Patch test results in 542 patients with suspected contact dermatitis in Turkey

Analysis of patch testing results in patients with contact dermatitis in Istanbul, Turkey, from 2012 to 2022

BACKGROUND

Allergens responsible for allergic contact dermatitis (ACD) differ between populations. They can even change over the years with the effect of environmental factors.

AIMS

To evaluate the results of patch testing performed in our center.

METHODS

In this study, the thin-layer rapid-use epicutaneous (T.R.U.E.) test results of patients with a diagnosis of ACD between 2012 and 2022 were retrospectively evaluated.

RESULTS

In 431 (42.5%) of the total 1012 patients, a positive reaction to at least one allergen was detected in the patch test. Allergen positivity was most detected for nickel sulphate (16.8%), gold sodium thiosulfate (GST) (6.9%), thimerosal (4.2%), fragrance mix (3.4%), carba mix (3.2%), and cobalt dichloride (2.9%). Nickel sulfate and GST sensitivity was found to be significantly higher in women, fragrance mix sensitivity in men, thimerosal sensitivity in individuals aged under 40 years, colophony and balsam of Peru sensitivity in head and neck dermatitis, and carba mix and thiuram mix sensitivity in atopic individuals.

CONCLUSIONS

This study presents comprehensive data from Turkey concerning the sensitivity frequencies for allergens included in the T.R.U.E. test.

An ICP-MS Study for Quantitation of Nickel and Other Inorganic Elements in Urine Samples: Correlation of Patch Test Results with Lifestyle Habits

Nickel (Ni) is a frequently used metal in the production of many products, and Ni exposure occurs in humans through food, inhalation, and skin. Studies reported Ni as the most common allergen diagnosed in the serial patch test. The main purpose of our study was to determine the concentration of Ni and other elements in the urine samples of individuals with Ni-sensitivity and to determine the effect of lifestyle habits on these variables. This study was conducted with 388 participants; additionally, both Ni patch test and inorganic analysis (for 24 elements) method in urine with inductively coupled plasma-mass spectrometry (ICP-MS) were applied to all participants. Ninety-two (23.7%) of the participants were found to have nickel sensitivity with a mean urine concentration of 4.475 μg/g creatinine (median=4.260; SD=2.527). The urine nickel concentration was significantly different between female and male participants (p =0.001). We found a significant correlation between Ni and other metals alongside various element pairs. The mean urine Ni concentration of the individuals with a positive Ni sensitivity test result was not different from that of the participants without Ni sensitivity (4.475 vs 4.256 μg/g creatinine, respectively; p = 0.068). The high accuracy, recovery, and repeatability data obtained from the analyses indicate that this study is efficient and appropriate for the quantitative determination of nickel and other elements in urine samples. Ni-containing objects and Ni-rich foods should be of concern for individuals with hypersensitivity reactions to the element.

Importance of Supplemental Patch Testing Beyond a Screening Series for Patients With Dermatitis: The North American Contact Dermatitis Group Experience

IMPORTANCE

Patch test screening series for patients with dermatitis are limited and may miss clinically relevant contact allergens.

OBJECTIVE

To characterize individuals with dermatitis who showed clinically relevant patch test findings to supplemental (nonscreening) allergens or substances.

DESIGN, SETTING, AND PARTICIPANTS

A 17-year, retrospective cross-sectional analysis (January 1, 2001, to December 31, 2018) of North American Contact Dermatitis Group (NACDG) data from multiple centers in North America was conducted. A total of 43 417 patients with dermatitis underwent patch testing to the NACDG screening series in a standardized manner with 65 to 70 allergens and supplemental allergens as clinically indicated. Patients with 1 or more clinically relevant reactions to a supplemental (nonscreening) allergen/substance were analyzed between November 18, 2020, and March 12, 2021.

MAIN OUTCOMES AND MEASURES

The main outcomes were to assess the number of patients with clinically relevant reactions to supplemental (nonscreening) allergens and compare characteristics (including demographic characteristics and occupations) between patients with a clinically relevant patch test reaction to 1 or more supplemental allergens or substances (supplement-positive) and those without a reaction (supplement-negative) using odds ratios (ORs) and 95% CIs. Secondary outcomes included sources of allergic contact dermatitis and, for occupationally related cases, specific occupations and industries.

