Publications by authors named "Evelyne Collet"

26 Publications

  • Page 1 of 1

Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS): Series of 49 French Pediatric Cases.

J Allergy Clin Immunol Pract 2021 Jul 29. Epub 2021 Jul 29.

Service de Dermatologie, Hôtel Dieu, Centre Hospitalier Universitaire de Nantes, Nantes, France. Electronic address:

Background: Drug reaction with eosinophilia and systemic symptoms (DRESS) is a rare and potentially fatal adverse reaction. It can be difficult to diagnose, even more so among children, because symptoms may mimic other commonly encountered pediatric conditions.

Objective: To describe clinical and laboratory features of DRESS syndrome in the pediatric population (age ≤18 years) and establish causative agents and treatment modalities.

Methods: This was a multicenter retrospective study of probable and definite DRESS cases (Registry of Sever Cutaneous Adverse Reaction score ≥ 4) in children hospitalized in 15 French university hospitals between 2000 and 2020.

Results: We included 49 cases. All children had fever and rash, 69.4% had lymphadenopathy, and 65.3% had facial edema. The most common organ affected was the liver (83.7%). Treatment consisted of topical corticosteroid in only 30.6% and systemic corticosteroid in 55.1%; 12.2% received intravenous immunoglobulin. Among probable and likely culprit drugs, 65% were antibiotics and 27.5% were antiepileptics, median time to DRESS symptom onset after initiation of 15 days (13 days with antibiotics and 21 days with antiepileptics). Twenty-seven children had allergy assessment for causative agents, 65.4% of whom had positive tests.

Conclusions: Culprit drugs are frequently antibiotics and antiepileptic drugs, and onset is often less than 2 weeks after treatment starts, especially with antibiotics. Treatment with topical corticosteroids appears to be sufficient in the least severe cases. Treatment by systemic corticosteroid therapy remains the reference treatment in case of severe organ damage.
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http://dx.doi.org/10.1016/j.jaip.2021.07.025DOI Listing
July 2021

First case of contact dermatitis caused by C12-13 alkyl malate used in a skin care product for acne.

Contact Dermatitis 2019 Dec 22;81(6):465-466. Epub 2019 Aug 22.

Department of Dermatology, CHU Dijon, Dijon, France.

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http://dx.doi.org/10.1111/cod.13369DOI Listing
December 2019

Immediate Hypersensitivity to Contrast Agents: The French 5-year CIRTACI Study.

EClinicalMedicine 2018 Jul 28;1:51-61. Epub 2018 Jul 28.

Service de Pneumologie, Consultation d'Allergolo-Anesthésie, CHU Pontchaillou, Rue H. Le Guilloux, 35033 Rennes Cedex 09, France.

Background: Iodinated and gadolinium-based contrast media (ICM; GBCM) induce immediate hypersensitivity (IH) reactions. Differentiating allergic from non-allergic IH is crucial; allergy contraindicates the culprit agent for life. We studied frequency of allergic IH among ICM or GBCM reactors.

Methods: Patients were recruited in 31 hospitals between 2005 and 2009. Clinical symptoms, plasma histamine and tryptase concentrations and skin tests were recorded. Allergic IH was diagnosed by intradermal tests (IDT) with the culprit CM diluted 1:10, "potentially allergic" IH by positive IDT with pure CM, and non-allergic IH by negative IDT.

Findings: Among 245 skin-tested patients (ICM = 209; GBCM = 36), allergic IH to ICM was identified in 41 (19.6%) and to GBCM in 10 (27.8%). Skin cross-reactivity was observed in 11 patients with ICM (26.8%) and 5 with GBCM (50%). Allergy frequency increased with clinical severity and histamine and tryptase concentrations (p < 0.0001). Cardiovascular signs were strongly associated with allergy. Non-allergic IH was observed in 152 patients (62%) (ICM:134; GBCM:18). Severity grade was lower (p < 0.0001) and reaction delay longer (11.6 vs 5.6 min; p < 0.001). Potentially allergic IH was diagnosed in 42 patients (17.1%) (ICM:34; GBCM:8). The delay, severity grade, and mediator release were intermediate between the two other groups.

