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PubMed2005

Use of consumer product ingredients for patch testing.

BACKGROUND: Patch testing for suspected sensitivity to cosmetics and other personal care products is usually done by testing with nonirritating products "as is" and by panels of antigens likely to contain causative ingredients. Most allergic reactions are reportedly due to sensitivity to either fragrances or preservatives. Although most preservatives found in patients' products are available for patch testing, only a small number of fragrance ingredients are available, and fragrance components are seldom labeled. Most personal care products contain many other ingredients, and unless the patient reacts to the whole product and the ingredients are obtained from the manufacturer, most of these are seldom tested. OBJECTIVE: To investigate the importance of testing with these other ingredients. METHODS: Investigators reviewed patch-test records of patients who presented with eruptions compatible with the use of their personal care products and who were tested with available ingredients that were listed on the labels of products they were using. This allowed testing with many ingredients in products that are too irritant for "as is" testing. Some of the results included those of persons who were tested in other series, so these were separated. RESULTS: Of patch tests with 52 cosmetic ingredients also tested in other series, 3.4% produced at least one+or greater reaction. Of those antigens tested only when present in products used by the patient, 55 of the 121 ingredients produced at least one+reaction, and about 3.6% of the test results were positive. CONCLUSIONS: Adding ingredients found in the patient's personal care products to patch tests done on those compatible with exposure increases the positive yield in patch testing, and the number of positive results is likely to increase as more ingredients are available for testing.

Allergens↗
PubMed1999

Long-lasting allergic patch test reactions: a study of patients with positive standard patch tests.

The purpose of this study was to determine the duration of patch test reactions and the frequency of long-lasting allergic patch test reactions (LLAPTR), and to identify the possible factors related to the development of the LLAPTR. For this purpose, a group of 263 patients positive to 1 or more allergens in the GIRDCA standard series was recruited. Readings were made for each patient 2 and 3 days after patch test application and continued every 2nd and 3rd day until the disappearance of all palpable erythema. The % of LLAPTR out of the total of reactions was high: 17.9%). Kathon CG was the hapten that caused LLAPTR most frequently, with 16 cases, a frequency of 76.1%), and a mean duration of the patch test reactions of 25.4 days. Risk factors investigated were age, sex, atopy, intensity of the patch test reaction and sensitivity to some allergens with the greatest number of positive patch tests. The relative importance of each risk factor was calculated by multivariate stepwise logistic regression analysis. It was found that a Kathon CG sensitivity was the most important risk factor for LLAPTR. 2nd was atopy, followed by strong patch test reaction. Rejected risk factors were sex, age and sensitivity to nickel sulfate, potassium dichromate, Disperse Blue 124, fragrance mix and p-phenylenediamine.

Adult↗
PubMed1992

Comparative study of TRUE Test and Finn Chamber patch test techniques in Singapore.

This is a report on a comparative study of the reactivity of TRUE Test and Finn Chamber patch test techniques. 413 patients attending a contact dermatitis clinic in Singapore were simultaneously patch tested with panels 1 and 2 of the TRUE Test standard series and with corresponding allergens (Hermal, Hamburg) using Finn Chambers. The left/right application of the TRUE Test and Finn Chambers was randomized. The concordance of positive patch test reactions to the 2 test techniques was studied. The number of patient with positive reactions was 38% and 42% for TRUE Test and Finn Chamber techniques, respectively (n.s.). The overall concordance of positive patch test reactions was 64% (209/328). 13% (42/328) of positive reactions appeared on TRUE Test only and 24% (77/328) on Finn Chamber only. When only relevant positive reactions were considered, the concordance rate was 67%; 11.6% of positive reactions appeared on TRUE Test only and 21% on Finn Chamber only. Positive reactions to p-phenylenediamine (PPD) and neomycin were more frequent with the Finn Chamber technique than with TRUE Test, i.e., false negative reactions to PPD and neomycin were more likely to occur with TRUE Test. It appeared that the TRUE Test and Finn Chamber techniques were comparable when used for patch testing. However false negative and false positive patch test reactions can occur when using either technique.

