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At least 163 records · Page 9Linked to original sources
PubMed2003

Patch-testing practices of American Contact Dermatitis Society members: a cross-sectional survey.

BACKGROUND: Patch testing is an example of how medicine blends art and science, resulting in differences among practitioners in methods of history taking, application of patch tests, and interpretation of results. OBJECTIVE: To evaluate the "art" of patch testing (specifically, the prevalence of Thin-Layer Rapid Use Epicutaneous (T.R.U.E.) TEST use, photopatch testing, patch testing to dust mites, and immediate testing for latex allergy) as practiced by American Contact Dermatitis Society (ACDS) members and to compare the results of this survey with those of similar studies among United States dermatologists and allergists. METHODS: A cross-sectional survey of all 322 members of the ACDS. RESULTS: The response rate was 46%. The largest proportions of respondents were male, had practiced for 11 to 20 years, were located in the northeast United States, and were in private practice. Forty percent of respondents used T.R.U.E. TEST, and 65% performed photopatch testing. Seventy percent of respondents evaluated patients for latex allergy, and 15% patch-tested to dust mites. CONCLUSIONS: As expected, respondents reported significantly higher prevalences of patch testing, photopatch testing, and evaluation for latex allergy than did United States dermatologists generally. Respondents reported significantly lower prevalences of single patch-test readings and use of T.R.U.E. TEST than did either general United States dermatologists or general United States allergists.

Allergens↗
PubMed1995

Pretreatment of the test area with 1-day occlusion improves the response rate to NiSO4 5% pet. patch tests in subjects with a positive history of nickel allergy.

A group of 58 women, aged 18 to 51 years, with a clinical history of nickel allergy, who exhibited equivocal or negative reactions to nickel sulfate 5% pet. patch tests performed on the skin of the back, were recruited consecutively from the patch test clinic from September 1993 to June 1994. In order to improve the response rate to NiSO4 5% pet. patch tests, a testing procedure utilizing pretreatment of the test area by 1-day (24-h) occlusion was introduced. Patients underwent 2 patch tests on adjacent sites of the volar surface of both forearms. 3 of the patch tests were performed with 40 mg nickel sulfate 5% pet., whereas a control test was carried out by occluding with an empty chamber. 2 of the nickel sulfate test sites were pretreated with 1-day occlusion performed with an empty chamber. A visual grading system and echographic measurement were used to quantify the responses 30-40 min after patch test removal. Echographic evaluations were carried out using a 20 MHz B-scanner. Measurement of skin thickness and determination of the hypoechogenic dermal area, both considered to be parameters of inflammation, were used to evaluate the intensity of the allergic reaction. At the 3-day (72-h) evaluation, 19 subjects out of 58 clearly showed positive reactions to nickel sulfate 5% pet. at pre-occluded skin sites. Moreover, values of skin thickness and of 0-30 areas at positive pre-occluded nickel test areas were higher in respect to control test areas, confirming clinical evidence of increased response to NiSO4 after occlusion.

Adolescent↗
PubMed2001

Pitfalls of irritant patch testing using different test chamber sizes.

BACKGROUND: Test chambers for irritant patch testing are usually larger than those used in allergic patch testing. In general, larger areas show stronger skin reactions than smaller areas. OBJECTIVE: This study investigated whether this difference is of practical relevance, when a model irritant is applied in small and large Finn chambers and evaluated by measurement of transepidermal water loss (TEWL). METHODS: Patch testing was performed with 2 concentrations of sodium lauryl sulfate (SLS) (0.25% and 0.5%) on forearms of healthy volunteers. Large (inner diameter, 12 mm) and small (inner diameter, 8 mm) chambers were used. RESULTS: A variance analysis (3 factors, 2-tailed) showed that the test outcome, as assessed by TEWL, was strongly dependent on SLS test concentration and test chamber size. The larger chambers gave approximately 30% to 50% higher values than the smaller. CONCLUSIONS: This may be explained by the fact that with the small chambers, the adjacent small area of nontreated skin was also assessed by the evaporimeter, biasing the results. A formula estimating TEWL value of the large chamber from values of the small chambers has been proposed.

Adolescent↗
PubMed1996

Pre-treatment of nickel test areas with sodium lauryl sulfate detects nickel sensitivity in subjects reacting negatively to routinely performed patch tests.

