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Allergic contact dermatitis (ACD) is a common cutaneous inflammatory skin disorder that is diagnosed via epicutaneous patch testing (PT). ACD may also coexist with other systemic inflammatory conditions such as atopic dermatitis and psoriasis. Many of the treatments used to manage severe ACD, along with other systemic conditions, interact with and suppress the immune system, thereby potentially interfering with the mechanism of PT. There is uncertainty in the literature regarding the effects of immunosuppression on the results of PT. A comprehensive literature review was conducted using PubMed and Google Scholar to identify articles relevant to the topic of this review. Only articles available in English were included. This review discusses the impact of immunomodulating therapies on the results of PT. We summarize the available evidence and provide updated recommendations for several immunomodulating drugs commonly used in patients undergoing PT. In general, the results of PT are most reliable when performed without immunosuppression. If this is not feasible, it is best to have patients on as low a dose of immunosuppression as possible, but it may not be necessary to stop or change an immunomodulating drug prior to PT. [ABSTRACT FROM AUTHOR]

Propyl, octy-and dodecyl gallates are largely used in food, cosmetic and pharmaceutical industry as additives - preservatives. The main source of exposure non-related with food consumption is their use of cosmetic products. Gallates are classified as skin sensitization human health hazard. This research aims to evaluate the prevalence of contact sensitization to gallates and to estimate the possible cross/ concomitant sensitization to gallate mix and other cosmetics ingredients among cosmeticians and cosmetology students. Skin patch testing with Gallate mix along with 19 other haptens was performed among 109 participants - 37 cosmetology students, 26 cosmeticians, and 46 controls. The study established high prevalence of contact sensitization to gallates, with higher risk for students (45.9%) and cosmeticians (38.5%). A significantly higher (p = 0.008) prevalence of co-sensitization to decyl glucoside was established for the control group. Proper risk information, with complex programs for prevention of occupational skin diseases should be provided. [ABSTRACT FROM AUTHOR]

Background: It is known that a large number of hairdressing apprentices (HA) develop occupational contact dermatitis (OCD) during schooling, but studies that address prevalence of contact sensitization in HAs with hand eczema are missing. Objectives: To assess the prevalence, incidence rate and clinical characteristics of OCD, including contact sensitization, in a sample of Croatian HAs. Materials and Methods: A total of 408 HAs from 25 Croatian towns were examined at the beginning of education and monitored at the end of each school year. Clinical evaluation of skin changes was performed using the Osnabrueck Hand Eczema Severity Index (OHSI). Standard patch test (PT) with baseline and hairdresser series of contact allergens was performed in 46 HAs with skin changes lasting ≥3 months. Results: The overall incidence rate of OCD was 32.3/100 person‐years, and the 3‐year prevalence 50.3%. Contact sensitization was found in 14 out of 46 (30.3%) HAs, with 10 of these 14 HAs (71.4%) sensitized to specific hairdressing allergens. The strongest reactions were found to PPD. HAs with positive PT had higher OHSI than HAs with negative patch test (median, IQR: 3, 2–4 vs. 2, 2–4). Conclusions: Contact sensitization to specific hairdressing chemicals was found in 71.4% of HAs with a positive patch test, supporting evidence on the early contact sensitization to occupational allergens among HAs. [ABSTRACT FROM AUTHOR]

Background: The European baseline series (EBS) of contact allergens is subject to change. An allergen is considered for inclusion when routine patch testing of patients with suspected contact dermatitis results in ≥0.5% prevalence rate. Objectives: We aimed to determine the frequency of sensitizations to 30 EBS allergens and 10 locally added allergens. Additionally, we assessed the strength and evolution of reactions to all tested allergens and co‐reactivity of additional allergens. Methods: Patch testing with our baseline series of 40 allergens was done in 748 consecutive adults. Tests were applied to the upper back and removed by patients after 48 h. Readings were done on Day 3 (D3) and D6 or D7 (D6/7). Positive reactions fulfilled the criteria of at least one plus (+) reaction. A retrospective analysis was done. Results: Eight allergens not listed in the EBS had ≥0.5% prevalence rate (i.e., cocamidopropyl betaine, thiomersal, disperse blue mix 106/124, 2‐bromo‐2‐nitropropane‐1,3‐diol, diazolidinyl urea, propylene glycol, Compositae mix II and dexamethasone‐21‐phosphate), and 16.6% of positive reactions would have been missed without D6/7 readings. Conclusion: We propose further studies to evaluate whether cocamidopropyl betaine, disperse blue mix 106/124, 2‐bromo‐2‐nitropropane‐1,3‐diol, diazolidinyl urea and Compositae mix II need to be added to the EBS. [ABSTRACT FROM AUTHOR]