RESULTS

Of 43 417 patients included in the study who underwent patch testing to the NACDG screening series (65-70 allergens), 9507 individuals (21.9%) had currently relevant reactions to 1 or more supplemental allergens or substances. Of these, 6608 were women (69.5%) and the mean (SD) age was 47.2 (0.54) years. Compared with patients who had supplement-negative results, patients with supplement-positive findings were significantly less likely to be male (OR, 0.90; 95% CI, 0.85-0.94; P < .001) and/or have atopic dermatitis (OR, 0.89; 95% CI, 0.84-0.93; P < .001). Common primary sites of dermatitis in 9499 patients with supplement-positive findings included the face (2856 [30.1%]), hands (2029 [21.4%]), and scattered/generalized distribution (1645 [17.3%]). Frequent sources of supplemental allergens in 9235 patients included personal care products (4746 [51.4%]) and clothing/wearing apparel (1674 [18.1%]). Of 9362 patients with available data, supplemental allergens/substances were occupationally related in 1580 (16.9%); of those with identified occupations, 25.1% (384 of 1529) were precision production, craft, or repair workers. Of 9507 patients with supplement-positive findings, 2447 (25.7%) had no currently relevant reactions to NACDG screening allergens.

CONCLUSIONS AND RELEVANCE

This cross-sectional study found that 21.9% of patients who underwent patch testing to an allergen screening series of 65 to 70 allergens had at least 1 relevant reaction to supplemental allergens/substances. Of these, one-quarter reacted only to a supplemental allergen/substance. Screening series include common, important allergens, but these findings suggest that the addition of specialty allergens and personal or work products is critical for the successful diagnosis and management of allergic contact dermatitis.

Occupational allergic contact dermatitis: A 24-year, retrospective cohort study from Turkey

BACKGROUND

Limited data exist on occupational allergic contact dermatitis (OACD) in Turkey.

OBJECTIVES

To investigate the epidemiologic profile of OACD in Turkey.

METHODS

A retrospective cohort study on 294 patients with OACD among 2801 consecutively patch-tested patients in the Allergy Unit of the Dermatology Department of İstanbul Faculty of Medicine between 1996 and 2019.

RESULTS

The overall prevalence of OACD was 10.5%, showing a male predominance. OACD was most frequently seen in construction workers (45.2%), followed by hairdressers, metalworkers, health care workers, and miscellaneous. The main relevant allergens were chromium in cement, thiurams in rubber gloves, hairdressing chemicals, resins/glues/plastics, metals, isothiazolinones, and fragrances. Hands were the mainly involved site (95.6%). Airborne eczema was observed in 21.4%. Hand and foot eczema and co-sensitizations to chrome and thiuram and chrome and cobalt were significantly associated with being a construction worker. Sensitizations to isothiazolinones in house painters, ammonium persulfate and p-phenylenediamine in hairdressers, and colophonium increased after 2010.

CONCLUSION

This was the largest group of data on OACD from Turkey, reflecting the importance of rubber glove allergy in all occupations and the striking increase in ammonium persulfate allergy among hairdressers. Chrome and cobalt were still the main cement allergens in Turkey, where the cement directive is not yet in force.

Multiyear Group and Medical Center Patch Test Frequency Data: Confounding Variables

Patch test frequency data have been extensively published by research groups, such as the International Contact Dermatitis Research Group, North American Contact Dermatitis Group, Dermato-Allergology Study and Research Group, and European Environmental Contact Dermatitis Research Group. As this knowledge accumulation is widely applied in clinical and public health settings, we describe confounding factors to consider when using such data for medical policy considerations. These concepts can also be used in individual reports of new allergens or series of cases. Some of these confounders may have been reported in current literature (until October 2020), whereas others have not been mentioned/considered in most group publications.

Patch Test Results to European Baseline Series in Turkey: A Prospective and Multicenter Study

BACKGROUND

Patch testing with the European Baseline Series (EBS) is an essential diagnostic tool for the assessment of allergic contact dermatitis.

