Patch Test Positive Patients Research Articles

Topical eye medications causing allergic contact dermatitis.

Allergic contact dermatitis (ACD) in the eye region caused by topical eye medications is difficult to diagnose and may be overlooked. To study the characteristics and causative agents in patients with ACD caused by topical eye medications in a Danish tertiary dermatology department. A retrospective study of 318 patients, patch tested between 2013 and 2021 due to suspected ACD to topical eye medications. All patients were tested with a locally developed eye medication series, some were additionally tested with suspected eye medications. Medical records were studied in patch test positive patients. Contact allergy to a topical eye allergen/medication was found in 12.9% (n= 41) of 318 patients, and culprit allergens were phenylephrine (6.9%), timolol (2.5%) and ketotifen (1.6%). Patch test positive patients were often previously diagnosed with cataract (29.3%) or glaucoma (24.4%), and the majority reported more than one previous reaction. Initial symptoms were oedema (56.0%), erythema (48.8%) and dermatitis (31.7%) in the eye region, and facial dermatitis was also seen. Patients with symptoms from the eye region who have been using topical eye medications should be patch tested with ingredients from commonly used eye medications supplemented by the products tested 'as is'.

The epidemic of contact allergy to methylisothiazolinone-An analysis of Danish consecutive patients patch tested between 2005 and 2019.

In 2005, methylisothiazolinone (MI) was allowed as a stand-alone preservative in cosmetics. This resulted in an epidemic of allergic contact dermatitis to MI, mainly affecting women exposed to leave-on cosmetics. Consequently, a regulation of Annex V in the European Union in 2017 banned the use of MI in leave-on cosmetics and reduced the allowed concentration in rinse-off products. To analyze the temporal trends in contact allergy to MI in Danish patients in relation to key events including European regulations over time. A retrospective study of consecutive patients patch tested with methylisothiazolinone from 2005 to 2019. Demographics and clinical characteristics in terms of MOAHLFA (male, occupational, atopic dermatitis, hand dermatitis, leg dermatitis, facial dermatitis and age >40 years), sources of exposure, and clinical relevance were analyzed in relation to key historical events. Three hundred eighty of 12 494 patients (3.0%, 95CI: 2.7-3.4%) tested from 2005 to 2019 were sensitized to MI. An increasing trend in the prevalence of MI contact allergy from 2005 to 2019 (P < .01) was observed, although a decline in the absolute number of patch-test positive patients was seen from 2013 and onward. A reduction in leave-on cosmetics as a source of exposure was observed following the legislative ban in 2017, from 24.8% from in 2010 to 2013 to 6.2% in 2017 to 2019 (P < .01). The epidemic of MI contact allergy is declining in absolute terms, although the prevalence in the patch-tested population has not returned to its pre-epidemic levels. The legislative regulation of MI in 2017 has been effective in terms of leave-on cosmetics as a source of exposure in MI allergic patients. The process of post-marketing risk assessment of contact allergens in the European Union needs improvement.

Increase in concentration of patch test allergen reduces patch test occlusion time to 12 hours without affecting patch test reactivity in patients with parthenium dermatitis.

Patch testing is the standard method to diagnose contact allergy. Patches are applied for 48 hours, which is inconvenient to patients in tropical weather. Therefore, we evaluated different patch test occlusion times with increased concentrations of an allergen to determine if occlusion time can be reduced without compromising patch test reactivity. Patch test positive patients with parthenium dermatitis were enrolled and patch tested using five different concentrations (10%, 4%, 2%, 1%, and 0.5%) of parthenium extract. The patches were applied in triplicate. The first set was removed after 12 hours, whereas the second and third sets were removed after 24 and 48 hours, respectively. Readings were performed at 24, 48, and 96 hours. Fifty patients with parthenium dermatitis were included. The positive patch test reaction rates were comparable in all three sets at 24- and 48-hour readings irrespective of the occlusion time. All were positive, with 10%, 4%, and 2% concentrations at 96-hour reading with an occlusion time of 12 hours. An occlusion time of 12 hours seems adequate to elicit positive patch test reaction at a 96-hour reading if the concentration of patch test allergen can be increased, that is, from 1% to 2% in these patients.

