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Background: The burden of occupational hand eczema in hairdressers is high, and (partly strong) allergens abound in the hair cosmetic products they use., Objectives: To systematically review published evidence concerning contact allergy to an indicative list of active ingredients of hair cosmetics, namely, p-phenylenediamine (PPD), toluene-2,5-diamine (PTD), persulfates, mostly ammonium persulfate (APS), glyceryl thioglycolate (GMTG), and ammonium thioglycolate (ATG), concerning the prevalence of sensitization, particularly in terms of a comparison (relative risk; RR) between hairdressers and non-hairdressers., Methods: Following a PROSPERO-registered and published protocol, eligible literature published from 2000 to February 2021 was identified, yielding 322 publications, and extracted in standardized publication record forms, also considering risk of bias., Results: Based on 141 publications, the contact allergy prevalence to PPD was 4.3% (95% CI: 3.8-4.9%) in consecutively patch tested patients. Other ingredients were mostly tested in an aimed fashion, yielding variable, and partly high contact allergy prevalences. Where possible, the RR was calculated, yielding an average increased sensitization risk in hairdressers of between 5.4 (PPD) and 3.4 (ATG). Additional evidence related to immediate-type hypersensitivity, experimental results, exposures, and information from case reports was qualitatively synthesized., Conclusions: An excess risk of contact allergy is clearly evident from the pooled published evidence from the last 20 years. This should prompt an improvement in working conditions and product safety., (© 2022 The Authors. Contact Dermatitis published by John Wiley & Sons Ltd.)

Background: Corticosteroids (CS), anti-inflammatory drugs also widely used to treat various allergic diseases, may themselves give rise to immediate and delayed allergic hypersensitivity reactions., Objectives: To realise an appropriate diagnostic work-up in order to determine the CS-allergic patient's sensitization/tolerance profile and define the potential replacement agents that can still be tolerated., Methods: Analysis of the patch test results and concomitant (cross-) reaction patterns obtained with 315 corticosteroid-allergic patients, as well as molecular modelling of molecules., Results: Proposal of a simplified classification of corticosteroids as to their allergenic properties into 3 groups, determination of two patient profiles according to steric and electrostatic properties of the molecules. Conclusion. Practical information to the medical profession in order to detect and manage such reactions is provided., (© 2011 John Wiley & Sons A/S.)

Local anaesthetics (LA) are widely used drugs. Adverse reactions are rare but may be caused by delayed-type hypersensitivity reactions and probably also immediate-type reactions. As it is not always easy to clinically differ between these subtypes, allergy skin testing should be considered. Although numerous test protocols have been published, how patients with hypersensitivity reactions to LA are ideally evaluated remains a topic of discussion. This review attempts to generate a comprehensive update on allergic reactions to LA and to present an algorithm that can be used for the evaluation of patients suspected with immediate- and delayed-type immune reactions. Literature was examined using PubMed-Medline, EMBASE, Biosis and Science Citation Index. Based on the literature, the proposed algorithm may safely and rapidly distinguish between immediate-type and delayed-type allergic immune reactions.

Background: Evaluation of possible photoallergic contact dermatitis in at-risk populations is often not undertaken, and an agreed methodology for investigation is uncommonly used., Objectives: We conducted a retrospective multicentre study to determine the prevalence of photoallergic contact dermatitis in Italy., Methods: A total of 1082 patients with histories and clinical features suggestive of photoallergic contact dermatitis were evaluated. All the patients had undergone photopatch testing with allergens proposed for Italy as well as other substances suggested by each patient's personal history., Results: 234 patients (21.6%) were positive to at least one test substance of the standard photopatch testing series or to added substances. 234 patients (21.6%) were positive to at least one substance with a total of 290 reactions. 204 of the reactions were typically photoallergic; 68 reactions were allergic and within this group 10 were photoaugmented reactions; 18 reactions were considered to be phototoxic., Conclusion: The predominant group of photoallergens was drugs, followed by organic UV filters and antimicrobial agents.

