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Profissional Documentos
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9
Service de Dermatologie, Nantes, France hour reading the patches were removed and there
10
Service de Dermatologie, Sainte-Marguerite, were large areas of unusual painful superficial ero-
Marseille, France sions where the patch test tape – Scanporä had been
in contact with the skin. This appearance was diffi-
Introduction: Patients sensitized to para-phenylene- cult to explain. He denied interfering with the
diamine (PPD) have a high degree of patch test patches. The erosions were dressed with non-
reactivity to Disperse Orange 3 (DO3), and a lesser adherent dressings held in place by a different tape-
one to Disperse Red 1 and Red 17. Two successive Microporeä. At the 96 hour reading these dressings
patients positive to PPD, Disperse Red 1 and 17, were removed and in the areas under the Micro-
negative to DO3 were real eye-openers for our con- poreä tape there were further erosions around
siderations about purity of our current allergen DO3. the edge and also some thin walled vesicles and
Materials and methods: We realized comparative small bullae. There were þþ allergic reactions to
thin-layer chromatography (TLC), with DO3 from sodium metabisulphite, disperse blue 35, 124 and
Chemotechnique1 (DO3-Chem) and Trolab1 106 all of which were felt to be relevant as he had
(both extracted from petrolatum), and ‘‘pure’’ used Trimovateâ cream and regularly wore dark
DO3 from two chemical providers. TLC clearly nylon clothing when refereeing lacrosse matches.
indicated that DO3-Chem was not DO3. HPLC A biopsy was taken for histology and immuno-
analysis with pure DO3 from Chemotechnique1 fluorescence from an area of blistering. This
and comparison of structures by NMR with demonstrated suprabasal acantholysis with vesi-
samples of DO3, revealed that DO3-Chem was cle formation. There were occasional corps
Disperse Orange 31 (DO31). In addition, signals ronds. The immunofluorescence was negative.
through the GERDA network allowed the collec- Anti-epidermal (skin) antibodieswere also negative.
tion of test materials and observations. Among This striking and alarming clinical presentation
other members, only 2 used DO3-Chem (from 2 after removal of patch tests had been encoun-
different batches) that was DO31 too, according tered once previously in our Contact Dermatitis
to TLC Results: According to their data, they Investigation Unit. The possibility that the disor-
observed no or a lower reactivity to DO3 than der was artefactual either due to an irritant intro-
expected (4 patients DO3-Chem þ among 23 duced under the tapes or perhaps due to a
PPDþ e.g.). Finally, the error was proved to be contaminant within the tape adhesive was consid-
due to the provider of the dye to Chemotechni- ered but no conclusion was reached In this case
que1, who likely deleted the 1 of Disperse Orange the clue to diagnosis became apparent at the
31 on his packaging. second patch test reading when small vesicles
Discussion: Chemical structure of DO31 indicates and bullae could be seen at the edge of where
a possible in vivo hydrolysis into nitroaniline and the Microporeâ had been. A diagnosis of Hailey
a second compound, a substituted PPD derivative Hailey disease (HHD) trigered by the trauma caused
that clearly does not frequently react in PPD by the adhesive tapes and their removal was made.
positive patients. Like drugs, patch tests are sub- The relatively persistent nature of his presenting
mitted to post-commercialization controls. In addi- problem makes Grover’s disease less likely. The
tion to allergens providers who should enhance their affected sites healed after two weeks. Allergic contact
quality controls, dermato-allergologists have to be dermatitis particularly to medicaments is reported to
vigilant, and must active networks when they be a frequent complication and routine patch testing
observe a rare bird. has been advocated1. There has been a previous
report of blistering at the site of patch testing how-
ever he was an individual already known to have
HHD2. Despite having patch tested around 30 000
FS01.4 people in the last 22 years this complication had not
been encountered until this year. We present this
Hailey Hailey disease – a significant hazard to
case whose clinical features are distinctive as we
consider when patch testing
feel similar instances may have been or will be
S Walker, Jason Williams, J O’Driscoll, M Beck
seen by colleagues. Diagnosis may be difficult if
Dermatology Centre, University of Manchester,
there are no blisters in association with the pain-
Manchester, UK
ful erosions.
A 42 year old man was referred to the Contact
Dermatitis Investigation Unit because of a 12 References
month history of an inflammatory eruption affecting 1. Reitamo S, Remitz A, Lauerma A I, Förstöm. Contact aller-
his neck. He was patch tested to our standard series, gies in patients with familial benign chronic pemphigus
textile series and his own medicaments. At the 48 (Hailey-Hailey Disease) J Am Acad Dermatol 1989;21: 506–10.
128 ABSTRACTS
2. Peppiatt T, Keefe M, White J E. Hailey-Hailey disease- test conditions. From January 1990 to December
exacerbation by herpes simplex and patch tests. Clin Exp 1999 14,001 patient’s with suspected contact dermat-
Dermatol 1992;17:201–2.
itis were tested with the European standard series in
St. Johns. We selected and obtained the records
FS01.5
of all patient’s during this time period who had
a positive patch test to PPD free base 1% pet.
Establishment of safe exposure limits for the Of the 14,001 patient’s tested, 1035 had previously
elicitation of contact allergy been patch tested on at least one occasion repre-
David A Basketter1, S Fletcher1, N Gilmour1, senting 7.4% of the population. This proportion
I Duangdeeden2, P Kullavanijaya2, J McFadden3, varied from 5.6% in 1994 to 11.1% in 1991
1
Unilever Safety and Environmental Assurance but there was no obvious trend during the ten
Centre, Sharnbrook, UK year period. The total number of PPD positive
2
Institute of Dermatology, Bangkok, Thailand reactions (þ to þþþ) over the ten year period
3
St John’s Institute of Dermatology, London, UK in the whole population was 449 (3.2%). The
Although the primary point of intervention for the number of PPD positive reactions in the first
prevention of allergic contact dermatitis (ACD) time testers was 419 (3.2%) compared to
should be appropriate assessment and management 30 (2.9)% in the repeat testers. Our figures over
of potential skin sensitization hazards, there is never- a ten-year period do not show an increase in the
theless a place for secondary prevention in individuals rate of PPD sensitivity in patients who have been
who are already sensitized. Thus it is necessary to previously patch tested. These figures suggest that
ensure a full appreciation of the variables impacting PPD 1% pet. as used in the standard series is not
the elicitation of ACD exist. To this end, we have been actively sensitising patients who are repeatedly patch
engaged in a series of investigations of the elicitation tested.
of p-phenylenediamine (PPD) sensitization. In par-
ticular, we have studied the impact of duration and
frequency of exposure on elicitation. Using groups of
FS01.7
PPD sensitized volunteers, in patch tests and repeated
open application tests, we have shown that exposures Prevalence of contact allergy in an adult Thai
of only a few minutes are often without consequence population
in such individuals, except where the exposure is often David A Basketter1, I Duangdeeden2, N Gilmour1,
repeated and/or the individual is highly allergic. With P Kullavanijaya2, J McFadden3
1
volunteers who were 1þ or 2þ positive to the diag- Unilever Safety and Environmental Assurance
nostic patch test, and where exposure to PPD was at Centre, Sharnbrook, UK
2
0.5%–1.0% in a short contact rinse-off hair colouring Institute of Dermatology, Bangkok, Thailand
3
product, no scalp reactions were experienced. It is our St John’s Institute of Dermatology, London, UK
view that the establishment of safe exposure limits to
contact allergens should be based wherever possible There is only very limited data on the prevalence of
on a detailed assessment of the risk to sensitized contact allergy, as judged by a positive diagnostic
humans. patch test, in unselected, non-clinical populations.
We carried out a 48 h patch test to 7 common aller-
gens and to the petrolatum vehicle in a total of 2545
adult volunteers in Bangkok. The patch tests were
FS01.6 read at 48 h approximately 1 h after patch removal.
Positive results were as follows Ni 27.8%, fragrance
A 10-rear review to determine whether exposure
mix 2.9%, Cr 2.6%, PPD 2.3%, colophony 2.1%,
to p-phenylenediamine during patch tests leads
MI/MCI 1.2% and formaldehyde 0.7%. No reac-
to sensitisation
tions were found to petrolatum. The particularly
Simon Dawe, I White, R Ryecroft, J McFadden
high frequency of reactions to Ni was surprising.
St Johns Institute of Dermatology, London, UK
However, the large female bias (approximately
Our review aimed to answer the question of whether 75:1) strongly suggested that, despite the absence of
exposure to PPD in the European standard series a 96 h score, that irritancy did not play a significant
could lead to subsequent sensitisation in a signifi- part in these reactions. Reaction rates to the other 6
cant number of patients. We aimed to achieve this contact allergens appeared to confirm predictions
by comparing the frequency of PPD sensitivity in made from the extrapolation of diagnostic patch
patients who had never been patch tested compared testing or from previous published studies on smal-
to those who were having repeat patch testing and ler population groups. The rates of reaction to these
who therefore had been exposed to PPD in patch allergens also are likely to reflect the extent of
ABSTRACTS 129
(ACD) response upon renewed allergen expo- week and 0,1 mg/cm/week in 163 (21,2%) and
sure. This has been ascribed to the local persis- below 0,1 mg/cm/week in 450 (58,4%). Nickel
tence of few, but allergen-specific, T cells. release was above 0,5 mg/cm/week in 132 out of
Here, firstly, we characterized effector T cells, 432 (30,6%) 14 (or lower) karat gold jewels and in
and, subsequently, studied which of these cell 25 out of 338 (7,4%) 18 karat gold jewels
populations are present at former challenge suggesting an inverse relationship between nickel
sites and might contribute to LSM. Peripheral release and karatage. However, when comparing
blood T cells were stimulated with nickel sul- jewels with the same karatage, we found no clear
phate. Cellular phenotypes and chemokine relationship between nickel content and nickel
receptor expression profiles were analysed by release in the 256 items of which the exact alloy
FACS-staining: CLA together with CD4/CD8, composition was known. Data seem to indicate
CD45R0/RA, CXCR3, CCR4, CCR6 and that other factors, besides nickel content, such as
CCR10. Skin biopsies were taken at 0, 3 and ratio between nickel and other elements, presence
21 days after allergen application and analysed of grain refiners and homogenization state of the
for the same markers. Upon nickel-stimulation, alloy play a crucial role in nickel release.
amount of CD4þ CLAþ CD45R0þ T cells
was increased. Together with CLA, CXCR3,
CCR4 and, mainly, CCR10 expression was
augmented. CCR6 expression was negative on FS02.4
CLAþ cells. In biopsies from patch tests, cel-
Differential gene expression in allergen-
lular infiltrates were present at 3 and 21 days
activated peripheral blood mononuclear
after allergen application. Interestingly at day
cells from allergic patients
21, residing cells were localized at the peri-
Malene Barre´ Hansen1, L Skov1, T Menne´1, J Olsen2
vascularity and were characterized as CD4þ CD8 1
Gentofte Hospital, University of Copenhagen,
CCR10þ T cells. In conclusion, nickel-activated
Gentofte, Denmark
effector T cells can be characterised as CD4þ 2
IMBG, The Panum Institute, University of
CD8 CLAþ memory T cells. They express
Copenhagen, Copenhagen, Denmark
CXCR3, CCR4 and, in particular, CCR10. After
clinical recovery from an ACD reaction, CD4þ Allergic contact dermatitis is a delayed type
CCR10þ memory T cells apparently reside locally. hypersensitivity reaction mediated by allergen
The persistence of these CCR10þ T cells, expressing specific T-lymphocytes. Allergen exposure leads
the appropriate receptor of the skin specific chem- to the activation of specific T-lymphocytes, which
okine CCL27, can explain clinically important subsequently start to produce and release a vast
phenomena such as LSM and flare up reactions. array of cytokines and chemokines. However, the
list of relevant genes taking part in the elicitation
phase of contact dermatitis is not complete. In
this study, we evaluate the use of the high-density
FS02.3 microarray technology, which enable us to assess
the global gene expression in allergen-stimulated
Nickel release from white-gold jewellery
peripheral blood mononuclear cells (PBMC). We
A Belloni Fortina1, A Basso2, I Romano1,
included 3 chromium-allergic patients and 3 non-
M Poliero2, Andrea Peserico1
1 allergic controls in the study. Cultures of PBMC
University of Padova, Padova, Italy
2 were established from each participant and stimu-
Legor srl, Italy
lated with 100 ug/ul CrCl3 or media alone. The
A history of reacting to jewellery contact on the cell cultures were grown for 24 hours and the gene
skin is a common symptom of nickel allergy; expression was analysed using an Affymetrix
wearing cheap jewellery is a common cause of GeneChip(R) Array. Of the genes that exhibited
nickel sensitization. We analyzed nickel release differences of expression (p < 0.01) in allergen-
from 770 white gold jewels with different shape activated PBMC from patients compared to con-
and karatage from the Italian market. Jewels were trols, 54% (159/294) displayed increased activity
stored in artificial sweat for 1 week at 30 C and and 46% (136/294) displayed decreased activity.
nickel in sweat after the release procedure was Of the 159 up-regulated genes, 41 genes had a fold
analyzed by inductively coupled plasma detection change above 1.50 and 30 genes among the 136
(ICP), according to the European Standard down-regulated genes had a fold change below -
EN1811 ‘‘Reference test method for release of 1.5. A significant number of the genes that
nickel’’. Nickel release was above 0,5 mg/cm/ showed differential expression in the cell cultures
week in 157 jewels (20,4%), between 0,5 mg/cm/ established from the allergic patients are known
ABSTRACTS 131
2
to be involved in immune responses and inflam- Department of Peadiatrics, Odense University
mation. The data indicates that the method of Hospital, Odense, Denmark
3
microarrays is a valuable tool for investigating Department of Statistics, University of Southern
the gene expression profile in our model system Denmark, Odense, Denmark
for allergic contact dermatitis.
Objectives: Study patch test reactivity to nickel
sulphate and fragrance mix in a population of
FS02.5 unselected infants with focus on reproducibility,
Nickel allergy and hand eczema – a twenty-year clinical relevance, and nickel patch test concen-
follow-up tration.
Anna Josefson1, G Färm1, B Meding2 Method: The data presented is part of a clinical
1 epidemiological study of allergic diseases in new-
University Hospital, Örebro, Sweden
2 borns followed prospectively with questionnaire,
National Institute for Working Life, Stockholm,
Sweden clinical examination and testing at 0, 3, 6, 12 and
18 months of age. TRUE Test patches were used
Aim: To investigate the occurrence of hand with nickel sulphate in 3 concentrations: 200, 66,
eczema after 20 years in schoolgirls previously 22 ı̀g/cm2 and fragrance mix 430 ı̀g/cm2. A posi-
patch-tested to nickel. tive reaction suggesting sensitisation was defined
Methods: In 1982–83, 960 schoolgirls, aged 8, 11 as at least palpable erythema present at both the
and 15 years, were investigated for the occurrence 12 and 18 months follow-up visits.
of nickel allergy (Larson-Stymne B and Widström Results: A total of 543 children (268 girls, 275 boys)
L, Contact Dermatitis 1985:13:289–293). The were patch tested at least once, 304 children were
girls were patch-tested and the prevalence of tested at both 12 and 18 months. The prevalence of
nickel allergy was 9%. Twenty years later, the a reproducible positive reaction to nickel sulphate
same individuals have received a questionnaire 200 ı̀g/cm2 was 8.6% (20 girls, 6 boys). A transient
regarding hand eczema and factors of importance reactivity was observed in 111 children (53 girls, 58
for the development of hand eczema. After two boys). A clinical relevance to nickel was found in
reminders, the response rate was 81%. only one child. There was no association between
Results: In total 17.5% of the girls reported hand number of patch test procedures performed and
eczema after the age of 15. The 1-year prevalence reactions to nickel sulphate. Reproducible reactivity
of hand eczema was 12.6%. Of the previously to fragrance mix was not found.
patch-tested schoolgirls who answered the ques- Conclusion: A high proportion of transient patch
tionnaire, 63 were sensitive to nickel. In this test reactivity to nickel sulphate 200 ı̀g/cm2 was
study, the prevalence of hand eczema among found. Patch testing with nickel in concentrations
those 63 was 16%, compared to 17% in the non- used for adults cannot be recommended in
sensitive group (NS). Excluding persons with infants. The interpretation of a singular positive
atopic dermatitis, the prevalence of hand eczema nickel patch test in small children must be
was 12.5% in the nickel-sensitive group, and 10% assessed with caution. Allergic reactions to fra-
among the others (NS). 32% of the persons who grance mix were not found in this age group.
had had atopic dermatitis reported hand eczema
after 15 years of age, compared to 10% of those
with no history of atopic dermatitis (p < 0.001).
Conclusion: Contact allergy to nickel in early child-
hood (8–15 years) did not seem to increase the pre-
valence of hand eczema later in life. The prevalence FS02.7
of hand eczema was increased by a factor of three Rates of persistent itchy nodules after fourth
among those with a history of atopic dermatitis, dose of DT vaccines
which is in accordance with earlier reports. Eva Netterlid1, M Bruze2, M Hindse´n2,
M Isaksson2, P Olin1
1
Swedish Institute for Infectious Disease Control,
FS02.6 Stockholm, Sweden
2
Department of Occupational and Environmental
Patch test reactivity to nickel sulphate and
Dermatology, University Hospital, Malmö,
fragrance mix in unselected children
Sweden
Hanne Jøhnke1, LA Norberg2, W Vach3,
C Bindslev-Jensen1, A Høst2, KE Andersen1 Background: Studies in Gothenburg, Sweden,
1
Department of Dermatology, Odense University reported unexpectedly high rates, 0.35–1.66%,
Hospital, Odense, Denmark of late occurring itching nodules at the site of
132 ABSTRACTS
injection of aluminium containing vaccines. different vehicles, water and alkaline buffer,
Among 455 children with itching nodules after using 2 different test techniques, the Finn
vaccination, 352 had a positive epicutaneous test Chamber technique with aluminium chambers
to aluminium. When switching to a new booster and van der Bend technique with polypropene
diphtheria-tetanus vaccine in Sweden these chambers.
findings warranted a comparative study of local Results: Irritant patch test reactions were
itching nodules that had remained at least 2 obtained with aqueous gold trichloride tested in
months after injection, and of aluminium contact van der Bend chambers in 10 patients without
allergy. gold allergy. In gold-allergic patients no positive
Methods: A prospective cluster randomised study test reactions were obtained from aqueous gold
was done in 25,232 10-year-olds. Participating trichloride in Finn chambers while 2 positive
schools in each municipality were randomised in test reactions were obtained from gold trichloride
a 1/1 ratio to use the old diphtheria-tetanus tox- in alkaline buffer tested in van der Bend
oid (DT) vaccines, Duplex1 or the new vaccine, chambers.
diTeBooster1. Parental reports 6 months after Conclusion: If gold trichloride is patch tested
vaccination were obtained for 22,365 (88%) in wrong vehicle and with wrong test technique
pupils in 851 schools. Patch testing with alumin- irritant test reactions may occur which can be
ium chloride-hexahydrate was performed in 9 misinterpreted as positive allergic reactions in
children with an itching nodule, 6 children only patients without gold allergy as well as negative
pruritus and 17 children without any itching reactions in patients with gold allergy.
nodule after the fourth dose of DT vaccine.
Results: We identified 3–6 children per 10000 with
a local itching nodule persisting for at least
2 months. There were no significant differences
between the vaccine groups. Contact allergy to Thursday, 10 June 2004
aluminium was not detected. 12:00–12:30
Conclusion: Our findings support the use of the
KL02
vaccine presently available in the Swedish vaccin-
ation program. Continued surveillance of per- Keynote Lecture
sistent itching nodules after vaccination with Chair: Klaus E Andersen, Denmark
different aluminium containing DT and
Contact allergy caused by air oxidation
diphtheria-tetanus-pertussis toxoid (DTP) vac-
of common materials – diagnosis and
cines is however warranted.
prevention
Ann-Therese Karlberg
Dermatochemistry and Skin Allergy, Department
of Chemistry, Göteborg University, Göteborg,
FS02.8
Sweden
Patch testing with gold trichloride can give
When considering the allergenic activity of a com-
false test results
pound not only the possibility of bioactivation by
Birgitta Gruvberger, I Ahnlide, H Möller, M Bruze
skin metabolism but also air activation by auto-
Department of Occupational and Environmental
xidation must be taken into account.
Dermatology, Malmö University Hospital,
Natural compounds (terpenes) easily oxidize at
Malmö, Sweden
air exposure. They are found in products that are
Background: Hydrochloric acid is formed in common causes of allergic contact dermatitis
water solutions of gold trichloride. Hydrochloric (ACD) i.e. colophony and fragrances.
acid in contact with aluminium generates hydro- The introduction of oxygen enables the mole-
gen gas which can reduce and transform trivalent cules to form antigens with skin proteins via a
gold to elemental gold. nucleophilic- electrophilic interaction or via a
Objective: To investigate whether patch testing radical reaction. The latter mechanism seems to
with aqueous gold trichloride can cause false be important since the primary oxidation pro-
positive (irritant) reactions in patients without ducts, the hydroperoxides, are the most potent
contact allergy to gold and false negative reac- sensitizers formed. Oxidative decomposition at
tions in patients with gold allergy. air exposure resulting in allergenic oxidation pro-
Methods: 13 patients with and 13 patients without ducts is observed also for other common com-
positive patch test reactions to gold sodium pounds e.g. ethoxylated fatty alcohols used as
thiosulfate were tested with gold trichloride in 2 surfactants.
ABSTRACTS 133
It is important to test the patient with the offend- Thursday, 10 June 2004
ing compounds for diagnosis of ACD. A negative 14:05–15:30
diagnosis can be due to failure in testing with the FS03
correct substances. In the case of air activated
compounds, testing should not be performed with Irritant contact dermatitis
the pure substances but rather with the oxidation Chairs: Pieter-Jan Coenraads, The Netherlands &
mixture or the most sensitizing oxidation products Donald Belsito, USA
(the hydroperoxides). We have in multicenter-stu- FS03.1
dies shown that the common fragrance terpenes,
limonene and linalool, are frequent sensitizers The hand eczema severity index (HECSI). A
when oxidized. This is a challenge in clinical prac- study of inter- and intraobserver reliability
tice since such patch test materials are not easily Elisabeth Held1, R Skoet2, T Agner2, J Duus
standardized. Johansen1, L Theil Skovgaard3
1
Compounds, easily activated at air exposure, National Allergy Research Centre for Consumer
should be prevented from oxidative decomposi- Products, Gentofte Hospital, Gentofte, Denmark
2
tion by addition of antioxidants and proper hand- Department of Dermatology, Gentofte Hospital,
ling and storage. More research is needed in this University of Copenhagen, Gentofte, Denmark
3
area. Department of Biostatistics, University of
Copenhagen, Panum Institute, Copenhagen, Denmark
In clinical studies on hand eczema (HE) an objec-
Thursday, 10 June 2004 tive and accurate assessment of the severity of the
13:30–14:00 disease is needed. The present study was undertaken
in order to develop and validate a scoring system
KL03
called the hand eczema severity index (HECSI)
Keynote Lecture designed for clinical assessment of HE. Twelve der-
Chair: Tove Agner, Denmark matologists (observers) assessed 15 HE patients (11
women and 4 men) twice with an interval of 30 min.
Contact dermatitis and danger models
To minimise recall bias only the hands and wrists of
John P McFadden, the patients were visible to the observers. Agree-
St John’s Institute of Dermatology, St Thomas ment between the observers was determined by
Hospital, London, UK using the intraclass correlation coefficient (ICC).
Conventional models of the immune response ICC for total HECSI score was 0.79 at time 1 and
are based on distinguishing self and non-self. 0.85 at time 2 respectively. When looking at ICC for
However, the more recently proposed ‘danger’ the different items in the scoring system (extent of
model may be an illuminating alternative for lesions, anatomical location and intensity of clin-
studying allergic contact dermatitis. In the ical signs) best agreement was found for extension
presence of a ‘danger’ signal, which in some followed by anatomical location and least agree-
cases of allergic contact dermatitis could be ment was found for the scoring of clinical signs.
cutaneous ‘irritancy’ (ie cytokine release from ICC for intraobserver agreement was 0.90. A
non-immune/keratinocyte cells in response to regression correlation coefficient of 0.993 was
chemical stimulus in a non-sensitising manner), found (simple linear regression analysis of time 1
the immune system would become activated, scores against time 2 scores) indicating high
leading first to the induction of sensitisation reproducibility. Overall good agreement existed
and then subsequently to the elicitation of a for both inter- and intraobserver reliability
contact hypersensitivity response. In most although some inter- and intraobserver variation
cases both the antigenic signal and signal for existed.
keratinocyte cytokine release will come from the
hapten, although for example in an occupational
FS03.2
setting, traumiterative dermatitis would be
the source of the ‘‘danger’’ signal. A further Visual scoring of skin irritation reactions – what
prediction of this hypothesis is that reported are the limits?
animal experiments demonstrating low dose toler- DA Basketter, Marie Marriott, L Peters,
ance with contact allergens may be explained by the K Cooper
loss of the ‘irritant’ effect at lower dilutions whilst Unilever Safety and Environmental Assurance
an antigenic stimulus remains present. Centre, Sharnbrook, UK
134 ABSTRACTS
We have previously reported that, with suitable and for the oral mucosa before and 15 minutes
training and experience, skin irritation reactions after exposure. Information was extracted from
can be graded visually with a high degree of sensi- the impedance spectra using four indices based on
tivity and precision. The objective of the work pre- magnitude and phase at 2 frequencies, emphasis-
sented is to demonstrate the possibilities and ing different aspects of the impedance properties
limitations of the grading of skin irritation reac- of the tissues. The SLS-containing pastes showed
tions by subjective visual assessment. In the present for both skin and oral mucosa some positive
work, we have recorded a wide range of relatively visual grade 1 reactions. Significant changes
minor skin irritation reactions using a high quality were found for the impedance indices, and the
digital camera. The skin reactions recorded have reaction patterns of the indices differed between
then been graded by independent observers accord- the skin and the oral mucosa. We conclude that
ing to their appearance on a computer monitor. very slight reactions of skin and oral mucosa are
The results show that very subtle degrees of both detected by IMP. Furthermore, betaine contain-
erythema and skin dryness can be accurately ing toothpaste does not irritate neither skin nor
described by trained skin graders in a reliable and oral mucosa, but the effect together with SLS is
reproducible manner. Examples of the grading insignificant.
scales and sensitivity of scoring will be shown. We
conclude that visual scoring, when conducted well,
represents a rapid and accurate method for the
assessment of minor degrees of skin irritation. The
present evidence, taken in combination with pre- FS03.4
viously presented information on bioengineering
Irritant dermatitis following tape stripping
techniques, leads us to the conclusion that visual
Hanne Nybæk1, DB Knudsen2, LF Nielsen2,
assessment is both an adequate and a robust tech-
T Karlsmark3, GBE Jemec1
nique, delivering information of the quality neces- 1
Roskilde Hospital, Division of Dermatology,
sary for safety assessment of consumer products.
Department of Medicine, Roskilde, Denmark
2
Coloplast A/S, Humlebæk, Denmark
3
Department of Dermatology, Bispebjerg Hospital,
Copenhagen, Denmark
FS03.3
Repeated tape stripping of the skin associated with
Bioimpedance revealing irritation by toothpastes
e.g. the use of stoma care products can cause irri-
in skin and mouth
tant dermatitis. This experimental study in 12
Ingrid Nicander1, I Rantanen2, E Söderling2,
healthy volunteers was designed to assess the effects
S Ollmar3
1 of 3 chemically and physically different adhesives
Huddinge University Hospital, Department of
commonly used in stoma care products. Two dif-
Dermatology, Huddinge, Sweden
2 ferent frequencies of stripping (daily vs twice
University of Turku, Institute of Dentistry,
weekly) were tested, and the various parameters of
Turku, Finland
3 inflammation and barrier integrity were studied
Karolinska Institutet, Division of Medical
with established non-invasive methods (Measure-
Engineering, Huddinge, Sweden
ment of erythema, conductance, and Trans Epider-
The aim of the study was to compare the effects mal Water Loss (TEWL)) on day 0, 4, 6, 10, 16, 22
of a SLS toothpaste formulation with and with- and 28. All adhesives caused increases in all the
out betaine on skin and oral mucosa using elec- studied parameters during the 28 day period
trical bioimpedance (IMP). Two groups, in total compared to the corresponding non-stripped values.
47 participants, were recruited. In the skin group Furthermore, daily stripping caused significantly
(27 participants) four test sites on the volar fore- greater inflammation and barrier disruption than
arms were used: SLS paste, SLS þ betaine paste, stripping twice weekly. In conclusion, it was possible
betaine paste, and one unoccluded control site. In by measuring skin erythema, conductance and
the oral group (20 participants) the same tooth- TEWL to detect different patterns of inflammatory
paste formulations were used. The test substances changes and barrier disruption in areas treated with
were applied in 12 mm Finn chambers for 24 the 3 adhesives. As expected, more frequent strip-
hours at randomised test sites on the skin, and ping caused greater changes. These differences did
in 18 mm Finn chambers for 15 minutes on the however appear at different times during the study
oral mucosa. Visual examination and readings period, suggesting that the chemical and mechanical
with IMP were taken before application and 24 properties of the adhesives may affect the skin
hours after removal of the chambers for the skin, differently.
ABSTRACTS 135
FS03.5 FS03.6
Evaluation of the irritancy potential of Efficacy of MAS063D (‘Atopiclair’) in irritant
adapalene and tretinoin in volunteers of different contact dermatitis
ethnic origins Hongbo Zhai, I Villarama, Z Hasan Hafeez,
Chee-Leok Goh1, A T-J Goon1, V Sorba2, P Soto2, HI Maibach
A Kaoukhov2 University of California, Department of
1
National Skin Centre, Singapore Dermatology, San Francisco, USA
2
Sophia Antipolis, France
Objective: To determine the efficacy of a topical,
Objectives: To compare the cumulative irritancy MAS063D, in managing the clinical signs and
potential of adapalene gel, 0.1% to that of treti- symptoms of experimentally induced irritant con-
noin gel, 0.025% following repeated applications tact dermatitis (ICD).
to the skin of human volunteers of different Methods: Two patches of ICD were created
ethnic origins. using sodium lauryl sulfate (SLS) in 20 con-
Methods: Single center study, randomized, senting volunteers. MAS063D was applied to
investigator blind, intra-individual, comparison one patch and a vehicle-only control to the
in healthy volunteers, 18 years of age and older. other. Measurements were taken at baseline,
Volunteers were randomized to apply each 24, 48 and 72 hours as follows: blood flow
product daily to one or the other half-face volume (BFV); skin color (a*); transepidermal
for 21 days. On the forearms products were water loss (TEWL); patient’s view of itch and
applied under occlusive conditions for 4 days. visual scoring. Results: The objective measure-
Criteria for evaluation were signs and symptoms ments of BFV, a* and TEWL all showed sta-
(erythema, desquamation, dryness, stinging/ tistically significant benefits of MAS063D over
burning, pruritus) on the face and on the fore- the vehicle-only control. BFV and a* were sig-
arms (irritation, stinging/burning, pruritus, nificantly better at all time points (p ¼ 0.046,
and biophysical measurements: colorimetry-a* p ¼ 0.045 respectively at 72 hours) and TEWL
and Trans-epidermal Water Loss (TEWL)). at 48 and 72 hours (p ¼ 0.02 at 72 hours).
Overall safety evaluation was based on adverse MAS063D demonstrated benefit in the visual
events information collected throughout the scoring of irritant contact dermatitis that was
study. not statistically significant. Patient-assessed
Results: Seventy-three (73) volunteers from 4 itch was low at baseline; significant improve-
ethnic groups (Chinese, European, Indian and ment was neither expected nor demonstrated
Malaysian volunteers) were randomized. On although a small benefit of MAS063D over
the face the between treatment differences in vehicle was seen in the mean values.
olerability parameters were similar in all Conclusions: BFV and a* are both good indica-
ethnic groups, thus allowing to conclude that tors of local erythema. TEWL is a good indicator
adapalene was significantly better tolerated of skin integrity. MAS063D therefore demon-
than tretinoin in all ethnic groups. This also strated statistically significant benefit over vehicle
allowed us to compare overall irritation suscept- on three clinically meaningful outcomes of SLS-
ibility of different ethnic groups using the induced ICD, and therefore may benefit irritant
sum of clinical sign scores. An overall ethnic contact dermatitis.
effect could be shown (p < 0.001): Chinese being
most susceptible (33.5), followed by Indians
(26.9), Malaysians (23.6) and Europeans (14.1). FS03.7
Forearm evaluations showed significantly better
Tape stripping procedure: influence of anatomic
tolerability for adapalene than for tretinoin.
site, application pressure, duration and removal
However in each patient TEWL measurements
Harald Löffler1, F Dreher2,3, HI Maibach2
correlated poorly with clinical assessments. 1
Philipp-University, Marburg, Germany
Throughout the study more treatment related 2
University of California, San Francisco, USA
adverse events occurred with tretinoin than with 3
TOPALIX, Topical Product Development, San
adapalene.
