SEARCH · Search PubMed
Results for “Patch Tests”
Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.
Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.
[Effects of vehicles in patch tests].
Explore the source record for details and available documents.
Reduction of environmental mites improved atopic dermatitis patients with positive mite-patch tests.
During a series of studies on the involvement of house dust mite antigens in 183 cases of atopic dermatitis, we observed an improvement in two patients following the removal of mites from their environment by means of a thorough housecleaning and replacement of the mattress. Both patients manifested the typical clinical skin lesions of atopic dermatitis and had similar laboratory findings. Although the serum IgE concentrations and specific IgE to Dermatophagoides pteronyssinus and Dermatophagoides farinae were each relatively low, the results of patch tests with these antigens were positive. Thus, a regimen aimed at reducing the presence of house dust mites can produce clinical improvement in a subset of patients with atopic dermatitis who show contact hypersensitivity to mite antigens on skin testing, but negative results on IgE (RAST; radioallergosorbent technique) testing.
The immunologic basis of patch testing.
During the past decade much has been learned about the cell-mediated immune responses that result in allergic contact dermatitis. The complex interaction between the hapten, the Langerhans cell, the specifically sensitized T cell, and the various soluble mediators of cellular immunity have begun to be delineated. This article reviews the pathophysiology of allergic contact dermatitis. Clinical and physicochemical modulators of this response, such as patient age, the anatomic site of antigenic challenge, and prior treatment with UVB, PUVA, glucocorticoids, or cyclosporine (Cyclosporin A), are stressed. The implications of these findings to the techniques of patch testing are summarized.
Evaluation of patch testing in patients with chronic vulvar symptoms.
The Dermogynaecology Clinic was established at the Mercy Hospital for Women in 1989. Since its inception, 700 patients have been investigated and 15% were clinically diagnosed as having contact dermatitis. Primary irritant dermatitis was regarded as the common cause but to investigate the place of contact allergy 50 patients were patch tested to a standard battery, medicaments, preservatives, corticosteroids and miscellaneous allergens. Twenty-one patients (42%) had a total of 44 positive tests. The most common positive reactions were to nickel (22%), cobalt (6%), fragrances (12%), caine mix (6%) and ethylenediamine (8%). Medicaments and fragrances were regarded as important allergens. Corticosteroid and imidazole allergy was not a problem in this series of patients.
Cinnamic aldehyde in toothpaste. 1. Clinical aspects and patch tests.
Although cinnamon is known to cause dermatitis in bakers and confectioners, it has only rarely been reported as causing trouble in food or cosmetics. A newly-formulated 'spicy' toothpaste containing cinnamon as a flavouring agent was the cause of oral symptoms in eight patients referred to clinics in Buckinghamshire and in Malmö and in a further eight patients discovered subsequently. Similar symptoms and patch test results were observed independently at both centres. Positive reactions were obtained with 1% cinnamic aldehyde in 15 out of 16 patients tested. Only one patient reacted to a standard sample of balsam of Peru (25% in petrolatum).
[Result of "as is patch test" using mite elements in atopic dermatitis (AD) patient. 2nd report, "Mite lipid"].
The antigenicity of mite lipid was studied, taking atopic dermatitis as an allergic disease. Lipid was extracted from Dermatophagoides pteronyssinus (Dp) and D. farinae (Df). It was tentatively designated a mite lipid antigen (Dp-L, Df-L), and then a patch test was performed. An extract from animal food (LC) and acetone were used as the controls. With only Dp-L, a positive reaction of more than one plus (+) of the ICDRG standard was noted in 3 out of 21 cases of AD. Histology of the above-mentioned positive cases revealed spongiosis and infiltration of small round cells in the upper dermis along with scattered eosinophiles. Leu 6 positive cells were noted frequently in the epidermis and dermis. The lipid components of Dp-L were made up mostly of phospholipid and triglycerides+, and lipoprotein was not contained. Judging from the findings above it appears necessary to study not only protein but also lipid in connection with the mite antigenicity++ in AD in the future.
Common shoe allergens undetected by commercial patch-testing kits: dithiodimorpholine and isocyanates.
The diagnosis of allergic contact dermatitis of the feet is challenging because the constituents of shoes are not labeled. In addition, the materials and technologies used in the manufacturing of shoes are continuously evolving. Since the 1950s, rubber allergens have been the most common cause of shoe dermatitis. However, the causal allergens in rubber have changed. Instead of 2-mercaptobenzothiazole, dithiodimorpholine, an allergen that is not contained on standard patch-testing trays, now may be one of the more common rubber sensitizers in shoes. Other allergens not found on standard series that can account for shoe dermatitis include isophorone diisocyanate, dimethylaminoethyl ether, and mixed dialkyl thioureas. Therefore, physicians evaluating patients with allergic-appearing foot dermatitis need to test with allergens beyond those present on standard screening series.
