Contact Allergy In Patients Research Articles

Patterns of simultaneous contact allergies in patients with contact sensitization to oxidised linalool and oxidised limonene.

Contact allergy rates of linalool and limonene hydroperoxides (HPs) have increased. To demonstrate the patterns of simultaneous positive patch test (PT) reactions and prevalences of multiple contact allergies (MCAs) in patients with contact allergy to linalool and/or limonene HPs. A retrospective analysis of consecutive dermatitis patients in 2015-2020 was performed. Of all 4192 patients, 1851 had at least one positive PT reaction. Of these, 410 (22.2%) had MCAs, significantly related to a higher age (p-value = 0.003). Patients with an exclusively positive reaction to linalool HPs but not limonene HPs were shown to have MCAs (p-value <0.001, odds ratio (95% confidence interval) = 4.15 (3.01-5.73)). Patients with simultaneous contact allergies to both linalool and limonene HPs had contact allergies to many other screening and fragrance allergens. Simultaneous positive PT reactions to allergens in baseline series and fragrances are common in patients with the HPs contact allergy, especially linalool HPs. The pattern of simultaneous PT reactions principally suggested the co-sensitization of the cosmetic allergens.

Frequency and clinical relevance of contact allergy in dental patients.

While many studies have reported on occupational allergic contact dermatitis amongst dental personnel, studies on the relevance of patch testing in dental patients are scarce. To determine the frequency and clinical relevance of contact allergy in patients with intra- and perioral complaints. A total of 360 patients with intra- and perioral complaints suspected of having a contact allergy were patch-tested with the dental allergen series, European Baseline Series, and extended Amsterdam Baseline Series at Amsterdam University Medical Centers between January 2015 and November 2021. A total of 285 patients (79.2%) had a positive patch test reaction for either one (18.6%) or multiple allergens (60.6%). Sodium tetrachloropalladate was the most sensitising allergen with 98 patients (27.2%) testing positive, followed by nickel sulphate (23.3%), methylisothiazolinone (15.6%), and fragrance mix I (14.2%). Clinical relevance was found in 68 of 208 patients (32.7%), with patients having one (15.4%) or multiple (17.3%) patch test reactions clinically relevant to their (peri)oral complaints. Clinically relevant patch test reactions were frequently seen in dental patients. Although this study provides us with a better understanding on the frequency and clinical relevance of contact allergy in dental patients, further studies are needed to confirm our results.

Translated article] Contact Allergy in Patients With Rosacea

Background and objectiveRosacea 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 methodsRetrospective cohort study of all patients who underwent patch testing in our skin allergy clinic between May 1991 and May 2019. ResultsA 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 1 positive 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 mix II (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 mix II, and toluensulfonamide formaldehyde resin in 4 patients (2%) each; and to tixocortol and fragrance mix I 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. ConclusionsWe 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.

CD05: Contact allergy in patients with lichen planus

CD05: Contact allergy in patients with lichen planus

Contact allergy in patients with chronic venous leg ulcers.

Contact allergy in patients with chronic venous leg ulcers.

Contact sensitization and allergic contact dermatitis in patients with eczematous lesions

Context: Patch testing is an effective investigative tool in the determination of specific allergens responsible for allergic contact dermatitis (ACD). Sensitization to various allergens has been shown to vary by geographic regions. AIMS: The aim of this study was to use patch test to assess the frequency/pattern of contact allergy in patients with eczematous lesions and to identify possible relationships between sex, age, and type of eczema. Subjects and Methods: From a total of 1331 patients seen at the dermatology clinic of the University of Abuja Teaching Hospital, Gwagwalada, in March 2015 to April 2016, 79 patients with eczema were consecutively patch tested. Statistical Analysis Used: Chi-square test was used to analyze the categorical variables. The level of significance for all analyses was 0.05. Results: One or more positive reactions were observed in 53 patients (67.1%). The highest yield was observed with potassium dichromate (10.4%), nickel sulfate (9.7%), cobalt chloride (7.6%), and fragrance mix 1 (6.9%). Of the 51 patients (64.6%) diagnosed to have ACD, clinical relevance was observed in 37 cases (69.8%). Contact sensitivity to potassium dichromate was more frequent in male patients (P = 0.036), whereas fragrance mix 1 sensitivity was more in female patients (P = 0.032). There was no significant relationship between the frequency of contact allergy and age, patient's occupation, and type of eczema. Conclusions: Most ACD patients showed contact sensitization to leather products, metal, and perfume use. This knowledge is important when considering preventive measures. However, further studies are needed to provide more insight into contact allergy in Nigeria.