A fair % of patients with a clinical history of nickel allergy show negative patch test results. To improve the response rate to NiSO4 5% pet. patch tests, a testing procedure utilizing pre-treatment of the test area by a 24-h application of sodium lauryl sulfate (SLS) was introduced. 46 women with a clinical history of nickel sensitivity, who exhibited negative reactions to nickel sulfate 5% pet. patch tests, were studied. Patients underwent 6 patch tests on adjacent sites on the volar surface of the forearms. 4 patch tests were performed with a 72-h application of 40 mg nickel sulfate 5% pet. While 1 of these patch tests served as control, 3 test areas underwent 24-h pre-treatment with 40 microliters SLS, 1 with 0.1% and 2 with 0.5% solution. To evaluate differences in the reactivity to SLS plus nickel sulfate related to the site on the forearm, 0.5% SLS pre-treatment was performed both on a proximal and on a distal test site. At the 72-h evaluation, 19 subjects out of 46 showed positive reactions to nickel sulfate 5% pet. at skin sites pre-treated with 0.1% SLS, whereas 23 patients reacted positively at 0.5% SLS pre-treated areas. Echographic values of skin thickness and of hypo-echogenic dermal areas at positive pre-treated nickel test areas were higher than at control test areas, confirming the clinical evidence of an increased response to NiSO4 after SLS pre-treatment. The inflammatory reaction, as evaluated clinically and echographically, was much higher at distal skin areas (0.1% SLS and distal 0.5% SLS) than at proximal 0.5% SLS ones.

Adult↗
PubMed1996

A retrospective evaluation of patch testing in patients diagnosed with allergic contact dermatitis.

One reason given by clinicians for not using patch testing in patients with dermatitis is that it may not improve the treatment outcome. The main objectives of this retrospective study were to determine the frequency of use of patch testing as an aid to the diagnosis of allergic contact dermatitis (ACD), to determine the ACD-related costs before and after diagnosis of the disease, and to determine the benefit of the diagnosis of ACD, with or without patch testing, to the patient's treatment outcome. This study will also provide definite direction for a prospective outcome study. Medical records of 270 patients with ACD were utilized retrospectively to study the benefit of patch testing. Patch testing was performed on 56 percent of these patients. Patch testing was found to bring about a larger decrease in the disease severity index and percentage disease activity from prediagnosis to postdiagnosis than diagnosis without patch testing. In the group of patients with a prediagnosis disease duration of two months to one year, the postdiagnosis duration was considerably less for those patch tested and treated than those that were treated without patch testing. Patch testing was found to be the most cost-effective in patients with a disease duration of two months to one year.

Adult↗
PubMed1999

Concomitant positive reactions to allergens in a patch testing standard series from 1988-1997.

BACKGROUND: Patch testing is a useful diagnostic technique in patients with suspected allergic contact dermatitis (ACD). Concomitant reactions may reflect associations between tested allergens. OBJECTIVE: This study was performed to identify positive correlations between reactions to test substances in a standard screening series. The results of patch testing in patients seen from 1988 to 1997 are described. METHODS: Data were collected from chart review for patients who underwent patch testing to the full standard screening series at the Massachusetts General Hospital Contact Dermatitis Clinic. The Fisher exact test was used to evaluate associations between allergens. RESULTS: A total of 927 patients were patch tested to 22 allergens included in a screening tray. The mean age was 43.9 years, and 68.6% were women. Two or more positive reactions occurred in 36.5% of patients. Reactions to 13 pairs of allergens were found to be significantly correlated: balsam of Peru/fragrance mix, carba mix/thiuram mix, carba mix/paraben mix, cobalt chloride/potassium dichromate, cobalt chloride/nickel sulfate, ethylenediamine/neomycin sulfate, formaldehyde/imidazolidinyl urea, formaldehyde/paraben mix, formaldehyde/quaternium-15, imidazolidinyl urea/quaternium-15, neomycin sulfate/potassium dichromate, paraben mix/quaternium-15, and potassium dichromate/thimerosal. CONCLUSION: Concomitant reactions to 13 pairs of allergens in a standard series occurred at a rate greater than would be predicted by chance. Such associations may reflect cross-sensitization or cosensitization.

Adult↗
PubMed1984

Sodium lauryl sulfate irritant patch tests. III. Evaporation of aqueous vehicle influences inflammatory response.

Patch tests with aqueous solutions of the irritating detergent sodium lauryl sulfate (SLS) elicit varying degrees of inflammation from subject to subject and from site to site. For an investigation of the causes of this variability, two patch tests with 10% aqueous solutions of SLS were applied to adjacent areas of ventral forearm skin of eighteen volunteers. In one test the water vehicle was allowed to evaporate from the patch test unit before the patches were applied. After 22 hours the patch tests were removed, and 2 hours later the degree of inflammation was graded. Less inflammation was present at the site of the dry patch test in fifteen of eighteen subjects, and the score of inflammation between each pair was significantly less at the dry patch test site (p less than 0.001). These studies show that evaporation of water from aqueous solutions can influence the irritating potential of SLS on human skin.

