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Lymphocytes and Langerhans cells in allergic patch tests.

An immuno-histochemical study of immuno-competent cells in the skin during fully developed 3-7 d patch tests was performed. Most inflammatory cells were OKT 11 positive T-lymphocytes. The majority of these cells were of the helper/inducer phenotype (OKT 4+), but in the later stages a relative increase of OKT 8+ cells was seen in 5 specimens out of 20. A focal decrease of OKT 6+ Langerhans cells was observed in the epidermis, while their number increased considerably in the dermis. Also observed was an inflammatory reaction of hair follicles with moderate numbers of OKT 6+ cells in the peribulbar infiltrate. This indicates that hair follicles may possibly act as shunt pathways for allergens.

Allergens↗

Nickel allergy: analysis of metal clothing objects and patch testing to metal samples.

In 22 nickel-sensitive subjects, 57 metal clothing objects were said to be not tolerated (37) or tolerated (20). They were analysed by X-ray energy dispersion in electron microscopy, and by the dimethylglyoxime spot test. The correlation between the analytical results and the statements of patients is discussed. Patch tests to nickel-plated metal samples with various thicknesses of chromium (0.25 mu to 1 mu) or gold/copper/cadmium (0.5 mu) were performed in human subjects or in guinea pigs sensitive to nickel. Surface-plating and anticorrosive techniques, as well as the results in nickel-sensitive subjects, are described and discussed. Good tolerance will not be obtained under experimental conditions if nickel in any form is a component of the object. It is to be hoped that appropriate regulations will prohibit the use of nickel in the manufacture of clothing objects.

Adolescent↗

Cellular and cytokine kinetics after epicutaneous allergen challenge (atopy patch testing) with house dust mites in high-IgE beagles.

The cellular and cytokine dynamics of reactions triggered by atopy patch testing with house dust mites were studied in six high-IgE beagles. Sites were scored and biopsied at 6, 24, 48, and 96 h, and samples were processed for histopathology, immunohistochemistry, and polymerase chain reaction (PCR). All dogs developed positive reactions at some point in time. Mean clinical scores were significantly higher than baseline at 24, 48, and 96 h. Clinically, one of six dogs had a positive reaction at 6 h; two of six reacted at 24 and 48 h, and five of six at 96 h. Histologically, superficial perivascular mononuclear and granulocytic dermatitis developed (5/6) after 6 h, and progressed in severity at 24 h (6/6). Additionally, at 48 h epidermal spongiosis, hyperplasia and pustules developed (5/6), and were marked at 96 h (6/6). At and beyond 6 h, progressive CD1c-positive epidermal Langerhans cell hyperplasia with cluster formation and dermal dendritic cell infiltration was noted. Cutaneous infiltration of CD3-positive T lymphocytes with epidermal clusters developed over time. mRNA expression for the cytokines gamma-interferon (gamma-IFN), interleukin-6 (IL-6), IL-12p35, IL-13, IL-18, and thymus and activation regulated chemokine (TARC) exhibited significant increases during the challenge compared to baseline, but there was no appreciable alteration in expression for tumour necrosis factor-alpha (TNF-alpha), IL-12p40, IL-10, regulated on activation normal T-cell expressed and secreted (RANTES), IL-5, IL-2, IL-4, and IL-8. No correlation was detected between clinical scores and cytokines. It is concluded that IL-6 plays a role in early reactions followed by an increase of TARC and IL-13, while IL-18 progressively increases in later reactions.

Allergens↗

Late patch test reaction to acrylates in a dental worker.

A dental technician developed eyelid and hand dermatitis. She had been previously patch-tested elsewhere with a sample of an acrylic material from a nail salon that reportedly was positive only after 1 month. Repeat testing with ethyl acrylate and methyl methacrylate gave no reaction at 48 or 96 hours, but became positive 5 weeks later. This very late reaction is probably a true allergic manifestation and not a case of active sensitization.

Acrylates↗

Irritant patch testing with sodium lauryl sulphate: interrelation between concentration and exposure time.

