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Background: Allergic contact dermatitis (ACD) in paediatric patients is on the rise. Continuous identification of emerging allergens is of great importance to ensure accurate patch testing. Objectives: To assess the frequency and relevance of contact sensitivity in children and adolescents and evaluate changes in sensitization rates in the last decade. Methods: All patients with suspected ACD who underwent patch testing at the Amsterdam University Medical Centers between 2015 and 2021 were included. Results: Of 439 patients tested with the European Baseline Series (EBS) and additional series, 334 (76%) patients had at least 1 positive reaction and 172 patients (39%) had 1 or more relevant positive reactions. If additional series would have been omitted, 20% of patients would have been underdiagnosed. Compared to patients tested between 1996 and 2013, reactions to metal allergens, isothiazolinones, methyldibromo glutaronitrile, carba mix, amerchol L‐101, and benzophenone‐4 were more frequently observed. Conclusions: This study confirms the need for patch testing in paediatric patients suspected of having ACD. For accurate patch testing, it is advised to include additional series. [ABSTRACT FROM AUTHOR]

Introduction: Oral lichen planus (OLP) is a chronic autoimmune inflammatory disease with an unknown aetiology and a higher prevalence in women. Oral lichenoid lesions both clinically and histologically resemble oral lichen planus and are often associated with contact allergy to dental materials. Aim: To investigate the prevalence of delayed hypersensitivity reactions in patients with OLP and to identify the most common allergens that may exacerbate the disease. Material and methods: Twenty patients diagnosed with OLP and undergoing treatment in the Gerodontology and Oral Pathology Department of the Poznan University of Medical Sciences were enrolled in the study. The subjects underwent a detailed oral examination consisting of anamnesis and a clinical evaluation by a qualified dentist, while an assessment of the skin and skin appendages was carried out by a dermatologist. Patch testing was performed using the Polish Baseline Series and Dental Screening Series. Results: Fifty percent of the examined patients displayed positive patch test reactions. A total of 18 allergic reactions were revealed, but only four appeared during the first test. The most common allergens were found to be nickel, gold, and a fragrance mix. Only 1 patient had a positive reaction to more than three allergens. Conclusions: There seems to be a high contact reaction rate in patients with oral lichen planus, which is not related to contact with synthetic dental materials. However, further investigations on a larger population with the introduction of additional tests administered 7 days after exposure are required to confirm the effects of delayed hypersensitivity reactions on patients with OLP exacerbation. [ABSTRACT FROM AUTHOR]

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Introduction: Chromium has been responsible for occupational skin disease, both irritant and/or allergic contact dermatitis. In order to minimize this problem, regulatory measures limiting its use have been implemented. The impact of these regulations should be monitored over time. Material and Methods: A retrospective study from 2009 to 2018 was carried out in the Department of Dermatology to assess the temporal trend of chromium sensitization evaluated by patch testing with potassium dichromate 0.5% pet, particularly considering age, sex and its relationship with occupational activity. Results: 3277 individuals were studied, 2369 females (72.29%) and 908 males (27.71%). Of those 621 (18.95%) fulfilled criteria for occupational contact dermatitis. Chromium allergy was found in 118 (3.60%) patients, 64 females (54.4%) and 54 males (45.76%). We found that male patients were significantly more frequent (45.76% vs 27.03%; p<0.001), as well as occupational dermatitis (31.35% vs 18.47%; p<0.001), hand dermatitis (53.54% vs 23.52%; p<0.001) and age above 40 years (70.34% vs 56.76%; p=0.003). Discussion/Conclusion: The results show a high prevalence (3.60%) of chromium positive patch tests. In our study, there has not been a significant decrease in sensitization to chromium over the years. Interestingly cases classically related to this allergy (cement in the building industry) are no longer the main cause of the problem. We found other sources such as leather as a main cause of allergic sensitization, suggesting a change of the panorama. [ABSTRACT FROM AUTHOR]

Angry back, bismuth, case report, delayed-type hypersensitivity, gastric ulcer, Helicobacter pylori, maculopapular rash, patch tests Therefore, both drugs were re-tested, on separate skin locations, eventually allowing us to identify Pylera, and ultimately its bismuth component, as the actual culprit drug.4 In conclusion, we present the extensive workup, including some pitfalls, of a rare case of a delayed-type hypersensitivity, presenting as a generalized micro-maculopapular rash skin eruption, attributed to bismuth salts. Keywords: angry back; bismuth; case report; delayed-type hypersensitivity; gastric ulcer; Helicobacter pylori; maculopapular rash; patch tests EN angry back bismuth case report delayed-type hypersensitivity gastric ulcer Helicobacter pylori maculopapular rash patch tests 228 229 2 02/24/22 20220301 NES 220301 Bismuth compounds, historically used in the topical treatment of leg ulcers, and occasionally present in eye ointments,1 are nowadays used perorally to treat gastrointestinal disease (eg, stomach ulcers).1 CASE REPORT A 42-year-old nonatopic man had been diagnosed with infection due to I Helicobacter pylori i . [Extracted from the article]

Allergic contact dermatitis, case report, patch tests, benzoic acid, CAS-No. 10310-32-4, serial dilutions, tribenoside Keywords: allergic contact dermatitis; benzoic acid; case report; CAS-No. 10310-32-4; patch tests; serial dilutions; tribenoside EN allergic contact dermatitis benzoic acid case report CAS-No. 10310-32-4 patch tests serial dilutions tribenoside 718 719 2 11/18/21 20211201 NES 211201 CASE REPORT A 48-year-old female patient presented to our clinic with a 2-week history of erythematous and itchy dermatitis around her anus (Figure 1). GLO:FQV/01dec21:cod13952-fig-0001.jpg PHOTO (COLOR): 1 Positive patch tests reactions to Procto-Glyvenol crème gl Patch tests were performed with the European baseline series complemented with lidocaine 5.0% pet., cetyl alcohol 5.0% pet., benzisothiazolinone 0.1% pet. [Extracted from the article]

