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Background: Current frequency and features for positivity to textile dye mix (TDM) in Spain are unknown. Objectives: To study the frequency, clinical features and simultaneous positivity between TDM, para‐phenylenediamine (PPD) and specific disperse dyes. Materials and Methods: We analysed all consecutive patients patch‐tested with TDM from the Spanish Contact Dermatitis Registry (REIDAC), from 1 January 2019 to 31 December 2022. Within this group, we studied all selected patients patch‐tested with a textile dye series. Results: Out of 6128 patients analysed, 3.3% were positive to the TDM and in 34% of them, the sensitization was considered currently relevant. TDM positivity was associated with working as a hairdresser/beautician and scalp, neck/trunk and arm/forearm dermatitis. From TDM‐positive patients, 57% were positive to PPD. One hundred and sixty‐four patients were patch‐tested with the textile dye series. Disperse Orange 3 was the most frequent positive dye (16%). One of every six cases positive to any dye from the textile dye series would have been missed if patch‐tested with the TDM alone. Conclusions: Positivity to TDM is common in Spain and often associated with PPD sensitization. TDM is a valuable marker of disperse dyes allergy that should be part of the Spanish and European standard series. [ABSTRACT FROM AUTHOR]

Objective: To analyse the clinical characteristics and sensitivity of an essential oil patch test series (EOS) in patients sensitized to their own essential oils (EOs). Method: We analysed the clinical data and patch test results obtained with the European baseline series (BSE) and an EOS, as well as the mode of use of EOs, through a questionnaire included in the patient file. Results: The study included 42 patients (79% women, average age 50 years) with allergic contact dermatitis (ACD), 8 patients required hospitalization. All patients were sensitized to the EO they used, primarily lavender (Lavandula augustifolia, 8000‐28‐0), tea tree (Melaleuca alternifolia leaf oil, 68647‐73‐4), ravintsara (Cinnamomum camphora oil, 92201‐50‐8), and 2 cases were attributed to helichrysum (helichrysum italicum flower absolute, 90045‐56‐0). 71% had positive patch tests to fragrance mix I or II, 9 only to the EOS and 4 only with their personal EO. Interestingly, 40% of patients did not spontaneously mention the use of EOs, and only 33% received advice on their use at the time of purchase. Conclusion: Patch tests with the BSE, limonene and linalool HP, and oxidized tea tree oil is sufficient to detect most EO‐sensitized patients. The most important is to test the patient's own used EOs. [ABSTRACT FROM AUTHOR]

Background/Purpose: Chronic actinic dermatitis (CAD) is a spectrum of diseases with chronic photosensitivity occurring mostly among middle‐aged and older men. We seek to explore the characteristics and pathogenesis of CAD among the Chinese population. Methods: The medical records of 488 CAD cases diagnosed by phototesting at Huashan Hospital, Fudan University from January 2014 to December 2018 were analyzed retrospectively. Results: Among the 488 patients, 344 were male and 144 were female. 84.8% of the cases were over 40 years old at the age of onset, while the remaining with an early age of onset had a prevalence of atopic history of 21.6%. Up to 45.0% of the patients reported excessive sun exposure and outdoor activities before the initiation of symptoms. The typical skin lesions were erythema, papules and plaques laid predominantly in sun‐exposed areas. 42.8% of the cases showed sensitivity to UVB only, 20.7% were both sensitive to UVA and UVB, and 18.2% had UVA sensitivity only. The most predominant photoallergens were chlorpromazine (80.1%), thimerosal (17.2%), potassium dichromate (12.7%), etc. The most prevalent patch test allergens were potassium dichromate (24.4%), thimerosal (20.5%), formaldehyde (16.8%), etc. Conclusions: CAD was more commonly seen in males over 40 years old. The action spectrum of Chinese patients is primarily in the UVB range. Exposure to excessive sunlight or contact allergens and photoallergens are important risk factors. Photobiology tests are essential in detecting photosensitivity and recognizing potential photosensitizers. Early avoidance of confirmed photoallergens and sun exposure may prevent photosensitive reactions from progressing into persistent photosensitivity. [ABSTRACT FROM AUTHOR]

This article discusses a case of occupational contact dermatitis in a 44-year-old man who developed a recurrent facial rash after exposure to pyrethrum daisies (Tanacetum cinerariifolium) at his workplace. The man experienced symptoms for 2-4 weeks each summer, which improved but did not completely resolve after 2 months. Patch testing revealed positive reactions to the crop, as well as other substances. The patient was prescribed medication and provided with protective equipment to wear during exposure. The article emphasizes the importance of patch testing for specific allergens to which a patient may be exposed, rather than relying solely on commonly tested allergens. [Extracted from the article]

Background: Current frequency and risk factors for sensitization to methylisothiazolinone (MI), methylchloroisothiazolinone/methylisothiazolinone (MCI/MI), benzisothiazolinone (BIT) and octylisothiazolinone (OIT) in Spain are not well known. Objectives: To study the frequency of sensitization, risk factors and simultaneous sensitization between the four isothiazolinones. Materials and Methods: We analysed all 2019–2021 consecutive patients patch‐tested with MI (0.2% aq.), MCI/MI (0.02% aq.), BIT (0.1% pet.) and OIT (0.1% pet) within the Spanish Contact Dermatitis Registry (REIDAC). Results: A total of 2511 patients were analysed. Frequencies of sensitization were: any isothiazolinone 15.7%, MI 6.8%, MCI/MI 4.8%, BIT 3.5% and OIT 0.5%. MI and MCI/MI sensitization was associated with being occupationally active, hand dermatitis, detergents and age over 40. BIT sensitization was associated with leg dermatitis and age over 40. About one in nine MI‐positive patients were positive to BIT, whereas one in five BIT‐positive patients were positive to MI. Conclusions: Sensitization to MI, MCI/MI and BIT is still common in Spain, while sensitization to OIT is rare. Currently, sensitization to MI and MCI/MI seems to be occupationally related. Although its origin is unknown, sensitization to BIT is more frequent in patients aged over 40 years. Simultaneous sensitization between MI and BIT is uncommon. [ABSTRACT FROM AUTHOR]

