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Abstracts

Abstracts

Additives

In pathologies caused by foods, real IgE-mediated allergic reactions are rather rare. More commonly observed and apparently on a constant rise in Western countries are reactions from food intolerance, especially in relationship with the massive exposure to additives used in industrial food products.

This study involved a population of adults (# 582) with chronic pseudo-allergic dermatopathies. The link between symptoms and intolerance to food additives has been proved on the basis of the efficacy of a strict diet that eliminates certain foods and the positivity of the provocation test in double-blind trial controlled with a placebo in 165 patients (about 28% of the cases).

Antico A & Di Berardino L The role of additives in chronic pseudo-allergic dermatopathies from food intolerance. Allerg Immunol (Paris), 27: 5, 1995 May, 157-60.

Antibodies & eczema

Investigated whether chronic urticaria might be related to food allergy which had remained undetected during routine examination.

Specific IgE against 19 food allergens frequently involved in urticaria were investigated in all subjects with the new CAP System (Pharmacia). Positive results (CAP > 0.70 kU/l) for one or more food allergens were found in none of the nonatopic controls, in six of the subjects with respiratory allergy, and in 16 of the urticaria patients. The use of an in vitro test with an increased sensitivity allowed us to detect a significant prevalence of IgE specific for food allergens in patients with chronic urticaria of unknown origin. This suggests that, in several of those patients, chronic urticaria might be triggered by a food allergy undetected by the usual methods.

Kaeser P et al., Prevalence of IgE antibodies specific for food allergens in patients with chronic urticaria of unexplained etiology. Allergy, 49: 8, 1994 Sep, 626-9.

Complementary therapies

1. Complementary therapies are just that and not an alternative to routine therapies.

2. The growing use of complementary therapies for eczema reflects a renewed interest in self-medication and a declining belief in orthodox medicine.

3. Prior to using essential oils, nurses should check for sensitivity to certain oils.

4. Herbalism offers a number of approaches to the treatment of eczema.

Frost J: Complementary treatments for eczema in children. Prof Nurse, 1994 Feb, 9:5, 330-2.

Chinese herbs

Chinese herbal medicine (1)

Chinese herbal medicines are increasingly being used as an alternative treatment for chronic skin disease. Most patients and many doctors remain insufficiently aware of their potential toxicity.

We report a patient with eczema who developed a severe cardiomyopathy following a 2-week course of Chinese herbal medicine. The connection between the two conditions was not made until 2 weeks after presentation when the patient was specifically asked if she had ingested any unusual substances. The belief that herbs, as natural products available without prescription, are harmless, is commonplace and patients may not consider them worthy of mention during a standard medical history.

Ferguson JE et al., Reversible dilated cardiomyopathy following treatment of atopic eczema with Chinese herbal medicine. Br J Dermatol, 136:592-3, 1997 Apr.

Chinese herbal therapy (2)

Ten patients with atopic eczema (AE) received treatment with Chinese herbal therapy (CHT; Zemaphyte) for 2 months. The severity of the eczema was recorded and skin biopsies were taken from lesional (L) and non-lesional (NL) skin before and after treatment. The skin biopsies were stained to detect T-cell subsets (CD4, CD8, CD45Ro and CD25), macrophage subsets (RFD7), dendritic cells (RFD1). Langerhans cells (CD1), HLA-DR, low-affinity IgE receptors (CD23) and high-affinity IgE receptors (15A5, 22H7).

A quantitative assessment of the numbers of positively stained cells was made.

CHT is clinically efficacious and that clinical improvement is associated with a significant reduction in antigen-presenting cells expressing CD23.

Xu XJ et al., Modulation by Chinese herbal therapy of immune mechanisms in the skin of patients with atopic eczema. Br J Dermatol, 136:54-9, 1997 Jan.

Chinese herbs (3)

A standardized mixture of Chinese herbs has recently been demonstrated to be an effective treatment for chronic atopic eczema in placebo controlled trials in the UK.

Antioxidant activity was detected in some components of both the active and placebo mixtures, but the formulated active mixture (PSE 222) was significantly more effective than the formulated placebo mixture.

