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Epoxy resin systems (ERSs) are a frequent cause of occupational allergic contact dermatitis. A 50-year-old patient developed eczematous skin lesions on the back of his hands, lower arms and eye lids, 2 months after he had started working in aircraft construction. Patch tests showed positive reactions at day 3 to nickel sulfate, epoxy resin based on diglycidyl ether of bisphenol F (DGEBF) and 1,4-butanediol diglycidyl ether (1,4-BDDGE). The chemical triglycidyl-p-aminophenol (TGPAP) applied at 1% and 0.1% induced the strongest (+++ positive) reaction. About 4 months after the patch test with TGPAP, the patient presented with 2 circular depigmented spots in the former TGPAP-patch test areas. Dermatohistopathology confirmed the diagnosis of contact vitiligo. [ABSTRACT FROM AUTHOR]

Periorbital dermatitis is common and can be due to the external use of ophthalmic drugs. We evaluated patch test results of the Information Network of the Departments of Dermatology. During a 5-year period (1995–99), of a total 49 256 patch-tested patients, 1053 (2.1%) were eventually diagnosed as allergic periorbital contact dermatitis (APD) and 588 (1.2%) as non-allergic periorbital dermatitis (NAPD). Patient characteristics between APD, NAPD and other cases (OCs) differed with respect to sex (19.7% male in both periorbital groups versus 36.3% in OCs), atopic dermatitis (10.4% in APD versus 60.2% in NAPD versus 16.9% in OCs) and age, APD being substantially more often (68.2%) aged 40 and above than NAPD (52.6%). Several of the top allergens in OCs [such as fragrance mix, Myroxylon pereirae resin (balsam of Peru), lanolin alcohol and potassium dichromate] caused significantly fewer positive test reactions in both periorbital groups. In contrast, thimerosal, phenylmercuric acetate, sodium disulfite, gentamicin sulfate, phenylephrine hydrochloride and benzalkonium chloride tested positively significantly more often in APD but not in NAPD, verifying them as true ophthalmic allergens. Finally, in 42 cases (4%) of APD patients, additional allergens were identified by testing of the patients' own substances (mostly β-blockers, oxybuprocaine and dexpanthenol), supporting the necessity of testing with ophthalmic drugs as is where individual substances are not readily available. [ABSTRACT FROM AUTHOR]

Several contact allergens are tested at concentrations which might cause irritant reactions. In this study we investigated whether the reactivity to a standard irritant is useful in identifying subjects with hyperreactive skin yielding a higher rate of doubtful or irritant reactions. Sodium lauryl sulfate (SLS) 0.5% (aqua) was tested in addition to the standard series routinely for 5 years in the Department of Dermatology, Dortmund. For data analysis, we compared reactions at D3 to the standard series, the vehicle/emulsifier and preservative series and benzoyl peroxide to the reactions obtained with SLS. Proportions were standardized for age and sex. The association between reactivity to a certain allergen and SLS reactivity as a dichotomous outcome, controlled for age and sex as potential confounders, was assessed with logistic regression analysis. Results showed that of the 1600 tested patients, 668 (41.8%) had an irritant reaction to SLS which exceeded 2 + in only 41 patients. Seasonal variation was statistically significant, showing reduced SLS reactivity in summer vs. winter. Patients with irritant reactions to SLS showed significantly more erythematous reactions to the following 10 allergens of the standard series: fragrance mix, cobalt chloride, balsam of Peru (Myroxylon pereirae), lanolin alcohol, 4-phenylenediamine base (PPD), propolis, formaldehyde, N -isopropyl-N ′-phenyl-p -phenylenediamine (IPPD), benzocaine, and 4-tert -butylphenol-formaldehyde resin. No significant differences regarding strong positive allergic reactions were observed. Concerning other allergens, significantly more erythematous reactions were observed in SLS-reactive patients to benzoyl peroxide, octyl gallate, cocamidopropyl betaine, Amerchol L-101, tert -butylhydroquinone, and triethanolamine. In the SLS-reactive group of patients, the reaction index was negative for 10 allergens of the standard series compared to only 5 in the SLS non-responder group. For the first... [ABSTRACT FROM AUTHOR]

