无锡市1065例皮炎湿疹类皮肤病的接触性变应原分析

目的 探讨无锡市皮炎湿疹类皮肤病患者的接触性变应原及其临床意义。 方法 斑贴试剂盒对门诊确诊的1065例皮炎湿疹类皮肤病患者进行斑贴试验,并对结果作统计学处理。 结果 斑贴试验总阳性率83.19%,性别、年龄差异无统计学意义。阳性率居前6位的变应原依次为重铬酸钾、氯化钴、硫酸镍、甲醛、卡巴混合物和芳香混合物。其中重铬酸钾和卡巴混合物的阳性检出率男性显著高于女性,硫酸镍和甲醛的阳性检出率女性显著高于男性,差异有统计学意义（P < 0.01）。氯化钴的阳性检出率中青年组和老年组显著高于儿童组,硫酸镍的阳性检出率中青年组显著高于儿童组,差异有统计学意义（P < 0.05）。结论 重铬酸钾、氯化钴、硫酸镍、甲醛、卡巴混合物和芳香混合物是无锡市引起皮炎湿疹类皮肤病的主要变应原。     

Epicutaneous testing with a standard series. Results in 12,026 patients

From 1977 to 1983, 12,026 patients were given patch tests with a standard series of substances. A total of 4,494 (37.4%) had positive patch-test reactions to one or more allergens; the average number of positive reactions was 1.85. The most frequent reactions were due to nickel sulphate (positive reactions in 9.2% of those tested), fragrance mix (8.9%), balsam of Peru (6.3%), cobalt chloride (4.7%), potassium dichromate (4.3%) and wool alcohols (4.3%). Women showed significantly more positive reactions than men to nickel sulphate, cobalt chloride, wool alcohols, and parabens and significantly fewer positive reactions than men to potassium dichromate, PPD mix, and epoxy resin. Younger patients showed significant more positive reactions to nickel sulphate and cobalt chloride; middle-aged patients reacted more to potassium dichromate, paraphenylendiamine, formaldehyde and thiuram mix; elderly patients reacted to balsam of Peru, wool alcohols, caine mix, neomycin sulfate, benzocaine, colophony, clioquinol, mafenide, parabens, and gentamycin sulfate.     

Relevance of positive patch test reactions in patients attending a dermatology tertiary referral centre

Our purpose was to determine the proportion of relevant patch test reactions among all patch tested patients in the National Skin Centre (NSC), Singapore, from 1 January 1999 to 31 December 2000. A retrospective study was made of the patch test records of all patients patch tested in the study period. The proportion of relevant patch tests in this population was then determined. The allergens most likely to have present or past relevance were: nickel sulfate (79%), p-phenylenediamine (76%), colophonium (73%), cobalt chloride (68%) and potassium dichromate (67%). The most common allergens for each of the following relevance categories were as follows - present: p-phenylenediamine, thiuram mix, potassium dichromate; past: colophony, nickel sulfate, cobalt chloride; exposed: neomycin, gold sodium thiosulfate, fragrance mix and unknown: gold sodium thiosulfate, potassium dichromate, cobalt chloride. Evaluating relevance is difficult, and the results of relevance scoring vary widely between different groups. A consensus on the definition and standardization of the concept of relevance is needed.     

深圳地区500例过敏性皮肤病斑贴试验结果分析

目的分析深圳地区过敏性皮肤病患者常见的接触性过敏原。方法对来自我科门诊的500例过敏性皮肤病患者进行瑞敏欧洲标准系列斑贴试验,对结果进行统计学分析。结果 500例患者中,斑贴试验总阳性率为49.80%,阳性率列前5位的过敏原依次为硫酸镍(21.20%)、卡松CG(14.40%)、氯化钴(7.40%)、重铬酸钾(5.80%)、甲醛(4.80%),男女斑贴试验阳性率差异无统计学意义,各病种间斑贴试验总阳性率差异有统计学意义。结论硫酸镍是过敏性皮肤病患者最常见的接触性过敏原。     

Concomitant positive reactions to allergens in a patch testing standard series from 1988-1997.

