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PubMed2005

Atopy patch test reaction to airborne allergens in the diagnosis of atopic dermatitis.

The aim of the study was to evaluate the possible use of atopy patch test in the diagnosis of atopic dermatitis and to characterize an optimal standardized system for atopy patch test in terms of allergen concentrations and time of allergen exposure. The study included 36 patients with atopic dermatitis and IgE-mediated airborne allergy. Patients presented positive results of skin prick tests and serum antigen specific IgE against house dust mite allergens and/or selected grass pollen allergens. Control groups consisted either of patients with allergic rhinitis (control group 1) or healthy volunteers with no signs or symptoms of atopy (control group 2). Allergologic diagnostic workup consisted of skin prick test, serum antigen specific IgE and total IgE evaluation, atopy patch test with selected airborne allergens of different concentrations (0.1xSPT, 1xSPT and 10xSPT), time of allergen exposure (8, 24 and 48 h), and readings of the results (8, 24, 48 and 72 h). Positive results of atopy patch test with airborne allergens were obtained in 47.2% of atopic dermatitis patients and none of control subjects. Contact reaction itself and the intensity of reaction were demonstrated to correlate with allergen concentration and time of allergen exposure on atopy patch test. The dose and time response analysis showed the optimal concentration of allergens for atopy patch test to be 10xSPT, 500000 SBE/ml, and optimal evaluation time 24 and 48 h of allergen application. There was no correlation between atopy patch test results and mean serum concentrations of total or antigen specific IgE. Atopy patch test results did not correlate with localization of skin lesions, severity and extensiveness of skin inflammation. A significantly higher contact reactivity to airborne allergens was recorded in the group of atopic dermatitis patients with polyvalent allergy in comparison with atopic dermatitis patients allergic to only one aeroallergen. It is concluded that atopy patch test is the only provocation test currently available with clinical relevance for contact IgE-mediated sensitization in atopic dermatitis patients. Using petrolatum as a vehicle, allergen concentration of 500000 SBE/ml and evaluation time of 24 and 48 h of allergen application may lead to improved atopy patch test results.

Adolescent↗
PubMed1992

Skin reactivity to metallic cobalt in patients with a positive patch test to cobalt chloride.

458 consecutive patients were patch tested with a metallic cobalt disc as a supplement to the standard series. 23 patients had a positive reaction to CoCl2 1% pet. Of these, 19 were tested with the cobalt disc. 11 had a positive reaction and 5 a questionable reaction. There were no positive reactions to the cobalt disc in patients with a negative patch test to CoCl2 1% pet. Patch testing with CoCl2 1% pet. diagnoses all patients with allergy to metallic cobalt, but the test method is limited by a high number of irritant and questionable reactions.

Cobalt↗
PubMed2005

Atopy patch test reactions to house dust mites in patients with scabies.

It is well known that the house dust and the scabies mites are related phylogenetically. We therefore performed atopy patch tests with house dust mite antigens (Dermatophagoides pteronyssinus (Dp) and/or Dermatophagoides farinae (Df)) in scabies patients without atopy and healthy controls. We studied 25 men with active scabies and 25 healthy controls. Skin prick tests with standardized house dust mite extract were performed for all patients and controls. An intradermal test procedure was carried out in skin prick test-negative patients, and for controls showing positive atopy patch test to Dp and/or Df. While atopy patch tests were performed directly in all healthy controls, patients with scabies were first treated and on the next day, atopy patch tests were performed. Twenty-two of 25 patients with scabies (88%) had skin prick test and/or intradermal test positivity against house dust mites, whereas 17/25 patients (68%) had atopy patch test positivity against house dust mites (Dp and/or Df). There was no statistically significant difference between skin prick test and/or intradermal test positivity and atopy patch test positivity in a regression analysis (p=0.222). The only statistically significant correlation was between atopy patch test positivity and the extent of scabies involvement (p<0.05). Only few of the healthy controls had positive tests. In this study, we have shown that a positive atopy patch test to house dust mite antigens is not specific for patients with atopic dermatitis, but also occurs in scabies patients without a history of atopic dermatitis.

