Epicutaneous Patch Testing Research Articles

Contact Dermatitis to Personal Sporting Equipment in Youth.

Contact dermatitis to personal sporting equipment in youth is poorly studied. To review the results of patch testing 6 youth to their sporting equipment in a dermatology general private practice from 2006 to 2011. A retrospective analysis of 6 youth aged 11 to 14 who were evaluated for chronic and persistent dermatitis occurring in relation to sports equipment was conducted. All patients were subjected to epicutaneous (patch) testing, which included some or all of the following: North American Contact Dermatitis Group (NACGD) series, textile series, rubber series, corticosteroid series, and raw material from the patients' own personal equipment. All cases had 1 or more positive patch test reactions to an allergen within the aforementioned series, and 3 subjects tested positive to their personal equipment in raw form. Allergic contact dermatitis, not irritant, was deemed the relevant cause of chronic dermatitis in 4 of the 6 patients due to positive reactions to epicutaneous tests and/or personal equipment. The utility of testing to patients' own sporting equipment was shown to be of additional value and should be considered when patch testing for contact allergy to sporting equipment.

Gold contact allergy: clues and controversies.

In 2001, gold was named Contact Allergen of the Year. More than a decade later, we continue to face several challenges in defining the role of gold in contact allergy. First, interpretation of gold reactions in the setting of epicutaneous patch testing may be difficult; in addition to being a common irritant, gold may be associated with significantly delayed and persistent reactions. Second, although gold compounds are commonly positive on patch testing, clinical relevance is relatively low and may be challenging to determine. Third, the complex interplay between gold and the human body is still poorly understood. In this review, we provide an overview of the literature concerning gold patch test positivity and present recommendations for epicutaneous patch testing with gold.

Toxidermies

Cutaneous adverse drug reactions (CADR) represent a heterogeneous field including various clinical patterns without specific features suggesting drug causality. Exanthematous eruptions, urticaria and vasculitis are the most common forms of CADR. Fixed eruption is uncommon in western countries. Serious reactions (fatal outcome, sequelae) represent 2% of CADR: bullous reactions (Stevens-Johnson syndrome, toxic epidermal necrolysis), DRESS (drug reaction with eosinophilia and systemic symptoms or drug-induced hypersensitivity syndrome) and acute generalized exanthematous pustulosis (AGEP). These forms must be quickly diagnosed to guide their management. The main risk factors are immunosuppression, autoimmunity and some HLA alleles in bullous reactions and DRESS. Most systemic drugs may induce cutaneous adverse reactions, especially antibiotics, anticonvulsivants, antineoplastic drugs, non-steroidal anti-inflammatory drugs, allopurinol and contrast media. Pathogenesis includes immediate or delayed immunologic mechanism, usually not related to dose, and pharmacologic/toxic mechanism, commonly dose-dependent or time-dependent. In case of immunologic mechanism, allergologic exploration is possible to clarify drug causality, with a variable sensitivity according to the drug and to the CADR type. It includes epicutaneous patch testing, prick test and intradermal test. However, no in vivo or in vitro test can confirm the drug causality. To determine the cause of the eruption, a logical approach based on clinical characteristics, chronologic factors and elimination of differential diagnosis is required, completed with a literature search. A reporting to pharmacovigilance network is essential in case of a serious CADR whatever the suspected drug and in any case if the involved drug is a newly marketed one or unusually related to cutaneous reactions.

Patch testing in children from 2005 to 2012: results from the North American contact dermatitis group.

Allergic contact dermatitis is common in children. Epicutaneous patch testing is an important tool for identifying responsible allergens. The objective of this study was to provide the patch test results from children (aged ≤18 years) examined by the North American Contact Dermatitis Group from 2005 to 2012. This is a retrospective analysis of children patch-tested with the North American Contact Dermatitis Group 65- or 70-allergen series. Frequencies and counts were compared with previously published data (2001-2004) using χ statistics. A total of 883 children were tested during the study period. A percentage of 62.3% had ≥1 positive patch test and 56.7% had ≥1 relevant positive patch test. Frequencies of positive patch test and relevant positive patch test reaction were highest with nickel sulfate (28.1/25.6), cobalt chloride (12.3/9.1), neomycin sulfate (7.1/6.6), balsam of Peru (5.7/5.5), and lanolin alcohol 50% petrolatum vehicle (5.5/5.1). The ≥1 positive patch test and ≥1 relevant positive patch test in the children did not differ significantly from adults (≥19 years) or from previously tested children (2001-2004). The percentage of clinically relevant positive patch tests for 27 allergens differed significantly between the children and adults. A total of 23.6% of children had a relevant positive reaction to at least 1 supplemental allergen. Differences in positive patch test and relevant positive patch test frequencies between children and adults as well as test periods confirm the importance of reporting periodic updates of patch testing in children to enhance clinicians' vigilance to clinically important allergens.

