Epicutaneous Tests Research Articles

Value Proposition of Epicutaneous Patch Testing: A Win-Win for the Patient and the Medical System

Value Proposition of Epicutaneous Patch Testing: A Win-Win for the Patient and the Medical System

Thermovisiographic Study of Epicutaneous Testing with Dental Haptens in Different Concentrations

Dental haptens are used to study sensitization to their respective dental materials. The concentration of haptens is important for the diagnostic process, as different concentrations lead to different severity of skin reactions. The aim of the study was to examine the dermal reactivity to 15 dental haptens in two different concentrations after the Patch test, by thermal imaging and calculating the temperature parameters of the respective reactions. The present study included 15 haptens from five different categories of dental materials, each with two different concentrations, with the objective to examine the results ensuring the Patch test. Thirty-three patients were included in the study. A total of 990 skin reactions were observed. They were subject to standard and thermal imaging evaluation. Approximately 5% of reactions were positive. The thermovisiographic indicator `dT' confirms the results of the standard readings, as its values vary from 0 to 0.8 ⁰C in the case of positive reactions. The study observed no significant differences in the results based on gender, both in the standard and in the thermal imaging examination. The study also confirms that it is necessary to apply certain concentrations of each hapten depending on its nature.

Dermatitis alérgica de contacto por Furacin®

Background: Allergic sensitization to topical antimicrobial treatments is a well-known problem. Furacin® is one of the most widely used in our environment. It contains 0.2% nitrofurazone and polyethylene glycol (PEG) as a vehicle. Case report: 57-year-old male with no history of interest. He presented skin rash, blisters, and serous exudate 2-3 days after starting treatment with Furacin® (applied to an infected skin wound). Epicutaneous tests were performed with a true test battery, nitrofurantoin 1% in petrolatum, PEG15000 and 4000 1% in petrolatum, pure PEG 400, PEG monomethyl ether 350 1% in water. Positive result at 96 hours for nitrofurantoin. Conclusion: Nitrofurazone is widely used as a topical antibiotic because of its bactericidal spectrum. It (including its excipients) should be considered in case of adverse reactions after application. Keywords: Dermatitis; Nitrofurazone; Topical antibiotics.

A cross-sectional review of contact allergens in popular self-tanning products

Background: In recent years, self-tanners have become a well-liked alternative to sun tanning and tanning bed usage, as strikingly similar results can be achieved without the harmful side effects of ultraviolet exposure. Objective: The aim of this study is to investigate the presence and prevalence of potential allergens in the most popular self-tanning products. Methods: Five major retailers in the United States were evaluated, from which 17 different brands and 44 unique self-tanning products were analyzed. The ingredients in each self-tanning product were compared with 80 and 36 notable contact allergens taken from the North American Contact Dermatitis Group and Food and Drug Administration–approved T.R.U.E (Thin-Layer Rapid Use Epicutaneous Patch Test), respectively. Results: We found that contact allergens are frequently present in self-tanning products; allergens especially common are propylene glycol, linalool, polysorbate, d-limonene, benzyl alcohol, tocopherol (vitamin E), fragrances, and other scented botanicals. On average, each self-tanner we analyzed contained 11.86 allergens. Limitations: The limitation is that commercial names could not be eliminated from the analysis, introducing potential bias. Conclusion: While self-tanning products are a safer alternative to tanning bed use or sunbathing, consumers and clinicians alike must be aware that they may cause an allergic reaction of the skin for some users.

Isolation, Identification, and Antimicrobial Evaluation of Secondary Metabolite from Serratia marcescens via an In Vivo Epicutaneous Infection Model.

