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PubMed1982

The possible chelating effect of sodium diethyldithiocarbamate (DDC) in nickel allergic patients. Patch test procedures with nickel on DDC pretreated skin.

Encouraged by some reports about the chelating effect of p.o. given sodium diethyldithiocarbamate (DDC) in nickel allergic patients, some experiments were performed to determinate the blocking effect of locally applied DDC on positive patch test reactions with nickel. Two groups of nickel allergic patients were patch tested with different concentrations of nickel sulphate on with DDC treated skin. Control patch tests were done on areas which were pretreated with the creambase only. In one group 10% DDC in the cream was applied under 24 h occlusion; in this group also a nickel coin was tested. In the second group of patients the DDC cream was rubbed four times during 24 h without occlusion. In both groups there were no statistical differences regarding the reactions on skin pretreated with DDC and with the cream base. From this investigation it may be concluded that there is no indication that a DDC-containing barriercream will be of great help in patients with occupational dermatitis, which is especially due to nickel sensitization.

Administration, Topical↗
PubMed2004

Are patch tests useful in plasma cell vulvitis?

OBJECTIVE: To evaluate eventual contact sensitization in 7 patients with plasma cell vulvitis (PCV). STUDY DESIGN: Seven women with PCV underwent patch tests with the Italian standard series and with additional batteries of allergens (perfumes, preservatives, emulsifiers, medicaments and corticosteroid series). RESULTS: One patient experienced a positive reaction t o balsam of Peru and wool alcohol. CONCLUSION: Patch testing is not normally necessary in the management of PCV. However, when a patient with PCV complains of burning or pruritus after application of topical products, patch tests could prove useful.

Adult↗
PubMed2005

The development and course of patch-test reactions to 2-hydroxyethyl methacrylate and ethyleneglycol dimethacrylate.

Because Methacrylic monomers are used in dental work, dental personnel, technicians, and patients are at risk of being sensitized. 2-hydroxyethyl methacrylate (2-HEMA) and ethyleneglycol dimethacrylate (EGDMA) are commonly used. Allergic test reactions to them sometimes appear beyond D7. This study was designed to study the development and course of positive test reactions to 2-HEMA and EGDMA in allergic patients as a mean to elucidate the issue of patch-test sensitization. 12 patients with contact allergy to 2-HEMA and EGDMA were retested with dilution series. The clinical course was followed for 1 month. During the study, 25 positive test reactions to 2-HEMA and 19 to EGDMA were diagnosed. Within the 1st week, 21 were noted for 2-HEMA and 18 for EGDMA. After 10 days, another 2 reactions appeared for 2-HEMA and 1 for EGDMA. All but 1 patient with the latter reactions also had positive reactions within the 1st week. After 1 month, 12 reactions for 2-HEMA and 10 for EGDMA remained. Patch-test reactions to 2-HEMA and EGDMA are long-lasting. The patch-test concentrations of 2.0% for 2-HEMA and EGDMA may be continually used. Positive test reactions emerging after 10 days do not automatically imply active sensitization.

Adult↗
PubMed2002

Positive patch test reactions to celecoxib may be due to irritation and do not correlate with the results of oral provocation.

Nonsteroidal anti-inflammatory drugs (NSAIDs) are among those therapeutics most frequently causing pseudoallergic and sometimes allergic cutaneous adverse reactions. Coxibs preferentially inhibiting cyclooxygenase-2 are increasingly propagated as alternatives in NSAID-sensitive patients. We evaluated the tolerability of celecoxib in NSAID-sensitive patients. In 14 consecutive patients (6 males, 8 females, age 18-72 years), scratch and patch tests with homogenized Celebrex were performed, followed by single-blind, placebo-controlled oral provocation (maximal single dose: 200 mg; cumulative dose: 350 mg). 8 of the first 10 patients showed erythematous reactions to celecoxib on patch testing after 2 days with decrescendo kinetics between then and day 3. 9 patients with no history of NSAID intolerance showed similar reactions. When the patch tests were repeated with homogenized Celebrex at final concentrations of 5% and 10% in petrolatum, no reaction was observed in any patient. Subsequent oral provocation was tolerated without adverse effects by all individuals. We conclude that patch tests with high concentrations of celecoxib cause irritant reactions and do not correlate with the outcome of oral provocation tests. Therefore, these tests should be performed with lower concentrations of celecoxib (Celebrex). Celecoxib itself seems to be a valuable alternative drug in NSAID-sensitive patients.