To quantify the independent impact of potential risk factors for nickel contact allergy (NCA), a multifactorial Poisson regression analysis of standardized anamnestic and patch test data (with nickel sulfate, 5% in petrolatum) was performed, comprising 74 940 patients assessed in the 33 German and Austrian contact dermatitis units of the Information Network of Departments of Dermatology (IVDK) between 1992 and 2000. NCA was observed in 15.5% patients. Female sex was the strongest risk factor (prevalence ratio 3.74, 95% CI: 3.51–3.98). Risk increased monotonically and significantly with decreasing age. Atopic dermatitis was not a risk factor. The year of patch test had no influence on NCA risk. Significant variation of risk between occupations was observed. In conclusion, our multifactorial analysis was able to quantify the impact of established risk factors and additionally address other, e.g. occupational, factors yet unidentified. [ABSTRACT FROM AUTHOR]

Clinical epidemiology (CE) is considered unable to estimate morbidity concerning either contact sensitization (CS) or allergic contact dermatitis (ACD) at the population level. Drug-utilization research (DUR) methods estimate the morbidity of suitable diseases based on prescription data for disease-specific drugs. Our objective was to estimate population figures for incidence and prevalence of ACD and CS based on sales data for patch test material in Germany and on patient data from the Information Network of Departments of Dermatology (IVDK). Approximately 600,000 standard series are sold per year in Germany, according to the 2 main manufacterers. This raw sales figure was corrected for certain effects (discarded preparations, proportion of formerly patch-tested patients, proportion of patients with ACD seeking medical advice) to obtain an estimate of the denominator of patients eligible for patch testing annually, and combined with patch test results from the Information Network of Departments of Dermatology (IVDK). In 17.8% (of 9,266 IVDK patients) ACD was established. Extrapolated to the general population, an incidence of ACD of between 1.7 and 7 per 1000 per year was estimated, depending on whether conservative or more liberal assumptions concerning the above effects were made. Of 78,067 IVDK patients tested between 1992 and 2000, 46.8% had at least 1 positive reaction (+ to + + +), and 22.7% had at least 1 stronger positive reaction (+ + or + + +).The 9-year prevalence of CS was estimated to lie between 4.0% and 16.6% for the first outcome, and between 2.0% and 8.1% for the second. Concerning single allergens, 1.9–4.5 million individuals are probably sensitized to nickel, and 1.4–3.4 million to fragrance mix among the German population of 82 million inhabitants. The morbidity data found in this study are in good accordance with data from population-based epidemiological studies. In comparison to these, the CE-DUR approach seems... [ABSTRACT FROM AUTHOR]

The preservative iodopropynyl butylcarbamate (IPBC) (0.1% in petrolatum) was tested in 4883 consecutive patients for 18 months between January 1998 and June 1999. With regard to the MOAHLFA-Index, the study population comprised 37% males; 17% with occupational and 19% with atopic dermatitis; 31% with hand, 10% with leg and 17% with face dermatitis; 61% were age 40 and above. According to readings at D3, 0.3% were allergic to IPBC, with 14 + and 2 + + reactions. Doubtful or irritant reactions occurred twice as frequently. Patients exposed for 24 h (n = 1814) reacted less frequently (0.1%) than the remaining patients exposed for 48 h (0.5%). Considering the possibility that a certain proportion of + reactions could be false positive, the reaction pattern was evaluated. More than 80% of the positive reactions displayed a crescendo or plateau time pattern. Furthermore, 18 of 43 doubtful reactions (?) appeared as late as D3 (thus, these could be false negative), whereas the majority of doubtful reactions occurred earlier and displayed a decrescendo pattern (corresponding to a typical irritant pattern). In conclusion, the large proportion of ‘?’ reactions may be due not only to the irritant potential of the substance, but also to test concentrations not being high enough to elicit an allergic reaction. We propose that higher concentrations of IPBC (0.3%) should be evaluated in a study also addressing suitable validation tests like ROAT or PUT. [ABSTRACT FROM AUTHOR]

