Allergens In Standard Series Research Articles

Allergens causing contact dermatitis of the feet: Investigation and analysis of allergic reaction causes.

Allergic contact dermatitis of the feet is a significant problem that affects the quality of life and requires attention from the medical community due to the number of studied and still unidentified allergens. The purpose of this review article is to summarize the available scientific data regarding the most common allergens that cause ACD of the feet. Nickel sulphate, neomycin sulphate, thiuram mix and colophony occupy a significant place in the prevalence of allergies. The prevalence of sensitization to rubber and leather products can vary depending on the ethno-demographic characteristics of the country, as well as the specifics of a person's professional activity, such as the use of protective waterproof shoes, increased humidity of the microclimate, and atopy in anamnesis. Patch testing has been shown to be an important method for identifying allergens, however, not all footwear components are tested during patch testing with standard allergen series, requiring the use of patches made from patient shoe samples. Expanding the scope of patch testing to include other possible allergens is important for the accurate diagnosis of ACD of the feet and a more detailed study of those allergens that were previously considered rare.

Nickel Sensitivity in Patients With Irritable Bowel Syndrome.

Nickel (Ni) is the most common contact allergen in the population. We aimed to investigate whether there is a relationship between Ni sensitivity and irritable bowel syndrome (IBS) in our study. This study was conducted in 50 patients with IBS who were followed up between March 2018 and July 2018, and 40 healthy people as a control group in a single center with a dermatology department. European standard contact allergen series Ni preparate and corticosteroid pomace were applied to the back region of the study subjects. The evaluation was performed at 48, 72, and 96 hours according to the scheme proposed by the International Contact Dermatitis Research Group (ICDRG). Those who reacted at 72 hours were considered to have Ni allergy. Results: The female/male ratio was 24/26 and 18/22 in the patient and control groups, respectively. The mean ages of the patient and control groups were 42.82 (±10.65) and 39.77 (±11.21) years, respectively. Ni sensitivity was present in 40% of the patient group and 17.5% of the control group (p=0.03). We believe that the presence of Ni sensitivity is important in the pathogenesis of IBS disease. In our study, Ni sensitivity was found to be quite high in IBS patients compared to the normal population.

Systematic Identification of Copositivity Groups in Standard Series Patch Testing Through Hierarchical Clustering

Patients are frequently copositive for multiple allergens simultaneously, either due to chemical similarity or simultaneous sensitization. A better understanding of copositivity groups would help guide contact avoidance. To use patient data to systematically determine copositivity groups in the Mayo Clinic Standard Series. In this retrospective cross-sectional analysis, the Mayo Clinic patch test database was queried for pairwise copositivity rates in the 80 allergen Mayo Clinic Standard Series between 2012 and 2021. Data were collected from 3 tertiary care sites of the Mayo Clinic Contact Dermatitis Group and a total of 5943 patients were included, comprising all patients undergoing patch testing to the Mayo Clinic Standard Series allergens. Copositivity rates between every 2 allergens in the 80-allergen Mayo Clinic Standard Series were estimated. After background correction, copositivity rates were analyzed using unsupervised hierarchical clustering to systematically identify copositivity groups in an unbiased manner. Overall, 394 921 total patches were applied to 5943 patients (4164 [70.1%] women, 1776 [29.9%] men, with a mean [SD] age of 52.3 [18.8] years ), comprising 9545 positive reactions. After background correction based on overall positivity rates, hierarchical clustering revealed distinct copositivity groups. Many were supported by prior literature, including formaldehyde releasers, cobalt-nickel-potassium dichromate, acrylates, 3-dimethylaminopropylamine-amidoamine-oleamidopropyl dimethylamine, alkyl glucosides, budesonide-hydrocortisone-17-butyrate, certain fragrances, compositae-sesquiterpene lactone mix, mercapto mix-mercaptobenzothiazole, carba mix-thiuram mix, and disperse orange-p-phenylenediamine. However, novel associations were also found, including glutaraldehyde-sorbitan sesquioleate, benzalkonium chloride-neomycin-bacitracin, bronopol-methylchloroisothiazolinone-methylisothiazolinone, and benzoic acid-iodopropynyl butylcarbamate. This retrospective cross-sectional analysis found that copositivity rates varied between allergens; allergens with extremely high positivity rates demonstrated nonspecific copositivity to multiple other allergens. Background correction based on positivity rates followed by hierarchical clustering confirmed prior known copositivity groups, contaminants and/or excipients leading to copositivity, and novel associations to guide contact avoidance.