Acute Localized Exanthematous Pustulosis (ALEP) is a rare skin reaction characterized by the sudden onset of multiple, small, sterile, non-follicular pustules in an erythematous and edematous base succeeding systemic drug administration. ALEP is considered a subtype of Acute Generalized Exanthematous Pustulosis (AGEP), although the exact pathogenic mechanism of the disease remains poorly defined. Numerous drugs have been implicated in the pathogenesis of ALEP, while contact mechanisms have also been reported. Herein, we describe the first case of ALEP attributed to minoxidil in a female patient with androgenetic alopecia. The positivity of patch tests and the topical application of minoxidil proposes a contact-induced hypersensitivity reaction. Identifying new agents—including minoxidil—which serve as inducers of drug-specific T-cell-mediated responses in the clinical spectrum of ALEP, adds further value in understanding the complex, yet unknown, pathophysiological mechanisms of this rare drug hypersensitivity reaction. [ABSTRACT FROM AUTHOR]

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]

Objective: The aim of this study was to identify which types of skin reactions are associated with slime toys and which of their ingredients are most frequently involved in cases of poisoning. Data source: Between January and July 2021, articles were selected using PubMed, SciELO, and LILACS databases. The following descriptors were used: (dermatitis OR rash OR eczema OR inflammation) AND slime. Inclusion criteria were articles available in full, in either Portuguese, English, or Spanish, published between January 2000 and July 31, 2021, and articles reporting cases of contact dermatitis or eczema potentially or directly attributed to slime toys. Articles not meeting these criteria and duplicate texts in the databases were excluded. Data synthesis: In total, 65 publications were identified, of which 16 were included in this review. This resulted in a total of 22 children (2 males, 20 females), aged between 4 and 13 years, who were reportedly intoxicated by slime toys, most of these being linked to homemade preparations. Studies reported the occurrence of contact or allergic dermatitis on hands, fingers, nails, forearms, and cheeks. The most allergenic and/or irritant ingredients included liquid detergent and soap. Additionally, patch tests identified positive reactions to methylisothiazolinone and methylchloroisothiazolinone, the preservatives used by chemical industries on preparation of glue, soap, detergents, etc. Conclusions: Although slime toys might be important for improving motor development and parental relationships, homemade slime toy recipes include several allergenic and irritant ingredients which might be exposed to vulnerable children and cause intoxications. Therefore, homemade slime toys preparations should be used cautiously and under the supervision of adults. [ABSTRACT FROM AUTHOR]

Objective: Some clinics interpret patch test results 48 hours after application and an additional reading is performed at 72 or 96 hours. Reports in the literature describe delayed positive reaction to some allergens in patients who underwent patch testing for suspected allergic contact dermatitis. However, an additional late reading may be neglected in some clinics. In this study we aimed to identify allergens with delayed positive patch test reactions and to determine the relevance of an additional day 7 (168 hours) patch test reading. Material and Methods: The data of 101 patients who underwent patch testing for suspected allergic contact dermatitis between January 2015 and July 2016 were analyzed retrospectively. Demographic data and patch test results of the patients were evaluated. Allergens without a positive reaction at the 48th and 96th hours but with a positive reaction at the 168th hour were considered as delayed positive patch test reaction. Results: Sixty-four (63.3%) of 101 patients had positive reactions to at least 1 allergen. A total of 125 positive reactions were detected. Of the 125 positive reactions, 85 (68%) were positive at 48 hours reading and 31 (24.8%) turned positive at 96 hours evaluation. Nine (7.2%) of 125 positive reactions were late reactions that turned positive at 168 hours. Nickel sulfate, gold sodium thiosulfate, Cl+Me-isothiazolinone, formaldehyde, tixocortol pivalate and hydrocortisone-17-butyrate, and fragrance mix were detected as allergens causing late positive reactions. Conclusion: We think that late reading at the 168th hour should not be neglected. [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]

Contact allergy to skin disinfectants is not often recognized in children. We report the cases of six children (1–16.5 years old) with allergic contact dermatitis to ingredients commonly contained in commercial antiseptic and cosmetic products. Patch test responses to chlorhexidine, benzyl alcohol, and benzalkonium chloride varied from one child to another one, but most children were sensitized to at least two components. In several of the cases, exposure had initially occurred in the neonatal period, but diagnosis occurred only after multiple reactions of increasing severity. [ABSTRACT FROM AUTHOR]

Skin tests, including patch tests (PTs), prick tests, and intradermal tests (IDTs), are useful in identifying the culprits of cutaneous adverse drug reactions (CADRs), and determining safer, alternative drugs. PTs have a low sensitivity but are valuable in investigating maculopapular exanthema (MPE), as well as severe CADR, including toxic epidermal necrolysis (TEN), Stevens‐Johnson syndrome (SJS), and in particular, acute generalized exanthematous pustulosis (AGEP), and drug reaction with eosinophilia and systemic symptoms (DRESS). To ensure their specificity, at least 10 control tests should be performed. Prick tests are mainly used in the evaluation of immediate‐type hypersensitivity and can be performed with all drugs, except opiates. IDTs can be used to explore immediate and delayed‐type hypersensitivity, if an injectable form of the drug exists. Except for SJS/TEN, IDTs should be performed by injecting 0.02 mL of the drug. We here provide a practical, up‐to‐date review on the use of these skin tests in the work‐up of CADRs. Numerous negative controls for drug PTs, as well as criteria for the immediate and delayed positivity of prick tests and IDT, are included. It should be emphasized that a negative result never excludes the potential responsibility of a drug in a CADR. [ABSTRACT FROM AUTHOR]