Introduction: Patients who receive orthopedic implants have been shown to develop sensitivity to its components and there are concerns that this sensitivity might lead to contact dermatitis or implant-related problems like loosening and/or failure. The objective of the study was to determine the sensitizing potential of orthopedic implants.Methods: Fifty-four patients undergoing knee, hip, or shoulder replacement surgeries between July 2014 and July 2015 were recruited. Patch tests were performed before the implant surgery with 10 allergens likely to be implicated in metal hypersensitivity. Postimplant patch test was performed 6 months after surgery. A majority of the patch tests were applied on the arms.Results: Four positive reactions were recorded in the preimplant patch tests - three positive reactions to nickel and one to chromium. Thirty patients made themselves available for the follow-up patch test. The incidence of new contact sensitivity to components of implants was 13.8% (4/29) at 6 months. One patient who had undergone knee replacement developed eczematous lesions around the knee joint after surgery. This patient tested negative to patch test at both the times.Limitations: Short follow-up duration and performing patch tests on the arms, a site known to elicit less positive patch test response compared to the back in sensitized individuals, are limitations of the study.Conclusion: There is an increase in the sensitivity to implanted components after 6 months of joint replacement surgery. The incidence of new sensitivity to a component of the implant was 13.8% (4/29). In this context, nickel is a good sensitizer and could sensitize 50% of patients who received a nickel-containing implant. [ABSTRACT FROM AUTHOR]

Background: Allergic contact dermatitis to cosmetics (ACDC) complicates the diagnosis and treatment of rosacea, and is increasingly observed in daily practice. Aims: The present study aimed to identify the contact allergens responsible for ACDC in Chinese female rosacea patients with or without suspected ACDC (SACDC). Methods: From a total of 1267 women with rosacea, 122 with SACDC, 145 without SACDC, and 100 age‐matched healthy controls without rosacea or SACDC were examined on a voluntary basis. Skin patch tests with C‐1000 cosmetic series (Chemotechnique Diagnostics, Malmo, Sweden) were conducted, including 20 selected allergens. Results: Positive allergic reaction was found in 85.2% and 33.8% of SACDC and non‐SACDC (P <.001), respectively, and 27.0% of healthy volunteers. Most reactions occurred at day 3, and the majority of all the examinees including normal controls reacted to more than 1 allergen. In SACDC patients, leading allergens were methylchloroisothiazolinone/methylisothiazolinone (28.7%), linalool hydroperoxide (27.1%), fragrance mix I (21.3%), methylisothiazolinone (17.2%), limonene hydroperoxides (16.4%), formaldehyde (14.8%), myroxylon pereirae (13.9%), and propolis (10.7%); the overall allergic reaction rate positively correlated with new onset of facial pruritus (P <.001). The occurrence of irritant contact reactions correlated with positive allergic reactions in rosacea patients with or without SACDC (P =.032 or P <.001, respectively). Conclusions: Preservatives and fragrances are primary culprits for ACDC in Chinese female rosacea patients. Patch testing should be considered in the suspected patients. [ABSTRACT FROM AUTHOR]

Background: In Sweden, cobalt chloride 0.5% has been included in the baseline series since the mid‐1980s. A recent study from Stockholm showed that cobalt chloride 1% petrolatum (pet.) was more suitable than 0.5%. Cobalt chloride at 1.0% has been patch tested for decades in many European countries and around the world. Objectives: To study the suitability of patch testing to cobalt 1.0% vs 0.5% and to analyze the co‐occurrence of allergy to cobalt, chromium, and nickel. Results: Contact allergy to cobalt was shown in 90 patients (6.6%). Eighty (5.9%) patients tested positive to cobalt 1.0%. Thirty‐seven of the 90 patients (41.1%) with cobalt allergy were missed by cobalt 0.5% and 10 (0.7%) were missed by cobalt 1.0% (P <.001). No case of patch test sensitization was reported. Allergy to chromium was seen in 2.6% and allergy to nickel in 13.3%. Solitary allergy to cobalt without nickel allergy was shown in 61.1% of cobalt‐positive individuals. Female patients had larger proportions of positive reactions to cobalt (P =.036) and nickel (P <.001) than males. Conclusion: The results speak in favor of replacing cobalt chloride 0.5% with cobalt chloride 1.0% pet. in the Swedish baseline series, which will be done 2021. Highlights: Contact allergy to cobalt was shown in 6.6% of patients; 5.9% were test positive to cobalt 1.0% and 0.7% to cobalt 0.5% only, P <.001.Solitary allergy to cobalt without nickel allergy was shown in 61.1% of cobalt‐positive individuals. Corresponding comparison with nickel and/or chromium was shown in 54.4% of cobalt‐positive individuals.Female patients had larger proportions of positive reactions to cobalt (P =.036) and nickel (P <.001) than males. [ABSTRACT FROM AUTHOR]

Background: Professional musicians have prolonged and intense physical contact with their instruments. This can lead to occupational skin diseases, particularly irritant and allergic contact dermatitis. Objectives: To assess the skin diseases and sensitization patterns common among professional musicians. Methods: A retrospective analysis of the data of the Information Network of Departments of Dermatology (IVDK) was performed, including data from 1997 to 2017. Results: We identified 236 professional musicians. In this group, male sex (58.6%) and younger age (60.6% aged < 40 years) were common. The musicians suffered more frequently from facial dermatitis (23.7% vs 15.7%) and less often from leg dermatitis (5.1% vs 10.7%) than the control group (the non‐musicians in the IVDK database). The most frequent diagnoses were allergic contact dermatitis, atopic dermatitis, and irritant contact dermatitis. The sensitization profile of the professional musicians was similar to that of the control group. In 8.9% of cases, an occupational background of skin disease was confirmed. Conclusions: Severe occupational skin diseases among professional musicians are not as common as in classic "skin‐damaging" professions. However, as these skin conditions can mostly be controlled with simple preventive measures, we recommend that this group should be patch tested and treated by a specialist. [ABSTRACT FROM AUTHOR]

