Coping with negative test results in patch testing.
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Adaptation, Psychological↗
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Variations in the quantities of petrolatum applied in patch testing.
When using patch tests to objectify contact allergy in patients, many different materials are used in different clinics. Whatever the material used, there are presumably differences in the quantities of allergens dispersed in petrolatum applied in the patch tests by the clinicians. Therefore, we designed an experiment in order to evaluate whether such differences do indeed exist. The results presented here clearly show that the quantities of petrolatum applied varies considerably in the patch tests (i.e. Leukotest Beiersdorf) from dermatologist to dermatologist. In addition, we found that for an individual dermatologist differences occur from day to day. It is our conclusion that in the interest of the patients and in the interest of multicentric studies, standardization of patch test materials is of great importance, especially in regards to the quantities of petrolatum applied.
Allergens↗
Comparison of skin prick test and atopy patch test with dust mite extracts in patients with respiratory symptoms or atopic eczema dermatitis syndrome.
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Adult↗
Relationship between use test and threshold patch test concentration in patients sensitive to 5-chloro-2-methyl-4-isothiazolin-3-one and 2-methyl-4-isothiazolin-3-one (MCI/MI).
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Dermatitis, Contact↗
A retrospective study of Patch test results from 163 patients with stasis dermatitis or leg ulcers. I. Discussion of the Patch test results and the sensitization indices and determination of the relevancy of positive reactions.
Patch test results from 163 patients with leg ulcers and/or chronic venous insufficiency, tested with a modified ICDRG standard test battery and a pharmaceutical test series, are analyzed and compared with the results obtained from a randomly selected control group of patients with eczematous conditions. A sensitization index for the most common contact allergens present in this test series is calculated, and the relevancy of hypersensitivity to specific topical agents is determined.
Allergens↗
Nitric oxide participates in prick test and irritant patch test reactions in human skin.
The aim of this study was to investigate the involvement of nitric oxide (NO) in the modulation of immediate and delayed immunological and nonimmunological reactions in human skin. The NO donor nitroglycerin, 0.1 microgram, and the NO synthase inhibitor, NG-nitro-L-arginine (L-NAME), 0.1 microgram, were injected intracutaneously prior to provocation tests. The following provocation tests were carried out: 8 patients with pollen allergy to birch were provoked by a prick test with the allergen and the volume of the weals was measured; 20 patients with allergy to nickel were provoked with nickel sulfate epicutaneously; and 26 healthy volunteers were provoked with tuberculin (causing delayed immunologic reaction), benzalkonium chloride (irritant contact dermatitis), UV radiation or benzoic acid (nonimmunological contact urticaria). The test reactions were evaluated by planimetry. L-NAME inhibited irritant contact dermatitis (P = 0.020) but augmented immediate immunological reactions (prick test) (P = 0.016). The other test reactions remained unchanged. Nitroglycerin did not affect any of the reactions significantly. The results suggest that NO is involved in immediate immunological reactions and irritant contact dermatitis.
Adult↗
Postmarketing survey results of T.R.U.E. TEST, a new allergen patch test.
BACKGROUND: T.R.U.E. TEST, (Thin-layer Rapid Use Epicutaneous Test; Glaxo Dermatology, Division of Glaxo Wellcome Inc, Research Triangle Park, NC) an allergen patch test used in the diagnosis of contact dermatitis, was first introduced to the United States market on January 16, 1995. A voluntary postmarketing survey of its use during the initial 19.5 months has been conducted. OBJECTIVE: The survey was conducted to provide information on the incidence of positive reactions to the specific allergens included in the panel as well as to evaluate test performance and safety. METHODS: Data collection forms were included with each initial order of T.R.U.E. TEST purchased by dermatologists and other physicians. Data for a total of 3,209 patients were analyzed for incidence of dermatitis by body site, reaction frequency to test allergens, physician interpretation of clinical relevance, and adverse events. RESULTS: Allergens with the highest reaction rates included nickel sulfate (17.8%), Quaternium-15 (10.6%), thimerosal (9.4%), and formaldehyde (8.7%). These figures were similar to those obtained in the North American clinical trials used to support the US market approval of T.R.U.E. TEST. Itching/burning sensation and excited skin were the most frequent adverse events recorded, each reported in less than 2% of patients tested. CONCLUSION: T.R.U.E. TEST provides a standardized, convenient, reliable, and safe method of assessing patients with contact dermatitis.
Adolescent↗
[Skin and laboratory tests: comparison of the epicutaneous patch test with the TTL and LIF tests in the diagnosis of medicamentous allergic contact dermatitis].
