Use of patch testing for identifying allergen causing chronic urticaria.

BACKGROUND AND AIMS: The aim of this present study was to evaluate the role of patch testing for the etiological diagnosis of chronic urticaria (CU) by using the Indian standard battery of patch test allergens approved by Contact and Occupational Dermatitis Forum of India (CODFI). METHODS: A total of 57 cases with chronic urticaria were tested with the Indian standard battery of allergens. All those cases that showed allergy to patch test allergens were advised to avoid contact with the allergen(s) to whom they had allergy; they were also advised to avoid/restrict allergens in the diet. This avoidance/restriction was advised for a period of six weeks. During this period, clinical improvement of each patient was evaluated and recorded at weekly intervals. RESULTS: Out of the 57 cases of CU, 11 patients showed positive reactions to one or more patch test allergens. Nine out of eleven showed complete disappearance of CU by 2-3 weeks on avoidance of the allergen and this improvement continued till the end of six weeks. The remaining two cases showed partial recovery from CU during the same period. CONCLUSION: Patch testing is a safe, simple and inexpensive alternative that can be used for the etiological diagnosis of chronic urticaria before undertaking expensive investigations.

Relationship between nickel allergy and diet.

Nickel is a ubiquitous trace element and it occurs in soil, water, air and of the biosphere. It is mostly used to manufacture stainless steel. Nickel is the commonest cause of metal allergy. Nickel allergy is a chronic and recurring skin problem; females are affected more commonly than males. Nickel allergy may develop at any age. Once developed, it tends to persist life-long. Nickel is present in most of the dietary items and food is considered to be a major source of nickel exposure for the general population. Nickel content in food may vary considerably from place to place due to the difference in nickel content of the soil. However, certain foods are routinely high in nickel content. Nickel in the diet of a nickel-sensitive person can provoke dermatitis. Careful selection of food with relatively low nickel concentration can bring a reduction in the total dietary intake of nickel per day. This can influence the outcome of the disease and can benefit the nickel sensitive patient.

Disulfiram and low nickel diet in the management of hand eczema: a clinical study.

BACKGROUND: Hand eczema due to nickel sensitivity is a challenging task for the dermatologist. The average human diet provides sufficient amount of nickel, which acts as a provocating factor in nickel-sensitive individuals. When such patients are treated with steroid or other immunosuppressives, only short-term remission is obtained. This is because unless the dietary intake of nickel is minimized and the existing amount of nickel in the body of the sensitized individual is depleted, long-term remission is unlikely. AIM: To evaluate the efficacy of oral disulfiram, a nickel-chelating agent and low nickel diet (LND) in reducing the clinical symptoms and preventing frequent relapse of hand eczema in nickel-sensitive individuals. METHODS: A total of 21 patients with chronic vesicular hand eczema with nickel sensitivity were taken for this study. Patients were randomly divided into two groups: (a) Study group consisting of 11 patients (8 females and 3 males). They were prescribed disulfiram orally for a period of 4 weeks; they started LND 2 weeks prior to initiation of disulfiram therapy and continued till the end of follow-up period. (b) Control (placebo) group consisting of 10 patients (7 females and 3 males). They were allowed to continue with normal diet. Each of them received lactose tablet daily as placebo for 4 weeks. It was a comparative study and participants were not aware if they belonged to study group or control group (single blind trial). RESULTS: Hand eczema healed completely in 10 (90.9%) out of 11 patients treated with disulfiram and LND during the treatment period in the study group, compared with 1 out 10 patients in control (placebo) group (non significant). Mild relapse was noted in 5 patients in between 2-12 weeks of follow-up period. CONCLUSION: Low nickel diet and short course of oral disulfiram therapy can be considered a good option for the control of chronic hand eczema in nickel-sensitive individuals.