Administration, Oral↗
PubMed2002

Tetrazepam drug sensitivity -- usefulness of the patch test.

The muscle relaxant tetrazepam may cause severe cutaneous adverse effects. We report 4 cases of varying intensity: Stevens-Johnson syndrome, erythema-multiforme-like exanthema, maculopapular and maculo-urticarial exanthema. Patch testing with tetrazepam (10% in petrolatum) was strongly positive in the 2 patients with severe skin eruptions and weakly positive in the other 2. Oral rechallenge with tetrazepam was positive in 3 patients (1 not done). Diazepam, with a similar chemical structure to tetrazepam, was negative on patch testing and on oral challenge testing in 2 patients. Although the optimal patch test concentration of tetrazepam has still to be determined, it is a useful diagnostic tool to confirm sensitization, particularly in patients with severe bullous eruptions.

Administration, Oral↗
PubMed2005

Cosmetic dermatitis in Chinese eczema patients patch tested with a modified European standard series of allergens.

The prevalence of cosmetic allergic contact dermatitis (CACD) in Chinese eczema patients (CEP) has not been reported. The purpose of our study was to analyse CACD in CEP and examine the frequency of patch test (PT) reactions to common cosmetic-related allergens (CRA). 378 consecutive CEP patch tested with a modified European standard series of allergens during a 2-year period in our clinic were analysed. 73 patients (19.3%) were considered as suspected CACD and 37 patients (9.8%) were confirmed. The frequencies of the positive PT reactions in suspected CACD and confirmed CACD to at least 1 CRA were 64.4% and 89.2%, to para-phenylenediamine (PPD) were 31.5% and 59.5%, to fragrance mix (FM) were 27.4% and 32.4% and to imidazolidinylurea were 5.5% and 8.1%, respectively. These results were much higher than those of CEP without cosmetic reactions (26.3% for at least 1 CRA, 5.8% for PPD, 8.8% for FM, and 0 for imidazolidinylurea) (P < 0.01 for all, Chi-square test and Fisher's exact test). These results suggested that CACD is very common in CEP patch tested. PPD and FM are the leading allergens identified. CACD should be strongly considered in CEP with positive PT reactions to PPD, FM and imidazolidinylurea.

Adult↗
PubMed2004

Relevance of positive patch-test reactions to cocamidopropyl betaine and amidoamine.

BACKGROUND: Cocamidopropyl betaine (CAPB) is a surfactant, primarily used in personal cleansing products, that may cause allergic contact dermatitis (ACD). Amidoamine (AA), a by-product and a known contaminant in CAPB synthesis, may be the true allergen responsible for some cases of CAPB allergy. Co-reactivity with these allergens and cocamide diethanolamine (CDEA) and formaldehyde has been noted anecdotally. OBJECTIVE: This study investigated (1) the correlation and clinical relevance of positive patch-test reactions to CAPB and AA in cases of ACD and (2) the rate of positive reactions to CDEA and formaldehyde in these patients. METHODS: Patients with patch-test reactions to either CAPB or AA during 2001 were retrospectively identified. Relevance of reactions to CAPB and AA was then graded as definite, probable, or not relevant, based on patient follow-up. The proportion of these patients who also had positive reactions to CDEA or formaldehyde was noted. RESULTS: Of 957 patch-tested patients, 49 had positive reactions to either CAPB (42.9%) or AA (34.3%) or to both (22.8%). Of these patients, 35 were available for follow-up. Twenty-nine (83.0%) of these patients identified the surfactant in their home products. In all of these patients, the dermatitis was felt to be due in whole or in part to CAPB exposure. Two patients (5.7%) had a positive reaction to CDEA, and 8 patients (23%) had a positive reaction to formaldehyde. CONCLUSION: Patch testing with both CAPB and AA identifies patients with ACD relevant to exposure to CAPB. Since few patients react to both allergens, testing with both separately is useful. Formaldehyde allergy was overrepresented in CAPB-allergic patients in this series of patients.

