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We report 3 patients with persistent symptoms at vaccination sites. All were allergic to aluminium and one to thiomersal and neomycin too. Aluminium allergy causes false positive patch test reactions and we propose methods of patch testing patients with symptoms at vaccination sites in order to avoid this problem. The practical relevance of allergy to non-toxoid constituents of vaccines is discussed.
A 3-year study of patch test reactions to the Standard European Battery has been carried out in two adjacent areas of S. E. England with the same climatic and cultural background. The source of materials and method of testing were identical; both observers had worked together in the same Contact Dermatitis department and the interpretation of reactions can therefore be considered to be consistent. The main differences between the two areas lay in the pattern of employment and of local medicament prescribing. The first only is examined here. One area was dominated by the automobile industry, the other by the furniture industry, with important subsidiary rubber, foam and electronics factories. The pattern that emerges shows that patch test reactions to the Standard European Battery were more likely to be related to environmental allergens and medicament usage than to industrial hazards. Chrome dermatitis was less common than elsewhere in Europe but nickel sensitivity showed the same pattern. Rubber chemical sensitivity reflected industrial, as well as domestic usage. Colophony and formaldehyde appeared to have less industrial significance than we expected. Special additional industrial allergens are not considered here but were of particular importance in the furniture industry. Although the numbers analysed were relatively small, we believe that they reflect the pattern to be expected in areas of relatively low industrial risk in Great Britain at the present time.
Epoxy resin systems (ERSs) are a frequent cause of occupational allergic contact dermatitis. A 50-year-old patient developed eczematous skin lesions on the back of his hands, lower arms and eye lids, 2 months after he had started working in aircraft construction. Patch tests showed positive reactions at day 3 to nickel sulfate, epoxy resin based on diglycidyl ether of bisphenol F (DGEBF) and 1,4-butanediol diglycidyl ether (1,4-BDDGE). The chemical triglycidyl-p-aminophenol (TGPAP) applied at 1% and 0.1% induced the strongest (+++ positive) reaction. About 4 months after the patch test with TGPAP, the patient presented with 2 circular depigmented spots in the former TGPAP-patch test areas. Dermatohistopathology confirmed the diagnosis of contact vitiligo.
PURPOSE: To compare laser Doppler perfusion imaging (LDPI) measurements in experimentally induced allergic contact reactions and irritant contact reactions. The degree of correlation between visual scores and LDPI measurements was also studied. METHODS: Fifteen patients with known contact allergy to nickel or fragrance were patch tested with nickel sulfate 5% pet., fragrance mix 8% pet., sodium lauryl sulfate (SLS) 0.5% pet., SLS 1.0% pet. and two empty control chambers. Visual readings and LDPI measurements were taken at 0, 48 and 96 h. RESULTS: There was a positive correlation between visual scores and LDPI measurement in the nickel sulfate and fragrance mix patch test sites. However, no correlation between visual scores and LDPI measurements was seen in the SLS 0.5% and SLS 1.0% patch test sites. There was no significant difference (P=0.125) in LDPI measurements between contact-allergic reactions and contact-irritant reactions. CONCLUSION: LDPI correlates with visual scoring in contact-allergic reactions, but not in irritant reactions. LDPI is not useful in distinguishing between allergic and irritant reactions.
BACKGROUND: Normal human skin harbors a single epidermal dendritic cell (DC) population, the CD1a(+++)CD11b(-) Langerhans cells. In many chronic inflammatory skin diseases, the epidermal DC pool bears a second population, the CD1a(+)CD11b(+++) inflammatory dendritic epidermal cells (IDECs). Immunophenotypic, ultrastructural, and functional aspects of IDECs have been investigated in chronic untreated skin lesions of intrinsic and extrinsic atopic dermatitis (AD), contact dermatitis (CD), and psoriasis, but little is known about freshly induced early skin lesions. OBJECTIVE: We sought to characterize enumerative and immunophenotypic changes in the epidermal DC pool during the development of eczematous skin lesions. METHODS: The atopy patch test with aeroallergens and food-protein allergens and a conventional patch test with standard-series haptens were performed as models for early skin lesions of extrinsic and intrinsic AD and CD, respectively. After 72 hours, epidermal cell suspensions were prepared, analyzed in a standardized flow cytometric technique, and compared with the results obtained from chronic lesions. RESULTS: The migration of IDECs into the epidermis occurs within 72 hours and is thus an early event. It continues in chronic AD, but not in chronic CD, lesions. The specific upregulation of FcepsilonRI, especially on IDECs, occurs later during formation of extrinsic but not intrinsic AD lesions. LCs were negative for Cd36 in patch test lesions, whereas in chronic skin lesions, LCs expressed Cd36. CONCLUSION: The DC alteration during skin lesion formation can be subdivided into early and late events, with the influx of IDECs as an early event and the alteration of the DC phenotype as a late event.