Second, in our case report, the patch tests with splint scrapings were positive, but only because the splint had been contaminated with the genuine culprit, the diclofenac gel. Allergic contact dermatitis, case report, diclofenac, patch tests, propylene glycol, retained allergen, topical drug Keywords: allergic contact dermatitis; case report; diclofenac; patch tests; propylene glycol; retained allergen; topical drug EN allergic contact dermatitis case report diclofenac patch tests propylene glycol retained allergen topical drug 475 476 2 09/21/21 20211001 NES 211001 CASE REPORT A 45-year-old woman was referred to our department for the investigation of a localized eczema on the right ankle with secondary extension. [Extracted from the article]

Background Modern dressings ( MDs) may have a low sensitization rate, but there is a lack of prospective studies in patients with chronic leg ulcers ( CLUs) to evaluate this. Objectives To determine the rate of sensitization (contact allergy) to MDs and substances present in dressings. Patients and methods A prospective multicentre study was carried out in patients with CLUs at five French dermatology departments; patch tests were performed with the European baseline series and with an additional 27 individual allergens and 10 MDs. Results Among 354 patients (226 women and 128 men) with CLUs, 59.6% had at least one positive patch test reaction to an MD and 19% had at least one sensitization to an MD. The number of positive test reactions per patient was correlated with the duration of ulcerative disease, but not with ulcer duration, the cause of the ulcer, or the presence of surrounding eczematous lesions. For 11 of 45 patients sensitized to Ialuset cream®, more detailed information could be obtained with sensitization to sodium dehydroacetate (5 cases) or Lanette SX® (3 cases). Conclusions Sensitization to MDs is not rare. It is absolutely necessary to label all components of MDs on their packaging and to avoid some sensitizing molecules, such as colophonium derivatives or any strong sensitizers. [ABSTRACT FROM AUTHOR]

Exposure to hair dye is the most frequent route of sensitisation to para-phenylenediamine ( PPD), a common contact allergen. International studies have examined the profile of PPD, but Australian-sourced information is lacking. Patients are often dissatisfied with advice to stop dyeing their hair. This study examines patients' characteristics, patch test results and outcomes of PPD allergy from a single Australian centre, through a retrospective analysis of patch test data from 2006 to 2013 at the Liverpool Hospital Dermatology Department. It reviews the science of hair dye allergy, examines alternative hair dyes and investigates strategies for hair dyeing. Of 584 patients, 11 were allergic to PPD. Our PPD allergy prevalence rate of 2% is at the lower end of international reported rates. About half these patients also react to para-toluenediamine ( PTD). Affected patients experience a significant lifestyle disturbance. In all, 78% tried alternative hair dyes after the patch test diagnosis and more than half continued to dye their hair. Alternative non- PPD hair dyes are available but the marketplace can be confusing. Although some patients are able to tolerate alternative hair dyes, caution is needed as the risk of developing an allergy to other hair dye ingredients, especially PTD, is high. [ABSTRACT FROM AUTHOR]

Introduction: The aim of the study was to provide current data on the incidence of allergy to various contact allergens in patients with allergic contact eczema and the analysis of selected socio-demographic data of the patients. Material and methods: The study included 1532 patients (1010 women and 522 men) treated for allergic contact dermatitis at the Department of Dermatology and Venereology and at the Dermatology Outpatient Clinic in Bialystok in 2007-2011. The assessment of selected demographic data and skin lesions was based on the MOAHFLA index, while the results of patch tests were analyzed with modified Baseline European Series consisting of 31 allergens. Results: In the group of patients with eczema, 34. 1% were men, and 55% of all respondents were people over 40 years of age. The occupational character of skin lesions was found in 22. 5%. Most frequently (38. 9%) skin lesions were localized on the hands, rarely involved legs (3. 98%). Atopic dermatitis was diagnosed in 4. 5% of patients. The ten most frequent allergens were: nickel sulfate (24%), cobalt chloride (15. 3%), fragrance mix (8. 25%), potassium dichromate (6. 8%), balsam of Peru (5. 5%), neomycin (4. 42%), paraphenylenediamine (3. 85%), Quatermium-15 (2. 1%), detreomycin (1. 83%) and budesonide (1. 44% of tested patients). Conclusions: Frequent allergy to detreomycin indicates the need of patch testing for this allergen of all examined patients with allergic contact dermatitis. The increased frequency of the nickel allergy is a worrying problem and indicates the need for education about the risk factors for nickel allergy development and the implementation of appropriate legal regulations. [ABSTRACT FROM AUTHOR]

