Late Breaking Poster Sessions - Wiley Online Library

Late breaking poster session Drug allergy

1886 Effect of anti-TNF and oral steroids on the cantharidin-induced skin blister inflammation

1887 Implications of IgG and IgE anti-Lasparaginase antibodies in children with acute lymphoblastic leukemia

Dinh, P1; Corraza, F2; Mestdagh, K3; Kassengera, Z2; Doyen, V3; Wiesel, P4; Michel, O3 1 Pham Ngoc Thach University of Medicine (PNTU), Department of Immunology, Ho Chi Minh city, Vietnam; 2 CHU Brugmann (ULB), Hematology department, Brussels, Belgium; 3CHU Brugmann (ULB), Clinics Immuno-allergology, Brussels, Belgium; 4Funxional Therapeutics Ltd., Medical department, London, United Kingdom

Galindo, G1; Gonzalez, S1; Cavazos, R2; Heredia, A2; Salinas, M3; Trevinõ, H3 1 University Hospital UANL, Allergy Deparment, Monterrey, N.L., Mexico; 2University Hospital UANL, Hematology, Monterrey, N.L., Mexico; 3University Hospital UANL, Immunology Department, Monterrey, N.L., Mexico

Background: Techniques, such as the cantharidin induced skin blister, can assess the anti-inflammatory properties of novel drugs. There is no data on the reproducibility of this technique or on the blocking effect of anti-inflammatory drugs, such as anti-TNF and corticosteroids. Methods: We evaluated the protective effect of anti-TNF or oral corticosteroids, compared to placebo, on the skin blisters reactions. A group of 30 healthy subjects were randomized into three parallel groups treated with placebo (P), oral methylprednisolone 20 mg/day during 7 days (PDN) or anti-TNF (adalimumab) 40 mg SD. One basal blister was induced and collected for cell count, immediately before the start of treatment (day 0), and a second blister was obtained 6 days after treatment. Results: The intra-subject reproducibility was significant among the placebo group, by comparison of the responses on day one and day seven, for the number of total cells, neutrophils, eosinophils and monocytes. PDN inhibited the eosinophil influx (in % (P < 0.02) and absolute (P < 0.02) values), while anti-TNF inhibited the neutrophil influx (% (P < 0.01) and absolute (P < 0.05) values). Conclusion: The cantharidin induced-blister is a valuable technique to evaluate new anti-inflammatory drugs in their early phase of development.

694

Background: L-aspararaginase (L-aspar) administration is critical for the treatment of children suffering acute lymphoblastic leukemia (ALL). IgG/IgE anti-L-aspar antibodies can develop, causing significant hypersensitivity reactions. The production of both, IgG and IgE anti-L-aspar antibodies and their clinical consequences in ALL was investigated. Methods: Patients younger than 18 years at diagnosis of B-cell ALL who completed induction or re-induction to remission therapy were included. IgG anti-L-aspar antibodies were determined through an enzyme-linked immunosorbent assay (ELISA). Cutaneous testing with L-aspar was carried out for detecting specific activity of IgE antibodies in vivo. Personal and maternal antecedents of allergy were also documented. Results: Fifty-one ALL patients met the inclusion criteria to enter the study. A median of eight doses of L-aspar was administered at a median of 25 months before the study. Allergic reactions to Laspar developed in hree children (6%); no anaphylactic reactions were registered. Twenty-four (47%) patients developed IgG antibodies, whereas IgE antibodies were revealed by a positive skin test in 32 (63%) children. The simultaneous presence of IgG and IgE anti-L-aspar antibodies was documented in 14 (27.5%) patients. Children who developed exclusively IgG antibodies had a statistically significant lower event-free survival, P = 0.02. Eighteen children (28.3%) suffered a relapse; five of nine with negative skin tests had additional relapses (range 2–4), compared to zero of nine with positive skin tests, P < 0.001. Conclusion: IgG and IgE antibodies to L-aspar in children with ALL can develop simultaneously during therapy; whereas IgG was associated with a higher relapse

rate, in those who relapsed the absence of IgE, as evidentiated by a negative result to L-aspar skin testing, was associated with a significant risk of additional relapses. 1888 A novel platform for drug-induced skin reactions: the european network for cutaneous adverse effects of drugs (ENCAD) Burbach, G; Kro¨pfl, L; Zuberbier, T Charite – Universita¨tsmedizin Berlin, Department of Dermatology and Allergy, Berlin, Germany