Background Contact allergy to rubber additives is common, particularly in patients with occupational dermatitis. Objectives To descriptively analyse and compare patch test reactions in patients patch tested both with the baseline series and with an additional 'rubber series' as used in the department. Methods Patch test data from those members of the European Surveillance System on Contact Allergies ( ESSCA) network () who also contributed data on rubber series patch test results were retrospectively analysed. Results Among 29 522 patients patch tested, 2870 were eligible, that is, patch tested both with the baseline series and with a special rubber series. Of these, 8.8% had positive reaction(s) to one of the baseline screening rubber allergens (as compared with 4.2% in all patients), most often to carba mix, 12.3% had positive reaction(s) to allergens from an additional rubber series, and 6.4% had positive reaction(s) to both. Conclusions Additional testing with a dedicated rubber series, containing break-down single ingredients of mixes from the baseline series and additional rubber allergens, is warranted in patients with suspected contact allergy to rubber, to avoid false-negative results. [ABSTRACT FROM AUTHOR]

Background There are no studies on contact allergy in patients with prurigo. With itch being important in the pathophysiology of prurigo diseases and being a symptom of allergic contact dermatitis, we aimed to investigate contact allergy in patients suffering from prurigo. Objectives Exploratory analysis of patch test results in prurigo patients. Materials and methods A retrospective analysis of data of the Information Network of Departments of Dermatology, 2005-2014, was performed. Results Of 116 744 patch tested patients, 639 (0.55%) were diagnosed with prurigo. The median age was 61 years, 286 (45%) were pensioners, and 252 (39.5%) had generalized prurigo. The indication for patch testing was exclusion of contact allergy in 412 patients (64.5%), and 223 patients (35%) had at least one positive patch test reaction. There was no distinctive pattern of sensitization. Prurigo patients had significantly more (and stronger) reactions to the irritant control patch test with sodium lauryl sulfate than a control group (27.6% versus 21.0%). Conclusions Although prurigo is not a typical clinical manifestation of contact sensitization, our results indicate that patch testing in these patients may be helpful. [ABSTRACT FROM AUTHOR]

Reports of contact dermatitis from ivy have regularly appeared since 1899, but only once in a child with concomitant Compositae sensitization.1-3 Allergic contact dermatitis may be caused by the leaves and roots. Keywords: allergic contact dermatitis; common ivy; contact sensitization; patch test EN allergic contact dermatitis common ivy contact sensitization patch test 315 316 2 03/16/22 20220401 NES 220401 CASE REPORT An otherwise healthy 8-year-old boy, with atopic disposition from his father, was referred with a recurring painful blistering rash for 2 years, primarily located on his hands and fingers, and to a lesser degree on his feet and around his mouth. [Extracted from the article]

Nickel sulfate in TRUE Test and nickel sulfate 2.5% pet. gave comparable test results. Keywords: allergic contact dermatitis; contact sensitization; nickel sulfate hexahydrate; patch test; TRUE Test EN allergic contact dermatitis contact sensitization nickel sulfate hexahydrate patch test TRUE Test 233 234 2 02/24/22 20220301 NES 220301 Despite the European Union (EU) Nickel Directive introduced in 2009, nickel contact allergy is still frequent and represents a health concern in the EU.1 Therefore, it is important to evaluate test methods and concentrations.2 Nickel sulfate 2.5% pet. is included in the ICDRG baseline patch test series. Allergic contact dermatitis, contact sensitization, nickel sulfate hexahydrate, patch test, TRUE Test. [Extracted from the article]

Background Contact allergy to fragrances is common, and impairs quality of life, particularly in young women. Objective To provide current results on the prevalences of sensitization to fragrance allergens used as markers in the baseline series of most European countries. Methods Data of patients consecutively patch tested between 2009 and 2012 in 12 European countries with fragrance allergens contained in the baseline series were collected by the European Surveillance System on Contact Allergies network and descriptively analysed. Four departments used the TRUE Test® system. Results The 'basic markers' were tested on 51 477 [fragrance mix II ( FM II)] to 57 123 [ Myroxylon pereirae, balsam of Peru] patients, and yielded positive reactions as follows: fragrance mix I 6.9%, Myroxylon pereirae 5.4%, FM II 3.8%, colophonium 2.6%, and hydroxyisohexyl 3-cyclohexene carboxaldehyde 1.7%, with some regional differences. Prevalences with TRUE Test® allergens were lower. Additional fragrances were tested on 3643 (trimethylbenzenepropanol) to 14 071 (oil of turpentine) patients, and yielded between 2.6% ( Cananga odorata) and 0.7% (trimethylbenzenepropanol) positive reactions. Conclusions Contact allergy to fragrances is common throughout Europe, with regional variation probably being explained by patch test technique, and differences in exposure and referral patterns. The current basic markers of fragrance sensitivity in the baseline series should be supplemented with additional fragrance allergens. [ABSTRACT FROM AUTHOR]