Kirby AJ & Schmidt RJ: The antioxidant activity of Chinese herbs for eczema and of placebo herbs--I. J Ethnopharmacol, 56:103-8, 1997 Apr.



Dietary factors

Contents:

Food Hypersensitivity
Diet
Dietary fat

Food Hypersensitivity


Most children with atopic dermatitis can be positively diagnosed for a food allergy using a prick skin test. In evaluating 165 patients with atopic dermatitis between 4 months and 21.9 years, 60% had at least 1 positive skin prick test. In doing a total of 266 double-blind, placebo-controlled food challenges 64 patients or 38.7% had a positive challenge. Milk, egg, peanut, soy, wheat, cod fish, catfish and cashew accounted for 89% of the positive challenges.

Burks, A., Wesley, M.D., et al: Atopic Dermatitis and Food Hypersensitivity Reactions, Journal of Pediatrics, 1998;132:132-136

Diet

In atopic dermatitis [AD], not only food consumption, but direct skin-contact too can provoke hypersensitivity reactions. We imitated food immediate-contact hypersensitivity [FICH] to cow's milk, egg, peanut or soy by a skin provocation test (the skin application food test [SAFT].

FICH was observed in:

egg72%
cow's milk 47%
peanut34%



FICH is an important symptom in children with AD and food allergy.

Oranje AP et al., Food immediate-contact hypersensitivity (FICH) and elimination diet in young children with atopic dermatitis. Preliminary results in 107 children. Acta Derm Venereol Suppl (Stockh), 176:1992, 41-4.

Dietary fat

The last two decades have seen an increase in the prevalence of asthma, eczema, and allergic rhinitis in developed countries. This increase has been paralleled by a fall in the consumption of saturated fat and an increase in the amount of polyunsaturated fat in the diet. This is due to a reduction in the consumption of animal fat and an increase in the use of margarine and vegetable oils containing omega-6 polyunsaturated fatty acids (PUFAs), such as linoleic acid. There is also evidence for a decrease in the consumption of oily fish which contain omega-3 PUFAs, such as eicosapentaenoic acid.

In a number of countries, there are social class and regional differences in the prevalence of allergic disease, which are associated with differences in the consumption of PUFAs. Linoleic acid is a precursor of arachidonic acid, which can be converted to prostaglandin E2 (PGE2), whereas eicosapentaenoic acid inhibits the formation of PGE2. PGE2 acts on T-lymphocytes to reduce the formation of interferon-gamma (IFN-gamma) without affecting the formation of interleukin-4 (IL-4).

This may lead to the development of allergic sensitization, since IL-4 promotes the synthesis of immunoglobulin E (IgE), whereas IFN-gamma has the opposite effect. Changes in the diet may explain the increase in the prevalence of asthma, eczema and allergic rhinitis. The effects of diet may be mediated through an increase in the synthesis of prostaglandin E2 which in turn can promote the formation of immunoglobulin E.

Black PN & Sharpe S: Dietary fat and asthma: is there a connection? Eur Respir J, 10:6-12, 1997 Jan.

Epidemiology

The escalation of allergic diseases (hay fever, asthma, atopic eczema) over recent decades has been linked to an increase in environmental pollutants.

The prevalence of hay fever is associated with genetic predisposition, and some reports show an association with urban areas, socioeconomic status, and combined high allergen and automobile exhaust exposure.

In asthma, there is also some evidence for geographical variations in prevalence; exercise challenge tests prove positive more often in urban areas than in rural areas.

Although genetic predisposition is the strongest single risk factor for atopic eczema, air pollutants may aggravate the condition by acting as unspecific irritants and immunomodulators, leading to increased immunoglobulin E expression.

A study of pre-school children revealed a positive association between smoking during pregnancy/lactation, and a positive history of atopic eczema.

An East-West German comparative study examining different types and levels of air pollution, i.e. sulphurous (industrial; East) and oxidising (urban; West), showed that the prevalence of atopic eczema was greatest in East Germany.

When various direct and indirect parameters of air pollution exposure were measured, the greatest association with atopic eczema was found with NOx exposure (indoor use of gas without a cooker hood), and close proximity to roads with heavy traffic.

