Patients with vulval pruritus: patch test results

Background:  Persistent vulval pruritus is a frequent problem and patients may not show signs of a primary vulval dermatosis. Allergic contact sensitivity is an important factor in such patients but may also occur as a secondary event in women with vulval dermatoses.
Objectives:  We aim to describe women with vulval pruritus who were evaluated for vulval dermatoses. We patch tested to help define or exclude allergens.
Methods:  In a 3-year period, 50 women with vulval pruritus were examined for existence of vulval dermatosis. All the patients were patch tested to the European Baseline Series, medicaments, preservatives, vehicles, cosmetics and products they routinely used.
Results:  Ages of the patients ranged from 22 to 62 years (mean 39.9 ± 9 years) and duration of the diseases ranged from 0.5–360 months (mean 56.1 ± 65.6 months). 52% of the women had at least 1 positive patch test. 8 patients (16%) had 1 or more relevant allergic positive reactions. The relevant allergens were usually cosmetics, preservatives and medicaments.
Conclusions:  Women with vulval pruritus were patch tested to help define or rule our allergens. Contact allergy incidence in these patients is high. The relevant allergens were usually cosmetics, preservatives and medicaments.     

A practical approach to patch testing for cosmetic allergens

Cosmetics are widely used products in our society today. The cosmetic industry is huge and continues to grow. Contact dermatitis to cosmetics is a major issue. Approximately 6% of all individuals patch tested are suspected of having a cosmetic allergic contact dermatitis. Patch testing is the gold standard for evaluating, diagnosing, and directing the management of patients with cosmetic allergic contact dermatitis. Patch testing beyond the standard tray is necessary to accurately diagnose and treat patients, and can be guided, in part, by patient history. Educating patients about the allergens identified via patch testing is crucial in the successful management of these patients.     

Allergy to cocamidopropyl betaine may be due to amidoamine: a patch test and product use test study

Cocamidopropyl betaine (CAPB) is an amphoteric surfactant commonly used in personal care products and surface cleaners. Patch testing with commercially-available CAPB has yielded occasional reactions indicative of allergic contact dermatitis. To determine if subjects with previous positive patch tests would react in provocative use tests of products containing CAPB, and to study various contaminants in commercial CAPB supplies for allergenicity in these subjects. 10 subjects previously positive to CAPB on patch testing used a hair shampoo, hand soap, and body wash containing CAPB for 1–6 weeks or until a reaction developed. Later, they were patch tested to 2 different purity grades of CAPB and 3 possible manufacturing contaminants (dimethylaminopropylamine, amidoamine, and sodium monochloroacetate). 7 of the 10 subject developed dermatitis from 1 or more CAPB-containing products at some point during the study 9 of the 10 use-test subjects were then patch tested, and 6 of these subjects showed a reaction to amidoamine, (0.1% aq.). None reacted to dimethylaminopropylamine (0.1% pet.). 1 subject reacted to CAPB but not to amidoamine. In the follow-up patch testing with CAPB that was free of amidoamine, there were no positive reactions. Most subjects who were patch-test-positive showed a reaction when using CAPB-containing skin and hair care products. The chemical amidoamine, which is used in the synthesis of CAPB and which is a known contaminant of CAPB preparations, is likely to be the actual sensitizer in most cases rather than CAPB itself. The results do not rule out the possibility shin CAPB itself may be an allergen in rare cases.     

The importance of a dedicated patch test clinic

BACKGROUND: A specialist patch test clinic was set up in April 1997 at the Department of Dermatology, South Infirmary-Victoria Hospital, Cork, Ireland. The number of batteries available was expanded from six to 21 and the routine testing of patients to their own products was introduced, as was prick testing for latex hypersensitivity. OBJECTIVES: To assess the impact of introducing this clinic on the detection of allergic contact dermatitis. METHODS: Patch test results for the first full year of operation of the clinic (1998) were compared with those in the year prior to setting it up (1996). RESULTS: Although the number of patients tested rose after the introduction of the new clinic, the difference was not significant as the number of new dermatology general referrals had also risen. Thirty-one of the 91 patients tested in 1996 had positive patch tests compared with 84 of 158 tested in 1998 (P = 0.0036). Eighteen allergens were detected in 1996 and 53 in 1998. Two patients were positive to their own products in 1996, compared with 12 in 1998 (P = 0.04). The commercial batteries were negative in four of these cases. Three cases of latex hypersensitivity were detected in 1998. CONCLUSIONS: The introduction of a specialist patch test clinic resulted in an increase in detected cases of allergic contact dermatitis. The larger range of batteries available and the more widespread testing of patients' own products were the principal factors involved.     

Delayed hypersensitivity to corticosteroids in a series of 315 patients: clinical data and patch test results

Background: Corticosteroids may cause immediate or delayed hypersensitivity. In 1989, based on structural and clinical characteristics, we put forward a classification of corticosteroids into four cross-reacting groups, namely group A, B, C, and D, the latter later subdivided into two subgroups, i.e. D1 and D2. The constituents on the D-ring of the corticosteroid-molecule are considered to have a central role for binding to skin proteins and for cross-reactions patterns; however, halogenation of the molecules is also interfering.
Objective: To study the clinical data and analyse simultaneous positive reactions obtained in a large group of corticosteroid-allergic patients.
Methods: Patch tests were performed with the baseline series, to which hydrocortisone butyrate and prednisolone caproate were added, as well as with the corticosteroids to which the patients had been exposed. Three hundred and forty subjects with a presumed or proven corticosteroid allergy were further investigated with an extended series containing 72 molecules.
Results: Out of 11 596 patients investigated, 315 subjects reacted positively to at least 1 corticosteroid-molecule, with most of them presenting with multiple positive reactions.
Conclusion: A prevalence of corticosteroid allergy of 2.7% was found. Despite validity of the ABCD (sub)classification in many cases, possible adjustments may have to be considered.     

A clinical and patch test study of adult widespread eczema

The purpose of this study was to investigate the role of contact hypersensitivity (CHS) in adult widespread eczema (WE) and to analyse the aetiology of WE. 108 consecutive adult WE patients were patch tested. 352 patients with suspected localized allergic contact dermatitis (ACD) tested in the same period served as a control. The average age of the patients with WE was significantly greater than the control group (47.6 +/- 15.0 v 39.2 +/- 14.9, p < 0.01, Student's t-test). More male patients were found in the WE group (42.6% vs 25.0%, p < 0.01, chi2-test). 71 (65.7%) of the WE patients were patch test positive. ACD was diagnosed in 29 out of 108 (26.9% of the WE patients and 40.8% of the PT positive patients) WE patients. ACD was also suspected in another 42 patients (39.8%), who had at least 1 positive PT result but the relevance of PT was hard to determine. In the remaining 37 patch test negative patients, 2 cases of food allergy were diagnosed by clinical findings and open food challenge test. 1 case of atopic dermatitis was diagnosed. 34 patients (31.5%) were diagnosed as unclassified endogenous eczema. Most of the WE patients with ACD (15/29, 51.7%) were ACD from widespread contact with hair dye during bathing. Most of the WE patients with hair dye ACD were male (male : female = 2.75). The total positive rates of PT in the WE group were no different to the control (65.7% vs 61.5%, p > 0.05, chi2-test). No significant difference was found for the positive rates of common contact allergens. The rate of atopy was no different between the 2 groups either (6.5% v 5.1%, p > 0.01, chi2-test). These results indicated that contact sensitization was very common in adult WE. Neglected widespread contact with contact allergens, especially hair dye, plays a very important role in our adult WE. The roles of age and sex in WE need to be studied further.