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PubMed1989

ETAF/interleukin-1 and epidermal lymphocyte chemotactic factor in epidermis overlying an irritant patch test.

We have previously demonstrated that the epidermal content of the lymphocyte activating peptide ETAF/IL-1 and lymphocyte chemotactic factor (ELCF) increases during the development of a cell-mediated immune reaction, represented either by the tuberculin skin reaction or by a positive patch test in patients with contact allergy. The present study describes the epidermal content of these mediators during an irritant patch test reaction. The results show that ELCF, but not ETAF/IL-1, is significantly increased in the epidermis of an irritant patch test with 3% SLS or 5% croton oil, irrespective of the intensity of the clinical patch test reaction. We observed that simple occlusion of epidermis did not induce ELCF activity in healthy persons, whereas patients with previous or current eczema had a significant release of ELCF following such occlusion. These results seem to indicate that there exist important functional differences between allergic and irritant patch test reactions with respect to the presence of lymphocyte activating signals in epidermis.

Adult↗

PubMed1981

Patch testing with mixes. Note on mercaptobenzothiazole mix.

Mixes for patch testing conserve space and time. History and current usage of mixes are reviewed with comments on stability, concentration, consistency, use of infrequent allergens, vehicles and ingredients of mixes. Phenomena of 'aging', 'maturity', 'balance' 'stability' and 'quenching' have been studied elsewhere for naturally occurring mixes such as aroma chemicals (fragrances and flavorings). Little is known about any such changes for mixes of chemicals made for patch test purposes. The correct concentration of mercaptobenzothiazole (MBT) for MBT mix is discussed.

Benzothiazoles↗

PubMed2003

Atopy patch test reactions to Malassezia allergens differentiate subgroups of atopic dermatitis patients.

BACKGROUND: The yeast Malassezia is considered to be one of the factors that can contribute to atopic dermatitis (AD). OBJECTIVES: To investigate the reactivity to Malassezia allergens, measured as specific serum IgE, positive skin prick test and positive atopy patch test (APT), in adult patients with AD. METHODS: In total, 132 adult patients with AD, 14 with seborrhoeic dermatitis (SD) and 33 healthy controls were investigated for their reactions to M. sympodialis extract and three recombinant Malassezia allergens (rMal s 1, rMal s 5 and rMal s 6). RESULTS: Sixty-seven per cent of the AD patients, but only one of the SD patients and none of the healthy controls, showed a positive reaction to at least one of the Malassezia allergens (extract and/or recombinant allergens) in at least one of the tests. The levels of M. sympodialis-specific IgE in serum correlated with the total serum IgE levels. Elevated serum levels of M. sympodialis-specific IgE were found in 55% and positive APT reactions in 41% of the AD patients with head and neck dermatitis. A relatively high proportion of patients without head and neck dermatitis and patients with low total serum IgE levels had a positive APT for M. sympodialis, despite lower proportions of individuals with M. sympodialis-specific IgE among these groups of patients. CONCLUSIONS: These results support that Malassezia can play a role in eliciting and maintaining eczema in patients with AD. The addition of an APT to the test battery used in this study reveals a previously overlooked impact of Malassezia hypersensitivity in certain subgroups of AD patients.

Adolescent↗

PubMed1983

Cinnamic aldehyde: a survey of consumer patch-test sensitization.

The potential for cinnamic aldehyde, an important fragrance and flavour ingredient, to induce or to elicit delayed contact hypersensitivity reactions in man was evaluated by analysing patch-test data. Results of studies involving a total of 4117 patch tests on various consumer products and fragrance blends containing cinnamic aldehyde and on the material itself were collected from fragrance and formulator companies. The data indicate that cinnamic aldehyde contained in consumer products and fragrance blends at concentrations up to 6 X 10(-1)%, and patch-tested at concentrations up to 8 X 10(-3)%, has no detectable potential to induce hypersensitivity. Cinnamic aldehyde when tested alone induced a dose-related hypersensitivity response. According to published reports, cinnamic aldehyde elicited positive delayed hypersensitivity responses in dermatitic patients. However, results of the current survey show that when cinnamic aldehyde was tested alone or as part of a mixture in subjects in the general population, no pre-existing hypersensitivity reactions to the fragrance material were observed in any of the 4117 patch tests which constituted the survey. Cinnamic aldehyde at the concentrations contained in consumer products and fragrances, has a very low potential to induce hypersensitivity ('induced' reactions) or to elicit sensitization reactions ('elicited' reactions) in the general population.