Although genetic factors probably account for differences in susceptibility to contact allergy, they have not yet been identified, partly due to an insufficient understanding of 'susceptibility'. Regarding polysensitization (PS) as a sign of increased susceptibility, we studied the relationship between PS and sensitization to weak versus strong allergens. Patch test data from 66,835 patients registered by the multicentre project, Information Network of Departments of Dermatology (IVDK) between 1 January 1997 and 31 December 2004, were analysed. The association between the number of sensitization to standard series allergens, and contact allergy to a strong allergen methyldibromoglutaronitrile (MDBGN) and to a weak allergen (paraben mix), was analysed with adjusted logistic regression analysis. In paraben-positive (++/+++) patients, the risk of > or = 2, > or = 3 or > or = 4 additional reactions were significantly increased by a factor of 2.1-4.6 compared to MDBGN-sensitized (++/+++) patients. Varying the basic model, a higher risk of additional positive reactions associated with paraben sensitization was consistently identified. The association between PS and sensitization to weak allergens adds a further characteristic of susceptibility to former findings of the IVDK, where PS was related to an increased risk of induction, elicitation, and cytokine polymorphisms. PS can be regarded as a phenotype to be considered in genetic studies.

Axillary dermatitis is common and overrepresented in people with contact allergy to fragrances. Many people suspect their deodorants to be the incriminating products. In order to investigate the significance of isoeugenol in deodorants for the development of axillary dermatitis when used by people with and without contact allergy to isoeugenol, patch tests with deodorants and ethanol solutions with isoeugenol, as well as repeated open application tests (ROAT) with roll-on deodorants with and without isoeugenol at various concentrations, were performed in 35 dermatitis patients, 10 without and 25 with contact allergy to isoeugenol. A positive ROAT was observed only in patients hypersensitive to isoeugenol (P<0.001) and only in the axilla to which the deodorants containing isoeugenol had been applied (P<0.001). Deodorants containing isoeugenol in the concentration range of 0.0063-0.2% used 2 times daily on healthy skin can thus elicit axillary dermatitis within a few weeks in people with contact allergy to isoeugenol.

Allergy to natural rubber latex (NRL) has become an important health issue in recent years, but little is known about how this condition is investigated by physicians in the UK. This postal questionnaire of British dermatology and allergy specialists shows substantial variation in diagnostic practice, most notably with regard to the utilization and choice of starting dose of commercial latex prick test dilutions, reliance on allergen-specific immunoglobulin E measurement, investigation of associated fruit allergy and provision of resuscitation equipment/method of consent when challenge testing. 17% of responding physicians who investigate for NRL allergy do not perform prick test or glove challenge because of the potential risk of anaphylaxis or lack of resuscitation facilities. 87% of allergy clinic specialists report no reduction in the number of patients presenting as new referrals with suspected NRL allergy. These findings suggest a need for robust guidance to achieve more consistent investigative practice by those dealing with this condition.

Immediate-type hypersensitivity to natural rubber latex (NRL) may be associated with chronic eczema, and it has recently been suggested that NRL should be used as a patch-test allergen. However, a standardized preparation does not exist, and experience of patch testing with this substance is extremely limited. The aims of our study were to investigate the patch-test response to different preparations of NRL amongst patients with suspected contact dermatitis. 608 patients were patch tested with a latex series which included wet and dry preparations of undiluted high-ammonia (HA) NRL and low-ammonia thiuram-containing NRL. Cutaneous reactions to 1 or more NRL patches were noted in 24 patients. None of these were strong allergic reactions (> +), and in 15 patients, the responses were only doubtful (?+). Positive patch tests were observed in 9 patients, and were probably due to concurrent thiuram allergy in 6. In the remaining 3 patients, the reactions had subsided by the 2nd reading and may have represented false positives. None of the patients showed consistent allergic reactions to all NRL patches, and most of the doubtful readings had resolved within 4 days, suggesting that they were irritant rather than weak allergic responses. Patch testing to dry HA latex was associated with the least number of reactions. We conclude that allergic patch test reactions to NRL are uncommon, and as reactions are usually weak and difficult to interpret, we suggest that patch testing with NRL should remain experimental until further studies have been undertaken.

Putative allergens in, clinical manifestations of, and patch tests with traditional Chinese medicinal materials (CMM) causing contact dermatitis (CD) were studied. 14 patients with CMM CD and 351 controls were patch tested with the standard series of allergens of Beijing Medical University and the suspected drug, as is. It was found that most CMM CD was caused by the CMM frequently used topically for analgesic and anti-inflammatory effect. All patients patch tested with the suspected drug gave positive results. Some patients also reacted to fragrance mix, colophony, rubber mix and ammoniated mercury. The positivity rates of fragrance mix and colophony in CMM CD patients were significantly higher than in controls (55.6% versus 16.5% for fragrance mix, chi 2 = 11.86, p < 0.01; and 55.6% versus 5.1% for colophony, chi 2 = 29.35, p < 0.01), while not those of rubber mix and ammoniated mercury. Results indicated that the topical analgesic and anti-inflammatory CMM, especially those containing fragrance, may cause contact sensitization. Clinical findings in CMM CD included cutaneous irritation, allergic contact dermatitis, immediate contact reactions and systemic contact dermatitis. CMM CD can be diagnosed by patch testing the putative drug, as is.

