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          "es" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Porcentaje de pacientes con alergia de contacto a la parafenilendiamina en 8 centros espa&#241;oles en la d&#233;cada comprendida entre los a&#241;os 2004 y 2014&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introducci&#243;n</span><p id="par0005" class="elsevierStylePara elsevierViewall">La parafenilendiamina &#40;PPD&#41; es una amina arom&#225;tica que forma parte de los tintes capilares&#44; de los tatuajes temporales de henna y de los tintes del cuero y textiles&#46; La frecuencia de alergia de contacto en los pa&#237;ses europeos oscila entre el 3 y el 5&#37; de los pacientes parcheados con sospecha de eccema de contacto<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">1&#44;2</span></a>&#46; En los Estados Unidos<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">3</span></a> la prevalencia es del 7&#37;&#44; y la frecuencia es menor en los estudios de la poblaci&#243;n general<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">4</span></a>&#46; La PPD no est&#225; incluida en la serie est&#225;ndar de algunos pa&#237;ses centroeuropeos debido al riesgo de sensibilizaci&#243;n activa&#46; Se desconoce la tendencia de la sensibilizaci&#243;n de contacto en nuestro pa&#237;s tras la regulaci&#243;n de su concentraci&#243;n en cosm&#233;ticos en el a&#241;o 2009<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">5</span></a>&#46; El objetivo del trabajo es mostrar la tendencia de la sensibilizaci&#243;n de contacto entre los a&#241;os 2004 y 2014 e investigar los factores de riesgo de los pacientes con alergia de contacto a la PPD&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Material y m&#233;todos</span><p id="par0010" class="elsevierStylePara elsevierViewall">Estudio con dise&#241;o observacional retrospectivo en el que se analiz&#243; a los pacientes con sospecha de alergia de contacto&#44; y que adicionalmente fueron parcheados con la serie est&#225;ndar del GEIDAC &#40;Grupo Espa&#241;ol de Investigaci&#243;n en Dermatitis de Contacto y Alergia Cut&#225;nea&#41;&#44; durante los a&#241;os 2004 a 2014&#44; en 8 Unidades de Contacto de diferentes hospitales terciarios espa&#241;oles con una distribuci&#243;n geogr&#225;fica representativa&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Las pruebas epicut&#225;neas fueron realizadas seg&#250;n las normas de la Sociedad Europea de Dermatitis de Contacto<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">6</span></a> aplicando la serie est&#225;ndar espa&#241;ola&#44; en la que est&#225; incluida la PPD al 1&#37;&#46; En vaselina o 0&#44;073<span class="elsevierStyleHsp" style=""></span>mg&#47;cm<span class="elsevierStyleSup">2</span> en el TRUE-test&#174;&#46; Las respuestas se valoraron de acuerdo con la escala internacional de &#43; &#40;eritema&#44; m&#237;nima p&#225;pula&#41;&#44; &#43;&#43; &#40;p&#225;pula franca&#44; m&#237;nima vesiculaci&#243;n&#41;&#44; &#43;&#43;&#43; &#40;intensa vesiculaci&#243;n&#44; ampolla&#41;&#46; Se consideraron como respuestas positivas las obtenidas a las 48<span class="elsevierStyleHsp" style=""></span>h y 96<span class="elsevierStyleHsp" style=""></span>h &#40;o 120<span class="elsevierStyleHsp" style=""></span>h&#41;&#46; Se consider&#243; la relevancia como profesional o no profesional si la cl&#237;nica del enfermo y la profesi&#243;n estaba relacionada o no con la reacci&#243;n del parche a la PPD&#44; consider&#225;ndola pasada&#44; actual o desconocida dependiendo de la cl&#237;nica y la localizaci&#243;n&#46; La polisensibilizaci&#243;n se defini&#243; como la alergia de contacto a 3 o m&#225;s al&#233;rgenos de contacto incluidos en la serie est&#225;ndar no relacionadas entre s&#237;&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Los datos de cada paciente se introdujeron de forma an&#243;nima e individual en cada centro a trav&#233;s del sistema inform&#225;tico Winalldat&#174; seg&#250;n el procedimiento indicado en una publicaci&#243;n previa<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">7</span></a>&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">El estudio estad&#237;stico se realiz&#243; siguiendo las recomendaciones internacionales del an&#225;lisis de los datos en alergia de contacto<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">8</span></a>&#46; Se realiz&#243; un an&#225;lisis descriptivo de las principales variables sociodemogr&#225;ficas y cl&#237;nicas&#44; la localizaci&#243;n inicial de las lesiones y los diferentes par&#225;metros del &#237;ndice MOAHLFA&#46; Se compararon las diferencias entre los pacientes sensibilizados a la PPD y los que no lo estaban&#44; utilizando la prueba chi-cuadrado&#46; Se calcularon las frecuencias y porcentajes de sensibilizaci&#243;n a la PPD en cada a&#241;o del estudio y se realiz&#243; un an&#225;lisis de tendencia para proporciones usando la prueba chi-cuadrado&#46; Adem&#225;s&#44; se obtuvieron la proporci&#243;n de pacientes con alergia a la PPD seg&#250;n relevancia&#44; intensidad de la alergia y sexo&#46; Se presentaron las estimaciones tambi&#233;n con los intervalos de confianza al 95&#37;&#46; Por &#250;ltimo&#44; se realiz&#243; un an&#225;lisis de regresi&#243;n log&#237;stica para relacionar los factores de riesgo con la alergia de contacto a la PPD&#46; El nivel de significaci&#243;n estad&#237;stica se fij&#243; en un valor de p menor de 0&#44;05&#46; Todos los an&#225;lisis se realizaron con el software estad&#237;stico STATA&#46; El dise&#241;o del trabajo fue aprobado por la Comisi&#243;n de &#201;tica del Hospital Universitario de La Princesa&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Resultados</span><p id="par0030" class="elsevierStylePara elsevierViewall">Se incluyeron 9&#46;341 pacientes que hab&#237;an sido parcheados en los 8 hospitales en los que se realiz&#243; el estudio&#44; de los cuales 386 &#40;4&#44;1&#37;&#44; IC 95&#37; &#91;3&#44;75-4&#44;5&#93;&#41; fueron positivos a la PPD&#44; cuya tendencia empez&#243; a decrecer en los primeros a&#241;os &#40;2004-2007&#41; y a partir de ah&#237; se mantuvo en torno al 4&#37;&#46; Los 2 primeros a&#241;os la prevalencia fue m&#225;s elevada&#44; como se observa en la <a class="elsevierStyleCrossRef" href="#fig0005">figura 1</a>&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">Las caracter&#237;sticas de los pacientes con alergia de contacto a la PPD que se estudiaron seg&#250;n el &#237;ndice MOAHLFA se muestran en la <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#46; El an&#225;lisis de los datos indica que el 25&#44;6&#37; eran varones y un 72&#44;5&#37; de los pacientes eran mayores de 40 a&#241;os &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46; Un 20&#44;7&#37; &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; de los pacientes con alergia de contacto a la PPD ten&#237;an un origen profesional&#46; Las localizaciones iniciales m&#225;s frecuentes eran las manos y el cuero cabelludo&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">El n&#250;mero de pacientes con pruebas epicut&#225;neas positivas a la PPD&#44; con relevancia actual y con relevancia pasada&#47;desconocida durante el per&#237;odo de 2004 a 2014 se representa en la <a class="elsevierStyleCrossRef" href="#fig0010">figura 2</a>&#46; De los 386 pacientes con reacciones