Acrolein↗

PubMed2005

Treatment of eosinophilic esophagitis with specific food elimination diet directed by a combination of skin prick and patch tests.

BACKGROUND: Eosinophilic esophagitis (EE) is a recently described disorder identified in patients with symptoms suggestive of gastroesophageal reflux disease (GERD) but unresponsive to conventional reflux therapies. Therapies have included corticosteroids, elemental diet, and diet restriction. We report our experience with skin prick and atopy patch testing and food elimination diets in patients diagnosed as having EE. OBJECTIVE: To identify food antigens that cause EE and the characteristics of patients who respond to food elimination vs those who are unresponsive. METHODS: Patients diagnosed as having EE had restricted diets based on skin prick and atopy patch testing results. Additional biopsies were performed after 4 to 8 weeks of restricted diet. Demographics, atopic tendencies, and food antigens were identified retrospectively in our food allergy database. RESULTS: A total of 146 patients diagnosed as having EE were evaluated with skin prick and atopy patch testing. Thirty-nine patients had unequivocal demonstration of food causing EE, with normalization of biopsy results on elimination and reoccurrence on reintroduction. An additional 73 patients, for a total 112 (77%) of 146 patients, had resolution of their EE as demonstrated by biopsy results. Fifteen (10%) of 146 patients were nonresponders manifested by no significant reduction in esophageal eosinophils despite restricted diet based on skin prick and atopy patch testing. Egg, milk, and soy were identified most frequently with skin prick testing, whereas corn, soy, and wheat were identified most frequently with atopy patch testing. CONCLUSION: In more than 75% of patients with EE, both symptoms and esophageal inflammation can be significantly improved with dietary elimination of foods. Skin prick and atopy patch testing can help identify foods in most patients.

Adolescent↗

PubMed1996

Combined skin prick and patch testing enhances identification of food allergy in infants with atopic dermatitis.

BACKGROUND: Early recognition of dietary allergies in infants with atopic dermatitis is essential for avoidance of unnecessary elimination diets, amelioration of the skin disease, and secondary prevention of the development of multiple food allergies. Simple and accurate methods of identifying provocative foods are urgently needed. METHODS: The usefulness of skin prick and patch tests as indicators of cow milk allergy was evaluated in 183 patients ranging in age from 2 to 36 months with double-blind, placebo-controlled (n = 118) or open (n = 65) cow milk challenges. RESULTS: The oral cow milk challenges were interpreted as positive in 54% of both challenge types. Positive challenge rapidly elicited pruritus, urticaria, and/or exanthema in 49% of cases and delayed-onset eczematous lesions in 51%. The skin prick and patch tests gave markedly discrepant results; prick tests were positive in 67% of the cases with acute-onset reactions to milk challenge, whereas patch tests tended to be negative. Patch tests were positive in 89% of those with delayed-onset reactions, although prick tests were frequently negative. CONCLUSIONS: The observations indicate that IgE and T cell-mediated responses to cow milk can be distinguished in atopic dermatitis. Parallel skin testing with combined prick and patch tests can significantly enhance the accuracy in diagnosis of specific dietary allergies in patients with atopic dermatitis.

Animals↗

PubMed2001

Screening for acetaldehyde dehydrogenase 2 genotype in alcohol-induced asthma by using the ethanol patch test.

