Contact allergy in Swedish professional ice hockey players

BACKGROUND

Professional ice hockey players may contract irritant and allergic contact dermatitis.

AIMS

To investigate the presence of contact allergy (CA) in professional ice hockey players in Sweden.

METHODS

Ten teams from the two top leagues were assessed for potential occupational exposure to sensitizers. Exactly 107 players were patch tested with an extended baseline series and a working series, in total 74 test preparations. The CA rates were compared between the ice hockey players and controls from the general population and dermatitis patients.

RESULTS

One out of 4 players had at least one contact allergy. The most common sensitizers were Amerchol L 101, nickel and oxidized limonene. CA was as common in the ice hockey players as in dermatitis patients and significantly more common than in the general population. Fragrances and combined sensitizers in cosmetic products (fragrances + preservatives + emulsifier) were significantly more common in ice hockey players compared with the general population.

CONCLUSION

The possible relationship between CA to fragrances and cosmetic products on the one hand and the presence of dermatitis on the other should be explored further.

[Selected aspects regarding social factors in skin diseases]

Skin diseases are complex and cannot be explained solely by genetic or environmental factors but are also significantly shaped by social influences. This review illuminates the bidirectional relationship between social factors and skin diseases, demonstrating how social determinants such as socioeconomic status, living environment, and psychosocial stress can influence the onset and progression of skin conditions. Simultaneously, it explores how skin diseases can affect individuals' social lives and work capability, leading to a cycle of social withdrawal and further deterioration of the condition. The paper describes the need for a holistic approach in dermatology that goes beyond the biomedical perspective and incorporates social factors to develop effective prevention and treatment strategies. The increasing prevalence of skin diseases in Europe and the expected rise in allergies due to climate change make the consideration of social determinants even more urgent. The findings of this review aim to raise awareness of the complex interconnections between social factors and skin health and contribute to reducing social disparities in skin health.

Contact Allergy to Allergens in the Swedish Baseline Series Overrepresented in Diabetes Patients with Skin Reactions to Medical Devices - A Retrospective Study from Southern Sweden

Allergic contact dermatitis is reported among individuals using continuous glucose monitoring systems and insulin pumps. The aim of this study was to describe contact allergy patterns for allergens in the Swedish baseline series and medical device-related allergens among users. Contact allergy to baseline series allergens and isobornyl acrylate was compared between diabetes patients and dermatitis patients patch-tested at the Department of Occupational and Environmental Dermatology during 2017 to 2020. Fifty- four diabetes patients and 2,567 dermatitis patients were included. The prevalence of contact allergy to fragrance mix II and sesquiterpene lactone mix was significantly higher in diabetes patients compared with dermatitis patients. Of the diabetes patients 13.0% and of the dermatitis patients 0.5% tested positive to sesquiterpene lactone mix (p < 0.001). Of the diabetes patients 7.4% and of the dermatitis patients 2.3% tested positive to fragrance mix II (p = 0.041). Of the diabetes patients 70.4% tested positive to medical device-related allergens. Of the diabetes patients 63.0% and of the dermatitis patients 0.2% were allergic to isobornyl acrylate (p < 0.001). In conclusion, not only medical device-related contact allergies, but also contact allergy to baseline series allergens (fragrance mix II and sesquiterpene lactone mix), is overrepresented in diabetes patients who use medical devices.

Comparison of Perceptions of Skin Condition, Product Use and Allergen Reactivity Between People with Psoriasis and Controls in the European Dermato-Epidemiology Network (EDEN) Fragrance Study

Psoriasis, a chronic inflammatory skin disease, goes beyond visible symptoms and affects the general well-being of patients. The aim of this study is to understand how patients with psoriasis perceive their skin characteristics and reactivity to allergens. The study population includes 11,283 participants within the European Dermato-Epidemiology Network (EDEN) Fragrance study, covering several European regions. The study compared perceptions of skin dryness, sensitivity, product avoidance and reactivity to allergens between patients with psoriasis and controls, evaluating the potential influence of psoriasis severity. The results showed that subjects with psoriasis reported dry skin (71.1%) and sensitive skin (49.4%) more often than did controls (51.6% and 38.5%, respectively). Psoriasis patients were more likely to avoid specific products. Interestingly, there were no significant differences in patch-test results between the 2 groups and the severity of psoriasis did not have a consistent impact on these perceptions. In conclusion, people with psoriasis tend to perceive their skin as drier and more sensitive. Notably, the severity of psoriasis did not consistently influence these perceptions and objective reactivity to allergens did not align with subjective perception. Understanding these aspects is crucial for tailoring treatments to improve the well-being of patients with psoriasis, which warrants further research to explore subjective perceptions of skin well-being in patients with psoriasis.