BACKGROUND: Persistent vulval pruritus is common and may not be associated with signs of a primary vulval dermatosis. Patients with established vulval disease may develop contact sensitivity as a secondary problem after the application of topical therapy. OBJECTIVE: A retrospective study was performed to establish the prevalence of allergic contact dermatitis in patients with pruritus vulvae. In addition, the results of patch testing in women with vulval lichen sclerosus were compared with those in patients with primary pruritus vulvae and essential vulvodynia. METHODS: Over a 5-year period, 121 women with vulval problems were patch tested to the European Standard Series, selected preservatives, perfumes, local anesthetics, medicaments, and a vulval battery. RESULTS: Fifty-seven patients (49%) had one or more relevant allergic positive reactions. Medicaments or their constituents were the most common allergens to give reactions. Seven of the 16 patients (44%) with lichen sclerosus had positive reactions. Symptoms resolved or improved significantly in 67 patients (55.4%) overall. Six of the seven women with lichen sclerosus who had positive reactions noted an improvement in their symptoms. Patients who had a relevant allergy were much more likely to improve than those whose tests were negative (p < 0.001). CONCLUSION: Patients with pruritus vulvae and lichen sclerosus are at high risk of contact sensitivity. Patch testing is useful in the management of these patients and many can be helped by allergen avoidance.
Although positive reactions to topical corticosteroids can occur in over 1% of a patch-test population, systemic reactions to oral corticosteroids are uncommon. A 45-year-old woman who gave a clear history of the generalization of a cutaneous eruption following oral prednisolone was positive on patch testing using prednisolone eye drops.
The rôle of contact allergens and aeroallergens in facial dermatitis (FD) was studied. 114 cases of FD were divided into 3 groups. Group 1 comprised 47 cases of facial cosmetic dermatitis (FCD), in which all patients had a history of dermatitis related to cosmetics clinically; group 2 comprised 15 cases of seasonal facial dermatitis (SFD); Group 3 comprised 52 cases of other FD (OFD) that could not be categorized as FCD or SFD. Reactions to contact allergens and aeroallergens were detected using patch testing and intradermal testing, respectively, with non-facial eczematous skin disease patients serving as controls. The positivity rate for each allergen between different groups was compared by the chi2-test. The results show that the positivity rate for fragrance mix in FCD is much higher than in non-FCD (27.7% versus 6.7% in SFD, 7.6% in OFD and 6% in eczema patients, p<0.05). No significant difference was detected for other common allergens, such as PPD, rubber mix, nickel sulfate, and colophonium (p>0.05 for all). These results suggest that fragrance mix contains the main contact allergens in FCD. Patch testing with patients' own products also yields high numbers of relevant results in FCD and OFD. No relevant patch test results were found in SFD, indicating that contact allergy may not be relevant to SFD. No significant difference was observed between intradermal skin reactions to aeroallergens, including pollens and moulds, in SFD, OFD, FCD and controls. These results suggest that Type I reactions to aeroallergens may not be relevant in FD. The rôle of aeroallergens in FD needs to be studied further.
The sweat-patch test is a new diagnostic test to measure the amount of alcohol a person is drinking. This study monitored the subjective responses of 41 volunteers before undergoing the test, and at the conclusion of the test one week later. There were no significant differences between the pre-test responses of returnees and drop-outs. The post-test rating of the comfort of the test showed a significant increase (p less than 0.05) over the pre-test rating; no significant changes occurred in the other ratings. The subjects generally rated the test highly for its potential benefits, and liking the test even though they knew it would objectively reveal their drinking habits. There was a tendency to believe that the test might induce them to drink less alcohol than usual. Subjects were generally neutral about their desire for other people to see the sweat-collecting patches, and learn that they were taking the test.
