Cosmetic dermatitis in Chinese eczema patients patch tested with a modified European standard series of allergens

The prevalence of cosmetic allergic contact dermatitis (CACD) in Chinese eczema patients (CEP) has not been reported. The purpose of our study was to analyse CACD in CEP and examine the frequency of patch test (PT) reactions to common cosmetic-related allergens (CRA). 378 consecutive CEP patch tested with a modified European standard series of allergens during a 2-year period in our clinic were analysed. 73 patients (19.3%) were considered as suspected CACD and 37 patients (9.8%) were confirmed. The frequencies of the positive PT reactions in suspected CACD and confirmed CACD to at least 1 CRA were 64.4% and 89.2%, to para-phenylenediamine (PPD) were 31.5% and 59.5%, to fragrance mix (FM) were 27.4% and 32.4% and to imidazolidinylurea were 5.5% and 8.1%, respectively. These results were much higher than those of CEP without cosmetic reactions (26.3% for at least 1 CRA, 5.8% for PPD, 8.8% for FM, and 0 for imidazolidinylurea) (P < 0.01 for all, Chi-square test and Fisher's exact test). These results suggested that CACD is very common in CEP patch tested. PPD and FM are the leading allergens identified. CACD should be strongly considered in CEP with positive PT reactions to PPD, FM and imidazolidinylurea.     

Patch testing and contact allergens in Ethiopia – results of 514 contact dermatitis patients using the European baseline series

Background: Patch testing is essential to diagnose allergic contact dermatitis. Dermatologists in many countries use a baseline (standard) series covering the major allergens responsible for allergic contact dermatitis in their population, with the addition of relevant allergens for the individual patient. However, a baseline series has not yet been developed for Ethiopia. Our objective in this study is to identify common contact allergens to form the basis of a future baseline series in Ethiopia. Methodology: We patch tested 514 subjects with dermatitis according to the recommended procedure using the European baseline series for 1 year. Results: 52.7% of the tested subjects showed positive reaction for at least one allergen tested. The top five contact allergens identified were nickel sulfate, fragrance mix I, cobalt chloride, p‐tert‐butylphenolformaldehyde (PTBP) resin and potassium dichromate. Positive reactions to nickel and PTBP were commoner in females. PTBP positivity was strongly associated with foot eczema. Positive test reactions were commoner in cement workers, notably to potassium dichromate, which was also a commoner allergen in patients presenting with hand dermatitis. There were no reactions to several allergens, including neomycin, benzocaine, budesonide, primin and quaternium‐15. Conclusion: Comparable patch test results with other countries have been shown and the European baseline series can be used as a baseline series in Ethiopia with some modification.     

Standard patch test results in patients with contact dermatitis in Israel: age and sex differences

Previous studies have shown that the prevalence of specific allergens varies by geographic area, population, age and sex. The objective of the present study was to determine the relative frequency of positive reactions to different sensitizers in Israeli patients with clinically suspected contact dermatitis (CD) and to identify possible sex and age differences. A total of 943 consecutive patients were tested for CD using the European standard patch test series. The most frequent allergen was nickel sulfate followed by potassium dichromate and fragrance mix. Positive reactions to nickel sulfate were more common among women, especially those in the younger age group (younger than 40 years). Positive reactions to balsam of Peru were more common among men, especially those in the older age group (40 years or older). This study presents the result of the standard patch test in Israel with stratification according to age and sex. The findings of the present study, combined with reports on geographic/population differences in the prevalence of specific allergens in CD, indicate the need for further investigations to identify prominent local allergens for better adaptation of the standard patch test to local needs.     

