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PubMed1986

High-frequency ultrasound measurement of patch test reactions.

53 patients who produced 34 positive patch test reactions (+/- 15, +10, ++4, +++5) had their reactions read by a high-frequency pulsed ultrasonic (A-scan) dermal depth detector with a resolution of 0.05 mm. The positive reactions were compared with both random and regional controls. The machine could not differentiate between + or +/- reactions from the control readings. However, for 75% of ++ cases and 80% of +++ cases, a significant change was confirmed by the detector. It is concluded that the high-frequency ultrasound method is of little use in confirming or quantifying of positive patch test results.

Adolescent↗
PubMed1995

A clinical and patch test study of contact dermatitis from traditional Chinese medicinal materials.

Putative allergens in, clinical manifestations of, and patch tests with traditional Chinese medicinal materials (CMM) causing contact dermatitis (CD) were studied. 14 patients with CMM CD and 351 controls were patch tested with the standard series of allergens of Beijing Medical University and the suspected drug, as is. It was found that most CMM CD was caused by the CMM frequently used topically for analgesic and anti-inflammatory effect. All patients patch tested with the suspected drug gave positive results. Some patients also reacted to fragrance mix, colophony, rubber mix and ammoniated mercury. The positivity rates of fragrance mix and colophony in CMM CD patients were significantly higher than in controls (55.6% versus 16.5% for fragrance mix, chi 2 = 11.86, p < 0.01; and 55.6% versus 5.1% for colophony, chi 2 = 29.35, p < 0.01), while not those of rubber mix and ammoniated mercury. Results indicated that the topical analgesic and anti-inflammatory CMM, especially those containing fragrance, may cause contact sensitization. Clinical findings in CMM CD included cutaneous irritation, allergic contact dermatitis, immediate contact reactions and systemic contact dermatitis. CMM CD can be diagnosed by patch testing the putative drug, as is.

Administration, Cutaneous↗
PubMed1992

Occupational pharyngitis associated with allergic patch test reactions from acrylics.

A female dentist specialized in orthodontics repeatedly developed symptoms of pharyngitis at work. A chamber provocation test indicated that her symptoms were caused by acrylics. Prick tests with acrylics were negative, while patch tests were strongly positive although the patient had no skin symptoms. The relationship between the symptoms and the patch test results is discussed. It is suggested that type IV allergic reactions may be involved in symptoms of the upper respiratory tract.

Bronchial Provocation Tests↗
PubMed2001

An 8-year experience with routine SL mix patch testing supplemented with Compositae mix in Denmark.

Routine patch testing with sesquiterpene lactone (SL) mix, supplemented with Compositae mix (CM) and other Compositae extracts and allergens where appropriate, was evaluated over an 8-year period. 190 of 4386 patients tested (4.3%) were Compositae-sensitive, 143 females (mean age 51.5 years) and 47 males (mean age 55 years), and 83% of reactions considered clinically relevant. 22% were suspected of occupational sensitization/dermatitis. 62% had a contact allergy to 2 or more compounds, most often to nickel, fragrance and colophonium. SL mix detected 65%, CM 87% of Compositae-allergic patients, and the overall detection rate with both mixes was 93%. Few irritant reactions and no cases of clear-cut active sensitization were recorded with the mixes, but our results emphasize the importance of differentiating late-appearing reactivation reactions from patch test sensitization. The weakly positive CM reactions could reflect some irritancy, but as they were associated with fragrance and/or colophonium allergy to a higher degree than weakly positive SL mix reactions, they probably represented cross-reactions. In conclusion, the detection rate with SL mix was high enough to support its continued use as a screening mix and it was very well and rather safely supplemented by aimed testing with CM.

Adolescent↗
PubMed1989

Histopathological changes in canine allergic contact dermatitis patch test reactions. A study on spontaneously hypersensitive dogs.