Trends in Patch Testing With the Mayo Clinic Standard Series, 2017-2021.

Background: Patch testing to a standard series is used to identify culprit allergens in patients with contact dermatitis. The reaction rates evolve over time based on trends in cutaneous exposures by the general population. Objective: The aim of this study was to analyze the patch test results of the Mayo Clinic standard series in patients tested from 2017 to 2021. Methods: The patch test reactions of standard series allergens tested from 2017 to 2021 were retrospectively reviewed and compared with the results of our prior report from 2011 to 2015 as well as the North American Contact Dermatitis Group (NACDG) report from 2017 to 2018. Results: Of 2667 patients tested, 1683 (63.1%) had at least 1 positive reaction. The 15 allergens with the highest reaction rates were hydroperoxides of linalool 1%, nickel (II) sulfate hexahydrate, methylisothiazolinone, Myroxylon pereirae resin, hydroperoxides of linalool 0.5%, methyldibromo glutaronitrile, neomycin sulfate, cobalt (II) chloride hexahydrate, fragrance mix I, benzalkonium chloride, bacitracin, hydroperoxides of limonene, methylchloroisothiazolinone/methylisothiazolinone, p-phenylenediamine, and textile dye mix. Twelve (80%) of these allergens were also in the top 15 of the most recent NACDG report. Conclusions: Hydroperoxides of linalool and hydroperoxides of limonene are new allergens that have been added to our standard series. These are associated with high reaction rates.

Sensitization to trometamol in patients with delayed local reactions after administration of the Moderna mRNA-1273 vaccine against SARS-CoV-2

Sensitization to trometamol in patients with delayed local reactions after administration of the Moderna mRNA-1273 vaccine against SARS-CoV-2

Changes in Chinese patch testing practices over 13 years: Updated cross-sectional survey and possible international implications.

Patch testing, the standard method for diagnosing allergic contact dermatitis, has been utilized for over 30 years in China. A 2006 survey found that patch testing was widespread among Chinese dermatologists, but the practice and perceptions were unsatisfactory. To evaluate the current situation of patch testing practice and perception, we resurveyed Chinese dermatologists. A cross-sectional survey of Chinese dermatologists was conducted by electronic questionnaires at the 15th National Congress of Dermatology in November 2019. There were 2199 valid questionnaires collected. About 75% of dermatologists performed patch testing; the majority (59.2%) utilized the baseline (standard) allergen series made in China; others used TRUE Test or the Chemotechnique Diagnostics series, a greater share compared with 2006. Most (92.8%) performed only one single reading, more than 2006. About two-thirds offered patient education after patch testing, but only 27% were executed by trained dermatologists. Dermatologists from regional hospitals more likely performed patch testing and had better perception of patch testing. The majority (88.1%) had received patch testing training, which however did not significantly improve dermatologists' perception. There was an insignificant improvement in practice and perception of dermatologists compared with 2006. Further education and studies should be conducted. Similar surveys in other countries would be of interest.

Prevalence of Contact Allergens in Best-Selling Ophthalmic Products.

Ophthalmic products are a common but often overlooked contributor to allergic contact dermatitis. Frequency of allergenic ingredients in over-the-counter ophthalmic products has not been well characterized. The purpose of this study was to determine the prevalence of allergenic ingredients in most commonly bought eye lubricants and contact lens solutions. A product list of Amazon.com's best-selling ophthalmic products was curated by searching for "Best Sellers in Eye Drops, Lubricants & Washes" and "Best Sellers in Contact Lens Care Products." For exploratory analysis, indication, price, consumer ratings, number of reviews, and US Food and Drug Administration approval status were recorded. The products' ingredients were compiled using NLM DailyMed, and products that had 1 or more allergens or relevant cross-reactors on either the 2018 American Contact Dermatitis Society Core Allergen Series or the 2015-2016 North American Contact Dermatitis Group Standard Allergen Series were noted. Forty-eight percent (n = 49) of the total products, (57.8% [n = 37] of eye lubricants, and 31.6% [n = 12] of contact lens solutions) had 1 or more allergens or associated cross-reactors. Identified allergens were benzalkonium chloride, propylene glycol, sorbic acid, amidoamine, sorbitan sesquioleate, chlorhexidine digluconate, lanolin alcohol, parabens, benzyl alcohol, and butylated hydroxytoluene. Awareness of potential allergens is crucial to diagnosing allergic contact dermatitis to ophthalmic products and helping patients navigate online pharmacological chaos.