DR(E)SS AO ABACAVIR CONFIRMADO POR TESTES EPICUTÂNEOS

A reacção de hipersensibilidade (HS) ao abacavir é uma doença sistémica, potencialmente fatal, que ocorre em 2-9% dos doentes expostos. Inicia-se nas primeiras 6 semanas de tratamento e assemelha-se clinicamente ao DRESS, no entanto, sem eosinofilia. A relação desta reacção com o HLA-B*5701 foi definitivamente comprovada quando os casos imputáveis ao abacavir foram confirmados com um teste epicutâneo (TE) positivo. O HLA-B*5701 foi considerado um indicador excelente de HS ao abacavir, com um valor preditivo positivo da ordem dos 55%, pelo que actualmente se recomenda a sua pesquisa antes de iniciar qualquer esquema de tratamento com este fármaco. Relata-se um caso de HS ao abacavir, relembrando a sua semelhança clínica com o DRESS e realçando as suas diferenças, bem como a importância da fenotipagem HLA antes de iniciar o tratamento e a utilidade dos TE, tanto na confirmação da etiologia da reacção imunológica como no estudo dos mecanismos efectores.

Neutrophlic dermatosis (Sweet's syndrome‐like) induced by paracetamol

Case-report An 82 year-old man with hypertension and ischemic heart disease underwent an inguinal hernioplasty. Twenty hours after initiating PC administration in the surgery room, a slightly pruritic eruption suddenly appeared with multiple tender, oedematous and erythematous plaques on the trunk and extremities, associated to general malaise, headache and myalgia. He didn’t seek for medical care until 1 week later, when he came to the hospital for suture removal. No treatment was prescribed and the eruption resolved in 4 weeks. Two months later the patient developed, once again, a similar generalized skin eruption with fever (38.5oC), general malaise and weakness. Neutrophilia (88.6%) and elevated C-reactive protein levels were detected. There was no mucosal or extracutaneous involvement. Few hours previously he had taken PC for a mild non-pyretic upper respiratory tract infection. The drug was withdrawn, and all signs and symptoms resolved after a short course of corticosteroid treatment. No evidence of active infection was detected. Histological examination of a skin biopsy specimen showed a neutrophilic infiltrate with mild eosinophilia, neutrophilic spongiosis and lichenoid damage. Five months later we performed epicutaneous patch test with PC in unaffected and previously affected skin, with negative results. The patient refused to perform more allergic studies. He had been tolerating ibuprofen, metamizole and acetylsalicylic acid after the last reaction. Neither new episodes nor evidence of malignancy have been detected in the meantime.

Concentrations and stability of methyl methacrylate, glutaraldehyde, formaldehyde and nickel sulfate in commercial patch test allergen preparations

Epicutaneous patch tests are used to reproduce allergy and diagnose allergic contact dermatitis. Reliable allergen test preparations are required. The purpose of the present study was to measure the actual concentrations of nickel(II) sulfate hexahydrate (NiSO4 ), methyl methacrylate, formaldehyde, and glutaraldehyde, and to compare them with the labelled concentrations, in commercial patch test allergen preparations found in dermatology clinics where patch testing is routinely performed. The commercial in-date and out-of-date patch test allergen preparations concentrations of NiSO4 , methyl methacrylate, formaldehyde and glutaraldehyde from one to three participating clinics were analysed with chromatographic or wet chemical techniques. NiSO4 and formaldehyde concentrations were at or above the labelled concentrations; however, formaldehyde loss occurred with storage. NiSO4 particulate was uniformly distributed throughout the petrolatum. 'In-use' methyl methacrylate reagent syringes all contained ≤ 56% of the 2% label concentration, with no observable relationship with expiration date. Lower methyl methacrylate cocentrations were consistently measured at the syringe tip end, suggesting loss resulting from methyl methacrylate's volatility. The concentrations of glutaraldehyde patch test allergen preparations ranged from 27% to 45% of the labelled (1% in pet.) concentration, independently of expiration date. Some false-negative methyl methacrylate, formaldehyde or glutaraldehyde patch test results may be attributable to instability of the test preparations.

