Patch Test Data Research Articles

Epidemiological case-control study on contact sensitisation in female foot care specialists with occupational contact dermatitis: Patch test data of the Information Network of Departments of Dermatology (IVDK), 2008 to 2022.

Mainly women work as foot care specialists (FCS). They are at risk to develop occupational dermatitis (OD). The objective of this study is to describe the contact sensitisation pattern of female FCS with OD. In a retrospective study, patch test and clinical data collected by the Network of Departments of Dermatology (IVDK) from 2008 to 2022 were analysed. Data of 116 female FCS with OD were compared with data of 13 930 female patients with OD working in other professions and 78 612 female patients without OD. Hand dermatitis (93.1%) was significantly more common and face dermatitis (0.9%) significantly less common in female FCS with OD compared to other female patients with or without OD. Frequent suspected allergen sources were disinfectants, gloves, leave-on and nail cosmetics. Occlusion and wetness were important co-factors. The most common diagnoses were irritant contact dermatitis (26.7%) and allergic contact dermatitis (21.6%). No sensitisation to any of the baseline series allergens was significantly more frequent in female FCS with OD than in the two control groups. However, sensitisations to allergens which FCS are abundantly exposed to, including fragrances, preservatives, rubber ingredients and disinfectants, were most common. FCS should be aware of the OD risk and prevention should be promoted.

Polysensitization in the Spanish Contact Dermatitis Registry (REIDAC): A 2019-2022 prospective study with cluster and network analysis.

There is still limited clinical-practice data on specific clinical and patch test features, as well as on allergen clusters in polysensitization (PS). To determine the frequency, relevance, symptoms duration and risk factors in polysensitized patients and to assess possible allergen aggregation. Prospective multicentric study (January 2019-December 2022) conducted in setting of the Spanish Contact Dermatitis Register (REIDAC). Clinical and patch test data of polysensitized and oligosensitized patients were compared, and risk factors of PS were investigated with logistic multivariate regression. Unsupervised hierarchical clustering and network analysis were used to study allergen aggregation in PS. A total of 10,176 patients were analysed. PS was found in 844 (8.3%). Current relevance was significantly higher in polysensitized patients (p < 0.01). Risk factors for PS were atopic dermatitis (OR: 1.58, 95% CI: 1.24-2.02), age (≥60 years vs. ≤24 years, OR: 1.75, 95% CI: 1.25-2.44) and some special locations (legs vs. face OR: 1.54, 95% CI: 1.05-2.25, hands vs. face OR: 1.46, 95% CI:1.15-1.85, arms vs. face OR: 1.49, 95% CI:1.01-2.20, trunk vs. face OR: 1.40, 95% CI:1.06-1.85). Cluster and network analyses revealed specific-allergen clusters and significant associations, including allergens belonging to metals group, fragrances and botanicals group, topical drugs group, rubber allergens and biocides. This study confirms that PS is structured by discernible patterns of specific-allergen clusters and reinforces significant allergen associations in PS. Cross-reactivity and/or concomitant sensitization could explain the formation of allergen clusters in PS.

Pediatric Patch Testing at Mayo Clinic Between 2016 and 2020.

Background: Allergic contact Dermatitis (ACD) is a common condition within the pediatric population. Patch testing is an important way to identify relevant allergens. Objective: To provide an update of the common contact allergens seen in children based on patch testing data at our institution from 2016 to 2020. Methods: We performed a retrospective analysis of patch test data from children aged 1-18 years from 2016 to 2020 at Mayo Clinic. Reaction rates were compared to the rates reported by the Pediatric Contact Dermatitis Registry (PCDR). Results: One hundred ninety-two children aged 1-18 were patch tested to various allergens. A total of 15,457 allergens were tested, with 291 positive tests. The top 5 allergens with highest positive reaction rates were hydroperoxides of linalool, hydroperoxides of limonene, methylisothiazolinone, nickel, and cobalt. Seven of the top 38 allergens with the highest reaction rates are not currently included in the Mayo Clinic Pediatric Patch Test Series, and 11 are not currently included in the Pediatric Baseline Series (as developed by the Pediatric Contact Dermatitis Workgroup). Conclusions: Patch testing is a useful tool to diagnose children with ACD. With new products and exposures, there is an opportunity to expand current pediatric patch testing series.

