[Epicutaneous sensitization to metals and contact allergic dermatitis: analysis of an ambulatory caseload]. / Sensibilizzazione epicutanea a metalli e dermatite allergica da contatto: analisi di una casistica ambulatoriale.

We have retrospectively analyzed the clinical and anamnestic features of 233 out-patients (197 females and 36 males; mean age: 33 years; SD: +/- 13.3) with epicutaneous sensitization to metals, who had been examined at the department of allergology of our institution during one year. Among females, nickel sulphate was the metallic salt which most frequently resulted positive at patch testing (87.8% of cases), followed by cobalt chloride (23.6%) and potassium bichromate (10.2%). Nickel was the most common sensitizing metal also in males (58.3%), among whom sensitization to chromate resulted second in order of frequency (30.6%), and sensitization to cobalt was relatively rare (11.1%). In selected cases, the utilization of additional, specific series allowed to document rare cases of sensitization to metallic salts not included in the standard patch test series (copper sulphate, cadmium chloride, zinc stearate, phenylmercuric nitrate). 78 patients were sensitized to more than one metal. Skin sensitivity to metals was often linked to allergic disease familiarity and/or to sensitization toward type I allergens. Allergic contact dermatitis was diagnosed in 80 patients: cutaneous manifestations had been present on average for over four years, sometimes in generalized or persistent form. An occupational contact with the causative metals was identified in 15 cases. However, the occupational origin of the disease could never be documented with certainty, due to concomitance of frequent non-occupational exposures and to lack of information on pre-employment skin sensitivity status. Thus, the value of patch testing, during both pre-employment screening and health surveillance, is emphasized.

Local immunotherapy by inhalation of a powder extract in asthma due to house dust mite Dermatophagoides pteronyssinus: a double-blind comparison with parenteral immunotherapy.

To verify the efficacy and the tolerability of local immunotherapy (LI) by inhalation of a powder extract of house dust mite (HDM), in comparison with parenteral immunotherapy (PI) by injection, 10 patients with asthma due to HDM were studied in a blind fashion. 5 patients (Group A) underwent LI and subcutaneous injections of placebo, 5 patients (Group B) underwent PI and inhalation of lactose for 6 months. In both groups each inhalation was preceded by premedication with disodium cromoglycate (DSCG) (40 mg). In Group A a significant decrease in symptoms score and in peak expiratory flow (PEF)-derived parameters was observed already after 3 months of treatment, and 2 patients lost the late component of the bronchial response to the challenge with HDM. No significant variation was found in bronchial responsiveness to methacholine and ultrasonically nebulized distilled water (UNDW) and in immunologic humoral and cellular parameters in peripheral blood after treatment in either group. No local important adverse reactions were observed in Group A and no systemic side effects were observed in either group. We conclude that LI is as effective as PI, but more rapid in its action, in the treatment of asthma due to HDM. Moreover, LI is locally well tolerated, providing DSCG is inhaled before each therapeutic inhalation, and does not induce systemic side effects.

Comparative study between two immunoassays for detection of allergen-specific IgG4.

In the present work two commercially available immunoassays for allergen-specific IgG4 detection were compared, IgG4 FAST Test and ALLERBLOCK-MS IgG4 EIA Kit. For this purpose 30 serum samples were tested for IgG4 antibodies (Abs) specific to Dermatophagoides pteronyssinus (Dp) by the two immunoassays. Eleven serum samples were collected from normal subjects, 6 from Dp-atopic patients never treated by specific immunotherapy (ITS) and 13 from Dp-atopic patients previously treated by ITS. Pearson's linear correlation analysis showed a significant correlation of results from the two immunoassays. However, a better discrimination of Dp-specific IgG4 values between ITS-treated and untreated patients or normal subjects was obtained by FAST than ALLERBLOCK-MS method; moreover, the former showed a better intra-assay coefficient of variation than the latter.

[Asthma caused by sodium p-toluene-n-chloro-sulfonamide: observations on a clinical case]. / Asma da p-toluen-n-cloro-solfonamide sodica: osservazioni su un caso clinico.

We describe the case of a patient exposed to chloramine-T who experienced severe asthmatic symptoms when spraying chloramine-T solutions. The patient used chloramine-T as a sterilising agent in medical facilities. Occupational asthma due to chloramine-T was diagnosed by means of specific bronchial provocation test (occupational type). We stress the risk of exposure to high levels of chloramine-T and the importance of this compound as a cause of occupational asthma.

[Vitiligo appearing after contact with mud containing solvents: an occupational cause?]. / Vitiligine comparsa dopo contatto con fango a base di solventi: sua origine professionale?

The authors describe one case of Vitiligo in a worker employed in a firm for the exploitation of underground energetic products. The disease occurred after contact with the mud used for the drilling containing aromatic, aliphatic and chlorinated hydrocarbons. The possible occupational cause of the disease, as more solvents in the mud have the structure of aromatic hydrocarbons is discussed.

[Allergic risk factors in wood working]. / Fattori di rischio allergico nella lavorazione del legno.

After an account on wood working schedule and on the main and most noxious chemical constituents of these materials, we consider 55 subjects working in touch with wood, on whom allergological researches have been performed through skin tests and bronchial provocation tests. The sensitivity to wood dust have been found in 10 cases (18.2%), in particular towards woods of obece, lanan, mahogany and samba. Skin tests have revealed 1 positivity to balsam of Perù and 3 to isocyanate (TDI). The bronchial provocation tests have pointed out 1 positive reaction to Mansonia's and ramin's wood and 2 to TDI. The results suggest that the respiratory manifestations due to wood's dust on subjects professionally exposed, have to be prevalently imputed to exotic woods, even if the irritant factors assume a not minor importance. It is discussed the possible role of isocyanates in this pathology.