Background Cobalt contact sensitization in consecutively tested patients is common. The sources of exposure, and thus clinical relevance, are mostly unclear. Objective To examine (i) long-term time trends of sensitization, (ii) risk factors that may point to relevant exposures, and (iii) coupling with nickel sensitization. Methods Data of all patients patch tested with cobalt( II) chloride hexahydrate (1% pet.) between 1992 and 2012 (n = 185 050) in the Information Network of Departments of Dermatology ( IVDK, ) were subjected to descriptive stratified and Poisson regression analysis. Results The overall prevalence of positive patch test reactions was 5.23% (95% confidence interal 5.13-5.33%). Regarding time trends, there were significant increases for males aged 18-44 years and for females aged ≥45 years, and a significant variation of co-reactivity with nickel over time. Female sex almost doubled the risk of sensitization; age ≥45 years was associated with a 30% decrease in the risk of positive patch test reactions to cobalt, and atopic eczema with an approximately 20% increase. Conclusions Notwithstanding some diagnostic difficulties with the test preparation, a persistent, notable proportion of cobalt sensitization, isolated or coupled with nickel allergy, can be observed. This warrants further in-depth research into causative exposures, both at the workplace and in consumers. [ABSTRACT FROM AUTHOR]

Background and Design: Our aim was to determine the frequency of contact sensitization to textile materials and the most common textile allergens in patients who work in the textile industry and have been diagnosed with allergic contact dermatitis (ACD). Materials and Methods: Fifty textile industry workers, who attended our outpatient clinic with the diagnosis of ACD, between October 2005-December 2009, were enrolled in this study. While 50 patients were tested with the Thin layer-Rapid-Use-Epicutaneous (TRUE) test, 36 patients were tested with the TRUE test and textile series allergen. The results were analyzed as percentage and statistically. Results: Of the 50 patients, 34 (68%) were men, 16 (32%) were women. The mean of the subjects was 37.4 years. In 38.8 of the patients in whom TRU E test and textile series allergens applied together, at least one allergic reaction was seen. Of the 36 patients applied textile series in addition to the TRUE test, 33.3% of patients had positive reaction to only textile allergens, 2.7% to only standard series allergens, and 2.7% of subjects had positive reaction to both textile series and standard series allergens. 76.9% of these reactions were to dyes, 1 5.3% to resins and 7.6% of them were to both of them. Disperse blue 106 (8.3%), acid red 359 (8.3%) and disperse red 17 (5.5%) were the most positive reaction seen dyes. 18% of 50 patients tested with TRUE test alone showed at least one positive reaction. The most common standard series allergens were nickel sulphate (6%) and ethylenediamine dihydrocloride (6%). Both the relationship between atopy and contact sensitization and also the relationship with hand localization and contact sensitization to textile allergens were not statistically significant. Conclusion: In occupational textile dermatitis, contact sensitization is common and especially seen to disperse dyes. For the contact sensitization to textile materials, standard series allergens cannot be adequate in finding causative agent. [ABSTRACT FROM AUTHOR]

In 17 dermato-allergology departments in the Czech Republic 56 147 patients with eczema (17 645 males a 38 502 females) were examined using European Standard Series (ESS) during the period 1995-2012. The most frequent sensitizers were: nickel in 15,90 % of patients (females 20,7 %, males 5,66 %), then cobalt in 7,15 % (females 8,20 %, males 4,85 %), balsam of Peru in 6,53 %, fragrance-mix in 5,45 %, fragrance-mix II in 2,69 %, colophonium in 2,55 %, formaldehyde in 2,48 %, paraphenylenediamine in 2,40 %, lanolin alcohol in 2,39 %, Kathon CG in 2,33 % of patients, in other ESS allergens the number of patients sensitized was lower than 2 %. In a nine-year period 2004-2012 sensitivity to metals and plastic materials increased and sensitivity to epoxy resin chemicals, fragrances, natural substances and pharmaceutical components decreased. [ABSTRACT FROM AUTHOR]

Keywords: allergen; allergic contact dermatitis; contact dermatitis; contact sensitization; Melaleuca alternifolia; patch test; pediatric contact dermatitis; tea tree oil EN allergen allergic contact dermatitis contact dermatitis contact sensitization Melaleuca alternifolia patch test pediatric contact dermatitis tea tree oil 139 140 2 01/28/21 20210201 NES 210201 I Melaleuca alternifolia i is a coniferous tree of tropical regions; the needles contain an essential oil used in "medical" and cosmetic products that contains terpenes (limonene, alpha-pinene, phellandrene) which are potentially sensitizers.1 Tea tree oil (TTO) is nowadays increasingly popular in a variety of household and personal-care products, including shampoos, massage oils, skin and nail creams, and laundry detergents.2,3 TTO is known to be used for its potential antiseptic, antifungal, and disinfectant action used, for example, to treat infections, burns, and pain, with considerable interest in this "natural" antimicrobial agent. REFERENCES 1 Fritz TM, Burg G, Krasovec M. Dermatite de contact allergique aux cosmétiques à base de Melaleuca alternifolia (tea tree oil) [Allergic contact dermatitis to cosmetics containing Melaleuca alternifolia (tea tree oil)]. Allergen, allergic contact dermatitis, contact dermatitis, contact sensitization, Melaleuca alternifolia, patch test, pediatric contact dermatitis, tea tree oil. [Extracted from the article]

