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PubMed1997

[Allergy and atopic eczema: on the value of the "atopy patch test"].

The role of allergic reactions in eliciting and maintaining atopic eczema (AE) is still controversial. In a subgroup of patients with atopic eczema, exacerbations of itching and eczematous skin lesions have been described after contract with aeroallergens. To investigate this observation, an epicutaneous patch test with IgE-inducing allergens (atopy patch test, APT) has been proposed, which results in eczematous skin reactions in 30-70% of AE patients. Usage of allergen concentrations exceeding 5000 PNU/g in petrolatum allows testing on clinically uninvolved skin without potentially irritating epidermal tape stripping. The clinical relevance of positive APT reactions is suggested by comparison of APT with skin prick test, specific IgE, patient's history and eczema pattern. Patients with an eczema pattern with preferred localization of skin lesions in air-exposed areas, a predictive history and raised specific IgE (depending on allergen) were shown to have the highest rate of positive APT. Future controlled studies with allergen avoidance and reexposition may focus on this patient group.

Allergens↗
PubMed1997

[Study on standard of patch test for cosmetic allergens].

39 allergens, chemical ingredients commonly used in cosmetics in China, were tested. The safe concentration of allergens was determined in experiments on animals. On the basis of the above results and referring to the literature, the concentration of allergens used in patch test for human was designed and the patch test was carried out on 10 volunteers by routine method. Finally the concentration which gave no reaction in all 10 volunteers was verified in patients with eczema or contact dermatitis. The rate of positive reactions for each allergen was raged from 0 to 12% with an average 3.4%, According to the results of three above mentioned experiments the series of allergen standards for patch test was established. It is used as an appendix to the document for diagnostic criteria and principles of management of consmetic diseases.

Allergens↗
PubMed1984

Patch testing in Japanese subjects.

Experience with various patch tests, usage tests, and other studies on Japanese and Caucasian subjects is presented. Differences between the races are noted by their responses.

Asian↗
PubMed2002

A clinical and patch test study of adult widespread eczema.

The purpose of this study was to investigate the role of contact hypersensitivity (CHS) in adult widespread eczema (WE) and to analyse the aetiology of WE. 108 consecutive adult WE patients were patch tested. 352 patients with suspected localized allergic contact dermatitis (ACD) tested in the same period served as a control. The average age of the patients with WE was significantly greater than the control group (47.6 +/- 15.0 v 39.2 +/- 14.9, p < 0.01, Student's t-test). More male patients were found in the WE group (42.6% vs 25.0%, p < 0.01, chi2-test). 71 (65.7%) of the WE patients were patch test positive. ACD was diagnosed in 29 out of 108 (26.9% of the WE patients and 40.8% of the PT positive patients) WE patients. ACD was also suspected in another 42 patients (39.8%), who had at least 1 positive PT result but the relevance of PT was hard to determine. In the remaining 37 patch test negative patients, 2 cases of food allergy were diagnosed by clinical findings and open food challenge test. 1 case of atopic dermatitis was diagnosed. 34 patients (31.5%) were diagnosed as unclassified endogenous eczema. Most of the WE patients with ACD (15/29, 51.7%) were ACD from widespread contact with hair dye during bathing. Most of the WE patients with hair dye ACD were male (male : female = 2.75). The total positive rates of PT in the WE group were no different to the control (65.7% vs 61.5%, p > 0.05, chi2-test). No significant difference was found for the positive rates of common contact allergens. The rate of atopy was no different between the 2 groups either (6.5% v 5.1%, p > 0.01, chi2-test). These results indicated that contact sensitization was very common in adult WE. Neglected widespread contact with contact allergens, especially hair dye, plays a very important role in our adult WE. The roles of age and sex in WE need to be studied further.

Adult↗
PubMed1992

Patch test results of the Dermatology Clinic Zurich in 1989: personal computer-aided statistical evaluation.