BACKGROUND: We have previously reported that alcohol-induced asthma in Japanese patients is caused by increased blood acetaldehyde concentration resulting from abnormalities of acetaldehyde dehydrogenase 2 (ALDH2) enzyme activity on the basis of ALDH2 genotype differences. OBJECTIVES: The purpose of the present study was to determine whether the ethanol patch test could predict the ALDH2 genotype in Japanese asthmatic subjects. METHODS: An ethanol patch test on the upper arm and a questionnaire survey addressing the past history of alcohol-induced asthma were administered to 148 adult Japanese asthmatic subjects. The ALDH2 genotypes in these 148 subjects were also determined by means of PCR. RESULTS: The genotype distribution of ALDH2 determined by PCR in 68 subjects with positive ethanol patch test results was 4 (5.9%), 56 (82.4%), and 8 (11.8%) for genotypes NN (normal homozygote), NM (mutant heterozygote), and MM (mutant homozygote). The ALDH2 genotype in 80 subjects with a negative test result was only NN. The distribution of ALDH2 genotype in 78 (52.7%) subjects who had experienced alcohol-induced asthma symptoms on the basis of the questionnaire was 27 (34.6%), 44 (56.4%), and 7 (9.0%) for genotypes NN, NM, and MM, respectively. On the other hand, 70 subjects had never experienced alcohol-induced asthma symptoms. In these subjects the ALDH2 genotype was NN in 51 (72.9%), NM in 18 (25.7%), and MM in 1 (1.4%). CONCLUSIONS: Our results indicate that the results of ethanol patch testing correlate well with ALDH2 genotype, as determined by means of PCR, suggesting that the ethanol patch test is useful for the screening of alcohol-induced asthma.

Adult↗

PubMed1984

Patch testing with colophony.

Colophony (rosin) has been fractionated into 2 parts, an acidic and a neutral fraction. Routine patch testing with neutral components gives positive reactions at a 40% higher frequency than routine patch testing with colophony (20%) (w/w in pet.). A concentration of 60% colophony is suggested for routine patch testing.

Dermatitis, Contact↗

PubMed2003

Marking patch tests sites: description of a practical, clean, durable and inexpensive method.

We propose an original method to mark patch test sites. A transparency is applied on the patient's back, surrounding patch tests, immediately after their application. Marks are performed with an erasable pen on test sites and on permanent skin lesions like naevi. For further readings performed after patch test removal, the transparency applied on the patient's back permits the attribution of a positive reaction. This method is clean (without ink marks on skin and without contamination of clothing), more comfortable for the patient (allowing back washing immediately after the 1st reading, never inducing allergy to inks), durable (permitting delayed readings after several days or weeks) and inexpensive (because transparencies can be reused).

Dermatitis, Allergic Contact↗

PubMed1993

Contact hypersensitivity to hydrocortisone-free-alcohol in patients with allergic patch test reactions to tixocortol pivalate.

It has been suggested that contact allergy to hydrocortisone alcohol is a frequent phenomenon. A recent study showed that all patients with allergic patch reactions to tixocortol pivalate reacted to intradermal hydrocortisone sodium phosphate. We studied patients with positive patch test reactions to tixocortol pivalate but negative to hydrocortisone alcohol, with penetration enhancers in hydrocortisone alcohol patch tests and oral challenges with hydrocortisone alcohol. Additionally, prick and intradermal tests with hydrocortisone sodium succinate were used. Using penetration enhancers and oral challenges enabled detection of more contact allergies to hydrocortisone alcohol compared to conventional patch testing alone. 9/12 patients with allergic reactions to tixocortol pivalate reacted to intradermal hydrocortisone sodium succinate. No immediate reactions were seen in prick or intradermal tests, suggesting that hydrocortisone contact hypersensitivity is probably not associated with immediate allergy to hydrocortisone. The present study suggests that allergic patch test reactions to tixocortol pivalate are caused by hypersensitivity to hydrocortisone alcohol itself or to one of its metabolites in the skin.

Anti-Inflammatory Agents↗

PubMed1997

Hand dermatitis and allergic patch test reactions caused by nickel in electroplaters.

