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European Annals of Allergy and Clinical... Nov 2015Allergic contact dermatitis (ACD) is a type IV delayed hypersensitivity reaction. The gold standard for diagnosis is patch testing. The prevalence of positive patch... (Review)
Review
Allergic contact dermatitis (ACD) is a type IV delayed hypersensitivity reaction. The gold standard for diagnosis is patch testing. The prevalence of positive patch tests in referred patients with suspected ACD ranges from 27 to 95.6%. The relationship between ACD and atopic dermatitis (AD) is complicated with conflicting reports of prevalence in the literature; however, in a patient with dermatitis not responding to traditional therapies, or with new areas of involvement, ACD should be considered as part of the work-up.
Topics: Dermatitis, Contact; Humans; Patch Tests; Predictive Value of Tests; Prognosis; Risk Factors
PubMed: 26549335
DOI: No ID Found -
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 -
Journal of Investigational Allergology... 2011Meglitinides (repaglinide and nateglinide) are insulin secretagogues used to treat diabetes mellitus. We present a case of hypersensitivity reaction to repaglinide in a...
Meglitinides (repaglinide and nateglinide) are insulin secretagogues used to treat diabetes mellitus. We present a case of hypersensitivity reaction to repaglinide in a 61-year-old man who developed a maculopapular rash 5 days after treatment. Skin prick tests including repaglinide (0.5 g/mL) and patch tests (0.05% in pet and saline) were performed, and the results were negative. A blind oral challenge test with repaglinide was performed and the therapeutic dose was subsequently taken at home every 24 hours for 7 days. The result was positive with a delayed reaction at day 3. A punch biopsy of the skin lesions revealed drug-induced exanthema. The clinical manifestations, the latency period, the reappearance of cutaneous lesions after rechallenge, and the histopathology report of the skin biopsy suggest a type IV mechanism.
Topics: Carbamates; Cyclohexanes; Diabetes Mellitus, Type 2; Drug Hypersensitivity; Erythema; Exanthema; Humans; Hypoglycemic Agents; Male; Middle Aged; Nateglinide; Patch Tests; Phenylalanine; Piperidines
PubMed: 21548456
DOI: No ID Found -
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 -
Contact Dermatitis Aug 2018Titanium is being increasingly used. Although it is considered to be a non-allergenic material, allergic reactions to it have been reported. Titanium dioxide has been...
BACKGROUND
Titanium is being increasingly used. Although it is considered to be a non-allergenic material, allergic reactions to it have been reported. Titanium dioxide has been found to be an unreliable patch test material. Few studies to date have profiled titanium allergy, and it therefore remains difficult to distinguish its manifestations.
OBJECTIVES
To evaluate alternatives for titanium dioxide as a patch test preparation, and to profile titanium reactions and manifestations.
METHODS
A retrospective chart review was conducted with 458 patients who underwent patch testing with at least 1 of 5 different titanium salts.
RESULTS
At least 1 positive result was noted in 5.7% of the patients. The frequency of positive results for the tested salts ranged from 0.9% to 7.9%. Titanium(IV) oxalate hydrate had the highest yield and titanium dioxide the lowest. Erythema, dermatitis and local swelling were the most common objective complaints. In 16 (61.5%) patients, the test result had partial or full clinical relevance.
CONCLUSIONS
No titanium-specific risk factors and clinical picture could be identified. Titanium dioxide is not adequately sensitive for identifying titanium allergy. The titanium salts seem to be possible superior patch test preparations, but appear to be unsuitable if used singly. The patient's medical history and clinical picture remain crucial in the diagnostic work-up.
Topics: Adult; Aged; Allergens; Dermatitis, Allergic Contact; Female; Humans; Male; Middle Aged; Patch Tests; Retrospective Studies; Titanium
PubMed: 29797739
DOI: 10.1111/cod.13010 -
Contact Dermatitis Apr 2023Occupational skin diseases have led the occupational disease statistics in Europe for many years. Especially occupational allergic contact dermatitis is associated with...
BACKGROUND
Occupational skin diseases have led the occupational disease statistics in Europe for many years. Especially occupational allergic contact dermatitis is associated with a poor prognosis and low healing rates leading to an enormous burden for the affected individual and for society.