Francisco, USA
Conclusions: Adapalene gel, 0.1%showed a better
cutaneous tolerability and safety profile than tre- Background and Objectives: Tape stripping is a
tinoin gel, 0.025% for all four ethnic groups. An common method for investigating stratum
interethnic difference in the irritation susceptibility corneum (SC) physiology as well as bioavailability
could be shown. and bioequivalence of topical drugs. However,
136 ABSTRACTS
little is known concerning the influence of procedures in a repeated open application test (ROAT)
(anatomic site, pressure, pressure duration, tape applied to different anatomical regions.
removal rate) inherent in each stripping protocol. 150 patients with known formaldehyde allergy
Methods: Tape stripping was performed using were reviewed for inclusion in the study. 108 patients
tapes on the forearm, forehead and back. On the were contacted and in 65 patients the formaldehyde
forearm different pressures (165 and 330 g cm2), sensitisation was reconfirmed by a patch test. Four
durations of pressure (2s and 10s), and removal groups of 10 formaldehyde allergic subjects were
rate (slow and rapid removal) was performed. exposed to 0.05%, 0.15%, 0.3% and 0.6% diazoli-
Changes in skin physiology were evaluated by meas- dinyl urea, corresponding to approximately 50, 100,
urement of transepidermal water loss (TEWL) and 200 and 400 ppm free formaldehyde, respectively.
hydration. Additional 10 individuals allergic to the formal-
Results: A significant influence of all parameters dehyde donor – diazolidinyl urea itself – were
on the TEWL-increase as a function of tape strip exposed to 0.15% diazolidinylurea, corresponding
number was observed. The fastest increase was to approximately 100 ppm free formaldehyde and
demonstrated on the forehead, followed by the 10 healthy non-allergic individuals were exposed to
back and, lastly, the forearm. Rapid removal 0.6% of diazolidinylurea (approximately 400 ppm
produced a protracted increase in comparison to free formaldehyde).
the slow removal. 10s pressure induced a faster A ROAT was performed in a scheduled
increase of TEWL than 2s pressure. Likewise, the sequence: upper arm, neck and face.
330 g cm2 pressure induced an earlier increase Contact allergy reactions were elicited in 39 out
than the 165 g cm2. Skin hydration was not of 58 formaldehyde-sensitive and in 5 out of 7
influenced by the variables tested. diazolidinyl urea-sensitive individuals.
Conclusion: Tape stripping results are influenced Elicitation responses were dose- and anatom-
dramatically by all investigated parameters. A ical region – dependent.
standardized procedure is necessary for a com- No reactions were observed at the lowest dose,
parable study design. A dynamic SC stress test suggesting that an elicitation threshold was
to more closely investigate SC cohesion is pro- attained in the study.
posed based on the present observations.
FS04.2
Immunotoxic effects of arylamine dyes
Thursday, 10 June 2004 Claudia Skazik1, L Wilbers1, S Breuer1,
14:05–15:30 HF Merk1, D Kunz2, B Blömeke3
1
Department of Dermatology, University Hospital
FS04
RWTH Aachen, Aachen, Germany
2
Cosmetic dermatitis Department of Clinical Chemistry, University
Chairs: An Goossens, Belgium & Patricia Engasser, Hosptial RWTH Aachen, Aachen, Germany
3
USA Department of Ecotoxicology/Toxicology,
University Trier, Trier, Germany
FS04.1
Allergic reactions to arylamine dyes are well-known
Formaldehyde allergy – clinically relevant
causes for allergic contact dermatitis (ACD). These
threshold reactions
compounds are found in synthetic and natural
Claus Zachariae1, B Hall2, M Cottin2,
materials, hair dyes, sun screen, photographic add-
KE Andersen3, T Menne´1
1 itives as well as temporary tattoos. Cross-reactions
Gentofte Hospital, University of Copenhagen,
between different para-compounds have been fre-
Gentofte, Denmark
2 quently observed but the underlying mechanisms
L’Oreal, Laboratoires de Recherche Applique´e et
are not fully elucidated. We investigated the immuno-
De´veloppement, Asnie`res-sur-Seine, France
3 genic capacities of p-phenylendiamine (PPD),
Department of Dermatology, University Hospital
Bandrowski’s base (BB), 2-methyl-1,4-phenylen-
of Odense, Odense, Denmark
diammoniumsulfat (PTD), 4-aminoazobenzene
The objective of the study was to establish elicit- (AAB), disperse orange (DO), disperse yellow
ing threshold concentrations of diazolidinyl urea (DY), 4–4-diaminophenylmethan (DDM), bis-
(Germall II) – derived formaldehyde in formalde- marckbrown (BBY) and 2-mercaptobenzothiazole
hyde and/or in diazolidinyl urea – sensitive (MBT) by measuring the proliferative responses
patients, using a leave-on face cream formulation of T-cells on polyclonal and monoclonal level
ABSTRACTS 137
(thymidine incorporation). T cell responses were activity relationship) model called TOPS-
based on CD4þ and CD8þ T cells. Recently, we MODE, based on local lymph node assay
characterized PPD/BB T cell clones (TCC) as pre- (LLNA) data and physical chemical properties
dominantly CD4þ/CD45ROþ cells with a alpha/ were used to predict the sensitization potential
beta T cell receptor (Sieben et al., 2002). We iso- and make a cluster analysis.
lated T cell lines (TCL, n ¼ 16) and T cell clones Results: Out of 315 hair dye substances 229 meet
(TCC, n ¼ 20) from totally 11 PPD-allergic persons the inclusion criteria. Most of the hair dye sub-
and 5 exposed persons. We established TCLs and stances 75% were predicted to be strong to mod-
TCCs to 4 para-amino compounds. We found erate sensitizers. Less were predicted to be weak
some PPD and/or BB specific TCCs with no cross- 22% and only a small part 3% were predicted to
reactivity to the other compounds tested. Some be extremely weak or non sensitizing. The 8 most
TCCs showed a narrow range of cross-reactions used hair dye substances were predicted to be
(BB, BBY, MBT), while others reacted to 6 different strong to moderate sensitizers. Ppd is the most
para-amino compounds. We observed similiar pat- used hair dye allergy marker but some azodyes
terns of crossreaction for the TCLs. The stimula- were predicted to be more potent than para-
tion indices (SI) varied between 2.2 and 14.0. phenylenediamine (ppd).
Our preliminary results on cross-reactions between Conclusions: Most hair dye substances are pre-
para-amino compounds support recent findings in dicted to be strong to moderate sensitizers,
mice (Wulferink et al., 2002) demonstrating a lim- which explain why some people gets hair dye
ited discriminatory capacity of T cells carrying an dermatitis. A patch test series with potent, much
alpha/beta T cell receptor. Further studies on the used azodyes, might prove useful in diagnosing
mechanisms of cross-reactivities and the cytokine ppd-negative patients, with hair dye allergy. The
profiles are now under investigation. This study cluster analysis grouped the substances which can
was supported by the Interdiciplinary Center for be helpful choosing substances for clinical patch
Clinical Research and Biomaterials (IZKF, Ger- test.
many) and the Deutsche Forschungsgemeinschaft
(Germany).
FS04.4
Decreased MDBGN conc. in a product is
FS04.3
counteracted by increased exposure
Hair dyes, prediction of sensitization potential Charlotte Devantier Jensen1,2, T Menne´2,3, J Duus
with QSAR Johansen2, KE Andersen1,2
Heidi Søsted1, G Patlewicz2, E Estrada3, 1
Department of Dermatology, Odense University
DA Basketter2, J Duus Johansen1 Hospital, University of Southern Denmark,
1
National Allergy Research Centre for Consumer Odense, Denmark
2
Products, Department of Dermatology, University National Allergy Research Centre, Gentofte,
of Copenhagen, Gentofte Hospital, Gentofte, Denmark
3
Denmark Department of Dermatology, Gentofte Hospital,
2
Safety and Enviromental Assurance Centre Gentofte, Denmark
(SEAC) Unilever Colworth, Sharnbrook, UK
3 Background: Some types of cosmetic products
X-Ray Unit (BioComputing) RIAIDT-
such as creams and soaps are commonly used
Structural Studies Area Edificio CACTUS.
several times a day, especially in occupational
University of Santiago de Compostela,
use-situations. Little is known about how the
Santiago de Compostela, Spain
daily frequency of application of an allergen in a
Objectives: To identify substances and tonnage product influences the allergic response.
data for use for hair dyes registered in Europe. Objectives: This study investigates the allergic
To predict the sensitization potential of each sub- responses elicited in pre-sensitised individuals
stance and to rank the substances due to their when exposed to a specific amount of allergen
sensitization potential. Further to group the applied either in 1 application per day or distribu-
substances in clusters based on their physical ted over 4 applications per day. As model allergen
chemical properties with a cluster analysis. is used the cosmetic preservative methyldibromo
Methods: The Inventory list of Cosmetics Ingre- glutaronitrile (MDBGN). Patients/Methods: 19
dients (INCI), new regulation on cosmetics, ton- contact allergic individuals and 12 controls partici-
nage data for use and Toxnet were used to pated in a double-blind, randomized repeated open
identify and quantify the hair dyes. Salts were application test (ROAT) using two coded aqua/
disregarded. A QSAR (Qualitative structure- ethanol (80:20) solutions preserved with 100 ppm
138 ABSTRACTS
and 400 ppm MDBGN, respectively. 12 cm2 areas IPBC were the reaction index, the positivity
on the lower arms were applied 2 drops either once ratio, the rate of crescendo reactions, and the
daily of the 400 ppm solution or 4 times a day for relation of IPBC-reactions with MOAHLFA-
the 100 ppm solution. indices, with irritant reactions to sodium lauryl
Results: Most patients developed dermatitis fol- sulfate, and with positive reactions to the most
lowing application of approximately equal common standard contact allergens and 4 other
amounts of MDBGN on both arms not distin- preservatives. For statistical evaluations the
guishing whether the allergen was applied as a exact McNemar test was applied and odds ratios
400 ppm solution once daily or a 100 ppm solu- were calculated according to the profile likeli-
tion 4 times daily. Controls were negative. hood method, as derived from logistic regression
Conclusions: Applications with 400 ppm MDBGN analyses. The rate of positive reactions to IPBC
once daily or 100 ppm MDBGN 4 times per day increased from 0.5% with IPBC 0.1% to 1.7%
had, in a ROAT study, approximately equal cap- with IPBC 0.5%, but there was a problem with
abilities of provoking allergic dermatitis in agree- sensitivity or specificity with both of these 2
ment with well-known patch test data that dose concentrations. Therefore, we focused on IPBC
per unit area is more important than concentration 0.2% (0.8% positive reactions) and IPBC 0.3%
of allergen in the product. This may complicate (1.3% positive reactions) for further detailed
risk assessment and regulation of cosmetic aller- analyses. An evaluation of the related param-
gens. Further studies, however, are needed before eters revealed that with IPBC 0.2% as compared
more general conclusions can be made. to IPBC 0.3% a higher percentage of crescendo
reactions, a higher reaction index, a lower num-
ber of doubtful reactions, a plausible association
FS04.5 of positive reactions with reactions to other pre-
servatives, nd no association with a pronounced
Iodopropynylbutyl carbamate (IPBC) 0.2% is
skin irritability was found. In conclusion, we
suggested for patch testing of patients with
recommend to start with IPBC 0.2% for patch
eczema possibly related to preservatives
testing of all persons with contact dermatitis that
Jochen Brasch1, J Geier2, A Schnuch2, W Aberer3,
may be related to preservatives.
W Uter4 for the German Contact Dermatitis
Research Group and the Information Network of
Departments of Dermatology
1
Department of Dermatology, University of
FS04.6
Schleswig-Holstein, Campus Kiel, Kiel, Germany
2
Center of the Information Network of Dose/unit area and time – key factors influencing
Departments of Dermatology, Insitute at the the elicitation capacity of MCI/MI
University of Göttingen, Göttingen, Germany Claus Zachariae1, A Sørensen1, P McNamee2,
3
Department of Dermatology, University of Graz, J Grey2, M Wooder3, T Menné1
1
Graz, Austria Gentofte Hospital, University of Copenhagen,
4
Department of Medical Informatics, Biometry Gentofte, Denmark
2
and Epidemiology, University of Erlangen- Procter & Gamble Technical Centres Limited,
Nürnberg, Erlangen, Germany Egham, UK
3
Rohm & Haas, European Operations, Croydon, UK
Iodopropynylbutyl carbamate (IPBC)is a preserva-
tive that has been increasingly used for skin The objective of the study was to investigate,
care products and cosmetics within the last using the Repeated Open Application Test
years and the first cases of contact sensitization (ROAT), two key parameters of exposure – aller-
have meanwhile been reported. Therefore, a gen concentration (dose/unit area) and time in
surveillance for IPBC contact allergy is now terms of the elicitation capacity of methylchloro-
necessary. Our study was aimed to find out a isothiazolinone and methylisothiazolinone
suitable test concentration of IPBC for this pur- (MCI/MI) in MCI/MI-sensitised individuals and
pose. The data 8106 patients tested by 23 centres to explore the inter-relationship between these two
of the German Contact Dermatitis Research key factors. The study was designed as a double-
Group (DKG) and the Information Network of blind, placebo-controlled, dose-response ROAT
Departments of Dermatology (IVDK)in the time preceded by a Diagnostic Patch Test (DPT). 79
from May 2001 to July 2003 with IPBC in con- patients with a known MCI/M allergy were con-
centrations of 0.1%, 0.2%, 0.3%, and 0.5% were tacted, 29 were diagnostically patch tested and 25
retrospectively evaluated. Criteria considered to had their allergy confirmed. 25 MCI/M-allergic sub-
determine the optimal test concentration of jects and 10 healthy non-allergic control subjects
ABSTRACTS 139
were challenged with 2 ppm of MCI/MI/unit area of studies. We highly recommend to patch test all
skin for 4 weeks. After a wash out period of at least 4 patients with atypical cutaneous T-cell infiltrates.
weeks the subjects were challenged with 7.5 ppm of
MCI/MI/unit area of skin for 4 weeks. A ROAT FS04.8
with 2 drops of solution twice a day was conducted
on the volar aspect of the left and right forearms on a The U.S. Cosmetic Ingredient Review: process
3 3 cm area resulting in dose/unit area of MCI/MI and products
of 0.025 mg/cm2 and 0.095 mg/cm2 for 2 ppm and Gerald McEwen
7,5 ppm MCI/MI respectively. The elicitation capa- The Cosmetic, Toiletry, and Fragrance
city of MCI/MI in MCI/MI sensitive patients is Association, Washington DC, USA
dependent on the exposure dose/unit area and time The U.S. Cosmetic Ingredient Review (CIR) pro-
The results of this study will be a useful addition to gram has evaluated safety in use data on approxi-
the risk assessment information available for MCI/ mately 1300 ingredient since 1976. The review
MI. The risk assessment for the use of MCI/MI in process, which relies on open public meetings and
rinse off consumer products is unaffected by the the active participation of the public, the U.S. Food
results of this study. and Drug Administration, and the cosmetics and
chemical industries, has identified many cosmetic
ingredients that should only be used under limited
FS04.7 conditions. Adhearance to the limitations on use in
Atypic T-cell infiltrate by isothiazolinone. the conclusions of the CIR reports, in the U.S.,
Question to discuss appears to have limited exposure and patient popu-
Ana Gime´nez-Arnau1, A Toll1, F Gallardo1, lation sensitivity to some widely used cosmetic ingre-
J Roman2, RM Pujol-Vallverdú1 dients that have produced high rates of reactions in
1 Europe. The advantages of the CIR process for the
Department of Dermatology. Hospital del Mar,
Universitat Autònoma, Barcelona, Spain public and the medical community; the deliberations
2 leading to the use limitations on two example ingre-
CAS. Castell-Platja, Aro, Spain
dients, and sources for attendees to locate CIR
Methyl(chloro)isothiazolinone is an effective preser- Reports and conclusions will be presented.
vative and a major cause of cosmetic allergy in most
European countries. On the face unusual clinical pre-
Thursday, 10 June 2004
sentations are seborrhoeic dermatitis, lupus erythe-
16:00–17:00
matosus, lymphocytic infiltrate, photodermatosis or
atopic dermatitis. Three patients who suffered a FC01
chronic, recurrent, itchy and generalized cutaneous
Free Communication – Occupational
erytematous-desquamative and eczematous eruption
dermatoses I
with a common pathologic event, an atypical lym-
Chairs: Rosemary Nixon, Australia & Mihály Matura,
phoid infiltrate, whose induction by a contact allergen
Sweden
can be discussed are presented. The first, a 59 years
old man showed a biopsy with an atypical dermal- FC01.1
epidermal T cell infiltrate of mycosis fungoides and
Occupational contact dermatitis from
monoclonal TCR-rearrangement. The second, a
methylisothiazolinone
74 years old man showed an atypical lymphoid
Marle´ne Isaksson, B Gruvberger, M Bruze
infiltration with polyclonal TCR-rearrangement
Department of Occupational and Environmental
and a second biopsy showed an eczematous
Dermatology, Malmö University Hospital,
pattern. The third, a 50 year old man with pathology
Malmö, Sweden
of plaque parapsoriasis with atypical lymphoid
infiltrate. The three patients showed strong Background: The preservative methylchloro-
positive reaction to methyl(chloro)isothiazolinone isothiazolinone/methylisothiazolinone (MCI/MI)
(0.01%aq.) Trolab,,m. Avoiding the allergen the has been used extensively in various products since
cutaneous eruption disappeared and any recur- the 1980s. Recently, a biocide containing only MI
rence has been observed yet. Pathologic criteria and not MCI has been launched on the Swedish
for mycosis fungoides remains controversial and market for use in industrial settings, paints and glues.
could not be done only on the basis of cellular Objectives: To describe sensitization to the
density or the percentage of atypical T-cells. unchlorinated isothiazolinone 2-methyl-4-isothia-
Autoinvolutive mycosis fungoides shows the zolin-3-one (MI) in 2 workers, a technician after
unknowledge of its pathogenesis. How some aller- a chemical burn and a painter, both exposed to a
gens could affect on the cellular life needs further preservative containing MI. Methods: Patch testing
140 ABSTRACTS
population. Furthermore, we analysed the different prominent dental-related allergens were rubber
allergens, irritants and constitutional factors (e.g. compounding agents and methacrylates. Positive
atopy) in the affected metal workers. reactions in the former were due to thiurams
Results: In metal workers, a total of 700 OSDs were (10%) and carbamates (12%). Positive reactions to
registered which comprise 18.8% of all OSDs in acrylates were most frequent to ethylene glycol
our register. They were classified into metal-surface dimethacrylate. All acrylate allergies were in den-
processors (260 OSDs, yearly incidence per 10,000 tists; typically theses dentists had chronic fingertip
employees ¼ 10.4), metal processors (129 OSDs, dermatitis. Preservative allergies were also common,
5.9), locksmiths and automobile mechanics (119 including thimerosal (31%) and benzoyl peroxide
OSDs, 2.5), electrical industry (69 OSDs, 1.4), (11%). Glutaraldehyde and formaldehyde each
machinists (47 OSDs, 11.6), mechanics (40 OSDs, produced 3.5% of positive reactions with no
6.6), electroplaters (22 OSDs, 20.6) and solderers evidence of cross-reactivity Common allergies
(14 OSDs, 13.4). The proportion between allergic that may be occupationally related were nickel
(ACD) and irritant contact dermatitis (ICD) varies (20%) in tools and orthodontic appliances and
conspicuously. While electroplaters and solderers fragrance mix (16%) containing eugenol and
predominantly suffer from ACD (82% resp. 71%), cinnamates. These results indicate that allergies
in other occupational groups ICD is more common: other than type I hypersensitivity to NRL pro-
mechanics (60%), locksmiths and automobile mech- teins occur in dental professionals with current
anics (59%) or metal-surface processors (53%). or past dermatitis.
The type IV allergens differ widely depending
on the occupational exposure. The most impor-
tant allergen in solderers is colophony, in electro-
platers nickel sulphate and potassium dichromate.
There is a wide range of allergens in metal working FC01.6
fluids and it is mandatory to patch test patient‘s
Hand dermatitis of hairdressers. Study of
own working materials due to the fact that impor-
protective gloves permeation
tant allergens are not yet included in the screening
Giulio Arcangeli1, P Bavazzano2, A Perico2,
series.
M Montalti1, L Guarducci1, V Cupelli1
1
Università di Firenze, Florence, Italy
2
Azienda Sanitaria di Firenze, Florence, Italy
FC01.5 Contact dermatitis among hairdressers is common
and is one of the most frequent occupational dema-
Occupationally based type IV hypersensitivity
toses due to continual exposure to water, deter-
in dental professionals
gents, hair dyes, permanent waves and metal
Daniel Hogan1, C Hamman2, P Rodgers2, C Siew3
1 equipment. Use of individual protection systems –
Louisiana State University Medical Center,
as gloves – is considered a good measure of pre-
Shreveport, USA
2 vention. Few data exist about the real permeation
Smart Practice, Phoenix, USA
3 resistance (PR) of gloves, also in term of time of
American Dental Association Health Foundation,
PR. We tested two types of djsposable latex gloves
Chicago, USA
different by thickness and density of the manufac-
The study’s objective was to determine the fre- ture material. We used a permeation cell composed
quency of type IV hypersensitivity in dentists, dental of two separated parts: in the upper part we intro-
hygienists, dental assistants or dental students duced the hair colouring formulation and in the
attending annual Health Screenings at the 1997, lower one the collection medium (NaHSO3 1% in
1998, 2000, 2002 and 2003 American Den- water); the two parts were separated by a portion
tal Association (ADA) Annual Sessions held in var- of the glove material. A 100 microL volume of
ious major American cities. We patch tested: 1997– the collection medium was collected and injected
59 dentists and 21 non-dentists; 1998–40 and 13; onto a HPLC apparatus after 1, 2, 4 and 24
2000–21 and 7; 2002–33 and 6; 2003–25 and 4. We hours. A diode array detector was utilised select-
patch-tested participants using T.R.U.E. Test ing two wavelengths in the UV range (240 and
panels and/or Finn chambers containing Trolab 275 nm) with a linear concentration gradient up
allergens. Due to the time constraints of the ADA to 60% of methanol/acetonitril mixture. We can
meeting dates, patches were placed for 48 hours and simultaneously analyse 9 oxidation dyes and the
skin reactions read at 0 and/or 24 hours after patch detection limits were sufficient to determine
removal. Overall, 49% of patch-testing participants these substances at very low concentrations. We
tested positive to at least one allergen. The most obtained respectively a breakthrough time less
142 ABSTRACTS
than 24 hours for the lower thickness glove and knowledge system DEREK (Deductive Estimation
of over 24 hours for the other one; the latex of Risk from Existing Knowledge).
gloves are suitable for prevent the skin contam- Results: The model diene was found to be a potent
ination during the preparation of the colourings contact allergen able to sensitise the control animals
mixture in the hairdresser activity. The obtained after only one dermal exposure. Both epoxides
data show those latex gloves, of both thickness, gave elicitation in the animals sensitised to the
have a very high PR. On the other hand, the use diene indicating that they are formed from
of latex gloves has been associated with the more the diene in the skin during induction. The diene
frequent recognition of immediate-type hyper- system was considered as a non-sensitiser in
sensitivity responses related to latex products. DEREK.
The prosecution of the study will evaluate the Conclusions: This study demonstrates that conju-
PR of latex-free gloves. gated dienes can be metabolised to strong contact
allergens in the skin and that it is important
to consider possible metabolic pathways when
constructing predictive databases, otherwise
Thursday, 10 June 2004 potent prohaptens might be considered as harm-
16:00–17:00 less chemicals.
FC02
Free Communication – Miscellaneous FC02.2
Chairs: Kristiina Turjanmaa, Finland & Hee-Chul Eun,
South Korea Patch tests with gluten and gliadin in children
with coeliac disease
FC02.1 Francesca Giusti1, S Amarri2, S Seidenari1
1
A diene identified as a prohapten metabolised University of Modena and Reggio Emilia,
to epoxides in the skin Modena, italy
2
Anna-Malin Nilsson1, K Luthman2, JLG Nilsson1, Department of Pediatrics, Ravenna, Italy
A-T Karlberg1,3 Atopy patch tests (ATPs) are believed to be a
1
University of Göteborg, Dermatochemistry and useful diagnostic procedure for atopic dermatitis
Skin Allergy, Göteborg, Sweden (AD), aiming at the detection of delayed reactions
2
Medicinal Chemistry, Department of Chemistry, to aeroallergens and food allergens. Our aim was
Göteborg University, Göteborg, Sweden to investigate immune responses to gluten and
3
National Institute for Working Life, Stockholm, gliadin in children affected by coeliac disease by
Sweden performing APTs, and to compare these data to
To predict the sensitising capacity of a chemical, the ones observed in AD patients. 31 children, 15
the only existing reliable method is testing in males and 16 females (mean age s.d. ¼ 5,5 3,8
animals and alternative methods are requested. years) affected by coeliac disease underwent
One approach is to use databases that predict APTs with gluten and gliadin. Among these,
the toxicity of novel compounds by comparing 15 children were on gluten-free diet at the
the chemical structure with data stored in the moment of our examination and 3 patients were
database. A chemical (hapten) must contain a affected by AD. 83 AD children not affected by
chemically reactive site to be able to bind to skin celiac disease, were used as controls. 19,4%
macromolecules and a good predictor for sensitis- and 12,9% of children with coeliac disease proved
ing capacity is the electrophilic character of the positive to APTs with gluten and gliadin, respec-
molecule. tively. No difference in the frequency and inten-
Objectives: The aim of this study was to investi- sity of APT responses were present between
gate the sensitising capacity of 5-isopropenyl-2- the patients on gluten-free diet and the children
methyl-1-methylene-2-cyclohexene, a conjugated not on diet. Among AD patients 12% reacted
diene with no electrophilic positions or any other to gluten, whereas no positive reactions to
structural alert for skin sensitisation. gliadin were observed. Going on these findings,
Methods: 5-Isopropenyl-2-methyl-1-methylene-2- the cellular-mediated reactivity to gliadin in
cyclohexene and two possible epoxide metabolites patients with coeliac disease may show a clinical
of the model compound were synthesised. Sensiti- expression by positive APT reactions to gliadin.
sation and elicitation experiments were performed These represent a specific finding in subjects
using the predictive guinea pig method FCAT. The with coeliac disease when compared to AD
diene system was analysed in the computer based children.
ABSTRACTS 143
the early 1970’s and 1980’s, respectively. This inves- the one found from 1988 to 1994, in particular for
tigation reveals that they have mistakenly been neomycin, nickel sulfate, wool alcohols, ammo-
regarded as pure chemical entities with specific niated mercury, propolis, potassium dichromate,
structures by the majority of the chemical society. mercaptobenzothiazole and thiuram mix. Our
In fact Germall 115 and Germall II both consist of data demonstrate that contact sensitization is
complex mixtures of numerous and fast degradable more and more frequent in children referring to
allantoin-formaldehyde condensation products and our department and that the importance of some
may not even contain the conventionally assigned allergens, such as neomycin, wool alcohols, propo-
chemical structures of imidazolidinyl urea (Germall lis and potassium dichromate, is increasing in the
115) and diazolidinyl urea (Germall II). Equili- paediatric age with respect to previous results.
brium between different structures may be formed
in different cosmetic formulations/test materials.
This may have led to the discrepancies in the litera- FS05.5
ture: Are the Germalls themselves sensitizers or are
The European Standard Series in 8 European
the allergic reactions caused by formaldehyde
countries – first results of the ESSCA network
release? The identification and structure assignment
Wolfgang Uter1, J Hegewald1, W Aberer2, A Bircher3,
of (4-hydroxymethyl-2,5-dioxo-imidazolidin-4-yl)-
J Brasch4, PJ Coenraads5, P Elsner6, M Fartasch7,
urea (HU) will be presented, as it is the major and
P Frosch8, T Fuchs9, T Menne´10, R Jolanki11,
chemically stable degradation product of both
B Kreˆcisz12, D Orton13, D Perrenoud14, A Schnuch15
Diazolidinyl urea and Imidazolidinyl urea. A guinea 1
IMBE, University of Erlangen-Nuernberg, Germany
pig maximization test has been performed to deter- 2
University Skin Hospital Graz, Austria
mine the potential of HU to induce delayed contact 3
University Skin Hospital Basel, Switzerland
hypersensibility in guinea pigs. Separate chemically 4
University Skin Hospital Kiel, Germany
stable TRUE Test patches containing the mixtures 5
University Skin Hospital Groningen, Netherlands
have shown clinical efficacy. 6
University Skin Hospital Jena, Germany
7
University Skin Hospital Erlangen, Germany
8
Klinikum Dortmund/Univ. of Witten-Herdecke,
FS05.4
Germany
9
Contact sensitization in Italian children over a 7 University Skin Hospital Göttingen, Germany
10
year period Allergy Centre, Gentofte Hospital, Copenhagen,
Stefania Seidenari, F Giusti, M Mondino, Denmark
11
F Massone, P Pepe, G Pellacani Section of Dermatology, Finnish Institute of
University of Modena and Reggio Emilia, Occupational Health, Helsinki, Finland
12
Modena, Italy Department of Dermatology, Nofer Institute, Lodz,
Poland
Our aim was to investigate contact sensitization in 13
Department of Dermatology, Amersham Hospital,
children over a 7 year period and to compare these
Amersham, UK
data to our previous findings. From January 1995 14
Service de Dermatologie, CHUV, Lausanne,
to December 2001, 1094 children with suspected
Switzerland
allergic contact dermatitis were patch tested with 15
Information Network of Deptartments of
our paediatric series of 30 substances. 404 were
Dermatology, University of Göttingen, Germany
affected by atopic dermatitis. 570 children (52.1%),
300 girls and 270 boys, proved to be sensitized. Since January 2001, the European surveillance sys-
Among them, 291 (51%) were polysensitized. tem on contact allergies (ESSCA) has developed
Neomycin, nickel sulfate, wool alcohols, thimero- a suitable infrastructure with the financial sup-
sal, ammoniated mercury, and propolis gave the port of EU funding (QLK4-CT-2001–00343 and
highest number of positive responses. No significant –2001–2812), and has started to collect patch test
differences were observed in the prevalence of con- data. These comprise a standardized clinical his-
tact sensitization among the patients with atopic tory and patch test results with the European
dermatitis and non atopics. However, in the latter standard series, contributed by the 12 centres in
the frequency of positive responses to nickel sulfate 8 European countries listed above. So far, with
and Kathon CG was significantly lower than in the the 2003 data collection not yet completed, 7636
former. The face (25%), the hands (23%), and the patients’ test results have been pooled and ana-
flexural areas of the limbs (18%) were most fre- lysed; current data pertaining to 2002 and 2003
quently affected in children with positive patch will be presented. Anamnestic data reflect partly
tests. In this study population the frequency of the specialties of some centres (e.g., the % of
sensitized children was significantly higher than occupational and hand dermatitis ranging
146 ABSTRACTS
between 6 and 29% and 18 and 56%), partly Parthenolide and Disperse blue 106, where the
different selection criteria or possibly also defin- latter consists of a complex mixture. Chemical
itions (e.g., 7–32% with underlying atopic dermati- stabilization of the patches as well as clinical
tis, 40–69% of patients age 40þ). The leading studies will be presented.
allergen was nickel sulfate (15.7%, age- and sex-
standardized), with however, large inter-national
variation (the lowest standardized prevalence,
Friday, 11 June 2004
9.7%, was observed in Gentofte, Denmark, where
08:00–09:05
nickel regulation had long been introduced). The
prevalence of contact allergy to Myroxylon Pereirae FS06
resin (7.8%) has almost reached the frequency
Fragrances
found with the fragrance mix (8.3%). In the two
Chairs: Peter Frosch, Germany & Jeanne Duus
centres using the True TestTM, both percentages
Johansen, Denmark
were even lower, which may be indicative of a
systematic effect. Within a few years, ESSCA is FS06.1
expected to meet its objective of increased consumer
Contact allergy to oxidized fragrance terpenes.
safety by post-marketing surveillance by continu-
Mihály Matura1, M Sköld1, A Börje1, P Frosch2,
ously monitoring contact allergy across Europe.