Background Iodopropynyl butylcarbamate ( IPBC) is a preservative that may cause contact allergy. The first cases were reported in 1997, and IPBC is currently included in our extended European baseline series in Denmark. Objectives To assess trends during the period 2000-2011 concerning IPBC allergy in Denmark, and to address the question of the significance of concomitant reactions to the thiuram mix. Patients/materials/methods Nine thousand seven hundred and fifty-five (6449 female; 3306 male) patients were patch tested with IPBC and the European baseline series at Gentofte Hospital during 2000-2011. The results were registered in an anonymized database, and analyzed with spss™. Results Fifty-four cases of IPBC contact allergy were detected. A significant rising trend during 2000-2011 was observed, with no significant changes during 2006-2011. MOAHLFA index analysis showed that IPBC contact allergy was, in our cohort, significantly more prevalent among male patients, occupational, related to hand eczema, and more frequent among patients over 40 years old. A significant relationship between IPBC and thiuram mix allergy was found. Conclusions IPBC continues to be among the less frequent allergens. A 0.2% concentration in patch testing has contributed to the diagnosis of more sensitizations to this substance. Further studies are needed to clarify the reason for the over-representation of thiuram allergy in patients sensitized to IPBC. [ABSTRACT FROM AUTHOR]

Background Multiple drug hypersensitivity ( MDH) has been defined as a hypersensitivity to two or more chemically different drugs. Two types of MDH have been reported: the first one, which develops to different drugs administered simultaneously and the second type, in which sensitizations develop sequentially. In children, studies which diagnose MDH on the basis of positive allergologic tests to 2 or more chemically different drugs are lacking. Methods We conducted a prospective study evaluating children with histories of MDH by skin tests, patch tests, serum-specific IgE assays, and drug provocation tests. Results A MDH was diagnosed in 7 (2.5%) of the 279 children evaluated who completed the study. The responsible drugs were β-lactams (penicillins and cephalosporins) in 5 episodes, ibuprofen and anticonvulsants in 3, and erythromycin, fentanyl, methylprednisolone, and cotrimoxazole in 1. Sensitivity to 2 chemically different drugs was diagnosed in 6 children and to 3 drugs in 1 child. Two of the 7 children presented the first type of MDH, whereas 5 displayed the second one. Conclusions MDH can occur in children, even to drugs other than antibiotics. It is crucial to evaluate children with histories of MDH using both in vivo and in vitro allergologic tests, including challenges. In fact, such approach allows the physician to confirm the diagnosis of MDH in a small percentage of children with histories of MDH, as well as to rule it out in the great majority of them. [ABSTRACT FROM AUTHOR]

Contact allergy to topical corticosteroids is usually detected by patch testing. This study compares the test results obtained with patch, prick and intradermal testing, to assess the most sensitive method for diagnosing corticosteroid hypersensitivity. Nineteen corticosteroid-allergic subjects and three control subjects were included. Patch, prick and intradermal tests were performed with five commercial corticosteroid preparations, as well as with the respective active principles diluted in ethanol. The test readings were performed at different time points, i.e. at 8, 24, 48 and 96 hr, and at 7 days. Patch tests with ethanolic preparations produced more positive reactions than the commercial ones. The intradermal tests became positive earlier than the patch tests, a concordance between patch and intradermal tests being found in 11/15 (two positive intradermal test results with negative patch test results and vice versa). However, several subjects developed skin atrophy (14/22) at intradermal injection sites. Patch testing with the active principles diluted in ethanol remains the diagnostic method of choice for the detection of delayed hypersensitivity to corticosteroids. Intradermal tests with late readings, despite detecting additional contact allergy cases, should not be routinely performed, because of an important risk of atrophy, particularly with corticosteroid suspensions. [ABSTRACT FROM AUTHOR]

The article discusses the findings of a study which evaluated the reproducibility of patients' patch test results for nickel, chromate, and cobalt from 1992-2014. It notes that 819 patients were patch tested twice to determine if they were positive for allergic contact dermatitis (ACD) when exposed to nickel, chromate, or cobalt. The results confirmed that nickel had a reproducibility rate of 67 percent, while chromate and cobalt were rated at 62 and 61 percent, respectively.

Background: Propolis is widely used in ‘natural’ cosmetics, remedies, and over-the-counter products. The incidence of propolis allergy is increasing, and cross-reaction with fragrance mix I (FMII), colophonium, and Myroxylon pereirae can occur. Objectives: To find out the prevalence and clinical relevance of positive patch tests to propolis and assess cross-reactions with Myroxylon pereirae, colophonium, FMI, and beeswax. Methods: Two thousand eight hundred and twenty-eight subjects in 10 UK centres were patch tested with propolis and beeswax. Generic data were acquired from British Contact Dermatology Society (BCDS) database and further relevant information was requested by survey of participating centres. Results: The prevalence of propolis allergy was 1.9% (55/2828). Out of these 55 subjects, only 4 (7.2%) were allergic to beeswax, 22 (40%) to Myroxylon pereirae, 15 (27.2%) to colophonium, and 6 (10.9%) to FMI. Additional data for 41 propolis allergic subjects were collected by questionnaire. Hands were the most common sites of involvement, and cosmetics were the most common source of contact. Eight out of 12 subjects reported improvement in eczema following avoidance of propolis. Conclusions: Propolis is an important allergen of increasing frequency and its inclusion in BCDS baseline series is appropriate. Cross-sensitivity to beeswax is rare. [ABSTRACT FROM AUTHOR]