Patch testing hydroxyethyl (meth)acrylate

Contact allergy occurs when the skin comes into contact with allergens (chemicals that cause allergy), causing sensitisation. This means that if the skin comes into contact with the same allergen again, it can develop an eczema-like reaction known as allergic contact dermatitis (ACD), which affects 20% of people. Patch testing is used by dermatologists to find out what the substance causing the reaction might be. This is done by applying a range of known allergens to patches of the skin to see which trigger a reaction. The baseline (standard) series of patch test allergens is recommended in everyone undergoing patch testing and aims to include the most common allergens which cause ACD. (Meth)acrylate chemicals are the key ingredients in acrylic nails, gel nails and gel polish nails. There are different types of meth(acrylates). The authors of this study from 15 centres in the U.K. decided to add 2-hydroxyethyl methacrylate (2-HEMA) 2% in petrolatum (pet.) to the baseline patch test series in 2016-7, aiming to detect ACD in patients using acrylic nails. Patients with a history of (meth)acrylate exposure, or who tested positive to 2-HEMA, were then selectively tested with a further short series of eight (meth)acrylate allergens. Of 5,920 patients, 1.7% (102) were allergic to 2-HEMA and 2.4% (140) to at least one (meth)acrylate. (Meth)acrylate allergy would have been missed in 0.6% of patients (36) without testing 2-HEMA in everyone. 94% of allergic patients were women. 37 of the 140 were sensitised by working in the nail industry and 97 were sensitised by wearing acrylic nails. Only six people developed the allergy due to exposure to other sources (surgical glue, adhesive medical appliances and printing ink). The authors recommend that 2-HEMA 2% pet. should be added to the British baseline patch test series and suggest a standardised short series of 15 (meth)acrylate chemicals, which is likely to detect most cases of (meth)acrylate allergy.

Contact sensitization to cosmetic series of allergens in patients with rosacea: A prospective controlled study.

Previous studies have documented the cosmetic allergic contact dermatitis due to common cosmetic allergens in standard series and various cosmetic products used in rosacea patients; however, the prevalence of contact sensitization to other cosmetic allergens other than those in standard series is largely unknown. To assess the prevalence of contact sensitization to a European cosmetic series of allergens (Chemotechnique Diagnostics AB, Malmö, Sweden) in rosacea patients and to compare this with the prevalence observed in general population. In this prospective monocenter study, 103 patients with rosacea and 104 control subjects were investigated for contact sensitizations via patch testing the cosmetic series including 49 allergens. At least one positive allergic reaction was observed in 62 (60.2%) rosacea patients, and in 25 (24.0%) control subjects. Compared with control subjects, rosacea patients were statistically more likely to have positive patch tests. The most common allergens giving positive results were octyl gallate (10.68%), dodecyl gallate (8.74%), tert-Butylhydroquinone (7.77%), thimerosal (6.80%), euxyl K400 (6.80%), cocamidopropyl betaine (5.83%), and 2,6-Di-tert-butyl-4-cresol (4.85%). This study shows that rosacea patients show a strikingly high prevalence of contact sensitization to cosmetic allergens. We recommend the additional use of cosmetic series for patch testing, and the careful use of cosmetics in rosacea patients if cosmetic contact sensitivity is suspected.

Trends in Patch Testing With the Mayo Clinic Standard Series, 2011-2015.

Patch testing to a standard (baseline) series of allergens is the screening tool used to identify culprit allergens in patients with contact dermatitis. The allergens and concentrations used in a standard series are constantly evolving to be most relevant to the patients being patch tested. The aim of this study was to analyze the 2011-2015 patch test results of the Mayo Clinic standard series. We retrospectively reviewed patch test reactions of standard series allergens from 2011 through 2015 and compared these results with the 2011-2012 and 2013-2014 North American Contact Dermatitis Group (NACDG) reports. Of 2582 patients included, 1566 (60.7%) had at least 1 positive reaction, and 516 (20.0%) had at least 1 irritant reaction. The 15 allergens with the highest reaction rates (from highest to lowest) were nickel sulfate hexahydrate, methylisothiazolinone, Myroxylon pereirae resin, neomycin sulfate, cobalt (II) chloride hexahydrate, benzalkonium chloride, fragrance mix I, potassium dichromate, bacitracin, methylchloroisothiazolinone/methylisothiazolinone, carba mix, formaldehyde, p-phenylenediamine, quaternium-15, and methyldibromo glutaronitrile. Twelve (80%) of these allergens were also in the top 15 of the most recent NACDG report; the 3 allergens not in the NACDG top 15 allergens were potassium dichromate, benzalkonium chloride, and methyldibromo glutaronitrile (the latter 2 allergens are not included in their series).

