New Jersey Medical School, 185 South Orange Avenue, Medical Science Building H-576, Newark, NJ, 07103-2757, USA
| | - Ann M John
- Dermatology, Robert Wood Johnson University Hospital, One World's Fair Drive, Suite 2400, Somerset, NJ, 08873, USA
| | - Marc Zachary Handler
- Dermatology, Rutgers New Jersey Medical School, 185 South Orange Avenue, Medical Science Building H-576, Newark, NJ, 07103-2757, USA
| | - Robert A Schwartz
- Dermatology, Rutgers New Jersey Medical School, 185 South Orange Avenue, Medical Science Building H-576, Newark, NJ, 07103-2757, USA.
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Loli-Ausejo D, Vílchez-Sánchez F, Gómez-Traseira C, Tomás-Pérez M, González-Muñoz M. Fixed food eruption caused by peanut confirmed by open oral food challenge and in vitro cellular testing. Contact Dermatitis 2020; 83:227-229. [PMID: 32297343 DOI: 10.1111/cod.13557] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 04/12/2020] [Accepted: 04/13/2020] [Indexed: 11/29/2022]
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Affiliation(s)
- Navin Kumar Devaraj
- Department of Family Medicine, Universiti Putra Malaysia Fakulti Perubatan dan Sains Kesihatan, Serdang, Malaysia
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12
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Adult-onset food allergies. Ann Allergy Asthma Immunol 2017; 119:111-119. [PMID: 28801016 DOI: 10.1016/j.anai.2017.05.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 05/11/2017] [Accepted: 05/15/2017] [Indexed: 02/07/2023]
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