The patch test results of 921 consecutively tested patients were registered on an IBM personal computer. A computer program based on the dBase III plus database software, especially designed for this purpose, was used. The statistical evaluation was performed with dBase III plus. 59% of the probands were females and 41% males. The average age was 42.8 years. 26% of the probands were inpatients and 74% outpatients. A majority of the patients presented with eczema of the hands, face or the lower legs. The largest occupational groups were houseworkers and cleaning personnel, office workers and pensioners. To 450 of the 921 patients, at least 4 test series were applied simultaneously. These included European standard, vehicles and emulgators, topical medications, and preservatives and biocides. The other 20 test series available were employed only by 2-81 patients each. The highest sensitization rates were found with: nickel, 18.7%; cobalt, 10.2%; balsam of Peru, 8.8%; framycetin, 8.0%; neomycin, 6.8%; potassium dichromate, 6.1%; p-phenylene diamine, 5.4%; paramix, 4.9%; formaldehyde, 4.8%, and (chlor)methylisothiazolinone, 4.7%. The critical evaluation of the data showed two kinds of problems: first, test-specific aspects led to optimization of the patch test procedures; second, the crucial importance of an adequate statistical analysis for epidemiological investigation was revealed.

Adolescent↗
PubMed1995

A study on expert reading of patch test reactions: inter-individual accordance.

To diagnose allergic or irritant contact dermatitis, a clinically relevant contact allergy has to be demonstrated or ruled out, respectively. Although patch testing has been used for 100 years, it remains the method of choice for diagnosing contact allergy. A disadvantage of patch testing is that reading is subjective, based on inspection and palpation of the test area, implying that the assessment is subject to the reader's knowledge and experience. This study was carried out to investigate the accordance in reading patch test reactions between 5 dermatologists. 4 groups, each with 10 patients, participated. Within each group, all 10 were allergic to one and the same sensitizer; nickel, epoxy resin, ethylenediamine, or Kathon CG. The sensitizers were tested in serial dilutions and applied randomly to the back. The tests were read independently by the dermatologists in a blinded fashion. A protocol was used where the dermatologists had to note the presence of the morphological features erythema, infiltration, papules, vesicles, and bullae. In this way, it was possible to allocate the various readings into 4 classification systems, 3 European and one American, although the definition of the various classifications might differ slightly. Based on the readings and classifications, it was possible to calculate the degree of accordance within the 4 systems used. It was also possible to analyze the degree of accordance for the various morphological features. Total accordance for the 5 reading dermatologists for positive and negative test reactions was noted in 36% and 46%, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1996

Contact allergy to popular perfumes; assessed by patch test, use test and chemical analysis.

The frequency of contact allergy to the 10 best-selling women's perfumes was studied in 335 consecutive female eczema patients by patch testing. The diagnostic ability of the fragrance mix, in relation to these products, was evaluated. Of eczema patients, 6.9% had a positive patch test to one or more of the perfumes, and 56.5% of these had a concurrent positive reaction to the fragrance mix. Hence, testing with the patients' own cosmetics is a significant part of diagnosing perfume allergy. The clinical relevance of the patch-test reactions to the commercial perfumes was equal to that of the fragrance mix, as judged from the patient's history and use testing with one of the perfumes. At least three of the chemically defined sensitizers in the fragrance mix were detected in all the perfumes by gas chromatography-mass spectrometry, which indicates that the fragrance mix is a good imitation of actual exposure.

Adolescent↗
PubMed2000

Expression of metallothioneins-I and -II isoforms at positive patch-test sites.

The expression and the distribution of metallothioneins (MT)-I and II isoforms were evaluated in 5 healthy volunteers and in 16 subjects with positive patch test reactions to various compounds. Skin specimens taken both from the healthy skin of the back and at positive patch test sites (at 48 h), were treated using a 3-step indirect immunoperoxidase procedure with a mouse monoclonal IgG1 antibody reactive against I and II isoforms of human, rat and horse MT. MT were expressed in the basal layer of the healthy skin of both controls and sensitive subjects, without any significant difference. At positive patch test sites, there was an overexpression of MT in basal and suprabasal layers of the epidermis. Overexpression of MT, related to the degree of the inflammatory reactions elicited by the penetrating compounds was observed in the dermis. The cells expressing MT in the dermis were mostly T lymphocytes and cells with dendritic morphology which positively stained in part for CD34 and in part for XIIIa markers and negatively for KP1, S100 and HLA-DR. Taken together, these results seem to indicate that MT represent a constitutive mechanism of defence expressed by different types of cells in the skin, which is triggered by contact with both metallic and non-metallic compounds. The biological significance of MT in the skin remains to be elucidated. Our preliminary findings do not permit evaluation of whether these nearly ubiquitous proteins exert their cytoprotective effects in the skin acting simultaneously as antioxidant, metal binding or zinc suppliers, or if they display these activities mainly depending on the nature of the penetrating substances.

