Use Of Patch Testing Research Articles

Tattoo-induced immunologic reaction to red inks

A 43-year-old male presented with pruritic nodular lesions in the red dye area of his leg tattoo, which developed 4 weeks after its application. Patch tests were performed using a standard series, and the inks used by the tattooist were tested semi-open. Tests identified a sensitization to 2 inks containing an azo-organic dye (Pigment Red 170), diketopyrrolopyrrole (Pigment Red 254), and copper phthalocyanine (Pigment Blue 15). Histopathological findings suggested a pseudolymphoid reaction, likely driven by T-cell hypersensitivity to the red pigments. Although the utility of patch testing in the assessment of tattoo reactions is not consensual, it can be useful in identifying the offending inks, helping to guide future tattoo choices and prevent recurrences. Patch testing including the suspected ink should not be disregarded from the diagnostic workup.

The value of patch testing with plants "as is" in diagnosing plant sensitization.

The number of commercially available plant allergens/extracts is limited and therefore patch testing with fresh/dried plant material may be a necessary supplement in diagnosing plant allergy. To evaluate the usefulness of patch testing with plants "as is" compared to patch testing with commercial and in-house produced plant test materials and to report on species eliciting positive patch test reactions. Consecutive eczema patients, who were patch tested between January 2019 and December 2023 and who had at least one positive reaction to a plant allergen and/or extract and/or plant "as is" were included in the study. A total 57 out of 1893 patients tested (3%) were sensitised to plants. Compositae plants were the most frequent sensitizers, followed by tomato, tulipalin A, falcarinol, and Philodendron plants. In 12 patients (21%), the diagnosis was based on patch testing with fresh plants only. Occupational sensitization occurred in 32%. Other sensitizers included Hydrangea, Pelargonium zonale, and Monstera. A large minority of plant-sensitised patients would have been undiagnosed without patch testing with plants "as is." Most of the culprit plants were known sensitizers, but not commercially available, and these and new species taken into cultivation makes patch testing with fresh plants unavoidable and worthwhile.

Inflammatory Foot Dermatoses: The Correlation Among Morphological Patterns, Histopathological Findings, and Patch Test Positivity.

Objective In this study, we aimed to investigate the correlation between the clinical diagnosis, histological diagnosis, and patch test positivity among patients with foot dermatoses receiving treatment at the Department of Dermatology, MES Medical College, Perinthalmanna. Methodology A hospital-based cross-sectional observational diagnostic evaluation was carried outfrom January 1, 2019, to December 31, 2019, among 44 patients with foot dermatoses who met the inclusion criteria. A thorough general physical and cutaneous examination was performed to determine the type, extent, and morphology of lesions after obtaining the written informed consent; sociodemographic informationand a thorough recording of patient history were gathered. In all cases, a potassium hydroxide (KOH) mount, skin biopsy, and patch testing were performed. Additionally, pus culture and sensitivity tests were conducted in pertinent cases. Results Our study found that the most prevalent foot dermatosis, based on clinical diagnosis, was allergic contact dermatitis (ACD) foot, affecting 26 patients (59.0%). This was followed by plantar psoriasis, observed in 13 patients (29.5%), and lichen planus, present in two patients (4.5%). The predominant histological diagnosis was ACD foot in 11 patients (25.0%),followed by plantar psoriasis in 10 patients (22.7%), spongiotic dermatitis in seven patients (15.9%), atopic dermatitis (AD) and psoriasiform dermatitis in four patients (9.1%) each, and tinea pedis in two patients (4.5%). The sensitivity of patch testing in detecting ACD foot was 90.91%, whereas its specificity was 57.58%. The positive and negative predictive values(PPV and NPV) were 41.67% and 95.0% respectively. Conclusions Based on our findings, histopathological evaluation is a highly effective diagnostic technique for foot dermatoses, as it demonstrated exceptional diagnostic accuracy (p<0.001). The sensitivity of patch testing in identifying ACDof the foot was 90.91% (p<0.05). This highlighted the usefulness of patch testing as a confirmatory diagnostic tool along with histopathological evaluation for precise diagnosis of ACD of the foot. While laboratory testing can increase diagnostic precision, it cannot replace a clinical examination.

