Intradermal testing in the diagnosis of allergic contact dermatitis

Contact hypersensitivity may be diagnosed with patch testing or intradermal testing. Although these methods have been used earlier in parallel, patch testing has gradually become the only method in routine diagnosis of contact allergy. Recent findings in corticosteroid contact hypersensitivity have shown that patch testing is not always an optimal method, especially when poor penetrants are used. Therefore, a reappraisal of intradermal testing is presented, based on the literature. Studies employing both patch and intradermal testing are reviewed and the advantages and disadvantages of intradermal tests as compared to patch tests in contact allergy diagnostics are discussed. We find that it might be worthwile to evaluate whether contact allergy to compounds other than corticosteroids may be easier to detect with intradermal than patch test.     

Patch testing in Israeli children with suspected allergic contact dermatitis: A retrospective study and literature review

Background/objectives

Childhood allergic contact dermatitis is recognized as a significant clinical problem. The objective was to evaluate the rate of positive patch tests in Israeli children with clinically suspected allergic contact dermatitis, identify possible sex and age differences, compare results with those in Israeli adults, and review pediatric studies in the literature.

Methods

The study sample included 343 children and adolescents (197 female, 146 male; 1‐18 years of age, mean age 11.8 years) with clinically suspected allergic contact dermatitis who underwent patch testing with a standard pediatric series of 23 allergens at a tertiary medical center from 1999 to 2012. Data on clinical characteristics and test results were collected retrospectively from the medical files.

Results

Ninety‐eight subjects (28.6%) (75 girls [38.1%], 23 boys [15.8%]) had at least one positive reaction. The most frequent reactions were to nickel sulfate, followed by potassium dichromate and cobalt chloride. Nickel sulfate sensitivity was more common in girls, especially those younger than 3 years and older than 12 years. The prevalence of contact sensitization was similar in subjects with and without atopic dermatitis (50% and 51%, respectively).

Conclusion

Nickel is the most common allergen in Israeli children, especially girls. Patch testing should be performed in children with clinically suspected allergic contact dermatitis regardless of atopic background.     

Occupational allergic contact dermatitis and patch test results of leather workers at two Indonesian tanneries

Background. Tannery workers are at considerable risk of developing occupational contact dermatitis. Occupational skin diseases in tannery workers in newly industrialized countries have been reported, but neither the prevalence of occupational allergic contact dermatitis nor the skin‐sensitizing agents were specifically examined in those studies. Objectives. To assess the prevalence of occupational allergic contact dermatitis in Indonesian tanneries, identify the causative allergens, and propose a tannery work series of patch test allergens. Patients/methods A cross‐sectional study in all workers at two Indonesian tanneries was performed to assess the prevalence of occupational contact dermatitis via a questionnaire‐based interview and skin examination. Workers with occupational contact dermatitis were patch tested to identify the causative allergens. Results. Occupational contact dermatitis was suspected in 77 (16%) of the 472 workers. Thirteen (3%) of these 472 workers were confirmed to have occupational allergic contact dermatitis. Potassium dichromate (9.2%), N,N‐diphenylguanidine (5.3%), benzidine (3.9%) and sodium metabisulfite (2.6%) were found to be the occupationally relevant sensitizers. Conclusions. The sensitization pattern showed some differences from the data in studies reported from other newly industrial countries. We compiled a ‘tannery work series' of allergens for patch testing. A number of these allergens may also be considered for patch testing in patients with (leather) shoe dermatitis.     

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

Background:  Occupational skin diseases, including allergic contact dermatitis (ACD), irritant contact dermatitis, and allergic contact urticaria (ACU), occur commonly among health care workers (HCWs).
Purpose:  To evaluate the aetiology of the various skin diseases afflicting HCWs evaluated for suspicion of ACD and/or ACU and to identify the most common allergens among HCWs found to have ACD and/or ACU.
Methods:  A total of 1434 patients underwent patch testing. The demographic data and most common allergens for HCWs ( n  = 100) and non-HCWS ( n  = 1334) were compared.
Results:  HCWs were statistically more likely than non-HCWS to be female, have hand dermatitis, and have a history of atopy. HCWs were also more likely to have work-related ACD especially to quaternium-15, thiuram, carba mix, glutaraldehyde and benzalkonium chloride, and to have ACU to latex.
Limitations:  This study was retrospective and is subject to the resultant biases of all such investigations. Only patients suspected of having ACD and who underwent patch testing are included in our database. The prevalence of ACD and ACU is likely to be higher than that seen in the general HCW population.
Conclusions:  Our results underscore the importance of thoroughly evaluating HCWs for ACD and ACU with the use of expanded standard allergen series and prick or radioallergosorbent testing to latex.     