Interpretation: Allergic IH accounted for < 10% of cutaneous reactions, and > 50% of life-threatening ones. GBCM and ICM triggered comparable IH reactions in frequency and severity. Cross-reactivity was frequent, especially for GBCM. We propose considering skin testing with pure contrast agent, as it is more sensitive than the usual 1:10 dilution criteria.
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http://dx.doi.org/10.1016/j.eclinm.2018.07.002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6537532PMC
July 2018

Low Cross-Reactivity Between Cisplatin and Other Platinum Salts.

J Allergy Clin Immunol Pract 2019 Jul - Aug;7(6):1894-1900. Epub 2019 Feb 15.

Dermatology Department, Dijon University Hospital, Dijon, France.

Background: Hypersensitivity reactions to platinum salts (PS) (cisplatin [CI], carboplatin [CA], and oxaliplatin [OX]) can be severe and their incidence is increasing due to their widespread use in cancer treatment.

Objective: To determine the rate of cross-reactivity between PS and whether CI can be administered without prior allergy testing in patients with a history of CA or OX hypersensitivity.

Methods: From September 2002 to April 2016, patients with suspected immediate PS hypersensitivity were tested and cross-reactivity between the 3 PS was evaluated. We then studied patients who were given CI without desensitization after immediate hypersensitivity to other PS.

Results: A total of 155 patients were included. Skin tests were positive in 97 patients (OX: 51, CA: 43, and CI: 3). Cross-reactivity to CA in OX-allergic patients was 45% (23 of 51) (95% confidence interval [CI]: 36% to 66%) and cross-reactivity to OX in CA-allergic patients was 37% (16 of 43) (95% CI: 23% to 53%). In contrast, cross-reactivity to CI was 0% (0 of 51) (95% CI: 0% to 7%) in OX-allergic patients and 7% (3 of 43) (95% CI: 2% to 17%) in CA-allergic patients. All these 3 patients had previously been exposed to CI in previous courses of chemotherapy. CI was initiated in 24 patients with proven hypersensitivity to CA or OX and had no hypersensitivity reactions.

Conclusion: Initiating CI in patients with proven immediate hypersensitivity to CA or OX appeared to be safe in our study.
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http://dx.doi.org/10.1016/j.jaip.2019.01.057DOI Listing
September 2020

Higher Frequency of Dipeptidyl Peptidase-4 Inhibitor Intake in Bullous Pemphigoid Patients than in the French General Population.

J Invest Dermatol 2019 04 10;139(4):835-841. Epub 2018 Dec 10.

Department of Dermatology, Poissy-Saint Germain Hospital, Saint-Germain-en-Laye, France.

Dipeptidyl peptidase-4 inhibitors have been suspected to induce bullous pemphigoid (BP). The objective of this study was to compare the observed frequency of gliptin intake in a large sample of 1,787 BP patients diagnosed between 2012 and 2015 in France, with the expected frequency after indirect age standardization on 225,412 individuals extracted from the database of the National Healthcare Insurance Agency. The secondary objective was to assess the clinical characteristics and the course of gliptin-associated BP, depending on whether gliptin was continued or stopped. The observed frequencies of intake of the whole gliptin class and that of vildagliptin in the BP population were higher than those in the general population after age standardization (whole gliptin class: 6.0%; 95% confidence interval = 4.9-7.1% vs. 3.6%, observed-to-expected drug intake ratio = 1.7; 95% confidence interval = 1.4-2.0; P < 0.0001; vildagliptin = 3.3%; 95% confidence interval = 2.5-4.1% vs. 0.7%, ratio = 4.4; 95% confidence interval = 3.5-5.7; P < 0.0001). The association of any gliptin+metformin was also higher than in the general population, ratio = 1.8 (95% confidence interval = 1.3-2.4; P < 0.0001). Gliptin-associated BP had no specific clinical characteristics. Gliptin was stopped in 48 (45.3%) cases. Median duration to achieve disease control, rate, and delay of relapse were not different whether gliptin was stopped or continued. This study strongly supports the association between gliptin intake, particularly vildagliptin, and the onset of BP.
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http://dx.doi.org/10.1016/j.jid.2018.10.045DOI Listing
April 2019

Is a specific eyelid patch test series useful? Results of a French prospective study.

