Allergic contact dermatitis from 4-isopropyl-dibenzoylmethane in a light moisturising cream.
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Biomedical subjects
Publications and source records attributed to A Forsyth.
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With the increased use of condoms, contact dermatitis to rubber is being seen more often. To develop a rubber condom suitable for use by rubber sensitive people, a "hypoallergenic" condom, which is washed in ammonia to reduce the residues of rubber accelerators, has been manufactured. Fifty patients allergic to various rubber accelerators were patch tested with an ordinary condom and the new washed condom. Fifty patients undergoing routine patch test investigation who were not allergic to rubber were also tested as controls. Twenty two of the rubber sensitive patients had a positive reaction to the new rubber condom compared with four of the control patients. Washing rubber condoms in ammonia does not appear to reduce the residues of rubber accelerators sufficiently for their use by rubber sensitive people. A non-allergenic condom is required.
Lung volumes and arterial blood gas tensions in patients undergoing coronary artery surgery were compared in 77 patients given an internal mammary artery graft (group 1) and 33 patients given a saphenous vein graft only (group 2). Patients in both groups developed a severe restrictive ventilatory defect after surgery, more pronounced in those receiving an internal mammary artery graft. Mean (SEM) vital capacity in groups 1 and 2 was reduced to 36% (1.2%) and 45% (2.0%) of preoperative values on the second postoperative day (1.56 and 1.85 1 respectively), with some recovery by day 4 to 56% (1.2%) and 63% (2.1%) of preoperative values. The mean (SEM) arterial oxygen tension was 7.34 (0.13) kPa for group 1 and 7.46 (0.20) kPa for group 2 on day 2, rising to 8.39 (0.13) and 9.01 (0.23) kPa on day 4. Analgesic requirements were greater in the group receiving an internal mammary artery graft. Possible explanations for the differences between the effects of the two grafts include the higher frequency of pleurotomy, the placing of pleural drains, and additional surgical trauma when internal mammary artery grafts are used.
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Thiomersal is the preservative in all toxoid vaccines routinely administered to children in the UK, but exposure from other sources is uncommon. Delayed hypersensitivity to thiomersal was demonstrated in 1% of individuals attending the Contact Dermatitis Investigation Unit, and 50 of these patients with positive patch tests to thiomersal were studied. Cross-reaction with other mercurials occurred in 17 of 29 patients tested (59%). 31 of the patients replied to a questionnaire regarding vaccination reactions, and were compared with case-controls matched for age, sex, and site of dermatitis. 4 patients in each group reported reactions to vaccines which contained thiomersal, suggesting that thiomersal hypersensitivity was not associated with an increased risk of vaccination reactions. However, individual cases of severe reactions to thiomersal demonstrate a need for vaccines with an alternative preservative.
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We report 3 patients with persistent symptoms at vaccination sites. All were allergic to aluminium and one to thiomersal and neomycin too. Aluminium allergy causes false positive patch test reactions and we propose methods of patch testing patients with symptoms at vaccination sites in order to avoid this problem. The practical relevance of allergy to non-toxoid constituents of vaccines is discussed.
Eight patients with severe symptomatic calcific aortic stenosis were considered to be unsuitable for valve replacement. Four were admitted with pulmonary oedema and three in cardiogenic shock and one had angina at rest. With the use of echocardiographic and radiographic guidance percutaneous transluminal aortic valvuloplasty was carried out. Aortic gradients were reduced by an average of 40%. All four patients who presented with cardiac failure improved immediately and remained well six months later. The patient with angina was symptom free at nine months. Two of the three patients who presented in cardiogenic shock improved immediately and were well nine and three months later. The other patient died four hours after the procedure. Doppler echocardiographic studies showed a slight initial increase in aortic incompetence, but this did not worsen and valvar gradients remained improved three and six months later. Percutaneous valvuloplasty of the aortic valve is an effective therapeutic option in patients with severe calcific aortic stenosis who are unfit for surgery. Its role as an alternative to surgery has not been considered and should be investigated in a controlled clinical trial.
Lichen planus is a common disorder of unknown aetiology. It has been proposed that in some cases it represents a form of allergic reaction to the metals contained in dental amalgam, particularly mercury. Twenty-nine consecutive dentate patients who had lichen planus of the oral mucosa were patch-tested to the range of metals contained in dental amalgam. Ten out of 29 (34%) showed an allergic reaction to mercury and all of these patients had amalgams greater than 5 years old. The amalgams were poorly contoured and had corroded, resulting in continued release of mercury ions. Six patients had their amalgams replaced with composite or glass ionomer materials resulting in resolution of ulcerated lesions. In a follow-up of 3-24 months, one patient had a recurrence of ulcerated areas and another, despite resolution of the oral lesions had persistent discomfort.
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Skin reflectance values were used as an objective measure of skin haemoglobin content at patch test sites to facilitate quantification of the erythematous response to contact allergens in patients with allergic contact dermatitis. Reflectance measurements of patch test responses correlated well with the clinical scoring and provided a numerical measure of reaction severity. Experimental contact allergen formulations were also evaluated by this method.
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Food or flavouring intolerance has been demonstrated in 14 out of 80 patients with oro-facial granulomatosis. Provoking molecules include cinnamaldehyde, carvone and piperitone, although a wide range of food or flavourings may be implicated. The nature of the reaction is not understood but does not seem to involve an IgE mediated response. At present the only reliable way of detecting specific provoking factors is by the use of an elimination diet.
A group of 43 patients with a clinical history of nickel allergy who exhibited an equivocal or no allergic reaction to a patch test at 48 h were further challenged using several different formulations of nickel sulphate. This experimental test battery comprised aqueous, dimethyl sulphoxide (DMSO) and propylene glycol (PG) solutions of nickel sulphate, and nickel sulphate incorporated into cetomacrogol cream and yellow soft paraffin (PMF). Although some of these vehicles were irritant, a formulation-dependent test response was observed, such that in terms of the number of responses per unit weight of nickel sulphate applied to the skin, the vehicles could be ranked: DMSO greater than PG greater than aqueous solution greater than cetomacrogol cream greater than PMF preparations. This ranking could be correlated with the relative ease with which nickel sulphate could be dialysed from each vehicle in vitro. This study demonstrates that for nickel sulphate, the vehicle can influence the outcome of patch testing apparently by modifying the quantity of nickel released into the skin for elicitation of the allergic response.
Allergy to gold dental appliances in very rare. This article reports the case of a patient who presented with acute oral ulceration following the placement of a gold crown. Biopsy of the ulcer and adjacent mucosa showed histologic features typical of a contact sensitivity. The patient subsequently had a positive patch test reaction to gold chloride. The literature is reviewed, and the dental implications are discussed.