[Tefillin-related contact dermatitis]

We describe a 14 year-old male with a background of atopic dermatitis who developed a contact dermatitis reaction on the left arm to the leather straps of tefillin (phylacteries), a religious article worn by observant Jewish men from the age 13 years during most morning prayer services. Patch testing revealed contact allergy to potassium dichromate, a chemical involved in leather tanning. Placing the leather straps over clothing and later switching to potassium dichromate-free leather straps resolved the condition. It is important to recognize this uncommon phenomena in a population in which a large proportion regularly use this religious article.

Frequency of standard and occupational contact allergens in Tuzla area, Bosnia and Herzegovina: retrospective study

Allergic contact dermatitis is acute or chronic inflammatory skin disease of allergic etiology, which develops as a result of delayed type of hypersensitivity, i.e. type IV reaction according to the Gell and Coombs classification. In the retrospective study, we reviewed medical records of 495 patients diagnosed with allergic contact dermatitis in the 1988-1998 period. The records were obtained from the Cabinet of Allergology of the Department of Dermatology and Venerology, Tuzla University Hospital Center. There were 312 women and 183 men, aged between 18 and 60 years. The patients were divided into 6 groups according to their occupation. Contact sensitization was established in 295 or 59.6% of them. The type and frequency of causative agent in allergic contact dermatitis depended on working environment. Potassium dichromate, a component part of cement, caused positive reaction in 48% of construction workers tested, which was significantly more than in the "other occupation" group, where 14.6% of patients showed positive reaction to potassium dichromate (p<0.001). Formaldehyde, used in leather processing, was the most frequent among the four leading allergens in the group of shoe workers (13.3%), whereas charcoal tar (used in the metal processing) was the most frequent allergen in the group of metal workers (13.9%). Nickel sulfate, potassium dichromate, cobalt chloride, and urushiol were frequent allergens in the "other occupation" group, housewives, and textile workers. The listed allergens are present at large in everyday life as well as in particular occupations.

Tefillin dermatitis

Tefillin (phylacteries) are a religious article worn by observant Jewish men. Only two cases of allergic contact dermatitis from tefillin have been reported previously. We describe 7 new cases of tefillin contact dermatitis and review the literature on contact allergy caused by religious objects and practices. All our patients had contact allergy to potassium dichromate, which was the only allergen relevant to tefillin .

Examination of a vehicle for use with water soluble materials in the murine local lymph node assay

The murine local lymph node assay (LLNA) is a validated method for identifying skin sensitization hazard. Vehicle choice can influence the sensitization potential of haptens in both the LLNA and in humans, therefore selection of an appropriate vehicle is important. Suggested vehicles for the LLNA include organic solvents and organic-aqueous mixtures. However, due to its high surface tension and poor wetting qualities, water is not recommended and therefore testing aqueous soluble materials can be problematic. The aims of this investigation were to identify a water-based vehicle that possesses better skin wetting properties than water alone, and to assess its performance relative to other solvents in the LLNA using aqueous soluble haptens. The selected wetting agent was the surfactant Pluronic(R) L92 (L92). Concentrations of L92 of up to 50% did not induce positive responses in the LLNA. 1% aqueous L92 was chosen for further examination. Dose-response analyses were performed with dinitrobenzene sulfonic acid (DNBS) and formaldehyde formulated either in water, 1% L92, dimethyl sulfoxide (DMSO) or dimethyl formamide (DMF). Potassium dichromate (PDC) and nickel sulfate were tested in 1% L92, DMSO or DMF. The highest concentration of potassium dichromate was retested in each vehicle and in water to assess the effect of the wetting agent. Estimates of the relative sensitizing potency in each vehicle were determined by calculation of EC3 values (the estimated concentration required to induce a threshold positive response). While DNBS and formaldehyde produced positive responses in all four vehicles, their relative potency varied among the vehicles. The rank ordering of potencies for both materials was, from highest to lowest, DMF > or = DMSO > 1% L92 > water. Compared with water, use of 1% L92 resulted in >2-fold increase in potency for DNBS and >3-fold increase for formaldehyde. PDC was positive in DMF, DMSO and 1% L92. The potency ranking was DMF > or = DMSO > 1% L92. Re-evaluation of 0.5% PDC confirmed that formulations of both DMSO and DMF induced strong proliferative responses, whereas somewhat less proliferation was recorded with the 1% L92 vehicle. PDC in water was without activity. The performance of 1% L92 as a vehicle for nickel sulfate was assessed relative to DMSO and DMF. In DMSO, nickel sulfate produced a stimulation index (SI) >3 at only the highest level. Testing in DMF induced low levels of proliferation, but failed to produce a SI of 3 at any concentration tested. When formulated in 1% L92, nickel sulfate caused a SI of 3 when tested at 2.5%. Based on the results of these experiments, for identification of sensitization hazard of aqueous soluble materials using the LLNA, DMF and DMSO are the preferred vehicles. However, if a test material is not soluble in DMF or DMSO, or if higher test concentrations can be achieved in an aqueous vehicle, then 1% L92 may provide a better alternative to water alone in terms of improved assay performance.

