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The Journal of Allergy and Clinical... Apr 2022Contact dermatitis is a common disease that is caused by repeated skin contact with contact allergens or irritants, resulting in allergic contact dermatitis (ACD) and/or... (Review)
Review
Contact dermatitis is a common disease that is caused by repeated skin contact with contact allergens or irritants, resulting in allergic contact dermatitis (ACD) and/or irritant contact dermatitis. Attempts have been made to identify biomarkers to distinguish irritant and allergic patch test reactions, which could aid diagnosis. Some promising candidates have recently been identified, but verification and validation in clinical cases still need to be done. New causes of ACD are constantly being recognized. In this review, 10 new contact allergens from recent years, several relating to anti-aging products, have been identified. Frequent allergens causing considerable morbidity in the population, such as the preservative methylisothiazolinone, have been regulated in the European Union. A significant drop in the number of cases has been seen, whereas high rates are still occurring in other areas such as North America. Other frequent causes are fragrance allergens, especially the widely used terpenes and acrylates found in medical devices for control of diabetes. These represent unsolved problems. Recent advances in immunology have opened the way for a better understanding of the complexity of contact dermatitis, especially ACD-a disease that may be more heterogenous that previous understood, with several subtypes. With the rapidly evolving molecular understanding of ACD, the potential for development of new drugs for personalized treatment of contact dermatitis is considerable.
Topics: Allergens; Dermatitis, Allergic Contact; Dermatitis, Irritant; Humans; Irritants; Patch Tests
PubMed: 35183605
DOI: 10.1016/j.jaci.2022.02.002 -
Indian Journal of Dermatology,... 2019
Topics: Dermatitis, Atopic; Humans; Immunoglobulin E; Patch Tests; Reagent Kits, Diagnostic
PubMed: 30058560
DOI: 10.4103/ijdvl.IJDVL_397_17 -
Actas Dermo-sifiliograficas Mar 2016Corticosteroids are widely used drugs in the clinical practice, especially by topic application in dermatology. These substances may act as allergens and produce... (Review)
Review
Corticosteroids are widely used drugs in the clinical practice, especially by topic application in dermatology. These substances may act as allergens and produce immediate and delayed hypersensitivity reactions. Allergic contact dermatitis is the most frequent presentation of corticosteroid allergy and it should be studied by patch testing in specific units. The corticosteroids included in the Spanish standard battery are good markers but not ideal. Therefore, if those makers are positive, it is useful to apply a specific battery of corticosteroids and the drugs provided by patients. Immediate reactions are relatively rare but potentially severe, and it is important to confirm the sensitization profile and to guide the use of alternative corticosteroids, because they are often necessary in several diseases. In this article we review the main concepts regarding these two types of hypersensitivity reactions in corticosteroid allergy, as well as their approach in the clinical practice.
Topics: Adrenal Cortex Hormones; Allergens; Dermatitis, Allergic Contact; Humans; Hypersensitivity, Delayed; Patch Tests
PubMed: 26621334
DOI: 10.1016/j.ad.2015.09.012 -
Annals of Allergy, Asthma & Immunology... Feb 1997Reading this article will reinforce the reader's knowledge of the definition, pathophysiology, differential diagnosis, evaluation, and management of the most common of... (Review)
Review
LEARNING OBJECTIVES
Reading this article will reinforce the reader's knowledge of the definition, pathophysiology, differential diagnosis, evaluation, and management of the most common of all the "eczemas," contact dermatitis, which can have an allergic and/or an irritant pathogenesis.
DATA SOURCES
Relevant articles and current texts on contact dermatitis were referenced and reviewed. The personal experiences of the authors in an Environmental Medicine Clinic, their private practices, and their teaching of residents and other physicians were evaluated. A MEDLINE database using subject keywords was searched from 1986 to date.
STUDY SELECTION
Book chapters, pertinent articles, data source abstracts, guidelines for the management of contact dermatitis set by the American Academy of Dermatology, and the American Contact Dermatitis Society were critiqued.
RESULTS
The recent elucidation of the pathoimmunology of contact dermatitis is concisely reviewed, highlighting its clinical implications. The protean clinical presentations of contact dermatitis, both "allergic" and "irritant" type are cited. The signs and symptoms warranting the search for a contactant are outlined. The most likely regional contactants are listed, but the need to reference a more complete textbook is often required. That patch testing is the gold standard to identify an allergenic agent causing allergic contact dermatitis is stressed. While the "who" and "when" to patch test is amply described, a cookbook "how" to patch test has been omitted in order to emphasize the importance of "hands on" experience for such testing. The advantages and limitations of the commercially available standard patch tests (Hermal, and T.R.U.E.) are described, plus the sources for "nonstandard" patch tests is made available. Therapeutic modalities, topical and systemic, for management of the uncomfortable patient are outlined.
