Positive Patch Test Results Research Articles

A prospective study of cutaneous intolerance to topical mechlorethamine therapy in patients with cutaneous T-cell lymphomas. French Study Group of Cutaneous Lymphomas.

To study the exact frequency and the histological features of cutaneous intolerance to mechlorethamine (CIM) hydrochloride therapy in patients with cutaneous T-cell lymphomas, including Langerhans cell histiocytosis. A multicenter prospective study was conducted from January 1, 1994, to May 31, 1996, in 12 different hospitals in France. Of the 52 patients with cutaneous T-cell lymphomas or Langerhans cell histiocytosis, 35 were men and 17 were women, aged 18 to 87 years. Of the 52 patients, 35 had mycosis fungoides, 8 had nonepidermotropic cutaneous lymphoma, 7 had lymphomatoid papulosis, 1 had Sézary syndrome, and 1 had Langerhans cell histiocytosis. Patients were treated with topical applications of a 0.02% aqueous solution of mechlorethamine. The diagnosis of CIM was determined by the presence of erythema and pruritus. Patients who developed CIM underwent closed patch testing with three 10-fold dilutions of 0.02% mechlorethamine solution. A positive patch test result was the presence of erythema and pruritus, a weak result was the presence of simple erythema without pruritus, and a negative result was the absence of erythema and pruritus. Skin biopsy specimens from patients with positive patch test results were obtained in patients who developed CIM. The biopsy specimens were reviewed, and the results determined by 2 pathologists (E.T. and J.W.). The histopathological findings were classified in 3 categories: (1) spongiotic dermatitis, (2) irritant dermatitis, and (3) insignificant or normal. In September 1998, the referring physicians were contacted if mechlorethamine therapy had been continued in patients with CIM. Of the 52 patients, 43 were evaluated for tolerance to mechlorethamine therapy. Of the 43 patients, CIM developed in 23, from 4 days to 9 months after the initiation of mechlorethamine therapy. Of those 23 patients, CIM developed within 3 months in 21 and within 1 month in 13. Closed patch tests were performed in 21 of the 23 patients who developed CIM. The results of the patch test were positive in 12, weak in 4, and negative in 5. Of these 21 patients, 14 skin biopsy specimens were obtained in 14 different patients who had positive or weak patch test results. The specimens showed histological features that were consistent with spongiotic dermatitis in 9 patients, irritant dermatitis in 2, and insignificant or normal in 3. All 9 patients with histological features of spongiotic dermatitis discontinued mechlorethamine therapy. All 5 patients without histological features of spongiotic dermatitis were able to resume mechlorethamine therapy. These results do not correlate with those of previous study results. Mechlorethamine therapy is a cost-effective and easily administered treatment for cutaneous T-cell lymphomas. Our study shows that allergic dermatitis caused by mechlorethamine therapy is an early and frequent adverse reaction in patients with cutaneous T-cell lymphomas. The most common histological feature of patients with CIM is spongiotic dermatitis.

Contact sensitivities in palmar plantar pustulosis (acropustulosis)

Acropustulosis, or chronic palmar plantar pustulosis (PPP), is a phenomenon of recurrent sterile pustules, erythema, and scaling affecting the palms and soles. Its pathogenesis is unclear, and it is difficult to treat. The purpose of this study was to elucidate further the factors involved in causing PPP, thereby enhancing the ability to manage this disease. All cases of PPP seen at Mayo Clinic Scottsdale from 1987 to 1993 were reviewed. 21 patients with PPP were identified, 15 of whom had been patch tested. 9 of the 15 patients (60%) showed positive patch test results. Fragrance was the most common sensitivity, but nickel, formaldehyde, para-phenylenediamine, thiuram, neomycin, mercury, balsam of Peru, and cinnamic aldehyde sensitivities were demonstrated. Less important factors included atopy, fungal and bacterial infections, and irritation. Although the mechanism of this sterile pustulosis response does not depend solely on delayed hypersensitivity mechanisms, we believe that we have demonstrated such a large number of positive patch tests in this chronic pustular dermatosis that patch testing should be considered in the routine work-up of these patients.

