[How dangerous is amalgam?].
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Biomedical subjects
Publications and source records attributed to W Aberer.
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Interferon alpha and gamma have been used to treat several hepatic, hematological and oncological diseases for years. Recently, interferon beta has been introduced as a therapeutic agent in relapsing-remitting multiple sclerosis. A 41-year-old female patient with multiple sclerosis developed non-tender, palm-sized, cutaneous-subcutaneous, reddish infiltrates at the injection sites on her thighs after 8 weeks of treatment with subcutaneous interferon beta injections. Histopathology revealed a perivascular lymphoid infiltrate of the dermis and a subtle lobular lymphoid infiltrate of the subcutis. Interferon beta therapy was discontinued for 4 weeks. With topical corticosteroids, the skin lesions resolved. When subcutaneous injections were resumed at a reduced dose, only erythema around injection sites developed without induration or pain. Slight erythema and swelling at interferon beta injection site are frequent and rare cases of cutaneous necrosis have been described. However, no reports of large, painful, cutaneous-subcutaneous infiltrates after interferon beta therapy have been published.
The incidence of allergy to airborne proteins derived from tree and grass pollen, feces of mites, spores of molds, and pet dander has been increasing over the last decades. Since precise diagnosis is a prerequisite for successful immunotherapy, there is a rising demand for rapid, reliable, and inexpensive screening methods such as dipstick assays. With the purified recombinant major birch-pollen allergen rBet v 1a as model protein, crystalline bacterial cell-surface layers (S-layers) were tested for their applicability as an immobilization matrix for dipstick development. For this purpose, S-layers were deposited on a mechanically stable microporous support, cross-linked with glutaraldehyde, and free carboxylic acid groups of the S-layer protein were activated with carbodiimide. In the present test system, rBet v 1a was immobilized via the monoclonal mouse antibody BIP 1, which, unlike the allergen, is too large to enter the pores of the S-layer lattice, and which therefore formed a closed monolayer on the outermost surface of the crystal lattice. Moreover, BIP 1 is known to modulate IgE binding to the allergen. After incubation of the dipsticks in serum, washing of the reaction zone under tap water, and binding of an anti-IgE alkaline phosphatase conjugate, 5-bromo-4-chloro-3-indolyl phosphate/nitro blue tetrazolium was used as substrate, forming an IgE concentration-dependent colored precipitate on the S-layer surface. The investigation of patient sera previously tested with the CAP system confirmed the specificity of the S-layer-based dipstick assay. Since the dipstick is easy to handle and the whole test procedure takes only 90 min, this test system should be applicable for rapid determination of specific IgE and for first screening in the doctor's practice.
We investigated whether patients with contact allergy differed from non-contact-allergic, non-atopic controls with regard to genotype and phenotype of the polymorphic enzyme N-acetyltransferase 2 (NAT2). 55 contact-allergic patients recruited from the Information Network of Departments of Dermatology (IVDK) were compared to 85 controls from among local health care personnel. NAT2 activity was calculated from HPLC analysis of the ratio of the caffeine metabolites 5-acetylamino-6-formylamino-3-methyluracil (AFMU) and 1-methylxanthine (1MX) in the urine. NAT2 genotype was determined by polymerase chain reaction (PCR). A statistically significantly increased proportion of rapid acetylators was found in contact-allergic patients. This may have 2 possible implications: acetylation may enhance contact sensitization; or NAT2 status may be a genetic marker for contact sensitizability.
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Bufexamac-containing ointments and creams are widely used by many patients with eczematous disorders as an alternative to topical corticosteroids. Recent studies provide evidence of a notable prevalence of contact sensitization in patch test populations. The aim of this study was to assess the frequency of use of this topically-applied drug by eczema patients in general, and to evaluate its potential to cause allergic contact reactions. 500 routinely patch tested patients (f:m = 377:123) were tested with bufexamac 5% and Parfenac ointment (the only commercial product available in Austria) in addition to the standard and other series of the German Contact Dermatitis Group. The packaging of the commercial product was shown to the entire study population, to decide whether or not they had ever used this product. In addition, their general practitioner was contacted to verify the anamnestic data. A total of 30 patients agreed that they had definitely used bufexamac, 5 others having probably applied it. The indication for and the duration of treatment were noted. Positive and relevant patch test reactions to bufexamac, as well as the bufexamac-containing ointment, were seen in 20 out of these 35 patients (57%), and sensitization occurred even after short-term application. Our study demonstrates that bufexamac has to be assumed to be a topical drug with a very high sensitization rate in an unselected patch test population (4% of 500 patients), and should therefore be added to the standard series.