positivas&#44; la relevancia cl&#237;nica se conoc&#237;a en 283 pacientes y en 103 no hab&#237;a informaci&#243;n cl&#237;nica&#46; De los 283 pacientes&#44; la mayor&#237;a hab&#237;a estado en contacto con un tinte capilar&#58; en 130 pacientes la relevancia fue actual&#44; en 109 la relevancia fue pasada y en 44 la relevancia fue desconocida&#46; Las profesiones m&#225;s frecuentemente relacionadas con la alergia de contacto fueron la peluquer&#237;a&#44; los trabajadores de la industria de la goma y el pl&#225;stico&#44; la profesi&#243;n de cocina y panader&#237;a y los trabajadores del textil y el cuero&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">En el an&#225;lisis de los factores de riesgo para el desarrollo de una alergia de contacto a la PPD&#44; resultaron estad&#237;sticamente significativos el sexo&#44; la edad por encima de los 40 a&#241;os&#44; la polisensibilizaci&#243;n y la profesi&#243;n&#44; entre las que destacan los trabajadores de la peluquer&#237;a &#40;OR 8&#44;3&#59; IC&#58; 4&#44;7-14&#44;7&#41; y los trabajadores de la goma y el pl&#225;stico &#40;OR 3&#44;7&#59; IC&#58; 0&#44;8-16&#44;9&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discusi&#243;n</span><p id="par0050" class="elsevierStylePara elsevierViewall">En este estudio multic&#233;ntrico en el que se incluy&#243; a todos los pacientes con sospecha de eccema de contacto que acudieron a los servicios de dermatolog&#237;a en 8 hospitales espa&#241;oles entre los a&#241;os 2004 y 2014 la prevalencia de la alergia de contacto a la PPD est&#225; en torno al 4&#37;&#44; sin que se apreciaran diferencias significativas entre los centros&#46; Esta tendencia se ha mantenido constante durante los a&#241;os del estudio&#44; excepto durante los a&#241;os 2004-2005&#44; en los que la prevalencia fue de un 7&#37; aproximadamente&#46; Un sesgo de selecci&#243;n podr&#237;a explicar el aumento de frecuencia en los a&#241;os 2004-2005&#44; ya que en este per&#237;odo los datos proceden de un centro hospitalario&#46; La sensibilizaci&#243;n de contacto a la PPD en los estudios publicados previamente de centros espa&#241;oles es m&#225;s elevada&#44; pero diferentes factores&#44; como el material y m&#233;todo&#44; el per&#237;odo de estudio&#44; el sesgo de selecci&#243;n de los pacientes y la concentraci&#243;n de PPD en los cosm&#233;ticos&#44; han podido condicionar los resultados<a class="elsevierStyleCrossRefs" href="#bib0150"><span class="elsevierStyleSup">9-15</span></a>&#46; Las frecuencias estimadas en la poblaci&#243;n europea son semejantes a las observadas en nuestro pa&#237;s<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">2&#44;16</span></a> y se ha observado que la intensidad de la reacci&#243;n del parche es mayor en pa&#237;ses del &#225;rea mediterr&#225;nea&#44; probablemente por la utilizaci&#243;n de tintes capilares de tonos m&#225;s oscuros<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">1</span></a>&#46; En 2009 se produjo una regulaci&#243;n oficial en la concentraci&#243;n m&#225;xima de PPD permitida en los tintes capilares&#44; pasando esta del 6 al 2&#37;&#44; sin que esta modificaci&#243;n haya tenido repercusi&#243;n alguna en la prevalencia del eccema al&#233;rgico a la PPD&#44; que tambi&#233;n ha sido confirmado en otros estudios<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">5</span></a>&#46; Varios factores pueden estar influyendo en mantener elevada la frecuencia de la sensibilizaci&#243;n de contacto a la PPD&#46; En los usuarios el mantenimiento del h&#225;bito de realizarse tatuajes temporales con henna&#44; habitualmente adulterada con PPD&#44; puede condicionar la sensibilizaci&#243;n de contacto&#46; La concentraci&#243;n m&#225;xima permitida de PPD en los tatuajes de henna no est&#225; regulada<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">17</span></a>&#46; Otro de los motivos est&#225; relacionado con el cambio en el estilo de vida que est&#225; condicionando que cada vez m&#225;s pacientes utilicen cosm&#233;ticos que contienen PPD a una edad m&#225;s temprana<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">4</span></a>&#46; En los profesionales de la peluquer&#237;a&#44; es frecuente no utilizar guantes antes de que aparezca el eccema de contacto y en otros casos la reutilizaci&#243;n habitual de los guantes contaminados con tintes puede favorecer la sensibilizaci&#243;n de contacto&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">El perfil cl&#237;nico de los pacientes estudiados utilizando el &#237;ndice MOAHLFA confirm&#243; que la mayor&#237;a de los pacientes sensibilizados eran mujeres&#44; y con una edad mayor de 40 a&#241;os&#44; lo que coincide con los resultados de estudios anteriores y se explica por la mayor exposici&#243;n a la PPD contenida en el tinte capilar por parte del sexo femenino<a class="elsevierStyleCrossRefs" href="#bib0125"><span class="elsevierStyleSup">4&#44;16</span></a>&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">En este estudio&#44; uno de los factores de riesgo que predispone a la alergia de contacto a la PPD es la profesi&#243;n&#44; especialmente la peluquer&#237;a&#44; en que la fuente m&#225;s importante de inducci&#243;n de la alergia de contacto a la PPD es el contacto con los tintes capilares que contienen PPD&#44; confirmando los hallazgos de estudios previos<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">2&#44;18&#44;19</span></a>&#46; Probablemente el contacto reiterado y prolongado con los tintes capilares explique la alta frecuencia de sensibilizaci&#243;n a la PPD en esta profesi&#243;n<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">20</span></a>&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">La polisensibilizaci&#243;n definida como alergia de contacto a 3 o m&#225;s sustancias qu&#237;micas no relacionadas se asocia tambi&#233;n con la mayor probabilidad de sensibilizaci&#243;n a la PPD&#44; lo que tambi&#233;n ha sido confirmado en otros trabajos<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">21</span></a>&#46; Es probable que estos pacientes contacten de forma concomitante con otras fuentes de al&#233;rgenos de contacto o que tengan una predisposici&#243;n gen&#233;tica a la alergia de contacto&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">El trabajo realizado tiene varias limitaciones comunes a los estudios epidemiol&#243;gicos multic&#233;ntricos&#46; Existen diferencias metodol&#243;gicas en el procedimiento de realizaci&#243;n de la prueba epicut&#225;nea &#40;material&#44; tipo de oclusi&#243;n&#44; concentraci&#243;n y veh&#237;culo de al&#233;rgenos&#41; entre los diferentes centros participantes&#46; La lectura de la prueba epicut&#225;nea y&#44; sobre todo&#44; la valoraci&#243;n de la relevancia es un procedimiento subjetivo sujeto a sesgos por parte de quien lo realiza&#46; Por &#250;ltimo&#44; las frecuencias de sensibilizaci&#243;n obtenidas a partir de pacientes que realizan pruebas epicut&#225;neas no pueden extrapolarse a la poblaci&#243;n general&#44; siendo esperable una sobreestimaci&#243;n en los datos por un sesgo de selecci&#243;n&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Conclusiones</span><p id="par0075" class="elsevierStylePara elsevierViewall">La alergia de contacto a la PPD sigue siendo elevada en nuestro medio&#44; en torno a un 4&#37; en la serie de pacientes parcheados con sospecha de eccema de contacto durante los a&#241;os 2004 a 2014 en varios centros hospitalarios de Espa&#241;a&#46; En este per&#237;odo no se han observado variaciones significativas en la frecuencia de la alergia de contacto a la PPD&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Los factores de riesgo que predisponen a la alergia de contacto a la PPD son el sexo femenino&#44; la edad de m&#225;s de 40 a&#241;os&#44; la profesi&#243;n de peluquer&#237;a y la polisensibilizaci&#243;n&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Conflicto de intereses</span><p id="par0085" class="elsevierStylePara elsevierViewall">Los autores declaran no tener ning&#250;n conflicto de intereses&#46;</p></span></span>"