Allergens↗
PubMed1996

The atopy patch test: an increased rate of reactivity in patients who have an air-exposed pattern of atopic eczema.

In a subgroup of patients with atopic eczema (AE), eczematous skin lesions can be induced by epicutaneous testing with aeroallergens (the atopy patch test: APT). An increased frequency of positive APT has been found in AE patients showing a predictive lesional pattern affecting air-exposed skin areas. This study investigates the dose-response of the APT in two different patient groups with AE. Petrolatum preparations of house dust mite, cat dander and grass pollen allergens in four concentrations (500-10,000 protein nitrogen units) were tested epicutaneously in 57 patients with AE, who were prospectively divided in two groups according to whether their AE pattern was with (group I) or without (group II) a predictive distribution. Sixty-nine per cent of patients in group I, and 39% in group II, had positive APT reactions (P = 0.02). The reactions in group I were elicitable with lower allergen concentrations (P = 0.03). A clinically recognizable subgroup of patients with AE showed increased cutaneous sensitivity to aeroallergens.

Adolescent↗
PubMed2006

European Standard Series patch test results from a contact dermatitis clinic in Israel during the 7-year period from 1998 to 2004.

The results of a 7-year retrospective study (1998-2004) from patch testing with the European Standard Series (ESS) establishing the frequency of sensitization in a contact dermatitis clinic in Israel are presented. 23 allergens were patch tested on 2156 patients, 1462 females (67.8%) and 694 males (32.2%). Atopy and asthma were present in 21.9% of the patients. One or more allergic reactions were observed in 937 patients (43.5%). The highest yield of patch test positives from the 1076 positive reactions were obtained from nickel sulfate (13.9%), fragrance mix (7.1%), potassium dichromate (3.8%), Balsam of Peru (3.6%), CL+Me-isothiazolinone (3.4%) and cobalt chloride (3.4%). Allergens which produced the least amount of positive results were primin and clioquinol. Allergic contact dermatitis (ACD) was established in 32.8%, whereas occupationally related allergic (8.0) and irritant contact dermatitis (5.6%) affected a total of 13.6% of the cases studied. The most common clinical forms of dermatitis were chronic dermatitis (47.7%) followed by acute dermatitis (22.8%), and lichenification and hyperkeratosis (7.9%). The hands (30.7%), face and neck (23.9%) and extremities (11.3%) were the most frequently affected areas. Four allergens in our study differed from the top 10 allergens in Europe namely: Cl+Me-isothiazolinone, formaldehyde, 4-tert-butylphenol formaldehyde resin and sesquiterpene lactone mix reflecting an existing difference in environmental exposure. Our study is the first to provide data on the frequency of sensitization and important allergens in the aetiology of ACD in Israel. In spite of the existing differences with Europe, we conclude that ESS is an appropriate screening system for the diagnosis of ACD in Israel.

Adolescent↗
PubMed1995

Concomitant positive patch test results with standard screening tray in North America 1985-1989.

Responses to patch test substances may occur contemporaneously. Such simultaneous reactions may reflect concomitant sensitization to 2 dissimilar allergens to which concurrent exposure has taken place (e.g., ethylenediamine dihydrochloride and neomycin). It may occur when the individual has been exposed to only 1 of the substances and exhibits a response to other substances of similar chemical structure (i.e., cross-sensitization such as between para-phenylenediamine and benzocaine). Such simultaneous responses may also be chance occurrences, reflecting multiple sensitization or the result of altered response due to the "angry back syndrome". This investigation established that such concurrence of response is not uncommon and adds further documentation to the literature of these associations in patch test responses.

