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On Allergic Contact Dermatitis to Virginiamycin

On Allergic Contact Dermatitis to Virginiamycin Short Communication • Kurze Mitteilung Brève communication Dermatológica 146: 320-322 (1973) On Allergie Contact Dermatitis to Virginiamycin J. M. Lachapelle and F. Lamy Unit for Occupational Dermatoses, Louvain University, Louvain Abstract. Allergic contact dermatitis to virginiamycin is a com­ Key Words mon problem among users. In contrast, a detailed inquiry has re­ Virginiamycin vealed no case among employees of the virginiamycin producing Pristinamycin factory. A maximization test with virginiamycin has been performed Allergy on 20 volunteers and its results are discussed. Contact dermatitis Maximization test Bleumink and N ater [1] reported in this Journal a case of allergic contact dermatitis to virginiamycin; in a note added in proof, they claimed to have encountered more recently a second case. By patch-testing the two patients, they noticed that both of them had a positive reaction to factor M of vir­ giniamycin (Staphylomycin®), but did not react to factor S. We would like to comment our own observations by the light of their communication. I. Allergic Contact Dermatitis among Users Allergic contact dermatitis to virginiamycin is a common problem in Belgium, where this antibiotic is frequently prescribed as a topical drug, either alone, or in association with other antibiotics, such as polymyxin B or neomycin sulphate. L a c h a p e ll e/ L a m y In 1972, one of us (J. M. L.) has collected five patients who had a positive patch test reaction to virginiamycin (5% in petrolatum). The tests were performed according to the recommendations of the International Contact Dermatitis Research G roup [3], and read at the 48th hour. The five patients reacted positively to factor M (5% in petrolatum), but did not react to factor S (5% in petrolatum). All of them had a positive cross-reaction to pristina- mycin (5% in petrolatum); in addition, two of the patients were sensitized to neomycin sulphate (20% in petrolatum). II. The M axim ization Test (after Kligman) Applied to Virginiamycin In order to substantiate to which degree virginiamycin has allergenic potentialities, we have used the maximization test in man, after K ligman [2], 20 adult volunteers of both sexes were chosen for this experiment. They were first tested to virginiamycin, pristinamycin and factors M and S of virginia­ mycin (each at a concentration of 5% in petrolatum), for screening a possible previous sensitization. None was found to have a positive reaction. The maximization test was then performed as follows: an area of skin of the volar aspect of the forearm was pretreated with a 5-percent aqueous sodium laurylsulphate solution for 24 h; virginiamycin (at a concentration of 25% in petrolatum) was then applied on the same site for 48 h in an occlusive patch; three subsequent applications of the antibiotic were made, each for 48 h. Two weeks after the last application, the volunteers were retested with virginiamycin, pristinamycin, and factors M and S of virginiamycin (5% in petrolatum). 19 of them showed no positive reactions (read at 48 h). But one patient strongly reacted: virginiamycin + + + ; pristinamycin + + + ; fac­ tor M virg. + + + ; factor S virg. + + ). It is the first time that a sensitization to factor S is reported; this is most probably a cosensitization between a more potent allergenic substance (factor M) and a less potent one (factor S), possibly elicited by the simul­ taneous presence of both substances at a higher concentration than usually used. It has to be emphasized that two months later, virginiamycin was given orally to this sensitized patient (despite our strong recommendations to avoid the drug). The patient developed a quite severe allergic eruption. This illustrates the real danger of submitting potential users of a drug to a maxi­ mization test with this drug. 322 L a o h a p e lle/ L a m y III. Allergic Contact Dermatitis among Employees in the Virginiamycin Producing Factory We have had the opportunity o f making inquiries about skin eruptions among employees in the pharmaceutical factory producing virginiamycin (RIT Genval, Belgium). Eleven people among about 100, who professionally came into contact with virginiamycin, were (or had been) affected by a skin disease possibly due to a contact sensitization. They were tested with virginia­ mycin and pristinamycin; none o f them was found positive to these anti­ biotics. Further investigations showed in three of them a positive reaction to other chemicals, that were possibly responsible for the dermatitis. This absence of contact dermatitis to virginiamycin among these workers is eventually related to the fact that the antibiotic is produced in an almost completely closed system. References 1 Bleumink, E. and N ater, J. P. : Allergic contact dermatitis to virginiamycin. Dermato­ lógica, Basel 144: 253-256(1972). 2 K ligman, A. M.: The identification of contact allergens by human assay. III. The maximization test. A procedure for screening and rating contact sensitizers. J. invest. Derm. 47: 393-409 (1966). 3 W ilkinson, D. S., et at.: Terminology of contact dermatitis. Acta derm.-vener. SO: 287-292 (1970). Request reprints from: J. M. L achapelle, MD, Unit for Occupational Dermatoses, Louvain University, 4, avenue Chapelle aux Champs, B-1200 Brussels (Belgium) http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Dermatology Karger

On Allergic Contact Dermatitis to Virginiamycin

Lachapelle, J.M.; Lamy, F.
Dermatology , Volume 146 (5): 3 – Jan 1, 1973
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Publisher
Karger
Copyright
© 1973 S. Karger AG, Basel
ISSN
1018-8665
eISSN
1421-9832
DOI
10.1159/000251984
Publisher site
See Article on Publisher Site