We investigated 158 patients from 15 to 82 years of age with clinically evident contact dermatitis, diagnosed at the Department for Allergic Diseases Investigations-Clinic for Dermatovenerological Diseases, Medical Faculty in Novi Sad, during the period of 1 year. We performed patch-epicutaneous test, lymphocyte transformation test (TTL) and leukocyte migration inhibition test (LIF). Among the 130 (82.2%) patients suffering from contact dermatitis, with the positive patch tests to commercial or standard battery epicutaneous allergens, 26 (20%) had at least one positive patch test to the medicament. In these cases contact allergic medicamentous dermatitis (SAMD) was proved by positive clinical and allergic investigations. In only one case, patch test was negative, with booth the TTL and LIF test positive. Among the medicaments TTL and LIF tested, antibiotics were the most frequent in 9 (34.61%) cases, analgetics were found in 6 (23.08%). Professional contact allergy to medicaments has been estimated in 5 patients (19.23%). According to the obtained results and statistic findings, relationships between the two variables-TTL and patch test, and LIF and patch test, were estimated due to the contact allergy to medicaments. Both of them were low and negative without statistic significance. Patch test remains to be the irreplaceable test with regard to CAMD.
Adolescent↗
Changes in eosinophil and leukocyte infiltration and expression of IL-6 and IL-7 messenger RNA in mite allergen patch test reactions in atopic dermatitis.
Patch testing with crude dust mite extracts after removal of homy layers was performed on normal-appearing skin of 11 adult patients with atopic dermatitis and high mite-specific IgE antibody scores. Positive skin reactions were observed in 9 subjects. Skin biopsy specimens were obtained from positive reaction sites at 2, 6, 12, 24, and 48 hours after allergen challenge and subjected to histologic studies and extraction of messenger RNA (mRNA). Perivascular infiltration of small mononuclear cells began at 2 hours and was followed by eosinophilic infiltration at 6 hours, and the number of eosinophils continued to increase at 24 and 48 hours. In addition to the increased expression of IL-4, IL-5, and tumor necrosis factor-alpha mRNA during the time course detected by reverse-transcription polymerase chain reaction, mRNA of IL-6 and IL-7 was also up-regulated. After the removal of test patches with mite allergen, the number of eosinophils started to decrease in a time-dependent manner. Histopathologic findings at 48 hours after removal showed lymphocyte-dominant infiltration intermingled with occasional eosinophils. These mite allergen patch test reactions may provide a useful model for studying the pathogenesis of atopic eczema, especially with regard to the initiation of eosinophil infiltration and the alternative increase in lymphocytes.
Adult↗
Nickel sulphate and epoxy resin: differences in iron status and glutathione redox ration at the time of patch testing.
The reactive patch test reaction is a useful model to characterize oxidative stress in acute allergic contact dermatitis. This model was used to study oxidative stress in the skin of individuals allergic to nickel and epoxy resin. The study included six and five patients, respectively, whose skin was simultaneously biopsied from a positive patch test site and from an apparently healthy area. The biopsies were homogenized and used for determination of iron content, unbound iron binding capacity, diene conjugate levels, and glutathione redox ratio. A positive test reaction to 5% nickel sulphate was accompanied by 2.5-fold increase in iron level as compared to apparently healthy skin (P<0.1). The percentage saturation of iron-binding capacity and the glutathione redox ratio were significantly increased (P<0.01 and P<0.05, respectively). Reactive patch test responses to 1% epoxy resin were not accompanied by clear alterations in iron status or glutathione redox ratio. Our investigation showed that apart from oxidative burst caused by accumulation of inflammatory cells, hapten properties might also influence the oxidative stress status of the skin. The high incidence of nickel allergy may be attributed, at least in part, to the influence of nickel ions on the glutathione redox ratio and iron status of the skin.
Adult↗
Occupational relevance of positive standard patch-test results in employed persons with an initial report of an occupational skin disease.