Background: Immunologic studies indicate that psoriasis may represent an organ-integrated response. Objective: We assessed contact hypersensitivity in plaque-type psoriasis, its frequency, etiology and association with severity of psoriasis. Methods: Contact hypersensitivity was defined as a positive patch test (PT) to at least one of 44 ubiquitous contact allergens. Patients with exclusively plaque psoriasis and control groups (patients with allergic contact or extrinsic atopic dermatitis and healthy persons) were tested with the European standard series; plant-related standard allergens; Compositae allergens, and our own extracts from Compositae plants ubiquitous in Vojvodina. Sensitization rates to allergens were standardized for age and sex, and rates in women and in men were both standardized for age. Disease severity was evaluated using the Psoriasis Area Severity Index score. Results: 15,123 PTs were performed. Among psoriatic patients in Vojvodina, the overall rate of sensitivity, standardized for age and sex, was 18.9%. Rates in women (27.7%) and men (5.8%), both standardized for age, were significantly different. Male psoriatic patients reacted less than healthy males, the difference being on the margin of significance. There was no relationship between severity of disease and PT reactivity. Yarrow extract, nickel and a Compositae mix were the most common allergens that produced positive reactions. Conclusion: Although patch testing in psoriatic patients can be quite challenging, time-consuming and difficult, it will provide further insight into the pathophysiology of psoriasis. Factors other than different exposure to allergens may also be responsible for a sex-related difference in contact sensitivity. Future studies should focus on this field. Copyright © 2008 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Background There are few studies comparing the incidence of allergic contact dermatitis among different racial groups living within the same community. Objectives The objectives of this study were to compare white European patients with Fitzpatrick's skin phototypes (FSP) I to IV and patients from Indian, Pakistan and Bangladesh with FSP V living within the same community. Referral rates for patch testing, incidence of contact allergies and differences in contact allergens found were assessed. Method All patients referred to the Contact Dermatitis Unit at Dewsbury and District Hospital between 2004 and 2006, inclusive, were included in the study. All patients were patch tested to the British Contact Dermatitis Society standard series, plus other series according to their clinical history, occupational history and clinical findings. Results Four hundred and thirty-five consecutive patients from the patch testing clinic were included in the study. Fewer patients from the Indian subcontinent underwent patch testing (11.5%) than would have been expected for the size of the local population (18%). Fewer patients from the Indian subcontinent (44%) had one or more positive reactions compared with the white European patients (56%). No significant differences in the contact allergens responsible were detected between the two racial groups. Conclusion There is a lower incidence of positive patch test results among patients with racial origins from the Indian subcontinent compared with white Europeans. This modest difference could be explained by a lower average age within the study population, and increased or differing exposure to contact allergens rather than demonstration of variability in the susceptibility to develop contact sensitivities following equal exposure. [ABSTRACT FROM AUTHOR]

Background The European Surveillance System on Contact Allergies (ESSCA) began in 2001 as project funded by a European Union grant to monitor and evaluate contact sensitization (CS) based on clinical data collected by participating European dermatology departments. Objectives ESSCA aims to detect trends in CS in an international patch test population, monitoring the frequency of CS to (standard series) allergens, evaluating the effectiveness of intervention (e.g. governmental regulations) and improving standardization of the patch test procedure on an international level. Methods In 2004, 31 ESSCA dermatology departments in 11 European countries collected patch test results and medical histories of patients tested with the European Standard Series (ESS) or a local standard allergen series using the multilingual Winalldat/ESSCA database, the German Winalldat/Information Network of Departments of Dermatology (IVDK) database or a locally created database including the items of the ESSCA ‘minimal data set’. Data were sent to the ESSCA data centre where they were imported, pooled, examined for quality and subsequently analysed. Results The departments patch tested 11 643 patients with a standard series, and 44% of the patients tested positive to one or more substances of the ESS. Nickel sulphate, the fragrance mix, Myroxylon pereirae resin, cobalt chloride, potassium dichromate, methyldibromoglutaronitrile and paraphenylenediamine are (still) the most important allergens detected. Several additional substances tested on consecutive patients in some clinics were also examined. Among these allergens, propolis and Compositae mix had a relatively high CS prevalence. Conclusions The expanding ESSCA network continues to provide up-to-date information regarding the pattern of CS diagnosed in participating departments across Europe. [ABSTRACT FROM AUTHOR]

Patients with multiple contact allergies, also referred to as polysensitized, are more frequent than predicted from prevalence of single sensitivities. The understanding of why some people develop multiple contact allergies, and characterization of patients with multiple contact allergies is limited. This review presents the current knowledge on the topic and discusses the evidence and characteristics of an increased susceptibility factor, possible causes to and genetic markers for the increased susceptibility, composition of the patient group and identification of patients at risk of developing multiple contact allergies. Evidence of allergen clusters among polysensitized individuals is also reviewed. The literature supports the idea that patients with multiple contact allergies constitute a special entity within the field of contact allergy. There is no generally accepted definition of patients with multiple contact allergies. We suggest that contact allergy to 3 or more allergens are defined as multiple contact allergies. [ABSTRACT FROM AUTHOR]

Drug skin tests can be helpful in determining the cause of a cutaneous adverse drug reaction (CADR). Patch tests and prick tests can be performed with any commercialized form of a drug. Intradermal tests (IDTs) have a greater value, but their techniques have not been standardized. Moreover, IDTs can be done only if an injectable form of the drug is commercialized and are restricted to patients with nonsevere CADR. Prick tests and IDTs are used in investigating immediate hypersensitivity. Patch tests both with IDTs with delayed readings are helpful for maculopapular rash and generalized or localized eczema. Results obtained with drug skin tests in β-lactam sensitization have been extensively published, but fortunately, during the last few years the value of skin tests in CADR due to other drug classes (e.g., synergistins, platinium salts or radiocontrast medias) was also studied. The analysis of recent literature permits to propose which tests to choose for each clinical feature of CADR and to give the list of all drugs, having had patch tests with positive results but, emphasizes the lack of standardization in performing and reading IDTs. This standardization is absolutely necessary to determine the thresholds of specificity of the IDT. Except for IDTs, drug skin tests induce only rarely adverse reactions. False-positive results can occur and should be considered by testing new products. The negative predictive value of drug skin tests is a crucial point that will have to be studied in more detail in the near future. [ABSTRACT FROM AUTHOR]