Contact Dermatitis 2018 Sep 8;79(3):157-161. Epub 2018 Jun 8.

Department of Dermatology, CHU Montpellier, Montpellier, France.

Background: Eyelids are frequent sites of contact dermatitis. No prospective study focused on eyelid allergic contact dermatitis (EACD) has yet been published, and this topic has never been studied in French patients.

Objectives: To prospectively evaluate the usefulness of an eyelid series in French patients patch tested because of EACD, and to describe these patients.

Methods: We prospectively analysed standardized data for all patients referred to our departments between September 2014 and August 2016 for patch testing for suspected EACD as the main reason. All patients were patch tested with an eyelid series, the European baseline series (EBS), the French additional series, and their personal products. Patch testing with additional series and repeated open application tests (ROATs) or open tests were performed if necessary. A standardized assessment of the relevance was used, and the analysis of the results was focused on patients having positive test results with a current certain relevance.

Results: Two-hundred and sixty-four patients (238 women and 26 men) were included. Three-hundred and twenty-two tests gave positive results in 167 patients, 84 of whom had currently relevant reactions: 56 had currently relevant positive test reactions to the EBS, 16 had currently relevant positive test reactions to their personal products, 8 had currently relevant positive test reactions to the French additional series, and 4 had currently relevant positive test reactions to the eyelid series. Sixty-seven per cent of all relevant cases were related to cosmetic products. The most frequent allergens with current relevance were methylisothiazolinone (10.2%), fragrance mix I (3%), nickel (2.7%), hydroxyperoxides of linalool (2.7%) and limonene (2.3%), and Myroxylon pereirae (2.3%). Current atopic dermatitis was found in 9.5% of patients. The duration of dermatitis was shorter (23.2 vs 34.2 months; P = .035) in patients with currently relevant test reactions. The percentage of currently relevant tests remained the same when atopic patients or dermatitis localized only on the eyelids were taken into account.

Conclusion: In French patients, testing for EACD with the extended baseline series and personal products, also including ROATs and use tests, appears to be adequate, considering the currently relevant positive test reactions. The regular addition of an eyelid series does not seem to be necessary.
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http://dx.doi.org/10.1111/cod.13040DOI Listing
September 2018

Airborne allergic contact dermatitis caused by isothiazolinones in water-based paints: a retrospective study of 44 cases.

Contact Dermatitis 2017 Sep 27;77(3):163-170. Epub 2017 Apr 27.

Dermatology and Allergology Department, Tenon Hospital (AP-HP), Sorbonne Universities, UPMC University Paris 06, 75020, Paris, France.

Background: Airborne allergic contact dermatitis caused by paints containing isothiazolinones has been recognized as a health hazard.

Objectives: To collect epidemiological, clinical and patch test data on airborne allergic contact dermatitis caused by isothiazolinone-containing paints in France and Belgium.

Methods: A descriptive, retrospective study was initiated by the Dermatology and Allergy Group of the French Society of Dermatology, including methylchloroisothiazolinone (MCI)/methylisothiazolinone (MI)- and/or MI-sensitized patients who developed airborne allergic contact dermatitis following exposure to isothiazolinone-containing paint.

Results: Forty-four cases were identified, with mostly non-occupational exposure (79.5%). Of the patients, 22.5% of also had mucosal symptoms. In several cases, the dermatitis required systemic corticosteroids (27.3%), hospitalization (9.1%), and/or sick leave (20.5%). A median delay of 5.5 weeks was necessary to enable patients to enter a freshly painted room without a flare-up of their dermatitis. Approximately one-fifth of the patients knew that they were allergic to MI and/or MCI/MI before the exposure to paints occurred.

