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PubMed2003

[Atopic patch test. Atopic eczema and allergy].

The role of IgE-mediated allergic reactions in atopic eczema remains controversial. Using the atopy patch test, aeroallergens such as house dust mites, animal dander or pollen can be identified as relevant trigger factors in a subgroup of patients with atopic eczema. The atopy patch test is an epicutaneous patch test employing allergens known to elicit IgE-mediated reactions and used to evaluate eczematous skin reactions. In a series of single- and multicenter studies, a method was developed, standardized and compared to other diagnostic techniques (specific serum-IgE, skin prick test) in atopic eczema patients. With regard to clinical history, the most specific results were obtained with the atopy patch test (allergen-dependent 69-92%), while sensitivity was higher for skin prick test (69-82%) and specific IgE (65-94%). The characterization of a patient subgroup with relevant IgE-mediated allergy may lead to more efficient avoidance and perhaps even specific immunotherapy strategies in the management of atopic eczema.

Adolescent↗
PubMed2004

Reactivity to patch tests with nickel sulfate and fragrance mix in infants.

The pattern of patch test reactivity to nickel sulfate and fragrance mix was studied with respect to patch test performance, reproducibility and clinical relevance in a population of unselected infants followed prospectively from birth to 18 months of age. TRUE Testtrade mark patches with nickel sulfate in 3 concentrations, 200, 66 and 22 microg/cm(2), and fragrance mix 430 microg/cm(2) were used. A likely case of nickel sensitivity was defined as a reproducible positive reaction with at least homogeneous erythema and palpable infiltration occurring at least 2x and present at both the 12 and 18 months follow-up. 543 infants (268 girls and 275 boys) were tested at least 1x, 304 were tested at both 12 and 18 months. The prevalence of a reproducible positive reaction to nickel was 8.6% (20 girls and 6 boys). A transient positive reaction was observed in 111 children. Clinical relevance of nickel sensitivity was found in only 1 child. No reproducible positive reaction to fragrance mix was found. The high proportion of transient patch test reactivity to nickel sulfate 200 microg/cm(2) indicates that this standard concentration used for adults cannot be applied to infants. The interpretation of a single positive nickel patch test in infants must be assessed with caution and it is probably of non-specific or irritant nature.

Allergens↗
PubMed1997

Threshold for occluded formaldehyde patch test in formaldehyde-sensitive patients. Relationship to repeated open application test with a product containing formaldehyde releaser.

Our purpose was to investigate the eliciting threshold concentration of formaldehyde in formaldehyde-sensitive individuals in the occluded and non-occluded patch test, and to evaluate the relationship to repeated open application test (ROAT) with a product containing a formaldehyde releaser. 20 formaldehyde-sensitive patients and a control group of 20 healthy volunteers were included in the study. Occluded and non-occluded patch tests with formaldehyde solutions from 25 to 10,000 ppm, and ROAT for 1 week with a leave-on cosmetic product containing on average 300 ppm formaldehyde, were carried out simultaneously on each subject. In the occluded patch test, 1/2 of the 20 patients only reacted to 10,000 ppm formaldehyde, 9 reacted to 5,000 ppm, 3 reacted to 1,000 ppm, 2 reacted to 500 ppm and 1 reacted to 250 ppm. No definite positive reactions were observed in the non-occluded patch test or in the ROAT. No positive reactions were observed in the control group to any of the test procedures. We concluded that the threshold concentration for occluded patch test to formaldehyde in formaldehyde-sensitive patients was 250 ppm. The threshold in occluded patch test corresponded to the degree of sensitivity. Definite positive reactions in the ROAT were not seen, either indicating that they are unlikely to happen with the type of product used or that the exposure time was too short.

Adult↗
PubMed2000

(Un)usual effects of patch testing?

BACKGROUND: Little information is available concerning subjective complaints associated with patch testing. OBJECTIVES: To gather information about the frequency and the nature of such complaints, and to evaluate, if possible, whether the complaints were really caused by patch testing. PATIENTS/METHODS: Four hundred and thirty-three patients took part in a questionnaire study between December 1996 and October 1997. Complaints of itch and other subjective complaints, such as tiredness and feeling unwell, were recorded. RESULTS: From the total group of 433 patients, 379 patients (87%) recorded one or more complaints on day 0. By day 2 this number was 383 patients (88%), with a significant reduction to 326 patients (75%) by days 3-4. Most complaints concerned itch on the back, and to a lesser extent tiredness. Fifty-four patients (54 of 433; 12%) did not report itch or other subjective complaints on day 0; of this group, 36 patients (66%) developed complaints by day 2. By days 3-4, 24 patients (44%) reported complaints: 20 patients from the day 2 group (37%) and four patients (7%) from days 3-4. Again the largest increase in complaints was found for itch on the back, but other complaints were also found to have increased, mainly tiredness, feeling unwell, headache, shakiness and light-headedness. CONCLUSIONS: We conclude that patch testing can, in addition to local skin reaction and itch, also cause other subjective complaints in a number of patients.

