Contact allergy to gold sodium thiosulfate

278 consecutive patients with suspected contact dermatitis were patch tested with the European standard series and gold sodium thiosulfate (0.5% pet.): 13 patients (4.6%) had a positive allergic response to gold sodium thiosulfate (GST). All of these patients were female, with a mean age of 37 years. The most frequent site of eczema in these patients was the head and neck (62%). A seborrhoeic distribution of eczema was common. 46% had involvement of the limbs, 15% had a perianal or perivulval rash. The mean duration of eczema in this group of patients was 15.8 months. 54% of patients allergic to gold were also allergic to nickel. Biopsy of positive patch test reactions to GST were consistent with allergic contact dermatitis.     

Pre-treatment of nickel test areas with sodium lauryl sulfate detects nickel sensitivity in subjects reacting negatively to routinely performed patch tests

A fair % of patients with a clinical history of nickel allergy show negative patch test results. To improve the response rate to NiSO₄ 5% pet, patch tests, a testing procedure utilizing pre-treatment of I he lest area by a 24-h application of sodium lauryl sulfate (SLS) was introduced 46 women with a clinical history of nickel sensitivity who exhibited negative reactions to nickel sulfate 5% pet, patch tests. were studied, Patients underwent d patch tests on adjacent sites on the volar surface of the forcarms. 4 patch tests were performed with a 72-h application of 40 mg nickel sulfate 5% pet. While I of these patch tests served as control. 3 test areas underwent 24-h pretreatment with 40 μl SLS. 1 with 0.1% and 2 with 0.5% solution. To evaluate differences in the reactivity to SLS plus nickel sulfate related to the site on the forearm, 0.5% SLS pre-treatment was performed both on a proximal and on a distal lest site. At the 72-h evaluation. 19 subjects out of 46 showed positive reaction to nickel sulfate 5%. At skin sites pre-t railed with SLS. Whereas 23 patients reacted positively at 0.5% SLS pre-treated ureas. Echographic values of skin thickness and of hypo-echogeme dermal areas al positive pre-treated nickel lest. Next higher than al control Jest areas, confirming the clinical evidence of an increased response to NiSO₄ after SLS pre-treatment. The inflammatory reaction, is evaluated clinically and echographically, was much higher al distal skin areas (0.l% SLS and distal (0.5%.) SLS than at proximal 0.5% SLS ones.     

Contact dermatitis around a tracheostoma due to salbutamol sulfate and Aldecin

Contact dermatitis around a tracheostoma is quite rare. So far, there have been only 2 reports about this in medical literature. We, in this study, report herewith contact dermatitis in a 61-year-old Japanese man around a tracheostoma due to salbutamol sulfate and Aldecin. The patient used inhaled Sultanol and Aldecin for the treatment for allergic asthma. On examination, it was found that there was lichenified, exudative erythema with pigmentation around the tracheostoma. Patch testing with 1% aq. Sultanol and Aldecin revealed a positive reaction. Furthermore, patch testing for salbutamol sulfate 1% pet. also showed positive reaction. Although the contact allergen of our patient has not been fully determined (beclomethasone or other ingredients), this must be the first reported case of double contact dermatitis around a tracheostoma from salbutamol and Aldecin.     

Pretreatment of the test area with 1-day occlusion improves the response rate to NiSO4 5% pet. Patch tests in subjects with a positive history of nickel allergy