A Goossens3, I White4, M Bruze5, T Menne´6,
K Andersen7, A-T Karlberg1
1
Department of Dermatochemistry & Skin Allergy,
FS05.6
Göteborg University, Göteborg, Sweden
2
New standardized allergens: the experimental Department of Dermatology, Dortmund and
TRUE Test1 Panel University of Witten/Herdecke, Dortmund,
Ulla Hoeck, S Lehmann, H Bjarnoe, J Meldgaard, Germany
3
L Holm Laugesen Department of Dermatology, University Hospital
Mekos Laboratories AS, Hillerød, Denmark Catholic University of Leuven, Leuven, Belgium
4
St.John’s Institute of Dermatology, St.Thomas’
TRUE Test1 is the only standardized patch test
Hospital, London, UK
system for the diagnosis of allergic contact dermat- 5
Department of Occupational Dermatology,
itis based on 24 fully stable and reproducible for-
University Hospital, Malmö, Sweden
mulations. New standardized patches are in process 6
Department of Dermatology, Gentofte Hospital,
of development for TRUE Test1 Panel 3. The aller-
University of Copenhagen, Copenhagen, Denmark
gens chosen are well-known sensitizers and include 7
Department of Dermatology, University Hospital,
preservatives, steroids, metals and others. 14 new
Odense, Denmark
patches are included in an Experimental panel
which is tested in several European clinics. 11 of Terpenes are among the most widely used fra-
the patches contain new allergens while 3 patches grances, found not only in fine fragrances but
consist of improved TRUE Test1 formulations most often incorporated in domestic and occupa-
with Neomycine sulphate, Fragrance mix and tional products. Terpenes oxidize easily at air-
Potassium dichromate. A number of the patches exposure. Our previous studies have proved that
from the Experimental panel will be selected for limonene, linalool and caryophyllene are not
TRUE Test1 Panel 3. The overall purpose with allergenic in themselves but easily form allergenic
pharmaceutical development of patch test materials products due to autoxidation. The aim of this
for TRUE Test1 is to obtain a precise dose, bio- study was to study the frequency and character-
availability and stability in every single patch. istics of allergic reactions in Europe to some
The patches have to be chemically stable for at oxidized fragrance terpenes.
least 2 years at refrigerated temperature. The Method: Consecutive dermatitis patients in six
selected preservatives on the Experimental panel European dermatological centers were patch tested
are Methyldibromoglutaronitrile, Germall 115, with oxidized terpenes. Questionnaires, standard
Germall II and Bronopol. All 4 patches have pro- and additional fragrance patch test materials
ven to be difficult to stabilize because of the natural were used in the diagnosis of fragrance allergy.
reactivity of the allergenic substances. The steroids Results: Oxidized limonene was tested in 2411,
chosen are Budesonide, Tixocortol-21-pivalate while oxidized linalool, linalool hydroperoxide,
and Hydrocortisone-17-butyrate. All 3 steroids oxidized caryophyllene, caryophyllene oxide and
are stable in TRUE Test1 formulations. Other oxidized myrcene in additional 1511 patients. Of
allergens on the Experimental panel are Ammo- the patients tested 2.6% showed positive reaction
niated Mercury, Goldsodiumthiosulphate, to oxidized limonene, 1.3% to oxidized linalool,
ABSTRACTS 147
0.5% to oxidized caryophyllene and 1 patient to Conclusions: The extensively used fragrance chem-
oxidized myrcene. 1.1% of the patients reacted to ical linalool is not allergenic in itself. The auto-
linalool hydroperoxide, while testing with caryo- xidation process that takes place at air-exposure
phyllene oxide resulted in few positive Results: leads to the formation of sensitizing oxidation
60% of the patients reacting to oxidized terpenes products. The frequency of consecutive patients
had fragrance related contact allergy and/or posi- reacting to oxidized linalool shows that the
tive history for fragrance related dermatitis. experimental findings are clinically important.
Conclusion: Oxidized limonene and linalool are
common allergens in dermatitis patients tested
consecutively in Europe. Our results indicate FS06.3
that autoxidation of fragrance terpenes contrib-
Chloroatranol – clinical studies and exposure
utes to fragrance allergy to a great extent. This
analysis
observation emphasises the need of testing with
Jeanne Duus Johansen1, SC Rastogi2,
chemicals that patients actually come in contact
KE Andersen3, G Bernard 4, C Svedman5, M Bruze5,
with and not only ingredients that were originally
R Bossi2, E Gimenez-Arnau4, J-P Lepoittevin4,
applied in the commercial formulations.
T Menné 6
1
National Allergy Research Centre, Gentofte Hospital,
University of Copenhagen, Gentofte, Denmark
FS06.2 2
Department of Atmospheric Environment, National
Autoxidation of linalool and impact on the Environmental Research Institute, Roskilde, Denmark
3
sensitizing capacity and allergenicity Department of Dermatology, Odense University
Maria Sköld, A Börje, E Harambasic, M Matura, Hospital, Odense, Denmark
4
A-T Karlberg Laboratoire de Dermatochimie, University Louis
Göteborg University, Department of Chemistry, Pasteur, Strasbourg, France
5
Dermatochemistry & Skin Allergy, Göteborg, Sweden Department of Occupational and Environmental
Dermatology, University Hospital Malmö, Malmö,
Linalool is one of the most frequently used fra-
Sweden
grance chemicals in scented products and a large 6
Department of Dermatology, Gentofte Hospital,
population is exposed to it. It is therefore import-
University of Copenhagen, Gentofte, Denmark
ant to study the allergenic properties of linalool,
and the effect of autoxidation. Objectives: To investigate the elicitation potency of
Objectives: To study the autoxidation of linalool chloroatranol – a newly identified allergen in the
and identify formed oxidation products, to investi- natural fragrance extract: oak moss absolute. Further
gate the impact of autoxidation on the sensitizing to compare chloroatranol and atranol and relate the
capacity and to study the frequency of contact findings to exposure assessed by chemical analysis.
allergy to oxidized linalool among consecutive Methods: A serial dilution patch and repeated open
dermatitis patients. application test was performed in 13 chloroatranol
Methods: Linalool was air-exposed and the sensitized patients and in 10 healthy controls.
degradation followed with GC. Oxidation prod- Further the relative potency between chloroatranol
ucts were identified with GC-MS and NMR. and atranol in equimolar patch test concentrations
Pure linalool, 2 different states of oxidized lina- was studied and exposure assessed by chemical
lool and 3 oxidation products were tested for their analysis (liquid chromatographic-tandem mass
sensitizing capacity in the local lymph node assay spectrometry) of perfumes on the European
(LLNA). Consecutive dermatitis patients were Market.
patch-tested with oxidized linalool and a fraction Results: Elicitation occurred in 92% (12/13) to the
of oxidized linalool. repeated open application of 5 ppm chloroatranol in
Results: Linalool started to decompose immedi- ethanol within 14 days of exposure and in none of the
ately when air-exposed. Several oxidation pro- controls (p < 0.001). Patch testing with eqimolar con-
ducts were identified among which 3 (2 centrations of chloroatranol and atranol indicated
hydroperoxides and an alpha, beta-unsaturated almost similar elicitation potency. Exposure assess-
aldehyde) contain structural features that make ment showed that chloroatranol and atranol were
them potential allergens. LLNA showed that the widespread in perfumes. Chloroatranol was found at
3 oxidation products were moderate allergens, 10 ppm and atranol 74 ppm (90% percentiles).
and that the sensitizing potential of linalool Conclusions: Chloroatranol and atranol are strong
increased with longer air-exposure times. In the elicitors. The current exposure to these fragrance
patch-test study positive reactions were observed allergens in perfumes is likely to cause clinical
to oxidized linalool in 1.65% of the patients. symptoms in sensitised individuals.
148 ABSTRACTS
fragrance products, also when adjusting for nickel 8.7% of tested patients had a certain fragrance
contact allergy, age, gender psychological vulner- history. Of these 25.2% were positive to FM I,
ability, educational level and social class. reactivity to FM II was dose-dependent and ranged
Conclusions: Individuals with BHR, hand eczema from 8.1% to 17.6% in this subgroup. Comparing 2
and/or perfume contact allergy, as opposed to groups of history – certain and none – values for
those without, are more frequently and more sensitivity (sens) and specificity (spec) were calcu-
severely bothered from the eyes or airways after lated. Sens: FM I, 27.2%; 2.8% FM II, 8.7%; 14%
volatile exposure to fragrance products. The lack FM II, 15.9%; 28% FM II, 21.5%. Spec: FM I,
of association with skin prick test reactivity indi- 96.3%; 2.8% FM II, 99.5%; 14% FM II, 98.7%;
cates that IgE mediated allergic mechanisms do 28% FM II, 97.9%. 31/70 (44.3%) patients positive
not play a major role in the development of these to 28% FM II were negative to FM I. In the group
symptoms. Having hand eczema has the greatest of patients with a certain history a total of 6 patients
impact on reporting mucosal symptoms elicited was found reacting only to FM II. Simultaneous
by fragrance products. break-down testing with the single constituents
produced positive reactions in 54.3% for 28% FM
II and 48% for 14% FM II. Lyral was the dominat-
ing single constituent with positive reactions
FS06.7 (37.1% for 28% FM II, 36% for 14% FM II),
followed by citral, farnesol, citronellol, AHCA and
The new fragrance mix II – test results of a
coumarin. Chemical analysis for the 6 constituents
multicentre European Study
of FM II was performed on 25 products used by
Peter Frosch1, C Pirker1, S Rastogi2,
12 patients being patch test positive to FM II.
KE Andersen3, M Bruze4, A Goossens5, IR White6,
Lyral was detected in 76% of these products, citral
W Uter7, J Duus Johansen8, T Menne´8,
1 in 16% and AHCA in 8%. In conclusion, the new
University of Witten/Herdecke, Department of
FM II detects additional patients with contact
Dermatology, Dortmund, Germany
2 allergy to fragrances missed by the currently used
National Environmental Research Institute,
FM I. The medium concentration, 14% FM II,
Roskilde, Denmark
3 is probably the most useful one for diagnostic
Department of Dermatology, Odense University
screening.
Hospital, Odense, Denmark
4
Department of Occupational and Environmental
Dermatology, Malmö University Hospita, Malmö,
Sweden Friday, 11 June 2004
5
Katolieke Universiteit Leuven, Dermatology & 09:10–10:15
Contact Allergy Unit, Leuven, Belgium
6 FS07
St John’s Institute of Dermatology, St Thomas’
Hospital, London, UK Legislation & prevention
7
Department of Medical Informatics, Biometry and Chairs: Carola Lide´n, Sweden & Ian White, UK
Epidemiology, Erlangen, Germany
8 FS07.1
National Allergy Research Centre, Gentofte, Denmark
A survey of occupational hand eczema in
A new fragrance mix (FM II) with 6 frequently used
Denmark
chemicals was evaluated in consecutive patients
Rikke Skoet1, B Mathiesen2, J Duus Johansen3,
patch tested in 6 dermatological centres in Europe.
J Olsen4, T Agner1
28% FM II contained 5% Lyral, 1% citral, 5% 1
University of Copenhagen, Department of
farnesol, 5% coumarin, 1% citronellol and 10%
Dermatology, Gentofte Hospital, Gentofte, Denmark
alpha-hexyl cinnamic aldehyde (AHCA); in 14% 2
The Danish National Board of Industrial Injuries,
FM II the single constituents’ concentrations was
Copenhagen, Denmark
lowered to 50% and in 2.8% FM II to 10%. Each 3
National Allergy Research Centre, Gentofte, Denmark
patient was classified regarding a history of adverse 4
The Department of Epidemiology Research, Danish
reactions to fragrances: certain, probable, question-
Epidemiology Science Centre, Copenhagen, Denmark
able and none. The frequency of positive reactions to
the currently used 8% fragrance mix (FM I) and the Background: The need for prevention to reduce
new mix in 1703 patients was as follows: FM I, 6.6%; the number of occupational hand eczema is high.
2.8% FM II, 1.3%; 14% FM II, 2.9%; 28% FM II, Occupational hand eczema is the most frequently
4.1%. The number of doubtful/irritant reactions was recognised work-related disease in Denmark. Pre-
7.2% for FM I and ranged from 1.8% to 10.6% for vious findings have shown that almost half of all
FM II. cases develop a chronic condition with persistent
150 ABSTRACTS
dermatitis, and the annual cost to society is months. At the time of diagnosis, 37% of respon-
immense. dents were health care workers, 10% hairdressers,
Aims: The aim of this study was to survey the 7% food handlers, and 29% worked in hospitals,
trends and development of occupational hand 24% manufacturing, 10% hairdressing salons, and
eczema in Denmark and thereby help to ensure 7% each vehicle maintenance, food service and
future successful prevention of chronic disabling trades. 31% no longer worked for the same
occupational hand eczema. employer, however 90% of respondents were still
Methods: 758 patients with recognised occupa- employed. Those who did not claim WC lost
tional hand eczema were included prospectively less time from work than those who claimed, but
in the period October 2001- November 2002. more non-claimants still had skin problems quite
Data on diagnoses, disease duration, severity, often or constantly than did claimants. 28.6% of
absence from work and occupation was obtained non-claimants had all or some of their medical
from The Danish National Board of Industrial and/or lost time costs paid by their employer, and
Injuries and an additional questionnaire was only 18% of claimants had all of their costs paid by
administered by mail. their employer or WC insurer. Although the sample
Results: 621 patients answered the questionnaire size was small, interesting data was also obtained
(response rate 82%). Irritant contact dermatitis from the qualitative responses.
was the most frequent diagnosis and the female/
male ratio was 2:1. High prevalence was found in
particularly wet occupations. 19 per cent had sick
leave more than 5 weeks per year and the mean
disease duration was 4.8 years (median 2.1 years). FS07.3
68.2% had chronic changes.
Skin sensitisation thresholds: a legislative
Conclusion: The results showed a marked gender
perspective
difference in the pattern of diagnosis and occupa-
David Basketter
tion. The impact of occupational hand eczema is
SEAC, Unilever Colworth, Sharnbrook, Bedford, UK
still high with prolonged absence from work and
a high percentage of chronic disease. The results Current EU legislation for skin sensitisers is a
of the study give important suggestions for future simple device, which crudely distinguishes between
preventive strategies for health authorities. chemicals which possess significant sensitising
potential and those which do not. Where a chem-
ical is clearly positive in predictive tests or by
human experience, it is classified and labelled
FS07.2 R43: May cause sensitisation by skin contact. Use
of such a chemical at 1% in products would require
Occupational contact dermatitis and workers’
appropriate labelling. Additional labelling require-
compensation
ments in relation to elicitation also exist, or
Kathryn Frowen1, J Cromie2, R Nixon1
1 are planned, which variously impact cosmetics,
Skin & Cancer Foundation Inc. Vic., Australia
2 detergents and a wide range of other consumer
La Trobe University, Australia
products. Improvements to this basic system are
Statistics for occupational contact dermatitis presently under consideration and largely are
(OCD) in Australia are gathered from workers’ focused on a consideration of options to categorise
compensation (WC) data and research has indi- sensitising chemicals according to their potency.
cated that occurrence is underestimated by as Central to this activity has been the demonstration
much as 400%. This study investigated reasons of the utility of the local lymph node assay (LLNA)
which might influence decisions whether to claim as a predictor of the human potency of skin sensi-
WC or not. A questionnaire was posted to 168 tisers. Arising from this, both industry (ECETOC)
individuals diagnosed with significantly work and regulatory bodies in the EU have taken
related OCD at a specialised occupational derma- proactive steps to initiate improvement in the exist-
tology clinic, therefore fulfilling valid claim cri- ing legislation. However, at a wider regulatory
teria under the WC scheme operating in the state level, the debate currently centres on whether formal
of Victoria. 70 completed responses were ana- validation processes are required to progress potency
lysed. Ages ranged from 18–65 and only 40% categorisation at the OECD level, and if so
had claimed workers’ compensation, with those how many categories and with what threshold
under 45 y less likely to claim. Females were signifi- levels. Political niceties here represent a barrier
cantly (P < 0.05) less likely to claim, as were respon- to progressing improvements in human health
dents who had dermatitis present for less than 6 protection.
ABSTRACTS 151
and to compare two different instruments for ferences in the persistence of hand eczema were
assessment of HRQL. related to the age at onset of hand eczema, skin
Methods: 100 consecutive hand eczema patients (51 atopy, and the extension of eczema at examination.
females and 49 males) at an occupational dermatol- Contact allergy related significantly to occurrence
ogy clinic completed the generic questionnaire Short of hand eczema during the year before follow-up.
Form-36 (SF-36), and the dermatology specific 32% had visited a doctor, 7% reported sick leave
Dermatology Life Quality Index (DLQI). To compare periods, 2% sick pension and 3% change of occu-
the instruments factor analysis, with a polychoric pation due to hand eczema.
correlation matrix as input, was performed, thus Conclusions: In this population-based study, a
taking the ordinal aspect of the data into account. majority of individuals with hand eczema reported
Results: HRQL was affected by hand eczema, periods of eczema during a 15-year follow-up,
measured with both SF-36 and DLQI. The mean implying that hand eczema is a longstanding dis-
(SD) sum scores of DLQI was 7.4 (5.8), no differ- ease. Young age at onset, history of childhood
ence between genders. However, the SF-36 showed eczema and extension of the hand eczema were
more impaired HRQL for females than for males prognostic factors. Hand eczema did entail conse-
in the mental health dimension. There was a high quences like change of occupation, sick leave or
correlation between the instruments for physical pension in more than 10% during a 15-year period.
health, but lower for mental health.
Conclusions: Hand eczema has an impact on HRQL,
and both SF-36 and DLQI are suitable instruments. FS08.5
Our conclusion from the factor analysis is that the SF-
Does childhood atopic dermatitis influence the
36 measures mental health better than the DLQI. The
future working life?
choice of instrument to be used in a specific study
Miruna Nyre´n1, M Lindberg1, B Stenberg2,
depends on the purpose of the study. A generic
Å Svensson3, M Svensson1, B Meding4
instrument has the advantage of making compari- 1
Department of Occupational and Environmental
sons with other diseases possible. The SF-36 also
Dermatology,Stockholm County Council,
appears suitable for use in hand eczema studies
Karolinska Institutet, Stockholm, Sweden
where gender differences in HRQL are of interest. 2
Department of Dermatology and Venereology,
Umeå University, Umeå, Sweden
3
Department of Dermatology, Malmö University
Hospital, Malmö, Sweden
FS08.4 4
National Institute for Working Life, Stockholm,
Prognosis of hand eczema – a 15-year follow-up Sweden
Karin Wrangsjö1, B Järvholm2, B Meding3
1 Aim: To investigate the risk of adult hand eczema
Department of Occupational & Environmental
and possible influence on later working life in
Dermatology, Stockholm County Council and
persons with childhood atopic dermatitis.
Karolinska Institute, Stockholm, Sweden
2 Method: After reviewing medical records from the
Occupational Medicine, Department of Public
school healthcare in Stockholm regarding individ-
Health and Clinical Medicine, Umeå University,
uals born 1960–69, 600 individuals where signs of
Umeå, Sweden
3 atopic dermatitis were noted (‘‘cases’’) and 600
Occupational Dermatology, National Institute
matched controls without eczema or allergic disease
for Working Life, Stockholm, Sweden
(‘‘controls’’) were identified. 405 cases and 378 con-
Aims: To study long-term prognosis of hand eczema trols answered a questionnaire regarding past and
and to identify factors of importance for the prognosis. present skin disease, choice of job, exposure at work
Methods: A cohort of 1238 individuals with verified and possible change of job due to eczema.
hand eczema diagnosis was established by a popu- Results: Hand eczema was more than 3 times
lation-based prevalence study in Gothenburg, Swe- more common among cases, 42%, compared to
den, in 1982–83. In 1998 a questionnaire was controls, 13% (p < 0.001). Hand eczema during
mailed to all individuals with available addresses the past 12 months was reported by 24% of the
(n ¼ 1115). The response ratio was 78% (868/1115). cases and 9% of the controls (p < 0.001). The
Results: 66% reported periods of hand eczema proportion of individuals working in jobs
since 1983, and 44% during the past year. 12% with high-risk for hand eczema was equal
stated continuous symptoms. No significant differ- between the groups, as well as exposure to
ence was found between the sexes. 74% of those water, detergents, chemicals and hand washing.
who reported symptoms after 1983 considered that Among the cases 9% reported change of job due
their hand eczema had improved. Significant dif- to eczema compared to 2% of controls
154 ABSTRACTS
(p < 0.001) and sick leave 10% compared to 2% follow-up patients from our clinic to better study
(p < 0.001). and define this condition.
Conclusions: Childhood atopic dermatitis is a risk
factor for hand eczema. As the proportion of individ- Friday, 11 June 2004
uals in jobs with high-risk for hand eczema and the 10:45–11:15
exposure was the same in cases and controls meas-
KL04
ures preventive measures are important to reduce
consequences like sick leave and change of job. Keynote Lecture
Chair: Thomas L Diepgen, Germany
FS08.6 Dose response aspects of contact allergy
Jeanne Duus Johansen
Persistent post-occupational dermatitis: National Allergy Research Centre, Department of
a case series Dermatology, Gentofte Hospital, University of
Rosemary Nixon1, P Sajjachareonpong2, Copenhagen, Denmark
T Keegel1,3, K Frowen1
1 It has been shown by series of experiments that
Occupational Dermatology Research & Education
Centre, Melbourne, Victoria, Australia the induction of contact allergy depends on the
2 concentration of allergen per unit skin rather than
Institute of Dermatology, Bangkok, Thailand
3 the total dose delivered. This means that a high
Department of Public Health, University of
Melbourne, Melbourne, Victoria, Australia concentration of allergen delivered to a small area
of the skin comprise a higher risk of induction
Objectives: Persistent post-occupational dermatitis than if the same total amount is applied to a
(PPOD) was mentioned by Wall and Gebauer in larger skin area. Attempts have been made to
1991 to describe ongoing skin disease precipitated exploit this knowledge in risk assessment models
by occupational contact dermatitis (OCD). There for induction of contact allergy. The concentra-
has been little formal recognition or clarification of tion (dose per unit skin) applied at induction also
this condition. determines the sensitivity of the individual at elicit-
Methods: Approximately 1600 records from our ation. It also seems that smaller concentrations of
Occupational Dermatology Clinic were searched allergen are required to sensitise individuals with
to identify likely cases. PPOD was difficult to pre-existing contact allergy than those without.
diagnose as relatively few patients had been Once a person is sensitised to a substance, the
reviewed after initial assessment. sensitivity of the individual in combination with
Results: A number of patients with reasonably the level of exposure to the allergen, determines
clear histories of persistent occupational contact whether clinical symptoms will occur. These dose-
dermatitis were identified, which followed either response relationships can be studied in sensitised
irritant or allergic occupational contact dermatitis. individuals by re-application of a serial dilution of
These included a 57 yr old male who worked the relevant allergen either under patch test condi-
with photographic chemicals, a 51 yr old female tions or by repeated open applications. Thresholds
food handler and a 25 yr old female food handler for no-response or minimum effect levels may be
who were all diagnosed with irritant contact derma- determined for different allergens and used system-
titis and yet experienced persistent dermatitis even atically for preventive purposes. Practical exam-
after avoiding the irritants that were associated with ples of such successful prevention exist regarding
causing their dermatitis. A 51 yr old process worker nickel and chromium allergy, providing both pri-
allergic to acrylates, a 28 yr old laboratory worker mary and secondary preventive effects. Further
allergic to rubber accelerators and coconut dietha- understanding of the dose- response relationships
nolamide in her hand wash and a 48 yr old epoxy is important in diagnosing contact allergy and
applicator allergic to epoxy resins experienced advising the patient relevantly.
recurrent dermatitis for years after avoiding their
causative allergens, although with gradual decrease
in the frequency of outbreaks of dermatitis. Unfor- Friday, 11 June 2004
tunately, many patients experienced difficulties with 11:20–12:45
workers’ compensation because the persistence of FS09
their dermatitis was thought by some medical
examiners negate its work-relatedness. Medicament allergy/drug eruptions
Conclusion: There needs to be greater recognition Chairs: Derk P Bruynzeel, The Netherlands & Åke
and understanding of PPOD. We are planning to Svensson, Sweden
ABSTRACTS 155
patch test with capsaicin was positive (þþ) Standardisation results: Perform stripping at one
at 48/96 hours and the excipient components upper part of the back until the surface becomes
at the appropiate concentrations were all negative. glistening: gently press a 25 mm diameter adhe-
Patch test biopsy showed an eczematous pattern. sive tape downward vertically for about 2 seconds
Twenty controls showed negative results. This and then remove it in one quick movement at
case is probably an allergic reaction but shows the angle in direction of adherence; continue
how still remains difficult to distinguish among stripping with a new tape cut on exactly the
allergic and irritative cutaneous reactions. same skin area. Multiply number of strips by
the correction factor (cf ¼ a/A ¼ 11/26 ¼ 0.4).
Perform calculated number of strips likewise on
FS09.7 the contralateral site and then apply there the test
preparation for 24 hours.
Standardisation of the ‘‘strip’’ patch test: a
Conclusions: If clinically an allergic contact
multicentre study
dermatitis is expected but PT is negative, the
Heinrich Dickel1, J Brasch2, T Bruckner3,
SPT might reveal the potential allergen.
S Erdmann4, J Fluhr5, P Frosch6, J Grabbe7,
H Löffler8, HF Merk4, C Pirker6, H Schwanitz1,
E Weisshaar3; for the German Contact Dermatitis
FS09.8
Research Group (DKG)
1
University of Osnabrück, Department of Drug-induced Baboon syndrome: SDRIFE at
Dermatology, Osnabrück, Germany strife with systemic contact dermatitis?
2
University of Kiel, Department of Dermatology, Andreas Bircher, P Häusermann, T Harr,
Kiel, Germany M Lerch
3
University Hospital of Heidelberg, Department of Allergy Unit, Department of Dermatology,
Social Medicine, Heidelberg, Germany University Hospital Basel, Basel, Switzerland
4
University Hospital of Aachen, Department of
The term baboon syndrome was introduced 20
Dermatology, Aachen, Germany
5 years ago. It was proposed for a particular erup-
University of Jena, Department of Dermatology,
tion mimicking the red gluteal area of the baboon
Jena, Germany
6 after systemic exposure either to the contact aller-
University of Witten/Herdecke, Department of
gens nickel and mercury or to oral ampicillin.
Dermatology, Dortmund, Germany
7 Previously this phenomen was e.g. termed flex-
Medical University of Lübeck, Department of
ural exanthema to mercury. Since then similar
Dermatology, Lübeck, Germany
8 incidences have been reported after systemic
University of Marburg, Department of
exposure to betalactam antibiotics and other
Dermatology, Marburg, Germany
drugs, sometimes under different terms. Clinically
Objectives: The strip patch test (SPT), proposed sharp demarcation of a V-shaped erythema is
by Spier and Sixt (Hautarzt 1955;6:152–9), is a present in inguinal/genital and gluteal/perianal
modification of the patch test (PT). This tech- areas. Additionally papules, vesicles and hemor-
nique is used to enhance penetration through the rhagic lesion may be found. In most patients pres-
stratum corneum for poorly penetrating sub- ence of exanthema in other anatomical flexural
stances such as medicaments. So far, a standard- regions (axilla, elbow, knee, ventral neck) has
ised procedure is lacking. This multicentre study been identified. However, involvement of the
aims at standardising the SPT procedure. plantar/palmar regions, face and mucosal sites
Methods: A total of 83 healthy volunteers par- has not been documented. Typically blood tests are
ticipated. In each subject, we determined the num- normal and systemic symptoms are absent. Histolo-
ber of strips (A) until the surface became gical results vary but a predominance of superficial
glistening and then calculated the median number perivascular infiltrate with mononuclear cells has
of strips in the sample (A ¼ 26). We ascertained been reported. Occasional positive patch tests or
the median number of strips in the sample stimulation of lymphocytes in the LTT may be
a ¼ 11) that was necessary to achieve a first sta-
( suggestive for a type IV allergic reaction. Since the
tistically significant and medically relevant drug-related baboon syndrome shows clinically and
increase of the TEWL revealing a critical stratum histologically different findings to systemic contact
corneum strip depth. For the finally calculated dermatitis and acute generalized exanthematous
number of strips for each subject (a/A ¼ (a/ pustulosis (AGEP), it should be seen as a separate
),a ¼ A (
A )), the actual increase in test
a/A entity. The mainstay for the diagnosis of systemic
sensitivity was substantiated employing SLS contact dermatitis requires contact sensitization and
0.125% aqueous. elicitation by a contact allergen. In contrast in the
158 ABSTRACTS
baboon syndrome and AGEP history for sensi- (III) a patch test study in five centres of the German
tization is often negative, although sometimes posi- Contact Dermatitis Research Group (DKG) with
tive patch and LTT results can be found. AGEP, on components of MWF not routinely tested,
the other hand, requires a distinct score including and (IV) information from the interdisciplinary
systemic signs and leucocytosis. In all three symp- task force on allergy diagnostics in the metal
toms typically occur within 1 to 2 days. The term branch. Potential allergens are found in various
baboon syndrome does not reflect the whole range MWF components, mainly in emulsifiers, rust
of symptoms and signs. And, although it is easily preventing agents, preservatives, and anti-wear-
remembered, the comparison to an animal may additives. Various special additives also
be insulting. Therefore, we suggest that drug- may contain potential allergens. Currently, the
induced baboon syndrome should be separated most important MWF allergens are: – oxidation
from the contact allergen-induced form, and products from resin acids, e.g. abietic acid, in
should be recognized as a separate entity within distilled tall oil, a frequently used base material
the spectrum of drug eruptions. For this reason of MWF. Contact allergy to these is detected by
we propose the acronym SDRIFE (symmetrical patch testing with colophony. – monoethanol-
drug related intertriginous flexural exanthema). amine, diglycolamine – used as rust preventing
This refers to the distinctive clinical pattern of agents and emulsifiers. – formaldehyde and var-
this drug eruption without implicating any ious formaldehyde releasers, mainly oxazolidine
pathomechanism, which has not been clearly derivatives – used as biocides. Other biocides,
elucidated. The following criteria are proposed: e.g. Methylchloroisothiazolinone/Methylisothiazoli-
1) Exposure to a systemically administered drug, none (MCI/MI), Benzisothiazolinone (BIT) or
2) Sharply demarcated erythema of the gluteal/ Iodopropynyl butylcarbamate (IPBC) are also
perianal area and/or V-shaped erythema of the used in MWF and should hence be tested routin-
inguinal/perigenital area, 3) Involvement of at least ely. While odour masks for MWF are available,
one other intertriginous/flexural fold, 4) Bilaterally little is known about the extent of their usage.
or symmetrically affected areas, and 5) Absence of However, this allergen source should be considered
systemic symptoms and signs. in cases of fragrance allergy. Cobalt apparently is
a relevant MWF allergen only in carbid metal
processing.
few weeks, 4 out of 12 workers got itchy eczema- rently subscribers.The use of the service has
tous lesions at the face, lower arms and hands. All increased steadily over the years. In average, the
of them reported on a work-relationship with dermatologists order 6–7 allergens for each
recoveries during holidays and sick-leaves. This patient. The dermatologists use pattern of the
prompted the responsible occupational physician bank service varies considerably, probably
to contact our occupational dermatological clinic reflecting what they have available in their clinic
for further examination. First, we got an overview of extra allergens beyond the standard series, as
of the chemicals and pathways used for the pro- well as their patient selection and interest in con-
duction of the highly specialized plastic products. tact dermatitis. Based on the test results reported
After working place examination, extended medical back from the dermatologists to the Allergen
histories of the employees were taken. All Bank a total of 197 positive reactions from 107
affected workers were patch tested with the Eur- different contact allergens were found in 2002.
opean Standard series, epoxy resins, preserva- This is a yield of approximately 7% positive
tives and own working materials. After an patch tests related to the number of allergens
occlusion time of 48 hours, skin tests were read ordered. The pro’s and con’s of the Allergen
at day 2 and 4 according to the ICDRG guide- Bank function will be reviewed.
lines. Examination of the plant revealed that all
affected workers were employed at the blending
unit where, in particular dusty, ingredients were FS10.7
mixed. Few months prior to the development of
A surveillance network for occupational contact
skin problems, 2-n-octyl-4-isothiazolin-3-one
dermatitis utilizing general practitioners
(OIT) preservative had been introduced in the
Rosemary Nixon1, T Keegel1,2, A Noonan1,
production pathway in partial exchange for
H Saunders1, K Frowen1
chloro/methylisothiazolin-3-one (CIT/MIT). 1
Occupational Dermatology Research and
Personal protection measures were rarely pro-
education Centre, Skin and Cancer Foundation,
vided.