Background: GA2LEN, the Global Allergy and Asthma European Network, has been created in the sixth EU framework program in order to ensure integration and harmonization of research and clinical care for all areas of allergy. In the field of drug allergy GA2LEN is cooperating with ENDA (European Network for Drug Allergy). The Department of Dermatology and Allergy, Charite`, Berlin, Germany as one of the partners of GA2LEN has longstanding interest and experience in consultant services for doctors in the field of cutaneous drug reactions. Based on this experience the project ENCAD has been created in close discussions with GA2LEN. It is now funded by the EU Regional Development Fund (EFRE). Method: ENCAD offers diagnostic and therapeutic consultant services for non-dermatologists as well as real-time tele-dermatological conferences for the discussion of difficult cases for non-dermatologists and dermatologists. In addition, an expert opinion on histological findings of druginduced skin reactions is offered. Furthermore, consultant services include the collection of detailed patient-related data on drug-induced skin reactions including drug history, clinical and laboratory findings as well as initiation or documentation of allergological assessments like provocation testing. Result: ENCAD will allow non-dermatologicals to seek professional advice regarding diagnosis and treatment of druginduced skin reactions. Dermatologists will be able to discuss interesting cases during real time teledermatological conferences. The collection of detailed data on druginduced skin reactions will allow the realization of further research aims. One of the

2010 The Authors Journal Compilation 2010 Blackwell Publishing Ltd Allergy 65 (Suppl. 92): 694–756

Late breaking poster session – Drug allergy

first ambitious aims of ENCAD is to develop a computer-based algorithm for physicians treating patients with druginduced skin reactions taking several drugs which might help to decide which drug to discontinue (probability ranking of eliciting drugs). Conclusion: ENCAD as a novel platform for drug-induced skin reactions might help to improve diagnostic and therapeutic measures in patients with cutaneous reactions related to drugs. Non dermatologists and dermatologists are, therefore, encouraged to join this project.

1889 Effective management of allergy to biphasic isophane insulin by dual desensitization: first case report Emad, K1; Tayeb, M2; Majdy, Q2; Khalid, B3 Albaha University Faculty of Medicine, Internal Medicine, Jeddah, Saudi Arabia; 2King Abdulaziz University, Family Medicine, Jeddah, Saudi Arabia; 3 Ministry of Health, Family Medicine, Jeddah, Saudi Arabia

1

Background: Allergic reactions in the form of nausea, vomiting, dizziness and itchy urticarial skin rash have been developed in a 41-year-old insulin dependent Diabetic Saudi women. These were started after three month of using isophane insulin NPH (Insulinatrad) and six months of subcutaneous biphasic isophane insulin (30% soluble, 70% isophane) (Mixtard 30). Her blood sugar was not controlled on diet, exercise and maximum oral hypoglycemic agents. Methods: By using extracts prepared from four different types of insulin, allergy skin prick tests were negative but intradermal tests were positive to all of them. These results were well-suited with the diagnosis of insulin allergy. Desensitization was carried out over a period of thirty-five days, starting at 0.01 unit of biphasic isophane insulin mixture till blood sugar was controlled with 10 units twice daily. Results: The dual desensitization using biphasic isophane insulin was successful and effective in the optimal control of her blood sugar. Conclusion: To our knowledge this is the first case report in the literature of insulin allergy who had a successfull desensitization using biphasic isophane insulin mixture.

1890 Occupational asthma due to antibiotics Diaz Angulo, S1; Cullinan, P2 Hospital Universitario Marques de Valdecilla, Allergy, Spain; 2Royal Brompton Hospital, Occupational Respiratory Diseases, London, United Kingdom

1

Background: Occupational asthma (OA) is a potential hazard associated with the manufacture of a wide variety of pharmaceutical agents, including antibiotics; exposure is believed to occur both by inhalation and skin contact. Since 1954, 39 cases have been reported of which 15 were attributed to penicillins. Here we report five new cases of respiratory antibiotic allergy. Methods: Cases were seen and diagnosed at Royal Brompton Hospital in London, UK. Hazards indices of the antibiotics were calculated using the Chemical Asthma Hazard Assessment Program. Results: Five patients employed in the manufacture of antibiotics (four of penicillins and one of erythromycin) presented with new onset, work-related asthmatic symptoms; in each case these improved at weekends and on holidays. Diagnoses of OA were confirmed by specific bronchial provocation testing in which, in each case, a delayed asthmatic reaction was provoked. Specific IgE to the antibiotics involved was detected in one patient with OA due to amoxicillin (positive specific IgE to Penicilloyl G and to Penicilloyl V). Calculations of hazard indices confirmed the high probability that these antibiotics were respiratory sensitising agents. Conclusion: Penicillins appear to be the most frequent antibiotic cause of OA among antibiotic manufacturing employees; here we present four new cases and the first case of OA due to erythromycin. The pathogenesis of the condition – as with many other low-molecular-weight causes of OA remains unclear. Immunological tests