Adult↗
PubMed1984

Amount of nickel applied with a standard patch test.

The concentration of nickel sulphate was determined in 9-16 mg test samples from commercially available patch test antigens. With two different manufacturers of 2.5% nickel sulphate in pet, the concentration range of 25 samples was 0.7 and 1.1% (+/- 2 SD) respectively, and with one manufacturer of 5.0% nickel sulphate in pet, the range was +/- 0.5%. In a normal patch test, the volume of patch test material applied with the Finn chamber technique should be 12-18 microliter (9-16 mg), but has been found to range between 9 and 50 microliter. Thus the amount of nickel applied in standard patch tests varies within at least 6-fold limits.

Dermatitis, Contact↗
PubMed2002

Lyral has been included in the patch test standard series in Germany.

Lyral 5% pet. was tested in 3245 consecutive patch test patients in 20 departments of dermatology in order (i) to check the diagnostic quality of this patch test preparation, (ii) to examine concomitant reactions to Lyral and fragrance mix (FM), and (iii) to assess the frequency of contact allergy to Lyral in an unselected patch test population of German dermatological clinics. 62 patients reacted to Lyral, i.e. 1.9%. One third of the positive reactions were + + and + + +. The reaction index was 0.27. Thus, the test preparation can be regarded a good diagnostic tool. Lyral and fragrance mix (FM) were tested in parallel in 3185 patients. Of these, 300 (9.4%) reacted to FM, and 59 (1.9%) to Lyral. In 40 patients, positive reactions to both occurred, which is 13.3% of those reacting to FM, and 67.8% of those reacting to Lyral. So the concordance of positive test reactions to Lyral and FM was only slight. Based on these results, the German Contact Dermatitis Research Group (DKG) decided to add Lyral 5% pet. to the standard series.

Aldehydes↗
PubMed2002

Prevalence and methodology of patch testing by allergists in the United States: results of a cross-sectional survey.

BACKGROUND: Patch testing is considered the gold standard for the diagnosis of allergic contact dermatitis. Whereas previous surveys have evaluated the patch testing practices of dermatologists, little information is available on the use of patch testing by allergists. OBJECTIVE: The objective of this study was to examine the prevalence of patch testing and associated methodologies used by allergists in the United States. METHODS: A cross-sectional survey of all US Fellows of the American Academy of Allergy, Asthma and Immunology was conducted. RESULTS: Of 1,239 questionnaires mailed, 519 (42%) were returned. Fifty-three percent of allergists reported performing patch testing. The majority (89%) patch tested 5 or fewer patients per month. Allergists who evaluated for latex allergy were twice as likely to patch test than those who did not. The most common patch test reading schedule was at both 48 and 72 hours (48%). Thirty-three percent of respondents performed only a single patch test reading. The majority (72%) used TRUE Test. Only 4% patch tested for Type IV allergy to dust mites. CONCLUSION: Many more allergists patch test than initially hypothesized. The patch testing methodologies used by allergists are similar to those of dermatologists.

Allergens↗
PubMed1976

Standardization of patch tests in Japan.

In order to standardize patch tests in Japan a comparative study of our former method of patch testing with that recommended by the International Contact Dermatitis Research Group (ICDRG) was carried out with the collaboration of dermatologists in the Mid-Japan Dermatological Society. The following differences were observed between the two methods of patch testing: 1. Four out of five ICDRG allergens which were common in Japanese standard allergen series--formaldehyde, potassium dichromate, cobalt chloride and nickel sulfate--showed higher reactivity than those of Japanese allergens. The other allergen, paraphenylenediamine (PPD), showed the same reactivity as Japanese PPD. Cobalt chloride of ICDRG origin showed a particularly higher reactivity than the Japanese one (a=0.05) 2. Higher reactivity was observed at the 48-h reading when aqueous reagents were patch-tested using Torii-Ban, Miniplaster and Leukotest, which are all popular in Japan. This higher reactivity could be attributed to the lint gauze of plasters which are pre-treated with fluorescent whitener. 3. The incidence of reactivity of the ICDRG allergens in Japan was also studied in order to establish a new standard allergen series.

Cobalt↗
PubMed1997

Evaluation of previously patch-tested patients referred to a contact dermatitis clinic.