Objective. Inflammatory bowel disease (IBD) has previously been investigated with relation to allergic conditions; however, diverging results were found and there are only a few small studies focusing on delayed hypersensitivity. The aim of this study was to investigate whether there was an association between contact allergy (CA), which is a type IV hypersensitivity reaction of the skin, and IBD. Material and methods. A database consisting of a cohort of 13,315 patients, patch tested between 1985 and 2003, was linked with the Danish National Patient Registry using a unique personal identifier number. The patients were patch tested at a dermatology department with a long history of research in CA. By record linking with the Danish National Patient Registry, patients were identified who had either an International Classification of Disease (ICD) code for Crohn's disease (CD) or an ICD code for ulcerative colitis (UC) diagnosis. Using logistic regression, with the result of the patch test as the dependent variable, we calculated the odds ratios for IBD, CD and UC, adjusted for gender and age. Results. An inverse association between CA and IBD was found, odds ratio adjusted for age and gender 0.71 (CI 95% 0.53-0.94), which is mainly the result of an inverse association between CA and CD, odds ratio adjusted for age and gender 0.42 (CI 95% 0.23-0.76). Conclusions. The association found between CA and IBD might be related to shared genetic factors or common environmental determinates. It may also be that having either disease result in skewness of the immune system might lead to an inverse disease association. [ABSTRACT FROM AUTHOR]

Background: Hypersensitivity reactions to platinum salts are potentially lethal adverse events in chemotherapy, and often require its discontinuation. Several preventive procedures have been proposed: premedication, desensitization regimens, or replacement with a different platinum salt. Objective: We therefore assessed the value of skin tests with platinum salts. A positive result would confirm their responsibility in hypersensitivity reaction, whereas a negative result would identify candidates for continuation of therapy using a different platinum salt. Methods: Patch tests, prick tests, and intradermal tests with cisplatin, carboplatin, and oxaliplatin were performed in 21 patients. Results: Skin tests were positive in 14 of 21 cases. Prick tests were positive in 5 cases with the suspected platinum salt. Intradermal tests were positive in 12 of 19 cases, always when the hypersensitivity occurred less than 2 hours after infusion. Cross-reactions were observed in 4 cases. Delayed readings of skin tests at 24 hours and 48 hours were positive in 3 patients. Patch tests were negative in all the 21 patients tested. Replacement with another platinum salt was performed in 13 patients using one that gave a negative skin test. A relapse of symptoms occurred in 1 patient. Conclusion: Intradermal tests are particularly indicated for the diagnosis of immediate hypersensitivity reaction. Their good negative predictive value allows safe retreatment by detecting a potential cross-reaction. Clinical implications: The frequency of cross-reactions among cisplatin, carboplatin, and oxaliplatin has not been clearly established. Skin tests allow different platinum salts to be given and avoid discontinuation of chemotherapy. [Copyright &y& Elsevier]

Abstract: The diagnosis of allergic contact dermatitis to cosmetics is based on a careful history (anamnesis), taking into account all the cosmetic products that have been used by the patient, on inspection of the clinical symptoms and localisation of the lesions, and on the performance of epicutaneous tests or patch tests. In addition, other types of tests such as open and semi-open testing with products having a certain irritant potential as well as repeated open application tests (ROAT) on the forearm can also be very useful in the diagnosis of contact dermatitis caused by cosmetic products. [Copyright &y& Elsevier]

Abstract: Occupational dermatitis (irritant dermatitis, contact urticaria and contact eczema) is frequent among healthcare workers. Irritant hand dermatitis, the most common occupational dermatitis, occurs often in individual who work in a humid environment, who handle disinfectants, and who are required to wash their hands frequently; atopic dermatitis is a risk factor for this condition. Natural rubber latex present in rubber gloves is the most common cause of contact urticaria. Contact eczema can be induced by rubber accelerators (for example, thiurams) present in gloves, and also by disinfectants (glutaraldehyde, dodecyldimethylammonium), disinfectants and detergents, hand creams, acrylates (in dentists), and echography gels. Nurses sometimes develop contact dermatitis to drugs they handle; these allergies should be diagnosed by appropriate skin testing because sensitized individuals may develop a severe, generalized cutaneous adverse reaction if they are subsequently exposed systemically to the sensitizing drug. [Copyright &y& Elsevier]

Vulvar tissue is more permeable than exposed skin due to differences in structure, occlusion, hydration and susceptibility to friction. The safety assessment of products that contact the vulva should account for this potentially heightened permeability. Standard clinical patch tests may not sufficiently mimic vulvar exposures. Because testing on the vulva is not routinely feasible, we are investigating new and modified cutaneous test methods to increase the degree of conservatism of the safety assessment. To this end, we have 1) developed a method to assess chemical and frictional effects by means of repeated application to the popliteal fossa (the behind-the-knee test); 2) modified the quantitative risk assessment for the induction of allergic contact dermatitis; and 3) proposed a modified human repeat insult patch test for assessing materials intended for vulvar contact. Modification of the traditional 4-day, irritation patch test by using wet samples or compromized skin sites failed to enhance test sensitivity. Future studies will evaluate testing in subjects with heightened susceptibility to chemical and sensory irritation, in order to increase test sensitivity to chemical irritants. These approaches can be employed to augment the margin of safety when cutaneous test methods are applied to agents that contact the vulva. [ABSTRACT FROM AUTHOR]