Perianal Dermatitis.

Perianal complaints are often consulted in dermatology clinics, and in many cases, a conclusive diagnosis is not easily made. The aim of this study was to study and identify the epidemiological, clinical, and contact allergy features of patients with perianal dermatitis who attended at a contact dermatitis unit in a tertiary hospital in Spain. Adult patients with long-lasting (>4 weeks) perianal dermatitis were recruited during the past 10 years for investigation and follow-up. Every patient underwent a diagnostic workup consisting of dermatological exploration and patch tests with the standard and specific series, as well as the patients' own products. General surgical exploration was also performed in some patients. One hundred twenty-four patients were included. The MOAHLFA index was as follows: 43.5, 0, 4.8, 11.3, 1.6, 8.1, and 75. The main final diagnoses were allergic contact dermatitis (32.3%), psoriasis (24.2%), irritant contact dermatitis (17.7%), and lichen simplex (neurodermatitis) (10%). Eighty-one patients (66.1%) showed 1 or more positive reactions, and in 52 patients (43%), positive reactions relevant to the present disease were found. Contact allergy in patients with long-lasting perianal complaints is frequent. It is mandatory for these patients to be referred to a dermatologist for an adequate evaluation and patch testing. Methylchloroisothiazolinone/methylisothiazolinone seems as the most common allergen implicated in perianal contact dermatitis.

Amalgam Contact Allergy in Oral Lichenoid Lesions.

Oral lichenoid lesions (OLLs) cannot be distinguished from oral lichen planus (OLP) except that causative factors can be identified. Amalgam is one of the causative allergens, and replacement may lead to resolution. The aim of this study was to determine the prevalence, prognosis, and aggravating factors of amalgam contact allergy in patients with OLLs. A clinical retrospective and prospective cohort study was carried out at the Dermatology Department, Siriraj Hospital, Mahidol University. In cases with patch test positive for an amalgam component, patients were suggested to replace their amalgam restorations. Of 53 patients with OLLs, 39 (73.6%) had positive patch test results, and 31 (58.5%) reacted to at least one amalgam component. The most common causative allergen was mercury (35.8%). Lesions on bilateral buccal mucosa and gingiva tended to have negative patch test results (P < 0.05). Spicy food was the main aggravating factor. Amalgam replacements were performed in 10 patients. Clinical improvement was observed in all cases with complete healing in 3 cases. The prevalence of amalgam contact allergy in patients with OLLs was 58.5%. Mercury was the most common allergen, followed by copper sulfate. An association between clinical, topographic relation, and positive patch test results would be a useful predictor for favorable outcome after amalgam removal.

Contact sensitization in prurigo patients.

There are no studies on contact allergy in patients with prurigo. With itch being important in the pathophysiology of prurigo diseases and being a symptom of allergic contact dermatitis, we aimed to investigate contact allergy in patients suffering from prurigo. Exploratory analysis of patch test results in prurigo patients. A retrospective analysis of data of the Information Network of Departments of Dermatology, 2005-2014, was performed. Of 116 744 patch tested patients, 639 (0.55%) were diagnosed with prurigo. The median age was 61 years, 286 (45%) were pensioners, and 252 (39.5%) had generalized prurigo. The indication for patch testing was exclusion of contact allergy in 412 patients (64.5%), and 223 patients (35%) had at least one positive patch test reaction. There was no distinctive pattern of sensitization. Prurigo patients had significantly more (and stronger) reactions to the irritant control patch test with sodium lauryl sulfate than a control group (27.6% versus 21.0%). Although prurigo is not a typical clinical manifestation of contact sensitization, our results indicate that patch testing in these patients may be helpful.

European Society of Contact Dermatitis guideline for diagnostic patch testing - recommendations on best practice.

The present guideline summarizes all aspects of patch testing for the diagnosis of contact allergy in patients suspected of suffering, or having been suffering, from allergic contact dermatitis or other delayed-type hypersensitivity skin and mucosal conditions. Sections with brief descriptions and discussions of different pertinent topics are followed by a highlighted short practical recommendation. Topics comprise, after an introduction with important definitions, materials, technique, modifications of epicutaneous testing, individual factors influencing the patch test outcome or necessitating special considerations, children, patients with occupational contact dermatitis and drug eruptions as special groups, patch testing of materials brought in by the patient, adverse effects of patch testing, and the final evaluation and patient counselling based on this judgement. Finally, short reference is made to aspects of (continuing) medical education and to electronic collection of data for epidemiological surveillance.

Prevalence of methylchloroisothiazolinone and methylisothiazolinone contact allergy in facial dermatitis: a single centre Irish study.