Metal implant allergy: A retrospective cohort analysis at a university allergy practice.

Background: Concern of metal sensitization in pre- and postsurgical evaluation is growing, with the recent guidelines remaining the criterion standard for consideration of patch testing. Information remains scarce on surgical screening in the groups of patients who reported a history of metal sensitivity versus those with no reported history. Objective: The objective of this study was to assess the utility of patch testing in surgical candidates based on reported metal allergy history. The secondary objective was to evaluate the utility and outcomes in postsurgical patch testing. Methods: Nine hundred and thirty-one patient charts of patients with the diagnosis of "contact dermatitis" who underwent an evaluation at a single allergy clinic site between January 2013 and December 2022 were identified and reviewed as part of a retrospective chart review study. Patients were included in subgroups based on the time of patch testing and history of reported metal allergy. Results: In all, 67 patients underwent patch testing, 10 (14.9%) of whom were surgical candidates without a history of metal sensitivity, 31 (46.2%) of whom were surgical candidates with a history of metal sensitivity, and 26 (38.8%) of whom were postsurgical patients. Twenty-nine (43.3%) of patients had positive patch testing results, with only one (10%) in the presurgical group, 17 (54.8%) in the presurgical with a history of metal sensitivity, and 11 (42.3%) in the postsurgical group. Zero patients in our cohort without metal sensitivity who were undergoing the Nuss procedure had positive reactions on patch testing, whereas two of four (50%) with reported metal sensitivity who were undergoing the Nuss procedure had positive relevant metal reactions. Conclusion: Ambiguity in the utility of patch testing for surgical decision making remains, despite common utilization. Recent guidelines along with coordination of care among the surgeon, allergist, and patient remains the criterion standard of care.

Patch Test in Chronic Urticaria as a Diagnostic Investigative Tool – A Study in a Tertiary Care Center

Abstract Background: Chronic urticaria (CU) is associated with diverse clinical presentations and varied etiology. Contact allergy plays a critical role in the etiopathogenesis of CU; thus, a patch test can be helpful in identifying potential contact allergens. Aims and Objectives: The aim and objective of this study were to study the causative contact allergen in CU using the Indian Standard Battery allergens approved by the Contact and Occupational Dermatoses Forum of India and to establish the use of patch test in CU. Materials and Methods: One hundred clinically diagnosed cases of CU patients attended to the dermatology department for 2 years were evaluated with detailed history and clinical examination and a patch test was done using the Indian standard series. The patches were removed after 48 h and a reading was taken after 30 min. Observations were graded according to the International Contact Dermatitis Research Group recommendations. Results: Hospital-based prevalence of CU among patients attending the dermatology outpatient department was 3%. A positive patch test was observed in 30% of our study cases. Nickel sulfate was the most common allergen followed by fragrance mix. Patch test positivity was more in housewives, followed by farmers, teachers, and construction workers. Conclusion: The patch test can be used as a diagnostic investigative tool for the etiological diagnosis of CU.

Contact allergens in African countries: A review of published patch test studies

AbstractOnly few studies on contact allergy in African countries have been published. The aim of the present study was to provide an overview of the most common contact allergens identified by the use of patch tests in African countries based on a review of the existing literature. A total of twenty‐four publications from eight African countries were initially identified by search in PubMed. The abstracts and method sections were screened, and 15 studies in which patch tests were actually used to identify the allergen causing the allergic contact dermatitis (ACD) were finally selected. Nickel, cobalt, chromium, fragrance mix and p‐tert‐butylphenol‐formaldehyde resin were the dominating contact allergens responsible for 40%–90% of the positive patch test reactions. This study indicates that a targeted effort directed towards prevention, avoidance and regulation of reliably identified contact allergens could reduce the disease burden of ACD considerable in some African countries.