BACKGROUND: One of the frustrations for clinicians who use patch testing is the patient in whom screening patch tests does not yield a relevant result that improves patient outcome. Is it allergic contact dermatitis? Was an allergen missed? Is the screening allergen relevant after all? OBJECTIVE: The purpose of this study was to look at the subset of patients referred to a contact clinic who had previously undergone patch testing to seek answers to these questions for this population. METHOD: The charts of all 119 physician-referred patients seen in the contact clinic from February through August 1995 were reviewed. Information was gathered about the sites of dermatitis, previous patch testing results, current patch testing results (using the North American Contact Dermatitis Group series and supplemental allergens when indicated), and final diagnosis. RESULTS: Forty-three patients had previously undergone patch testing. Nineteen had been tested with the True Test and 24 with the screening series presumed to be Hermal. The sites of skin involvement were similar to the untested group (approximately 1/3 hands, 1/3 face/exposed sites, and 1/3 other). Eighteen pretested patients(42%) had been reported to have one or more positive patch tests, with the most frequently reported allergens, including neomycin (4), quaternium 15 (3), Balsam of Peru (3), fragrance (2), and formaldehyde (2). On repeat testing, 77% of the previous positives were again positive, and many were thought to be relevant. Nine of the 18 had additional allergens deemed relevant. Twenty-five pretested patients had been negative on initial patch testing. Eighteen of the 25 (72%) had positive allergens on repeat testing, and most were thought to be relevant. There were 17 reactions to screening allergens and 16 reactions to additional allergens or products. Variations noted with initial negative testing included use of systemic corticosteroids, patient self-removal of tests, and single 48-hour readings. Overall, 27 of 43 pretested patients (63%) were found to have relevant additional allergens with contact clinic evaluation. Screening allergens were underrecognized as being relevant by clinicians in practice. CONCLUSIONS: Patients suspected of having an allergic component to their dermatitis should be patch tested with the screening series of allergens. Interpretation of the relevance of the allergens and appropriate avoidance is a challenge. If screening allergen patch testing is negative or believed to be not relevant in a patient with persistent dermatitis, there may be a high yield on further patch test evaluation.

Dermatitis, Allergic Contact↗
PubMed2003

Influence of climatic conditions on the irritant patch test with sodium lauryl sulphate.

Irritant patch testing with detergents is increasingly being used as a measure of skin barrier function, but there is evidence that climatic changes can influence the test outcome. In this study we investigated the relation between cutaneous reactivity to a detergent and climatic conditions. Between January 2000 and December 2001 epicutaneous patch testing with 0.5% sodium lauryl sulphate was performed on the forearm of 487 volunteers and evaluated by measuring transepidermal water loss (TEWL). Atopic individuals were excluded. Climatic conditions recorded by the German Meteorological Service were then compared with the test outcome. Climatic measurements 7 days before evaluation of the patch test were used to calculate an arbitrary mean value for each climatic parameter. A strong correlation was observed between temperature, steam pressure, absolute and relative humidity and the increase in TEWL, and most pronounced during winter and spring. The data provide experimental confirmation of epidemiological studies in which the incidence of irritant skin changes was found to be increased during the winter season with cold and dry air. For the first time, two formulae for adjusting TEWL values according to climatic conditions are presented. It is possible with these formulae to compare between a measured TEWL value and a calculated value.

Adolescent↗
PubMed2003

North American Contact Dermatitis Group patch-test results, 1998 to 2000.

BACKGROUND: Patch testing is the most worthwhile diagnostic tool for the evaluation of patients with suspected allergic contact dermatitis. OBJECTIVE: This study reports patch-testing results from July 1, 1998, to December 31, 2000, by the North American Contact Dermatitis Group. METHODS: Patients were tested with the same screening series of allergens, using a standardized patch-testing technique. The data from these patients were recorded on a standard computer entry form and analyzed. RESULTS: Fifty allergens were tested on over 5,800 patients. Amidoamine, benzophenone-3, and iodopropynyl butylcarbamate were the new allergens. The top 10 allergens in frequency of positive reactions were identical to those of our 1996-to 1998-study period. The incidence of allergic nickel reactions continues to go up, leading all the test substances by 16.2%. CONCLUSION: Our findings reinforce the need for a more comprehensive group of diagnostic allergens than is found in the T.R.U.E. TEST, which is sold in the United States.

Allergens↗
PubMedDate not supplied

[The "false-positive" patch test reaction].