Isobornyl acrylate (IBOA) has recently caused a number of cases of allergic contact dermatitis (ACD) from its use in medical devices. We would like to enhance the awareness of this issue with the reporting of three Australian cases, involving two adults and a child. We also report a successful solution by using hydrocolloid wafer (Stomahesive®) as a barrier. As IBOA is not usually found on baseline patch test series and does not cross‐react with other acrylic monomers, ACD to IBOA may be missed by clinicians. [ABSTRACT FROM AUTHOR]

Background: Patch tests (PTs) with two readings have been used for decades to identify the culprit drug in nonimmediate cutaneous adverse drug reactions (NICADRs), followed more recently by late reading of intradermal tests (IDTs). Some teams tend to perform PTs with only one reading before IDTs or even directly perform IDTs. Objectives: To evaluate the relevance of a late PT reading on day 4 (D4) in NICADRs. Methods: We retrospectively selected patients who had a PT for an NICADR between July 2014 and March 2020. Results: During the study period, 328 patients had a PT with available results. Among the 75 positive‐PT patients with available data for the two readings, 41 (54.7%) had positive results on D2 and D4 and 34 (45.3%) had negative results on D2 but positive results on D4. No patient had positive results on D2 and negative results on D4. Conclusion: This study shows that a D4 reading enhanced the PT‐positive results. A positive PT result allows for reducing the number of IDTs, which are more difficult and costly to perform. Our series suggests that a late PT reading at D4 should be performed for exploring NICADRs. [ABSTRACT FROM AUTHOR]

Propolis is a lipophilic resin extracted from plants by bees. The purpose of this case report was to show the importance of this substance as cause of allergic contact cheilitis. A 21-year-old female patient complained of pruritic perioral eczema for 5 years. In the past months it also affected the neck. After diagnosing contact dermatitis, she was submitted to a patch test with a Latin American baseline series. The result was strongly positive for propolis (++) and weakly positive for perfume mix I (+). After the test, the patient revealed she had been using propolis drops, per oris, for 10 years. The worsening of the condition was due to increased dose, aiming "to improve immunity", during the coronavirus disease 2019 (COVID-19) pandemic. The contact allergy to propolis might be increasing due to the widespread use of natural products. Propolis is a sensitizer to be considered in patients with long-lasting cheilitis. [ABSTRACT FROM AUTHOR]

Keywords: 4-phenylenediamine; dermatitis; allergic contact; drug-related side effects and adverse reactions; immunotherapy; patch tests EN 4-phenylenediamine dermatitis allergic contact drug-related side effects and adverse reactions immunotherapy patch tests 377 379 3 09/08/22 20221001 NES 221001 Abbreviations ACD allergic contact dermatitis CTLA-1 cytotoxic T-lymphocyte associated protein 4 ICP immune check points ICPI immune check point inhibitor IRAE immune-related adverse events MI methylisothiazolinone PD-1 programmed cell death protein 1 PDL1 programmed death ligand 1 PPD para-phenylenediamine Treg T regulatory cells Allergic contact dermatitis (ACD) arising during immune check point inhibitor (ICPI) therapy has rarely been reported and is likely an under-recognized cause of a number of cutaneous immune-related adverse events (IRAE), especially treatment refractory dermatitic eruptions. Dermatitis, allergic contact, drug-related side effects and adverse reactions, 4-phenylenediamine, immunotherapy, patch tests Just as immunosuppression risks false-negative results,7 an immune-enhanced anti-PD-1 state could theoretically cause allergy induction, severe patch test reactions and false positives. [Extracted from the article]

Patients with patch test reactions associated with eye care products: Retrospective analysis of North American contact dermatitis group data, 2001-2018 Keywords: allergic contact dermatitis; contact allergy; eye care products; patch tests EN allergic contact dermatitis contact allergy eye care products patch tests 712 715 4 11/18/21 20211201 NES 211201 Eye care products (ECP) may cause allergic contact dermatitis (ACD). Eighty-three of the 154 ECP-positive patients (53.9%) had 99 total reactions to NACDG screening allergens; the remainder (n = 71) had reactions to allergens/substances not on the screening series. [Extracted from the article]

Background: Methyldibromo glutaronitrile (MDBGN) was one of the most frequent and relevant allergens found in patch testing at the beginning of this century. In 2008, this preservative was banned from cosmetics in Europe and ever since the prevalence of contact allergy to MDBGN has progressively decreased. Despite that gradual decline, MDBGN is still patch‐tested in most baseline series. This study assessed the frequency of MDBGN sensitization, epidemiological characteristics of allergic patients, and the relevance of positive patch tests in a nationwide Spanish registry (REIDAC). Patients and methods: We evaluated consecutively patch‐tested patients in all participating centres. Using these data, we calculated the proportion of patients with positive patch tests to MDBGN from June 2018 to June 2020 and evaluated the relevance of the positive patch tests. Results: One hundred and fourteen out of 5072 (2.24 %) tested patients were sensitized to MDBGN. Clinical current relevance was confirmed in only one case. Conclusion: Although the frequency of contact allergy to MDBGN remains high, no clinical significance was found in most of these patients (5072 tests needed to obtain one relevant positive result). The clinical usefulness of this allergen seems weak and its continued inclusion in the European baseline series is questionable. [ABSTRACT FROM AUTHOR]

