Patch Testing In Children Research Articles

What We Have Learned-Milestones in Pediatric Contact Dermatitis.

Purpose of ReviewThis review highlights recent developments in the field of pediatric allergic contact dermatitis (ACD) and patch testing. We will review updates on the pathophysiology of contact dermatitis, discuss new contact allergens, explore the impact of dupilumab on patch testing, and provide pearls for the diagnosis and management of ACD in children.Recent FindingsACD is not a single immunologic phenomenon but rather has contributions from multiple inflammatory pathways. Emerging contact allergens include ingredients found in “slime” toys, glucose monitors and insulin pumps, and electronic equipment. Data thus far suggests that patch testing results are generally reliable in the face of concurrent dupilumab use.SummaryACD is likely underrecognized and underdiagnosed in pediatric patients, including infants and young children. Providers should keep patient-specific factors and emerging trends in mind when addressing suspected ACD, consider contact dermatitis when they encounter challenging cases of atypical, refractory, or chronic dermatitis, and feel comfortable performing patch testing in children.

Changes in Product Use and Quality of Life After Patch Testing in Children With Allergic Contact Dermatitis: A Follow-up Survey.

Patch testing is the standard to diagnose allergic contact dermatitis (ACD). This study assessed the value of patch testing for product changes and quality of life in children with ACD. In this cross-sectional survey, we used a questionnaire to follow up with families of ACD patients about changes since patch testing and counseling preferences. Eligible participants were 18 years or younger during expanded series or personalized patch tests at the Washington University School of Medicine from 2007 to 2020. Of the 43 enrolled participants, most were positive for multiple allergens (63%) and changed personal products after patch testing (71%). Only 26% of the families consistently read product labels before patch testing, compared with 66% after. Patients saw a mean relative reduction of 49% in severity of rash (8.2-4.2 of 10), 46% in interference with activities (5.7-3.1), and 51% in self-consciousness (7.0-3.4) since patch testing. Families gave favorable feedback for counseling on products to avoid (9.4 of 10 average rating of usefulness), product recommendations (8.5 of 10), and chemical names (7.9 of 10). Patch testing can lead to meaningful improvements in quality of life for most children with ACD. Counseling related to positive patch test results should include discussion of specific products to use and avoid.

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

Evaluation of drug patch tests in children.

Background: Patch tests are used to diagnose nonimmediate T-cell-mediated drug hypersensitivity reactions. The aim of this study was to evaluate the results of patch tests performed with suspect drugs in children. Methods: Patients < 18 years of age who had a drug patch test at the pediatric allergy outpatient clinic of our hospital between January 2014 and January 2020 were included in the study. Age, sex, culprit drug(s), reaction characteristics, and patch test results were recorded from the patients' files. Results: A total of 105 drug patch tests were performed on 71 patients during the study period. The patients' median age was 7 years (interquartile range, 4-11 years), and 57.7% (n = 41) were boys. Twenty-three patients (32.3%) had severe cutaneous adverse reaction (Stevens-Johnson syndrome in 11, drug reaction with eosinophilia and systemic symptoms in 9, and acute generalized exanthematous pustulosis in 3 patients), 45 (63.3%) had maculopapular rashes, and 3 (4.2%) had fixed drug eruption. A total of 20 patch test results (28%) were positive: 18 of 44 patch tests (40.9%) with antiepileptic drugs and 2 of 48 patch tests (4.1%) with antibiotics. Positive results were obtained in 23% of the patch tests (6/26) in 20 patients with severe cutaneous adverse reactions and in 17.7% of the patch tests (14/79) in 51 patients with mild cutaneous reactions. No adverse reactions occurred during or after the patch tests. Conclusion: In our study, patch test positivity was more common with antiepileptic drugs and in patients with severe cutaneous drug reaction.

Cross-sectional evaluation of the pediatric baseline series in detection of contact sensitization in children

Cross-sectional evaluation of the pediatric baseline series in detection of contact sensitization in children

Allergic Contact Dermatitis in Children: Recommendations for Patch Testing.