Environmental risk factors may be an important contributing factor.

Schäfer T & Ring J: Epidemiology of allergic diseases. Allergy, 52:14-22; discussion 35-6, 1997.

Guide

Eczema is a very common skin problem in primary care, and is used to describe a group of conditions where there is inflammation in the skin. It can be either acute or chronic, or a combination of the two.

Acute eczema presents as a red weeping rash, with the presence of vesicles and exudate.

Chronic eczema is the reverse, being dry and scaly with lichenification.

Poyner T: Know how guide to eczema/dermatitis. Nurs Times, 1997 Mar 26-Apr 1, 93:13, 30-1.

Herpes simplex & eczema

Eczema herpeticum, sometimes called Kaposi’s varicelliform eruption, is usually caused by a disseminated herpes simplex virus infection in a patient whose underlying skin disease is atopic dermatitis.

Herpes simplex virus type 1 (HSV-1), a widespread infectious agent in human populations, is the etiologic agent of eczema herpeticum.

Two of four HSV-1 strains of F35 genotype were from patients with eczema herpeticum, whereas none of 12 HSV-1 strains of F1 genotype was from those with eczema herpeticum. Thus, the F35 genotype seemed to be associated more frequently with eczema herpeticum than the F1 genotype.

Umene K et al., Comparison of the association with eczema herpeticum in the two
predominant genotypes of herpes simplex virus type 1. J Med Virol, 49:329-32, 1996 Aug.

Eczematous dermatitis

Eczematous dermatitis is a common condition that can interfere with social function, sleep and employment. Its persistence and accompanying pruritus may be stressful and frustrating for patients.

The most common and best characterized type of eczema, atopic dermatitis, appears to be increasing in incidence.

Other common eczematous dermatoses, particularly allergic dermatitis and irritant contact dermatitis, must be accurately diagnosed, since improvement and resolution rely on appropriate diagnosis and avoidance of pertinent triggering factors.

Principles of treatment include general skin care, patient education about avoidance of irritants, skin hydration and the use of topical corticosteroids when necessary. Use of systemic corticosteroids is not generally recommended for the treatment of chronic eczematous dermatitis.

Zug KA & McKay M: Eczematous dermatitis: a practical review. Am Fam Physician, 1996 Sep 15, 54:4, 1243-50, 1253-4.

Eosinophilia & eczema

Eosinophilia

Food-sensitive atopic dermatitis is associated with skin and blood eosinophilia, but the role of eosinophils in the pathogenesis of the skin lesions is poorly understood.
A clear relationship was found between the number of light-density eosinophils and the severity of the disease both during the active disease and after clinical improvement. Furthermore, we describe an adhesion-stimulating activity for eosinophils in patients' plasma, which does not change after recovery
Eosinophils play a pivotal role in the pathogenesis of the skin lesions in atopic dermatitis. In particular, the light-density phenotype seems to be an essential feature of eosinophils involved in this process. The adhesion-promoting activity could be important in the recruitment of eosinophils from the blood into the skin.

Magnarin M et al., A role for eosinophils in the pathogenesis of skin lesions in patients with food-sensitive atopic dermatitis. J Allergy Clin Immunol, 96: 2, 1995 Aug, 200-8.

Gold

Studied cases (#16) of either a pityriasiform or discoid eczematous rash in patients with rheumatoid arthritis receiving treatment with gold (sodium aurothiomalate and auranofin).

This seems to be a dose related, not allergic, reaction to gold. The development of this rash is not an absolute indication to stop treatment with gold. Control can often be effected with potent topical steroids or a reduction in the dose or frequency of treatment with gold.

Wilkinson SM: Pityriasis rosea and discoid eczema: dose related reactions to treatment with gold. Ann Rheum Dis, 1992 Jul, 51:7, 881-4.

Hamamelis

Hamamelis ("witch hazel")

Hamamelis ("witch hazel") distillate cream (5.35 g hamamelis distillate with 0.64 mg ketone/100 g) was compared with the corresponding drug-free vehicle and 0.5% hydrocortisone cream, and reductions of the basic criteria of severe atopic eczema i.e. itching, erythema and scaling, were evaluated.