The histopathology of allergic patch test reactions in dogs with spontaneous allergic contact dermatitis (ACD) was investigated. Epidermal necrosis was present in half of the biopsies and neutrophilic granulocytes were present within epidermis in these biopsies as well as in some of the biopsies without necrosis. Spongiosis was only occasionally observed. Dermal infiltration with neutrophilic granulocytes and oedema was found in all biopsies while the number of lymphocytes was small. The results may indicate a different secretion of or responsiveness towards cytokines in canine ACD compared to ACD in man where epidermal necrosis is not a characteristic feature and where the predominant inflammatory cell is the lymphocyte. It is anticipated that histopathological investigation of patch test reactions in dogs will not be helpful in discriminating between allergic and toxic patch test reactions.

Animals↗
PubMed1999

Individual variation in nickel patch test reactivity.

BACKGROUND AND OBJECTIVE: Various factors such as hormones, drugs, and ultraviolet (UV) radiation may influence patch test reactions. The aim was to study the individual variation in nickel reactivity, also in relation to the menstrual cycle. METHODS: Thirty women allergic to nickel were studied for 7 months with patch tests with a serial dilution of nickel sulfate in water on four different test occasions. The patients belonged to two different eczema groups, one with nickel allergy, atopy, and pompholyx (12 patients); and the other with nickel allergy, but without both atopy and hand eczema. RESULTS: None of the patients showed the same patch test reactivity on all four occasions, and the highest individual difference noticed was 250 times for the four test occasions. Furthermore, two of the patients had completely negative test reactions on at least one test occasion. CONCLUSION: The variation in nickel reactivity as shown in this article is of great importance and should be kept in mind when a patient has a positive history of allergic contact dermatitis but negative patch test results to nickel.

Adult↗
PubMed1989

Clinical patch test data evaluated by multivariate analysis. Danish Contact Dermatitis Group.

The aim of the present study was to evaluate the influence of individual explanatory factors, such as sex, age, atopy, test time and presence of diseased skin, on clinical patch test results, by application of multivariate statistical analysis. The study population was 2166 consecutive patients patch tested with the standard series of the International Contact Dermatitis Research Group (ICDRG) by members of the Danish Contact Dermatitis Group (DCDG) over a period of 6 months. For the 8 test allergens most often found positive (nickel, fragrance-mix, cobalt, chromate, balsam of Peru, carba-mix, colophony, and formaldehyde), one or more individual factors were of significance for the risk of being sensitized, except for chromate and formaldehyde. It is concluded that patch test results can be compared only after stratification of the material or by multivariate analysis.

Adolescent↗
PubMed1984

Quantification of cutaneous oedema in patch test reactions by measurement of skin thickness with high-frequency pulsed ultrasound.

69 doubtful and positive patch test readings (?+21, +23, ++18, 7) in 15 contact dermatitis patients were studied by measurement of skin thickness as an expression of allergic oedema. Exposed skin was compared with a regional control. Skin thickness was measured by 15 MHz pulsed ultrasound (A-scan) to 0.1 mm accuracy. The ?+, +, ++, and reactions could be separated by measurements of absolute difference in thickness (p less than 0.001, p less than 0.001, p less than 0.02) between exposed and non-exposed skin; the mean increases were 0.14, 0.49, 0.93, and 1.37 mm. The ?+, +, and ++ reactions, but not the reactions, could also be separated by measurements of relative increase in skin thickness (p less than 0.001, p less than 0.001, n.s.); the mean increases were 7%, 25%, 50% and 55%. The normal thickness of the skin of the back was shown to have increased (p less than 0.02) in patients with reactions only. It is concluded that the high-frequency ultrasound method is suitable for quantification of doubtful and positive patch test reactions. The reactions are probably explained by the normal thick skin of the back, and they need no separate recording in patch testing. Standards of increase in skin thickness in doubtful and positive patch tests are defined: absolute increase (mm) was ?+ less than or equal to 0.2; +0.3-0.7; ++0.8-1.3 ( greater than or equal to 1.4); relative increases were ?+ less than 15%; +15-45%, ++ ( included) greater than 45%.

Adult↗
PubMed2006

Patch test responses to Malassezia pachydermatis in healthy basset hounds and in basset hounds with Malassezia dermatitis.