Adult↗
PubMed1984

The Langerhans cells in healed patch tests reactions, before and after oral administration of nickel.

Langerhans cells (LC) were studied at the light and electron microscopic levels in normal skin and in positive patch test areas after long-term healing before and after the flare-up reaction induced by oral administration of nickel. A number of reactive changes indicating increased cell activity, similar to those found in positive patch tests 72 hours after allergen application, were registered in the test areas. Thus, strong reactive changes persist in the LC system after a fulminant contact allergic dermatitis, even beyond clinical healing. Some cellular reactions, especially pronounced after oral nickel provocation, indicate that much of the LC activity takes place on a superficial level of the epidermis. Oral nickel administration induced, among other things, an intense formation of lipid-like inclusions in the LC, formerly observed only in contact allergic reaction to nickel. Goniometric analysis of the LC cytomembrane showed that the concept "spotty damage" is probably erroneous and that the LC are not targets of destruction in contact allergy. Keratinocytes adjacent to LC exhibited membrane and cytoplasmic changes indicative of interaction between these two cell types. Combined fluorescence and electron microscopic analyses of contact allergic dermatitis using long series of sections have disclosed a variety of reactive changes in, and an increased activity of, the Langerhans cell system (1, 2). In the present study Langerhans cells (LC) have been scrutinized for reactive changes after long-term healing of challenged epidermis and after oral nickel provocation causing a flare-up reaction of healed patch test areas.

Administration, Oral↗
PubMed2003

High frequency of simultaneous sensitivity to Disperse Orange 3 in patients with positive patch tests to para-phenylenediamine.

Cross-sensitization between para-phenylenediamine (PPD) and Disperse Orange 3 (DO3), among other textile dyes, has frequently been reported. We evaluated the frequency of simultaneous patch test reactions to PPD and a range of textile dyes. Retrospectively, we studied 128 patients who were patch test positive to PPD and who had also been tested to textile dyes. The dyes that most commonly also reacted were DO3 (46.1%) followed by Disperse Yellow 3 (21.9%). 80% of 55 patients who had a + + or stronger reaction to PPD also reacted to DO3. Dyes that were least likely also to react were Bismarck Brown (0%), Naphthol AS (1.06%), Disperse Yellow 9 (1.06%), Disperse Blue 3 (1.56%) and Disperse Red 11 (2.13%). We interpreted the simultaneous patch test reactions to PPD and DO3 as due either to cross-sensitivity proper, or to metabolic conversion of textile dyes in the skin to PPD.

Allergens↗
PubMed2002

The effect of race and ethnicity on patch test results.

BACKGROUND: Allergic contact dermatitis is a condition that may be affected by differences in genetic and environmental factors. Race and ethnicity are possible examples of the former. OBJECTIVE: The objective of this study was to examine the differences in patch test results between white and black individuals tested by the members of the North American Contact Dermatitis Group from July 1, 1992, to June 30, 1998. METHODS: Patients evaluated in our patch test clinics were exposed to a standardized patch testing technique involving a standard series of 41 allergens in total. The standard series we used varied over the 6 years of the study in 2-year cycles. The series was the same at all centers during each of these 2-year cycles: 1992-94, 1994-96, and 1996-98. Over a 6-year period, our group tested 9624 patients. Of those individuals, 8610 (89.5%) were white and 1014 (10.5%) were black. RESULTS: Allergic contact dermatitis and irritant contact dermatitis were the final diagnoses assigned by the investigators to individuals of the 2 races: 49% and 16%, respectively, for the white patients and 46% and 15%, respectively, for the black patients. In at least one of the three 2-year periods, testing in white patients revealed higher rates of sensitization to formaldehyde, glutaraldehyde, and a number of the formaldehyde-releasing preservatives, as well as lanolin, epoxy resin, thioureas, and balsam of Peru. Black patients exhibited higher rates of sensitization to para-phenylenediamine, cobalt chloride, thioureas, and p-tert-butylphenol formaldehyde resin in at least one of the 2-year periods. CONCLUSION: In this test population, we found no differences in the overall response rate to allergens. There were some differences between white and black patients in their response to specific allergens. These differences, although possibly related to genetic factors based on race, are more likely related to differences in allergen exposure determined by ethnicity.

