Environmental contact factors in eczema and the results of patch testing Chinese patients with a modified European standard series of allergens

Environmental contact factors in eczema were investigated in China by clinical questionnaire and patch testing patients with a modified European standard series of allergens. 217 consecutive eczema patients were studied. Contact dermatitis (CD) was clinically diagnosed in 30% of the patients. Among the patients patch tested, 46 patients had clinically diagnosed allergic CD (ACD), 20 patients clinically had non-ACD (NACD) (including 16 cases of irritant contact dermatitis, 1 case of phototoxic contact reaction and 3 cases of asteatotic eczema) and 115 patients had clinically suspected ACD. 45 patients (98%) in the ACD group went on to have relevant patch test results. The most common ACD was from metals, fragrance materials, cosmetics and rubber materials. The most common contact allergens identified were nickel, fragrance mix, para-phenylenediamine (PPD), carba mix and thimerosal. No adverse reactions were observed to patch testing, except for pruritus in patch-test-positive patients. The positive rate of patch testing in ACD was much higher than that in NACD (98% versus 15%, P < 0.05, chi(2)-test). 60 (28%) patients had facial dermatitis (FD). Among these, 20 (33%) were confirmed as having ACD. 48 (22%) patients had hand dermatitis (HD). Among these, 7 (15%) were confirmed as having ACD. Fewer patients were confirmed as having ACD in the HD group than in the FD (15% versus 33%, P < 0.05, chi(2)-test). Although the difference was not significant, the total positivity rate in the HD group (55%) was lower than in the other groups. 65 (30%) patients had unclassified endogenous eczema (UEE). The total positive rate of patch testing in the UEE group (56%) was no different from that in the FD or HD groups. However, the relevance of positive patch tests was hard to determine in UEE. These results indicate that CD is common in eczema; relatively more patients with FD have ACD, while other factors, such as irritation, may play more of a role in HD. The total positive rate of patch testing in the UEE group was no different from that in the FD or HD groups, suggesting that patch testing should be stressed in UEE and the relevance of positive patch test results in UEE should be studied further. It is effective and safe to patch eczema patients with a modified European standard series of allergens in China.     

Pruebas epicutáneas en pacientes con eczema perianal

Introduction and objectivesReports show that between 25% and 78% of patients with anogenital dermatitis have positive patch test results. Consequently, patch testing would appear to be warranted in patients presenting with eczema in the anogenital region. The objectives of the present study were to identify the most common allergens in patients with perianal eczema and to determine which allergen series are most useful for patch testing in patients with this condition.Material and methodsWe performed a retrospective review of patch test results in patients with only perianal eczema between 2001 and 2012.ResultsOf the 37 patients with perianal eczema, 16 had a positive reaction; methylchloroisothiazolinone/methylisothiazolinone was the main allergen involved. With the exception of 1 case of sensitization to gentamicin, all the positive results with present relevance were to allergens from the standard series of the Spanish Contact Dermatitis and Skin Allergy Research Group (GEIDAC) or to the patient's own products.ConclusionsIn our experience, methylchloroisothiazolinone/methylisothiazolinone is the main allergen involved in perianal eczema, and sensitization often results from using wet wipes. Patch testing in perianal eczema should be based on the GEIDAC standard series and the patient's own products.     

Patch test reaction on Ethiopian subjects with eczema

Background  Allergic contact dermatitis is a common condition with an incidence of 1–10% in the general population. An increasing number of allergens in the environment are responsible for the condition. These allergens can be identified using patch testing. Many countries have a standard series of common allergens used for patch testing. There is no standard series of allergens in Ethiopia, and our objective was to obtain baseline data for common allergens for future standardization.
Methods  One hundred and eighty-one subjects with eczema were patch tested using 17 selected allergens from Chemotechnique Diagnostics AB employing a standard procedure.
Results  Positive patch test reactions were detected in more than 60% of subjects, the most common allergen being nickel, followed by fragrance mix and butylphenolformaldehyde. A higher incidence of positive reactions was seen in females.
Conclusions  A high incidence of positive patch test reactions was identified in the study population, and the introduction of patch testing in Ethiopia is essential for the management of allergic contact dermatitis.     

Clinical review: thioureas and allergic contact dermatitis.