Assessment of hand eczema severity by patients using the hand eczema severity index (HECSI)

BACKGROUND

Hand eczema severity index (HECSI) is a widely used tool for assessment of hand eczema (HE) severity. Generally, HECSI has been used by health care providers, and a validation of the HECSI tool when used by patients is lacking.

OBJECTIVES

To evaluate the construct validity and reliability of HECSI as a tool for patients based on comparison to HECSI assessments by physicians.

METHODS

Patients with HE, enrolled from the dermatological outpatient clinic, Bispebjerg Hospital, assessed HE severity with a patient version of HECSI (patient-HECSI). Afterwards, HECSI was assessed by a trained physician (physician-HECSI).

RESULTS

This study found a strong correlation and very good absolute agreement between patient-HECSI and physician-HECSI assessments with a correlation coefficient of 0.756 and intraclass correlation coefficient (ICC) of 0.844. Cronbach's alpha was 0.861 indicating very good internal consistency.

CONCLUSION

With a strong construct validity and reliability, the patient-HECSI may be used by patients as a patient-reported outcome assessing their personal HE severity.

Chronic hand eczema in Europe: Patient experiences and perspectives (CHEPEP) in qualitative interviews

BACKGROUND

Chronic hand eczema (CHE) is a very common skin disease among the European population. It causes itch and pain and, in more severe cases, seriously impairs hand functioning at work and in private life.

OBJECTIVES

To explore perspectives of people with lived experience on CHE-related problems, wishes and goals.

METHODS

Following a qualitative approach, we conducted topic-guided interviews in five European countries and applied template analysis to identify recurrent themes among patients with CHE.

RESULTS

We interviewed 60 patients in 7 outpatient dermatological and occupational medicine clinics in Croatia, Denmark, Germany, the Netherlands, and Spain. Five main themes were identified: 1) knowledge about the disease and its course, 2) preventive behaviour, 3) hand eczema therapy, 4) impact on everyday life, 5) attitudes towards CHE and healthcare. Participants did not feel well informed about CHE, especially about causes, triggers, and treatment options. Preventive measures were experienced as more or less effective but also cumbersome. Experiences with therapy were diverse. Treatment satisfaction depended on the results and on the perceived support from the treatment teams. Participants found it important to be taken seriously, to receive practical advice, to try out additional treatments or examinations, find new hope, and have occupational perspectives. They wished that others could better understand the physical and emotional burden of CHE. Patient support groups were not mentioned. Participants found it important to learn to take care of themselves and accept life with CHE.

CONCLUSIONS

Due to its annoying symptoms, high visibility, and impaired functioning at work and in private life, CHE has a high emotional and social impact. Some people may require support to learn coping with CHE and its prevention. Patients wish for information about causes and triggers. They value physicians who listen to them and keep looking for solutions.

Which outcomes should be measured in hand eczema trials? Results from patient interviews and an expert survey

BACKGROUND

Hand eczema (HE) is a common skin disease characterized by itch, pain and visible skin changes such as fissures, erythema and vesicles. It is not yet clear which outcome domains are most important for patients. The Hand Eczema Core Outcome Set (HECOS) initiative is developing a consented set of core domains and suitable measurement instruments for the future application in all HE trials. This includes an online Delphi survey about core domains, which requires a 'Long List' of all domains that might be important to measure.

OBJECTIVES

To compile a 'Long List' of candidate outcome domains for therapeutic HE trials with suggestions from patients and experts.