are of uncertain value and most diagnoses require confirmation with specific provocation testing. The frequency of OA in those who manufacture antibiotics (and some other pharmaceuticals) remains unclear. While prevalence estimates of around 10% have been reported, clinical experience suggests a less common problem. Further workplace-based surveys are required.

1891 A desensitization with iron sucrose Go´mez Galań, C; Ferre´-Ybarz, L; De la Borbolla, J; Sansosti, A; Torredemer Palau, A; Nevot Falco´, S; Althaia H Sant Joan de Deú, Allergy section, Manresa, Spain

Background: Allergic reactions to iron compounds are rare. In the case of oral iron salts, anaphylactic reactions have been reported and some protocols of oral desensitization to manage them have been described. There are studies in which parenteral iron administration (iron sucrose) is a safe alternative in patients with hypersensitivity reactions to the administration of dextran and iron gluconate. Methods: We report the case of a 64 years old woman, with no history of previous reaction to drugs. She had a severe iron deficiency anemia secondary to rectal neoplasm that requires urgent treatment with iron supplements. On the third day after initiating treatment with Tardyferon tablets (iron (II) sulfate) she developed an itching rash on both legs. Subsequently, given the degree of anemia was decided to start intravenous iron. Although antihistamine treatment was given prior to intravenous iron therapy (Venofer iron (III) sucrose), patient immediately began facial flushing and hypotension (100/60 mm Hg) requiring volume replacement. Skin prick

Table 1. For abstract 1891. Antibiotic Amoxicillin Amoxicillin Amoxicillin

Flucoxacillin

Erytromycin

Allergic symptoms

Latency

Specific ig e

Wheeze, cough Wheeze, cough Cough

27 years

Not done

27 years

Penicilloyl G (+), Penicilloyl V (+) Not done

Wheeze, cough, rash Wheeze, rhinitis

5 years

Penicilloyl G (-), Penicilloyl V (-)

2 years

Erytromycin ylsuccinate, erythromycin and erythromycin ylsuccinate sf

26 years


Bpc

eth-

Amoxicillin (+) Late asthmatic reaction Amoxicillin (+) Late asthmatic reaction Amoxicillin (+) Late asthmatic reaction Flucoxacillin (+) Late asthmatic reaction, Amoxicillin (-) Erythromycin (+) Late asthmatic reaction

Hazarz index 1 1 1

1

0.98

base eth(-)

695


test were performed to Tardyferon and Venofer with the following results: Prick test with Tardyferon (25.6 mg/ml) was positive (4 · 4 mm). Prick test with Venofer (1 mg/ml) and intradermal (0.001 mg/ ml, 0.01 mg/ml) were negative. Desensitizing treatment was performed with Venofer (100 mg/100 ml), increasing doses at intervals of 15 min, intravenous administration with infusion pump to a milliliter per minute: 0.2 ml; 0.4 ml; 0.8 ml; 1.6 ml; 3 ml; 7 ml; 13 ml; 26 ml; 48 ml. Conclusion: We present a patient who developed allergic reaction during treatment with oral an intravenous iron supplements. After taking a desensitization with Venofer she received intravenous iron sucrose (1100 mg) until the day of surgery without any problem.

1892 Acyclovir and dexamethasone phosphate, neomycin sulphate induced adverse drug reaction in 3-year-old patient Radovic, V STADA Hemofarm AD, Institute Hemofarm AD, Belgrade, Serbia

Background: This report was received from a physician via the Medicines and Medical Devices Agency of Federation BIH on 2010-January-18. Methods: The application and evaluation of adverse drug reaction. Results In patients aged 3 years in the application of Neodeksacin (INN: dexamethasone phosphate, neomycin sulphate) 1 mg + 3.5 mg/ 1 ml, eye drops, solution and Virolex (INN: acyclovir), 3%, eye ointment developed strong irritating signs with hyperemia of conjunctiva and hemorrhagic content of bublles at conjunciva of the sclera. Patient was recovery after four days. Extremely rare local application of corticosteroids can use occurrence of ulcerations on the cornea and lead to increased intraocular pressure, optic nerve damage and narrowed the width field of view. Consequence of longterm application may be posterior subcapsular cataract, ptosis of the eyelid or punctate Keratitis. Conclusions: In summary characteristics of drug (SmPC) for Neodeksacin (Dexamethasone phosphate, Neomycin) eye drops, solution 1 mg + 3.5 mg/1 ml of the states that the drug contraindicated in eye infections caused by viruses (herpes, varicella, vaccinia, etc..) or fungi.