OBJECTIVE

The aims of the study were to describe the most common contact allergens identified with patch testing in Turkey and to establish the distribution of contact allergens among different regions in Turkey.

PATIENTS AND METHODS

Twelve centers consisting of tertiary health care institutions were included in the study. A total of 1169 patients were patch tested with the EBS from 2015 to 2017.

RESULTS

A total of 596 patients (51.0%) had 1 or more positive patch test reactions to the EBS. A total of 30.2% (n = 353) of those tested had clinical relevance. Contact sensitivity was more common in young patients. The most common 10 allergens were nickel sulfate (20.4%), followed by textile dye mix (8.6%), cobalt chloride (8.3%), potassium dichromate (8.0%), p-phenylenediamine base (4.5%), balsam of Peru (4.3%), methylchloroisothiazolinone/methylisothiazolinone (3.8%), thiuram mix (3.6%), fragrance mix I (3.0%), and methylisothiazolinone (2.9%).

CONCLUSIONS

This study provides a comprehensive profile of patch test results with the EBS in Turkey. An ongoing decrease in contact allergy to methylchloroisothiazolinone/methylisothiazolinone and methylisothiazolinone was observed. Textile dye mix and p-phenylenediamine are beginning to pose a new risk in Turkey.

Methylchloroisothiazolinone/methylisothiazolinone and methylisothiazolinone contact allergy: A 24-year, single-center, retrospective cohort study from Turkey

BACKGROUND

Methylchloroisothiazolinone/methylisothiazolinone (MCI/MI) and MI allergy caused a global epidemic during the period 2010 to 2015, reaching its peak in 2013/14.

OBJECTIVE

To investigate the characteristics of MCI/MI and MI allergy in Turkey over 24 years.

METHODS

A total of 2310 patients patch tested between 1996 and 2019 with MCI/MI 0.01% aq. or MCI/MI 0.02% aq., with or without MI 0.2% aq., were analyzed.

RESULTS

The overall prevalence of contact sensitization was 3.3% (n = 77) with a peak level of 16.4% in 2015. The prevalence gradually decreased thereafter, but was still high (6.5%) in 2019. Seventy-three patients had clinically relevant sensitizations. MI could detect clinically relevant sensitizations in all seven patients with a negative patch test reaction to MCI/MI 0.02%. Non-occupational allergic contact dermatitis (ACD) was most frequently seen, mainly in women, with hand/face eczema from rinse-off or leave-on cosmetics, such as wet wipes. Occupational ACD was mainly seen among men with airborne eczema from wall paints in house painters, or with hand eczema from hair gel/wax in men's barbers.

CONCLUSIONS

The prevalence of MCI/MI and MI sensitization in Turkey following the peak in 2015 is still high. This is probably due to the currently allowed level of 100 ppm for MI in rinse-off cosmetics. This needs to be urgently reduced.

European Standard Series Patch Test Results in Contact Dermatitis Patients in a Tertiary Care Hospital

Objectives:

Sensitization of allergens varies among societies and also it is influenced by various factors, such as age and gender. It may even change over the years. In this study, we aimed to evaluate the patch test results in patients with contact dermatitis (CD) in our center.

Methods:

European standard series patch test results of patients with CD between 2017 and 2018 were evaluated retrospectively.

Results:

Of the 135 patients, 65 (48.1%) were males, 70 (51.9%) were females. The mean age of patients was 41.43±14.26 (11-78) years. In 78 (57.8%) patients, a positive reaction against at least one allergen was detected. The most common allergens were nickel sulfate (27.4%), potassium dichromate (14.8%), cobalt chloride (11.9%), textile dye mix (8.1%), fragrance mix i, ii (6.7%) and balsam of Peru (4.4%). The sensitization of nickel sulfate was higher in females and sensitization of cobalt chloride and potassium dichromate in males (p=0.03, 0.05, 0.03, respectively). In the multivariate logistic regression analysis, age was independently related to a positive reaction against at least one allergen.

Conclusion:

Nickel sulfate, potassium dichromate, cobalt chloride and textile dye mix were the most common allergens. Legal regulations should be made to decrease exposure to allergens.