Melbourne, Victoria, Australia
All 4 tested workers were found patch test 2
Department of Public Health, University of
positive to CIT/MIT, 3/3 positive to OIT and 1/3
Melbourne, Melbourne, Victoria, Australia
positive to 1,2-benzisothiazoloin-3-one (BIT) and
methyldibromoglutaronitril. Industrial usage of Objectives: The Surveillance by General Practi-
preservatives can result in frequent sensitisation tioners of Occupational Contact Dermatitis Pro-
of exposed employees. Adequate protection and ject (Spot) has been designed to provide disease
prevention advices are required. This study high- estimates for occupational contact dermatitis
lights the need for extended (occupational) medical within a defined geographic area in Melbourne,
histories and working place examination to iden- Australia.
tify individual risk factors and to trace potential Method: Spot collected reports of occupational
hazards at the working place. contact dermatitis from four separate sources:
general practitioners, dermatologists, a Derma-
tology Outpatient clinic, and an Occupational
FS10.6 Dermatology Clinic. Case definition was strati-
fied into two levels, suspected and confirmed.
10 years experience with the Allergen Bank
All cases of suspected occupational contact
Klaus Ejner Andersen
dermatitis reported to Spot were assessed and
Department of Dermatology, Odense University
required to undergo diagnostic confirmation,
Hospital, Odense, Denmark
including appropriate patch testing by an occupa-
The Allergen Bank supplies dermatologists on tional dermatologist. The rates generated by Spot
request with special contact allergens for aimed were compared to the rates generated by Victor-
patch testing of suspected contact dermatitis ian workers’ compensation data (Victorian Work
patients. Easy access to patch test materials Cover Authority) for ‘‘Contact dermatitis and
beyond the standard patch test series makes it other and unspecified dermatitis.’’
possible for the dermatologists to make an early Results: To date, a total of 125 suspected cases
diagnosis of special cases of allergic contact derma- have been reported to Spot. 56 cases of occupa-
titis. The Allergen Bank was established in 1992, tional contact dermatitis have been confirmed
and the concept described in Acta Derm Vener- with an incidence rate of 12.5 per 100,000 full-
eol 1996; 76: 136–140. The Allergen Bank service time workers and a prevalence rate of 28 per
is financed through an annual subscription fee, 100,000. This can be compared to the rate from
and about 60 Danish dermatologists are cur- Victorian WorkCover Authority of 4 per 100,000
ABSTRACTS 161
(with information not available for incidence or already there are some pointers that OCD can
prevalence). be prevented effectively.
Conclusions: Although limited by resources,
clinician and worker participation rates, Spot
provides a better estimate for occupational Friday, 11 June 2004
contact dermatitis in an Australian urban setting 13:45–14:15
than that currently available through workers’ KL05
compensation statistics. The information gener-
ated by Spot will provide an important contribu- Keynote Lecture
tion towards the characterisation of occupational Chair: Halvor Möller, Sweden
contact dermatitis in Australia. The value of skin testing in the study of drug
eruptions
Margarida Gonçalo,
Portugal
FS10.8
Abstract not available at the time of printing.
Prevention of occupational contact dermatitis
Thomas L Diepgen
University of Heidelberg, Department of Clinical Friday, 11 June 2004
Social Medicine, Heidelberg, Germany 14:20–15:30
Conclusion: Our study shows that the incidence of patch tested in the patient and 20 controls. Calo-
primula contact dermatitis is falling. The overall trend cephalin was isolated from the plant extract of
is moving towards primin-free varieties provided they cushion bush by column chromatography and pre-
continue to be horticulturally viable long term. parative high-performance liquid chromatography
(HPLC) and identified by mass spectrometry and
FS11.2 nuclear magnetic resonance (NMR) spectroscopy.
Results: The patient was negative to the standard
Contact allergy to herbal teas from Asteraceae
series but positive to parthenolide and to the cush-
plants
ion bush extract. Likewise, positive reactions to
Kerstin Mårtensson1, M Hindse´n1, B Gruvberger1,
cushion bush extracts were seen in SL-mix positive
H Möller1, Å Svensson2, M Bruze1
1 but not in negative patients. Parthenolide was not
Department of Occupational and Environmental
present in the plant extract as shown by gas chro-
Dermatology, Malmö University Hospital,
matography-mass spectrometry (GC-MS) analysis,
Malmö, Sweden
2 while the guaianolide calocephalin was identified as
Department of Dermatology, Malmö University
the major SL. The patient tested positively to calo-
Hospital, Malmö, Sweden
cephalin while the controls tested negatively.
Objective: A possible contact allergy to herbal Conclusion: The plant cushion bush can cause
teas, in particular those derived from the occupational allergic contact dermatitis and the
Asteraceae plant family, was investigated in major contact sensitizer in the plant is the SL
patients allergic to sesquiterpene lactones (SL). calocephalin.
Method: Twenty patients with a contact allergy to
SL were recalled and patch-tested with aqueous,
ethanol and acetone extracts of 8 different herbal
teas based on Asteraceae plants as well as with
parthenolide and other SL.
Results: In 18/20 patients with SL allergy there
were positive test reactions to the Asteraceae teas,
mainly to those based on German chamomile,
dandelion and milfoil. Among the SL, partheno-
lide was the most frequent co-reactor.
Conclusion: Most patients with a contact allergy
to SL are allergic to commercial teas derived from
the Asteraceae plant family as well.
FS11.3 FS11.4
Contact allergy to the sesquiterpene lactone Garlic-fingered chefs – a study of contact
calocephalin dermatitis to garlic in curry chefs
Monica Hindse´n1, LP Christensen2, E Paulsen3 Viginia Hubbard, P Goldsmith
1
Department of Occupational and Environmental Barts and The Royal London NHS Trust,
Dermatology, Malmö University Department of Dermatology, London, UK
2
Hospital, Malmö, Sweden
3 Allergic contact dermatitis to garlic is described in
Department of Food Science, Danish Institute of
caterers and can be an important occupational
Agricultural Sciences, Research Centre Aarslev,
hazard.
Aarslev, Denmark
4 Our department serves an area with a large
Department of Dermatology, Odense University
Bengali population. We noted a relatively high
Hospital, Odense, Denmark
number of curry chefs and housewives have
Background: A 63-year old female gardener hand dermatitis. We wanted to see whether garlic
developed eczema on her hands, arms and face. was an important sensitiser in this group.
She suspected cushion bush, Calocephalus We use diallyl disulphide to test for garlic sen-
brownii F. Muell., a plant introduced in Sweden sitisation. We reviewed the notes of all patients
by her. This plant belongs to the Asteraceae family. who had been patch tested to this over a 12
Methods: Patch testing with our standard series, month period. We recruited further curry chefs
plant series and acetone extract of cushion bush. by visiting local restaurants. We also asked
The predominating sesquiterpene lactone (SL) local GPs to refer suitable patients for patch
calocephalin identified in the plant extract was testing.
ABSTRACTS 163
We identified 26 patients who were patch tested Wales was referred to the Contact Dermatitis Inves-
to diallyl disulphide. Of this group, 13 were curry tigation Unit because during the summer months
chefs and 11 housewives. 4 patients were found to for the previous four years she had experienced an
have an allergic reaction to diallyl disulphide – all intermittent, intensely pruritic, vesicular and in
were chefs. All had presented with dermatitis of parts linear eruption affecting her face, arms and
the non-dominant hand. 1 was atopic. legs. This responded slowly to potent topical corti-
Advice was given on avoidance of contact costeroids. She is a keen gardener and suspected
with garlic and onion (a cross-reactant). Unfor- that it was related to a plant in her garden. She
tunately this proved difficult in practice. 1 patient was patch tested to our Standard Series, Plant
required acitretin with a good result. 1 patient Series and all the plants in her garden. She showed
responded well to hand PUVA. þþ allergic reactions to sodium metabisulphite,
Previous studies have shown a high incidence propolis and a strong vesicular reaction to the leaf
of occupational garlic dermatitis but some of of one of the plants from her garden Inspection of
these have tested with garlic plant or extract the plant revealed that it had three leaflets per stem.
which can be a powerful irritant and produce She had taken a cutting whilst visiting friends in
misleading Results: Diallyl disulphide, allylpropyl Pennsylvania in 1996 and on returning to the UK
disulphide and allicin have been identified as the had planted it in her garden. It grew but had never
allergens in garlic. Diallyl disulphide is considered flowered or produced seeds. Once the cause of her
the main allergen. This study shows the import- dermatitis had been confirmed our patient took the
ance of testing for garlic allergy in caterers. necessary protective measures and removed the
plant including its roots from her garden. She has
not experienced any further problems with her skin.
FS11.5 She contacted her friends in the USA who knew
precisely where she had picked the plant. A further
Toxicodendron dermatitis in the United Kingdom
specimen was taken to the local Conservation
Stephen Walker1 J Williams1, J Lear1,2, M Beck1
1 Office where it was confirmed to be poisonivy.
Contact Dermatitis Investigation Unit,
Poison ivy and poison sumac belong to the genus
Manchester, UK
2 Toxicodendron which is native to North America
Department of Dermatology, Manchester Royal
and Mexico. They cause an allergic contact derma-
Infirmary, Manchester, UK
titis when there is exposure to a bruised portion of
We describe two cases of Toxicodendron dermati- the plant. This leads to the oleoresin, urushiol com-
tis, one acquired in the United States but presenting ing into contact with the skin. 25–60% of North
in the United Kingdom, the other a recurrent der- Americans are reported be allergic to poison ivy
matitis following importation to the UK. Poison and its relatives. The importation of plants into
ivy, poison oak and poison sumac are native to the UK is restricted by law. It is clear that this
North America and belong to the genus Toxicoden- plant grew in its new habitat but did not extend
dron. This group of plants is of interest to the beyond the confines of the garden. With frequent
dermatologist because they contain a mixture of and more extensive air travel it seems reasonable
potent sensitisers which cause a severe allergic con- to speculate that similar occurrences have taken
tact dermatitis. The dermatitis can present to the place and that plants not endemic to Europe
dermatologist in Europe after an individual has should be considered in those with suspected plant
been in contact with the plant whilst visiting an dermatitis.
endemic area. The plants have the potential to
grow in the UK and it is therefore possible for an
individual to be sensitised and subsequently to FS11.6
develop the rash without leaving the UK. A 35-
Contact dermatitis to Iris in a florist
year-old American man who lived in the UK visited
Yves Dejobert1, L Arzur2, A S Thellart2,
his family in Marietta, Georgia USA. Shortly
P Martin1, M Torck3, P Frimat2, F Piette1,
before his return to the UK he cut some plants
P Thomas1
back in his mother’s garden. Two days following 1
Service de Dermatologie CHRU, Lille, France
his arrival back in the UK he developed a wide- 2
Institut de Me´decine du Travail CHRU, Lille,
spread pruritic and painful vesicobullous eruption.
France
He required admission for intensive potent topical 3
Pharmacie Centrale CHRU, Lille, France
corticosteroid therapy and the eruption settled over
the next two weeks. The plant he had been pruning Objective: To detect a possible allergen in a florist
was subsequently identified as poison sumac (Tox- with occupational dermatitis. Patient and meth-
icodendron vernix). A 54-year-old woman living in ods: a 27-year-old atopic female working in a
164 ABSTRACTS
greenhouse since 10 years presented with a 3 these are potential allergens. Contact allergy
months history of severe eczema involving to plastic gloves is rare. The allergen responsi-
hands, face, eyelids and neck requiring a stop of ble for the sensitization usually remains
the work. Tests were performed with European unknown. An organic pigment, Irgalite Orange
standard series (Trolab1), additional series, plant F2G, and bisphenol A have both caused con-
series, (Chemotechnique Diagnostics1) and flow- tact allergy from household-type PVC gloves. 1
ers. Readings were performed at D2 and D3 patient with allergic contact dermatitis from his
according ICDRG criteria. Results: positive PVC gloves reacted also to tricresyl phosphate
patch tests were parabens þ/þ nickel sulphate and triphenyl phosphate, chemicals known to
þþ/þþ cobalt chloride /þþ palladium chloride be used as plasticizers in PVC. A plasticizer,
þþ/þþ thiomersal þþ/þþ, Iris petal þþ/þ. di(2-ethylhexyl) phthalate (DOP), caused 1 case
Then various colours of Iris were tested and pale of contact urticaria from the vinyl chloride slip
blue, yellow and white petals were positive þþ/ guard of cotton gloves. 1 patient with
þþ but purple blue petal was negative. The prox- contact urticaria from his polyethylene gloves
imal yellow part of purple blue petal and orange reacted to 3 antioxidants, octadecanoic acid
part of yellow petal were also positive þþ/þþ. methyl ester and di-tertiary butyl phenol of
The leaf and pistil of Iris were negative. One con- the gloves on scratch testing. We report 3 add-
trol with a white Iris petal was negative. Then the itional cases of allergic contact dermatitis from
patient presented flare up of her dermatitis in the PVC gloves due to bisphenol A. 2 of the patients
presence of Iris, at home, without handling them, reacted also to para-tertiary butyl catechol, a
that could make suspect an airborne contact der- polymerization inhibitor in PVC. In chemical
matitis. Even after examination by a botanist, the analysis, the connection between sensitization to
precise identificaton of these Iris was not possible. para-tertiary butyl catechol and the use of vinyl
Positive patch tests to unspecified Iris (petal and gloves could not be proven. We analysed 16
leaf) have already been reported in a florist who brands of disposable PVC gloves for medical
was allergic to safflower (Van der Willigen A.H. use, covering at least 80% of the Finnish
and al, Contact Dermatitis, 1987, 17,184). Conclu- market. We found a very small amount of
sion: this case could evoke the responsibility of bisphenol A in 1 brand, and no para-tertiary
anthocyans, which play a role in the colours, but butyl catechol in any of the gloves. However,
essential oils or other components are also possible bisphenol A should be remembered as a possible
responsibles. allergen in PVC gloves.
FS12.2
Friday, 11 June 2004
14:20–15:30 Occupational allergic contact dermatitis from
UV-cured adhesive
FS12
Stefano Francalanci1, S Giorgini1, M Gola1,
Plastics and rubber S Sestini2, S Moretti3
1
Chairs: Kristiina Alanko, Finland & James S Taylor, Unit of Allergological Dermatology, Florence,
USA Italy
2
I Dermatological Clinic, Florence, Italy
FS12.1 3
II Dermatological Clinic, Florence, Italy
Allergic contact dermatitis from plastic
A 35-year-old woman presented with a 8-month
gloves
1 1 history of scaling, hyperkeratotic and fissured
Kristiina Aalto-Korte , K Alanko ,
lesions of the fingertips of the first three fingers
ML Henriks-Eckerman2, T Estlander1, R Jolanki1
1 of both the hands. She referred the healing of the
Finnish Institute of Occupational Health,
dermatitis during the summer holidays. She was
Helsinki, Finland
2 employed in a small firm where she was used to
Turku Regional Institute of Occupational Health,
glue together silver components with glass ones of
Turku, Finland
decorative pieces. For this aim, she applied a glue
Plastic gloves are made of polymers including (Loxeal UV 30–20) cured by exposition to UV
polyvinylchloride, polyvinylalcohol, polyethyl- light coming from a proper lamp. The material
ene and polyvinylacetate. Additives such as safety data sheet (MSDS) indicated that the glue
plasticizers, stabilizers, UV light absorbers, contained hydroxyethyl methacrylate (HEMA)
fungicides, bactericides, flame retardants and and hydroxypropyl methacrylate (HPMA).
colourants are added to the polymer, and Patch tests performed with the standard SIDAPA
ABSTRACTS 165
series gave negative results; patch tests carried out in fibreglass materials, in binders e.g. brakes,
with an additional one (acrylic adhesive series) foundry sand, and from adhesives.
showed positive reactions towards glue compon- Conclusions: Patients should be investigated for
ents (HEMA,HPMA) and towards other acryl- contact allergy by patch testing them with their own
ates (possible cross-reacting). An inspection resins. PFR-2 identified by M. Bruze was the best
performed in the work-place showed that the commercially available allergen to screen for contact
patient was in contact with the glue not only allergy. Concomitant allergy to formaldehyde and
when she applied it on the components, but PTBP formaldehyde resin is rare. The possibility of
particularly when she handled the bottle cap allergy to reactive diluents should be considered in
(splashed with the glue) in its opening and clos- those exposed to epoxy novolac systems.
ing. After the changing of her occupation, the
patient has not presented relapse of the derma-
titis. The UV-cured acrylic resins are known for FS12.4
some time to be a frequent cause of occupational
An analytical method for p-tert-butylphenol-
allergic contact dermatitis in dentists and in print-
formaldehyde resin
ing industry. The case reported shows a different
Erik Zimerson
exposition source towards these resins, i.e. from
Department of Occupational and Environmental
UV-cured acrylate adhesive employed for sticking
Dermatology, University Hospital, Malmö,
metal pieces with glass ones.
Sweden
p-tert-Butylphenol-formaldehyde resin (PTBP-F-R)
is frequently reported to give positive patch test
FS12.3 reactions with uncertain clinical relevance. A
possible explanation is deficient knowledge of
Occupational contact dermatitis to phenol
the sources of exposure. An analytical method for
formaldehyde resins
PTBP-F-R could be used to investigate products
Michael H Beck
in the patient’s environment. Most individual
Contact Dermatitis Investigation Unit, University
PTBP-F-R substance constitute less than 1% w/w
Department of Dermatology, Dermatology Centre,
of the resin contributing to analytical difficulties.
Hope Hospital, Manchester, UK
Objective: To develop an analytical method for
Phenol formaldehyde resins were the first syn- PTBP-F-R and to use it to investigate some
thetic plastics to be used commercially, being patients’ products.
patented as Bakelite in 1907.There are two main Methods: 10 identified PTBP-F-R substances in
types of phenol formaldehyde resin [PFR], resols silylated form were used as reference substances
[phenol reacted with excess formaldehyde in alka- in gas chromatography-mass spectrometry
line conditions] and novolacs [formaldehyde (GC-MS) analysis.
reacting with excess phenol in acid conditions]. Results: The recording of ion chromatograms for
Novolac resins may require cross-linking agents the 3 largest mass peaks in the MS for each refer-
to cure them but resol can be hardened by heat ence substance was used to avoid interference of
alone. Usually sensitisation occurs when the disturbing substances. Demonstration of a PTBP-
resins are handled in partially condensed form. F-R substance was defined as the simultaneous
Modifications and additives to these resin systems detection the 3 defined mass peaks at the expected
increase the range of potential allergens. PFRs retention time and with the same relative intensities
have electrical resistance and binding properties as found with the corresponding reference sub-
resulting in their widespread use in electrical stance. A minimum criterion for the demonstration
appliances, glues, laminated floorboards, ply- of PTBP-F-R was the demonstration of 3 PTBP-F-
wood, fibreglass including insulation, brake lin- R substances. PRBP-F-R was demonstrated in
ings, clutch facings, grinding wheels, foundry watchstraps, shoes, glues and ECG-electrodes.
sand moulds, abrasive cloths and papers, plastic p-tert-Butylcatechol, a PTBP-F-R substance but also
moulds, telephones and steering wheels. an antioxidant, was demonstrated in: an ECG-
Study aim: To analyse retrospectively the causes, electrode, watchstraps, a prosthesis, a protective
occupations and investigations of patients mask, a glue, an oil for bikes and in a nail polish.
demonstrated to have dermatitis from occupa- Conclusion: An analytical method for PTBP-F-R
tional contact with PFRs. was developed, which when applied to products
Summary of Results: 27 dermatitis cases were could show the presence of PTBP-F-R substances
identified (4 irritant and 23 allergic). The com- and PTBP-F-R in products and indicate contact
monest causes were from contact with PFR used of clinical relevance.
166 ABSTRACTS
Objectives: To evaluate the characteristics and number of weeks per year years of work in
outcome of staff attending this clinic and to assess the pool. 85 of the subjects (45%) reported on the
patient satisfaction. development of skin disease for the first time after
Methods: A retrospective case note survey was starting work at the swimming pool. 21 (11.8%)
performed from staff attending the clinic from had a preexisting skin disease. The most frequent
1999 to 2002. A questionnaire was sent to them symptoms included pruritus, burning, stinging,
>3 months following consultation. erythematous patches and xerotic skin on the
Results: A total of 116 patients were identified (12 extremities, trunk and folds. A statistically signifi-
male, 104 female), and 85 (73%) were nurses. 77 cant relationship between the cumulative working
(66%) patients were referred with hand eczema time and the incidence of dermatological pathol-
(HE). Of the 45 patients referred with adverse ogy compatible with contact dermatitis was found.
reactions or exacerbation of hand dermatitis fol- Conclusions: The incidence of self reported skin
lowing the use of latex gloves, only 4 had positive diseases, developing for the first time or due to
prick tests and were considered to have NRL exacerbation of preexisting dermatological condi-
allergy. Patients with significant HE or occupa- tions, in hydrotherapists working in swimming
tional exacerbation of HE were referred for pools is high. Statistically significant relationship
patch testing (n ¼ 36). Of the remainder, most between the cumulative hours of immersion in the
could be discharged after a single visit. 49/95 pool and the incidence of the dermatological
(52%) questionnaires were returned, 34/45 pathology was observed suggesting a dose
(76%) patients found the consultation useful. response relationship between exposure and
As a separate study, the data recorded within effect.
the patch test clinic looking at health care work-
ers (HCW) referred both from this clinic and
from other sources was analysed. This showed FC03.3
relevant positive patch tests in 16/49 (33%)
Identification of subjects with atopic dermatitis
patients. In 55/99 (56%), an occupational cause
in questionnaire studies
was likely.
Karen Frydendall Jepsen, M-A Flyvholm,
Conclusion: Occupational skin disease in HCW
K Mygind
is common, attendance at the clinic was bene-
National Institute of Occupational Health,
ficial and a single visit was sufficient in most
Copenhagen, Denmark
cases.
The performances of three different questions
from The Nordic Occupational Skin Question-
naire (NOSQ-2002) were compared with respect
FC03.2 to their ability to identify subjects with atopic
dermatitis. NOSQ-2002 was used in an interven-
Cumulative incidence of self reported skin
tion study on the prevention of work related skin
disease in hydrotherapists working in
diseases among gut cleaners. The questions were:
swimming pools
‘‘Have you ever had an itchy rash that has been
Aneta Lazarov1, K Navo2, A Pardo2, P Froom
1 coming and going for at least 6 months, and at
Contact Dermatitis Clinic, Meir Hospital, Kfar
sometime has affected skin creases?’’ (A1), ‘‘Have
Saba, Sackler Faculty of Medicine, Tel Aviv,
you ever had eczema on the fronts of the elbow or
Israel
2 behind the knees?’’ (S5a), and ‘‘Have you ever
National Institute of Occupational and
had ‘‘childhood’’ eczema?’’ (S5b). Question A1
Environmental Health, Israel
is the single UK-working party question on ato-
Objective: To assess the cumulative incidence and pic dermatitis; questions S5a & S5b are national
characteristics of self reported skin disease in atopic dermatitis questions previously used in
hydrotherapists. different Nordic studies. A total of 255 of 622
Methods: Hydrotherapists, who had completed a (41%) gut cleaners answered ‘‘yes’’ to question
hydrotherapy training course answered a ques- A1. Questions S5a and S5b gave rise to 14%
tionnaire in reference to newly appeared skin dis- and 5% positive answers, respectively. The high
ease. Data were analyzed statistically. frequency of positive answers to question A1
Results: 190 subjects presently working as hydro- could be due to the occupational exposure of
therapists were studied. Of them 75.8% were gut cleaners. Their working environment is wet
female and 24.2% were male. 80% of the hydro- and often involves both forearms and hands,
therapists worked up to 10 000 cumulative hours hence often leading to eczema of elbow creases.
defined by the formula: working hours per weeks In conclusion, compared to other Danish studies
168 ABSTRACTS
the UK question seems to lead to over-reporting. 53 randomly chosen nurses were observed during
Question S5a seems to give a reliable frequency of their morning shift. Hand skin exposure to water,
atopic dermatitis in adult populations at risk for soap/detergents and occlusion by using gloves were
work-related skin diseases. recorded during 112 different 8-hour morning shifts.
Results: In nursing wet work activities make up 9%
(dialysis ward), 16% (regular ward) and 24%
FC03.4 (I.C.-unit) of the duration of one shift. On a regular
ward duration of wet work is mainly divided into
Eczema, skin symptoms and risk factors among
34% patient washing, 31% glove use and 26%
hospital employees
hand washing. These main wet work activities
Bodil Bach1, M-A Flyvholm2, E Villadsen2
1 have a short exposure cycle of 1.4–3.6 minutes.
Department of Occupational and Environmental
Hand washing, excluding the use of hand alcohol,
Medicine, Nykøbing Falster Hospital, Nykøbing
and patient washing (without gloves) form both one
Falster, Denmark
2 third of the frequency of wet work activities.
National Institute of Occupational Health,
Conclusions: Wet work activities take up a sub-
Copenhagen, Denmark
stantial portion of nursing activities and are char-
Hospital employees and especially nurses have a acterised by frequent short-term exposures.
high frequency of work-related skin diseases. The Effective prevention programs on reducing the
purpose of the present study was to collect baseline risk of hand dermatitis in nursing should primarily
data in order to plan an intervention project with focus on the high frequencies of hand washing and
focus on skin problems among different hospital job patient washing. Using gloves in the procedure of
groups reporting high frequencies of work related patient washing will reduce the frequency of expos-
skin problems or eczema. Self-administered ques- ure to water and soap with 24%, at the expense of
tionnaires based on a standardized questionnaire increasing exposure to occlusion by these gloves.
for work-related skin diseases and exposure
(NOSQ-2002) were used. A total of about 1.900
employees from all job groups at the hospital
where invited to participate. Due to anonymous FC03.6
distribution of the questionnaires it was not possible
Exposure of the hands to wet work in nurses
to administer reminders. The overall response rate
Frank Jungbauer, G Lensen, PJ Coenraads
was 65%. Among the 1.246 respondents the fre-
Academic Hospital Groningen, Department of
quency of self-reported eczema within the last year
Dermatology, Groningen, The Netherlands
varied between different departments from 7% to
44%. Assessed by job group the eczema frequency Background/objectives: Prevention of hand derma-
varied from 8% to 31%, with the highest frequency titis among nurses can be achieved by reduction
found among nurses and assistant nurses. of wet work exposure. Kwodledge about the
amout of wet work in nursing is import imple-
menting hand dermatitis prevention plans. Wet
work exposure in nursing can be assessed by
FC03.5 questionnaire or observation.
Method: Duration and frequency of wet work
Characteristics of wet work in nurses
activities were assessed by a questionnaire in a
Frank Jungbauer, F Steenstra, PJ Coenraads
population of 1471 nurses.In addition a randomly
Academic Hospital Groningen, Department of
chosen sample of 53 nurses from this population
Dermatology, Groningen, The Netherlands
was observed on duration and frequency of wet
Background/objectives: The health care sector is work during 112 different morning shifts.
known for its high prevalence of hand dermatitis, Results: questionnaire: wet work between 26 minutes
mainly because of the high exposure to wet work in (at a dialysis ward) and 100 minutes (in nursing
nursing activities. Wet work can be activities with homes). For frequency a range between 12 and 21
wet skin and activities with glove use (skin occlu- episodes of wet hands during morning shifts was
sion). A prevention program to reduce wet work reported. In nursing homes and regular wards gloves
exposure should be based on knowledge about were reported to be used less than once during a shift.
activities that are components of wet work. We Observation: A duration of wet work of 10
observed the frequency and duration of skin expos- minutes (dialysis ward), 28 minutes (regular
ures to irritants with nursing activities. ward) and 19 minutes (I.C.-unit) and 45 minutes
Method: Duration and frequency wet work activ- in a nursing home. Frequency: between 19 and 43
ities were assessed in parts of the health care sector: episodes of wet hands during morning shifts.
ABSTRACTS 169
3
Institute of Hygiene and Environmental Medicine, Gene expression profiling in allergic contact
University Hospital RWTH Aachen, Aachen, dermatitis
Germany Ian Kimber1, RJ Dearman1, CA Ryan2,
4
Department of Ecotoxicology/Toxicology, University GF Gerberick2
1
Trier, Trier, Germany Syngenta Central Toxicology
Laboratory, Alderley Park, Macclesfield,
A large number of monoterpenes and their degrad-
Cheshire, UK
ation products are likely skin sensitizing agents 2
Procter&Gamble Company, Miami Valley
(Hausen et al., 1999). Terpenes are very common
Laboratories, Cincinnati, OH, USA
e.g., as constituents of cosmetics, food and other
daily used products. The successful acquisition of skin sensitisation
We investigated responses to the endoperoxide requires orchestrated cellular and molecular inter-
1,4-epidioxy-2-p-menthen (ascaridol), an autoxi- actions that collectively result in the induction of a
dation product of tea tree oil, using monocyte cutaneous immune response of the required quality
derived dendritic cells (MDDC). Therefore, we and vigour. Pivotal roles are played by epidermal
isolated peripheral blood mononuclear cells Langerhans cells (LC), and by the mature
(PBMC) from 9 healthy donors by the standard immunostimulatory dendritic cells (DC) into
Ficoll-Paque gradient centrifugation. which they mature. LC serve as sentinels of the
Monocytes were isolated by adherence and incu- adaptive immune system with responsibility for
bated in media (RPMI 1640) containing GM-CSF surveying changes in the local microenvironment
(800 units/ml), IL-4 (1000 units/ml) and 10% auto- and for processing antigen (and chemical allergens)
logous serum. The immature MDDC (day 6) were encountered at skin surfaces. Following such
characterized by flow cytometry (CD1aþ, CD14 encounters LC are mobilised and stimulated to
, CD40, CD45, CD80, CD83, CD86, HLA-DR migrate, via afferent lymphatics, to regional
and CCR-7) and incubated with various concen- lymph nodes. While in transit they lose the proper-
trations of ascaridol (1–70 mg/ml). After one hour ties of antigen processing cells and acquire instead
incubation time LPS was added (1 mg/ml) for 23 h. the characteristics of mature DC that are able to
Cell culture supernatants were collected after 24 h interact effectively with, and present antigen to,
for cytokine analysis. T lymphocytes. To gain a greater understanding
IL-12p40, IL-12p70 and prostaglandin E2 were of the molecular events that induce and regulate
measured by ELISA, TNF-alpha and IL-2 were cutaneous immune responses to chemical allergens,
measured by flow cytometry (FACS). Methods of we have used microarray transcript profiling and
the quantification of steady state mRNA levels related experimental approaches to characterise
were established for IL-12 and CCR7 (real-time changes in gene expression and protein production
RT-PCR). Ascaridol enhanced significantly IL- associated with the development of skin sensitisa-
12p70 production (120% up to 396%) by tion. Our attention has focused particularly on
MDDC as well as mRNA levels for IL-12 and changes in the expression of mRNA and protein
CCR7. Moreover, we detected a distinct increase resulting from the interaction of chemical allergens
of TNF-alpha (110% up to 146%) secretion, IL-2 with DC, and associated with the presentation of
(135%) and PGE2 (102% up to 155%). antigen to T lymphocytes.
Totally, these results suggest that ascaridol
may be a potent modulator of maturation and
antigen presenting function of dendritic cells, Saturday, 12 June 2004
and we performing further experiments to verify 10:20–11:35
this hypothesis.
This study was supported by the Deutsche FS13
Forschungsgemeinschaft.