All treatment regimens significantly reduced itching, erythema and scaling after 1 week. Hydrocortisone proved superior to hamamelis distillate.

The mild, yet unmistakable anti-inflammatory effect of hamamelis cream in experimental models of inflammatory skin disease was thus not reflected by an efficacy in patients with atopic eczema greater than that obtained from the base preparation.

Korting HC et al: Comparative efficacy of hamamelis distillate and hydrocortisone cream in atopic eczema. Eur J Clin Pharmacol, 1995, 48:6, 461-5.

Insect bites & eczema

Australian data were collected by interview and questionnaire from patients (#496).

Of the 93 patients with eczema 65% claimed they were prone to insect bite and that they were bitten in preference to other people when in a group, compared with 17% of the 403 patients with other chronic dermatoses.

There is evidence that patients with eczema and those with a family history of atopy are prone to being bitten by insects. Further confirmatory work, perhaps using volunteers and mosquitoes, is indicated. However, patients with severe eczema or a family history of atopy should take care when travelling to areas where disease-carrying insects are prevalent

Harford-Cross M: Tendency to being bitten by insects among patients with eczema and with other dermatoses. Br J Gen Pract, 1993 Aug, 43:373, 339-40.

Maternal smoking & eczema

Maternal smoking during pregnancy has been shown to lead to immunologic changes in the offspring. However, little is known about the influence of this exposure on atopic manifestations.

Of all children, 39% exhibited at least one manifestation of atopy. Atopic eczema was reported in 8% to 16%, hayfever in 4% to 26%, and asthma in 3% to 8%. Of the mothers, 13% smoked during pregnancy or lactation or both.

Analysis of the manifestation of atopy including sex, location, nitrogen oxide and sulfur dioxide exposure and maternal smoking as covariates revealed an influence of the maternal smoking during pregnancy/lactation.

Of children whose mothers had smoked during pregnancy/lactation, 52% exhibited manifestations of atopy in contrast to 36% of children of nonsmoking mothers.

A history of atopic eczema was the only component of the variable "manifestation of atopy" that was significantly associated with maternal smoking during pregnancy and lactation. A causal interpretation of this finding, however, was not supported by a follow-up study.

Maternal smoking might play a role in the development of atopic eczema and should be avoided.

Schäfer T et al., Maternal smoking during pregnancy and lactation increases the risk for atopic eczema in the offspring. J Am Acad Dermatol, 1997 Apr, 36:4, 550-6.

Lactose intolerance & eczema

Contents:

Lactose-intolerance
Milk-induced eczema

Lactose-intolerance

The primary acquired lactase deficiency of the adult is known to cause various disturbances in the gastrointestinal tract while extraintestinal symptoms are unusual.

The introduction of a lactose-free diet led to a complete disappearance of the eczema and allowed the discontinuation of the corticosteroid treatment. As far as we know, this is the first case report of an eczema caused by a lactose intolerance.

Grimbacher B et al., Lactose-intolerance may induce severe chronic eczema. Int Arch Allergy Immunol, 1997 Aug, 113:4, 516-8.

Milk-induced eczema

Peripheral blood mononuclear cells were isolated from seven milk allergic children with a history of eczema when exposed to milk. All patients had a positive prick skin test and double-blind placebo-controlled food challenge to milk. 10 children with either allergic eosinophilic gastroenteritis or milk-induced enterocolitis and 8 nonatopic adults served as controls.

Data suggest that after casein stimulation allergic patients with milk-induced skin disease have an expanded population of CLA+ T cells, as compared with nonatopics or allergic patients without skin involvement. We postulate that heterogeneity in the regulation of HR expression on antigen-specific T cells may play a role in determining sites of involvement in tissue-directed allergic responses.

Abernathy-Carver KJ et al: Milk-induced eczema is associated with the expansion of T cells expressing cutaneous lymphocyte antigen. J Clin Invest, 1995 Feb, 95:2, 913-8.

Olive oil & eczema

Adverse cutaneous reactions to topically applied olive oil are seldom reported, and positive patch tests to it are mostly regarded as allergic.

