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PubMed1983

Oral challenge with metal salts. (I). Vesicular patch-test-negative hand eczema.

202 patients, 68 males and 134 females, with patch-test-negative, symmetrical vesicular hand eczema were challenged orally in a controlled study with 2.5 mg nickel, 2.5 mg chromium and 1 mg cobalt given as salts of the respective metals. Initially a mixture of the 3 metal salts was given, and if this produced a flare of the eczema, the salts were administered individually at 1 week intervals. 55 patients reacted to the mixture of salts as well as to 1 or 2 of the individual salts. 3 other patients were challenged openly with nickel alone. Male patients reacted primarily to chromate and cobalt, while female patients more commonly reacted to nickel and cobalt. 56 patients were instructed to follow diets planned to reduce the daily intake of the respective metals. The dermatitis of 36 patients cleared or improved markedly after 1 month of dieting. Responses to a questionnaire sent to these 36 patients indicated that 28 of them had followed the prescribed diet rigorously or intermittently for at least a year, because they experienced recurrence of the dermatitis if they stopped dieting. 6 noted no long-term benefit and 2 did not respond.

Chromium↗
PubMed2005

A multifactorial analysis of concurrent patch-test reactions to nickel, cobalt, and chromate.

BACKGROUND: Previous research indicates that positive patch tests to nickel (II) sulphate, cobalt (II) chloride and potassium dichromate commonly occur together. METHODS: To further examine the relationship between nickel, cobalt, chromate, and the factors that may potentially be related to concurrent sensitizations to two or all three metal allergens, data from the Information Network of Dermatology Departments have been investigated. RESULTS: Women had a higher conditional odds of concurrent nickel-cobalt (OR = 6.80; 95% CI: 5.65-8.19) and nickel-chromate (OR = 2.13; 95% CI: 1.67-2.72) reactions than men. Construction workers had a significantly higher odds of cobalt-chromate reactions (OR = 13.89; 95% CI: 10.36-18.64), while the odds of isolated cobalt allergy was only 0.92 (95% CI: 0.48-1.74). Patients with underlying atopic eczema/dermatitis syndrome had a 40-90% higher chance of any positive outcome, which involved chromate. Polysensitization, defined as the number of positive reactions to standard series substances other than nickel, cobalt, and chromate, was also significantly associated with the concurrent reactions; moreover, steady and significant effect gradients were noted. CONCLUSIONS: This research confirms the occupational nature of cobalt-chromate concurrent reactions, in particular, in construction workers. Polysensitization, which is considered to represent susceptibility to delayed-hypersensitivity in general, is also associated with the concurrent reactions to the metals. Hence, not only coupled exposure, but also individual susceptibility may be responsible for concurrent reactions to metals in man.

Adult↗
PubMed1995

Euxyl K 400: incidence of sensitization, patch test concentration and vehicle.

The aim of this study was to verify the most suitable vehicle and concentration for testing Euxyl K 400 and its individual ingredients, and to evaluate the prevalence of sensitization to this preservative over the years in Italy. From January 1991 to October 1994, Euxyl K 2.5% pet. was positive in 99 patients (35 male, 64 female) out of 3455 (2.8%). Of these, 22 out of 855 patients had a positive reaction during 1991 (2.6%), 29 out of 1037 in 1992 (2.8%), 28 out of 858 in 1993 (3.3%), and 20 out of 705 in 1994 (2.8%). 51 of the 99 patients with a reaction to Euxyl K 400 2.5% pet. showed a positive reaction to dibromodicyanobutane 0.5% pet. and 2 to phenoxyethanol 5% pet. The results of patch testing with serial dilutions of Euxyl K 400 in different vehicles indicate that water is a good vehicle for testing the preservative. However, since Euxyl K 400 is only hydrosoluble to a limited extent, the maximum concentration that can be tested using water is 0.5%, and so with this concentration about 40% of sensitized patients are missed. The results of patch testing with serial dilutions of Euxyl K 400 in petrolatum demonstrate that concentrations lower than 2.5% are not suitable for detection of all sensitized patients. Euxyl K 400 in ethanol frequently causes irritant reactions without offering significant advantages in detecting sensitized patients.

Adolescent↗
PubMed2003

Combined skin prick and patch testing enhances identification of peanut-allergic patients with atopic dermatitis.

BACKGROUND: Food atopy patch tests (APTs) are considered a useful tool for the diagnosis of food allergy. Hypersensitivity to peanuts has not been investigated by means of APTs so far. METHODS: APTs and skin prick tests (SPTs) with peanuts were performed in 136 atopic dermatitis (AD) patients. Relevance of positive and negative responses to these tests was assessed by repeated open challenges with peanuts. RESULTS: Nine percent of our AD patients reacted to the challenge. Positive responses to APTs were recorded in 19% of the patients, whereas in 12% positive SPTs were observed. APTs were more frequently positive in subjects with eczematous responses after challenge with respect to those with urticarial reactions. SPT reactivity proved to be higher in patients above 12 years of age, whereas APT positivity was more frequent in children under 6 years. APT sensitivity proved significantly higher than SPT sensitivity, in particular in children under 12 years of age. On the contrary, SPT specificity and positive predictive value were significantly higher with respect to those of APT in the age group of subjects under 6 years of age. CONCLUSIONS: Our data suggest that APTs with peanuts may represent a useful integration to standard testing modalities employed for the diagnosis of peanut allergy in AD patients.

