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PubMedDate not supplied

Patch testing in children, adults, and the elderly: influence of age and sex on sensitization patterns.

Patch testing was done on 2776 consecutive patients (76.5% female) with a locally revised standard series of 34 contact allergens and the results analyzed for age- and gender-specific differences. At least one positive epicutaneous test reaction occurred in 48.9% of patients. Nickel (20.9%), ethylmercuric chloride (13.2%), thimerosal (11.8%), fragrance mix (9.3%), metallic mercury (8.9%), palladium (5.8%), balsam of Peru (3.8%), copper (3.7%), cobalt (3.3%), and chromium (2.3%) were the 10 most important sensitizers. The following tested allergens with sensitization rates of more than 1% were not part of the usual standard series: ethylmercuric chloride, metallic mercury, copper, propolis (1.3%), propylene glycol (1.0%). Reactions to nickel, cobalt, and palladium, but not to chromium, were significantly more abundant in females (p < 0.002, chi-squared test). The overall sensitization rate was highest in children less than 10 years old (62%) and decreased steadily, to be lowest among patients more than 70 years old (34.9%). The rate of positive reactions to nickel and thimerosal decreased with age, while fragrance mix and metallic mercury stayed at the same level through all age groups.

Adolescent↗
PubMed2001

Contact allergy to balsam of Peru. II. Patch test results in 102 patients with selected balsam of Peru constituents.

BACKGROUND: In Switzerland, Germany, and Austria, allergic reactions to balsam of Peru (BP) have now made it the third most common contact allergen. OBJECTIVE: A series of 20 single BP constituents (including resorcinol monobenzoate), established in 1995, was used for patch tests in patients with a positive reaction to BP in the standard series. MATERIALS AND METHODS: Between 1995 and 1998, 2,273 patients were tested with the standard series, including BP, fragrance mix (FM), and propolis. Patients positive for BP were requested to participate in a further test using the 19 compounds of the BP constituents and resorcin monobenzoate (BP series); 102 patients agreed and were patch tested. The results of the 72-hour reading were used for the evaluation. RESULTS: A total of 93 patients reacted to 1 or more of the BP series compounds. Positive reactions were seen, in decreasing order, to cinnamic alcohol, cinnamic acid, coniferyl benzoate, benzoic acid, cinnamyl cinnamate, eugenol, resorcinol monobenzoate, coniferyl alcohol, and benzyl alcohol. There were no positive reactions to vanillin or ferulic acid. A correlation between skin lesions and frequent consumption of sweets was found in 7 patients with major positive test reactions to coniferyl benzoate and benzyl alcohol. Most of the reactions to eugenol and isoeugenol had less to do with BP itself than with a primary sensitization to fragrances. Although resorcin monobenzoate (RMB) has up to now not been detected in BP, 16 patients reacted distinctly to this compound. Eleven were strong smokers; the remaining ones had contact with plastic materials that have been reported to contain RMB. RMB is used frequently as an antioxidant in synthetic material. When these patients stopped smoking, the skin lesions cleared. However, consumption of sweets caused recurrences. CONCLUSION: The evaluation of reactions to single constituents of BP by testing with the special BP series facilitates understanding how sensitization may be acquired. The allergen may prove to be BP itself or 1 or more of its constituents. Testing for the constituents of this series may provide patients with a more specific allergen diagnosis and may facilitate improved therapy. BP may function as an important indicator for contact allergy to RMB.

Adolescent↗
PubMed1985

Immunophenotype of lymphoid cells in positive patch tests of allergic contact dermatitis.

The immune phenotype of the infiltrating cells in 13 positive patch tests from 8 cases of contact dermatitis and 1 case of poison ivy was studied. An indirect immunoperoxidase technique was used in conjunction with monoclonal antibodies directed against mature T cells (Leu-1, T11), helper T cells (Leu-3A), suppressor/cytotoxic T cells (Leu-2A), killer and natural killer cells (HNK 1), B cells (B1), Langerhans cells (HLA-DR), and the common acute lymphoblastic leukemia antigen (CALLA), (J5). The majority of infiltrating mononuclear cells were Leu-1+, T11+, Leu-3A+, Leu-2A-, HLA-DR+, T9-, T10-, HNK-, B1-, J5-. Occasional T6+ cells were observed in the epidermis (including spongiotic microvesicles) and also isolated in the dermis and within the dermal mononuclear infiltrates. The phenotype was compared with cutaneous T-cell lymphoma, a disease in which contact allergy and antigenic persistence may play a role.

Antibodies, Monoclonal↗
PubMed1995

Patch testing with preservatives at St John's from 1982 to 1993.