Investigates the seasonal variability of patch test results in contact dermatitis. Influence of irritant reactions on the variability; Surveillance data on seasonal variations from the German Information Network of Departments of Dermatology; Association between allergen reactivity and environmental factors.

Contact allergy to oil of turpentine was reported to have become rare. However, the evaluation of standardized data of 45,005 patients tested 1992–1997 in 30 Dermatological Centers associated with the German-Austrian Information Network of Departments of Dermatology (IVDK) showed an increase in positive patch test reactions to turpentine from 0.5% during the years 1992–1995, up to 1.7% in 1996 and 3.1% in 1997. In particular, 17,347 patients tested in 1996–1997 were evaluated in detail by comparing 431 individuals with positive patch test reactions with the rest of the group found negative to turpentine. Using the so-called MOAHLFA index, the following characteristics were shown. Turpentine allergy (a) was found to be significantly less frequent in men and in patients with occupational dermatitis, (b) showed no difference in its association with atopic dermatitis, (c) patients with turpentine allergy had significantly less symptoms of the hands, more symptoms of the legs or in the face and (d) were significantly more often aged over 60 years. Also, patients sensitized to turpentine had increased rates of additional sensitizations. The definite reason for the increase in turpentine sensitization in the population tested here is not clear. Therefore, a detailed exposure analysis is necessary; the new increase in turpentine allergies may be due to popular topical remedies or household chemicals. [ABSTRACT FROM AUTHOR]

Sensitization rates to contact allergens vary between centers and are influenced by sex and age. Eliminating the latter 2 factors by standardization of data by age and sex, the present analysis adresses possible differences between centers remaining after elimination of these confounders and analyzes other factors which might influence rates e.g., the MOAHL index. Overall standardized rates were well within the range reported in previous studies and may be regarded as representing the rates were well within the range reported in previous studies and my be regarded as representing the rates of the "patch test population" in Central Europe (e.g., nickel sulfate 12.9% of fragrance mix 10.5%,balsam of Peru 7.3%, thimerosal 5.6%). For this analysis data of those departments which contributed more than 2000 patients, or of those with extreme proportions concerning sex, age and occupational cases were selected. Patients from these 10 departments differed considerably with regard to the items of the MOAHL index and with regard to standarized rates. The items of the MOAHL index proved to be suitable for describing different patch test populations and for explaining some differences between centers. Only 'atopic dermatitis' seems to have little influence on (standardized ) rate. Face dermatitis is not yet represented in the MOAHL index, but should be included, together with age >40 years in an extended index (acronym: MOAHLFA). Regional allergen exposure (with striking differences between East Germany, West Germany and to a lesser extent. In addition, sociological factors may influence sensitization rates, which is exemplified by high rates of nickel allergy in a socially defined subgroup. Future studies should focus on these factors as well as on factors concerning patch test practices and quality control. [ABSTRACT FROM AUTHOR]

791 patients, among them 59 dental technicians and 732 other patients were tested with the denture material series (DMS) recommended by the German Contact Dermatitis Research Group (DKG) in the hospitals of the Information Network of Departments of Dermatology (IVDK) between January 1990 and July 1993. Most frequently, positive reactions occurred to cadmium chloride in both groups. However, there was no evidence at all for relevance a these reactions. Benzoyl peroxide (BPO) ranked 2nd in patch test positivity. Although not statistically significant, reactions were more frequent in dental technicians, who might be exposed to BPO the in working environment. Methyl methacrylate (MMA) and triethylene glycol dimethacrylate (TEGDMA) were common sensitizers in dental technicians but not in other patients. This finding, too, has its, explanation in the working process of manufacturing dental prostheses. [ABSTRACT FROM AUTHOR]

A letter to the editor in response to "Both mercaptobenzothiazole and mercapto mix should be part of the standard series", by Diepgen T L and his colleagues, published in vol 55 of 2006, is presented.

