Patch Test Reactions In Patients Research Articles

Limonene and linalool hydroperoxides review: Pros and cons for routine patch testing.

Limonene and linalool are among the most common fragrance terpenes used in everyday products. They are pre-haptens, forming hydroperoxides (Lim-OOHs, Lin-OOHs) upon oxidation and inducing frequent positive patch test reactions in patients with dermatitis, and yet they are not routinely tested in Europe. This review evaluates current patch testing with Lim-OOHs and Lin-OOHs by asking whether hydroperoxide patch testing is warranted, examining the difficulties or challenges related to reading and interpreting hydroperoxide patch test results with currently available material, and assessing their relevance. Studies are increasingly pointing to high percentages of positive reactions in patients consecutively patch tested with these oxidized products. An association between a positive clinical history and a strong patch test reaction has been described, but problems with doubtful/irritant reactions have also been reported. Considering the high frequency of relevant positive reactions, the incorporation of Lim-OOHs 0.3% and Lin-OOHs 1% in the baseline series may be justified. Since exposure, sensitization, and elicitation limits of Lim-OOHs and Lin-OOHs in the products still need to be better determined, an assessment of previous exposure, possible sensitizations, and reactions may help to improve the clinical assessment.

Concomitant positive patch test reactions in FreeStyle-allergic patients sensitized to isobornyl acrylate.

Concomitant positive patch test reactions in patients sensitized to isobornyl acrylate (IBOA) have rarely been documented. To report concomitant sensitizations in patients with allergic contact dermatitis (ACD) from the glucose sensor FreeStyle Libre and sensitized to IBOA. In 2019, 26 patients with suspected ACD from FreeStyle Libre were patch tested to a baseline series and to a (meth) acrylate series containing IBOA and 2-phenoxyethyl acrylate (PEA) 0.1% pet. Diabetes devices and patch test preparations were analyzed with gas chromatography - mass spectrometry (GC-MS) for the presence of IBOA and PEA. Of the 26 patients, 18 (69%) were sensitized to IBOA, and eight (44%) and 11 (61%) of these were co-sensitized to sesquiterpene lactones and fragrances, respectively. Ten patients (56%) were co-sensitized to PEA, which, contrary to IBOA, could not be detected in any device. The PEA test material was shown to be contaminated with IBOA. Contact allergy to IBOA appears to be declining and IBOA-sensitized patients are most often co-sensitized to sesquiterpene lactones and fragrances. Vigilance is required when patch testing (acrylate) materials obtained from industry, as these might be contaminated and, hence, alter the results and their interpretation.

Long-term reproducibility of positive patch test reactions in patients with non-immediate cutaneous adverse drug reactions to antibiotics.

As in contact allergy, T cell-mediated hypersensitivity in non-immediate (NI) cutaneous adverse drug reactions (CADRs) to antibiotics is considered to be lifelong, but, in this setting, patch tests have rarely been repeated after long time intervals. To evaluate the long-term reproducibility of positive patch test reactions to antibiotics in patients with NI CADRs. Fifty-six patients with NI CADRs to antibiotics who had relevant positive reactions during patch testing were invited to repeat patch tests with a similar antibiotic series 2-15 years thereafter. Twenty patients were included (9 males and 11 females; mean age 54.6 years): 18 with maculopapular exanthema, 1 with drug hypersensitivity syndrome, and 1 with acute generalized exanthematous pustulosis. Results were reproducible in 17 of 20 patients after a mean interval of 6.0 years (range 2-14.7 years). Concerning β-lactams, 7 of 8 patients remained positive for aminopenicillins, 4 of 4 for isoxazolyl penicillins, and 1 for cefoxitin. Patch test results were also reproducible for clindamycin in 5 of 7 patients, for vancomycin in 1 patient, and for spiramycin in 1 patient. Reproducibility was not affected by the time interval between tests, sex, or age at testing. In the context of NI CADRs, we showed high reproducibility of positive patch test reactions to various antibiotics, even after several years.

