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PubMedDate not supplied

Patch testing in the detection of cutaneous reactions caused by carbamazepine.

Carbamazepine is a widely used antiepileptic drug associated with various side effects including skin eruptions. Peroral provocation test with any suspected drug is a reliable method of investigating the etiology: however, it is both laborious and potentially dangerous to the patient. Patch testing has been reported with variable success in skin drug reactions. Four cases (one male, three females) with epileptic seizures were reviewed; all had received carbamazepine therapy with appropriate dosage, then suffered from various cutaneous reactions including maculopapular exanthema, exfoliative dermatitis, erythema multiforme and Stevens-Johnson syndrome after the initial therapy for two weeks to one month. Skin patch test was done with 1% and 10% carbamazepine in petrolatum applied on the back, then read at 48 and 72 hours. All four patients had positive allergic patch test reactions to carbamazepine. One patient had extreme (+3), one had strong (+2) and another two had weak (+) reactions. There were no any skin reaction to vehicle and control cases. This limited study demonstrates that patch testing may be useful in the detection or confirmation of any type of exanthematous eruption caused by carbamazepine.

Adolescent↗
PubMed2003

Detection of occupational allergic contact dermatitis by patch testing.

Occupational allergic contact dermatitis (OACD) is an important medical and occupational health problem. If undiagnosed, the disease may persist and even spread widely, resulting in severe and permanent disability to the worker, who may be deprived of his legal right to compensation. OACD is not uncommon in China, although many dermatologists fail to establish the connection between disease and working conditions, because they think that the diagnosis of OACD is the work of occupational medicine and that special diagnostic methods are required. The Ministry of Health and Ministry of Labour and Social Security of China have issued a new law recently to emphasize the prevention and treatment of occupational disease. It requires physicians to make an accurate diagnosis and report of occupation-related diseases. In this study, we have successfully investigated 14 cases of OACD in our hospital by patch testing the patients with a standard series of allergens and investigating by questionnaire the suspected offending occupational allergens. During a 2-year period (2001-2003), 14 patients with suspected allergic contact dermatitis were investigated and confirmed as having OACD. OACD may develop in many different occupations. In this study, nickel, 4-phenylenediamine, fragrance mix, black rubber mix, colophonium, epoxy resin and thiuram mix were identified by patch testing as the main offending allergens in such patients. These results indicate that patch testing plays a vital role in the diagnosis and identification of occupational allergens, and our study shows that OACD can often be diagnosed by patch testing patients with a standard series. The clinician should be alert to recognize the offending allergens of OACD by referring to patch testing all patients with clinically suspected contact dermatitis, and then educating the sensitized worker in how to avoid further exposure to the causative allergens.

Adult↗
PubMed1996

Patch testing to cosmetics and topical drugs.

Evaluating patients with a possible cosmetic or medicament allergy is an excellent way for dermatologists to become acquainted with using patch test substances beyond the standard tray. Testing should include standard tray allergens and almost all topical products themselves. False-positive and false-negative results must always be considered in evaluating patch test results. Repeat open application testing can be useful in confirming patch test results, but it is best to test each ingredient separately. If they are willing to take the time, dermatologists can easily and efficiently evaluate these patients.

Allergens↗
PubMed2006

Optimizing reproducibility for clinical studies involving patch testing and application of topical preparations.

