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PubMed1980

Petechial reaction following patch testing with cobalt.

A total of 132 patch tested patients reacted with petechial reactions to cobalt chloride 1% in petrolatum; 23 were retested with various concentrations of cobalt. In about 60% of those retested the petechial reaction could be reproduced. Histopathological examination showed slight perivascular lymphocytic infiltration, swollen endothelium and extravasation of erythrocytes but no signs of vasculitis. It is suggested that in predisposed patients the petechial reaction following patch testing could be the result of primary irritation.

Cobalt↗
PubMed1997

More positive patch test reactions with larger test chambers? Results from a study group of the German Contact Dermatitis Research Group (DKG).

Test chambers of various sizes are commercially available for patch testing. Therefore, we asked the question whether the size of patch test chambers may affect allergic patch test reactions. A total of 495 patients were double tested synchronously with small and large Finn Chambers containing standard preparations of fragrance mix, wool wax alcohols, Kathon CG and formaldehyde. Double tests in 217 patients who had reacted with at least 1 allergic, questionable, or irritant reaction to 1 of these allergens were statistically evaluated. For each of the 4 allergens, a significantly higher number of stronger reactions was seen with the large chambers as compared to the small ones. It is concluded that large test chambers may be useful for detection of weak sensitizations to particular contact allergens.

Adult↗
PubMed1985

False-positive, follicular and irritant patch test reactions to metal salts.

853 hard metal workers were patch tested with nickel sulphate 5%, potassium dichromate 0.5% and cobalt chloride 1%, each in petrolatum. Non-allergic reactions appeared in 6.5% of the nickel tests, 13% of the chromium tests and 18.3% of the cobalt tests. Most of the individuals with positive, poral or pustular reactions were retested with serial dilutions of metal salts in pet. and in water. The accuracy of a positive initial nickel reaction was 83%, a chromium reaction 40% and a cobalt reaction 62%. The nonallergic reactions were partly reproducible and correlated with both the type of patch test material and with individual factors. Weak and moderately strong positive patch test reactions to metal salts may be irritant and should be checked with serial dilution tests or at least be retested. A reduction of the cobalt chloride concentration from 1% to 0.5% in the standard test material is discussed.

Chromates↗
PubMed1992

Results of routine patch testing with corticosteroid series in 2073 patients.

The patch test results of 61 patients allergic to at least 1 corticosteroid molecule are presented. These contact allergies were detected by testing with several corticosteroids included in our standard patch test series between February 1988 and December 1990. Whenever possible, further investigations were conducted by means of a more complete corticosteroid series. We found corticosteroids to be the 7th most frequent allergen, positive results being obtained in 2.9% of all patients referred to our contact dermatitis unit. In this series, budesonide was the most common allergen and often gave simultaneous reactions with other corticosteroids.

Administration, Topical↗
PubMed2001

Relevance and reproducibility of patch-test reactions to corticosteroids.

We present our patch test findings with dermatocorticosteroids during the period 1995-1999. We retrospectively studied the % of doubtful and positive reactions to each allergen in our corticosteroid series and assessed the relevance of these reactions. To assess reproducibility, we retested 15 patients with doubtful or positive reactions in 1999. The % of + or ++ reactions on D2-D3 and D7 ranged from 0.0% to 0.9% for most of the compounds tested. Hydrocortisone acetate 1% alc.abs./DMSO 50/50 showed a much higher % of positive reactions. Most of these reactions were not relevant and therefore probably due to the irritant nature of the vehicle. An overall reproducibility of 47.2% was obtained. 100.0% of the non-reproducible patch test reactions were not relevant. Definite relevance was much higher in the reproducible + or ++ reactions than in the reproducible doubtful reactions: 100.0% and 18.2%, respectively. We conclude that the mean % of + and ++ reactions to the corticosteroid series on D2-D3 is 0.5%, with an overall reproducibility of 47.2%. Tixocortol pivalate and budesonide proved to be important markers for dermatocorticosteroid allergy.

Administration, Topical↗
PubMedDate not supplied

The 'atopy patch test' in evaluating the role of aeroallergens in atopic eczema.