Microbial secondary metabolites, which play a pivotal role in struggling with infectious diseases, are the new source for controlling bacterial contaminations and possess a strong antimicrobial potential. The present study is designed to evaluate the in vitro and in vivo bactericidal activities of prodigiosin against Staphylococcus aureus. For this purpose, Serratia marcescens was used to produce prodigiosin. Characterization of the prodigiosin was carried out using NMR. In addition, bioautographic detection of prodigiosin was detected by TLC. Antibacterial assays, in vivo epicutaneous infection tests, swap analyses, and histopathological examinations were determined. The results revealed that prodigiosin was detected by NMR and TLC. According to antimicrobial susceptibility tests, prodigiosin is an efficient bactericidal compound that demonstrated strong antibacterial activity toward S. aureus. In vivo, animal studies determined that the strong inhibition of S. aureus-caused epidermal infection occurs by prodigiosin at 48 h. Histopathological results showed that S. aureus + prodigiosin skin sections consist of improved and healthy tissues without any infection area compared with the S. aureus and control groups. The in vivo study verified the antibacterial results with swap analyses, and histopathological findings showed that prodigiosin is a promising microbial metabolite effective against S. aureus infection. This study proved that prodigiosin with excellent bioactivity exhibited antibacterial properties, which might possess massive potential for new therapeutic approaches using micro-organisms.

Dermatite de Contato Alérgica Ocupacional a múltiplos agentes num Canalizador

Introduction Contact dermatitis can have an irritating or allergic background and are the most frequently encountered occupational dermatosis. Allergic Contact Dermatitis can be of occupational origin and most often affects the hands, wrists, and forearms. The occupational and clinical history is critical for its diagnosis. The relationship between the symptoms and work, identifying substances that may cause the dermatosis is important to perform epicutaneous tests. The initial stage of treatment consists of evicting the agent, which may include removing the worker from his workplace. Early and appropriate treatment is important to prevent further deterioration and persistence of skin lesions. Case Report 47-year-old man, a plumber for thirty years, and no relevant personal background. About seventeen years ago, he started erythematous, scaly, and fissured lesions on the dorsum of both hands and in the interdigital spaces, which he associated with his professional activity. Initially, he did not wear gloves when working with plastic pipes, glues, sealants, and other rubber and steel materials. With the appearance of the injuries, he began to use them, without improvement. However, he kept the injuries. Dermatology followed it, where it performed the first epicutaneous tests with positivity for the agent Isopropyl-N-Phenyl 4 Phenylenediamine, present in rubbers. Due to continued exposure to the agent present in his workplace, with consequent worsening of the skin lesions, he returned to the consultation. He carried out new epicutaneous tests that revealed new positivities: Paraphenylenediamine, Mixture of Thiurans and Colophony. These agents are present in his work, and the diagnosis of Occupational Allergic Contact Dermatitis was assumed. Discussion/ Conclusion Occupational Allergic Contact Dermatitis is associated with high personal and professional suffering, loss of earning capacity and decreased productivity. Given the multiplicity of sensitized agents, this case was a challenge for Occupational Health, as it was present in various work materials and protective equipment. In this case, it was not possible to leave the workplace, which was not the option accepted by the worker, so the management of the case involved minimizing contact, giving preference to other types of materials, by reducing the time and intensity of exposure, using safer individual protection material, as well as using inner cotton gloves and outer vinyl gloves, in addition to concomitant pharmacological treatment. This case is also positive for other agents due to cross-reactivity, as well as the multiplicity of reactions that was partly caused by the continuous injury to the skin. Keywords: Allergic Contact Dermatitis; Isopropyl-N-Phenyl 4 Phenylenediamine; Paraphenylenediamine; Tiurans; Colophony.

Patch test in the diagnosis of food allergy

Food allergens are capable of producing adverse reactions through multiple mechanisms of an allergic or non-allergic nature, and through different routes of exposure; generally by ingestion or contact, as in protein contact dermatitis or contact urticaria, including inhalation. Food allergy reactions, in turn, can be mediated by immediate hypersensitivity mechanisms, delayed hypersensitivity or mixed immediate-delayed mechanisms. The reference diagnostic method in food allergy is the double-blind placebo-controlled food challenge test (DBPCFC), but skin and serological tests are important in the clinical context. The diagnosis of immediate food allergy depends on well-standardized allergological tests, such as the skin prick test (SPT) or specific IgE dosing, which are ideally tested by food challenge testing. However, the diagnosis of delayed mechanism food allergy and mixed allergies, which combine both immune mechanisms, is more complex. Delayed hypersensitivity reactions are evaluated with the epicutaneous patch test, or patch testing, for the diagnosis of contact dermatitis. The atopy patch test is initially used for the investigation of inflammatory reactions, which may be linked to food allergens in patients with atopic dermatitis. It was later applied in other diseases, whose pathogenesis is mainly mediated by a mechanism of delayed hypersensitivity to protein allergens: eosinophilic esophagitis, enterocolitis induced by food proteins, protein contact dermatitis, contact urticaria, among other disorders.