1893 Delayed-type hypersensivity to methylprednisolone Callero Viera, A; Martinez Tadeo, J; Gonzalez, R; Hernandez Santana, G Hospital Universitario Nuestra Senora de Candelaria, Department of Allergology, Santa Cruz de Tenerife, Spain

Background: Glucocorticoids are steroid hormones used as powerful anti-inflammatories. Due to the low incidence of the allergic reactions to the systemic treatment, sensitization by topical pathway seems to be a better option. Methods: The patient, 8 years old, was put under topical treatment with methylprednisolone for sting lesions. After 24 h we reported an eczematous lesion in the application area. Skin tests by applying a battery of corticosteroids and methylprednisolone cream (occlusive pathway and photo-exposure) were made. Results: - Positive results were recorded in relation to the skin testing with prednisone (48 h) and to the occlusive pathway with methylprednisolone cream (48 and 96 h). Results of the rest of the battery were negative. - To offer the patient a corticoid therapy, an oral exposure test with deflazacort and a nasal provocation with fluticasone were made reaching therapeutic doses with good systemic and inhaled tolerance. Conclusion: - We present the case of a patient with delayed-type hypersensitivity to methylprednisolone (A group). She presents sensitization to the same group of corticosteroids (prednisone). We decided to make a deeper study in order to offer therapeutic alternatives to the patient, who showed a good tolerance to deflazacort by systemic pathway and to fluticasone by nasal pathway. - Cross-reactions patterns between corticoids of the same group were recorded, as well as between different groups. Although, in this particular case it seems to be a selective sensitization to the glucocorticoids of the A group. - Skin tests are effective to involve the responsible corticosteroid and/or to reject the sensitization to other groups of corticoids.

1894 Selective hipersensitivity reaction to carbapenems: a case report Pin˜ero Saavedra, M; Ortega-Camarero, M; Gonzalez-Quevedo Tejerina, T; Avila Castellano, M; Prados Castanõ, M; Cimbollek, S Spain

Background: Carbapenems are beta-lactamic antimicrobial agents acting by inhibiting bacterial cell wall synthesis by 696

binding to and inactivating penicillin-binding proteins (PBPs), basically used on serious polimicrobian infections treatments. We present a case of selective hipersensitivity to Carbapenems with proved tolerance to another beta-lactamic agents. Patient and methods: We present a 58-yearold women, renal transplantated 6 years before, in treatment with Meropenem because of urinary sepsis due to E. Coli BLEE infestation. One month after the antibiotic treatment was started, she presented a non pruritic generalized exanthema. No other sistemic symptoms were observed. The drug was retired and 48 h later the symptons resolved completely. After obtaining informed consent, nine months later, prick test and patch test (100 mg/ml both) with Ertapenem and Meropenem was performed and a graded dosis intravenous challenge with Ertapenem and Ceftriaxone (up to 1000 mg both) and oral challenge with amoxicillin-clavulanic acid (1000 mg) in a supervised clinical setting. Results: Skin tests with Ertapenem and Meropenem were both negative. The patient developed non pruritic erythema in neckline 6 h after reaching graded therapeutical doses of Ertapenem. Nevertheless, tolerance to oral Amoxicillin- clavulanic acid and to intravenous Ceftriaxone, was confirmed with graded doses challenge. No excipients were tested, because the same ones were in the drugs that had been well tolerated. Conclusion: We present a patient that manifested a skin reaction with two Carbapenems drugs confirmed by oral challenge, with negative cutanous test, and oral tolerance confirmed to other two beta-lactamic agents with different lateral chains.