Exposure source for skin sensitizing hydroperoxides of limonene and linalool remains elusive: An analytical market surveillance

Positive patch test reactions of dermatological patients to oxidized samples of linalool and limonene are frequently reported. The sensitizing ingredients in the oxidation mixtures are hydroperoxides (HP). It is not clear whether fragranced consumer products are a relevant exposure source for HP. Analytical methodologies had been validated, allowing quantification of HP in different consumer products. The analytical approach was used to analyse 104 consumer products. Samples included aged and new samples from the same brand, products suspected by patients to elicit their symptoms and products containing essential oils. Only four samples contained >50 μg/g of at least one of the HP by the screening method. Confirmatory analysis by LC-MS methods indicated that levels are even below those observed by the conservative screening method. The samples retrieved from patch-test positive patients were below detection limit for all target analytes. This market surveillance indicates that concentrations of HP in consumer products and patient products are orders of magnitude below sensitizing doses in animal tests. No evidence for hydroperoxide accumulation in aged products or products used by patients was found. The nature and source of the inducing agent responsible for the frequent positive patch test reactions to oxidized terpenes remains elusive.

Patch Testing with a New Composition of Mercapto Mix: A Multi-centre Study by the Swedish Contact Dermatitis Research Group.

This study investigated whether more patients with contact allergies were detected by patch testing with mercapto mix with a higher concentration of 2-mercaptobenzothiazolinone (MBT) than the commonly used mercapto mix. A total of 3,143 dermatitis patients in 5 Swedish dermatology departments were patch- tested with 3 mercapto test preparations: MBT 2.0% petrolatum (pet.); mercapto mix 2.0% pet.; and mercapto mix 3.5% pet. Positive reactions to these mercapto mixes varied between 0-0.50%, 0-0.93%, and 0-1.4%, respectively, in the 5 centres. Numerically, mercapto mix 3.5% pet. detected all positive patients and more patch-test positive patients than did the 2 other substances, but the difference was not statistically significant. The authors recommend replacing mercapto mix 2.0% pet. in the Swedish baseline series with mercapto mix 3.5% pet., since the latter also detected those patients who would have been missed because MBT 2.0% is not included in the Swedish baseline series.

A study on incidence of various allergens involved in allergic contact dermatitis by patch testing among 150 patients in a tertiary care hospital in South India

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Allergic contact dermatitis is common dermatoses seen among patients attending dermatology clinics. Allergic contact dermatitis is due to delayed type of hypersensitivity reaction. The diagnosis of allergic contact dermatitis is made by patch testing. A positive reaction to a patch test commonly proves the cause of dermatitis.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; A retrospective study was conducted&lt;strong&gt; &lt;/strong&gt;to estimate the incidence of various allergens among 150 patch test positive patients with allergic contact dermatitis who had attended the dermatology OPD in Rajiv Gandhi Government General Hospital, Chennai, between October 2014 and September 2016. All the details regarding history, examination findings, investigations and patch test results were collected from case records, the data were tabulated and analysed.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Allergic contact dermatitis to cement was the commonest (44.7%), followed by nickel (10%) and plant antigens (9.3%). The commonest allergen to be tested positive was Potassium dichromate (82 cases), followed nickel (15 cases) and formaldehyde (8 cases). Most of the patients were in the age category between 41 and 50 years (47 cases– 31.33%). Male to female ratio was 2.41:1. 14 were atopic individuals (9.33%) by Hanifin and Rajka's criteria. Allergic contact dermatitis in 103 cases of our study were of occupational in origin (67%).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Avoidance of allergen and proper preventive measures in workplace and day to day activities will lead to significant decrease in the morbidity of the disease and improvement in quality of life in patients with allergic contact dermatitis. &lt;/p&gt;

Common Contact Allergens in Patients with Palmoplantar and Scalp Psoriasis and Impact of their Avoidance on Dermatology Life Quality Index: A Hospital-Based Study.

Background:Scalp psoriasis and psoriasis limited to palms and/or soles have been referred to as difficult to control psoriasis. Contact allergy has long been suspected to aggravate existing lesions and cause resistance to therapy in these psoriasis variants.Objectives:The objective of the study was to assess common contact allergens in patients with palmoplantar and scalp psoriasis and the impact of their avoidance on dermatology life quality index (DLQI).Materials and Methods:A total of 54 patients with palmoplantar and scalp psoriasis were patch tested with Indian Standard Series. The patch test results were read on day 2 and day 4. DLQI was calculated before patch testing and at 1 month and 3 month in patch test positive patients after instructing allergen avoidance.Results:Sixteen out of fifty-four patients (29.62%) showed positive patch test reactions. Metal antigens like nickel and cobalt were the most common sensitizers identified. Statistically significant improvement in DLQI was observed at 1 month and at 3 month of allergen avoidance.Conclusion:Patch testing is a useful test to determine the triggering or aggravating antigens in patients with palmoplantar and scalp psoriasis and subsequent allergen avoidance should be stressed on.