Contact allergy to ingredients of hair cosmetics in female hairdressers and female consumers-An update based on IVDK data 2013-2020.

Hair cosmetic products contain several, partly potent contact allergens, including excipients like preservatives. Hand dermatitis in hairdressers is common, scalp and face dermatitis in clients or self-users (summarised here as 'consumers') may be severe. To compare frequencies of sensitization to hair cosmetic ingredients and other selected allergens between female patch tested patients working as hairdressers and consumers without professional background, respectively, who were tested for suspected allergic contact dermatitis to such products. Patch test and clinical data collected by the IVDK (https://www.ivdk.org) between 01/2013 and 12/2020 were descriptively analysed, focusing on age-adjusted sensitization prevalences in the two subgroups. Amongst the 920 hairdressers (median age: 28 years, 84% hand dermatitis) and 2321 consumers (median age: 49 years, 71.8% head/face dermatitis), sensitization to p-phenylenediamine (age-standardised prevalence: 19.7% and 31.6%, respectively) and toluene-2,5-diamine (20 and 30.8%) were most common. Contact allergy to other oxidative hair dye ingredients was also more commonly diagnosed in consumers, whereas ammonium persulphate (14.4% vs. 2.3%) and glyceryl thioglycolate (3.9 vs. 1.2%) as well as most notably methylisothiazolinone (10.5% vs. 3.1%) were more frequent allergens in hairdressers. Hair dyes were the most frequent sensitizers both in hairdressers and in consumers; however, as indication for patch testing may differ, prevalences cannot directly be compared. The importance of hair dye allergy is evident, often with marked coupled reactivity. Workplace and product safety need to be further improved.

A review of patch-test data over the period of eight years in the allergy and immunology department in Qatar.

Patch testing is the primary diagnostic approach for contact dermatitis,1 an inflammatory skin reaction caused by exposure to external irritants. The pathophysiology of contact dermatitis may entail an immunological response (hypersensitivity type IV), a non-immunological response (irritant contact dermatitis), or a mix of the two. The diagnosis of contact dermatitis requires a correlation between a positive patch test and clinical relevance.2 This study aims to determine the prevalence of allergy sensitization among adults in Qatar and the allergens most frequently associated with positive patch test findings. Retrospective analysis used patch testing data from 2015 to 2022. Of the 87 patients tested, 43 had at least one positive reaction (mean age 41.7; range 19-68). Females were 33 of the total patients (76.7%). Thirteen (30%) patients had two or more positive reactions. The most common allergen groups associated with positive patch test reactions were nickel sulfate no. 12 (27.9%), and all reactants were female. followed by gold sodium thiosulfate no. 10 (23.3%, F:M = 2.3), p-phenylenediamine no. 10 (23.3%, F:M = 1.5), and p-tert-butylphenol formaldehyde resin no. 7 (16.2%, F:M = 6). Twenty-six reactants had one or more allergic disorders (allergic rhinitis, asthma, drug allergy, insect bite allergy, or chronic idiopathic urticaria), and 11 had atopic dermatitis. Triggering agents for contact dermatitis vary among geographic regions and populations. This study gives an idea of the allergens that are the most common sensitizers among the contact dermatitis population in the adult allergy clinic in Qatar.

Patch Testing Results From the Massachusetts General Hospital Occupational and Contact Dermatitis Clinic, 2017-2022.