Adult↗
PubMed2004

Environmental contact factors in eczema and the results of patch testing Chinese patients with a modified European standard series of allergens.

Environmental contact factors in eczema were investigated in China by clinical questionnaire and patch testing patients with a modified European standard series of allergens. 217 consecutive eczema patients were studied. Contact dermatitis (CD) was clinically diagnosed in 30% of the patients. Among the patients patch tested, 46 patients had clinically diagnosed allergic CD (ACD), 20 patients clinically had non-ACD (NACD) (including 16 cases of irritant contact dermatitis, 1 case of phototoxic contact reaction and 3 cases of asteatotic eczema) and 115 patients had clinically suspected ACD. 45 patients (98%) in the ACD group went on to have relevant patch test results. The most common ACD was from metals, fragrance materials, cosmetics and rubber materials. The most common contact allergens identified were nickel, fragrance mix, para-phenylenediamine (PPD), carba mix and thimerosal. No adverse reactions were observed to patch testing, except for pruritus in patch-test-positive patients. The positive rate of patch testing in ACD was much higher than that in NACD (98% versus 15%, P < 0.05, chi(2)-test). 60 (28%) patients had facial dermatitis (FD). Among these, 20 (33%) were confirmed as having ACD. 48 (22%) patients had hand dermatitis (HD). Among these, 7 (15%) were confirmed as having ACD. Fewer patients were confirmed as having ACD in the HD group than in the FD (15% versus 33%, P < 0.05, chi(2)-test). Although the difference was not significant, the total positivity rate in the HD group (55%) was lower than in the other groups. 65 (30%) patients had unclassified endogenous eczema (UEE). The total positive rate of patch testing in the UEE group (56%) was no different from that in the FD or HD groups. However, the relevance of positive patch tests was hard to determine in UEE. These results indicate that CD is common in eczema; relatively more patients with FD have ACD, while other factors, such as irritation, may play more of a role in HD. The total positive rate of patch testing in the UEE group was no different from that in the FD or HD groups, suggesting that patch testing should be stressed in UEE and the relevance of positive patch test results in UEE should be studied further. It is effective and safe to patch eczema patients with a modified European standard series of allergens in China.

Adult↗
PubMed2005

Patch testing with methyldibromo glutaronitrile, a multicentre study within the EECDRG.

Contact allergy to and allergic contact dermatitis from methyldibromo glutaronitrile (MDBGN) have frequently been reported. As there has been no agreement on which MDBGN test preparation to use, a study was initiated to help determine the optimal patch test preparation for MDBGN. 2661 consecutively patch tested patients at 11 test clinics representing 9 European countries participated. Petrolatum preparations with MDBGN at 1.0%, 0.5%, 0.3% and 0.1% were inserted in the standard series. Contact allergy rates were noted in the range 4.4-1.1% following decreasing test concentrations. Reactions not fulfilling all criteria to be classified as allergic reactions could represent either weak allergic or irritant reactions, and such reactions were noted in the range 8.2-0.5% with decreasing concentrations. A significant number of these reactions represented weak allergic reactions, as allergic reactions were obtained to higher patch test concentrations in the same individual. Morphologically irritant reactions were noted only for the highest test concentrations. In summary, the contact allergy rates and frequencies of doubtful and irritant reactions vary with the patch test concentration. The final decision on patch test concentration for MDBGN should not only rely on these factors but also include information on patch test concentrations required to diagnose individual cases with allergic contact dermatitis from MDBGN as well as results of repeated open application tests.

Allergens↗
PubMed2003

Disperse dyes in fabrics of patients patch-test-positive to disperse dyes.

