Relevance of patch testing in patients of chronic spontaneous urticaria and its correlation with serum IgE level

Objectives: Chronic spontaneous urticaria (CSU) is defined as short lived (< 24h) wheals occurring spontaneously without any triggering factors, daily or almost daily for at least 6 weeks. Though CSU is mainly a Type 1 hypersensitivity reaction, earlier studies suggested contact allergy may have some role to play an important role in the etiopathogenesis of CSU. The objective of the study is to find out the relevance of patch test in the etiopathogenesis of and its correlation with serum IgE level. Materials and Methods: Thirty-one patients of CSU were thoroughly evaluated for clinical and laboratory parameters. We conducted patch testing with Indian Standard Series (ISS) in all of them and tried to find out the relevance of every positive reaction. Relevant positive cases were asked to avoid exposure for 2 months and were maintained only in breakthrough antihistamines. Furthermore, correlation of positive patch test reaction with high IgE and eosinophil count were studied. Results: Seventeen (55%) cases came positive for patch test. Potassium dichromate, lanolin, benzocaine, and fragrance mix were the most common offenders. Patients with very high IgE count had patch test positivity with multiple allergens. Seven of the fifteen patients who had relevant positive patch results could be followed up to remission; three were lost to follow-up. Conclusion: Patch test with ISS may give important clue to in a subset of patients of CSU and thus may be considered an important part of routine investigations of CSU.

Evaluation of skin irritation and skin sensitization potential of Venusia max lotion (paraben-free, alcohol-free, mineral oil-free, animal origin free) using human repeat insult patch test

<p class="abstract"><strong>Background:</strong> Topical exposure to chemicals from cosmetics can lead to adverse skin effects or skin irritation. This study aimed to investigate the skin irritation and sensitizing potential of a moisturizer Venusia max lotion (paraben-free, alcohol-free, mineral oil-free, animal origin free (PAMA) free).</p><p class="abstract"><strong>Methods:</strong> In this single-center, non-randomized, observational study, skin irritation, and skin sensitization potential of a test product was assessed using the human repeat insult patch test (HRIPT) technique. Approximately 0.04 g of the test product and filter papers dipped in 0.9% isotonic saline solution (~0.04 ml of solution) were filled in different wells of patch chambers and applied occlusively, on the back of each participant. Scoring of the skin reactions in the induction phase and challenge phase was done using Draize and international contact dermatitis research group (ICDRG) scales respectively. Scores were compared to the baseline and the negative control (isotonic saline).<strong></strong></p><p class="abstract"><strong>Results:</strong> In total 234 participants (50 with sensitive skin), 224 and 221 participants completed the induction phase and challenge phase respectively. Scores for the induction phase for Venusia max lotion (PAMA free) and isotonic saline were 0.46 and 0.06 respectively. The mean cumulative score of erythema and oedema for Venusia max lotion (PAMA free) was below 2. For the challenge phase, none of the participants showed any positive reactions at any time point for test product and isotonic saline.</p><p class="abstract"><strong>Conclusions:</strong> Test product Venusia max lotion (PAMA free) found to be non-irritant and hypoallergenic. Thus, it can be used without fear of skin irritation or sensitization.</p>

Allergic Contact Dermatitis to Temporary Black Henna Tattoo Due to Sensitization to Para-Phenylenediamine

The fashion for temporary “black henna tattoo” is becoming increasingly more common among young adults and teens. An adolescent case with itching, erythema, edema, and inflammatory discharge on the right forearm two days after a temporary tattoo application is presented in this report. To determine the contact sensitizer, a patch test was performed one month after the end of the treatment. A bullous strong positive reaction (3+) was observed against para-phenylenediamine at the 48th and 72nd hours of evaluation after the application. Despite the common belief that henna tattoo application is harmless, the ingredients used in henna tattoo especially para-phenylenediamine can lead to allergenic reactions that can even be severe.Keywords: Adolescent, contact dermatitis, para-phenylenediamine

Morbidity profile of workers and workplace assessment in selected soap industries in Puducherry

Background: The high risk, fast-paced industrial expansion reflects unique health and safety challenges for occupational health and safety resulting in increasing incidence of various injuries and health morbidities. This warrants the assessment of morbidity profile and workplace assessment of the workers.Methods: A facility based cross sectional descriptive study was carried out among 305 workers of selected soap industries in Puducherry for a period of four months from September to December 2018. Workers were interviewed using a semi-structured questionnaire for their morbidity profile and work ability along with skin patch test and spirometry. Finally, workplace assessment was done.Results: Of 305 workers interviewed, eczema was reported in two workers and generalized pruritus in 4.9% of the workers. In patch test, 9 (34.6%) workers were sensitive to Paraphenylenediamine among 26 workers tested. Upper respiratory tract infection was reported in 17.3% and breathlessness in 4.6% of the employees. Spirometer was abnormal in 5.9% of the workers. Hypertension was diagnosed for the first time in 10.3% of the workers. Work ability index was good in 99.0% of the workers. The most common illness in the past six months was febrile illness. Workers who availed treatment from the private facility were 35.9%. Working environment was better in large-scale industries as compared to the small-scale industries.Conclusions: The morbidity of workers in selected soap industries were very less as majority of the workers was from the organized sectors with regular periodic examination. Hence further studies concentrating only on the unorganized small-scale industries are recommended.

Mucosal Fixed Drug Eruption to Levetiracetam with Early Positive Patch Test on Non-Lesional Skin

Levetiracetam (LEV) is a second-generation antiepileptic drug (AED) that is well tolerated, has a broad spectrum of action, low protein binding, and minimal hepatic metabolism. The incidence of hypersensitivity to LEV in children and adults is 0.6%. This is the first reported fixed drug eruption (FDE) identified using a patch test in a pediatric case associated with LEV