Polysensitisation in a laboratory scientist associated with allergic contact dermatitis from methylisothiazolinone in skin cleansers

Polysensitisation refers to reactivity to three or more allergens on epicutaneous patch testing, and is likely to affect a distinct subgroup of individuals with allergic contact dermatitis (ACD). Methylisothiazolinone (MIT) is an increasingly prevalent allergen, recently having been described as occurring in epidemic proportions. We report a patient with ACD to 12 allergens, including MIT, and discuss the implications of polysensitisation and the likely need for repeat patch testing in such patients if they subsequently re-present with dermatitis.

Dental materials in patients with oral mucosal disease based on the results of patch test study

The aim of this study was to investigate the frequency of positive patch test reaction to dental materials in patients with oral mucosal diseases. Epicutaneous patch test was performed in 110 patients with oral mucosal diseases; 41 patients with oral lichen planus(OLP), 44 patients with burning mouth syndrome(BMS), 25 patients with other oral mucosal diseases including recurrent aphthous ulcer and mucous membrane pemphigoid. The obtained results were as follows: Oral gold restorations were most common in patents with oral mucosal diseases and porcelain fused metal crown, implant appeared in the order. 33 of 110 patients did not appear skin reactions (negative, 30%) and 77 patients (positive, 70%) had skin reactions including redness, rash, blisters. Dental materials causing positive reaction to patch test were mainly as gold-sodium-thiosulfate (26.7%), nickel sulfate(Ni) (22.7%), cobalt chloride(Co) (14.7%), palladium chloride(Pd) (11.9%), potassium dichromate (10.7%) in order, respectively. In conclusion, old metal restorations could be the cause of oral mucosal diseases and epicutaneous patch test could be used as a tool to improve the oral conditions.

Mango, Pulp Fiction?

Contact reactions to mango have been previously reported. Here we present an unusual dual reaction to mango peel and pulp. Skin prick, Finn Chamber and in-vitro IgE testing. A 23-year old gentleman was evaluated after 2 episodes of delayed reactions to mango ingestion. Both episodes involved a perioral and pruritic rash associated with dry and cracked lips developing 1 day after unpeeled mango consumption and lasting 1 week. The second episode involved significant periorbital and lip edema as well as extension of the rash to the abdomen and extremities. He denied systemic symptoms but recalled that a pruritic papulovesicular rash on his lower extremities had appeared after poison oak exposure 7 years prior. Physical exam revealed an erythematous papular rash on the left thigh and the right hand. In-vitro IgE testing was positive to dust mite but negative to mango. Skin prick testing was negative to mango skin and pulp. Epicutaneous patch testing using mango skin and pulp placed in duplicate under Finn Chambers was positive to mango skin at 72 hours and to mango pulp at 96 hours. We present a patient with contact dermatitis to mango skin and pulp. Patch testing using Finn Chambers is an efficient method for evaluating delayed type hypersensitivity to mango fruit. It is worth considering extending the observation to 96 hours given the clinically significant reaction to pulp.

Genetic testing for prevention of severe drug-induced skin rash

Genetic testing for prevention of severe drug-induced skin rash

Epicutaneous patch test—A new diagnostic option to prevent the rejection of silicone-covered cochlear implants in children

ObjectivesCochlear implantation (CI) is a revolutionary method for hearing rehabilitation in patients with severe or profound sensorineural hearing loss. One of the surgical complications may be the necrosis of the skin flap above the receiver-stimulator coil, resulting in device extrusion. Our aim was to find the plausible causes of the silicone covered implant rejection. Patients and methodsAuthors present four cases of cochlear implant rejection, briefly describe their dermato-surgical solutions and analyse their innovative method – the epicutanoeus patch testing with silicone samples. ResultsThey observed positive skin reaction in three of the four cases. ConclusionAuthors analyse the applicability and results of their surgical solutions and the epicutaneous testing in connection with the prevention of skin flap necrosis and rejection of silicone-covered cochlear implants.

