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Effects of topical testosterone propionate on the positive nickel patch test.

In a group of nickel sensitized women, we investigated the effects of topical application of testosterone propionate on the epidermic density of CD1 + dendritic cells and on the response to patch tests performed with scaled nickel concentrations. In a significant number of examined subjects, treatment with testosterone propionate induced an increase of the minimum eliciting dose of nickel and an evident reduction of CD1 + dendritic cell epidermic density. In those subjects in which the minimum eliciting dose resulted unmodified, the epidermic density of CD1 + dendritic cells also did not undergo significant variations following treatment with testosterone propionate. This parallelism between the behaviour of the responses to patch tests and the epidermic density of CD1 + dendritic cells induces us to think it possible that testosterone propionate is able to increase the tolerance to contact with allergen by interfering with the activity of Langerhans cells. The possible mechanisms of testosterone action on Langerhans cells remain to be elucidated.

Administration, Topical↗

Anaphylactic shock and contact urticaria after the patch test with professional allergens.

It is reported on 3 patients of medical profession who suffered from anaphylactic complications after the patch test with penicilline G, aminophenazone and promethazinhydrochloride. The triggering of the IgE mediated allergy is explained by the quick and complete epidermal penetration of the haptens because their low molecular weight and optimal solubility. It could be proved by the positive mast cell degranulation test, whereas the IgE level was elevated in serum only in one case, but in tissue in no case. Prophylactically, if the careful exploration is positive, the open patch test is indicated. It should carried out in the clinic or ambulance with consecutive observation of the patients for 60 min and with the possibility of the treatment of shock.

Allergens↗

Atopy Patch Test (APT)--its role in diagnosis of food allergy in atopic dermatitis.

During the past few years, the Atopy Patch Test (APT) has become a valuable additional tool in the diagnostic work-up of food allergy in infants and children with atopic dermatitis. A positive APT may help to prevent restrictive and unnecessary diets which may be the consequence of misjudging late reactions by clinical assessment alone. Furthermore, the combination of positive atopy patch tests together with defined levels of specific IgE (cow milk = 0.35 kU/l and egg = 17.5 kU/l) makes DBPCFC superfluous for suspected milk and egg allergy. However, several open questions indicate the need for further studies.

Dermatitis, Atopic↗

Patch test results in schoolchildren. Results from the Information Network of Departments of Dermatology (IVDK) and the German Contact Dermatitis Research Group (DKG)

Our aim was to explore the current spectrum of contact allergens in schoolchildren, as a basis for diagnosis and prevention of allergic contact dermatitis. Results of patch tests in children 6-15 years old, performed in the years 1990-1995 by 22 centres of the German Contact Dermatitis Research Group and filed by the Information Network of Departments of Dermatology, were analysed and evaluated retrospectively, including epidemiologic data. Children with positive tests (62 out of 156 boys and 108 out of 260 girls tested) had a higher frequency of allergic contact dermatitis and a lower frequency of atopic dermatitis than patch test negative ones. 16 distinct allergens elicited positive reactions in > or = 1% of the children tested. Reactions to nickel sulfate occurred in 15.9% of all children tested, but in 25.0% of girls 14/15 years old, and in only 4.5% of boys 6-13 years old. Double-sensitizations with cobalt salts, potassium dichromate and palladium were seen. Mercury compounds were found in 2nd place (thimerosal: all children: 11.3%; 6-13 years old: 14.3%; 14/15 years old: 8.0%), followed by fragrance allergens. We conclude that contact allergy in children is related to their sex and age. Prophylaxis against nickel, mercury, and fragrance allergy needs to be improved. A shortened standard series may be sufficient for testing children.

Adolescent↗

[Patch tests performed with Epidian in workers exposed to epoxy resins].

The patch tests according to the Jadassohn-Bloch's method were made with five Polish epoxy resins--"Epidian"--in 487 workers exposed to their action, and in 113 persons of the control group. The percentage of sensitized persons among 487 examined amounted to 22,8%, the results of test in the control group being negative. It has been found that particularly sensitizing action is produced by the non hardened resins (the percentage of persons sensitized in the group working at non hardened resins was 26,7, at hardening ones--2.6).

Dermatitis, Contact↗

Glyceryl p-aminobenzoate patch testing in benzocaine-sensitive subjects.