CONCLUSION
The physician who manages a patient with an "eczematous" rash must be aware of the complete differential diagnosis of that clinical presentation. Suspicion that a "contactant" is the cause must have high priority, especially when the rash is persistent, and fails to respond to "appropriate" therapy. The value of a skin biopsy is limited to confirming its eczematous (spongiotic) nature and ruling out other diseases. Appreciating the paradox of patch testing, namely the deceptive simplicity of application versus the required expertise for interpretation and recognition of clinical significance, is the key to the proper management of the patient with contact dermatitis.
Topics: Allergens; Dermatitis, Allergic Contact; Dermatitis, Irritant; Diagnosis, Differential; Histamine H1 Antagonists; Humans; Patch Tests; Skin; Steroids
PubMed: 9048524
DOI: 10.1016/S1081-1206(10)63383-2 -
Actas Dermo-sifiliograficas Apr 2023Atopic dermatitis is a chronic inflammatory disease that is multifactorial in nature. Allergic contact dermatitis and protein contact dermatitis are allergic conditions... (Review)
Review
Atopic dermatitis is a chronic inflammatory disease that is multifactorial in nature. Allergic contact dermatitis and protein contact dermatitis are allergic conditions that may occur in the context of atopic dermatitis and be the cause of exacerbations. Although the prevalence of allergic contact dermatitis is similar in atopic patients and the general population, these 2 conditions are frequently associated because atopic inflammation disrupts the skin barrier. Skin tests are therefore recommended in atopic individuals. Dupilumab could be useful for treating allergic contact dermatitis if it is mediated by type 2 helper T cells but could exacerbate inflammation if mediated by T1 cells: further study is needed before conclusions can be drawn. Although the mechanism by which exposure to environmental proteins exacerbates atopic dermatitis remains under discussion, such exacerbations are routinely seen in clinical practice. Prick testing is recommended in symptomatic atopic dermatitis. When prick-test findings are positive, patients should be advised to avoid the culprit substances.
Topics: Humans; Dermatitis, Atopic; Haptens; Patch Tests; Dermatitis, Allergic Contact; Inflammation; Allergens
PubMed: 36529271
DOI: 10.1016/j.ad.2022.11.009 -
Giornale Italiano Di Dermatologia E... Jun 2018Contact allergies are common cause of eczema in all age groups and are one of the most common causes of occupational disability. Contact dermatitis (CD) can be divided... (Review)
Review
Contact allergies are common cause of eczema in all age groups and are one of the most common causes of occupational disability. Contact dermatitis (CD) can be divided into irritant and allergic contact dermatitis. Distinguishing between irritant and allergic triggers of CD by clinical and histologic examinations can be challenging. The approach to patients with CD should consist of a detailed (work and leisure) history, skin examination, patch tests with allergens based on history, physical examination, education on materials that contain the allergen and adequate therapy and prevention.
Topics: Allergens; Dermatitis, Allergic Contact; Dermatitis, Irritant; Dermatitis, Occupational; Eczema; Humans; Patch Tests
PubMed: 29199804
DOI: 10.23736/S0392-0488.17.05844-8 -
Anais Brasileiros de Dermatologia 2016The number of studies on patch-test results in children and adolescents has gradually increased in recent years, thus stimulating reviews. This paper is a systematic... (Review)
Review
The number of studies on patch-test results in children and adolescents has gradually increased in recent years, thus stimulating reviews. This paper is a systematic review of a 15-year period devoted to studying the issue. Variations pertaining to the number and age groups of tested children and/or adolescents, the number of subjects with atopy/atopic dermatitis history, the quantity, type and concentrations of the tested substances, the test technique and type of data regarding clinical relevance, must all be considered in evaluating these studies, as they make it harder to formulate conclusions. The most common allergens in children were nickel, thimerosal, cobalt, fragrance, lanolin and neomycin. In adolescents, they were nickel, thimerosal, cobalt, fragrance, potassium dichromate, and Myroxylon pereirae. Knowledge of this matter aids health professionals in planning preventive programs aimed at improving children's quality of life and ensuring that their future prospects are not undermined.
Topics: Adolescent; Age Factors; Allergens; Child; Dermatitis, Allergic Contact; Dermatitis, Atopic; Female; Humans; Male; Patch Tests; Sex Factors; Time Factors
PubMed: 26982781
DOI: 10.1590/abd1806-4841.20163927 -
Indian Journal of Dermatology,... 2022The reliability of patch testing with expired Indian standard patch test kits has been not evaluated before.
BACKGROUND
The reliability of patch testing with expired Indian standard patch test kits has been not evaluated before.
METHODS
Thirty adults (men:women 25:5) with allergic contact dermatitis were divided into three groups of ten patients each for patch testing by Finn chamber® method using Indian standard patch test kits having expiry in 2016, 2015 and 2014. The results were compared with those from a new kit with 2018 expiry.
RESULTS
Ten patients in group-1, eight patients in group-2 and seven patients in group-3 developed positive reactions of identical intensities and mostly from identical allergens from all four kits. The major contact allergens eliciting positive reactions of identical intensities were parthenium in nine, five and three patients, colophony in four, one and zero patients, fragrance mix in three, three and one patients, thiuram mix in three, one and one patients, and paraphenylene diamine in two, one and three patients from group-1,-2, and -3, respectively.