A Case of an Allergic Reaction to a Spinal Cord Stimulator: Identification of the Antigen With Epicutaneous Patch Testing, Allowing Successful Reimplantation

A Case of an Allergic Reaction to a Spinal Cord Stimulator: Identification of the Antigen With Epicutaneous Patch Testing, Allowing Successful Reimplantation

THE FIRST BULGARIAN STANDARDIZED SERIES FOR EPICUTANEOUS PATCH TESTING FOR ALLERGIES TO DENTAL MATERIALS AND ALLOYS

SUMMARY The teeth and teeth rows restoration in the maxillofacial area is the last stage of the ongoing patient treatment and a basic purpose for the dental doctors. For this purpose a different set of modern and classic contemporary dental materials is used. The choice of each material during the treatment of every patient with proven allergy to different kind of allergens is very specific and strictly individual. In the everyday oral diagnostics a standardized set of allergens for diagnostics is used for proving the allergy to dental materials. The set has been developed on the base of all existing and permitted by the Bulgarian authorities dental materials, as well as professional series. The difference between the developed and standardized allergens for diagnostics used in our country and the existing ready-for-use series is that the first are made of the final product (material) in the form introduced to the oral cavity and persisting there for a different period of time, sometimes for tenths of years. This enables the possibility for early or late contact allergic reactions with symptoms in the oral cavity and on the skin, maxillofacial area, head and neck, as well as the entire organism. The current article introduces the readers to the results obtained by the realization of the research project No.28/2011 “Research on the type of sensibilisation to contemporary dental materials and development of set of allergens for its diagnosing through epicutaneous patch testing” funded by the Committee of Medical science of MU Sofia (CMC). Through the project became possible the creation and the initial research of the first Bulgarian series for epicutaneous testing whose aim is to prove the allergenic potential of the most frequently used by the dental doctors dental materials.

Patch testing is an effective method for the diagnosis of carbamazepine‐induced drug reaction, eosinophilia and systemic symptoms (DRESS) syndrome in an 8‐year‐old girl

Drug reaction, eosinophilia and systemic symptoms (DRESS) is an acute and life-threatening disease, characterised by fever, rash and systemic symptoms, including lymphadenopathy, abnormal liver function, interstitial nephritis, pulmonary and cardiac infiltrates and haematological abnormalities with eosinophilia and atypical lymphocytes. The drugs mostly associated with DRESS are anticonvulsants, allopurinol, minocycline and sulfonamides. This syndrome is rarely seen in childhood even though a large number of children have anticonvulsant treatment. An 8-year-old girl was admitted with fever, lymphadenopathy and skin eruptions on her trunk. Her medical history was notable for epilepsy and carbamazepine treatment had been started 5 weeks previously. Laboratory studies showed a white cell count of 6200/µL (normal, 4100-11 200/µL) with 22% eosinophils and a γ-glutamyl transpeptidase level of 296 U/L (normal, 0-23 U/L). Laboratory tests for infections and collagen diseases were in the normal range. Persistence of fever and maculopapular eruption with generalised desquamation and the appearance of cheilitis and facial angioedema suggested a hypersensitivity reaction to carbamazepine. The carbamazepine was replaced with levetiracetam. All clinical symptoms improved within a week with corticosteroids and antihistamine treatment. Six weeks after complete recovery an epicutaneous patch test with carbamazepine was performed and a carbamazepine-induced positive skin reaction was observed at 48-h. Carbamazepine-induced DRESS syndrome is a rare entity in children. An epicutaneous patch test is a useful tool for identifying the inducing agent for the DRESS syndrome and for identifying a safe anticonvulsant drug.

Diagnostic handling of the preparation of epicutaneous patch tests requested by the Allergology Department

BackgroundIn epicutaneous patch testing, the substance suspected of being responsible for the skin reaction (contact dermatitis and/or delayed drug reaction) is applied (in excipient) on the skin under occlusion to...