We have reviewed our patch test results for preservative allergy from 1982 to 1993. 8 preservatives were included: formaldehyde, 2-bromo-2-nitropropane-1,3-diol (Bronopol(TM)), quaternium-15 (Dowicil 200TM), imidazolidinyl urea (Germall 115TM), diazolidinyl urea (Germall IITM), parabens, 5-chloro-2methyl-isothiazolin-3-one (Kathon CG(TM)) and 1,2-dibromo-2,4-dicyanobutane (one of the constituents of Euxyl K 400TM). Whereas the allergy rate to formaldehyde is quite stable, there is a slight increase in the imidazolidinyl urea allergy rate. Quaternium-15's rate is decreasing and 5-chloro-2-methyl-isothiazolin-3-one plus 2-methyl-isothiazolin-3-one's rate, after a rapid rise, seems to have stabilized. Although very important constituents of cosmetics, preservatives not only induce allergies on the face but also on the hands, and, as expected, the allergy rate in men and women generally differs. Among the 5 formaldehyde-releasers, there are some favoured simultaneous reactions: quaternium-15 and formaldehyde, and diazolidinyl urea and imidazolidinyl urea. Concomitant reactions between 1-bromo-2-nitropropane-1,3-diol and formaldehyde are not common, and those between 2-bromo-2-nitropropane-1,3-diol and diazolidinyl urea, and formaldehyde are not very common. This supports the hypothesis that allergic reactions to the Germalls are directed toward the initial molecule rather than to formaldehyde.

Dermatitis, Allergic Contact↗
PubMed2006

Proposal for a standardized interpretation of the atopy patch test in children with atopic dermatitis and suspected food allergy.

The interpretation of the atopy patch test (APT) to foods is not standardized. This study aimed to validate the reading of the APT in terms of the diagnostic accuracy of individual skin signs. Eighty-seven children (mean age 2.4 +/- 2.5 yr, range 0.5-13.5; 57 male) with atopic dermatitis (AD) and suspected food allergies underwent APT to cow's milk, hen's egg, wheat and soy. Twelve-millimetre Finn chambers were applied for 48 h, and results were read after 48 and 72 h. Skin changes were graded for erythema, induration, papule formation and 'crescendo' phenomenon (increase of skin sign severity from 48 to 72 h). Food allergy was assessed by double blind, placebo-controlled food challenges (DBPCFC). Sensitivity, specificity and predictive values were calculated for each skin signs in relation to challenge outcome. Of 165 DBPCFC children, 75 (45%) were positive. The combination of any skin induration plus papules (seven or more), or of moderate erythema plus any induration plus seven or more papules had a positive predictive value (PPV) and specificity for the challenge outcome of 100%; however, the sensitivity was low (8% and 15%). The best diagnostic accuracy for single signs was found for induration beyond the Finn chamber margin (PPV 88%, specificity 99%, sensitivity 9%) and presence of at least seven papules (PPV 80%, specificity 96% sensitivity 21%). Presence of both induration and of at least seven papules at 72 h were the APT skin signs with the greatest diagnostic accuracy for food allergy in children with AD.

Adolescent↗
PubMed1996

Evaluation of a human patch test for the identification and classification of skin irritation potential.

Current regulations require that the skin irritation/corrosion potential of new chemicals is assessed in the rabbit Draize test, although there are opportunities to use alternative methods to identify the most aggressive materials. Previously, we have proposed that it is possible to employ a strategy that avoids the use of animals and at the same time delivers a more relevant assessment of skin irritation/corrosion potential. The approach is to identify corrosive materials in vitro and then proceed to human volunteer testing for skin irritation. In this study, the human 4-h patch test, its interpretation, and results with 29 test materials are presented. Using 14 materials not classified as "Irritating to skin" by EU criteria, 13 classified as "Irritating to skin" by suppliers, and 2 as "Corrosive - causes burns", it is demonstrated that, by evaluating these on human skin in vitro and in vivo, a significant proportion are either over-classified or under-classified. In conclusion, we are convinced that by application of the approach described in detail here, it is possible to avoid the use of animals, whilst at the same time obtaining an assessment of skin irritation/corrosion potential that is more relevant to man, and which, if required, may be used directly for classification and labelling of substances and preparations within the European Union.

Acyclic Monoterpenes↗
PubMed1978

Concentrations of patch test allergens: are we comparing the same things?

A new way of expressing the concentrations of patch test allergens solutions (or emulsions) is proposed. From these new expressions it can be seen that apparently similar concentrations (0.5% chromium, 2% formaldehyde) can actually be in the ratio 1 to 15 as expressed at the molecular level.

Allergens↗
PubMedDate not supplied

Modulation of atopy patch test reactions by topical treatment of human skin with a fatty acid-rich emollient.