Adolescent↗
PubMed2005

Contact dermatitis in hairdressers, 10 years later: patch-test results in 300 hairdressers (1994 to 2003) and comparison with previous study.

BACKGROUND: In the last 20 years, the hairdressing profession has undergone important modifications, mainly because of a change in the substances and techniques used and improved occupational education. OBJECTIVE: To evaluate the modifications in the hairdressing profession and its actual risk of occupational allergic contact dermatitis (OACD). METHODS: We studied all 300 hairdressers seen in our department from 1994 to 2003 and compared the results with those of a previous study of 379 hairdressers who attended our department from 1980 to 1993. All were patch-tested with the European Standard series and specific hairdressing products. As previously, most of the workers were women (93%), with a mean age (23.7 years) slightly higher than that of the workers in our previous study. RESULTS: We found a significant increase in the frequency of positive patch-test responses (78.3% vs 58.8%) and OACD (58% vs 48.8%) with respect to our previous study. We also observed a significant increase in sensitization to most allergens, including p-phenylenediamine base (54% vs 45.9%), 4-aminobenzene (40.7% vs 31.9%), ammonium thioglycolate (2.7% to 12.3%), ammonium persulfate (7.9% to 14.3%), p-toluenediamine sulfate (6.8% to 15.3%), p-aminodiphenylamine (2.9% to 7.7%), o-nitro-4-phenylenediamine (2.1% to 7.3%), and aminophenols (0% to 9%), whereas a decrease was found in sensitization to Disperse Orange (17% vs 32.7%) and thioglycolic acid (15.3% to 3%). CONCLUSION: The high frequency and increase of sensitizations among hairdressers require urgent measures to improve protective measures and their application.

Adolescent↗
PubMed1998

Application of a 4-h human patch test method for comparative and investigative assessment of skin irritation.

A human 4-h patch test has recently been developed for testing the irritation hazard potential of chemicals. The original method was developed for comparative irritation assessments relative to benchmark irritants using simple statistical tests. In this context, the method has been shown to be robust in intralaboratory testing over time. Recent interlaboratory testing has also established the consistency of the method in assessment of the relative irritation potential of selected chemicals. These data help to position the method as a suitable replacement for animal test methods in assessment of skin irritation hazard. In addition, the method has great utility for investigating different parameters of clinical skin irritation. Using kinetic response patterns and curve fitting analysis, we have compared the relative irritation potential of chemicals in greater detail, using as a basis the time required for test subjects to respond as well as the incidence of positive responses. Also, using the response to 20% sodium dodecyl sulfate (SDS) as a benchmark, we've been able to examine the intersubject variation in clinical skin irritation responses. In general, subjects most reactive to 20% SDS, in terms of the exposure time required to produce a positive response, were relatively more sensitive to a 2nd irritant chemical as well. However, this was not an absolute correlation in that some test subjects showed divergent patterns of response. The method was also used to compare directly the relative skin reactivity of different populations, based on race (Caucasian versus Asian) or on neurosensory skin sensitivity. Our results using this acute exposure test method indicate little difference in visually assessed skin irritation among these diverse human subpopulations.

Acetic Acid↗
PubMed2003

Evaluation of the histologic characteristics of patch test confirmed allergic contact dermatitis.

BACKGROUND: Microscopic features of experimentally induced allergic contact dermatitis (ACD) have been reported; however, the histologic characteristics of environmentally induced ACD have not been definitively elucidated. OBJECTIVE: This pilot study was conducted to describe the histologic features most useful in differentiating ACD from other forms of eczematous dermatitis. METHODS: A retrospective chart review of patients who underwent evaluation for contact dermatitis was performed. The results of skin biopsy were reviewed in a blinded manner, and two subgroups were compared: gold standard ACD cases and control cases (eczematous dermatitis with negative results of patch testing). RESULTS: Of 317 cases reviewed, 39 fulfilled the inclusion criteria. Many histologic similarities were noted: both subgroups had substantial acanthosis and lymphocytic infiltration. In addition, present to a moderate degree in both groups were hyperkeratosis, spongiosis, eosinophils, and dermal dendritic fibrohistiocytic (DFH) cells. However, compared with the control cases, eosinophilic spongiosis and multinucleate dermal DFH cells were found to a considerably greater degree in the standard ACD cases. CONCLUSIONS: Eosinophilic spongiosis and multinucleate dermal DFH cells, in the presence of acanthosis, lymphocytic infiltrate, dermal eosinophils, and hyperkeratosis, are particularly suggestive of ACD. While such findings alone are not diagnostic of ACD, the presence of these combined histologic features supports the pursuit of patch testing in cases of chronic eczematous dermatitis.