The British standard series of contact dermatitis allergens: validation in clinical practice and value for clinical governance

BACKGROUND: All centres use an empirically determined set of 'standard' test allergens for patch testing that contain the commoner environmental sensitizers. Objectives To assess the validity of the British standard series of 12 allergens used in addition to the 23 already in the European standard series. PATIENTS AND METHODS: Results for 3062 consecutive patients patch tested in seven centres across the United Kingdom during the year 2000 were analysed. RESULTS: The additional allergens from the British series and positive rates were: methyl dibromoglutaronitrile 2.4%, carba mix 1.6%, tixocortol pivalate 1.5%, ethylenediamine 1.3%, cetearyl alcohol 0.8%, 2-bromo-2-nitropane-1,3-diol 0.8%, diazolidinyl urea 0.7%, chlorocresol 0.6%, budesonide 0.6%, fusidic acid 0.5%, imidazolidinyl urea 0.5%, and chloroxylenol 0.4%. The allergens with the lowest positive rate in the European standard series were primin at 0.6% and isopropyl-phenyl-para-phenylenediamine at 0.4%. CONCLUSIONS: The 12 allergens in the British series should continue being tested as a standard addition to the European series within the U.K. The collection of data in this manner to allow comparisons between centres shows differences that reflect selection criteria and interpretation of results, and offers a useful tool for audit and clinical governance. Testing fewer than 1 : 2150 population may indicate underprovision of service. Similarly, rates of sensitization for nickel contact allergy above 26% and for fragrance mix above 16% (the upper 95% confidence intervals) should stimulate inquiry into the reasons behind this.     

Contact sensitivity to standard series allergens in 1038 patients with contact dermatitis in Turkey

We planned to determine the frequency of sensitivity to European standard patch test allergens in 1038 patients with contact dermatitis. From 1992 to 2004, 1038 patients with the diagnosis of contact dermatitis were patch tested with the European standard series. Seven hundred and five patients were female (67.9%) and 333 patients were male (32.1%). A total of 336 patients (32.3%) had one or more positive patch test reactions. The most common allergens were nickel (17.6%), cobalt chloride (5.3%), potassium dichromate (4.6%), neomycin (2.4%), fragrance mix (2.1%) and balsam of Peru (2.1%). Contact sensitivity to potassium dichromate and thiuram was significantly more frequent in male patients, whereas nickel and primin sensitivity was significantly more frequent in female patients. Higher sensitivity rates for potassium dichromate, neomycin, balsam of Peru, wool alcohol, fragrance mix and primin were noted in patients over 40 years of age. Sensitivity rates of the standard series allergens were all similar in atopic patients and in non-atopic patients. Metals, neomycin and fragrances are the leading allergens in Turkey. Although fragrances are among the most important sensitizers, sensitivity rates to fragrances and also to preservatives are much lower than the rates in Europe and the US.     

Common contact sensitizers in the Czech Republic. Patch test results in 12,058 patients with suspected contact dermatitis*

The patch test results of 12 058 patients (4416 male and 7642 female) referred to 9 clinics in the Czech Republic between January 1997 and December 2001 were evaluated. Patients were tested with the same series of allergens by using the standardized patch testing method. The current standard tool for diagnosing allergic contact dermatitis (ACD) in the Czech Republic is the Trolab test panel (Hermal, Reinbeck, Germany) which consists of 23 allergens. Only a few data exists on ACD in the Czech Republic. All patients were tested with the 23 allergen European standard series. Of these patients, 7661 (63.5%) had 1 or more positive reactions. On average, there were 2.8 positive reactions per patient. ACD, according to clinical relevance, was diagnosed in 5339 (69.7%) of these patients. The most frequent allergens were metals (22.9%), especially nickel sulfate (13.8%), and followed by Myroxylon pereirae resin (balsam of Peru) (7.3%), fragrance mix (5.8%), formaldehyde (4.2%) and lanolin alcohol (3.0%). Our results were compared with results from other countries. We conclude that the European standard series is suitable for detection of ACD in the Czech Republic.     