Occupational contact dermatitis is often of multifactorial origin, and it is difficult to determine the relative significance of the various contributing factors. Contact allergies are relevant in 20–50% of recognised occupational contact dermatitis cases. The reported frequency in different studies varies, depending on differences in how occupational diseases are notified and recognised, in types of occupation in a geographical area, and the "quality" of the dermatological examination, including the accuracy of the diagnostic patch-test investigation. However, the clinical relevance of the reported contact allergies is often uncertain. Many occupational contact dermatitis patients with documented contact allergies develop chronic eczema, in spite of work changes and attempted allergen avoidance. Recognition/non-recognition of a notified case may be based on circumstantial evidence, because of difficulties in the establishing of a firm proof of work exposure and subsequent development of skin disease. Reliable quantitative exposure measuring techniques are needed. Methods are developed for the measurement of exposure to allergens such as nickel and acrylates, which makes it possible for exposure–effect relationships to be established with increased certainty. For prevention of allergic contact dermatitis it was a major step forward, with mandatory ingredient labelling of cosmetic products. However, improved labelling of the presence of contact allergens in household and industrial products is needed. For the identification of hazardous contact allergenic compounds, guinea pig or mice assays are still required. The local lymph node assay (LLNA), which is an objective and sensitive mouse assay has now been internationally validated and accepted. [ABSTRACT FROM AUTHOR]

Background: Allergic contact sensitization to ‘para amino’ compounds is frequent and the spectrum of cross-reactivity between members of this chemical group is variable. Methods: A retrospective analysis of clinical patch test data obtained with a special test series in the centres of the Information Network of Departments of Dermatology (IVDK) between 1995 and 1999. Results: In the 638 patients tested with the above test panel positive reactions were observed most often to p- aminoazobenzene (16.2%), p- phenylenediamine (14.1%), p- toluylenediamine (10.0%), followed by 4,4′-diaminodiphenylmethane (8.5%), Disperse Orange 3 (8.4%) and p- aminophenol (3.1%). Among the 544 patients tested with p- phenylenediamine and all seven additional ‘para amino’ compounds, concordance between reactions varied greatly. The stronger the positive test reaction to p- phenylenediamine, p- toluylenediamine or p- aminoazobenzene, the more frequently additional positive reactions to the other compounds were observed. Conclusions: A screening employing several ‘para amino’ compounds is necessary to describe the individual spectrum of allergic contact sensitization, as there is no reliable marker substance. Further research should aim at (i) establishing the mechanism of cross-reactivity to ‘para amino’ compounds and (ii) identifying exposures in the environment. Background: Allergic contact sensitization to ‘para amino’ compounds is frequent and the spectrum of cross-reactivity between members of this chemical group is variable. Methods: A retrospective analysis of clinical patch test data obtained with a special test series in the centres of the Information Network of Departments of Dermatology (IVDK) between 1995 and 1999. Results: In the 638 patients tested with the above test panel positive reactions were observed most often to p- aminoazobenzene (16.2%), p- phenylenediamine (14.1%), p- toluylenediamine... [ABSTRACT FROM AUTHOR]

Background: The development of persistent subcutaneous nodules at the injection sites of aluminium-adsorbed hyposensitization solutions is rare. These nodules have been interpreted as a delayed, granulomatous hypersensitivity reaction to aluminium. We report for the first time a case of persistent intradermal granulomas that developed at the sites of inaccurate intradermal, instead of subcutaneous, hyposensitization injections. Methods: An intradermal nodule was excised and processed for histopathology, scanning electron microscopy, and X-ray microanalysis. Intradermal and patch tests with aluminium hydroxide were performed. Results: Histologically, the nodule presented a pattern of granulomatous inflammatory reaction surrounding foci of necrotic tissue. Scanning electron microscopy and X-ray microanalysis revealed deposits of aluminium within the granulomas. Patch tests with aluminium hydroxide were negative, and intradermal tests caused persistent intradermal granulomas. Subsequent hyposensitization therapy in our department with the usual subcutaneous injections of aluminium-adsorbed allergen extracts was well tolerated by the patient. Conclusions: Local toxic effects of aluminium may be crucial in the development of persistent intradermal injection-site granulomas. Such intradermal nodules may develop even if the subcutaneous route is well tolerated. We conclude that inaccurate intradermal injections of aluminium-containing solutions have to be strictly avoided. [ABSTRACT FROM AUTHOR]

Fifty normal control volunteers were patch tested to 20% neomycin as well as tobramycin 1%, 10%, 20% and 30% in white petrolatum. Tobramycin is a new aminoglycoside antibiotic for prescription ophthalmologic use in the United States. There were no reactions on any of the control volunteers. Twenty known and proven neomycin-allergic patients were then tested to tobramycin 10% and 20% in white petrolatum, as well as to neomycin 20% aqueous and 20% in white petrolatum. All 20 reacted with a 2+ or greater response to the neomycin patch tests. Twelve out of the 20 or 60% of the neomycin-allergic patients reacted to 20% tobramycin in white petrolatum. From these data, tobramycin (ophthalmic) should not be used to treat known neomycin-allergic patients without first patch testing the patient with 20% tobramycin in white petrolatum. It appears probable that 65% of neomycin-allergic patients would react with a dermatitic response to such therapy. [ABSTRACT FROM AUTHOR]