The atopy patch test (APT) is a procedure involving epicutaneous patch tests with allergens known to elicit IgE-mediated reactions and the evaluation of eczematous skin lesions. APT can be performed on normal uninvolved skin without artificial manipulations such as tape stripping or use of irritants. APT has been standardized regarding the use of vehicle and dose response relationships. In several studies, approximately two thirds of patients with atopic eczema (AE) showed positive APT reactions to aeroallergens, most frequently to house dust mite. Positive APT reactions were significantly more frequent in patients with a typical air-exposed eczematous distribution pattern. Using evaporimetry to study transepidermal water loss, allergen-induced disturbance of epidermal barrier functions was found to be significantly more pronounced on APT reactions compared to classical contact allergy patch test sites in the same individual. It has been shown that with APT eczematous skin lesions can be elicited by skin contact with aeroallergens, at least in a subgroup of patients with AE, and thereby, that IgE-mediated allergy does play a role in the etiopathophysiology of this disease. Future studies should help to bring this test into clinical routine in order to establish an equivalent for 'skin provocation' comparable to nasal and bronchial provocation tests in respiratory allergy.

Allergens↗
PubMed1997

Impact of patch testing on dermatology-specific quality of life in patients with allergic contact dermatitis.

BACKGROUND: A dermatology-specific quality-of-life instrument has been created and validated for its sensitivity, reproducibility, content, and construct validity. This instrument was used in an observational prospective study that evaluated the cost-effectiveness of patch testing in patients with contact dermatitis and suspicion of allergic component. OBJECTIVE: This multicenter, prospective, observational study was designed to study the various direct and indirect costs associated with diagnosis and treatment of suspected allergic contact dermatitis and the benefits of diagnosis with and without patch testing. The costs and benefits of various methods of diagnosis are evaluated to determine if patch testing is more cost-effective as a diagnostic method. One of the outcomes evaluated was the quality of life of the participants in the study and the impact of patch testing on this cohort. METHODS: A total of 567 subjects were enrolled to obtain evaluable data from at least 500 subjects from ten study centers; the investigators were chosen so as to obtain a mix of stratified degrees of usage of patch testing. Data were collected on demographics, physical characteristics, history of disease, visits to physicians, and, to evaluate costs, the use of resources such as drugs, nondrug substances, and services; other outcome data collected were on physician evaluation of improvement, confirmation of diagnosis, physician opinion of the disease management, and patient evaluation of dermatology-specific quality of life (DSQL), and pertinent economic factors. Only 6-month and 12-month follow-up visits were mandatorily scheduled according to the protocol; however, participants and providers were free to arrange additional visits as deemed necessary for health care. RESULTS: This report focuses on the evaluations at the 6-month follow-up. There are completely evaluable data on pharmacoeconomics and DSQL for 431 patients. About 43% were patch tested, and the rest were diagnosed using the information from history and physical examinations. There was significantly better improvement in each of the DSQL domains in patch tested subjects compared with non-patch-tested subjects. In addition, patients treated in "low" use clinics had lower quality of life at 6-month follow-up than those treated in "high" use clinics. CONCLUSION: Patch testing helps to diagnose the etiology of contact dermatitis early and treat the disease before it becomes chronic, thus reducing resources used and improving patient quality of life considerably.

Case-Control Studies↗
PubMed1999

Influence of patch-test application tape on reactions to sodium dodecyl sulfate.

There remains much room for improvement in the accuracy of the patch test procedure. There has been a lack of knowledge regarding the possible relationship between the intensity of test reactions and the quality of the tape used to apply patch tests. Using different brands of tape, patches coated with 2 mg/cm2 sodium dodecyl sulfate (SLS) were applied for 24 h to the backs of 10 volunteers. The tape specimens varied in terms of manufacture, elasticity, adhesive strength, and water permeability. The intensity of patch test reactions, evaluated visually and objectively with both the high resolution laser Doppler perfusion imaging technique (HR-LDPI) and transepidermal water loss measurements (TEWL), varied significantly with the different brands of tape. Observed variations in the intensity of reactions to the patch tests could not be explained by any of the 4 tape parameters investigated. In order to attain optimal test quality in the future, both the tape and patches used in the testing system should be standardized and clearly labelled.