BACKGROUND: It is well known that the degree of skin reaction to an irritant depends on its concentration and exposure time. OBJECTIVES: To determine the interrelationship between the concentration of sodium lauryl sulphate (SLS) and exposure time in both weak (subclinical) and severe reactions. METHODS: Patch testing with SLS was performed at different concentrations (0.125%, 0.25%, 0.5%, 1.0% and 2.0%) and with different exposure times (3, 6, 12, 24 and 48 h). Evaluation was conducted by measurement of transepidermal water loss and by laser-Doppler flowmetry both 30 min and 24 h after patch removal. RESULTS: We found more reliable and constant skin reactions 24 h after patch removal, and a higher correlation between SLS concentration and skin reaction. CONCLUSIONS: We conclude that the concentration of SLS influences the test outcome to a larger degree than the exposure time. We present formulae by which the outcome of SLS patch testing at various SLS concentrations ranging from 0.125% to 2% and any exposure time between 3 and 24 h can be estimated.

Adolescent↗

[Hapten selection for patch tests in the diagnosis of allergic contact dermatitis: epidemiologic data].

Aim of the study was to verify the reliability in clinical practice of patch testing with "standard" series and additional series of haptens for the diagnosis of occupational and non-occupational allergic contact dermatitis, evaluating positive reactions and relating those reactions to professional categories. A total of 392 out of 937 patients (41.8%) showed at least one positive reaction to "standard" series testing; the hapten most frequently noted as the cause of positive reaction was nickel sulphate. Professional categories that showed positive reactions to "standard" series most frequently were clerks, hairdressers and hospital auxiliary workers. Among 897 patients tested with nonstandard allergens, only 124 (13.8%) elicited at least one positive reaction, ammonium persulphate being the most frequently positive hapten. A dominant percentage of positive results was seen in hairdressers and cleaning personnel. No positive reactions were observed in a large number of haptens, tested more than 200 times. Haptens of "standard series" elicited a higher number of positive reaction than the additional series, even though there was a high specificity of few additional series haptens in some professional categories. Data suggest some caution in systematically testing additional series, despite a higher accuracy and diagnostic efficacy in some job categories.

Dermatitis, Occupational↗

Standard patch test results in 3,225 consecutive Danish patient from 1973 to 1977.

From 1973 to 1977 a total of 3,225 patients were patch tested at the Department of Dermatology, Odense University Hospital, Denmark; 1,038 patients reacted to one or more allergens. The data on frequency of the most common allergens are presented. The most common allergens observed were nickel, dichromate, balsam of Peru, wood tar, carba mix and wool alcohols.

Adolescent↗

Positive patch test reactions to nickel, cobalt, and potassium dichromate in a series of 576 patients.

In 1988, 633 patients attending our Allergology Center underwent patch testing with the standard series recommended by the Gruppo Italiano Ricerca Dermatiti da Contatto e Ambientali. Of these, 576 patients completed the test correctly and their results were evaluated statistically. Nickel, cobalt, and potassium dichromate were the three most common sensitizers; concomitant positive reactions were present at significant levels. The authors discuss environmental and occupational exposure to contact allergens and correlate the major sites of dermatitis with the sensitivity to each metal in patients of both sexes.

Cobalt↗

Site variations in patch test responses on the back.

To establish the existence of intra-regional variations in response to allergens on the back, we performed patch tests in 21 patients at 2 different sites on the back. Visual readings using the numerical scale established by the International Contact Dermatitis Research Group were carried out 2 days after application of the allergen. After each visual reading, the skin blood flow at the test sites was quantified by laser Doppler flowmetry. The results of laser Doppler flowmetry showed a highly significant difference between the upper and lower back. It is therefore necessary that in quantitative and comparative investigations, symmetrical sites, i.e., left versus right sides of the body, should be studied.

Adolescent↗

Bioengineering and the patch test.

Several non-invasive techniques based on different physical principles have been developed to investigate skin function and have been used for patch test assessment. In the present paper, the advantages and the defects of these methods are described in the light of the more recent data available in literature. Meanwhile, the eye and the fingers still remain the simplest method to assess skin irritancy. Bioengineering techniques could provide efficient recording systems for monitoring skin color, skin blood flow and barrier function damage, useful to the investigator rather than to the clinician.

Colorimetry↗

Prevalence and relevance of allergic reactions in patients patch tested in North America--1984 to 1985.

