Impact of dupilumab on patch test results and allergic contact dermatitis: A prospective multicenter study

BACKGROUND

Limited and conflicting data have been reported on the impact of dupilumab (DUPI) on patch test (PT) results and its efficacy against allergic contact dermatitis (ACD).

OBJECTIVE

This study was undertaken to analyze PT reactivities and relevance during treatment with DUPI to determine whether they could detect ACD in patients with uncontrolled or worsened atopic dermatitis (AD) who were receiving this agent.

METHODS

This prospective, multicenter study examined 76 DUPI-treated patients who had undergone PTs. The relevant information was collected during 3 visits.

RESULTS

Overall, 36 patients (47%) had ≥1 positive PT reaction, and 142 PT results were positive. Twenty-three patients (30%) had ≥1 positive and clinically relevant PT result. Five of them had clinical eczema improvement after allergen avoidance. We compared the PT results of 36 patients before and during DUPI therapy, representing 1230 paired PT allergens, of which 1022 were the same, 34 were positive, 44 were lost, and 130 were uninterpretable.

LIMITATIONS

Because the number of patients included remains limited, our findings should be confirmed with a larger sample.

CONCLUSION

Our results confirmed the usefulness of PTs for patients receiving DUPI, with good PT reproducibility. We suggest that all DUPI-treated patients with AD developing partial responses or experiencing symptom worsening should undergo PTs to look for contact sensitization.

Allergic contact dermatitis from essential oil in consumer products: Mode of uses and value of patch-tests with an essential oil series. Results of a French study of the DAG (dermato-allergy group of the French Society of Dermatology)

OBJECTIVE

To analyse the clinical characteristics and sensitivity of an essential oil patch-test series (EOS) in patients sensitized to their own essential oils (EOs).

METHOD

We analysed the clinical data and patch-test results obtained with the European baseline series (BSE) and an EOS, as well as the mode of use of EOs, through a questionnaire included in the patient file.

RESULTS

The study included 42 patients (79% women, average age 50 years) with allergic contact dermatitis (ACD), 8 patients required hospitalization. All patients were sensitized to the EO they used, primarily lavender (Lavandula augustifolia, 8000-28-0), tea tree (Melaleuca alternifolia leaf oil, 68647-73-4), ravintsara (Cinnamomum camphora oil, 92201-50-8), and 2 cases were attributed to helichrysum (helichrysum italicum flower absolute, 90045-56-0). 71% had positive patch tests to fragrance mix I or II, 9 only to the EOS and 4 only with their personal EO. Interestingly, 40% of patients did not spontaneously mention the use of EOs, and only 33% received advice on their use at the time of purchase.

CONCLUSION

Patch-tests with the BSE, limonene and linalool HP, and oxidized tea tree oil is sufficient to detect most EO-sensitized patients. The most important is to test the patient's own used EOs.

Hand eczema in glove-wearing patients

BACKGROUND

Allergic contact dermatitis to gloves is mostly induced by rubber accelerators. The European baseline series (EBS) appears insufficient to detect glove allergy. Since 2017, it is recommended to use the European rubber series (ERS) and to test the patients' own gloves.

OBJECTIVES

To investigate the clinical profile of glove-wearing patients with hand eczema (HE) and to evaluate their sensitisation profile to glove allergens and the value of testing the patients' own gloves.

METHODS

We conducted a French multicentre study of patients evaluated for HE between 2018 and 2020 and tested with the EBS, the ERS and their own gloves in patch tests and semi-open (SO) tests.

RESULTS

A total of 279 patients were included; 32.6% of patients had positive tests to their own gloves or to glove allergens. Almost 45% of the sensitisations to glove allergens were detected only by the ERS. Among the patients tested both in patch tests and SO tests with their own gloves with positive results, 28% had positive SO tests only. Polyvinylchloride (PVC) gloves were positive in four patients.

CONCLUSION

Our series confirms the need to test the ERS. All the patients' gloves must also be tested including PVC gloves. SO tests with gloves are useful as a complement to patch tests.

Prévalence de COVID-19 chez le personnel du chu de Lille

Introduction

Matériel et méthodes

Résultats

Conclusion

What is the optimal duration for a ROAT? The experience of the French Dermatology and Allergology Group (DAG)

The repeated open application test (ROAT) is an adjuvant investigation measure to patch testing in the diagnosis of allergic contact dermatitis. ESCD recommends a 15 days duration but its overall duration varies according to publications and patients hardly adhere to prolonged ROAT duration beyond one week .

MATERIEL AND METHOD

The Dermatology and Allergy Group of the French Society of Dermatology performed a prospective study with the aim of determining the best duration for the ROAT.

RESULTS

A total of 328 ROAT results were collected for topical products, including cosmetics (60%) and topical medications (31.1%). Fifty-nine (18%) ROATs were positive, and 16 (5%) were doubtful. All the positive ROATs occurred within 10 days, with a median time to positivity of 3 days.

CONCLUSION

According to our results, a minimum duration of 10 days is necessary to achieve a positive ROAT to a topical product. This article is protected by copyright. All rights reserved.

