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PubMed1982

0.1% triamcinolone acetonide ointment and patch test responses.

The effect of topical steroids on patch test responsiveness was investigated in 15 subjects. A 0.1% triamcinolone acetonide ointment and a control preparation were applied three times daily to opposing sites on the upper part of the inner arms prior to patch testing. From a total of 18 pairs of patch tests applied to the 15 patients, substantial differences in the paired reactions were seen in only three patients after 96 hours. Of these, two had the more intense reaction on the control side, and the third had a greater reaction on the triamcinolone-pretreated side. Previously applied, intermediate-strength topical steroids are unlikely to prevent the detection of contact allergy by patch testing.

Dermatitis, Contact↗
PubMed1999

The benefit of patch testing with a corticosteroid at a low concentration.

BACKGROUND: Patch testing with corticosteroid marker molecules is advocated because testing with all available corticosteroids is impossible in clinical practice. Most commonly used are budesonide, tixocortol pivalate, and hydrocortisone-17-butyrate. We have been patch testing not only with the three markers, but also with two corticosteroid mixes, each consisting of different concentrations of the three markers. OBJECTIVE: We describe a patient allergic to tixocortol pivalate, who was diagnosed by using a lower patch test concentration that recommended, 0.1% in petrolatum, as well as a weak corticosteroid mix, 0.202%. METHODS: The patient was patch tested to a standard series, including the two corticosteroid mixes and its three constituents. RESULTS: None of the corticosteroid preparations were positive on the first ordinary reading day, day 3, whereas both tixocortol pivalate at 0.1% and the corticosteriod mix at 0.202% were positive on the second ordinary reading day, day 7, whereas all tested corticosteroids in the standard series gave positive reactions on d10. CONCLUSION: The possible benefit of patch testing with a corticosteroid at a low concentration is supported, as is the significance of late readings beyond D4.

Administration, Topical↗
PubMed2003

An audit of the value of patch testing and its effect on quality of life.

We have assessed the value of patch testing from the patient's perspective and examined the impact of patch testing on their quality of life (QoL). 140 patients were recruited over 5 months. 2 questionnaires were designed to investigate the patient's views on patch testing. The 1st questionnaire was completed at the final visit to the clinic and the 2nd was posted 6 weeks later. The Dermatology Life Quality Index (DLQI) questionnaire was completed on both occasions. There was a significant improvement of the DLQI score in all patch-tested subjects (P = 0.003). Patients with involvement of the trunk had worse QoL. At the 4-day visit, 77 patients (55%) expressed the opinion that patch testing had been helpful. 6 weeks later, 71 patients replied. 47 patients were diagnosed as having allergic contact dermatitis: 87% of them found that patch testing had been useful, 91% were able to avoid the allergen(s) and 57% reported improvement/clearing in their skin condition. 58% of the 24 patients with negative results also found that patch testing had been beneficial. Overall, patient perception was that they understood verbal information (92%) better than written information (76%). Patch testing is beneficial to patients, leading to improved QoL. Patient perception was that they understood verbal advice better than written information.

Dermatitis, Allergic Contact↗
PubMed2002

Prevalence of patch testing and methodology of dermatologists in the US: results of a cross-sectional survey.

BACKGROUND: Patch testing is considered to be the standard for diagnosis of delayed-type hypersensitivity reactions of the skin (allergic contact dermatitis). OBJECTIVE: The objective of this study was to examine the prevalence of patch testing by US dermatologists and associated practice characteristics. METHODS: One-third of US Fellows of the American Academy of Dermatology were sampled systematically with a written survey. Responses from this survey were compared with responses from a 1990 survey of dermatologists. RESULTS: Eighty-three percent of responding dermatologists stated that they performed patch testing in their practice. Whereas the majority of patch testing dermatologists (52%) used a 48-hour, 96-hour patch test reading schedule, 26% performed a single reading at 48 or 72 hours. Among patch testing dermatologists, most (74%) used TRUE Test, and many (44%) did so because it was less time consuming for staff. Many dermatologists (46%) felt that they were patch testing more patients now than when TRUE Test was not available. Eleven percent of dermatologists who patch tested also photopatch tested. CONCLUSIONS: The proportion of US dermatologists who patch test has significantly increased from 1990 to 1997 (P <.0001). Whereas the majority of US dermatologists patch test, one quarter of those who do so perform only a single reading.

Cross-Sectional Studies↗
PubMed1987

Quantification of skin blood flow at patch test sites.