Allergic contact dermatitis (ACD) affects 20% of children. However, diagnosis of ACD may be underreported in children due to lack of recognition. Patch testing is the gold standard for evaluation of ACD in children but poses unique challenges in this population. Recent studies highlight the significance of ACD and the utility of patch testing in children. Evaluation of ACD in children is difficult and requires knowledge of a child's exposure history, careful selection of allergens, and knowledge of specialized patch testing considerations to minimize irritation and maximize cooperation. Until recently, there were no agreed upon patch test series for children. In 2018, a comprehensive pediatric baseline series was published enabling thorough evaluation of ACD in children (Yu J, Atwater AR, Brod B, Chen JK, Chisolm SS, Cohen DE, et al. Dermatitis. 2018;29(4):206-12). This review provides an overview of the current literature, an update on pediatric ACD, and patch testing methods in children to effectively evaluate and manage ACD.

Skin Prick Tests and Patch Tests in Children with Food Allergies.

Abstract Diagnosing food allergies can be challenging for patients and health professionals. Standard diagnostic methods include skin prick testing, food-specific immunoglobulin E (IgE) and oral food challenge. There is no scientifically sufficient evidence for routine use of patch testing for food allergy evaluation in children.

Expanded Series and Personalized Patch Tests for Children: A Retrospective Cohort Study

Epicutaneous patch testing was developed as a simple and effective method for diagnosing allergic contact dermatitis (ACD). Despite its proven value in ACD diagnoses, there is no defined standard for patch testing in children. The aims of this study were to assess patch test positivity in pediatric patients with and without a history of atopic dermatitis suspected to have ACD, to compare these results with what the Thin-Layer Rapid Use Epicutaneous (T.R.U.E.) Test would have captured, and to evaluate likely exposures. Pediatric patients receiving a North American 80 Comprehensive Series patch test or a personalized patch test were analyzed for allergen sensitization 48 to 72 hours after patch removal. These data were analyzed for allergen inclusion in the North American 80 Comprehensive Series patch test compared with the T.R.U.E. Test, as well as compared with patients with and without a history of atopic dermatitis. Of the 29 patients (mean ± SD age = 10.9 ± 5.1 years), 25 children demonstrated at least 1 positive reaction, with a total of 81 reactions overall. 40 (49.4%) of the reactions came from allergens outside of the T.R.U.E. Test, including cocamidopropyl betaine, which was frequent in patients with atopic dermatitis. Expanded and personalized patch tests provide a more comprehensive allergen inventory than the traditional T.R.U.E. Test. Pediatric patients frequently have reactions to allergens not included in the T.R.U.E. Test, and these allergens are commonly found in household products. Cocamidopropyl betaine was a particularly relevant allergen in our population. Expanded series patch testing and appropriate counseling should be provided to pediatric patients with ACD.

Contact dermatitis in pediatric age group: Indian scenario

Contact dermatitis was previously considered to be rare in children except some forms of irritant contact dermatitis which were seen commonly in children. However, nowadays, there are an increasing number of cases of allergic contact dermatitis (ACD) being reported in children due to increased exposure to a variety of allergens at an earlier age. Various predisposing factors which influence the occurrence of contact dermatitis include age, sex, atopy, and presence of any concomitant skin disease. Nickel has been identified as leading cause of ACD in children. Other common allergens reported are cobalt, fragrance mix, rubber, lanolin, thiomersal, neomycin, gold, mercapto mix, balsam of Peru, and colophony. Clinical presentation in children is similar to that in adults with eczema of the hands, feet, wrists, face, forehead, scalp, eyelids, earlobes, neck, axilla, trunk, thighs, and anogenital area being seen. Disseminated lesions can as well be seen. When ACD is suspected, patch testing is the gold standard diagnostic procedure. However, patch testing in children differs from adults as some technical difficulties are encountered in children due to their smaller test area and frequent movements. However, the general opinion stands that children can be patch tested with the same methods and patch test concentrations as adults. For the prevention of recurrence, allergen elimination should be the aim of treatment; however, in many cases, it is not possible to completely eliminate the allergen from the patients environment. Topical steroids and calcineurin inhibitors form the mainstay of treatment in most cases.

