Occupational allergic contact dermatitis to chromium from cement: Estimating the size of the problem in Australia.

BACKGROUND: Allergic contact dermatitis (ACD) caused by chromium in cement is a significant occupational hazard. However, legislation in Europe over the past two decades to reduce the concentration of chromium in cement to <2 ppm through the addition of ferrous sulphate to cement, has seen a significant decrease in the incidence of chromium allergy. No such legislation exists in Australia. METHODS: A retrospective analysis of results from the Patchcams database of patients attending the Occupational Dermatology Clinic at the Skin & Cancer Foundation, Melbourne, who were patch tested for chromium between 1 January 1993 to 31 December 2013, was conducted. RESULTS: Our review revealed that there has not been any significant change in the number of cases of ACD to chromium attributed to sensitisation through cement. Based on our data, we estimate that a minimum of 24 cases of chromium occupational ACD (OACD) from cement is found in Australia yearly, causing considerable morbidity, often associated with an inability to work, costly workers' compensation claims and sometimes the development of the disabling condition, persistent post-occupational dermatitis. CONCLUSION: These findings highlight the need for high-level discussions about adopting European legislation in Australia in order to reduce the likelihood of developing chromium OACD from cement.

Allergic contact dermatitis to indium in jewellery: diagnosis made possible through the use of the Contact Allergen Bank Australia.

We report a case of a 39-year-old woman from Adelaide who developed allergic contact dermatitis to the rare allergen indium in her ring. The allergen was sourced for patch testing using the Contact Allergen Bank Australia (CABA), based at the Skin and Cancer Foundation in Melbourne, and posted to Adelaide. This case illustrates the usefulness of CABA in facilitating patch testing throughout Australia, especially when rare allergens are involved.

Allergic contact stomatitis to dodecyl gallate? A review of the relevance of positive patch test results to gallates.

Gallic acid esters or gallates are antioxidants used as preservatives in food and cosmetics. Few cases of gallates causing allergic contact dermatitis (ACD) have been reported in the literature. We present a case report of a 42-year-old beauty therapist who presented with a swollen tongue. Patch testing was positive to dodecyl gallate, commonly reported as being present in edible oil and oily foods such as margarine. Our patient avoided foods presumed to contain gallates and at the 6-week review reported a substantial improvement in her tongue symptoms. We reviewed our database and found 16 (7%) definitely or possibly relevant reactions to dodecyl gallate, seven (15%) definitely or possibly relevant reactions to propyl gallate and six (3%) definitely or possibly relevant reactions to octyl gallate. Most reactions were attributed to margarine, moisturising cream and lipstick. These products are often mentioned in the literature as containing gallates; however, ingredient labelling and discussions with manufacturers made it difficult to establish whether they are currently present in foods. Ascertaining relevance for these reactions is not always possible.

Infant feeding and the development of food allergies and atopic eczema: An update.

There is an increasing awareness of food allergies in the community. Dermatologists frequently see patients with atopic eczema, where parents are extremely concerned about the role of food allergy. Advice given to parents regarding the timing of introduction of solid foods has changed markedly over the past decade. Whereas previous advice advocated delaying the introduction of solid foods until the infant's gastrointestinal system had matured, recent studies suggest that the introduction of solids from around 4 to 6 months may actually prevent the development of allergies. Studies on maternal dietary restrictions during pregnancy and lactation have led researchers to believe that antigen avoidance does not play a significant role in the prevention of atopic disease. Breastfeeding exclusively for 4 to 6 months has multiple benefits for mother and child, however, it does not convincingly prevent food allergies or decrease atopic eczema. New evidence suggests that the use of hydrolysed formulas does not delay or prevent atopic eczema or food allergy. This article aims to highlight current evidence and provide an update for dermatologists on the role of food exposure in the development of atopic disease, namely atopic eczema.

Accuracy of Doppler echocardiography to estimate key hemodynamic variables in subjects with normal left ventricular ejection fraction.

BACKGROUND: The accuracy of Doppler echocardiography to estimate key hemodynamic parameters in subjects with normal left ventricular ejection fraction (LVEF) has not been fully investigated. METHODS AND RESULTS: Thirty-six subjects with LVEF >50% (median age 62 years), with a broad clinical profile, underwent Doppler echocardiography immediately followed by right heart catheterization. Correlation coefficients between invasive and noninvasive right atrial pressure (RAP), systolic (sPAP) and mean (mPAP) pulmonary artery pressure, cardiac output (CO), and pulmonary vascular resistance (PVR) were 0.39, 0.70, 0.72, 0.57, and 0.60 (P < .001 for all). There was no significant correlation between invasive and noninvasive (based on the peak early transmitral to peak early septal mitral annular velocity ratio) pulmonary capillary wedge pressure (PCWP; r = 0.23; P = .18). Bland-Altman plots revealed variable bias but with consistently large limits of agreement for all noninvasive parameters, particularly PCWP. Areas under the receiver operating characteristic curve for noninvasive sPAP, CO, PVR, and PCWP to predict an invasively assessed mPAP ≥25 mm Hg, cardiac index <2.5 L min(-1) m(-2), PVR >3 Wood units, and PCWP ≤15 mm Hg, respectively, were 0.92, 0.83, 0.70, and 0.58. CONCLUSIONS: Single Doppler echocardiography parameters are not accurate enough to reliably estimate key hemodynamic parameters, particularly PCWP, in subjects with normal LVEF.