Hyposensitization in nickel allergic contact dermatitis: clinical and immunologic monitoring.
ABSTRACT In allergic contact dermatitis (ACD) previously sensitized T cells cause skin damage. If an ubiquitous allergen such as nickel is involved, no effective treatment is available. Down-regulation of this allergic response has been described after antigen presentation in the absence of adequate costimulatory signals. UV exposure can enhance such hyposensitization.
The aim of this study was to establish the capability of a hyposensitization procedure to induce antigen-specific tolerance.
Twenty-one patients with nickel ACD were randomly assigned to either a hyposensitized or control group. A schedule consisting of UVB treatment and subcutaneous nickel sulfate administration (hyposensitization) or UVB only (control) was applied. During the ensuing 2 years, several clinical and immunologic features were monitored.
During UVB treatment we observed a significant clinical improvement in both groups that persisted in the hyposensitized group. Except for increased slope variances of specific lymphocyte proliferation in time, no clear changes were seen in the immunologic findings.
Despite significant clinical improvement induced by UVB, hyposensitization did not induce significant changes in the immunologic findings in patients with nickel ACD.
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ABSTRACT: In the group of urticaria, contact urticaria syndrome is a particular variety. In these patients, appearance of typical skin lesions is preceded by contact of the skin and mucous membranes with various inhaled allergens, nutrients or contact details. Furthermore, symptoms connected with contact urticaria syndrome are characterized by gradual, stepwise waveform, which can be easily generalized - patients may develop systemic symptoms similar to those found in the angioedema, asthma or anaphylactic shock. It is an attribute of contact urticaria syndrome in the course of which potentially life-threatening symptoms may develop after contact of the skin with the allergen. The underlying mechanisms are poorly understood; both immunological and non-immunological mechanisms are taken into account, therefore contact urticaria syndrome can be classified into two categories - allergic and non-allergic. An intriguing phenomenon seems to be the immediate reaction after exposure to low molecular weight allergens - haptens, such as metals, which are usually the cause of delayed allergic reactions. Diagnosis is based on clinical presentation indicating a coincidence of the onset of allergy with contract with allergen, and helpful exposure tests. Treatment consists of supportive antihistamines and corticosteroids - locally and systemically. In the case of anaphylaxis, appropriate treatment intensification of the integration of pressor amines and hydration is necessary. It is also regarded that prevention is advisable, which consists of relevant information to avoid situations connected with contact with well-known factors. In this paper we describe a case of a 57-year-old female admitted to the Department of Internal Medicine, Geriatrics and Allergology, Medical University in Wroclaw to undergo diagnostic tests of chronic urticaria and angioedema. According to information obtained from the clinical presentation and after the diagnostic procedures, contact urticaria syndrome due to exposure to metals was diagnosed.Postepy Dermatologii I Alergologii 05/2014; 31(2):108-12. DOI:10.5114/pdia.2014.40915 · 0.66 Impact Factor
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ABSTRACT: We previously demonstrated that repeated intradermal steroid injections administered at weekly intervals into positive patch-test sites induce hyposensitization and desensitization. To examine changes in CD4CD25CD127lo/ regulatory T cells during the attenuation of the patch-test response. Ten patients with known allergic contact dermatitis were patch tested weekly for 10 weeks. The patch-test site was injected intradermally with 2 mg triamcinolone. At weeks 1 and 7, a biopsy was performed on the patch-test site in 6 patients, and flow cytometry was performed assessing CD4CD25CD127lo/ regulatory T cells. Secondary outcomes were clinical score, reaction size, erythema, and temperature. Statistical analysis included regression, correlation, and repeated-measures analysis of variance. The percentage of CD4CD25CD127lo/ regulatory T cells, measured by flow cytometry, increased from week 1 to week 7 by an average of 19.2%. The average grade of patch-test reaction decreased from +++ (vesicular reaction) to ++ (palpable erythema). The mean drop in temperature following treatment was 0.28°C per week. The mean area decreased 8.6 mm/wk over 10 weeks. Intradermal steroid injections of weekly patch-test reactions resulted in hyposensitization of the allergic contact dermatitis reaction. CD4CD25CD127lo/ regulatory T cells showed a tendency to increase; however, further studies are needed to determine if this is significant.Dermatitis 03/2014; DOI:10.1097/DER.0000000000000022 · 1.36 Impact Factor
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ABSTRACT: Acquired allergic contact dermatitis (ACD) causes significant morbidity. Certain occupations predispose workers to ACD, especially those that may damage the skin barrier. Allergic contact dermatitis has significant socioeconomic effects. Allergic contact dermatitis is difficult to treat, particularly if exposure is unavoidable. The objective of this study was to establish the efficacy of intradermal steroid injections in inducing specific antigen hyposensitization when administered weekly into shifted patch-test sites. Prospective, open-label trial included 10 patients with ACD. Each week for up to 8 weeks, patients were patch-tested to their known allergen, and the patch-test site was injected with triamcinolone. Primary outcomes were clinical score, reaction size, erythema, and thermal characteristics. Statistical analysis included regression, correlation, repeated measures, and analysis of variance with contrast variables. Overall results suggest significant decreases in patch-testing reactions as evidenced by improved clinical scores, reaction sizes, and reduced heat production. In 3 patients, the patch test became negative. This desensitized state persisted for 2 months in 1 patient and for 4 months in the other 2 patients. Repetitive treatments of weekly, shifted, positive patch test sites with intradermal steroid injections show a tendency toward allergen-specific hyposensitivity and in some cases to nonreactivity at repeat patch testing. This finding may influence future management of ACD.Dermatitis 07/2012; 23(4):148-52. DOI:10.1097/DER.0b013e318260d568 · 1.36 Impact Factor