Adolescent↗
PubMed1996

Patch testing in an aged population without dermatitis: high prevalence of patch test positivity.

BACKGROUND: Epidermal immune function has been observed to decline in the aged. OBJECTIVE: The purpose of this study was to determine the prevalence and relevance of patch test reactivity in an aged population without dermatitis and compare this with patch test reactivity in healthy younger volunteers. METHODS: Patch testing with the North American Contact Dermatitis Group standard tray was performed on 82 healthy volunteers ranging in age from 68 to 87 years (mean age, 75 years), and the results were compared with those of 41 healthy younger volunteers (mean age, 24 years). A questionnaire regarding cutaneous symptoms was administered to both groups. RESULTS: Thirty subjects in the older population (37%) had one or more positive patch test results compared with 6 members of the control group (15%) (P = .01). Common sensitizers in the older group included balsam of Peru (7[9%]), fragrance (8[10%]), neomycin (6[7%]), nickel (5[6%]), and methylchloroisothiazolinone/methylisothiazolinone (3[4%]). A history of severe pruritus (without dermatitis) was associated with positive patch test results to balsam of peru and nickel. CONCLUSION: A high prevalence of positive patch test results in an aged population without dermatitis was observed. Factors contributing to to the high prevalence of patch test reactivity in the aged population may include cumulative exposure to potential allergens over time, a preserved ability to develop contact allergy, and altered percutaneous absorption. Patch testing in the aged must be interpreted carefully because the results may relate to past rather than present relevance.

Adult↗
PubMed1985

Biocide patch tests.

Routine patch testing with a series of 6 industrial biocides containing methylene-bis-thiocyanate (Cytox 3522), benzisothiazolin-3-one (BIT), chlorocresol (Preventol CMK), 2-n-octyl-4-isothiazolin-3-one (Kathon 893), polyhydroxymethylene monobenzylether (Preventol D2) or 1,3,5-tris (hydroxy-ethyl) hexahydrotriazine (Grotan BK) was carried out in 6 Danish out-patient clinics to evaluate guinea pig allergy test results with the same compounds. A total of 1652 consecutive patients with dermatitis were tested. The usefulness of this patch test battery was limited. There were a few positive reactions to Cytox 3522, BIT and the 2 formaldehyde releasers, Preventol D2 and Grotan BK. These reactions could not, however, be explained. The MOAHL-index (% of Male patients, Occupational cases, Atopic patients, Hand eczemas, and Leg ulcers/stasis dermatitis) for patients from the 6 clinics showed equal frequencies of male patients and atopics, but significant differences in the frequencies of occupational cases, hand eczemas, and leg ulcers/stasis dermatitis, indicating possible variations in referral patterns, use of patch tests, and/or environmental factors.

Animals↗
PubMed1989

Metal hypersensitivity in dentists: a patch test study.

Patch test of dental alloys was conducted on dentists in the Department of Prosthetic Dentistry, Hiroshima University School of Dentistry. The positive rate of the first patch test in the test group was 47.1%, and that in the control group was 10.0%, showing a large difference between the two groups. Furthermore, a second patch test was conducted on those who showed a positive response together with pustular or follicular reaction. As neither positive response nor pustular or follicular reaction was observed in the second patch test, the results were regarded as negative. Only a very slight difference in the positive rate could be observed when the results of the two tests were combined. The results of the present study suggest that the possibility is small for dentists to develop metal hypersensitivity in normal clinical practice.

Adult↗
PubMed2000

Positive nickel patch tests do not intensify positive reactions to adjacent patch tests with dichromate. Results from a double-blind multicentre study of the German Contact Dermatitis Research Group (Deutsche Kontaktallergie-Gruppe, DKG).