The Lifestyle and the Usefulness of Patch Tests among Elderly Male Patients; Reflections on the Role of T Helper 2 Profile in Allergic Contact Dermatitis

Allergic contact dermatitis (ACD), a T-cell-mediated inflammatory disease, appears in predisposed individuals as a result of exposure to allergens in the environment. This condition is frequently seen as a feminine problem. This investigation presents three examples of male subjects over 60 who recently experienced ACD onset, as determined by the standard series of the European Baseline Series. Our data demonstrate that due to their actual lifestyle and repeated exposures, elderly male patients can develop an ACD to “traditionally female allergens”. Patch tests (PT) in older participants indicate equal effectiveness as compared to every adult. However, allergists should consider the additional reading outside the 48 hours following PT application and interpret mild reactions as positive ones. Our data support the idea that when an initial disease history is ineffective, patch testing may help allergists identify the responsible allergen(s) and help patients further prevent exposure to them. In line with literature reports, our findings indicate that the penetration of concentrated allergens into subepithelial tissue, particularly when the epithelial layer is damaged, may result in an allergic reaction and even the development of ACD, which is probably linked to a T helper 2 response (including the synthesis of IgE). Due to the IgE-mediated antitoxic effect, this alternative might assist organisms by allowing exposure to increased allergen levels. However, further research must be done before this thesis can be evaluated.

Trends in Patch Testing in the Medicare Part B Fee-for-Service Population.

Patch testing is a vital component of the workup for allergic contact dermatitis. There are limited data on changes of patch testing use among Medicare providers, as well as patch testing reimbursement rates. The aim of the study was to evaluate trends in the use of patch testing among various Medicare providers and Medicare patch testing reimbursement. A longitudinal analysis of patch testing claims was performed with the Medicare Part B Physician/Supplier Procedure Summary files from 2010 to 2018. The primary outcomes were the total number and change in the number of submitted patch testing services from 2010 to 2018 by 3 provider groups: dermatology physicians, nondermatology physicians, and nonphysician providers. Secondary outcome measures included Medicare reimbursement amounts and changes in reimbursement amounts for patch test services (total and per 1000 enrollees) from 2010 to 2018 for the 3 provider groups, as well as per patch test service. From 2010 to 2018, submitted patch testing services per 1000 enrollees grew by 89.0%. The annual trend estimate for submitted services relative to 2010 was +10.1% (95% confidence interval [CI] = 8.1 to 12.0) for physicians and +34.1% (95% CI = 32.1 to 36.0) for nonphysician providers (physician assistants and nurse practitioners). Among physicians, the annual trend estimate for submitted services was +5.1% (95% CI = -11.3 to 21.5) for dermatologists and +31.40% (95% CI = 15.00 to 47.81) for allergists. Patch testing increased in the US Medicare population from 2010 to 2018, and this increase was largely driven by nonphysician providers and allergists.

WITHDRAWN: Usefulness of Patch Tests in the Management of Generalized and/or Disseminated Eczema: Experience at a Tertiary Hospital

The Publisher regrets that this article is an accidental duplication of an article that has already been published, https://doi.org/10.1016/j.ad.2022.01.007 . The duplicate article has therefore been withdrawn. The full Elsevier Policy on Article Withdrawal can be found at https://www.elsevier.com/about/our-business/policies/article-withdrawal

Usefulness of Patch Testing With Patient's Own Products in the Diagnosis of Allergic Contact Dermatitis