Predictive tests are of value in forecasting the response of a population to a sensitizer; diagnostic testing is used to determine what substances may actually be producing dermatologic problems. Skin sensitization predictive and diagnostic data for the eleven most frequently encountered skin sensitizers in Western Europe, Canada and the United States are reviewed. These compounds include two drugs (benzocaine and neomycin), two cosmetic ingredients (p-phenylenediamine and balsam of Peru), four preservatives (formaldehyde, ethylenediamine, parabens and mercurials) and three ingredients of wearing apparel (nickel, chromium and thiram). Many of the data were collected by the North American Contact Dermatitis Group and the International Contact Dermatitis Research Group on tests with 1,200 and 4,825 dermatologic patients, respectively; the remainder were obtained by individual investigators with smaller groups of subjects. The data obtained by various investigators are discussed in relation to the factors which affect the extent and degree of sensitization which they can cause. [ABSTRACT FROM AUTHOR]

It has been suggested that contact allergy to hydrocortisone alcohol is a frequent phenomenon. A recent study showed that all patients with allergic patch reactions to tixocortol pivalate reacted to intradermal hydrocortisone sodium phosphate. We studied patients with positive patch test reactions to tixocortol pivalate but negative to hydrocortisone alcohol, with penetration enhancers in hydrocortisone alcohol patch tests and oral challenges with hydrocortisone alcohol. Additionally, prick and intradermal tests with hydrocortisone sodium succinate were used. Using penetration enhancers and oral challenges enabled detection of more contact allergies to hydrocortisone alcohol compared to conventional patch testing alone. &frac912; patients with allergic reactions to tixocortol pivalate reacts to intradermal hydrocortisone sodium succinate. No immediate reactions were seen in prick or intradermal tests, suggesting that hydrocortisone contact hypersensitivity is probably not associated with immediate allergy to hydrocortisone. The present study suggests that allergic patch test reactions to tixocortol pivalate are caused by hypersensitivity to hydrocortisone alcohol itself or to one of its metabolites in the skin. [ABSTRACT FROM AUTHOR]

We have studied a group of 104 patients with pompholyx. to investigate the relationship between allergotogical factors and its etiopathogenesis, The following examinations were performed, blood sampling routine tests and IgE levels. allergological tests (patch, prick. intradennal. and oral renovation tests with nickel sulphate), skin biopsy to exclude pemphigus vulgarism or bullous pemphigoid. An accurate history of familial and personal allergic diathesis was enquired for and various possible aggravating factors (season. microclimate, perspiration and emotional stress) were considered. The results were age `and sex-matched with a healthy control group (208 Subjects). We found familial and personal atopic diathesis in 50% of patients versus 11.5% of controls (P < 0.001); 39 positivity on patch testing 20.19% versus 6.25% of the control group (P<0.001) the % of Patients allergic to nicked reached 26% meluding those (6 Patients) reacting to the oral propagation test season 143 patients) and hyperhidrosis (38) were the aggravating factors most commonly claimed. We detected no correlation between age, sex, grading of pompholyx, and the allergological parameters investigated. Though several different allergological findings have previously been reported indydhidroiss their role in its pathogenses has not yet been fully explained. We think that different haptens or antigens can produce the same clinical and histological picture of pompholyx in predisposed subjects [ABSTRACT FROM AUTHOR]

Computer data on 4721 consecutive patients patch tested with an extended standard series were analysed for the frequency of allergic reactions to each substance. Particular attention was given to the negative first reading at day 2 (D2) which later became positive at day 4(D4). A total of 4210 allergic reactions were recorded, 933 of which were negative on D2 (24%). The most frequent positive reactions were to nickel sulphate (18%), fragrance-mix (8%), colophony (6%), neomcycin (6%), cobaltchloride(6%), thiuram-mix (4%) and potassium dichromate. The Frequency of negative D2 positive D4 readings was sizeable for all but one substance, primin, with a range of 14% for fragrance-mix to 64% for neomycyin. All of 21 positive reactions to primin were recorded on D2. In our opinion, it is unjustified to perform D2-only patch test readings. [ABSTRACT FROM AUTHOR]

Bronopol (2-bromo-2-nitropropane-1, 3-diol) is an antimicrobial compound widely used as a preservative, primarily in cosmetic formulations. Analysis of patch tests performed on our patients revealed an incidence of 12.5% relevant positive results to 0.5% and/or 0.25% bronopol. This result reflects a history of prolonged use of bronopol-containing lubricants in our referral population of patients with different types of severe, extensive dermatitis. Contact sensitization to bronopol in this population is probably facilitated by abnormal cutaneous barrier function. Our findings emphasize the need for further clinical study of the potential for bronopol to produce contact sensitivity and suggest caution with regard to its use in patients with dermatitis. [ABSTRACT FROM AUTHOR]

Benzoyl peroxide patch testing was performed on 60 young adults who had participated in a double-blind acne study. 25% of those who had used a benzoyl peroxide product showed reactivity of +1 or greater (on a 0-3 scale). None of these individuals demonstrated symptoms suggestive of irritancy or allergy greater than those who did not have positive patch tests and who were on the same treatment program. The positive patch tests did not correlate with acne treatment responses. 2 of 44 individuals in the acne study group developed clinical allergy and had dramatically positive patch tests, while the majority of individuals with positive patch tests could use products containing benzoyl peroxide daily without significant adverse effects. [ABSTRACT FROM AUTHOR]

Forty-eight patients with a positive patch test to potassium dichromate 0.5 % were retested after 4-7 years; 38 patients (79 %) still had a positive patch test. Chromate allergy seems to be persistent. In 72 % of the cases a history of occupational exposure to chromates could be proved. [ABSTRACT FROM AUTHOR]