BACKGROUND: Patch testing is a useful diagnostic technique in patients with suspected allergic contact dermatitis (ACD). Concomitant reactions may reflect associations between tested allergens. OBJECTIVE: This study was performed to identify positive correlations between reactions to test substances in a standard screening series. The results of patch testing in patients seen from 1988 to 1997 are described. METHODS: Data were collected from chart review for patients who underwent patch testing to the full standard screening series at the Massachusetts General Hospital Contact Dermatitis Clinic. The Fisher exact test was used to evaluate associations between allergens. RESULTS: A total of 927 patients were patch tested to 22 allergens included in a screening tray. The mean age was 43.9 years, and 68.6% were women. Two or more positive reactions occurred in 36.5% of patients. Reactions to 13 pairs of allergens were found to be significantly correlated: balsam of Peru/fragrance mix, carba mix/thiuram mix, carba mix/paraben mix, cobalt chloride/potassium dichromate, cobalt chloride/nickel sulfate, ethylenediamine/neomycin sulfate, formaldehyde/imidazolidinyl urea, formaldehyde/paraben mix, formaldehyde/quaternium-15, imidazolidinyl urea/quaternium-15, neomycin sulfate/potassium dichromate, paraben mix/quaternium-15, and potassium dichromate/thimerosal. CONCLUSION: Concomitant reactions to 13 pairs of allergens in a standard series occurred at a rate greater than would be predicted by chance. Such associations may reflect cross-sensitization or cosensitization.     

Nickel cobalt and chromium sensitivity in patients with pompholyx (dyshidrotic eczema)

Sixteen patients with negative routine patch tests were challenged orally in a controlled trial with 2.5 mg nickel, 1 mg cobalt, and 2.5 mg chromium given as salts of the respective metals. All of the patients had symmetrical, vesicular hand dermatitis and in some cases also foot involvement. The dermatitis of two patients flared after challenge with cobalt; in two patients flare occurred following chromate ingestion. Prior to the oral challenge all the patients were patch tested with nickel sulphate, cobalt chloride and potassium dichromate after adhesive tape stripping. Solutions of the same metal salts were used for intradermal testing. The intradermal test sites were read after 20 minutes and 48 hours, the patch tests after 48 h. Skin test reactivity correlated poorly to the results of the oral challenge, possibly due to nonspecific skin test reactivity. It is concluded that oral challenge is a valuable adjunctive diagnostic procedure in patients with pompholyx who have negative routine patch tests.     

Prevalence, incidence and course of eczema on the hands and forearms in a sample of the general population

In 1979, the inhabitants of a geographically defined area were examined for skin disorders of the hands and forearms. In 1982 this cohort was invited for re-examination. In persons with eczema, patch testing was performed. Irritant factors were found to play a rôle in 73% of the cases, whereas a contact allergy could be detected in 30%. The must frequent allergens were nickel sulphate (20%), potassium dichromate (6%), land cobalt chloride (4%). In some persons with a definite history of allergy to metals, no positive patch test with nickel, chromate or cobalt could be obtained; other mechanisms may be involved. Significantly more positive patch tests were found among persons with an eczema of longer than 2 years duration compared with persons, with eczema present for a shorter period of time, indicating that many cases of eczema are primarily of irritant nature, but later complicated by sensitisation. In 41%, the eczema was healed. A poor healing tendency was observed in those with a combination or irritant and allergic eczema. Relatively few ascribed healing to medical treatment.     

皮炎湿疹类皮肤病201例斑贴试验结果分析

目的探讨皮炎湿疹类皮肤病患者的变应原,以期更好地诊断与治疗。方法对201例皮炎湿疹类患者进行瑞敏标准变应原系列斑贴试验检测。结果201例患者斑贴试验总阳性率77.6%,变应原阳性率位居前8位的分别是硫酸镍、重铬酸钾、氯化钴、芳香混合物、N-环己基硫酞内酯、夸特15、卡巴混合物、对苯类。男女性患者斑贴试验阳性率差异有显著性的变应原分别为N-环己基硫酞内酯、对苯类、卡巴混合物、夸特15。结论硫酸镍、重铬酸钾、氯化钴、芳香混合物、N-环己基硫酞内酯、夸特15、卡巴混合物、对苯类是目前引起皮炎湿疹类患者的主要变应原。N-环己基硫酞内酯、对苯类、卡巴混合物、夸特15是男性患者的主要变应原。     

False-positive, follicular and irritant patch teat reactions to metal salts

853 hard metal workers were patch tested with nickel sulphate 5%, potassium dichromate 0.5% and cobalt chloride 1%, each in petrolatum. Non-allergic reactions appeared in 6.5% of the nickel tests, 13% of the chromium tests and 18.3% of the cobalt tests. Most of the individuals with positive, poral or pustular reactions were retested with serial dilutions of metal salts in pet. and in water. The accuracy of a positive initial nickel reaction was 83%, a chromium reaction 40% and a cobalt reaction 62%. The nonallergic reactions were partly reproducible and correlated with both the type of patch test material and with individual factors. Weak and moderately strong positive patch test reactions to metal salts may be irritant and should be checked with serial dilution tests or at least be retested. A reduction of the cobalt chloride concentration from 1% to 0.5% in the standard test material is discussed.     

