Patch testing with palladium and aluminium, epidemiological and experimental studies

AbstractThe aim of this thesis was to investigate the prevalence and significance of contact allergy to palladium from a Swedish perspective. Our initial findings made it necessary to also explore the importance of the metal aluminium used in test chamber systems and the effect of aluminium chloride (Al-Cl) in patch test preparations. A retrospective study (study I), with 18,306 patch test results obtained from 1995-2016 showed that the prevalence of contact allergy to palladium is following that of nickel. After the introduction of the EU Nickel Directive in 2001, there was a significant decrease in contact allergy to sodium tetrachloropalladate (Na-PdCl), palladium chloride (Pd-Cl), and nickel sulphate (Ni) among younger females, age six to 30 years. Regression analysis revealed that women with contact allergy to Ni were approximately 36 times more likely to have contact allergy to Pd-Cl compared to females with no allergy to Ni.The prevalence of isolated palladium (Pd) allergy in the whole study population (men and women) was 1.4% and remained stable from 1995 to 2016. In study II, Na-PdCl showed less variability in patch test results, compared to Pd-Cl. When re-testing the same 15 participants with known contact allergy to Ni, Na-PdCl, and Pd-Cl, a seasonal variation was seen. In wintertime, there were significantly higher summarised test scores compared to in late summertime for the three metal salts Pd-Cl, Na-PdCl, and Ni.A retrospective study (study III) showed that the use of Finn Chambers in patients with contact allergy to aluminium could be a risk for false-positive patch test reactions to Na-PdCl and Pd-Cl. No such risk was seen in patients tested with Finn Chamber Aqua. In study IV, the use of Al-Cl in test preparations with Ni seemed to increase the sensitivity for detecting Ni allergy. When adding 30.0% Al-Cl to Ni 15.0% aqua, the sensitivity increased to 91% from 50.0% in Ni 5.0% in petrolatum. This increase in sensitivity was only seen when adding Al-Cl to Ni and was not seen when adding Al-Cl to methylisothiazolinone and to fragrance mix I

Patch testing with aluminium Finn Chambers could give false-positive reactions in patients with contact allergy to aluminium

Background Earlier laboratory studies have shown that sodium tetrachloropalladate, Myroxylon pereirae, caine mix II, and palladium chloride trigger the release of aluminium (Al) from Finn Chambers (FC). Objectives To investigate whether aluminium realease from FC could influence the diagnostic outcome of patch testing with FC. Method A retrospective analysis of patch test results from 2010 to 2019 was performed. A two-sided Fisher\u27s exact test was used to calculate any overrepresentation of contact allergy to Al among patients with positive reactions to sodium tetrachloropalladate, Myroxylon pereirae, caine mix II, and palladium chloride. Results A total of 5446 patients had been tested with FC during the study period. There was a significant overrepresentation of contact allergy to Al among patients with positive reactions to sodium tetrachloropalladate, Myroxylon pereirae, caine mix II, and palladium chloride. Patients with a strong Al allergy had significantly higher amounts of concomitant reactions to sodium tetrachloropalladate, Myroxylon pereirae, caine mix II, and palladium chloride compared to patients with weak Al allergy. These results were not seen for patients tested with Finn Chambers AQUA. Conclusion In patients with contact allergy to Al, patch testing with Finn chambers could give false-positive reactions to sodium tetrachloropalladate, Myroxylon pereirae, caine mix II, and palladium chloride

Improvement of microstomia in scleroderma after intense pulsed light: A case series of four patients.

Introduction: Intense pulsed light (IPL) treatment is well known for, for example, photo rejuvenation, where higher cut-off filters are used. The longer wavelengths penetrate deeper in the dermis leading to damage of the collagen and stimulation of new collagen formation, which lead to more soft and elastic skin. Microstomia in systemic sclerosis is the end result of excessive collagen deposition, which makes the perioral skin firm and tight. The patients have difficulties performing oral self-care, and even professional dental care can be complicated. Methods: Four patients with systemic sclerosis and microstomia were treated with IPL (Ellipse A/S Flex System, Denmark ) in the perioral region. The patients received 3-5 treatments with 4-week interval. Oral opening was measured before and after treatments. Results: The oral opening increased approximately 1 mm per treatment in three patients. One patient had temporomandibular joint symptoms of locking and did not have any increase in mouth opening. All four patients felt softening of the perioral skin, and all four patients described that articulation, eating and tooth brushing had become easier. Conclusion: IPL can be a new adjunctive alternative in the non-surgical treatment of microstomia in patients with systemic sclerosis

Effects of aluminium chloride added to common patch test substances

Background: A modulating effect of aluminium regarding type IV reactions might exist but has not been further investigated. Objectives: The aim of this study was to investigate the effect on patch test reactions when adding aluminium chloride hexahydrate (Al-Cl) to common test preparations. Materials and methods: Al-Cl in different concentrations was added to nickel sulphate 15.0% aqua (Ni), methylisothiazolinone 0.2% aqua (MI) and fragrance mix I 10.0% aqua/ethanol (FM I). The Ni preparations were tested in 120 consecutive patients. MI and FM I were tested in participants known to have contact allergy to the respective allergen. McNemar's test was used to decide which Ni preparation had the highest sensitivity. Wilcoxon signed-rank test was used to calculate pairwise comparison in summarized test score for the preparations with MI and FM I. Results: Adding Al-Cl 20.0%/30.0% to Ni identified twice as many patients with contact allergy to nickel compared to Ni without Al-Cl. Adding Al-Cl 20.0%/10.0% to MI, decreased the patch test reactivity compared to MI without Al-Cl. No differences in patch reactivity were noticed when adding Al-Cl to FM I. Conclusion: Al-Cl 20.0% or 30.0% seems to enhance the patch test reactivity to Ni 15.0% aqua