Allergic Contact Dermatitis to Acrylates: A Study Among Manicurists and Clients

Summary The study aimеd to investigate the association between the professional environment and hypersensitivity reactions to various contact allergens, features of the clinical course, and types of allergic contact dermatitis (ACD) in 34 manicurists and ten service users. The analysis was based on the data on length of professional experience, localisation of rashes, clinical diagnoses and allergens, and the cause of positive reactions in epicutaneous testing. Pathological skin changes most often affected the upper limbs (hands, palms, fingers). As a diagnosis, the frequency of ACD was the highest – 79.4%, followed by that of dyshidrotic eczema (DE) – 17.6%, which also determines the highest percentage of dermatitis on the upper limbs (97%). Of the patients, 47.1% had a history of the disease for up to one year. For manicurists, the results of patch tests with the specialised MH-1000 series showed the highest frequency of positive reactions to 2-Hydroxyethyl methacrylate (2-HEMA) and 2-Hydroxypropyl methacrylate (2-HPMA) – 88.88% each, Ethylene glycol dimethacrylate (EGDMA) – 83.33% and 2-Hydroxyethyl acrylate (2-HEA) – 61.11%. After combining data for manicurists and clients, correlation analysis found a significant effect on the development of ACD to 2-HPMA (p=0.003) and EGDMA (p=0.005), as well as for hand dermatitis to 2-HEMA (p=0.05) and 2-HEA (p=0.044).

Contact Allergy in Atopic Patients

Summary Atopic dermatitis (AD) is a chronic inflammatory disease based on genetic and immune alterations and is part of the atopic symptom complex, including allergic rhinitis, allergic conjunctivitis, and bronchial asthma. A disturbed barrier function facilitates antigen penetration through the skin, with the subsequent development of allergic contact dermatitis (ACD). The gold standard for diagnosing ACD is epicutaneous (patch) testing, also applied to objectify contact sensitization in AD. This study aimed to determine the frequency of contact allergy (CA) among individuals with atopic history and the allergens that caused ACD in those cases. We studied 453 individuals tested in the period 2009-2022. Of these, a subpopulation of 189 individuals with atopic diathesis was identified. A retrospective analysis was used. Using clinical and allergological methods, we divided the tested patients according to sex, age, professional occupation, and areas of the body affected by dermatitis and identified the most common contact allergens that cause positive reactions and ACD. In conclusion, our results highlight the possibility of developing ACD in people with atopic diathesis. As far as we know, our study is the first one in Bulgaria to examine the frequency of contact sensitization in AD patients.

Cutaneous adverse drug reactions

Cutaneous adverse drug reactions (ADRs) represent a heterogeneous field including various clinical patterns without specific features suggesting drug causality. Maculopapular exanthema and urticaria are the most common types of cutaneous ADR. Serious cutaneous ADRs, which may cause permanent sequelae or have fatal outcome, may represent 2% of all cutaneous ADR and must be quickly identified to guide their management. These serious reactions include bullous manifestations (epidermal necrolysis i.e. Stevens-Johnson syndrome and toxic epidermal necrolysis), drug reaction with eosinophilia and systemic symptoms (DRESS) and acute generalized exanthematous pustulosis (AGEP). Some risk factors for developing cutaneous ADRs have been identified, including immunosuppression, autoimmunity or genetic variants. All drugs can cause cutaneous ADRs, the most commonly implicated being antibiotics (especially aminopenicillins and sulfonamides), anticonvulsants, allopurinol, antineoplastic drugs, non-steroidal anti-inflammatory drugs and iodinated contrast media. Pathophysiology is related to immediate or delayed "idiosyncratic" immunologic mechanisms, i.e., usually not related to dose, and pharmacologic/toxic mechanisms, commonly dose-dependent and/or time-dependent. If an immuno-allergic mechanism is suspected, allergological explorations (including epicutaneous patch testing and/or intradermal test) are often possible to clarify drug causality, however these have a variable sensitivity according to the drug and to the ADR type. No in vivo or in vitro test can consistently confirm the drug causality. To determine the origin of a rash, a logical approach based on clinical characteristics, chronologic factors and elimination of differential diagnosis (especially infectious etiologies) is required, completed with a literature search. Reporting to pharmacovigilance system is therefore essential both to analyze drug causality at individual level, and to contribute to knowledge of the drug at population level, especially for serious cutaneous ADRs or in cases involving newly marketed drugs.