Conclusion: Our series confirms that airborne allergic contact dermatitis caused by paints containing isothiazolinones is not rare, and may be severe and long-lasting. Better regulation of isothiazolinone concentrations in paints, and their adequate labelling, is urgently needed.
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http://dx.doi.org/10.1111/cod.12795DOI Listing
September 2017

A Typical Vascular and Pigmentary Dermoscopic Pattern of Capillary Malformations in Capillary Malformation-Arteriovenous Malformation Syndrome: Report of Four Cases.

Pediatr Dermatol 2016 Sep 2;33(5):e337-41. Epub 2016 Aug 2.

Dermatology Department, Dijon University Hospital, Dijon, France.

We report dermoscopic characteristics of cutaneous capillary malformations in four patients with capillary malformation-arteriovenous malformation (CM-AVM) syndrome. We observed a mixed vascular and pigmentary pattern with branched linear vessels and an underlying homogeneous brown background. Disappearance of the vascular pattern on pressure revealed an underlying faint pigmentary reticular pattern. Our results suggest that this typical biphasic pattern on dermoscopy may be useful for the diagnosis of CM-AVM syndrome.
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http://dx.doi.org/10.1111/pde.12937DOI Listing
September 2016

Etiologies and prognostic factors of leukocytoclastic vasculitis with skin involvement: A retrospective study in 112 patients.

Medicine (Baltimore) 2016 Jul;95(28):e4238

Service de médecine interne et immunologie clinique Service de médecine interne et maladies systémiques Service de dermatologie Laboratoire d'anatomopathologie Service de pneumologie Service de maladies infectieuses, CHU François Mitterrand, Dijon, France.

In this study, outcomes of patients with leukocytoclastic vasculitis (LCV) were analyzed focusing on clinical, histopathology and laboratory findings, relapses, and survival.Data from patients with cutaneous vasculitis diagnosed between January 1, 2000, and December 31, 2010, at Dijon University Hospital (France) were retrospectively reviewed. LCV was defined as perivascular neutrophilic infiltrate, endothelial cell nuclear swelling, extravasation of red blood cells, and/or fibrin deposition in vessels. Patients were classified according to the 2012 Chapel Hill Consensus Conference. Relapses were defined as the recurrence of vasculitis symptoms after a period of remission >1 month. Time to relapse and/or death was calculated from the date of diagnosis. Univariate and multivariate (Cox model) analyses were performed.A total of 112 patients (57 males and 55 females), with a mean age of 60 ± 19 (18-98) years, were analyzed. Overall follow-up was 61 ± 38 months. At diagnosis, all patients had skin lesions, purpura being the most common (n = 83). Lesions were associated with systemic involvement in 55 (51%) patients. Only 41 (36.6%) patients received specific treatment: glucocorticoids in 29 of 41 (70.7%) and immunosuppressants in 9 of 41 (22%). Sixty-two patients (55%) had LCV due to underlying causes, 29 (25.9%) had single-organ cutaneous small vessel vasculitis (SoCSVV), and 21 (18.8%) had unclassifiable LCV. Twenty patients of the cohort (18%) experienced relapse, 14 ± 13 (1-40) months after the diagnosis of LCV. None of the 29 patients with SoCSVV relapsed. Independent risk factors for relapse were vascular thrombosis in the biopsy [hazard ratio (HR) = 4.9; P = 0.017], peripheral neuropathy (HR = 9.8; P = 0.001), hepatitis (HR = 3.1; P = 0.004), and positive antineutrophil cytoplasm antibodies (ANCA, HR = 5.9 P = 0.005). In contrast, SoCSVV was a protective factor for relapse (HR = 0.12; P = 0.043).The 1-, 3-, and 6-year overall survival rates were 99%, 83%, and 71%, respectively, with no difference between relapsers and nonrelapsers (P = 0.960) or between SoCSVV and unclassifiable LCV (P = 0.588).This study demonstrates that global survival for LCV patients is good but relapses remain frequent, especially when the cutaneous biopsy shows vascular thrombosis, or in patients with peripheral neuropathy or hepatitis. Conversely, SoCSVV is a protective factor for relapse.
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http://dx.doi.org/10.1097/MD.0000000000004238DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4956825PMC
July 2016

Dyskeratosis of the Face: A Quiz.

