Patch Test Kits Research Articles

Patch testing with expired Indian patch test kits: Results of a pilot study

The reliability of patch testing with expired Indian standard patch test kits has been not evaluated before. Thirty adults (men:women 25:5) with allergic contact dermatitis were divided into three groups of ten patients each for patch testing by Finn chamber® method using Indian standard patch test kits having expiry in 2016, 2015 and 2014. The results were compared with those from a new kit with 2018 expiry. Ten patients in group-1, eight patients in group-2 and seven patients in group-3 developed positive reactions of identical intensities and mostly from identical allergens from all four kits. The major contact allergens eliciting positive reactions of identical intensities were parthenium in nine, five and three patients, colophony in four, one and zero patients, fragrance mix in three, three and one patients, thiuram mix in three, one and one patients, and paraphenylene diamine in two, one and three patients from group-1,-2, and -3, respectively. Small number of patients in each group remains the major limitation of the study. Whether or not these results can be extrapolated with patch test results from other similar patch test kits available across countries also needs confirmation. The patch test allergens can be used beyond labeled expiry dates but needs confirmation by a few large studies and using other available patch test kits. This is important as the relevance of patch test results for individual allergen in this scenario may remain debatable requiring careful interpretation.

Thin-Layer Rapid Use Epicutaneous Patch Test (T.R.U.E. Test) for Confirmation of Contact Sensitization

ABSTRACT The patch test is considered the gold standard for the diagnosis of allergic contact dermatitis. The Thin-Layer Rapid Use Epicutaneous Patch Test (T.R.U.E. Test) is a patch test approved by the U.S. Food and Drug Administration containing 35 preloaded, ready-to-apply allergens and allergen mixes. Our objective is to provide a comprehensive review of the commercially available patch test kit.

Analysis of the results of patch test in 192 patients with hand eczema

Objective: To investigate the common allergens in the patients with hand eczema. Methods: From November 2014 to March 2016, the patients with hand eczema were tested by the patch test kit of daily life series. Results: The results of the patch test of 192 patients with hand eczema were collected. Allergens were detected in 178 (92.71%) cases. The top 5 allergens were nickel chloride (23.96%) , cobalt chloride (18.75%) , aromatic compounds (17.19%) , nickel sulfate (16.67%) and thimerosal (13.54%). The positive rates of kappa mixture, aromatic compounds, tertiary butyl phenolic resin in males were 16.88% , 14.29% , 11.69% , respectively, which were higher than those (5.22% , 4.35% , 3.48%) in females. Conclusion: Nickel chloride, cobalt chloride, aromatic compounds, nickel sulfate and thimerosal are common allergens in patients with hand eczema.

Toothpaste Allergy as a Cause of Cheilitis in Israeli Patients

Allergic contact cheilitis may appear after exposure to different substances, including dental materials, toothpastes, cosmetics, foods and medications. To compare the rate of toothpaste allergy between patients with and without cheilitis and to examine the yield of our proposed toothpaste patch test kit for use in patients with cheilitis. A patch test kit containing 11 substances used in toothpastes was formed. The study sample consisted of 44 patients, 24 with cheilitis (study group) and 20 with contact dermatitis but without cheilitis (control group). Eleven patients in the study group (45%) were found to be allergic to toothpaste, compared to only one patient (5%) in the control group (p < .05). The rate of toothpaste allergy among patients with cheilitis might be higher than previously reported. Patch-testing with our toothpaste series is recommended in the evaluation of cheilitis.

Eyelid Dermatitis: Contact Allergy to 3-(Dimethylamino)propylamine

We present the case of a 42-year-old woman with intractable eyelid dermatitis. Patch testing revealed sensitization to 3-(dimethylamino)propylamine (DMAPA). DMAPA is an important etiology of allergic contact dermatitis of the eyelids and face but is easily missed even with expanded-series patch testing. We also review the most common causative allergens in eyelid dermatitis cited in the literature over the past decade. DMAPA is a reagent used in the formation of cocamidopropyl betaine (CAPB), a common additive to liquid soaps, shampoos, and other cleansing products because of its utility as a surfactant. Beginning in the 1980s, reports of allergy to CAPB surfaced in the literature. Ultimately, a majority of patch testing studies have shown that clinical allergy to CAPB-containing products actually reflects allergy to contaminant DMAPA in most cases. Amidoamine, another intermediate in the formation of CAPB, may also be implicated through a proposed mechanism of conversion to DMAPA in the skin. When patch-testing for eyelid and facial dermatitis, it is crucial to test with DMAPA directly, not just with CAPB; unlike commercial-grade CAPB, the CAPB in patch test kits is ultrapure and does not contain contaminant DMAPA.

