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PubMed1993

Eczematous skin reaction from patch testing with aeroallergens in atopic children with and without atopic dermatitis.

To determine whether aeroallergens could induce eczematous lesions, 30 patients with atopic dermatitis were studied in comparison with 30 patients with respiratory atopy without atopic dermatitis. All patients were between 2 and 14 years of age. Patch testing with five aeroallergens--housedust, mite, cockroach, mold mix, and grass mix--was done on skin that was stripped by 10 applications of adhesive tape. Intradermal tests with the same antigens were done on the forearm. In 27 (90%) children with atopic dermatitis, patch testing with aeroallergens induced eczematous lesions at one or more sites. Mite, cockroach, house dust, mold mix, and grass mix caused reactions in 21 (70%), 21 (70%), 19 (63%), 15 (50%), and 13 (43%) patients, respectively. Three patients had a dermatitis flare at the antecubital and popliteal fossae during testing. Only three (10%) atopic children without atopic dermatitis had eczematous lesions, which was significantly different from children with atopic dermatitis (P < 10(-6)). Intradermal skin tests in both groups were not significantly different. This study supports previous reports that aeroallergens plays an important role in causing eczematous skin lesions.

Adolescent↗
PubMedDate not supplied

Does food allergy cause atopic dermatitis? Food challenge testing to dissociate eczematous from immediate reactions.

The objective is to evaluate and diagnose, in a controlled setting, suspected food allergy causation in patients hospitalized for management of severe, unremitting atopic dermatitis (AD). Nineteen children were hospitalized at Oregon Health and Science University with atopic dermatitis from 1986 to 2003 for food restriction, then challenge, following standard recommendations. Challenges were prioritized by categories of (a) critical foods (e.g., milk, wheat, egg, soy); (b) important foods; and (c) other suspected foods. Patients were closely observed for evidence of pruritus, eczematous responses, or IgE-mediated reactions. If results were inconsistent, double-blind, placebo-controlled food challenge was performed. A total of 17 children with atopic dermatitis were assessed. Two could not be fully evaluated, thus were excluded from data tabulations. Only one positive eczematous food response was observed of 58 challenges. Three children had well-documented histories of food-induced IgE-mediated anaphylactoid or urticaria reactions to seafood and/or nuts and were not challenged with those foods. Atopic dermatitis, even in the highest-risk patients, is rarely induced by foods. Undocumented assumptions of food causation detract from proper anti-inflammatory management and should be discouraged. Immediate IgE-mediated food reactions are common in atopic dermatitis patients; such reactions are rapid onset, typically detected outside the clinic, and must be distinguished from eczematous reactions. Diagnosis of food-induced eczema cannot be made without food challenge testing. Such tests can be practical and useful for dispelling unrealistic assumptions about food allergy causation of atopic dermatitis.

Adolescent↗
PubMedDate not supplied

The role of Helicobacter pylori in urticaria and atopic dermatitis.

INTRODUCTION: Helicobacter pylori, a common cause of gastritis and peptic ulcer, has been associated with several extragastrointestinal diseases. Many studies have shown a positive relation between H. pylori infection and both chronic idiopathic urticaria and atopic dermatitis. METHODS: The study included 20 patients diagnosed with chronic idiopathic urticaria and 20 with atopic dermatitis. A randomized sample of 20 healthy individuals was selected as a control group. H. pylori infection was assessed using the C-urea breath test, and anti-H. pylori IgG antibody titers were determined by enzyme-linked immunosorbent assay. RESULTS: In the chronic idiopathic urticaria group, the urea breath test titer was positive in 75% of patients, and anti-IgG antibodies were also detected in 75% of patients. In the atopic dermatitis group, titer was positive in 70% and antibodies were detected in 65% of patients, while in the control group, the urea breath test titer was positive in 55% and antibodies were seen in 20% of patients. This difference was statistically highly significant (p < 0.001) in the case of anti-H. pylori antibodies in relation to chronic idiopathic urticaria and significant (p < 0.05) in the case of atopic dermatitis. CONCLUSIONS: These results provide some evidence of a relationship between H. pylori infection and both chronic idiopathic urticaria and atopic dermatitis. Treatment of infection demonstrated by reduction in C-urea breath test and anti-H. pylori antibody titers resulted in partial improvement of clinical symptoms in patients with atopic dermatitis.