Background: Patch testing is gold standard for identifying the source of allergic contact dermatitis (ACD). Objective: To report patch testing results from the Massachusetts General Hospital (MGH) Occupational and Contact Dermatitis Clinic from 2017 to 2022. Methods: Retrospective analysis of patients referred to MGH for patch testing, 2017-2022. Results: In total, 1438 patients were included. At least 1 positive patch test (PPT) reaction was observed in 1168 (81.2%) patients and at least 1 relevant PPT reaction was observed in 1087 (75.6%) patients. The most common allergen with a PPT was nickel (21.5%), followed by hydroperoxides of linalool (20.4%) and balsam of Peru (11.5%). Sensitization rates statistically increased over time for propylene glycol and decreased for 12 other allergens (all P values <0.0004). Limitations: Retrospective design, single institution tertiary referral population, and variations in allergens and suppliers across the study period. Conclusion: The field of ACD is constantly evolving. Regular analysis of patch test data is crucial to identify emerging and diminishing contact allergen trends.

Occupational contact allergy: The European perspective-Analysis of patch test data from ESSCA between 2011 and 2020.

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. 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. 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. 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. Among allergens in the European Baseline Series, occupational relevance is most frequently attributed to rubber accelerators, epoxy resins and preservatives.

Reduced specificity for the local lymph node assay for lipophilic chemicals: Implications for the validation of new approach methods for skin sensitization

Meaningful and accurate reference data are crucial for the validation of New Approach Methodologies (NAMs) in toxicology. For skin sensitization, multiple reference datasets are available including human patch test data, guinea pig data and data from the mouse local lymph node assay (LLNA). When assessed against the LLNA, a reduced sensitivity has been reported for in vitro and in chemico assays for lipophilic chemicals with a LogP ≥3.5, resulting in reliability restrictions within the h-CLAT OECD test guideline.Here we address the question of whether LLNA data are an appropriate reference for chemicals in this physicochemical range. Analysis of LLNA vs human reference data indicates that the false-discovery rate of the LLNA is significantly higher for chemicals with LogP ≥3.5. We present a mechanistic hypothesis whereby irritation caused by testing lipophilic chemicals at high test doses leads to unspecific cell proliferation. The accompanying analysis indicates that for lipophilic chemicals with negative calls in in vitro and in chemico assays, resorting to the LLNA is not necessarily a better option. These results indicate that the validation of NAMs in this particular LogP range should be based on a more holistic evaluation of the reference data and not solely upon LLNA data.

A Retrospective Analysis to Investigate Contact Sensitization in Greek Population Using Classic and Machine Learning Techniques.

Allergic contact dermatitis (ACD) is an inflammatory reaction affecting all age groups and both sexes. ACD is characterized by a delayed-type hypersensitivity reaction IV caused by skin contact with haptens. Chronic exposure typically leads to a decrease in erythema accompanied by lichenification (thickening and hardening of the skin) and persistent itching. The current study aims to investigate the patterns of contact sensitization in the Greek population using patch test data analysis. Patch test data from 240 patients (120Males/120Females) with allergic contact dermatitis were collected at the Laboratory for Patch Testing, National Reference Center for Occupational Dermatoses "Andreas Syggros" Hospital in Athens Greece. The contact allergic reactions were caused by ethylenediamine dihydrochloride 1%, thimerosal 0.5%, and methyldibromo-glutaronitrile 0.1% from the European baseline series of allergens; information was also collected for ICDRG evaluation, an extended MOAHLFA index and patient-reported outcomes (daily routine questionnaire). The chi-square test for independence and Spearman's rank were used to evaluate the association and correlation, respectively, between patient characteristics and ACD-related factors. Multiple correspondence analysis (MCA), which is a data analysis approach, was used to find and depict underlying structures in the data collection for nominal categorical data. Statistically significant associations were found between the following pairs of characteristics: eczema triggers and gender and eczema triggers and hand dermatitis. The results from MCA showed that there is correlation between allergic contact dermatitis onset, allergens, and demographic variables.

Contact sensitizations in massage therapists with occupational contact dermatitis: Patch test data of the Information Network of Departments of Dermatology, 2008-2020.