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            0 => "p-Phenylenediamine"
            1 => "Contact dermatitis"
            2 => "Prevalence"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objetivos</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">El objetivo del trabajo es mostrar la tendencia de la sensibilizaci&#243;n de contacto entre los a&#241;os 2004 y 2014 tras la regulaci&#243;n de su concentraci&#243;n en cosm&#233;ticos en el a&#241;o 2009 e investigar los factores de riesgo de la alergia de contacto a la parafenilendiamina&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Material y m&#233;todos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">El dise&#241;o del estudio fue observacional retrospectivo e incluy&#243; a pacientes con sospecha de alergia de contacto parcheados con la serie est&#225;ndar del Grupo Espa&#241;ol de Investigaci&#243;n en Dermatitis de Contacto y Alergia Cut&#225;nea durante los a&#241;os 2004 a 2014&#44; en 8 hospitales terciarios espa&#241;oles&#46;</p><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">En las pruebas epicut&#225;neas estaba incluida la parafenilendiamina al 1&#37; en vaselina o 0&#44;073<span class="elsevierStyleHsp" style=""></span>mg&#47;cm<span class="elsevierStyleSup">2</span> en el TRUE-test&#174;&#46; El estudio estad&#237;stico se realiz&#243; siguiendo las recomendaciones internacionales del an&#225;lisis de los datos en alergia de contacto&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Resultados</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Un total de 386 &#40;4&#44;1&#37;&#41; pacientes de los 9&#46;341 incluidos fueron positivos a la parafenilendiamina&#44; cuya tendencia empez&#243; a decrecer en los primeros a&#241;os &#40;2004-2007&#41; y a partir de ah&#237; se mantuvo en torno al 4&#37;&#46; Los factores de riesgo para el desarrollo de una alergia de contacto a la parafenilendiamina fueron el sexo&#44; la edad por encima de los 40 a&#241;os&#44; la polisensibilizaci&#243;n y la profesi&#243;n&#44; entre las que destacan los trabajadores de la peluquer&#237;a&#44; los trabajadores de la goma y el pl&#225;stico</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusiones</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">La alergia de contacto a la parafenilendiamina sigue siendo elevada en pacientes con eccema de contacto&#46; Los factores de riesgo que predisponen a la alergia de contacto a la PPD coinciden con los que han sido publicados previamente&#46;</p></span>"
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        "titulo" => "Abstract"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objectives</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">To analyze trends in the prevalence of contact sensitization to p-phenylenediamine between 2004 and 2014&#44; taking into consideration that the concentration of this product in cosmetics was regulated in 2009&#46; To explore risk factors for contact allergy to <span class="elsevierStyleItalic">p</span>-phenylenediamine&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Material and methods</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Retrospective observational study of patients suspected of having contact dermatitis from allergy to <span class="elsevierStyleItalic">p</span>-phenylenediamine during the years between 2004 and 2015 in 8 tertiary level hospitals&#46; The patients underwent patch testing &#40;TRUE-test&#41; with the standard series of the Spanish Research Group on Contact Dermatitis and Skin Allergies&#46; This series included <span class="elsevierStyleItalic">p</span>-phenylenediamine 1&#37;&#46; We followed international recommendations for the statistical analysis of data related to contact allergies&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Results</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Three hundred eighty-six out of 9341 patients &#40;4&#46;1&#37;&#41; had positive reactions to <span class="elsevierStyleItalic">p</span>-phenylenediamine&#46; The prevalence tended to decrease in the early years &#40;2004&#8211;2007&#41; and then leveled off at around 4&#37;&#46; Risk factors for developing contact dermatitis from <span class="elsevierStyleItalic">p</span>-phenylenediamine were sex&#44; age over 40 years&#44; multiple sensitivities&#44; and profession&#44; notably workers in hair salons and those who handle rubber and plastics&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusions</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">The prevalence of <span class="elsevierStyleItalic">p</span>-phenylenediamine allergy remains high among patients with contact eczema&#46; Risk factors for <span class="elsevierStyleItalic">p</span>-phenylenediamine contact allergy are consistent with previous reports&#46;</p></span>"
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">PPD&#43;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">N &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">p&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">0&#44;003<a class="elsevierStyleCrossRef" href="#tblfn0005">&#42;</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">O&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">80 &#40;20&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1162 &#40;13&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;000<a class="elsevierStyleCrossRef" href="#tblfn0005">&#42;</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">A&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1507 &#40;16&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;008<a class="elsevierStyleCrossRef" href="#tblfn0005">&#42;</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">H&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;504&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">L&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1160 &#40;13&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;074&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">F&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">57 &#40;14&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1134 &#40;12&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;225&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">A&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">280 &#40;72&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">8955 &#40;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