ALLERGIC CONTACT DERMATITIS WITH AN UNUSUAL CONFIGURATION AFTER PREOPERATIVE POVIDONE-IODINE DISINFECTION. A CLINICAL CASE

Contact dermatitis is an inflammatory skin reaction resulting from skin contact with exogenous substances that act as allergens and/or irritants. Epicutaneous testing is the gold standard for diagnosing allergic contact dermatitis and differentiating it from irritant contact dermatitis. We present a clinical case of allergic contact dermatitis after preoperative povidone-iodine disinfection.

Detecting Skin Reactions in Epicutaneous Patch Testing with Deep Learning: An Evaluation of Pre-Processing and Modality Performance.

Epicutaneous patch testing is a well-established diagnostic method for identifying substances that may cause Allergic Contact Dermatitis (ACD), a common skin condition caused by exposure to environmental allergens. While the patch test remains the gold standard for identifying allergens, it is prone to observer bias and consumes valuable human resources. Deep learning models can be employed to address this challenge. In this study, we collected a dataset of 1579 multi-modal skin images from 200 patients using the Antera 3D® camera. We then investigated the feasibility of using a deep learning classifier for automating the identification of the allergens causing ACD. We propose a deep learning approach that utilizes a context-retaining pre-processing technique to improve the accuracy of the classifier. In addition, we find promise in the combination of the color image and false-color map of hemoglobin concentration to improve diagnostic accuracy. Our results showed that this approach can potentially achieve more than 86% recall and 94% specificity in identifying skin reactions, and contribute to faster and more accurate diagnosis while reducing clinician workload.

Dermatological adverse effects of hair dye use: A narrative review.

Hair dyeing is a popular practice dating back to ancient Egyptian times. Initially, hair dye use was restricted to concealing grey and white hairs of the elderly population. However, in recent times, its use is common among the younger generation as a fashion statement. Hair dye contact dermatitis is a common dermatological condition encountered by dermatologists. It is a delayed type of hypersensitivity reaction that commonly affects the scalp and the vicinity of hair line and neck. Para-phenylenediamine (PPD), a synthetic aromatic amine is the most common allergen specifically implicated in hair dye contact dermatitis. Para-phenylenediamine was announced as the allergen of the year in 2006 by the American Contact Dermatitis Society. Contact allergy to para-phenylenediamine can occur in 0.1-2.3% of the general population. Epicutaneous patch testing is the gold standard test for the diagnosis of hair dye contact dermatitis. However, para-phenylenediamine carries a risk of cross-sensitivity and co-sensitization to other allergens. Apart from contact dermatitis, hair dye use is also associated with various other cutaneous adverse effects such as pigmentary changes, hair loss, skin malignancies and autoimmune disorders. Due to the various adverse effects associated with hair dye use, it is prudent to look for safer alternatives to allergenic hair dyes. In this article, we review the epidemiology, cutaneous and systemic adverse effects associated with hair dye use, patch testing, preventive strategies to minimize the risk of hair dye contact dermatitis, and treatment aspects.