Acta Derm Venereol 2016 Feb;96(2):285-7

Dermatology Department, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, Université Paris Diderot, Sorbonne Paris Cité, Paris, France.

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http://dx.doi.org/10.2340/00015555-2207DOI Listing
February 2016

Neostigmine induced anaphylaxis in the wake of surgery.

Anaesth Crit Care Pain Med 2015 Apr 1;34(2):109-11. Epub 2015 Apr 1.

CHRU Hôpital du Bocage, Department of Dermatology, 21000 Dijon, France.

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http://dx.doi.org/10.1016/j.accpm.2014.08.005DOI Listing
April 2015

Iodinated contrast media-induced acute generalized exanthematous pustulosis confirmed by delayed skin tests.

J Allergy Clin Immunol Pract 2014 Nov-Dec;2(6):805-6. Epub 2014 Aug 29.

Department of Dermatology, University Hospital, Dijon, France.

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http://dx.doi.org/10.1016/j.jaip.2014.07.015DOI Listing
October 2015

Contact sensitization to modern dressings: a multicentre study on 354 patients with chronic leg ulcers.

Contact Dermatitis 2015 Feb 7;72(2):90-6. Epub 2014 Oct 7.

Dermatology and Allergy, University Hospital of Nancy, rue du Morvan 54511, Vandoeuvre-les-Nancy, France.

Background: Modern dressings (MDs) may have a low sensitization rate, but there is a lack of prospective studies in patients with chronic leg ulcers (CLUs) to evaluate this.

Objectives: To determine the rate of sensitization (contact allergy) to MDs and substances present in dressings.

Patients And Methods: A prospective multicentre study was carried out in patients with CLUs at five French dermatology departments; patch tests were performed with the European baseline series and with an additional 27 individual allergens and 10 MDs.

Results: Among 354 patients (226 women and 128 men) with CLUs, 59.6% had at least one positive patch test reaction to an MD and 19% had at least one sensitization to an MD. The number of positive test reactions per patient was correlated with the duration of ulcerative disease, but not with ulcer duration, the cause of the ulcer, or the presence of surrounding eczematous lesions. For 11 of 45 patients sensitized to Ialuset cream®, more detailed information could be obtained with sensitization to sodium dehydroacetate (5 cases) or Lanette SX® (3 cases).

Conclusions: Sensitization to MDs is not rare. It is absolutely necessary to label all components of MDs on their packaging and to avoid some sensitizing molecules, such as colophonium derivatives or any strong sensitizers.
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http://dx.doi.org/10.1111/cod.12307DOI Listing
February 2015

Outbreak of contact sensitization to methylisothiazolinone: an analysis of French data from the REVIDAL-GERDA network.

Contact Dermatitis 2014 May 19;70(5):262-9. Epub 2014 Mar 19.

Department of Dermatology, Larrey Hospital, Paul Sabatier University, 31059, Toulouse, France.

Background: The preservative methylisothiazolinone (MI) is used in combination with methylchloroisothiazolinone (MCI), but the MCI/MI mixture has been identified as highly allergenic. MI is considered to be less allergenic, and since the mid-2000s has been widely used alone, but is now clearly identified as a contact allergen. The French Vigilance Network for Dermatology and Allergy of the Study and Research Group on Contact Dermatitis (REVIDAL-GERDA) added MI to its baseline patch testing series in 2010.

Objective: To evaluate the change in the proportion of MI-positive tests in France between 2010 and 2012.