A worksite survey was conducted in all 38 Finnish electroplating plants. All workers (n = 163) who worked with nickel plating (bath workers, hangers and solution makers) were interviewed with a questionnaire about symptoms of nickel dermatitis, hand dermatitis, and about protective measures, atopy, etc. Patch testing with nickel sulfate was done with the TRUE TestTM method. All the workers, 94 men and 69 women, answered the questionnaire. The mean age of women was 41.1 years, and of men 43.1 years, respectively. Men had longer occupational exposure to nickel (14 years) than women (10 years). Most workers used protective gloves. 35% of women and 30% of men reported present or past hand dermatosis. 19% reported a history of atopic dermatitis. 15% of women (n = 8) and 4% (n = 2) of men had an allergic patch test reaction to nickel sulfate. 70% of those with an allergic patch test reaction to nickel reported past or present hand eczema. The prevalence of nickel allergy among the electroplaters was similar to that of patients in patch test clinics in Finland. An allergic patch test reaction to nickel sulfate does not necessarily oblige an electroplater to change jobs.

Adult↗

PubMed1991

A model for contrast discrimination with incremental and decremental test patches.

Whittle [Vision Research, 26, 1677 (1986)] has shown that the metric of contrast W = delta L/Lmin (delta L = difference in luminance between test patch and background, Lmin = the smaller of the luminance of the background or test patch) is able to provide a unifying description of the pattern of contrast discrimination thresholds for pairs of test patches set against a common background. In particular the metric W unifies the pattern of discrimination thresholds for both increment and decrement pairs. We argue that while W provides a good mathematical description of Whittle's data it is functionally implausible since it implies that the component of the stimulus which sets the adaptational level for increments is different from that which sets the adaptational level for decrements. We argue that the metric G = ln(L/Lb) (L = test patch luminance, Lb = background luminance) is physiologically more plausible than W and show that G can provide at least as good a fit as W to Whittle's data when incorporated in a transfer function of the form RG = kG1-n, with n set to 0.69. The fit to the data can be improved still further if a parameter representing the non-linearity in the gain-luminance function at low luminances is included in the RG equation. The theoretical implications for retinal gain mechanisms are discussed.

Contrast Sensitivity↗

PubMed2003

Adult-onset atopic dermatitis in a patch test population.

BACKGROUND: Epidemiological studies about atopic dermatitis (AD) almost exclusively relate to childhood disease with little mention of adult-onset disease. In clinical practice, however, patients who have AD and in whom the onset of disease occurs in adult life are sometimes seen. OBJECTIVE: Because the subjects with a chronic and recalcitrant eczema are frequently patch tested, the aim of this study was to evaluate the prevalence of adult-onset AD in a patch test population and the differences existing between the early- and adult-onset subsets. METHODS: This retrospective analysis was performed on 502 adults (458 males, 44 females) affected by eczematous dermatitis, consecutively examined in the Department of Dermatology of the Italian Navy Hospital in Taranto. In this department, all the eczematous subjects are routinely submitted to the following tests: standard series (GIRDCA or SIDAPA with integrative haptens), prick test with environmental aeroallergens and common food allergens and dosage of total serum IgE. If it is required, additional series of patch tests are also applied. Many patients are also submitted to the atopy patch test (APT) with whole bodies of house dust mites at a concentration of 20%. In the AD patients, diagnosed according to the criteria of Hanifin and Rajka, the ages of onset were subdivided into the following categories: infancy (0-3 years); childhood (4-11 years); adolescence (> or =12 years). We arbitrarily also used the age of 18 years as the cut-off mark to allocate the patients to the adult-onset group (AOG) and defined as early-onset group (EOG) the cases encompassed in the aforesaid categories (i.e. onset < or =17 years). RESULTS: 8.8% of all eczemas were adult-onset ADs. 28 (5.6% of all eczemas) adult-onset ADs were 'sole' ADs, while 22 cases (3.2% of all eczemas) were adult-onset ADs in which a contact sensitization was detected. The mean SCORAD indexes, according to the age-of-onset groups, decreased when the age of onset increased. No statistical difference was detected between the EOG and AOG with regard to true contact sensitization, clinically relevant or non-relevant contact sensitization, prevalence of 'pure' AD and 'mixed' AD, and outcome of the APT. The hands were the most frequently affected site in the AOG. CONCLUSION: A small but significant number of patch-test-negative eczematous cases could be adult-onset ADs and, in this instance, the other two allergological tests (i.e. prick tests and dosage of total serum IgE) and an accurate evaluation according to stated clinical criteria should be performed. However, other studies on large series of patients are required to confirm our observation.