Evaluation of lymphocyte transformation tests as compared with patch tests in nickel allergy diagnosis.

The patch test is considered to be the gold standard for diagnosing nickel (Ni) allergy. The lymphocyte transformation test (LTT) can also be used to detect Ni sensitization. However, little is known about the correlation between patch test and LTT reactions to Ni. To establish and validate an LTT for Ni sensitization by comparison with patch test reaction and history. Fifty individuals without self-reported 'Ni allergy' (controls) and 50 patients with self-reported suspicion of Ni allergy were included. A questionnaire-aided history was taken, and patch tests with at least the baseline series and LTTs with various NiSO4 dilutions were performed. In the patch tests, 2 of 50 controls and 18 of 50 patients with self-reported suspicion of Ni allergy showed positive reactions to Ni. In the LTTs, 2 of 50 controls and 26 of 50 patients with self-reported suspicion of Ni allergy showed positive reactions to NiSO4 2.5 × 10-5 m, and 2 of 50 controls and 17 of 50 patients with self-reported suspicion of Ni allergy showed positive reactions to NiSO4 1 × 10-5 m. Sixteen of the 18 history-positive and patch test-positive patients (i.e. 88% sensitivity) were also LTT-positive, in contrast to only 2 positive LTT reactors within the 48 PT and history negative individuals (i.e. 96% specificity). [Correction added on 16 February 2017, after first online publication: The preceding sentence has been edited for language and this has been amended in this version.] CONCLUSION: Performing the LTT with optimized stimulating conditions might be a useful additional tool for the diagnosis of Ni allergy if non-sensitized controls are included.

Langerhans cell collections, but not eosinophils, are clues to a diagnosis of allergic contact dermatitis in appropriate skin biopsies.

Langerhans cell collections (LCCs) and eosinophils are traditionally considered histologic clues to allergic contact dermatitis (ACD), but rigorous histologic analyses are limited. We correlated the presence of LCCs and eosinophils in skin biopsies with patch test results in patients evaluated for ACD. Charts of all patients patch tested and biopsied at one institution from 2011 to 2013 were reviewed. Biopsies had to have a diagnosis of either spongiotic dermatitis, psoriasiform dermatitis or mixed psoriasiform/spongiotic dermatitis. Various histologic parameters were assessed, including the presence of LCCs and number of eosinophils. A total of 68 biopsies met study criteria. Of these, 27 (40%) had ≥1 LCC. Twenty-one out of 27 (78%) with ≥1 LCC were patch test positive; 6 were patch test negative (22%). Of 41 cases with no LCCs, 23 were patch test positive (23/41, 56%) and 18 were patch test negative (18/41, 44%). LCCs were significantly more common in patch test positive patients (p = 0.046). Eosinophil count did not significantly differ in patch test positive and negative cases (p = 0.216). LCCs are significantly more common in patch test positive cases. There were no differences with regards to presence of eosinophils between patch test positive and negative groups.

Clinical relevance of tixocortol pivalate‐positive patch tests and questionable bioequivalence of different hydrocortisone preparations

Tixocortol-21-pivalate (tixocortol pivalate) is used as a surrogate marker for contact allergy to hydrocortisone and other corticosteroids. To review the results of repeated open application testing (ROAT) and patch testing with hydrocortisone creams and ointments in tixocortol pivalate patch test-positive patients. ROAT was performed when the history of hydrocortisone contact dermatitis was negative or equivocal. Hydrocortisone cream and/or ointment patch tests were performed in patients with and without histories of hydrocortisone contact dermatitis. Results were excluded in patients allergic to vehicle ingredients. ROAT was positive in 15 of 20 patients (75%) with hydrocortisone cream versus 6 of 16 (38%) with hydrocortisone ointment (p = 0.02). Patch testing was positive with hydrocortisone cream in 23 of 27 patients (85%) versus 1 of 14 (7%) with hydrocortisone ointment (p < 0.0001). Only 1 of 26 tixocortol pivalate patch test-negative patients had a positive patch test with hydrocortisone cream caused by a vehicle ingredient. Clinical relevance was shown in most patients with positive tixocortol pivalate patch tests. Hydrocortisone creams gave positive patch tests and positive repeated open application tests much more often than hydrocortisone ointments. There were also significant differences in patch test reactivity among different hydrocortisone creams. We hypothesize that these differences may be explained by differences in hydrocortisone transepidermal penetration in different vehicles.