Benzocaine-reactive patients were patch tested to two commercial sources of glyceryl p-aminobenzoate containing varying concentrations of benzocaine as a contaminant. Eleven of 20 reacted to the source with approximately 0.3% benzocaine; none reacted to the source with approximately 0.001% benzocaine.

4-Aminobenzoic Acid↗

Patch testing with cement containing iron sulfate.

Addition of iron sulfate to cement means transformation of water-soluble hexavalent chromium into nonwater-soluble trivalent chromium. This has been the basis for preventive measures concerning sensitization to hexavalent chromium (chromate) in cement. For some years, iron sulfate has been added to cement manufactured in the Scandinavian countries. In the present in vivo study, cements with and without iron sulfate were compared concerning their capacity to elicit allergic patch-test reactions in eight chromate-hypersensitive individuals. No patch-test reactions were obtained from a water extract of cement with iron sulfate when appropriately buffered.

Chromium↗

Degradation of triglycidyl isocyanurate as a cause of false-negative patch test reaction.

Triglycidyl isocyanurate (TGIC) is mainly used in polyester-based powder paints, but also in laminates, insulating varnishes, coatings and adhesives. Several cases of contact allergy to TGIC have been reported during the last 10 years. Contact allergy to TGIC has developed in a factory producing the chemical, in a factory producing powder paints containing TGIC, and in industries using powder coating. In this paper, we report a man who developed a work-related dermatitis when working on the painting of metal frames. He was exposed to polyester powder pigments containing TGIC. When patch tested, he was negative to TGIC (prepared in 1988) 3x and positive to polyester powder pigment. Only when a new test preparation of fresh TGIC powder was tested, was a positive reaction obtained. Chemical analyses showed that there was no TGIC in the test preparation from 1988, and that in the TGIC powder from 1988, there was only 30% of the expected amount of TGIC. The investigations, clinical and chemical, strongly indicate degradation of TGIC in the test preparation and powder. Both substances and the test preparations made from them may change over time. Therefore, if a false-negative reaction due to a test preparation is strongly suspected, we recommend a re-test of the patient with a new test preparation of fresh material. As a general rule, patch testing should be performed with fresh substances and test preparations made from them, unless their stability and durability are known.

Adult↗

Epicutaneous patch test reactions in atopic dermatitis patients.

During the 1998-2003 period, patch testing was carried out in 65 atopic dermatitis patients, 20 (31%) male and 45 (69%) female, mean age 34.7 (range 6-77) years. Twenty-six (40%) patients, 7 (27%) male and 19 (73%) female, showed positive reaction to one or more allergens. Allergic reactions were more common in women. The most common allergens were nickel (33.3%), cobalt (11.1%), fragrance mix (11.1%), white mercury precipitate (8.4%), and others (36.1%). There was a significant association between nickel allergy and cobalt allergy. It is concluded that contact hypersensitivity is not rare in patients with atopic dermatitis.

Adolescent↗

Patch testing to exclude allergic contact dermatitis caused by povidone-iodine.

Povidone-iodine (polyvinylpyrrolidone-iodine, PVP-I) solution is an effective and safe disinfectant agent used throughout the world; however, prolonged exposure to PVP-I solution may cause irritation or rarely severe skin reactions. When PVP-I as is in the aqueous state is used for patch testing, a false-positive result is likely to arise due to irritation. Patch testing to exclude allergic contact dermatitis caused by PVP-I should be done with dried 10% PVP-I solution, 10% PVP-I gel, 8% sodium thiosulfuric acid and a mixture of 10% PVP-I solution and 8% sodium thiosulfuric acid.

Aged↗

The CXCR3 activating chemokines IP-10, Mig, and IP-9 are expressed in allergic but not in irritant patch test reactions.