Allergic proctocolitis is a cell-dependent food allergy that is present in both breast and formula-fed infants. The presence of blood with different amounts in the stool is the main manifestation of the disease. Different results have been published on the accuracy and specificity of the atopic patch test (APT). The purpose of this study was to evaluate the results of the APT and compare them with those obtained in the food elimination/introduction (E/I) challenge, as the gold standard of confirming the allergy. Twenty-eight patients (18 boys, 10 girls, <1 year) with allergic proctocolitis were recruited in this study. The mean age of the disease onset and enrolling the study were 2.23±1.7 and 5.25±2.19 months, respectively. After performing APT with fresh foods, an E/I challenge was done in a patient with positive tests, and results were analyzed. APT was positive in 14/28 (50%) individuals. The most common foods detected by APT in all of the individuals were: milk (10/28), rice (5/28), soy (4/28), and egg white (4/28), while in E/I challenge in the APT-positive individuals were: milk (8/10), rice (3/5), egg white (1/4), and soy (0/4). APT was positive in half of the infants<1 year with allergic proctocolitis and there was no significant correlation between the APT results and the E/I challenge test for all foods. Comparing the results of APT and E/I challenge methods showed a convergence between the milk and rice sensitivity, thus we suppose APT to be a useful tool in identifying these two allergens in cell-mediated food allergies like allergic proctocolitis. [ABSTRACT FROM AUTHOR]

Background: Sodium disulfite (SD), also known as sodium metabisulfite, is an increasingly recognized cause of allergic contact dermatitis. Objectives: The objective of this work was to characterize individuals with positive patch test reactions to SD as well as analyse reaction strength, clinical relevance, and sources. Methods: This is a retrospective analysis of patients patch tested with SD (1% petrolatum) by the North American Contact Dermatitis Group (NACDG), 2017 to 2018. Results: Of 4885 patients patch tested with SD, 132 (2.7%) had a positive reaction. Common primary anatomic sites of dermatitis were face (28.8%), hands (20.5%), and a scattered/generalized distribution (13.6%). Compared with SD‐negative patients, SD‐positive patients were more likely male (odds ratio 2.81, 95% confidence interval 1.98‐4.00) and/or over 40 years (odds ratio 1.95, 95% confidence interval 1.30‐2.94). Reactions were most commonly + (50.4%) or ++ (34.1%); 65.2% were considered currently relevant. About 15.2% were definitively confirmed in sources, commonly personal care products (18.9%, especially hair dye), and drugs/medications/alcoholic beverages (9.1%). Only 2.3% of positive reactions were linked to occupation. Conclusions: Positive reactions to SD occurred in 2.7% of tested patients. Reactions were often clinically relevant and linked to personal care products and drugs/medications/alcoholic beverages. [ABSTRACT FROM AUTHOR]

Contact dermatitis in music professionals referred for patch testing: North American Contact Dermatitis Group data, 1996-2018 Keywords: allergic contact dermatitis; contact allergy; music professionals; musicians; patch tests EN allergic contact dermatitis contact allergy music professionals musicians patch tests 359 362 4 08/16/21 20210901 NES 210901 Music professionals (MPs) are at risk for both allergic contact dermatitis (ACD) and irritant contact dermatitis (ICD). Allergic contact dermatitis, contact allergy, music professionals, musicians, patch tests. [Extracted from the article]

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]

Background: Contact sensitization is frequent among patients with frontal fibrosing alopecia (FFA) (52%–76%). Objective: To evaluate the frequency of sensitization/photosensitization in an FFA population. Methods: A population of FFA patients were patch tested (Spanish Contact Dermatitis Research Group [GEIDAC] baseline; cosmetic and fragrance series), and photopatch tested (sunscreen series). Results: Thirty‐six patients (mean age: 64.6 years; 35/36: women) were studied. A history of dermatitis was recorded in 69.4% (frequently involving the face). Overall, 80.5% patients showed positive patch‐test reactions. The most frequently positive allergens were nickel sulfate (25%), benzyl salicylate (22%), gallates (16.6%), propolis (16.6%), and limonene hydroperoxides (13.8%). Benzyl salicylate was likely relevant to the dermatitis (labeled on personal care products and most patients reporting clinical improvement with allergen avoidance). Patch tests with sunscreens showed positive reactions to 11 materials (five patients). Photopatch tests were positive in one case. Conclusion: We speculate a possible relationship between sensitization to benzyl salicylate and FFA. Hypothetically, the most likely explanation is that sensitization to benzyl salicylate involving FFA patients is a consequence of increased exposure to it. It is unclear whether allergen avoidance may impact the prognosis of alopecia. However, it seems to significantly improve the patients´ quality of life by lessening dermatitis and pruritus. [ABSTRACT FROM AUTHOR]

Generalized bullous fixed drug eruption (GBFDE) is a specific variant of fixed drug eruption that belongs to severe cutaneous adverse reactions (SCARs) and its diagnosis is based mainly on clinical course and especially on the reoccurrence of typical bullous lesions in previous and new sites after re-administration of the offending drug. We present a well-documented case of fluconazole-induced GBFDE, with a positive patch test to fluconazole (30% weight/volume preparation) and clinical tolerance to itraconazole proven by negative oral provocation. Even in SCARs, patch testing represents a useful diagnostic tool, while oral provocation remains the gold standard in cases that an alternative but the chemically relevant drug must be administered. [ABSTRACT FROM AUTHOR]

Background: Data on the cutaneous side effects of herbal medicine is scarce, especially with regard to allergy skin testing. Our objective was to determine the relevancy of patch testing in the exploration of the cutaneous side effects of herbal medicine. Material and Methods: A prospective study was conducted in the Department of Dermatology of the Hospital Institute of Social Hygiene of Dakar over a one-year period. Patch tests were given to patients with cutaneous side effects related to the exclusive use of herbal medicine. The plants recovered were turned into macerates and powders and mixed with Vaseline at concentrations of 5%, 20%, and 30%. Results: Patch tests were given to 31 of the 53 patients included. They were positive in 11 patients (35.48%). Positive patients displayed systemic eczema (n = 7/15 of cases), Stevens--Johnson syndrome (n = 2/3), contact eczema (n = 1/1), and fixed pigmented erythema (n = 1/2). Positive tests were obtained for 11 medicinal plants identified: Jatropha chevalieri (n = 2), Terminalia avicennoïde (n = 2), Detarium microcarpum, Acacia seyal, Acacia albida, Acacia italic, Sesamum indicum, Mangifera indica, Momordica charantia, Nauclea latifolia, and Anogeisius leiocarpus (in one case each). There was no statistically significant relationship between the type of cutaneous side effect and the test result (p = 0.388) and between the nature of the plant used and the test result (p = 0.402). Conclusion: In view of their high rates of positivity, patch tests could prove promising in the exploration of the cutaneous side effects of herbal medicine. [ABSTRACT FROM AUTHOR]