There has been an increase in methylchloroisothiazolinone (MCI) and especially methylisothiazolinone (MI) contact allergy in recent years. We examined the prevalence and demography of MCI/MI and MI contact allergy in patients presenting with facial dermatitis. Eighty patients with facial dermatitis were patch tested to the British Society for Cutaneous Allergy standard series, preservatives and own products between January 2012 and March 2014. A total of 14 (17.5%) patients had positive reactions to this preservative. Five (6.3%) patients tested positive to MCI/MI (0.02%), four (5%) patients tested positive to MI (0.2%) and five (6.3%) patients tested positive to both preparations. Six (7.5%) of these patients were atopic. All patients were female and the mean age was 53.8 years. Sources of allergen were in cosmetics and skin care products. Contact allergies to MCI/MI and MI are commoner than what was reported before and is an emerging cause of facial dermatitis. The detection rate of this allergen was increased by 5% in our cohort since the inclusion of MI (0.2%) in the standard series.

Is there a risk using hypoallergenic cosmetic pediatric products in the United States?

Is there a risk using hypoallergenic cosmetic pediatric products in the United States?

Prevalence of contact allergy at a dermatology clinic in China from 1990-2009.

The prevalence of contact allergy varies in different regions and populations. To describe the frequency of sensitization in patients with dermatitis or eczema referred to Peking University First Hospital and analyze the trends in the prevalence of common allergens from January 1, 1990, to December 31, 2009. A total of 1,858 patients were patch tested with the Chinese baseline series of contact allergens. Data were collected from retrospective charts and analyzed. Positive reactions to one or more allergens were shown in 1,374 patients (74.0%). The most common sensitizers were nickel sulfate (25.7%), fragrance mix I (25.6%), thiuram mix (25.5%), ammoniated mercury (20.5%), and p-phenylenediamine (19.1%). A statistically significant increase of sensitization over the 20-year period was seen for nickel sulfate, fragrance mix, ammoniated mercury, colophony, ethylenediamine, and potassium dichromate. Mercapto mix showed a trend of a statistically significant decrease in sensitizations from 1990 to 2009. The patterns of contact allergy in patients from Peking University Hospital are different from those of patients in other regions of China, in European countries, and in the United States. Nickel and fragrance mix were the most common allergens, and the sensitization rates of these two allergens had been increasing remarkably during the 20 years from 1990 to 2009.

Textile dyes Disperse Orange 1 and Yellow 3 contain more than one allergen as shown by patch testing with thin-layer chromatograms.

It is known that some patch-test preparations containing disperse dyes contain impurities with unknown relevance for the development or elicitation of contact allergy. To evaluate the significance of the impurities found in the commercial dyes Disperse Orange 1 (DO1) and Disperse Yellow 3 (DY3) regarding contact allergy in patients with known sensitivity to them. Ten patients allergic to DY3 and/or DO1 were tested with a dilution series of commercial and purified DY3 and DO1 (with water-soluble parts prepared from the commercial dyes) and with naphthalene sulfonate. Nine patients were additionally tested with thin-layer chromatograms (TLCs) made from the commercial DO1 and DY3 and with paper chromatograms made from the water-soluble part of these dyes. Eight of nine and three of six patients tested positively to the TLCs of DO1 and DY3, respectively. Among them, 4 of 8 and 2 of 3 patients, respectively, were positive also to another spot on the TLCs. One patient was positive to the paper chromatogram from the water-soluble part of DO1. None of the tested patients reacted to naphthalene sulfonate. The results of our study suggest that there are more relevant allergens in the fat-soluble and water-soluble fractions of the commercial disperse dyes.

Time trends of contact allergy to a modified European baseline series in Beijing between 2001 and 2006

Monitoring trends of sensitivity rates in a population is useful for epidemiological surveillance. The time trends for sensitivity rates of allergens have not previously been reported in China. The aim of the present study was to determine the prevalence and trends of contact allergy in patients with suspected allergic contact dermatitis in Beijing, China. A retrospective analysis of all patch test data from our database was performed. A total of 1354 patients with suspected allergic contact dermatitis between 2001 and 2006 were studied. Patch tests with 20 allergens or mixtures of allergens were performed and analysed. Sensitivity to potassium dichromate (50.1%) was most frequent, and sensitivity to imidazolidinyl urea (3.0%) was least frequent. Increasing trends in sensitivity rates for 10 allergens with significant linear regression were observed (p < 0.05), including mercapto mix, black rubber mix, potassium dichromate, formaldehyde, epoxy resin, benzocaine, ethylenediamine dihydrochloride, paraben mix, tixocortol-21-pivalate, and sesquiterpene lactone mix. Sensitivity rates for the other 10 allergens remained stable or showed only a trend (fragrance mix) towards an increase (p(trend) > 0.05). High sensitivity rates were observed in the study. Significant increasing trends in sensitivity rates for 10 allergens, probably reflecting increasing changes in exposure, were found.