BACKGROUND: Little evidence exists that dyes to which individuals are patch test positive are in those garments that they suspect cause their dermatitis, which makes diagnosis and management of colored-textile allergic contact dermatitis difficult. OBJECTIVE: We determined whether disperse dyes to which a patient suspected of having a colored garment-dye contact allergy were in the garment that the patient suspected to be the cause of his or her skin lesions. METHODS: Each patient was patch-tested with 12 disperse dyes in a commercial patch test series. Disperse dyes in the submitted garment(s) were identified. The dyes to which each patient was patch test positive were compared with the dyes identified in that patient's submitted fabric(s). When a dye appeared in both lists, a correlation was found. RESULTS: Twenty-two of 32 garments received contained disperse dyes. In all, 35 different disperse dyes were identified. Twelve dyes elicited a reaction in at least one patient. Only nine patients were patch test positive to at least one dye identified in the fabric submitted. Dyes appearing in both lists were Blue 106 (8 times), Blue 124 (2 times), Yellow 3 (once), and Red 1 (once). CONCLUSION: Dyes to which a patient was patch test positive were infrequently identified in the fabric suspected to be the cause of the skin lesions, which means that the next step will be to patch-test with fabric swatches and extracts of dye from the submitted garments.

Allergens↗
PubMed1989

The irritancy and allergenicity of 2-n-octyl-4-isothiazolin-3-one (Skane M-8), with recommendations for patch test concentration.

Preparations of 2-n-octyl-4-isothiazolin-3-one (Skane M-8) at 1000 p.p.m. a.i. and 500 p.p.m. a.i. in pet. induced allergy in a cumulative insult human patch test. Challenge patch testing using 250 p.p.m. a.i. Skane M-8 elicited allergy in 6 out of 6 sensitized individuals. Sensitized individuals did not cross react with Kathon biocide, (Kathon CG), a mixture of 5-chloro-2-methyl-4-isothiazolin-3-one and 2-methyl-4-isothiazolin-3-one. All pretrolatum preparations to which Tween 85 was added at 2.5% produced mild irritation in cumulative insult patch tests, but no irritation was observed with Tween 85 at 0.625%. We conclude that Skane M-8, 250 p.p.m. a.i. with Tween 85 0.625% in petrolatum is appropriate for patch testing for Skane M-8 allergy.

Adult↗
PubMed1992

Fc epsilon R11/CD23 receptor distribution in patch test reactions to aeroallergens in atopic dermatitis.

There is increasing evidence that exposure to organic allergens may induce or exacerbate lesional skin in patients with atopic dermatitis. In this study, patients with atopic dermatitis were patch tested to 11 common organic allergens and to control chambers containing 0.4% phenol and 50% glycerin in 0.9% saline. In biopsies from positive patch test reactions, patch test control skin, lesional eczematous and non-lesional skin from atopic individuals, and normal skin from non-atopic volunteers, the presence and distribution of macrophages (RFD7+), dendritic cells (RFD1+), and Langerhans cells, and the expression of the low-affinity receptor for IgE (CD23) were investigated. In patch test reactions and lesional skin samples, inflammatory infiltrates of diffusely distributed macrophages (RFD7+), dendritic cells (RFD1+), T lymphocytes (RFTmix+), and Langerhans cells (CD1+) were seen, the latter being present in both the epidermis and the dermis. The numbers of Langerhans cells were reduced in the epidermis and increased in the dermis in patch test reactions and lesional skin compared to their controls. Double staining revealed a change in the distribution of CD23 antigen. In patch test control and non-lesional biopsies many macrophages and only a few Langerhans cells within the dermal infiltrates expressed this antigen. In patch test reaction and lesional skin samples, however, the proportion of CD23+ dermal Langerhans cells had increased compared to macrophages. Furthermore, in these latter samples an increased proportion of dermal CD1+ cells expressed the dendritic cell (RFD1+) marker. These results show that following antigen challenge there are marked similarities between the phenotype of the cellular infiltrate in patch test reaction and lesional skin biopsies, and also demonstrate a changing distribution of CD23 on antigen-presenting cells.

Adult↗
PubMed1987

Ultrasound for assessment of allergic and irritant patch test reactions.

The oedema formation of patch test reactions was quantified by high-frequency ultrasound measurement of skin thickness. Patch testing with nickel sulphate, nickel chloride and sodium lauryl sulphate 1, 2, 5 and 10% was performed in 12 individuals with known nickel allergy. Oedema was greater in allergic than in irritant reactions similar in strength according to the clinical reading. In allergic reactions, the oedema appeared more transcutaneous, while in irritant reactions, more superficial. For differentiation of the 2 types of reaction, application of substances for a 24-h period with measurements the following day is preferable. For rating of allergic and irritant reactions, 48 h of application is preferable with measurements performed on the day patches are removed.