Patients/materials/methods: We conducted a nationwide, multicentre, retrospective study of all MI-tested patients between 2010 and 2012.

Results: Sixteen centres participated in the study (7874 patients were tested). Patch tests were performed mainly at a concentration of MI 200 ppm aq. We observed a significant increase in the proportion of MI-positive tests in 2012 and 2011 as compared with 2010 (5.6%, 3.3%, and 1.5%, respectively; p < 0.001).

Conclusions: We report a significant increase in the number of MI-positive tests. MI is confirmed to be a rapidly emerging allergen, as also observed in other European countries.
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http://dx.doi.org/10.1111/cod.12207DOI Listing
May 2014

Cheilitis, perioral dermatitis and contact allergy.

Eur J Dermatol 2013 May-Jun;23(3):303-7

Department of Dermatology Dijon University Hospital Hôpital du Bocage 2 Bd du Maréchal de Lattre de Tassigny 21000 Dijon, France.

Cheilitis is a superficial inflammatory condition of the lip. It can occur either alone or be associated with stomatitis or perioral eczema. Contact hypersensitivity reactions are a frequent cause of cheilitis. Cosmetic and hygiene products are the most usual causes. Less frequently, allergic cheilitis is caused by contact with musical instruments, topical medicines or food allergens. Cases of cheilitis induced by dental material are rare and debated. The diagnosis relies on patch tests, which start with the European baseline series and the patient's personal cosmetic and topical products. This investigation will then be completed by the ingredients in the topical products and specific test series.
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http://dx.doi.org/10.1684/ejd.2013.1932DOI Listing
November 2015

Quinoline Yellow dye-induced fixed food-and-drug eruption.

Contact Dermatitis 2013 Mar;68(3):187-8

Department of Dermatology, CHU Le Bocage, 21000 Dijon, France.

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http://dx.doi.org/10.1111/cod.12019DOI Listing
March 2013

Allergic contact dermatitis caused by sodium dehydroacetate, not hyaluronic acid, in Ialuset® cream.

Contact Dermatitis 2011 Dec;65(6):359-61

Service de Dermatologie, Centre Hospitalier Universitaire, Bordeaux, France.

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http://dx.doi.org/10.1111/j.1600-0536.2011.01958.xDOI Listing
December 2011

Fixed eruption due to quinine contained in tonic water: positive patch-testing.

Contact Dermatitis 2009 Oct;61(4):242-4

Dermatology Department, CHU Le Bocage, Dijon cedex, France.

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http://dx.doi.org/10.1111/j.1600-0536.2009.01617.xDOI Listing
October 2009

Contact allergy in chronic leg ulcers: results of a multicentre study carried out in 423 patients and proposal for an updated series of patch tests.

Contact Dermatitis 2009 May;60(5):279-87

Dermatology Department, Fournier Hospital, University Hospital of Nancy, Nancy, France.

Background: There is a lack of prospective studies investigating contact sensitization in patients with chronic leg ulcers.

Objectives: To determine the frequency of contact sensitization in patients with chronic leg ulcers using a special series of patch tests and to determine whether the number of sensitizations was correlated with the duration of the chronic leg ulcers.

Patients/methods: Multicentre study carried out in patients with chronic leg ulcers; patch tests with the European baseline series and with an additional 34 individual allergens or mixes and 3 commercial products.

Results: Of the 423 patients (301 women, 122 men, mean age 68.5 years) with chronic leg ulcers, 308 (73%) had at least one positive patch test with 3.65 positive patch tests per patient. The main allergens were Myroxylon pereirae (41%), fragrance mix I (26.5%), antiseptics (20%), and corticosteroids (8%). The number of positive tests per patient was not correlated with the cause of ulcer but was increased with the duration of the ulcer with a statistical difference between the group of the <1 year compared with the group >10 years duration.