Is the European standard series suitable for patch testing in Riyadh,Saudi Arabia?

Due to the lack of a regional patch test series in our geographical area, the suitability of the European standard series was evaluated by patch testing dermatitis patients in Riyadh, Saudi Arabia. Of 240 consecutive patients with various forms of dermatitis, 136 (57%) showed 1 or more positive patch tests, women, 74 (54%), slightly outnumbering men, 62 (46%), Positive reactions were found to 21 of the 22 items in the test series. Sensitization was most common to nickel sulfate (51=37.5%), potassium dichromate (48=35%) and cobalt chloride (43 = 32%). The frequency of sensitization to nickel was higher in women (41=30%) while that to dichromate was higher in men (39=29%). Less reactions were found to fragrance mix (21 = 15%). formaldehyde (15=11%) and neomycin sulfate (15=11%). Sensitization to other allergens ranged between 10 and 1%. Less than 1% of patients (0.7%) reacted to benzocaine and none to primin. The frequency of occurrence of multiple sensitivities is also presented. We conclude that the European standard series is suitable for patch testing dermatitis patients in our region, with the exception of benzocaine and primin. The addition of 3 allergens that could be of local relevance is discussed.     

Patch testing of nickel sulfate and potassium dichromate with a standardized ready-to-use test system gives highly reproducible results: a double-blind multicentre study

There is still some doubt about the reproducibility of patch tests. A sound assessment needs optimized and unbiased studies. This study analysed the results of a double-blind multicentre study with nickel sulfate and potassium dichromate patch tests attached synchronously to both sides of the back of patients with a history of nickel allergy, conducted with a highly standardized randomized test system (TRUE-test). Out of 589 patients tested, a total of 388 had responded with allergic reactions to nickel sulfate and 130 to potassium dichromate. The reproducibility of positive nickel (dichromate) patch tests was 99.2% (90.8%). The reaction index was also calculated, which relates the number of allergic reactions obtained with a test preparation to the number of questionable and irritant reactions; the reaction index can range from -1 (questionable and irritant reactions only occur) to 1 (allergic reactions only occur). For nickel sulfate the reaction index was 0.91, but it was only 0.23 for potassium dichromate, as a result of considerably more questionable reactions. In conclusion, a highly synchronous reproducibility of results can be achieved by using a well-standardized patch-test system, especially with nickel sulfate. However, distinct allergens and test systems need to be evaluated separately.     

Contact hypersensitivity and allergic contact dermatitis among school children and teenagers with eczema

Background:  Patch testing is an essential procedure in the investigation of eczema in children.
Objectives:  To analyse the frequency of contact hypersensitivity and allergic contact dermatitis among Polish children with eczema.
Patients/methods:  During an allergy screening programme involving 9320 children aged 7 and 16 years, 12.6% reported symptoms of chronic/recurrent eczema. From this group, a representative sample of 229 eczema children underwent patch testing: 96 children aged 7 years and 133 teenagers aged 16 years. Patch testing was with 10 allergens: methylchloroisothiazolinone/methylisothiazolinone (MCI/MI), nickel sulfate, mercury ammonium chloride, thimerosal, cobalt chloride, potassium dichromate, lanolin, fragrance mix I, Myroxylon pereirae (balsam of Peru), and colophonium.
Results:  49.4% tested children were found patch test (PT) positive. 43.8% of 7 year olds with eczema were PT positive, with sensitization to nickel sulfate (30.2%), thimerosal (10.4%), cobalt chloride (8.3%), fragrance mix I (7.3%), MCI/MI (6.3%), potassium dichromate (6.3%), M.   pereirae (3.1%), mercury ammonium chloride (2.3%), and colophonium (1.0%). 52.6% teenagers were PT positive, with sensitization to nickel sulfate (23.3%), thimerosal (27.8%), cobalt chloride (10.5%), potassium dichromate (6.0%), mercury ammonium chloride (2.3%), M. pereirae (1.5%), and MCI/MI (0.8%). The final diagnosis of allergic contact dermatitis was confirmed in 36% of 7 year olds and 26% of 16 year olds.
Conclusions:  Every second child with eczema is PT positive, whereas every third child is finally diagnosed with allergic contact dermatitis.     