Abstract

Short Communication • Kurze Mitteilung Brève communication Dermatológica 146: 320-322 (1973) On Allergie Contact Dermatitis to Virginiamycin J. M. Lachapelle and F. Lamy Unit for Occupational Dermatoses, Louvain University, Louvain Abstract. Allergic contact dermatitis to virginiamycin is a com­ Key Words mon problem among users. In contrast, a detailed inquiry has re­ Virginiamycin vealed no case among employees of the virginiamycin producing Pristinamycin factory. A maximization test with virginiamycin has been performed Allergy on 20 volunteers and its results are discussed. Contact dermatitis Maximization test Bleumink and N ater [1] reported in this Journal a case of allergic contact dermatitis to virginiamycin; in a note added in proof, they claimed to have encountered more recently a second case. By patch-testing the two patients, they noticed that both of them had a positive reaction to factor M of vir­ giniamycin (Staphylomycin®), but did not react to factor S. We would like to comment our own observations by the light of their communication. I. Allergic Contact Dermatitis among Users Allergic contact dermatitis to virginiamycin is a common problem in Belgium, where this antibiotic is frequently prescribed as a topical drug, either alone, or in association with other antibiotics, such as polymyxin B or neomycin sulphate. L a c h a p e ll e/ L a m y In 1972, one of us (J. M. L.) has collected five patients who had a positive patch test reaction to virginiamycin (5% in petrolatum). The tests were performed according to the recommendations of the International Contact Dermatitis Research G roup [3], and read at the 48th hour. The five patients reacted positively to factor M (5% in petrolatum), but did not react to factor S (5% in petrolatum). All of them had a positive cross-reaction to pristina- mycin (5% in petrolatum); in addition, two of the patients were sensitized to neomycin sulphate (20% in petrolatum). II. The M axim ization Test (after Kligman) Applied to Virginiamycin In order to substantiate to which degree virginiamycin has allergenic potentialities, we have used the maximization test in man, after K ligman [2], 20 adult volunteers of both sexes were chosen for this experiment. They were first tested to virginiamycin, pristinamycin and factors M and S of virginia­ mycin (each at a concentration of 5% in petrolatum), for screening a possible previous sensitization. None was found to have a positive reaction. The maximization test was then performed as follows: an area of skin of the volar aspect of the forearm was pretreated with a 5-percent aqueous sodium laurylsulphate solution for 24 h; virginiamycin (at a concentration of 25% in petrolatum) was then applied on the same site for 48 h in an occlusive patch; three subsequent applications of the antibiotic were made, each for 48 h. Two weeks after the last application, the volunteers were retested with virginiamycin, pristinamycin, and factors M and S of virginiamycin (5% in petrolatum). 19 of them showed no positive reactions (read at 48 h). But one patient strongly reacted: virginiamycin + + + ; pristinamycin + + + ; fac­ tor M virg. + + + ; factor S virg. + + ). It is the first time that a sensitization to factor S is reported; this is most probably a cosensitization between a more potent allergenic substance (factor M) and a less potent one (factor S), possibly elicited by the simul­ taneous presence of both substances at a higher concentration than usually used. It has to be emphasized that two months later, virginiamycin was given orally to this sensitized patient (despite our strong recommendations to avoid the drug). The patient developed a quite severe allergic eruption. This illustrates the real danger of submitting potential users of a drug to a maxi­ mization test with this drug. 322 L a o h a p e lle/ L a m y III. Allergic Contact Dermatitis among Employees in the Virginiamycin Producing Factory We have had the opportunity o f making inquiries about skin eruptions among employees in the pharmaceutical factory producing virginiamycin (RIT Genval, Belgium). Eleven people among about 100, who professionally came into contact with virginiamycin, were (or had been) affected by a skin disease possibly due to a contact sensitization. They were tested with virginia­ mycin and pristinamycin; none o f them was found positive to these anti­ biotics. Further investigations showed in three of them a positive reaction to other chemicals, that were possibly responsible for the dermatitis. This absence of contact dermatitis to virginiamycin among these workers is eventually related to the fact that the antibiotic is produced in an almost completely closed system. References 1 Bleumink, E. and N ater, J. P. : Allergic contact dermatitis to virginiamycin. Dermato­ lógica, Basel 144: 253-256(1972). 2 K ligman, A. M.: The identification of contact allergens by human assay. III. The maximization test. A procedure for screening and rating contact sensitizers. J. invest. Derm. 47: 393-409 (1966). 3 W ilkinson, D. S., et at.: Terminology of contact dermatitis. Acta derm.-vener. SO: 287-292 (1970). Request reprints from: J. M. L achapelle, MD, Unit for Occupational Dermatoses, Louvain University, 4, avenue Chapelle aux Champs, B-1200 Brussels (Belgium)

Journal

Dermatology – Karger

Published: Jan 1, 1973

Keywords: Virginiamycin; Pristinamycin; Allergy; Contact dermatitis; Maximization test

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