Prevalence of contact allergy to metals: nickel, palladium, and cobalt in Southern Sweden from 1995-2016

BACKGROUND

In 2001, the EU nickel directive was introduced to prevent contact allergy to nickel. Contact allergy to palladium and/or cobalt is often seen together with contact allergy to nickel.

OBJECTIVES

To compare the contact allergy prevalence of nickel, palladium, and cobalt allergy before and after the introduction of the EU nickel directive in consecutive patients with dermatitis.

METHODS

A retrospective analysis of patch test results from 1995-2016 was performed (n = 18 264). Chi-square tests were used to examine trends for nickel, palladium, and cobalt across test years. Logistic regression was used for associations.

RESULTS

The prevalence of nickel allergy decreased significantly in the youngest age group (6-30 years) for both female and male patients from 1995-1999 to 2012-2016: females: 33.4% to 19.1% (P < .001); males: 5.9% to 2.1% (P < .05). The concomitant reactions between nickel and palladium and nickel and cobalt among young females, respectively, also decreased significantly. Isolated palladium and cobalt allergy remained stable (1.4% and 2.3%, respectively) during the same time period for both men and women.

CONCLUSIONS

The prevalence of nickel has decreased among young females and males suspected of contact allergy in Southern Sweden after the introduction of the EU nickel directive. There has been no change in isolated palladium or cobalt allergy.

Skin application of glutathione and iron sulfate can inhibit elicitation of allergic contact dermatitis from hexavalent chromium

BACKGROUND

Allergic contact dermatitis (ACD) caused by hexavalent chromium, Cr(VI), is often severe and difficult to treat. The most common source of exposure to Cr(VI) in Sweden used to be cement, and more recently leather. The contact allergy can be diminished or inhibited if the exposure is decreased or ceases. Barrier creams against different kinds of allergens have been investigated for their protective properties which may offer protection against Cr(VI) exposure.

OBJECTIVES

To investigate the capacity of formulas containing glutathione (GSH) and iron sulfate to inhibit elicitation of ACD in Cr(VI)-allergic individuals when exposed to Cr(VI).

METHODS

In 18 Cr(VI)-allergic volunteers the back was divided into eight patch test areas which were treated with preparations of possible barrier creams, prior to patch testing with a dilution series of potassium dichromate and a buffered extract of cement.

RESULTS

A significant reduction in reactivity to Cr(VI) and cement extract on skin treated with formulas containing GSH or iron sulfate was noticed, compared with untreated skin.

CONCLUSION

Formulas containing GSH or iron sulfate in barrier creams inhibit ACD in individuals allergic to Cr(VI) when applied before exposure to Cr(VI) and cement extract.

A seven-year retrospective analysis of patch test data in a cohort of patients with contact dermatitis in Sri Lanka

Background

Patch testing with a baseline series is a common tool employed when the sensitizing agent in contact dermatitis is unclear. However, for Asian countries, there are no locally validated baseline series to utilize in screening.

Methods

We completed a retrospective analysis of all patients that had undergone patch testing with the European Baseline series, Shoe Series or Comprehensive International Baseline series, over 7 years from 2012 to 2018 in a tertiary care reference dermatology clinic in Sri Lanka to evaluate the suitability of these investigations to identify causes for contact dermatitis in the local study population.

Results

Out of 438 patients tested, 239 (54.8%) reacted to at least one substance in the series. The Shoe Series was significantly more likely to yield a positive result than the European Baseline Series (70.2% vs 46.9%, p < 0.05). The top three sensitizers identified by all series were nickel sulfate (16%, 70/438), p-phenylenediamine (12.3%, 54/438) and 2-mercaptobenzothiazole or mercapto mix (10.5%, 46/438).

Conclusion

Shoe series has a comparatively high yield in the local population compared to European Baseline series. Since little less than half of the study population did not have any reactivity to any of the allergens tested it is important to develop or modify and validate a locally relevant, more suitable baseline series which is based on the Shoe Series in Sri Lanka. This is further evidence for the continuously changing nature of allergens in the environment and the need to modify existing patch testing standards accordingly.