Thioureas are an uncommon underrecognized cause of allergic contact dermatitis (ACD). This article presents the findings in 3 individuals with ACD to thioureas and reviews the medical literature concerning thiourea-induced ACD. Thioureas are often the allergenic sources in ACD involving high-grade rubber products made of neoprene. Standard patch test series and rubber allergen patch test series usually do not contain thiourea allergens and will fail to diagnose these causes of ACD. Thioureas--most notably diethylthiourea, dibutylthiourea, and diphenylthiourea--should be considered in individuals with potential rubber allergy who fail to react to antigens in the standard allergen patch test tray.     

Which children should we patch test?

BACKGROUND: Allergic contact dermatitis (ACD) in childhood was considered rare until recently. However, reports are increasing, which may reflect an increased incidence and/or more frequent patch testing of children. It is also likely that allergen exposure in children has changed with time. AIMS: To determine the most common contact allergens and the rate of positive patch-test reactions among children with suspected contact allergy. METHODS: We carried out a retrospective case study of 114 children (66 girls and 48 boys) aged from 3 to 15 years (median 11.5) patch tested over a 3-year period. Indications for patch testing included uncontrolled or deteriorating atopic dermatitis, localized dermatitis or a history of reacting to a specific allergen. RESULTS: Of 110 children for whom we had notes, 83 (75%) had a history of atopy. Positive reactions that were of current, past or possible relevance were seen in 61 children (54%); in 58 (52%) of 111 tested with the standard series (SS) and in 6 (10%) of 60 tested with the medicament series. None of the children patch tested to the corticosteroid (n = 47), shoe (n = 15), fragrance (n = 12), cosmetic (n = 10) or rubber (n = 5) series had a positive reaction. However, 11 (10%) reacted to rubber allergens within the SS and one of five to their own shoes. The lowest rate of relevant positive reactions was among those with deteriorating atopic dermatitis (22%) and facial (33%) or perioral dermatitis (40%), and the highest rate amongst those with eyelid (86%) or hand (71%) dermatitis. Nickel was the most common allergen (20%) in line with previous reports (82% female), followed by rubber chemicals (10%), fragrance (7.2%), cobalt (5.4%) and lanolin (wool alcohol) (4.5%). CONCLUSIONS: The reported incidence of ACD among children, in particular nickel and rubber allergy, appears to be increasing, which may relate to changing fashions and hobbies. Contact allergy should be considered in all children with dermatitis, particularly with eyelid or hand dermatitis, and patch testing carried out more frequently.     

Analysis of patients with allergic patch test reactions to a plastics and glues series

839 patients were patch tested with a series of 31 plastics and glues allergens at a dermatologic clinic over a period of 7 years. 52 (6%) had a positive patch test reaction to 1 or more such allergens. Clinic charts of 47 patients (out of 52) were available for the study. All but 3 patients had dermatitis on their hands: 17 had only hand dermatitis. 25 (53%) patients' test results were of present or past relevance to their skin diseases. 11 patients (68%) with occupational allergic contact dermatitis (ACD) and 14 (45%) with non-occupational dermatitis had relevant reactions. p -tertiary-butylphenol-formaldehyde resin was the most common allergen (9 cases). 7 patients reacted to diaminodiphenylmethane. 5 patients, who had colophony allergy, reacted to abietic acid and 4 to abitol. There was no reaction to 14 test substances. Special series, such as this plastics and glues series, reveal the cause of ACD less frequently than standard series. However, there is no other way to confirm allergy to these usually industrial allergens, which can also sensitize through non-occupational exposure during hobby working or through unpolymerized monomer left in the finished plastic product.     

Patch testing and aeroallergen intradermal testing in suspected allergic contact dermatitis, unclassified endogenous eczema and non-atopic chronic urticaria

The purpose of this study was to investigate the significance of contact allergen and aeroallergen sensitization in suspected allergic contact dermatitis (ACD), unclassified endogenous eczema (UEE) and non‐atopic chronic urticaria (NACU). 63 cases of suspected ACD, 140 cases of suspected UEE and 21 cases of suspected NACU were patch tested with the standard series of Beijing Medical University and, if available, suspected materials as is. 22 such cases of ACD, 104 such cases of UEE and 42 such cases of NACU were intradermally tested with common aeroallergens. Patients with non‐allergic skin disease served as controls. 85.7% of the suspected ACD patients, 57.9% of the suspected UEE patients and 52.4% of the suspected NACU patients were positive on patch testing, and the results in 81.0% of the suspected ACD patients and 23.6% of the suspected UEE patients were considered relevant. No patch test reactions in the NACU patients were considered relevant. 27.1% of the suspected UEE patients, 41.3% of the suspected ACD patients and 14.3% of the suspected NACU patients reacted to 2 or more contact allergens. High positive rates on aeroallergen intradermal testing were also found in suspected NACU (69.0%), UEE (49.0%) and ACD (59.1%) patients. These results support the conclusions that patients with allergic skin diseases will develop multiple sensitization, and that early detection and avoidance of sensitizing allergens is necessary. The exact rôle of aeroallergen sensitization in these diseases needs further study.     