Adhesives↗
PubMed2001

Associated positive patch test reactions to standard contact allergens.

BACKGROUND: Patch testing with a standard allergen series often yields positive reactions to more than 1 allergen in a patient. OBJECTIVE: To identify all significantly associated pairs of positive reactions and to assess their relation to the strength of the reactions and to the irritative potential of the allergens. METHODS: Based on the filed data of 57,822 patients, associations between positive reactions to 2 different allergens were quantified with odds ratios. Statistical methods included Fisher's exact test, the Bonferroni adjustment to account for the effect of multiple testing, and the Spearman rank correlation. RESULTS: Out of the 32,779 patients with complete readings of 24 standard allergens, 7,501 had shown more than 1 positive reaction. Statistically significant associations were detected for 166 out of the 276 possible different combinations of 2 distinct positive reactions, including combinations that had not been identified before. Patients with a strong reaction or a positive reaction to an allergen with a high irritative potential tended to have additional positive reactions to further allergens more often than others, but the number of significant associations was not dependent on these parameters. CONCLUSION: There are more significant associations that have to be taken into account for patch testing than has been known so far. Although irritation can favor a higher number of positive reactions, significant associations of positive reactions to distinct allergens are probably caused by other mechanisms that require further analyses.

Adult↗
PubMed2006

Which children should we patch test?

BACKGROUND: Allergic contact dermatitis (ACD) in childhood was considered rare until recently. However, reports are increasing, which may reflect an increased incidence and/or more frequent patch testing of children. It is also likely that allergen exposure in children has changed with time. AIMS: To determine the most common contact allergens and the rate of positive patch-test reactions among children with suspected contact allergy. METHODS: We carried out a retrospective case study of 114 children (66 girls and 48 boys) aged from 3 to 15 years (median 11.5) patch tested over a 3-year period. Indications for patch testing included uncontrolled or deteriorating atopic dermatitis, localized dermatitis or a history of reacting to a specific allergen. RESULTS: Of 110 children for whom we had notes, 83 (75%) had a history of atopy. Positive reactions that were of current, past or possible relevance were seen in 61 children (54%); in 58 (52%) of 111 tested with the standard series (SS) and in 6 (10%) of 60 tested with the medicament series. None of the children patch tested to the corticosteroid (n = 47), shoe (n = 15), fragrance (n = 12), cosmetic (n = 10) or rubber (n = 5) series had a positive reaction. However, 11 (10%) reacted to rubber allergens within the SS and one of five to their own shoes. The lowest rate of relevant positive reactions was among those with deteriorating atopic dermatitis (22%) and facial (33%) or perioral dermatitis (40%), and the highest rate amongst those with eyelid (86%) or hand (71%) dermatitis. Nickel was the most common allergen (20%) in line with previous reports (82% female), followed by rubber chemicals (10%), fragrance (7.2%), cobalt (5.4%) and lanolin (wool alcohol) (4.5%). CONCLUSIONS: The reported incidence of ACD among children, in particular nickel and rubber allergy, appears to be increasing, which may relate to changing fashions and hobbies. Contact allergy should be considered in all children with dermatitis, particularly with eyelid or hand dermatitis, and patch testing carried out more frequently.

Adolescent↗
PubMed2003

Effects of skin occlusion in patch testing with sodium lauryl sulphate.

BACKGROUND: When evaluating transepidermal water loss (TEWL) in patch testing, the occlusive effect of the patch must be considered as an important artificial impairment of the measurement. OBJECTIVES: To investigate the time course of effects of occlusion. METHODS: Epicutaneous patches with sodium lauryl sulphate (SLS) 0.25%, SLS 0.5%, water and an empty test chamber (control) were applied on the volar forearm for different time intervals (12, 24, 48 h). Test reactions were evaluated by measurement of TEWL immediately, every 15 min during the first hour, every 30 min during the following 3 h and 24 h after patch removal. RESULTS: After patch removal, TEWL values showed a steep increase. When compared with basal values, TEWL values after SLS patch testing remained increased for 24 h, whereas TEWL values on water patch sites were only significantly increased for up to 180 min, and on empty patch sites for only up to 120 min after patch removal. The prolonged increase in TEWL values in SLS patch testing seemed to be induced by barrier function damage caused by SLS itself, as shown in various earlier studies. After the initial increase, TEWL values showed a significant decrease for all patches from 0 to 120 min after patch removal. Patch testing with water gave a significant decrease in TEWL values up to 180 min, and for empty chambers (control) up to 150 min after removal of patches. These data suggest that the occlusive effect on TEWL in patch testing ends 3 h after the removal of test chambers. CONCLUSIONS: We recommend TEWL measurement in SLS patch testing after a period of at least 3 h after patch removal. For practical purposes a 24-h period after patch removal may be useful.