Differential effect of chromium compounds on the immune response of the African mouth breeder Oreochromis mossambicus (Peters)

The objective of this study was to investigate the effect of trivalent (chromic chloride) and hexavalent (potassium dichromate) forms of chromium in the African mouth breeder Oreochromis mossambicus (Peters), with reference to the humoral immune response and lymphoid cells/organs. The 96 h LD50 for hexavalent and trivalent chromium was found to be 75 and 1,000microg fish(-1), respectively. Groups of fishes were injected intraperitoneally with 10, 1, 0.1 and 0.01% LD50 hexavalent and trivalent forms of chromium and subsequently immunised with bovine serum albumin (5 mg in 0.2 ml physiological saline). Both forms of chromium suppressed the antibody response, with hexavalent chromium being more suppressive than trivalent chromium. Reduction in spleen weight, splenocyte number and the percentage of blood lymphocytes was observed following administration of both forms of chromium. The possible immunological mechanisms behind the differential suppression of the antibody response and the reduction in spleen weight, splenocyte and lymphocyte counts are discussed.

Positive nickel patch tests do not intensify positive reactions to adjacent patch tests with dichromate. Results from a double-blind multicentre study of the German Contact Dermatitis Research Group (Deutsche Kontaktallergie-Gruppe, DKG)

The possible interference of neighbouring allergic patch-test reactions is still an open question. In this study, we investigated whether there is a distance-related mutual modification of neighbouring allergic patch-test reactions to nickel sulfate and potassium dichromate. We used a double-blind multicentre study design with randomized attachment of special TRUE Tests with 1, 3 and 7 cm distance between nickel sulfate and potassium dichromate patches. 589 patients with a history of nickel allergy (523 female, 66 male) were tested, with a mean age of 35 years. A log-linear modelling approach was used for statistical assessment of the relation between the distance separating neighbouring patch tests with nickel and dichromate and the reactions to the allergens. Non-reproducibility coefficients were compared by the generalized version of Fisher's exact test for arbitrary 2-dimensional contingency tables. For the left side of the back, virtually no differences (p=0.70) were found in the reaction patterns obtained for the 3 distances separating nickel and dichromate patch tests. On the right side of the back, the number of reactions to dichromate patches with only 1 cm distance from moderate/strong nickel reactions was lower than the number of positive dichromate tests at larger distances from nickel tests (on the border of statistical significance: p= 0.05). Corresponding side-related results were obtained for subgroups of patients with and without a history of atopic dermatitis. The non-reproducibility of reactions to dichromate was not significantly related to the distance between neighbouring tests. Our data argue against a "spillover" effect of strong/moderate nickel reactions, but indicate that such reactions may, under certain conditions, attenuate adjacent reactions to an unrelated allergen. In the case of future verification, this will have implications for the interpretation of patch tests.

Experimentally induced malignant lymphoma due to chronic antigen stimulation

Animal experiments were started in 1988 with the aim of inducing malignant lymphomas. 52 guinea pigs were exposed to potassium dichromate using the TINA test (plus 39 control animals). Following the sensitization procedure, the test animals and 15 control guinea pigs were exposed daily (5 x a week) epicutaneously to the antigen up to the present time. Currently, 30 exposed and 17 control animals are still in the experiment. In 3 out of 17 post-mortem examinations, histologically evident lymphomas were found. In the control animals, no tumor has been seen. The experiments support lymphoma causation by chronic antigen stimulation. The experiments are continuing.