Suspected fragrance allergy requires extended patch testing to individual fragrance allergens

This study has been performed to evaluate the efficacy of fragrance mix (FM) as a screen for fragrance allergy. Patients were included if they had had positive allergic reactions to FM, to 1 of the 8 ingredients of FM, to 1 of 14 other fragrance materials, or to their own perfume. 91 patients were studied. There were 65 women and 23 men (in 3, their sex was not recorded) allergic to FM on patch testing. The mean (+/-SD) age was 48.4+/-18.6 years. 22 patients gave a past history of atopic eczema. Dermatitis of the hands (31%) and face (26%) were the most common presenting complaints. 85 patients (93%) had a positive allergic patch test reaction to FM. 22 of the 40 tested to the extended fragrance series were positive to other perfumes as well, and of these, there were 14 reactions (in 9 patients) to allergens not in the FM. In addition, 6 patients were positive only to separately tested fragrance constituents and not to the FM. In conclusion, FM is an accurate screen for fragrance contact sensitivity. However, patch testing to an extended series is needed if there is clinical suspicion of perfume allergy, as otherwise about 7% of patients allergic to fragrances will be missed.     

Analysis of patch testing results in patients with contact dermatitis in Istanbul,Turkey, from 2012 to 2022

Background

Allergens responsible for allergic contact dermatitis (ACD) differ between populations. They can even change over the years with the effect of environmental factors.

Aims

To evaluate the results of patch testing performed in our center.

Methods

In this study, the thin-layer rapid-use epicutaneous (T.R.U.E.) test results of patients with a diagnosis of ACD between 2012 and 2022 were retrospectively evaluated.

Results

In 431 (42.5%) of the total 1012 patients, a positive reaction to at least one allergen was detected in the patch test. Allergen positivity was most detected for nickel sulphate (16.8%), gold sodium thiosulfate (GST) (6.9%), thimerosal (4.2%), fragrance mix (3.4%), carba mix (3.2%), and cobalt dichloride (2.9%). Nickel sulfate and GST sensitivity was found to be significantly higher in women, fragrance mix sensitivity in men, thimerosal sensitivity in individuals aged under 40 years, colophony and balsam of Peru sensitivity in head and neck dermatitis, and carba mix and thiuram mix sensitivity in atopic individuals.

Conclusions

This study presents comprehensive data from Turkey concerning the sensitivity frequencies for allergens included in the T.R.U.E. test.     

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.     

Frequency of immediate reactions to the European standard series

Immediate contact reactions (contact urticaria) can occur after skin contact with a wide range of substances. We studied the incidence of immediate contact reactions (wheal and flare) to the European standard series allergens in 664 patients. Patch tests were first examined at 30 min for immediate patch test (IPT) reactions, and again at D2 and D4 for delayed patch test (DPT) reactions. Almost all the allergens of the European standard series caused IPT reactions. IPT reactions were most commonly seen with Myroxylon Pereirae (balsam of Peru) (113 reactions), fragrance mix (112 reactions), paraben mix (30 reactions) and clioquinol (13 reactions); these reactions were followed by DPT reactions to the same substance in 13.4%, 8.8%, 10% and 7.7%, respectively. For certain substances, patients with (+) IPT reactions had a significantly higher incidence of DPT reactions to the same allergen, as compared to patients with (-) IPT reactions (fragrance compounds p<0.001, formaldehyde p<0.005, thiuram mix p<0.01, paraben mix p<0.05). Thus, perhaps the mechanisms involved in IPT reactions are not the same for all substances. At least for certain substances, an IPT reaction may be related to the development of a DPT reaction.     

Patch testing with European and American standard allergens in Japanese patients

256 patients with a clinical diagnosis of contact dermatitis were patch tested with European standard series allergens in a period from 1976 to 1979. Significant positive reactions were observed with all allergens, among which were paraphenylenediamine (7.8%), wood tars (7.8%), formaldehyde (7.0%), balasam of Peru (6.6%), neomycin (5.1%), ethylene-diamine (0.8%), naphthyl-mix (0.8%), mercapto-mix and PPD-mix (1.2%).
North American Standard Series allergens were also patch tested in another 178 patients in the years 1976, 1977, 1979 and 1980. Similar results were obtained with allergens common to both series and, of the others, ammoniated mercury (12.9%), thimerosal (9.5%), captan (5.6%), and hydroxycitronellal and Caine mix (4.5% each) were positive.     