Absence of metal allergy in patients with very late drug-eluting stent thrombosis: A pilot study

Stent thrombosis (ST) is a rare but devastating complication of percutaneous coronary intervention (PCI) associated with myocardial infarction and death. While ST <1 year after PCI occurs more frequently and with similar frequency after bare metal stent and drug-eluting stent (DES) implantation, very late ST >1 year after PCI appears to be more germane to DES, or at least to first-generation DES, i.e., the Cypher® sirolimus-eluting stent (SES; Cordis, Johnson & Johnson, Miami Lakes, FL) and the Taxus® paclitaxel-eluting stent (PES; Boston Scientific, Natick, MN) [ [1] Windecker S. Meier B. Late coronary stent thrombosis. Circulation. 2007; 116: 952-965 Crossref Scopus (208) Google Scholar ]. The mechanisms underlying very late ST with DES are poorly understood, but delayed vessel healing, chronic inflammation, incomplete endothelialization, stent malapposition, and resistance to antiplatelet agents appear to contribute to the pathogenesis [ [1] Windecker S. Meier B. Late coronary stent thrombosis. Circulation. 2007; 116: 952-965 Crossref Scopus (208) Google Scholar ]. Specifically, autopsy studies and intracoronary thrombus aspirates from patients with very late ST of DES have indicated the presence of hypersensitivity reactions in the stented coronary segment with infiltrating eosinophils and T lymphocytes, suggesting that delayed hypersensitivity to DES, i.e., the metallic stent platform, the drug-eluting polymer, and/or the antiproliferative drugs (sirolimus and paclitaxel), may be a prevailing mechanism [ 2 Virmani R. Guagliumi G. Farb A. et al. Localized hypersensitivity and late coronary thrombosis secondary to a sirolimus-eluting stent: should we be cautious?. Circulation. 2004; 109: 701-705 Crossref PubMed Scopus (1400) Google Scholar , 3 Virmani R. Farb A. Guagliumi G. Kolodgie F.D. Drug-eluting stents: caution and concerns for long-term outcome. Coron Art Dis. 2004; 15: 313-318 Crossref PubMed Scopus (220) Google Scholar , 4 Nebecker J.R. Virmani R. Bennett C.L. et al. Hypersensitivity cases associated with drug-eluting coronary stents: a review of available cases from the Research on Adverse Drug Events and Reports (RADAR) project. J Am Coll Cardiol. 2006; 47: 175-181 Abstract Full Text Full Text PDF PubMed Scopus (589) Google Scholar , 5 Cook S. Ladich E. Nakazawa G. et al. Correlation of intravascular ultrasound findings with histopathogical analysis of thrombus aspirates in patients with very late drug-eluting stent thrombosis. Circulation. 2009; 120: 391-399 Crossref PubMed Scopus (412) Google Scholar ]. The metallic stent platform of most stents including first-generation DES is made from 316 L stainless steel, which contains and releases sensitizing metals, e.g., nickel, chromium, and molybdenum, and limited evidence has indicated that contact allergy to metals as determined by epicutaneous patch tests is more prevalent in patients with in-stent restenosis of bare metal stents [ 6 Köster R. Vieluf D. Kiehn M. et al. Nickel and molybdenum contact allergies in patients with coronary in-stent restenosis. Lancet. 2000; 356: 1895-1897 Abstract Full Text Full Text PDF PubMed Scopus (452) Google Scholar , 7 Iijima R. Ikari Y. Amiya E. et al. The impact of metallic allergy on stent implantation: metal allergy and recurrence of in-stent restenosis. Int J Cardiol. 2005; 104: 319-325 Abstract Full Text Full Text PDF PubMed Scopus (64) Google Scholar ]. It was recently also suggested that ST after DES can represent a manifestation of acute coronary syndrome caused by allergic conditions, i.e., the Kounis syndrome [ [8] Chen J.P. Hou D. Pendyala L. Goudevenos J.A. Kounis N.G. Drug-eluting stent thrombosis: the Kounis hypersensitivity-associated acute coronary syndrome revisited. JACC Cardiovasc Interv. 2009; 2: 583-593 Abstract Full Text Full Text PDF PubMed Scopus (101) Google Scholar ]. This specific association remains unproven and the impact of metal allergy on ST has not, to our knowledge, been reported previously. We therefore performed a small pilot study in order to assess the prevalence of metal allergy as determined by positive patch tests in patients with very late ST after DES.