Adolescent↗
PubMed1985

Occupational dermatitis from soldering flux among workers in the electronics industry.

Although numerous occupational irritants and allergens have been known to cause contact dermatitis in the electronics industry, soldering flux is seldom mentioned. Soldering flux used in the electronics industry can cause both irritant and allergic contact dermatitis. Irritant dermatitis is commoner than allergic contact dermatitis. Aminoethylethanolamine, a constituent of some fluxes, is a sensitizer. Dermatitis tends to start over the periungual area and spread to the finger shafts and sometimes the wrists. The use of cotton gloves by workers appeared to aggravate the problem. Prophylactic measures are essential to prevent occupational contact dermatitis in workers handling flux in the electronics industry.

Adult↗
PubMed1990

Occupational dermatitis in animal feed mill workers.

In an epidemiological study of occupational dermatitis in 15 different northern Italian animal feed mills, 204 workers were interviewed, examined and patch tested to 34 allergens, selected from the additives most commonly used in the animal feed mills under consideration. The prevalence of occupational contact dermatitis was 13.7% (28/204): 7.8% (16/204) irritant contact dermatitis and 5.8% (12/204) allergic contact dermatitis from animal feed additives. Among the latter, there were sensitizations, to our knowledge hitherto unreported in the literature: to indigo carmine (2 cases), monensin sodium (1 case), thiabendazole (1 case), methylchlorpindol (1 case) and amprolium hydrochloride (1 case). 3.9% (8/204) of the workers complained only of pruritus sine materia on exposed areas of the body. Contact dermatitis increased with respect to duration of employment: the difference in the rate of contact dermatitis between workers employed in animal feed mill for greater than 10 years and those employed for less than 10 years was statistically significant (p less than 0.05). 6.8% (14/204) had latent sensitivity, which was more frequent in workers with less than 1 year of employment with respect to more experienced colleagues.

Adult↗
PubMed1992

Diaper dermatitis: a study of contributing factors.

A 44-week clinical study was carried out on a large sample of the Italian infant population to measure the incidence of diaper (napkin) dermatitis and to identify the factors related to the development of diaper dermatitis. Factors such as age, sex, the presence of atopic dermatitis, the general state of health of the child, the use of drugs and the type of diaper used were recorded. At the end of the test, 2169 clinical dermatological examinations were performed. The frequency of episodes of diaper dermatitis was 15.2%. Statistical correlations between diaper dermatitis and age, presence of atopic dermatitis, and health conditions were found.

Age Factors↗
PubMed1996

Prognosis of occupational hand dermatitis in metalworkers.

Hand dermatitis is common in workers employed in the cutting and grinding of metals. Previous studies have given conflicting results on the prognosis of this common occupational disease. This study was designed to determine the prognosis of hand dermatitis in metalworkers and the responsible allergens. A questionnaire survey was conducted on 64 patients seen between 1 and 5 years previously in the contact dermatitis clinic. Of the 51 patients responding, 82% still had hand dermatitis. There was no difference in outcome between those who continued to work with metals and oils, and those who had changed their occupation. Hand dermatitis in metalworkers carries a poor prognosis, with most workers remaining symptomatic even if they no longer had occupational exposure to metals or oils. This study also demonstrates that biocides are the most important allergen group in the aetiology of hand dermatitis in metalworkers.

Adult↗
PubMed2006

Non-infectious granulomatous dermatitis: a clinicopathological study.