A clinical assessment of a patch test kit marketed to U.K. hairdressers for detecting hair dye allergy

In 2004 a U.K.-based company developed and marketed a patch test kit (Colourstart); Trichocare, Ridgmont, Beds, U.K.) for use by hairdressers. It is intended to assess whether clients have a 'problem with hair dye' and promotes itself as the 'only practical solution to sensitivity testing'. However, a patient presented with a hair dye reaction that had not been detected while using this patch test system. To assess the Colourstart system in the next seven consecutive patients presenting with a history of adverse reactions to hair dyes. The Colourstart system was tested in parallel with commercially available hair dye patch test reagents, where applicable. Only three of seven patients allergic to p-phenylenediamine were detected using this system and one patient allergic to toluene-2,5-diamine sulphate was not detected using this system. The results raise concerns about the sensitivity of this kit for consumer protection, but also wider questions about the regulation, use and interpretation of 'home diagnostic patch test kits' in general.

North American Contact Dermatitis Group patch test results for the detection of delayed-type hypersensitivity to topical allergens

Background: Allergic contact dermatitis is a significant cause of cutaneous disease affecting many individuals. Patch testing, when used properly, often provides support for the diagnosis of allergic contact dermatitis. Objective: This article reports patch testing results from July 1, 1994, to June 30, 1996, by the North American Contact Dermatitis Group (NACDG). Methods: Patients evaluated in our patch test clinics were tested with the same screening series of allergens by the use of a standardized patch testing technique. The data from these patients were recorded on a standard computer entry form and analyzed. Results: Forty-nine allergens were tested on 3120 patients. Budesonide was added to the series in July 1995 and tested on 1678 patients. Of these patients, 66.5% had positive allergic patch test reactions, and 57% had at least one allergic reaction that was felt to be clinically relevant to the present or past dermatitis. The 20 screening allergens commercially available to United States dermatologists in the Allergen Patch Test Kit, accounted for only 54.1% of the patients with positive allergic reactions. The additional 30 allergens on the NACDG screening series accounted for 47% of patients with positive allergic reactions. Had the Allergen Patch Test Kit alone been used, 12.4% of all patients tested may have had their disease misclassified as a nonallergic disorder, and an additional 34.4% of all tested patients would not have had their allergies fully defined. Among those patients with positive responses to the supplemental allergens, 81% of the responses were of present or past relevance. The 12 most frequent contact allergens were nickel sulfate, fragrance mix, thimerosal, quaternium-15, neomycin sulfate, formaldehyde, bacitracin, thiuram mix, balsam of Peru, cobalt chloride, para-phenylenediamine, and carba mix. The present relevance varied with the specific allergen from 10.7% (thimerosal) to 85.7% (quaternium-15). Among newer allergens, methyldibromoglutaronitrile/phenoxyethanol (cosmetic preservative) caused positive allergic reactions in 2% of the patients; tixocortol-21-pivalate and budesonide (corticosteroids), in 2.0% and 1.1% of the patients, respectively; and ethylene urea/melamine formaldehyde mix (textile resin), in 5% of the patients. Conclusion: The usefulness of patch testing is enhanced with the number of allergens tested, because allergens not found on the commercially available screening series in the United States frequently give relevant allergic reactions. (J Am Acad Dermatol 1998;38:911-8.)