Influence of irritants on lymph node cell proliferation and the detection of contact sensitivity to metal salts in the murine local lymph node assay

Dimethyl sulfoxide (DMSO) and sodium lauryl sulfate (SLS) are known to cause irritation of the skin, and to enhance the penetration of chemicals into the epidermis. In the present study, the lymph node cell (LNC) proliferative response following exposure to irritants, such as SLS and DMSO, was examined in the murine local lymph node assay (LLNA). Exposure to DMSO or SLS aqueous solution induced a small increase in lymph node cell proliferation compared with aqueous solution alone. Exposure to SLS in DMSO caused a significant increase in LNC proliferation. Further, the effect of addition of the irritants in a vehicle on the detection of contact sensitivity to metal allergens was examined. Application of potassium dichromate and nickel sulfate in DMSO or SLS aqueous solution caused increases in LNC proliferation. Exposure to metal allergen with SLS in DMSO also induced a significant LNC proliferative response, but did not induce a significant increase in stimulation index (increase in 3H-thymidine incorporation relative to vehicle-treated control group). This was because of increased 3H-thymidine incorporation following exposure to SLS-DMSO in the control group. These results suggest that irritants enhance the LNC proliferative responses to metal allergens. The use of SLS in aqueous solution is effective for the detection of sensitivity to water-soluble allergens, such as metal allergens, in the LLNA, as well as the use of DMSO as an application vehicle.

Patch testing in atopic dermatitis

Because patients with atopic dermatitis are less prone to type IV allergies, there has been controversy regarding the role of patch testing in these patients. However, recent observations indicate that patch testing with standard allergens often adds valuable information about contact sensitivity in these patients.

Chromium in US household bleach

Spectrophotometric analysis for chromium in hypochlorite bleach sampled at random throughout the USA shows that the highest level found in those products is of the order of 0.1 ppm (2/20). This probably does not represent a significant risk factor for chromate sensitization of the consumer population.

Prevalence of positive epicutaneous tests among infants, children, and adolescents

We studied 314 otherwise healthy children younger than 18 years of age with epicutaneous testing, and found that 20% of those tested had at least one positive epicutaneous test result. Neomycin, nickel, and potassium dichromate were the most prevalent allergens detected in our study group. We found that sensitization occurred at less than 5 years of age for all but fragrance allergens. Aluminum chambers and the American Academy of Dermatology Patch Test Kit were found to be safe for use in infants, children, and adolescents.

[Chromium binding to leukocytes]

The experiment has been done on 63 patients affected by allergic contact dermatitis and sensitized to potassium dichromate and on 76 non allergic subjects to control: if leukocytes (separated in emagel), mononuclear cells (separated in lymphoprep) and T-lymphocytes (separated through rosettes with neuraminidase) bind the 51Cr, if this binding depends on the valence (Cr3+ and Cr6+) and on the type of cells and if it is conditioned by the hypersensitivity. Through incubation of the cells with the tracing at 4 degrees C and in different times, it has been demonstrated that the binding takes place, it depends on the valence and, in certain conditions it is bigger for the mononuclear cells and the T-lymphocytes in allergic subjects.

Investigation of ability of the metal allergens cobalt chloride, nickel sulfate and potassium dichromate to give a mitogenic response in human thymocytes

The metal allergens cobalt chloride, nickel sulfate and potassium dichromate were tested for the ability to give a mitogenic response in human thymocytes, both unseparated and Percoll-separated, including a fraction of low density, which has been shown to have characteristics of medullary cells (unsensitized, virgin T cells). With cobalt chloride and potassium dichromate, no stimulation occurred; instead, cobalt chloride at a concentration of 3.5 X 10(-5) M and potassium dichromate at 5.7 X 10(-7) M were inhibiting. After nickel sulfate addition, a small DNA synthesis stimulation was obtained in both unseparated cells and in fractionated cells of different densities. The results thus speak against that cobalt chloride and potassium dichromate are unspecific mitogens for human lymphoid cells, while an unspecific mitogenic effect is indicated for nickel sulfate.