The cow’s milk allergy that wasn’t: allergy to supplemental oral lactase enzyme

BackgroundAllergy to supplemental lactase is sparsely reported in the literature with only one prior case of anaphylaxis documented [2]. Reactions to this agent can occur following cow’s milk ingestion which could lead to an erroneous diagnosis of cow’s milk allergy in the absence of another explanation.Case presentationOur patient, a 48-year-old male with eczema, exercise-induced asthma and rhinoconjunctivitis, presented with four episodes of systemic reactions characterized by mucosal swelling and asthma symptoms following ice-cream exposure. It was later recognized that he had been taking a lactase enzyme supplement just prior to all of his reactions. Epicutaneous testing was strongly positive to a saline slurry of the lactase supplement he had been using. The patient has been avoiding supplemental lactase since with no subsequent reactions.DiscussionOur patient was diagnosed with an allergy to supplemental lactase enzyme on the basis of convincing Immunoglobulin E (IgE) mediated symptoms and positive skin testing. He continued to eat cow’s milk products, ruling out an IgE-mediated allergy to cow’s milk. In the literature, there is one prior case of anaphylaxis documented. Another case of localized oropharyngeal symptoms described in the literature was thought to be a form of oral allergy syndrome as the patient had positive epicutaneous testing to Aspergillus oryzae-derived lactase as well as Aspergillus species. Occupational sensitization, rhinitis/asthma, and protein contact dermatitis have also been detailed in the literature. Although rare, this case highlights the importance of a thorough history of over-the-counter supplements when assessing a patient with features of anaphylaxis.

Use of Epicutaneous Tests in the Study of Drug Allergy

Use of Epicutaneous Tests in the Study of Drug Allergy

Analysis of patch testing results in patients with contact dermatitis in Istanbul, Turkey, from 2012 to 2022.

Allergens responsible for allergic contact dermatitis (ACD) differ between populations. They can even change over the years with the effect of environmental factors. To evaluate the results of patch testing performed in our center. In this study, the thin-layer rapid-use epicutaneous (T.R.U.E.) test results of patients with a diagnosis of ACD between 2012 and 2022 were retrospectively evaluated. In 431 (42.5%) of the total 1012 patients, a positive reaction to at least one allergen was detected in the patch test. Allergen positivity was most detected for nickel sulphate (16.8%), gold sodium thiosulfate (GST) (6.9%), thimerosal (4.2%), fragrance mix (3.4%), carba mix (3.2%), and cobalt dichloride (2.9%). Nickel sulfate and GST sensitivity was found to be significantly higher in women, fragrance mix sensitivity in men, thimerosal sensitivity in individuals aged under 40 years, colophony and balsam of Peru sensitivity in head and neck dermatitis, and carba mix and thiuram mix sensitivity in atopic individuals. This study presents comprehensive data from Turkey concerning the sensitivity frequencies for allergens included in the T.R.U.E. test.

What should be considered during epicutaneous patch testing?

AbstractIndications for epicutaneous patch testing include the detection or exclusion of allergic contact dermatitis of the skin, transitional mucosa or oral mucosa, suspected delayed-type immune reactions to ingredients of implants, and certain drug reactions (maculopapular exanthema, symmetrical drug-related intertriginous and flexural exanthema [SDRIFE], acute generalized exanthematous pustulosis [AGEP], and fixed drug eruption). When available, allergen preparations that have been pharmaceutically tested and that are approved or marketable as medicinal products should be used. Existing diagnostic gaps can be closed by testing the patient’s own materials in a suitable preparation. Interferences of ultraviolet (UV) light exposure or drugs with patch test reactions have to be considered. In addition to the reading after 48 h and 72 h, a further reading between day 7 (168 h) and day 10 (240 h) is useful, since about 15% of the positive test reactions remain undetected without this late reading. All positive patch test reactions considered allergic must be evaluated with regard to their clinical relevance based on existing exposures.

Screening for Allergic Contact Dermatitis Based on Pattern of Patch Test Results: A Retrospective Study