Adverse cutaneous reactions to topically applied olive oil are seldom reported, and positive patch tests to it are mostly regarded as allergic. To evaluate such "positive" patch test reactions, 77 female (mean age: 44 years) and 23 male eczema patients (mean age: 46 years) were prospectively patch tested with freshly prepared olive oil. Tests were performed openly (including ROAT) as well as using Al-tests and Finn Chambers on Scanpor. 5 patients (2 male) showed "positive" test reactions (all patients at the Al-test site, 3 at the Finn Chamber site, 1 with ROAT). In only 1 patient could the reaction be classified as probably allergic, in contrast to previous reports. In conclusion, olive oil is very weakly irritant in general, but bears relevant irritant capacity when applied under occlusive conditions. Therefore, olive oil appears to be less than suitable for the topical therapy of patients with venous insufficiency and associated eczema of the lower extremities.
Sensitization rates to contact allergens vary between centers and are influenced by sex and age. Eliminating the latter 2 factors by standardization of data by age and sex, the present analysis addresses possible differences between centers remaining after elimination of these confounders, and analyzes other factors which might influence rates, e.g., the MOAHL index. Overall standardized rates were well within the range reported in previous studies and may be regarded as representing the rates of the "patch test population" in Central Europe (e.g., nickel sulfate 12.9%, fragrance mix 10.5%, balsam of Peru 7.3%, thimerosal 5.6%). For this analysis, data of those departments which contributed more than 2000 patients, or of those with extreme proportions concerning sex, age and occupational cases were selected. Patients from these 10 departments differed considerably with regard to the items of the MOAHL index and with regard to standardized rates. The items of the MOAHL index proved to be suitable for describing different patch test populations and for explaining some differences between centers. Only 'atopic dermatitis' seems to have little influence on (standardized) rates. Face dermatitis is not yet represented in the MOAHL index, but should be included, together with age > 40 years, in an extended index (acronym: MOAHLFA). Regional allergen exposure (with striking differences between East Germany, West Germany and, to a lesser extent, Austria) seems to have a great influence on the sensitization pattern observed in a department. In addition, sociological factors may influence sensitization rates, which is exemplified by high rates of nickel allergy in a socially defined subgroup. Future studies should focus on these factors, as well as on factors concerning patch test practices and quality control.
In a multicenter study, 100 patients with chronic urticaria were examined with a standardized personality test (Giessen test), a standardized symptom questionnaire (Giessener Beschwerdebogen) and a specially developed questionnaire concerning symptoms, history and behaviour during symptomatic periods. Almost one third of the patients showed elevated scores both for depression and for symptoms that are often associated with depression. It therefore seems worth-while examining such persons more specifically and possibly treating them by psychosomatic methods. The present results do not allow the classification of chronic urticaria as a somatization disorder. Since one-third of the patients had symptoms of depression, combined dermatological and psychosomatic approach may make it possible to offer them an appropriately targeted treatment.
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The lack of standardized definitions and reliable test methods disclosed a wide field of often incorrect speculation on the incidence and importance of allergies and intolerance reactions to food and its ingredients. It was only recently that, based on guidelines in statements from national and international scientific societies, serious studies were initiated to determine the correct incidence and prevalence of these problems. First results clearly document that lay people and the press overestimate the role of food as causative agent for disease, which might result in unjustified dietary restrictions and exaggerate the problem, whereas the scientific community might have underestimated the dimensions. New developments in the field of antigen characterization and new guidelines for a correct test performance should soon enable unproven alternative methods which frequently hurt the person concerned more than they help, to be disposed of.
Allergy to dental amalgam is rare--in contrast to Press reports and public opinion. Whereas sensitivity to one or more mercury salts is quite frequently detected in the patch test, it is seldom of clinical relevance. In this report we define the limited indications for performing an allergy test, describe the exact test criteria and delineate the consequences of a positive test result. A critical appraisal of the result is essential in order to avoid unnecessary procedures which are expensive and far from being effective, may even be potentially dangerous.