Increase in vesicular hand eczema after house dust mite inhalation provocation: a double‐blind, placebo‐controlled, cross‐over study

Abstract

Citation for published version (APA): Schuttelaar, M., Coenraads, P. J., Huizinga, J., De Monchy, J. G., & Vermeulen, K. M. (2013). Increase in vesicular hand eczema after house dust mite inhalation provocation: a double-blind, placebo-controlled, cross-over study. CONTACT DERMATITIS, 68(2), 76-85. DOI: 10.1111/j.1600-0536.2012 Copyright Other than for strictly personal use, it is not permitted to download or to forward/distribute the text or part of it without the consent of the author(s) and/or copyright holder(s), unless the work is under an open content license (like Creative Commons).Take-down policy If you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediately and investigate your claim.Downloaded from the University of Groningen/UMCG research database (Pure): http://www.rug.nl/research/portal. For technical reasons the number of authors shown on this cover page is limited to 10 maximum. Methods. Eighteen patients with vesicular hand eczema and HDM allergy received inhalation challenges with four concentrations of HDM in a randomized, doubleblind, placebo-controlled, cross-over study. Early asthmatic reactions and late asthmatic reactions were defined as a placebo-corrected fall of 15% or more from baseline of forced expiratory volume in 1 second. Hand eczema was scored according to the Dyshidrotic Eczema Area and Severity Index (DASI) at baseline, and 1, 6, 24 and 48 hr.Results. The median DASI increased significantly as compared with baseline at 6 and 48 hr after HDM inhalation. This increase was significantly different between the provocations at 6 hr. The median vesicles score increased significantly from baseline at 24 and 48 hr. Patients with a placebo-corrected increase in the number of vesicles at 24 hr and 48 hr had significantly more often late asthmatic reactions than those without an increase in the number of vesicles. Patients with a placebo-corrected increase of the DASI score at 24 hours had as a group a higher mean total IgE level than those without an increase of the DASI score. Conclusion.Hand eczema increased significantly more after HDM provocation than after placebo provocation. An increase in the number of vesicles was preceded by late asthmatic reactions. The group patients with an increase of hand eczema tended to have a higher mean total IgE level.

Respiratory allergy caused by house dust mites: What do we really know?

“…84 Although nonrespiratory allergic symptoms are beyond the scope of this review, it is worth noting that sensitization can be both systemic and localized. Inhalation of HDM aeroallergens can elicit eczematous lesions, 85,86 and patients with nonsteroidal anti-inflammatory drug-induced urticaria/angioedema show a high prevalence of HDM sensitization. 87 This suggests that deposition of an allergen in one organ (the respiratory tract) causes symptom flare-ups in another organ.…”

Hand eczema: epidemiology, prognosis and prevention

“…34 Endogenous sub-diagnoses comprise atopic HE, hyperkeratotic HE and acute recurrent vesicular HE. 54,55 It is important to understand that twoand sometimes more sub-diagnoses may be necessary to characterize HE cases, 41 and that the sub-diagnoses may even change over time. It may be the only sub-diagnosis or may occur in combination with ICD or ACD and is interpreted as an eczema caused by the impaired barrier function related to atopic skin disease.…”

Temperature‐controlled laminar airflow (TLA) device in the treatment of children with severe atopic eczema: Open‐label, proof‐of‐concept study

“…The magnitude of the reduction was similar to that seen in the experimental chamber studies, confirming that major reduction in exposure in real life is possible. Allergen challenges in AE patients have shown that exposure to sensitizing allergens via inhaled route induces flares of eczema, and reduction in allergen exposure may be the mechanism behind the effects observed in our study. However, it remains unclear which other factors in the home “exposome” may be relevant for AE severity.…”

“…Sensitization rates to inhalant allergens among patients with AE are high, and there is evidence that aeroallergen exposure can trigger AE exacerbations . However, studies investigating the use of allergen avoidance and allergen‐specific immunotherapy in the treatment of AE have yielded mixed results, and these interventions are currently not recommended in the disease management .…”