If a positive patch test reaction occurs in the absence of sensitization to a certain antigen, we call it a false positive reaction. There may be several reasons for this: impurities of the test substances, too high a concentration, wrong choice of test location and reading time; positive reactions against test vehicle, or adhesive tape, nonspecific reactions due to adjacent strongly positive patch test reactions and finally wrong interpretation by the doctor. Diagnosis of contact allergy, especially to potent allergens or topical medications and questions relating to occupational disease may be of eminent importance to the patient. Therefore false positive as well as false negative test reactions should be recognized; this also appears particularly important for medicolegal reasons.

Dermatitis, Contact↗
PubMed1998

Objective assessment of nickel sulfate patch test reactions with laser Doppler perfusion imaging.

The laser Doppler perfusion scanning technique was used to assess the superficial blood flow of nickel sulfate hexahydrate patch test reactions. There was good agreement between laser Doppler and visual assessments when the highest assessment values of reactions were studied. Earlier detection of reactions was possible with the laser technique. There was great inter-individual variance in perfusion between identically tested patients. 4 patients were visually negative when a TRUE Test patch test dose of 0.20 mg/cm2 was applied for 48 h and the test area read 4x up to 168 h. These 4 showed a dose-related increase in perfusion and visually positive reactions using longer application times. The instrument allowed a dose reduction not possible for visual assessments. Reading transparent patches in contact with the skin through transparent semi-occlusive plastic foil or through windows in the tape strip over the patches, allowed us to detect perfusion at 48 h, where a longer application would have been needed using tape and visual assessments.

Adult↗
PubMed1998

Patch testing reactions to a standard series in 608 patients tested from 1990 to 1997 at Massachusetts General Hospital.

BACKGROUND: Patch testing is a useful diagnostic tool when allergic contact dermatitis is suspected clinically. OBJECTIVE: This study describes the results of patch testing performed from January 1, 1990 to June 1, 1997 at the Massachusetts General Hospital Contact Dermatitis Clinic. The findings are compared with those previously reported by the North American Contact Dermatitis Group (NACDG). METHODS: Data were collected from chart review and analyzed. Patients included in the study underwent patch testing to the full European standard series of allergens. A standardized patch testing technique was used, and readings were performed by a single observer. RESULTS: A total of 608 patients were patch tested to a screening tray of 24 allergens; 69.9% were women. At least one positive patch test reaction was observed in 60.0% of patients. The most common sensitizers were nickel sulfate, fragrance mix, potassium dichromate, cobalt chloride, balsam of Peru, quaternium-15, and neomycin sulfate. The sensitization rate to potassium dichromate (9.4%) was higher than has been reported by the NACDG. A statistically significant difference in the sensitization rate in men and women was observed for nickel, quinoline mix, epoxy resin, and formaldehyde. The prevalence of positive patch test reactions was not found to be influenced by testing during the summer months. CONCLUSIONS: In the authors' opinion, the prevalence of contact sensitization is generally comparable with the findings of the NACDG, with the exception of reactions to potassium dichromate. This difference in results probably reflects, in part, differences in methodology. The test concentration of potassium dichromate was 0.5%, commonly used in Europe, instead of the 0.25% concentration used by the NACDG. Further investigation is necessary to determine the optimal testing concentration of potassium dichromate.

Adolescent↗
PubMed2003

Patch-test-induced subjective complaints.

BACKGROUND: Many patients report subjective complaints during epicutaneous patch testing. OBJECTIVE: To demonstrate the possible relationship between the occurrence of subjective complaints and patch testing. METHODS: All consecutive patients who were referred to our clinic for patch testing, during 1 year, were investigated to study a possible association of the patch test procedure and subjective complaints like tiredness, shakiness or feeling unwell. The patients were asked to fill in a form concerning subjective complaints on the days of the investigation. Only those without complaints on the day the patches were applied were included in the study (n=102). RESULTS: Of the 102 patients, 17 had complaints on both days 2 and 3, 14 only on day 2, 6 only on day 3 and 65 did not develop any complaints at all. The number of patients with complaints on both days 2 and 3 (n=17) was larger than was to be expected from chance (n=4.6; p<0.01). There was a significant correlation between the number of positive patch test reactions and the number of complaints on day 2 (r=0.19; p<<0.001) and on day 3 (r=0.15; p<0.001). Positive patch tests were found in 72.2% of the patients who reported the complaint of shakiness; this proportion is significantly higher than expected from chance (p<0.05). CONCLUSION: The results confirm those of our earlier study and demonstrate that patch testing can cause subjective complaints, especially when positive patch tests are present.

Adolescent↗