Electronic supplementary material

The online version of this article (10.1186/s12895-019-0090-8) contains supplementary material, which is available to authorized users.

Experience in patch testing: A 6-year retrospective review from a single academic allergy practice

BACKGROUND

Patch testing is the "gold standard" to identify culprit allergen(s) causing allergic contact dermatitis (ACD), but there are limited studies of patch testing from allergy practice settings.

OBJECTIVE

We sought to explore patch test findings in a large academic allergy practice, including patch testing results, history of atopy, location of dermatitis, and referral source. We also wanted to determine whether patch testing using an extended panel, such as the North American screening series, compared with a limited series, such as the Thin-Layer Rapid-Use Epicutaneous (T.R.U.E.) Test, increased the sensitivity.

METHODS

A retrospective chart review was conducted of patients referred for patch testing over a 6-year period.

RESULTS

A total of 585 patients (mean age 48.7 years, 71.6 % female) underwent patch testing over the 6-year period, of which 369 (63%) had a positive test. Of those who tested positive, 202 (55%) reported a history of atopy. The extremities were the most commonly involved site, followed by the head/neck and trunk. The 5 most common positive allergens were nickel sulfate, gold sodium thiosulfate, methylchloroisothiazolinone, thimerosal, and bacitracin. Three hundred fourteen (53.6%) patients were positive to at least 1 allergen on TRUE testing. Extended screening series identified an additional 10.8% of patients with positive tests who were negative to T.R.U.E. test allergens.

CONCLUSION

Patch testing is a valuable diagnostic tool for the practicing allergist and provides early identification of culprit allergens in ACD. Performing an extended screening series such as the North American Contact Dermatitis Group (NACDG) or supplemental panel of allergens increased sensitivity when compared with a limited series.

Allergic contact dermatitis pattern in Kuwait: nickel leads the pack. In-depth analysis of nickel allergy based on the results from a large prospective patch test series report

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.

Incidence of allergic contact sensitization in central Chinese subjects with chronic urticaria

BACKGROUND

Chronic urticaria (CU) can be provoked by a wide variety of causes. Some studies suggest contact sensitization may play a role in the disease.

OBJECTIVE

To investigate the incidence and distribution characteristics of allergic contact sensitization in central Chinese subjects with CU, and assess contact allergen avoidance measures in managing CU.

METHODS

Patch tests were performed, following the recommended standard procedure, with 20 selected allergens, in line with the European baseline series. All subjects with positive results were prescribed appropriate avoidance measures for the sensitizing substances, while subjects with negative results served as the control group. CU severity was assessed daily from week1 to week4 and for each subject, applying the Urticaria Activity Score.

RESULTS

42.9% (233/543) of subjects with CU showed positive reactions to one or more contact allergen(s). Potassium dichromate, benzene mix and carba mix were more common in male patients, while nickel sulfate was more frequent in females. The positive rates for different allergens varied with age and occupation. The median (interquartile range) severity scores at week 1 were 20 (14-21) and 15 (14-27) for the allergen avoidance group and control group, respectively (P>0.05); and 12 (7-15) and 14 (12-17) at week 4 (P<0.001).

CONCLUSION

The incidence of allergic contact sensitization in CU patients was high, and appropriate contact allergen avoidance measures benefitted CU management. Contact allergens may play a role in the pathogenic mechanism of CU and patch tests are an option for CU patients.

Comparison of European Standard Patch Test Results of 330 Patients from an Occupational Diseases Hospital

Background and Aim. Contact dermatitis (CD) is the most prevalent occupational skin disease with a significant impact on quality of life. Patch testing is used for the identification of responsible allergens which may improve protective and preventive measures in the workplace. Herein, we aim to identify the demographic characteristics and occupation of patients with early diagnosis of occupational CD and compare patch test results. Materials and Methods. The study included 330 patients referred to our clinic between April 2009 and April 2011 and who were patch-tested with 28-allergen European Standard Test. Results. 126 (38%) patients were female and 204 (62%) were male with a mean age of 36.12 (±13.13) years. Positive allergic reactions were observed in 182 (55%) patients. Nickel sulphate (41/126) and potassium dichromate (39/204) were significantly the most common allergens in women and men, respectively (P < 0.005). Additionally, the most common occupation in women was household activities (83/126) and in men was manufacturing (80/204). Conclusion. The allergens to which people become sensitized differ according to their working environment and occupation. Classification of occupations is important for identification of sensitization risks and monitoring of changes in allergen distribution of different occupations.