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          "es" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">&#205;ndice MOAHLFA &#40;M&#58; sexo masculino&#59; O&#58; ocupacional&#59; A&#58; antecedentes de atopia&#59; H&#58; localizaci&#243;n en las manos&#59; L&#58; localizaci&#243;n en las piernas&#59; F&#58; Localizaci&#243;n en la cara&#59; A&#58; Edad mayor de 40 a&#241;os&#41; de los pacientes sensibilizados y no sensibilizados a la parafenilendiamina &#40;PPD&#41;</p>"
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        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at2"
            "detalle" => "Tabla "
            "rol" => "short"
          ]
        ]
        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
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                  \t\t\t\t" scope="col">PPD&#43;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col">OR&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">IC 95&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">99 &#40;3&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Referencia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Mujer&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">287 &#40;4&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;42&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;13-1&#44;80&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Edad menor de 40 a&#241;os&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">106 &#40;3&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Referencia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Edad mayor de 40 a&#241;os&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">280 &#40;4&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;45&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;15-1&#44;82&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Localizaci&#243;n</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Tronco&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">76 &#40;3&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Referencia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Cabeza&#47;cuello&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">131 &#40;5&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;64&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;23-2&#44;19&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Manos&#47;MMSS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">113 &#40;3&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;85-1&#44;54&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Pies&#47;MMII&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">41 &#40;3&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;04&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;71-1&#44;53&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Localizaci&#243;n desconocida&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9 &#40;3&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;95&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;47-1&#44;92&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Profesi&#243;n</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Oficinistas&#47;profesores&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">21 &#40;2&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Referencia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Peluquer&#237;a&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">34 &#40;20&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#44;7-14&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Trabajadores de la construcci&#243;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1 &#40;0&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;2&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0-1&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Granjeros&#47;agricultores&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">3 &#40;2&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;3-3&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Trabajadores del textil y cuero&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">2 &#40;7&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">2&#44;5&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;6-11&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Pintores&#47;carpinteros&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">2 &#40;3&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&#44;3&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;3-5&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Trabajadores de la goma y pl&#225;stico&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">2 &#40;10&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">3&#44;7&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;8-16&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Amas de casa&#47;limpieza&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">70 &#40;4&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#44;5&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;9-2&#44;4&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Estudiantes&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">26 &#40;3&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#44;2&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;6-2&#44;1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Pensionistas&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">75 &#40;4&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#44;6&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1-2&#44;7&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Sanitarios&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">9 &#40;2&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;8&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;4-1&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Trabajadores del metal&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">5 &#40;3&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#44;1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;4-2&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Cocineros&#44; panaderos&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">8 &#40;8&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">3&#44;1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&#44;4-7&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Polisensibilizaci&#243;n &#40;n&#250;mero de otras reacciones positivas en la serie est&#225;ndar&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">101 &#40;2&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Referencia&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">129 &#40;5&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2&#44;7&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2&#44;1-3&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>2&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">68 &#40;5&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">2&#44;8&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">2&#44;0-3&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>3&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">48 &#40;9&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">4&#44;9&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">3&#44;4-7&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>4 o m&#225;s&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">40 &#40;10&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">5&#44;8&nbsp;\t\t\t\t\t\t\n
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¿Sigue siendo la parafenilendiamina un alérgeno de contacto prevalente en España?