Allergens↗
PubMed2006

Contact allergy to (meth)acrylates in the dental series in southern Sweden: simultaneous positive patch test reaction patterns and possible screening allergens.

Contact allergy to dental allergens is a well-studied subject, more so among dental professionals than dental patients. 1632 subjects had been patch tested to either the dental patient series or dental personnel series at the department of Occupational and Environmental Dermatology, Malmö, Sweden. Positive patch tests to (meth)acrylate allergens were seen in 2.3% (30/1322) of the dental patients and 5.8% (18/310) of the dental personnel. The most common allergen for both groups was 2-hydroxyethyl methacrylate (2-HEMA), followed by ethyleneglycol dimethacrylate (EGDMA), triethyleneglycol dimethacrylate, and methyl methacrylate. 47 (29 dental patients and 18 dental personnel) out of these 48 had positive patch tests to 2-HEMA. All 30 subjects who had a positive reaction to EGDMA had a simultaneous positive reaction to 2-HEMA. One dental patient reacted only to 2,2-bis[4-(2-hydroxy-3-methacryloxypropoxy) phenyl]propane (bis-GMA). From our data, screening for (meth)acrylate contact allergy with 2-HEMA alone would have picked up 96.7% (29/30) of our (meth)acrylate-allergic dental patients and 100% (18/18) of our (meth)acrylate-allergic dental personnel. The addition of bis-GMA in dental patients would increase the pick-up rate to 100%.

Allergens↗
PubMed2002

Dosage considerations in patch testing with liquid allergens.

This study examines reproducibility of water and ethanol drop volumes from plastic squeeze dropper bottles, examines the difference in drop volumes between commonly used liquid patch test solutions, and evaluates the volumes of water and ethanol needed to saturate Finn and IQ Chamber filter papers. 2 plastic squeeze dropper bottles recommended for use in patch testing have poor reproducibility compared to other bottles tested. 3 aqueous allergens tested (formaldehyde 1%, methylchloroisothiazolinone/methylisothiazolinone 0.01%, and dimethylol dihydroxyethyleneurea 4.5%) have drop volumes equivalent to water. Smaller drop volumes are produced by ethanol, hydrocortisone butyrate 1% in ethanol, cocamidopropyl betaine 1% a.q., and propylene glycol 30% a.q. Filter paper saturation volumes using distilled water are 16-19 micro L in standard Finn Chambers and 29-35 micro L in IQ Chambers. Ethanol saturation volumes are slightly lower. Previously recommended volumes of application for aqueous allergens of 15 micro L for standard Finn Chambers and 25 micro L for IQ Chambers (slightly below the filter paper saturation points) are appropriate. Selection of dropper bottles should consider drop volume reproducibility, differing drop volumes for different allergens, and the patch test chamber system being used.

Allergens↗
PubMed1996

Patch testing in children.

92 children (45 girls, 47 boys), mean age 9.3 years (3-14.75), were referred to the Contact Dermatitis Investigation Unit, Belvidere Hospital, Glasgow, for patch testing during the period 1979-93 for the investigation of allergic contact dermatitis (ACD). The diagnoses at the time of referral were atopic dermatitis (45), non-atopic with localized dermatitis (26), juvenile plantar dermatosis (15), orofacial granulomatosis (2), vaccination reaction (2) and atypical psoriasis (2). In total, there were 55 positive reactions in 30 children. The commonest allergens were metals (18), fragrances (11) and rubber compounds (6). The patient groups with the highest yield of positive patch tests were those patients with atopic dermatitis who had a good history of a precipitating contact factor (4/5), and non-atopic patients with dermatitis of hand and/or feet (7/14). Our findings suggest that allergic contact dermatitis is more common in children than generally appreciated and that patch testing is a practicable and clinically worthwhile procedure in children.