Pattern of contact sensitization in patients with and without atopic dermatitis in a hospital‐based clinical database

Both atopic dermatitis and contact sensitization are common conditions; however, a definite understanding of the relationship between contact sensitization and atopic dermatitis has not been reached. In this descriptive study, we investigated the differences between positive patch test reactions in patients with and without atopic dermatitis in a patch test cohort, and explored the influence of disease severity. Patch test results, information on atopic dermatitis and demographic variables were taken from a database, including all patients patch tested at Bispebjerg and Roskilde Hospitals from January 2009 to January 2013. Severe atopic dermatitis was defined as systemic therapy or hospitalization resulting from atopic dermatitis. All other patients with atopic dermatitis were defined as having mild/moderate disease. The study included 2221 patients: 293 patients with atopic dermatitis and 1928 without. Forty-one per cent of patients with and 46.2% of patients without atopic dermatitis had at least one positive patch test reaction (p = 0.092). More patients with severe atopic dermatitis than patients with non-severe atopic dermatitis had multiple positive patch test reactions (19.4% versus 10.0%, p = 0.046). Overall, we found similar frequencies of positive patch test reactions in patients with and without atopic dermatitis. However, a higher frequency of multiple sensitizations was found in patients with severe atopic dermatitis.

The necessity of a test reading after 1 week to detect late positive patch test reactions in patients with oral lichen lesions

Establishing the clinical relevance of contact allergy to dental materials in patients with oral lichen lesions (OLL) may be difficult, and tests are often read only on day 3 or day 4; also, concentration of the tested allergens may vary. Several studies on dermatitis patients have shown that additional positive patch test reactions can be found after day 4. Therefore, the aim of the present study was to analyse the frequency of late positive reactions to potential allergens in patients with OLL. Eighty-three of 96 consecutive patients with biopsy-verified OLL were patch-tested with a recently developed lichen series. The patches were removed after 48 h and reactions read 3 and 7 days after application. A total of 129 contact allergies were found, and 26 (20.2 %) of the allergic reactions in 23 patients were seen on day 7 only. The 25.2 % increase in positive test reactions with an additional reading on day 7 in addition to day 3 was statistically significant. Metals were the substances with the highest frequency of late positive reactions. Patients with OLL cannot be considered properly investigated with regard to contact allergy, unless the testing has been performed with mandatory readings on day 3 (or day 4) and day 7. Late patch test readings are crucial in order to elucidate the role of contact allergy to dental materials in the aetiology of OLL.

Patch test reactions in patients with the additional diagnosis of vitiligo

Melanocytes involved in vitiligo may have inherent aberrations that make them vulnerable to extracellular insult. Allergic contact dermatitis (ACD) has been implicated in the development and progression of vitiligo. This study was conducted to investigate the association between ACD and vitiligo. A total of 125 patients with vitiligo, who showed lesions in particular locations, onset at an older age, and/or pre-existing inflammation or pruritus, were included. Patch tests were performed using a Korean standard series. In order to investigate the association between avoidance of allergen and clinical improvement, 43 vitiligo patients who showed positive reactions to the patch test completed a questionnaire administered by telephone and self-assessed the status of their condition using a 10-point scale. A total of 98 (78.4%) of 125 patients with vitiligo showed positive patch test reactions to at least one antigen. Although a limited number of contact allergens may have specific predilection sites, a significant association (P = 0.002, odds ratio 3.06) was found between lesions distributed on the scalp and/or hairline and a positive patch test reaction to paraphenylenediamine (PPD). A positive correlation (P = 0.03) was also detected between avoidance of allergen and improvement of vitiligo lesions. Causative allergens of ACD may play a role in the development and/or aggravation of vitiligo.

Trend of contact allergy to cosmetic ingredients in Thais over a period of 10 years*

Contact allergy to cosmetic ingredients is common. However, there are no recent comprehensive studies on contact allergy to cosmetic ingredients in Asia. To identify positive patch test reactions in patients tested at Siriraj Hospital, Bangkok, Thailand to allergens present in cosmetics. A retrospective review of medical records from the outpatient contact dermatitis clinic was conducted from January 1999 to December 2008. Patients with at least one positive patch test reaction to allergens associated with cosmetic ingredients were studied. The results were evaluated using Pearson's χ(2) -test with Yates' continuity correction or Fisher's exact test where appropriate,and a p-value <0.002 was considered to be statistically significant by Bonferroni correction. There were 1247 cases (239 males and 1008 females; mean age 38.5 years). Fragrance chemicals and preservatives were the most commonly recognized cosmetic allergens. Ammoniated mercury was the only allergen that showed a significantly increased frequency over the 10-year period (p = 0.0008). Our study showed that ammoniated mercury is an emerging cosmetic allergen, showing an increased prevalence in recent years in Thailand. A focus is required on emerging cosmetic allergens and what may account for the upward trend of cosmetic contact dermatitis.