The effects of the patch test application of Malassezia pachydermatis extracts were evaluated in seven healthy basset hounds and in seven basset hounds with Malassezia dermatitis. Antigens (4 and 0.4 mg/ml) and saline controls were applied for 48 h using filter paper discs in Finn chambers. One healthy basset hound and five affected hounds showed positive patch test reactivity to the yeast antigens. Positive patch test reactions were characterized histologically by mild epidermal hyperplasia and mild to moderate perivascular, periadnexal and interstitial infiltrates of neutrophils and CD3+ lymphocytes. Immediate intradermal test reactivity to M. pachydermatis antigens was seen in one healthy and one affected hound, whereas delayed intradermal test reactivity was seen in six healthy hounds and five affected hounds. This study indicates that patch test reactivity to M. pachydermatis antigen may occur in healthy basset hounds, and in contrast to delayed intradermal test reactivity, is more frequent in basset hounds with Malassezia dermatitis.

Allergens↗
PubMed2003

Papular dermatitis and a persistent patch test reaction to gold sodium thiosulfate.

The role of gold in allergic contact dermatitis is poorly understood and is a subject of increasing interest. Recent studies demonstrate that gold-positive patch testing is not uncommon, but persistent patch test reactions are rarely reported. We present a case of a 53-year-old woman with a 7-year history of a scattered, pruritic papular dermatitis. Patch testing demonstrated a persistent, positive reaction to gold sodium thiosulfate. The histopathology of the patch test site and that of the cutaneous eruption were similar in nature but differing in severity. No other allergens have been identified, but gold avoidance has not yet resulted in the clearing of her eruption. This case underscores the difficulty in making a clinical correlation despite suggestive clinical pathologic evidence.

Allergens↗
PubMed1999

Histological distinction between early allergic and irritant patch test reactions: follicular spongiosis may be characteristic of early allergic contact dermatitis.

Comparative light microscopic studies have revealed subtle differences between allergic and irritant reactions in the skin. In the search for specific differences, we focussed on the early inflammatory response. This pilot study was conducted to test the hypothesis that follicular spongiosis can differentiate between early allergic and irritant patch test reactions. 8 patients with known contact allergy to either colophony or quarternium-15 participated in the study. In each patient, allergic and irritant patch tests reactions were elicited, and 4-mm punch biopsies were taken after 6 8 h from clinically equipotent reactions. Paired sets of slides were assessed blindly by 2 pathologists. 1 patient showing a pityrosporum folliculitis was excluded from the study. All biopsies from allergic patch tests were characterized by follicular spongiosis, while biopsies from irritant patch tests showed no recognizable changes except a slight follicular spongiosis in 1 patient. The 2 pathologists agreed independently on the correct classification in 6 out of 7 cases (p=0.0156). We tested an optimized model, selecting non-irritant allergens and a well-known irritant. Further investigations are needed to elucidate the diagnostic significance of the histological classification of allergic and irritant cutaneous reactions in punch biopsies.

Adult↗
PubMed1993

The involvement of eosinophils in the patch test reaction to aeroallergens in atopic dermatitis: its relevance for the pathogenesis of atopic dermatitis.

Atopic dermatitis (AD) is considered a T-cell mediated disease. Activated T-cells, mainly of the CD4-subtype, are abundantly present in lesional AD skin. Although not many intact eosinophils are present, deposits of eosinophil derived major-basic-protein (MBP) and eosinophil-cationic-protein (ECP) suggest eosinophil involvement. After patch testing AD patients with aeroallergens, an eczematous reaction develops after 24-48 hr at the site of application. This patch test reaction shows macroscopic resemblance to lesional AD skin and does not take place in normal individuals, asthma and allergic rhinitis patients. Lymphocytes together with eosinophils infiltrate into the dermis 2-6 hr after allergen application. Twenty-four to forty-eight hours after patch testing, eosinophils are in an activated state since they release ECP (being EG2-positive). At this point in time eosinophils have also infiltrated the epidermis. Here they are EG2-negative. Forty-eight to seventy-two hours after patch testing the eczematous reaction decreases. This coincides with disappearance of eosinophils from both the dermis and the epidermis; then, a dendritic staining pattern can be observed in the epidermis with anti-eosinophil peroxidase. Thus, eosinophils infiltrate the dermis and epidermis after patch testing AD patients with aeroallergens and release part of their granular constituents. Recent in vitro investigations revealed that eosinophils from the circulation of AD patients react more powerfully in in vitro test systems such as chemiluminescence, chemotaxis and endothelial adherence and transmigration. It is very likely that this activated (= primed) state is caused by the influence of lymphocyte-derived cytokines like IL-3, IL-5 and GM-CSF, since activated lymphocytes in the circulation (and tissue) may release these cytokines. The primed state of the eosinophils may facilitate tissue infiltration. The subsequent activation of eosinophils within the tissue leading to mediator release and the function of these mediators need to be further elucidated. The close similarity between the cellular events after a patch test reaction to aeroallergens in AD patients and those present in lesional AD skin suggests that the patch test reaction may be a helpful in vivo model to study the pathogenesis of AD. The prominent involvement of lymphocytes and eosinophils in this reaction also suggests some similarity with late phase reactions (LPR) observed in the skin after intracutaneous allergen challenge.