1895 Delayed hypersensitivity to omeprazole Sańchez Lo´pez, P; Martinez San Ireneo, M; Jimeńez Lara, M; Marchań Martıń, E; Caban˜es Higuero, N; Senent Sańchez, C Spain

Background: Adverse reactions by proton pump inhibitors are infrequent. Most of described reactions are immediate (urticaria, anaphylaxis). Delayed reactions are rare. Case report: We report here a case of 77 years old man who was referred to our unit to drug allergy study. As personal history, the patient had hypertension, hyperlipidemia, diabetes mellitus, ischemic heart disease and acute stroke. Three months before, while he was admitted by angina, he was showing skin itching and eczema followed by desquamation after 15 days. This reaction pointed to omeprazole and/ or clopidogrel.



Methods: Skin prick test (20 mg/ml) and intradermal reaction (0.1 and 1 mg/ml) with omeprazole, and patch tests with omeprazole 20% and 1% and pantoprazole 20% and oral challenge with clopidogrel (75 mg) were carried out. Results: Skin prick test and intradermal reaction with omeprazole were negatives. Patch tests with omeprazole and pantoprazole gave positive reactions at 48 and 96 h readings. Patch test positive skin biopsy showed spongiosis, exocytosis, focal parakeratosis and lymphocytic inflammatory infiltrate in superficial dermis. Oral challenge with clopidogrel was negative. Conclusions: We have presented a patient who experienced an episode of delayed hypersensitivity to omeprazole with cross reactivity between pantoprazole and omeprazole.

1896 Rapid desensitization to acetylsalicylic Alba, P; Calderon, R; Roig, B; Alvarinõ, M; Iglesias, I; Frechina, C Spain

Background: Aspirin, platelet aggregation, plays an important role in reducing ischemic complications of coronary disease and percutaneous coronary intervention. A case of rapid desensitization to aspirin (ASA) of emergency in a patient who required cardiac catheterization for acute myocardial infarction (AMI) in the days before. Material and methods: Female 76 years old, admitted to ICU for inferior AMI presenting after fibrinolysis, reocclusion requires urgent antiplatelet therapy with ASA. Reports multiple episodes of acute urticaria and angioedema in relation to treatment with ASA, paracetamol and chloroquine. Nolotil tolerate only later. Skin tests are done with ASA and then rapid desensitization acetylsalicylic acid (0.1, 0.3, 10, 30, 40, 81, 162, 325) separated every 15–20 min, without premedication. Results: ASA-skin test: + + (100 controls negative) Desensitization fast-acetylsalicylic acid (0.1, 0.3, 10, 30, 40, 81, 162, 325): well tolerated except epigastric pain as a side effect. Within 2 days presented pruritic urticaria lesions less than 0.5 cm in greatest diameter isolated chin and neck. Dubious relationship with treatment with ASA. Nonetheless, given the need for treatment with ASA in this patient, and the lightness of symptoms would be recommended to continue with AAS, after exposing the patient clearly the various treatment options for AMI. After 10 months continuous tolerate ASA. Conclusions: In patients with a history of urticaria and angioedema compatible

hypersensitivity to ASA can be effective, a rapid desensitization to ASA in case of ischemic complications of coronary artery disease or coronary intervention.

1897 Nonpigmenting fixed drug eruption due to pseudoephedrine Elices, A; Chamorro-Go´mez, M; Davila, G; Va´zquezCorte´s, S Hospital del Henares, Allergy department, Madrid, Spain

Background: Pseudoephedrine hydrochloride is a sympathomimetic drug widely used as nasal decongestant. Few cases of non-pigmenting fixed drug eruption due to pseudoephedrine have been reported. Casereport: We present a 35 years-old female with mild rhinoconjunctivitis symptoms in spring. She presented macular eruption in both forearms and erythematous rash in thighs 2 h after the intake of a second dose of pseudoephedrine and dexchlorpheniramine. Methods and results: Patch tests with European Standard Series (ESS), pseudoephedrine and dexchlorpheniramine vehiculized in vaseline were applied on the patient’s back with negative results at 48 and 96 h. A single-blind placebo-controlled drug challenge performed with pseudoephedrine 120 mg was negative. After 8 h of the oral challenge she developed nonpigmenting, large, symmetrical, well-circumscribed tender erythematous plaques in both thighs. She was treated with oral antihistamines and a reducing course of oral corticosteroids and the eruption cleared completely without residual pigmentation in one week. We decided to repeat patch tests with pseudoephedrine vehiculized in vaseline at the previously affected sites with positive result at 48 and 96 h in both thighs. Conclusion: We describe a patient with a non-pigmenting fixed drug eruption to pseudoephedrine confirmed by positive patch test and oral challenge.

