手部湿疹严重指数(HECSI):手部湿疹临床评价的评分系统在观察者间及观察者内的可靠性研究

Background: There is a need for a standardized clinical grading system for a more objective and accurate assessment of the severity of hand eczema (HE). Objectives: To develop and validate a scoring system called the hand eczema severity index (HECSI) designed for clinical assessment of HE.Methods: Twelve dermatologists (observers) assessed 15 HE patients twice, with an interval of 30 min. The study was performed blinded for the observers, and only the hands and wrists of the patients were visible to the observers. Agreement between the observers was determined by using the intraclass correlation coefficient (ICC), which is the correlation between (single) ratings of the same patient. Results: ICC for total HECSI score was 0.79 at the first assessment and 0.84 at the second assessment, ICC for intraobserver agreement was 0.90. Conclusions: Overall excellent agreement existed for both inter-and intra-observer reliability and the scoring system is suggested for use in future clinical studies on HE. Because HECSI is an entirely objective assessment of clinical signs, in addition, inclusion of patient-rated symptoms should be considered.

Cr(VI)阳性患者的Cr(III)反应性与足部皮炎

Chromium allergy has become synonymous with Cr(VI) allergy.However, real exposure to chromium from leather products may include both Cr(III) and Cr(VI). In this study,we investigate the reactivity to both Cr(VI) and Cr(III) in consecutive patients to analyse the relation between foot eczema/leather exposure and reactivity to Cr(III). From March 2002 to December 2004, 2211 consecutive patients with suspected allergic contact dermatitis were patch tested with 0.5%potassium dichromate (Cr(VI)) and 13%chromium trichloride(Cr(III)). A total of 71 (3.2%) patients had a positive reaction to Cr(VI), of which 31 also had a positive Cr(III) reaction. No Cr(VI) negative patients had a positive reaction to Cr(III). An increased risk of foot dermatitis was found in Cr(VI) positive patients with a concomitant positive or doubtful reaction to Cr(III) compared with Cr(VI) positive patients with no reactions to Cr(III). The increased risk was not due to a higher degree of sensitivity to Cr(VI). Leather was reported most frequently as the suspected cause of chromium dermatitis (54%).However, Cr(VI) allergics having foot eczema and positive or doubtful Cr(III) reactions often had positive reactions to other shoe allergens. Thus, Cr(III) allergy is part of a multiple shoe allergy pattern.

伴有香料引发的呼吸系统症状的湿疹患者的辣椒碱咳嗽反射

Respiratory symptoms elicited by perfume are common in the population but have unclear pathophysiology. Increased capsaicin cough responsiveness has been associated with the symptoms, but it is unknown whether the site of the symptoms in the airways influences this association. The aim of this study was to investigate the association between the site of airway symptoms elicited by perfume and cough responsiveness to bronchial challenge with capsaicin. 21 eczema patients with respiratory symptoms elicited by perfume were compared with 21 healthy volunteers in a sex and age-matched case control study. The participants completed a symptom questionnaire and underwent a bronchial challenge with capsaicin.Lower, but not upper, respiratory symptoms elicited by perfume were associated with increased capsaicin cough responsiveness. Having severe symptoms to perfume (n = 11) did not relate to the site of the symptoms in the airways and was not associated with increased capsaicin cough responsiveness.In conclusion, respiratory symptoms elicited by perfume may reflect local hyperreactivity related to defensive reflexes in the airways, and measurements of the capsaicin cough reflex are relevant when patients with lower respiratory symptoms related to environmental perfume exposures are investigated.

基因转录产物作为变态反应性接触性皮炎的潜在诊断指征

The standard procedure for diagnosing allergic contact dermatitis is to perform a patch test. Because this has several disadvantages, the development of a new in vitro test system would be of immense value. Gene transcripts that distinguish allergies from non-allergies may have the potential to serve as the molecular basis for such a diagnostic tool. In this study, we use the microarray technology in the identification of differentially expressed genes in allergen-stimulated peripheral blood mononuclear cells (PBMCs) from 3 chromium-allergic patients versus 3 healthy controls. Using an Affymetrix GeneChip., the gene expression was analysed in PBMC cultures grown with 100 μg/ml CrCl3 or in media alone for 24 hr. A total of 26 genes were differentially expressed by more than twofold (P < 0.01) in allergen-activated PBMCs from patients compared with controls. 18 of these were upregulated, whereas 8 were downregulated. The expression of 1 downregulated gene, CASP8, was also found specifically and significantly reduced in an expanded population including 4 additional chromium allergic patients and 1 additional control subject by real-time reverse transcriptase polymerase chain reaction (RT-PCR) analysis. The expression of 2 upregulated genes, ETS2 and CISH, correlated with a high-proliferative response following CrCl3 exposure. Additionally, real-time RT-PCR analysis indicated that the same gene expression changes are valid for nickel allergies, potentially making the expression profile more widely available. The 26 differentially expressed genes identified in this study may potentially function as diagnostic markers for contact sensitivity.

丹麦异硫氰酸丙烯酯过敏性接触性皮炎259例

Allyl isothiocyanate is present in many plants. Allergic contact dermatitis from allyl isothiocyanate is well known but infrequently reported. The aim of this study was to investigate the prevalence of contact allergy to allyl isothiocyanate in patients with suspected contact dermatitis from vegetables and food. 259 such patients were tested at the Department of Dermatology,Gentofte Hospital,Denmark,from 1994 to 2003. Only 2 patients (0.8%) had a positive reaction (+) to allyl isothiocyanate and 43 patients (16.6%) had a ?+reaction. One of the patients with a positive reaction provided samples of margarine,salad cream,oil and mayonnaise. These were analysed with high-performance liquid chromatography,and amoderate concentration of allyl isothiocyanate (2.5 ppm) was detected in the sample of margarine. This patient was a professional sandwich maker presenting with fingertip dermatitis mimicking’tulip fingers’or allergic contact dermatitis from garlic and onions. In conclusion,allergic contact dermatitis from allyl isothiocyanate occurs in only a limited number of cases,despite frequent exposure. The large number of ?+reactions raises the question as to whether the recommended patch test concentration is too low.