Ethosome formulation of contact allergens may enhance patch test reactions in patients*

Ethosomes and liposomes are ultra-small vesicles capable of encapsulating drugs and cosmetic ingredients for topical use, thereby potentially increasing bioavailability and clinical efficacy. So far, few reports have suggested that formulation of cosmetic ingredients in vesicular carrier systems may increase the allergenicity potential. To investigate the effect of ethosome formulation of isoeugenol and methyldibromo glutaronitrile on the elicitation response under patch test conditions and by repeated open applications. A total of 27 volunteer patients with a previous positive patch test reaction to either isoeugenol or methyldibromo glutaronitrile were included in the study. In all patients, a serial dilution patch test was performed with the allergen in question formulated in ethosomes and in an ethanol/water solution. In addition, a repeated open application test (ROAT) was performed in a subset of 16 patients, and lag time until a positive response was recorded. Both contact allergens encapsulated in ethosomes showed significantly enhanced patch test reactions as compared with the allergen preparation in ethanol/water without ethosomes. No significant difference in the median lag time was recorded between preparations in the ROAT. Encapsulating potential contact allergens in ethosomes may increase the challenge response as compared with the same concentrations in an ethanol/water base without ethosomes.

Allergic skin diseases

The skin is one of the largest immunologic organs and is affected by both external and internal factors, as well as innate and adaptive immune responses. Many skin disorders, such as atopic dermatitis, contact dermatitis, urticaria, angioedema, psoriasis, and autoimmune blistering disorders, are immune mediated. Most of these diseases are chronic, inflammatory, and proliferative, in which both genetic and environmental factors play important roles. These immunologic mechanisms might have implications for potential targets of future therapeutic interventions.

A correlation found between gold concentration in blood and patch test reactions in patients with coronary stents

Patients with dental gold restorations are known to have a higher level of gold concentration in blood (B-Au). To further investigate, in a study on patients with intracoronary stents and contact allergy to metals, the gold and nickel release from stainless steel stent with (Au stent) and without (Ni stent) gold plating. A total of 460 patients treated with stenting underwent patch testing with metals, and information on gold and nickel exposure and blood samples were collected. About 200 blood samples were randomly selected and the analysis of B-Au and nickel concentration in blood (B-Ni) was made using inductively coupled plasma mass spectrometry. There was a correlation between the intensity of Au patch test reaction and B-Au (P < 0.001). This correlation could not be seen between Ni patch test reaction and B-Ni. A Au stent gave a fivefold higher B-Au than a Ni stent. Gold is released from the Au stent and patients with a Au stent have a fivefold higher B-Au than patients with an Ni stent. The patch test reactions for gold were correlated with B-Au.

Gold trichloride and gold sodium thiosulfate as markers of contact allergy to gold

The usefulness of a trivalent gold salt, gold trichloride (GTC), was evaluated as a marker of contact allergy to gold. Patients patch test-positive or patch test-negative to gold sodium thiosulfate (GSTS), 13 subjects of each, were patch tested with dilution series of GTC and equimolar concentrations of GSTS. In order to avoid false-positive and false-negative test reactions, the salts were buffered and placed on polypropene chambers. Allergic reactions were registered in 9/13 gold-allergic patients with GSTS and in 2/13 with GTC. The sum of positive reactions was 18 with GSTS and 5 with GTC. Irritant reactions were none with GSTS and 2 with GTC in the gold-allergic patients. It is concluded that GTC can elicit positive patch test reactions in patients with gold allergy but to a lesser degree when compared with GSTS. Thus, GTC cannot be recommended in patch testing, and GSTS is still the test agent of choice.

FS14.4 Gold trichloride as a marker of contact allergy to gold.