Adult↗
PubMed2005

[Hypersensitivity to fluindione (Previscan). Positive skin patch tests].

INTRODUCTION: Fluindione (Previscan) is an oral anticoagulant belonging to the vitamin K antagonist class and is very widely used in France. While bleeding is a common complication, severe immunoallergic reactions are less frequent. The authors report a case of drug-induced hypersensitivity syndrome. CASE REPORT: A 75 year-old woman was hospitalized for diffuse erythematous papular rash associated with facial oedema. These symptoms appeared 3 weeks after the beginning of treatment with fluindione, allopurinol and perindopril. Laboratory tests showed hyperleukocytosis, mixed hepatitis and moderate renal failure, with the entire picture being evocative of drug-induced hypersensitivity reaction. The eruption was associated with eosinophilia, hepatic cytolysis with cholestasis, and acute renale failure. While allopurinol and perindopril were stopped definitively, fluindione was only suspended temporarily following overdosage. On reintroduction, rapid recurrence of clinical and biologic signs was observed with increased severity. The skin rash resolved completely on withdrawal of the drug. Patch tests performed later were positive for fluindione and negative for allopurinol and perindopril. DISCUSSION: These manifestations were consistent with the diagnosis of drug-induced hypersensitivity syndrome due to fluindione. Very few cases have been described with fluindione despite widespread prescription of the treatment is in France. While there may be no skin involvement, immunoallergic signs such as fever, hepatitis and acute tubular interstitial nephritis have been described with fluindione and these may be related to this syndrome (DRESS - Drug Reaction with Eosinophilia and Systemic Symptoms). Skin patch testing, which is easily performed, can be extremely helpful in determining a causal relationship with medication.

Administration, Oral↗
PubMed1987

Patch test results with standard allergens over a decade.

The results of 10 years of patch testing with standard allergens are reported. An increase of sensitivity was found in nickel. Sensitivity to chromate had decreased. Sex and age differences in the incidence of allergy to metals were analysed. Nickel allergy appeared to be more common among women and was of most importance in the younger age groups.

Adult↗
PubMed1997

In vitro lymphocyte proliferation as compared to patch test using gold, palladium and nickel.

BACKGROUND: A conventional lymphocyte transformation test (LTT) was compared to the commercially available MELISA (memory lymphocyte immunostimulation assay), a lymphoproliferative assay that has been suggested to be a valuable instrument for the diagnosis of metal allergy. Sensitivity and specificity of the two assays were calculated using a patch test as a reference method. METHODS: 34 patients were patch-tested for gold sodium thiosulfate, palladium chloride and nickel sulfate, and the lymphocyte proliferation to these metals was tested in vitro using mononuclear cells from peripheral blood. RESULTS: No significant differences regarding sensitivity and specificity were found between MELISA and conventional LTT. The sensitivity varied between 55 and 95% and the specificity between 17 and 79%. CONCLUSIONS: The low specificity of the two in vitro assays suggests that they are not useful for diagnosis of contact allergy to the metals gold, palladium and nickel, since a large number of false-positive results will be obtained.

Adult↗
PubMed1989

Contact allergy due to colophony. (V). Patch test results with different types of colophony and modified-colophony products.

The results of patch tests with colophony in the standard series between 1983 and 1987 were analyzed. 5521 patients were tested in the Department of Dermatology, Hamburg, while 354 were tested in other clinics and private practices. Colophony was positive in 2.4% and 11.9%, respectively. Out of 62 patients in the 1st group and 75 in a 2nd group tested subsequently with 6 unmodified types of colophony and 12 types of modified-colophony products, 17 did not react to the unmodified material. However, most of them responded to 1 or more of the modified products. In the enlarged group (n = 75), reactions to Abitol and the maleic-modified products were the most frequently obtained. As the authors are convinced that the actual incidence of allergic reactions to modified-colophony products is underestimated, they propose to test a mixture of 3 materials: Chinese colophony (today 50% of the world market) and 2 derivatives (modified colophony), instead of the 60% mix of unmodified colophony, in the standard series.

Dermatitis, Contact↗
PubMed1985

Clinical experience and patch testing using colophony (rosin) from different sources.

Patients with suspected allergy to colophony were patch-tested with colophony (rosin) of different kinds (gum rosin, tall oil rosin). More cases of allergy were detected by testing with more than one type of colophony. Tall oil rosin produced a smaller number of positive reactions than the gum rosins tested, which suggests a lower allergenic activity. Venice turpentine was a useful additional screening substance. When different test concentrations were compared (20% and 5%) the lower concentration failed to reveal four of 30 cases. The patients' eczema had been caused chiefly by contact with colophony in their work.

Chromatography, Gas↗
PubMedDate not supplied

Suitable bases for patch testing in tropical countries.

Patients suspected of having contact dermatitis due to topical medicaments were patch tested with various bases to evaluate the most suitable base for tropical countries. Plastibase and polyethylene glycol 400 produced the least positive reactions. Both were therefore found to be suitable bases, although polyethylene glycol had more positive results than plastibase.

Dermatitis, Contact↗