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Competing Interests: The authors have no funding or conflicts of interest to declare.

Background: The Alexander Fisher Award (AFA) recognizes excellence in research among dermatology residents or medical students who make formal presentations at the annual American Contact Dermatitis Society (ACDS) meeting., Objective: The aim of the study was to investigate long-term likelihood of patch testing, academic practice, and society membership among Alexander Fisher Award winners (AFAWs)., Methods: The AFAWs from 1989 to 2012 were identified with Internet searches to obtain their current practice location. Each practice was contacted by phone, and staff was asked whether the AFAW performed patch testing. Current ACDS membership was confirmed by ACDS leadership. Academic status was assessed by university association on practice Web sites., Results: Sixty-two awards were presented to 60 individuals from 1989 to 2012. Fifty AFAWs are actively practicing dermatology in the United States (n = 43) and Canada (n = 7). Of 50 practicing AFAWs, 18 (36%) are active patch testers, 29 (58%) do not perform patch testing, and 3 (6%) could not be reached or staff declined to answer. Of the 50, 14 (28%) practice in an academic setting, and 10 (20%) are current ACDS members.

Background: Dose/area and reading paradigms for gold patch testing are controversial and not standardized worldwide., Objectives: The aims of this study were to determine the optimum patch test dose of gold sodium thiosulfate (GST) in a hydrogel (HYD) and to establish GST HYD safety/efficacy and further characterize normal morphology and time course of GST reactions., Methods: Twenty gold-allergic patients were patch tested with a dilution series of GST HYD and with GST 2% petrolatum (pet). Furthermore, this previously determined optimal dose was compared with GST 0.5% pet in 19 known-allergic and 216 consecutive subjects., Results: The optimal GST HYD dose was 0.075 mg/cm, not statistically different from GST 2% pet (P = 0.4795). Gold sodium thiosulfate HYD outperformed GST 0.5% pet in both known-allergic subjects (79% vs 63%, P = 0.2482) and consecutive subjects (30% vs 9%, P < 0.0001). Late reactions were common in consecutive patients with both HYD and pet. Significantly more persistent reactions were associated with GST HYD than with GST 0.5% pet., Conclusions: Gold sodium thiosulfate HYD 0.075 mg/cm is the optimal dose for diagnosis of gold contact allergy with GST. Gold sodium thiosulfate 0.5% pet yielded false-negatives in some patients, suggesting inadequate dose per centimeter squared. Late reads are normal, expected, and necessary for diagnosis of gold contact allergy in this cohort.

Background: Present screening methods to rapidly detect release of nickel and cobalt ions from metallic surfaces involve colorimetric dimethylglyoxime (DMG)- and disodium-1-nitroso-2-naphthol-3,6-disulfonate-based spot tests with a cotton bud. There is a risk of false-negative test reactions because test outcomes are dependent on the pressure, area, and duration of surface wiping., Objective: The aim of the study was to develop a miniaturized electrochemical device that uses a voltage to accelerate nickel and cobalt release from the tested item and perform an initial validation., Methods and Results: A device was built in plastic, and its performance was investigated using 0.5 mL of test solutions of, respectively, DMG and disodium-1-nitroso-2-naphthol-3,6-disulfonate. Cotton buds that had been wetted in test solution were pressed against different metal surfaces at various voltages (0-9 V) and a range of test durations (0-120 seconds). Duplicate testing for nickel and cobalt release was also performed on a sample of 163 jewelry items., Conclusions: This novel electrochemical device makes it possible to perform nickel and cobalt ion release testing without rubbing, thereby reducing interindividual differences in testing technique. The nickel testing with the device seemed to be superior to conventional DMG spot testing.