Massage therapists are particularly exposed to constituents of massage preparations, wet work and mechanical strain and therefore, at high risk to develop occupational dermatitis (OD). To describe the sensitization spectrum of massage therapists with OD. In a retrospective study, patch test data of patients with OD (128 massage therapists and 24 374 patients working in other professions) collected by the Network of Departments of Dermatology (IVDK, 2008-2020) were analysed. Hand dermatitis (91.4%) and allergic contact dermatitis (34.4%) were common in massage therapists with OD. Most frequent were sensitizations to fragrances/essential oils which were found in 54 (42.2%) massage therapists and thus, more often than in other patients with OD. Concomitant positivity to several fragrances/essential oils was frequent. In 8 (14.8%) of the 54 massage therapists, sensitizations to fragrances/essential oils were not detected with the baseline series, but only with special fragrance series. Allergic contact dermatitis is common in massage therapists with OD and is mainly caused by fragrances and essential oils. Hence, massage therapists should be aware of this risk. When OD is suspected, not only the baseline series, but also special fragrance series should be patch tested in this occupational group.

Reevaluating Corticosteroid Classification Models in Patient Patch Testing

Individuals with allergic contact dermatitis to one topical corticosteroid may also react to other corticosteroids. Corticosteroid classification models have been proposed to predict such copositivity, recommend representative screening corticosteroids, and guide allergen avoidance. To use patient data to determine copositivity patterns between corticosteroids and evaluate against previous corticosteroid classification models. This qualitative study included a retrospective analysis of the Mayo Clinic Contact Dermatitis Group corticosteroid patch test data from 2010 to 2019. Among patients undergoing patch testing with the Mayo Clinic's standard or steroid series who consented to research participation, 5637 patients were included in the analysis. Copositivity rates were determined between corticosteroids and analyzed by hierarchical clustering for comparison to previous classification models. The frequency of patch test positivity to each of the analyzed corticosteroids was noted and compared with previously published patch test positivity rates. Copositivity rates between each pair of corticosteroids were determined, and overall copositivity patterns were analyzed and evaluated against known steroid classes. A total of 49 472 individual patches were applied to 5637 patients, testing 18 corticosteroids. Patch test positivity rates ranged between 0.3% and 4.7%. The fluocinonide positivity rate corresponded to the highest copositivity rate with other corticosteroids (mean [SD], 50.7% [26.1%]). Tixocortol-21-pivalate, 0.1%, and tixocortol-21-pivalate, 1%, positivity rates corresponded to the lowest copositivity rates (mean [SD], 4.1% [1.7%] and 3.6% [1.4%], respectively). Hierarchical clustering elucidated patterns that did not support previous corticosteroid classification models. In this qualitative study, copositivity rates were variable between corticosteroids, and overall patch test positivity for allergy to topical corticosteroids was rare. Previously published corticosteroid classifications are not supported by real patient-derived data and may not be accurate in predicting corticosteroid copositivity.

Prevalence of contact allergy to corticosteroids in a Danish patient population.

BackgroundAllergic contact dermatitis to corticosteroids can be a challenging diagnosis as corticosteroids are used in the treatment of dermatitis. The prevalence of contact allergy to corticosteroid varies between previous studies.ObjectiveTo study the prevalence of sensitization to budesonide, tixocortol‐21‐pivalate and hydrocortisone‐17‐butyrate in a Danish patient population from 2006‐2020, cross‐sensitization, risk factors and clinical relevance.MethodsA retrospective analysis of patch test data and MOAHLFA index was performed among 6823 patients consecutively patch tested with TRUE test as part of the baseline series.ResultsA positive patch test for corticosteroids was found in 185 patients (1.2% budesonide, 1.6% tixocortol‐21‐pivalate, 1.0% hydrocortisone‐17‐butyrate) without gender difference. For women, the prevalence of tixocortol‐21‐pivalate sensitization increased significantly from 1.3% in 2006–2008 to 2.9% in 2018–2020. Tixocortol‐21‐pivalate sensitization had more frequently clinical relevance in women (61.3%) compared to men (34.5%). Age above 40 years was positively associated to corticosteroid sensitization. Budesonide and hydrocortisone‐17‐butyrate accounted for 67.7% of co‐sensitizations.ConclusionsThe prevalence of corticosteroid sensitization was 2.7%. Age was the only risk factor for corticosteroid sensitization. The frequency of corticosteroid sensitization was stabile over time except for tixocortol‐21‐pivalate sensitization for women. About one third of sensitized patients had co‐sensitizations to other corticosteroid groups.