METHODS

First, 60 patients with chronic HE were interviewed at seven study sites in Croatia, Denmark, Germany, the Netherlands and Spain. Patients were asked about domains that were important from their perspectives. Second, 185 HE experts were invited by email to complete an online survey. With an open question, they were asked to suggest up to six domains.

RESULTS

Suggestions were provided by 58 patients and 82 experts. Most patients and experts suggested to measure the domains 'signs', 'symptoms' and 'HE-related quality of life'. Specifically, >25% of patients said that less itch, pain or fissures indicated a successful treatment. Among experts, >25% suggested 'itch' and 'ability to work' as core sub-domains. Further outcomes from the domains 'HE control over time', 'patient-reported treatment experience' and 'skin barrier function' were mentioned.

CONCLUSION

'Itch' was rated high among patients with HE and professional HE experts. While patients emphasized fissures as important, experts underlined the ability to work. This investigation allowed us to define a 'Long List' of 7 candidate outcome domains with 58 sub-domains. From this list, a panel of stakeholders will select core domains during an online Delphi survey.

Increased rates of fragrance allergy in fibromyalgia individuals tested with the Swedish baseline patch test series

BACKGROUND

Contact allergy can manifest in a variety of ways clinically. Systemic contact allergy may occasionally present with pain in muscles and joints. Fibromyalgia is a chronic rheumatic disease characterized by pain and with virtually unknown aetiology.

OBJECTIVES

The aim of this study was to investigate the contact allergy rates to the sensitizers in a baseline series and compare with corresponding rates in dermatitis patients and the general population.

METHODS

Patch testing with the Swedish baseline series was performed in 120 individuals with fibromyalgia. Fisher's exact test was used for pair-wise comparisons of contact allergy rates between the fibromyalgia group and two control groups, dermatitis patients and individuals in the general population.

RESULTS

Contact allergy was significantly more common in the fibromyalgia group compared to the general population concerning nickel and the fragrance markers Myroxolon pereirae and fragrance mix I. There were fewer allergic reactions to preservatives in the fibromyalgia group compared with the dermatitis group.

CONCLUSIONS

Myroxolon pereirae and fragrance mix I represent besides fragrance allergy also allergy to flavouring substances which indicate that oral exposure to flavouring substances and hygiene products might be important for sensitization and possibly elicitation of systemic contact allergy symptoms in fibromyalgia individuals.

Prevalence of contact allergies in the population compared to a tertiary referral patch test clinic in Jena/Germany

BACKGROUND

The contact allergy prevalences in patch-tested patients are usually higher than those in the population, owing to morbidity-driven selection.

OBJECTIVES

To examine the differences between two samples, one from the population, one from the patch test clinic, in one area of Germany (Jena, Thuringia).

METHODS

Between August 2008 and October 2011, a total of 519 participants of the population-based european dermato-epidemiology network (EDEN) fragrance study were patch tested in Jena using a TRUE Test baseline series extended with some pet.-based (fragrance) allergen preparations. Between 2007 and 2012 (inclusive), 1906 routine patients were patch tested for suspected allergic contact dermatitis (ACD) in the Jena University Hospital Department; of these 1694 (83.2%) with the German baseline series using pet./aq.-based, investigator-loaded allergens.

RESULTS

In the population (clinical) sample, 19.6% (41.1%) were sensitized to at least one of the allergens considered. The most common baseline series allergens in the population/clinical sample were nickel (10.5%/13.2%), fragrance mix (FM) II (2.9%/6.7%), FM I (2.3%/8.3%), and cobalt (1.6%/5%). The clinical sample was slightly older (71.5% vs 55.9% age 40+) and included less males (36% vs 49.3%).

CONCLUSIONS

Results are quite similar, although prevalences are usually higher in the clinical setting, with the exception of p-tert-butylphenol formaldehyde resin.

Validation of questionnaire algorithm based on repeated open application testing with the constituents of fragrance mix II: the EDEN Fragrance Study

BACKGROUND

In a European study on contact allergy in the general population, it has been hypothesized that the combination of contact allergy to a fragrance together with a history indicating dermatitis at exposure and thereafter subsequent avoidance of scented products implied a diagnosis of allergic contact dermatitis.