129例颜面再发性皮炎患者斑贴试验临床分析

目的：通过斑贴试验研究颜面再发性皮炎的病因。方法：对临床诊断为颜面再发性皮炎的133例患者进行问卷调查和斑贴试验（瑞典产“瑞敏牌”斑贴试剂）。结果：133例检测患者中有116例斑贴试验阳性，占受试者的87.22％，其中对1种阳性者42例（35.90％），对2种阳性者37例（31.62％），对3种阳性者19例（16.24％），对4种及4种以上阳性者19例（16.24％）。阳性发生率较高的前6位过敏原依次为甲醛、卡巴混合物、重铬酸钾、硫酸镍、硫酸汞、对苯类。阳性率与年龄、环境相关，与性别、化妆品的使用无关。结论：颜面再发性皮炎的发生与接触变应原关系密切，斑贴试验是指导颜面再发性皮炎治疗的一个有力手段。     

Facial dermatitis: patch test results and final diagnoses.

BACKGROUND: Facial dermatitis may result from allergic or irritant contact dermatitis, from endogenous conditions such as atopic or seborrheic dermatitis, or a combination of contributing factors. OBJECTIVE: To determine the final diagnoses in patients referred for evaluation of facial dermatitis, and the relevant allergens in those ultimately diagnosed with allergic contact dermatitis (ACD). METHODS: A retrospective chart analysis of all patients patch tested for evaluation of facial dermatitis in an Occupational and Contact Dermatitis referral clinic over a 2-year period from October 1995 to October 1997. RESULTS: Of the 383 patients patch tested, 85 (22%) had facial dermatitis. Of these 85 patients, 55 (65%) had spotty or diffuse facial involvement, 21 (25%) had only eyelid involvement, and in 9 (10%) only the lips were involved. Final diagnoses were relatively equally distributed among three categories: one third had ACD, one third had ACD with other contributing factors, and one third had diagnoses other than ACD. Among patients with ACD, the most common relevant allergens were personal care products, preservatives, and fragrances. CONCLUSION: Allergic contact dermatitis is a frequent cause of facial dermatitis in a referral dermatology clinic. However, in up to two thirds of patients, other diagnoses represent either the primary process or a major component contributing to the eruption. Personal care products, preservatives, and fragrances represent the most common relevant allergens in those diagnosed with ACD. A significant number of relevant reactions would be missed if only the TRUE test standard series were used.     

昆明地区女性200例慢性湿疹和接触性皮炎斑贴试验结果分析

目的探讨昆明地区女性慢性湿疹和接触性皮炎的变应原分布特点及其相关性。方法对100例慢性湿疹和100例接触性皮炎患者进行斑贴试验。结果斑贴试验显示,慢性湿疹组病人的斑贴试验阳性率为44％,接触性皮炎组病人的斑贴试验阳性率为68％,P〈0．0l,显示两者之间有显著性差异;湿疹组阳性病例中一种变应原的阳性率为63．57％,两种及以上变应原阳性率为36．43％;接触性皮炎组阳性比例中1种变应原阳性率为82．53％,两种及以上变应原阳性率为17．47％,均有统计学差异（P〈0．05）。结论 斑贴试验有助于明确慢性湿疹和接触性皮炎患者的接触变应原,其主要变应原不尽相同。     