Adolescent↗

PubMed2005

Recommendation to include methyldibromo glutaronitrile in the European standard patch test series.

The preservative methyldibromo glutaronitrilc (MDBGN) is used non-occupationally and occupationally. High contact allergy rates have been reported when tested in consecutive dermatitis patients as well as clinical cases with allergic contact dermatitis. Up till now there has been no agreement on which patch test preparation to use to trace contact allergy to MDBGN. From the year 2005 on, MDBGN at 0.5% w/w in petrolatum is recommended for the European standard patch test series. The choice of 0.5% is based on consideration of rates of contact allergy, doubtful and irritant reactions, as well as on information on clinical relevance represented by results of a repeated open application test, and patch test concentrations to diagnose allergic contact dermatitis from MDBGN in individual cases.

Allergens↗

PubMed1998

Unusual edge effect in patch testing with silver nitrate.

Silver nitrate is a widely used substance and has been applied topically for cauterizing bleeding and healing wounds. In the past it has even been used to mark patch test sites, when no one knew that the substance itself might be a sensitizer. However, there are also toxic reactions to that substance. We report a case in which a positive "edge effect" at the periphery of the patch test site could be shown. It can be explained by the unequal distribution of patch test solutions in the different patch test systems with a concentration at the rim. Distinguishing between allergic and toxic reactions may be difficult when an edge effect occurs. Therefore, in certain rare cases a biopsy or a lymphocyte transformation test might be of help.

Allergens↗

PubMed2000

Patch testing with neomycin sulfate.

The recommended patch test concentration of neomycin sulfate is 20% in petrolatum applied occluded for 48 h (2 days [D]). In the current study, the efficiency of such a test is compared to results with other techniques using lower allergen dose than obtained by approximately 20 microl of the 20% substance. Efficiency of petrolatum and demineralized water as vehicles are compared. 16 neomycin-sulfate positive subjects were retested with serial doses ranging from 0.4 to 0.0085 mg/cm2 neomycin sulfate in cellulose printed on polyester squares and applied by both tapes and plastic foils. Additionally, tests were performed with the 20% petrolatum substance in Finn Chambers. Tests containing the 20% substance in petrolatum and in water were applied directly with transparent foils. Readings ranged from 3 to 264 h (11D) following applications. Results show that foil applications of a polyester square dose, that is 7% of the dose obtained with the 20% substance, distinguished between perfusion of subjects who were visually positive and not with any test in the study. With the same test technique and visual assessments, 2 subjects were false-negative but developed doubtful test responses with the Finn Chambers.

Dermatitis, Allergic Contact↗

PubMed1984

Finn chamber patch test technique.

Proper technique aids reliable patch test results. The Finn chamber volume was determined to be 25 microliters. These studies suggest the optimal volume semi-solid test substance to be 12-15 microliters. More than 18-21 microliters caused significant extrusion of test substance and improper adhesive adherence. Finn chamber paper discs used with solutions absorb a maximum of 17.5 microliters test solutions and keep 15 microliters within the chamber. The evaporation rate of aqueous test solutions from Finn chambers was 1 mg/3 min; thus, the chambers should be applied quickly to avoid drying.

Dermatitis, Contact↗

PubMed1989

Patch testing with nickel chloride in a hydrogel.

Various concentrations of NiCl2 in a hydrogel were evaluated as a possible alternative to the standard patch test material of 5% NiSO4 pet. Patch test responses were recorded on a total of 430 patients with known or suspected contact allergy. A NiCl2 concentration of 1% or less in the hydrogel failed to elicit a response in some patients who reacted to 5% NiSO4 pet. The 2% NiCl2 hydrogel produced a small increase in response frequency and may reduce false-negative reactions. Along with the ability of the material to improve the topical bioavailability of nickel ions, more irritant reactions were observed. However, in cases with a positive history and a negative patch test with petrolatum, the hydrogel prepared from Methocel-E-4M seems to be a useful alternative vehicle for water-soluble allergens.

Dermatitis, Contact↗