Background The usefulness of using patient's own products in patch tests for the diagnosis of allergic contact eczema is well known. However, most of the literature is based on case series published decades ago, and they are focused on cosmetics and fragrances. Objective The aim of the study was to evaluate the usefulness of using patient's own products in patch tests for the diagnosis of contact eczema in a contact dermatitis unit, describing the most frequently positive own products, as well as the most frequently responsible allergens. Methods In a 17-year period, 3514 patients were patch tested in our department. In 2429 patients, patch testing with the patients' own products was performed. Results We found that 363 patients (10.33%) reacted to their own products. In 131 cases (3.81%), reacting to their own product was the only clue for detecting the responsible allergen for allergic contact eczema. Most reactions were found for topical medications, moisturizers, and adhesives. Fragrance mix I, methylchloroisothiazolinone/methylisothiazolinone, ketoprofen, and colophony were found to be the allergens most often responsible. Conclusions It is essential to include patient's own products in the study of allergic contact eczema to make a correct diagnosis. In our series, 3.81% of the patients would not have been correctly diagnosed if their own products had not been included in patch tests.

Expanding Patch Testing Beyond the Baseline Series: Usefulness of Customized Antimicrobials, Vehicles, and Cosmetics Series.

Testing cosmetics and their ingredients is essential to avoid missing relevant allergens and to monitor fluctuating incidence of hypersensitivity. The aim of this study was to review the usefulness of patch testing with a customized antimicrobials, vehicles, and cosmetics (AVC) series over 15 years at a single Canadian site. Between January 1, 2005, and December 31, 2019, patients suspected of having cosmetics allergy were patch tested with a 40-allergen AVC series in addition to the North American Contact Dermatitis Group standard screening series. We reviewed the patch test results of 2868 patients. We consecutively patch tested with the baseline series 6103 patients, of which 2868 (47%) were also tested with the AVC series. Of 53 different allergens that were tested at some point, 26 remained in the series throughout the 15-year span. The most common positive allergens were thimerosal (4.52%), polyvidone-iodine (2.25%), propolis (2.06%), sodium metabisulfite (1.94%), dodecyl gallate (1.53%), carmine (1.10%), lauryl glucoside (1.01%), sandalwood oil (0.7%), and tert-butylhydroquinone (0.7%). Although the expansion of the North American Contact Dermatitis Group standard screening series has decreased the yield from the AVC series from 21.1% to 13.9%, it still remains a useful adjunct for patients suspected of having cosmetics or disinfectants allergy.

Patch testing in New Zealand: Barriers to evidence-based care.

Allergic contact dermatitis is a disabling condition, significantly impacting on quality of life, which can only be alleviated by identification and avoidance of a relevant allergen. Patch testing remains the gold standard diagnostic test for allergic contact dermatitis. The consistency with which patch testing is used varies throughout the world. The purpose of this study was to look at the adequacy of current patch testing practice in New Zealand. We undertook literature review of current guidance regarding patch testing and created a web-based survey to evaluate use of patch testing in New Zealand. This was sent to all 75 vocationally registered New Zealand dermatologists. Of respondents, 46% do not perform patch testing. The most commonly cited barriers were lack of nursing support, poor remuneration, time pressure and lack of facilities. 23% noted that public patch testing services are not available in their region. The majority do not record patch test results in a database. Access to and utilisation of patch testing in New Zealand is suboptimal. Increasing services in the public sector requires investment by health boards, as there remains a dermatology workforce shortage in New Zealand. In private practice, patients often find it unsatisfactory to pay for negative tests, and adequate remuneration of patch testing by private insurers is necessary. Surveillance of patch test results at a national level is lacking, and the development of a centralised database to identify common allergens affecting our population is recommended.

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.

Allergic contact dermatitis in patients with frontal fibrosing alopecia: An international multi-center study.