The possible interference of neighbouring allergic patch-test reactions is still an open question. In this study, we investigated whether there is a distance-related mutual modification of neighbouring allergic patch-test reactions to nickel sulfate and potassium dichromate. We used a double-blind multicentre study design with randomized attachment of special TRUE Tests with 1, 3 and 7 cm distance between nickel sulfate and potassium dichromate patches. 589 patients with a history of nickel allergy (523 female, 66 male) were tested, with a mean age of 35 years. A log-linear modelling approach was used for statistical assessment of the relation between the distance separating neighbouring patch tests with nickel and dichromate and the reactions to the allergens. Non-reproducibility coefficients were compared by the generalized version of Fisher's exact test for arbitrary 2-dimensional contingency tables. For the left side of the back, virtually no differences (p=0.70) were found in the reaction patterns obtained for the 3 distances separating nickel and dichromate patch tests. On the right side of the back, the number of reactions to dichromate patches with only 1 cm distance from moderate/strong nickel reactions was lower than the number of positive dichromate tests at larger distances from nickel tests (on the border of statistical significance: p= 0.05). Corresponding side-related results were obtained for subgroups of patients with and without a history of atopic dermatitis. The non-reproducibility of reactions to dichromate was not significantly related to the distance between neighbouring tests. Our data argue against a "spillover" effect of strong/moderate nickel reactions, but indicate that such reactions may, under certain conditions, attenuate adjacent reactions to an unrelated allergen. In the case of future verification, this will have implications for the interpretation of patch tests.

Adolescent↗
PubMed1985

The thin layer rapid use epicutaneous test (TRUE-test), a new patch test method with high accuracy.

The thin layer rapid use epicutaneous test (TRUE-test) is a new patch test, in which the allergens are incorporated in a thin, flexible solid vehicle on a water impermeable backing. The vehicle shows good stability for allergens, which are crystallized, micronized or emulsified into a gel. The TRUE-test produces an exact dosage, even surface spread and high bioavailability for the allergens. This solves the problems of low bioavailability, uncertain dosage and uneven surface distribution which are commonly seen when petrolatum is used as the vehicle.

Cobalt↗
PubMed1996

Evaluation of human skin irritation by carboxylic acids, alcohols, esters and aldehydes, with nitrocellulose-replica method and closed patch testing.

Closed patch testing and the nitrocellulose-replica method are performed as useful clinical methods for the evaluation of human skin irritation by cosmetics and topical medicaments. Comparison of the sensitivity between microscopic scoring by nitrocellulose-replica method and visual scoring by closed patch test in the detection of skin irritation, however, has not been well studied with statistical analysis. Here, we evaluated human skin irritation by carboxylic acids, alcohols, esters and aldehydes, with different chain length (C8-C18), using both methods. The results of closed patch testing showed that, although the score of skin irritation for carboxylic acids (C8, C12), alcohols (C8) and aldehydes (C8), tested at a concentration of 0.5 m-2.0 m, significantly increased with increasing concentration of the test compounds, ester compounds scarcely caused any irritation on the surface of the skin occluded. In addition, an increase of carbon chain length in the test compounds made it impossible to detect skin irritation. In contrast, the nitrocellulose-replica method could evaluate skin reactions against very weak irritants that gave no macroscopic alterations on the skin surface in the closed patch test. However, the scoring system is somewhat subjective and should be improved to make the analysis more objective.

Adult↗
PubMed1999

A quantitative comparison of induction and challenge concentrations inducing a 50% positive response in three skin sensitization tests; the guinea pig maximization test, adjuvant and patch test and Buehler test.