Epicutaneous patch test results in children and adults with allergic contact dermatitis in Karlovac county: a retrospective survey

The aim of the study was to evaluate the results of epicutaneous patch testing with a standard series of contact allergens in children suspected to have allergic contact dermatitis (ACD), and to compare the results of patch testing between children and adults. Clinical records of children defined as patients aged ≤18 years and adults examined at Department of Dermatology and Venereology, Karlovac General Hospital, for suspicion of ACD during the 1994-2009 period were reviewed. Epicutaneous patch testing with a standard series of contact allergens, manufactured by the Institute of Immunology, Zagreb, Croatia, was performed in group 1 consisting of 412 children (274 female and 138 male, mean age 13.4 years, range 4-18 years) and group 2 consisting of 4440 adult patients (2918 female and 1522 male, mean age 40.3 years, range 19-81 years). The most common six allergens differed between the two groups. Adult subjects were divided into three age subgroups: 19-40 (n=1708), 41-60 (n=1570) and 61-81 (n=1162 subjects). The high sensitization rate in younger subgroup and lower sensitization rate in the oldest group compared to adult patient group as a whole was statistically significant (P<0.05). In children, the most common positive reactions were recorded to nickel sulfate (25.4%), thimerosal (17.8%), cobalt chloride (11.6%), fragrance mix (8.9%), white mercury precipitate (6.2%), formaldehyde (4.7%) and other allergens (25.4%). In adult patients, positive reactions were most common to nickel sulfate (32.6%), cobalt chloride (10.8%), fragrance mix (9.0%), wood tars (7.1%), potassium dichromate (6.6%), balsam of Peru (5.1%) and other allergens (28.8%). The group of children included 179 (43.4%) atopic subjects (according to Hanifin and Rajka criteria) and 233 (56.6%) non-atopic subjects. There was no statistically significant between-group difference and no statistically significant difference in nickel sulfate, cobalt chloride, fragrance mix and balsam of Peru sensitization between children and adult patients. A higher sensitization rate in children versus adults was recorded for thimerosal, white mercury precipitate and formaldehyde. Less frequent sensitization in children versus adults was found for wood tars and potassium dichromate. It is concluded that pediatric ACD exists and is more common than previously recognized. Sensitization to allergens differs between children and adults.     

Contact Dermatitis in Salvador, Brazil

In Salvador, Brazil, 536 patients were patch tested with 24 contact allergens. The most common sensitizers included potassium dichromate, thimerosal, hydroquinone, nitrofurazone ointment and nickel sulfate. The results of this South American study are compared with those published by North American and European dermatologists. Low frequencies of positive reactions were encountered in Salvador to some substances, including mercury bichloride and p -phenylenediamine. The influences of climate and life style in determining patterns of contact sensitivity are discussed.     

Nickel release from tools on the Swedish market

200 patients (122 male, 78 female) with suspected allergic contact dermatitis were patch tested with the European standard series (ESS) and the results compared with other Asian centres. 131 (65.5%) patients showed 1 or more patch test positives to the ESS. Patch tests were positive to all allergens except primin. Potassium dichromate was the most common allergen (20.5%) followed by nickel sulfate (16.5%), SQL mix (14%), PPD (11.5%), cobalt (8%), fragrance mix (7.5%), formaldehyde (6.5%), colophony (5.5%), neomycin sulfate and mercapto mix (5% each). In women, nickel sulfate was the commonest allergen (30.8%) followed by SQL mix (16.7%) and potassium dichromate (15.4%). In men, potassium dichromate was the commonest sensitizer (23.8%) followed by SQL mix and PPD (12.3% each). Our results are at variance with other centres in Asia. SQL mix was able to detect less than ½ (42.2%) of patients allergic to ethanolic dilutions of ether extracts of parthenium. We conclude that the European standard series, with exclusion of primin, is suitable for detection of allergic contact dermatitis in India. However, SQL mix is not a adequate screen for parthenium sensitivity and patch testing with extracts of the plant should be continued, wherever indicated.     

Retrospective survey of patch testing at department of dermatology and venerology, zagreb university hospital center in zagreb, croatia

Epicutaneous (patch) test is a standard test to confirm contact allergy. During a six-year period (1998-2003), contact allergic dermatitis was diagnosed in 4132 (65%) of 6341 patients using standard patch test with a Croatian series of allergens according to the International Contact Dermatitis Research Group (ICDRG). The most common clinical diagnoses related to contact allergy (male; female) were contact allergic dermatitis (65.4%; 72.2%); atopic dermatitis (15.9%; 11.7%); contact irritant dermatitis (7.0%; 6.6%) and nummular eczematoid dermatitis (4.2%; 2.4%). According to occupation, positive patch test reaction was most commonly observed in workers, whereas 65% of patients showed positive reactions to one or more substances. There was an increased frequency of positive patch test reactions to potassium dichromate, nickel sulfate, thimerosal and neomycine sulfate, along with a significant decrease in the frequency of positive patch test reactions to cobalt chloride, carba mix, wood tars, detergents, parabens mixture, urushiol and rubber mixture. We strongly recommend keeping up-to-date with the epidemiology of contact allergy in Croatia.     