Adolescent↗
PubMed1992

Patch test reactions in atopic patients.

Patch testing was carried out in 851 atopic patients; 181 atopic dermatitis (AD) patients were additionally tested with 50% dilutions of the test substances. The occurrence of allergic and irritant reactions was frequent, being 57% and 33% for AD patients aged 28-41 years and 19-27 years, respectively. Among age-matched allergic rhinitis (AR)/allergic conjunctivitis (AC) or asthma (A) patients, the number of allergic reactions varied from 25 to 30%, and for irritant reactions was 24%. In all groups, nickel, fragrance-mix, balsam of Peru and neomycin were the commonest allergens. Contact allergy to ingredients of topical medicaments was common among AD patients and patients with severe and long-lasting dermatitis were most frequently sensitized. However, sensitivity to multiple substances was not common among those patients. The number of irritant reactions was considerable, but 50% dilution of the test substances did not solve the problem.

Adult↗
PubMed2006

Atopy patch testing in children with asthma and rhinitis symptoms allergic to house dust mite.

The atopy patch test (APT) is generally used to assess immunoglobulin E (IgE) mediated sensitization to allergens in patients with atopic dermatitis, but its diagnostic role in children with respiratory allergy is still controversial. The aim of the study was to evaluate APT with house dust mite (HDM) in children with asthma and rhinitis symptoms allergic to HDM and its relevance to skin prick test (SPT) diameters and specific IgE levels. The study population consisted of 33 children, aged 8-16 yr (median: 12 yr) with asthma and 30 children with allergic rhinitis in the same age range (median: 11 yr). All patients had positive SPT results and high serum specific IgE levels for Dermatophagoides pteronyssinus APT was performed on back skin of all patients with 200 index of reactivity (IR)/ml of D. pteronyssinus allergen extracts in petrolatum (Stallerpatch) and evaluated at 72 h. Of 63 patients, 16 (25%) showed a positive patch test result. APT with HDM showed 30% (10/33) positivity among the patients with asthma and 20% (6/30) positivity among the patients with allergic rhinitis. APT presented no significant correlation with age, SPT diameter, serum total and specific IgE levels for D. pteronyssinus, nasal provocation test or pulmonary function test results. Patch testing with HDM may partly identify mite sensitive children with respiratory allergy. Positive APT results may imply that delayed hypersensitivity reactions play a role in children with asthma and rhinitis allergic to HDM.

Adolescent↗
PubMed2001

Usefulness of patch tests for diagnosing selective allergy to captopril.

Captopril, enalapril, and lisinopril are angiotensin-converting enzyme (ACE) inhibitors widely prescribed for hypertension and heart failure. Cutaneous side effects of captopril include angio-edema, anaphylactoid reactions, maculopapular eruptions, pitiryasis rosea-like rash, toxic erythema, and exfoliative dermatitis. Some of the immunological captopril-induced cutaneous adverse reactions have been diagnosed in recent years by patch tests. A case of a cutaneous immune adverse reaction to captopril with tolerance to enalapril and lisinopril demonstrated both by patch tests and double-blind challenge tests is reported for the first time. A 71-year-old nonatopic woman suffered a generalized pruriginous maculopapular rash. Two months earlier, she had started oral treatment with captopril 50 mg t.i.d and glibenclamide 5 mg daily. After the rash appeared, she stopped both drugs and the reaction cleared. A skin biopsy from one of the lesions showed perivascular lymphocytic infiltrate of the upper dermis. Skin prick tests with captopril and glibenclamide and patch tests with enalapril, lisinopril, and glibenclamide at 1% and 10% pet., and with mercaptobenzothiazole (a sulfhydryl group-containing chemical at 1% pet were negative. Only patch tests with captopril at 1% and 10% concentrations were positive at 48 h. Oral double-blind challenge tests with glibenclamide, enalapril, lisinopril, and placebo showed good tolerance. The patient was advised to avoid only captopril. Because captopril is the only ACE inhibitor containing a sulfhydryl group and has occasionally been implicated in complex immunological diseases, this chemical group has been considered the culprit of allergic reactions to captopril. The lack of cross-reactivity between captopril, enalapril, and benazepril has been demonstrated in a few patients by patch tests. In our patient, patch tests identified captopril as the drug responsible for a probably immune adverse reaction not due to the sulfhydryl group. Patch tests are useful and safe in the diagnostic work-up of allergic drug reactions and in studies of cross-sensitivity among ACE inhibitors.