Practical problems in the use of patch testing in the evaluation of patients with contact dermatitis

Practical problems in the use of patch testing in the evaluation of patients with contact dermatitis

Challenges for the future of patch testing

The importance of patch testing was highlighted by the comments of Dr. Marion Sulzberger, who was asked the five most important advances in clinical dermatology during the twentieth century. He listed as the first advance the increased use and usefulness of the patch test and the international standardization of test concentrations and methods. The other four advances that Sulzberger listed were the use of systemic corticosteroids, the use of topical corticosteroids, immunofluorescent techniques, and our increased knowledge of the role of the Langerhans cellin allergic contact dermatitis and homograft resistance to cancer.1 It should be noted that Sulzberger listed patch tests as the first of the most important advances in clinical dermatology. Obviously, such a clinically important diagnostic procedure should not be withheld because certain rare and mostly minor adverse reactions may occur. A major abuse of patch testing is its omission in the diagnosis and management of allergic contact dermatitis. In discussing the hazards of patch tests, Snyder and Maibach 2 state: Patch testing, like many diagnostic methods, is not without hazard. The risk is greatly decreased by expertise with the method. In any instance, the risk of not identifying the allergen is greater than that of performing such testing. Likewise it is a challenge to prevent abuse of the patch test for medical diagnosis. One such abuse is easily seen in the actions of a Florida company that marketed a mercury chloride patch test kit. This product was sold to dentists with instructions to apply the patch and monitor the patient's pulse and blood pressure. It was recommended that ff the pulse and blood pressure rose, any dental fillings containhag mercury were to be removed and replaced with gold fillings. The U.S. Food and Drug Administration had to intervene in this abuse. 3 Another abuse promoted to allergists involved the use of dimethylsulfoxide (DMSO) as an agent for

Prevalence of Positive Epicutaneous Tests Among Infants, Children, and Adolescents

We studied 314 otherwise healthy children younger than 18 years of age with epicutaneous testing, and found that 20% of those tested had at least one positive epicutaneous test result. Neomycin, nickel, and potassium dichromate were the most prevalent allergens detected in our study group. We found that sensitization occurred at less than 5 years of age for all but fragrance allergens. Aluminum chambers and the American Academy of Dermatology Patch Test Kit were found to be safe for use in infants, children, and adolescents.

Hypersensitivity to mercury from dental amalgams

A small but vocal group of dentists around the country is claiming that certain people have an extremely low tolerance for mercury and will exhibit signs and symptoms of mercury poisoning at very low body burdens of mercury. These dentists are terming this group of people hypersensitive to mercury and are advocating cutaneous patch testing to detect such hypersensitivity. Because of the different mechanisms involved in mercury poisoning versus bona fide type IV (cell-mediated, delayed) to mercury, as well as the dissimilar clinical manifestations of the two conditions, it is difficult to find any basis for such a diagnostic procedure. At least one mercury patch test kit is currently marketed for use by dentists.* The kit consists of foil packs of 0.02% mercuric chloride, rectangular adhesive bandages, evaluation forms, and instructions. In addition to the usual cutaneous signs evaluated in the interpretation of a conventional patch test, this test kit includes change in systolic Or diastolic blood pressure of -+ 10 mm Hg, change of • 10 beats per minute in pulse rate, body temperature change of --_0.5 ~ F, as well as the development of indigestion, blurred vision, headaches, irritability, fatigue, depression, redness of eyes, and other nonspecific signs and symptoms during the 48-hour test period in assessing hypersensitivity to mercury.] For example, if, dur-

Sensitivity test may aid in avoiding `poison' plant-induced dermatitis

A research project that will soon get under way in the Los Padres National Forest near Santa Barbara, Calif, may make outdoor recreation activities a lot safer and more comfortable for people throughout the country. Using a patch test kit developed by William L. Epstein, MD, professor and chair of dermatology, University of California, San Francisco, School of Medicine, under contract with the Department of Agriculture's Forest Service Equipment Development Center in Missoula, Mont, approximately 300 to 400 men and women who work in the woods will determine their sensitivity to poison oak and poison ivy. West of the Rocky Mountains, poison oak is the name for the ubiquitous North American plant containing the phenollike compound urushiol. It is this oil in the plant's sap that causes the redness, blisters, and interminable itching that makes so many summertime pursuits so memorable. Dissimilar looking— although still illustrating the old admonition leaves