Terbinafine-induced acute generalized exanthematous pustulosis confirmed by a positive patch-test result

Terbinafine-induced acute generalized exanthematous pustulosis confirmed by a positive patch-test result

Utility of a standard allergen series alone in the evaluation of allergic contact dermatitis: A retrospective study of 732 patients

Patch testing remains the standard for the diagnosis of allergic contact dermatitis. The validity and usefulness of a standard patch test allergen series has not been addressed adequately by previous studies. We sought to examine the utility of the standard allergen series as a sole screening tool in the diagnosis of allergic contact dermatitis. The charts of 732 patients referred for patch testing were reviewed for positive patch test results. The group of patients with positive reactions was stratified into two groups based on the clinical relevance of their reactions. These groups were subsequently analyzed to determine whether the reactions were to part of the standard series of allergens or to part of a supplementary group. Of patients tested, 50% had a positive patch test. Of those, 221 (30%) had reactions deemed clinically relevant. Only 23% of patients with positive patch tests reacted to an allergen(s) in the standard series exclusively. When adjusted for clinical relevance, only 15.7% of patients were completely evaluated with the standard series of 20 allergens. The standard allergen series of 20 allergens available in the United States is limited as a screening tool when used alone in the evaluation of patients with allergic contact dermatitis.

Drug-Induced Acute Generalized Exanthematous Pustulosis With Positive Patch Test Results

Drug-Induced Acute Generalized Exanthematous Pustulosis With Positive Patch Test Results

Drug-Induced Acute Generalized Exanthematous Pustulosis With Positive Patch Test Results

Drug-Induced Acute Generalized Exanthematous Pustulosis With Positive Patch Test Results

Drug-induced acute generalized exanthematous pustulosis with positive patch test results

Drug-induced acute generalized exanthematous pustulosis with positive patch test results

Anaphylaxis to 6-α-methylprednisolone in an eight-year-old child

Corticosteroids are widely used in the treatment of several diseases, including allergic or pseudoallergic reactions. It is therefore somewhat ironic that they may be responsible for adverse events and provoke allergic or allergic-like reactions. Allergic reactions to hydrocortisone have been reported since the 1950s. 1,2 These reactions may be immunologic or nonimmunologic in nature, and they are very rare. Allergic contact dermatitis caused by corticosteroids, however, seems to be more common, and prevalences near 4% have been reported in recent studies of patients who have undergone patch testing? Hydrocortisone and methylprednisolone are the most common drugs involved in systemic adverse reactions. Prednisone, betamethasone, and dexamethasone are reported less frequently as causative agents?, 2, 6 Allergic or pseudoallergic reactions to systemic corticosteroid therapy include bronchospasm, ~, 2, 4, 5 urticaria with or without angioedema,1, 2, 6 and anaphylaxis. :l, 2, 7 Previous contact dermatitis resulting from topical corticosteroid therapy may occasionally predispose the patient to a generalized reaction after systemic corticosteroid therapy. 6 We report a case of anaphylaxis resulting from an intramuscular injection of 6-e~-methylprednisolone. Type 1 hypersensitivity was proved by a positive skin test response. Other corticosteroids were tolerated.

Contact sensitivity to menthol and peppermint in patients with intra-oral symptoms.

We report 12 cases of contact sensitivity to the flavouring agents menthol and peppermint oil in patients presenting with intra-oral symptoms in association with burning mouth syndrome, recurrent oral ulceration or a lichenoid reaction. The patients were referred from the Glasgow Dental Hospital over a 4-year period for assessment of the possible contribution of contact sensitivity to their complaints. 5 patients with burning mouth syndrome demonstrated contact sensitivity to menthol and/or peppermint, with 1 patient sensitive to both agents, 3 positive to menthol only and 1 to peppermint only. 4 cases with recurrent intra-oral ulceration were sensitive to both menthol and peppermint. 3 patients with an oral lichenoid reaction were positive to menthol on patch testing, with 2 also sensitive to peppermint. 9 of the 12 cases demonstrated additional positive patch test results. After a mean follow-up of 32.7 months (range 9-48 months), of the 9 patients that could be contacted, 6 patients described clearance or improvement of their symptoms as a consequence of avoidance of menthol/peppermint.

Immediate and delayed hypersensitivity reactions to birch pollen in patients with atopic dermatitis.

