title: Increase in vesicular hand eczema after house dust mite inhalation provocation: a double-blind, placebo-controlled, cross-over study.
abstract: BACKGROUND
  It is unclear whether the respiratory tract is involved in eliciting or aggravating eczematous lesions in patients with vesicular hand eczema. Objectives. To investigate the effect of inhalation of house dust mite (HDM) on vesicular hand eczema.
  
  
  METHODS
  Eighteen patients with vesicular hand eczema and HDM allergy received inhalation challenges with four concentrations of HDM in a randomized, double-blind, 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Dermatology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands. m.l.a.schuttelaar@umcg.nl
authors.forename: Marie Louise A
authors.initials: ML
authors.lastname: Schuttelaar
authors.forename: Pieter Jan
authors.initials: PJ
authors.lastname: Coenraads
authors.forename: Janneke
authors.initials: J
authors.lastname: Huizinga
authors.forename: Jan G
authors.initials: JG
authors.lastname: De Monchy
authors.forename: Karin M
authors.initials: KM
authors.lastname: Vermeulen
mesh_terms: D000328:Adult; D000485:Allergens / Q000009:adverse effects*; D000818:Animals; D039741:Antigens, Dermatophagoides / Q000009:adverse effects*; D001985:Bronchial Provocation Tests; D018592:Cross-Over Studies; D040002:Dermatophagoides pteronyssinus; D004311:Double-Blind Method; D004391:Dust; D011146:Eczema, Dyshidrotic / Q000209:etiology* / Q000473:pathology; D004804:Eosinophils; D005260:Female; D005541:Forced Expiratory Volume; D006229:Hand Dermatoses / Q000209:etiology* / Q000473:pathology; D006801:Humans; D006967:Hypersensitivity / Q000209:etiology*; D007073:Immunoglobulin E; D019570:Inhalation Exposure / Q000009:adverse effects; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D012720:Severity of Illness Index; D055815:Young Adult
chemical_list: D000485:Allergens; D039741:Antigens, Dermatophagoides; D004391:Dust; D007073:Immunoglobulin E