Foot contact dermatitis: nitrofurazone as the main cause in a retrospective, cross-sectional study over a 16-year period from Turkey

BACKGROUND

The major causative agents in allergic contact dermatitis of the foot may differ from country to country. Sufficient data on foot eczema in patients from Turkey are lacking.

OBJECTIVE

To identify the clinically relevant contact allergens in foot eczema and determine the role of patch test series and patients' own materials in the detection of the responsible allergens.

METHODS

Among 1753 patients patch tested between 1996 and 2012 in our clinic, 53 with suspected allergic foot eczema were enrolled in this retrospective, cross-sectional study. Forty nine patients were patch tested with the extended European baseline series, 49 with supplemental series including rubber, leather, topical drugs, textile, cosmetic series containing preservatives and emulgators and varnish/plastic/glue series, and 37 with their own substances.

RESULTS

Thirty of the 53 patch tested patients showing sensitization to at least one clinically relevant allergen were diagnosed with allergic foot eczema. The main eliciting agent was nitrofurazone (n = 8), followed by leather shoe allergens, ie, potassium dichromate (n = 6), p-tert-butylphenol formaldehyde resin and formaldehyde, in the second range. Rubber shoe allergens were less frequently observed (n = 3). In more than 1/3 of the patients, the causative agent could only be identified by testing the patient's own substances and/or supplemental series.

CONCLUSION

Nitrofurazone was the leading causative agent followed by leather shoe allergens. Pediatric patients were frequently sensitized with shoe allergens. Patch testing with patient's own substances had a critical value in the detection of the causative agent in a significant number of patients.

Allergic reaction to a red plastic allergy alert patient identification bracelet: implications for surgical patient safety

We present a case of allergy to a hospital thermally-printed red plastic allergy alert bracelet in a 48 year old lady admitted to the day surgery unit. Two hours postoperatively, an intensely itchy area of erythema and oedema was seen extending from her left wrist distally to the fingers. The bracelet was removed and the rash resolved overnight without further complication. A diagnosis of contact dermatitis was made, secondary to exposure to an agent within the bracelet. We discuss the safety implications for surgical patients unable to wear an identification bracelet and the steps that may be taken to minimise the risk of harm from misidentification. We believe this to be the first documented case of an allergy to a patient identification bracelet in the medical literature.

Contact sensitivity in Behçet's disease

CONTEXT

Behçet's disease (BD) is a multisystemic inflammatory disorder with unknown etiology. Many immunological changes were reported in BD previously and these changes may affect the frequency of contact sensitivity in these patients.

OBJECTIVE

We aimed to identify whether there is an interaction between contact sensitivity and BD.

METHODS

The 'European standard series' with 27 allergens were performed on the upper backs of patients and healthy volunteers according to international standards using the IQ-Chamber. The test-units which contain these allergens were removed after 2 days. According to International Contact Dermatitis Research Group Recommendations test areas were evaluated on days 2, 3 and 7 to detect any delayed allergic reactions. The results of both groups were compared by using chi-square test.

RESULTS

One hundred adult persons (50 BDs and 50 healthy controls) were tested. Positive patch test reaction to 1 or more allergens was observed in 7 (14%) patients in BD group and in 12 (24%) persons in control group. There was no statistically significant difference between these two groups.

CONCLUSIONS

The frequency of contact sensitivity in BD is not different from healthy persons.

Concurrent sensitization to metals and occupation

BACKGROUND

Cosensitization to nickel, cobalt and chromium occurs in the general population and in some occupational groups.

OBJECTIVES

To estimate the isolated and concurrent occurrence of nickel, cobalt and chromium contact sensitization and their association with individual and occupational risk factors.