BACKGROUND: The reproducibility and consistency of patch-test techniques can be problematic, making controlled clinical trials of patch testing difficult. OBJECTIVE: To measure the accuracy and reproducibility of applying controlled quantities of petrolatum onto Finn Chambers. METHODS: Four dermatology nurses applied a total of 240 samples of white petrolatum, using three syringe sizes and types. Three different amounts of white petrolatum (0.02 mL, 0.05 mL, and the "usual" amount) were expressed onto previously weighed Finn Chambers, using three different syringe sizes (5 mL, 1 mL, and 0.5 mL), five times each on two separate days. RESULTS: The average weights of 0.05 mL of petrolatum expressed with each type of syringe (5 mL: 0.04252 g; 1 mL: 0.04084 g; and 0.5 mL: 0.04139 g) were not significantly different from each other in pairwise comparisons (p > .36) or from the "gold standard" expected value (0.04138 g, p > .72). The average weights of 0.02 mL of petrolatum expressed with two types of syringes (5 mL: 0.02138 g; 0.5 mL: 0.01778 g) were significantly different from each other (p = .0012), but neither differed significantly from the expected value (0.01655 g, p > .08). The variance due to the effect modifications of nurse, day, and interaction of nurse and day was statistically significant for measurements made with the 5 mL syringe but not for measurements made with the 1 mL or 0.5 mL syringe. CONCLUSION: The average amounts of petrolatum extruded from smaller syringes (0.5 mL and 1 mL) were less variable and more reproducible than those extruded from a 5 mL syringe.

Administration, Cutaneous↗
PubMed1996

Statistical evaluation of the persistence of acquired hypersensitivity by standardized patch tests.

Numerous studies have focused attention on the influence of various biological and environmental factors on contact hypersensitivity. In order to evaluate the persistence and/or modification of allergic contact sensitivity to a number of common contact sensitizers, the same standardized patch tests were repeated on 174 subjects with contact sensitivity after a time lapse of 5 years (1987-1992). In 18.4% of the cases, 1 or more sensitivities were lost; 28.7% of the patients had a higher number of positive patch tests after 5 years, while the remaining 52.9% of the patients showed no change in the number of positive patch tests. In 88%, the positive allergens were unchanged, whereas in the remaining 12% of the subjects, they showed 1 or more variations. The association between the allergens most often positive was calculated for both the 1st and the 2nd patch test results. Moreover, to evaluate the frequency of an allergen's positivity, we studied the disappearance of old sensitivities and the appearance of new sensitivities by the McNemar test. Cobalt chloride was the only allergen with a significant frequency of new positivities over the period of observation (p < 0.01). Logistic regression analysis was performed to evaluate the possible influence of positive tests to other allergens, and of some clinical findings associated with contact dermatitis, on the sensitivity to cobalt chloride in 1987 and in 1992.

Adult↗
PubMed1990

[Histological findings of patch tests with dermatofagoides antigens in atopic dermatitis of the adult type].

Patch testing with Dermatophagoides antigens, mite antigens, and fecal antigens of mites was performed on 34 cases of atopic dermatitis of the adult type. The fecal antigens induced positive reactions more frequently than mice antigens in patients with higher scores of IgE RAST (score 4). Histologically, the positive reaction showed mild perivascular infiltration of lymphocytes and edema in the papillary dermis at 24 hours after the patch test. The lymphocytic infiltration became more prominent and was intermingled by eosinophils at 48 hours. The epidermis showed mild intercellular edema. Eosinophils and lymphocytes infiltrated into the epidermis to form spongiotic bulla at 72 hours.

Adolescent↗
PubMed1989

Atopy in subjects with a history of nickel allergy but negative patch tests.

Various markers of atopy were studied in 20 subjects with a history of nickel allergy but negative patch test reactions, and compared with 2 control groups: 13 subjects with no history of nickel allergy and negative patch tests; 11 subjects with a history of nickel allergy and positive patch tests. No significant difference in the incidence of atopy was detected in the 3 groups.

Dermatitis, Atopic↗
PubMed2005

Cross-comparison of patch test and lymphocyte proliferation responses in patients with a history of acute generalized exanthematous pustulosis.