1898 Acne due isocyanates Calderon, R; Alba, P; Mencia, G Clinica Medinorte, Unidad de Alergia, Valencia, Spain

Background: Isocyanates are low molecular weight allergens, and conform a common cause of occupational asthma. They are currently used to produce insecticides, flexible foam (mattresses, pillows, bath sponges ...) rigid foam (filled walls, filling, and packaging), adhesives, molds, gums, lacquers, carpentry, etc.. Exposure to iso-


cyanates produces respiratory (rhinoconjunctivitis and bronchial asthma) and skin symptoms (allergic contact dermatitis). Although there is a wide legislation about occupational diseases, new cases occur daily. Methods: Female 30 years old without atopy history, presents acneiform lesions on the face for a month, accompanied by conjunctivitis, sneezing, cough and shortness of breath associated with occupational exposure. Recently new rooms were built with prefabricated panels, without proper ventilation in her workplace. After investigating the composition of these panels, we concluded that these are made of poly-isocyanurate, so we decided to perform further tests. Results: Standard patch test was negative. Patch test with petrolatum/poly-isocyanurate was positive at 48 h. Use Test: rhinoconjunctivitis after 2 h of exposure. five healthy controls were negative. Conclusion: We have diagnosed a case of acne due isocyanates, which is an unusual manifestation in occupational pathology caused by isocyanates. Indeed we haven¢t found a similar case report. Proper ventilation is essential to reduce the air concentration of toxic isocyanates in the workplace. It¢s very important to demonstrate allergic sensitization by the legal implications for our patients.

1899 Allergic contact dermatitis due to Kathon CG Rodrı´guez-Pacheco, R1; Antoń-Girone´s, M1; JoverCerda´, V1; Prieto-Ucha, D2; Alcolea-Martıńez, M1; Pacheco-Martıńez, M1 1 Hospital General de Elda, Unidad de Alergologıá, Elda (Alicante), Spain; 2Instituto Marni, Departamento de Lenguas Extranjeras, Valencia, Spain

Background: Presenting the case of a woman with eczema in the anogenital area, with one year progression, caused by type IV hypersensitivity to Kathon CG. Method: Fourth-two years old woman who has had hemorrhoids for a year, since her latest pregnancy. The surgeon prescribed perianal hygiene using moist wipes and different topic treatments, which she has been using since then: hidrocortisone acetate, methylprednisolone aceponate, triamcinolone acetonide, benzocaine, glyceril trinitrate, fenticonazol, not showing improvement. After the begin of the prescribed treatment, the patient’s eczema in the anoperineal area became more severe and extensive, as far as affecting the vulva. It also became chronical, severely affecting the patient’s quality of life. The patient had also shown mild eczema in her extremities and scalp, for a period of two years. 697


She does not show other antecedents of allergic pathology. Results: Prick Test to aeroallergens, Anisakis simplex and latex: positive for Salsola kali, Chenopodium album and Plantago lanceolata, negative for the rest. Standart patch test: Positive at 48 h for caines mix ++++, kathon cg ++++, p-phenylenediamine ++. Positive at 96 h for caines mix +++, kathon cg +++, p-phenylenediamine +. Cosmetics patch test: Negative. Topics drugs (methylprednisolone aceponate, triamcinolone acetonide, glyceryl trinitrate, fenticonazole nitrate) patch test: negative. Given these results, we suggested the patient measures for the avoidance of Caines, Kathon CG and P-phenylenediamine. It was confirmed that intimate hygiene moist wipes contained Kathon CG, so their use was forbidden. One month after this measure was implemented, the perineal eczema had fully disappeared, to the great improvement of the patient’s quality of life. The mild eczema in her extremities and scalp also improved, almost to its total disappearance. Conclusion: We presented the case of a woman with eczema in the anogenital area, caused by type IV hypersensitivity to Kathon CG, found in the moist wipes she used for her intimate hygiene.