Case report, cetirizine, cutaneous adverse drug reaction, fixed drug eruption, hydroxyzine, levocetirizine, patch tests Keywords: case report; cetirizine; cutaneous adverse drug reaction; fixed drug eruption; hydroxyzine; levocetirizine; patch tests EN case report cetirizine cutaneous adverse drug reaction fixed drug eruption hydroxyzine levocetirizine patch tests 318 319 2 03/15/23 20230401 NES 230401 Fixed drug eruption (FDE) is a cutaneous adverse drug reaction most frequently caused by non-steroidal anti-inflammatory drugs (NSAIDs), antibiotics, anticonvulsants, or paracetamol.[1] Uncommonly, cetirizine and other H1 antihistamines have also been implicated in FDE.[[2]] We report a case of cetirizine-induced FDE with cross-reaction with other piperazine derivatives confirmed by patch test. 2 Cravo M, Gonçalo M, Figueiredo A. Fixed drug eruption to cetirizine with positive lesional patch tests to the three piperazine derivatives. [Extracted from the article]

Keywords: acrylates, allergic contact dermatitis; glucose monitoring devices; isobornyl acrylate (CAS no. 5888-33-5); patch tests EN acrylates, allergic contact dermatitis glucose monitoring devices isobornyl acrylate (CAS no. 5888-33-5) patch tests 154 157 4 07/27/20 20200801 NES 200801 Diabetes mellitus (DM) is a chronic condition, the prevalence of which is increasing in Europe.1 Continuous glucose monitoring systems, such as FreeStyle Libre (Abbott Diabetes Care, UK) have improved DM management.2 This device is applied to the skin through an adhesive and remains in place for up to 14 days, dynamically measuring interstitial glucose levels.3 Several cutaneous side effects have been recognized since its introduction, such as infections, hematomas, and irritant or allergic contact dermatitis (ACD).4,5 Regarding ACD, the most commonly identified culprit allergen is isobornyl acrylate (IBOA; CAS no. 5888-33-5). When these patients consult, patch tests with at least IBOA and other acrylates should be conducted, and contact allergies reported to the manufacturers and local health authorities, in order to obtain alternatives in the future.13 AUTHOR CONTRIBUTIONS B Catarina Queirós: b Conceptualization; formal analysis; methodology; writing-original draft. 18 Corazza M, Scuderi V, Musmeci D, Foti C, Romita P, Borghi A. Allergic contact dermatitis caused by isobornyl acrylate in a young diabetic patient using a continous glucose monitoring system (Freestyle Libre). Acrylates, allergic contact dermatitis, glucose monitoring devices, isobornyl acrylate (CAS no. 5888-33-5), patch tests. [Extracted from the article]

Introduction: : Drug reaction with eosinophilia and systemic symptoms (DRESS) is a severe cutaneous adverse drug reaction. According on the culprit drug(s), imputability can be confirmed by patch test (PT). Our objective was to evaluate the value of PT in DRESS in the last 10 years, in comparison with our study in the preceding 10 years. Material & Methods: From 2009 to 2018, patients with DRESS performed PT at the Dermatology Department of Coimbra University Hospital, with the main culprit drug(s) and all drugs administered concomitantly or suspected of inducing DRESS flares. Drugs at 1% - 10% pet (Chemotechnique diagnostics®) or from a commercial preparation diluted at 10% pet were patch tested. Results: We studied 41 patients (20 male/21 female, mean age 53 years). The main culprits were allopurinol (n=15), antiepileptics (n=14), trimethoprim/ sulfamethoxazole (n=4), salazopyrine (n=3), diclofenac (n=2), antiretrovirals, ezetimibe/simvastatin and strontium ranelate (1 each). In 15 patients other drugs (n=18) were suspected of worsening DRESS, amoxicillin (n=8), ciprofloxacin (n=2), cefoxitin (n=2), levofloxacin, ceftriaxone, ceftazidime, vancomycin, acyclovir and metamizole (1 each). A positive PT to the culprit drug was observed in 10 patients (24.3%), all to antiepileptics. All patients tested for alopurinol had negative results. Positive reactions were observed to drugs related with flares in 12/18 suspected drugs (67%), but not to quinolones. Conclusion: Results were similar to the study conducted 10 years before when 18/56 (32.1%) patients had positive PT, mostly to carbamazepine and other anticonvulsants. Distinct from our previous study, when no tests were performed with the antibiotic series or other drugs used after the initiation of DRESS, we showed that PT can be a valuable tool to diagnose co-sensitisation in DRESS and emphasise the importance of testing all medications taken during the whole episode, even when PT has no value for the main culprit, like allopurinol. Recognising a co-sensitisation can prevent a new DRESS induced by the second drug. [ABSTRACT FROM AUTHOR]

Background: Patients suffering from drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome caused by first‐line antituberculosis drugs often need to be retreated rapidly. Patch tests prior to the reintroduction of antituberculosis drugs are rarely performed. Objectives: To highlight those drugs most often involved in DRESS caused by antituberculosis drugs, illustrate the potential value of patch tests to identify these culprit(s), and provide insights into how to rapidly retreat these patients. Methods: A detailed description of the work‐up of two illustrative patients, together with a literature review of similar cases, is provided. Results: All first‐line antituberculosis drugs may cause DRESS syndrome, but rifampicin and isoniazid are most frequently involved. Patch tests can be performed sooner than usually advised in the context of DRESS syndrome, and potentially with lower test concentrations, but false‐negative results are possible. Sequential reintroduction of patch test‐negative drugs is feasible, although the dose and order of drugs to be readministered, as well as the use of concomitant systemic corticosteroids, remain a matter of debate. Conclusion: Patch tests in the context of DRESS syndrome caused by antituberculosis drugs, despite their shortcomings, may potentially guide rapid retreatment of these patients. [ABSTRACT FROM AUTHOR]