Adolescent↗
PubMed1999

Inverse correlation of domestic exposure to Dermatophagoides pteronyssinus antigen patch test reactivity in patients with atopic dermatitis.

BACKGROUND: In recent years considerable interest in the pathogenetic role of aeroallergens exacerbating atopic dermatitis (AD) has emerged. The 'atopy patch test' with aeroallergens was introduced by Platts-Mills et al. as an experimental model and as a diagnostic tool. However, its relevance for the clinical manifestation of AD is still not clear. OBJECTIVE: We asked whether there is a relationship between the individual antigen exposure to the major allergen of Dermatophagoides pteronyssinus (Der p 1) and the immunological markers of sensitization to Der p 1 or the clinical severity of AD. METHODS: We investigated 92 patients with moderate to severe AD. For clinical evaluation the SCORAD severity score was used. Patch tests were performed with purified Der p 1. Specific IgE was measured by a commercial assay. Der p 1 exposure was quantified in a sample of the patient's mattress dust by using a commercial ELISA. RESULTS: No correlation between SCORAD, Der p 1 exposure and RAST could be established. However, there was an unexpected significant inverse correlation between the quantity of mite antigen in the mattress dust and patch test reactivity. Patients with a high antigen load (> 25 microg/g) mostly had a negative patch test. Also, when Der p 1 was correlated to the mattress area (m2) in this group all patch tests were negative. A possible explanation could be that continuous exposure of the skin to house dust mite allergen Der p 1 may induce a down-regulation of the skin immune system of patients with AD. CONCLUSION: Although the mechanism of this phenomenon is presently unknown, our study shows that a positive allergen patch test alone should not be an indication to undertake allergen exclusion measures in AD patients.

Adolescent↗
PubMed1986

Softisan--a new vehicle for patch testing.

Petrolatum is a good vehicle for many patch test allergens, because it is stable, unreactive, and allergy to it is rare. Some difficulties exist, however, when water-soluble allergens are tested, because emulsifiers are often needed; these can change the properties of both the test material and the vehicle itself. In the present study, we compared petrolatum with a new lanolin substitute based on vegetable fatty acids as a patch test vehicle for nickel sulphate.

Adolescent↗
PubMed2007

Staphylococcus aureus-derived enterotoxins enhance house dust mite-induced patch test reactions in atopic dermatitis.

BACKGROUND: Up to 65% of Staphylococcus aureus strains isolated from the skin of patients with atopic dermatitis (AD) produce exotoxins with superantigenic properties that may also act as allergens leading to an induction of exotoxin-specific IgE antibodies. Staphylococcal enterotoxin B (SEB) applied epicutaneously in a concentration of 10 micro g/cm(2), i.e. 200 micro g/ml, under occlusion induces cutaneous inflammation in patients with AD and healthy individuals. METHODS: We performed patch tests in 32 adult patients with AD using different concentrations (i.e. 2-200 micro g/ml) of SEA, SEB and house dust mite (HDM) extract (500 micro g/ml). Furthermore, the respective enterotoxins and HDM extract were applied simultaneously to the same patch test site. Specific IgE levels to SEA, SEB and HDM were measured with the CAP FEIA. RESULTS: The rates of patch test reactions to SEA and SEB increased with rising enterotoxin concentrations. There were no differences in the rates of patch test reactions to SEA and SEB between patients sensitized to the corresponding enterotoxin and non-IgE-sensitized patients. The number of patch test reactions to the mixture of enterotoxin and HDM extract was higher than the number of patch test reactions to either the enterotoxins or HDM extract. We identified 11 patients with AD who reacted neither to the enterotoxins nor to HDM extract, but who showed patch test reactions to the mixture. These reactions were not predicted by the presence of enterotoxin- or HDM-specific IgE. CONCLUSIONS: Colonization with exotoxin-producing S. aureus may influence the outcome of patch tests in patients with AD.

Adolescent↗
PubMed1985

Single cell DNA measurements in benign cutaneous lymphoid infiltrates and in positive patch tests.

