Home gardening may be a risk factor for contact dermatitis to Alstroemeria

BACKGROUND: Occupational allergy among florists and people who work in cut flower production of Alstroemeria cultivars (Peruvian lily or Inca lily) has been previously reported. The allergen involved in sensitization is tulipalin A (alpha-methylene-gamma-butyrolactone). CASE REPORT: We describe the case of a 65-year-old woman who developed severe dermatitis on her right thumb, index and middle fingers and less severe dermatitis on her left palm and front of forearm with occasional itching of the neck and face after taking up home gardening activities, including cutting flowers such as Alstroemeria. METHODS: The patient and three healthy individuals were submitted to epicutaneous tests with the European standard series, the plant series, and stem portions of three suspected ornamental plants (Alstroemeria, Lilium and Zantedeschia), garlic, and onion. RESULTS: Patch tests performed in our patient, revealed an extreme reaction (+ + +) to Alstroemeria and alpha-methylene-gamma-butyrolactone, a strong reaction (+ +) to propolis and wood tar mix, a weak reaction (+) to balsam of Peru, an irritant reaction to garlic and negative results to diallyl disulfide and the other components investigated. Patch tests performed in the healthy individuals revealed negative. CONCLUSIONS: We stress the importance of Alstroemeria as a cause of allergic contact dermatitis not only in workers involved in the flower trade, but also in other people that come into contact with this plant in their leisure activities

Goat's milk allergy

BACKGROUND: Goat's milk (GM) allergy not associated with allergy to cow's milk (CM) is a rare disorder. Caseins have been implicated has the major allergens eliciting symptoms. METHODS: We report the case of a 27 years-old female patient that experienced two episodes of urticaria related to ingestion of goat's cheese (GC). She tolerated CM, dairy products and sheep cheese. Skin prick tests were performed with GM, CM, bovine casein and alpha -lactalbumin and fresh milk and GC. Serum specific IgE to GM, CM and its fractions, and GM and CM immunobloting assays with inhibition were also evaluated. RESULTS: Skin tests were positive to GM and GC and negative to CM. GM immunoblot showed an IgE-binding 14 kDa band that was totally inhibited after serum pre-incubation with GM. CONCLUSIONS: Allergens other than casein can be involved in allergy to GM. Even small quantities of protein can elicit symptoms

Well´s syndrome: report of two cases

A síndrome de Wells, também conhecido como celulite eosinofílica, é uma patologia cutânea rara. As lesões clínicas características incluem pápulas, vesículas ou grandes placas eritematosas, que podem aparecer em toda a superfície corporal, podendo mimetizar um quadro de urticária crónica. Os autores apresentam dois casos clínicos de doentes com o diagnóstico de S. Wells: doente 1, sexo feminino, 41 anos e doente 2, sexo masculino, 40 anos. Ambos apresentavam um quadro clínico de lesões maculopapulares generalizadas, pruriginosas recorrentes, que persistiam pelo menos 24 horas, refractárias a anti -histamínicos, com necessidade frequente de corticoterapia sistémica para controlo sintomatológico. Como sintomas associados salientam -se astenia, mialgias e artralgias. O estudo complementar em ambos os casos excluiu a presença doutra patologia associada e as biópsias cutâneas revelaram celulite eosinofílica. Ambos efectuaram dapsona 100 mg/dia com evolução clínica favorável. Estes casos demonstram a necessidade do estudo histopatológico cutâneo em doentes com lesões urticariformes com necessidade de recorrer frequentemente aos corticóides sistémicos e com reaparecimento das lesões com a redução ou interrupção destes fármacos