Atopic dermatitis, hand eczema and contact sensitization are prevalent disorders, and may, in many cases, be secondary to skin barrier abnormality. The aim of this study was to investigate the association between self-reported generalized xerosis, atopic dermatitis, hand eczema and contact sensitization, taking filaggrin gene mutations into account. Questionnaire data were collected from a cross-sectional study performed in a general population in Copenhagen. A total of 3,460 18-69-year-olds were patch-tested and 3,335 were genotyped for the 2282del4 and R501X mutations in the filaggrin gene. Atopic dermatitis and hand eczema were significantly associated with generalized xerosis, whereas contact sensitization (not nickel) showed only a borderline significant association. These results suggest that generalized xerosis may increase the risk of common skin disorders. [ABSTRACT FROM AUTHOR]

In the Czech Republic the trends of development of contact sensitivity to additives in pharmaceutical and cosmetic products in patients with dermatitis are monitored by the section of dermatological allergology of The Czech Society of Dermatology of the Czech Medical Association JEP. Sensitivity to allergens from European standard series e. g. parabens, Quaternium-15, Kathon CG, lanolin alcohol are monitored since 1995. Sensitivity to bronopol, imidazolidinyl urea, diazolidinyl urea, DMDM-hydantoin, chloroacetamide dibromdicyanobutan/phenoxyethanol a cocamidopropyl betaine is monitored since 2005. In 2011 the frequency of sensitization in dermatitis patients (n = 2944) was as follows: 4,1% to Kathon CG, 1,8% to cocamidopropyl betaine, 1,4% to lanolin alcohol, 1,1% to dibromdicyanobutan/phenoxyethanol, 0,9% to parabens, 0,8% to chloroacetamide, 0,7% to Quaternium-15, 0, 6% to bronopol and diazolidinyl urea, 0,5% to DMDM-hydantoin and 0,4% to imidazolidinyl urea. Increased sensitivity to Kathon CG (1,5% in 2001) and decreased sensitivity to lanolin alcohol (3,8% in 2003) was noticed. [ABSTRACT FROM AUTHOR]

Background It was recently shown that filaggrin gene ( FLG) null mutations are positively associated with nickel sensitization. We have hypothesized that histidine-rich filaggrin proteins in the epidermis chelate nickel ions and prevent their skin penetration and exposure to Langerhans cells. Furthermore, we have proposed that the low degree of genetic predisposition to nickel sensitization found by a Danish twin study was explained by a high prevalence of ear piercing among participants resulting in ‘bypassing’ of the filaggrin proteins. Objectives To investigate the association between FLG null mutations and (nickel) contact sensitization. Methods A random sample of 3335 adults from the general population in Denmark was patch tested and genotyped for R501X and 2282del4 in the FLG gene. Results The combined carrier frequency of FLG null mutations was 8·1%. Nickel, fragrance and contact sensitization to at least one allergen were not associated with FLG null mutations. A crude analysis on women who did not have ear piercings revealed a positive association between FLG null mutations and nickel sensitization [8·3% vs. 2·4%; odds ratio (OR) 3·71, 95% confidence interval (CI) 0·73–18·96] as well as between FLG null mutations and allergic nickel dermatitis (8·3% vs. 1·3%; OR 6·75, 95% CI 1·17–38·91). FLG mutation status and atopic dermatitis were positively associated with neomycin or ethylenediamine sensitization. Conclusions This study suggests that FLG null mutations may be a risk factor for the development of nickel sensitization. However, ear piercing was a much stronger risk factor in our general population and we could therefore identify a positive association only in women without ear piercings. Contact sensitization to specific chemicals is related to treatment exposure. [ABSTRACT FROM AUTHOR]

Background The prevalence of sensitization to fragrance mix (FM) I and Myroxylon pereirae (MP, balsam of Peru) has decreased in recent years among Danish women with dermatitis. Objectives This study investigated whether the decrease could be confirmed among women in the general population. Furthermore, it addressed the morbidity of FM I sensitization. Methods In 1990, 1998 and 2006, 4299 individuals aged 18–69 years (18–41 years only in 1998) completed a premailed questionnaire and were patch tested to FM I and MP. Data were analysed by logistic regression analyses and associations were expressed as odds ratios (ORs) with 95% confidence intervals (CIs). Results The prevalence of FM I and MP sensitization followed an inverted V-pattern among women aged 18–41 years (i.e. an increase from 1990 to 1998, followed by a decrease from 1998 to 2006). Logistic regression analyses showed that ‘medical consultation due to cosmetic dermatitis’ (OR 3·37, 95% CI 1·83–6·20) and ‘cosmetic dermatitis within the past 12 months’ (OR 3·53, CI 2·02–6·17) were significantly associated with sensitization to FM I. Conclusions In line with trends observed in Danish patients with dermatitis, our results supported a recent decrease in the prevalence of FM I and MP sensitization in Denmark. The study also showed that fragrance sensitization was associated with self-reported cosmetic dermatitis and use of health care related to cosmetic dermatitis. [ABSTRACT FROM AUTHOR]