Allergens↗
PubMed1992

American Academy of Dermatology Patch Testing Survey: use and effectiveness of this procedure.

The results of an American Academy of Dermatology (AAD)-sponsored survey on the use and effectiveness of patch testing are presented. Academy members' responses indicate that 27% do not patch test at all. Reasons given for not testing included (1) the patient history was adequate for diagnosis, (2) patch testing was too time-consuming, and (3) reimbursement was not sufficient. Dermatologists in residency training programs who responded to a similar survey are testing frequently and report a high degree of positivity and relevancy among tests applied. Recommendations are presented with a focus toward increasing interest in patch testing among the membership.

Academies and Institutes↗
PubMed1995

Contact hypersensitivity to corticosteroids in routine patch test patients. A multi-centre study of the Swiss Contact Dermatitis Research Group.

BACKGROUND: Contact hypersensitivity to corticosteroids is increasingly reported and has been identified as a problem of considerable clinical relevance. The prevalence of positive patch tests to corticosteroids ranges from 0.2 up to 5%. OBJECTIVE: The prevalence of positive patch tests to corticosteroids in Switzerland was determined in a multi-centre study of patients undergoing routine patch tests. METHODS: As representatives of corticosteroid groups, the following substances were used for screening: tixocortol pivalate and hydrocortisone for group A (hydrocortisone type), hydrocortisone butyrate for group D (hydrocortisone butyrate type) and budesonide for both groups B (triamcinolone type) and D. Patients positive for at least one corticosteroid were retested with the screening series and 12 corticosteroids commonly used in Switzerland. RESULTS: Among 3,016 consecutive patients, 65 individuals (2.2%) with a total of 106 positive reactions were found. Retesting showed a concordance of 70-98%, depending on the corticosteroid and the score of the positive reaction. In the subsequently tested corticosteroid series including 12 substances, 19 out of 56 screening-positive patients had a positive result to one or several corticosteroids. There were only few evident cross-reactive patterns in between the corticosteroids tested. CONCLUSIONS: Corticosteroids should be included in routine patch testing, because contact sensitization to a corticosteroid is of considerable practical importance. We confirm that as markers of corticosteroid sensitization tixocortol pivalate, budesonide and hydrocortisone butyrate may be suited, because there is no single corticosteroid which is a marker for all four corticosteroid groups. Patch test reactions of 2+ or higher have a better reproducibility than 1+ reactions.

Administration, Topical↗
PubMed1997

Gramineae pollen as trigger factors of atopic eczema: evaluation of diagnostic measures using the atopy patch test.