Modulation of the atopy patch test reaction by topical corticosteroids and tar.
BACKGROUND: Pharmacologic studies in atopic eczema (AE) are difficult to standardize. Patients with AE differ in the stage of their skin disease (acute, subacute, chronic). OBJECTIVE: This study was designed to assess macroscopic and microscopic effects of pretreatment with topical glucocortico-steroids (GCSs) and tar on the atopy patch test (APT) reaction in patients with atopic eczema. METHODS: Nonlesional skin of the back of patients with AE (n = 6) was treated for 3 weeks at 3 different sites with triamcin-olonacetonide 0.1% in cetamacrogol ointment (GCSs), pix liquida 10% in cetamacrogol ointment (tar), and cetamacrogol ointment (vehicle), respectively. APTs were performed, and biopsy specimens were taken from all these sites (time = 0 and 24 hours) for immunohistochemical analysis. RESULTS: Treatment with both GCSs and tar was able to reduce the macroscopic outcome of the APT reaction. Furthermore, both treatment modalities had an almost equally inhibiting effect on the influx of T cells, eosinophils, and CD1(+), RFD1(+), IFN-gamma(+), and IL-4(+) cells, as well as on the percentage of vessels expressing the adhesion molecules vascular cell adhesion molecule 1 and E-selectin in response to epicutaneous aeroallergen challenge. CONCLUSION: Although both treatments significantly reduced the various cellular constituents of allergic inflammation, all cell types remained present. In addition, this study shows that the APT can be used to evaluate the effect of topical anti-inflammatory treatments on allergic inflammation in patients with AE.
Patch testing with a new fragrance mix detects additional patients sensitive to perfumes and missed by the current fragrance mix.
The currently used 8% fragrance mix (FM I) does not identify all patients with a positive history of adverse reactions to fragrances. A new FM II with 6 frequently used chemicals was evaluated in 1701 consecutive patients patch tested in 6 dermatological centres in Europe. FM II was tested in 3 concentrations - 28% FM II contained 5% hydroxyisohexyl 3-cyclohexene carboxaldehyde (Lyral), 2% citral, 5% farnesol, 5% coumarin, 1% citronellol and 10%alpha-hexyl-cinnamic aldehyde; in 14% FM II, the single constituents' concentration was lowered to 50% and in 2.8% FM II to 10%. Each patient was classified regarding a history of adverse reactions to fragrances: certain, probable, questionable, none. Positive reactions to FM I occurred in 6.5% of the patients. Positive reactions to FM II were dose-dependent and increased from 1.3% (2.8% FM II), through 2.9% (14% FM II) to 4.1% (28% FM II). Reactions classified as doubtful or irritant varied considerably between the 6 centres, with a mean value of 7.2% for FM I and means ranging from 1.8% to 10.6% for FM II. 8.7% of the tested patients had a certain fragrance history. Of these, 25.2% were positive to FM I; reactivity to FM II was again dose-dependent and ranged from 8.1% to 17.6% in this subgroup. Comparing 2 groups of history - certain and none - values for sensitivity and specificity were calculated: sensitivity: FM I, 25.2%; 2.8% FM II, 8.1%; 14% FM II, 13.5%; 28% FM II, 17.6%; specificity: FM I, 96.5%; 2.8% FM II, 99.5%; 14% FM II, 98.8%; 28% FM II, 98.1%. 31/70 patients (44.3%) positive to 28% FM II were negative to FM I, with 14% FM II this proportion being 16/50 (32%). In the group of patients with a certain history, a total of 7 patients were found reacting to FM II only. Conversely, in the group of patients without any fragrance history, there were significantly more positive reactions to FM I than to any concentration of FM II. In conclusion, the new FM II detects additional patients sensitive to fragrances missed by FM I; the number of false-positive reactions is lower with FM II than with FM I. Considering sensitivity, specificity and the frequency of doubtful reactions, the medium concentration, 14% FM II, seems to be the most appropriate diagnostic screening tool.
A patch test study to evaluate the allergenicity of a metallic jewelry alloy in patients allergic to cobalt.