PATIENTS/METHODS

Twelve thousand four hundred and ninety-two patients were patch tested with the European baseline series between 1997 and 2004 in north-eastern Italy. The associations between patch test results and patient characteristics and occupations were investigated by means of multinomial logistic regression analysis.

RESULTS

Of the patients, 34.7% (4334 patients) had one or more positive patch test reactions to metals. As compared with those with negative reactions to all three metals, nickel sensitization was significantly higher in females than in males, not only as monosensitization, but also as cosensitization with cobalt, with chromium, or with both metals. Building and related trades workers showed positive reactions to chromium + nickel [odds ratio (OR) 1.99; 95% confidence interval (CI) 1.05-3.76) and chromium + cobalt (OR 2.61; 95% CI 1.46-4.67]. Cleaning workers showed a high prevalence of nickel, chromium, nickel + chromium and nickel + cobalt + chromium cosensitization (ORs 1.29, 1.66, 2.11, and 1.79, respectively). An excess risk for cosensitization to all three metals was found in textile and leather workers (OR 2.19; 95% CI 1.10-4.33), and in bartenders (OR 2.10; 95% CI 1.03-4.26).

CONCLUSIONS

Some occupational groups are more likely to develop nickel, cobalt and chromium cosensitization.

Final Report of the Amended Safety Assessment of Quaternium-15 as Used in Cosmetics

Quaternium-15 is an antimicrobial agent used in cosmetics as a cosmetic preservative and antistatic agent. Little systemic toxicity was reported in most single-dose or repeated-dose animal studies. Quaternium-15 was an oral teratogen, but not a dermal teratogen, in rats at doses that exceeded the expected cumulative exposure from cosmetics. The frequency of sensitization increased in North America but not in Europe, where Quaternium-15 is used less often. In almost all animal and human studies, Quaternium-15 at 0.2% was not a sensitizer. The weight of evidence suggested that a 0.2% concentration is not a sensitizer and that cosmetic products containing Quaternium-15 up to that level are safe.

The additive value of patch testing with patients' own products at an occupational dermatology clinic

BACKGROUND AND OBJECTIVES

Patch testing with commercially available kits detects only 70-80% of relevant allergens in patients with contact dermatitis. This is not ideal, especially when occupational issues are being evaluated. This study analyses our data regarding reactions to patients' own products.

METHODS

In a 5-year period, 1532 patients were assessed in our occupational dermatology clinic.

RESULTS

We found that 101 patients (6.6%) reacted to their own samples. In 20 (1.3%) cases, reacting to their own samples was the only clue for detecting the responsible allergen. In 59 (3.9%) cases, testing with their own samples reinforced their reactions to commercial allergens.

CONCLUSIONS

We found the overall additive value of testing with patients' own products to be 5.2%. This is not a low proportion considering the 20-30% false negative rate when patch testing. Patch testing with patients' own samples, appropriately diluted should be undertaken whenever possible.

Epidemiological data on consumer allergy to p-phenylenediamine

Many women and men now dye their hair. p-Phenylenediamine (PPD) is a frequent and important component of permanent hair dye products; exposure to it may cause allergic contact sensitization, acute dermatitis, and severe facial oedema. To increase our understanding of PPD allergy, we reviewed published literature containing PPD patch test data from dermatitis patients and individuals in the general population. This was performed to estimate the median prevalence and the weighted average of PPD sensitization and thereby assess the burden of PPD-containing hair care products on health. Literature was examined using PubMed-MEDLINE, Biosis, and Science Citation Index. The median prevalence among dermatitis patients was 4.3% in Asia, 4% in Europe, and 6.2% in North America. A widespread increase in the prevalence of PPD sensitization was observed among Asian dermatitis patients. In Europe, a decrease in the 1970s was replaced by a plateau with steady, high prevalences ranging between 2% and 6%. The prevalence remained high in North America, although a decreasing tendency was observed. Contact allergy to PPD is an important health issue for both women and men. More stringent regulation and enforcement are required as public health measures to reduce the burden of disease that exposure to PPD has brought to populations.