Pediatric Baseline Patch Test Series: Pediatric Contact Dermatitis Workgroup.

Allergic contact dermatitis is a challenging diagnostic problem in children. Although epicutaneous patch testing is the diagnostic standard for confirmation of contact sensitization, it is less used in children by dermatologists treating children, pediatric dermatologists, and pediatricians, when compared with adult practitioners. The aim of the study was to create and evaluate standardization of a pediatric patch test series for children older than 6 years. We surveyed dermatologists and allergists conducting epicutaneous patch testing in children attending the 2017 American Contact Dermatitis Society meeting held in Washington, DC. This was followed by discussion of collected data and consensus review by a pediatric contact dermatitis working group at the conference. A baseline pediatric patch test panel was established through working group consensus.

Patch testing in children and adolescents with contact dermatitis

Patch testing in children and adolescents with contact dermatitis

Diagnosis and management of allergic contact dermatitis in children: common allergens that can be easily missed.

Contact dermatitis is an economically burdensome pediatric disease, and it is important to know the top allergens that have remained as top offenders for over the last decade. A comparative analysis of the 20-allergen screen was done against the current top 40 pediatric allergens, and it revealed that the 20-allergen screening series would have theoretically only captured 47.5% of the relevant contact allergens (52.5% failure to detect rate). In addition, the T.R.U.E. Test (SmartPractice, Phoenix, Arizona, USA) would have revealed 60% of the top 40 allergens (40% failure to detect rate). Patch testing in children has become a more common practice, and management requires the identification and avoidance of the offending allergen from the sensitized person's environment.

Testy skórne punktowe i płatkowe w diagnostyce nadwrażliwości na pokarmy u niemowląt i małych dzieci – badanie pilotażowe

IntroductionIn the light of increasing frequency of food allergy in young children, it is important to choose optimal diagnostic methods. PurposeTo ascertain the usefulness of skin prick tests with synthetic and natural allergens and atopy patch tests in children up to 3 years of age with the suspicion of food hypersensitivity. Patients and methodsFor the analysis, we included 53 children up to 3 years of age, with symptoms suggesting food allergy. On the basis of an interview, we established the set of allergens to test. ResultsThe highest percentage of positive results were obtained respectively in atopy patch tests – for egg white, egg yolk, chicken, milk, carrot, and wheat; in skin prick test with native allergens – for egg white, and egg yolk; and in skin prick test with synthetic allergens – for milk, egg white, and egg yolk. The interviews and test results allowed to diagnose hypersensitivity to milk in 33.96% patients, egg white in 37.74%, egg yolk in 43.4%, wheat in 22.64%, chicken in 20.75%, celery and carrot in 18.87%, and potato in 16.98% patients. ConclusionsThe choice of the test type can be important to the diagnosis but differ for different types of food. Conducting diagnostic tests, which allow for combined assessment of IgE-mediated and non-IgE-mediated food allergy, including skin prick tests and patch tests, increases the chance of establishing an accurate diagnosis.

Countering Staphylococcus Overgrowth During Patch Testing in Children with Moderate to Severe Atopic Dermatitis.

Patients with moderate to severe atopic dermatitis (AD) often have a concurrent diagnosis of contact dermatitis, but patch testing in these patients presents a unique set of challenges. Barrier impairment and Staphylococcus aureus colonization and infection, along with the sealed occlusion that takes place during the patch testing procedure, can create an optimal environment for bacterial overgrowth. To identify patients at risk for S. aureus overgrowth during patch testing and provide pre- and peripatch testing interventions to aid clinicians in obtaining the best possible patch test results in this complicated population. A retrospective review was performed of five patients with moderate to severe AD for which S. aureus overgrowth and superinfection complicated patch test evaluation. All five patients were able to complete the patch test procedure and all had relevant positive patch test reactions. Complications during patch testing included erythema, oozing, foul odor under the patches, and purulent material at the patch sites. One patient had a culture performed during patch testing that showed methicillin-sensitive S. aureus. Patch testing can play an important role in the examination and management of patients with refractory AD. Moderate to severe AD and concern regarding S. aureus overgrowth should not preclude patch testing.