Measures directed at improving the skin barrier function are thought to be effective in preventing reexacerbation of atopic dermatitis, but direct proof of a prophylactic effect of emollients has been elusive. In the present study, the atopy patch test has been employed as a model for the initiation phase of atopic dermatitis in order to assess whether pretreatment of non-lesional skin with a fatty acid-rich emollient (Eucerin Omega Creme) has a prophylactic effect in patients with atopic dermatitis. Pretreatment of test sites with Eucerin Omega Creme either prevented or diminished the development of eczema, as compared with untreated control test sites in the same patients (n = 38). These studies indicate that the use of fatty acid-rich emollients prevents the development of atopic eczema. They also demonstrate that the atopy patch test can be used to assess the capacity of a given regimen to exert prophylactic effects in this disease.

Adult↗
PubMed1997

Patch test materials for mercury allergic contact dermatitis.

The objective of this study was to define adequate patch test materials to evaluate mercury allergic contact dermatitis. We applied 0.1% and 0.05% mercuric chloride, and 0.5% and 0.2% mercury in petrolatum to systemic eczematous contact-type dermatitis (baboon syndrome), and gold-dermatitis patients. All baboon-syndrome patients reacted not only to mercuric chloride but also to metallic mercury. In gold-dermatitis patients, significantly more patients reacted to mercuric chloride than to metallic mercury (21 of 35, 60%, versus 2 of 19, 10.5%, p < 0.0005). We speculated that sensitization to mercury may be of 2 types: one a reaction to ionized mercury only, the other to both ionized mercury and non-ionized mercury. The possibility that the phenomenon is caused by differences in bioavailability or percutaneous penetration between ionized and non-ionized mercury cannot be ruled out, but could be explored by penetration measurement. For the evaluation of mercury hypersensitivity, it may be more reliable to apply both ionized and non-ionized mercury, rather than only mercuric chloride or ammoniated mercury.

Adult↗
PubMed1998

Arachidonic acid metabolism in primary irritant dermatitis produced by patch testing of human skin with surfactants.

A clinical study was performed to determine the effects of patch testing human skin with four industrially used surfactants on erythema formation, transepidermal water loss, and the contents in suction blister fluids of primary proinflammatory mediators including arachidonic acid, eicosanoids, and IL-1 alpha, which were analyzed by quantitative gas chromatography/negative ion chemical ionization mass spectrometry and by an enzyme-immunoassay, respectively. Benzalkonium chloride (BKCI) and sodium lauryl sulfate (SLS) elicited erythema and caused increased transepidermal water loss, indicating a disturbance of the epidermal barrier. Triethanolamine (TEA) and Tween 80 did not evoke these gross symptoms of inflammation. Suction blister fluids collected after a 24-h application of BKCl, SLS, and Tween 80 contained significantly increased amounts of individual eicosanoids whereas TEA induced no response. The induced eicosanoid profile was characteristic for each compound, pointing to different cell types of skin to be involved in their production. The elevation of prostaglandin and LTB4 contents correlated with the induction of erythema and the impairment of the epidermal barrier as shown for BKCl and SLS and preceded the maximum of erythema formation. IL-1 alpha contents did not correlate with these gross symptoms of inflammation. The results of this in vivo study support those of a previous study using human keratinocytes in culture indicating the release of arachidonic acid and prostaglandins to be an early event involved in the interaction of keratinocytes with surfactants. Moreover, the in vivo data with human skin underscore the mechanistic relationship to the in vitro model and support the concept that arachidonic acid and eicosanoid release from keratinocytes can be used as a marker of primary skin irritation.

Adult↗
PubMed2004

Multicentre patch test study of air-oxidized ethoxylated surfactants.

Frequent exposure to water and surfactants is considered to be the main cause of hand eczema from wet work. Ethoxylated surfactants are susceptible to oxidation and some of the oxidation products formed have proved to be contact sensitizers in guinea pigs. The question of human sensitization to oxidized surfactants was addressed in a multicentre study in the Stockholm region. 528 consecutive dermatitis patients were patch tested with widely used ethoxylated surfactants in oxidized and non-oxidized form as well as certain identified oxidation compounds. 61 patients presented with mild, clearly irritant reactions to some of the surfactants tested. 18 patients showed not only erythema but also oedema and/or papules and vesicles, using a morphologic descriptive system for reading the patch test reactions. These reactions occurred mostly to oxidized surfactants and oxidation products. When retesting 9 of these 18 patients only an allergic reaction to acetaldehyde was confirmed. We conclude that oxidized ethoxylated surfactants have increased irritant potential compared to non-oxidized material. Our working hypothesis is that oxidized surfactants of technical quality exert a lower risk of sensitization than do oxidized homologous pure surfactants. Among the potential allergens formed during autoxidation, formaldehyde and acetaldehyde must be considered as a source of unexpected exposure.