Background: Preservative sensitivity patterns evolve with changing use patterns in products. During the last decade, the use of methylisothiazolinone (MI) at higher concentrations in both leave-on and rinse-off products has significantly increased. This is the first North American Contact Dermatitis Group reporting cycle that includes both methylchloroisothiazolinone (MCI)/MI and MI data., Objective: The aim of this study was to report the prevalence of isothiazolinone allergy (MCI/MI and MI) in the North American Contact Dermatitis Group patch-test population from January 1, 2013, to December 31, 2014., Methods: At 13 centers in North America, 4860 patients were patch tested in a standardized manner with a series of 70 allergens, including MCI/MI 0.01% aqueous (aq) and MI 0.2% aq., Results: Three hundred five patients (6.3%) had a positive reaction to MCI/MI; this is a significant increase from the previous cycle (5.0%, 2011-2012; P = 0.011). Five hundred twenty-one patients (10.7%) had a positive reaction to MI. These 2 isothiazolinones were among the most common preservative allergens in the 2013 to 2014 cycle; 11.9% of patch-tested individuals were allergic to 1 or both isothiazolinones. Individuals with MCI/MI and MI allergy were significantly more likely to have occupationally related skin disease (P < 0.0001) and hand dermatitis (P < 0.0001, P = 0.0474)., Conclusions: The epidemic of isothiazolinone sensitivity documented in Europe is now in North America. Patch testing with only MCI/MI 0.01% aq will miss approximately half of isothiazolinone allergy cases, whereas testing with only MI 0.2% aq will miss approximately 10% of isothiazolinone allergy cases.

Background: Cobalt was recently identified in a leather couch responsible for dermatitis. Cobalt content/release in leather in the United States is unknown. We evaluated leather for cobalt content/release and investigated screening methods for identifying cobalt in leather., Methods: One hundred thirty-one leather swatches were screened for cobalt content/release with X-ray fluorescence (XRF) spectrometry and cobalt indicator solution (CIS). Samples with positive screens and 1 negative control were analyzed using inductively-coupled plasma mass spectrometry (ICPMS)., Results: CIS showed that 5 of 131 samples contained cobalt, subsequently found to be between 1 and 190 parts per million (ppm) when evaluated with ICPMS. The XRF analysis showed that 6 samples contained >5% cobalt, subsequently found to contain greater than 300 ppm cobalt by ICPMS. 7 of 12 tested swatches contained cobalt in excess of 100 ppm. One sample contained greater than 1000 ppm cobalt. The prevalence of swatches containing cobalt at levels in excess of 190 ppm was at least 5% (n = 7; total, N = 131)., Discussion: Some leather consumer goods contain and release cobalt. Cobalt indicator solution is a poor screening test for cobalt in leather while XRF screening may be effective. Leather is a new source of cobalt exposure. Exposures to metal allergens are changing in ways that impact clinical decision making.

Background: Nickel is the most common allergen detected by patch testing in children. There is an increasing number of cases in children who have not had exposure to piercing. Although the clinical relevance of nickel patch test reactions in children is sometimes uncertain, continued vigilance to identify new sources of nickel exposure in this age group is important. Recent case reports have described allergic nickel contact dermatitis in children following exposure to toys, but the magnitude of this problem is unknown., Objective: The aim of this study was to evaluate nickel and cobalt release from children's toys., Methods: We purchased 212 toys in 18 different retail and online stores in the United States and Denmark. Nickel and cobalt release was tested using the dimethylglyoxime and cobalt screening spot tests., Results: A total of 73 toys (34.4%) released nickel, and none released cobalt., Conclusions: Toys are a commonly overlooked source of nickel exposure and sensitization. Therefore, dermatologists, allergists, and pediatricians should consider the role of toys in their evaluation of children with dermatitis, and the parents of children with positive nickel patch test reactions should be told that toys may release nickel and be a potential chemical source in the manifestation of allergic contact dermatitis.

Background: Standardization of patch testing has been difficult to achieve., Objectives: This study aimed to identify physical variations in patch test systems that could affect delivery of allergens., Methods: We compared the volume, depth, and contact area of 21 patch test delivery systems. We also filled a variety of patch test systems with different volumes of liquid (ferrous chloride) and petrolatum (disperse blue) allergens to investigate coverage and extrusion., Results: The depth of chambers varied from minimal to greater than 1 mm. Mean areas ranged from 50 to almost 350 mm2. In most chambers, even the largest volume of liquid (40 μL) seemed to be completely contained by each product's absorbent material. The amount of petrolatum required to provide 100% coverage ranged from 15 to 45 μL. The dose delivered, as defined by mg per cm2, varied more than 2-fold across the systems., Conclusions: There are considerable differences across various patch tests. Different patch test systems likely do not deliver the same dose of allergen if the same volume of excipient is applied. Appreciating the differences between different patch test systems may help refine recommendations for the amount of allergens that should be applied to different patch test systems.