Evaluated such "positive" patch test reactions.

5 patients (2 male) showed "positive" test reactions. In only 1 patient could the reaction be classified as probably allergic, in contrast to previous reports.

Olive oil is very weakly irritant in general, but bears relevant irritant capacity when applied under occlusive conditions. Therefore, olive oil appears to be less than suitable for the topical therapy of patients with venous insufficiency and associated eczema of the lower extremities.

Kränke B et al., Olive oil?contact sensitizer or irritant? Contact Dermatitis, 36:5-10, 1997 Jan.

Phototherapy & eczema

Several studies have shown a beneficial effect of ultraviolet radiation on eczema, especially atopic dermatitis.

The action spectrum lies at higher wavelengths compared with psoriasis. UVAB seems to be superior to UVB and best suited for mild to moderate cases.

From a carcinogenic point of view, the therapy seems safe and the doses are low compared with UVB treatment of psoriasis.

UVA-1 therapy seems to be a promising new alternative, especially for more severe cases. High-dose regimens work well but the hazards are not yet fully elucidated. The very high dosage regimens should be reserved for very resistant cases where lower doses have been tried but proven inadequate.

PUVA is also very effective, but due to the long-term hazards it should be reserved for the most severe cases of atopic dermatitis.

Lark” O: Phototherapy of eczema. Photodermatol Photoimmunol Photomed, 12:91-4, 1996 Jun.

Triggering factors & eczema

Atopic dermatitis is a hereditary disorder, frequently associated with allergic rhinitis and bronchial asthma. The disease may be influenced by many triggering factors such as irritants, aeroallergens, food, microbial organisms, sex hormones, stress factors, sweating, and climatologic factors. Moreover, it is important to be aware of contact allergy as a complicating factor. This review deals with recent clinical, experimental, and some therapeutic data on these triggering factors.

Morren MA et al: Atopic dermatitis: triggering factors. J Am Acad Dermatol, 31: 3 Pt 1, 1994 Sep, 467-73.

Hand eczema

Hand eczema in hairdressers

The development of hand eczema was evaluated in an 8-year follow-up study carried out in 51 junior hairdressers.

None of the junior hairdressers presented with hand eczema at the start of the survey. After 8 years, however, 51% had developed hand eczema.

No significant difference in prevalence of hand eczema was found between practicing and non-practicing hairdressers (58% versus 33%). Development of hand eczema was not related to atopic constitution or nickel sensitivity. Dry skin type was associated with increased risk of developing hand eczema.

Majoie IM et al., Development of hand eczema in junior hairdressers: an 8-year follow-up study. Contact Dermatitis, 1996 Apr, 34:4, 243-7.

Infants & eczema

Contents:

Dietary manipulation High risk babies (2)
High-risk infants
Dietary manipulations (children with atopic eczema)

Dietary manipulation High risk babies (1)

Several studies have demonstrated that dietary and environmental manipulations in the first months of life have a protective effect on the development of allergic diseases in babies "at risk" of atopy.

Dietary and environmental manipulations include: exclusive breast-feeding for the first 6 months of life, supplemented if necessary with soy-protein formula (Isomil, Abbott), delayed weaning beyond the 6th month of life, and rigorous environmental manipulations for the elimination of house-dust mite and passive smoking.

The low prevalence of atopic disease (10%) and the trivial course of the allergic manifestations in this "at risk" population confirm the effectiveness of this preventive program. Moreover, this study demonstrates that the incidence of atopic dermatitis peaks at 6 months and decreases until it disappears. Food allergy appears only at 6 months and may disappear later. The incidence of asthma peaks at 6 and 36 months and decreases at low levels in the intervals. Allergic rhinitis develops not sooner than 36 months.

Bruno G et al., Prevention of atopic diseases in high risk babies (long-term follow-up). Allergy Proc, 14: 3, 1993 May-Jun, 181-6; discussion 186-7.

Dietary manipulation High risk babies (2)

A preventive diet was prescribed that recommended breastfeeding for the first 6 months of life, with maternal diet restricted to no more than 200 dL of cow milk per day, no more than one egg per week, and no tomato, fish, shellfish, nuts, or foods allergenic to the mother. Only soy formula was recommended, and introduction of solid foods was also carefully prescribed. Furthermore, doctors recommended against exposure to tobacco smoke, animal allergens, and early entrance into daycare.