Abstract Background: Contact allergies are associated with morbidity worldwide. Purpose: To investigate the patterns of sensitization to contact allergens in a local population. Methods: A retrospective study investigated patch test reactivity among patients with a clinical diagnosis of contact dermatitis referred to the dermatology clinic at King Fahad Armed Forces Hospital, Jeddah, between January 2021 and January 2023. Pregnant women, immunosuppressed patients, and those receiving immunosuppressive therapy were excluded. Only 92 of 101 referred patients underwent patch testing after fulfilling requirements. The patch test was performed using a Thin-layer Rapid-Use Epicutaneous patch test containing 35 contact allergenic elements and one control (total = 36). Results: Among 92 patients, 35 (38%) were males, and 57 (62%) were females. Of these, 62 (67.4%) patients had a positive patch test and reacted to one or more allergens. The most common sensitizing allergens were p-phenylenediamine (PPD), gold sodium thiosulfate, and disperse blue 106, with equal positive reactions in 16 (25.8%) patients, followed by nickel sulfate in 13 (21%), p-tert-butylphenol formaldehyde resin in eight (13%), fragrance mix in 7 (10.8%), and epoxy resin in six (9.2%) patients. No significant sex differences were found among patients with contact dermatitis where notable patch test allergen reactivity was observed. Conclusion: Patch test reactivity to PPD, gold sodium thiosulfate, and disperse blue 106 was high. The pattern of contact allergy observed here highlights the need for large-scale investigations to identify local allergens for contact allergy and formulate policies for avoiding exposure.

Preliminary Results of the European Standard Battery Epicutaneous Tests at the Dermatology Hospital of Bamako

Contact dermatitis is a frequent reason for consultation in dermatology. In recurrent and erythrodermic forms, patch testing in search of an allergenic substance is necessary. The aim of this study is to describe the preliminary results of patch testing using the standard European battery at the Dermatology Hospital of Bamako. This was a descriptive cross-sectional study conducted at the Dermatology Hospital of Bamako over a period of two years. All patients screened for recurrent or extensive eczema were included. The patch tests performed were those of the standard European battery. After application of the allergens, the tests were read at 48 and 72 hours. During the study 5777 cases of eczema were detected , 29 patients presenting a recurrent and/or extensive form were tested, of which 28 patients had a positive test at 72 hours (96%): 17/29 males (56%) and 12/25 females, i.e. a sex ratio of 1.42. The mean age of the patients was 39 years (range 7-72 years). With the exception of 1 patient, all patients were poly-sensitized: 9 patients reacted to 2 allergens, 9 others to three allergens and 6 to at least 5 allergens. Potassium dichromate was found 12 times, paraphenylene diamine 7 times, nickel 5 times and finally epoxy resin and fragrance mix 3 times each. In Africa, in the absence of suitable test batteries, the standard European battery was used. The positivity rates observed in our series are higher than those reported in other African populations. Although the detection of an allergen alone is not sufficient to explain a clinical picture, it is possible that the poly-sensitization observed in our cases could be one of the consequences of exposure to several allergens. In addition, it would have been interesting to explore the role of phytotherapy in the clinical pictures observed in our cases.

The German S3 guideline on titanium hypersensitivity in implant dentistry: consensus statements and recommendations

BackgroundThere is currently a lack of guidelines for clinicians regarding titanium hypersensitivity in implant dentistry. Diagnostic tests such as the epicutaneous test or the lymphocyte transformation test showed inconsistent results regarding reliability and validity and thus, evidence-based consensus recommendations regarding diagnostic and therapeutic options may be helpful in clinical decision-making. Therefore, the German S3 guideline on titanium hypersensitivity in implant dentistry was developed.FindingsIn the objectives, procedure, voting method and venue were defined and the consensus participants were invited. A systematic literature research was performed, and the overall quality of the evidence was rated according to the GRADE working group. Eight recommendations were formulated within the framework of a structured consensus conference under independent moderation and could be voted on with strong consensus (> 95% agreement). The formulated statements and recommendations were developed in small groups according to the guidelines of the Association of the Scientific Medical Societies in Germany (AWMF) and were discussed and agreed upon in the plenum.ConclusionsFor reasonable decision-making, a patient’s clinical symptoms should be regarded as leading parameters, which are usually expressed by a local inflammatory reaction with subsequent disturbed osseous integration. Allergy tests, such as the epicutaneous test or the lymphocyte transformation test are not helpful in titanium intolerance assessments, since these tests indicate T cell-mediated allergies, which are not observed in titanium intolerance reactions. Other metals and impurities that might be present in superstructures or alloys also need to be considered as the cause of an intolerance reaction and a trigger for contact sensitization. In the case of a suspected titanium particle-related, local immunologically induced inflammatory reaction with subsequent impaired osseous integration, dental ceramic implants can be considered as a therapeutic option.Graphical