BACKGROUND: Granulomatous dermatitis frequently presents a diagnostic challenge to dermatopathologists because an identical histologic picture is produced by several causes, and conversely, a single cause may produce varied histologic patterns. METHODS: A retrospective analysis of skin biopsies received over a period of 7 years was performed, and cases of non-infectious granulomatous dermatitis diagnosed on histopathological examination were retrieved. RESULTS: Out of a total of 586 cases of granulomatous dermatitis, 71 cases (12.11%) were categorized as non-infectious granulomatous dermatitis on the basis of clinicopathological findings. Further subcategorization was done based on morphology of granulomas as epithelioid granulomas; 15 cases of sarcoidosis, 21.1%, one case of Crohn's vulvitis, 1.4%, necrobiotic granulomas; 11 cases of granuloma annulare, 15.4%, two cases of rheumatoid nodule, 2.8%, 10 cases of foreign body granulomas, 14.0%; 32 cases of miscellaneous group, 45%. CONCLUSIONS: Morphology alone is seldom specific and cannot be used as a diagnostic tool for identification of specific diseases. Adequate clinical data and work up in combination of pathological resources can help in elucidation of specific etiology of granulomatous dermatitis. Mohan H, Bal A, Dhami GP. Non-infectious granulomatous dermatitis: a clinicopathological study.

Adolescent↗
PubMed1994

Humoral immunity to Malassezia furfur serovars A, B and C in patients with pityriasis versicolor, seborrheic dermatitis and controls.

This study examined the humoral immune responses to Malassezia furfur serovars A, B and C of 10 patients with pityriasis versicolor, 10 patients with seborrheic dermatitis and 20 age- and sex-matched controls. A transferable solid-phase ELISA was used to determine titres of total Igs, IgM, IgA and IgG specific to M. furfur serovars A, B and C. The results demonstrated that patients with seborrheic dermatitis had a significantly higher titre of total Igs to serovar A than patients with pityriasis versicolor; and that patients with seborrheic dermatitis had a significantly higher titre of IgA to serovar C than patients with pityriasis versicolor. The titres of total Igs for controls and patients with seborrheic dermatitis were significantly lower to serovar B than to serovar C. A modified TSP ELISA was used to determine the titres of the IgG subclasses. Titres of IgG1,3,4 to serovar B were significantly higher in seborrheic dermatitis patients than pityriasis versicolor patients and titres of IgG3 to serovar A were significantly higher in seborrheic dermatitis patients than pityriasis versicolor patients. However, despite the differences between the patient groups, none of these results was significantly different to those of controls. Thus, this study did not demonstrate any differences in humoral immunity of patients suffering from Malassezia-associated dermatoses when compared to normal controls. These results may suggest that the humoral immune response to M. furfur is not related to the pathogenesis of Malassezia-associated dermatoses, but simply to the carriage of M. furfur on the skin.

Adult↗
PubMed1996

The chemotactic activity of T-lymphocytes in response to interleukin 8 is significantly decreased in patients with psoriasis and atopic dermatitis.

Involvement of T-lymphocytes in the pathogenesis of psoriasis and atopic dermatitis is well established. The question arises as to whether not only tissue infiltrating but also circulating T-lymphocytes are involved in the disease process. Therefore we sought to determine whether T-lymphocytes from patients with psoriasis and atopic dermatitis show abnormal biological behavior to the proinflammatory chemokine interleukin 8 (IL-8) in vitro as studied by their chemotactic activity. In addition, the expression of T-cell activation markers such as HLA-DR and interleukin 2 receptor (IL-2R) were analysed with FACS-technique. In all, 25 patients with psoriasis (13 patients with severe psoriasis and 12 patients with mild psoriasis) and 11 patients with atopic dermatitis were investigated. For comparison. T-lymphocytes from 14 healthy controls were tested equally. The results show that T-cell chemotactic responses to IL-8 were significantly decreased in patients with severe psoriasis as compared to healthy controls. T-cells from patients with atopic dermatitis demonstrated an even more pronounced decrease in chemotactic response as compared to T-cells from psoriasis patients or healthy controls. In contrast, increased expression of activation markers HLA-DR and IL-2R were demonstrated in circulating T-cells from patients with severe psoriasis and atopic dermatitis in comparison to healthy controls. It can be concluded that circulating T-cells in patients with severe psoriasis and atopic dermatitis show a decreased in vitro chemotactic response to IL-8. Furthermore, the in vivo phenotypic activation state of T-lymphocytes in these patients seemed to be associated with their decreased in vitro functional capacity.