Families who complied with the prescribed diet had a lower incidence of atopy during the first year of life (13.3%, n = 158) than infants whose parents had ignored the prescribed diet (54.7%, n = 86) or infants whose parents were offered no dietary recommendations (28.9%, n = 218).

Bardare M et al., Influence of dietary manipulation on incidence of atopic disease in infants at risk. Ann Allergy, 71: 4, 1993 Oct, 366-71.

High-risk infants

Allergy is a common cause of illness. The effect of feeding different infant formulas on the incidence of atopic disease and food allergy was assessed in a prospective randomized double-blind study of high-risk infants with a family history of atopy.

Follow-up until 5 years of age showed a significant lowering in the cumulative incidence of atopic disease in the breast-fed and the whey hydrolysate groups, compared with the conventional cow’s milk group. Soy formula was not effective.

The occurrence of both eczema and asthma was lowest in the breast-fed and whey hydrolysate groups and was comparable in the cow’s milk and soy groups.

Similar significant differences were noted in the 18-60 month period prevalence of eczema and asthma. Eczema was less severe in the whey hydrolysate group compared with the other groups. Double-blind placebo-controlled food challenges showed a lower prevalence of food allergy in the whey hydrolysate group compared with the other formula groups.

Exclusive breast-feeding or feeding with a partial whey hydrolysate formula is associated with lower incidence of atopic disease and food allergy. This is a cost-effective approach to the prevention of allergic disease in children.

Chandra RK: Five-year follow-up of high-risk infants with family history of allergy who were exclusively breast-fed or fed partial whey hydrolysate, soy, and conventional cow’s milk formulas [see comments]. J Pediatr Gastroenterol Nutr, 24:380-8, 1997 Apr.

Dietary manipulations (children with atopic eczema)

Clinical and immunological features were compared before and after a food elimination diet, and after double blind randomized food challenges in which a food was given for several days at a time.
Eczema improved significantly during the diet and became worse on food challenges.
Results of food challenges could not be predicted by initial serum immunoglobulin levels. A history of spring/summer exacerbations of eczema correlated with positive skin prick tests to silver birch pollen but not to grass pollen. Serological tests did not help in planning food diets in atopic eczema and the immunological studies did not delineate any particular mechanism by which foods might exacerbate eczema.

Sloper KS et al: Children with atopic eczema. II: Immunological findings associated with dietary manipulations. Q J Med, 80: 292, 1991 Aug, 695-705.

Teenagers (Ireland)

Irish teenagers

The national prevalence of asthma, hay fever and eczema, employing the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire, was determined during 1995 in 3,148 Junior Certificate secondary school children aged 13-14 years throughout the Republic of Ireland.

The prevalence values for asthma, hay fever and eczema were 15%, 25% and 9% respectively. Although 5% reported having both asthma and hay fever, combinations of the other allergic conditions were less than 2%.

Sex difference in prevalence rates for the various conditions occurred with asthma prevalence being higher for males, eczema in females, but hay fever was almost equally reported between males and females.

Manning PJ et al., Asthma, hay fever and eczema in Irish teenagers (ISAAC protocol). Ir Med J, 1997 Apr-May, 90:3, 110-2.

Incidence of eczema

Increase in hay fever and eczema

Investigated whether changes in certain perinatal and social factors explain the increased prevalence of hay fever and eczema among British adolescents between 1974 and 1986.

The prevalence of the conditions over the 12 month period increased between 1974 and 1986 from 3.1% to 6.4% for eczema and from 12.0% to 23.3% for hay fever. Both conditions were more commonly reported among children of higher birth order and those who were breast fed for longer than 1 month.

Eczema was more commonly reported among girls and hay fever among boys.

The prevalence of hay fever decreased sharply between social classes I and V, increased with maternal age up to the early 30s, and was lower in children whose mothers smoked during pregnancy. Neither condition varied significantly with birth weight.