How to test for contact allergy in patients with fragile skin

How to test for contact allergy in patients with fragile skin

Contact allergy in patients with rosacea: a clinic‐based, prospective epidemiological study

Rosacea is a relatively common inflammatory skin disease of unknown prevalence. The proportion of contact allergy complicating rosacea and its therapy, respectively, is largely unknown. To estimate the prevalence of specific contact allergy in rosacea patients and to compare this with the prevalence observed in the general population and in general patch test patients. In this prospective monocentre study, 78 patients with rosacea were investigated for contact sensitizations via patch testing the standard series, constituents of topical formulations, preservatives, fragrances, topically applied drugs and, if available, patient's own products. Positive reactions occurred to nickel (II) sulphate (12 of 78, 15.4%), fragrance mix I (4 of 77, 5.2%), balsam of Peru (8 of 77, 10.4%; significantly elevated prevalence compared to that observed in the population-based KORA study), potassium dichromate (4 of 78, 5.1%) and Lyral (3 of 78, 3.8%). Regarding topical antibiotics, only 1 of 78 (1.3%) patients was positive to neomycin sulphate, and none to metronidazole; however, 6 of 75 (8%) patients were positive to gentamicin sulphate, and 4 of 76 (5.3%) patients were positive to framycetin sulphate. No allergic but irritant patch test reactions, instead, were provoked by various patients' own products as well as by the irritant sodium lauryl sulphate (SLS) even in low concentrations. Despite the limited power of the study, a strikingly high prevalence of contact allergy to gentamicin sulphate was observed, which is probably due to antibiotic treatment of rosacea-associated eye symptoms. The reactions to the irritant SLS probably mirror the extreme skin sensitivity in rosacea.

Patch-Testing North American Lip Dermatitis Patients: Data from the North American Contact Dermatitis Group, 2001 to 2004

The most common differential diagnoses for patients presenting with lip dermatitis or inflammation include atopic, allergic, and irritant contact dermatitis. Patch testing can be performed to identify the allergic contact conditions. To report North American Contact Dermatitis Group (NACDG) patch-test results of patients who presented for patch testing with only lip involvement from 2001 to 2004. Patient characteristics, allergen frequencies, relevance, final diagnoses, and relevant allergic sources not in the NACDG screening series were evaluated. The NACDG 2001-2004 database was used to select patients presenting with only lip involvement. Of 10,061 patients tested, 2% (n = 196) had lips as the sole involved site. Most (84.2%) were women. After patch testing, 38.3% (n = 75) were diagnosed with allergic contact cheilitis. Fragrance mix, Myroxilon pereirae, and nickel were the most common relevant allergens. Of 75 patients, 27 (36%) had relevant positive patch-test reactions to items not on the NACDG series; lipstick and cosmetics were the predominant sources. Patch testing is valuable in the evaluation and identification of contact allergy in patients referred for lip dermatitis. The use of supplementary allergens based on history and exposure is important in the identification of additional relevant allergens. Over a third of patients with contact allergy had other factors, such as irritant dermatitis, considered relevant to their condition.

Contact allergy in patients with chronic venous leg ulcers – possible role of chronic venous insufficiency

The purpose of this study was to evaluate frequency of contact allergy in patients with chronic venous leg ulcers (CVLU) and to estimate possible relationships between allergic contact reactions and characteristics of both chronic venous insufficiency (CVI) and CVLU. We performed patch tests with the European standard series, antibiotics, glucocorticosteroids and ointment vehicles in 50 patients with CVLU. Patients underwent detailed CVI diagnostics using colour flow duplex ultrasound examination, ankle brachial pressure index determination and leg ulcers area measurement. Positive patch tests results were found in 80% and polyvalent allergy in 56% of patients. Statistically significant correlations were recorded between CVI and CVLU duration, CVLU duration and CVLU area and between CVI duration and polyvalent allergy frequency. Statistically significant differences were observed between coexistence of superficial and deep system insufficiency and CVLU duration, characteristics of contact allergic reactions and CVI duration, frequency of allergic contact reaction and presence or absence of long saphenous vein insufficiency, incidences of vein thrombosis and characteristics of contact allergic reactions as well as between characteristics of contact allergic reactions and both CVLU duration and area. Complex pathophysiological processes, including inflammatory reactions, in course of CVI may influence development of allergic contact reaction in CVLU patients.