OBJECTIVES

The primary aim of this study was to validate this hypothesis/algorithm. The secondary aim was to investigate whether there was any association between the outcome of the recent repeated open application test (ROAT) and the patch test reactivity.

METHODS

One hundred nine subjects with and without contact allergy to fragrance mix II (FM II) were recruited. Volunteers from six European dermatology clinics participated in the study including a patch test and a ROAT.

RESULTS

Twenty-four positive ROAT reactions were noted in total including 20 of those 32 with contact allergy to FM II. None of the volunteers reacted to the vehicle (P < 0.001). More individuals with a positive algorithm had positive ROATs when compared with those with a negative algorithm. However, the difference was not statistically significant (P = 0.12). The lower the patch test concentration eliciting a positive test reaction, the more likely was a positive ROAT and the more likely that the positive ROAT appeared early during the investigative period.

CONCLUSIONS

The algorithm used in this study was not validated but it was indicated in this ROAT setup. The stronger the patch test reactivity the more likely was a positive ROAT and the more likely it was that the positive ROAT appeared early during the application period.

New evidence on the minimal important change (MIC) for the Hand Eczema Severity Index (HECSI)

BACKGROUND

How changes in hand eczema (HE) severity correlate with the single scores on the Hand Eczema Severity Index (HECSI) is sparsely investigated and particularly needed in clinical trials.

OBJECTIVES

To find the minimal important change (MIC) for HECSI based on patient's and physician's assessments using different methods.

METHODS

In this prospective follow-up study, three different anchors were used: two anchor questions for patients and physician, respectively, and the Physician Global Assessment (PGA) with a photographic guide. MIC was estimated by mean change in patients with a one-step increase to anchor-questions, receiver-operating characteristic (ROC) plot, and smallest detectable change (SDC).

RESULTS

One hundred fifty-two patients with HE (63.8% female) were included at baseline (89% completed follow-up). The mean change, ROC cutoff, and SDC values were 7.1, 4.5, 21.4 (patient-rating), 8.2, 4.5, 8.3 (physician-rating), and 16.6, 6.5, 27.1 points (PGA), respectively. SDC stratified by baseline severity was 2.9 and 11 points for mild and moderate-severe HE (physician-rating), respectively.

CONCLUSION

Identification of the MIC for the HECSI is important in relation to evaluation of treatment, intervention, and sample-size calculations. An improvement of 8.3 points on the HECSI is recommended as the MIC. MIC values may differ according to baseline severity, and this variation should be clarified in future studies.

Protocol for the development of a core domain set for hand eczema trials

BACKGROUND

Clinical hand eczema trials measure a variety of outcome domains to determine the success of interventions. This considerably limits the comparability and overall confidence in the study results, and thereby the strength of recommendations for clinical practice.

OBJECTIVES

The Hand Eczema Core Outcome Set (HECOS) initiative aims to develop a core outcome set (COS) for the standardized evaluation of interventions in future hand eczema trials and reviews. This COS will define the minimum that should be measured and reported in controlled and randomized-controlled trials of therapeutic hand eczema interventions. The objective of this protocol is to specify the methods to develop a core domain set.

METHODS

In Phase 1, a list of candidate domains will be derived from a systematic literature review concerning previously measured outcomes in hand eczema trials, from qualitative patient interviews and from expert interviews. In Phase 2, a consensus study about core domains will be conducted by an online 3-round Delphi survey and a face-to-face meeting, applying predefined consensus criteria. HECOS involves hand eczema and methods experts as well as patients and further stakeholders with an interest in the initiative.

OUTLOOK

When a set of core domains has been defined, HECOS is going to identify appropriate outcome measurement instruments in a development process that will be detailed in another protocol. The COS will considerably enhance the methodological quality, comparability and usefulness of hand eczema trials for clinical decision-making and the development of new therapeutic options for hand eczema, and also reduce the effort of planning, conducting, and reporting individual hand eczema studies, reviews and meta-analyses.

New positive patch test reactions on day 7-The additional value of the day 7 patch test reading

BACKGROUND

Not performing a day (D) 7 patch test reading might result in positive patch test reactions being missed.