Irritancy caused by the patch test procedure itself can be evaluated by measuring the skin blood flow with a laser Doppler flowmeter before application of the patches and at intervals after their removal. To investigate this technique further, van der Bend and True test patches with and without nickel sulfate were applied to the skin of the back and to the volar forearm in healthy subjects. Immediately after removal of the patches, the blood flow values in 26 of 32 test sites were higher than the corresponding pre-application values. In the majority of cases, blood flow had returned to pre-application values at 72 h (24 h after removal). This favours these patches compared to those used in previous studies (A1-test, Finn chambers, Silver patches), which caused a more lasting effect on skin blood flow. The common practice of relying mainly on the 72 h and 96 h readings of patch test sites was thus justified.

Blood Flow Velocity↗
PubMed1977

Multiple concomitant positive patch test reactions.

Thirty-five patients who showed 90 one plus (+) patch test reactions to 28 patch test chemicals at Day 2 (D2) were retested to the chemicals at D7. On retesting, 60% (54/90) reactions were positive but 42% (38/90) were negative at D9, suggesting that false positive patch test reactions were common when more than one positive reaction was obtained by concomitant patch testing. On retesting, the total % positivity was reduced from 344 to 241 suggesting that the true index of sensitivity was falsely exaggerated by concomitant testing.

Aged↗
PubMed1991

Patch testing with amalgam at various concentrations.

27 patients with positive D3 reactions on patch testing to 3 mercury screening allergens were patch tested with 13 mercury patch test preparations, 6 inorganic and 7 organic, and amalgam 20% pet. The 13 patients (all women) showing positive reactions to 20% amalgam were then patch tested to reducing concentrations. 2 patients reacted down to 1%, 4 down to 2%, 4 down to 5%, 2 down to 10% and 1 only to 20%, a total of 10 of the 13 patients therefore reacting to the 5% concentration of amalgam. The appropriate patch test concentration of amalgam is discussed and the clinical significance and female preponderance of amalgam reactivity suggested as being worthy of further investigation.

Adolescent↗
PubMed2006

Retrospective evaluation of the consequence of alleged patch test sensitization.

The risk of actively sensitizing a patient in connection with diagnostic patch tests exists. This risk, however, is extremely low, especially from standard allergens, and if the test is carried out according to internationally accepted guidelines. This retrospective study investigates the clinical consequences in cases of possible patch test sensitization. Among 7619 consecutively tested eczema patients in a 14-year period 26 (0.3%) were identified in the database as having had a late patch test reaction, which may be an indication of patch test sensitization. 9 of these cases were not suitable or available for the follow-up investigation and 3 patients were not traceable. Among the 14 remaining patients 1 had a reaction to gold sodium thiosulphate, which was assessed to be a persistent reaction and not a late reaction, and in 2 patients a clear relevance for the late reacting allergen was found. For the remaining 11 patients we could not rule out that they were patch test sensitized, and they were investigated further. 1 was diseased and 10 were interviewed regarding the possible consequences of the alleged patch test sensitization. 9 had not experienced any dermatitis problems, and 1 could not exclude the possibility that the alleged patch test sensitization had aggravated her dermatitis problems, although we find it unlikely based on the full clinical history. Even though the patient material is small and the limitations inherent in such a retrospective study, the results and the literature indicate that development of clinical contact dermatitis following patch test sensitization is very rare.

Dermatitis, Allergic Contact↗
PubMed1992

Failure of routine patch test results to detect eyelid dermatitis.

The results of patch tests in one hundred patients were classified according to the site of clinical involvement. None of the twelve patients with clinical contact dermatitis of the eyelids had a positive patch test reaction when tested with a routine screening patch test tray. More than 50 percent of the patients with contact dermatitis in exposed areas other than the eyelids had one or more positive results of epicutaneous tests. Although we cannot explain why standard patch test reactions are unsatisfactory indicators of eyelid dermatitis, this fact has significant clinical importance.

Adult↗
PubMed2001

Patch testing with 20% Dermatophagoides pteronyssinus/farinae (Chemotechnique) antigen.