Allergic reactions in oral and perioral diseases—what do allergy skin test results show?

The aim of this study was to examine potential allergic reactions to different materials in oral and perioral diseases. The study included 230 consenting subjects in total-180 patients with oral and perioral diseases (30 patients each in the following groups: angioedema, oral lichenoid reactions [OLRs], burning mouth syndrome [BMS], gingivostomatitis, cheilitis, and perioral dermatitis) and 50 healthy controls. Comprehensive diagnostic workups were performed prior to patch testing with standard series allergens and with specific dental materials and skin prick testing (SPT) for food, preservatives and additives, and inhalants. Positive allergy test results were more common in patients with oral diseases than in controls, with significantly greater frequency of contact allergies in the cheilitis group (P = .048). The most common allergens in the majority patients were cobalt chloride (13.3% in BMS vs 10% in controls) and nickel sulfate (10% in gingivostomatitis and 6.7% in cheilitis vs 3.3% in controls), and preservatives (23.3% in angioedema and BMS). Allergy skin tests are reliable and justified for diagnosing allergies in cases of persistent or recurrent oral diseases. This is the only way to confirm allergies and is the basis for consequent allergen avoidance for the benefit of the patient.

Common Contact Sensitizers among Patients with Hand Eczema: A Multicenter-Study in Nepal

Introduction: Allergic contact dermatitis in Nepal is not an uncommon disorder. Patch testing is a well established method of diagnosing allergic contact dermatitis. Patients with contact dermatitis are well known to have impaired quality of life which often leads to frequent dermatological consultations.Objective: Lack of data from Nepal has prompted us to undertake this study with the aims to know the frequency of allergic contact dermatitis and the commonest contact allergens among the patients with Hand eczema attending the out-patient department of dermatology, B.P. Koirala Institute of Health Sciences and Kathmandu Medical College Teaching Hospital.Material and Methods: A total of 256 patients were included in the study. Out of them 195 with hand eczema agreed to participate and undergo patch testing. The antigens used included the Indian standard series of patch test allergens approved by Contact and Occupational Dermatoses Forum of India.Results: Hundred and ten cases (56.4%) were patch test positive (PTP) at 48 as well as 96 hours to at least one allergen. PTP was seen more commonly in females. The most common allergen in females was nickel sulphate followed by cobalt chloride, gentamicin and mercapto mix while males were positive to potassium dichromate, followed by epoxy resin, fragrance mix and nickel sulphate.Conclusion: Patch testing has proved a useful tool for the detection of allergic contact dermatitis and for identification of contact allergens. When positive reactions correlate with environmental exposure the test usually assists the physician in establishing the cause of dermatitis, hence treating the patients and improving their quality of life.Nepal Journal of Dermatology, Venereology & Leprology, Vol.14(1) 2016, pp.14-17

Frontal fibrosing alopecia: possible association with leave-on facial skin care products and sunscreens; a questionnaire study.

Since its first description in 1994, frontal fibrosing alopecia (FFA) has become increasingly common, suggesting that environmental factors are involved in the aetiology. To identify possible causative environmental factors in FFA. A questionnaire enquiring about exposure to a wide range of lifestyle, social and medical factors was completed by 105 women with FFA and 100 age- and sex-matched control subjects. A subcohort of women with FFA was patch tested to an extended British standard series of allergens. The use of sunscreens was significantly greater in the FFA group compared with controls. Subjects with FFA also showed a trend towards more frequent use of facial moisturizers and foundations but, compared with controls, the difference in frequencies just failed to reach statistical significance. The frequency of hair shampooing, oral contraceptive use, hair colouring and facial hair removal were significantly lower in the FFA group than in controls. Thyroid disease was more common in subjects with FFA than controls and there was a high frequency of positive patch tests in women with FFA, mainly to fragrances. Our findings suggest an association between FFA and the use of facial skin care products. The high frequency of sunscreen use in patients with FFA, and the fact that many facial skin care products now contain sunscreens, raises the possibility of a causative role for sunscreen chemicals. The high frequency of positive patch tests in women with FFA and the association with thyroid disease may indicate a predisposition to immune-mediated disease.