Is p-Phenylenediamine Still a Prevalent Contact Allergen in Spain?
J. Sánchez-Péreza,
Corresponding author
jsanchezperez@aedv.es

Autor para correspondencia.
, M.A. Descalzo-Gallegob, J.F. Silvestrec, V. Fernández-Redondod, J. García-Gavíne, I. Ruiz-Gonzalezf, P. Mercaderg, J.C. Armario-Hitah, I. Garcia-Dovalb, A. Giménez-Arnaui
a Hospital Universitario de La Princesa, Madrid, España
b Unidad de Investigación, Fundación Piel Sana de la AEDV, Madrid, España
c Hospital General Universitario de Alicante, Alicante, España
d Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, España
e Clínica de Vigo, Vigo, España
f Hospital Universitario de León, León, España
g Hospital General Universitario Morales Meseguer, Murcia, España
h Hospital Universitario Puerto Real, Cádiz, España
i Hospital del Mar, Barcelona, España
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          "es" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Porcentaje de pacientes con alergia de contacto a la parafenilendiamina en 8 centros espa&#241;oles en la d&#233;cada comprendida entre los a&#241;os 2004 y 2014&#46;</p>"
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La PPD no est&#225; incluida en la serie est&#225;ndar de algunos pa&#237;ses centroeuropeos debido al riesgo de sensibilizaci&#243;n activa&#46; Se desconoce la tendencia de la sensibilizaci&#243;n de contacto en nuestro pa&#237;s tras la regulaci&#243;n de su concentraci&#243;n en cosm&#233;ticos en el a&#241;o 2009<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">5</span></a>&#46; El objetivo del trabajo es mostrar la tendencia de la sensibilizaci&#243;n de contacto entre los a&#241;os 2004 y 2014 e investigar los factores de riesgo de los pacientes con alergia de contacto a la PPD&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Material y m&#233;todos</span><p id="par0010" class="elsevierStylePara elsevierViewall">Estudio con dise&#241;o observacional retrospectivo en el que se analiz&#243; a los pacientes con sospecha de alergia de contacto&#44; y que adicionalmente fueron parcheados con la serie est&#225;ndar del GEIDAC &#40;Grupo Espa&#241;ol de Investigaci&#243;n en Dermatitis de Contacto y Alergia Cut&#225;nea&#41;&#44; durante los a&#241;os 2004 a 2014&#44; en 8 Unidades de Contacto de diferentes hospitales terciarios espa&#241;oles con una distribuci&#243;n geogr&#225;fica representativa&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Las pruebas epicut&#225;neas fueron realizadas seg&#250;n las normas de la Sociedad Europea de Dermatitis de Contacto<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">6</span></a> aplicando la serie est&#225;ndar espa&#241;ola&#44; en la que est&#225; incluida la PPD al 1&#37;&#46; En vaselina o 0&#44;073<span class="elsevierStyleHsp" style=""></span>mg&#47;cm<span class="elsevierStyleSup">2</span> en el TRUE-test&#174;&#46; Las respuestas se valoraron de acuerdo con la escala internacional de &#43; &#40;eritema&#44; m&#237;nima p&#225;pula&#41;&#44; &#43;&#43; &#40;p&#225;pula franca&#44; m&#237;nima vesiculaci&#243;n&#41;&#44; &#43;&#43;&#43; &#40;intensa vesiculaci&#243;n&#44; ampolla&#41;&#46; Se consideraron como respuestas positivas las obtenidas a las 48<span class="elsevierStyleHsp" style=""></span>h y 96<span class="elsevierStyleHsp" style=""></span>h &#40;o 120<span class="elsevierStyleHsp" style=""></span>h&#41;&#46; Se consider&#243; la relevancia como profesional o no profesional si la cl&#237;nica del enfermo y la profesi&#243;n estaba relacionada o no con la reacci&#243;n del parche a la PPD&#44; consider&#225;ndola pasada&#44; actual o desconocida dependiendo de la cl&#237;nica y la localizaci&#243;n&#46; La polisensibilizaci&#243;n se defini&#243; como la alergia de contacto a 3 o m&#225;s al&#233;rgenos de contacto incluidos en la serie est&#225;ndar no relacionadas entre s&#237;&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Los datos de cada paciente se introdujeron de forma an&#243;nima e individual en cada centro a trav&#233;s del sistema inform&#225;tico Winalldat&#174; seg&#250;n el procedimiento indicado en una publicaci&#243;n previa<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">7</span></a>&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">El estudio estad&#237;stico se realiz&#243; siguiendo las recomendaciones internacionales del an&#225;lisis de los datos en alergia de contacto<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">8</span></a>&#46; Se realiz&#243; un an&#225;lisis descriptivo de las principales variables sociodemogr&#225;ficas y cl&#237;nicas&#44; la localizaci&#243;n inicial de las lesiones y los diferentes par&#225;metros del &#237;ndice MOAHLFA&#46; Se compararon las diferencias entre los pacientes sensibilizados a la PPD y los que no lo estaban&#44; utilizando la prueba chi-cuadrado&#46; Se calcularon las frecuencias y porcentajes de sensibilizaci&#243;n a la PPD en cada a&#241;o del estudio y se realiz&#243; un an&#225;lisis de tendencia para proporciones usando la prueba chi-cuadrado&#46; Adem&#225;s&#44; se obtuvieron la proporci&#243;n de pacientes con alergia a la PPD seg&#250;n relevancia&#44; intensidad de la alergia y sexo&#46; Se presentaron las estimaciones tambi&#233;n con los intervalos de confianza al 95&#37;&#46; Por &#250;ltimo&#44; se realiz&#243; un an&#225;lisis de regresi&#243;n log&#237;stica para relacionar los factores de riesgo con la alergia de contacto a la PPD&#46; El nivel de significaci&#243;n estad&#237;stica se fij&#243; en un valor de p menor de 0&#44;05&#46; Todos los an&#225;lisis se realizaron con el software estad&#237;stico STATA&#46; El dise&#241;o del trabajo fue aprobado por la Comisi&#243;n de &#201;tica del Hospital Universitario de La Princesa&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Resultados</span><p