Adolescent↗
PubMed2002

Results of atopy patch tests with house dust mites in adults with 'intrinsic' and'extrinsic' atopic dermatitis.

BACKGROUND: The most frequently employed diagnostic criteria of atopic dermatitis (AD) can be fulfilled in the absence of elevated total circulating IgE or specific IgE to food allergens or environmental aeroallergens and/or in the absence of personal or familial history of atopy as well. Therefore a distinction between 'extrinsic' or 'allergic' and 'intrinsic' or 'non-allergic' AD has been suggested. Recently, a patch test with environmental aeroallergens, named atopy patch test (APT), has been proposed for use in the study of AD. OBJECTIVE The aim of this study was to investigate the reactivity to APT in patients with 'extrinsic' and 'intrinsic' AD. PATIENTS, MATERIALS AND METHODS: Two groups of adult male subjects with AD were examined consecutively in our department (Department of Dermatology, Italian Navy Main Hospital, Taranto, Italy) andpatch tested with whole bodies of house dust mites (HDM) at a concentration of 20% in petrolatum (Dermatophagoides pteronyssinus 50%, D. farinae 50%). The groups included: (i) 95 patients affected by the adult clinical form of 'extrinsic' AD; (ii) 12 patients affected by the adult clinical form of 'intrinsic' AD; and (iii) a control group of 49 adult healthy male subjects with a negative anamnesis for eczema and atopy and negative skin prick test to aeroallergens/food allergens and/or normal level of total circulating IgE, also patch tested with the same allergen. The statistical differences were calculated by chi2 test and 95% confidence intervals (CI) were provided. RESULTS: The APT was positive in 47.4% (CI: 37-57%) of'extrinsic'AD, in 66.6% (CI: 41-93%) of'intrinsic' AD and in 12.2% (CI: 3-21%) of healthy subjects. The differences between the two AD subgroups and the control group were statistically significant (P < 0.001). CONCLUSIONS: APT positivity is more frequent in both 'extrinsic' and 'intrinsic' AD than in unaffected subjects. Other studies are needed to confirm our data and to explain why the APT is positive in the 'intrinsic' form.

Adult↗
PubMed1990

[Cosmetic dermatitis. Its relationship with positive patch test results, clinical features and atopy].

Although cosmetic manufacturing has progressed significantly, we still see a lot of skin problems caused by cosmetics. We patch tested 307 patients who showed signs of cosmetic contact dermatitis on the face from using their own cosmetics. The most common sensitizers were hair dyes, especially paraphenylenediamine (PPDA). Eighty-six of the 307 patients were assessed with patch tests for 23 perfumes, 16 tar dyes, preservatives, bases and 7 other items. Perfumes were frequently identified as allergens such as hidroxycitronellal, which turned out to be the most common sensitizer. The eighty-six patients were divided into 7 groups according to the clinical features and were discussed in terms of the period of onset and their age distribution. The relationship between positive patch test results and atopy is also reported.

Age Factors↗
PubMed2000

Evaluation of an experimental patch test model for the detection of irritant skin reactions to moisturisers.

BACKGROUND/AIMS: Moisturisers are used daily by a large number of people to prevent dryness of the skin. Irritant skin reactions to moisturisers are, however, known to occur. In order to prevent such irritant reactions reliable test methods for irritancy testing of moisturisers are needed. This study was undertaken to evaluate a non-invasive patch test model for the detection of irritant skin reactions to moisturisers. METHODS: Twenty healthy volunteers were patch tested with three different moisturisers: empty chamber, sodium lauryl sulphate and a moisturizer known to be non-irritating. Skin reactions were evaluated by visual scoring, measurement of transepidermal water loss (TEWL) by an Evaporimeter, blood flow by laser Doppler flowmetry and electrical capacitance by a Corneometer. RESULTS: A statistically significant increase in blood flow was found 48 h after application of one of the moisturisers tested, indicating an irritant effect of the product. A statistically significant decrease in skin hydration was found for the same moisturiser after 48 h. No statistically significant differences between the moisturisers were found by visual scoring. None of the products tested had any negative effect on the skin barrier function. CONCLUSION: The non-invasive patch test model was found useful for detecting irritant skin reactions to moisturisers.