Cellular DNA in skin biopsies from eighteen patients with positive patch tests and eleven patients with benign lymphocytic skin infiltates (cutaneous lymphocytoma, lymphoplasia or Jessner's lymphotic infiltrate) was estimated by flow cytometry of propidium iodide-stained dermal cells. Specimens from three patients with patch tests and one with cutaneous lymphocytoma had DNA histograms similar to those of normal blood mononuclear cells. The remaining patients demonstrated DNA histogram abnormalities in the form of hyperdiploid peaks in forty-two of forty-five specimens. The estimated proportion of cells in the S-phase was similar in patch tests (median: 9.2%) and in benign lymphocytic skin infiltrates (median: 9.6%). The median number of cells in the G2/M-phase was 3.1% in both groups of disorders. These data indicate DNA content heterogeneity of the dermal cells in benign lymphocytic skin infiltrates. This may be attributed to DNA replication and/or chromatin dispersion during cellular activation and proliferation. The data also emphasize that hyperdiploid peaks are not necessarily indicative of the presence of separate cell clones.

Adult↗
PubMed1997

Differences in skin-prick and patch-test reactivity are related to the heterogeneity of atopic eczema in infants.

Current data indicate an obvious relation between food allergy and atopic eczema in infants. However, diagnostic methods for food allergy need to be supplemented. The objective was to study the relevance of food patch testing in the detection of food allergy in correlation with oral food challenge and skin prick tests in atopic infants. Infants with atopic eczema (n = 113) aged 2-24 months were studied. Each patient was subjected to double-blind, placebo-controlled, or open cow's milk challenge, and skin prick and patch tests. Polysensitization, as judged from skin test results, was common in patients with atopic eczema (79/113). Cow's milk challenge was positive in 54/113 infants; reactions were immediate in 36/54 and delayed in 18/54. Immediate-type reactions were associated with skin prick test positivity and delayed reactions with patch test positivity. Altogether 26% of the cow's milk-allergic infants were detected by patch testing only. Patch testing improved the accuracy of skin testing in the diagnosis of food allergy in infants with atopic eczema, but it needs to be standardized. Polysensitization appears to be more common than generally believed among infants with atopic eczema.

Animals↗
PubMed1995

Analysis of the cytokine pattern expressed in situ in inhalant allergen patch test reactions of atopic dermatitis patients.

In the present study, we examined the cytokine pattern expressed in situ during the development of eczematous reactions that had been provoked in atopic dermatitis patients by patch testing with house dust mite allergen. In 24-h house dust mite allergen patch test reactions, expression of interleukin (IL)-4 mRNA and IL-2 mRNA increased, but interferon (IFN)-gamma mRNA did not, as compared with control skin. In 48-h inhalant allergen patch test reactions, however, IFN-gamma mRNA and IL-2 mRNA expression were increased above levels observed in control skin, whereas IL-4 mRNA expression was decreased below background levels. These data demonstrate that a switch from a Th2-like to a Th1-like cytokine response occurs in inhalant allergen patch tests of atopic dermatitis patients. This biphasic pattern was specific to inhalant allergen patch test reactions, as it was not observed in irritant reactions in the same patient. IFN-gamma production by T cells may be induced by the cytokine IL-12. In the present study, up-regulation of IFN-gamma mRNA expression in inhalant allergen patch test reactions was preceded by an increased expression of the p35 subunit of IL-12 mRNA. These observations suggest that increased IL-12 expression may contribute to the observed switch of the in situ cytokine secretion pattern. Further studies are necessary to determine whether a similar biphasic pattern of cytokine expression is also operative in the initiation phase of atopic eczema.

Allergens↗
PubMed2004

North American Contact Dermatitis Group patch-test results, 2001-2002 study period.

