J ALLERGY CLIN IMMUNOL

FEBRUARY 2014

AB198 Abstracts

MONDAY

685 Contact Dermatitis Due To Topical AmorolfineDr. Ruperto Gonzalez Perez, Mrs. Paloma Poza-Guedes,

Mrs. Inmaculada S�anchez Mach�ın, Dr. Victor Matheu, MD; Hospital del

T�orax-Ofra, Sta Cruz de Tenerife, Spain.

RATIONALE: Contact eczema caused by allergy to antifungal drugs si

uncommon. Imidazole derivatives have been described as the most

sensitising agent.

METHODS:We report the case of a 49 year-old female non-atopic patient

presentingwith an extensive eczematous pruritic rash on her right great toe.

She had been prescribed 3 weeks before a topical cream twice daily

containing 0,25% amorolfine, polyethylene glicol 40 monosterate, stearyl

alcohol, parafin, carbomer 934P, sodium hydroxyde, disodium edetate, 2-

phenoxy ethanol and purified water. Patch test were performed with the

suspected antifungal cream.

RESULTS: Patch test showed positive (+++) readings at 48 and 96 hours.

Five control subjects obtained negative patch test with the same suspected

cream. A negative result to a cosmetic battery was also included to exclude

the rest of the cream components.

CONCLUSIONS: we describe the rare case of a contact dermatitis due to

amorolfine. To our knowledge only three cases have been previously

reported in the literature review.

686 Sweet's Syndrome By A Show Of HandsDr. Syeda Hamadani, Dr. Anita Ravi, Dr. Seth Politano,

Dr. Eric Hsieh, Dr. Gina Rossetti; USC, Los Angeles, CA.

RATIONALE: Recognize an atypical presentation of Sweet’s Syndrome.

METHODS: Skin biopsy.

RESULTS: 57 year old Hispanic male with no PMH presents with new

onset bilateral hand pain. Five days prior to admission, he noticed black

discoloration in his fingernails. He then developed a constant pulsating

pain, swelling and pruritic rash in his bilateral hands. He also

complained of fevers, sweats and chills. On physical exam, patient

had splinter hemorrhages on multiple fingers, marked diffuse tender-

ness to palpation over bilateral hands, diffuse edema of hands. Skin

exam demonstrated maculopapular non-blanching erythematous rash

on dorsal aspect of bilateral wrists, painful purpura on palms and

fingertips bilaterally. Labs included WBC 12.9 (Neutrophil count 72.9),

ESR 82, CRP 146.2. Biopsy of the hand lesion showed dense dermal

neutrophilic infiltrate.

CONCLUSIONS: The above patient had fever, painful/erythematous

rash, and neutrophilic infiltration of the skin on biopsy, leukocytosis,

and responded to systemic steroids. The patients’ clinical picture, labs,

and pathology were consistent with Sweet’s Syndrome. However, this

case was unusual as the patient’s rash was limited to his hands. Sweet’s

Syndrome clinically favors upper body and face but restriction of rash

to the hands are rare. NDDH (Neutrophilic dermatosis od the dorsal

hands) is a rare variant of Sweet’s Syndrome with localized lesions

clinically restricted to the hands and less frequent systemic symptoms.

Systemic symptoms such as fever, leukocytosis and increased

ESR are observed in 1/3 of the cases. NDDH is a recent disease

concept which is evolving as it has been described in only a few case

studies.

687 Mango, Pulp Fiction?Dr. Alexander S. Kim, MD1, Dr. Sandra C. Christiansen, MD,

FAAAAI2; 1University of California San Diego, La Jolla, CA, 2Southern

CA Permanente Med Grp, San Diego, CA.

RATIONALE: Contact reactions to mango have been previously

reported. Here we present an unusual dual reaction to mango peel

and pulp.

METHODS: Skin prick, Finn Chamber and in-vitro IgE testing.

RESULTS: A 23-year old gentleman was evaluated after 2 episodes of

delayed reactions to mango ingestion. Both episodes involved a

perioral and pruritic rash associated with dry and cracked lips

developing 1 day after unpeeled mango consumption and lasting 1

week. The second episode involved significant periorbital and lip

edema as well as extension of the rash to the abdomen and extremities.

He denied systemic symptoms but recalled that a pruritic papulove-

sicular rash on his lower extremities had appeared after poison oak

exposure 7 years prior. Physical exam revealed an erythematous

papular rash on the left thigh and the right hand. In-vitro IgE testing

was positive to dust mite but negative to mango. Skin prick testing was

negative to mango skin and pulp. Epicutaneous patch testing using

mango skin and pulp placed in duplicate under Finn Chambers was

positive to mango skin at 72 hours and to mango pulp at 96 hours.

CONCLUSIONS: We present a patient with contact dermatitis to mango

skin and pulp. Patch testing using Finn Chambers is an efficient method for

evaluating delayed type hypersensitivity to mango fruit. It is worth

considering extending the observation to 96 hours given the clinically

significant reaction to pulp.

688 Preoperative Patch Testing In Patients Undergoing PectusExcavatum Repair

Dr. Laura Helfner, MD1, Dr. David Rosenthal, DO1, Dr. Blanka M.

Kaplan, MD, FAAAAI2, Dr. Punita Ponda, MD, FAAAAI3; 1Division of

Allergy/Immunology, Departments of Medicine and Pediatrics, Hofstra

North Shore-LIJ School of Medicine, Great Neck, NY, 2Department of Pe-

diatrics, Division of Allergy & Immunology, Hofstra-North Shore-LIJ

School of Medicine, Great Neck, NY, 3Allergy and Immunology, North

Shore LIJ Health System, Great Neck, NY.

RATIONALE: The Nuss procedure is a minimally invasive surgery to

correct pectus deformities using a stainless-steel rod containing several

metals including nickel. Occasionally, devastating complications occur

in patients who develop delayed type hypersensitivity to the implanted

rod. A retrospective study showed the incidence of metal hypersensi-

tivity was 2.2% in patients having undergone the Nuss procedure.

Yet, if metal contact dermatitis is determined a priori, a titanium

bar is customized. This case series investigated preoperative

incidence of metal allergy in patients scheduled to undergo the Nuss

procedure.

METHODS: Twelve patients were assessed to determine the

incidence of metal allergy using the allegEAZE� patch testing

system, according to the manufacturer’s direction, to a panel of

metals in the stainless-steel rod(ASTM F899, A564, A276) (Biomet

Microfixation). All participants were male, mean6SD age 14.561.4

years.

RESULTS: Positive responses to the metal components of the patch test

occurred in 33%(4/12) of patients, while 17%(2/12) had indeterminate

reactions. Therefore, 50%(6/12) had preoperative patch testing prohibiting

implantation of the traditional rod.

CONCLUSIONS: Previously, preoperative patch testing was per-

formed only in patients with a history of atopy. In our series one

patient met this prior criterion and had a positive patch test, while

one patient met this criterion and had negative patch testing. Thus,

history alone is neither sensitive nor specific in predicting metal

contact hypersensitivity in patients scheduled for pectus repair.

Although additional longitudinal studies are needed, we recommend

that preoperative metal patch testing, performed by specialists

experienced in patch testing, be the standard-of-care for patients

undergoing pectus repair.