An adverse cutaneous reaction to a systemically administered drug may rarely manifest as acute generalized exanthematous pustulosis (AGEP). Several recent reports have documented positive patch test results in patients with a history of AGEP, while two have demonstrated drug-specific in vitro lymphocyte proliferative responses. These findings suggest that drug-specific T cells mediate AGEP. We describe two patients with a history of AGEP who each demonstrated positive patch test results specific for the inciting drug: Patient #1 to the antibiotic metronidazole, and Patient #2 to the calcium channel-blocker diltiazem. Histologic examination of biopsy specimens taken from the patch test sites of these patients revealed spongiotic dermatitis and perivascular lymphocytes consistent with a delayed-type hypersensitivity reaction, rather than demonstrating subcorneal neutrophilic pustules more typical of AGEP. In vitro testing by measuring peripheral T cell proliferative responses to chemically purified drug correlated with the clinical response. In a direct cross-comparison, patch test results were shown to correlate with in vitro lymphocyte proliferative responses in two patients with a history of AGEP to different drugs. These findings provide additional evidence that the pathogenesis of AGEP involves a T cell-mediated immune response.

Adult↗
PubMedDate not supplied

Predicting visual assessment of allergic patch test reactions by non-invasive measurements.

The quantification of allergic patch test reactions to several compounds was evaluated on patients using laser Doppler velocimetry (LDV), transepidermal water loss and colorimetry. The correlation between visual scores and instrumental measurements was investigated by the implementation of a modern statistical method: a classification tree. The LDV showed the highest correlation with the severity of the reaction. The best prediction model was obtained when the data of the three instruments were considered together. Using the classification tree methodology, a model of classification, independent of human observation, was developed. The technique can not only predict an allergic reaction for a new patient, but can also give a measure of how reliable its predictions are. This new method, when entirely standardised and approved, could help in the harmonisation of patch test reactions in different laboratories, thus allowing a more homogenous interpretation of these reactions.

Adult↗
PubMed1989

Patch testing in Hong Kong.

The acceptability and value of patch testing in Hong Kong was studied in 56 cases of suspected dermatitis (CD), 26 cases of endogenous eczema (EE) and 30 cases of unclassified eczema (UE), selected systematically: all those suspected of having CD and 1 in 3 of the others. 81.3% of the 112 patients selected accepted the test. The main reasons for refusal were inconvenience and lack of time for the readings. Of the 91 tested, in 88 they were successfully completed. In 39 patients, the results were negative, while 49 patients reacted to 1 or more allergens. The 2 commonest sensitizers were fragrance-mix (15 patients) and nickel sulphate (14 patients). The "usefulness" of patch testing was defined as it causing the initial clinical diagnosis to be changed. The test was found to be "useful" in 10 cases (21.3%) of those diagnosed as CD in 2 respects: (a) changing the diagnosis from irritant to allergic CD (6 cases) and (b) changing the diagnosis from CD to a suspected substance, to CD to another unsuspected substance (4 cases). For EE and UE, the initial diagnosis was changed to allergic CD in 3 (18.7%) and 7 (28.0%) cases, respectively.

Climate↗
PubMed2004

Iodopropynylbutyl carbamate 0.2% is suggested for patch testing of patients with eczema possibly related to preservatives.

BACKGROUND: Iodopropynyl butylcarbamate (IPBC) is a new preservative in medical and cosmetic leave-on products. Although cases of allergic contact dermatitis to IPBC have been reported, it is not known whether the usual test concentration of 0.1% is appropriate for screening tests with IPBC. OBJECTIVES: To determine the concentration of IPBC that should be used in screening patch tests. METHODS: An analysis was made of data filed by 26 centres of dermatology on patch tests performed with one or two concentrations of IPBC (0.1%, 0.2%, 0.3% or 0.5%) in 8106 unselected patients. Criteria used to determine the best test concentration of IPBC were the reaction index, the positivity ratio, the rate of crescendo reactions, and the relations between IPBC reactions and the MOAHLFA index irritant reactions to sodium lauryl sulphate (SLS), and allergic reactions to other contact allergens including preservatives. RESULTS: IPBC 0.1%, 0.2%, 0.3% and 0.5% yielded 0.5%, 0.8%, 1.3% and 1.7% positive reactions, but this increase was accompanied by an even greater increase in doubtful and irritant reactions. These figures and the other criteria examined suggested the range of suitable test concentrations of IPBC to lie between 0.2% and 0.3%. A detailed analysis of MOAHLFA indices and of associations between reactions to IPBC and reactions to other allergens and to SLS showed that most of the positive reactions to IPBC 0.2% can be assumed to be allergic ones and that with IPBC 0.2% fewer false-positive reactions can be expected than with IPBC 0.3%. CONCLUSIONS: Patch testing with IPBC 0.2% is suggested for patients with eczema possibly related to preservatives.