Intervention and prevention
Chairs: Tove Agner, Denmark & Manige´ Fartasch,
Germany
Saturday, 12 June 2004
08:45–09:15 FS13.1
KL06 How to change habits at wet work – an
implementation research study
Keynote Lecture Karen Mygind, V Borg, K Frydendall Jepsen,
Chair: David A Basketter, UK M-A Flyvholm
172 ABSTRACTS
National Institute of Occupational Health, ized questionnaire for work-related skin diseases
Copenhagen, Denmark and exposure (NOSQ-2002).* The intervention
activities included an evidence-based prevention
Skin problems are often regarded as part of the
program and an evidence-based method for imple-
job in wet occupations. Bad habits as not using
mentation. Six of the 18 participating departments
protective gloves and moisturizers are often
were randomly assigned to the intervention group
justified by the workers and ignored by the man-
and the remaining 12 departments to the compari-
agement. To change habits at the shop floor,
son group. A total of 644 employees responded in
involvement of the whole organisation is neces-
the baseline interview and 622 in the follow-up inter-
sary. The objective of an intervention in 6 gut-
view carried out a year later. The participation rates
cleaning departments was to implement good
were 87,5% and 71,6% respectively. Among the 495
habits by establishing a safety management
participants answering in both interviews the fre-
system to manage skin risk. Local teams with
quency of eczema on hands or forearms within the
representatives from all levels of the organisa-
past 3 months was reduced significantly by more
tion were trained to run the process. Each team
than 25% in the intervention departments. A minor
included 2–5 gut-cleaners, who should embody
increase was observed in the comparison depart-
good habits and supervise their colleagues.
ments. This study has shown that even in jobs with-
Implementation research studies evaluate the
out the possibility to reduce high exposure to wet
understanding and acceptance of the interven-
work work-related skin problems can be reduced by
tion at the workplace and the association of the
proper preventive measures.
implementation and the reduction of work
*) Susitaival P, Flyvholm M-A, Meding B,
related diseases. Data are collected from
Kanerva L, Lindberg M, Svensson Å, Ólafsson JH.
questionnaires, interviews, written documents,
Contact Dermatitis 2003;49:70–76.
etc. The change after one year in the frequency
of eczema on hands and forearms within the past
FS13.3
3 months, varied in the 6 departments from
a minor increase to a 2/3 reduction. 3 months Development of risk reduction strategies for
after the start of the intervention the gut- preventing dermatitis
cleaners in the team were asked to grade their Terry Brown1, L Rushton1, W Williams2,
expectations for success on a scale from 1 to J English2
1
10; 10 being the optimum. The average grade MRC Institute for Environment and Health,
varied from 4,8 to 10, indicating very different Leicester, UK
2
local expectations to the colleagues’ acquisition University of Nottingham Hospital, Centre of
of new habits. Further data and analysis will Evidence-Based Dermatology, Nottingham, UK
show if there is a covariance between the local
Introduction: A recent survey of the UK printing
changes in eczema frequency and the degree of
industry found a prevalence of 11% of occupa-
implementation.
tional contact dermatitis (OCD), much higher
than previously identified.
Objective: This pilot study aimed to evaluate risk
FS13.2 reduction strategies derived from recommendations
of a literature review of preventive intervention studies
Intervention on work-related skin problems
and a series of focus groups of printers and observa-
among gut cleaners
tions of printers undertaking their normal duties.
Mari-Ann Flyvholm1, K Mygind1, A Jensen2,
Methods: Four interventions were evaluated:
KF Jepsen1, L Sell1, E Villadsen1,
1 (1) Provision of gloves of the correct size/type,
National Institute of Occupational Health,
plus use of an after-work skin cream; (2) Provision
Copenhagen, Denmark
2 of information; (3) Provision of skin checks;
Department of Occupational and Environmental
(4) Development of best practice skin care policy.
Medicine, Haderslev Hospital, Haderslev,
Each intervention was evaluated in two companies
Denmark
over a three-month period, at the end of which
Work-related skin problems are frequent in the food printers and managers were interviewed as to the
processing industry. A randomised intervention effectiveness and acceptability of each intervention.
study with a one-year follow up was carried out Results: Although this pilot study was short, all inter-
among gut cleaners in order to prevent work-related ventions were acceptable to some extent. The preva-
skin problems due to wet work. The effects of the lence of frank dermatitis fell over the study period,
intervention were primarily measured by telephone particularly in intervention (3). Intervention (1)
interviews using questionnaires based on a standard- achieved an improvement of awareness in both
ABSTRACTS 173
management and workforce and an increase in the employees were found to have work related skin
use of both gloves and cream. Intervention (2) high- problems.
lighted problems of dissemination and the need for Conclusions: We could demonstrated that the occur-
relevant information in an appropriate format. How- rence of occupationally-related hand eczema can
ever. no single intervention was completely effective. be significantly reduced by setting up and providing
Conclusions: This qualitative research approach instruction in a skin protection concept matched
forms an essential first stage to improving under- to the hazards the skin is exposed to at work.
standing of ways in which OCD may be reduced Additionally, valuable knowledge and experience
among workers in the printing industry, and were gained on implementing industrial skin protec-
points towards the need for further testing of tion programmes and performing intervention
preventive strategies in larger-scale intervention studies.
trials, in printing and other industries.
FS13.5
Occupational contact dermatitis: printer
FS13.4
worker’s viewpoints
Prevention of occupational hand eczema by Terry Brown1, L Rushton1, H Williams2,
skin-care management – results of an J English2
1
intervention study MRC Institute for Environment and Health,
Thomas L Diepgen Leicester, UK
2
University of Heidelberg, Department of Clinical University of Nottingham Hospital, Centre of
Social Medicine, Heidelberg, Germany Evidence-Based Dermatology, Nottingham, UK
Objectives: In the prevention of occupational Introduction: Occupational contact dermatitis
contact dermatitis the usage of personal skin (OCD) is very common in the printing industry
protection measures have a high priority, how- due to contact with chemicals, paper, and wet
ever there is a lack of intervention field studies work. It can be avoided by adequate protective
to demonstrate its efficacy. Therefore we con- measures, but the effectiveness of intervention
ducted a field study in a plant of the metal- depends heavily on the employer’s and employee’s
working industry and investigated the efficacy of awareness of this health risk.
an established skin protection programme. Objectives: The study aimed to collect informa-
Methods: First, a professional dermatological tion on the knowledge, attitudes and beliefs of
appraisal of the current status and a skin-protection print workers about the risk of OCD and meth-
analysis were carried out for 180 company ods of prevention.
employees, and a dermatological evaluation of Methods: A series of focus groups were held with
each workplace from the aspect of prevention print workers, health and safety officers and man-
was conducted. Using the information obtained agers to discuss their awareness of dermal risk
a skin protection programme for the whole com- factors, risk behaviour at work, attitudes to
pany was devised and subsequently set up. The health and safety and options on possible prevent-
follow-up examination was performed eight ive measures. A number of companies were also
months later. visited to observe, overtly and covertly, the normal
Results: At the beginning of the study 26% of the work practices.
employees were found to have skin problems Results: OCD was not perceived to be either a
related to the work they were doing. In 50% of major problem or a health and safety priority.
the cases skin protection was never or only rarely There was general agreement about the processes
used, with the right kind of skin protection almost and work practices that could cause skin prob-
never being applied. There was no skin protection lems. However, work practices varied consider-
programme in place meeting today’s professional ably and did not always reflect this awareness.
dermatological requirements, or at the most there There was general concern about the type and
were just the first signs of one. After the pro- availability of personal protective equipment,
gramme had been set up and suitable instruction especially gloves and after-work skin cream. The
and information given there was a follow-up provision of an occupational health service was
observation period of eight months, during generally felt to be inadequate, and no company
which several professional dermatological exam- had a policy in place that specifically addressed
inations of the employees were carried out and skin care.
further instruction (individual prevention) was Conclusions: These findings highlight the urgency
given. In the final examination only 8.7% of the to intensify health and safety education on skin
174 ABSTRACTS
care within the printing industry. Recommenda- tigated whether chemokine production by moDC
tions were developed for the evaluation of a series is increased upon maturation and, ultimately,
of risk reduction strategies. whether chemokine production can be used as a
sensitive method to discriminate allergens from
irritants.
Methods: MoDC were exposed for 48 hours to
FS13.6
allergens (NiSO4, CoCl2, PdCl2, CuSO4, CrCl3,
Risk management for workplace dermal K2Cr2O7, PPDA and DNCB) and irritants
exposure – a practical approach (SDS, DMSO, BCl2 and propan-1-ol). CD83
Christopher Leonard Packham and CD86 expression was analysed by flow cyto-
EnviroDerm Services, Evesham, UK metric determination and chemokine production
(CXCL8, CCL5, CCL17 and CCL20) was deter-
Contact dermatitis remains one of the most com-
mined by ELISA.
mon forms of occupational ill health in most
Results: Exposure to strong allergens caused up-
industrial countries. Eliminating or minimising
regulation of CD83 and CD86 expression whereas
contact can significantly reduce the incidence
exposure to irritants did not. Remarkably, increased
and prevalence of occupational contact derma-
CXCL8 production by moDC was detected after
titis. However, this is often believed by managers
allergen exposure whereas a decrease in CXCL8
to be associated with either expensive measures,
production was observed after irritant exposure.
such as constly changes in the process or in the
CCL20 production was induced only by NiSO4.
need for expensive new equipment, or with the
CCL5 and CCL17 production was increased upon
provision of personal protective equipment such
exposure to both allergens and irritants.
as gloves. Frequently, however, an analysis of the
Conclusion: CXCL8 production by moDC can be
actual source of exposure can lead to a simple
used to distinguish allergens from irritants. This
change that can have a significant effect in elimnin-
chemokine is a potentially novel marker for deter-
ating or controlling exposure. In many cases not
mining the sensitising capacity of a chemical in vitro.
only has this led to the elimnination of the skin
Furthermore, our results suggest an important role
problems, but also to a reduction in operating
for CXCL8 in the sensitization phase of ACD.
costs and/or an improvement in productivity. A
structured approach to the elimination or ade-
quate control of exposure will be explained and
its benefits illustrated by a number of case studies Saturday, 12 June 2004
where simple intervention methods have achieved 10:20–11:35
the desired results.
FS14
Photo dermatitis/Metal allergy II
Chairs: Torkil Fischer, Sweden & Christophe J Le Coz,
France
FS13.7
FS14.1
CXCL8: a potential novel marker in predicting
contact sensitisers Safety of various fragrances: allergy and
Susan Gibbs1, MJ Toebak1, PR Pohlmann1, phototoxicity, joint study in Korea
BME Blomberg2, RJ Scheper2, T Rustemeyer1, Hee-Chul Eun1, S An2, H Lee2, A Lee1, CH Lee1,
DP Bruynzeel1 D-W Kim1, K-C Moon1, Y-H Won1, Y-S Ro1,
1
Department of Dermatology, VU University J-H Hahm1, K-J Kim1
1
Medical Centre, Amsterdam, The Netherlands Korean Society for Contact Dermatitis and Skin
2
Department of Pathology, VU University Allergy, Seoul, South Korea
2
Medical Centre, Amsterdam, The Netherlands Amore Pacific Corporation R&D Center,
Youngin, South Korea
Cultured monocyte-derived dendritic cells
(moDC) have been shown to provide a promising The purpose of this study is to know the pre-
alternative for identifying potential sensitisers valence of allergic patch test responses in
in vitro. Allergen induced moDC maturation patients with suspected fragrance allergy in
results in elevated expression of the cell surface Korea and to know the photoxic potentials of
markers CD83 and CD86. Unfortunately, limited fragrance substances. Nine dermatology
this increase in CD83 and CD86 expression is departments of university hospitals and one
not sensitive enough to identify moderate and research institute of cosmetic company were
weak contact sensitisers. In this study, we inves- participated in this study for the past 1 year.
ABSTRACTS 175
To inquire the specific fragrance allergens in very strong photopatch test reactions. 26 patients
Korea, eighteen fragrance ingredients were also had positive reactions to fentichlor.
added to Korean standard series and fragrance 27 of the ketoprofen – photoallergic patients
series (Chemotechnique Diagnosis, Sweden). had also been photopatch tested with fenofibrate,
Among 422 patients, 83% were women and 17 had positive reactions. 21 had positive
the most common topographic site was face. reactions to balsam of Peru and 13 to fragrance
Except the fragrance mix and Balsam of Peru, mix.
Cinnamic alcohol and Sandalwood oil showed Conclusion: Ketoprofen is a strong photosensitizer.
high frequency of positive responses. Among
the added specific fragrance ingredients,
3-methyl-5-(2,2,3-trimethyl-3-cyclopenen-1-yl)
pent-4-en-2-ol, alpha-isomethyl-ionone(methyl
ionone gamma), Lyral showed high positive FS14.3
responses. With eighteen added specific fra-
Interleukins in patch-test blisters for the
grance substances, we have also performed two
detection of contact allergy
in vitro phototoxicity tests, 3T3 NRU photo-
Margret S Sigurdardottir1,2, H Sigmundsdottir3,
toxicity test and photohemolysis test. 3T3
H Valdimarsson3, B Bjarnason1,4,5
NRU phototoxicity test is a screening method 1
Utlitslaekning Ehf, Kopavogur, Iceland
for DNA or cellular damage and Photohemo- 2
Faculty of Medicine, University of Iceland,
lysis test is a useful screening method for photo-
Reykjavik, Iceland
toxic chemicals that cause oxygen-dependent 3
Department of Immunology, Landspitali
membrane damage. Only Lyral showed photo-
University Hospital, Reykjavik, Iceland
toxicity in photohemolysis test and no other 4
Department of Dermatology, University of
fragrance ubstances showed phototoxicity in
Iceland, Reykjavik, Iceland
3T3 NRU phtototoxicity test. We think our 5
Department of Dermatology, University of
data are useful to know the current status of
Alabama School of Medicine, Birmingham, AL,
the frequent fragrance allergens in our society
USA
and the possible phototoxic potency of limited
fragrance substances. Objective: To investigate whether interleukins in
blisters formed at patch-test sites can be used as
markers of the grade of contact allergy.
FS14.2 Methods: Recently patch-tested volunteers with
and without allergy to nickel sulfate were retested
Photoallergic contact dermatitis from ketoprofen
with 5 nickel sulfate patch tests and 5 control
in Southern Sweden
tests. 48 hours later, the test were removed and
Monica Hindse´n, Zimerson E, Bruze M the perfusion of the test sites was assessed with a
Department of Occupational and Environmental laser Doppler perfusion imaging (LDPI) tech-
Dermatology, Malmö University Hospital, nique. Then, suction blisters were made at the
Malmö, Sweden test sites. Blister fluids were collected separately
Objective: In Sweden ketoprofen has been from the allergen test sites and the control-test
available for topical applications since 1995. sites.
Photoallergic contact dermatitis from ketoprofen Results: The patch-test results prior to the study
has been reported since almost 20 years. Photo- and in current study, and the results with the
allergic contact dermatitis from ketoprofen- LDPI helped to distinguish between subjects
containing topical treatment usually includes with and without allergy to nickel sulfate. The
severe eczematous reactions. Ketoprofen is an concentration of one of the interleukins was
NSAID derived from propionic acid. Ketopro- high in the blister fluid from the nickel-test sites
fen, fenofibrate and benzophenones are structu- in all of the allergic subjects while the concentra-
rally similar. tion was not detectable or low in fluid from the
Methods: Photopatch testing and patch testing control sites and in fluid both from the nickel and
with 2 standard series, the ketoprofen-containing the control sites in subjects without nickel allergy.
gels and their ingredients, fenofibrate and Conclusion: Immunological factors in fluid from
benzophenones. blisters at patch-test sites may be important for
Results: During the last year 35 patients have the detection of contact allergy.
been photopatch tested with ketoprofen with Acknowledgement: Icelandic Research Council.
176 ABSTRACTS
Begoña Garcia-Bravo1, V Fernandez-Redondo2, potential exposure factors that may have led to the
P Sanchez-Pedreño3 concomitant sensitizations. Gender, age, occupa-
1
University Hospital V. Macarena, Sevilla, Spain tional dermatitis, and construction work were
2
University Hospital Gil Casares, Santiago de considered and examined with multivariate logistic
Compostela, Spain regression models with the dependent response
3
University Hospital V. Arrixaca, Murcia, Spain variable being concurrent reactions to a metal pair
versus no reactions. In addition to the aforemen-
Objective: Prevalence of textile dye contact tioned anamnestic data, examination of a poly-
dermatitis (TD-CD) are lacking in many countries. sensitizations variable (reactions to 1, 2, or 3
Our aim is to know the frequency of TD-CD in standard series allergens other than Nickel, Cobalt
three different areas of Spain. or Chromate) provided information regarding gen-
Methods: 100 patients were tested with Spanish eral susceptibility to positive patch test reactions.
standard series and the five most frequent TD in Combined reactions to Cobalt and Chromate were
each city. D. Orange 1, D. Orange 3, D. Blue 35, strongly linked to construction work (OR ¼ 11.23
D. Blue 106, D. Blue 124 were included in Murcia (7.46, 16.90)) and occupational dermatitis. Female
and Seville, and the three last and D. Red 1, D. patch test patients had a higher odds of a positive
Red 17 in Santiago. patch test reaction to both Nickel and Cobalt
Results: 23/300 (15 women and 8 men) were posi- (OR ¼ 4.73 (3.81, 5.87)). Sensitization to other,
tives to one or more TD. D. Blue 124 was the most unrelated standard series substances was associated
frequent allergen (18/300), followed by D. Blue with concurrent reactions to all of the metal pairs.
106 (17/300). D. Red 1, D. Red 17 and D. Orange The association between construction work and
1 were positives in 2/200. D. Orange 3 and D. Blue Cobalt-Chromate reactions corresponds with the
35 were positives in 1/200. Eczema was located on hypothesis that cement exposures lead to cobalt-
hands in 13 cases. Clinical picture was variable. chromate sensitizations. Individual susceptibility
Origin of sensitization was clothing and occupa- to delayed-type sensitizations, as represented by
tional. Relevance was obtained in 20/23 cases. the poly-sensitization variable, also appears to be
Conclusions: The study confirm an high fre- associated with coupled sensitizations to metals and
quency of disperse dye allergy in Spain with a warrants further examination.
very different prevalence in the three areas: Seville
14%, Murcia 5% and Santiago 4%, that are
P03
probably due to social and cultural factors. We
Type-I and -IV hypersensitivity to platinum salts
recommend the inclusion of D. Blue 106, D. Blue
Willeke Kamphof, T Rustemeyer, D Bruynzeel
124, D. Blue 35, D. Red 1, D. Red 17, D. Orange
VUMC University Hospital, Amsterdam,
1 and D. Orange 3 in standard series in order to
The Netherlands
detect sensitivity to textile colours that is most
frequent than previously suspected. A 28-year-old female analytical chemist visited
our patch test clinic with initially complaints of
severe hand dermatitis. Later on she developed
rhinitis, bronchial asthma and tightness of the
P02 chest. The complaints seemed work related: her
condition improved during holidays and on sick
Analysis of coupled patch test reactions to leaves. She worked in a laboratory with several
nickel, cobalt and chromate platinum salts and used different kinds of gloves
Janice Hegewald1, W Uter1, A Schnuch2, (latex, nitril, etc.).
A Pfahlberg1 Methods: Patch tests were performed with the
1
Department of Medical Informatics, Biometry & European Standard series and prick tests with
Epidemiology, University of Erlangen, Erlangen, common inhalant allergens. Patch-, prick- and
German open patch tests were carried out with various
2
IVDK, University of Göttingen, Göttingen, Germany aqueous dilutions of platinum chloride (PtCl2).
Concomitant sensitizations to Nickel, Cobalt and Results: Patch tests with 0.01–2% PtCl2 were
Chromate are often observed among patch test positive on day 2, 3 and 6, and at 0.001% a
patients. However, the reasons for being sensitized follicular reaction was found. The prick-test was
to two or more of these substances are not comple- already positive at the lowest concentration tested
tely understood. Examination of IVDK (www. (0.001%). The open patch test, carried out retro-
ivdk.org) patch test results with multivariate proce- auricular, showed a positive reaction at 1 and 2%
dures has been conducted to further elucidate the PtCl2 after 20 min. Controls in healthy volunteers
mechanisms involved with these sensitizations and (n ¼ 5) were all negative.
ABSTRACTS 179
effects from repeated open tests seems better but Amersham Hospital, Department of Dermatology,
still has challenges; currently we are assessing Amersham, UK
alternative strategies to permit rapid identifica-
There is a need for a diversity of approaches to
tion of potential issues without recourse to
predictive irritancy testing. In this study we exam-
extended in use tests.
ined the potential for changes in the expression of
the nitric oxide generating enzyme, nitric oxide
P07 synthase, to act as a marker of skin irritation.
Human volunteers were patch tested with sodium
The poverty-one of the reasons for chronic toxic
lauryl sulphate and dithranol so as to induce
contact dermatitis
acute irritant contact dermatitis. Test and control
Violeta Kuzmanovska1, M Petkovska2,
biopsies were removed at various time points and
L Biserkoska-Atanasovksa3
1 skin sections immunocytochemically labelled with
Medical Center Kumanovo, Kumanovo, FYR of
a range of polyclonal and monoclonal antibodies
Macedonia
2 against the three nitric oxide synthase isoforms,
Department of Health Protection, Kumanovo,
NOS1, NOS2 and NOS3. Quantitative image
FYR of Macedonia
3 analysis of keratinocytes and endothelial cells
Health Care Center, Skopje, FYR of Macedonia
revealed major inconsistencies in the labelling of
The aim of the work is to present the incidence both normal and inflamed skin between anti-
and the main reasons for this illness at women bodies, including those purported to recognise the
who live in very bad and poor conditions, in town same epitope. Of the ten antibodies tested, two,
and in village. AHP303 and N2643, gave statistically significant
Material and methods: 137 women were included, changes in NOS2 and NOS3 expression, respect-
who were inspected during the time period of ively, in well-established 48 h and 96 h reactions.
8 months in 2003. A proper therapy was intro- Importantly, the changes were consistent for both
duced-per os and in loco, and all of them were irritants, despite their differing mechanisms of
controled for 14 days. action. Further investigations are needed to assess
Results: All together, 137 women were inspected their suitability as markers of irritation in animal
and they were classified by their age, place of and in-vivo models.
leaving and nationality. The detail anamnesis
showed that 80% are housewifes who live in pov-
erty and who are in contact with detergents every- P09
day, becouse they do the dish-washing and the
laundry with hands, without any machines. The Comparison between mild irritant response in
following therapies were applicated: corticoster- haired and hairless guinea pigs
oid and antihystaminic therapy per os and corti- Flemming Andersen1, Kathryn Hedegaard2, Ann
costeroid therapy in loco. After 14 days, a control Fullerton2
1
look over was made, and they were given the Odense University Hospital, Odense, Denmark
2
preparation with vitamin A and lanolinum, for LEO Pharma, Ballerup, Denmark
14 days more. All of them were adviced to use The hairless guinea pig offers the possibility of
protection gloves when they are in contact with performing irritant studies without the use of
detergents, especially for the laundry. depilatory agents or clipping. Studies have
Conclusion: One of the reasons for the appear- shown a response to allergens and simple irritants
ance of chronic toxic contact dermatitis is the low comparable to that of the haired guinea pig.
standard of living when, becouse of the poverty, Histoanatomical studies have demonstrated dif-
people can’t use machines and still in the 21th ferences in cutaneous structure in the two strains,
Century they wash the clothes and dishes with differences that might influence the response to
hands. The only help at this category of people mild irritants such as topical drug vehicles. The
is to give them advices for using protection purpose of this study was to compare the usability
gloves. of hairless (HLGP) and shaved haired guinea pigs
(SGP) in tolerability studies of complex topical
formulations. The tolerability of 6 selected skin
P08 care formulations (SCF), known to cause a dif-
Changes in Nitric oxide synthase expression in ferentiated irritative response in HLGP, was stu-
acute irritant contact dermatitis: a possible died in 15 male SGP and 15 male HLGP. All
predictive tool animals were treated on a 5 5 cm area on each
Carolyn Willis, L Britton, D Orton flank twice daily for 4 consecutive days with SCF.
ABSTRACTS 181
present study the MoistureMeter-D was applied fragrance mix (30.0% vs. 12.9% in those not
to quantitate local skin edema related to skin reacting positively to this product category),
irritation. The irritation was induced in the volar Myroxylon Pereirae resin (18.6% vs. 8.4%) and
forearms of 12 healthy volunteers with the topical some biocides like MCI/MI (11.4% vs. 1.8%) and
application of 1% sodium lauryl sulfate (SLS) for methyldibromo glutaronitrile þ phenoxyethanol
6 hours. After induction the volunteers were (12.1% vs. 5.3%) were the most common aller-
divided into two groups: the irritation site of gens. In conclusion, patch testing own products –
group I (six volunteers) had no treatment for the although not without pitfalls – may (i) help to
irritation site while for group II (six volunteers) correctly diagnose ACD and (ii) give important
the corticosteroid cream was topically adminis- hints on the occurrence of allergens in a particular
tered on the irritation site. A good correlation type of (cosmetic) product.
was measured between the temporal changes of
edema during the three days’ follow-up by the
ultrasound-measured skin thickness and the
edema-specific MoistureMeter-D in group I P14
(p < 0.001). The reduction of edema in group II
Hydrolysed wheat protein: a new allergen in
by the corticosteroid treatment was consistently
cosmetics and food
measured by both instruments. The coefficient of
Catherine Pecquet1, O Bayrou1, M Vigan2,
variation for a single measurement varied
N Raison3, M Lauriere
between 2 and 3%. The results demonstrate that 1
Allergologie, Hôpital Tenon, Paris, France
the MoistuMeter-D is an accurate instrument for 2
Service de Dermatologie, CHU, Besançon,
the quick quantitative evaluation of local oedema
France
and fluid retention in irritated skin. 3
Service de Dermato-Aallergologie, Hôpital
St-Eloi, Montpellier, France
4
INRA, Grignon, France
P13
For the pas few years, mainly because of mad cow
Results of patch testing with patients’ own
disease, hydrolysed wheat proteins (HWP) have
cosmetics and toiletries
been used in cosmetics and food as emulsifiers
Wolfgang Uter1, C Balzer1, A Schnuch2
1 and stabilizers in replacement of bovine collagen.
IMBE, University of Erlangen, Erlangen,
We report here contact urticaria to cosmetics
Germany
2 induced by these HWP in 7 patients of which 6
IVDK, University of Göttingen, Göttingen,
had food allergy to modified gluten and the
Germany
results of their immunological testing. These
Patch testing with materials brought in by the cases were regrouped through the french network
patient is useful to identify the cause(s) of current REVIDAL-GERDA.
allergic contact dermatitis (ACD). However, little All 7 women developped contact urticaria
is known (i) on the contribution of such tests to immediatly after applying cosmetics (mainly
diagnostic success and (ii) on the spectrum of facial cream), from different brands, containing
contact allergens associated with ACD to certain HWP. Six of them had also anaphylactic reac-
product categories. Between 1998 and 2002, 5911 tions or urticaria after eating preserved foods or
out of 48381 patients patch tested in the centres of delicatessen which contained modified gluten.
the IVDK (www.ivdk.org) have been tested with Neither had allergic reaction after eating broad
own cosmetics and toiletries in addition to com- or bread.
mercial allergens. These were manually assigned Skin tests were positive with the cosmetics,
to 26 categories, based on a EU classification HWP contained in them and, in case of food
(annex I to 76/768/EEC), which was further allergy, modified gluten. They were negative
refined. As illustrative example, data on ‘‘Bath with natural wheat flour. Despite that, spe-
and shower preparations’’ are presented: out of cific IgE to wheat flour were positive in 2
1333 patients tested with a total of 2336 single cases. Specific IgE to gluten were positive in 3
patches (1102 with 1%, 391 with 10% and 280 patients.
with 0.1% in water, remainder with other pre- Sera were also investigated for their specificity
parations, depending on the actual kind of toward wheat proteins and various preparations
product), 71 had positive reactions at the D3 of gluten. Individual variations of specificity were
reading. Only in 46 of these, reactions to potential observed. All sera contained IgE reacting with
cosmetic ingredients, tested as commercially both hydrolysed peptides and some native flour
available allergens, were observed. Among these, proteins.
ABSTRACTS 183
It appears that, from the medical history, stopped the use of make up; she had acrylic arti-
allergy to cosmetics preceeded food allergy. In ficial nails since 2 months and sometimes used
view of these elements, may be the use of HWP hair dyes;patch tests were performed with Finn
in cosmetics should be questionned. Chamber1 tests with readings at D2 and D3,
according ICDRG criteria, with European stand-
ard series, additional series (including toluene-
P15 sulfonamide formaldehyde resin), cosmetic,
A randomized double-blind controlled trial
acrylates, hairdressing series, in 3 patch test ses-
comparing extra-virgin coconut oil with mineral
sions, using Chemotechnique Diagnostics1
oil as a moisturizer for mild to moderate xerosis
allergens.
Anna Liza Agero, V Verallo-Rowell Results: The only positive patch test was coconut
Makati Medical Center, Department of diethanolamide (0.5% pet.)þþ at D2 and D3.
Dermatology, Makati, The Philippines After removal of the shampoo containing this
allergen, the dermatitis cleared. Coconut dietha-
Coconut oil, a traditional moisturizer used for nolamide (cocamide DEA), tensioactive synthe-
centuries by people in the tropics, does not have sized with coconut oil is widely used in shampoos,
any clinical studies documenting its effectivity soaps, shower gels, barrier creams, washing up
and safety. This study aims to determine effectiv- liquids, metalworking fluids, hydraulic oils.
ity and safety of coconut oil compared to mineral Involvement of eyelids is not frequently described
oil as moisturizer for mild to moderate xerosis. A in the literature with this allergen.
review board-approved randomized double-blind Conclusion: Coconut diethanolamide should be
controlled trial was conducted in 34 patients after added in cosmetic series, and it should be useful to
negative patch-testing. Patients applied either test this allergen in patients with eyelid dermatitis.
coconut or mineral oil twice a day for two
weeks. Quantitative outcomes for effectivity, P17
measured at baseline and each weekly visit, were
skin hydration (Corneometer CM8251) and skin Allergic contact dermatitis from hydrolyzed
lipids (Sebumeter SM8101); for safety, transepi- wheat protein
dermal water loss [TEWL] (Tewameter TM2101) Olivia Bordalo
and skin surface pH (Skin pH meter PH9001). Centro de Dermatologia, Lisbon, Portugal
Patients and investigator evaluated symptoms of Allergic Contact Dermatitis (ACD) from hydro-
dryness, scaling, roughness, and pruritus using lysed wheat protein (HWP) is rarely reported in
visual analogue scales (VAS) and grading of xero- the literature. We describe 2 cases of ACD to this
sis. Both groups showed significant improvement new allergen. Case1- A 39-year-old non atopic
in skin hydration and increased skin surface lipid woman presented with a dermatitis of the face,
levels. TEWL and Skin pH were not affected. mainly eyelids and neck. She had been using a
Objective instrumental determinations showed new cosmetic cream for 2 months. The lesions
no significant difference between both groups. subsided with topical corticosteroids. Patch tests
Patient and investigator subjective grading of with the standard, cosmetic, fragrance series and
xerosis and VAS showed general trend toward with her own products gave positive reactions
better, though not statistically evident, with coconut only to the new cosmetic cream. We also tested
over mineral oil. Coconut oil is as effective and safe all the components of this cream and only HWP
as mineral oil as a moisturizer. gave a doubtful reaction with occlusive tests and
positive reaction with ROAT. Case 2 – A 48-year-
old atopic woman presented with a dermatitis of
the face and hands for 1 month. She had been
P16 using a new cosmetic cream for 11 months and
kept using the product without any suspicion.
Eyelid dermatitis with positive patch test to
The dermatitis subsided with cetirizine and topical
coconut diethanolamide
corticosteroids. Patch tests with the standard,
Yves Dejobert, E Delaporte, F Piette, P Thomas
cosmetic, fragrance series and her own products
Service de Dermatologie CHRU, Lille, France
revealed positive reactions to the cosmetic cream.