Prevalence of delayed hypersensitivity to the European standard series in a self-selected population

There are limited reports of the prevalence of positive reactions in healthy adults to patch tests with standard allergens; there are no recent comprehensive studies from Australia. Healthy adult volunteers (n = 219) from the Western Australian community were patch tested using the European standard series of allergens. Seventy-seven (35%) reacted to at least one allergen, positive patch tests being most prevalent to nickel sulfate (20%), potassium dichromate (9%), cobalt chloride (6%) and fragrance mix (4%). Prevalence of positive patch tests to nickel and chromate was higher than that reported for another healthy population, which may stem from self-selection of volunteers or geographical differences, including extent of exposure to allergens.     

Standardization of patch tests in Japan

In order to standardize patch tests in Japan a comparative study of our former method of patch testing with that recommended by the International Contact Dermatitis Research Group (ICDRG) was carried out with the collaboration of dermatologists in the Mid-Japan Dermatological Society.
The following differences were observed between the two methods of patch testing: 1. Four out of five ICDRG allergens which were common in Japanese standard allergen series – formaldehyde, potassium dichromate, cobalt chloride and nickel sulfate – showed higher reactivity than those of Japanese allergens. The other allergen, paraphenylenediamine (PPD), showed the same reactivity as Japanese PPD. Cobalt chloride of ICDRG origin showed a particularly higher reactivity than the Japanese one (α=0.05).
2. Higher reactivity was observed al the 48-h reading when aqueous reagents were patch-tested using Torii-Ban, Miniplaster and Leukotest, which are all popular in Japan. This higher reactivity could be attributed to the lint gauze of plasters which are pre-treated with fluorescent whitener.
3. The incidence of reactivity of the ICDRG allergens in Japan was also studied in order to establish a new standard allergen series.     

Allergic contact dermatitis to metal allergens in Iran

Background Metallic allergens such as nickel are among the most common causes of allergic contact dermatitis (ACD), but frequencies of contact dermatitis to these allergens may vary in different areas. Objectives This study aimed to determine the frequencies of ACD caused by three common metallic allergens: nickel sulfate; potassium dichromate; and cobalt chloride. Methods Data for 1137 patients with clinical diagnoses of contact dermatitis and/or atopic dermatitis evaluated by patch testing in Iran during a 5‐year period were retrospectively studied to establish the frequencies of hypersensitivity to these metallic allergens. Results A total of 313 patients (27.5%) gave positive patch test results for at least one metallic allergen. Allergy to nickel (229 cases, 20.0%) was the most commonly observed, followed by allergy to cobalt (90 cases, 8.0%) and allergy to chromium (70 cases, 6.2%). Nickel allergy was significantly more frequent in females and in subjects aged <40 years, whereas chromium hypersensitivity was more common in males and in subjects aged >40 years. Sensitivity to nickel or chromium was a risk factor for cobalt allergy. Conclusions Nickel was most commonly identified as a metallic allergen in Iran and tended to affect women aged <40 years. Regulations pertaining to nickel release may decrease the frequency of nickel hypersensitivity in Iran.     

过敏性皮肤病患者的接触性变应原分析：基于883例斑贴试验

目的 了解过敏性皮肤病患者接触性变应原特点。方法 回顾性分析883例过敏性皮肤病患者斑贴试验结果,并比较不同性别、年龄、疾病诊断的斑贴试验结果阳性率情况。结果 斑贴试验阳性751例(85.05%)。前6位变应原依次为硫酸镍、重铬酸钾、硫柳汞、卡巴混合物、芳香混合物、夸特15。男性患者重铬酸钾(χ²=48.58)和硫柳汞(χ²=4.36)阳性率均高于女性(均P<0.05)。不同年龄组斑贴试验阳性率差异有统计学意义(χ²=22.33,P<0.01),其中18～45岁和46～59岁组硫酸镍阳性率均高于<18岁组(χ²值分别为4.09、12.06,均P<0.01),18～45岁组卡巴混合物阳性率及46～59岁组重铬酸钾阳性率也均高于<18岁组(χ²值分别为7.50、7.47,均P<0.01);18～45岁组硫柳汞阳性率高于>59岁组(χ²=10.28,P<0.01);而18～45岁组夸特15阳性率低于>59岁组...