Adolescent↗
PubMed1987

Allergic dermatitis (sweet itch) of Icelandic horses in Sweden: an epidemiological study.

A survey of allergic dermatitis (sweet itch) in Sweden contained information on 441 Icelandic horses. Results of a questionnaire indicated that approximately 15 per cent of the country's Icelandic horses suffered from the disease. The prevalence of allergic dermatitis was significantly higher among horses imported from Iceland (26.2 per cent) compared to that of Swedish-born animals (6.7 per cent). In addition, horses born in Iceland were significantly more severely affected than horses born in Sweden. The risk of allergic dermatitis in Sweden appeared to be more than six times higher for horses exported from Iceland to Sweden relative to that of horses originally born in Sweden. The prevalence of disease for horses of seven years or older was 30 per cent for Icelandic-born individuals as compared to 7.3 per cent for horses born in Sweden. Similarly, the risk of allergic dermatitis in Sweden for horses of seven years or older appeared to be nearly 10 times higher for horses imported from Iceland relative to that of horses born in Sweden. Allergic dermatitis usually appeared during the third grazing season for imported horses and during the fourth season for horses born in Sweden. Furthermore, the course of the disease tended to become worse with time. Analysis of the prevalence of allergic dermatitis relative to gender revealed no significant differences. Certain geographical variations in the prevalence of the disease was also found.

Age Factors↗
PubMed1998

Production of antibodies to staphylococcal superantigens in atopic dermatitis.

Staphylococcal superantigens (SAG) are implicated in the inflammation of atopic dermatitis. As SAG mediated diseases may be modified by specific antibodies, the antibody response to SAG in atopic dermatitis was investigated. Immunoglobulin (Ig) G to staphylococcal enterotoxin A (SEA), staphylococcal enterotoxin B (SEB), and toxic shock syndrome toxin 1 (TSST-1) were measured by sandwich enzyme linked immunosorbent assay (ELISA) in 74 children with atopic dermatitis and 111 controls. Controls had detectable IgG to SEA, SEB, and TSST-1, which increased with age. Atopic dermatitis subjects had an increased response to SEB at 6 months to 2 years (76% v 42%) and 2 to 7 years (79% v 57%), and equivalent responses to SEA and TSST-1, compared to controls. It is suggested that increased responses to SEB relate to increased colonisation and hence exposure to superantigen producing staphylococcus in atopic dermatitis, and that inflammation of atopic dermatitis is not caused by an inability to make antibody to SAG.

Adolescent↗
PubMed2001

Contact dermatitis in students practicing sports: incidence of rubber sensitisation.

BACKGROUND: Over the last few years, changes in cutaneous homoeostasis resulting from sports activities have been reported. In particular, alterations in sweating mechanisms, the hydrolipid barrier, and surface bacterial flora, together with exposure to atmospheric conditions and the need to use medicaments, detergents, and other topical substances, predispose subjects to allergic contact dermatitis. OBJECTIVE: To evaluate the incidence of allergic contact dermatitis in a group of young people practising sports activities. METHODS: Patch tests were performed to confirm the diagnosis of irritant or allergic dermatitis; in addition, the radioallergoabsorbent test (RAST) to latex was evaluated in the group studied. RESULTS: Allergic contact dermatitis caused by thiourams (23.3%) and mercaptobenzothiazole (20.9%) was prevalent. Other haptens, such as benzocaine and nickel, which are contained in clothing, equipment, topical medicaments, and creams used for massage, were also allergenic. In two cases, RAST positivity to latex was registered. CONCLUSIONS: -The results suggest that close contact with sports equipment may increase the incidence of allergic contact dermatitis. Students practising certain sports may have "professional" allergic contact dermatitis to additives used in the production of rubber.

