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• Thirteen costus-sensitive patients were patch tested with 38 sesquiterpene lactones of five different classes over a two-year period. Cross-reacting agents fell into two chemical categories: (1) those that resembled the primary sensitizer, and (2) those belonging to different skeletal classes. An exocyclic methylene group conjugated to a γ-lactone was present in both chemicals that cross-reacted and those that did not. The difference between these two groups is that cross-reacting chemicals are not highly substituted, tending to be lipophilic, while those giving negative responses all are highly substituted at the C-8/C-6 position. This functional group may hinder binding of exocyclic methylene with skin protein or the actual antigenic site with an immune receptor cell. ( Arch Dermatol 116:59-60, 1980)

A case of phenytoin-carbamazepine cross-sensitivity is presented. Similar signs and symptoms occurred during administration of both drugs. A common metabolic intermediate is offered as a possible explanation of the mechanism. Clinicians should be careful when choosing alternatives in patients with hypersensitivity reactions to anticonvulsants. Valproic acid may be the safest choice in this setting.

The concentric Mohr circles of modified apparent strain, true strain and stress permit quick visualisation and calculation of true strains and stresses from readings of gauges with known cross-sensitivities.

THE phenyl-derived anticonvulsant drugs described by Putnam and Merritt1 have been in use for over fifteen years. Although they have been found to be of great value in the control of epilepsy, both...

A patient receiving adjuvant chemoimmunotherapy for breast carcinoma developed urticaria secondary to cyclophosphamide, one of the drugs of the chemotherapy regimen. Chlorambucil, another alkylating agent, was substituted with no cross-sensitivity noted. ( Arch Intern Med 138:1725-1726, 1978)

Reports about cross-sensitivity among the various "Mycins" are contradictory. Sidi, Hincky, and Longueville 1,2 were the first to report cross-sensitivity between neomycin and streptomycin, and vice versa. Calnan and Sarkany 3 were not able to confirm this fully, although 2 of their neomycin-sensitive patients also reacted to streptomycin. Pirila and Wallenius 4 and Pirila and Rouhunkoski 5,6 as well as Hjorth 7 reported that a great number of their neomycin-sensitive patients were also sensitive to bacitracin. This, however, is not the experience of others. To clarify these matters we investigated experimentally in guinea pigs sensitization to, and cross-sensitivity between, neomycin, kanamycin, streptomycin, and bacitracin. Materials and Methods We set out to sensitize albino guinea pigs, weighing between 400 and 500 gm., in groups of 10, to neomycin, kanamycin, streptomycin, dihydrostreptomycin, and bacitracin. The animals received 4 weekly injections of 5 mg. of the antibiotic mixed with Freund's adjuvant. This technique

Eyeglass dermatitis limited to the nose occurred in a 58-year-old woman. Patch testing revealed the offending agent to be a common solvent, ethylene glycol monomethyl ether acetate, used to chemically weld the nosepads to the eyeglass frame. The patient also had an unrevealed allergy to ethyl acetate.

Cross sensitivity between fenticlor and bithionol has been shown in seven cases. The positive photopatch test to bithionol depended upon exposure to an increased quantity of sunlight compared to that needed to show positives to multifungin and tribromosalicylanilide. It is postulated that bithionol breaks down to fenticlor on exposure to ultraviolet light. Two cases of allergy to fenticlor are described because of their differing clinical responses. There is evidence that fenticlor can combine with skin protein, that it can be absorbed through skin into the general circulation and, in this way, act in a similar fashion to a drug given internally.

Five patients with mycosis fungoides were treated topically with three nitrosourea compounds, 1-(2-chloroethyl)-1-nitrosourea (NSC 47547), 1-methyl-1-nitrosourea (NSC 23909), and 1,3-bis(2-chloroethyl)-1-nitrosourea (carmustine [NSC 409962, BCNU]), using aqueous and alcoholic solutions of 0.025% to 0.075% (0.25 to 0.75 mg/ml). Clearing of some plaques was achieved with all three compounds, but was most consistently obtained with NSC 47547. Cross sensitivity to mechlorethamine did not occur. This is an early efficacy experimental trial, and more work must be done before it can be recommended for nonexperimental use.

A student developed acute eczematous contact dermatitis in response to the application of tincture of benzoin to the skin under a cast. This was followed within 48 hours by the appearance of generalized noneczematous exanthem. Analysis led to the conclusion that absorption of benzoin through the skin was responsible for both the contact dermatitis and the exanthem. Patch tests demonstrated an eczematous reaction to benzoin, with cross sensitivity extending to the gums of myrrh, locust, galbanum, gamboge, and olibanum.

To the Editor:— Recently I have been impressed with a series of cases in which the presenting complaint was the common problem of metal sensitivity. These patients are for the most part sensitive to nickel, which is alloyed into a large number of metallic products which contact the skin, eg, jewelry, buckles, garters, and snaps. I have been impressed by the considerable number who have a history of active or healed duodenal ulcer (x-ray-proven). Whether this observation is true to the point of being able to withstand controlled study is difficult to say. Since our knowledge of the pathogenesis of duodenal ulcer is incomplete, conjecture regarding something more than a coincidence between the metal sensitivity and the ulceration could be useful and worthy of presentation. Cross sensitivity reactions between contact dermatitis of the skin and the mucosa have been demonstrated, as in acrylic dermatitis due to dentures. Whether this mucosal

Introduction Three case reports of dermatitis from English ivy (Hedera helix) have appeared in the literature, 1-3 but, to my knowledge, dermatitis from Algerian ivy (Hedera canariensis) has never been reported. Recently, however, two patients were seen with moderately severe dermatitis which was traced to contact with juice from stems and leaves of this plant. After the attack of dermatitis both patients proved sensitive to English ivy as well. Since neither patient had ever before been sensitive to English or Algerian ivy it is suspected that a cross sensitivity to English ivy was produced by the intense reactions to Algerian ivy. However, the evidence for a true cross sensitivity was not conclusive. The purpose of this paper is to remind other physicians that both of these ivies—which are among the most widely cultivated of all plants—are capable of producing a severe contact dermatitis in sensitized individuals. Report of