Differentiation between allergic and irritant contact dermatitis reactions is difficult, as both inflammatory diseases are clinically, histologically, and immunohistologically very similar. Previous studies in mice revealed that the chemokine IP-10 is exclusively expressed in allergic contact dermatitis reactions. In the present study, we investigated whether the mRNA expression of IP-10 and the related CXCR3 activating chemokines, Mig and IP-9 are also differentially expressed in human allergic contact dermatitis and irritant contact dermatitis reactions. Skin biopsies from allergic (13 cases) and sodium lauryl sulfate-induced irritant patch test reactions (13 cases), obtained 1-72 h after patch testing, were studied by means of an in situ hybridization technique. Results of chemokine mRNA expression were correlated with clinical scoring, histology, and immunohistochemical data including the proportion of inflammatory cells expressing CXCR3, the receptor for IP-10, Mig, and IP-9, and ICAM-1 and HLA-DR expression on keratinocytes. IP-10, Mig, and IP-9 mRNA were detected in seven of nine allergic contact dermatitis reactions after 24-72 h, but not in sodium lauryl sulfate-induced irritant contact dermatitis reactions. ICAM-1 expression by keratinocytes was only found in allergic contact dermatitis reactions and correlated with chemokine expression. Moreover, up to 50% of the infiltrating cells in allergic contact dermatitis expressed CXCR3, in contrast to only 20% in irritant contact dermatitis reactions. In conclusion, we have demonstrated differences in chemokine expression between allergic contact dermatitis and irritant contact dermatitis reactions, which might reflect different regulatory mechanisms operating in these diseases and may be an important clue for differentiation between allergic contact dermatitis and irritant contact dermatitis reactions.

Chemokine CXCL10↗

Modulation of the atopy patch test: tacrolimus 0.1% compared with triamcinolone acetonide 0.1%.

BACKGROUND: The atopy patch test (APT) is an in vivo model to study the induction of eczema by inhalant allergens in atopic dermatitis patients. We studied the effect of pretreatment with topical tacrolimus 0.1% on APT in nonlesional skin of patients with atopic dermatitis. METHODS: Nonlesional skin of the back of patients with atopic dermatitis (n = 8) was treated once daily for 3 weeks with tacrolimus 0.1% ointment. Cetomacrogol ointment (placebo) was used as a negative control and triamcinolone acetonide 0.1% ointment as positive control. Twenty-four hours after the last APT application, samples were taken from the three treated areas (t = 0 and 24 h) for immunohistochemical analysis. RESULTS: Pretreatment with tacrolimus ointment did not suppress nonlesional skin infiltrate, in contrast to triamcinolone acetonide. Furthermore, tacrolimus did not inhibit the induction of the APT macroscopically (t = 24 h). An equal influx of T cells, eosinophils, dendritic cells, CD64+ and Fc epsilon RI-positive cells was present compared with placebo. Only CD36+ and CD68-positive cells were inhibited compared with placebo. All cell types were significantly inhibited in triamcinolone acetonide-treated sites compared with placebo. CONCLUSIONS: Pretreatment with tacrolimus 0.1% ointment does not inhibit the APT reaction in patients with atopic dermatitis.

Adult↗

Patch testing for nickel allergy. The influence of the vehicle on the response rate to topical nickel sulphate.

A group of 43 patients with a clinical history of nickel allergy who exhibited an equivocal or no allergic reaction to a patch test at 48 h were further challenged using several different formulations of nickel sulphate. This experimental test battery comprised aqueous, dimethyl sulphoxide (DMSO) and propylene glycol (PG) solutions of nickel sulphate, and nickel sulphate incorporated into cetomacrogol cream and yellow soft paraffin (PMF). Although some of these vehicles were irritant, a formulation-dependent test response was observed, such that in terms of the number of responses per unit weight of nickel sulphate applied to the skin, the vehicles could be ranked: DMSO greater than PG greater than aqueous solution greater than cetomacrogol cream greater than PMF preparations. This ranking could be correlated with the relative ease with which nickel sulphate could be dialysed from each vehicle in vitro. This study demonstrates that for nickel sulphate, the vehicle can influence the outcome of patch testing apparently by modifying the quantity of nickel released into the skin for elicitation of the allergic response.

Dermatitis, Atopic↗

The role of patch testing in stasis dermatitis.

Stasis dermatitis, a chronic varicose inflammation of the skin of the lower legs, frequently is complicated by the development of contact hypersensitivity. This retrospective study of forty-six patients with stasis dermatitis found a 60.9 percent incidence of at least one significantly positive patch test reaction. The two allergens that elicited positive reactions most commonly were neomycin and epoxy resin. These results and those of other authors reinforce our contention that patch testing should be a part of the routine work-up of patients with stasis dermatitis.

Dermatitis, Contact↗

Electron microscopy of tubuloreticular structures in allergic patch test. Observations with 2,3-epoxypropyl trimethyl ammonium chloride.

