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Reeder MJ, Nihal A, Aravamuthan SR, Warshaw EM, DeKoven JG, Atwater AR, Houle MC, Adler BL, Silverberg JI, Taylor JS, Pratt MD, Belsito DV, Yu J, Botto NB, Mowad CM, Dunnick CA, DeLeo VA. Allergic or Not: Final Interpretation of Doubtful Patch Test Reactions From the North American Contact Dermatitis Group, 2019-2020. Dermatitis 2024; 35:138-143. [PMID: 38320244 DOI: 10.1089/derm.2023.0285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
Background: Doubtful patch test reactions generally do not meet criterion for positivity in patch testing. However, the North American Contact Dermatitis Group (NACDG) allows for doubtful reactions to be coded with a final determination of "allergic/positive" based on the temporal pattern, appearance, known characteristics of the allergen, and/or other supportive patch test reactions. Objectives: To analyze NACDG data from the 2019-2020 patch test cycle to identify patterns in the interpretation and relevance of doubtful reactions. Methods: The frequency and proportions of doubtful reactions were tabulated and analyzed for patterns. Statistical analyses were limited to allergens with ≥30 doubtful reactions to ensure adequate sample size. Results: Of patch-tested patients, 31.9% (1315/4121) had ≥1 doubtful reaction. Of 2538 total doubtful reactions, 46% (n = 1167) had a final interpretation of "allergic/positive." The allergens with the highest proportion of doubtful reactions at the final visit were hydroperoxides of linalool 1% (4.5%), fragrance mix I 8.0% (3.9%), and cetrimonium chloride 0.5% (3.4%). Methylchloroisothiazolinone/methylisothiazolinone (MCI/MI) 0.02% (P < 0.001), MI 0.2% (P < 0.001), nickel sulfate hexahydrate 2.5% (P = 0.001), and neomycin sulfate 20.0% (P = 0.003) doubtful reactions were more likely to be interpreted as allergic than nonallergic. Methyldibromoglutaronitrile/phenoxyethanol 0.2% (P < 0.001), oleamidopropyl dimethylamine 0.1% (P < 0.001), formaldehyde 2.0% (P < 0.001), cetrimonium chloride 0.5% (P < 0.001), benzophenone-4 (sulisobenzone) 10% (P < 0.001), iodopropynyl butylcarbamate 0.5% (P < 0.001), cocamidopropyl betaine 1.0% (P = 0.002), and benzisothiazolinone 0.1% (P = 0.012) doubtful reactions were less likely to be interpreted as allergic. Of the 1167 doubtful reactions interpreted as allergic, 84.9% had current relevance. Conclusions: Doubtful reactions were common and approximately one half were coded with a final interpretation of "allergic/positive." Of those, most were clinically relevant. MCI/MI, MI, nickel, and neomycin were more likely to be interpreted as allergic.
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Affiliation(s)
- Margo J Reeder
- From the Department of Dermatology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Aman Nihal
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Srikanth R Aravamuthan
- From the Department of Dermatology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Erin M Warshaw
- Department of Dermatology, Park Nicollet Health Services, Minneapolis, Minnesota, USA
- Department of Dermatology, Minneapolis Veterans Affairs Medical Center, Minneapolis, Minnesota, USA
- Department of Dermatology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Joel G DeKoven
- Division of Dermatology, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada
| | - Amber R Atwater
- Department of Dermatology, Duke University Medical Center, Durham, North Carolina, USA
| | - Marie-Claude Houle
- Division of Dermatology, CHU de Quebec, Laval University, Quebec City, Quebec, Canada
| | - Brandon L Adler
- Department of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Jonathan I Silverberg
- Department of Dermatology, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | - James S Taylor
- Department of Dermatology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Melanie D Pratt
- Division of Dermatology, University of Ottawa, Ontario, Canada
| | - Donald V Belsito
- Department of Dermatology, Columbia University Irving Medical School, New York, New York, USA
| | - Jiade Yu
- Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Nina B Botto
- Department of Dermatology, University of California, San Francisco, California, USA
| | - Chris M Mowad
- Department of Dermatology, Geisinger Medical Center, Danville, Pennsylvania, USA
| | - Cory A Dunnick
- Department of Dermatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA; and
- Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, Colorado, USA
| | - Vincent A DeLeo
- Department of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
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Contact Allergy to Shellac. Retrospective Cross-Sectional Study With Data From the Spanish Registry of Research in Contact Dermatitis and Cutaneous Allergy (REIDAC). ACTAS DERMO-SIFILIOGRAFICAS 2023; 114:377-381. [PMID: 36828274 DOI: 10.1016/j.ad.2023.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 02/18/2023] [Accepted: 02/20/2023] [Indexed: 02/25/2023] Open