Effects of intense pulsed light in microstomia in patients with systemic sclerosis : A pilot study

Introduction: The effects of intense pulsed light (IPL) on collagen structures are well known in the treatment of photodamaged skin. Objective: The objective of this study was to investigate the effect of IPL on sclerotic skin by treating patients with microstomia due to systemic sclerosis. Methods and materials: 13 patients all with microstomia and systemic sclerosis were treated with IPL, PR (530-750 nm filter) and/or VL (555-950 nm filter) applicator. They were treated in the perioral area 8 times with 3–4 weeks of interval and follow-up for 6 months. The outcomes were the inter-incisal distance and the inter-ridge distance. Results: A significant increase in mouth opening of 4.1 mm (95% confidence interval, 1726–6638, p < 0.005) was found in the inter-ridge distance when comparing the distance before treatment with the distance at six-month follow-up. No significant difference was found in the inter-incisal distance. The patients experienced improved mobility and better control of lip movements after the treatments. Conclusion: IPL can improve the inter-ridge distance between the lips in patients with microstomia due to systemic sclerosis but does not affect the inter-incisal distance, which is also dependent on the mobility of the mandibular joints. This treatment can be considered an adjunctive therapy in patients with microstomia due to systemic sclerosis

Variation and covariation in patch test reactivity to palladium and nickel salts

Concomitant reactions to palladium chloride (PdCl2), sodium tetrachloropalladate (Na2PdCl4), and nickel hexahydrate sulphate (NiSO4·6H2O) are very common during patch testing and have mainly been explained by cross-sensitisation. Whether there is variation in reactivity to palladium or covariation to nickel and palladium is not known. The aim of this study was to investigate the variation in patch test reactivity to PdCl2 and Na2PdCl4 over time and compare this to variation in patch test reactivity to NiSO4·6H2O. Fifteen females known to be sensitised to nickel and palladium were patch tested four times with 12-week intervals using a dilution series of NiSO4·6H2O, PdCl2 or Na2PdCl4. Patch test reactivity to Na2PdCl4 was less variable compared to that for NiSO4·6H2O or PdCl2. All test salts showed higher patch test reactivity during wintertime. No significant correlation was observed between the variation in patch test reactivity to Na2PdCl4 and PdCl2 and the variation in patch test reactivity to NiSO4·6H2O during the entire test period. Patch test reactivity to Na2PdCl4 is less variable over time compared to that for PdCl2 or NiSO4·6H2O. No clear covariation was identified between tests for palladium salts and NiSO4·6H2O. The variation in patch test reactivity found in this study could be due to seasonal changes

Patch testing with Finn Chambers could give false positive reactions in patients with contact allergy to aluminium

BackgroundEarlier laboratory studies have shown that sodium tetrachloropalladate, Myroxylon pereirae, caine mix II, and palladium chloride trigger the release of aluminium (Al) from Finn Chambers (FC).ObjectivesTo investigate whether aluminium realease from FC could influence the diagnostic outcome of patch testing with FC.MethodA retrospective analysis of patch test results from 2010 to 2019 was performed. A two-sided Fisher's exact test was used to calculate any overrepresentation of contact allergy to Al among patients with positive reactions to sodium tetrachloropalladate, Myroxylon pereirae, caine mix II, and palladium chloride.ResultsA total of 5446 patients had been tested with FC during the study period. There was a significant overrepresentation of contact allergy to Al among patients with positive reactions to sodium tetrachloropalladate, Myroxylon pereirae, caine mix II, and palladium chloride. Patients with a strong Al allergy had significantly higher amounts of concomitant reactions to sodium tetrachloropalladate, Myroxylon pereirae, caine mix II, and palladium chloride compared to patients with weak Al allergy. These results were not seen for patients tested with Finn Chambers AQUA.ConclusionIn patients with contact allergy to Al, patch testing with Finn chambers could give false-positive reactions to sodium tetrachloropalladate, Myroxylon pereirae, caine mix II, and palladium chloride

Prevalence of contact allergy to metals : nickel, palladium, and cobalt in Southern Sweden from 1995–2016

Background: In 2001, the EU nickel directive was introduced to prevent contact allergy to nickel. Contact allergy to palladium and/or cobalt is often seen together with contact allergy to nickel. Objectives: To compare the contact allergy prevalence of nickel, palladium, and cobalt allergy before and after the introduction of the EU nickel directive in consecutive patients with dermatitis. Methods: A retrospective analysis of patch test results from 1995–2016 was performed (n = 18 264). Chi-square tests were used to examine trends for nickel, palladium, and cobalt across test years. Logistic regression was used for associations. Results: The prevalence of nickel allergy decreased significantly in the youngest age group (6–30 years) for both female and male patients from 1995–1999 to 2012–2016: females: 33.4% to 19.1% (P <.001); males: 5.9% to 2.1% (P <.05). The concomitant reactions between nickel and palladium and nickel and cobalt among young females, respectively, also decreased significantly. Isolated palladium and cobalt allergy remained stable (1.4% and 2.3%, respectively) during the same time period for both men and women. Conclusions: The prevalence of nickel has decreased among young females and males suspected of contact allergy in Southern Sweden after the introduction of the EU nickel directive. There has been no change in isolated palladium or cobalt allergy