BACKGROUND: Patch testing with dust mite antigens might identify mite-sensitive individuals, particularly those with atopic dermatitis who can benefit from avoidance measures. Currently available dust mite allergens have not been well studied. OBJECTIVE: To determine the proper dilution of 20% Dermatophagoides pteronyssinus/farinae mix antigen (Chemotechnique, Malmo, Sweden) for use in closed patch testing. METHODS: Eighteen nonatopic, healthy control subjects were patch-tested to the 20% concentration, yielding 15 (83%) positive reactions, most showing a decrescendo or persistent pattern suggesting an inordinately high number of false positive reactions. Dilutions of 1.25% to 0.1% in white petrolatum were used in patch testing 8 atopic dermatitis and 11 respiratory atopy patients, and 12 nonatopic controls. RESULTS: Positive reaction rates to the 0.25% and 0.1% concentrations, respectively, were 87.5% and 62.5% for atopic dermatitis, 54% and 18% for respiratory atopy, and 33% and 8% for healthy controls. Using Fisher's exact test, the 0.1% dilution was shown to significantly differentiate rates of positivity among the 3 groups, particularly between atopic dermatitis subjects and healthy controls. CONCLUSION: We find that a 0.1% dilution of 20% D. pteronyssinus/farinae mix antigen (Chemotechnique) to be useful in identifying mite-allergic individuals with atopic dermatitis.

Adolescent↗
PubMed1996

Allergic patch test reactions to palladium chloride in schoolchildren.

A study of the prevalence of allergic patch test reactions to palladium chloride compared to nickel sulfate was performed in a group of Finnish schoolchildren. All adolescents 14-18 years of age in a Finnish town with 40,000 inhabitants, who had received orthodontic treatment with metallic appliances at a municipal dental clinic, were included in the study. The selection of patients was based on patient records. A non-treatment control group was randomly selected from the same age groups of the town population. A total of 700 subjects (77% of those invited), 417 (60%) girls and 283 (40%) boys, participated. The majority (91%) of the girls had pierced ears. Orthodontic treatment was equally common (67-70%) in the boys and the girls. The girls had a much higher frequency of allergic patch test reactions to both nickel sulfate and palladium chloride. Of the 700 adolescents tested, 48 (7%) had an allergic patch test reaction to palladium chloride. Of the 417 girls, 44 (11%) were palladium-chloride-positive, whereas only 4 of the 283 boys tested (1%) had an allergic patch test reaction to palladium chloride. 3 patients reacted to palladium chloride only, whereas all other patients with allergic patch test reactions to palladium chloride also had an allergic patch test reaction to nickel sulfate. The results support the concept of cross-reactivity between nickel sulfate and palladium chloride. The clinical significance of the allergic patch test reactions caused by palladium chloride remains unclear.

Adolescent↗
PubMed1996

1- versus 2- and 3-day diagnostic patch testing.

One inconvenience of the routine patch test technique is the 2-day patch wear. Adjusting the routine patch test technique to a shorter allergen exposure would be more comfortable for the patient. Studies define this feasibility; the available data do not permit a definite answer as to the suitability of 1-day application. An idealized protocol suitable for resolving this issue is presented.

Dermatitis, Contact↗
PubMed2004

The "strip" patch test: results of a multicentre study towards a standardization.

BACKGROUND: The "strip" patch test (SPT) is a variant of patch testing which is used for substances with a poor percutaneous penetration. Penetration of the substances is enhanced by repeated applications of adhesive tape prior to their application to the skin. However, no guidelines exist for standardized performance of the SPT. OBJECTIVES: The aim of this multicentre study was to obtain a first practical approach towards a standardized SPT procedure. METHODS: Intact noninflamed skin of the upper back of 83 healthy volunteers was tape-stripped. For sequential strips, a 25-mm diameter 3M Blenderm surgical tape was vertically applied and gently pressed downward using the fingertips for about 2 s. The tape was removed in one quick movement at an angle of 45 degrees in the direction of adherence. Each strip was performed with a new piece of tape on exactly the same skin area. RESULTS. In each subject, we first determined the number of strips (A) until the skin surface started to glisten and calculated the median number of strips (A) in the sample (A=26 strips). We then ascertained the median number of strips (a) in the sample that was necessary to achieve a statistically significant and twofold increase in TEWL (a=11 strips), revealing a "critical" stratum corneum strip depth. The unknown number of strips (a) for each subject was finally calculated from the formula a/A=a/A, i.e. the individual number of strips (A) until the skin surface started to glisten was multiplied by a derived tape-specific correction factor (cf=a/A=11/26=0.4). The increase in percutaneous penetration in strip patch testing by performing "a" strips versus conventional patch testing was shown by scoring of clinical and subjective SLS irritant reactions. CONCLUSIONS: The present multicentre study outlines an experimentally derived approach for a uniform SPT procedure, which does not require the use of complex technical equipment. This first approach now requires validation by a study involving the application of allergens to obtain evidence of enhancement in the sensitivity of patch testing.