Tubuloreticular structures (TRS) are intracellular tubular inclusions that can be detected by means of electron microscopy. TRS have earlier been found in autoimmune, viral and neoplastic diseases. Here the occurrence of TRS is for the first time described in allergic patch tests, where they were detected in dermal macrophages. TRS are believed to be reaction products of metabolically active cells, and the TRS described here are probably formed as a result of the activation of the immune system in allergic patch tests.

Dermatitis, Contact↗

Poor correlation between stated and found concentrations of diphenylmethane-4,4'-diisocyanate (4,4'-MDI) in petrolatum patch-test preparations.

Diphenylmethane diisocyanate (MDI) is widely used in its polymeric form in the manufacturing of polyurethane products. Previous reports on MDI-related contact allergy have shown a pattern, where patients seem to react to their own MDI-based work material but not to commercial patch-test preparations, which contain 4,4'-MDI. Therefore, we performed chemical analyses of 14 commercial test preparations of 4,4'-MDI obtained from 8 European and 4 American dermatology departments as well as 2 preparations from 2 major European suppliers of patch-test allergens. A new method for monitoring 4,4'-MDI in petrolatum preparations was developed and the determination of 4,4'-MDI as the MDI-dibutylamine derivative using liquid chromatography-mass spectrometry was performed. None of the preparations obtained from the dermatology departments contained more than 12% of the concentration stated on the label. In most cases, 4,4'-MDI content was only a few percentages or less of the concentration stated. 7 of the 14 preparations were analysed before the expiry date. Yet, only 1 of them, a preparation directly obtained from the supplier, came close to the concentration stated on the label. Thus, using these preparations, patients will be tested with a lower concentration than intended, leading to possible false-negative reactions.

Allergens↗

[Effect of cignolin and infrared irradiation on the patch test and lymphocyte transformation test].

In a study on the effect of anthralin and infrared irradiation (IR) on the allergic patch test in vivo and the lymphocyte transformation test in vitro, we observed that anthralin enhanced the local test reaction. Our findings suggest an additive reaction of toxic anthralin dermatitis and allergic test reaction. Immunohistology showed that additional treatment with anthralin resulted in elevated numbers of the OKT-6+ dendritic cells in the epidermis. Anthralin in concentrations of greater than or equal to 10(-5) M inhibited the lymphocyte transformation in vitro. IR irradiation-either before or during patch testing-did not significantly influence the allergic test reaction or the lymphocyte transformation, if the temperature was adjusted to 37 degrees C. In comparison to convective heat, we found no specific effect of IR irradiation.

Anthralin↗

Patch testing with oxidized R-(+)-limonene and its hydroperoxide fraction.

R-(+)-Limonene is an ubiquitous allergen in our environment. It is one of the most widely used fragrance materials not only in fine fragrances but also most often incorporated in domestic and occupational products. Although the non-oxidized R-(+)-limonene itself is not allergenic, it easily forms allergenic products due to autoxidation during handling and storage. 2273 patients at 4 dermatological clinics in Europe were patch tested between 1997 and 1999 in 2 steps. First, the oxidation mixture of R-(+)-limonene and 1 selected allergen fraction of the mixture, the limonene hydroperoxides, were tested in 2 different vehicles in consecutive patients. A diverging frequency of positive patch test reactions was observed in the 4 clinics. 3.8% of the consecutive patients tested reacted to oxidized R-(+)-limonene in 2 clinics, 6.5% in the 3rd, whereas 0.3% in the 4th clinic. In 2 of the centres, different but significant concomitant positive response rates to other allergens were observed; e.g. to fragrance materials and to colophonium. However, in the total test population, 57% of the limonene-allergic subjects did not react to any of the fragrance allergy markers used in the standard series. In the 2nd step, patients showing positive reactions were retested, also including additional separate allergens of the limonene oxidation mixture (carvone and limonene oxide). 60% of the limonene-allergic patients showed positive results at retesting. The limonene hydroperoxide fraction was proved to be the most important allergen of the oxidation mixture, showing positive reactions in around 60% of the limonene-allergic patients at both test sessions. Testing limonene oxide and carvone separately resulted in very few positive reactions. 3% oxidized R-(+)-limonene in non-stabilized petrolatum is most suitable when using only 1 test preparation for diagnosis of contact allergy to oxidized limonene. Our data give clinical support to the European classification of R-(+)-limonene, containing oxidation products, as a skin sensitizer.

Cyclohexenes↗