Journal Article↗
PubMed1992

Patch testing with pure palladium metal in patients with sensitivity to palladium chloride.

During a 15-month period, 536 patients being investigated for suspected contact dermatitis were patch tested with the European standard series and palladium chloride 1% pet. 13 patients (2.4%) had a positive allergic response to palladium chloride and all 13 were also allergic to nickel. 12 of these 13 patients consented to further patch testing with discs of pure palladium metal foil, and none reacted. We have shown previously that palladium chloride patch test material contains traces of nickel, and propose an explanation for these results in terms of the additive effect of allergens when tested in combination.

Adult↗
PubMed1985

Irritant and allergic responses as influenced by triamcinolone in patch test materials.

While the prior application of triamcinolone acetonide to skin does not strongly influence patch test reactions, the presence of triamcinolone in the materials used for patch testing has a profound effect. Both irritant and allergic reactions to thimerosal are consistently negated when triamcinolone acetonide is present in concentrations of 0.1% and 0.025%.

Dermatitis, Contact↗
PubMed1999

Are contact allergens stable in patch test preparations? Investigation of the degradation of d-limonene hydroperoxides in petrolatum.

Several of the products formed after oxidation of d-limonene exhibit strong contact allergenic properties. Some, e.g., the hydroperoxides, are unstable compounds. In this study, we have examined whether the limonene hydroperoxides are chemically stable in white petrolatum used for patch testing. We found that the stability of the hydroperoxides was strongly dependent on whether or not the petrolatum was stabilized with alpha-tocopheryl acetate. In the presence of this antioxidant, the hydroperoxides were degraded to a greater extent. The hydroperoxides were shown to be directly reduced to the corresponding alcohols by this agent. On the other hand, the compounds where shown to be stable in non-stabilized petrolatum throughout clinical patch testing for a period of 6 weeks, provided that the preparations were stored in a refrigerator when not used. Thus, it is recommended that vehicles without alpha-tocopheryl acetate are used when peroxy or hydroperoxy compounds are patch tested or used in sensitization experiments. However, it is important to limit the storage time so that optimal conditions are at hand. A fast method was developed to enable isolation and quantification of the hydroperoxides in white petrolatum. This analytical method may also be applicable to other compositions of patch test preparations.

Allergens↗
PubMed2005

Patch testing with patients' own cosmetics and toiletries--results of the IVDK*, 1998-2002.

Patch test results with products brought in by the patients collected by the members of the Information Network of Departments of Dermatology (IVDK) between 1998 and 2002 were analysed. 5911 patients were patch tested with their own cosmetics and toiletries during this period. The 34 082 single test preparations applied to these 5911 patients were manually assigned to 1 of 26 categories, based on the EU Classification Annex I to 76/768/EEC, which had been further refined. The leave-on product category most commonly tested was 'creams, emulsions, lotions, gels and oils for the skin' (n = 3621 tested, n = 312 positive). The rinse-off product type most commonly tested was 'bath and shower preparations' (n = 1333 tested, n = 71 positive). In one-third of patients tested positive to these products, no other positive test result was observed. In the remainder, positive reactions to the fragrance mix, Myroxylon pereirae resin, methyldibromo glutaronitrile, (chloro-)methylisothiazolinone, 2-bromo-2-nitropropane-1,3-diole and further ingredients of cosmetics and toiletries were more common than in product-negative patients. However, in view of the potential for false-positive reactions mainly to rinse-off products, the results must be interpreted with caution. In conclusion, testing of patients' own products can be regarded as efficient and safe, if in accordance with current recommendations.

Adult↗
PubMed2003

Patch testing with components of water-based metalworking fluids.