Adolescent↗
PubMed2000

The purpuric patch test in patients with allergic contact dermatitis from azo dyes.

The histopathological features of the purpuric patch test have been described in individual cases only. We report a series of patients with allergic contact dermatitis, who developed purpuric patch tests at the sites of allergens from the azo dye group. 105 patients were clinically evaluated and tested with the TRUE Test and the textile color & finish series (Chemotechnique Diagnostics) because of suspected clothing dermatitis. Positive results to the latter were found in 31 patients (29.5%). In 9 of these, purpuric patch tests were observed at the sites of the allergens Disperse Blue 124, 106 and 85. 10 biopsies were performed and studied. The histopathological changes of the purpuric patch test included: spongiosis (in 90% of cases), exocytosis (70%), and dilated blood vessels (100%) without signs of vasculitis, surrounded by an inflammatory infiltrate composed mainly of T lymphocytes. Extravasated erythrocytes were seen perivascularly, but also in the interstitium, surrounding the acrosyringium, at the dermoepidermal junction, and in the epidermis. Increased number of mast cells were found in 22.2% of cases. Disperse Blue 124, 106, and 85 are potent allergens that can elicit purpuric patch test reactions. The purpuric patch test in our cases was a manifestation of an allergic reaction, based not only on histopathological changes, but also on evolution and relevance of the patch tests.

Adolescent↗
PubMed2003

Patch-test reaction patterns in patients with a predisposition to atopic dermatitis.

Patients with a predisposition to atopic dermatitis often need to be patch tested in order to detect possible contact sensitization. However, it is unknown whether immunologic or other peculiarities of atopic skin are related to altered patch-test reaction patterns. Our study was aimed at answering this question, because patch-test reaction patterns are of considerable practical importance in the reading and interpretation of patch tests. Therefore, we compared patterns of patch-test reactions in patients with a predisposition to atopic dermatitis and in control patients matched for sex, age, reason for testing and test centre. Patch-test results from 9 centres (2322 patients with a disposition to atopic dermatitis and 2126 matched controls) were evaluated retrospectively. All patients were tested with nickel sulfate, fragrance mix, potassium dichromate, lanolin alcohol, formaldehyde and mercury ammonium chloride. Patch tests applied for 1 day with readings on days 1, 2 and 3 were evaluated in order to cover the early phase of the reactions. Not unexpectedly, we found that, compared to the matched controls, patients with a predisposition to atopic dermatitis tended to have more doubtful and irritant reactions on day 1. As a new observation, it turned out that they had less reactions of crescendo pattern and more strong reactions on day 3. All these differences were slight/insignificant. A higher skin irritability in patients with a predisposition to atopic dermatitis is a likely explanation. In conclusion, standard methods for patch testing can be applied in patients with a predisposition to atopic dermatitis, but minor differences in reaction patterns should be considered.

Adult↗
PubMed2001

Which bioengineering assay is appropriate for irritant patch testing with sodium lauryl sulfate?

For testing with sodium lauryl sulphate (SLS), measurements of transepidermal water loss (TEWL) and cutaneous blood flow with laser Doppler (LD) are considered to be the most reliable methods. The aim of this study was to determine which method of measurement should be preferred when conducting SLS testing under varying conditions. Patch testing with SLS at different concentrations and exposure times was performed. TEWL values were compared with those of LD. TEWL values showed distinct changes at low SLS concentrations and short application periods. By contrast, higher SLS concentrations were necessary to increase LD values. Short application of patches changed TEWL rather than LD values. When evaluating SLS patch testing by bioengineering methods, TEWL measurement appears to be more suitable for a test procedure that provokes mild skin reactions (SLS concentration <1%), whereas LD measurement is more appropriate to evaluate pronounced skin reactions (SLS concentration >or=1%).

Dermatitis, Irritant↗
PubMed1997

Value of patch testing in atopic dermatitis.