OBJECTIVES

To investigate the added value of the D7 patch test reading for individual allergens, and to identify patient characteristics and allergen groups associated with new positive D7 reactions.

METHODS

Data from patients patch tested between 2008 and 2018 with the extended European baseline series were analysed. Patch test readings were performed on D3 and D7. Positive reactions were categorized into positive on D3 or new positive on D7.

RESULTS

A total of 3292 patients were consecutively patch tested with at least 43 allergens of the TRUE Test panels 1 and 2 supplemented with investigator-loaded allergens. In total, 447 (13.6%) patients showed new positive D7 reactions. In univariable regression analysis, age between 18 and 30 years showed a negative association with new positive D7 reactions. Significantly more D7 positive reactions were seen for topicals (odds ratio [OR] 2.60, 95% confidence interval [CI]: 1.92-3.51) and corticosteroids (OR 1.87, 95%CI: 1.09-3.21). No associations were found between sex, atopic dermatitis and occupational dermatitis and a new positive D7 reaction.

CONCLUSION

A D7 reading to identify new positive patch test reactions is of added value, especially for topicals and corticosteroids.

[Hand eczema registries: Background, value and future prospects : Registry data in hand eczema research]

BACKGROUND

Population-based studies on hand eczema (HE) show a 1-year prevalence up to 10.0% of which 5-7% are severe chronic HE (CHE) which can severely impair the life of those affected. Registry data can help to investigate and optimize burden of disease as well as healthcare of HE in a real-life setting.

OBJECTIVES

To assess how data from registries have been used in studies concerning HE. What is the benefit of registry data and which limitations occur when researchers use registry data in their studies?

MATERIALS AND METHODS

This is a review of publications where registry data were used in studies concerning HE. Most of the publications included in this review are from Germany, but some studies are from other countries like Denmark and Switzerland.

RESULTS

Currently, only Germany and Switzerland have established a disease-specific registry for CHE. The chronic hand eczema registry with the acronym CARPE assesses the characteristics of CHE as well as treatment and course of the diseases in a real-life setting. In Denmark, data from public registries (Danish National Board of Industrial Injuries Registry) were used to identify patients with occupational HE in order interview them using a questionnaire. In Saarland and north Bavaria, registries for occupational skin diseases were established in the 1990s, and more than 90% of the patients registered in these had HE.

CONCLUSION

Diseases registries for HE can generate considerable data to describe characteristics of HE patients in a dermatological setting as well as the treatments prescribed. The completeness of data can be assessed in disease registries, while this is not possible when using public registry data.

The course of chronic itch in hemodialysis patients: results of a 4-year follow-up study of GEHIS (German Epidemiological Hemodialysis Itch Study)

BACKGROUND

Chronic itch (CI) is a frequent symptom in hemodialysis (HD) patients. Previous studies demonstrated great impairments of general well-being and health-related quality of life (HRQOL) as well as a higher mortality in those suffering from CI.

OBJECTIVE

The German Epidemiological Hemodialysis Itch Study (GEHIS) is a representative cohort of HD patients in Germany. All patients were followed up 4 years later. The current analyses present data on the course of CI in HD patients, its associated factors including comorbidities, laboratory values and HRQOL.

METHODS

We assessed sociodemographic data, routine laboratory values, comorbidities, HRQOL (SF-12), depression and anxiety (HADS), sleep (duration and quality) and in those suffering from CI characteristics, intensity of CI and itch-related quality of life (ItchyQoL). Those with CI were offered a dermatological examination and CI was classified according to the IFSI classification. Patients were asked if they had consulted a physician about CI.

RESULTS

Of the patients who had suffered from CI in 2013 (n = 234), 90.5% (212) patients could be followed up. About 36.3% (n = 85) had died, 9.8% (n = 23) had received a kidney transplant in the meantime. A total of 52 HD patients still suffered from CI, in 52 CI had stopped. Those patients still suffering from CI (n = 52) reported a higher mean itch intensity, lower ItchyQoL, higher levels of anxiety and a lower mean sleeping time in 2013. On the other hand, those who did not suffer from CI anymore showed a significant increase of HRQOL compared to 2013. There was no significant difference in dialysis characteristics and laboratory values except for albumin. Only a minority of patients in HD had consulted a dermatologist because of CI (29.9%).