Background: Correlation of several patient factors with contact sensitization to nickel, cobalt, chromate, and other metal allergens has not been reviewed in the Taiwanese population. Objectives: A retrospective analysis was performed to define the characteristics of patients with positive patch tests to metals in a tertiary referral medical centre between 1978 and 2003. Patients and Methods: Patch test data of 3559 patients at a medical centre in Taiwan from 1978 to 2003 were retrospectively analysed. Contact sensitization to metals was defined as a positive reaction to at least one of the metal substances in the patch test series. Chi-squared test, Fisher’s exact test, and multivariate logistic regression were used for statistical analysis. Results: Female patients were more likely to have contact sensitization to metal allergens except chromate or mercurochrome. Patients who reacted to chromate were more likely to be male, with an occupational correlation, older age, and a site of predilection towards the extremities. Within the first and sixth decades of age, thimerosal and chromate were the leading causes of metal contact sensitization, respectively. Nickel was the major metal sensitizer among the other age groups. Conclusions: Several patient factors were characterized related to metal sensitization in the Taiwanese population. The sources of exposure were further discussed. [ABSTRACT FROM AUTHOR]

Dermatological testing was used to assess the skin compatibility of a menstrual pad with an emollient-treated surface layer and a novel, polymeric absorbent foam core. The test program included: 1) skin patch tests to assess cumulative skin irritation, 2) human repeat insult patch tests to assess the potential for contact sensitization, and 3) repeated application to the popliteal fossa (“behind-the-knee” test) to assess combined chemical irritation and frictional effects. Studies showed the new product and its components to be as mild to skin as other commercially available materials with no evidence for the induction of delayed contact hypersensitivity. Pads with an emollient-based topsheet finish were milder to the skin than pads with a conventional topsheet finish. The test program provides reassurance that the skin compatibility of the new menstrual pad is similar to that of conventional marketed pads with a history of safe use and consumer acceptance. [ABSTRACT FROM AUTHOR]

Background: Diisocyanates and 4,4′-diaminodiphenylmethane (MDA) are industrial sensitizers. Occupational asthma is a risk among workers exposed to diisocyanates. Exposure may also lead to contact sensitization and allergic contact dermatitis. Objective: The aim of this study was to determine the occurrence of contact sensitization to MDA and to diisocyanates among general dermatology patients. Patients and methods: Patch testing with MDA was carried out in 1595 patients. Diphenylmethane-4,4′-diisocyanate (MDI) and toluene-2,4-diisocyanate (TDI) were tested in 1023 patients and isophorone diisocyanate (IPDI) and 1,6-hexamethylene diisocyanate (HDI) in 433 patients. The clinical data and sources of exposure are analysed. Results: MDA reactions were seen in 17 (1.1%) patients and MDI reactions in 4 patients. Six MDA-positive patients reacted to p-phenylenediamine and two to epoxy chemicals. 5/10 of the TDI reactions were seen concurrently with reactions to MDI, MDA, HDI, or to IPDI. IPDI reactions were seen in eight patients and HDI reactions in two patients. Possible sources of exposure were traced in most patients, although the association with the current dermatitis was not apparent in all cases. Conclusion: (Di)isocyanates may induce contact sensitization with or without allergic contact dermatitis. [ABSTRACT FROM AUTHOR]

Background: Nickel dermatitis may be caused by frequent and prolonged use of cell phones. Because little is known about the frequency of nickel release from cell phones, it is difficult to estimate the risk of nickel sensitization and dermatitis among their users. Objective: Inspired by a recent case of nickel dermatitis from prolonged cell phone use, the frequency of dimethylglyoxime (DMG)-positive cell phones on the Danish market was investigated. Methods: Five major cell phone companies were contacted. Two were visited, and the DMG test was performed on a sample of their products. Results: 5 of 15 (33.3%) phones from company A and 3 of 26 (11.5%) phones from company B showed at least 1 positive reaction. 3 phones had more than 1 positive DMG spots. Conclusions: This study documents that excessive nickel release (i.e. a positive DMG test) is relatively frequent in a sample of cell phones from the Danish market. Prolonged use of cell phones may in some cases fulfil the criteria for items included in the European Union Nickel Directive. We believe that this new cause of nickel dermatitis should be carefully followed and that regulatory steps may be necessary. [ABSTRACT FROM AUTHOR]