id="par0030" class="elsevierStylePara elsevierViewall">Se incluyeron 9&#46;341 pacientes que hab&#237;an sido parcheados en los 8 hospitales en los que se realiz&#243; el estudio&#44; de los cuales 386 &#40;4&#44;1&#37;&#44; IC 95&#37; &#91;3&#44;75-4&#44;5&#93;&#41; fueron positivos a la PPD&#44; cuya tendencia empez&#243; a decrecer en los primeros a&#241;os &#40;2004-2007&#41; y a partir de ah&#237; se mantuvo en torno al 4&#37;&#46; Los 2 primeros a&#241;os la prevalencia fue m&#225;s elevada&#44; como se observa en la <a class="elsevierStyleCrossRef" href="#fig0005">figura 1</a>&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">Las caracter&#237;sticas de los pacientes con alergia de contacto a la PPD que se estudiaron seg&#250;n el &#237;ndice MOAHLFA se muestran en la <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#46; El an&#225;lisis de los datos indica que el 25&#44;6&#37; eran varones y un 72&#44;5&#37; de los pacientes eran mayores de 40 a&#241;os &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46; Un 20&#44;7&#37; &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; de los pacientes con alergia de contacto a la PPD ten&#237;an un origen profesional&#46; Las localizaciones iniciales m&#225;s frecuentes eran las manos y el cuero cabelludo&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">El n&#250;mero de pacientes con pruebas epicut&#225;neas positivas a la PPD&#44; con relevancia actual y con relevancia pasada&#47;desconocida durante el per&#237;odo de 2004 a 2014 se representa en la <a class="elsevierStyleCrossRef" href="#fig0010">figura 2</a>&#46; De los 386 pacientes con reacciones positivas&#44; la relevancia cl&#237;nica se conoc&#237;a en 283 pacientes y en 103 no hab&#237;a informaci&#243;n cl&#237;nica&#46; De los 283 pacientes&#44; la mayor&#237;a hab&#237;a estado en contacto con un tinte capilar&#58; en 130 pacientes la relevancia fue actual&#44; en 109 la relevancia fue pasada y en 44 la relevancia fue desconocida&#46; Las profesiones m&#225;s frecuentemente relacionadas con la alergia de contacto fueron la peluquer&#237;a&#44; los trabajadores de la industria de la goma y el pl&#225;stico&#44; la profesi&#243;n de cocina y panader&#237;a y los trabajadores del textil y el cuero&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">En el an&#225;lisis de los factores de riesgo para el desarrollo de una alergia de contacto a la PPD&#44; resultaron estad&#237;sticamente significativos el sexo&#44; la edad por encima de los 40 a&#241;os&#44; la polisensibilizaci&#243;n y la profesi&#243;n&#44; entre las que destacan los trabajadores de la peluquer&#237;a &#40;OR 8&#44;3&#59; IC&#58; 4&#44;7-14&#44;7&#41; y los trabajadores de la goma y el pl&#225;stico &#40;OR 3&#44;7&#59; IC&#58; 0&#44;8-16&#44;9&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discusi&#243;n</span><p id="par0050" class="elsevierStylePara elsevierViewall">En este estudio multic&#233;ntrico en el que se incluy&#243; a todos los pacientes con sospecha de eccema de contacto que acudieron a los servicios de dermatolog&#237;a en 8 hospitales espa&#241;oles entre los a&#241;os 2004 y 2014 la prevalencia de la alergia de contacto a la PPD est&#225; en torno al 4&#37;&#44; sin que se apreciaran diferencias significativas entre los centros&#46; Esta tendencia se ha mantenido constante durante los a&#241;os del estudio&#44; excepto durante los a&#241;os 2004-2005&#44; en los que la prevalencia fue de un 7&#37; 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probablemente por la utilizaci&#243;n de tintes capilares de tonos m&#225;s oscuros<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">1</span></a>&#46; En 2009 se produjo una regulaci&#243;n oficial en la concentraci&#243;n m&#225;xima de PPD permitida en los tintes capilares&#44; pasando esta del 6 al 2&#37;&#44; sin que esta modificaci&#243;n haya tenido repercusi&#243;n alguna en la prevalencia del eccema al&#233;rgico a la PPD&#44; que tambi&#233;n ha sido confirmado en otros estudios<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">5</span></a>&#46; Varios factores pueden estar influyendo en mantener elevada la frecuencia de la sensibilizaci&#243;n de contacto a la PPD&#46; En los usuarios el mantenimiento del h&#225;bito de realizarse tatuajes temporales con henna&#44; habitualmente adulterada con PPD&#44; puede condicionar la sensibilizaci&#243;n de contacto&#46; La concentraci&#243;n m&#225;xima permitida de PPD en los tatuajes de henna no est&#225; regulada<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">17</span></a>&#46; Otro de los motivos est&#225; relacionado con el cambio en el estilo de vida que est&#225; condicionando que cada vez m&#225;s pacientes utilicen cosm&#233;ticos que contienen PPD a una edad m&#225;s temprana<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">4</span></a>&#46; En los profesionales de la peluquer&#237;a&#44; es frecuente no utilizar guantes antes de que aparezca el eccema de contacto y en otros casos la reutilizaci&#243;n habitual de los guantes contaminados con tintes puede favorecer la sensibilizaci&#243;n de contacto&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">El perfil cl&#237;nico de los pacientes estudiados utilizando el &#237;ndice MOAHLFA confirm&#243; que la mayor&#237;a de los pacientes sensibilizados eran mujeres&#44; y con una edad mayor de 40 a&#241;os&#44; lo que coincide con los resultados de estudios anteriores y se explica por la mayor exposici&#243;n a la PPD contenida en el tinte capilar por parte del sexo femenino<a class="elsevierStyleCrossRefs" href="#bib0125"><span class="elsevierStyleSup">4&#44;16</span></a>&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">En este estudio&#44; uno de los factores de