BACKGROUND: Allergic contact dermatitis is a significant cause of cutaneous disease affecting many individuals in the home and at the workplace. Patch testing is the most worthwhile diagnostic tool for the evaluation of patients with suspected allergic contact dermatitis. OBJECTIVE: This study reports the results of patch testing from January 1, 2001, to December 31, 2002, by the North American Contact Dermatitis Group (NACDG). METHODS: Patients were tested with an extended screening series of 65 allergens. A standardized patch-testing technique was used. Data from these patients were recorded on a standardized computer entry form and analyzed. RESULTS: Sixty-five allergens were tested on 4,913 patients. The top 10 allergens remain the same in this study period as in the 1999-2000 study period: nickel sulfate (16.7%), neomycin (11.6%), Myroxilon pereirae (balsam of Peru) (11.6%), fragrance mix (10.4%), thimerosal (10.2%), sodium gold thiosulfate (10.2%), quaternium-15 (9.3%), formaldehyde (8.4%), bacitracin (7.9%), and cobalt chloride (7.4%). Of the 4,913 patients tested, 69% had at least one positive allergic patch-test reaction. Of all patients, 15.8% had occupation-related dermatitis; 15.4% were determined to have irritant contact dermatitis, and 11.1% of the 15.4% had a relevant reaction to an occupational irritant. Of all patients tested, 16.7% had a relevant reaction to an allergen not in the NACDG standard series, and 5.5% had a relevant reaction to an occupational allergen not in the standard series. CONCLUSION: Our findings once again reinforce the need for a more comprehensive group of diagnostic allergens than those found in the standard screening kits. The usefulness of patch testing is enhanced when a greater number of allergens are tested, especially nonstandard allergens occupationally encountered.

Adolescent↗
PubMed1999

T-cell reaction to local anaesthetics: relationship to angioedema and urticaria after subcutaneous application--patch testing and LTT in patients with adverse reaction to local anaesthetics.

BACKGROUND: Local anaesthetics are known to elicit T-cell reactions after epicutaneous application, namely contact dermatitis. In addition, adverse reactions like urticaria and angioedema are rather common after submucosal or subcutaneous injection. The pathogenesis of these side-effects, which appear frequently hours after application, is unknown, but thought to be not immunoglobulin E-mediated, since immediate skin tests are mostly negative. OBJECTIVES: We investigated whether patients who developed urticaria and angioedema after subcutaneous application have a T-cell sensitization to local anaesthetics, which might be responsible for the symptoms. METHODS: Twenty patients with generalized and/or local cutaneous reactions after LA were examined with intradermal testing using a standard panel of six LAs and patch testing using between seven and nine LAs in vaseline and four LAs in PBS. In 10 patients, a lymphocyte transformation test (LTT) was performed. RESULTS: Only 2/20 patients had an immediate skin reaction (positive intradermal test), whereas 6/20 patients had a positive delayed skin reaction (positive patch test). In 6/10 subjects the LTT was positive. CONCLUSIONS: Delayed appearance of urticaria and angioedema after subcutaneous application of local anaesthetics may be related to a T cell- mediated sensitization, which might be detected by patch testing or LTT.

Adolescent↗
PubMed2004

Evaluation of modifications of the traditional patch test in assessing the chemical irritation potential of feminine hygiene products.

BACKGROUND/AIMS: The first main objective of the work presented in this paper was to investigate ways of optimizing the current arm patch test protocol by (1) increasing the sensitivity of the test in order to evaluate more effectively the products that are inherently non-irritating, and/or (2) reducing the costs of these types of studies by shortening the protocol. The second main objective was to use the results of these studies and the results of the parallel studies conducted using the behind-the-knee method to better understand the contribution of mechanical irritation to the skin effects produced by these types of products. In addition, we were interested in continuing the evaluation of sensory effects and their relationship to objective measures of irritation. METHODS: Test materials were prepared from three, currently marketed feminine protection pads. Wet and dry samples were applied to the upper arm using the standard 24-h patch test. Applications were repeated daily for 4 consecutive days. The test sites were scored for irritation prior to the first patch application, and 30-60 min after removal of each patch. Some test sites were treated by tape stripping the skin prior to the initial patch application. In addition, in one experiment, panelists were asked to keep a daily diary describing any sensory skin effects they noticed at each test site. RESULTS: All protocol variations ([intact skin/dry samples], [compromised skin/dry samples], [intact skin/wet samples], and [compromised skin/wet samples]) gave similar results for the products tested. When compared to the behind-the-knee test method, the standard upper arm patch test gave consistently lower levels of irritation when the test sites were scored shortly after patch removal, even though the sample application was longer (24 vs. 6 h) in the standard patch test. The higher level of irritation in the behind-the-knee method was likely due to mechanical irritation. The sensory skin effects did not appear to be related to a particular test product or a particular protocol variation. However, the mean irritation scores at those sites where a sensory effect was reported were higher than the mean irritation scores at those sites were no sensory effects were reported. CONCLUSIONS: All four protocol variations of the standard upper arm patch test can be used to assess the inherent chemical irritant properties of feminine protection products. For these products, which are inherently non-irritating, tape stripping and/or applying wet samples does not increase the sensitivity of the patch test method. Differences in irritation potential were apparent after one to three 24-h applications. Therefore, the standard patch test protocol can be shortened to three applications without compromising our ability to detect differences in the chemical irritation produced by the test materials. The patch test can be used to evaluate effectively the inherent chemical irritation potential of these types of products. However, this method is not suitable for testing the mechanical irritation due to friction that occurs during product use. There is no relationship between specific test conditions, i.e., compromised skin and/or testing wet samples and reports of perceived sensory reactions. However, there seems to be a clear relationship between sensory reactions and objective irritation scores.