Vulvar contact dermatitis is a common problem in dermatology and gynecology. It affects the health and life quality of women with this disease in a significant way. Over 50% of cases of chronic vulvar pruritus in adult women can be attributed to irritative or allergic substances (1), including the use of all those soaps self-referenced as intimate soaps, which is becoming increasingly frequent. The main symptom is irritation in the vulvar region; it can present related symptoms such as itching, burning and pain. Contact dermatitis occurs after exposure to exogenous irritants or allergens. Clinically, both of these states are difficult to differentiate; an adequate clinical history is required to investigate possible allergens, along with a complete physical examination and patch test being the only diagnostic method that confirms allergic contact dermatitis (2) in order to have an accurate diagnosis, initiate appropriate treatment and eliminate the triggering factor. [ABSTRACT FROM AUTHOR]

Background: Iodopropynyl butylcarbamate (IPBC) is a broad‐spectrum preservative for use in several product types, including cosmetics, in which its concentrations have been limited by EU legislation because of concerns related to its iodine content and release, and the risk of subsequent iodine overdose. Objectives: To report on concomitant patch test reactions observed with iodine and IPBC in patients sensitized to iodine‐containing antiseptics. Patients Between 2012 and 2018, seven patients, six from Belgium and one from France, two suffering from acute dermatitis during surgical interventions, four from dermatitis caused by wound treatment, and one from occupational dermatitis, were shown to be sensitized to iodine and/or povidone‐iodine (PVP‐I), which was considered to be relevant for their dermatitis. All patients were coincidentally also patch tested with IPBC. Results: All patients showed positive patch test reactions to several other allergens, including IPBC. No relevance could be detected for IPBC. Conclusions: We suspect that, notwithstanding the absence of firm evidence for IPBC being dehalogenated to produce free iodine in animals or in humans, the patch test reactions to IPBC in iodine‐allergic subjects were possibly caused by free iodine released from this preservative agent, thus underlining the EU restrictions regarding the use of this preservative in cosmetics. [ABSTRACT FROM AUTHOR]

Despite being a well‐recognised cause of allergic contact dermatitis with an embargo in many countries around the world, bufexamac is available over the counter in topical preparations in Australia. We present a series of patients who developed severe cutaneous eruptions after the topical application of bufexamac containing preparations to highlight the potential risks of this medication, as well as advocate for the reconsideration of its registration by the Therapeutic Goods Administration in Australia. [ABSTRACT FROM AUTHOR]

The 9-node quadrilateral shell element MITC9i is developed for the Reissner-Mindlin shell kinematics, the extended potential energy and Green strain. The following features of its formulation ensure an improved behavior: 1. The MITC technique is used to avoid locking, and we propose improved transformations for bending and transverse shear strains, which render that all patch tests are passed for the regular mesh, i.e. with straight element sides and middle positions of midside nodes and a central node. 2. To reduce shape distortion effects, the so-called corrected shape functions of Celia and Gray (Int J Numer Meth Eng 20:1447-1459, 1984) are extended to shells and used instead of the standard ones. In effect, all patch tests are passed additionally for shifts of the midside nodes along straight element sides and for arbitrary shifts of the central node. 3. Several extensions of the corrected shape functions are proposed to enable computations of non-flat shells. In particular, a criterion is put forward to determine the shift parameters associated with the central node for non-flat elements. Additionally, the method is presented to construct a parabolic side for a shifted midside node, which improves accuracy for symmetric curved edges. Drilling rotations are included by using the drilling Rotation Constraint equation, in a way consistent with the additive/multiplicative rotation update scheme for large rotations. We show that the corrected shape functions reduce the sensitivity of the solution to the regularization parameter γ of the penalty method for this constraint. The MITC9i shell element is subjected to a range of linear and non-linear tests to show passing the patch tests, the absence of locking, very good accuracy and insensitivity to node shifts. It favorably compares to several other tested 9-node elements. [ABSTRACT FROM AUTHOR]

The flow of incompressible fluids through porous media plays a crucial role in many technological applications such as enhanced oil recovery and geological carbon-dioxide sequestration. The flow within numerous natural and synthetic porous materials that contain multiple scales of pores cannot be adequately described by the classical Darcy equations. It is for this reason that mathematical models for fluid flow in media with multiple scales of pores have been proposed in the literature. However, these models are analytically intractable for realistic problems. In this paper, a stabilized mixed four-field finite element formulation is presented to study the flow of an incompressible fluid in porous media exhibiting double porosity/permeability. The stabilization terms and the stabilization parameters are derived in a mathematically consistent manner, and the computationally convenient equal-order interpolation of all the field variables is shown to be stable. A systematic error analysis is performed on the resulting stabilized weak formulation. Representative problems, patch tests and numerical convergence analyses are performed to illustrate the performance and convergence behavior of the proposed mixed formulation in the discrete setting. The accuracy of numerical solutions is assessed using the mathematical properties satisfied by the solutions of this double porosity/permeability model. Moreover, it is shown that the proposed framework can perform well under transient conditions and that it can capture well-known instabilities such as viscous fingering. [ABSTRACT FROM AUTHOR]