OBJECTIVES
To present the sensitization frequencies to the most relevant allergens of the European baseline series in patients with occupational contact dermatitis (OCD) and to compare sensitization profiles of different occupations.
METHODS
The data of 16 022 patients considered having OCD after patch testing within the European Surveillance System on Contact Allergies (ESSCA) network between January 2011 and December 2020 were evaluated. Patients (n = 46 652) in whom an occupational causation was refuted served as comparison group.
RESULTS
The highest percentages of OCD were found among patients working in agriculture, fishery and related workers, metal industry, chemical industry, followed by building and construction industry, health care, food and service industry. Sensitizations to rubber chemicals (thiurams, carbamates, benzothiazoles) and epoxy resins were associated with at least a doubled risk of OCD. After a decline from 2014 onwards, the risks to acquire an occupation-related sensitization to methyl(chloro)isothiazolinone (MCI/MI) and especially to methylisothiazolinone (MI) seem to increase again. Sensitization rates to formaldehyde were stable, and to methyldibromo glutaronitrile (MDBGN) slightly decreasing over time.
CONCLUSIONS
Among allergens in the European Baseline Series, occupational relevance is most frequently attributed to rubber accelerators, epoxy resins and preservatives.
Topics: Humans; Dermatitis, Allergic Contact; Patch Tests; Rubber; Epoxy Resins; Dermatitis, Occupational; Allergens; Benzothiazoles
PubMed: 36694979
DOI: 10.1111/cod.14280 -
BMC Pediatrics May 2024Celiac disease is one of the most common autoimmune disorders. This study aimed to evaluate the relationship between celiac disease and wheat sensitization.
INTRODUCTION AND AIM
Celiac disease is one of the most common autoimmune disorders. This study aimed to evaluate the relationship between celiac disease and wheat sensitization.
SUBJECTS AND METHODS
In the current study, children aged < 18 years with confirmed celiac disease were included. Data were analyzed using SPSS.
RESULTS
Gastrointestinal problems were the most common indication for evaluation in terms of celiac disease. Prick and patch tests were positive in 43.4% and 34% respectively.
CONCLUSION
Prick test and patch test for wheat sensitization were positive in about 30-45% of the children for celiac disease.
Topics: Humans; Celiac Disease; Child; Male; Female; Child, Preschool; Wheat Hypersensitivity; Patch Tests; Immunoglobulin E; Adolescent; Skin Tests; Triticum; Infant
PubMed: 38807087
DOI: 10.1186/s12887-024-04844-6 -
PloS One 2020Dermatological services in Laos, South East Asia are limited to the capital and patch testing is currently not available, so no data exists regarding the common...
BACKGROUND
Dermatological services in Laos, South East Asia are limited to the capital and patch testing is currently not available, so no data exists regarding the common cutaneous allergens in this population.
OBJECTIVES
The aim of this study was to document positive patch tests in medical students without evidence of contact dermatitis in Laos.
PATIENTS/MATERIALS/METHODS
One hundred and fifty medical students were patch tested using TRUE Test® panels 1 to 3 (35 allergens). Readings were taken at Days 2 and 4.
RESULTS
Thirty-eight students (25.3%) had a positive reaction to at least one allergen, accounting for 52 reactions in total. The proportion of the students with positive patch test reading was significantly higher in the female [33/96 (34%)] than in the male [5/54 (9%)], p<0.001. The most common allergens were: nickel (10%), gold (6.6%), thiomersal (6.6%), cobalt dichloride (2%) and p-tert-Butylphenol formaldehyde resin (2%). Balsam of Peru (0.66%), black rubber mix (0.66%), Cl+Me-Isothiazolinone (0.66%), fragrance mix 1 (0.66%), quinolone mix (0.66%), methyldibromo glutaronitrile (0.66%), mercapto mix (0.66%), epoxy resin (0.66%), paraben mix (0.66%), thiuram (0.66%) and wool alcohols (0.66%) accounted for all of the other positive reactions.
CONCLUSION
This study represents the first documented patch test results in Lao medical students and in the adult Lao population. The results of this study will inform any future research into contact allergy in Laos and give an insight into the background level of contact sensitivity in this population.