1900 Allergic exanthem due to tetrazepam Rodrı´guez-Pacheco, R1; Antoń-Girone´s, M1; JoverCerda´, V1; Prieto-Ucha, D2; Pacheco-Martıńez, M1; Alcolea-Martıńez, M1 1 Hospital General de Elda, Unidad de Alergologıá, Elda (Alicante), Spain; 2Instituto Marni, Departamento de Lenguas Extranjeras, Valencia, Spain

Background: Presenting the case of a woman who presented generalized exanthem after taking tetrazepam for the first time in her life. Method: Seventy two year old woman who presented an erythematous pruritic maculopapulose exathem in her chest, abdomen, back, upper and lower extremities, for approximately 15 days and which reverted after treatment with hydroxicine, cetirizine and topic clobetasol. The patient presented muscle contracture, starting 5 days before the exanthema onset; treatment with omeprazole 20 mg (one pill per day) and tetrazepam 50 mg ½-0–1. One day before the start of the clinical condition she had taken one pill of ibuprofen 600 mg. When the exanthem appeared, she stopped her treatment with omeprazole, tetrazepam and ibuprofen. She kept following her usual treatment with Captopril 25 mg (one pill per day). The patient denied taking tetrazepam prior to this treatment, but she didn’t 698

remember whether or not she had taken other benzodiazepines. She had taken ibuprofen and omeprazole, without problems. The patient does not show antecedents of allergic pathology. Patch tests with ibuprofen 5%, omeprazol 1% and tetrazepam 5% in vaseline were carried out. Results: 1. Patch test: - Ibuprofen 5%: negative. - Omeprazole 1%: negative. Tetrazepam 5%: positive (++) after 48 and 96 h. 2. Drug Provocation test: - Ibuprofen 600 mg 1 pill/12 h for 7 days: tolerated. Omeprazole 20 mg one pill/day for 7 days: tolerated. Conclusion: We presented the case of a woman with generalized exanthem caused by type IV hypersensitivity to tetrazepam. Her condition appeared five days after her first contact with the drug. The results are compatible with the revised bibliography, in which we found the following delayed hypersensitivity reactions to tetrazepam: exanthem, fixed drug eruption, toxic epidermal necrolysis, acute generalized exanthematous pustulosis, Stevens-Johnson syndrome. Although most of the publications reviewed patch test was performed with tetrazepam 5% in vaseline, in our case the patient had a positive test with tetrazepam 1% in vaseline.

1901 Contact dermatitis by sensitization to 3-dimetilaminopopilamina (DMAPA)

cases of allergic contact dermatitis eczema manifestation DMAPA with lid on makeup remover lotion (patient 1) and retroauricular eczema with the use of shampoo (patient 2). Methods: In the 2 patients and in 52 controls were performed with aeroallergens prick test; patch test contacted directly to standard with bial; prick test own cosmetics; patch test with battery bial cosmetics, patch test 3 -dimetilaminopopilamina, amidoamine and cocamidopropyl betaine (CAPB) in vaseline and in water at 1, 0.5, 0.2 and 0.1, with read 2 days, 4 days and 7 days and then test with the cosmetic use responsibly. Results: Patch test: Cleansing (1) or shampoo (2): + + + CAPB and DMAPA patch test in vaseline (Reading 2, 4, 7 days): Conclusion: In both cases the patch test for DMAPA were positive, while there was no significant reaction to CAPB. The current relevance of these tests was confirmed by re-exposure of patients to the products suspected, containing CAPB Although contact allergy to CAPB is now rare, partly because of the increasing use of new nonirritating surfactants introduced into the market, are becoming known cases of patients allergic to commercial CAPB only react to the DMAPA and not CAPB when they are patched. DMAPA itself or other molecules such as allergens amidoamine be true allergens and therefore should be included in the range of cosmetics in patch test.

Alba, P; Calderon, R; Iglesias, I; Frechina, C; Alvarinõ, M Spain

Background: In recent years cosmeticrelated substances have been implicated as a frequent cause of contact dermatitis: The cocamidopropilbetaina. It is an amphoteric surfactant which is derived from coconut fatty acids, highlighting dimetilaminopropilamina as an impurity. We present two Table 1. For abstract 1901. Patient 1

CAPB 2 days

DMAPA 2 days

CAPB 4 days

DMAPA 4 days

CAPB 7 days

DMAPA 7 days

Vaseline aqua 1% aqua 0.5% aqua 0.2% aqua 0.1% Patient 2

+ + CAPB 2 days + -

+++ +++ +++ ++ DMAPA 2 days +++ +++ +++ ++ -

+ + CAPB 4 days + -

+++ +++ +++ ++ DMAPA 4 days +++ +++ ++ ++ -

CAPB 7 days -

+++ +++ +++ + DMAPA 7 days +++ +++ ++ + -

Vaseline aqua 1% aqua 0.5% aqua 0.2% aqua 0.1%

Negative amidoamine Use test: positive Additionally, patient 2: mixing perfumes + + +. 52 negative controls for non-standard patch.