Cobalt is a common inducer of allergic contact dermatitis. A new jewelry alloy containing cobalt was developed and tested on 30 individuals with documented allergy to cobalt. Of these subjects, 5 (18%) were found to be allergic to the new alloy after 7 or 8 days of exposure. In all cases, the reaction was much less severe than allergy to the 1% cobalt chloride patch test material. This new alloy should be better tolerated by individuals allergic to cobalt, perhaps because the cobalt is tightly bound in the alloy by the other main component, platinum.
Individual, ethnic and seasonal variability in irritant susceptibility of skin: the implications for a predictive human patch test.
Since irritants are the major cause of contact dermatitis, it is important to identify those chemicals that possess significant ability to cause skin irritation. This process must then be followed by risk assessment and risk management. Historically, animal tests have played a major rôle in this process, but human volunteer studies are of increasing importance in this field. Where the appropriate safety and ethical controls are in place, human testing can give data that identifies skin irritation hazard. To be of widest value, these human studies must not be flawed due to inter-individual, inter-ethnic or seasonal variation. We conducted a large dose-response study and studied the impact of summer and winter weather on a predictive human assay. Sodium dodecyl sulphate (SDS) was tested at 0.1%-20% in 3 national groups of approximately 100 volunteers, using 25 mm Hill Top chambers loaded with 0.2 ml, solution and applied to the upper outer arm for 4 h. Reactions were scored at 24, 48 and/or 72 h after patch application. The German and Chinese studies were completed in a few weeks under similar winter conditions, whereas the UK work was spread fairly evenly over about a 15-month period. Some relatively minor differences were observed in the dose-response curves obtained, probably due to weather conditions. The effect of the weather on the intensity, but not the pattern, of irritant reactivity was also evident in the smaller specific study that assessed reactions to SDS in summer and in winter. Whereas 45% of the panel reacted to 20% SDS in summer, 91% reacted in the winter. However, in both studies, substantial inter-individual variations in response to SDS dominated the pattern of response. When designing a human patch test to discriminate skin irritant substances from those that are of minimal effect, it is this inter-individual variability, rather than any small inter-ethnic or seasonal variation, which must be taken into account. This can be achieved by the routine inclusion of a suitable positive irritant control, which then calibrates each human volunteer panel.
Psychological and somatic subjective symptoms as a result of dermatological patch testing with metallic mercury and phenyl mercuric acetate.
Sixty patients with a history of malaise over the ensuing weeks following the drilling out of old amalgam fillings were included in the study. They were tested epicutaneously weekly (standard procedure) with either 0.5% metallic mercury in petrolatum or 0.01% phenyl mercuric acetate in water, and, on 2 separate occasions, with only saline or petrolatum as a control according to a randomized double-blind protocol. The presence or absence of an allergic patch test response was read on day 3. Two patients showed allergic cutaneous responses towards metallic mercury and 1 to phenyl mercuric acetate. There was a concurrent 7-day self-registration of subjective psychological and somatic symptoms, using a validated visual analogue scale (minor symptom evaluation profile; MSE). In the group analysis it was clearly shown that the patients reacted with subjective symptoms to phenyl mercuric acetate. A reaction to test doses of metallic mercury seems to exist but could only be visualized when a scoring system was elaborated to individually define those subjects with a psychological and somatic response to test doses of mercury. This psychosomatic reactivity, named intolerance, seems to be unrelated to the cutaneous delayed allergic skin response. Thus, it might be possible to identify patients intolerant to small test doses of percutaneously penetrating mercury (previously considered innocuous). These findings may have a bearing on the systemic side-effects attributed to mercury released from amalgam tooth fillings.
A preliminary report of the occupation of patients evaluated in patch test clinics.
BACKGROUND: The interplay between the occupational environment and worker's skin can result in contact dermatitis of both irritant and allergic types. Other forms of dermatitis can also be influenced by occupational exposures. OBJECTIVE: The aim of this study is to compare the occupations and allergens of occupational contact dermatitis cases with nonoccupational contact dermatitis cases. METHODS: Diagnostic patch testing with allergens of the North American Contact Dermatitis Group and occupational coding by the National Institute for Occupational Safety and Health methods. RESULTS: Of 2,889 patients referred for evaluation of contact dermatitis, 839 patients (29%) were found to have occupational contact dermatitis. Of the 839 cases deemed occupational, 455 cases (54%) were primarily allergic in nature and 270 cases (32%) were primarily irritant in nature. The remaining 14% were diagnoses other than contact dermatitis, aggravated by work. The occupation most commonly found to have allergic contact dermatitis was nursing. Allergens strongly associated with occupational exposure were thiuram, carbamates, epoxy, and ethylenediamine. CONCLUSION: Some contact allergens are more commonly associated with occupational contact dermatitis. Nursing and nursing support are occupations most likely to be overrepresented in contact dermatitis clinics.