Allergic contact cheilitis from a lipstick misdiagnosed as herpes labialis: Subsequent worsening due to Zovirax�contact allergy

A 29-year-old Turkish woman with allergic contact cheilitis from a lipstick was misdiagnosed as herpes labialis and subsequently worsened with the application of Zovirax cream. Patch tests were positive to Zovirax cream, propylene glycol, the patient's favourite lipstick and propyl gallate. No reaction was seen with Zovirax ophthalmic ointment and Zovirax tablet. The propylene glycol component of the Zovirax cream and the propyl gallate component of the lipstick were regarded as the responsible contact sensitizers. The differential diagnosis was challenging due to concomitant contact sensitization with these agents.

Standard patch test results in patients with contact dermatitis in Israel: age and sex differences

Previous studies have shown that the prevalence of specific allergens varies by geographic area, population, age and sex. The objective of the present study was to determine the relative frequency of positive reactions to different sensitizers in Israeli patients with clinically suspected contact dermatitis (CD) and to identify possible sex and age differences. A total of 943 consecutive patients were tested for CD using the European standard patch test series. The most frequent allergen was nickel sulfate followed by potassium dichromate and fragrance mix. Positive reactions to nickel sulfate were more common among women, especially those in the younger age group (younger than 40 years). Positive reactions to balsam of Peru were more common among men, especially those in the older age group (40 years or older). This study presents the result of the standard patch test in Israel with stratification according to age and sex. The findings of the present study, combined with reports on geographic/population differences in the prevalence of specific allergens in CD, indicate the need for further investigations to identify prominent local allergens for better adaptation of the standard patch test to local needs.

Common contact sensitizers in the Czech Republic. Patch test results in 12,058 patients with suspected contact dermatitis*

The patch test results of 12 058 patients (4416 male and 7642 female) referred to 9 clinics in the Czech Republic between January 1997 and December 2001 were evaluated. Patients were tested with the same series of allergens by using the standardized patch testing method. The current standard tool for diagnosing allergic contact dermatitis (ACD) in the Czech Republic is the Trolab test panel (Hermal, Reinbeck, Germany) which consists of 23 allergens. Only a few data exists on ACD in the Czech Republic. All patients were tested with the 23 allergen European standard series. Of these patients, 7661 (63.5%) had 1 or more positive reactions. On average, there were 2.8 positive reactions per patient. ACD, according to clinical relevance, was diagnosed in 5339 (69.7%) of these patients. The most frequent allergens were metals (22.9%), especially nickel sulfate (13.8%), and followed by Myroxylon pereirae resin (balsam of Peru) (7.3%), fragrance mix (5.8%), formaldehyde (4.2%) and lanolin alcohol (3.0%). Our results were compared with results from other countries. We conclude that the European standard series is suitable for detection of ACD in the Czech Republic.

Patch testing: a retrospective analysis of 103 patients with emphasis on practical aspects for the clinician

BACKGROUND

Allergic contact dermatitis is a common dermatologic disorder caused by small chemical molecules that can penetrate the skin barrier. Thousands of chemicals capable of inducing allergic contact dermatitis have been identified. To cure allergic contact dermatitis, the allergen should be identified and eliminated from the environment of the patient. Patch testing, utilizing a variety of standard panels of the most frequent allergens, is used to identify the allergen in question. Patch testing is still the gold standard tool used to identify one or more substances that may contribute to the etiology of allergic contact dermatitis.

OBJECTIVE

To determine the frequency of patch test positivity and to identify the most common allergens in patients with suspected allergic contact dermatitis.

METHODS

A retrospective analysis of files of 103 patients who have been clinically diagnosed to have allergic contact dermatitis and have been patch tested using a standard technique with a Northern American Contact Dermatitis Group series.

RESULTS

Sixty-two patients (60.2%) showed positive reactions to one or more substance. The most common allergens were nickel sulfate, fragrance mix, and neomycin sulfate. There was an increased frequency of positive reactions to fragrance mix and a significant decrease of frequency of thimerosal positive reactions.

CONCLUSIONS

Increased awareness of allergens and their potential sources may help to limit the usage of these chemicals in manufacturing consumer products. This may have contributed to decreased prevalence rates of certain allergens such as thimerosal and paraphenylenediamine.