Patch test results in children and adolescents. Study from the Santa Casa de Belo Horizonte Dermatology Clinic, Brazil, from 2003 to 2010

BACKGROUNDPatch testing is an efficient method to identify the allergen responsible for allergic contact dermatitis.OBJECTIVETo evaluate the results of patch tests in children and adolescents comparing these two age groups' results.METHODSCross-sectional study to assess patch test results of 125 children and adolescents aged 1-19 years, with suspected allergic contact dermatitis, in a dermatology clinic in Brazil. Two Brazilian standardized series were used.RESULTSSeventy four (59.2%) patients had "at least one positive reaction" to the patch test. Among these positive tests, 77.0% were deemed relevant. The most frequent allergens were nickel (36.8%), thimerosal (18.4%), tosylamide formaldehyde resin (6.8%), neomycin (6.4%), cobalt (4.0%) and fragrance mix I (4.0%). The most frequent positive tests came from adolescents (p=0.0014) and females (p=0.0002). There was no relevant statistical difference concerning contact sensitizations among patients with or without atopic history. However, there were significant differences regarding sensitization to nickel (p=0.029) and thimerosal (p=0.042) between the two age groups under study, while adolescents were the most affected.CONCLUSIONNickel and fragrances were the only positive (and relevant) allergens in children. Nickel and tosylamide formaldehyde resin were the most frequent and relevant allergens among adolescents.

Allergic contact dermatitis: Kids are not just little people

Over the last ten years, there has been an increased awareness of allergic contact dermatitis (ACD) in children, in addition to adults. Historically, ACD was not considered a significant disease in the pediatric population. This may have been due to failure to employ patch testing, which is the gold standard for establishing a diagnosis of ACD. A number of epidemiologic studies now reflect upon the significance of positive patch tests in children and its utility in diagnosing ACD. While there is significant overlap among the most common allergens in children and adults, the patterns of exposure and sources of allergens can significantly differ, because children have distinct experiences related to their exposure to personal care products, articles of clothing, and time spent in play as opposed to work. Evaluation of the pediatric patient with dermatitis involves specialized knowledge in taking the pediatric history and specific techniques employed for successful patch test application.

Contact Allergy in Atopic Patients: What We Suspected and What We Know

Contact allergy in children was previously considered to be uncommon. However, data from the last decades have shown an increase in its prevalence, which is thought to result from more frequent exposure to allergens at a younger age, new trends in body piercing, use of cosmetic and pharmaceutical products, and participation in sports and hobbies. Factors that may influence the onset of sensitization in children are atopic dermatitis, skin barrier defects, and intense or repetitive contact with allergens. Although there are many similarities between adult and children with contact allergy, the patch test results obtained in adults cannot always be applied to children. Moreover, the notion of an association between atopy and contact allergy in children has been challenged. Experimental studies have shown that individuals with atopic dermatitis (AD) have suppressed contact sensitivity due to their disease. Patch testing should be considered at early stages in patients with AD; it is indicated not only when contact allergy is suspected but also in cases of persistent eczema on specific localizations, such as on the hands and the feet, around the mouth, and also in the umbilical region. Patients with AD should be tested when multiple exacerbations occur, even when they are treated, or when the dermatitis is asymmetrical. The most frequent contact allergens in children are metals, fragrances, hair dyes, adhesive and rubber chemicals, preservatives, and topical pharmaceutical products. Toys and portable electronic devices are another potential source of hapten exposure in children. Positive reactions in atopic children must be interpreted carefully, as atopic skin is readily irritated; this is specially the case for metals. Patch testing in children is safe, but false-positive reactions can occur. In addition, an abbreviated baseline series, supplemented with allergens suggested by the child’s history, should be tested. The fundamental relationship between atopic disease and environmental chemical exposure in children is complex and occurs more tightly than previously supposed.

Differences in sensitization rates between children with Chronic Eczema and general population: Can they provide insight into significance of particular haptens for the disease?

