白凡士林(Ph.Eur.)事实上无致敏性(对1992—2004年IVDK试验中80000例患者的资料进行分析,并简要讨论变应原的鉴定)

Sporadic cases of contact allergy to white petrolatum, which is used as a vehicle in patch test preparations, have been reported. The quantitative relevance of the phenomenon remains yet to be elucidated. Methods: Retrospective analysis of patch test data of the Information Network of Departments of Dermatology (IVDK, http://www.ivdk.org) between 1992 and 2004. Results: Analysis of 79 365 patients patch tested with pure petrolatum yielded 27 ‘ + ’ (0.03% ) and 2 ‘ + + + ’ (0.003% ) reactions. The majority of non-negative reactions (0.3% ) was interpreted as doubtful (235) or mild irritant (32). The negative reaction index (RI) (- 0.8), and the high positivity ratio (PR) (93% ) especially a lack of concordance with patch test preparations containing ≥ 99% petrolatum indicate that many of the ‘ positive’ (+ ) reactions have to be considered as irritant. There were 2 ‘ + + + ’ reactions. In 1 case, an ‘ angry back reaction’ was confirmed. The other case is probably a reading or documentation error, as the majority of patch test reactions to preparations containing petrolatum remained negative in this case also. Conclusions: True allergic patch test reactions to white petrolatum are extremely rare and probably due to an individually increased susceptibility to allergens and/or irritants. This is in agreement with considering petrolatum as a non-sensitizer.

德国接触性皮炎研究组报道的金属加工液斑贴试验结果

Based on the information of the interdisciplinary task force on allergy diagnostics in the metal branch,in 2001,the German Contact Dermatitis Research Group (DKG) compiled two metalworking fluid (MWF) test series with currently and previously used components,respectively. After 2 years of patch testing,we present results obtained with these series,based on data of the Information Network of Departments of Dermatology (IVDK). 251 metalworkers who were patch tested because of suspected MWF dermatitis in 2002 and 2003 were included in this retrospective data analysis. Of these,206 were tested with the current MWF series and 155 with the historical MWF series. Among the current MWF allergens,monoethanolamine ranked 1st with 11.6%positive reactions. Diethanolamine (3.0%)-,triethanolamine (1.1%),and diglycolamine (1.9%) elicited positive reactions far less frequently. Allergic reactions to paminoazobenzene were frequently observed (6.0%),but the relevance of these reactions is still obscure. Positive reactions to biocides ranged from 4.5%for Bioban. CS 1135 to 0.5%for iodopropynyl butylcarbamate and 2-phenoxyethanol. Concomitant reactions to formaldehyde,which caused positive reactions in 3.3%,and formaldehyde releasers occurred to varying extents without conclusive pattern. No positive reactions were seen to dibutyl phthalate,di-2-ethylhexyl phthalate,tricresyl phosphate,isopropyl myristate or benzotriazole. With the historical MWF test series,positive reactions to methyldibromo glutaronitrile (MDBGN) were observedmost frequently. However,sensitization via allergen sources other than MWF seems likely,as MDBGN,during the study period,has been one of the most frequent preservative allergens in cosmetics and body care products. Other historical MWF allergens comprisedmorpholinyl mercaptobenzothiazole (3.3%),benzisothiazolinone (BIT; 2.0%) and Bioban. P 1487(1.3%). BIT is currently used in MWF again,so it was shifted to the current MWF test series. As decreasing reaction frequencies to former MWF allergens that are no longer used can be expected,the historical series should be re-evaluated after some years. The test series with current MWF allergens has to be kept up-to-date based on information from industry and to be kept concise by eliminating test substances which never cause positive reactions.

