ABSTRACT
We herein present a patient with delayed-type allergic hypersensitivity against prilocaine leading to spreading eczematous dermatitis after subcutaneous injections for local anesthesia with prilocaine. Prilocaine allergy was proven by positive skin testing and subcutaneous provocation, whereas the evaluation of other local anesthetics - among them lidocaine, articaine and mepivacaine - did not exhibit any evidence for cross-reactivity.Interestingly, our patient repeatedly tolerated strictly deep subcutaneous injection of prilocaine in provocation testing while patch and superficial subcutaneous application mounted strong allergic responses. We hypothesize, that lower DC density in deeper cutaneous compartments and/or different DC subsets exhibiting distinct functional immunomodulatory properties in the various layers of the skin may confer to the observed absence of clinical reactivity against prilocaine after deep subcutaneous injection.The term compartment allergy indicates that the route of allergen administration together with the targeted immunologic environment orchestrates on the immunologic outcome: overt T-cell mediated allergy or clinical tolerance.
ABSTRACT
Transient aquagenic palmar hyperwrinkling (TAPH) is a rarely reported cutaneous condition clinically characterized by swelling and hyperwrinkling of the palms, and associated with burning sensations after briefly immersing the hands in water. Upon the withdrawal of water, the symptoms rapidly disappear. We report on a 10-year-old boy with type I diabetes, who developed the typical symptoms of TAPH concomitantly with the onset of palmar hyperhidrosis. Determination of the sodium chloride concentration of the sweat revealed elevated levels. Subsequent screening for the most common mutations of the gene responsible for cystic fibrosis (CF) was negative. Review of the literature shows that TAPH may develop in conditions of increased water absorption due to an increased sweat quantity, such as hyperhidrosis, or an increased sweat electrolyte concentration, such as CF. In the majority of reported cases TAPH has been associated with CF; therefore, it is a cutaneous sign, which should be recognized by dermatologists, and patients should be referred for evaluation of the sodium chloride concentration of the sweat.
Subject(s)
Cystic Fibrosis/complications , Hand Dermatoses/etiology , Hyperhidrosis/complications , Water/adverse effects , Adolescent , Adult , Child , Cystic Fibrosis/diagnosis , Cystic Fibrosis/genetics , Cystic Fibrosis Transmembrane Conductance Regulator/genetics , DNA Mutational Analysis , Electrolytes/analysis , Female , Hand/physiopathology , Hand Dermatoses/physiopathology , Humans , Hyperhidrosis/diagnosis , Immersion , Male , Middle Aged , Pain/etiology , Skin/physiopathology , Skin Absorption/physiology , Sweat/chemistryABSTRACT
Delayed-type hypersensitivity to subcutaneously injected heparin is relatively common. Particularly, extensive cross-reactivity between different heparins and heparinoids often occurs. Delayed-type hypersensitivity to heparin implies the risk of a generalized eczema when heparin is administered intravenously. However, case reports demonstrated a tolerance to intravenous heparin in patients with delayed-type hypersensitivity to subcutaneous heparin, but prospective studies have not been performed. Our study group, of 28 patients with a proven delayed-type hypersensitivity to subcutaneous heparin, was challenged with intravenous heparin, which was well tolerated in all 28 patients. Therefore, in case of therapeutic necessity, the shift from subcutaneous to intravenous heparin administration is justified.