Contact allergy and allergic contact dermatitis in children - a review of current data

Allergic contact dermatitis (ACD) in children was previously considered to be a rare occurrence. However, the growing number of case reports and cross-sectional studies through the past three decades indicate that ACD is, in fact, a highly relevant diagnosis in children. Furthermore, the frequency of ACD in children seems to be increasing. In 1999, a review of the literature reported prevalence rates of 14.5-70% in selected paediatric populations. The current paper reviews the studies on the prevalence of positive patch test reactions and ACD in the paediatric population during the past decade, and provides an overview of the main findings. We found reported sensitization rates of 26.6-95.6% in selected groups of children. The associated relevance was 51.7-100%. The most common allergens were nickel, cobalt, thimerosal, and fragrance. Tailored patch testing increases the rate of relevant patch test reactions. Children with atopic dermatitis are as frequently sensitized as children with no history of atopic dermatitis, and there are no differences associated with sex. Children and adults can be tested with equal concentrations of patch test allergens. Our findings may support the notion that the prevalence of ACD in children is increasing over time or indicate an increased awareness.     

重庆地区193例化妆品变应性接触性皮炎患者斑贴试验结果分析

 目的:分析重庆地区化妆品变应性接触性皮炎患者主要化妆品成分变应原,以便指导患者合理选择和使用化妆品,降低皮炎的发生率。方法:选取我院皮肤科门诊确诊为化妆品变应性接触性皮炎的193例患者进行化妆品成分斑贴试验,并对结果作统计学分析。结果:斑贴试验总阳性率为69.43%,合并2种及2种以上变应原的患者占50.26%,阳性率前5位的变应原分别为硫柳汞、十二烷基硫酸钠、尼泊金酯、三乙醇胺和乙二胺;女性斑贴试验阳性率为73.33%,明显高于男性,差异有统计学意义(X²=9.67,P<0.05）;青年组明显高于其他年龄组,差异有统计学意义（ X²=36.79,P<0.05）。结论：硫柳汞、十二烷基硫酸钠、尼泊金酯、三乙醇胺和乙二胺5种物质是重庆地区化妆品变应性接触性皮炎患者主要的致敏成分。化妆品变应性接触性皮炎患者以女性为主,中青年多见。     

Bronopol allergic contact dermatitis

Bronopol (2-bromo-2-nitropropane-1, 3-diol) is an antimicrobial compound widely used as a preservative, primarily in cosmetic formulations. Analysis of patch tests performed on our patients revealed an incidence of 12.5% relevant positive results to 0.5% and/or 0.25% bronopol. This result reflects a history of prolonged use of bronopol-containing lubricants in our referral population of patients with different types of severe, extensive dermatitis. Contact sensitization to bronopol in this population is probably facilitated by abnormal cutaneous barrier function. Our findings emphasize the need for further clinical study of the potential for bronopol to produce contact sensitivity, and suggest caution with regard to its use in patients with dermatitis.     

Allergic contact dermatitis to cow's hair

A 32-year-old farmer woman with delayed type of allergy to cow's hair is described in this study. She had the 5-year history of erythematous, desquamative lesions on the dorsal side of the hands and forearms. Shortly after entering the cowshed, she showed relapse of skin symptoms and total regression when she was away from the farm. The patch test to European standard series, hair of the cow from the patient's cowshed, hay, and stable hay was performed. Additionally, prick tests were performed on inhalant allergens such as hair of the cow from the patient's cowshed, hay, stable hay and cow's milk, total immunoglobulin class E (IgE) together and specific IgE to cow dander and milk. Patch test showed positive reaction to cow's hair, cobalt chloride, nickel sulfate, and thimerosal. All other tests were negative.