Adult↗
PubMed2006

Age related, structured educational programmes for the management of atopic dermatitis in children and adolescents: multicentre, randomised controlled trial.

OBJECTIVE: To determine the effects of age related, structured educational programmes on the management of moderate to severe atopic dermatitis in childhood and adolescence. DESIGN: Multicentre, randomised controlled trial. SETTING: Seven hospitals in Germany. PARTICIPANTS: Parents of children with atopic dermatitis aged 3 months to 7 years (n = 274) and 8-12 years (n = 102), adolescents with atopic dermatitis aged 13-18 years (n = 70), and controls (n = 244, n = 83, and n = 50, respectively). INTERVENTIONS: Group sessions of standardised intervention programmes for atopic dermatitis once weekly for six weeks or no education (control group). MAIN OUTCOME MEASURES: Severity of eczema (scoring of atopic dermatitis scale), subjective severity (standardised questionnaires), and quality of life for parents of affected children aged less than 13 years, over 12 months. RESULTS: Significant improvements in severity of eczema and subjective severity were seen in all intervention groups compared with control groups (total score for severity: age 3 months to 7 years - 17.5, 95% confidence intervals - 19.6 to - 15.3 v - 12.2, - 14.3 to - 10.1; age 8-12 years - 16.0, - 20.0 to - 12.0 v - 7.8, - 11.4; - 4.3; and age 13-18 years - 19.7, - 23.7 to - 15.7 v - 5.2, - 10.5 to 0.1). Parents of affected children aged less than 7 years experienced significantly better improvement in all five quality of life subscales, whereas parents of affected children aged 8-12 years experienced significantly better improvement in three of five quality of life subscales. CONCLUSION: Age related educational programmes for the control of atopic dermatitis in children and adolescents are effective in the long term management of the disease.

Adolescent↗
PubMed2004

Cohort study of sibling effect, infectious diseases, and risk of atopic dermatitis during first 18 months of life.

OBJECTIVES: To determine whether early infectious diseases could explain the association between number of siblings and other markers of microbial exposure and the development of atopic dermatitis before the age of 18 months. DESIGN: Cohort study. Information on atopic dermatitis, infectious diseases occurring before 6 months of age, number of siblings, early day care, pet keeping, farm residence, and background factors was collected in telephone interviews. SETTING: Danish national birth cohort. PARTICIPANTS: 24,341 mother-child pairs. MAIN OUTCOME MEASURES: Incidence rate ratios of atopic dermatitis. RESULTS: 13,070 children (54%) had at least one clinically apparent infectious disease before 6 months of age. At age 18 months, 2638 (10.8%) of the children had had atopic dermatitis. The risk of atopic dermatitis increased with each infectious disease before 6 months of age (incidence rate ratio 1.08, 95% confidence interval 1.04 to 1.13). The risk of atopic dermatitis decreased with each additional exposure to three or more siblings, day care, pet ownership, and farm residence (0.86, 0.81 to 0.93). CONCLUSIONS: Early infections do not seem to protect against allergic diseases. The protective effect of number of siblings, day care, pet ownership, and farm residence remained after adjustment for clinically apparent infectious diseases, suggesting that the effect is established independently early in life.

Age Distribution↗
PubMed1984

Dermatitis herpetiformis: diagnosis, diet and demography.

We describe a long term study of 76 patients with dermatitis herpetiformis. Unlike patients with coeliac disease, where the peak incidence was during the first and fourth decades, no dermatitis herpetiformis patients presented in the first decade; also, there was a male preponderance in dermatitis herpetiformis which contrasts with the excess of females in coeliac disease. The apparent prevalence of dermatitis herpetiformis was 11 per 100 000 in our population; approximately one fifth of that of coeliac disease. Jejunal villous atrophy was present in 78% of our dermatitis herpetiformis patients, and a single jejunal biopsy was as effective at detecting this as the multiple biopsy technique. A majority of patients were able to stop, or radically reduce their dapsone or sulphapyridine treatment after the institution of a gluten free diet. Spontaneous remission of the skin lesion occurred in only two patients not receiving a gluten free diet. Gastric parietal or thyroid antibodies were detected in 38% of patients, and three cases of thyroid disease and two cases of pernicious anaemia were detected. Lymphoma developed in two patients, one being intestinal in origin. We conclude that a gluten free diet is of therapeutic benefit in dermatitis herpetiformis and that spontaneous remission is uncommon in those not on a diet. Despite patchiness of the enteropathy, a single jejunal biopsy is quite adequate to diagnose the presence of upper intestinal villous atrophy.