Background Population-based epidemiological studies have indicated that alcohol consumption is associated with IgE-mediated immune diseases (i.e. allergic rhinitis, asthma and urticaria). These studies have been strongly supported by several immunological studies. Furthermore, an inhibitory effect of alcohol consumption on the development of delayed-type hypersensitivity has been shown in healthy controls. However, a possible association between contact sensitization and alcohol consumption in a general population has never been reported. Objectives To investigate whether alcohol consumption is associated with contact sensitization in a general population. Methods In 1990, self-reported consumption of alcohol and patch testing results were assessed in 1112 subjects, aged 15–69 years, participating in a population-based cross-sectional study in Glostrup, Denmark. In 1998, they were invited to a follow-up and 734 were re-examined (participation rate 69·0%). Adjustment for potential confounders was performed by using logistic regression analyses. Results Women who reported no consumption of alcoholic drinks per week were more likely to develop contact sensitization (adjusted odds ratio 2·12, 95% confidence interval 0·98–4·61) during a 8-year follow-up period. A positive trend among women was detected ( P = 0·045). Conclusions These data support the hypothesis that alcohol consumption leads to IgE-mediated immune responses rather than delayed-type hypersensitivity reactions. It is probable that alcohol consumption prevents the development of contact sensitization. Further epidemiological studies are warranted. [ABSTRACT FROM AUTHOR]

Like all physiological systems, the human immune system exhibits dose–response relationships in its reactions. The strength of sensitization is related to the potency of the immunogen and the dose that reaches the immune system. In skin, as sensitizing dose per unit area (μg cm−2) is increased on a log scale, there is a sigmoid dose–response curve for subsequent reactivity. Similarly, the response to elicitation shows a classical sigmoid response to increasing challenge dose, with the dose per unit area again being the determinant. There is a clear inverse correlation between the strength of sensitization and the subsequent dose of antigen to which an individual will respond. This is reflected in the different challenge systems used to diagnose the existence of allergic contact sensitization to a given allergen. The occluded patch test aims to use the highest concentration possible to detect the weakest degrees of allergy, whereas the repeated open application test uses much lower concentrations similar to those encountered in real life, applied repeatedly but without occlusion, to assess clinical relevance. Many authors have attempted to use the lowest concentrations to which rare, highly sensitized individuals can react to define the concentrations which might be free of risk in terms of inducing allergic sensitization. However, it is clear that the dose–response relationships for induction of sensitivity by repeated low-dose exposures must be carefully defined in future studies. This article reviews the dose–response relationships of human contact sensitization. [ABSTRACT FROM AUTHOR]

Objectives. This study investigated the prevalence of contact sensitization in a general adult population and the relationship between the history of metal dermatitis and sensitization to metal allergens. Study design. A cross-sectional population study using patch tests and a questionnaire was conducted among adults in Tromsø, Northern Norway. Methods. A random sample of 830 participants aged 18-75 years were invited to participate in the patch testing and completed a 1-page self-administered questionnaire. Of the adults, 531 (64%) were actually TRUE tested (using a standardized, ready-to-apply patch test system) and completed the self-administered questionnaire about ear piercing, metal reactions, skin reactions to different allergens, atopic dermatitis, eczema, cooking equipment and diet. Results. The study showed that nickel (19.2%; women 31.1% and men 5.0%), fragrance mix (3.4%) and cobalt (1.7%) were the most prevalent allergens causing contact sensitization. For all other allergens, less than 1.1% tested positive. Eighty-four (45.2%) subjects with a positive history of metal dermatitis had negative patch tests. Conclusions. Contact sensitization was found frequently in this general adult population, especially to nickel and perfumes with a predominance among females. An eczematous reaction caused by cheap earrings seemed to be the best indicator for metal sensitivity. [ABSTRACT FROM AUTHOR]

Dendritic cells (DC) are highly specialized antigen-presenting cells (APC) located in lymphoid and many nonlymphoid tissues, and Langerhans cells (LC), a specialized form of DC, are found in the skin. LC play a critical role in the induction of contact dermatitis and therefore have become a focal point for the development of in vitro cell-based methods for contact sensitization testing. Because of the low abundance of skin-derived LC, methods to culture DC from peripheral blood are being used by investigators to generate LC surrogates to examine the effects of sensitizing chemicals on APC. It has been reported recently that chemical allergens can induce changes in the expression of various DC surface markers and it has been suggested that the measure of these changes in surface marker expression following allergen treatment could provide the basis for an in vitro test method to predict the contact sensitization potential of a chemical. For the work presented here, DC were differentiated from human peripheral blood mononuclear cells (PBMC-DC) in culture medium containing GM–CSF and interleukin (IL)-4 to ensure an immature phenotype or were derived from the KG-1 cell line (KG-1 DC) using a defined cytokine cocktail consisting of GM–CSF, IL-4, Flt-3/Flk-2-ligand, thrombopoietin, stem cell factor, and tumor necrosis factor-α (TNFα). Surface marker expression (HLA-DR, CD54, CD80, and CD86) on these DC was measured by flow cytometry after 48 h treatment with the known chemical allergens dinitrofluorobenzene (DNFB) and methylchloroisothiazolinone/methylisothiazolinone (MCI/MI), the irritant sodium dodecyl sulfate, lipopolysaccharide (LPS), and TNFα. Treatment of PBMC-DC with either MCI/MI or DNFB induced a slight upregulation of class II major histocompatibility (MHC) expression (HLA-DR), whereas LPS and TNFα significantly upregulated CD54 and slightly upregulated CD80 and HLA-DR expression. For KG-1 DC, only MCI/MI upregulated CD86 expression, whereas TNFα upregulated CD54 and slightly upregulated CD80 and CD86 expression. SDS had no effect on surface marker expression in either PBMC-DC or KG-1 DC. Changes in surface marker expression in PBMC-DC treated with chemical allergens were detected in two of five donors, suggesting a limited sensitivity of PBMC-DC under these defined isolation and culture conditions. Furthermore, we found that the presence of GM-CSF and IL-4 during chemical allergen treatment masked the ability to detect changes in surface marker expression. Our data suggest that, under these culture and treatment conditions, measurement of surface marker changes in vitro using PBMC-DC or KG-1 DC does not provide a sensitive in vitro method with sufficient dynamic range for assessing the contact sensitization potential of a chemical. [Copyright &y& Elsevier]