用患者工作场所中的金属加工液进行斑帖试验

In view of the wide variety of components currently used in metalworking fluids (MWF), relevant contact sensitizations may be overlooked, because commercially available MWF test series cannot cover the full spectrum. Hence, patch testing with MWF from the patient’s workplace is an important additional diagnostic tool. However, recommendations on how to perform such patch tests vary. We retrospectively analyzed patch test data of the Department of Dermatology in Dortmund, 1992-2003. In 141 metalworkers tested because of suspected occupational contact dermatitis due to MWF, 829 patch tests with 306 samples of MWF were performed. Water-based MWF (wb MWF) were mainly tested in 2 dilution series, i.e. pure (workplace concentration), 10%aq. and 1%aq., and pure, 50%aq. and 10%aq. Positive reactions to wb MWF occurred in 27 patients. Patch testing with wb MWF at workplace concentration resulted in 16.1 %(39/242) positive reactions, with a positivity ratio of 69%and a reaction index of 0. From the analysis of reaction patterns and concomitant reactions,we conclude that most of these positive reactions indicated true contact allergy. With lower concentrations, relevant allergic reactions may be missed. Neat oils were tested as is or diluted from 1 to 50%in olive oil, but no reactions at all were observed. For optimum benefit of patch testing with MWF from the patient’s workplace, breakdown testing is recommended. To overcome the time-consuming difficulties associated with this procedure, we propose a centre for information and documentation of contact allergies due to occupational exposure. Furthermore, full declaration of MWF ingredients is desirable.

提高对环氧树脂系统接触致敏诊断的尝试:EPOX2002多中心研究的第一结果

Epoxy resin systems (ERSs) are a frequent cause of occupational allergic conta ct dermatitis. Sensitization occurs not only to the resins, but also to hardener s and reactive diluents. However, only a fraction of the ERS components currentl y in use are available for patch testing. With the multicentre study EPOX 2002, we attempted to improve diagnostics in this field by patch testing with componen ts currently used in ERSs. During the first study period (October 2002 to July 2 003), in addition to commercially available ERS patch test substances, 16 study substances (1 resin, 9 hardeners and 6 reactive diluents) were patch tested in 7 0 patients with suspected contact allergy due to ERSs and 22 patients with a pri or positive patch test reaction to epoxy resin (ER) in the standard series. Most frequently, allergic reactions to ER based on diglycidyl ether of bisphenol A a nd F were observed (55.2%and 43.7%, respectively). Agreement between positive reactions to both resins, which can be explained by immunological cross-sensiti zation and/or coexposure, was substantial [Cohen’s kappa 0.65 (95%CI:0.49-0 . 80)]. Among the reactive diluents, 1,6-hexanediol diglycidyl ether (1,6-HDDGE ) and 1,4-butanediol diglycidyl ether (1,4-BDDGE) were the most frequent allerg ens, with 19.5%and 18.4%positive reactions, respectively. Although agreement b etween positive reactions to 1,6-HDDGE and 1,4BDDGE was even better than with t he 2 resins, the sample size is considered too small to decide reliably whether 1,6-HDDGE alone could serve as a marker allergen for both. Allergic reactions t o p-tert-butylphenyl glycidyl ether and to phenyl glycidyl ether (PGE) occurre d in 11.5%of the patients tested, with only moderate agreement. All patients po sitive to cresyl glycidyl ether (6.8%) also reacted to PGE. Of the hardeners te sted, m-xylylene diamine was the most frequent allergen (13.8%), followed by i sophorone diamine (5.7%). No reactions were observed to several substances, the test concentration of which may have been too low and will be increased in the future.

不同时期的对甲苯二胺制剂斑贴试验

Analyses of the stability of 1 %p-toluene diamine (PTD) in petrolatum used for patch testing showed a rapid decline of the PTD concentration down to 0.1%,possibly due to the generation of dye complexes. To study whether the diagnostic quality of this test preparation is compromised by the chemical reactions taken place, a multicentre study was conducted by the German Contact Dermatitis Research Group (DKG), comparing patch test results in 177 patients with simultaneously tested PTD preparations of different ages. During the 10-month course of this study, the age of the batches ranged from 2 to 11 months for batch A, from 7 to 16 months for batch B and from 11 to 20 months for batch C. There were no statistically significant differences between reactions to batches A and B, A and C, and B and C. Agreement of patch test reactions to the 3 batches was very good and comparable to the general reproducibility of patch test with standard allergens. The chemical reactions mentioned above apparently do not affect the diagnostic quality of PTD patch test preparations because the true allergen probably is not PTD itself, but one or more of the reaction products.