Between Jan. 1, 1984, and May 1, 1985, 1199 patients with suspected allergic contact dermatitis were patch tested with 32 "standard" allergens, 707 patients with 19 "vehicle and preservative" allergens, and 613 patients with 10 "special study" allergens. Ten dermatologists representing nine geographic centers collected and analyzed data with the use of the American Academy of Dermatology's mainframe computer in Evanston, Illinois. The most common sensitizers identified were nickel, p-phenylenediamine, quaternium-15, neomycin, thimerosal, formaldehyde, cinnamic aldehyde, ethylenediamine, potassium dichromate, and thiuram mix. Each positive reaction was assessed for its clinical relevance.

Adult↗

10 years' experience of patch testing with a shoe series in 230 patients: which allergens are important?

Over a 10-year period, 230 patients with foot dermatitis were patch tested to a shoe series of allergens. About 54 (23%) had relevant allergic positive reactions to one or more allergens. The commonest relevant allergens groups were, in order, chromate, medicaments, rubber chemicals, dyes and cosmetic constituents, with the most frequent individual allergens being chromate (4%), neomycin (3%), rubber chemicals (> 3%), paraphenylenediamine (2%) and tixocortyl pivolate (2%). Some allergens previously thought to be important, e.g. certain plastic and adhesive chemicals, did not show any positives over the period of study. In addition, para-tertiary butyl phenol formaldehyde resin was a relatively unimportant allergen in this series. The main practical points to emerge from this study are that, in patients with foot dermatitis, chromate is still the principal allergen, and that medicament and cosmetic allergens may be prominent.

Adhesives↗

[Metal allergies. Results of patch tests from 1981 to 1984].

From 1981 to 1984 987 patients of the Allergy Department of the Würzburg University Dermatological Hospital were evaluated with patch testing using a standard series; 199 patients were additionally tested with a specially composed metal battery. The results of the standard series with regard to the four metals contained in it, namely mercuric chloride, nickel sulphate, cobalt sulphate and potassium bichromate, were contrasted with the test results of the metal battery. Here there were conspicuous discrepancies between the two collectives, above all, with respect to cobalt. In comparison to the data contained in the literature we found appreciable differences in the metals copper, cobalt and potassium bichromate.

Dermatitis, Contact↗

Fixed drug eruption induced by lidocaine and patch testing.

Fixed drug eruption (FDE) is a peculiar drug-induced cutaneous reaction, that characteristically reappears at the same site when the etiologic drug is readministered. We present a case of a 27-year old male who was referred to us after two episodes of erythema on the palms, soles, and genital areas with posterior desquamation after receiving local anesthetics. Skin tests with lidocaine, mepivacaine and bupivacaine were negative. Eight hours after challenge with lidocaine the lesions reoccurred. Patch tests with lidocaine on healthy skin and residual lesions were negative, but 48 hours later the lesions reappeared on the same areas as before. Challenge with mepivacaine and bupivacaine were negative.

Adult↗

The atopy patch test in the diagnostic workup of suspected food-related symptoms in children.

BACKGROUND: There is an increasing need to develop test instruments that make oral food challenges superfluous. OBJECTIVE: We sought to study the utility of atopy patch tests (APTs) in the diagnostic workup of food allergy. METHODS: We investigated 437 children (median age, 13 months; 90% with atopic dermatitis) referred for evaluation of suspected food allergy. Specific serum IgE (sIgE) measurements, skin prick tests (SPTs), APTs, and controlled oral food challenges were performed. RESULTS: We analyzed 873 oral challenges with cow's milk, hen's egg, wheat, and/or soy. One thousand seven hundred single APTs were performed. As a single parameter, the APTs showed the best specificity compared with sIgE measurements, SPTs, or both. Combining the APT with either the SPT or sIgE measurement resulted in improved sensitivity and specificity. Decision points for sIgE measurement and for the SPT showed lower values when combined with a positive APT result. Correctly bypassing an oral food challenge with combined testing, including APTs, only between 0.5% and 7% (99% predicted probability) and between 6% and 14% (using 95% predicted probability) of children would fulfill the criteria for avoiding an oral food challenge. CONCLUSION: Although the predictive capacity of the APT is improved when combined with sIgE measurement or the SPT, oral food challenges become superfluous in only 0.5% to 14% of study patients. In addition, the APT is time consuming and demands a highly experienced test evaluator. CLINICAL IMPLICATIONS: For daily clinical practice, the APT adds only a small predictive value to the standard SPT and sIgE measurement in the diagnostic workup of suspected food-related symptoms in our study population.

Age Factors↗