Child↗
PubMed1998

Purified Der p1 and p2 patch tests in patients with atopic dermatitis: evidence for both allergenicity and proteolytic irritancy.

Atopic dermatitis has many similarities with allergic contact dermatitis. Previous studies have revealed delayed-type allergic reactions indicating specific cell-mediated immune reactions in subgroups of patients. It has recently been recognized that purified house dust mite major allergens, Der p1 and Der p2 from Dermatophagoides pteronyssinus, exhibit a proteolytic enzyme activity similar to papain and maybe serine proteases (e.g. trypsin), respectively. This opens the possibility that house dust mites apart from an allergic epitope could elicit irritant reactions in atopic skin. We examined cutaneous reactivity to the purified proteins of house dust mite antigens, Der p1 and Der p2, in 36 consecutive patients with atopic dermatitis. We also patch-tested with trypsin and papain, in order to see if these proteolytic enzymes could induce irritant reactions. Twelve patients had type 1 allergy to Der p1 and two of these had type IV reactivity to D. pteronyssinus extract. Positive reactions were observed in another four patients, but they had also irritant reactions to papain and trypsin, indicating that the enzymatic activity may have elicited the reactions. The cutaneous reactivity was not linked to total serum IgE, but the patients with specific allergic patch tests had type I reactions to D. pteronyssinus extract. Our observations indicate that allergic patch tests towards Der p1 and p2 are rare and that irritant reactions from D. pteronyssinus proteolytic activity may be a more common phenomenon when patch-testing atopic dermatitis patients with house dust mite antigen extract.

Adolescent↗
PubMed1995

Patch testing with fragrances: results of a multicenter study of the European Environmental and Contact Dermatitis Research Group with 48 frequently used constituents of perfumes.

The objective of this study was to determine the frequency of reactivity to a series of commonly used fragrances in dermatological patients. A total of 48 fragrances (FF) were chosen, based on the publication of Fenn in 1989 in which the top 25 constituents of 3 types (1. perfumes, 2. household products, 3. soaps) of 400 commercial products on the US market had been determined. In a pilot study on a total of 1069 patients in 11 centres, the appropriate test concentration and vehicle were examined. For most fragrances, 1% and 5% were chosen, and petrolatum proved to be the best vehicle in comparison to isopropyl myristate and diethyl phthalate. In the main study, a set of 5 to 10 fragrances at 2 concentrations was patch tested in each centre on a minimum of 100 consecutive patients seen in the patch test clinic. These patients were also patch tested to a standard series with the 8% fragrance mix (FM) and its 8 constituents. In patients with a positive reaction to any of the 48 FF, a careful history with regard to past or present reactions to perfumed products was taken. A total of 1323 patients were tested in 11 centres. The 8% FM was positive in 89 patients (8.3% of 1072 patients). Allergic reactions to the constituents were most frequent to oak moss (24), isoeugenol (20), eugenol (13), cinnamic aldehyde (10) and geraniol (8). Reactions read as allergic on day 3/4 were observed only 10X to 7 materials of the new series (Iso E Super (2), Lyral (3), Cyclacet (1), DMBCA (1), Vertofix (1), citronellol (1) and amyl salicylate (1)). The remaining 41 fragrances were negative. 28 irritant or doubtful reactions on day 3/4 were observed to a total of 19 FF materials (more than 1 reaction: 5% citronellol (2), 1% amyl salicylate (2), 1% isononyl acetate (3), 0.1% musk xylol (2), 1% citral (2), and 1% ionone beta (2)). Clinical relevance of positive reactions to any of the FF series was not proved in a single case. This included the 4 reactions in patients who were negative to the 8% FM. In conclusion, the top 25 fragrances commonly found in various products caused few reactions in dermatological patients and these few appeared to be clinically irrelevant, with the possible exception of Lyral. However, this data should be interpreted in the light of the relatively small number of patients tested (only 100 in most centres).

Acrolein↗