A group of 58 women, aged 18 to 51 years, with a clinical history of nickel allergy, who exhibited equivocal or negative reactions to nickel sulfate 5% pet, patch tests performed on the skin of the back, were recruited consecutively from the patch test clinic from September 1993 to June 19944. In order to improve the response rate to NiSO₄ 5% pet, patch tests, a testing procedure utilizing pretreatment of the test area by 1-day (24-h) occlusion was introduced. Patients underwent 2 patch tests on adjacent sites of the volar surface of both forearms. 3 of the patch tests were performed with 40 mg nickel sulfate 5% pet., whereas a control test was carried out by occluding with an empty chamber. 2 of the nickel sulfate test sites were pretreated with 1-day occlusion performed with an empty chamber. A visual grading system and echographic measurement were used to quantify the responses 30–40 min after patch test removal. Echographic evaluations were carried out using a 20 MHz B-scanner. Measurement of skin thickness and determination of the hypoechogenic dermal area, both considered to be parameters of inflammation, were used to evaluate the intensity of the allergic reaction. At the 3-day (72-h) evaluation. 19 subjects out of 58 clearly showed positive reactions to nickel sulfate 5% pet, at pre-occluded skin sites. Moreover, values of skin thickness and of 0–30 areas at positive pre-occluded nickel test areas were higher in respect to control test areas, confirming clinical evidence of increased response to NiSO₄, after occlusion.     

Patch test results with serial dilutions of nickel sulfate (with and without detergent), palladium chloride, and nickel and palladium metal plates

Clinical experience suggests the existence of different degrees of sensitivity in nickel-allergic patients. For quantification of this phenomenon, 462 consecutive patients with previously diagnosed or strongly suspected nickel allergy were tested with serial dilution patch tests with 5 ppm to 5% nickel sulfate in pet. (Ni), and 5 ppm to 1% nickel sulfate in pet. with 1% detergent (Ni/D). Additionally, nickel and palladium metal plates were tested in 103, and cobalt salts, dichromate and palladium chloride (PdCl₂) in most patients. 332 patients reacted positively to Ni or Ni/D. The influence of a concomitantly administered detergent was not significant. A significant correlation was found between positive reactions to low concentrations of Ni (or Ni/D), i.e., 0.1% or less ( N =166), and concomitant reactions to nickel metal plates, cobalt salts and PdCl₂ and a history of ear piercing with metal intolerance. The clinical relevance of reactions to PdCl₂ is at present not clear. A subgroup of nickel-allergic patients with "high sensitivity" can be defined. In future studies further addressing the clinical relevance of high versus low sensitivity, patch testing with 0.01, 0.1, 1.0 and 5% nickel sulfate in pet is recommended instead of routine tests with 5% only.     

Allergic contact dermatitis due to phenylephrine hydrochloride, with an unusual patch test reaction

2-day (2-D) closed patch tests are often used in daily clinical practice and useful for evaluating the cause of allergic contact dermatitis. However, even when 2-D closed patch tests at appropriate concentrations are performed for suspected allergic contact dermatitis based on clinical findings, positive reactions are not always obtained. Therefore, although the use of the allergen again induces similar symptoms, a definite diagnosis cannot be made in some cases. We report a case of allergic contact dermatitis due to phenylephrine hydrochloride in eyedrops, with an unusual patch test reaction. Although the results of the routine 2-D closed patch test were negative, a definite diagnosis could be made by closed scratch-patch test. In addition, long-lasting allergic patch test reactions were observed at the positive scratch-patch test site for about 3 months. We speculated that these unusual results on patch testing in our case were associated with the degree of percutaneous absorption of causative agents. Therefore, even when 2-D closed patch tests are negative, scratch-patch tests may be indicated for patients in whom clinical symptoms continue strongly to suggest contact dermatitis.     

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.     

Increased sensitivity of patch testing by standardized tape stripping beforehand: a multicentre diagnostic accuracy study

Background: As a modification of patch testing, the strip patch test was established to obtain more sensitive and reliable test results. Comparative data on diagnostic accuracy for both tests are missing. Objectives: To compare the diagnostic accuracy of strip patch tests and patch tests in detecting sensitizations in patients with suspected allergic contact dermatitis by using patient history as the reference standard. Patients/methods: In a multicentre, prospective, investigator‐blinded study 790 patients were enrolled. The defined reference standard was established prior to patch testing. Patch tests were performed with nickel sulfate, potassium dichromate, and lanolin alcohol. Duplicate tests were simultaneously performed on both sides of the back, of which one randomly chosen side was tape stripped beforehand, according to a standardized procedure. Primary outcome was the difference in sensitivity between strip patch test and patch test. Results: Seven hundred and eighty‐seven patients were included in the analysis. Strip patch tests detected considerably more sensitization to nickel sulfate and potassium dichromate than patch tests: differences of sensitivities were 16.4% (95% CI, 8.7–24.1%) for nickel sulfate and 25.0% (95% CI, 8.9–41.0%) for potassium dichromate, both favouring the strip patch test. Conclusions: The standardized strip patch test proved to be accurate and clinically safe and is promising to improve diagnosis of allergic contact dermatitis beyond the patch test.     