Red tattoo reactions: X-ray microanalysis and patch-test studies.
Eighteen patients who developed cutaneous reactions to red tattoos were studied to identify the chemicals responsible for the reactions to modern red tattoo pigments. Biopsies from the tattoos were examined histologically and the chemical composition of the red pigments was analysed by X-ray microanalysis. A variety of metallic elements including aluminium, iron, calcium, titanium, silicon, mercury and cadmium were detected. Patch tests were performed to the relevant chemicals in nine cases, and only one patient reacted to mercury. This study demonstrates that although reactions to mercury still occur, other red dyes containing a variety of inorganic pigments may provoke a cutaneous inflammatory response.
PUVA treatment of nickel contact dermatitis: effect on dermatitis, patch test sensitivity, and lymphocyte transformation reactivity.
Five females with nickel contact allergy and longstanding hand dermatitis were treated with oral methoxsalen and a series of whole-body UVA irradiations with a cumulative UVA dose of 30 to 58 J/cm2. Lymphocyte stimulation to nickel sulphate was determined prior to PUVA therapy, and monitored during the treatment and at 1 year after treatment. In 4 patients the cutaneous threshold to nickel sulphate patch testing was determined immediately post-PUVA and at 1 year. In all cases, the dermatosis cleared during the PUVA treatment. In 2 patients the immediate post-PUVA skin nickel reactivity was low compared with the 1-year follow-up value, while in 2 patients a progressive diminution of the skin reactivity was noticed. One patient was in clinical remission and had negative skin test at 1-year follow-up. In spite of diminished cutaneous sensitivity and/or clinical remission, the sensitivity of blood lymphocytes to nickel was approximately the same or increased, as determined by the lymphocyte transformation test. Thus no evidence was found to indicate that systemic, nickel-specific suppressive immune regulative mechanisms would have been activated by the treatment.
Comparison of patch test results with a standard series among white and black racial groups.
BACKGROUND: Environmental, cultural, occupational, genetic, individual, and racial differences are important factors in the study of contact dermatitis. Some epidemiologic studies have compared overall sensitization rates among different racial groups, but similar data are lacking on individual allergens. OBJECTIVE: Determine differences in sensitization rates between 2 racial groups in North America undergoing patch testing over a period of 4 years at the Cleveland Clinic Foundation (CCF), Ohio. METHODS: Retrospective computer review of the standard screening tray results of 991 patients with an average age of 45.9 years consisting of 877 (88.5%) whites and 114 (11.5%) blacks. RESULTS: Nickel sulfate and thiomersal (both 8.0%) and nickel sulfate and p-phenylenediamine (both 10.6%) were the 2 most common sensitizers among whites and blacks respectively. There was a statistically significant difference (P =.00599) in the sensitization rate for p-phenylenediamine in blacks (10.6%) compared with whites (4.5%). There were also statistically significant differences in sensitization rates for p-phenylenediamine (21.2%; P =.00005) and imidazolidinyl urea in petrolatum (pet.) (9.1%; P =.04103) in black men compared with white men (p-phenylenediamine [4.2%] and imidazolidinyl urea [2.6% pet.]). CONCLUSION: The differences in sensitization rates, especially for p-phenylenediamine, may reflect variations in allergen exposure among racial groups or interindividual variations in the N-acetylation (N-acetyltransferase 1 [NAT1] and 2 [NAT2]) capacities of human skin for p-phenylenediamine.
Patch tests demonstrating immune (antibody and cell-mediated) reactions to foods.
For decades food allergists have sought a simple, inexpensive test for food allergy. Intradermal tests of aqueous material have not proved reliable. When positive, they are probably only 10% accurate. The newer laboratory tests for food allergy are expensive and highly sophisticated. They are impractical for use in the laboratories of practicing allergists with whom individuals with a potential food allergy are most liable to consult. The RAST is capable of identifying only Type I of the Gell-Coombs' reaction classification. Since 1980, a patch test of individual foods suspended in dimethylsulfoxide has been used as a screen for sensitivity to foods. Controlled clinical studies suggest this might prove to be a valuable test for food allergy. Immune studies appear to confirm the accuracy and reliability of this inexpensive test. No systemic reactions have been observed in the 400 patients tested indicating it to be a safe procedure.