BACKGROUND: Because patients with atopic dermatitis are less prone to type IV allergies, there has been controversy regarding the role of patch testing in these patients. OBJECTIVE: The present study was conducted to evaluate the role of patch testing in atopic individuals. METHODS: One-hundred patients with hand eczema were patch tested using the standard patch test battery (HERMAL, Kurt Herrmann, Reinbek, West Germany) and the Finn chamber units. The total immunoglobulin class E (IgE) level was determined and correlated to the results of patch testing. RESULTS: Eighty-seven patients had positive patch test reactions. Among the 87 patients, 39 (44.8%) had atopic dermatitis. The most common allergens yielding positive results were nickel sulfate, 2.5%, (58.6%); potassium dichromate, 0.25% (56.3%); carba mix, 3%, (44.82%); formaldehyde, 1% in H2O, (40.22%); neomycin sulfate, 20%, (33.3%); and balsam of Peru 25%, (17.24%) respectively. Patients with atopic dermatitis were more frequently sensitive to neomycin sulfate than nonatopics. CONCLUSION: Patients with atopic dermatitis should be patch tested when indicated because they also develop contact allergic sensitization to a significant degree. Our observations indicate that patch testing with standard allergens often adds valuable information about contact sensitivity in these patients.

Adult↗
PubMed1992

House dust mite-specific T cells in the skin of subjects with atopic dermatitis: frequency and lymphokine profile in the allergen patch test.

The mechanism underlying positive patch tests with house dust mite-allergen, Dermatophagoides pteronyssinus (Der p), in patients with atopic dermatitis was investigated by isolating T cells from the test sites of two patients. Eighty-five T cell clones (TCC) were established from the epidermis and dermis of lesional skin by the limiting-dilution method with Der p and interleukin (IL)-2. With restimulation assays, 29 of 60 TCCs tested demonstrated specific proliferation; 85% were of the CD3+, CD2+, and CD4+ phenotype. Der p-specific T cells constituted 0.4% to 2.7% of lesional T cells, and they were more frequent in the skin than in the blood of the patients by one order of magnitude. The mitogen-stimulated lymphokine profile of 55 TCCs was assessed; 42% (11/26) of the allergen-specific TCCs secreted IL-4 but almost no interferon-gamma, as described for the Th2 subset of the mouse. Also, six selected TCCs supported IgE secretion by autologous lymphocytes. Only three of 26 allergen-specific, skin-derived TCCs demonstrated a Th1-like lymphokine profile. These results support the specific nature of Der p-induced patch test lesions in patients with atopic dermatitis, and the results demonstrate also that a considerable proportion of lesional T cells are allergen-specific, IL-4-producing T cells that are capable of enhancing IgE production.

Allergens↗
PubMed2003

Scratch-patch and patch testing in drug allergy--an assessment of specificity.

BACKGROUND: Adverse drug reactions occur frequently in daily practice, but the identification of the eliciting drugs is difficult due to a lack of standardized procedures. The aim of this study was to evaluate and compare scratch-patch and patch tests prospectively with frequently used drugs in persons exposed or not exposed to the drug in order to define a nonirritating concentration. MATERIALS AND METHODS: Altogether, 23 different drugs, mainly antibiotics and analgesics, were evaluated. Any contraindications for patch tests were excluded by a questionnaire. Sixty-one healthy individuals were tested. They were divided into two groups: Group 1 consisted of individuals who hadn't been exposed to the drug; Group 2 was comprised of individuals who had been exposed to the drug, without side effects. Each individual was tested with 10-20 scratch-patch and patch tests. The tests were performed on the upper back. Freshly prepared drug solutions were applied, on one side after scarification of the epidermis, on the other side without. Scratch-patch tests were read at 24 and 48 h, patch tests after 48 and 72 h. In addition, we included 73 individuals with a drug allergy to illustrate that the chosen drug concentrations are able to elicit a positive reaction in truly sensitized individuals. RESULTS: A positive reaction in the non-exposed and nonallergic individuals was considered to be an irritant reaction (IR). In Group 1 (non-exposed individuals), 341 scratch-patch tests were performed, with 22 showing a reaction at the first reading, 3 at the second. Of the 341 patch tests performed in this group, 21 reactions were observed at the first reading, and 7 at the second. In Group 2 (exposed individuals), 141 scratch-patch tests were performed, with 5 IR at the first reading and 1 at the second. Of the 138 patch tests performed in this group, 6 individuals showed an IR at the first, 2 at the second reading. The majority of IR were four drugs, namely cefuroxim, acetylsalicylic acid, propyphenazone/drofenin-HCl, and celecoxib. Lowering the concentration did not reduce the unspecified irritant skin reaction, while a change of the solvent (petrolatum instead of PBS) did reduce the IR. CONCLUSIONS: Our data show concentrations of 23 drugs suitable for scratch-patch or patch tests, as they do not elicit IR. Fourteen of these test preparations elicited a positive reaction in truly sensitized individuals, demonstrating that the test preparation is suitable to identify sensitized persons. Scratch-patch tests are an interesting alternative to patch tests, as they do not elicit more IR than patch tests but can be evaluated earlier. Certain drugs solved in PBS are irritant over a wide dosage range and need to be applied in petrolatum.