LIMITATIONS
Small number of patients in each group remains the major limitation of the study. Whether or not these results can be extrapolated with patch test results from other similar patch test kits available across countries also needs confirmation.
CONCLUSION
The patch test allergens can be used beyond labeled expiry dates but needs confirmation by a few large studies and using other available patch test kits. This is important as the relevance of patch test results for individual allergen in this scenario may remain debatable requiring careful interpretation.
Topics: Adult; Aged; Allergens; Dermatitis, Allergic Contact; Female; Humans; India; Male; Middle Aged; Patch Tests; Pilot Projects; Time Factors
PubMed: 33969657
DOI: 10.25259/IJDVL_390_19 -
Actas Dermo-sifiliograficas Jun 2022Rosacea is a chronic acneiform skin disorder in which impaired skin barrier function can lead to sensitization to allergens. We aimed to analyze contact allergies in our...
BACKGROUND AND OBJECTIVE
Rosacea is a chronic acneiform skin disorder in which impaired skin barrier function can lead to sensitization to allergens. We aimed to analyze contact allergies in our patients with rosacea.
MATERIAL AND METHODS
Retrospective cohort study of all patients who underwent patch testing in our skin allergy clinic between May 1991 and May 2019.
RESULTS
A total of 200 patients with rosacea were referred to our clinic for patch testing during the study period; they represented 2.1% of all patch tested patients in the period. Eighty-one percent were women (mean age, 44.7years). At least 1positive patch test was recorded for 46.5%; 15% were of current relevance. The most frequent positive reaction was to nickel (26%), followed by cobalt chloride (6.5%), isothiazolinones (6%), p-phenylenediamine (5.5%), fragrance mixII (5%), and thimerosal (3.5%). The most common currently relevant patch test reactions were to isothiazolinones in 10 of the 200 patients (5%); to phenylenediamine, fragrance mixII, and toluensulfonamide formaldehyde resin in 4 patients (2%) each; and to tixocortol and fragrance mixI in 2 patients (1%) each. The allergen groups most often implicated were metals (of current relevance in 12.6%) and drugs (of current relevance in 25.8%). Preservatives and fragrances were the next most common allergen groups, and 70.8% and 43.7% of the positive reactions in these groups, respectively, were of current relevance. Cosmetics were the most frequent source of sensitization, followed by topical medications - notably corticosteroids and antifungal agents.
CONCLUSIONS
We emphasize the high prevalence of allergic contact dermatitis in patients with rosacea, a finding which supports patch testing, especially if eruptions worsen when these patients use cosmetics and topical medications.
Topics: Adult; Allergens; Cosmetics; Dermatitis, Allergic Contact; Female; Glucocorticoids; Humans; Male; Patch Tests; Retrospective Studies; Rosacea
PubMed: 35288101
DOI: 10.1016/j.ad.2022.02.026 -
Clinical Reviews in Allergy & Immunology Jun 2022Confirming drug imputability is an important step in the management of cutaneous adverse drug reactions (CADR). Re-challenge is inconvenient and in many cases life... (Review)
Review
Confirming drug imputability is an important step in the management of cutaneous adverse drug reactions (CADR). Re-challenge is inconvenient and in many cases life threatening. We review the literature on ideal patch testing technique for specific CADRs. Testing should be performed approximately 3 months after the resolution of the eruption using standard patch testing techniques. Commercially available patch test preparations are available for a minority of drugs, so in most cases, testing should be performed with the drug at various recommended concentrations and in different vehicles. Testing to all known excipients, such as dyes, vehicles and preservatives is also important. Immunosuppressive medications should be discontinued or down titrated to the lowest tolerable dose to decrease the risk of false negative reactions. We provide an overview of expert recommendations and extant evidence on the utility of patch testing for identifying the culprit drug in common CADRs and for specific drug or drug classes. Overall, there appears to be significant variability in the patch test positivity of different drugs, which is likely the result of factors intrinsic to the drug such as dermal absorption (as a function of lipophilicity and molecular size) and whether the drug itself or a downstream metabolite is implicated in the immune reaction. Drugs with high patch test positivity rates include beta-lactam antibiotics, aromatic anticonvulsants, phenytoin, and corticosteroids, among others. Patch testing positivity varies both as a function of the drug and type of CADR. The sum of the evidence suggests that patch testing in the setting of morbilliform eruptions, fixed drug eruption, acute generalized exanthematous pustulosis, and possibly also drug-induced hypersensitivity syndrome, photoallergic and eczematous reactions may be worthwhile, although utility of testing may vary on the specific drug in question for the eruption. It appears to be of limited utility and is not recommended in the setting of other complex CADR, such as SJS/TEN and leukocytoclastic vasculitis.
Topics: Anticonvulsants; Drug Eruptions; Drug Hypersensitivity; Exanthema; Humans; Hypersensitivity, Delayed; Patch Tests
PubMed: 35113364
DOI: 10.1007/s12016-022-08924-2