Late breaking poster session – Drug allergy 1902 Leukopenia after titanium dental implants Pigatto, P1; Marsili, C1; Brambilla, L2; Ferrucci, S2; Guzzi, G3 1 IRCCS Galeazzi Hospital, University of Milan, Milan, Italy, Department of Technology for Health, Dermatological Clinic, Milan, Italy; 2IRCCS Ca’ GrandaOspedale Maggiore Policlinico Foundation, Milan, Operative Unit of Dermatology, Milan, Italy; 3Italian Association for Metals and Biocompatibility Research – A.I.R.M.E.B., Milan, Italy, Dental Toxicology, Italy

Background: Leukopenia has been observed in patients with adverse events related to titanium implants, mainly neutropenia has been linked to adverse outcomes in patients with skin reactions to titanium implanted in the head and neck area. Methods: Here we report on a 40-year-old woman with prolonged afebrile leukopenia after surgical implantation procedure of two maxillary and mandibular pure titanium dental implants. There was no family history of immunodeficiency. She had had

Hashimoto’s thyroiditis. She did not take medications and any immunosuppressive treatments. Her sister had celiac enteropathy. Results: In 2002, the patient was patchtested with general and dental series. She displayed an allergy to nickel sulfate 5% (++), cobalt chloride 1% (+), metallic mercury 0.5% (+), all petrolatum. Titanium-IV-oxide 0.1% in petrolatum gave a irritant reaction (+/)). The reaction was so weak that it was not reported in clinical chart. Lymphocyte transformation test (LTT) confirmed the nickel allergy (stimulation index SI = 5.8). She had five mercury dental amalgam restorations on posterior molars and a large mercury amalgam tattoo on her maxillary gingiva. We diagnosed a leukopenia (possibly) related to mercury allergy as well as prolonged exposure to mercury amalgam fillings. In 2003, we removed her dental amalgams. After total removal, white blood cells subsequently raised to normal levels (total


white blood cells count 5.1 · 109/l) and were stable for one year. In 2006, she decided to have titanium dental implants even if we decided against this treatment, because of her contact irritant reaction to titanium. The first commercially pure (cpTi) titanium dental implant was implanted in the toothless area of the maxilla and a second cpTi dental implant was placed into her jawbone. After implantation of the first titanium implant, the white-cell count fell below 4000 · 109/l (3.7 · 109/l), but not neutropenia. She was found to have leukopenia even after the second titanium implant. A clinical followup after 5 years, until the last visit, we have not yet observed any attempt to reverse the leukopenia. Conclusion: This report describes a patient in whom a leukopenia possibly related to titanium immuno-reaction developed after titanium dental implants.

699

Late breaking poster session Dermatology

1903 Filaggrin loss-of-function mutations are associated with early onset eczema, eczema severity, and transepidermal water loss at three months of age Flohr, C1; England, K2; Radulovic, S1; McLean, W2; Campbell, L2; Barker, J3; Perkin, M1; Lack, G1 1 King’s College London, Department of Children’s Allergies, MRC/Asthma UK Centre in Allergic Mechanisms of Asthma, London, United Kingdom; 2 King’s University of Dundee, Division of Molecular Medicine, Dundee, United Kingdom; 3College London, St John’s Institute of Dermatology, London, United Kingdom;

Background: Filaggrin loss-of-function (FLG) mutations are associated with eczema and skin barrier impairment, but it is unclear whether skin barrier impairment precedes phenotypic eczema in FLG mutation carriers, or whether it is primarily an epiphenomenon of disease activity. We therefore studied the association between FLG mutations, skin barrier impairment, and clinical eczema at three months of age. Methods: Eighty eight infants were examined for eczema. Disease severity was determined by SCORAD eczema severity score. Transepidermal water loss (TEWL) was measured with the Aquaflux closed chamber device on unaffected forearm skin. Venous blood samples were screened for the four commonest FLG mutations in the UK white population (R501X, 2282del4, R2447X, and S3247X), using the TaqMan allelic discrimination assay. Median SCORAD and TEWL measurements in children with and without eczema and FLG mutations were compared using the Mann-Whitney test and correlation coefficients. Results: 31.8% (28/88) of children had clinical eczema. Median SCORAD was 10.6 (range 0–31). TEWL was higher in children with eczema compared to unaffected infants (median TEWL [g/m2 · h] 14.24 versus 11.24, P < 0.001). Higher TEWL was associated with more severe disease (r = 0.59, P < 0.001, median TEWL SCORAD