Objective: The aim was to detect a possible aller- Again, testing all the components of the cream, only
gen in a patient with eyelid dermatitis. Patient HWP gave doubtful reactions with occlusive tests
and methods: a non atopic 27-year-old female and positive reactions with ROAT.
presented with eyelid dermatitis since 3 months. Discussion: In recent years, a number of protein
This dermatitis persisted despite the fact she had hydrolysates have been introduced into cosmetic
184 ABSTRACTS
and cobalt respectively with a doubtful (? þ) reac- For 6 products, the name alone did not make
tion to mercury 0.5% in petrolatum after 96 hours. it possible to identify its use. 2 collective publica-
Tattoo reactions, especially red tattoo reactions can tions were made (many declarations about a new
present with a spectrum of histological changes, problem)
including lichenoid, granulomatous, hypersensitiv- Conclusion: There were many declarations. The
ity, nodular, pseudolymphomatous or sarcoidal number of product is much larger than what was
reactions. One of our cases responded well to intra- published before:
lesional steroid injection and one case resolved The under declaration is certain to the public
spontaneously. vigilance
The medical motivation is a good motor to
obtain declarations
P21 These declarations can be useful to help
patients, to publish new problems and to program
Is medical motivation a good motor to collect
prospective studies
side effects of cosmetics? Results of REVIDAL
GERDA from the 1st January of 2000 to the 31st
December of 2002
Martine Vigan P22
GERDA, Department of Dermatology, Besançon,
France Patch testing with p-toluene diamine (PTD)
preparations of different ages
Background: Why are there few declarations of
Johannes Geier1, H Lessmann1, W Uter2,
side effects to public vigilance? Are there really
S Hildebrandt3, A Schnuch1
few cases? Is there a lack of motivation? 1
IVDK, University of Göttingen, Göttingen,
Motivation of revidal gerda is a medical motiva-
Germany
tion. Acceleration of knowledge by each about 2
Department of Medical Informatics, Biometry
side effects. Amelioration of the tracking of side
and Epidemiology, University of Erlangen/
effects. Amelioration of management of patients
Nüremberg, Erlangen, Germany
Aim: to answer the question: is the medical moti- 3
Hermal, Reinbek, Germany
vation a good motor to collect the side effects of
cosmetics? Background: PTD, a component of oxidative hair
Patients and methods: dyes, is a frequent sensitizer in hairdressers.
REVIDAL GERDA Investigations on the stability of the patch test
1/collects the declaration od S.E. of cosmetics preparation PTD 1% pet. revealed a decline of
which are sent by dermato-allergologists who the PTD concentration to 0.1% within 6 months,
are astonished by these S.E possibly due to a reaction of PTD molecules to
2/shows reception for each declaration dye complexes. This raises the question if the
3/wake up the vigilance of all in the event of long-term diagnostic quality of the PTD prepara-
concordant declarations tion is hampered by chemical changes.
3/inform each one of all the declarations 2 times Objective: To systematically compare intra-
per annum individually patch test results obtained with
The majority of the declared S.E. is allergic three PTD patch test preparations of different
1/evocative clinical history age, tested synchronously in a multicenter study
2/and positive reaction with a mufactured of the German Contact Dermatitis Research
product Group (DKG).
3/or positive reaction with an allergen of the Methods: 3 PTD preparations, produced in
allergotheque and presence of this allergen in the January 2002 (batch A), August 2001 (batch B),
list ‘‘ingredients’’ of manufactured product (s) and April 2001 (batch C), were patch tested in 177
here is the analysis of declarations which was patients from March to December 2002. Patch
made from the 1st january of 2000 to the 31th testing was performed blinded, with respect to
december of 2002 the production date.
Results: Results: There were 150 concordant reactions to
42 dermato-allergologists had declared 304 batch A, B, and C, i.e. 133 negative, 1 doubtful
declarations for 398 products; 188 used for the face (?), 11 weak positive (þ), 3 strong positive (þþ
58 used for the body, 38 used for hair, 31 used for and þþþ), and 2 irritant reactions. In 27
legs, 30 parfums, 15 sunscreens, etc. patients, discordant reactions to batch A, B, and
The declared pathology was: 12 immediate C had been observed. Altogether, 22 positive
type, 281 delayed type, 10 other reactions were noted to batch A, and 19 to
186 ABSTRACTS
tion, intradermal tests with serial (ten-fold) dilu- Español para la Investigación de la Dermatitis de
tions are recommended. Surprisingly in most Contacto, GEIDC) (2001)
publications dealing with serial skin test dilution, Mercedes Rodrı´guez-Serna1, JF Silvestre2, J De la
the technique is not described in detail. Cuadra1, B Garcia-Bravo3, and the other GEIDC
Aim: Comparison of the variability of test sub- Membres
stance concentrations produced with two serial 1
Hospital General de Valencia, Spain
dilution techniques conducted by experienced 2
Hospital General de Alicante, Spain
allergy nurses. 3
Hospital Virgen de la Macarena, Sevilla, Spain
Methods: Two allergy nurses produced dilution
series. Isosulfane blue was chosen as test sub- An epidemiological study is made to evaluate the
stance, since it enabled easy and sensitive present or past relevance of positivity to the allergens
detection. Dilution series of isosulfan blue pertaining to the GEIDC standard series. A retro-
(aqueous solution of 10 mg/ml) from 1:10 to spective study was made of patients evaluated with
1:10’000 were produced under sterile conditions patch tests corresponding to the GEIDC standard
by two dilution techniques: 1) Dilution in vials: series by 14 GEIDC dermatologists in the course of
0.5 ml isosulfane blue solution was serially 2001. The following parameters were evaluated: age,
transferred with 1 ml tuberculine syringes to sex, positive allergens, and present, past and total
vials containing exactly 4.5 ml NaCl 0.9% relevance. A total of 3343 patients were studied, of
2) Dilution in syringes: 0.1 ml isosulfane blue which 1892 had at least one positive test (56.59%).
solution with the higher concentration was The most relevant allergens were mercaptoben-
aspirated into 1 ml tuberculine syringes fol- zothiazole (93,93%), thiuram mix (93%) and nickel
lowed by 0.9 ml NaCl 0.9%. These procedures sulfate (92.33%). In women, paraphenylenediamine
were compared with a controlled experiment was moreover also very relevant, while in males
carried out using piston-stroke pipettes. The epoxy resin, butylphenol formaldehyde resin and
concentrations of isosulfan blue in all dilutions colophony were particularly relevant. Among the
were determined by UV/VIS-spectroscopy and less relevant allergens in both sexes, we found the
external standard calibration. following in relation to the total: quinolein (44.44%),
Results: In almost all samples the concentrations lactones (45.45%) and caine mix (48.07%). In 1783
were higher than expected. In vials the concentra- patients with at least one positive test, an evaluation
tions varied from 83 to 360%, in syringes from 83 was made of whether allergen relevance was past or
to 711% of the expected values. The dilution in present. In 60.78% of the positive tests present
vials gave consistently better results than dilution relevance was established. The allergens of greatest
in syringes. A considerable interindividual vari- present relevance were ethylenediamine (100%),
ability was observed between the conducting budesonide (100%), euxyl K 400 (96.96%), epoxy
nurses, however variability over time was smaller. resin (93.33%), and Quaternium 15 (92.85%). The
Conclusions: In routinely performed serial dilu- allergens of least present relevance were nickel sulfate
tions of allergen test preparation considerable (36.38%), caine mix (40%), and neomycin (41.37%).
deviations from the expected allergen test concen- Determination of the relevance of positive
tration have been observed. This might be of patch test is fundamental in all cases. In our
minor importance for an individual patient, how- study nickel and rubbers were the most relevant
ever, in establishing e.g. cut-off concentrations allergens, though nickel was essentially of past
for non-irritant drug concentrations or in multi- relevance. Few studies have addressed the present
center studies such variations may result in major or past relevance of the standard allergen series.
errors. Quality management of skin testing
should not only include the recording, injection
technique and test reactivity evaluation, but also
the exact description of the preparation of test P27
dilutions. In clinical routine dilution techniques
‘‘Two feet-one hand syndrome’’ masquerading
should be applied, which give more accurate
as occupational hand eczema
results.
Nada Meljanac, H Dickel, HJ Schwanitz
University of Osnabrück, Department of
Dermatology, Osnabrück, Germany
P26
Background: Occupational hand eczema is
An epidemiological study of the relevance of the mainly characterised by bilateral manifest-
allergens of the standard series of the Spanish ation whereas one-sided hand involvement is
Group for the study of contact dermatitis (Grupo unusual.
188 ABSTRACTS
Subject: We report on a 38-year old dental tech- gen concentrations, allergen exposure times and
nician who presented with interdigital skin alter- cell culture times were used. At the end of each
ations of the left hand resistant to previous culture time, IL-8 RNA and protein of the culture
eczematous treatment. Main professional task supernatants were analyzed by PCR and ELISA.
was the production and processing of plaster or Results: The concentration of IL-8 in the supernatants
plastic dental models. While handling with dental proved to be a successful way to distinguish between
models like smoothing by the left hand, usually subjects who patch tested positive with a non-toxic
this one was splashed with plaster. On clinical concentration of urushiol and subjects who tested
examination the patient showed additionally negative. In the allergic subjects, a correlation was
scaly lesions on the soles. established between the dose of the allergen and the
Results: No sensitisation could be ascertained IL-8 protein concentration in the supernatants.
performing patch and prick tests. By normal IgE- Conclusions: In vitro testing of contact allergies in
level, no specific antibodies against aeroallergens or patients makes possible an objective assessment
occupational allergens such as isocyanates, formal- of their allergic status without causing a booster
dehyde or latex could be found. Mycological cultures effect or risking active sensitizations. The results
of scaly lesions of the left hand and soles revealed an indicate that the method may be used as an alter-
infection with Trichophyton rubrum. In accordance native method to animal models for testing con-
with the subjective perception, the starch-iodine test sumer products before their marketing, thus
showed the left hand more sweating. We diagnosed a avoiding ethical problems and problems related
‘‘two feet-one hand syndrome’’ and achieved healing to interpretation of tests because of biological
after local antimycotical treatment. differences between animals and humans.
Conclusions: In case of one-sided, suspicious work-
related skin alterations of the hands, a ‘‘two feet-
one hand syndrome’’ (i.e. bilateral plantar tinea in P29
coexistence with a unilateral tinea manuum) should
Interleukin-8 in patch-test blisters is chemotactic
be considered as differential diagnosis. A common
and detects allergy
explanation for the fungal infection of one hand is
Bolli Bjarnason1–3, H Xu1, CA Elmets1,
the scratching of the already infected soles. How- 1
Department of Dermatology, University of
ever, within occupational fields little is published
Alabama School of Medicine, Birmingham, AL,
about the ‘‘two feet-one hand syndrome.’’ An
USA
asymmetric increased palmar sweating and a one- 2
Department of Dermatology, University of
sided chronic professional burden of the hands are
Iceland, Reykjavik, Iceland
discussed as predisposing factors for the unilateral 3
Department of Dermatology Utlitslaekning Ehf,
fungal infection.
Kopavogur, Iceland
Objective: To investigate interleukin-8 (IL-8) as a
P28 chemokine for T-lymphocytes and as a marker of
magnitude of contact allergy.
Interleukin-8 from keratinocytes can be used to
Subjects, Materials and Methods: Urushiol, the
test for contact allergy
contact allergen of poison ivy, was applied to
Bolli Bjarnason1–3, H Xu1, CA Elmets1,
1 allergic and anergic volunteers. Suction blisters
Department of Dermatology, University of
of urushiol exposed and non-exposed skin were
Alabama School of Medicine, Birmingham, AL,
produced 48 h later and the fluids were analyzed
USA
2 for chemotactic activity for T-lymphocytes using
Department of Dermatology, University of
modified Boyden chambers. Anti-IL-8-antibodies
Iceland, Reykjavik, Iceland
3 were added to the fluids to investigate their effect
Department of Dermatology Utlitslaekning Ehf,
on the chemotactic activity. IL-8 protein concen-
Kopavogur, Iceland
tration of the fluids was determined by ELISA
Objective: To investigate whether secretion of and its correlation with visible test responses was
interleukin-8 (IL-8) proteins by keratinocytes fol- investigated.
lowing in vitro exposure to a contact allergen can Results: Significant chemotactic activity for
be used to detect contact allergy. T-lymphocytes was only present in blister fluid
Methods: Suction blisters were made on skin of from urushiol exposed skin and only from the
allergic and anergic subjects to urushiol, the con- allergic subjects. The chemotactic activity could
tact allergen of poison ivy. Keratinocyte cultures be neutralized with the anti-IL-8 antibodies.
were prepared and exposed to the allergen in vitro. There was an excellent correlation between the
Controls were the allergen solvent. Variable aller- IL-8 protein concentration in blister fluids and
ABSTRACTS 189
(0.01–1 ı̀M) on nitric oxide (NO) production (by Results: Of patients tested, 62 had at least 1 posi-
the Griess reaction), on nitric oxide synthase type tive allergic reaction, and among these, 44 had
II expression (iNOS) (by immunocytochemistry reactions deemed clinically relevant. Of all the
and western blot) and on the activation of the patients with relevant positive tests, 70.5% (31/
nuclear factor-kappaB pathway (NF-êB) (by 44) reacted only to allergens in the standard tray;
electrophoretic mobility shift assay – EMSA), 11.4% (5/44) reacted to supplementary allergens
pathways that we have previously shown to be exclusively; 4.5% (2/44) reacted to both standard
activated by these sensitizers. and supplementary allergens. Finally, 6 more
Results: NO production induced by Ni was sig- patients (13.6%) reacted to other sensitizers.
nificantly inhibited by DEX in a dose dependent Conclusion: In our study, 15.9% relevant allergies
way. Future studies using 0.5 ı̀M of DEX, showed would have been missed by the standard series
a significant reduction of iNOS expression at 24 h alone. Patch testing an extended standard
induced by both sensitizers. This effect occurred series increased our diagnostic capability, and
in parallel with the inhibition of NF-êB acti- might be a useful screening tool in those
vation, which was most evident at 45 min. dermatology offices where other series are
Conclusions: These results suggest that dexa- lacking.
methasone inhibits intracellular events that are
relevant for DC activation induced by skin sensi-
tizers during antigen presentation. Therefore, P34
besides the anti-inflammatory activity of DEX
Reproducibility of the positive patch test
usually used for the treatment of ACD, this
reactions with the TRUE Test
drug can also interfere with the initial steps of
Charlotte Devantier Jensen1,2,3, KE Andersen1,2,3
skin sensitization. This work was supported by 1
Department of Dermatology, Odense University
FCT (Portugal).
Hospital, Denmark
2
University of Southern Denmark, Odense,
Denmark
P33 3
National Allergy Research Center, Denmark
Patch testing an extended standard series
The patch test results of patients tested at least
Marcos Hervella1, JI Yanguas2, ME Iglesias2,
twice at our clinic during a period of 11 years
M Larrea2, L Cascante1, M Gállego2
1 were analyzed with regard to reproducibility of
Hospital ‘Garcı´a Orcoyen’, Estella (Navarra),
the positive patch test reactions found in the first
Pamplona, Spain
2 patch testing session.
Hospital de Navarra, Pamplona, Spain
A retrospective analysis of 257 patients who have
Objective: To examine the usefulness of the stan- been tested with the TRUE Test at least twice
dard allergen series as a sole tool in the diagnosis between 1991 and 2002 and had a minimum of one
of allergic contact dermatitis and consider the positive reaction in the first testing session was done.
diagnostic benefits yielded by the routine use of Test reactions were read routinely after 3 and 5–7
an extended standard series in general dermato- days.
logy practice. In the first testing session a total of 299 positive
Methods: From January 1, 2003, to December 31, reactions were found. Of these allergens, 151
2003, one hundred patients attended in a general (51%) stayed positive in the second test, 31
dermatology unit were recruited for patch testing. (10%) produced a doubtful reaction, 67 (22%) a
Every patient underwent testing with the standard negative response, and 50 (17%) were not retested
tray recommended by the Spanish Contact Derma- because of strong positive reactions in the first
titis Research Group, and simultaneously, with a test. Of the individual allergens, positive reactions
supplementary series of 35 allergens. Other specific from thiuram-mix, kathon CG and colophony
series were performed in some cases, but their were the most reproducible.
results have been omitted in this study. Patients If it is assumed that allergens which were not
with positive allergic reactions were divided into retested because of strong positive reactions
two groups based on the clinical relevance of their would have shown positive reactions in a retest,
reactions. These groups were subsequently stra- a total of 68% of positive reactions were repro-
tified in four subgroups: (1) reactions only to duced. A multitude of factors, such as: avoidance
allergens in the standard series; (2) reactions only of relevant allergens between tests, diminished
to additional allergens; (3) reactions to both stand- sensitivity, retesting within a period of more or
ard and additional allergens; and (4) reactions to less active dermatitis, different observers, method-
own substances or allergens in other series. ological error, and prior false-positive responses,
ABSTRACTS 191
influence the reproducibility of patch tests. The employing a finer age categorization than pre-
results will be put in perspective. viously used (Uter W et al., Occup. Environ.
Med. 2001; 58: 392–8), additionally adjusting for
P35 ‘‘polysensitization’’, operationalized as the num-
ber of additional positive patch test reactions to
Photo-, phyto- and frostbite- provoked cases of other standard series allergens. The aim was to
contact dermatitis cured with o3 disentangle a possible association between age
Sergey L Krivatkin, EV Krivatkina and contact sensitization in general, and age and
Sormovo Interdistrict Dermatovenereological FM contact allergy in particular. The strongest of
Dispensary, Nizhny Novgorod, Russian Federation all associations observed was to the number of
Objectives: To show cases of contact dermatitis additional positive patch test reactions (‘‘polysen-
(CD) provoked by different factors and possibil- sitization’’; OR for 1 vs. 0 additional reactions:
ity of their treatment with ozone application. 2.7 [95% CI: 2.6–2.9] steadily increasing to OR
Methods: Description of clinical cases: for 4þ vs. 0 additional reactions: 12.8 [11.7–
Patient S., female, 17 years old, came to derma- 13.9]). Independently from this, the well-known
tologist with complaints on erythema and vesic- increase of FM contact allergy with age (OR 1.9
les, sense of burning on the face during two beyond age 60) and higher prevalence in female
weeks. The patient works on the market, expos- patch test patients, but only up to age 60, was
ures by sun. As a result of a talk with the patient, confirmed, however, no decline beyond age 80
new perfume as a possible reason of photoallergic was observed. Moreover, it was found that not
reaction was suspected. The patient was success- health care workers in general, but masseurs/
fully treated by use of ozone therapy: 6 auto- physiotherapists, and, to a lesser extent, geriatric
chemotherapy minor (AHTmin) treatments were nurses have a high risk of FM contact allergy. In
applied. By the end of the course crusts and conclusion, our results confirm the profound
hyperpigmentation only were observed. impact of age, and partially of sex, on FM contact
Patient T., male, 36 years old, suffered from allergy, which makes stratification, standardiza-
erythema and vesicles, itching and sense of burn- tion or adjustment a prerequisite for meaningful
ing on both hands and arms for 3 days. During comparative analyses. The phenomenon of ‘‘poly-
weekend he had contact with cow-parsnip plant. sensitization’’ deserves further attention.
The patient got 5 AHT minor treatments: clinical
recovery was registered. P37
Patient S., 36 years old, frosted his hands two Autoxidation of the fragrance caryophyllene
weeks ago. When he came to dermatologist, forms contact allergens
erythema, vesicles, erosions and crusts on the Anna Börje, M Sköld, M Matura, A-T Karlberg
backs of the hands were observed. Ozone therapy Göteborg University, Göteborg, Sweden
(AHTmin – 5 treatments plus ozonized water
externally) was successfully applied: full recovery This is part of an ongoing effort to investigate how
was registered. autoxidation affects the sensitzing potential of ter-
Summary of results: Different cases of CD were pene-based fragrances. We have previously shown
successfully treated by ozone therapy use. that terpenes such as abeitic acid (diterpene), limo-
Conclusions: CD provoked by different factors nene and linalool (monoterpenes) form stable
can be cured with ozone. hydroperoxides when oxidized. These hydroperox-
ides have proved to be strong allergens. Its there-
fore of special interest to study the connection
P36 between formation of hydroperoxides caused by
autoxidation of fragrance chemicals during hand-
Risk factors of fragrance allergy revisited
ling and storage and an increased allergenic effect.
Wolfgang Uter1, J Geier2, A Schnuch2
1 Objective: To investigate the autoxidation of car-
IMBE, University of Erlangen, Erlangen,
yophyllene (sesquiterpene) and study its effect on
Germany
2 the sensitizing capacity.
IVDK, University of Göttingen, Göttingen,
Methods: Caryophyllene was exposed to air and
Germany
the autoxidation was monitored by GC and
Prompted by a recent publication on contact HPLC. The major oxidation products were isol-
allergy to the fragrance mix (FM) declining with ated and their structure determined. The aller-
age, patch test data of the IVDK (1992–2002, genic activity of pure caryophyllene and its
www.ivdk.org, n ¼ 90824 patients) were subjected oxidation products was investigated in animal
to a multifactorial logistic regression analysis, assays and clinical testing.
192 ABSTRACTS
Result: Only 10% of the staring material improved rules for sensitisation in the expert tox-
remained after 20 weeks of air exposure. The icity prediction system Deductive Estimation of
major oxidation product was caryophyllene Risk from Existing Knowledge (DEREK).
oxide. Substantial amounts of formaldehyde
were found in the oxidation mixture. Little or
no hydroperoxides were detected in the total oxi-
dation mixture. Caryophyllene oxide and oxi- P39
dized caryophyllene showed a low sensitizing
The accuracy of material safety data sheets:
capacity in animals and very few positive reac-
reporting of skin irritants and skin sensitisers
tions at patch testing.
T Keegel1,2, H Saunders1, Rosemary Nixon1
Conclusion: Caryophyllene is easily oxidized 1
Occupational Dermatology Research and
at air exposure. A low allergenic effect is observed
Education Centre, Skin and Cancer Foundation,
in both sensitization studies and clinical
Melbourne, Victoria, Australia
testing. This is consistent with our earlier findings 2
Department of Public Health, University of
that the amount of hydroperoxides is impor-
Melbourne, Melbourne, Victoria, Australia
tant for the allergenic activity of autoxidized
terpenes. Objectives: In Australia the National Occupa-
tional Health and Safety Commission (NOHSC)
requires that manufacturers provide Material
Safety Data Sheets (MSDS) for all hazardous
P38 materials. However the accuracy of MSDS
has not previously been assessed, utilizing the
Quantitative structure activity relationships for
specified NOHSC criteria for hazardous sub-
fragrance aldehydes
stances.
DA Basketter1, Grace Patlewicz1, E Gimenez-
Methods: 100 consecutive product MSDS were
Arnau2, J-P Lepoittevin3
1 collected from workers with potential work-
Unilever Safety and Environmental Assurance
related cutaneous exposure, attending an occupa-
Centre, Sharnbrook, UK
2 tional dermatology clinic. Manufacturers were
Department of Dermatology, Hospital del Mar,
contacted to verify the ingredients of each prod-
Universitat Autònoma, Barcelona, Spain
3 uct. MSDS were evaluated using for skin irri-
Laboratoire de Dermatochimie, Universite Louis
tants and skin sensitisers, and for compliance
Pasteur, Strasbourg, France
with the NOHSC criteria for hazardous sub-
Fragrance substances represent a diverse group of stances (sensitisers present at a concentration
chemicals, some being associated with the ability >¼1%, irritants present at a concentration
to cause allergic skin reactions. In recent work, >¼20%). All sensitisers were checked for clinical
we evaluated two groups of fragrance chemicals, significance (relevant positive patch test result) to
saturated aldehydes (aryl substituted and alipha- the worker’s dermatitis.
tic aldehydes) and ?,?-unsaturated aldehydes. Results: On manufacturer follow-up, 58% of the
QSAR models relating the LLNA EC3 values to MSDS satisfied the NOHSC criteria. However, 3
a measure of the lipophilicity of a chemical (log P) products omitted sensitisers, present at <1%.
and s* (a measure of reactivity) were developed Importantly, one sensitiser was clinically signifi-
for both sets of aldehydes. The outcome was cant. 19% failed to meet the NOHSC criteria. 17
consistent with ?,?-unsaturated aldehydes reacting MSDS omitted sensitisers at >¼1%, two omitted
via Michael addition, whilst saturated aldehydes irritants at >¼1%. Irritants were specified cor-
formed Schiff bases with proteins. In the present rectly in 19/22 cases, whereas sensitisers were spe-
study we evaluated further aldehydes to test the cified correctly in only 30/71 cases (p ¼ 0.0003).
robustness and extend the scope of the QSARs. Non-compliant MSDS may have been as high as
The QSAR models were used to predict EC3 values 42%, as insufficient information to enable assess-
for 4 new Michael addition aldehydes and 6 new ment was provided on manufacturer follow-up
Schiff base formers. LLNA data generated for these regarding the percentage concentration of 1
compounds demonstrated the original QSARs were unlisted irritant and 22 unlisted sensitisers.
fairly accurate but still required improvement. Conclusion: MSDS are significantly inaccurate
Development of the QSAR models has provided with respect to skin sensitisers. Sensitisers and
us with a better understanding of the potential percentage concentration are frequently omitted
mechanisms of action for aldehydes and hence from MSDS, thereby providing inadequate infor-
how to avoid or limit allergy. Knowledge generated mation for the prevention of skin sensitisation for
from this project is being incorporated into new/ workers.
ABSTRACTS 193
different test agents may be inappropriate for dermatitis on the lumbar region, following
assessment of neomycin sulfate patch tests. The repeated applications of a transdermal therapeutic
clinician should only consider assessment scales system (TTS) with flurbiprofen for lumbar pain.
as an aid in the assessment of test responses and Patch testing with the SIDAPA (Italian Society of
be aware that morphology of test responses may Allergological, Occupational and Environmental
differ between test agents and test techniques. Dermatology) standard series, the TTS as is and
the constituents of TTS, including flurbiprofen 2%
pet., isopropyl myristate 5% pet., polysorbate 80
P46 5% pet., sorbitan sesquioleate 20% pet., pepper-
mint oil 2% pet. and menthol 1% pet. gave a
Allergic contact dermatitis to a retarding cream
strong positive reaction to TTS, peppermint oil
in a condom
and menthol and a weak reaction to fragrance
Caterina Foti, D Bonamonte, A Conserva,
mix. Allergic contact dermatitis to peppermint oil
A Antelmi, V Mastrandrea
and its principal constituent (menthol) is rare. Iso-
University of Bari, Department of Internal
lated cases of patients with oral symptoms after
Medicine, Unit of Dermatology, Bari, Italy
the use of mentholated cigarettes, toothpaste
We describe a case of a 42-year-old non atopic flavours and fragrances have been reported.
man with a history of ano-perianal eczema in Peppermint oil and menthol are used in TTS with
consequence of the use of anti-haemorroidal oint- anti-inflammatory activity for their anesthetic
ments and allergic contact dermatitis to Myrox- properties and their vasodilatation effects that aid
ylon pereirae, benzocaine, paraben mix and topical drug penetration. Reapplication of the
paraphenylenediamine. He was referred to our device to the same site, the irritant action of the
Unit for a strong eczematous reaction in the gen- vehicle or adhesive, the length of occlusion, asso-
ital area with a marked oedema of the balanopre- ciated with warm and humid climates, may pro-
puzial region that had appeared some hours after mote sensitization to menthol otherwise rarely a
the use of a condom (Settebello-Hatù1 Durex) cause of contact dermatitis, when used in products
made of natural latex and containing a retarding designed for a brief contact with the oral mucosa.
cream composed with benzocaine 5%, polyethyl- In contact allergies induced by TTS-treatment
ene glycol plus glycerin 94,7% and paraben 0,3% patch tests are needed to make a precise identifica-
as preservative. The suspension of the use of the tion of the causative agent.
condom and treatment with a corticosteroid
cream healed the eruption in few days. Patch
testing with the SIDAPA (Società Italiana di Der- P48
matologia Allergologica, Professionale e Ambien-
Actual risk of contact dermatitis in hairdressers
tale) standard series, an additional rubber series,
Luis Conde-Salazar, R Valks
a piece of the rubber’s condom washed clean of
Instituto Nacional de Medicina y Seguridad del
cream and the condom’s cream gave positive
Trabajo, Madrid, Spain
reactions to Myroxylon pereirae, benzocaine, para-
ben mix, paraphenylenediamine and condom’s In order to know the actual risk of contact der-
cream. Further patch test with the other ingredients matitis in hairdressers, we studied, from 1994 to
of condom’s cream was negative as well as latex 2003, 300 hairdressers of a total of 7510 patients
prick test. We discuss about the ethiologic agents seen in our Department of occupational skin dis-
and the most useful diagnostic test in allergic eases. Most of them were women (93%) with a
contact dermatitis condom-related and the preven- mean age of 23.7 years. A positive patch test
tive measures that should be adopted. response to one or more of the allergens tested
was presented by 215 patients (71.7%). Occupa-
tional allergic contact dermatitis was diagnosed in
P47 174 cases (58%). The most frequent sensitizations
showed by positive patch test response were to:
Contact dermatitis to peppermint and menthol in
PPD (54.3%), 4-aminobenzene (40.7%),
a transdermal therapeutic system
nickel (36.7%), disperse orange (17%),
Cataria Foti, A Conserva, A Antelmi, L Lospalluti,
p-toluene-diamine (15.3%), ammonium persul-
G Angelini
fate (14.3%), aminophenoles (14.0%), acid thio-
University of Bari, Department of Internal
glycolic (12.7%) and kathon (10.3%). Irritant
Medicine, Unit of Dermatology, Bari, Italy
contact dermatitis (20%), no occupational
A 60-year-old non atopic was referred to our Unit allergic contact dermatitis (5.3%), atopic derma-
due to the onset of severe eczematous contact titis (6.7%) were some of the other diagnoses
196 ABSTRACTS
1
between the hairdressers. We compare these results Occupational Dermatology, National Institute for
with those of a previous study of 379 hairdressers Working Life, Stockholm, Sweden
2
who attended our department from 1980 to 1993, Occupational and Environmental Dermatology,
in order to evaluate the effects of the changes in the Stockholm County Council and Karolinska
substances and techniques used in hairdressing and Institute, Stockholm, Sweden
the occupational education in the risk of sensitization
Objective: To assess occupational dermal expos-
in this trade.
ure to permanent hair dyes in hairdressers.
Methods: Dermal exposure was assessed in 31 hair-
dressers using a previously evaluated method, hand
P49 wash sampling with bag rinsing. The measurements
Occupational dermatoses of machinists – were performed in hairdressing saloons during
Finnish statistics working hours. Hand wash samples were collected
Katri Maria Suuronen, K Alanko, T Tuomi, from each hand before start of the hair dyeing
R Jolanki process, after application of the hair dye and after
Finnish Institute of Occupational Health, Dept. cutting the newly dyed hair. 13 of the hairdressers
Occupational Medicine, Helsinki, Finland did not use gloves during application of the hair dye,
and during cutting of the dyed hair no one used
Objective: In this study the statistical data on gloves. The samples were analysed for aromatic
occupational dermatoses of Finnish machinists amines and resorcinol using an HPLC-method.
in 1992–2001 were analysed. Results: After application of the hair dye PPD
Methods: The data were collected from the Fin- (p-phenylenediamine) was found in samples
nish Register of Occupational Diseases (FROD) to from 1 hairdressers (148–185 nmol/hand), TDA
which physicians are obligated to report all cases (toluenediamine) in samples from 12 hairdressers
of occupational disease. Each case record consists (range 10–735 nmol/hand) and resorcinol in 22
of information on the patient and the employer, individuals (range 19–769 nmol/hand). In the
date and diagnosis, causative agents, etc. samples taken after cutting the dyed hair PPD
Results: During the 10-year period, a total of 281 was found in 2 hairdressers (range 36–358 nmol/
occupational dermatoses of machinists were diag- hand), TDA in 14 (range 8–361 nmol/hand) and
nosed. Dermatoses consisted mostly of irritant resorcinol in 20 (range 10–725 nmol/hand.
contact dermatitis (N ¼ 144), allergic contact Conclusion: Skin exposure to aromatic amines
dermatitis (N ¼ 108) and unspecified contact and resorcinol was detected in more than half of
dermatitis (N ¼ 21). Only few cases of protein the hairdressers after application of hair dye and
contact dermatitis and contact urticaria as well also after cutting newly dyed hair. To reduce
as occupational acne were reported. The main exposure improved skin protection is important.
causes of irritant contact dermatitis were cutting
oils and fluids, oils and lubricants, and organic
solvents; the commonest inducers of allergic con-
tact dermatitis were formaldehyde, cutting oils P51
and fluids, metals (nickel, chromium and cobalt) Occupational contact dermatitis among
and various antimicrobial agents. operating room nurses
Conclusion: Dermatoses were the second com- Laura Stoskute, R Dubakiene, E Glumbakaite
monest occupational diseases of machinists, after Vilnius University Hospital Santariskiu Klinikos,
hearing loss, and they accounted for 27% of all Vilnius, Lithuania
occupational diseases within the profession.