Quantitative repeated open application testing with a rinse‐off product in methyldibromo glutaronitrile‐sensitive patients: results of the IVDK

While the use of methyldibromo glutaronitrile (MDBGN) in leave-on products is clearly associated with high sensitization or elicitation risk, such a clear-cut relation could be questioned with regard to rinse-off products. The objective of this study was to find a maximum non-eliciting concentration for rinse-off products in MDBGN patch test-positive patients. We performed a use-related test [repeated open application test (ROAT)] in patients sensitized to MDBGN with a liquid soap containing three concentrations of MDBGN (50, 200, and 400 p.p.m. MDBGN, respectively). The soap at 50 p.p.m. was used twice daily for 4 weeks. If no reaction of the skin was observed, the product with the next higher concentration was used for another 4 weeks, etc. In total, 32/37 evaluated cases [86.5%; lower exact one-sided 95% confidence limit (CL): 73.7%] did not react to any of the preparations. The remaining reacted as follows: 1/37 reacted to 50 p.p.m., 3/37 to 200 p.p.m., and 1/37 to 400 p.p.m. The cumulative non-response to 50 p.p.m. was 97.3% (lower CL: 87.8%). The majority of subjects sensitized to MDBGN-tolerated rinse-off products containing a maximum concentration of 400 p.p.m. A concentration in rinse-off products in the range of 50 p.p.m. could be regarded as safe for most individuals already sensitized. These concentrations will presumably prevent induction (sensitization) also.

Activation of T-Cells from Allergic Patients and Volunteers by p-Phenylenediamine and Bandrowski's Base

Allergic contact dermatitis is commonly associated with exposure to p-phenylenediamine. The aim of this study was to determine whether p-phenylenediamine (PPD) and/or Bandrowski's base (BB) stimulate T cells from allergic patients and volunteers, and to explore the relationship between T-cell immunogenicity and allergy. Lymphocytes from allergic patients proliferated with PPD and BB (n=8). Lymphocytes from 14/16 non-allergic individuals also proliferated following stimulation, but only with BB; cord blood lymphocytes failed to respond (n=6). Glutathione, which prevented BB formation, but not binding of PPD to cells and serum, did not prevent p-phenylenediamine-specific stimulation of patient lymphocytes. T-cell clones generated from allergic patients were stimulated separately with PPD and BB, while clones from volunteers proliferated with BB alone. Patient and volunteer clones secreted IL-4, IL-5, IL-13, TNF-alpha, MIP-1alpha, MIP-1beta, and RANTES. These data show that activation of T lymphocytes from allergic individuals alone with PPD represents an important discrimination between allergic and non-allergic groups. BB-specific T cells are found in both allergic patients and volunteers, but not in cord blood. Their presence seems to reflect an acquired immune response, which is not translated into an allergic reaction.

Oral reactions to sublingual immunotherapy: a bioptic study

glucocorticosteroids without the necessity for hospitalization. After resolution, the oral challenge test with a cephalosporin was well tolerated. Another amoxicillin patch test positive patient tolerated the oral challenge with penicillin, thereby revealing an isolated allergy to amoxicillin. As a challenge test would involve the risk for the patients to experience the same signs and symptoms of the previous drug reaction, the decision of four out of eight patients not to perform an oral challenge test was respected. Two of three patients, who were completely negative in the allergy diagnostic tests, agreed to an oral challenge with verum and revealed tolerance to the drug. It can be hypothesized that the third patch test negative subject may also have tolerated amoxicillin challenge. These three individuals may belong to the population, which only has a transient decrease in drug tolerance during EBV infection. Two amoxicillin patch test positive patients could be examined in a follow-up visit 2.2 and 1.5 years, respectively, after the first patch testing. Those patients revealed a patch test reaction similar in strength to the preliminary test result, which is indicative for a persistent delayed-type reaction to amoxicillin. In conclusion, this study does not only provide additional evidence that true delayed-type allergic reactions to aminopenicillins may develop during a florid viral infection, but that they may be definitely more prevalent than previously assumed and published (5, 6). Additionally, follow-up investigations on two patients revealed the persistence of the delayed-type reactions to amoxicillin, an approach, which has to the best of our knowledge not been published before. These observations should encourage the investigation of patients with aminopenicillin-induced exanthema for both, EBV-infection and true drug allergy. Particularly young women should be recommended an oral challenge with cephalosporins and maybe penicillins because the latter are antibiotics which may be given safely during pregnancy.