Acute generalized exanthematous pustulosis following paracetamol ingestion in a 5-year-old child: A case report According to the literature, tests can be positive in up to 58% of the patients.3 Some selected allergens from the European baseline series, propolis syrup ("as is"), amoxicillin 10% pet., acetaminophen (paracetamol) 10% pet. and ibuprofen 10% pet. were tested. Keywords: acute generalized exanthematous pustulosis; case report; children; paediatrics; paracetamol; patch tests EN acute generalized exanthematous pustulosis case report children paediatrics paracetamol patch tests 290 291 2 08/16/22 20220901 NES 220901 Acute generalized exanthematous pustulosis (AGEP) is a severe skin condition characterized by an acute onset of a widespread erythematous eruption with non-follicular, sterile pustules, in association with fever. [Extracted from the article]

Allergic contact dermatitis, case report, cosmetics, patch tests A 53-year-old woman experienced a widespread eczema after application of two Tamanu oils on insect bites, with positive patch test results to the two Tamanu oils at 1% in olive oil. Keywords: allergic contact dermatitis; case report; cosmetics; patch tests EN allergic contact dermatitis case report cosmetics patch tests 99 100 2 06/14/22 20220701 NES 220701 Allergic contact dermatitis (ACD) to Tamanu oil is rare, but two recent cases underline that an increase in frequency of use could bring out more cases of ACD to this vegetable oil. [Extracted from the article]

Keywords: allergic contact dermatitis; case report; common ivy; erythema multiforme; patch tests; plant EN allergic contact dermatitis case report common ivy erythema multiforme patch tests plant 235 237 3 03/23/20 20200401 NES 200401 CASE REPORTS Case 1 A 50-year-old male with no significant medical history apart from contact cheilitis from scented lip balm was referred for investigation of an acute and widespread rash. Patch tests with plants and fragrance series were negative, while of the three plants handled during gardening, the only positive (+ at D2 and ++ at D4) were common ivy stalk and the related leaf, ++ at D2 and +++ at D4. Allergic contact dermatitis, case report, common ivy, erythema multiforme, patch tests, plant. [Extracted from the article]

Introduction: Hand eczema is a multifactorial disease that can include manifestations of atopic dermatitis, irritant contact dermatitis, allergic contact dermatitis (mediated mainly by T cells) and/or immediate reactions such as contact urticaria or protein contact dermatitis (mediated or not by IgE). The study aim was the characterization of patients with hand eczema who reported immediate symptoms with the handling of suspected triggers. Material and Methods: Retrospective analysis of medical records of patients from the Dermatology Department with hand eczema who performed patch tests (baseline and complementary series according to the clinical history) and skin prick test whenever patients presented immediate symptoms with suspected triggers. Skin prick test results were correlated with specific and total IgE. Results: A total of 52 patients were evaluated (49F/3M), mean age: 33.4 ± 9.9 years, 25 (48.1%) with a personal history of atopy (nine with atopic dermatitis). Besides hand eczema, considered occupational in 33 patients (63.5%), dermatitis also involved the face in six (11.5%). We found positive patch tests in 31 patients (59.6%), mainly to nickel (45.2%). Skin prick test were positive in 28 patients (53.8%), mainly for latex (10, 35.7%) and kiwi (8, 28.6%). There was no statistically significant correlation between positive skin prick test and the presence of atopy or high total serum IgE. Conclusion: Although the study included a limited number of patients with hand eczema and we only performed skin prick test in those with complaints, we observed immediate reactions in a very significant proportion of patients (53.8%), mainly in the atopic group. Specific IgE was not useful for the diagnosis, compared to the skin prick test. Immediate mechanisms, not directly dependent on T cells, may be significantly involved in the pathogenesis of hand eczema, so immediate tests should be added more often to patch tests in the study of hand eczema. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 39-year-old woman with a known history of atopic dermatitis (AD) and referred to the dermato-allergology department due to persistent, painful, hyperkeratotic palmoplantar eczema despite the use of betamethasone dipropionate ointment and emollients. The patient was treated with intramuscular injections of methotrexate (MTX) and folic acid. The treatment of MTX was stopped after one year due to the improvement in AD lesions.

Abstract: Background: A minority of children reporting non‐immediate reactions to beta‐lactams (BLs) are allergic. Allergy workup usually includes late‐reading (48‐72 hours) skin tests (ST) and short (1‐3 days) drug provocation tests (DPT), regardless of the chronology of the index reaction. The sensitivity of hyper‐late‐reading (≥6‐7 days) ST and of prolonged DPT for the diagnosis of non‐immediate hypersensitivity to BLs is yet to be determined. Objectives: To establish the diagnostic values of late‐reading ST and hyper‐late‐reading ST and of prolonged DPT in children reporting non‐immediate reactions to BLs. Methods: Prospective assessment of children reporting non‐immediate reactions to BLs with late‐ and additional hyper‐late‐reading intradermal (ID) and patch tests, and if negative, with prolonged DPT. Results: Five hundred and fifty children reporting reactions to a single or several BLs (674 suspected BLs) were included. Non‐immediate hypersensitivity to BLs was diagnosed in 63 children (11.5%), reporting 66 reactions (9.8%), based on responses in ST (n = 17, 25.8%: 5 to ID, 8 to patch tests, and 4 to both tests), DPT (n = 43, 65.2%), and clinical history (n = 6, 9.1%), including 3/9 children with severe cutaneous adverse reactions. Skin test positivity was observed after the 6‐7th day in 14/17 children, and DPT positivity after a median time of 3 days. No severe reaction was observed after ST or during prolonged DPT. Conclusion: Additional hyper‐late‐reading of ST enhanced their positivity. However, their overall sensitivity remained weak, especially in non‐severe cases. Prolonged DPT are safe and may improve the performance of DPT in the diagnosis of non‐immediate hypersensitivity to BLs. [ABSTRACT FROM AUTHOR]