Contact Allergy to Polymyxin B Among Patients Referred for Patch Testing

Polymyxin B is not included in most standard contact allergen series. The aim of this study was to determine the prevalence of contact sensitization to polymyxin B in a population of patients referred for patch testing. A retrospective cohort study design was used to collect data on 795 patients referred to the contact dermatitis clinic of the McGill University Health Centre, as well as to the office of one of the authors (L.M.), between March 2014 and November 2015. Patients were patch tested to the North American Contact Dermatitis Group baseline series and polymyxin B sulfate 3% in petrolatum. Out of 795 tested individuals, 18 were allergic to polymyxin B, for a prevalence of 2.3%. The eruptions affected almost all body parts, but mostly the face. The degree of reaction ranged from 1+ to 2+. Isolated reactions to polymyxin B occurred in 9 (50%) patients, whereas reactions to bacitracin and polymyxin B were seen in the other 9. Only 1 patient reacted to bacitracin, polymyxin B, and neomycin (11.1%). Most reactions (12/18) were from past exposure to polymyxin B. Allergic reactions to polymyxin B are not rare, and this antibiotic warrants inclusion in the standard patch testing series.

Occupational dermatitis in health care workers evaluated for suspected allergic contact dermatitis.

Contact dermatitides occur commonly among health care workers (HCWs). To contrast the atopic status and incidence, location, and final diagnosis of skin diseases afflicting HCWs versus non-HCWs (NHCWs) evaluated for suspicion of allergic contact dermatitis (ACD); and among the population diagnosed with ACD, to compare the incidence and occupational relatedness of allergens found in HCWs with the rates observed in NHCWs. Between July 1, 1994, and May 30, 2014, 2611 patients underwent patch testing by the senior author. Of these, 165 were classified as HCWs based on their primary occupation. Statistical analysis was done using a χ test. Health care workers were more likely than NHCWs to be women and to have hand dermatitis. Women, but not men, HCWs suffered more irritant contact dermatitis. Health care workers had significantly more work-related ACD, especially to formaldehyde, quaternium-15, 2-bromo-2-nitropropane-1,3-diol, cocamide diethanolamine (DEA), thiuram mix, carba mix, thimerosal, benzalkonium chloride, glutaraldehyde, and bacitracin. Only patients suspected of having ACD were tested. Our population was geographically limited to metropolitan Kansas City, MO and metropolitan New York, NY. Health care workers suffer more from occupational ACD, especially of the hands, than do NHCWs, including to allergens not present on available standard allergen series.

Retrospective review of the trends and allergens in the patch test standard series in Singapore

Retrospective review of the trends and allergens in the patch test standard series in Singapore

Contact dermatitis in saffron workers: clinical profile and identification of contact sensitizers in a saffron-cultivating area of Kashmir Valley of North India.

Saffron, a bulbous perennial plant belonging to Iridaceae family, is the most expensive cultivated herb that is widely used for industrial and nonindustrial purposes. However, besides its attractive and valuable properties, contact dermatitis due to saffron is an uncommon reported entity. The aims of this study were to determine the clinical pattern patch-testing profile of contact dermatitis in saffron workers and to identify the most common allergens/sensitizers. One hundred ten saffron workers were patch-tested with 39 allergens, which included Indian standard series antigens, plant series antigens, and extracts from different parts of saffron flower. The allergens in Indian standard series accounted for 52.44% of positive reactions. Plant series and different parts of saffron accounted for 47.56% of the positive reactions. Among those patients with positive responses to the supplemental saffron allergens, 83.3% were of present or past relevance. The data observed in the present study confirm that the saffron dermatitis is a distinct clinical entity with characteristic clinical presentation and has a strong significance as an occupational allergen in those handling this plant. Patch testing with different parts of saffron flower has a role to play in finding out the etiological cause.

Evaluation of suspected cosmetic induced facial dermatoses with the use of Indian standard series and cosmetic series patch test.