P‐Phenylenediamine allergy: the role of Bandrowski's base

p-Phenylenediamine (PPD) is a commonly used hair-dye and a potent skin allergen. The mechanism of sensitization is unknown, as PPD is protein unreactive. We studied Bandrowski's base (BB), a PPD trimer, as well as 1,4-benzoquinone (BQ), a PPD hapten. PPD patch-test positive patients were patch-tested to BB and BQ. All tests were negative to 0.01% BQ and 0.01% BB. Five of 14 (35.7%) tested had true positive reactions to 0.1% BQ. One percent BQ was found to be irritant. Seven of 43 tested (16%) were positive to either 0.1% or 1% BB. The positive reactions to BB were weak, even when PPD reactions were strong. Mice lymph node assay gave EC3 values of 0.14% for PPD compared with 0.03% for BB. Therefore, BB is approximately 10 times more potent than PPD, taking into account the molarity. We suggest that while PPD may act as a prohapten, there is probably a spectrum of antigenic determinants in vivo. BB may be bound or metabolized by keratinocytes before it reacts with Langerhans cells.

金属アレルギー患者における末梢血リンパ球の免疫学的検討

Recently, the number of patients with dental metal allergy has risen significantly. The aim of this study was to evaluate the clinical availability of the lymphocyte stimulation test (LST) using metal reagents as a method for diagnosing metal allergy. In vitro, peripheral blood mononuclear cells (PBMC) from 18 patients with metal allergy and five healthy volunteers were examined by LST using 12 metal reagents (HAuCl₄, PdCl₂, NiSO₄, CoCl₂, CuSO₄, SnCl₄, K₂Cr₂O₇, MoCl₅, H₂PtCl₆, IrCl₄, AgBr, FeCl₃). To define metal allergy, a patch test (PT) was performed with metal reagents, and then the components of dental alloys in their mouth were analyzed. The expressions of CD 4, CD 8, CD 25, and CLA of metal-specific T cells were determined by flow cytometric analysis (FACS). PBMC from patients with positive PT showed LST positive for nickel sulfate (Ni), gold chloride (Au), palladium chloride (Pd) and cobalt chloride (Co). The results of LST in other metals indicated negative in spite of the positive result by PT. FACS results indicated the increase of CD 4 + T/CD 8 + alpha 4 + T cells, CD 4 + T/CD 8 + CLA+ T cells by stimulation with metal reagent. Thus, metal-specific T cells were stimulated in PT positive patients, so LST could be a more specific test for diagnosing dental metal allergy.

Oral lichenoid lesions (OLL) and mercury in amalgam fillings.

84 patients with oral lichenoid lesions (OLL) were seen in the contact dermatitis clinic. All these patients had reticulate, lacy, plaque-like or erosive lichenoid changes adjacent to amalgam fillings. Patch testing to metallic mercury, 0.1% thimerosal, 1% ammoniated mercury, 0.1% mercuric chloride, and in some cases 0.05% phenylmercuric nitrate and amalgam discs was undertaken. 33 (39%) patients had positive patch test findings. 30/33 patch test positive patients had replacement of their amalgam fillings, with 28 (87%) patients experiencing improvement of symptoms and signs within 3 months. This confirms that mercury allergy is a factor in the pathogenesis of OLL in some cases. In cases where patch test negative patients improve with amalgam replacement, mercury may be acting as an irritant in the pathogenesis of OLL.

Clinical Analysis on the Effect of Substitution or Removal of Dental Materials on the Clinical Course of Metal Patch Test-Positive Patients with Dermatological Disease

Clinical Analysis on the Effect of Substitution or Removal of Dental Materials on the Clinical Course of Metal Patch Test-Positive Patients with Dermatological Disease

The Importance of Including Thimerosal, an Increasingly Frequent Allergen in Europe, in Standard Screening Series for Allergic Contact Dermatitis

The incidence of positive patch tests with 0.1% thimerosal increased from 12.9% in late 1988 to 21.5% in early 1990 in our test population, with a marked preponderance of young-age classes. From these patch test-positive patients, 69% also reacted to 0.05% thimerosal, 22% to thiosalicylic acid, and only 10% to mercury. The increasing incidence coincides with a statewide immunization program, using a thimerosalcontaining vaccine. However, patch test positivity does not necessarily prospectively predict intolerance to such a vaccine, but precautions are mandatory. The high sensitizing capacity of thimerosal makes the inclusion of this substance in the standard screening series for allergic contact dermatitis seem important and the replacement of thimerosal in vaccines by other antibacterial agents desirable.