LETTERS TO THE EDITOR 55

To the Editor:

Dr. Lasse Kanerva suggests that our patients who were allergic to ethyl alpha cyanoacrylate (EACA) were cosensitized rather than cross-reacting to other acrylates. The patients we reported had been sensitized to either nail cosmetics or to anaerobic sealants. In the United States, EACA is usually used to apply silk nails or to apply nylon tips to fingernails. As a result, it is often used as a nail cosmetic but in a different sort of process than are the “sculptured nails,” which are made out of the acrylate analogs discussed by Dr. Kanerva. As a result, it is helpful for patients to know if they are allergic to EACA so that they can choose a different nail cosmetic.

Our EACA was tested full strength, and in fact it was tested as a “Super Glue@” sort of commercially available EACA. Because these commercial glues almost always contain some hydroquinone to prevent polymerization in the tube, hydroquinone was also tested as a control. Perhaps the fact that we tested EACA at a higher concentration provided more positive reactions than Dr. Kanerva got at 2% EACA in petrolatum.

FACA reactions had the same morphology as our other allergic reactions. We were careful to allow the glue to very nearly dry before it was applied to our patients’ backs to avoid any irritancy. Many controls were run, and we arc confident that we were not seeing irritant reactions. No patients reacted to hydroquinone.

As are the other acrylates that cross-react, EACA is an acrylate that has an “ethyl alpha side group” (See Table 1 in our paper).’ Methylmethacrylate, for example, does not contain this side group and was a rare reactor in our series.

Because of our theory, we were not surprised to see cross-reactivity between EACA and other related acrylates. Perhaps Dr Kanerva and his group might try testing their patients at a higher concentration of BACA.

Frances J. Stem, MD Professor ofDermatology

Sandhya V. Koppula, MD Assistant Pro&or of Dermatology

Jack H. Fellman, MD Professor of Biochemistry

REFERENCES

I. Koppula SV, Fellman JH, Storrs FJ: Screening akrgens for acrylate drrmatitis asscciatd Gth artificial nails. AmJ Contact Dermatitis 6:78-85, 199.5

To the Editor:

Those of us treating allergic problems should be looking for effective primary desensitization with specific allergens. New double-blind placebo-controlled studies have proved sublingual immunotherapy works for dust mites and several pollens.1-4

The sublingual methods are particularly suited for treatment of contact dermatitis from difficult to avoid antigens such as nickel. Nickel is a very common cause of contact dermatitis and hand eczema. More than 10% of women in Europe have nickel allergy.”

Thirty-nine patients with positive history and positive intradermal testing with or without patch tests were given careful doses of nickel sulfate three times daily as part of their overall allergy treatment. Treatment lasted at least 3 months. Eighty-five percent were improved (Table l), and none were made worse.

It is time for dermatologists to take a more serious look at oral desensitization.

Dauid L. Morris, MD, AL&II Allqy Associates of La Crosse, Ltd

La Crosse, WI