The results of patch tests with mercury compounds and disinfectant solutions as well as the clinical picture of mercury contact dermatitis are presented and discussed. During the period from Nov. 1983 to Dec. 1986, 686 patients were tested with mercury compounds. During the 13 year period from 1974-1986, 118 patients were tested with disinfectant solutions and 59 patients with mercury contact dermatitis were seen. Among the disinfectant solutions tested, the highest incidence of positive reaction, 11.5%, was obtained with thimersal. Cross sensitization has been shown between mercurochrome and ammoniated mercury, but no statistical correlation existed that demonstrated cross sensitization between mercury and thimerosal until our study. Therefore, the allergen in mercurochrome contact dermatitis is mercury. No statistical correlation could be established between the occurrence of atopic dermatitis and the patch test reactions to mercury compounds. The contactants were mercurochrome, thimerosal, and broken thermometers in 49 out of 59 cases of mercury contact dermatitis. Consequently, the number of occurrence of mercury dermatitis can be reduced by the elimination of the use of these two disinfectant solutions and the substitution of electric thermometers for mercury thermometers.
During a 22-month period, 2.0% cadmium chloride in distilled water was included in our routine patch test series. Twenty-five of 1502 eczema patients showed reactions (1.7%), but none had any relevant history. At serial dilution test only one patient reacted to 1.0% cadmium; all the other dilutions applied gave negative reactions. Analysis by atomic absorption spectrophotometry of the cadmium chloride used for patch testing showed that it contained less than 1 microgram/g of chromium, copper, cobalt and nickel. The conclusion is that no certain case of contact allergy to cadmium chloride has been revealed. An experimental study using the guinea pig maximization test is in progress.
BACKGROUND: The atopy patch test (APT) was proposed to evaluate IgE-mediated sensitizations in patients with atopic eczema (AE). OBJECTIVE: The prevalence and agreement with clinical history and specific IgE (sIgE) of positive APT reactions was investigated in six European countries using a standardized method. METHODS: A total of 314 patients with AE in remission were tested in 12 study centers on clinically uninvolved, non-abraded back skin with 200 index of reactivity (IR)/g of house dust mite Dermatophagoides pteronyssinus, cat dander, grass, and birch pollen allergen extracts with defined major allergen contents in petrolatum. Extracts of egg white, celery and wheat flour with defined protein content were also patch tested. APT values were evaluated at 24, 48, and 72 h according to the European Task Force on Atopic Dermatitis (ETFAD) guidelines. In addition, skin-prick test (SPT) and sIgE and a detailed history on allergen-induced eczema flares were obtained. RESULTS: Previous eczema flares, after contact with specific allergens, were reported in 1% (celery) to 34% (D. pteronyssinus) of patients. The frequency of clear-cut positive APT reactions ranged from 39% with D. pteronyssinus to 9% with celery. All ETFAD intensities occured after 48 and 72 h. Positive SPT (16-57%) and elevated sIgE (19-59%) results were more frequent. Clear-cut positive APT with all SPT and sIgE testing negative was seen in 7% of the patients, whereas a positive APT without SPT or sIgE for the respective allergen was seen in 17% of the patients. APT, SPT and sIgE results showed significant agreement with history for grass pollen and egg white (two-sided Pr > /Z/ < or = 0.01). In addition, SPT and sIgE showed significant agreement with history for the other aeroallergens. With regard to clinical history, the APT had a higher specificity (64-91% depending on the allergen) than SPT (50-85%) or sIgE (52-85%). Positive APT were associated with longer duration of eczema flares and showed regional differences. In 10 non-atopic controls, no positive APT reaction was seen. CONCLUSION: Aeroallergens and food allergens are able to elicit eczematous skin reactions after epicutaneous application. As no gold standard for aeroallergen provocation in AE exists, the relevance of aeroallergens for AE flares may be evaluated by APT in addition to SPT and sIgE. The data may contribute to the international standardization of the APT.
INTRODUCTION: Celecoxib (Celebrex(R)) is a new generation non-steroidal anti-inflammatory drug, recently introduced in France. We report a maculopapular rash due to this drug with positive patch-tests. CASE REPORT: A forty year-old man received with 3 tablets/day of celecoxib for intercostal pain. Nine days after initiation of treatment a maculopapular rash appeared. At the end of treatment, the eruption persisted for two days, then rapidly improved within one week. Six weeks later, patch-tests with celecoxib diluted at 20 p. 100 in petrolatum were positive at 48 hours. DISCUSSION: Cutaneous reactions due to celecoxib are rare. In our case report, the delay, clinical aspect, improvement on withdrawal of treatment and positive patch test all emphasize the imputability of celecoxib. We wish to underline the possible cutaneous reactions with this new non-steroidal anti-inflammatory drug.