51例面部化妆品接触性皮炎的斑贴试验和光斑贴试验结果分析

目的:检测分析面部化妆品接触性皮炎患者常见致敏原。方法:回顾性分析我院面部化妆品接触性皮炎患者的临床资料、斑贴试验和光斑贴试验资料。结果:51例患者进行了斑贴试验,总体阳性率为96%。阳性率高的过敏源依次为：硫酸镍(47.1%)、氯化钴(35.3%)、甲基异噻唑啉酮(27.5%)、纺织染料混合物(19.6%)、没食子酸辛酯(19.6%)、松香(13.7%)、对苯二胺(13.7%)、硫柳汞(13.7%)、叔丁基氢醌(13.7%)、棓酸十二烷酯(13.7%)。46例患者完成光敏实验和光斑贴检查,14例存在光敏感(30.43%);其中UVA敏感7例(15.22%),UVB敏感8例(17.39%)。光斑贴阳性率19.6%,常见致敏原依次为：依托酚那酯(6.5%)、癸基葡糖苷(6.5%)、甲酚曲唑三硅氧烷(4.3%)。结论:防腐剂、香料、重金属、乳化剂、抗氧化剂、表面活化剂等原料均可能引起面部接触致敏。面部化妆品皮炎患者还可能存在光敏反应和光变态反应。全面的斑贴试验有助于更好的帮助患者查找致敏原。     

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.     

Contact dermatitis in children: 6 years experience (1992–1997)

We report the results of patch tests carried out over the last 6 years (1992-1997) on 141 children. This corresponds to 2.8% of the total patients who were patch tested in our Allergy Department (5,014). These 141 children were patch tested using the TRUE Test^TM standard series and an additional allergen, metallic mercury. Allergens from the Chemotechnique medicaments, cosmetics, plants and shoe series were added in some. The most frequent localization of eczema was to the feet, face and hands and the most frequent suspected causes were costume jewellery, footwear, topical medicaments and cosmetics. The most frequent allergens, assessed by degree of relevance, were first, nickel, followed by cobalt, mercurials (thimerosal and metallic mercury), fragrance and rubber chemicals (naphthyl mix, mercapto mix, carba mix and PPD mix). 13 children, 18% of the total, between the ages of 12 and 14 years, showed positivities relevant to some occupation, i.e., metalworking, building, hairdressing, catering, etc. Once patch tests had been carried out and relevant positive patch tests assessed, the most frequent diagnoses were contact dermatitis 45%, atopic dermatitis 25%, juvenile plantar dermatitis 15%, and other diagnoses in the remaining 15%.     

Eczema en los pies en una consulta de alergia cutánea: estudio retrospectivo de 13 años

IntroductionFoot eczema is a common complaint encountered by skin allergists.ObjectiveTo study a series of patients with foot eczema who underwent patch testing and describe their demographic profile, diagnoses, and the main allergens involved.Material and methodsCross-sectional observational study of all patients tested with the standard Spanish patch test series at a dermatology department over a period of 13 years (2004-2016). We studied patch test results and definitive diagnoses by comparing different subgroups of patients with foot eczema.ResultsOf the 3,265 patients included in the study, 308 (9.4%) had foot eczema, 176 (57.9%) had foot eczema only and 132 (42.1%) had concomitant foot and hand eczema. Positive patch test results were more common in patients with foot eczema only (positivity rate of 61.5% vs. 53.4% for foot and hand eczema). In the subgroup of patients with concomitant foot and hand involvement, patients aged under 18 years had a lower rate of positive results (51.3% vs. 64.6% for patients > 18 years). Potassium dichromate was the most common allergen with current relevance in all subgroups. The main diagnosis in patients with foot involvement only was allergic contact dermatitis (49.1%). In the subgroup of patients with concomitant hand and foot eczema, the main diagnoses were psoriasis in adults (33.6%) and atopic dermatitis in patients aged under 18 years (60.0%).ConclusionPatch tests are a very useful diagnostic tool for patients with foot eczema with or without concomitant hand involvement.     

185例面部皮炎患者临床及斑贴试验结果分析

目的:测定面部皮炎患者过敏原.方法:对185例面部皮炎患者进行国际接触性皮炎研究组认定产品-瑞敏接触变应原斑贴试验.结果:斑贴试验阳性者136例(73.5%),其中常见的致敏原依次为硫酸镍(25.9%),硫柳汞(20.5%)、重铬酸钾(16.2%)、甲醛(13.5%)、对苯二胺(11.4%)、芳香混合物(10.3%)等.结论:所有面部皮炎患者均应进行斑贴试验以寻找可能致敏原.     