Machinists are a large occupational group (about Background: Occupation related dermatitis is a
19 000 employees; 0.8% of the work force) in common problem in health care workers, especially
Finland, and their dermatoses formed a noteworthy in nurses, who are exposed to a wide variety of
proportion (about 2.6%) of the occupational skin allergenic and irritant substances. The aim of this
diseases reported during the study period. study was to assess the prevalence rate of skin
symptoms among personnel handling chemical dis-
infectants and to examine which allergens were
important.
P50
Methods: We investigated 460 randomly
Occupational dermal exposure to permanent selected health care workers (HCW), who had
hair dyes in hairdressers constant contact with chemical disinfectants
Marie-Louise Lind1, A Boman2, J Sollenberg2, during their work. The study was performed
S Johnsson2, G Hagelthorn2, B Meding1 by means of a questionnaire, a medical exam-
ABSTRACTS 197
ination, skin patch test using Finn chambers the right hand palm. In our patients, all the
and glutaraldehyde, benzalkonium chloride, epicutaneous tests were negative or without rele-
hydrogen peroxide and chlorine compounds at vance, suggesting a mechanical cause to the
0,1, 0,5 and 1,0% wat. occupational dermatitis presented.
Results: 241 HCW (52,5%) described various skin Comments: Products used in the fabrication of ABS
symptoms they attributed to disinfectant exposure. plastics, employed to make personal computers
Generally, these symptoms were mild and ranged mouse, such as ftalates, cobalt salts and resorcinol
from pruritis to hand eczema. Of these 66 (14,4%) monobenzoate have been described as possible
tested were skin patch test positive. Of the 460 allergens. However, concentration of these allergens
HCW tested, 37 (8%) had positive patch test reac- is too small to ensure a causal relationship. Pressure
tions to benzalkonium chloride, 22 (4,8%) to or an excessive sweating could facilitate these react-
chlorine compounds, 18 (4% ) to glutaraldehyde, ions. Wide use of informatics nowadays obliges us
6 (1,2%) to hydrogen peroxide. 5 HCW (7,6%) to consider those factors in patients presenting
testing positive to disinfectants gave no history of chronic dermatoses in their hands. Furthermore,
reactivity to them. History of atopic dermatitis better ergonomics in work places could prevent
was found in 50 (10,9%) and it was associated this kind of occupational dermatitis.
with diagnosis of allergic contact dermatitis and
positive patch test reactions to benzalkonium
chloride. Also positive patch tests reactions were P53
associated with frequent use of latex gloves in
Hand contact dermatitis in jewellwery 2 cases
contrast to those, which used latex gloves while
Sabrina Sanchez-Politta, P Piletta
working constantly or didn’t use them at all.
Department of Dermatology and Venerology,
Conclusions: 1. Skin symptoms related to work
HUG, Geneva, Switzerland
with chemical disinfectants are common, but mostly
mild. 2. Benzalkonium chloride is one of the stron- The production of jewellery is currently mostly
gest sensitizing disinfectants used in health care pro- industrial and the jewellers perform only one or
fessions, especially for atopic persons who do not two stages in the manufacturing process. The jew-
take measures of protection during exposure to it. ellers make jewellery by hand in small workshops
and are more polyvalent: they shape the metal with
pliers or hand tools or cast it in moulds, assemble
P52 the individual parts with glues, carve metal, dia-
monds and other stones, clean metals with soaps
Contact dermatitis due to computer’s mouse
and ultrasonic baths. The occupational dermatitis
Virginia Fernandez-Redondo, O Suarez Amor,
is of irritant nature (acid and alkalis in metal
J Toribio
cleaners, soaps, detergents, metal dust, abrasions
Hospital Gil Casares, Servicio Dermatologı´a,
from polishing wheels and emery paper, heat,
Santiago de Compostello, Spain
adhesives, etc) and allergic nature (potassium
Background: Introduction of informatics has dichromate, 2-mercaptobenzothiazole, ammo-
facilitated the apparition of lesions affecting the niated mercury, carba mix, epoxy resin, mercapto
hand responsible of mouse movement. Different mix, formaldehyde, nickel, colophony). We report
cases of contact dermatitis related to the use of the cases of two jewellers working in workshops.
personal computers have been published in the A 47 year old atopic woman already known for
last years and two new morphologic patterns within a sensitivity to metals (nickel, potassium dichro-
cutaneous pathology affecting hands have been mate and cobalt) developed recurrent vesiculo-
described in direct relationship with professional pustular erythematous lesions of both palms
occupation, named generally ‘‘computer fingers’’ with occasional infections treated with systemic
and ‘‘computer palms’’. antibiotics and topical steroids. Patch tests were
Case report: We present a 7-patient series pre- performed for the European standard series,
senting lesions suggesting contact dermatitis woods, and personal series. There were posi-
after continued use (min 8 hours/day) of perso- tive þ reactions at 96 h to colophony, palladium,
nal computer from a total of 700 patients and personal waxes. Information obtained
revised. Patch tests including standard series of through the manufacturer revealed colophony in
the GEIDC, series for plastics and glues and the waxes frequently used by jewellers to fix the
others related to specific details of each patient precious stones to woods and metal allowing the
were performed in all cases. Six of our patients stones to be carved. A 47 years old atopic man
presented lesions in the 2, 3 and 4 fingers of the working as a jeweller for 32 years developed
right hand while the other one was affected in recurrent eczematous lesions of the fingers of the
198 ABSTRACTS
right hand. Patch tests were performed for the Signs of hand eczema reported in the question-
European standard series, preservatives, plastics, naire based on any occasion during the last 12
acrylates and personals series and were posi- months: desquamation in 18%; erythema in 17%;
tive þ þ at 96 h for urea formaldehyde, diethylene- fissures in 22%; infiltration in 11%; vesicles in 15%.
triamine, araldite hardener and the soap used to False negative self-reporting by the question-
clean the jewels. Uncommonly this contact naire: desquamation in 26%; erythema in 18%;
allergy is not due to the epoxy resins themselves fissures in 14%; infiltration in 11%; vesicles in 3%.
but to the hardener. The urea formaldehyde and False positive self-reporting by the question-
the diethylenetriamine are in fact used as epoxy naire: desquamation in 5%; erythema in 10%;
resins hardeners. There were no reactions to the fissures in 10%; infiltration in 8%; vesicles in 11%.
araldite resin but there was one to its hardener. Conclusions: Desquamation and erythema were
In conclusion we report two unusual cases of the most common signs both in clinical examin-
hand contact dermatitis in jewellers. Because ation and in questionnaire. The self-reported pre-
jewellers are exposed to a variety of substances, valence (both current and over the last 12
to detect the allergens the inquiry must be accu- months) of erythema and desquamation is an
rate and extensive patch testing may be required. underestimation of the true prevalence. Scoring
Common allergens are compounds of uncommon hand eczema revealed that most of the employees
substances and tools and uncommon allergens are scored one or two points; indicating that most of
compounds of well-known sensitizers. the clinical signs of hand eczema are minor. False
negative self-reporting by questionnaire was high;
indicating that these minor symptoms of hand
P54 eczema were probably not recognized by the
employees. False positive self-reporting was also
Prevalence of skin changes in the cleaning
high; probably because they misunderstood the
industry
questions. This study illustrates the need for a
Marie-Louise Anna Schuttelaar, PJ Coenraads
consensus about the distinction between ‘‘minor
Department of Dermatology, Groningen
skin damage’’ and ‘‘true eczema’’.
University Hospital, Groningen, The Netherlands
Background: In the cleaning industry, the hands
are exposed to water and irritants, resulting in dry Reference
skin and hand eczema. The prevalence and sever- 1. Rosèn K, Mobacken H, Swanbeck G. Chronic eczematous
dermatitis of the hands: a comparison of PUVA and UVB
ity of skin changes is unknown. treatment. Acta Derm Venereol 1987;67(1):48–54.
Objectives: To quantify the prevalence and the
severity of skin changes of the hands. To compare
questionnaire-based self-reported signs of hand P55
eczema (both current and at any occasion during
Nordic Occupational Skin Questionnaire (NOSQ-
the last 12 months), with skin changes revealed by
2002)
clinical examination.
Mari-Ann Flyvholm1, P Susitaival2, B Meding3,
Methods: A random sample of 231 employees in
L Kanerva4, M Lindberg5, Å Svensson6,
the cleaning industry participated in the study.
JH Ólafsson7
Most of them were immigrants. They had to 1
National Institute of Occupational Health,
answer a (translated) questionnaire about signs
Denmark
of hand eczema. Then all of them were examined 2
Department of Dermatology, North Karelia
and the severity of hand eczema was graded by a
Central Hospital, Joensuu, Finland
scoring system1. In the comparison only objective 3
National Institute for Working Life, Stockholm,
subvariables (desquamation, erythema, fissures,
Sweden
infiltration, vesicles) were used. 4
Finnish Institute of Occupational Health,
Results: Clinical examination of the hands
Helsinki, Finland
detected desquamation in 38%; erythema in 29%; 5
Occupational & Environmental Dermatology,
fissures in 24%; infiltration in 12%; vesicles in 4%.
Stockholm County Council, Stockholm, Sweden
Severity scoring of hand eczema: one point in 6
Department of Dermatology, Malmö University
21%; two points in 18%; three points in 9%; four
Hospital, Malmö, Sweden
points in 4%. 7
Department of Dermatology, Landspitali,
Signs of hand eczema reported in the question-
University Hospital, Reykjavik, Iceland
naire based on the current situation: desquama-
tion in 17%; erythema in 20%; fissures in 20%; Questionnaire-tools for surveying occupational
infiltration in 10%; vesicles in 12%. skin diseases and exposure are needed for com-
ABSTRACTS 199
parable epidemiological research, workplace were negative, with the exception of D. farinae
assessments, and evaluation of workplace inter- (3 mm). The prick-to-prick test was positive for
ventions. The Nordic Occupational Skin Ques- shiitake gill (3 mm), shiitake stalk (3 mm) and dry
tionnaire Group supported by the Nordic shiitake (8 mm ps). The histamine wheal was
Council of Ministers has developed a standard- 5–7 mm. Control prick tests with shiitake on 5 non-
ized questionnaire-tool for surveys on work-related exposed subjects were negative. An open test was
skin diseases and skin exposures to environmental performed with shiitake on the flexor side of the
factors. upper arm. Within 20 minutes a positive reaction
Nordic Occupational Skin Questionnaire appeared comprising two wheals and flare reac-
(NOSQ-2002) includes two questionnaires tions. Patch test with shiitake gave a strong toxic
designed for separate purposes. NOSQ-2002/ reaction in 2 days, which continued to diminish on
short is a 4-page questionnaire for screening skin days 3 and 4. Conclusion: Contact urticaria is the
problems at workplaces. NOSQ-2002/long is an clinical skin symptom of immediate allergy, but
in-depth survey tool for research purposes. The repeated exposure may lead to protein contact
questionnaire covers occupational history, atopic dermatitis. However, our patient has not had
symptoms, self-reported hand or forearm eczema, urticaria symptoms from shiitake, although the
exacerbating factors, consequences and life prick-to-prick and open tests were positive. To
impact of dermatoses, self-reported contact urti- our knowledge, this is the first report of protein
caria on hands or forearms, skin symptoms, skin contact dermatitis from shiitake in a patient with a
tests, exposures, and protective glove use. For the positive immediate skin reaction and negative
time being, NOSQ-2002 is available in English, patch test result.
Danish, Swedish, Finnish and Icelandic. Further
translations are welcomed.
The NOSQ-2002 report includes a review of
pertinent literature on questionnaire methods for P57
skin disease studies. Questions on work and expos-
Allergic contact dermatitis to compositae mix in
ure can be tailored to specific populations or
children
occupational groups, according to the instructions
Anna Belloni Fortina1, I Romano1, F Marciani
and recommendations given in NOSQ-2002/INFO
Magno2, A Peserico2, F Zacchello1
version of the questionnaire. 1
Pediatric Department, University of Padua,
The NOSQ-2002 questionnaire files can be
Padua, italy
downloaded from www.ami.dk/NOSQ. The 2
Institute of Dermatology, University of Padua,
Nordic Council of Ministers has the copyright to
Padua, Italy
the NOSQ-2002 questionnaires. Use of the ques-
tionnaires is free of charge. The NOSQ-2002 ques- Background and aim: Recent studies have
tionnaires and their present and possible future demonstrated that contact sensitization to Com-
translations cannot be used commercially. positae is not uncommon in adults. However, to
our knowledge, no data are available in children.
Our purpose was to investigate the prevalence of
contact sensitization to Compositae in a pediatric
P56 population.
Methods: 434 consecutive pediatric patients (205
Occupational protein contact dermatitis from
M; 229 F; mean age 6,7,,b3,4 years) with suspected
shiitake mushrooms
allergic contact dermatitis were patch tested with
Renata Kaminska, K Aalto-Korte, K Alanko
30 haptens comprising Composite mix 5% (Tena-
Section of Dermatology, Institute of Occupational
cetum volgare, Arnica montana, Partenolide,
Health, Helsinki, Finland
Chamomilla recutitia, Achillea millefolium) at the
Case report: A 54-year-old woman, with no Dermatology Unit of the Department of Pediatrics
family or personal history of atopy, developed in Padua.
skin symptoms and cough after she had been Results: 11 patients (7 M; 4 F; mean age 5,6,,b2,8
cultivating shiitake mushrooms for 12 months. years) had a positive patch test reaction to Com-
The patient reported dermatitis on the backs of positae mix. In all these patients dermatitis was
her hands, fingers and on her wrists, after 1 or 2 localized on the face and/or on the hands. Most
days of being in contact with shiitake mush- of them had more than one positive reaction. 6 were
rooms. The skin lesions and cough disappeared affected by atopic dermatitis, 2 had a personal
entirely during the holidays. Result: Prick tests to history of mucosal atopy and one had both. In
common inhalant allergens, molds and flours 8 patients (5 with atopic dermatitis, 2 with mucosal
200 ABSTRACTS
atopy) the reaction was considered clinically series contained Sesquiterpene-lactone mix (SL
relevant. mix) since 1993 (3/1998–10/1999 excluded) and
Conclusion: It might be useful to add Compositae Compositae mix since 3/1998. We present the
mix to the pediatric screening series, when inves- cases where either SL mix or Compositae mix
tigating dermatitis of air-exposed areas in chil- gave an allergic reaction and where, in addition,
dren with atopic diseases. the series of plant extracts was tested.
Results: SL mix and Compositae mix were tested
to 900 patients. Among them, plant extracts were
P58 tested in 122 and plant chemicals in 104 cases. 30
Multisensitization to plants: clinical case
patients had an allergic reaction to Compositae
António Luı´s Santos1,2, AP Cunha1,3, mix and 17 to SL mix as well. In the plant extract
AM Barros1,3, MA Barros1 series, there were more than 5 allergic reactions to
1
Hospital S. João do Porto, Oporto, Portugal feverfew(21), true chamomile(21), arnica(18),
2
Escola de Cieˆncias da Saúde da Universidade chrysanthemum(18), laurel bay leaf(13),
do Minho, Minho, Portugal tansy(12), gaillardia(9), yarrow(8) and pot mari-
3
Faculdade de Medicina do Porto, Porto, gold(7). In the plant chemical series, there were 9
Portugal allergic reactions to parthenolide and single reac-
tions to primin, chlorophorin and Mansonone A.
We observed a 65 years old male patient with Conclusions: Compositae mix gave a positive test
pruritus, scaling erythema and liquenification reaction always together with SL mix, which
areas on the face, neck, forearms and hands. gave a positive reaction in only part of these
For six years he had a story of episodic crisis of cases. The concentration of Compositae mix
exsudative erythema associated with farm work. was lowered from 6% to 3% in 1/1999 because
The skin biopsy showed irregular acantosis with of cases of active sensitisation. The lower con-
slight hyperkeratosis and a mild multifocal centration seems to be reliable for detecting
lymphohistiocytic infiltrate, with many eosinophils. allergy, although it still causes active sensitisa-
The patch tests with the Contact Dermatitis tion.
Portuguese Group of Study standard tray were
positive for colophony, perfume mix and lactone
mix. The patch tests with plant series were positive
to atranorin, usnic acid, alantolactone, Parthen- P60
olide, lichen mix, Frulania dilatata, Achillea
millefolium and Tanacetum extracts. Treatment Permeability of gloves to plant allergens
was started with oral prednisone and hydroxyzine Margarida Gonçalo, R Mascarenhas, R Vieira,
plus topical hydrocortisone and emollient cream A Figueiredo
with great improvement. The patient was advised Hospital da Universidade, Clinica de Dermatologia
about the avoidance of possible allergens sources. Coimbra, Portugal
This kind of multisensitization to plants is an Objective: Study permeability of gloves to plant
uncommon finding and poses diagnostic and ther- allergens, therefore evaluating glove efficacy for
apeutic problems. This patient had a sustained hand protection.
recovery by avoiding farm work and by removal Material and methods: We studied 20 female
of in house plants. patients (aged 21–71; mean 45,1 years) with
ACD from plants, 10 allergic to diallyl disulfide
(DAD) from Allium sativa, 8 allergic to alpha-
methylene-gama-butyrolactone (AMGBL) from
P59 Alstroemeria ligtu and 2 allergic to primin from
Primula obconica. Patch testing was performed
Patch test results to plant extracts and
applying the allergens, for 24 or 48 h, directly on
chemicals
the skin and over fragments of different gloves:
Kristiina Alanko, R Jolanki
domestic rubber gloves (RG), nitrile latex gloves
Finnish Institute of Occupational Health,
(NG), vinyl gloves (VG), surgical latex gloves
Helksinki, Finland
(LG) and polyethylene gloves (PG).
Objective and methods: We review patch test Results: VG, PG or LG gloves offered no protec-
results from two special patch test series for tion for these 3 allergens. With RG and NG
plant allergens, ‘plant extracts’ and ‘allergenic gloves, DAD reactivity was abolished or signifi-
plant chemicals’, provided by Prof. Hausen cantly reduced, respectively, in 5 and 7 cases.
(Germany) and tested in 1992–2003. The standard Reactivity to AMGBL wasn’t abolished by any
ABSTRACTS 201
glove material. NG abolished skin reactivity to cidylether (PTBPGE) occured in 9 patients, while
primin; RG was efficacious only in 1 patient. 5 patients reacted to PGE without reaction to
Conclusions: Advising gloves in patients with PTBPGE and 6 patients vice versa.
ACD from plants is difficult, as allergen perme- Conclusions: Immunological cross sensitization as
ability through gloves associated with occlusion well as frequent concomitant exposure to
may intensify the dermatitis, as occurred during DGEBA and DGEBF epoxy resins is well
skin testing. Nitrile latex gloves may protect from known. Our data support testing a DGEBA
primin and garlic dermatitis, whereas they are not resin as an indicator. HDDGE might serve as an
helpful for manipulating Alstroemeria. Although indicator allergen for BDDGE; however, the
exposure time in this study is higher than in real sample size is too small yet to make a final deci-
life, results show interesting data on glove perme- sion. PGE obviously is a valuable tool to detect
ability to these plant allergens and support our sensitization to CGE, but not to PTBPGE.
patients’ complaints that gloves didn’t protect
them.
P62
Methacrylates in dental restorative materials
Maj-Len Henriks-Eckerman, KM Suuronen,
P61 R Jolanki, K Alanko
Finnish Institute of Occupational Health, Finland
EPOX 2002: concomitant sensitizations to epoxy
resin components Commercial dental restorative materials were ana-
Johannes Geier1, H Lessmann1, U Jappe2, lysed in order to get information about the occur-
U Hillen3, W Uter4, A Schnuch1 rence and amounts of sensitizing acrylates and
1
IVDK, University of Göttingen, Göttingen, methacrylates. The analytical results were compared
Germany to information given in the safety data sheets.
2
Department of Dermatology, University of Acetone soluble methacrylates of seven bonding
Heidelberg, Heidelberg, Germany materials, eight composite resins and two glass
3
Department of Dermatology, University of Essen, ionomers were identified by gas chromatography
Essen, Germany with mass selective detection and quantified by
4
Department of Medical Informatics, Biometry liquid chromatography with UV detection.
and Epidemiology, University of Erlangen/ The most frequently occurring methacrylates in
Nuremberg, Erlangen, Germany the bonding materials were 2-hydroxyethyl-
metharylate (2-HEMA) in the concentration
Objective: The study EPOX 2002 is performed to
range 0.3–28% and 2,2-bis(4-(2-hydroxy-3-meth-
detect the most frequent allergens in epoxy resin
acryloxypropoxy)phenyl)-propane (bisGMA) in
systems (ES) currently in use. In particular, con-
the concentration range 21–40%. BisGMA and
comitant test reactions are analysed to identify
triethyleneglycol dimethacrylate (TEGDMA)
possible ‘indicator’ allergens for a future ES test
were the most frequently occurring methacrylates
series.
in composite resins. Their concentration ranges
Methods: Multicenter study within the German
were 5.8–21% and 3.2–6.7% respectively. The
Contact Dermatitis Research Group (DKG) and
main methacrylate of the two glass ionomers
the Information Network of Departments of
was 2-HEMA (23%) or trimethylolpropane
Dermatology (IVDK) with 27 ES components.
trimethacrylate (TMPTMA, 9%).
Results: From Oct. 2002 to Nov. 2003, 120
Information about methacrylates was given
patients have been tested with the preliminary
in the safety data sheets for about half of the
ES series. Of the 49 patients reacting to epoxy
products that according to the analysis results
resin based on diglycidylether of bisphenol F
contained methacrylates. Safety data sheets need
(DGEBF), 44 also reacted to the standard epoxy
to be improved so that the health risks for
resin based on diglycidylether of bisphenol A
dental personnel can be reliably asessed and
(DGEBA), i.e., 90% (95%-CI [confidence inter-
controlled.
val]: 78%-97%).
Out of 21 patients positive to 1,4-butanediol
diglycidylether (BDDGE), 18 also reacted to
1,6-hexanediol diglycidylether (HDDGE) (86%;
P63
95%-CI: 64%-97%). All 8 patients with allergic
reaction to cresyl glycidylether (CGE) also Prevention of occupational dermatitis in the
reacted to phenyl glycidylether (PGE). Concomi- digital age: www.2hands.ch
tant reactions to PGE and p-tert butylphenyl gly- Daniel Perrenoud 1, T Gogniat 2, Q-V Tran 3
202 ABSTRACTS
1
CHUV, Department of Dermatology, and Hispano Hospital, between 1999 and 2003, 804
Institute for Occupational Health, Lausanne, patients were observed with suspicion of contact
Switzerland dermatitis. In 9,3% there was a history of recur-
2
Designer, La Chaux-de-Fonds, Switzerland rent foot dermatitis. All these patients were patch
3
Web designer, La Chaux-de-Fonds, Switzerland tested with GPEDC standard and shoe series and
shoe fragments.
In 1998 we began to develop multi-lingual edu-
Results: Twenty-five patients revealed shoe con-
cational material for apprentice schools. This
tact dermatitis with positive reactions to the series
material was highly graphical, consisting of over-
tested, with an average age of 40 years. The
heads with explanatory notes. The kit also
dermatitis involved the dorsal aspect of the foot
included clinical slides, an introductory videotape,
in 20 patients and the volar aspect in 8, the lateral
and handcream samples. By early 2000, 300 kits
aspects in 4, typically sparing the instep and flex-
had been distributed to teachers of apprentices all
ural creases of the toes. The most common aller-
over Switzerland. Teachers rapidly embraced the
gen were para-tertiary-butylphenol formaldehyde
kit thanks to its simplicity and ease of use. Feed-
resin – PTBFR (12 patients-48%), mercapto mix
back was also gratifyingly high among those out-
(7 patients-28%), potassium dichromate (24%),
side teachers per se: health professionals, safety
mercaptobenzothiazole (24%).
engineers and others involved in prevention, even
Conclusions: The most common causes of shoe
outside Switzerland.
contact dermatitis were glues, followed by rubber
By 2004, however, we had made a total para-
components and chromated leather. As in other
digm shift: kits were out, the Internet was in. The
studies the most common allergen in shoe derma-
advantages were obvious, both in quantity and in
titis in Portugal is PTBFR in neoprene adhesives.
quality. We could reach more people and we
Rubber components (accelerators) were the
could reach them better. When we made 300 kits
second more frequent allergen in this study, prob-
our budget reached its limit, but with the virtually
ably a direct result of improved fixation of
free Internet, using only one highly developed
chrome and a change in footwear style and
digital course, we can now reach a potentially
chrome sensitivity explains leather allergy. Other
limitless audience. Moreover, we can refine,
causes of foot contact dermatitis are iatrogenic
update and amend our material continuously.
complication, clothing (socks), cosmetics, adhe-
Our main course includes defining and prevent-
sive tape and professional etiology.
ing contact dermatitis, defining the special
requirements of such varied users as hairdressers,
bricklayers and machinists. It also shows how to
avoid misuse of protective gloves. The course still
P65
involves an intense use of graphics, but they were
redrawn from scratch for the Internet to maxi- Patch testing to plastics in Sheffield
mize simplicity, immediacy and elegance. Adam Ferguson, DJ Gawkrodger
Conclusions: The risk of hand eczema is more Royal Hallamshire Hospital, Department of
than doubled in dental technicians. The work Dermatology, Sheffield, UK
involves frequent and unprotected exposure to
We reviewed our experience patch testing to plastics
acrylates and wet work. Education regarding
at the Royal Hallamshire Hospital in Sheffield, Eng-
skin protection is important.
land. The department’s electronic database was
searched from June 2002 to December 2003. In
total 434 patients where patch tested to the British
P64 Standard Series. All positive reactions to epoxy
resin and p-tert-Butylphenol-Formaldehyde resin
Shoe contact dermatitis
(PTBF)where recorded. 28 of the patients tested to
Ofe´lia Pereira, A Araújo, S Ribeira, J Rozeira
the Standard Series where also tested to an extended
Pedro Hispano Hospital, Matosinhos, Portugal
Plastics Series and again positive reactions where
Because of its numerous etiologies, foot derma- recorded. Type-4 mediated hypersensitivity reac-
titis can be difficult to diagnose despite of thorough tions where seen in, 3 men secondary to epoxy
history and physical examination. The differential resin, 2 men secondary to PTBF and in 1 women
diagnoses are challenging and include allergic secondary to triethylene glycol acrylate. No irritant
contact dermatitis, dyshidrosis, juvenile plantar reactions where recorded. Epoxy resin was thought
dermatosis, atopic dermatitis, lichen planus. to be the cause of an occupational allergic hand
Methods: In the Cutaneous Allergology Unit of dermatitis in 2 of the men. The positive reactions
the Department of Dermatovenereology of Pedro in the other patients where felt not to be of current
ABSTRACTS 203
relevance to their dermatitis. Allergic contact with occupational CD from glues, epoxy resin com-
dermatitis to plastic appears to be rare in ponents being the most important allergens.
patients attending for patch testing in Sheffield. In
particular the frequency of reactions to epoxy resin,
a potent sensitizer, is less than 1%. This is perhaps
surprising as Sheffield is a large industrial city
where exposure to epoxy resins is likely to be P67
common. Hopefully this reflects safe workin Hand eczema, skin exposure and glove use in
practices in Sheffield. dental technicians
Birgitta Meding1, S Hosseiny2, K Wrangsjö3,
E Andersson4, S Hagberg4, K Wass4, K Tore´n4,
J Brisman4
1
Occupational Dermatology, National Institute for
P66 Working Life, Stockholm, Sweden
2
Occupational contact dermatitis from glues Department of Dermatology, County Hospital,
Uwe Hillen1, J Geier2 Gävle-Sandviken, Sweden
1 3
Department of Dermatology, University of Essen, Occupational and Environmental Dermatology,
Essen, Germany Stockholm County Council and Karolinska
2
Department of Dermatology, University of Institutet, Stockholm, Sweden
4
Göttingen, Göttingen, Germany Department of Occupational and Environmental
Medicine, Sahlgrenska University Hospital,
Objective: Exposure to adhesives and glues is Göteborg, Sweden
common in occupation. We here analyse the
data of patients with suspected contact dermatitis Aims: To estimate the incidence of hand eczema
(CD) from glues recorded within the Information in dental technicians and to elucidate occupa-
Network of Departments of Dermatology tional risk factors.
(IVDK). Methods: This was a retrospective cohort study
Methods: Data recorded between 1996 and 2001 among former dental technician students (n ¼
within the IVDK were searched for patients who 2139). Controls comprised population controls
underwent patch testing because of suspected (n ¼ 2288) with similar distribution of age and
contact dermatitis from glues. sex as the dental technicians. A mail question-
Results: Overall data of 829 patients were found, naire asked for occurrence of hand eczema
among them 336 with occupational skin disease. including age of onset, occupational exposure
Allergic CD was diagnosed in 171/336 patients and use of protective gloves. The response rate
(50.9%), irritant CD in 24.7%. CD was mostly was 58% (1210 dental technicians and 1316 con-
localized on the hands (72.6%), followed by the trols answered the questionnaire).
face (13.4%) and arms (3.9%). By far the most Results: In dental technicians the incidence of
common cause of an allergic patch-test reaction hand eczema was 7.1 cases/1000 person years in
was epoxy resin (EP): 18.2% (age- and sex- males and 10.8 in females during acrylate-exposed
standardized proportion of sensitization) reacted time. In controls the incidence of hand eczema
to the standard EP based on diglycidylether of was 3.1 in males and 3.7 in females. The relative
bisphenol A. reactive diluents and hardeners risk (RR) for males was 2.3 (95% CI 1.6–3.4) and
which elicited a positive patch-test reaction in for females 2.9 (95% CI 2.1–4.0). 48% of the dental
> 5% of the patients were phenyl glycidylether technicians and 30% of the controls reported more
and 4,40 diamino diphenylmethane respectively. than 10 hand-washings/day (p < 0.001). 80% of the
Cresyl glycidylether was positive in 4.9%. dental technicians reported skin exposure to
(Meth-)acrylates which showed an allergic uncured acrylates, 14% daily. 87% had skin contact
patch-test reaction in >¼ 5% of the patients with grinding dust from acrylates, 42% daily. 38%
were 2-hydroxypropyl methacrylate, hydro- used protective gloves when handling uncured acry-
xyethyl acrylate, 2-hydroxyethyl methacrylate, lates, males 29%, females 48% (p < 0.001). 58%
ethyleneglycol dimethacrylate, BIS GMA and did not know for how long the normally used
triethyleneglycol dimethacrylate. Colophony gloves protected the skin against uncured acrylates.
was positive in 8.3% and p-tert-butylphenol Conclusions: The risk of hand eczema is more
formaldehyde resin in 4.1% of the patients than doubled in dental technicians. The work
respectively. involves frequent and unprotected exposure to
Conclusion: In our collective allergic CD was nearly acrylates and wet work. Education regarding
2-fold more frequent than irritant CD in patients skin protection is important.
204 ABSTRACTS
of the contact hypersensitivity response as meas- isation hazards (a sensitiser is a chemical that
ured by the laser Doppler perfusion imaging (LDPI) induces a stimulation index 3 or more times that
technique was associated with immunological para- of the concurrent vehicle control). The LLNA has
meters implicated in the pathogenesis of the disease. also been used to determine the potency of sensi-
Methods: Urushiol was applied on one of the tisers, by derivation of an EC3 value, the estimated
forearms of volunteers for 48 hours while the concentration of chemical required to induce a
other forearm served as a control. Twenty-four stimulation index of 3. At present, various
hours later, measurements of perfusion of the agencies, including in EU and OECD, together
patch test sites were performed with the LDPI with industry bodies, are considering whether and
technique. To determine whether there was a how to adapt these data into regulations which
correlation with immunological parameters asso- would place sensitisers into one of several potency
ciated with human contact hypersensitivity, suc- categories. It is our view, based on an evaluation of
tion blisters were produced at the test sites. Blister over 300 chemicals, that five categories: extreme,
fluid was removed and examined for the cytokine strong, moderate, weak and negative represent the
interleukin-8 (IL-8). optimal approach and is consistent with what is
Results: There was an extremely close correlation understood regarding the potency of these skin
between the magnitude of the contact hypersensi- sensitisers in humans. To illustrate this approach,
tivity response as measured by the imaged perfu- an example dataset of 100 selected organic chemi-
sion and the level of IL-8 in the blister fluid cals is shown, where the accuracy of prediction of
(r ¼ 1.00). Compared to subjects with visually human potency is in the region of 90%. This cate-
positive urushiol reactions, patients who failed gorisation has utility as a simple guide for risk
to develop urushiol contact hypersensitivity management strategies as well as representing an
despite repeated exposures to that substance had important first step in risk assessment.
both greatly diminished perfusion and blister
fluid IL-8 levels.