European patch test results with audit allergens as candidates for inclusion in the European Baseline Series, 2019/20: Joint results of the ESSCAA and the EBSB working groups of the ESCD, and the GEIDACC.

In 2019, a number of allergens (haptens), henceforth, "the audit allergens," were considered as potential additions to the European Baseline Series (EBS), namely, sodium metabisulfite, 2-bromo-2-nitropropane-1,3-diol, diazolidinyl urea, imidazolidinyl urea, Compositae mix II (2.5% or 5% pet), linalool hydroperoxides (lin-OOH), limonene hydroperoxides (lim-OOH), benzisothiazolinone (BIT), octylisothiazolinone (OIT), decyl glucoside, and lauryl glucoside; Evernia furfuracea (tree moss), was additionally tested by some departments as well. To collect further data on patch test reactivity and clinical relevance of the audit allergens in consecutive patients across Europe. Patch test data covering the audit allergens in 2019 and 2020 were collected by those departments of the European Surveillance System on Contact Allergies testing these, as well as further collaborators from the EBS working group of the European Society of Contact Dermatitis (ESCD), and the Spanish Grupo Español de Investigación en Dermatitis de Contacto y Alergia Cutánea. As patch test outcome, reactions between day (D) 3 and D5 were considered. Altogether n= 12 403 patients were tested with any of the audit allergen. Positive reactions were most common to lin-OOH 1% pet. (8.74% [95%CI: 8.14-9.37%]), followed by lin-OOH 0.5% pet., and lim-OOH 0.3% pet (5.41% [95% CI: 4.95-5.89%]). Beyond these terpene hydroperoxides, BIT 0.1% pet. was the second most common allergen with 4.72% (95% CI: 4.2-5.28%), followed by sodium metabisulfite 1% pet. (3.75% [95%CI: 3.32-4.23%]) and Compositae mix 5% pet. (2.31% [95% CI: 1.84-2.87%]). For some allergens, clinical relevance was frequently difficult to ascertain. Despite many positive patch test reactions, it remains controversial whether lin- and lim-OOH should be tested routinely, while at least the two preservatives BIT and sodium metabisulfite appear suitable. The present results are a basis for further discussion and ultimately decision on their implementation into routine testing among the ESCD members.

A retrospective study of standard series patch test data from a tertiary referral centre in Singapore from 2014 to 2019.

A retrospective study of standard series patch test data from a tertiary referral centre in Singapore from 2014 to 2019.

Reference for common contact allergens present in prescription topical corticosteroids

To the Editor: Contact sensitization is a requisite for the development of allergic contact dermatitis. This process may occur more readily on an impaired skin barrier, particularly for weak sensitizers.1 Therefore, patients with eczematous dermatoses treated with a topical corticosteroid (TC) can experience worsening due to the very medication meant to help. In these situations, the selection of an appropriate TC can be challenging. Patch testing data suggest that sensitization to inactive ingredients in prescription TCs occurs more frequently than to the active ones,2,3 and the use of specific inactive ingredients can vary with the TC active ingredient, vehicle, and even manufacturer.

Patch testing results in skin of color: A retrospective review from the Massachusetts General Hospital contact dermatitis clinic

Patch testing results in skin of color: A retrospective review from the Massachusetts General Hospital contact dermatitis clinic

Patch Testing With Tocopherol and Tocopherol Acetate: The North American Contact Dermatitis Group Experience, 2001 to 2016.