Patch testing with pure palladium metal in patients with sensitivity to palladium chloride

During a 15-month period, 536 patients being investigated for suspected contact dermatitis were patch tested with the European standard series and palladium chloride 1% pet. 13 patients (2.4%) had a positive allergic response to palladium chloride and all 13 were also allergic to nickel. 12 of these 13 patients consented to further patch testing with discs of pure palladium metal foil, and none reacted. We have shown previously that palladium chloride patch test material contains traces of nickel, and propose an explanation for these results in terms of the additive effect of allergens when tested in combination.     

652例过敏性皮肤病斑贴试验变应原分析

目的:分析我院过敏性皮肤病患者常见的接触性变应原.方法:回顾性分析我院门诊652例行斑贴试验的过敏性皮肤病患者资料,包括接触性皮炎249例、面部皮炎158例、湿疹87例、激素依赖性皮炎64例、特应性皮炎51例、唇炎43例,并对斑贴试验结果及不同年龄、性别阳性率进行比较分析.结果:斑贴试验总阳性448例(68.71％)....     

Patch testing with nickel chloride in a hydrogel

Various concentrations of NiCl2 in a hydrogel were evaluated as a possible alternative to the standard patch test material of 5% NiSO4 pet. Patch test responses were recorded on a total of 430 patients with known or suspected contact allergy. A NiCl2 concentration of 1% or less in the hydrogel failed to elicit a response in some patients who reacted to 5% NiSO4 pet. The 2% NiCl2 hydrogel produced a small increase in response frequency and may reduce false-negative reactions. Along with the ability of the material to improve the topical bioavailability of nickel ions, more irritant reactions were observed. However, in cases with a positive history and a negative patch test with petrolatum, the hydrogel prepared from Methocel-E-4M seems to be a useful alternative vehicle for water-soluble allergens.     

Long-lasting allergic patch test reactions to nickel sulfate: analysis by nickel quantification and immunocytochemistry

We previously showed the median duration of positive patch test reactions to nickel sulfate(5% pet) was 9 days, and defined as long-lasting (LLAPTR) the 14.3% of reactions that persisted for 17 Days or longer. The pathomechanisms of LLAPTR are unclear, but may involve either localized antigen persistence or abnormal down regulation of the cellular immune response. In this study, we compared (a) the nickel concentration and (b) the immunocytochemical nature of the local immune reaction, between biopsies from LLAPTR ( n = 8) and normally resolving allergic patch lest reactions (NRAPTR) ( n = 8) to nickel sulfate. The concentration of nickel in LLAPTR (median 0.8μg/g, μg/g, range 0.25–3.87 μg/g, mean 0.83μg/g, 95% CI 0 35–1.31) and NRAPTR (median 0.58 μg/g, range 0.2 1.85 μg/g, mean 0.88 μg/g, 95% CI 0.02 1.74) was similar. Activated T lymphocytes, expressing surface IL-2 receptor, HLA DR, DR alpha 1, DP, DQ, and CD2>CD8>CD4 antigens, were seen throughout the dermis and occasionally infiltrating the suprabasal layer of the epidermis in all biopsies. CDI and HLA DR, DR alpha 1, DP, and DQ-expressing Langerhans cells were present throughout the epidermis and occasionally seen in the papillary dermis. HLA DR, DR alpha 1, DP, and DQ antigen expression were also seen on the surface of non-dendritic cells in the epidermis (probably either keratinocytes or T lymphocytes) and vascular endothelial cells in the papillary dermis. There were no significant qualitative or quantitative differences in the immuno-cytochemical nature of the localized immune reaction between LLAPTR and NRAPTR. These findings suggest that the pathomechanism of LLAPTR to nickel sulfate is unlikely to be explained simply on the basis of nickel concentration or the nature of the localized immune reaction at the patch test site.     