Topics: 2-Naphthylamine; Adolescent; Adult; Allergens; Balsams; Cobalt; Dermatitis, Allergic Contact; Epoxy Resins; Female; Gold; Humans; Laos; Male; Middle Aged; Nickel; Patch Tests; Phenylenediamines; Resins, Synthetic; Students, Medical; Thimerosal
PubMed: 31945067
DOI: 10.1371/journal.pone.0217192 -
Allergy and Asthma Proceedings Mar 2021Patch tests are used to diagnose nonimmediate T-cell-mediated drug hypersensitivity reactions. The aim of this study was to evaluate the results of patch tests...
Patch tests are used to diagnose nonimmediate T-cell-mediated drug hypersensitivity reactions. The aim of this study was to evaluate the results of patch tests performed with suspect drugs in children. Patients < 18 years of age who had a drug patch test at the pediatric allergy outpatient clinic of our hospital between January 2014 and January 2020 were included in the study. Age, sex, culprit drug(s), reaction characteristics, and patch test results were recorded from the patients' files. A total of 105 drug patch tests were performed on 71 patients during the study period. The patients' median age was 7 years (interquartile range, 4-11 years), and 57.7% (n = 41) were boys. Twenty-three patients (32.3%) had severe cutaneous adverse reaction (Stevens-Johnson syndrome in 11, drug reaction with eosinophilia and systemic symptoms in 9, and acute generalized exanthematous pustulosis in 3 patients), 45 (63.3%) had maculopapular rashes, and 3 (4.2%) had fixed drug eruption. A total of 20 patch test results (28%) were positive: 18 of 44 patch tests (40.9%) with antiepileptic drugs and 2 of 48 patch tests (4.1%) with antibiotics. Positive results were obtained in 23% of the patch tests (6/26) in 20 patients with severe cutaneous adverse reactions and in 17.7% of the patch tests (14/79) in 51 patients with mild cutaneous reactions. No adverse reactions occurred during or after the patch tests. In our study, patch test positivity was more common with antiepileptic drugs and in patients with severe cutaneous drug reaction.
Topics: Age Factors; Child; Child, Preschool; Drug Hypersensitivity; Female; Humans; Male; Patch Tests; Pharmaceutical Preparations; Predictive Value of Tests; Reproducibility of Results; Retrospective Studies; Severity of Illness Index
PubMed: 33685563
DOI: 10.2500/aap.2021.42.200110 -
Contact Dermatitis Oct 2022Continual analyses of patch test results with the European baseline series (EBS) serve both contact allergy surveillance and auditing the value of included allergens.
BACKGROUND
Continual analyses of patch test results with the European baseline series (EBS) serve both contact allergy surveillance and auditing the value of included allergens.
OBJECTIVES
To present results of current EBS patch testing, obtained in 53 departments in 13 European countries during 2019 and 2020.
METHODS
Anonymised or pseudonymised individual data and partly aggregated data on demographic/clinical characteristics and patch test rest results with the EBS were prospectively collected and centrally pooled and analysed.
RESULTS
In 2019 and 2020, 22 581 patients were patch tested with the EBS. Sensitization to nickel remained most common (19.8 [19.2-20.4]% positivity [95% confidence interval]). Fragrance mix I and Myroxylon pereirae yielded very similar results with 6.80 (6.43-7.19)% and 6.62 (6.25-7.00)% positivity, respectively. Formaldehyde at 2% aq. yielded almost one percentage point more positive reactions than 1% concentration (2.49 [2.16-2.85]% vs. 1.59 [1.33-1.88]); methylchloroisothiazolinone/methylisothiazolinone (MCI/MI) and MI alone up to around 5% positives. Among the new additions, propolis was most commonly positive (3.48 [3.16-3.82]%), followed by 2-hydroxyethyl methacrylate (2.32 [2.0-2.68]%).
CONCLUSION
Ongoing surveillance on the prevalence of contact sensitization contributes to an up-to-date baseline series containing the most frequent and/or relevant contact sensitizers for routine patch testing in Europe.
Topics: Allergens; Dermatitis, Allergic Contact; Europe; Humans; Nickel; Patch Tests
PubMed: 35678309
DOI: 10.1111/cod.14170