CONCLUSION

Our data demonstrate that CI is a persisting symptom in 50% of the HD patients and when it disappears HRQOL recovers. We confirm that CI is a disregarded symptom in HD patients.

Measurement properties of quality-of-life measurement instruments for infants, children and adolescents with eczema: a systematic review

BACKGROUND

Quality of life (QoL) is one of the core outcome domains identified by the Harmonising Outcome Measures for Eczema (HOME) initiative to be assessed in every eczema trial. There is uncertainty about the most appropriate QoL instrument to measure this domain in infants, children and adolescents.

OBJECTIVES

To systematically evaluate the measurement properties of existing measurement instruments developed and/or validated for the measurement of QoL in infants, children and adolescents with eczema.

METHODS

A systematic literature search in PubMed and Embase, complemented by a thorough hand search of reference lists, retrieved studies on measurement properties of eczema QoL instruments for infants, children and adolescents. For all eligible studies, we judged the adequacy of the measurement properties and the methodological study quality with the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist. Results from different studies were summarized in a best-evidence synthesis and formed the basis to assign four degrees of recommendation.

RESULTS

Seventeen articles, three of which were found by hand search, were included. These 17 articles reported on 24 instruments. No instrument can be recommended for use in all eczema trials because none fulfilled all required adequacy criteria. With adequate internal consistency, reliability and hypothesis testing, the U.S. version of the Childhood Atopic Dermatitis Impact Scale (CADIS), a proxy-reported instrument, has the potential to be recommended depending on the results of further validation studies. All other instruments, including all self-reported ones, lacked significant validation data.

CONCLUSIONS

Currently, no QoL instrument for infants, children and adolescents with eczema can be highly recommended. Future validation research should primarily focus on the CADIS, but also attempt to broaden the evidence base for the validity of self-reported instruments.

Prevalence of Contact Allergy to p-Phenylenediamine in the European General Population

Population-based studies on contact allergy to p-phenylenediamine (PPD) are scarce. A cross-sectional study was performed to assess the prevalence of contact allergy to PPD and its risk factors in the general population of 5 European countries. A total of 10,425 subjects were interviewed, and a random sample (n = 2,739) was patch tested to PPD. Overall, 5,286 individuals (50.9%) reported having used hair colorants at least once in their lifetime (78% female, 20% male), and 35% had used hair colorants during the last 12 months. Hair colorant avoidance because of any skin problem during the lifetime was reported by 6%. Black henna tattoos had been used by 5.5% during their lifetime. The prevalence of PPD contact allergy was 0.8% (95% confidence interval 0.6-1.0%), with no statistically significant association with gender or hair dye use. The prevalence of PPD in black henna tattoo users was 3.2% versus 0.6% in nonusers (P < 0.001). A clinically relevant positive patch test reaction to PPD related to hair coloring products was found in 0.1% (95% confidence interval 0.0-0.2%). A significant association with PPD contact allergy was observed for subjects who had black henna tattoos in their lifetime, with an age- and gender-adjusted odds ratio of 9.33 (95% confidence interval 3.45-25.26, P < 0.001). Black henna tattoos are an important risk factor for PPD contact allergy.

Measurement properties of adult quality-of-life measurement instruments for eczema: a systematic review

BACKGROUND

The Harmonising Outcome Measures for Eczema (HOME) initiative has identified quality of life (QoL) as a core outcome domain to be evaluated in every eczema trial. It is unclear which of the existing QoL instruments is most appropriate for this domain. Thus, the aim of this review was to systematically assess the measurement properties of existing measurement instruments developed and/or validated for the measurement of QoL in adult eczema.

METHODS

We conducted a systematic literature search in PubMed and Embase identifying studies on measurement properties of adult eczema QoL instruments. For all eligible studies, we assessed the adequacy of the measurement properties and the methodological quality with the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist. A best evidence synthesis summarizing findings from different studies was the basis to assign four degrees of recommendation (A-D).