We investigated immediate and delayed hypersensitivity to birch pollen in 10 patients with atopic dermatitis (AD) who had experienced a worsening of their eczema during the birch pollen season. The patients were prick- and patch-tested and antigen-induced basophil histamine release and lymphocyte proliferation were measured. 9/10 birch pollen-allergic patients proved positive in the histamine release test and the results correlated with specific IgE levels measured by RAST. Birch pollen antigen induced lymphocyte proliferation in 6/10 patients, but a positive patch test result was obtained in only one case. Both peripheral blood monocytes and purified epidermal Langerhans' cells were able to present birch pollen antigen to T cells, although Langerhans' s cells seemed to function less efficiently in this respect.

Occupational dermatoses and allergy to metals in Polish construction workers manufacturing prefabricated building units

The incidence of dermatoses and allergy to metals (Cr, Co, Ni) was determined in 1782 workers exposed to cement, waste fly ash and asbestos cement. They were also exposed to reclaimed (used), mineral oils. Dermatitis was found in 23.6% of the subjects, and oil acne in 11.2%. Allergy to chromium was found in 23% of the subjects; the % of definitely positive patch test results (the total of positive +(+) and strongly positive +(+)+ was, however, 8.6%. Allergy to cobalt was found in 13.4% of the subjects examined (definite in 3.1%). Allergy to nickel was found in 2.7% of the subjects (definite in 1.1%). The risks of occurrence of occupational skin disease and allergy to metals in subjects exposed to ash were found to be lower than in subjects exposed to cement, and were similar to those in subjects exposed to asbestos cement. Overall chromium, cobalt and nickel contents in ash and asbestos were higher than in cement. Soluble chromium compound content in ash was lower than in cement from European countries and similar to that in American cement.

化粧品皮膚炎 その貼布試験陽性結果，臨床，アトピー素因との関係について

Although cosmetic manufacturing has progressed significantly, we still see a lot of skin problems caused by cosmetics. We patch tested 307 patients who showed signs of cosmetic contact dermatitis on the face from using their own cosmetics. The most common sensitizers were hair dyes, especially paraphenylenediamine (PPDA). Eighty-six of the 307 patients were assessed with patch tests for 23 perfumes, 16 tar dyes, preservatives, bases and 7 other items. Perfumes were frequently identified as allergens such as hidroxycitronellal, which turned out to be the most common sensitizer. The eighty-six patients were divided into 7 groups according to the clinical features and were discussed in terms of the period of onset and their age distribution. The relationship between positive patch test results and atopy is also reported.

Identification of cross-reaction patterns in allergic contact dermatitis from topical corticosteroids.

Contact allergy to topical corticosteroids occurs more frequently than previously supposed. Cross-allergic phenomena are common. On the basis of a review of the literature and our own patch test data on 15 patients, we conclude that positive patchtests to corticosteroids occur approximately six to seven times more frequently in well-defined groups of structurally-related substances than between corticosteroids of different groups. An analogous substitution pattern on the steroid D-ring or the carbon side chain (C20, C21) seems to have a significant influence on the association of positive patchtest results. This is not the case for other structural variables, such as the presence of a double bond in the steroid A-ring or fluoride substitutions on the B-ring. The effect of other factors such as concomitant sensitization and steroid metabolism in the skin on the development of a corticosteroid polyallergy are analysed, and the specificity and sensitivity of cross-allergy phenomena are evaluated. These are important in the selection of a topical steroid in the future treatment of a corticosteroid sensitive patient.

High-frequency ultrasound measurement of patch test reactions.

53 patients who produced 34 positive patch test reactions (+/- 15, +10, ++4, +++5) had their reactions read by a high-frequency pulsed ultrasonic (A-scan) dermal depth detector with a resolution of 0.05 mm. The positive reactions were compared with both random and regional controls. The machine could not differentiate between + or +/- reactions from the control readings. However, for 75% of ++ cases and 80% of +++ cases, a significant change was confirmed by the detector. It is concluded that the high-frequency ultrasound method is of little use in confirming or quantifying of positive patch test results.

Contact Urticaria to Parabens

Contact urticaria developed in a patient after topical application of paraben-containing compounds. Positive open patch test results and a positive passive transfer (Prausnitz-Küstner reaction) test demonstrated an immunologic mechanism for the patient's skin reaction. The importance of parabens to contact urticaria is described.