Objective: To study the usefulness of a trivalent gold salt, gold trichloride (GTC), as a marker for contact allergy to gold. Method: Patients patch test positive or negative to gold sodium thiosulfate (GSTS), 13 subjects of each, were patch‐tested with dilution series of GTC and equimolar concentrations of GSTS; each series started at 0.03 mM and contained 5 steps. In order to avoid false positive and false negative test reactions the salts were dissolved in an alkaline buffer and placed on van der Bend® polypropene chambers. The tests were applied for 48 h; reading was blinded and performed on D3 and D7.Results: Allergic reactions were observed in 9/13 gold‐allergic patients with GSTS and in 2/13 with GTC. The sum of positive reactions was 18 with GSTS and 5 with GTC. Primary toxic reactions: 0 with GSTS and 2 with GTC among the gold‐allergic patients; and 2 with GSTS and 1 with GTC among the controls.Conclusion: GTC can elicit positive patch test reactions in patients with gold allergy but to a lesser degree than GSTS. GTC cannot be recommended for patch testing.

Patch-test reaction patterns in patients with a predisposition to atopic dermatitis.

Patients with a predisposition to atopic dermatitis often need to be patch tested in order to detect possible contact sensitization. However, it is unknown whether immunologic or other peculiarities of atopic skin are related to altered patch-test reaction patterns. Our study was aimed at answering this question, because patch-test reaction patterns are of considerable practical importance in the reading and interpretation of patch tests. Therefore, we compared patterns of patch-test reactions in patients with a predisposition to atopic dermatitis and in control patients matched for sex, age, reason for testing and test centre. Patch-test results from 9 centres (2322 patients with a disposition to atopic dermatitis and 2126 matched controls) were evaluated retrospectively. All patients were tested with nickel sulfate, fragrance mix, potassium dichromate, lanolin alcohol, formaldehyde and mercury ammonium chloride. Patch tests applied for 1 day with readings on days 1, 2 and 3 were evaluated in order to cover the early phase of the reactions. Not unexpectedly, we found that, compared to the matched controls, patients with a predisposition to atopic dermatitis tended to have more doubtful and irritant reactions on day 1. As a new observation, it turned out that they had less reactions of crescendo pattern and more strong reactions on day 3. All these differences were slight/insignificant. A higher skin irritability in patients with a predisposition to atopic dermatitis is a likely explanation. In conclusion, standard methods for patch testing can be applied in patients with a predisposition to atopic dermatitis, but minor differences in reaction patterns should be considered.

752 Disturbance of epidermal barrier function in atopy patch test reactions in patients with atopic eczema

752 Disturbance of epidermal barrier function in atopy patch test reactions in patients with atopic eczema

Contact sensitivity in atopic dermatitis

Background: There is some debate about whether the prevalence of contact allergy in patients with atopic dermatitis is the same as in the general population. Objective: The aim of this study was to estimate the prevalence of allergic and irritant patch test reactions in patients with atopic dermatitis and to relate these to clinical patterns of disease. Methods: One hundred twenty-two patients with atopic dermatitis were patch tested during a 3-year period. Results: Sixty patients (49%) had one or more positive allergic reactions, and 49 patients (40%) had one or more irritant reactions. Positive allergic responses to topical preparations were found in 25 patients (21%) with six reacting to topical steroids. Overall, 54 (44%) had allergic reactions considered to be relevant to their clinical problem. Nickel sulfate, fragrance mix, lanolins, and neomycin were the most common allergens giving allergic reactions. Conclusion: This study showed the importance of allergic and irritant factors in the causation of exacerbations of atopic dermatitis. Patch testing is helpful in the management of patients with worsening atopic dermatitis and should be undertaken at an early stage in patients whose disease is difficult to control.

Studies on the allergenicity of Baltic amber.

Baltic amber is a fossil resin deposited 36-7 million years ago and one source may be the extinct tree Pinites (Pinus) succinifer. Palaeobotanical studies of amber have an extensive literature, but the aspect of allergenicity has not been addressed before. The aim of our study was to present the results from sensitization studies with Baltic amber and to discuss these in view of possible cross-reactivity with contact allergens in colophony. It is concluded that allergens found in colophony can also be present in Baltic amber. The main resin acids were identified in an ether-soluble extract of amber. Amber suspended in petrolatum caused positive patch test reactions in patients with contact allergy to colophony. Furthermore, animals sensitized to colophony showed positive reactions to amber, but animals induced with amber did not react when challenged with amber. A use test with an amber necklace in patients with positive test reactions to amber and colophony was negative, which supports the view that amber in personal ornaments is not a clinical problem.