Awareness about skin beauty or cosmetic elegance has received worldwide attention in the present day youth oriented society. Along with careful detailed history and thorough examination patch test is considered cornerstone in diagnosis of allergic contact dermatitis. Fifty patients suspected clinical diagnosis of contact facial dermatitis due to attended the Department of Dermatology, were included in a hospital based study. The patch test was applied on the upper back of using 32 allergens present in Indian cosmetic series and 20 known allergens in Indian standard battery series procured from Systopic Pharmaceutical Ltd, after applying the patch test, the patient was asked to come after 48h and 72h for reading the results of the patch test. Out of 50 patients there were 32 (64%) females (housewives 36%) patients and 18 (36%) male (farmers 12%). Itching was the most common presenting symptom in 39 patients (78%) least was hypopigmentation and pain in 2%. Forehead was the most common site of involvement in 25 patients (50%) least were cheeks in 15 patients (30%). Erythema was the commonest morphological presentation seen in 36 patients (72%). Hair dye was suspected in maximum number of patients that is 13 (26%). Most common antigen showing patch test positivity was paraphenylenediamine in nine patients (18%). There are significantly more chances of developing positive test reaction with Indian standard series compared to cosmetic series. (p=.0053 using Fischer Exact test). In India there is no legislation regarding labeling ingredients on cosmetics as in the western countries, so labelling of the contents of cosmetic products should be the main challenge in cosmetic dermatitis is to identify.

English

BACKGROUND: Eczema of the hands and feet is one of the commonest conditions encountered in dermatologic practice affecting 1% of adults. The patch test is the only scientific proof of contact allergy, a positive reaction to a correctly prepared and applied patch test confirms the person has allergic contact sensitivity. There are not much studies done on the patterns of lower leg and foot eczema's especially from India. Hence this study tries to determine the patterns of lower leg and foot eczema and also to evaluate the common allergens by patch testing. The aim of this study is: To determine the pattern of lower leg and foot eczema. Confirm the common allergens responsible by patch testing using Indian Standard Series. METHODS: A prospective clinical study was done comprising of 50 clinically suspected cases of lower leg and foot eczema for a period of 2 years from September 2008 to September 2010. The study included 32 males and 18 females. An informed consent was obtained from all the patients and detailed history with particular emphasis on age of onset, site of initial lesion, extent of dermatitis, seasonal variation, aggravating factors and association with atopy were noted. RESULTS: Mean age of 50 patients in this study was 44.52 years with a standard deviation of 15.8 (range 7 - 70 years). The most common age group affected was 46- 60 years (40%), followed by 31-45 years (30%). 32 cases (64%) were males and 18 cases (36%) were females with a male to female ratio of 1.78: 1.0. Out of 50 cases, 23 patients (46%) showed positive patch test result to at least a single allergen. To the 26 allergens in Indian standard series tested, around 19 allergens were found to be positive. Some were having positivity to multiple allergens, giving a total of 51 positive results. Out of which 46 were relevant (90.20%) against which only 5 cases were non-relevant (9.80%) according to the history.

Contact sensitization to cosmetic series of allergens in a general population in Beijing

Cosmetic allergic contact dermatitis (CACD) due to common cosmetic allergens in standard series has been extensively studied; however, the prevalence of contact allergy to other cosmetic allergens other than those in standard series is largely unknown. In this study, the frequency of contact sensitization to a European cosmetic series of allergens (Chemotechnique Diagnostics, Vellinge, Sweden) in healthy university student volunteers were detected in Beijing. Of 201 students studied, fifty-eight exhibited positive results, and 9 of them reported had cosmetics related dermatitis previously. The total positivity rate was not correlated to gender. The leading allergens were thimerosal (19.4%), shellac (3.0%), cocamidopropyl betaine (2.0%), hexamethylenetetramine (1.5%), dodecyl gallate (1.5%), hexahydro-1,3,5-tris-(2-hydroxyethyl)triazine (1.0%) and methyldibromo glutaronitrile (1.0%). The positivity rate of thimerosal patch test in men (9.8%) was lower than that of women (23.6%, P<0.05, Chi square test), but no difference could be found between the prevalence of other cosmetic allergens in men and women (P>0.05, Chi square test). These results suggested that some cosmetic-related contact allergies may be missed by just testing patients with the European standard series or T.R.U.E. test system only, we recommend shellac, cocamidopropyl betaine, hexamethylenetetramine and dodecyl gallate as the additionally candidates for patch testing in patients with suspected CACD.