The sensitivities of three skin sensitization tests such as the Guinea pig maximization test (GPMT), Adjuvant and patch test (APT) and Buehler test (BT), were quantitatively compared with reference to induction and challenge concentrations. Four chemical which had different physico-chemical properties (octanol-water partition coefficient (logP) and reactivity with NH2-group) were used in order to clarify the effect of the physico-chemical properties of chemicals on the sensitivity of the different methods. The induction concentrations inducing a 50% positive response (IC50) demonstrated extreme variation with the three methods. For example, the BT/GPMT ratio of IC50 values for 2,4-dinitrochlorobenzene was 33, whereas that for maleic anhydride was 300,000. The results were thought to be caused by difference properties such as the logP and reactivity of chemicals. This correlation was confirmed by using 2-dodecen-1-yl succinic anhydride, which had the same reactivity but higher logP than that of maleic anhydride. On the other hand, the challenge concentrations inducing 50% positive responses (CC50) were less affected by the methods and the BT/GPMT ratios for CC50 values were all within a 10-fold range. These results suggest that the sensitivity might be strongly different with reference to induction concentration, but not challenge concentration among the three methods.

Adjuvants, Immunologic↗
PubMed2002

Positive patch tests with a dermatophagoides mix relate to an increased responsiveness to standard patch test allergens.

The diagnostic meaningfulness of patch tests with house dust mite allergens is still questionable. Our own impression has been that positive results with a dermatophagoides mix may occur preferentially in patients with a generally enhanced responsiveness to contact allergens. To check this, all of our patients allocated to patch testing with the standard series were additionally patch tested with a dermatophagoides mix by the same technique that was used for standard contact allergens. Out of 571 patients tested, 188 showed delayed responses to this mix that were indistinguishable from typical allergic patch test reactions but of no apparent clinical relevance. No relationship was found between positive dermatophagoides patch tests and an atopic disposition of the patients or characteristics of their eczema. However, 64.4% of the patients with a positive dermatophagoides patch test showed a response to at least 1 contact allergen of the standard series, compared to only 56.4% of the patients without a positive dermatophagoides reaction (p < 0.05). The reactivity to the mite mix was not related to the responsiveness towards any particular contact allergens. We suppose that some unidentified factors may contribute to positive reactions to the dermatophagoides mix that may also favour an enhanced general responsiveness to contact allergens.

Adult↗
PubMed2004

Skin reaction and recovery: a repeated sodium lauryl sulphate patch test vs. a 24-h patch test and tape stripping.

BACKGROUND: Little is known of the predictive value of methods to test an individual's susceptibility to acquiring occupational contact dermatitis. Recently, the recovery rate after induced irritation was suggested for this purpose. Although it is likely that repeated exposure to sodium lauryl sulphate (SLS) is preferable to a single application, there is little evidence to support this idea. Similarly, little is known about whether the outcome of a repeated SLS test can be predicted by a brief test. OBJECTIVES: We studied the relationship between the skin reaction after a repeated SLS test and two brief tests, devoting special attention to the recovery rate. METHODS: In 29 healthy volunteers, we measured transepidermal water loss (TEWL) and erythema after applying 0.03, 0.1 and 0.3% SLS for 6 h, 3 days per week, over a course of 3 weeks. The data were compared with the effects after applying 0.1, 0.3 and 1.0% SLS for 24 h and with 10 and 15 repetitions of tape stripping. RESULTS: A poor correlation was found between the repeated test and the brief SLS test, or tape stripping, when using an increase in TEWL (r = 0.04 and 0.26, respectively) or its recovery rate (r = - 0.01 and 0.42, respectively). CONCLUSIONS: We presume that in a repeated test of sufficient duration, additional mechanisms come into play that are absent in a brief test, e.g. an alteration in the thickness of the epidermis, with a resulting change in the permeability of SLS. When such an effect differs between subjects it could explain the lack of agreement between the acute and the repeated tests. At present, a brief irritation test will, in all likelihood, be unable to assess an individual's susceptibility to occupational contact dermatitis.

Adult↗
PubMed2002

Positive atopy patch test reaction to Malassezia furfur in atopic dermatitis correlates with a T helper 2-like peripheral blood mononuclear cells response.