Correlation between laser Doppler perfusion imaging and visual scoring of patch test sites in subjects with experimentally induced allergic and irritant contact reactions

Purpose: To compare laser Doppler perfusion imaging (LDPI) measurements in experimentally induced allergic contact reactions and irritant contact reactions. The degree of correlation between visual scores and LDPI measurements was also studied.
Methods: Fifteen patients with known contact allergy to nickel or fragrance were patch tested with nickel sulfate 5% pet., fragrance mix 8% pet., sodium lauryl sulfate (SLS) 0.5% pet., SLS 1.0% pet. and two empty control chambers. Visual readings and LDPI measurements were taken at 0, 48 and 96 h.
Results: There was a positive correlation between visual scores and LDPI measurement in the nickel sulfate and fragrance mix patch test sites. However, no correlation between visual scores and LDPI measurements was seen in the SLS 0.5% and SLS 1.0% patch test sites. There was no significant difference ( P =0.125) in LDPI measurements between contact-allergic reactions and contact-irritant reactions.
Conclusion: LDPI correlates with visual scoring in contact-allergic reactions, but not in irritant reactions. LDPI is not useful in distinguishing between allergic and irritant reactions.     

Hand dermatitis and allergic patch test reactions caused by nickel in electroplaters

A worksite survey was conducted in all 38 Finnish electroplating plants. All workers ( n =163) who worked with nickel plating (bath workers, hangers and solution makers) were interviewed with a questionnaire about symptoms of nickel dermatitis, hand dermatitis, and about protective measures, atopy, etc. Patch testing with nickel sulfate was done with the TRUE Test^TM method. All the workers, 94 men and 69 women, answered the questionnaire. The mean age of women was 41.1 years, and of men 43.1 years, respectively. Men had longer occupational exposure to nickel (14 years) than women (10 years). Most workers used protective gloves. 35% of women and 30% of men reported present or past hand dermatosis. 19% reported a history of atopic dermatitis. 15% of women ( n = 8) and 4% ( n = 2) of men had an allergic patch test reaction to nickel sulfate. 70% of those with an allergic patch test reaction to nickel reported past or present hand eczema. The prevalence of nickel allergy among the electroplaters was similar to that of patients in patch test clinics in Finland. An allergic patch test reaction to nickel sulfate does not necessarily oblige an electroplater to change jobs.     

Cross-reactivity between nickel and palladium demonstrated by systemic administration of nickel

Concomitant patch test reactions to nickel and palladium have frequently been reported in patients undergoing investigation because of suspected allergic contact dermatitis. Theoretically, these reactions can be explained by multiple, concomitant, simultaneous sensitization as well as cross-sensitization. We studied whether concomitant reactions to nickel and palladium could represent cross-sensitization in females hypersensitive to combinations of nickel, palladium and cobalt. Females were patch tested with serial dilutions of nickel sulfate, cobalt chloride and palladium chloride on the upper back. 1 month later, when the patch test reactions were gone, the patients were randomized into 2 groups that were challenged orally with either nickel or placebo. 1 day later, the areas of previous positive patch test reactions were read in a blind way looking for flare-up reactions. Nickel provocation but not placebo yielded flare-up reactions on sites previously tested with nickel (P = 0.012) and palladium (P = 0.006), but were also observed on sites previously tested with cobalt, even though this was not statistically significant. Flare-up reactions of previous patch test reactions to nickel and palladium after oral challenge with nickel speak in favour of a cross-reactivity mechanism.     