Changes between cohorts in sex, birth weight, birth order, maternal age, breast feeding, maternal smoking during pregnancy, and father's social class at birth did not seem to explain any of the observed rise in the prevalence of hay fever and eczema. However, correlates of these factors which have changed over time may still underlie recent increases in allergic disease.

Butland BK et al., Investigation into the increase in hay fever and eczema at age 16 observed between the 1958 and 1970 British birth cohorts. BMJ, 1997 Sep 20, 315:7110, 717-21.

Living with eczema

An overview of eczema, including its assessment, the needs of patients with eczema and the management of eczema.

The prevalence of all forms of eczema is unknown but there is evidence that atopic eczema is increasing. Nurses can play a vital role in the management of this condition by giving patients time for explanation and discussion.

Lawton S: Living with eczema: the dermatology patient. Br J Nurs, 1996 May 23-Jun 12, 5:10, 600-4, 606-9.

Perfumes & eczema

Investigate the elicitation potential of perfumes from 17 commonly sold lower-price cosmetic products. 8 of the perfumes were from stay-on cosmetics and 9 were from wash-off cosmetics. Each perfume was tested in 500 consecutive eczema patients, who also were tested with the European standard patch test series.

4.2% reacted to 1 or more of the wash-off product perfumes and 3.2% to 1 or more of the stay-on product perfumes.

Concordant positive reactions between the fragrance mix and the product perfumes were found in 81% of positive reactions to the stay-on product perfumes and in 52% of the reactions to the wash-off product perfumes.

Chemical analysis revealed that between 1 and 5 of the chemically-defined constituents of the fragrance mix were present in all of the product perfumes. Geraniol was found in 12 of the 17 perfumes and was most often detected. The concentration of the target fragrance materials ranged from 0.005%-1.35 w/v%.

Allergenic constituents of the fragrance mix are impossible to avoid if perfumed cosmetics are used.

Patients suspected of perfume allergy need to be tested with their own perfumed products, as far from all cases of perfume allergy are detected by the fragrance mix and/or balsam of Peru in the European standard patch test series.

Johansen JD et al., Content and reactivity to product perfumes in fragrance mix positive and negative eczema patients. A study of perfumes used in toiletries and skin-care products. Contact Dermatitis, 36:291-6, 1997 Jun.

Schoolchildren & eczema

In a questionnaire survey of 2,813 children aged 4 to 19 years, eczema prevalence was 7.8% but rose to 21.3% in those with asthma. The prevalence was 5.9% in non-asthmatics.

The hay fever prevalence was 12.3% but rose to 36% in those with asthma. The prevalence was 8.9% in non-asthmatics.

Hay fever was more common in urban than rural children, but there was no town/country difference for eczema.

Taylor MR et al., Eczema and hay fever in schoolchildren. Ir Med J, 89:229-30, 1996 Nov-Dec.

Treatment of eczema

Atopic eczema remains a therapeutic challenge. However, new developments in the understanding of the pathogenesis of this complex disease have prompted new therapeutic strategies.

This review focuses on recently described treatment modalities for atopic eczema that are currently available or under investigation. The effectiveness of phototherapy, cytokines, and immunosuppressive drugs is evaluated.

Experimental approaches are also discussed.

Brehler R et al., Recent developments in the treatment of atopic eczema. Am Acad Dermatol, 36:983-94, 1997 Jun..

Aristolochia - Dangerous Side Effects

Aristolochia - Dangerous side effects

Aristolochia, a Chinese herb commonly used for eczema, may induce renal failure. The herb, also called Mu Ton and Fanjii, contains aristolochic acid, which was previously implicated in an outbreak of nephritis in Belgium. Two British women who used Aristolochia for 2 years and 6 years had rapidly progressive renal failure requiring transplant. In response, the UK Committee on Safety of Medicines placed an emergency ban on the use, import, or sale of Aristolochia due to its toxicity. Herbs that may have been confused with Aristolochia may also be permanently banned.

Lord GM, Tagore R, Cook T, Gower P, Pusey CD. Nephropathy caused by Chinese herbs in the UK. Lancet 1999 Aug 7;354(9177):481-2.

 


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