Adult↗
PubMed1990

Irritant patch testing: penetration of sodium lauryl sulphate into human skin.

To clarify the sources of variation in irritant patch testing, variability in delivery of the test substance from the patch test system was studied. An in vitro model was used to study the penetration of sodium lauryl sulphate (SLS) from a patch test system into the skin. Different formulations of SLS applied to the skin for 24 h were studied (aqueous solution and gels), but irrespective of the vehicle used permeation of SLS into the recipient phase was poor. Results were compared to in vivo patch testing in 12 subjects. Approximately 70% of the applied SLS in aqueous solution was released from the patch test system. Release from gels was poorer. High concordance between the in vivo and the in vitro model was found. No correlation was found between the amount of SLS left in the filter disc and the strength of the clinical reaction in vivo.

Adult↗
PubMed1988

Patch testing with a mixture of 2 phenol-formaldehyde resins.

1310 patients were routinely patch tested with a paratertiary-butylphenol-formaldehyde resin (PTBP-F-R), a resol resin based on phenol and formaldehyde (P-F-R-2), and a mixture of these 2 resins. Approximately 2.5 times more patients with contact allergy to phenol-formaldehyde resins were diagnosed when routinely patch tested with P-F-R-2 in addition to PTBP-F-R. Although patch testing with a mixture of both resins was not as good as patch testing with the 2 resins separately, it was better than testing only with PTBP-F-R, since 1.6 times more patients with contact allergy to phenol-formaldehyde resins were still diagnosed. P-F-R-2 is therefore recommended for routine patch testing, preferably as a separate patch test but otherwise as a mixture with PTBP-F-R.

Dermatitis, Contact↗
PubMed2006

Strong allergic patch test reactions may indicate a general disposition for contact allergy.

BACKGROUND: Patch test patients have two or more positive reactions to unrelated allergens more often than to be expected by chance. This study evaluates synchronous patch test reactions to test the hypothesis that in such cases an allergen-independent disposition for contact sensitization may be involved. METHODS: Data of 87 834 patients tested with a standard patch test series in 42 centers of a Central European Network were retrospectively evaluated. Analyses were done for synchronous positive reactions of graded strength to nickel sulfate, fragrance mix, and to those five allergens that followed in frequency of positive results. All seven allergens selected were not related by chemical structure or exposure. Descriptive univariate and bivariate analyses as well as a polytomous logistic regression analysis were performed. Odds ratios with 95% confidence intervals were calculated. RESULTS: With an increasing strength of a positive reaction to nickel or to fragrance mix the likelihood of further positive reactions to unrelated contact allergens increased significantly, and the mean strength of such additional reactions raised steadily with an increasing strength of a nickel or fragrance reaction. CONCLUSIONS: Our findings support the idea that patients who respond with a strong patch test reaction may have a particular general disposition to acquire contact sensitivity to additional unrelated allergens. They should therefore not only be advised to avoid their known allergen but in addition to minimize exposure other contact allergens.

Adolescent↗