A retrospective study of patch test results from 163 patients with stasis dermatitis or leg ulcers. II. Retesting of 50 patients.

Retesting 50 patients with stasis dermatitis after a period of time (3-25 months) revealed significantly less positive patch test results (p less than 0.05). All procedures were, of course, standardized. The main reasons for this were elimination of the sensitization agents in the interim and testing with a less acute skin condition. Allergens that are difficult to avoid, such as the 'para' compounds and balsam of Peru and related substances, show a higher degree of persistence in subsequent patch testing.

Reactions to Nickel

To the Editor.— Recent letters by Fisher and Kellum, Safety of Stainless Steel in Nickel Sensitivity (221:1279, 1972) in response to our article Eczematous Dermatitis From Nickel, (220:1244, 1972) seem to cast some doubt on the ability of nickel in stainless steel surgical implants to cause allergic contact dermatitis. Fisher states that positive results of patch tests to a hard metal like stainless steel may represent only an irritant reaction. As stated in our article, the patient also had a positive result in a patch test for chemical nickel in petrolatum. Fisher also apparently ignored that this patient's unrelenting dermatitis cleared completely and promptly only when the stainless steel screws were removed. He further states that he had never heard of allergic reactions to stainless steel. One of the references in our article 1 presented two documented cases of widespread eczematous dermatitis from internal exposure to nickel in stainless steel

Testing Neomycin Contact Sensitivity

<h3>To the Editor:—</h3> In a letter (<b>201</b>: 143, 1967), Dr. Wolfgang P. Raab questioned the diagnostic value of positive results of patch and intradermal tests done with the concentrations now used to prove neomycin allergy. His conclusions were based on an extrapolation of the results of animal experiments; namely, that guinea pigs, rats, and mice show anaphylactoid (ie, toxic, immediate-type) reactions to intracutaneous injections of 0.1 ml of a 1% neomycin solution. I am aware that intradermal injections of neomycin solutions of this concentration also produce a wheal with a flare in both allergic and nonallergic humans. This type of reaction, however, is not diagnostic of neomycin contact sensitivity. Dr. Raab has confused the issue. It is the delayed eczematous response to tests, not the immediate whealing reaction, that is characteristic of contact sensitivity. Some drugs, apparently "histamine releasers," may cause papular delayed reactions. Intradermal injections of 0.1 ml of

Influence of Ultraviolet Light on Patch Tests

The frequent observation of positive results of both photopatch tests and plain patch tests in patients with photosensitivity to chlorproma-zine (Thorazine®), promethazine (Phenergan®), bithionol and tetrachlorosalicylanilide has puzzled observers. Some (1) have believed that these persons have a double sensitivity (a plain contact sensitivity as well as a photoallergic sensitivity) ; however, recent findings contradict this concept (2, 3). Wilkinson (4), doubting the existence of a true photoallergy, has stated that positive photopatch tests are just an expression of plain contact sensitization “intensified” by light. Shelley (5) has recorded a similar opinion and rejected the concept of photoallergy, stating that in view of the proved ability of the above-mentioned compounds “to produce photodynamic action, as well as to induce allergic contact dermatitis, it would seem that all of the skin changes observed may reflect one or both of these mechanisms rather than a new system.” To clarify this issue, we studied the effect of ultraviolet light on plain patch tests in humans and in guinea pigs.

POSSIBLE DANGER IN USE OF MERTHIOLATE OPHTHALMIC OINTMENT

When the recent article on merthiolate dermatitis by Ellis and Robinson1was presented before the Dermatological Section of the Baltimore City Medical Society, the possibility of a severe ocular complication resulting from the use of merthiolate ophthalmic ointment was discussed. At that time there were no reports of contact dermatitis or of positive results of patch tests with this ointment, nor had proof been presented that merthiolate could cause by contact an inflammation of the mucous membrane. It was the opinion of several discussers that the question of ocular complications should be dismissed until experimental proof of a deleterious effect could be obtained. If merthiolate ophthalmic ointment could cause in a merthiolate-sensitive patient a severe reaction on the conjunctiva and cornea comparable to the cutaneous injury reported by Ellis and Robinson, then the use of this ointment on the sensitive patient would be dangerous and perhaps produce keratitis and