The yeast Malassezia furfur belongs to the normal cutaneous flora, but is also a triggering allergen that can contribute to atopic dermatitis. To illuminate the effect of circulating allergen-specific T cells in atopic dermatitis, the peripheral mononuclear cell response was correlated with the in vivo skin prick test and atopy patch test reactivity to M. furfur. None of 16 healthy controls showed any positive in vivo reaction. The 40 atopic dermatitis patients, of whom 18 had serum IgE reactivity to M. furfur, were subdivided according to their in vivo reaction to M. furfur extract into three groups: skin prick test positive/atopy patch test positive (n = 12), skin prick test positive/atopy patch test negative (n = 12), and skin prick test negative/atopy patch test negative (n = 16). The skin prick test positive/atopy patch test positive and the skin prick test positive/atopy patch test negative groups had a significantly higher peripheral mononuclear cell stimulation index than the healthy controls. Interestingly, the stimulation index values in the skin prick test positive/atopy patch test positive group were significantly higher than in the skin prick test positive/atopy patch test negative group. In the M. furfur skin prick test positive atopic dermatitis patients (n = 24) a correlation was found between stimulation index and the M. furfur atopy patch test reactions, but not between stimulation index and M. furfur-specific serum IgE levels. Skin prick test positive and/or atopy patch test positive reactions to the recombinant M. furfur allergens rMal f 1, rMal f 5, and rMal f 6 were observed in 7, 14, and 16 of the 40 atopic dermatitis patients, respectively. Further, there was a correlation between production of the T helper 2-related cytokines interleukins 4, 5, and 13 and stimulation index to M. furfur extract, but not between the T helper 1-related interferon-gamma and stimulation index to M. furfur extract. Our data strongly suggest a relationship between circulating specific T cells with a T helper 2-like cytokine profile and positive atopy patch test reactions.

Adult↗
PubMed2004

[Value of skin prick test and atopy patch test in mite-induced respiratory allergy and/or atopic eczema/dermatitis syndrome].

AIM: The atopy patch test (APT) was introduced to assess sensitization to inhalant allergens in patients with atopic/eczema dermatitis syndrome (AEDS), but its diagnostic role in subjects with respiratory allergy is scantly investigated. We sought to evaluate the response to APT and to skin prick tests (SPT) with mite extracts in subjects with persistent respiratory symptoms (rhinoconjunctivitis, rhinosinusitis, asthma), with AEDS, and with both the diseases. METHODS: Eighty-nine patients were included in the study, 75 (84.3%) children and 14 (15.7%) adults, 54 (60.7%) males and 35 (39.3%) females (median age 5.4 years). They were divided in 3 groups, respectively formed by 47 (mean age 12.3+/-11.6 years), 15 (mean age 2.2+/-2.5 years), and 27 (mean age 6.2+/-6.3 years) subjects, according to the presence of only respiratory symptoms, only AEDS, or both, and underwent to usual SPT with mite extracts and to APTs done by mite extract in Finn chambers and removed after 48 hours, with readings after 20 minutes and 24 hours. RESULTS: Of the 89 patients, 24 showed a positive SPT and 69 a positive APT; in 17 both SPT and APT were positive, while 13 were negative to the 2 tests. The APT was more frequently positive than SPT not only in the 2 groups with AEDS -- 32/42 (86.5%) vs 8/42 (21.6%) -- but also in the group with only respiratory symptoms -- 37/47 (78.7%) vs 16/47 (34%). CONCLUSION: These results confirm the high value of APT in patients with mite-induced AEDS and suggest that its routine use might improve also the diagnosis of respiratory allergy to house dust mites.

Adult↗
PubMed1994

Reproducibility of patch tests. A multicenter study of synchronous left-versus right-sided patch tests by the German Contact Dermatitis Research Group.