Mercury allergy in a contact dermatitis clinic in Northern Ireland

441 consecutive patients (294 female, 147 male) with suspected contact dermatitis were patch tested to the European standard series, mercury metal (1% pet.). ammoniated mercury (1% pet.), and mercuric chloride (0.1% aq.), 14 patients (3.2%), 12 of whom were female, showed a positive response to 1 or more mercury compounds: none reacted to mercuric chloride alone. Primary sensitization was most likely due to either inoculation with vaccines containing merthiolate preservatives or amalgam dental restorations. Mercury allergy was of historical clinical relevance in only 2 pa I rents, both women who developed gingivostomatitis following insertion of amalgam dental fillings. 1 of these women subsequently developed allergic contact dermatitis from contact lens solutions, shampoos and cosmetics which contained mercury preservatives. On the basis of these findings, we recommend patch testing with both metallic mercury and ammoniated mercury in patients with suspected mercury allergy.     

Minimum eliciting patch test concentration of thimerosal

Positive patch test reactions to thimerosal 0.1% pet. (40/690 subjects: 5.8%) were more common in younger age groups, in the allergic contact dermatitis group and in subjects who had used contact lens solutions. In the 40 thimerosal-positive patients, the minimum eliciting quantity of preservative was evaluated using different test concentrations: 0.05% and 0.01% pet. (patch testing) and 1:10,000 in saline (intradermal testing). Cross-reactions between thimerosal and other mercury compounds and sensitivity to thiosalicylic acid were also examined. The results of the investigation demonstrate that many of the reactions to 0.1% thimerosal are probably irritant, because only half the subjects studied had positive patch tests when allergen concentrations 5 to 10x lower than that conventionally used for patch testing, were utilized. In these subjects, the average strength of patch test reactions was higher, intradermal testing was more often positive and cross-reactions between mercurials more frequent. These data indicate that the optimal eliciting patch test concentration for studying thimerosal sensitivity is 0.05% pet.     

The influence exerted by cutaneous ligands in subjects reacting to nickel sulfate alone and in those reacting to more transition metals

To study the influence exerted by cutaneous ligands in nickel reactions we have evaluated the patch tests responses to 4 aqueous nickel salts (sulfate, chloride, nitrate, acetate) able to form different complexes with different geometry. Two groups of respectively 71 subjects who previously reacted only to nickel sulfate 5% petrolatum (pet) and of 30 subjects who previously reacted to nickel sulfate 5% pet and to at least 1 other transition metal, were simultaneously repatch-tested to 200 μg of Ni⁺⁺ contained in nickel sulfate in pet and to 47 μg of Ni⁺⁺ contained in 4 different aqueous nickel salts. Another 2 groups of 25 subjects with the same characteristics were simultaneously repatch tested to 200 μg of Ni⁺⁺ in pet and to 12μg of aq Ni⁺⁺ as in the first 2 groups. Visual score, total score, and mean value of the reactions were utilized in evaluating the degree of the responses. On testing to 200 μg of Ni⁺⁺ in pet all the subjects were able to give positive responses. Whilst a higher percentage of the responses of 2⁺ degrees was found in subjects reacting to nickel sulfate 5% pet alone, a higher percentage of responses of 3⁺ degrees was observed in subjects reacting to more transition metals. On testing to 47 and 12 μg of aqueous Ni⁺⁺ a large variability of responses to the single salts was observed in all the subjects. However, in subjects reacting to more metals there were either a greater number of multiple responses to 3 or 4 salts or responses stronger than those found in subjects reacting to nickel sulfate alone. Although patch testing cannot give us complete information about the degree of previous exposure, the results arising from the tests seem to demonstrate that the subjects allergic to nickel and other transition metals are more reactive than the subjects allergic only to nickel to the application of the same amounts of Ni⁺⁺ contained in different salts. When considering the QSAR model, the difference in the sensitizing potential of the metal at the same penetration properties can depend on the possibility of combining with specific ligands. Therefore, it is likely that in subjects reacting to more metals there is a more uniform availability of cutaneous ligands which conditions the formation of complexes more immunogenic. The arising inflammatory reaction in these cases leads to a stronger but less specific response.     

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。     

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.