The aim of this study was to evaluate disperse dye sensitization in patients with hand dermatitis. From January 1996 to December 2000, we identified 130 patients with hand dermatitis reacting to one of the 7 dyes included in our standard series. In 82 subjects the dermatitis was localized to the hands alone, whereas 48 patients had lesions both on the hands and on other skin sites. Disperse Blue dyes, and Disperse Orange 3 were the most common sensitizers. Among the 13 subjects allergic to disperse dyes alone, we found 3 cases of occupational allergic contact dermatitis, 1 child with atopic dermatitis worsening after the use of synthetic fibre garments, 4 subjects affected by clothing dermatitis, and 5 individuals occupationally exposed to irritants with a dermatitis involving the hands alone. In the latter, the hands may represent a ‘locus minoris resistentiae’, and both induction and elicitation of contact sensitization could be caused by impaired barrier function at a skin site repeatedly exposed to sensitizing garments. [ABSTRACT FROM AUTHOR]

The authors followed the frequency of fragrance contact sensitization in Hungary in a multicentre study in the years 1998 and 1999. A total of 3604 patients were tested with fragrance mix (FM), and positive reactions were observed in 294 (8.2%). In 160 FM hypersensitive patients, the study was continued with patch testing of the mix constituents (cinnamic alcohol, cinnamic aldehyde, eugenol, amyl cinnamic aldehyde, hydroxycitronellal, geraniol, isoeugenol, oak moss absolute). Of the patients tested, 70.6% produced positive reactions to the constituents. FM contact sensitization was mainly observed in female patients (74.4%). The incidence of contact urticaria in FM hypersensitive patients was 6.1%. Simultaneous patch test trials of other environmental contact allergens, in both early and late evaluations, mainly confirmed hypersensitivity reactions to balsams. Female dominance of hypersensitivity reactions observed during testing the individual components of the mix was striking (82.4%). In positive skin reactions, cinnamic alcohol, isoeugenol and oak moss provoked skin symptoms most frequently. We also tested the 104 patients who produced negative reactions to FM with the constituent individual allergens, with 11.9% positive incidence. The clinical symptoms of the patients were above all manifest in the form of contact eczema, located on the hands, face, eyelids and axillae. With this study, the authors, members of the Hungarian Contact Dermatitis Research Group , call attention to one of the most frequent allergens in the environment. [ABSTRACT FROM AUTHOR]

Background: We aimed to determine the prevalence of contact sensitization in the general population and to investigate associations with important sociodemographic and medical characteristics. Methods: Within a population-based nested, case-control study in Germany, we performed patch tests with 25 standard allergens in 1141 adults (50.4% female, age median 50 years). Additional information was obtained by a dermatologic examination, a standardized interview, and blood analysis. Results: At least one positive reaction was exhibited by 40.0% of the subjects, with reactions most frequently observed to fragrance mix (15.9%), nickel (13.1%), thimerosal (4.7%), and balsam of Peru (3.8%). Women were sensitized more often than men (50.2% vs 29.9%, OR 2.36, CI 1.84–3.03), and this was also significant for fragrance mix, nickel, turpentine, cobalt chloride, and thimerosal. Contact sensitization was more frequent in subjects who reported adverse skin reactions (53.8% vs. 32.6%; OR 2.41, CI 1.85–3.14), and this was particularly true for sensitization to nickel (45.5% vs 8.8%, OR 8.64, CI 5.67–13.17) and fragrance mix (29.0% vs 14.0%, OR 2.51, CI 1.60–3.91) and the corresponding intolerance of fashion jewelry and fragrances. Contact sensitization decreased with increasing degree of occupational training (unskilled 45.9%, apprenticeship 40.1%, technical college 40.4%, and school of engineering 12.5%; P=0.023; trend test P=0.042). Significant associations of contact sensitization and presence of allergen-specific IgE antibodies, atopic eczema, or psoriasis were not observed. Frequency estimates for the general adult population based on these findings were 28.0% for overall contact sensitization and 11.4% for fragrance mix, 9.9% for nickel, and 3.2% for thimerosal. Conclusions: It is concluded that contact allergy is influenced by sociodemographic parameters and plays an important role in the general population. [ABSTRACT FROM AUTHOR]

The article presents the case study of 37-year-old black woman who consult the doctor for desquamative lesions on the backs hands, that had been resistant to treatment with topical and systemic corticosteroids. It focuses on allergic contact dermatitis from prednicarbate presenting as chronic hand eczema.