A 33-year-old female patient presented to our clinic with a 1-year history of erythematous and itchy plaques on the both eyelids, the perioral area, and the neck (Figure 1). She associated her symptoms with food, spices and coffee, but not with cosmetics, as she stated that she used only "hypoallergenic cosmetic products for sensitive skin". She has no other health problems or atopy. Prick tests with inhalant allergens and food gave negative results. Patch tests were performed with the European baseline series and a cosmetic series (Chemotechnique Diagnostics, Vellinge, Sweden), as well as with her creams (all "as is") Noreva Global Exfoliac 6 and Noreva Recovery Cream, and "semi-open" with Noreva Exfoliac Gel, Noreva Actipur Wash (all by Noreva Laboratoires, Paris, France), and ODA Wash (ODA, Elektrėnai, Lithuania). We performed patch tests by the use of Finn Chambers (SmartPractice Europe, Barsbüttel, Germany) covered with Mefix (Mölnlycke Healthcare, Göteborg, Sweden), and read them according to ICDRG guidelines on day (D) 2, D3, and D7. Positive reactions to Noreva Exfoliac Global 6 cream (+++), drometrizole, propyl gallate, dodecyl gallate, 3-(dimethylamino)-1-propylamine (all + reactions) were detected. All positive reactions were considered to be not clinically relevant to the present dermatitis, with the exception of Noreva Exfoliac Global 6 cream. The Noreva Laboratoires representative was contacted, and ingredients were kindly provided and patch tested. Tests were read on D3 and D7. A +++ positive reaction to bakuchiol 0.1% pet. appeared at D3. Ten controls were 398 MALINAUSKIENE ET AL.
Background Chronic urticaria is a common disease. Plasmapheresis is an alternative treatment that can be appropriate for patients who are resistant to treatment with 2nd generation antihistamines or for whom treatment with omalizumab is unsuitable. Objective To investigate the effect of plasmapheresis treatment in chronic urticaria. Methods A retrospective analysis was performed based on the data of 98 patients suffering from refractory chronic urticaria who received plasmapheresis as an alternative treatment in Vilnius University’s Hospital Santaros Clinics from 2000 to 2020. The efficiency of the treatment was evaluated by clinical judgment. Results 58.2% of the patients exhibited a complete or significant response; of these, 37.8% had temporary relief of symptoms and 20.4% achieved disease remission; 41.8% showed no response to the plasmapheresis. Men (34.8%) had a tendency to achieve disease remission more often than women (16%) (p < 0.05). One patient did not finish the plasmapheresis treatment due to the symptoms’ exacerbation and treatment with omalizumab was initiated. Conclusion Plasmapheresis is a safe and effective alternative treatment when traditional treatment is unavailable or does not relieve symptoms completely. Our data showed that plasmapheresis was effective in more than half of our patients.
The coronavirus 2019 (COVID-19) disease is now responsible for one of the most challenging and concerning pandemics. Since December 2020, the world has had access to COVID-19 prophylaxis; thus, we encounter adverse events from vaccination more often due to the vast vaccination range. We present two case reports of difficult-to-treat skin vasculitis due to COVID-19 vaccination that were successfully treated in a tertiary-level university hospital. When encountering systemic treatment, resistant skin vasculitis plasmapheresis could be a choice of treatment.
Plėviasparnių vabzdžių įgėlimai sukelia sistemines alergines reakcijas iki 7,5 proc. suaugusiųjų ir iki 3,4 proc. vaikų. Jos gali būti įvairaus sunkumo: nuo lengvų odos simptomų iki sunkių, mirtimi gresiančių anafilaksinių reakcijų. Pacientai, patyrę sisteminę reakciją, dažnai jaučia baimę, yra stigmatizuoti, gali būti priversti keisti savo įpročius, šiltuoju metų laikotarpiu nešiotispirmosios pagalbos vaistų, o vienintelis gydymo būdas, galintis apsaugoti tokius pacientus nuo gyvybei pavojingos reakcijos – specifinė nuodų imunoterapija. Ji veiksmingai apsaugo nuo galimų sisteminių alerginių reakcijų ir rekomenduojama vaikams bei suaugusiems asmenims, kuriems nustatyta sensibilizacija ir sisteminės alerginės reakcijos, neapsiribojančios odos simptomais. Reikšminiai žodžiai: plėviasparniai, nuodai, anafilaksija, triptazė, specifinė nuodų imunoterapija.
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