Background: The common practice of preparing patch tests in advance has recently been called into question by researchers. It has been established that fragrance compounds are volatile and their testing efficacy may be affected by storage conditions and preparation. Allergens in fragrance mix I rapidly decrease in concentration after preapplication to test chambers., Objectives: This study aimed to investigate the volatility of hydroxyisohexyl 3-cyclohexene carboxaldehyde (HICC) in petrolatum when stored in test chambers and to explore the correlation between vapor pressure and allergen loss in petrolatum during preparation and storage., Methods: Standardized HICC in petrolatum was prepared and stored in IQ Chambers and Finn Chambers with covers at 5°C, 25°C, and 35°C, and concentration was analyzed at intervals for up to 9 days using gel permeation chromatography., Results: Changes in HICC concentrations were not statistically significant at 8 hours at 5°C, 25°C, and 35°C. After 9 days, HICC concentrations were found to fall approximately 30% when stored at 35°C, 10% at 25°C, and less than 5% at 5°C. There was no significant difference between IQ and Finn chambers., Conclusions: Hydroxyisohexyl 3-cyclohexene carboxaldehyde concentrations are more stable in petrolatum than many other studied fragrance allergens, but HICC is still at risk for decreasing concentration when exposed to ambient air or heat for prolonged periods.

Background: Keys are an important exposure source of metal allergens to consumers and confer a significant problem for nickel-allergic individuals because of repeated daily use., Objectives: The aims of this study were to investigate the frequency of nickel and cobalt release in keys and to consider the effectiveness of coatings for preventing metallic allergen release from common metal allergen-releasing keys., Methods: Keys from a variety of common stores were nickel and cobalt spot tested. Nickel-releasing keys were coated with enamel sprays, subjected to a use test, and retested to assess for metal allergen release., Results: Of 55 tested keys, 80% showed a strong positive result to the nickel spot test. None of the tested keys exhibited cobalt release. No keys initially released nickel after enamel coatings. Key coatings chipped at the portion inserted into a lock after 30 insertions, and keys were found to release nickel. The handle of the key was not found to release nickel after 60 insertions., Conclusions: Nickel release from keys is very common; nickel-allergic consumers should consider purchasing keys that do not release nickel (eg, brass, anodized). Enamel coating may be useful in protecting nickel-sensitive individuals from their keys but cannot consistently prevent nickel-release from portions used frequently.

Background: Nickel and cobalt are common causes of metal allergy., Objective: The objective of this study was to investigate nickel and cobalt exposure in belt buckles by testing 701 belts purchased in China and the United States and to consider the prevalence of nickel allergy and its relevance among Chinese patients., Methods: Seven hundred one belt buckles purchased in China and the United States were tested for nickel and cobalt release. Six hundred thirty-one Chinese patients with suspected allergic contact dermatitis were patch tested and interviewed to determine clinical relevance of results. The Chinese and American literature was reviewed to investigate trends in nickel prevalence over the past decades., Results: Sixty percent (n = 219) of belts purchased in China (n = 365) released nickel, and 0.5% (n = 2) released cobalt; 55.7% (n = 187) in the United States (n = 336) released nickel, and 0.9% (n = 3) released cobalt. Belt dermatitis was a significant clinical finding in 34.8% of Chinese nickel-allergic patients. Literature review suggests increasing nickel allergy prevalence in the United States and China., Conclusions: Metallic belt buckles are an important source of nickel exposure to consumers. Belts from lowest socioeconomic vendors were more likely to release nickel. Belts with silver color and dark metallic color were more likely to release nickel and cobalt, respectively. Clinical findings show belt dermatitis in China to be a problem.