RESULTS

A total of 15 articles reporting on 17 instruments were included. No instrument fulfilled the criteria for category A. Six instruments were placed in category B, meaning that they have the potential to be recommended depending on the results of further validation studies. Three instruments had poor adequacy in at least one required adequacy criterion and were therefore put in category C. The remaining eight instruments were minimally validated and were thus placed in category D.

CONCLUSIONS

Currently, no QoL instrument can be recommended for use in adult eczema. The Quality of Life Index for Atopic Dermatitis (QoLIAD) and the Dermatology Life Quality Index (DLQI) are recommended for further validation research.

Measurement properties of quality of life measurement instruments for infants, children and adolescents with eczema: protocol for a systematic review

BACKGROUND

Eczema is a common chronic or chronically relapsing, inflammatory skin disease that exerts a substantial negative impact on quality of life (QoL). The Harmonising Outcome Measures for Eczema (HOME) initiative has used a consensus-based process which identified QoL as one of the four core outcome domains to be assessed in all eczema clinical trials. A number of measurement instruments exist to measure QoL in infants, children, and adolescents with eczema, and there is a great variability in both content and quality of the instruments used. Therefore, the objective of the proposed research is to comprehensively and systematically assess the measurement properties of the existing measurement instruments that were developed and/or validated for the measurement of patient-reported QoL in infants, children, and adolescents with eczema.

METHODS/DESIGN

This study is a systematic review of the measurement properties of patient-reported measures of QoL developed and/or validated for infants, children, and adolescents with eczema. A systematic literature search will be carried out in MEDLINE via PubMed and EMBASE using a selection of relevant search terms. Eligible studies will be primary empirical studies evaluating, describing, or comparing measurement properties of QoL instruments for infants, children, and adolescents with eczema. Two reviewers will independently perform eligibility assessment and data abstraction. Evidence tables will be used to record study characteristics, instrument characteristics, measurement properties, and interpretability. The adequacy of the measurement properties will be assessed using predefined criteria. The COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist will be used to evaluate the methodological quality of included studies. A best evidence synthesis will be undertaken if more than one study has examined a particular measurement property.

DISCUSSION

The proposed systematic review will yield a comprehensive assessment of measurement properties of existing QoL instruments in infants, children, and adolescents with eczema. The results will serve as a basis to recommend a QoL measurement instrument for infants, one for children, and one for adolescents for use in future clinical trials.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42015023483.

Prevalence of fragrance contact allergy in the general population of five European countries: a cross-sectional study

BACKGROUND

Contact allergy to fragrances is assessed mostly in clinical populations of patients. Studies in the general population are scarce and vary in their methodology across countries.

OBJECTIVES

To determine the prevalence of fragrance contact allergy in the European general population and to assess the clinical relevance of positive patch test reactions to different fragrances.

METHODS

In five European countries (Germany, Italy, the Netherlands, Portugal and Sweden) a random sample from the general population aged 18-74 years was drawn. In total, 12 377 subjects were interviewed in this cross-sectional study and a random sample (n = 3119) was patch tested using the TRUE Test and Finn Chamber techniques. Patch test procedures were harmonized by mandatory training before the study and monitoring during the study.

RESULTS

The highest prevalence for contact allergy of 2·6% [95% confidence interval (CI) 2·1-3·2] was found for fragrance mix (FM) I in petrolatum, with a high content of atranol and chloratranol, followed by 1·9% (95% CI 1·5-2·4) for FM II in petrolatum. The conservatively estimated prevalence of fragrance contact allergy was 1·9% (95% CI 1·5-2·5). This is defined as the existence of a positive patch test to FM I or FM II; any of their individual materials; Myroxylon pereirae; sesquiterpene lactones or 3- and 4-hydroxyisohexyl 3-cyclohexene carboxaldehyde that show clinical relevance, defined conservatively as lifetime avoidance of scented products and an itchy skin rash lasting > 3 days in a lifetime. Using the reported lifetime prevalence of any contact dermatitis instead of the lifetime prevalence of any itchy skin rash, the prevalence is 0·8% (95% CI 0·5-1·2). The prevalence rates of contact allergy to fragrances in women are about twice those in men.

CONCLUSIONS

This study helps to identify targets for prevention of fragrance allergy.