After contact with grass pollen, seasonal exacerbations of eczematous skin lesions have been described in a subgroup of patients with atopic eczema (AE). Epicutaneous patch testing with aeroallergens (atopy patch test. APT) has been used to investigate these patients. We performed comparative APT in 79 patients with AE and 20 control subjects (14 non-atopic volunteers and six patients with grass pollen allergic rhinoconjunctivitis). Subjects were tested with grass pollen allergen extract in petrolatum and with unprocessed native dry pollen of Dactylis glomerata. Results after 48 h were compared with the patient's history, corresponding skin prick test and specific IgE. Fifteen of the 79 AE patients showed clear-cut eczematous reactions to unprocessed D. glomerata pollen; 14 of these had an elevated serum IgE to D. glomerata and 13 had a positive skin prick test. Twenty patients had a positive APT reaction to grass pollen allergen extract, including 12 of the D. glomerata reactive subjects (P < 0.001). Positive patch test reactions to D. glomerata were seen in 66.7% of cases with and 10.5% of patients without a predictive history of exacerbations during the pollen season. For the standardized extract, these percentages were 75% vs. 16.4% (P < 0.001). No side-effects were observed. Control subjects showed no positive reactions. We conclude that grass pollen preparations may be used to investigate trigger factors for eczematous skin lesions in a subgroup of patients with AE.

Adolescent↗
PubMed1991

Keratinocyte-expression of interleukin-6 but not of tumour necrosis factor-alpha is increased in the allergic and the irritant patch test reaction.

The cytokine expression on epidermal cells in the allergic patch test reaction (APR) and irritant patch test reaction (IPR) was studied using antibodies against rIL-6, rTNF alpha, rIL-1 alpha and rIL-1 beta in a histochemical biotin-avidin technique. Nickel sulphate was used for APR in 5 nickel allergic patients and sodium lauryl sulphate for IPR in 5 healthy individuals. The individuals served as their own control. Enhanced keratinocyte expression of IL-6 was observed in APR and IPR, whereas staining for TNF alpha remained unaltered compared with non-tested and petrolatum-tested skin. Staining for IL-1 alpha and IL-1 beta proved negative in all specimens. Double-staining experiments demonstrated that epidermal and dermal OKT-6 (CD1) positive Langerhans cells (LC) remained negative for all cytokines. These results demonstrate that enhancement of keratinocyte-bound IL-6 does not induce TNF alpha, IL-1 alpha/beta or IL-6 expression by LC during APR or IPR, and that enhanced keratinocyte expression of IL-6 fails to distinguish between these two reactions.

Adult↗
PubMed2003

Patch testing with thimerosal in a Canadian center: an 11-year experience.

BACKGROUND: Thimerosal has been used for decades as an antiseptic, a disinfectant, and a preservative in various consumer products. It is also a notoriously frequent contact allergen, but the significance of positive patch-test reactions has been debated over the past decade. OBJECTIVE: The aim of this study was to assess the prevalence and relevance of positive patch-test reactions to thimerosal in a large Canadian center and to compare our results with those of previous publications. METHODS: A retrospective analysis of data collected over the course of 11 years in the contact dermatitis clinic of a university hospital was performed. RESULTS: Of 2252 subjects patch-tested for thimerosal, positive reactions were observed in 102 individuals (4.53%), placing thimerosal as the fifth most common allergen in our practice. The sensitization rate was equivalent between the patients who underwent aimed patch testing and those who were routinely tested for reaction to thimerosal when this allergen was included in our standard patch-testing series 8 years into the study. There was an increased incidence of thimerosal sensitization in chemists and laboratory technicians, as well as in health care workers, including medical doctors, registered nurses, dentists, and dental assistants. While eight reactions were deemed possibly relevant, in none of the cases was it possible to definitely establish the relevance of positive reactions to thimerosal, either because the presence of this allergen could not be verified in patients' products or because patch testing with these products gave negative results. CONCLUSION: In agreement with previous reports, we conclude that even though positive reactions to thimerosal are frequent, very few seem to be clinically relevant.

Adolescent↗
PubMed1989

Patch testing in actinic prurigo.

42 out of 93 Saskatchewan Indians (32 female (F) and 10 male (M] with actinic prurigo were patch tested to standard series allergens between 1983 and 1987. Positive reactions were most frequently seen with nickel (3F:2M) and colophony. All 3 positive patch tests to colophony were in males. The same patients were also patch tested to extracts of 21 Saskatchewan plants and 3 Hollister-Stier plant extracts. Only 1 male and 2 females had positive patch tests. None of these 3 had rashes on the eyelids, behind the ears or under the chin. We conclude that plant contact dermatitis is unlikely to be mistaken for actinic prurigo in Saskatchewan.

Adolescent↗