Report drawn up on behalf of the Committee on Energy, Research and Technology on the development of advanced reactors, Part A: Motion for a resolution. Working Documents 1984-85, Document 1-224/84/A, 8 May 1984

Background Population/based studies about contact allergy are scarce. Objectives To obtain reliable estimates of the prevalence of contact allergy in the general population in Europe. Methods A cross-sectional study of a random sample from the general population, aged 18-74 years, in five different European countries (Sweden, the Netherlands, Germany, Italy and Portugal). In total, 12 377 subjects were interviewed and a random sample (n = 3119) patch tested to TRUE Test panels 1-3 and Fragrance Mix (FM) II, hydroxyisohexyl 3-cyclohexene carboxaldehyde (HICC) and sesquiterpene lactone mix. A positive patch test reaction is considered as contact allergy. Results In total, 27.0% [95% confidence interval (CI) 25.5-28.5] had at least one positive reaction to an allergen of the European baseline series, with a significantly higher prevalence in women than in men. The highest age-standardized prevalences (>= 1%) were found for nickel (14.5%, 95% CI 13.2-15.8), thiomersal (5.0%, 95% CI 4.2-5.8), cobalt (2.2%, 95% CI 1.7-2.7), FM II (1.9%, 95% CI 1.5-2.5), FM I (1.8%, 95% CI 1.4-2.3), HICC (1.4%, 95% CI 1.0-1.9), p-tert-butylphenol formaldehyde resin (1.3%, 95% CI 0.9-1.7) and para-phenylenediamine (1.0%, 95% CI 0.6-1.3). Only nickel and thiomersal showed a statistically significantly different prevalence for contact allergy among the different European populations. Subjects reporting contact dermatitis in their lifetime (age-standardized prevalence 15.1%, 95% CI 13.8-16.3) had an increased risk for contact allergy (odds ratio 1.9, 95% CI 1.5-2.5). The risk of having a contact allergy was not increased in those with atopic dermatitis (prevalence 7.6%, 95% CI 6.7-8.6; odds ratio 1.0, 95% CI 0.7-1.4). Conclusions Contact allergy to at least one allergen of the European baseline series was diagnosed in more than one-quarter of the general European population. Therefore measures to improve the primary prevention of contact allergy have to be enforced

Cost-effectiveness of oral alitretinoin in patients with severe chronic hand eczema - a long-term analysis from a Swiss perspective

BACKGROUND: The impact on patients suffering from chronic hand eczema (CHE) is enormous, as no licensed systemic treatment option with proven efficacy for CHE is available. Alitretinoin is a novel agent which showed high clinical efficacy in patients with severe, refractory CHE. We assessed the cost-effectiveness of alitretinoin for CHE patient treatment from a Swiss third party payer perspective. A further objective of this study was to determine the burden of disease in Switzerland. METHODS: A long-term Markov cohort simulation model was used to estimate direct medical costs (euro) and clinical effectiveness (quality adjusted life years, QALYs) of treating severe CHE patients with alitretinoin. Comparison was against the standard treatment of supportive care (optimised emollient therapy). Information on response rates were derived from a randomized controlled clinical trial. Costs were considered from the perspective of the Swiss health system. Swiss epidemiological data was derived from official Swiss Statistic institutions. RESULTS: Annual costs of alitretinoin treatment accounted for 2'212 euro. After a time horizon of 22.4 years, average remaining long-term costs accounted for 42'208 euro or 38'795 euro in the alitretinoin and the standard treatment arm, respectively. Compared with the standard therapy, the addition of alitretinoin yielded an average gain of 0.230 QALYs at the end of the simulation. Accordingly, the incremental cost-effectiveness ratio resulted in 14'816 euro/QALY gained. These results were robust to changes in key model assumptions. CONCLUSION: The therapy for CHE patients is currently insufficient. In our long-term model we identified the treatment with alitretinoin as a cost-effective alternative for the therapy of CHE patients in Switzerland

Evidence-Based Management of Hand Eczema

Hand eczema is a common skin disease with a wide variation in morphology and a complex etiology based on endogenous and exogenous factors.The diagnosis of hand eczema is based on patient history, exposure assessment, physical examination, and the results of patch testing. Management of hand eczema starts with education of the patient on the etiology of the disease, and the needed changes in behavior regarding skin care and preventive measures, and avoidance of relevant exposure factors. In many cases, medical treatment is needed for successful management of the disease; use of medication can only be successful with proper education and avoidance of relevant exposure

Therapie von handekzemen. Was können wir von publizierten klinischen Studien lernen?