Measurement properties of adult quality-of-life measurement instruments for eczema: protocol for a systematic review

BACKGROUND

Eczema is a common chronic or chronically relapsing skin disease that has a substantial impact on quality of life (QoL). By means of a consensus-based process, the Harmonising Outcome Measures in Eczema (HOME) initiative has identified QoL as one of the four core outcome domains to be assessed in all eczema trials (Allergy 67(9):1111-7, 2012). Various measurement instruments exist to measure QoL in adults with eczema, but there is a great variability in both content and quality (for example, reliability and validity) of the instruments used, and it is not always clear if the best instrument is being used. Therefore, the aim of the proposed research is a comprehensive systematic assessment of the measurement properties of the existing measurement instruments that were developed and/or validated for the measurement of patient-reported QoL in adults with eczema.

METHODS/DESIGN

This study is a systematic review of the measurement properties of patient-reported measures of QoL developed and/or validated for adults with eczema. Medline via PubMed and EMBASE will be searched using a selection of relevant search terms. Eligible studies will be primary empirical studies evaluating, describing, or comparing measurement properties of QoL instruments for adult patients with eczema. Eligibility assessment and data abstraction will be performed independently by two reviewers. Evidence tables will be generated for study characteristics, instrument characteristics, measurement properties, and interpretability. The quality of the measurement properties will be assessed using predefined criteria. Methodological quality of studies will be assessed using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist. A best evidence synthesis will be undertaken if more than one study has investigated a particular measurement property.

DISCUSSION

The proposed systematic review will produce a comprehensive assessment of measurement properties of existing QoL instruments in adult patients with eczema. We aim to identify one best currently available instrument to measure QoL in eczema patients.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42015017138.

Prevalence, correlates and characteristics of chronic pruritus: a population-based cross-sectional study

Pruritus is the most frequent symptom in dermatology. Its impact on quality of life is substantial. Epidemiological data on chronic pruritus (>6 weeks) at the population level is sparse, but is important in order to understand the burden and risk factors of this distressing symptom. The aim of this population-based cross-sectional study was to estimate the point, 12-month and lifetime prevalence of chronic pruritus, assessing its association with sociodemographic variables and describing its characteristics. A validated postal questionnaire was sent to 4,500 individuals in from the German General population. Three contact attempts were made. The response rate was 57.8% (n=2,540). The point prevalence of chronic pruritus was 13.5% (95% confidence interval (95% CI) 12.2-14.9%), 12-month prevalence 16.4% (15.0-17.9%) and lifetime prevalence 22.0% (20.4-23.7%). Multivariate analyses found only ethnic origin independently associated with chronic pruritus. The impact of chronic pruritus on quality of life and emotional well-being appears to depend on severity rather than on the presence of the symptom alone. This is the first study to investigate various prevalence estimates of chronic pruritus at the population level. Despite its limitations (self-report and potential self-selection) this study indicates a high burden of chronic pruritus in society.

Prevalence, correlates and characteristics of chronic pruritus: a population-based cross-sectional study

Pruritus is the most frequent symptom in dermatology. Its impact on quality of life is substantial. Epidemiological data on chronic pruritus (>6 weeks) at the population level is sparse, but is important in order to understand the burden and risk factors of this distressing symptom. The aim of this population-based cross-sectional study was to estimate the point, 12-month and lifetime prevalence of chronic pruritus, assessing its association with sociodemographic variables and describing its characteristics. A validated postal questionnaire was sent to 4,500 individuals in from the German General population. Three contact attempts were made. The response rate was 57.8% (n=2,540). The point prevalence of chronic pruritus was 13.5% (95% confidence interval (95% CI) 12.2-14.9%), 12-month prevalence 16.4% (15.0-17.9%) and lifetime prevalence 22.0% (20.4-23.7%). Multivariate analyses found only ethnic origin independently associated with chronic pruritus. The impact of chronic pruritus on quality of life and emotional well-being appears to depend on severity rather than on the presence of the symptom alone. This is the first study to investigate various prevalence estimates of chronic pruritus at the population level. Despite its limitations (self-report and potential self-selection) this study indicates a high burden of chronic pruritus in society.