Adhesives↗
PubMed1998

An economic evaluation of patch testing in the diagnosis and management of allergic contact dermatitis.

BACKGROUND: A previous retrospective study indicated that patch testing is cost-effective and well accepted by patients. OBJECTIVE: The objective of this observational prospective study was to show the cost-effectiveness of patch testing in patients suspected of allergic contact dermatitis (ACD) and to determine the order in which different severity groups rank in terms of cost-effectiveness. METHODS: This observational study was conducted in 567 patients from 10 investigator sites over a period of 1 year. All patients with a suspicion of contact allergy who exhibited at least moderate disease activity were included in the study and were stratified according to disease severity and whether or not they were patch tested. In each severity category, the cost-effectiveness of patch testing was evaluated. Patients who were ruled out for contact allergy by the first 6 months after admission were excluded. A validated dermatology-specific quality of life instrument was administered to all the patients at entrance into the study and at 6 and 12 months after that. The cost-effectiveness analysis is shown using a decision analysis model. RESULTS: Patch testing was performed on 22% of patients with mild disease, 41% of patients with moderate disease, and 50% of patients with severe disease. As a result of changes made in their lifestyle, 66% in the patch-tested group and 51% in the non-patch-tested group reported 75% or more improvement in disease symptoms after 6 months. Early confirmation of diagnosis helped reduce the prediagnosis costs of treatment, which was mostly based on preliminary diagnosis. The greatest quality of life benefits from patch testing, relative to no patch testing, occurred in subjects with recurrent or chronic ACD. CONCLUSION: Patch testing is most cost-effective and reduces the cost of therapy in patients with severe ACD.

Chronic Disease↗
PubMed2003

A systemic reaction to patch testing for the evaluation of acute generalized exanthematous pustulosis.

BACKGROUND: Patch tests are considered safe but adverse reactions have been reported. OBSERVATIONS: A case of acute generalized exanthematous pustulosis (AGEP) provoked by a patch test with acetaminophen is described. Of special interest are the negative patch test results obtained with the offending drug. The case is discussed against the background of the putative mechanisms of AGEP and the reported systemic reactions to patch testing for AGEP. CONCLUSIONS: To our knowledge, this is the first report in the English-language literature of a generalized AGEP-like reaction caused by patch tests carried out to determine the drug eliciting AGEP.

Acetaminophen↗
PubMed1997

Patch testing in discoid eczema.

We report a retrospective study of patch testing in patients with discoid eczema. 48 patients with persistent or severe discoid eczema were patch tested. The mean age of patients was 45 years and the median duration of symptoms was 6 months. 24 patients (50%) had positive patch tests, and 16 of these (33%) were considered to be clinically relevant. The most common allergens implicated were rubber chemicals, formaldehyde, neomycin, chrome, nickel (5, 2, 2, 2, 2, 2 reactions, respectively). 13 of 16 patients were followed up by telephone in 1996, and 8/13 (61%) stated they had benefited from patch testing. This study suggests allergic contact dermatitis is relatively common in persistent discoid eczema, and allergen avoidance may be of benefit. We recommend patch testing should be considered for all patients with severe or persistent discoid eczema.

Adolescent↗
PubMed1987

PA Patch--a new patch testing device. Preliminary report.

The PA Patch, a new multiple-antigen, predispensed patch testing device, was compared to the Finn Chamber in subjects with previous positive patch tests. After pressing the PA Patch well, the PA Patch performed as well as the Finn Chamber in nine subjects tested.

Equipment Design↗
PubMed1997

Comparison of personal history with patch test results in metal allergy.

In order to compare the validity of patient personal history of contact sensitivity to metal alloys with patch test results, 160 patients with hand eczema were patch tested with a standard series according to the ICDRG after a special questionnaire. In 65%, history and patch test results were identical. Seventy-eight (48.8%) patients thought they would be allergic to metal ions, whereas the patch test revealed a positive result in only 21.3% cases. Positive history but negative test was more frequent in women; in the male group, negative history and positive patch test was the most common finding. Although 82 patients had a negative history, the patch test was positive for contact sensitivity to metal allergens in 12 of them. Both false positive patch tests and false negative histories are possible. Since many factors influence a positive patch test, not only the patient's history but also a synopsis of the anamnesis and patch testing will help to achieve the correct diagnosis of metal contact hypersensitivity.

Dermatitis, Allergic Contact↗