Absorbent Pads↗
PubMed2002

Necrotizing cellulitis caused by Apophysomyces elegans at a patch test site.

Plant material occasionally is used in patch testing to diagnose contact dermatitis. Serious adverse reactions to this practice are extremely uncommon. The authors report on a 68-year-old non-insulin-dependent diabetic gentleman with hand dermatitis in whom severe necrotizing cellulitis developed caused by Apophysomyces elegans, a subtype of mucormycosis, at the site of a patch test to a snapdragon plant from his garden.

Aged↗
PubMed1991

Loss of lanolin patch-test positivity.

Thirty-seven patients who had shown a relevant positive patch-test response to lanolin within the previous 5 years were retested. Only 41% demonstrated persistence of the positive patch test to lanolin. Analysis according to age, sex, atopic status, interval between patch testings, strength of the original response and the number of concurrent reactions, were not associated with the persistence of the lanolin response.

Adult↗
PubMed2005

Patch testing with p-toluene diamine preparations of different ages.

Analyses of the stability of 1% p-toluene diamine (PTD) in petrolatum used for patch testing showed a rapid decline of the PTD concentration down to 0.1%, possibly due to the generation of dye complexes. To study whether the diagnostic quality of this test preparation is compromised by the chemical reactions taken place, a multicentre study was conducted by the German Contact Dermatitis Research Group (DKG), comparing patch test results in 177 patients with simultaneously tested PTD preparations of different ages. During the 10-month course of this study, the age of the batches ranged from 2 to 11 months for batch A, from 7 to 16 months for batch B and from 11 to 20 months for batch C. There were no statistically significant differences between reactions to batches A and B, A and C, and B and C. Agreement of patch test reactions to the 3 batches was very good and comparable to the general reproducibility of patch test with standard allergens. The chemical reactions mentioned above apparently do not affect the diagnostic quality of PTD patch test preparations because the true allergen probably is not PTD itself, but one or more of the reaction products.

Dermatitis, Contact↗
PubMed2003

Atopy patch tests in young adult patients with atopic dermatitis and controls: dose-response relationship, objective reading, reproducibility and clinical interpretation.

The clinical interpretation and reproducibility of atopy patch tests was studied in 23 selected young adult patients with atopic dermatitis and 25 healthy controls using standard inhalant allergens. Non-invasive measurements were used for objective assessment of test reactions and the participants were retested after 6 weeks. Ten of 19 (53%) evaluable patients with atopic dermatitis had at least one positive atopy patch test. However, there was no clear clinical relevance of the atopy patch test results when related to patient history and distribution of dermatitis. Reproducible and dose-dependent results were obtained with Dermatophagoides pteronyssinus, grass and cat with a reproducibility rate of 0.69 to 0.81 in patients and 0.60-0.96 in controls. A unique finding was a significant positive correlation between a positive atopy patch test, allergen dose and increase in transepidermal water loss and erythema, while measurement of capacitance did not distinguish between positive and negative reactions. The results of the present study do not support the routine use of atopy patch tests in the evaluation of adult patients with atopic dermatitis.

Adolescent↗
PubMed1993

Spice allergy evaluated by results of patch tests.

Allergic contact dermatitis caused by spices is well documented; however, commercial patch tests are unavailable. Between October, 1991, and August, 1992, a series of fifty-five patients with suspected contact dermatitis were tested at Ochsner Clinic for sensitivity to a group of spices at concentrations of 10 percent and 25 percent in petrolatum. Concordant patch test results (positive at concentrations of 10 percent and 25 percent) were most common with ginger (seven), nutmeg(five), and oregano (four); the remaining spices produced zero or one positive responses. Patients exhibiting positive reactions at only one concentration were more likely to do so at 25 percent: nutmeg (five), ginger and cayenne (four), curry, cumin, and cinnamon (three), turmeric, coriander, and sage (two), oregano (one), and basil and clove (zero). Solo responses at this level may represent a threshold for detecting true allergy or, as an alternative, a marginal irritant reaction. Those responding to only 10 percent concentrations generally did so weakly. Three patients were deemed to have relevant patch test responses to spices.

Dermatitis, Allergic Contact↗