BACKGROUND: The efficiency and reproducibility of patch tests remain controversial. OBJECTIVE: Our purpose was to determine the efficiency and reproducibility of patch tests and to identify factors influencing these features. METHODS: We double-tested 1285 patients concomitantly with 10 standard allergens by manually filled test chambers. Additional information was obtained from all patients with a standardized protocol. RESULTS: Patch test efficiency was good (> or = 0.94) with all 10 allergens. In contrast, nonreproducibility of patch tests was strongly allergen dependent, ranging from 0.2 for nickel sulfate to 0.6 for formaldehyde. The likelihood of nonreproducible allergic reactions increased when more than four positive reactions were seen at the same time, and with another positive reaction located in close proximity to an allergic reaction. Sex and age of patients, atopy, dermatitis at distant sites, sleeping habits, and the time of allergen exposure (24 or 48 hours) did not affect the rate of nonreproducible results. CONCLUSION: To increase patch test reproducibility, specific preparations of patch test allergens need to be improved. Furthermore, amplification effects by synchronous neighboring positive reactions should be excluded.

Allergens↗
PubMed1999

Evaluating the relevance of aeroallergen sensitization in atopic eczema with the atopy patch test: a randomized, double-blind multicenter study. Atopy Patch Test Study Group.

BACKGROUND: IgE-mediated sensitization of questionable clinical relevance is routinely demonstrated in patients with atopic eczema (AE) by skin prick test or radioallergosorbent test (RAST). We report the results of a randomized, double-blind multicenter study in patients with AE on the relevance and technical aspects of aeroallergen patch testing (atopy patch test, APT). METHODS: Two hundred fifty-three adult patients with AE in remission were tested in 7 study centers on clinically uninvolved, unabraded back skin with 3000 to 10,000 PNU/g of Dermatophagoides pteronyssinus, cat dander, grass, birch, and mugwort pollen allergen extracts in petrolatum. After skin prick and RAST and a detailed history on aeroallergen-induced eczema flares was obtained, reading was done at 48 to 72 hours. RESULTS: Previous eczema flares after contact with specific allergens were reported by 10% (mugwort pollen) to 52% (D pteronyssinus) of patients. The percentage of clear-cut positive APT reactions ranged from 44% with D pteronyssinus to 5% with mugwort. Positive skin prick (36% to 65%) and RAST (49% to 75%) results were more frequent. APT results showed significant concordances with history, skin prick, and RAST for D pteronyssinus, cat dander, and grass pollen (P < .001). Optimal test concentrations were 5000 (grass pollen) and 7000 PNU/g (D pteronyssinus, cat dander). The APT had a higher specificity (69% to 92% depending on allergen) with regard to clinical relevance of an allergen compared with skin prick test (44% to 53%) and RAST (42% to 64%). CONCLUSION: Aeroallergens are able to elicit eczematous skin reactions after epidermal application. The relevance of aeroallergens for AE flares may be evaluated by APT.

Adolescent↗
PubMed1993

Compositae dermatitis in a Danish dermatology department in one year (I). Results of routine patch testing with the sesquiterpene lactone mix supplemented with aimed patch testing with extracts and sesquiterpene lactones of Compositae plants.

To investigate the frequency of Compositae sensitivity, the recently-developed sesquiterpene lactone mix (SL mix) was included in the standard patch test series. Patients with positive reactions to this or patients suspected of having a Compositae allergy were supplementarily tested with a Compositae mix, consisting of ether extracts of 5 European Compositae plants. In the first year, 686 patients were tested with the SL mix and 79 with the Compositae mix. A total of 31 Compositae-sensitive patients (4.5%) were found. The frequency of positive reactions to either of the mixes was equal, but only 17 of 30 patients tested were positive to both mixes. Testing with the individual ingredients of the Compositae mix showed frequent positive patch test reactions to feverfew, followed in order by chamomile, tansy, yarrow and arnica. The reason for this distribution is discussed and the results of standard, photo- and other plant patch tests are presented. The only partial overlap between positive reactions to the mixes emphasizes the necessity of supplementary testing in patients suspected of Compositae allergy, as well as the lack of a reliable single screening agent. Since no cases of active sensitization or irritant reactions were seen, both the SL mix and the Compositae mix may be considered suitable for routine screening of Compositae allergy.

Adult↗