OBJECTIVES: It is commonly accepted that the standard screening tray is an essential diagnostic test in patch testing supporting the diagnosis of contact dermatitis, the most common type of occupational skin disease (OSD). In this study standard patch-test results of employed persons with an initial report of an OSD were analyzed within 24 occupational groups. METHODS: An evaluation was made of employed persons recorded in the Register of Occupational Skin Diseases in Northern Bavaria (Berufskrankheitenregister Haut-Nordbayern; BKH-N) between 1990 and 1999, catering for those standard screening tray allergens tested over the 10-year period. RESULTS: Nickel sulfate was the most common sensitizer (29.5%), showing occupational relevance in only 11% of the cases sensitized. Other common sensitizers were cobalt chloride (13.5%), p-phenylenediamine free base (10.7%), potassium dichromate (9.8%), fragrance mix (5.4%), thiuram mix (4.2%), balsam of Peru (4.0%), chloromethylisothiazolinone/methylisothiazolinone (4.0%), and formaldehyde (4.0%). The most occupationally relevant sensitizers were thiuram mix (71%), epoxy resin (67%), p-phenylenediamine free base (59%), p-phenylenediamine-black-rubber mix/ N-isopropyl- N'-phenyl- p-phenylenediamine (53%), potassium dichromate (48%), formaldehyde (38%), chloromethylisothiazolinone/methylisothiazolinone (37%), and mercapto-mix/mercaptobenzothiazole (35%). Occupational groups at risk of acquiring delayed-type sensitization were, in particular, electroplaters, tile setters and terrazzo workers, construction and cement workers, solderers, wood processors, and leather and fur processors. CONCLUSIONS: The standard series contributes valuable information and asserts its position in clarifying the causes of OSDs. Based on the study results, the rate of occupationally relevant sensitization to each single allergen is demonstrated, and the difficulties in verifying the occupational relevance are discussed.
Adult↗
Comparison of colophony patch test preparations.
The patch test reactivity to different petrolatum preparations and concentrations of colophony (gum rosin) was compared. A serial dilution test with gum rosin 20%-0.001% gave a clear dose-response relationship with a maximum response to 10% and 20%. Patch testing with 60% in the routine test did not reveal any further cases compared to simultaneous testing with 20%. Irritancy to the 60% concentration was seen in some cases. A good correlation in reactivity was found between commercially-supplied test preparations for routine testing and homogeneous preparations made up in our laboratory. Our results imply that a concentration of 10% is well worth considering for routine testing.
Dose-Response Relationship, Immunologic↗
Do positive nickel reactions increase nonspecific patch test reactivity?
The patch test reaction pattern in nickel-positive and -negative female patients was compared. Cobalt allergy was found in 24.8% of the positive patients. However, the occurrence of allergy to other common agents, i.e., neomycin, perfume mix, balsam of Peru and bacitracin, did not differ significantly between the 2 groups. Even in patients allergic to nickel and cobalt simultaneously, the frequencies were comparable. Chromate and PPDA allergy was significantly commoner in nickel sensitive patients (p less than 0.05 and p less than 0.01). Erythematous or follicular reactions were seen most often to wood tars, propylene glycol, formaldehyde, cobalt, chromate and perfume mix. Reactions to propylene glycol and perfume mix were as frequent in both groups, whereas formaldehyde, cobalt and chromate caused reactions more often in nickel-positive patients (p less than 0.05) and wood tars in negatives (p less than 0.05). Follicular reactions developed especially in patients who were positive to nickel and cobalt. The total number of non-specific reactions was not overpresented in nickel sensitive patients, despite their multiple patch test reactivity.
Allergens↗
Artificial disruption of skin barrier prior to irritant patch testing does not improve test design.
BACKGROUND: Irritant patch testing is often performed as a 24- or 48-h occlusive patch test with low concentrations of sodium lauryl sulphate (SLS). OBJECTIVES: The aim of this study was to investigate potential ways to shorten this test procedure and obtain precise test results. PATIENTS AND METHODS: Thirty-six healthy volunteers underwent irritant patch testing with different pretreatments (PT) of the test fields. Occlusive test chambers were applied on the upper back with SLS 0.5%, 1%, 2% and 5% in large Finn Chambers(R). The patches were removed after 4 and 24 h, respectively, depending on the concentration used. Test fields were pretreated as follows: PT 0, field without any PT (control); PT 1, prick with lancet; PT 2, prick with test stamp; PT 3, scratch with lancet; PT 4, incision with standardized incision instrument (0.1-0.2 mm depth). Skin reactions were evaluated by transepidermal water loss (TEWL), skin erythema and skin hydration and as well by a visual score (VS) at 4, 24 and 72 h. RESULTS: Our data show an obvious distinction between PT 0-2 and PT 3-4 at all measurement methods. The average TEWL values with PT 3-4 were higher than those with PT 0-2, especially on the 4-h course. This distinction may derive from the shape and size of the skin impairment achieved by PT 3-4, leading to a mechanical barrier disruption. However, SLS may infiltrate directly into deeper skin layers supported by capillarity. Consequently, no or little penetration through the epidermis and interaction with its structures occurs, which is responsible for irritant skin reactions. The SLS dose in the upper skin layers is therefore lower at these PTs. The lower remaining dose of SLS also explains this distinction, especially for the VS. Additionally, there are presumed reactions in deeper layers of the epidermis and dermis at PT 3-4. CONCLUSIONS: In summary, all data suggest a different reaction pattern from the classical irritant response. Therefore, application without any PT seems to be best suited for irritancy skin testing, especially for visual assessment. PTs prior to irritant patch testing have been shown to be unjustifiable.