Vitamin E (tocopherol) a naturally occurring mixture of antioxidants commonly used in topical skin care products, may cause allergic contact dermatitis. The aim of this study was to characterize positive patch test reactions to tocopherol and tocopherol acetate. This is a retrospective analysis of North American Contact Dermatitis Group patch test data to tocopherols (dl-α-tocopherol 100% and/or dl-α-tocopherol acetate 100%) from 2001 to 2016. Of the 38,699 patients patch tested to tocopherol and/or tocopherol acetate, 349 (0.9%) had positive reactions; of these, 87.6% were currently relevant. Most (51.4%) were weak (+) and/or not related to occupation (99.1%). Compared with tocopherol-negative patients, tocopherol-positive individuals were more likely to be female (72.5% vs 67.2%, P = 0.0355), have a final primary diagnosis of allergic contact dermatitis (74.2% vs 52.6%, P < 0.0001), and have dermatitis in a scattered generalized distribution (23.8% vs 18.2%, P = 0.0072); they were also less likely to have hand involvement (16.6% vs 22.3%, P = 0.0064). The most common source of tocopherol was personal care products, especially moisturizers. Positive patch test reactions to tocopherols were relatively rare given their widespread use. When positive, current clinical relevance was high. Tocopherol-positive patients were more likely to be female and presented with dermatitis on the face or in a scattered generalized pattern.

Evaluating the inclusiveness of common allergens in expanded series patch tests for children in the pediatric allergic contact dermatitis registry

Evaluating the inclusiveness of common allergens in expanded series patch tests for children in the pediatric allergic contact dermatitis registry

A baseline patch test series for New Zealand.

Patch testing is the gold standard diagnostic test for allergic contact dermatitis and needs to be relevant to the region and the population being tested. The aim of this study was to develop a specific New Zealand baseline series (NZBS). We performed a retrospective case note review of patients attending four regional patch test centres between 2008 and 2020. Demographic and diagnostic information was collected for each patient along with results of patch testing. Using the results of this review, a group of 11 dermatologists with an interest in contact dermatitis agreed on a core group of allergens for inclusion in an NZBS, based on the frequency of positive reactions and allergens of interest. The remaining potential allergens were ranked by each dermatologist using an online questionnaire, with inclusion in the final NZBS by consensus. Results from 2402 patients (67% female, mean age 44 years) from Auckland, Wellington, Palmerston North and Christchurch were collated. The 10 most frequent positive (relevant and non-relevant) allergens were nickel sulfate (22.0%), fragrance mix I (8.6%), cobalt chloride (7.3%), Myroxylon pereirae (5.6%), colophonium (5.1%), p-phenylenediamine (4.9%), methylisothiazolinone/methylchloroisothiazolinone (4.1%), fragrance mix II (3.9%), potassium dichromate (3.5%) and methylisothiazolinone (3.4%). Based on these results, a core series of 30 allergens was developed, with an additional 30 allergens added to form the extended series (total 60 allergens). The baseline series of patch test allergens for routine use in New Zealand (NZBS) is based on national patch test data and expert consensus.

Analysis of factors influencing patch test reactions: Results from a large- population-based study in Chinese.

Patch test, as a helpful tool in clinic diagnosis and safety assessment of cosmetics, is affected by many factors. To investigate the influencing factors of patch test reactions in a highly standardized large-scale dataset of Chinese. Patch test data (n=151,280) from safety assessments of cosmetic products were obtained following internationally standardized patch testing protocols during 2004-2017 in China. The frequency of patch test reactions was 1.45% (2,191/151,280), with majority of the reactions being "score 1" reactions (also known as doubtful reactions, n=2,075) and a small number being "score 2" reactions (weak reactions, n=116). Patch test reactions were 67% more frequent in winter (p<0.001), associated with temperatures (p<0.001), rather than relative humidity (P:0.29). The frequency of reactions was higher in men than in women (p:0.001), especially in winter. The risk to develop reactions clearly increased with age in women (p<0.001), but not in men (p:0.14). In women, the frequency of reactions in the old group (≥50years old) was 30% more than the young group (<30years old). The frequency of patch test reactions to cosmetic products was 1.45% in our large-scale study. The influencing factors of patch test include season, sex, and age, which should be considered when conducting and interpreting patch testing.