Adult↗
PubMed2001

Diagnostic value of skin-prick and patch tests and serum eosinophil cationic protein and cow's milk-specific IgE in infants with cow's milk allergy.

The diagnosis of cow's milk allergy is based on a clinical response to an elimination-challenge test with cow's milk. We studied the usefulness of the skin-prick and patch tests and measurement of cow's milk-specific IgE and eosinophil cationic protein in serum as diagnostic tools for cow's milk allergy in a cohort of 6209 unselected infants followed from birth for the development of cow's milk allergy. Of the 239 infants challenged with cow's milk, 118 showed a positive and 121 a negative response at a mean age of 6.9 months. A positive reaction to a skin-prick test with cow's milk (> or = 3 mm) was seen in 72 (61%) and 29 (24%) infants with positive and negative challenges, elevated serum cow's milk-specific IgE (> or = 0.7 kU/L) in 52 (45%) and 15 (13%) infants, a positive reaction to patch test with cow's milk protein fractions in 26 (26%) and eight (8%) infants, and elevated serum eosinophil cationic protein (> or = 20 microg/L) in 22 (21%) and seven (13%) infants, respectively. Parallel use of the four tests with the above-mentioned cut-off values correctly classified 73% of the infants with a sensitivity of 0.76 and a specificity of 0.67. An immediate reaction to cow's milk challenge correlated with skin prick test positivity and elevated serum milk-specific IgE, and tended to correlate with patch test positivity. No single test or parallel use of the four tests could predict the challenge outcome acceptably in this prospectively followed, unselected cohort of 6209 infants. A positive reaction to one or more tests needs to be confirmed by a challenge test and a negative response to all four tests does not rule out the possibility of cow's milk allergy.

Blood Proteins↗
PubMed2005

Positive patch-test reactions to gold: patients' perception of relevance and the role of titanium dioxide in cosmetics.

BACKGROUND: Positive patch-test reactions to gold that are without obvious clinical relevance are common. We speculate that titanium dioxide in cosmetics and sunscreens may adsorb gold particles in jewelry that occasionally contacts facial skin and cause contact dermatitis on this area despite the absence of dermatitis under gold jewelry worn on the hands. OBJECTIVE: To identify subgroups of gold allergic patients who improve with avoidance of gold. METHODS: A questionnaire was mailed to 102 gold-allergic patients. RESULTS: There were 49 responses, of which all but one were from women. When asked to evaluate the statement that patch testing with gold was useful to them, one-third of respondents agreed completely, one-third agreed in part, and one-third disagreed. The majority of patients reported that their dermatitis improved after patch testing, but most were avoiding other allergens in addition to gold. CONCLUSIONS: Avoidance of gold earrings did not appear to benefit patients with earlobe dermatitis, but total avoidance of gold jewelry on the hands and wrists did seem to benefit a subgroup of patients with facial and eyelid dermatitis who wore powder, eye shadow, or foundation on affected areas.

Allergens↗
PubMed2000

Clinical and immunologic variables in skin of patients with atopic eczema and either positive or negative atopy patch test reactions.