riesgo que predispone a la alergia de contacto a la PPD es la profesi&#243;n&#44; especialmente la peluquer&#237;a&#44; en que la fuente m&#225;s importante de inducci&#243;n de la alergia de contacto a la PPD es el contacto con los tintes capilares que contienen PPD&#44; confirmando los hallazgos de estudios previos<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">2&#44;18&#44;19</span></a>&#46; Probablemente el contacto reiterado y prolongado con los tintes capilares explique la alta frecuencia de sensibilizaci&#243;n a la PPD en esta profesi&#243;n<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">20</span></a>&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">La polisensibilizaci&#243;n definida como alergia de contacto a 3 o m&#225;s sustancias qu&#237;micas no relacionadas se asocia tambi&#233;n con la mayor probabilidad de sensibilizaci&#243;n a la PPD&#44; lo que tambi&#233;n ha sido confirmado en otros trabajos<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">21</span></a>&#46; Es probable que estos pacientes contacten de forma concomitante con otras fuentes de al&#233;rgenos de contacto o que tengan una predisposici&#243;n gen&#233;tica a la alergia de contacto&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">El trabajo realizado tiene varias limitaciones comunes a los estudios epidemiol&#243;gicos multic&#233;ntricos&#46; Existen diferencias metodol&#243;gicas en el procedimiento de realizaci&#243;n de la prueba epicut&#225;nea &#40;material&#44; tipo de oclusi&#243;n&#44; concentraci&#243;n y veh&#237;culo de al&#233;rgenos&#41; entre los diferentes centros participantes&#46; La lectura de la prueba epicut&#225;nea y&#44; sobre todo&#44; la valoraci&#243;n de la relevancia es un procedimiento subjetivo sujeto a sesgos por parte de quien lo realiza&#46; Por &#250;ltimo&#44; las frecuencias de sensibilizaci&#243;n obtenidas a partir de pacientes que realizan pruebas epicut&#225;neas no pueden extrapolarse a la poblaci&#243;n general&#44; siendo esperable una sobreestimaci&#243;n en los datos por un sesgo de selecci&#243;n&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Conclusiones</span><p id="par0075" class="elsevierStylePara elsevierViewall">La alergia de contacto a la PPD sigue siendo elevada en nuestro medio&#44; en torno a un 4&#37; en la serie de pacientes parcheados con sospecha de eccema de contacto durante los a&#241;os 2004 a 2014 en varios centros hospitalarios de Espa&#241;a&#46; En este per&#237;odo no se han observado variaciones significativas en la frecuencia de la alergia de contacto a la PPD&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Los factores de riesgo que predisponen a la alergia de contacto a la PPD son el sexo femenino&#44; la edad de m&#225;s de 40 a&#241;os&#44; la profesi&#243;n de peluquer&#237;a y la polisensibilizaci&#243;n&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Conflicto de intereses</span><p id="par0085" class="elsevierStylePara elsevierViewall">Los autores declaran no tener ning&#250;n conflicto de intereses&#46;</p></span></span>"
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            1 => "Eccema de contacto"
            2 => "Prevalencia"
            3 => "Multic&#233;ntrico"
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            1 => "Contact dermatitis"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objetivos</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">El objetivo del trabajo es mostrar la tendencia de la sensibilizaci&#243;n de contacto entre los a&#241;os 2004 y 2014 tras la regulaci&#243;n de su concentraci&#243;n en cosm&#233;ticos en el a&#241;o 2009 e investigar los factores de riesgo de la alergia de contacto a la parafenilendiamina&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Material y m&#233;todos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">El dise&#241;o del estudio fue observacional retrospectivo e incluy&#243; a pacientes con sospecha de alergia de contacto parcheados con la serie est&#225;ndar del Grupo Espa&#241;ol de Investigaci&#243;n en Dermatitis de Contacto y Alergia Cut&#225;nea durante los a&#241;os 2004 a 2014&#44; en 8 hospitales terciarios espa&#241;oles&#46;</p><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">En las pruebas epicut&#225;neas estaba incluida la parafenilendiamina al 1&#37; en vaselina o 0&#44;073<span class="elsevierStyleHsp" style=""></span>mg&#47;cm<span class="elsevierStyleSup">2</span> en el TRUE-test&#174;&#46; El estudio estad&#237;stico se realiz&#243; siguiendo las recomendaciones internacionales del an&#225;lisis de los datos en alergia de contacto&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Resultados</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Un total de 386 &#40;4&#44;1&#37;&#41; pacientes de los 9&#46;341 incluidos fueron positivos a la parafenilendiamina&#44; cuya tendencia empez&#243; a decrecer en los primeros a&#241;os &#40;2004-2007&#41; y a partir de ah&#237; se mantuvo en torno al 4&#37;&#46; Los factores de riesgo para el desarrollo de una alergia de contacto a la parafenilendiamina fueron el sexo&#44; la edad por encima de los 40 a&#241;os&#44; la polisensibilizaci&#243;n y la profesi&#243;n&#44; entre las que destacan los trabajadores de la peluquer&#237;a&#44; los trabajadores de la goma y el pl&#225;stico</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusiones</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">La alergia de contacto a la parafenilendiamina sigue siendo elevada en pacientes con eccema de contacto&#46; Los factores de riesgo que predisponen a la alergia de contacto a la PPD coinciden con los que han sido publicados previamente&#46;</p></span>"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objectives</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">To