Background Objectives Patients and Methods Results Conclusions Permanent tattooing is the invasive introduction of tattoo ink (pigments) into the dermis. The ink and aftercare cosmetics applied on pre‐damaged skin may contain skin sensitisers.To identify patient characteristics and the pattern of sensitisation in tattooed patients patch tested within the Information Network of Departments of Dermatology (IVDK).Comparative analysis of patient characteristics and reaction frequencies to baseline series allergens in 1648 consecutive patients with and 8045 consecutive patients without permanent tattoos. Non‐overlapping 95%‐confidence intervals were considered as significant.Having permanent tattoos was related with female sex, age <40 years, tobacco smoking, atopic dermatitis, (occupational) hand dermatitis and being employed in particular occupational groups (e.g., healthcare workers, mechanics, hairdressers). Sensitisation to nickel was increased in tattooed patients and associated with female sex (OR 4.23 [95%‐CI, 3.48–5.18]), age ≥40 years (OR 1.26 [95%‐CI, 1.08–1.49]), tobacco smoking (OR 1.19 [95%‐CI, 1.01–1.40]) and having permanent tattoos (OR 1.27 [95%‐CI, 1.05–1.53]).The association between nickel sensitisation and permanent tattoos is probably confounded by past reactions to pierced costume jewellery. Socio‐economic factors most probably contribute to the connection between tattoos, tobacco smoking, occupational or hand dermatitis, and being employed in particular occupational groups. [ABSTRACT FROM AUTHOR]

We investigated whether patients with contact allergy differed from non-contact-allergic, non-atopic controls with regard to genotype and phenotype of the polymorphic enzyme N-acetyltransferase 2 (NAT2). 55 contact-allergic patients recruited from the Information Network of Departments of Dermatology (IVDK) were compared to 85 controls from among local health care personnel. NAT2 activity was calculated from HPLC analysis of the ratio of the caffeine metabolites 5-acetylamino-6-formylamino-3-methyluracil (AFMU) and 1-methylxanthine (1MX) in the urine. NAT2 genotype was determined by polymerase chain reaction (PCR). A statistically significantly increased proportion of rapid acetylators was found in contact-allergic patients. This may have 2 possible implications: acetylation may enhance contact sensitization; or NAT2 status may be a genetic marker for contact sensitizability. [ABSTRACT FROM AUTHOR]

This article focuses on the use of phenylmercuric acetate (PMA) in patch testing for contact dermatitis. PMA has been used as a preservative in eyedrops, as disinfectant, as a paint preservative, formerly as fungicide in agriculture and possibly as fungicide in leather processing. Contact allergy to PMA has been reported. However, the diagnostic quality of the patch test preparation, PMA 0.05% pet., is not satisfying. The German Contact Dermatitis Research Group conducted a multicentre study in order to find out whether the irritancy of the PMA patch test preparation can be diminished by reducing the test concentration. PMA 0.05% pet. caused positive reactions in 121 patients and doubtful or irritant reactions occurred in 125 patients.

Replies to a comment on an article exploring the relationship between different demographic and clinical factors assembled in the MOAHLFA index and irritant patch test reactions to sodium lauryl sulfate. Use of the SLS patch test in conjunction with diagnostic allergen patch testing as an aid in the interpretation of certain patch test reactions to allergens as allergic or irritant; Conceptual background of the analysis.

Analyzes the frequency of allergic sensitization to ammonium thiolactate and thiolactic acid among hairdressers. Methods used in determining the subjects' allergic reactions; Stability of the Hermal patch test material.