Inhibition of lymphoid cell DNA synthesis by metal allergens at various concentrations. Effect on short-time cultured nonadherent cells compared to nonseparated cells

Metal allergen concentrations inhibiting lymphoid cell DNA synthesis were tested on short-time cultured nonadherent and nonseparated thymic and splenic cells. With all tested metal allergens, the DNA-synthesis-inhibiting effect was more marked for nonadherent compared to nonseparated splenic cells. In thymocytes, a stronger inhibition of nonadherent cells was seen after addition of mercuric chloride. A protective or modifying role of adherent cells towards inhibiting or toxic effects of metal allergens in vitro is postulated.

Effect of metal allergens on the DNA synthesis of unsensitized guinea pig lymphoid cells cultured in vitro

The metal allergens cobalt chloride, mercuric chloride, nickel sulfate and potassium dichromate were tested regarding their effect on the DNA synthesis of lymphoid cells from unsensitized guinea pigs. At certain concentrations in the range of 10(-8) to 10(-6) M, all tested metal compounds stimulated the DNA synthesis of both thymocytes and peripheral lymphocytes after 48 h of culture. The most consistent stimulation with all tested metal allergens was obtained with spleen cells. Thymocytes and spleen cells were stimulated even when the small fraction of adherent cells was eliminated. Mercuric chloride and potassium dichromate were found to be inhibiting at 10(-6) to 10(-4) M, while cobalt chloride and nickel sulfate were less toxic and inhibiting at 10(-4) to 10(-3) M. At 5 h of culture the lowest inhibitory concentration of potassium dichromate was found to be about 100-fold lower than that of nickel sulfate, which may be of practical interest for the choice of concentrations used in human patch test. The lowest concentrations of mercuric chloride and potassium dichromate which at 5 h were inhibitory, were stimulating at 48 h. The presence of serum seemed to have a protective and modifying role regarding the effect of the various metal compounds on the DNA synthesis.

Persistence of contact allergy to chromium

Forty-eight patients with a positive patch test to potassium dichromate 0.5% were retested after 4-7 years; 38 patients (79%) still had a positive patch test. Chromate allergy seems to be persistent. In 72% of the cases a history of occupational exposure to chromates could be proved.

Sensitization with Cr, Ni and Zr salts and allergic type granuloma formation in the guinea pig

Guinea pigs were sensitized to potassium dichromate, nickel sulfate and sodium zirconium lactate by three methods of immunization in Freund's complete adjuvant: Polak, split adjuvant, and maximization (modified Magnusson and Kligman). These were followed after 2 weeks by weekly intradermal injections of 25 microng of the metal salt. Delayed hypersensitivity-like reactions developed 3 to 12 weeks after initial injection. Reactivity, although strong with an increase in thickness of over 0.7 mm and/or diameter of erythema of over 8 X 8 mm, was frequently transient, the animal losing reactivity on subsequent skin test or after 2 or 3 skin tests. In two-thirds of the experiments using sodium zirconium lactate, delayed hypersensitivity-like reactions at 24 hr developed into nodular lesions which reached peak intensity at 8 days and histologically contained histiocytes with an epithelioid cell appearance and giant cells. In some experiments, sodium zirconium lactate-sensitive animals showed cross reactivity with potassium dichromate, but not with nickel sulfate.

The role of carrier in sensitivity to chromium and cobalt

Patients suffering from contact dermatitis caused by chromium sensitivity showed positive reactions to intradermal tests with chromium and cobalt chlorides. Patch tests to cobalt in unaffected and in healed eczematous skin areas gave negative results. A large number of chromium-sensitive patients also showed a positive intradermal test reaction to cobalt bound to human serum albumin and a negative reaction to cobalt bound to rabbit liver glycogen. It has been suggested that these positive reactions to cobalt are secondary sensitivities to cobalt, caused by cobalt-denaturated human serum albumin that is so similar to the denaturated product of chromium cations that the competent cells cannot distinguish between them.