Sodium tetrachloropalladate for diagnosing palladium sensitization

Exposure to palladium (Pd) may lead to clinical allergic reactions. With frequent nickel (Ni) exposure and cross-reactivity between Ni and Pd at the T cell recognition level, positive Pd reactions on patch testing are surprisingly uncommon. PdCl(2) is often used for epicutaneous patch testing. To compare the sensitivity and specificity of sodium tetrachloropalladate (Na(2) PdCl(4)) and PdCl(2) for Pd patch testing in metal-allergic patients and non-allergic controls. Twenty-six metal-allergic patients and 26 non-allergic controls were selected on the basis of detailed medical histories. Patch test results were used to determine the diagnostic performance of the two Pd salts as compared with NiSO(4). With three outliers in both groups, the sensitivity/specificity were calculated to be 42%/96% for PdCl(2), 65%/92% for Na(2) PdCl(4) , and 77%/92% for NiSO(4). Furthermore, of all (n = 19) Na(2) PdCl(4) reactors, 17 (89%) also showed positive reactions to NiSO(4). Conversely, of all (n = 22) NiSO(4) reactors, 17 (77%) showed concomitant positive reactions to Na(2) PdCl(4) . Positive test reactions to Na(2) PdCl(4) are confirmed by large-scale concordant reactions to PdCl(2) and NiSO(4). Although statistical significance was not reached, the increased sensitivity has important clinical relevance, as false-positive results are rare. Incorporation of Na(2) PdCl(4) into standard and/or dental screening patch test series is suggested.

Metal Allergy and Systemic Contact Dermatitis: An Overview

Contact dermatitis is produced by external skin exposure to an allergen, but sometimes a systemically administered allergen may reach the skin and remain concentrated there with the aid of the circulatory system, leading to the production of systemic contact dermatitis (SCD). Metals such as nickel, cobalt, chromium, and zinc are ubiquitous in our environment. Metal allergy may result in allergic contact dermatitis and also SCD. Systemic reactions, such as hand dermatitis or generalized eczematous reactions, can occur due to dietary nickel or cobalt ingestion. Zinc-containing dental fillings can induce oral lichen planus, palmoplantar pustulosis, and maculopapular rash. A diagnosis of sensitivity to metal is established by epicutaneous patch testing and oral metal challenge with metals such as nickel, cobalt, chromium, and zinc. In vitro tests, such as the lymphocyte stimulating test (LST), have some advantages over patch testing to diagnose allergic contact dermatitis. Additionally, the determination of the production of several cytokines by primary peripheral blood mononuclear cell cultures is a potentially promising in vitro method for the discrimination of metal allergies, including SCD, as compared with the LST.

Acute generalised exanthematous pustulosis

Acute generalised exanthematous pustulosis (AGEP) is a severe cutaneous adverse reaction and is caused by drugs in >90% of cases. It is rare, with an incidence of 1-5 patients per million per year. The clinical manifestations are characterised by fever and the rapid appearance of disseminated sterile pustules 3-5 days after the commencement of treatment. It is accompanied by marked neutrophilia. Mucous membranes are not typically involved. The drugs conferring the highest risk of AGEP according to the EuroSCAR study are aminopenicillins, pristinamycin, hydroxychloroquine, antibacterial sulphonamides, terbinafine and diltiazem. The pathogenesis of AGEP involves the initial influx of CD8 cytotoxic T-cells resulting in the apoptosis of keratinocytes and formation of vesicles. Then CXCL-8-producing and granulocyte macrophage-colony stimulating factor-producing CD4 cells enter the epidermis, resulting in neutrophil mediated inflammation and the formation of pustules. As a result, the histology reveals intraepidermal, usually subcorneal, pustules and an accompanying neutrophilic and lymphocytic infiltrate. Epicutaneous patch testing may also support the diagnosis by causing a localised pustular reaction 48-96 h after the offending drug is applied. The condition usually resolves by 15 days after the causative drug is withdrawn but oral corticosteroid therapy may be necessary in some individuals. The mortality rate is up to 5% and mostly occurs in elderly people who have significant comorbidities.

Serum Immunoglobulin E (IgE) Measurement and Detection of Food Allergy in Pediatric Patients With Eosinophilic Esophagitis

EA Erwin, HR James, HM Gutekunst. Ann Allergy Asthma Immunol. 2010;104(6):496–502 To determine the degree of allergic sensitization in patients with eosinophilic esophagitis by using serum immunoglobulin E (IgE) testing and comparing the results to those obtained by epicutaneous skin-prick tests (SPTs) and patch testing. This was a cross-sectional study of pediatric patients ( N = 53) referred for evaluation for biopsy-proven eosinophilic esophagitis at an allergy referral clinic at Nationwide Children's Hospital (Columbus, OH) over a 2½-year period (January 2007 to June 2009). Questionnaires about symptoms and treatment of eosinophilic esophagitis …