Abstract in German Handekzeme sind sehr häufig, können verschiedene Ursachen haben und trotz einer Vielzahl von Behandlungsoptionen, die von topischen Kortikosteroiden über Phototherapie bis zur oralen Gabe von Ciclosporin und Retinoiden reichen, eine therapeutische Herausforderung darstellen. In den führenden Literaturdatenbanken (ldquorCochraneldquo, ldquorMEDLINEldquo, ldquorEmbaseldquo, ldquorPascalldquo, ldquorJicst-Eplusldquo, ldquorAmedldquo) wurden systematisch publizierte Studien zur Therapie des Handekzems recherchiert und nach Qualitätskriterien bewertet. Zusätzlich wurden vier führende medizinische Zeitschriften (BMJ, JAMA, Lancet, NEJM) und 17 dermatologische Zeitschriften ab 1977 per Hand durchsucht. Eingeschlossen wurden alle Studien, die sich auf alle möglichen Varianten von ärztlich diagnostizierten Handekzemen bezogen. Dabei konnten von insgesamt 100 klinischen Untersuchungen 31 als randomisierte klinische Studien (RCT) identifiziert werden. Diese RCTs weisen teilweise erhebliche methodische Mängel auf und untersuchen sehr unterschiedliche Therapieoptionen. Es besteht ein großer Bedarf an guten RCTs zur Therapie des Handekzems, wobei nicht nur neue, sondern auch etablierte Therapieoptionen untersucht werden sollten und die verschiedenen Handekzemtypen Berücksichtigung finden müssen

Design and feasibility of an international study assessing the prevalence of contact allergy to fragrances in the general population: the European dermato-epidemiology network fragrance study

Background/Aims: Data on contact allergy to fragrances in the general population are limited. Data from allergological services suggest that the frequency of contact allergy to fragrances is increasing. The European Dermato-Epidemiology Network (EDEN) Fragrance Study aims to obtain reliable data on the prevalence of contact allergy to fragrances and other sensitizers of the European baseline series, in the general population of different geographical areas of Europe. We report the methodology and the reliability of instruments adopted and discuss the feasibility based on a pilot phase. Methods: Descriptive epidemiology survey. A random sample from the general population is selected and interviewed, and is offered patch testing in a randomized way. We specifically enquire about any skin rash reported during the previous year, and any history of reactions to products that may contain the sensitizer and/or a history of avoidance of the same products. Patch test data are linked to the questionnaire information to define clinical relevance. Results: The questionnaire showed high test-retest reliability in 94 individuals. Patch test reading also showed a high level of interrater reliability. During the pilot phase, a total of 589 participants were recruited. Conclusions: The EDEN Fragrance Study is feasible and able to provide useful data on fragrance allergy. Copyright (C) 2010 S. Karger AG, Basel

Management of chronic hand eczema

Hand eczema (HE) is one of the most frequent skin diseases and has often a chronically relapsing course with a poor prognosis resulting in a high social and economic impact for the individual and the society. In this article, we highlight the results of an expert workshop on the 'management of severe chronic hand eczema' with the focus on the epidemiology, the burden of severe HE, its classification and diagnostic procedures, and the current status of treatment options according to an evidence-based approach (randomized controlled clinical trials, RCTs). We conclude that despite the abundance of topical and systemic treatment options, disease management in patients with severe chronic HE is frequently inadequate. There is a strong need for RCTs of existing and new treatment options based on clearly diagnosed subtypes of HE and its severity

Notification of occupational skin diseases by dermatologists in The Netherlands

Background A voluntary surveillance scheme of occupational skin diseases (OSDs) in The Netherlands starting in 2001 aimed to improve insight in the incidence of OSD especially occupational contact dermatitis (OCD), risk professions and causal agents. This paper presents the results of this scheme during 2001-05. Methods Reports of new cases of OSD received from the participating dermatologists on a monthly basis were analysed. Data evaluated included information on diagnosis, sex, age, sickness, absenteeism, profession and causal agents. Relative differences in incidence rates between industries or branches were estimated by calculating incidence rate ratios. Results About 80% of the notifications concerned OCD. The highest number of notifications was recorded in the first year of the scheme. This was probably due to reporting of a mixture of incident and prevalent cases. During the following 5 years, the number of yearly notifications of OSD declined. Hairdressers, nurses, metalworkers, mechanics and cleaners were the most commonly affected professions. Wet work and irritating substances were the most frequently reported causal agents. Most patients with OCD were not absent from work. Conclusions A voluntary surveillance scheme with dermatologists provides valuable data about the distribution of OCD in risk professions and the causal agents. However, it has certain limitations in assessing trends in incidence. Active medical surveillance in populations at risk should be encouraged not only to improve secondary prevention but also to obtain more reliable information about the incidence of OCD