Background Contact allergy is present in 58-67% children with chronic eczema, yet some children with contact allergy never develop eczema. To assess the significance of contact allergy in eczema, rates of sensitization to each hapten should be compared between eczema patients and general (healthy”) population. It seems reasonable that haptens with higher odds ratios and attributed risk for sensitization (i.e. better discriminating between ill and healthy) are “more important” in eczema, whether cause or result. The present study was aimed at estimating these indices for selected haptens. Method A systematic review of published data on the prevalence of sensitization to various haptens in eczema patients and the general population of children. The data were extracted and pooled to calculate estimated odds ratios (eOD) and estimated attributable risks (eAR). Results Preliminary analysis has shown that these indices differ substantially for various haptens. The highest eOD was found for formaldehyde: its value of 31.3 means that contact sensitization to this hapten was 31.3 times more frequent in children with eczema than in healthy ones. As 9.4% children with eczema and only 0.3% healthy children were sensitized to formaldehyde, the computed eAR for this hapten amounted to 9.1%. Other analysed haptens were Myroxylon pereirae (Balsam of Peru, eOD=21.6; eAR=10.3%), wool alcohols (lanolin, eOD=17.3; eAR=11.4%), MI/MCI (Kathon CG, eOD=15.0; eAR=19.6%), chromium (eOD=8.3; eAR=10.9%), fragrance mix (eOD=6.9; eAR=10.1%), nickel (eOD=2.3; eAR=10.9%), PTBF resin (eOD=1.4; eAR=0.4%) and neomycin (eOD=0.9; eAR=-0.3), to name just a few examples. Conclusion Sensitization rates to certain haptens are considerably higher among children with eczema than in healthy children, while there is no difference for others. The proposed approach offers a valuable insight into significance of particular haptens and may help at selecting haptens for routine patch testing in children with eczema.

Patch testing in children from 2005 to 2012: results from the North American contact dermatitis group.

Allergic contact dermatitis is common in children. Epicutaneous patch testing is an important tool for identifying responsible allergens. The objective of this study was to provide the patch test results from children (aged ≤18 years) examined by the North American Contact Dermatitis Group from 2005 to 2012. This is a retrospective analysis of children patch-tested with the North American Contact Dermatitis Group 65- or 70-allergen series. Frequencies and counts were compared with previously published data (2001-2004) using χ statistics. A total of 883 children were tested during the study period. A percentage of 62.3% had ≥1 positive patch test and 56.7% had ≥1 relevant positive patch test. Frequencies of positive patch test and relevant positive patch test reaction were highest with nickel sulfate (28.1/25.6), cobalt chloride (12.3/9.1), neomycin sulfate (7.1/6.6), balsam of Peru (5.7/5.5), and lanolin alcohol 50% petrolatum vehicle (5.5/5.1). The ≥1 positive patch test and ≥1 relevant positive patch test in the children did not differ significantly from adults (≥19 years) or from previously tested children (2001-2004). The percentage of clinically relevant positive patch tests for 27 allergens differed significantly between the children and adults. A total of 23.6% of children had a relevant positive reaction to at least 1 supplemental allergen. Differences in positive patch test and relevant positive patch test frequencies between children and adults as well as test periods confirm the importance of reporting periodic updates of patch testing in children to enhance clinicians' vigilance to clinically important allergens.

Allergic contact dermatitis in children; has there been a change in allergens?

Allergic contact dermatitis (ACD) is now recognized as a common relevant diagnosis in children. We reviewed the results of patch tests in children under 16 years of age over the 3-year period January 2009 to December 2011, comparing the results with those in a similar 3-year retrospective study performed in our unit for the period August 1999 to September 2002. In total, there were 137 children (70 girls and 67 boys) aged 3-15 years enrolled. Of these, 28 girls (40%) and 22 boys (32.8%) had a positive reaction to at least one allergen, with nickel sulfate and potassium dichromate being the most common allergens, each having an incidence of 7.2%, in contrast to the 20% incidence of nickel allergy in 1999-2002. The rate of fragrance allergy was unchanged at 5.8%, and rubber allergy incidence was greatly reduced. These results show that allergens may be changing in children, and that patch testing is still a useful test to consider.