Adult↗
Minimum eliciting patch test concentration of thimerosal.
Positive patch test reactions to thimerosal 0.1% pet. (40/690 subjects: 5.8%) were more common in younger age groups, in the allergic contact dermatitis group and in subjects who had used contact lens solutions. In the 40 thimerosal-positive patients, the minimum eliciting quantity of preservative was evaluated using different test concentrations: 0.05% and 0.01% pet. (patch testing) and 1:10,000 in saline (intradermal testing). Cross-reactions between thimerosal and other mercury compounds and sensitivity to thiosalicylic acid were also examined. The results of the investigation demonstrate that many of the reactions to 0.1% thimerosal are probably irritant, because only half the subjects studied had positive patch tests when allergen concentrations 5 to 10x lower than that conventionally used for patch testing, were utilized. In these subjects, the average strength of patch test reactions was higher, intradermal testing was more often positive and cross-reactions between mercurials more frequent. These data indicate that the optimal eliciting patch test concentration for studying thimerosal sensitivity is 0.05% pet.
Adolescent↗
Patch test methods. I. A comparative study of six different types of patch tests.
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Humans↗
Wipe-test and patch-test for alcohol misuse based on the concentration ratio of fatty acid ethyl esters and squalene CFAEE/CSQ in skin surface lipids.
Fatty acid ethyl esters (FAEE) are known to be formed in blood and almost all human tissues after alcohol consumption and to be incorporated from sebum into hair where they can be used as long-term markers for excessive alcohol consumption. In order to examine whether skin surface lipids which consist mainly of sebum are an equally useful matrix for measurement of FAEE as alcohol abuse markers, samples were collected by a wipe-test from the forehead of 13 teetotallers, 16 social drinkers, 10 death cases with known recent alcohol misuse and five death cases without indications of alcohol misuse. The samples were analysed by headspace solid-phase microextraction and gas chromatography-mass spectrometry for ethyl myristate, ethyl palmitate, ethyl oleate and ethyl stearate and by high performance liquid chromatography with photodiode array detector for squalene, (SQ), as a natural reference substance which the FAEE concentrations were related to. The ratio mFAEE/mSQ ranged between 0.16 and 1.12 ng/microg (mean 0.34 ng/microg) for the teetotallers and between 0.08 and 0.94 ng/microg (mean 0.37 ng/microg) for the social drinkers with no significant difference between both groups. For the alcoholics 2.4-24.2 ng/microg (mean 13.1 ng/microg) were found. For two volunteers the course of mFAEE/mSQ 2 weeks before and 3 weeks after a single high alcohol dose was pursued by daily wipe tests. A strong increase of mFAEE/mSQ occurred between 7 and 12 days after the drinking event. This delay can be explained by the transition time of about 8 days between sebum production and its appearance on the skin surface known from literature. For seven social drinkers skin surface lipid samples were also collected using drug of abuse patches of the firm PharmCheck. The ratios mFAEE/mSQ in these samples were in the same range as from the wipe-test. The comparison with the self-reported ethanol amounts consumed the week before and during the test gave no good correlation (R2 = 0.42). It can be concluded from the results that FAEE in skin surface lipids can be used for medium-term retrospective detection of heavy drinking.
Adult↗
Patch testing: pitfalls and performance.
PURPOSE OF REVIEW: Contact dermatitis is a common disease process that includes allergic and irritant contact dermatitis. The gold standard for diagnosing allergic contact dermatitis, a type IV delayed hypersensitivity reaction, is patch testing. Patch testing is not a difficult procedure, however, there are several critical components that determine the success of the test: having an appropriate level of suspicion for the diagnosis of allergic contact dermatitis, an adequate threshold for patch testing, the necessary experience to properly interpret the results and to determine their relevance, and the ability to thoroughly educate the patient about the condition. RECENT FINDINGS: Research shows that patch testing practices differ among individuals and specialties. The level of patch testing education, interest in, and experience with, the procedure can affect the results of the test. Some of these practice differences and how they affect the outcome of patch testing are highlighted. SUMMARY: Physicians' knowledge and experience with patch testing, their level of interest and access to allergens will determine the performance of this test, the reliability of the results and the benefits gained from this procedure.
Allergens↗