瑞敏系列和TURE TEST系列斑贴试剂检测结果比较

目的分析瑞敏系列(R)和TURE TEST系列(T)斑贴试剂检测结果及一致性。方法分别用这两个系列斑贴试剂检测196例慢性湿疹和接触性皮炎患者,对其检测结果进行比较。结果瑞敏系列和TURE TEST系列斑贴试剂对各变应原检测阳性率不完全相同,它们检测常见变应原种类均与国内已有报道类似;两个系列中相同的16种变应原的检测反应强度一致性较好,检测的阳性率差异无统计学意义(P>0.05)。结论两个系列斑贴试剂的一致性较好,临床上可根据患者情况选择应用。     

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.     

The relationship between the proportion of the population tested annually and the rate of patients with positive patch test reactions

Background. Differences exist between the rates of patients with positive patch test reactions in different centres. Objectives. To explore the varying relationship between the percentage of patients with one or more positive reactions (rate of patients with positive reactions) and the proportion of the population tested annually (intensity of testing) by UK centres contributing to a shared data pool. Methods. Patch test data were pooled from 11 UK centres that use the British Society for Cutaneous Allergy (BSCA), formerly known as the British Society for Contact Dermatitis, database. The catchment population size was estimated for each centre, and the rate of patients with positive reactions to allergens in the BSCA baseline series was calculated. Results. As the intensity of testing increases, the rate of patients with positive reactions decreases. We found a strong linear correlation in the range of interest between the intensity of patch testing and the proportion of tests returning a positive result (R² = 0.598). Conclusion. Within the range of testing intensities covered by our reporting centres, the data show that as the intensity of testing increases, the rate of patients with positive reactions decreases.     

Patch testing is a useful investigation in children with eczema

Background. Allergic contact dermatitis in children is less recognized than in adults. However, recently, allergic contact dermatitis has started to attract more interest as a cause of or contributor to eczema in children, and patch testing has been gaining in recognition as a useful diagnostic tool in this group. Objectives. The aim of this analysis was to investigate the results of patch testing of selected children with eczema of various types (mostly atopic dermatitis) attending the Sheffield Children's Hospital, and to assess potential allergens that might elicit allergic contact dermatitis. Patients and methods. We analysed retrospectively the patch test results in 110 children aged between 2 and 18 years, referred to a contact dermatitis clinic between April 2002 and December 2008. We looked at the percentages of relevant positive reactions in boys and girls, by age groups, and recorded the outcome of treatment following patch testing. Results. One or more positive allergic reactions of current or past relevance was found in 48/110 children (44%; 29 females and 19 males). There were 94 allergy‐positive patch test reactions in 110 patients: 81 had a reaction of current or past relevance, 12 had a reaction of unknown relevance, and 1 had reaction that was a cross‐reaction. The commonest allergens with present or past relevance were medicaments, plant allergens, house dust mite, nickel, Amerchol® L101 (a lanolin derivative), and 2‐bromo‐2‐nitropropane‐1,3‐diol. However, finding a positive allergen was not associated with a better clinical outcome. Conclusions. We have shown that patch testing can identify relevant allergens in 44% of children with eczema. The commonest relevant allergens were medicament allergens, plant allergens, house dust mite, nickel, Amerchol® L101, and 2‐bromo‐2‐nitropropane‐1,3‐diol. Patch testing can be performed in children as young as 2 years with the proper preparation.     

Patch test reactions in patients with the additional diagnosis of vitiligo

Background Melanocytes involved in vitiligo may have inherent aberrations that make them vulnerable to extracellular insult. Allergic contact dermatitis (ACD) has been implicated in the development and progression of vitiligo. This study was conducted to investigate the association between ACD and vitiligo. Methods A total of 125 patients with vitiligo, who showed lesions in particular locations, onset at an older age, and/or pre‐existing inflammation or pruritus, were included. Patch tests were performed using a Korean standard series. In order to investigate the association between avoidance of allergen and clinical improvement, 43 vitiligo patients who showed positive reactions to the patch test completed a questionnaire administered by telephone and self‐assessed the status of their condition using a 10‐point scale. Results A total of 98 (78.4%) of 125 patients with vitiligo showed positive patch test reactions to at least one antigen. Although a limited number of contact allergens may have specific predilection sites, a significant association (P = 0.002, odds ratio 3.06) was found between lesions distributed on the scalp and/or hairline and a positive patch test reaction to paraphenylenediamine (PPD). A positive correlation (P = 0.03) was also detected between avoidance of allergen and improvement of vitiligo lesions. Conclusions Causative allergens of ACD may play a role in the development and/or aggravation of vitiligo.