Water-based metalworking fluids (MWFs) may cause both irritant and allergic contact dermatitis. Several well-known MWF allergens are available for patch testing, but considering the wide variety of possible components used in MWF, our diagnostic arsenal covers only a small part of potential allergens. We therefore selected 13 frequently used MWF components that might be sensitizers and had not yet been tested routinely. In 5 centres, 233 dermatitis patients with present or past occupational exposure to MWF were patch tested with this and other panels. Only 7 patients showed positive reactions to the study panel. Allergic reactions to the emulsifier diglycolamine [syn. 2-(2-aminoethoxy) ethanol] were seen in 5 patients, and 1 patient each reacted positively to 2-amino-2-ethyl-1,3-propanediol (AEPD) and methyldiethanolamine (MDEA). Clinical relevance of the reactions to diglycolamine was unequivocally proven by its presence in the MWF from the patients' workplace in 3 cases. Diglycolamine seems to be an important MWF allergen, independently from monoethanolamine and diethanolamine. A test concentration of 1% petrolatum (pet.) appears to be appropriate. The importance of AEPD and MDEA as MWF allergens still remains to be established. The lack of positive test reactions to the other MWF components tested may be due to their low-sensitizing potential or too low a patch test concentration being used.

Adult↗
PubMed1977

Sodium lauryl sulfate irritant patch tests: degree of inflammation at various times.

Irritant reactions were induced on the forearms of 10 normal subjects with 10% aqueous sodium lauryl sulfate under patch test occlusion for 24 h. Test sites were observed at 24, 26, 28, 30, 48, 72 and 96 h and the degree of inflammation recorded. Inflammation was most prominent at 28 h and decreased in intensity over the time course of the study. Inflammation at 48 and 72 h was similar to when patches were removed. This suggests that inflammatory responses in skin for at least certain irritants like sodium lauryl sulfate do slowly decrease in intensity after 48 h. However, the inflammatory response may initially accelerate after patch test removal and remain intense for at least 48 h. Fading of irritant reactions by 48 or 72 h may not reliably distinguish irritant from allergic patch test reactions. This does not refute the usefulness of a delayed (96 h) reading since inflammation from sodium lauryl sulfate had decreased significantly by this time.

Adolescent↗
PubMed1999

Thimerosal positivities: patch testing to methylmercury chloride in subjects sensitive to ethylmercury chloride.

The aim of this paper was to evaluate whether methylmercury chloride (MeHgCl) aq., when patch tested in a group of thimerosal-positive subjects reacting to ethylmercury chloride (EtHgCl), might be a reliable model for the better understanding of interactions between alkylmercury compounds and the skin. 19 out of 21 consecutive patients who previously had given positive patch-test reactions to both ethylmercury chloride 0.0165% eth.(EtHgCl, 0.615 mM) and MeHgCl 0.031% aq.(1.23 mM), and negative reactions to thiosalicylic acid 0.05% (3.24 mM) aq./eth. 50/50, were repatch tested to 8 microl of MeHgCl 0.031% aq. and to 8 microl of aq. solutions containing MeHgCl mixed with cysteine, glutathione, ZnSO4, MgSO4, MnSO4, ZnCl2, MgCl2 and MnCl2, respectively. The results showed that cysteine, glutathione and Zn(II) salts were able to abolish the positive reactions, demonstrating the rôle played by both thiol groups and Zn(II) itself. Patch tests concomitantly carried out in 16 out of 19 patients to 8 microl of aqueous MeHgCl and to 8 microl of aqueous solutions containing MeHgCl and MeHgCl mixed to fragment 56-61 of metallothionein I (MT I), MT I and MT II-Zn, respectively, revealed that all the MTs tested were able to reduce or to inhibit the reactions, demonstrating the effect of the thiol groups. Due to the close chemical similarities to EtHgCl and to its water solubility, MeHgCl seems to be a suitable model for evaluating the reactivity of alkylmercury compounds in the skin. We speculate that both EtHg- and MeHg-derivatives are xenobiotics with similar reactivity. However, the lack of clinical relevance of the reactions to both alkyl compounds lead us to conclude that, since environmental exposure does not seem to play a pivotal rôle, they probably have mostly to do with compounds included in in the standard series, and are elicited by reduced function of physiological SH chelators.

Adult↗