5 non-disperse azo dyes, used for colouring natural fibers, were added to the standard patch test series, as 5% pet. preparations. 1814 consecutive patients attending the patch test clinic were patch tested, of whom 16 (0.88%) reacted to the newly added dyes: 8 to Direct Orange 34, 5 to Acid Yellow 61, 2 to Acid Red 359 and 1 to Acid Red 118. On the basis of clinical history and results of patch tests with pieces of fabrics, contact sensitization to non-disperse azo dyes seemed to be related to the appearance of skin lesions at least in 8 subjects. We conclude that systematic exploration of the sensitizing potential of textile dyes, selected after careful investigation, can provide additional information on the frequency of occurrence of textile dye dermatitis, supporting individual investigation in sensitized subjects.

20 patients with contact urticaria from rubber gloves were prick tested using eluates from 4 latex (Triflex, Ansell Gammex, Exona, Armi) and 2 non-latex (Tactylon, Elastyren) glove brands. All patients showed a positive prick test reaction to at least 2 latex glove eluates. A hypoallergenic glove (Ansell Gammex) gave a positive prick test reaction in 1 patient, but non-latex gloves were negative in all cases. All patients showed a positive result in the use test with a latex surgical glove (Triflex), whereas none did with a non-latex glove (Tactylon). Non-latex gloves and, in some cases, also hypoallergenic latex gloves, are a good alternative to rubber gloves for patients with immediate latex allergy.

Immediate and delayed photocontact dermatitis from the UVA absorber isopropyl dibenzoylmethane is described in 1 patient. In a dose response study in a 2nd patient with delayed photocontact dermatitis, the minimal dose of UVA needed to elicit a positive photopatch to isopropyl dibenzoylmethane 2% was determined to be 2 J/cm2.

Of 7887 patients with eczema seen in a private dermatological practice over a period of 2 years and 4 months, a specific final diagnosis was found in 5376 (68%), while a final diagnosis of non-specific eczema was made in 2511 cases (32%). The most common final diagnoses were seborrhoeic dermatitis (1351), contact dermatitis (1317), atopic dermatitis (1009) and nummular eczema (822). Battery patch testing was the initial diagnostic procedure performed, and 897 of the 3164 patients who were patch tested had one or more positive patch tests. In 545 cases, the reactions were considered of relevance to the current dermatitis. Tests for immediate-type allergy were carried out in 618 patients, and 284 of these had one or more positive tests. In 86 patients, these test results were of diagnostic significance. 257 patients with positive patch tests were challenged orally with the relevant substance, and 53 of 156 reacted to metal salts, most commonly nickel, while 25 of 101 reacted to orally ingested balsam of Peru. Among patch-test-negative patients, 66 of 408 had positive reactions to one or more metal salts; 41 of 180 reacted to balsam of Peru, while 15 of 41 reacted to various food additives.

From a review of the literature, and the results of scratch, intracutaneous and subcutaneous injections of patients with parbens and benzyl alcohol sensitivity of the delayed type characterized by allergic contact dermatitis and strongly positive patch patch tests, it would appear that such sensitivity is not usually accompanied by the immediate urticarial type of allergic sensitivity. This communication concerns itself with results of testing patients with clinical sensitivity and positive patch test reactions to the parabens or benzyl alcohol with scratch, intracutaneous and subcutaneous injections of these preservatives in order to determine the relationship of the "delayed" type of allergic hypersensitivity to the parabens and benzyl alcohol with the "immediate" variety of hypersensitivity. The parabens and benzyl alcohol are widely employed as preservatives for many allergenic extracts used in scratch and intracutaneous testing. In addition, these preservatives are used in injectable corticosteroid medicaments and in local anesthetic solutions. In order to determine whether the presence of these preservatives in allergenic extracts would produce false positive scratch or intracutaneous tests or might produce an immediate, urticarial or anaphylactic reaction in patients with allergic contact dermatitis and positive patch test reactions to these preservatives, two patients with positive patch test reactions and allergic contact dermatitis to the parabens and two with similar benzyl alcohol sensitivity were tested in the manner detailed in the following case reports.