Contact allergy to fragrances is very common. It is the second sensitizer in contact allergic dermatitis, after nickel sulphate. The fragrance mix and Balsam of Peru affects about 50-80% of patients affected by fragrance allergy, but the study of recent literature highlights new markers implicated in the pathogenesis of this dermatitis. We report an unusual case of contact allergy to limonene in a young woman after daily use of a self-made cosmetic product containing lemon juice and peel (rich in limonene), with a positive reaction to Balsam of Peru to patch test and a positive reaction to patch by patch performed with her cosmetic and lemon peel. This simultaneous sensitization has been previously described in literature. [ABSTRACT FROM AUTHOR]

Background: Both epoxy resin (diglycidyl ether of bisphenol A) and fragrance mix I are included in the European baseline series of contact allergens. A significant association between positive reactions to epoxy resin and fragrance mix has been reported by others. Objective: To investigate and possibly reproduce this association with the use of TRUE® test data and supplementary tests with fragrance mix ingredients from the Department of Dermatology, Odense University Hospital. Materials and Methods: Six thousand one hundred and fifteen consecutive eczema patients tested from 1995 to 2007 were included, and test results from all patients tested with fragrance mix ingredients were analysed. Results: One hundred and forty-five (2.4%) were positive to epoxy resin and 282 (4.6%) were positive to fragrance mix I. Nineteen were positive to both giving an odds ratio of 3.3, which is significant (95% CI 2.0–5.4). Analysis of association to individual fragrance mix ingredients showed a significant association to α-amyl cinnamal and isoeugenol. Conclusions: The significant association between positive reactions to epoxy resin and fragrance mix I was reproduced. However, the clinical implications are not clarified, and even though the association may be coincidental, the fact that it can be reproduced with a different patch test system and in a different population speaks against a random result. Further studies may help to interpret the association. [ABSTRACT FROM AUTHOR]

The article discusses on clinical cases involving hundreds of patients evaluated for contact urticaria and allergic contact dermatitis to a pain reliever called lidocaine and other ointment between 1988 to 2004 in Serbia and Montenegro. Those patients were being implemented with patch test and scratch-chamber testing with several ointments and creams to determine their skin reaction.

In patients suspected of allergic contact dermatitis because of topical ophthalmic medicaments, patch tests performed with patients' own products are often negative. The irritant anionic surfactant sodium lauryl sulfate (SLS) may alter the stratum corneum and increase antigen penetration. Pre-treatment of the skin with SLS 0.5% for 24 h was performed in the sites of patch tests with patients' own products in 15 selected patients. In patients previously negative to their own products tested with conventional patch tests, SLS pre-treatment showed 6 new relevant positive reactions and induced a stronger positive reaction in 1 patient. SLS pre-treatment could be proposed as an alternative promising method, which may increase sensitivity of patch tests with patients' own products. [ABSTRACT FROM AUTHOR]

High frequencies of contact allergy to fragrance ingredients have been reported in recent years. Only approximately 70–80% are detected by fragrance allergens in the standard patch test series. This investigation compares the patch test reactions to fine fragrances with reactions to fragrance mix (FM), balsam of Peru (BP) ( Myroxylon pereirae resin) and a fragrance series. 641 consecutive patients with eczema were patch tested with the European standard series and with selected fine fragrances. Those who were positive to 1 of the fine fragrances or the FM or BP were also tested with the fragrance series. 95 (14.8%) patients were found to have a positive patch test reaction to FM or BP; 41 (6.4%) had positive results to fragrance no. 1 and 29 (4.5%) to no. 2. 9 (9.5% of the 95 positive patients) had a positive reaction to fine fragrances and a negative reaction to all other fragrance allergens in the standard series. These findings indicate that testing with fine fragrances can add to our evaluation of fragrance-sensitive patients. [ABSTRACT FROM AUTHOR]

Positive and negative patch tests to merthiolate occur with the same frequency in mono- zygotic and dizygotic twin pairs. There is no correlation to strong or weak reactions to primary irritants. Consequently, the positive merthiolate reactions should be considered allergic rather than irritant. [ABSTRACT FROM AUTHOR]

A 43-year-old woman suffered from recurrent localized swellings and an eczematous dermatitis starting 1 day after an injection of lidocaine. Intradermal, patch and lymphocyte transformation tests revealed sensitization to lidocaine and cross-reactivity to the other aminoacylamide local anesthetics bupivacaine, mepivacaine and prilocaine, but not to articaine. Contact allergy to the ester local anesthetics benzocaine, procaine and tetracaine, and quinoline or aminoalkylamide cinchocaine, and the preservatives methylparaben and metabisulfite, was excluded. A subcutaneous challenge with articaine was well tolerated. [ABSTRACT FROM AUTHOR]

The article presents a case study of female patient with superficial perivascular lymphocytic dermatitis with some eosinophil and some lymphocyte permeation in the epidermis. Patch test confirmed reaction due to pregabalin, and suggested alternative drug Lacosamide.

The article describes a case of allergic contact dermatitis due to Cineraria hybrid flower, belonging to the Compositae (Asteraceae) family in a 58-year-old housewife. A localized, chronic dermatitis affecting the sites of contact with the plant was observed in the patient, and the Compositae mix was used for patch testing.

The article discusses on the cross-reactivity among proton-pump inhibitor drugs. Skin allergies due to proton-pump inhibitors have been described as common and mild in intensity, though there have been few cases of severe skin reactions including erythroderma and Lyell's syndrome. Meanwhile, a case of drug rash with eosinophilia and systemic symptoms (DRESS) following administration of esomeprazole drugs have been cited. DRESS is considered as a serious hypersensitivity syndrome.