Allergic Contact Dermatitis Clinical Trial
Official title:
Nickel Desensitization Using Topical Therapy
Nickel contact dermatitis (eczema) is one of the most common allergic conditions affecting the skin. This is a study looking at potentially desensitizing nickel-allergic patients to their allergy using anti-inflammatory ointments applied to the skin (arm). Application of these ointments (ie. modified Vitamin D) has been shown to increase specific immune cells (T regulatory cells), which play a role in preventing immune activation and subsequently inflammation. The investigators propose use of topical anti-inflammatory agents (corticosteroids, modified Vitamin D, or both) may desensitize patients with nickel allergy.
1. Purpose: To evaluate whether topical anti-inflammatory ointments (calcipotriol,
betamethasone dipropionate, or a combination of both) can decrease sensitivity to
nickel in known nickel allergic patients. Optional blood samples will be part of the
protocol to measure immune responses.
2. Hypothesis: Use of these topical agents will prevent sensitization to nickel sulfate
upon re-exposure.
3. Justification: Currently, no cure can yet be offered to nickel sensitive patients.
Standard treatment only involves avoiding nickel-containing products. However, this is
not always easily achieved depending on patient awareness and environmental exposures.
Topical desensitization has not yet been explored in patients with pre-established
contact allergy. This research will be placebo-controlled with Vaseline petroleum jelly
to compare reactions to nickel in those treated with anti-inflammatory ointments.
4. Objectives: a) To evaluate the use of topical anti-inflammatory agents and its role in
desensitizing known nickel allergic patients to nickel. b) To measure immune cell
responses to nickel allergen from a blood sample taken before and after topical
anti-inflammatory application.
5. Research Method: Randomized, double-blinded, placebo-controlled, proof of principle
study. Subjects meeting inclusion and exclusion criteria with known nickel sensitivity
will be recruited into the study. Those who consent will undergo 3 sets of nickel patch
testing: At week 1 to confirm nickel allergic status, week 3 to induce tolerance by
patch testing at the site of topical ointment application, and finally at week 5 to
test for desensitization. (Week 2 is self-application with topical ointment; Week 4 is
a rest week).
6. Statistical Analysis: a) Primary end-point: Clinical responses measured by standard
patch testing scores will be documented and photographed for comparison. b) Secondary
end-point: Levels of T regulatory cell responses before and after topical treatment. c)
Planned sample size: 24 patients. Given that this is a proof-of-principle study, the
investigators are choosing to study a small sample size to detect any differences
amongst treatment arms, if any. A larger-scale, adequately-powered study would be
needed to detect any statistical significance.
;
Allocation: Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Single Group Assignment, Masking: Double Blind (Subject, Investigator, Outcomes Assessor), Primary Purpose: Treatment
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