Primin standard patch testing: 5 years experience

From 1 November 1984 to 1 November 1989. 3075 patients (1949 female and 1126 male) were patch tested with the European standard series, including primin 0.01% pet. 57 positive reactions were obtained (1.8%). About 95% of the patients with positive patch tests were female. 60% of the patch-test-positive patients were above age 60 and 35% above 70 years. The test was negative in all under the age of 20 and rarely positive under the age of 35 years. Only 2 patients had probable patch test sensitization observed 8 and 14 days after application of the test material. 41% of the patients with positive reactions had current primula dermatitis at the time of patch testing. The frequency and high degree of current relevance justify inclusion of primin in the standard series, at least in certain geographical regions. The patch test concentration of 0.01% pet. seems to be correct.     

The European Surveillance System of Contact Allergies (ESSCA): results of patch testing the standard series, 2004

Background The European Surveillance System on Contact Allergies (ESSCA) began in 2001 as project funded by a European Union grant to monitor and evaluate contact sensitization (CS) based on clinical data collected by participating European dermatology departments. Objectives ESSCA aims to detect trends in CS in an international patch test population, monitoring the frequency of CS to (standard series) allergens, evaluating the effectiveness of intervention (e.g. governmental regulations) and improving standardization of the patch test procedure on an international level. Methods In 2004, 31 ESSCA dermatology departments in 11 European countries collected patch test results and medical histories of patients tested with the European Standard Series (ESS) or a local standard allergen series using the multilingual Winalldat/ESSCA database, the German Winalldat/Information Network of Departments of Dermatology (IVDK) database or a locally created database including the items of the ESSCA ‘minimal data set’. Data were sent to the ESSCA data centre where they were imported, pooled, examined for quality and subsequently analysed. Results The departments patch tested 11 643 patients with a standard series, and 44% of the patients tested positive to one or more substances of the ESS. Nickel sulphate, the fragrance mix, Myroxylon pereirae resin, cobalt chloride, potassium dichromate, methyldibromoglutaronitrile and paraphenylenediamine are (still) the most important allergens detected. Several additional substances tested on consecutive patients in some clinics were also examined. Among these allergens, propolis and Compositae mix had a relatively high CS prevalence. Conclusions The expanding ESSCA network continues to provide up‐to‐date information regarding the pattern of CS diagnosed in participating departments across Europe.     

Time trends of contact allergy to a modified European baseline series in Beijing between 2001 and 2006

Background. Monitoring trends of sensitivity rates in a population is useful for epidemiological surveillance. The time trends for sensitivity rates of allergens have not previously been reported in China. Objectives. The aim of the present study was to determine the prevalence and trends of contact allergy in patients with suspected allergic contact dermatitis in Beijing, China. Patients/Methods. A retrospective analysis of all patch test data from our database was performed. A total of 1354 patients with suspected allergic contact dermatitis between 2001 and 2006 were studied. Patch tests with 20 allergens or mixtures of allergens were performed and analysed. Results. Sensitivity to potassium dichromate (50.1%) was most frequent, and sensitivity to imidazolidinyl urea (3.0%) was least frequent. Increasing trends in sensitivity rates for 10 allergens with significant linear regression were observed (p < 0.05), including mercapto mix, black rubber mix, potassium dichromate, formaldehyde, epoxy resin, benzocaine, ethylenediamine dihydrochloride, paraben mix, tixocortol‐21‐pivalate, and sesquiterpene lactone mix. Sensitivity rates for the other 10 allergens remained stable or showed only a trend (fragrance mix) towards an increase (p_trend > 0.05). Conclusions. High sensitivity rates were observed in the study. Significant increasing trends in sensitivity rates for 10 allergens, probably reflecting increasing changes in exposure, were found.