Frontal fibrosing alopecia (FFA) mainly affects the anterior hairline and eyebrows and its etiology and associated factors remain obscure. The aim of this study was to evaluate the allergic contact dermatitis with patch test in patients with FFA. In this prospective study, 20 patients with FFA and 24 age and sex-matched healthy individuals were evaluated with patch testing. Diagnosis was made histologically, clinically and based on dermoscopic findings. Demographic data, age of onset, disease duration and FFA severity index are evaluated in all patients. Positive patch test reaction to one or more allergen was observed in 65% of patients while it was 37.5% in control group (P = .003). There was a significant difference between age (P = .006) and positive patch test results. No statistical significant difference was observed in the results of patch testing and disease duration (P = .519), menopausal status (P = .085), and FFA severity index (P = .573). Our findings suggest an association between FFA and allergic contact dermatitis. The utility of patch testing in FFA patients can explore the role of allergic etiology and may have an enormous impact on the diagnostic potential and quality of life of these patients.

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.

Atopy patch tests may identify patients at risk for systemic contact dermatitis.

BackgroundA subset of patients with positive patch tests demonstrates systemic contact dermatitis (SCD) upon ingestion or inhalation of the allergen. Concern has been raised about the use of patch tests for protein allergens (APTs) to detect SCD in atopic dermatitis (AD) patients.MethodsWe present atopy patch test (APT) data for 97 people. We reviewed APTs and tests for antigen‐specific immunoglobulin E (IgE) to the same allergen in pediatric AD patients. We compared the frequency of APTs as a function of age in AD patients. To study the irritancy potential of APTs, we prospectively tested consenting non‐AD dermatitis patients undergoing evaluation for allergic contact dermatitis and healthy controls to an APT panel.ResultsAPT demonstrated fewer positive results than serum‐specific IgE or skin prick tests to the same allergen. Positive APT to food was more common in children under 3 years, whereas positive APT to aeroallergens were more common in teens and adults. Only positive APTs to dust mite were significantly more common positive in subjects without AD.ConclusionOur aggregate findings suggest that most APTs, but not dust mite, behave like conventional patch tests to low‐potency allergens. They are more likely to be positive in patients with chronically inflamed skin and to identify allergens that cause SCD. The higher prevalence of APT positivity to foods in young children is consistent with food allergy as a trigger of AD (also known as SCD) being more common in children than adults. Positive APTs define patients who may have SCD; negative APTs may guide elimination diets.

Utility of Patch Testing and Lymphocyte Transformation Testing in the Evaluation of Metal Allergy in Patients with Orthopedic Implants.

Total joint arthroplasties are increasingly common orthopedic procedures performed throughout the United States. Implant failure after these procedures occurs due to a number of causes such as infection or mechanical problems, with metal hypersensitivity being an area of growing interest. The nature and mechanism of a causative relationship between metal hypersensitivity and implant failure have been unclear as it is not known whether implant failure occurs due to a previous metal allergy or metal allergy results from secondary sensitization via metal exposure in existing failing implants. Overall, there appears to be growing support and evidence for metal-hypersensitive patients having worse outcomes with regard to total hip and knee arthroplasties. However, there are conflicting recommendations (outside of Nuss procedures) for pre-implant testing for metal hypersensitivity as testing has not consistently been shown to change patient outcomes.

T lymphocyte phenotype of contact-allergic patients: experience with nickel and p-phenylenediamine.

There is considerable interest in understanding the immunological variables that have the greatest influence on the effectiveness of sensitization by contact allergens, particularly in the context of developing new paradigms for risk assessment of novel compounds. To examine the relationship between patch test score for three different contact allergens and the characteristics of T cell responses. A total of 192 patients with confirmed nickel, p-phenylenediamine (PPD) or methylisothiazolinone (MI) allergy were recruited from the Contact Dermatitis Investigation Unit at Salford Royal Hospital. Severity of allergy was scored by the use of patch testing, peripheral blood lymphocytes were characterized for T cell phenotype by flow cytometry, and proliferative activity was characterized by radiolabelled thymidine incorporation. Comparisons were drawn with buffy coat samples from healthy volunteers. Patch test positivity for nickel, PPD and MI was associated with changes in the phenotype of peripheral blood T cells: increases in naïve cells, decreases in regulatory T cell frequency and the CD4+ /CD8hi ratio, and increased expression of the skin-homing marker cutaneous lymphocyte antigen (CLA), particularly for those patients with a +++ patch test score. This increased understanding of the characteristics of the T cell responses to contact allergens may provide parameters with which to better measure health risks associated with skin sensitization.