Introduction: The patterns of positive patch test in Nepal have not been defined so far. The aim of this study was to describe the patterns of patch test reactivity in suspected Allergic Contact Dermatitis (ACD) patients. Methods: This was a hospital based retrospective study performed to investigate patch test reactivity in patients with ACD from April, 2016 through October, 2016. The data of patients who underwent patch test during this period were extracted and analyzed. Results: A total of 35 patients were included in the study. Nineteen (54.3%) tested positive to either one or more allergens. Among them, 17 (89.4%) reacted positively to a single allergen. The following patterns of positives were seen: nickel sulfate, 5 (26.3%), fragrance mix 3 (15.7%), and parthenium 3 (15.7%). Cobalt sulfate, formaldehyde, potassium dichromate, benzocaine, nitrofurazone, chlorocresol each was positive in single patient. Majority of the patients were housewives (22.6%) followed by students and officers (13% each), farmers (10%), health care workers (9.7%), wet work (6.5%) and others (20). Less than half (45%) of the hand eczema showed positive patch test. Similarly,40% of the patient of scattered generalized dermatitis showed reactivity to parthenium, nickel sulfate and multiple antigens. Conclusions: The most common allergens identified were nickel sulfate, fragrance mix and parthenium. Since, there is no well defined contact allergen in the Nepalese community, so patch test kits developed elsewhere might not have been beneficial and calls for need of large scale investigation to identify the local allergens. [ABSTRACT FROM AUTHOR]

Propylene glycol (PG) has widespread use in pharmaceuticals, cosmetics, fragrances and personal care products. PG is not classified as hazardous under the Globally Harmonised System of Classification and Labelling of Chemicals (GHS) but poses an intriguing scientific and regulatory conundrum with respect to allergic contact dermatitis (ACD), the uncertainty being whether and to what extent PG has the potential to induce skin sensitisation. In this article we review the results of predictive tests for skin sensitisation with PG, and clinical evidence for ACD. Patch testing in humans points to PG having the potential to be a weak allergen under certain conditions, and an uncommon cause of ACD in subjects without underlying/pre-disposing skin conditions. In clear contrast PG is negative in predictive toxicology tests for skin sensitisation, including guinea pig and mouse models (e.g. local lymph node assay), validated in vitro test methods that measure various key events in the pathway leading to skin sensitisation, and predictive methods in humans (Human Repeat Insult Patch and Human Maximisation Tests). We here explore the possible scientific basis for this intriguing inconsistency, recognising there are arguably no known contact allergens that are universally negative in, in vitro , animal and human predictive tests methods. • Propylene glycol (PG) a weak allergen in humans. • Allergic contact dermatitis (ACD) appears limited to individuals with underlying/pre-disposing skin conditions. • PG is negative in predictive toxicology tests for skin sensitisation. • PG represents a dilemma with respect to classification under GHS. [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]

Introduction: Contact dermatitis is a relatively common dermatosis reported among several population groups from all around the globe. However, the data from Kuwait is unavailable. Patch tests are essential for the diagnosis of contact sensitization. Aim: To determine a relative frequency and pattern of sensitizers to different allergens in patients of suspected contact dermatitis in Kuwait and, also to study the role of the commonest sensitizer in detail. Material and methods: Patch tests were performed in 2461 consecutive patients with a clinical diagnosis of contact dermatitis seen at our hospital between September 1, 2014 and August 31, 2015. Out of the total of 1381 (56.1%) patients with positive patch test results to at least one allergen, 546 (22.2%) patients with a single positive reaction to nickel only (single largest sensitizer) were selected as the study population for further detailed analysis. Results: At least one positive patch test reaction was found in 1381 (56.12%) patients. Nickel was found to be the most common sensitizer seen in 546 (40%) patients. The mean age was 37.3 ±13.8 years and the mean duration of disease was 27.3 ±13.8 months. Most (387/546) patients sensitized were females. The forearms/hands and wrists were the most prevalent sites (52.56% of the participants). In 58.91% of women, dermatitis was more often confined to other sites, mostly ears and the neck due to earrings and necklaces. Just more than half of the number (51.09%) of nickel allergic patients were found in the age group of 15-25 years. Hairdressers/beauticians were the most affected group followed by house workers (housewives, cleaners, housekeepers). Conclusions: Nickel is the single most common sensitizer found in our patients, and female sex, young age, occupation with long hours of contact to nickel are high risk factors. We recommend that a directive, which limits the release of nickel from products with extended skin contact, be approved in Kuwait. [ABSTRACT FROM AUTHOR]

Introduction: Like in allergic contact dermatitis, in non-immediate (NI) cutaneous adverse drug reactions (CADR) delayed hypersensitivity to antibiotics and anticonvulsants is considered to be lifelong. Although in allergic contact dermatitis patch tests remain positive for several years, this has seldom been assessed in the setting of NI-CADR to systemic drugs. Objective: To evaluate the long term behaviour of positive patch test reactions in NI-CADR to beta-lactams, clindamycin and carbamazepine. Methods: The drugs associated with the largest number of positive patch test reactions (beta-lactams, clindamycin and carbamazepin) were selected and 64 patients with history of NI-CADR to these drugs and relevant positive reactions were invited to repeat patch tests, at least 2 years thereafter. New patch test reactions were compared with the original ones. Results: In the 23 patients included in the study (10 males/ 13 females, median age 51 years) there were 44 positive reactions at the first patch tests and 40 (91.1%) of these remained positive after a median interval of 6.5 years (min. 2.0 - max. 30.7 years). Concerning beta-lactams, 17/19 reactions persisted positive for aminopenicillins (amoxicillin or ampicillin), 8/8 for isoxazolyl penicillins (flucloxacillin or dicloxacillin), 3/3 for benzylpenicillin, 1/1 for cefoxitin and 1/1 with piperacillin. Reactions with clindamycin remained positive in 5/7 cases. All five patch tests repeated with carbamazepine were positive. In 62.5% of the tests the same intensity of reaction was observed and was not affected by the time interval between tests, gender or age at performing patch tests. Conclusion: In NI-CADR to several antibiotics and carbamazepine, most of the patch test reactions remained positive after several years. [ABSTRACT FROM AUTHOR]