Herpes Zoster Following a Nucleoside-Modified Messenger RNA COVID-19 Vaccine

Herpes zoster (HZ) was suspected as a predictive cutaneous manifestation of COVID-19, with a debated prognostic significance. We report a series of 5 cases of HZ occurring after vaccination with a nucleoside-modified messenger RNA (mRNA) COVID-19 vaccine (Comirnaty, Pfizer-BioNTech). These new cases do not prove causality between COVID-19 vaccination and HZ. The pathophysiologic mechanism remains elusive, but local vaccine-induced immunomodulation may be involved. The occurrence of HZ does not justify avoiding the second injection of vaccine due to the benefit of vaccination.

Réactions cutanées aux vaccins anti-COVID-19 : cohorte prospective descriptive régionale

Introduction

Les manifestations cutanées possiblement liées à la Coronavirus Disease 19 (COVID-19) ont été rapportées dès printemps 2020. Nous observons désormais des réactions cutanées aux vaccins anti-COVID-19, impliquant les dermatologues dans le processus de vaccination. L’objectif de cette étude était de rapporter et caractériser ces réactions cutanées aux vaccins anti-COVID-19 dans la région des Hauts-de-France.

Matériel et méthodes

Il s’agit d’un recueil multicentrique prospectif anonyme, sur appel à cas auprès des dermatologues hospitaliers des départements du Nord et du Pas-de-Calais entre janvier et juin 2021, des réactions cutanées suite à tout vaccin anti-COVID-19 réalisé au sein de structures munies d’un centre de vaccination. Au CHU de Lille, en plus du recueil prospectif, les fiches de suivi inter-dose ont été recueillies rétrospectivement de janvier à février 2021 afin d’identifier les effets indésirables cutanés.

Résultats

143 patients ont été inclus dont 108 femmes et 35 hommes. L’âge moyen était de 53 ans. 60 patients ont été examinés par un dermatologue sénior, tandis que 83 ont rempli un formulaire de suivi inter-dose au CHU de Lille. Le vaccin le plus souvent réalisé était le vaccin Pfizer/BioNtech (n = 115/143, 80,4 %), suivi par le vaccin AstraZeneca (n = 23/143, 16,1 %), et le vaccin Moderna (n = 5/143, 3,5 %). Peu de patients avait été infectés par la COVID-19 (n = 14/145, 9,8 %). L’essentiel des réactions recueillies est survenu après la première injection (n = 135/143, 94,4 %). La réaction cutanée la plus fréquente était une réaction érythémateuse au point d’injection (n = 80/143, 55,9 %), un prurit (n = 13/143, 9,1 %), un zona (n = 10/143, 7 %), une poussée d’urticaire typique (n = 7/143, 9 %), des éruptions eczématiformes (n = 6/143, 4,2 %), des éruptions pseudo-urticariennes (n = 5/143, 3,5 %), des exanthèmes (n = 4/143, 2,8 %). Nous rapportons aussi 2 éruptions purpuriques (1,4 %), un pityriasis rosé de Gibert, et une poussée d’herpès labial. Le délai médian de survenue après vaccination était de 2 jours (IIQ, 1–5,5 jours). Six patients (4,9 %) ont eu une poussée d’une dermatose préexistante, dont 5 (3,4 %) étaient des maladies bulleuses auto-immunes. Concernant les 60 patients (41,9 %) ayant été évalués par un dermatologue sénior, la prise en charge consistait principalement en une surveillance seule (n = 27/60, 45 %), une prescription d’émollient (n = 22/60, 36,1 %), ou d’antihistaminique (n = 21/60, 35,6 %). La seconde injection a toujours été autorisée. Nous ignorons cependant la fréquence de la récidive lors de la seconde injection.

Discussion

Notre série rapporte diverses réactions aux vaccins anti-COVID-19, dont aucune grave, ne contre-indiquant pas la réalisation de la seconde injection en cas de survenue lors de la première injection. Le service médical rendu de la vaccination anti-COVID-19 demeure important.

Transient aversion and long-lasting amnesia following cycloheximide injection in the rat

Rats were first trained to press a bar for water reinforcement. The day after reaching criterion, the animals received a subcutaneous injection of cycloheximide (CXM-2.5 mg/kg) or saline, 15 minutes before a single punishment (P) session where bar pressing was followed by a strong inescapable footshock (CXM-P and saline-P groups). No punishment was given to control groups (CXM-NP and saline-NP groups). Retention for this learning experience was tested 24 hr, one week or two weeks later. Performances of the control groups were similar at the three retention intervals although some CXM-induced aversion appeared at 24 hr. The saline-P groups always demonstrated good retention of prior aversive experience. By contrast, a long-lasting CXM-induced amnesia was apparent among the CXM-P groups. This deficit is not easily explained by nonspecific effects of the drug such as altered motor activity or motivational changes. Moreover, CXM-induced amnesia seems to be the result of impaired memory formation rather than impaired memory retrieval.