Conclusions: From this large prospective multicentre study, polysensitization is frequent in patients with chronic leg ulcers, increasing with the duration of the ulcer. We propose avoidance of topical antiseptics and ointments containing perfumes in patients with chronic leg ulcers and an updated patch test series for investigating these patients.
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http://dx.doi.org/10.1111/j.1600-0536.2009.01541.xDOI Listing
May 2009

Chronic eczematous eruptions of the elderly are associated with chronic exposure to calcium channel blockers: results from a case-control study.

J Invest Dermatol 2007 Dec 23;127(12):2766-71. Epub 2007 Aug 23.

Department of Dermatology, Inserm U519, Rouen University Hospital, Rouen, France.

It has been suggested that chronic eczematous eruptions of the elderly could be associated with chronic drug exposure. To determine the drugs associated with these eruptions, we conducted a case-control study on 102 cases and 204 controls. Cases were consecutive patients older than 60 years presenting with an eczematous eruption that had evolved continuously or recurrently for more than 3 months without a reliable cause. Two controls were matched to each case on age, sex, in/outpatient origin, and center. Information about drug exposure was obtained from patients and their pharmacists. Drug use for more than 3 months within the year preceding the eruption was compared between cases and controls. An association was found between calcium channel blockers (CCB) and eczema, with a matched OR (odds ratio) of 2.5 (95% CI (confidence interval): 1.3-4.6). To ascertain the course of patients after CCB withdrawal, two ancillary studies were performed on 74 patients with eczematous eruptions from our department before the case-control study period, and on 101 patients registered in the French "Pharmacovigilance" database. Healing of these eruptions after CCB withdrawal occurred in 83 and 68% of these cases, respectively. The long-term use of CCB is a risk factor for chronic eczematous eruptions of the elderly.
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http://dx.doi.org/10.1038/sj.jid.5701018DOI Listing
December 2007

A rare nail polish allergen: phthalic anhydride, trimellitic anhydride and glycols copolymer.

Contact Dermatitis 2007 Mar;56(3):172-3

Institut Pasteur, Centre Medical, Service d'Allergologie, 25, rue du Dr Roux 75015 Paris, France.

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http://dx.doi.org/10.1111/j.1600-0536.2007.01034.xDOI Listing
March 2007

Diagnostic and predictive value of skin testing in platinum salt hypersensitivity.

J Allergy Clin Immunol 2007 Mar 25;119(3):726-30. Epub 2007 Jan 25.

Dermatology Department, University Hospital, Dijon Cedex, France.

Background: Hypersensitivity reactions to platinum salts are potentially lethal adverse events in chemotherapy, and often require its discontinuation. Several preventive procedures have been proposed: premedication, desensitization regimens, or replacement with a different platinum salt.

Objective: We therefore assessed the value of skin tests with platinum salts. A positive result would confirm their responsibility in hypersensitivity reaction, whereas a negative result would identify candidates for continuation of therapy using a different platinum salt.

Methods: Patch tests, prick tests, and intradermal tests with cisplatin, carboplatin, and oxaliplatin were performed in 21 patients.

Results: Skin tests were positive in 14 of 21 cases. Prick tests were positive in 5 cases with the suspected platinum salt. Intradermal tests were positive in 12 of 19 cases, always when the hypersensitivity occurred less than 2 hours after infusion. Cross-reactions were observed in 4 cases. Delayed readings of skin tests at 24 hours and 48 hours were positive in 3 patients. Patch tests were negative in all the 21 patients tested. Replacement with another platinum salt was performed in 13 patients using one that gave a negative skin test. A relapse of symptoms occurred in 1 patient.

Conclusion: Intradermal tests are particularly indicated for the diagnosis of immediate hypersensitivity reaction. Their good negative predictive value allows safe retreatment by detecting a potential cross-reaction.

Clinical Implications: The frequency of cross-reactions among cisplatin, carboplatin, and oxaliplatin has not been clearly established. Skin tests allow different platinum salts to be given and avoid discontinuation of chemotherapy.
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http://dx.doi.org/10.1016/j.jaci.2006.11.640DOI Listing
March 2007
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