Using health insurance administrative data to explore patch testing utilization in Ontario, Canada-An untapped resource.

Patch testing is the key diagnostic test for diagnosing allergic contact dermatitis, but there is limited information on the use of patch testing at the population level. To utilize Ontario Health Insurance Plan (OHIP) data to analyse trends in the rate of patch testing in Ontario. Patch testing billing data submitted to the OHIP between 1992 and 2014 were analysed. Two patch test billing codes were investigated: one for work-related testing (G198), and one for non-work-related testing (G206). Rates of patch testing overall were calculated, and trends over time were described. There were 51 576 patch test billings: 48 416 non-work-related and 3160 work-related. The annual rate of non-work-related patch testing (G206) ranged from 11.9 per 100 000 people to 25.9 per 100 000 people, increasing over time. The rate of work-related patch testing (G198) ranged from 0.17 to 2.32 per 1 000 000 people, and was relatively stable. The overall distribution of billing by specialty was 70% dermatology, 19% other medical subspecialties, and 10% paediatrics and family medicine. Administrative health data can contribute to a more complete understanding of patch test utilization at the population level and, over time, can be used to track patch testing practices.

Dermatite de Contacto Alérgica em Idade Pediátrica: Estudo Retrospectivo

Introdução: A dermatite de contacto alérgica em idade pediátrica, habitualmente considerada pouco frequente, tem sido recentemente objecto de numerosas publicações associadas a um aparente aumento da sua prevalência. Tal pode ser devido a exposição e sensibilização mais precoce a alergénios de contacto ou à mais ampla utilização de testes epicutâneos, cruciais ao diagnóstico desta patologia.Métodos: Com o objectivo de avaliar as características e causas da dermatite de contacto alérgica em idade pediátrica, foram analisados os processos clínicos dos doentes com &lt; 18 anos que efetuaram testes epicutâneos entre Janeiro de 2005 e Dezembro de 2014 na Unidade de Alergologia de Contacto do Serviço de Dermatologia dos HUC. Avaliaram- -se os seguintes parâmetros: sexo, idade, história pessoal e familiar de atopia, localização principal da dermatose, testes positivos a alergénios da série básica ou outros e respectiva relevância, hipótese de diagnóstico e diagnóstico final.Resultados: Foram estudados 106 doentes em idade pediátrica (3,6% do total), 68 do sexo feminino (64,2%) e 38 do sexo masculino (35,8%), quatro com idades compreendidas entre os 3 e 5 anos (3,8%), 28 entre os 6 e 11 anos (26,4%) e 74 entre os 12 e 17 anos (69,8%), 52,8% com antecedentes de atopia e 36,8% com lesões localizadas na face e/ou pescoço. Dos 106 doentes, 51 tiveram pelo menos um teste positivo (48,1%), mais frequentemente no sexo feminino por alergia ao níquel (18,9%). Seguiram-se o cobalto, a p-fenilenodiamina e a mistura de caínas (4,7%) entre os alergénios de série básica e, fora dela, o paládio positivo em cinco crianças. De notar que não observámos testes positivos ao níquel nos últimos dois anos. Doze doentes reagiram apenas a alergénios não incluídos na série básica, sobretudo medicamentos.Discussão: A alergia de contacto e dermatite de contacto alérgica antes dos 18 anos revelaram-se relativamente comuns. O diagnóstico etiológico precoce é importante para evitar a cronicidade das lesões e prevenir possíveis repercussões futuras a nível pessoal e profissional. O conhecimento dos principais alergénios nesta faixa etária poderá orientar medidas preventivas de futuras sensibilizações.