BACKGROUND: Epicutaneous application of aeroallergens induces a positive atopy patch test (APT) response in about 50% of patients with atopic eczema (AE) and sensitization for these allergens. OBJECTIVE: To elucidate the mechanisms determining the outcome of the APT, the following questions were addressed. Are there differences in clinical features between patients with AE who have positive versus negative APT responses? Is a macroscopically negative APT response also histologically negative, and if so, are there differences in clinically noninvolved skin between the two groups regarding (1) the sensitivity toward an irritant, (2) the composition of cellular infiltrate, (3) the presence of aeroallergen-specific T cells, and (4) the number of IgE(+) cells? METHODS: Punch biopsy specimens from both house dust mite patch tested and the clinically noninvolved skin of patients with AE who have positive APT responses (n = 10) and negative APT responses (n = 10) and those from the normal skin of atopic individuals without AE (n = 10) and nonatopic volunteers (n = 10) were analyzed by using immunohistochemistry with mAbs against eosinophil cationic protein, IgE, the high-affinity receptor for IgE, and CD3 and CD25 mAbs. Furthermore, T-cell lines were propagated from noninvolved skin of all patient and control groups. The T-cell lines were tested for house dust mite specificity. RESULTS: Negative APT sites were immunohistochemically similar to clinically noninvolved AE skin. There were no significant differences between patients with AE who had positive and negative APT results regarding either clinical features, the composition of cellular infiltrate, or the presence of allergen-specific T cells in clinically noninvolved skin. However, differences were observed regarding the presence of IgE on epidermal CD1a(+) cells. CONCLUSION: Our results indicate that a positive APT reaction requires the presence of epidermal IgE(+) CD1a(+) cells in clinically noninvolved skin, but that also other, as yet unknown, discriminatory factors are involved.

Animals↗
PubMed2003

Evidence-based diagnosis in patch testing.

Evidence-based medicine (EBM) is defined as the integration of the best research evidence with clinical expertise and patient values. Based on the principles of EBM, we can conclude that patch testing is cost-effective only if patients are selected on the basis of a clear-cut clinical suspicion of contact allergy and only if patients are tested with chemicals relevant to the problem (high pretest probability). Random patch testing (low pretest probability) should be discouraged. Proper pretest probability assessment can only be done in expert centres, because problem-based testing requires both a thorough knowledge of the patch-test procedure and knowledge about potential sensitizers in a specific environment.

Allergens↗
PubMed2004

Are adverse skin reactions to cosmetics underestimated in the clinical assessment of contact dermatitis? A prospective study among 1075 patients attending Swedish patch test clinics.

It is known that cosmetics and skin care products can cause adverse skin reactions. However, the frequency of adverse reactions reported to the Medical Product Agency (MPA) in Sweden is low. The purpose of the present study was to evaluate the occurrence of adverse skin reactions to cosmetics among patients referred for standard patch testing owing to suspected contact dermatitis in general, most frequently hand eczema. Consecutive patients at four patch test clinics in Sweden were invited to participate; 1075 were included. Of these, 47.3% (54.2% women and 30.8% men) reported current or previous adverse skin reactions to cosmetics and skin care products. This group showed significantly more positive patch test reactions, a higher prevalence of atopic dermatitis and the dermatitis was more frequently located in the face and neck region. Our results show that patients referred for standard patch testing have--or have had--a large proportion of self-reported adverse reactions to cosmetics or skin care products. We conclude that among patients with suspected contact dermatitis, adverse reactions to cosmetics can be a more important aetiological and/or complicating factor than is commonly acknowledged and that the reporting of such reactions to the MPA probably can be improved.

Allergens↗
PubMed2004

Patch testing with a standard allergen ("screening") tray: rewards and risks.

The TRUE Test panels, which are the only patch testing devices approved by the Food and Drug Administration in the US, consist of 24 patches, one of which is a negative control. The remaining 23 patches contain 42 unique allergens and four complex mixtures. Although these panels contain approximately 1.4% of the > 3700 known allergens, they perform robustly in detecting allergic contact dermatitis (ACD). Twenty-eight percent of patients are fully evaluated by application of TRUE Test((R)). The present paper reviews the appropriate use of the TRUE Test panels. The need to determine relevance of any positive reaction is stressed. The common causes of false-positive and false-negative reactions are outlined. Those product types where the TRUE Test panels detect the majority of relevant allergic reactions are reviewed, as are the other sources of exposure to the allergens on these panels. The impact of ACD on quality of life is significant. Only by patch testing can the diagnosis be made.

Allergens↗