BACKGROUND: Health care workers are exposed to many agents that can cause irritant or allergic contact dermatitis. Recently, much attention has been focused on latex sensitivity, which commonly causes contact urticaria. Most studies have examined the conditions of irritant or allergic contact dermatitis and contact urticaria independently. Therefore, we have little information about the possible occurrence of these conditions in the context of combined assessment including both prick and patch testing. OBJECTIVE: To determine the prevalence of irritant and allergic contact dermatitis and contact urticaria in a group of health care workers presenting with skin problems. METHODS: Retrospective review of health care workers assessed by both prick and patch testing in an occupational health clinic. RESULTS: The diagnoses included 61% with irritant contact dermatitis, 31% with allergic contact dermatitis, and 27% with contact urticaria to latex. Eleven percent had both allergic contact dermatitis related to thiuram and contact urticaria to latex. Ninety five percent were deemed to be work-related. CONCLUSION: Health care workers presenting with skin complaints should be assessed with both prick and patch testing.
This study has been performed to evaluate the efficacy of fragrance mix (FM) as a screen for fragrance allergy. Patients were included if they had had positive allergic reactions to FM, to 1 of the 8 ingredients of FM, to 1 of 14 other fragrance materials, or to their own perfume. 91 patients were studied. There were 65 women and 23 men (in 3, their sex was not recorded) allergic to FM on patch testing. The mean (+/-SD) age was 48.4+/-18.6 years. 22 patients gave a past history of atopic eczema. Dermatitis of the hands (31%) and face (26%) were the most common presenting complaints. 85 patients (93%) had a positive allergic patch test reaction to FM. 22 of the 40 tested to the extended fragrance series were positive to other perfumes as well, and of these, there were 14 reactions (in 9 patients) to allergens not in the FM. In addition, 6 patients were positive only to separately tested fragrance constituents and not to the FM. In conclusion, FM is an accurate screen for fragrance contact sensitivity. However, patch testing to an extended series is needed if there is clinical suspicion of perfume allergy, as otherwise about 7% of patients allergic to fragrances will be missed.
Local anesthetics have been contained in various OTC drugs and the number of cases of allergic contact dermatitis due to local anesthetics has increased recently. Thirty-five hundreds and fourteen cases suspected of suffering from drug eruption or contact dermatitis were the subjects of this study during the 8 years from January, 1988 to December, 1995. One hundred and thirty-eight cases, suspected of having allergic contact dermatitis were patch tested with topical medicaments including local anesthetics and 70 (50.7%) of them showed positive. In 49 of the 60 cases who reacted positively to anesthetics extensive patch tests with the individual ingredients of the products were carried out. The local anesthetics causing positive reactions were as follows (in order of frequency): dibucaine hydrochloride (35 cases: 71.4%), ethyl aminobenzoate (12 cases: 24.5%), lidocaine hydrochloride (2 cases: 4.1%), and procaine hydrochloride (1 case: 2.0%). The number of patients displaying allergies to local anesthetics has increased, especially cases caused by dibucaine hydrochloride. And the total positive reaction rate to dibucaine hydrochloride in the patch tests was 3.7%, which was as high that to the well-known strong sensitizer PPDA (3.9%) and neomycin (2.9%). Forty-three cases sensitive to local anesthetics were also studied for cross-sensitivity.
The effects of repeated topical application of a strong glucocorticosteroid (GCS) on patch test responses and the inflammatory infiltrate were studied in twenty nickel allergic patients. Patch test responses were strongly inhibited in 18 out of 20 patients. Immunohistochemical analysis revealed marked reductions in CD1+(T6+) Langerhans cells, activated inflammatory T cells and of mast cells in the skin. It is concluded that GCS suppress contact allergic responses by reduction, or functional inhibition of antigen presenting cells. The reduced number of mast cells release less vasoactive mediators, inhibiting recruitment of inflammatory cells.
25% of 315 tested subjects exhibited skin reactions when patch tested with mineral wool. Coating of the mineral fibres with phenol-formaldehyde did not influence the skin reactions. The reactions seem to be induced mechanically, as the mineral without the fibres did not give any reactions. No allergic reactions to the chemical additives were demonstrated. Macroscopically, the reactions may simulate an allergic response; microscopically, they seem to be toxic, sometimes with prominent spongiosis.