analyze trends in the prevalence of contact sensitization to p-phenylenediamine between 2004 and 2014&#44; taking into consideration that the concentration of this product in cosmetics was regulated in 2009&#46; To explore risk factors for contact allergy to <span class="elsevierStyleItalic">p</span>-phenylenediamine&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Material and methods</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Retrospective observational study of patients suspected of having contact dermatitis from allergy to <span class="elsevierStyleItalic">p</span>-phenylenediamine during the years between 2004 and 2015 in 8 tertiary level hospitals&#46; The patients underwent patch testing &#40;TRUE-test&#41; with the standard series of the Spanish Research Group on Contact Dermatitis and Skin Allergies&#46; This series included <span class="elsevierStyleItalic">p</span>-phenylenediamine 1&#37;&#46; We followed international recommendations for the statistical analysis of data related to contact allergies&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Results</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Three hundred eighty-six out of 9341 patients &#40;4&#46;1&#37;&#41; had positive reactions to <span class="elsevierStyleItalic">p</span>-phenylenediamine&#46; The prevalence tended to decrease in the early years &#40;2004&#8211;2007&#41; and then leveled off at around 4&#37;&#46; Risk factors for developing contact dermatitis from <span class="elsevierStyleItalic">p</span>-phenylenediamine were sex&#44; age over 40 years&#44; multiple sensitivities&#44; and profession&#44; notably workers in hair salons and those who handle rubber and plastics&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusions</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">The prevalence of <span class="elsevierStyleItalic">p</span>-phenylenediamine allergy remains high among patients with contact eczema&#46; Risk factors for <span class="elsevierStyleItalic">p</span>-phenylenediamine contact allergy are consistent with previous reports&#46;</p></span>"
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                  """
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Referencia&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&#44;15-1&#44;82&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#44;64&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Manos&#47;MMSS&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Pies&#47;MMII&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Localizaci&#243;n desconocida&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Profesi&#243;n</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Oficinistas&#47;profesores&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">21 &#40;2&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Referencia&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Peluquer&#237;a&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">34 &#40;20&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Trabajadores de la construcci&#243;n&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1 &#40;0&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0-1&#44;2&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Granjeros&#47;agricultores&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">3 &#40;2&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;3-3&#44;2&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Trabajadores del textil y cuero&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">2 &#40;7&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Pintores&#47;carpinteros&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2 &#40;3&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Trabajadores de la goma y pl&#225;stico&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2 &#40;10&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Amas de casa&#47;limpieza&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">70 &#40;4&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#44;5&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Estudiantes&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">26 &#40;3&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;6-2&#44;1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Pensionistas&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">75 &#40;4&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#44;6&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1-2&#44;7&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Sanitarios&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">9 &#40;2&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;8&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;4-1&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Trabajadores del metal&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">5 &#40;3&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#44;1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;4-2&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Cocineros&#44; panaderos&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">8 &#40;8&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                            2 => "M&#46; Casas-Mar&#237;n"
                            3 => "S&#46; Laviano-Men&#233;ndez"
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                          "etal" => true
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                            2 => "S&#46; Urrutia-Hernando"
                            3 => "C&#46; Soria-Mart&#237;nez"
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Article information
ISSN: 00017310
Original language: Spanish
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