Aged↗
PubMed1989

Immunohistochemical studies on dust mite antigen in positive reaction site of patch test.

We demonstrated that eczematous reactions could be induced by patch testing with mite antigens in the majority of patients with atopic dermatitis (AD). By using immuno-double labelling technique, many mite antigen-bearing Langerhans cells were seen in the epidermis in the early stage of the patch testing. Twenty-four hours later, these cells were observed only in the deep dermis. Immunoelectron microscopically, it was found that the mite antigens were trapped by macrophages, which were apposing lymphocytes. On the other hand, we observed that Langerhans cells and Leu 3a positive cells in the AD lesions carried IgE molecules. Furthermore, many IgE-positive dendritic cells bearing mite antigen were seen in the positive patch testing sites. Taken together, IgE-mediated contact hypersensitivity to mite antigen may play an important role in the pathogenesis of AD.

Adolescent↗
PubMed1999

Objective non-invasive assessment of patch tests with the laser Doppler perfusion scanning technique.

The laser Doppler perfusion scanning technique is an objective, non-invasive assessment method that may be used to assess patch tests. The purpose of this paper is to focus on its clinical use in individuals with light skin, tested with non-pigmented test materials. A laser Doppler perfusion imager PIM 1.0 (LDPI) is used to study different set-ups of the instrument that may affect readings. These set-ups are studied through simulated light-absorbing patch tests. The results have served as a base for clinical experiments comparing visual and LDPI assessments of normal skin, irritant patch-test reactions, and more than 25,000 allergic patch-test assessments of reactions of different intensities and control patches. This paper reviews the clinical experiments to suggest a set-up of the LDPI for patch-test readings. Such a set-up makes it possible to compare intra- and inter-individual test results and to obtain meaningful assessment values among users. Some subject-related factors that may affect reading results are studied, and the effect of non-subject related factors on readings are considered. Use of the technique is illustrated by images of perfusion and a perfusion profile of a patch-test reaction followed over time.

Anti-Inflammatory Agents↗
PubMed1997

Patch testing in children and adolescents: five years' experience and follow-up.

BACKGROUND: Allergic contact dermatitis in children is a significant clinical problem. Little information is available concerning the value of patch testing and the outcome in these children. OBJECTIVE: Our purpose was to assess the value of patch testing in children and the outcome of allergic contact dermatitis in childhood. METHODS: Clinical data on 83 children patch tested during a 5-year period were assessed. Clinical follow-up on 68 subjects was performed. RESULTS: Overall, 41 children had one or more allergic reactions (49%). Reactions to metals, topical preparations, and food additives were common. The clinical outcome at 6 months was significantly better for 36 children with a relevant allergen on patch testing than in 32 with no allergen or no relevant allergen (p = 0.006). CONCLUSION: Patch testing is useful in the management of children suspected of having an allergic contact dermatitis. Patch testing and subsequent allergen avoidance may improve the prognosis in children with a relevant contact allergen.

Administration, Cutaneous↗
PubMed1997

[Importance and results of photo-patch tests in photobiological research].

Photo patch tests (Standard battery of the SFPD) were made on 45 patients who were suspected of exogenous photosensitization during 1996. Certain suspected topicals or drugs completed the battery. The results obtained are analysed and compared with those in the literature.

Anti-Infective Agents, Local↗