Adolescent↗
PubMed1991

HLA association with dermatitis herpetiformis is accounted for by a cis or transassociated DQ heterodimer.

HLA-DR, DQ, and DP restriction fragment genotyping was undertaken in 23 dermatitis herpetiformis patients and 53 healthy control subjects. HLA-DQw2 was present in 100% of patients with dermatitis herpetiformis (23 of 23) versus 40% of control subjects (21 of 53). Significant secondary associations occurred with HLA-DR3 (91% of patients versus 28% of control subjects) and DPw1 (39% of patients versus 11% of control subjects). Dermatitis herpetiformis and coeliac disease thus share an identical HLA class II association. It is likely that HLA class II genes directly influence the immune responses leading to mucosal damage in both diseases. The strongest candidate for disease susceptibility to dermatitis herpetiformis is DQw2. The HLA molecule most likely to be involved in coeliac disease is a specific DQ alpha/DQ beta heterodimer, encoded in cis arrangement in DR3 haplotypes or in trans arrangement in a DR5, 7 genotype. Our data on dermatitis herpetiformis patients fits this model perfectly. All these patients are capable of expressing this molecule, which may be responsible for the gluten sensitive enteropathy seen in a subgroup of patients with dermatitis herpetiformis and coeliac disease.

Celiac Disease↗
PubMed2003

Clarithromycin inhibits the development of dermatitis in NC/Nga mice.

BACKGROUND: Colonization of Staphylococcus aureus on the skin is one of the exacerbating factors of atopic dermatitis (AD). Reduction of bacterial colonization in these lesions was reported to be effective for the treatment of subjects with AD. Clinical trials have demonstrated the efficacy of FK-506 (an immunosuppressive macrolide) ointment for AD, and many case reports have been published regarding its positive effects for other inflammatory skin diseases. Clarithromycin (CAM) is a macrolide antibiotic with immunological effects. One patient with AD was treated effectively with oral CAM for Helicobacter pylori infection. NC/Nga (NC) mice have recently been recognized to be a model of AD. METHODS: We examined the effects of CAM on the development of dermatitis, infiltration of mast cells and MHC class II-positive cells in the skin and the colonization of S. aureus on the skin of NC mice. CAM was compared with cefaclor, an antibiotic with no immunological effects. RESULTS: CAM suppressed the development of dermatitis at 5 and 6 weeks to a statistically significant degree, and these effects gradually weakened, but the severity of the dermis of CAM-treated mice was milder than in control mice. Dexamethasone was effective in the case of development of dermatitis at 5 weeks. These effects gradually weakened, and the difference between dexamethasone-treated mice and control mice disappeared. The severity of the skin lesions in CAM-treated mice was the lowest of the three groups at 9 weeks of observation. Histological analyses revealed that infiltration of inflammatory cells, especially degranulated mast cells and MHC class II-positive cells, was significantly reduced. Thickening of the epidermis and hyperkeratosis in CAM-treated mice were less than in control mice. CAM and cefaclor completely inhibited S. aureus on the skin of NC mice, for all experimental periods. Dexamethasone provided inhibition at 5 weeks, but eventually the difference between dexamethasone-treated mice and control mice disappeared. CONCLUSIONS: CAM inhibited the development of dermatitis for the first half of the experimental period in NC mice as a result of antibacterial and immunological effects. Our data show that CAM can be an effective antibiotic for AD with respect to delaying the development of dermatitis.

Animals↗