Adult↗
PubMedDate not supplied

Sweat-patch testing detects inaccurate self-reports of alcohol consumption.

The object of this study was to measure how accurately drinkers report their consumption of alcohol. Twenty-two normal volunteers kept a written record of all alcoholic beverages they consumed in 1 week. During the same period, their actual intake was monitored by the sweat-patch test for alcohol consumption. Only nine subjects (40.9%) reported their alcohol consumption accurately; two (9.1%) overreported their intake, and 11 (50%) underreported their intake. Five (22.7%) of those who underreported their consumption claimed to have drunk no alcohol at all, but elevated ethanol levels in their sweat-patch tests indicated otherwise. These data suggest that self-reported claims concerning alcohol consumption or abstinence should be received with a degree of skepticism, and that greater emphasis should be placed upon objective laboratory tests for the diagnosis of alcohol abuse.

Adult↗
PubMed1991

Patch testing in cases of eczema and dermatitis in Beijing, China.

Of 124 patients with eczema and dermatitis patch tested by the European standard series of allergens in the period from April to October 1989, 59 cases showed sensitivity to 1 or more allergens. Potassium dichromate, nickel sulphate and cobalt chloride were the 3 major sensitizers, with a frequency of 17.9%, 13.8% and 10.6%, respectively. The office and factory workers showed a higher incidence of positive reactions than the student group. The environment of the office and the factory seems to be the potential source of exacerbating factors of eczematous skin disease.

Adult↗
PubMed1984

Patch test responses evaluated by cutaneous blood flow measurements.

We measured the cutaneous blood flow in positive standard patch test reactions by use of the laser-Doppler technique. The results were compared with conventional visual readings to develop a quantitative method. Compared with the basal blood flow in negative or nontested sites, the blood flow was significantly increased about fivefold in the doubtful reactions (?+), and about tenfold in both weak (1+) and strong (2+) positive reactions. The blood flows in the 1+ and 2+ reactions did not differ significantly from each other. No 3+ positive reactions were measured. We conclude that this method might be used to separate negative, doubtful, and positive reactions, whereas weak and strong positive reactions have to be differentiated by other means.

Adult↗
PubMed1996

The effect of topically applied corticosteroid on irritant and allergic patch test reactions.

The purpose of the study was to assess the effect of topical corticosteroid on the patch test response in patients with known positive allergens and also to study any effect on the irritant response. In Study 1, 10 patients with known positive allergens had their backs pre-treated 2 x daily for 3 days with either betamethasone dipropionate 0.05% or the equivalent ointment base. On day 4, previous known allergens and dilutions of sodium lauryl sulfate (5% and 10%) as an irritant were applied to each side of the back. In Study 2 (4 patients), a 1:4 dilution of betamethasone dipropionate was substituted for the full-strength preparation. Betamethasone dipropionate 0.05% caused total or partial suppression of the allergic reaction in 8 of 10 cases. The 1:4 dilution caused partial suppression in 3 cases. The irritant reaction was totally suppressed by betamethasone dipropionate in 1 of 10 cases and partially suppressed in 7 of 10. The 1:4 dilution decreased the intensity of the irritant reaction in 3 of 4 cases. The relevance of these results to clinical practice is discussed.

Administration, Topical↗
PubMed1975

The patch test--who should and should not use it and why.

Since its introduction into medicine by Joseph Jadassohn in 1895, the patch test has proven its supreme value in tens of thousands of cases and in research. But emphasis must be placed on the grave errors which can occur when the test is used improperly. Errors are common in the direction of both false positives and false negatives. Common causes of errors are described in detail. The conclusion is drawn that this valuable test had best be used only by those who have been adequately trained and who can apply it regularly on a sufficiently large number of selected patients.

Allergens↗
PubMed1987

Hair bulb accumulation of Langerhans cells in allergic patch tests.

The occurrence of occupational allergic contact dermatitis due to 2,3-epoxypropyl trimethyl ammonium chloride (EPTMAC) is reported and supplemented with immunohistochemical and electron microscopic observations. Four young workers developed hand dermatitis at a factory in which modified, cationic starch is manufactured. EPTMAC, a quaternary ammonium compound used as a cationizing chemical in the process, produced allergic reactions in all four patients in epicutaneous testing. The patients had only been in contact with EPTMAC for a short time (one to three months) before developing allergic eczema, which indicates that EPTMAC is a strong sensitizer. Immunohistochemistry showed that dendritic OKT6+ cells (Langerhans cells) increase in the hair follicles and the peribulbar infiltrate during the allergic patch test indicating that hair follicles might actively be involved in delayed type allergic reactions, possibly as a shunt way for allergens. Using electron microscopy, mitotic immunocompetent cells were found in the epidermis during the allergic patch test.

Azo Compounds↗