Conclusion: The results indicate that LDPI is a P75
sensitive method of quantifying contact hypersen-
Molecular screening for skin sensitisation
sitivity reactions in humans and that the magni-
hazard in vitro using proteomics techniques
tude of the measurements with this technique
Maja Divkovic1, D Basketter2, C Pease1,
correlates extremely well with cutaneous cytokine
M Panico2, H Morris2, A Dell2
levels that have been implicated in the immuno- 1
Unilever Safety and Environmental Assurance
pathogenesis of contact hypersensitivity.
Centre, Sharnbrook, UK
2
Department of Biological Sciences, Imperial
College, London, UK
P74
Covalent binding of hapten to skin protein
Categorisation of human sensitisation potency
is required for sensitisation. It has long been
using local lymph node assay EC3 values
postulated that only sensitising chemicals will
David A Basketter1, N Gilmour1, C Ryan2,
modify skin protein(s), whereas non-sensitisers
GF Gerberick2, R Dearman3, I Kimber3,
1 and irritants do not. To pinpoint the amino
Unilever Safety and Environmental Assurance
acid residues involved in such modifications,
Centre, Sharnbrook, UK
2 we employed mass spectrometry (MS) based
Human and Environmental Safety Division,
proteomics techniques. Known sensitisers, non-
Procter & Gamble, Cincinnati, USA
3 sensitisers and irritants were incubated with
Syngenta Central Toxicology Laboratory,
human serum albumin (HSA). Modified HSA
Macclesfield, UK
samples were digested by trypsin and matrix
Effective evaluation of skin sensitisation demands assisted laser desorption/ionisation (MALDI-
that potential contact allergens are identified and MS) analyses were conducted on the digests.
the risk of sensitisation amongst exposed popula- Nano-electrospray tandem mass spectrometry
tions assessed. Sensitisation hazard is not an all or (ES-MS/MS) analyses were conducted on modi-
nothing phenomenon; dose response relation- fied peptides purified by high performance liquid
ships can be discerned and thresholds identified chromatography (HPLC). The HSA sequence
for induction and elicitation of contact allergy. was mapped and modified peptides identified. In
These parameters, under the heading of potency, HSA samples incubated with non-sensitisers and
are vital for the risk assessment process. The irritants there was no change compared to HSA
murine local lymph node assay (LLNA) is an incubated without chemical. Modified peptides
accepted method for the identification of sensit- were purified by HPLC and sequenced using
ABSTRACTS 207
ES-MS/MS. Lysine, histidine and cysteine were that there are no differences between healthy,
found to be involved in covalent modifications by psoriatic and atopic subjects. These studies have
the sensitising chemicals used. A double adduct of focused on adverse drug reactions or standard series
one sensitiser (MCI) on His 338 of HSA molecule of allergens, taking not in consideration an occupa-
was also identified. More sensitisers need to be tional origin. We suggest epicutaneous tests as a reli-
investigated to establish similarities between covalent able method to diagnose ACD in psoriatic patients
protein modifications of chemically related com- with chronic and/or refractory lesions in hands.
pounds. The aim is to develop an assay for protein
binding ability of chemicals which could form
part of a battery of tests needed to replace animal P77
testing for sensitisation potential. Incidence of psoriasis in Norway
Edgar Selvaag1,2, M Loeb3
1
Department of Dermatology, Ullevaal Hospital,
P76 University of Oslo, Norway
2
Allergic contact dermatitis vs. psoriasis Center for Health Administration, National
Virginia Fernandez-Redondo, I Rodriguez-Blanco, Hospital, Oslo, Norway
3
J Toribio SINTEF-UNIMED, Blindern, Oslo, Norway
Hospital Gil Casares, Servicio Dermatologı´a, Investigations in several western countries, espe-
Santiago de Compostela, Spain cially european, have shown an increase in the
Background: Psoriasis prevalence in the Spanish frequency of psoriasis. To investigate these trends
population is around 1.4% (2000). The last epi- in Norway, the following procedure was followed.
demiological enquire of the GEIDC (2001) Using four standardized interview-reports the
showed that 55.11% of the patients revised in development and the frequency of atopic derma-
specialized units presented Allergic Contact titis was determined.
Dermatitis (ACD). Concomitance of both pro- The questionnaires were conducted in the years
cesses has been widely studied being the opinions 1968, 1975, 1985 and 1995. The results were
of the different authors controversial. Palmo- registred electronically, and made available on
plantar psoriasis seems to be the most frequent the Statistical Package for the Social Sciences
type in patients presenting delayed hypersensitivity. (SPSS) in Windows version.
Aim and methods: A retrospective study In 1968 420 out of 11101 persons suffered from a
(2002–2003) of the incidence of ACD in patients skin disease, in 1975 the number had increased to
previously diagnosed of psoriasis was performed in 690 out of 11014 persons. These numbers still
the allergy unit of our hospital. The aim of our study increased; in 1985 1136 out of 10576 and in 1995
was to investigate the delayed hypersensitivity 1026 out of 10248 said to suffer from a skin disease.
among psoriatic patients as well as its clinical rele- The diagnosis psoriasis was reported by 34
vance in our influence area. 604 consecutive patients persons in 1968 (8% of all skin disease), increased
were studied. Standard batteries of the GEIDC as to 97 in 1975 (14.1%), to 149 in 1985 (13.1%),
well as complementary series (True-Test and Che- and finally to 284 in 1995 (26.7%).
motecnique) were performed. Allergen application In all, the infectious skin diseases decreased in
and posterior evaluation were done according to the number, whereas inflammatory skin diseases, such
ICDRG rules. as psoriasis but also atopic dermatitis increased.
Results: We studied 26 patients affected of Psori- Connections to air pollution, indoor environ-
asis, (4,3% of total). In contrast to the general ment, especially smoking are at present under
population, 9 were female (mean age 49 years) investigation.
and 17 male (mean age 48,4 years). ACD sugges- These results indicate that psoriasis is among the
tive lesions were located in the hands of 15 patients, most frequent skin diseases in Norway, comparable
feet in three of them and in 4 patients both. Patch to other western industrialized countries.
test was negative in 8 cases. The most detected
allergens were Nickel and Fragrance-mix. Occupa-
tional origin was discussed in 6 cases. Sensitivity to
P78
formaldehyde resins was demonstrated in several
patients. Medicamentous origin due to ethylendia- Frequency and development of atopic dermatitis
mine and Peru Balsam was also demonstrated. in Norway
Comments: Several revisions about the relation- Edgar Selvaag1,2, M Loeb3
1
ship of ACD and psoriasis have been published Department of Dermatology, Ullevaal Hospital,
in the last years and most of the authors think University of Oslo, Norway
208 ABSTRACTS
2
Center for Health Administration, National known of their potential to cause skin sensitiza-
Hospital, Oslo, Norway tion in humans. It is anticipated that this will be
3
SINTEF-UNIMED, Blindern, Oslo, Norway of value to other investigators in the evaluation
and calibration of novel approaches to skin sen-
Investigations in several western countries, espe- sitization testing, in particular for the develop-
cially european, have shown an increase in the fre- ment of in silico methods. Prerequisite for the
quency of atopic disease. To investigate these trends development of in silico models is always the
in Norway, the following procedure was followed. availability of a large high quality data set, suit-
Using four standardized interview-reports the able for modeling. This dataset encompasses both
development and the frequency of atopic derma- the chemical and biological diversity of known
titis was determined. chemical allergens, and provides also examples
The questionnaires were conducted in the years of negative controls. The data are a collection of
1968, 1975, 1985 and 1995. The results were published and non-proprietary industry data. All
registred electronically, and made available on materials were tested in standard vehicules fol-
the Statistical Package for the Social Sciences lowing the standard LLNA protocol. It is hoped
(SPSS) in Windows version. that this dataset will accelerate the development,
In 1968 420 out of 11101 persons suffered from evaluation and eventual validation of new
a skin disease. approaches to skin sensitization testing.
The diagnosis atopic dermatitis was not
recorded in 1968, in 1975 0.7% of all skin disease
considered atopic dermatitis, in 1985 1.3% and in
1995 10.1%. P80
The results show an increased incidence of ato-
pic dermatitis in Norway, comparable to other Preliminary findings on the histopathology of
western countries. chronic hand dermatitis
Connections to air pollution, indoor environ- Carolyn Willis, L Britton, D Orton
ment, especially smoking are at present under Amersham Hospital, Department of Dermatology,
investigation. Amersham, UK
Chronic hand dermatitis is a common and dis-
tressing condition with a complex, multifactorial
aetiology. In order to better understand its patho-
P79 physiology and hopefully improve diagnosis, we
have begun a systematic histopathological study
A chemical dataset for evaluation of alternative
of various forms of hand dermatitis, with a par-
approaches to skin sensitization testing
ticular emphasis on those in which exposure to
Petra S Kern1, GY Patlewicz2, RJ Dearman3,
irritants and allergens is strongly implicated. Suit-
CA Ryan1, I Kimber3, DA Basketter2, GF Gerberick1
1 able patients were recruited from amongst those
The Procter & Gamble Company, Miami Valley
presenting at the contact dermatitis clinic.
Laboratories, Cincinnati, OH, USA
2 Detailed past and present medical and personal
Syngenta Central Toxicology Laboratory,
histories, clinical examination, patch testing and
Alderley Park, Macclesfield, Cheshire, UK
3 prick testing were conducted in order to classify
SEAC, Unilever, Colworth Laboratory,
the eczema into one of several broad entities e.g.
Sharnbrook, Bedfordshire, UK
chronic irritant contact dermatitis (CICD), with
In recent years, the local lymph node assay or without atopy. After performing a range of
(LLNA) has emerged as a practical option for bio-engineering measurements on a pre-selected
assessing the skin sensitization potential of che- affected area of the hand, biopsies were removed
micals. In addition to accurate identification of and processed for high resolution light microscopy
skin sensitizers, the LLNA can also provide a and immunocytochemistry. Age/sex matched,
reliable measure of relative sensitization potency; healthy, non-atopic individuals provided control
information that is pivotal in successful manage- skin from similar sites of the hand. Using a range
ment of human health risks. However, even with of antibodies and quantification techniques, we
the significant animal welfare benefits provided examined the status and expression of certain
by the LLNA, there is interest still in the devel- immune-associated cells and receptor/adhesion
opment of non-animal test methods for skin sen- molecules. Of note amongst these, were the differ-
sitization. Here, we have collected a large dataset ences in epidermal CD1aþ cell density between
of chemicals that have been tested in the LLNA, groups. Non-atopics with CICD, for example,
and the activity of which correspond with what is had significantly fewer CD1aþ cells than both
ABSTRACTS 209
atopics with CICD and those with normal skin. airborne particulate matter and in biological sam-
CD54 (ICAM-1) and several cytokine/chemokine ples (serum, urine and hair) taken from of employ-
receptors were more widely and strongly expressed ees in a platinum refining and catalyst manufacture;
by keratinocytes in those with an atopic diathesis. to correlate environmental exposure role and plati-
Although preliminary in nature at this stage, num salts concentrations in biological samples in
our results suggest that different forms of hand the onset of allergy.
dermatitis display characteristic immunopatho- Material and methods: 132 subjects variable
logical features which may possibly be of diagnostic exposed were informed about the purpose of this
value. study and gave their consent. The examination
consisted of a work exposure and medical ques-
tionnaire, physical examination, skin prick test to
P81 platinum salts and to other common allergens
Occupational hypersensitivity to platinum group
and patch test to platinum salts. Airborne PGEs
elements
was collected by personal and area samples. Bio-
Antonio Cristaudo1, V Severino1, G Castellano1, logical samples (serum, urine and hair) were col-
A Papale2, S Caroli3, F Petrucci3 lected. Analitical procedure based on sector field
1
Istituto Dermatologico San Gallicano, IRCCS, inductively coupled plasma mass spectometry
Rome, Italy (SP-ICP-MS) for the analysis of airborne filter,
2
ISPESL, Rome, Italy serum, urine and hair was used. Results: positive
3
Istituto Superiore di Sanità, Rome, Italy prick test to platinum salts were found in 18
workers, 4 out 14 gave simultaneous positive
Objective: the increasing industrial use of plati- reactions to Pt, Rh and Ir. 2 out 14 gave a positive
num–group elements (PGEs), namely Ir, Pd, Pt reaction to Pt and Pd. Positive patch test reac-
and Rh and related hypersensitivity such as respira- tions to Pt were found in 2 subjects, 1 out 2 gave
tory symptoms, urticaria and contact dermatitis, positive reaction also to Pd.
have led to a growing need to monitor selected Conclusion: the preliminary results of the investi-
populations of exposed workers. Our aim is to gation indicate that Pt-salts are important aller-
determine the prevalence and the clinical character- gens in catalyst industry and that the clinical
istics of hypersensitivity to the platinum-group ele- manifestation involves both the respiratory sys-
ments; the levels of PGE measured in indoor tem and the skin.
210
Abstract index
Aalto-Korte K., FS12.1, P56 Britton L., P08, P80 Faria A., FS01.2
Aberer W., FS04.5, FS05.5 Brown T., FS13.3, FS13.5 Färm G., FS02.5
Agero, Anna Liza, P15 Bruckner T., FS09.7, FC01.4, FS10.2 Fartasch M., FS05.5
Agner T., FS03.1, FS07.1, FS08.1, FS09.4 Bruynzeel D. P., FS02.2, FS09.1, FS10.5, Ferguson A., P65
Ahnlide I., FS02.8, FS14.4 FS13.7, P03 Fernández Jorge B., P42, P70
Alanko K., FC01.3, FS10.4, FS12.1, Bruze M., FS02.7, FS02.8, FC01.1, FC01.2, Fernandez Vozmediano J. M., P23
P49, P56, P59, P62 FS06.1, FS06.3, FS06.7, FS09.3, FS11.2, Fernandez-Redondo V., P01, P23, P52, P76
Alomar Muntañola A., P23 FS12.5, FS12.6, FS14.2, FS14.4 Figueiredo A., FS09.5, P60, P32
Alomar A., FS10.3 Figueiredo V., P25
Amarri S., FC02.2 Cahang I., P05 Fischer T., P30
An S., FS14.1, P05 Caroli S., P81 Fletcher S., FS01.5
Andersen F., P09, P10 Cascante L., P33 Flier J., FS02.2
Andersen K. E., FS02.6, FS04.1, FS04.4, Castelain M., FS01.3 Flosadottir E., P30, P45, P72
FS06.1, FS06.3, FS06.4, FS06.7, FS10.6, Castellano G., P81 Fluhr J., FS09.7
P34 Christensen L. P., FS11.3 Flyvholm M.-A., FC03.3, FC03.4, FS13.1,
Andersson E., P67 Christiansen M., FS05.2 FS13.2, P55
Angelini G., P47 Coenraads P. J., FC03.5, FC03.6, FS05.5, Fonseca E., P70, P42
Antelmi A., P46, P47 FS09.1, P54 Foti C., P46, P47
Araújo A., P64 Collet E., FC04.3 Francalanci S., FS12.2
Arcangeli G., FC01.6 Conde Salazar L., P23, P48 Frick M., FS12.5
Archer C. B., P20 Connolly M., FS11.1, P20, P31 Frimat P., FS11.6
Arzur L., FS11.6 Conserva A., P46, P47 Frølund L., FS06.6
Azenha A., FS01.1, FS01.2 Cooper K., FS03.2, P11 Froom P., FC03.2
Correia T., FS01.2 Frosch P., FS05.5, FS06.1, FS06.7, FS09.7,
Bach B., FC03.4 Cottin M., FS04.1 C01.1
Balzer C., P13 Crippa R., FS14.6, FS14.7 Frowen K., FS07.2, FS08.6, FS10.7
Barros A. M., P58 Cristaudo A., P81 Frydendall Jepsen K., FS13.1
Barros M. A., FS01.2, P58 Cromie J., FS07.2 Fuchs T., FS05.5
Bartsch R., FS07.6 Cruz M. T., P32 Fullerton A., P09, P10
Basketter D. A., PCS04, PCS.07, FS01.5, Cuerda Galindo E., P42, P70
FS01.7, FS03.2, FS04.3, FS07.3, FC04.4, Cunha A. P., P58 Gallardo F., FS04.7
P06, P11, P38, P74, P75, P79 Cupelli V., FC01.6 Gállego M., P33
Basso A., FS02.3 Garcia-Bravo B., P01, P23, P26
Bauer A., FS07.6 Gawkrodger D. J., FC02.5, P65
Bavazzano P., FC01.6 Dauncey E., FS11.1 Geier J., FS04.5, FS10.1, P22, P36, P61,
Bayrou O., P14 Dawe, Simon, FS01.6 P66
Beck M. H., FS01.4, FS11.5, FS12.3, De la Cuadra Oyanguren J., P23, P26 Gerberick G. F., PCS.04, KL06, P74, P79
C01.3 Dearman R., KL06, P74, P79 Gibbs S., FS02.2, FS13.7
Belloni Fortina A., FS02.3, P57 Dejobert Y., FS11.6, P16 Gilaberte M., FS09.6, P43
Belsito D., FS08.2 Delaporte E., P16 Gilmour N., PCS07, FS01.7, FC04.4,
Berggren E., PCS.08 Dell A., P75 FS01.5, P74
Bernard G., FS06.3 Dickel H., FS09.7, P27 Giménez-Arnau A., FS04.7, FS09.6, P43
Bindslev-Jensen C., FS02.6 DiepgenT.L., FC01.4,FS10.2,FS10.8,FS13.4 Gimenez-Arnau E., FS06.3, P38
Bircher A., FS01.3, FS05.5, FS09.8, P25 Dirksen A., FS06.6 Giordano-Labadie F., FS01.3
Biserkoska-Atanasovksa L., P07 Divkovic M., P75 Giorgini S., FS12.2
Bjarnason B., FS14.3, P28, P29, P30, P45, Dreher F., FS03.7 Giusti F., FC02.2, FS05.4, FC04.2, P24
P72, P73 Duangdeeden I., FS01.5, FS01.7 Glumbakaite E., P51
Bjarnoe H., FS05.6 Dubakiene R., P51 Goday Buján J., P42, P70
Bloemeke B., FS01.8 Ducombs G., FS01.3 Gogniat T., P63
Blomberg B. M. E., FS13.7 Duisken M., P71 Goh, C.-L., FC02.6, FS03.5
Blömeke B., FS04.2, FC04.6, P71 Dunnill G. S., P20 Gola M., FS12.2
Bock M., FC01.4 Duus Johansen J., PCS.06, FS06.7, FS03.1, Goldsmith P., FS11.4
Boman A., P50 FS04.3, FS04.4, FS06.3, FS06.6, FS07.1, Gonçalo M., FS01.2, FS09.5, KL05, P32,
Bonamonte D., P46 KL04, FS09.4 P60
Boorsma D., FS02.2 Goon A.T.-J., FC02.6, FS03.5, FS09.3
Bordalo O., FS01.2, P17 Elberling J., FS06.6 Goossens A., FS01.3, FC04.1, FS06.1,
Borg V., FS13.1 Elmets C. A., P28, P29, P30, P73 FS06.7, C01.2
Börje A., FS06.1, FS06.2, P37 Elsner P., FS05.5, FS07.6 Grabbe J., FS09.7
Bossi R., FS06.3 Engasser P., FS07.5 Grey J., FS04.6
Brambilla L., FS14.6, FS14.7 English J., FS13.3, FS13.5 Grieshaber R., FS07.6
Brandão F. M., FS01.2 Erdmann S., FS09.7 Gruvberger B., FS02.8, FS09.3, FC01.1,
Brasch J., FS04.5, FS05.5, FS09.7 Erkek E., FS09.2 FS11.2, FS14.4
Breinholdt J., FS05.3 Estlander T., FS12.1 Guarducci L., FC01.6
Breuer S., FS01.8, FS04.2, FC04.6 Estrada E., FS04.3 Guimaraens Juanena D., P23
Brisman J., P67 Eun H.-C., FS14.1, P05 Guzzi G., FS14.6, FS14.7
ABSTRACT INDEX 211
Häberle M., P04 Kimber I., KL06, P74, P79 Menné T., PCS.05, FS02.4, FS04.1,
Hagberg S., P67 Katz S., KL01 FS04.4, FS04.6, FS06.1, FS06.3, FS06.7
Hagelthorn G., P50 Kirkup M., P31 Merk H. F., FS01.8, FS04.2, FC04.6,
Hahm J.-H., FS14.1 Kleesz P., FS07.6 FS09.7
Hall B., FS04.1 Knudsen D. B., FS03.4 Miettinen M., P12
Hall S., FS08.2 Kränke B., FC02.4 Miglietta R., FC04.2
Hamidizadeh N., FS01.8 Krivatkin E. V., P35 Milpied-Homsi, FS01.3
Hamman C., FC01.5 Krivatkin S. L., P35 Moed H., FS02.2
Hansen M. B., FS02.4 Kruyswijk M., FS07.4 Molander G., FS14.5
Harambasic E., FS06.2 Kullavanijaya P., FS01.5, FS01.7 Möller H., FS02.8, FS11.2, FS14.4
Harr T., FS09.8 Kunz D., FS04.2 Mondino M., FS05.4, P24
Hasan Hafeez Z., FS03.6 Kuzmanovska V., P07 Montalti M., FC01.6
Häusermann P., FS09.8 Moon K.-C., FS14.1
Hayakawa R., P44 Lahtinen M.-R., P12 Moon S., P05
Hedegaard K., P09, P10 Lahtinen T., P12 Morais O., FS01.2
Hegewald J., FS05.5, FC02.4, P02 Lamarão P., P19 Moretti S., FS12.2
Held E., FS03.1, FS09.4 Lammintausta K., FS10.4 Morris H., P75
Henrik Nielsen N., FS06.6 Langley N., FS05.2 Mosbech H., FS06.6
Henriks-Eckerman M. L., FS12.1, P62 Laroche C., PCS.09 Muratori S., FS14.7, FS14.6
Hervella M., P33 Larrea M., P33 Mygind K., FC03.3, FS13.1, FS13.2
Hildebrandt S., P22 Larsen K., FS08.1
Hillen U., P61, P66 Lauerma A., FS14.5 Nassif A., FC04.3
Hindsén M., FS02.7, FS11.2, FS11.3, FS14.2 Lauriere M., P14 Navo K., FC03.2
Hoeck U., FS05.3, FS05.6 Lazarov A., FC03.2 Netterlid E., FS02.7
Hogan D., FC01.5 Le Coz C. J., FS01.3, FC04.3 Neugebauer M., FC04.6
Hogen Esch A. J., FS09.1 Lear J., FS11.5 Newson T., FS02.1
Hollender J., FC04.6, P71 Lee A., FS14.1 Nicander I., FS03.3
Holm Laugesen L., FS05.6 Lee C. H., FS14.1 Nielsen L. F., FS03.4
Holmes J., P11 Lee E., P05 Niinimäki M., P12
Holschbach M., FC04.6 Lee H., FS14.1 Nilsson A.-M., FC02.1
Hooper R., FS02.1 Lehmann S., FS05.6 Nilsson J. L. G., FC02.1
Hosseiny S., P67 Lehmann S. V., FS05.3 Nixon R., FS07.2, FS08.6, FS10.7, P39
Høst A., FS02.6 Lensen G., FC03.6 Noiesen E., FS08.1
Hubbard V., FS11.4 Leow Y.-H., FS09.2 Noonan A., FS10.7
Lepoittevin J.-P., FS06.3, KL07, P38 Norberg L. A., FS02.6
Iglesias M. E., P33 Lerch M., FS09.8 Nuutinen J., P12
Ingber A., FC02.3 Lessmann H., FS10.1, P22, P61 Nybæk H., FS03.4
Isaksson M., PCS.03, FC01.1, FC01.2, Lidén, Carol, C01.5 Nyfjäll M., FS08.3
FS02.7, FS09.3, FS12.5 Lind M.-L., P50 Nyrén M., FS08.5
Lindberg M., FS08.3, FS08.5, P55
Jacobsen D., FS09.2 Linneberg A., FS06.6 O’Driscoll J., FS01.4
Jappe U., P61 Loeb M., P77, P78 Ólafsson J. H., P55
Järvholm B., FS08.4 Löffler H., FS03.7, FS09.7 Olin P., FS02.7
Jelen G., FS01.3 Lopes M. C., P32 Ollmar S., FS03.3
Jemec G. B. E., FS03.4 Lospalluti L., P47 Olsen C. E., FS05.3
Jenner T., FS07.4 Lovell C., FS11.1 Olsen J., FS02.4, FS07.1
Jensen A., FS13.2 Luthman K., FC02.1 Ortiz de Frutos J., P23
Jensen C. D., FS04.4, P34 Luukkonen R., FC01.3 Orton D., P08, P80
Jepsen K. F., FC03.3, FS13.2
John S. M., FC04.5 Madsen F., FS06.6 Packham C. L., FS13.6, P69
Jøhnke H., FS02.6 Mahler V., FS10.2 Panico M., P75
Johnsson S., P50 Maibach H. I., FS03.6, FS03.7 Papale A., P81
Jolanki R., FC01.3, FS10.4, FS12.1, P49, Makela E. A., FC01.3 Pardo A., FC03.2
P59, P62 Manrique P., P23 Passoni E., FS14.7, FS14.6
Josefson A., FS02.5 Marand Å., FS12.5 Patlewicz G., FS04.3, P38, P79
Joseph L., FS05.2 Marciani Magno F., P57 Paulsen E., FS11.3
Jungbauer F., FC03.5, FC03.6 Marriott M., FS03.2, P06, P11 Pease C., P75
Mårtensson K., FS11.2 Pecquet C., P14
Kadyk D., FS08.2 Martin P., FS11.6 Pedersen L. K., FS09.4
Kaminska R., P56 Martı́nez Gómez W., P70 Peiffer T. H., P71
Kamphof W., P03 Mascarenhas R., P60 Pellacani G., FS05.4
Kanerva L., P55 Massone F., FS05.4 Pepe P., FS05.4
Kannas L., FS14.5 Mastrandrea V., P46 Pereira M. F., FS01.2, P18
Kaoukhov A., FS03.5 Mathieen B., FS07.1 Pereira O., P64
Karlberg A.-T., KL02, FC02.1, FS06.1, Matsumo Y., P40 Perez M., P43
FS06.2, P37 Matura M., FS06.1, FS06.2, P37 Perico A., FC01.6
Karlsmark T., FS03.4 Mc Cune J., FS11.1 Perrenoud D., P63
Karlsson D., FS12.5 McEwen G., FS04.8 Peserico A., FS02.3, P57
Kato Y., P44 McFadden J., FS01.7, FS01.5, FS01.6, Peters L., FS03.2, P06, P11
Keegel T., FS08.6, FS10.7, P39 KL03 Petkovska M., P07
Kelterer D., FS07.6 McNamee P., PCS04, FS04.6 Petman L., FS14.5
Kemna G., FS07.4 Meding B., FS08.3, FS08.4, FS02.5, FS08.5, Petrucci F., P81
Kennedy C. T., P20 P50, P55, P67 Pfahlberg A., FC02.4, P02
Kern P. S., PCS04, P79 Meldgaard J., FS05.6 Piette F., P16, FS11.6
Kim D.-W., FS14.1 Meljanac N., P27 Pigatto P., FS14.6, FS14.7
212 ABSTRACT INDEX
Piletta P., P53 Serra-Baldrich E., FS09.6, FS10.3 Toll A., FS04.7
Pirker C., FS09.7 Sestini S., FS12.2 Tonucci D., FC04.4
Pohlmann P. R., FS13.7 Severino V., P81 Torck M., FS11.6
Poliero M., FS02.3 Siew C., FC01.5 Torén K., P67
Pons-Guiraud A., FS01.3 Sigmundsdottir H., FS14.3 Toribio J., P52, P76
Pontén A., FS12.6 Sigurdardottir M. S., FS14.3 Tran Q.-V., P63
Powell S., FC03.1, P41 Silva R., FS01.2 Tuomi T., FC01.3, P49
Pujol-Vallverdú R. M., FS04.7, FS09.6, Silvestre J. F., P26
P43 Sinovich V., P41 Uter W., P02, P22, P13, P36, P61, FS10.1,
Skarping G., FS12.5 FS04.5, FS05.5, FC02.4, FC04.5
Raison N., P14 Skazik C., FS04.2
Rantanen I., FS03.3 Skoet R., FS03.1, FS07.1 Vach W., FS02.6
Rastogi S. C., FS06.3 Sköld M., FS06.1, FS06.2, P37 Valdimarsson H., FS14.3
Ribeira S., P64 Skov L., FS02.4 Valks R., P48
Ro Y.-S., FS14.1 Slodownik D., FC02.3 van den Brink W., FS09.1
Rodgers P., FC01.5 Söderling E., FS03.3 van der Heide S., FS09.1
Rodrı́guez Lozano J., P42 Sollenberg J., P50 Veien N. K., FS05.1
Rodriguez-Blanco I., P76 Sorba V., FS03.5 Verallo-Rowell V., P15
Rodrı́guez-Serna M., P26 Sørensen A., FS04.6 Vieira R., FS09.5, P60
Roman J., FS04.7 Søsted H., FS04.3 Vigan M., FS01.3, P14, P21
Romano I., FS02.3, P57 Soto P., FS03.5 Villadsen E., FC03.4, FS13.2
Rozeira J., P64 Spiewak R., P68 Villarama I., FS03.6
Rodrı́guez Lozano J., P70 Stadeler M., FS07.6 Vital A. L., P32
Rushton L., FS13.3, FS13.5 Steel I., FS05.2 von Blomberg M., FS02.2
Rustemeyer T., FS02.2, FS10.5, FS13.7, Steenstra F., FC03.5
P03 Steiling W., PCS.01 Walker S., FS01.4, FS11.5
Ryan C. A., PCS04, KL06, P74, P79 Stenberg B., FS08.5 Wallenhammar L.-M., FS08.3
Ryecroft R., FS01.6 Stoof T., FS02.2 Wass K., P67
Stoskute L., P51 White I. R., PCS.02, FS01.6, FS06.1, FS06.7
Sajjachareonpong P., FS08.6 Stoudemayer T., FS05.2 Wilbers L., FS04.2, FC04.6
Sanchez-Pedreño P., P01 Suarez Amor O., P52 Williams H., FS13.5
Sanchez-Perez J., P23 Sugiura M., P44 Williams J., FS01.4, FS11.5
Sanchez-Politta S., P53 Surber C., P25 Williams W., FS13.3
Sansom J. E., P20, P31 Susitaival P., FC01.3, P55 Willis C., P08, P80
Santos A. L., P58 Suuronen K., FC01.3, P49, P62 Won Y.-H., FS14.1
Santos P., P18, P19 Svedman C., FC01.2, FS06.3 Wong Y. W., FC03.1
Santos R., P18, P19 Svensson M., FS08.5 Wooder M., FS04.6
Saunders H., FS10.7, P39 Svensson Å., FS08.5, FS11.2, P55 Wrangsjö K., FS08.4, P67
Scheper R. J., FS02.2, FS13.7
Scherer K., P25 Tamada Y., P40 Xu H., P28, P29, P73
Schmidt A., FC01.4, FS10.2 Tanaka S., P40
Schnuch A., FS10.1, FC02.4, FS04.5, P02, Tanzi C., FS14.7, FS14.6 Yanguas J. I., P33
P13, P22, P36, P61 Taylor J. S., FS09.2 Zacchello F., P57
Schürer N., FS06.5 ten Hove B., FS07.4 Zachariae C., FS04.1, FS04.6
Schuttelaar M.-L. A., P54 Theil Skovgaard L., FS03.1 Zerboni R., FS14.6, FS14.7
Schwanitz H. J., FC04.5, FS06.5, P27 Thellart A. S., FS11.6 Zhai H., FS03.6
Seidenari S., FS05.4, FC02.2, FC04.2, P24 Thomas P., FS11.6, P16 Zimerson E., FC01.2, FS12.4, FS12.5,
Sell L., FS13.2 Thormann H., FS06.4 FS12.6, FS14.2
Selvaag E., P77, P78 Toebak M. J., FS13.7