Abstract
INTRODUCTION Shellac is a known allergen present mainly in cosmetics used on the eyelids and lips, although new sources of exposure have recently been described. Our objective was to assess the use of shellac as a contact allergen in Spain and the clinical profile of patients allergic to shellac. METHODS This retrospective cross-sectional study included patients patch tested for shellac between 2018 and 2021 from the Spanish Registry of Contact Dermatitis and Cutaneous Allergy (REIDAC). RESULTS A total of 980 patients were patch tested for shellac (20% in ethanol), and 37 (3.77%, 95% confidence interval [CI], 2.58-3.97%) showed positive results. Most of these patients were tested for shellac due to a suspicion of cosmetic contact dermatitis. Seven patients with present relevance were found, five with relation to cosmetics, and the other two with an occupational background of food handling. The reaction index for shellac was 0.51 and the positivity ratio was 67.56% (95% CI, 52.48-82.65%). CONCLUSIONS Shellac appears to be a prevalent allergen in patients with suspected contact dermatitis related with cosmetics or foodstuff. However, further studies are needed to validate its use in other patients.
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Mahler V, Uter W. Epicutaneous Patch Testing in Type IV Allergy Diagnostics: State of the Art and Best Practice Recommendations. Handb Exp Pharmacol 2022; 268:405-433. [PMID: 34312717 DOI: 10.1007/164_2021_508] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
This chapter summarises all relevant aspects of patch testing, closely following recommendations outlined in a recent European, and a German S3 guideline on diagnostic patch testing with contact allergens and medicinal products (drugs). Patch testing is indicated in patients suspected of suffering, or having been suffering, from delayed-type hypersensitivity leading to allergic contact dermatitis or other skin and mucosal diseases. Sections of this chapter include detailed indications, reasons for possibly postponing the test, considerations on choosing haptens (contact allergens) to test, various aspects of the application of patch test allergen preparations (storage, dosing) and of testing with individual materials provided by the patients. Special aspects of patch testing in cutaneous adverse drug reactions, children, or occupational contact dermatitis are outlined. Supplemental test methods, notably the repeated open application test, are briefly described. Finally, the final evaluation in terms of assessment of clinical relevance of reactions and patient counselling are outlined.
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Affiliation(s)
- Vera Mahler
- Division of Allergology, Paul-Ehrlich-Institut, Langen, Germany.
| | - Wolfgang Uter
- Department of Medical Informatics, Biometry and Epidemiology, University of Erlangen/Nürnberg, Erlangen, Germany
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4
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Nyman GSA, Giménez-Arnau AM, Grigaitiene J, Malinauskiene L, Paulsen E, Hagvall L. Patch Testing with Propolis of Different Geographical Origins in a Baseline Series. Acta Derm Venereol 2021; 101:adv00591. [PMID: 34664078 PMCID: PMC9455323 DOI: 10.2340/actadv.v101.423] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The chemical composition of propolis varies with geographical origin; however, it is not known whether this affects the frequency of contact allergy to propolis. In order to study the frequency of contact allergy to propolis of different geographical origins and concomitant reactions, 1,470 consecutive patients with dermatitis from Denmark, Lithuania and Spain were patch tested with propolis from China, Lithuania, North America and Sweden, and with a baseline series. Patch test reactions to any type of propolis ranged from 1.3% to 5.8%. There were no statistically significant differences in the frequency of positive reactions between the 4 types of propolis in the respective countries. Testing with a single commercially available type of propolis detects only approximately half of propolis-allergic patients. In patients allergic to propolis, concomitant reactions to Myroxylon pereirae resin, colophonium and Fragrance mix I were common, ranging from 12.5% to 50.0%.
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Affiliation(s)
- Gunnar S A Nyman
- Department of Dermatology and Venereology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gröna stråket 16, SE-413 46 Göteborg, Sweden.
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5
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Andernord D, Bruze M, Bryngelsson IL, Bråred Christensson J, Glas B, Hagvall L, Isaksson M, Matura M, Nyman G, Stenberg B, Svedman C, Lindberg M. Contact allergy to haptens in the Swedish baseline series: Results from the Swedish Patch Test Register (2010 to 2017). Contact Dermatitis 2021; 86:175-188. [PMID: 34704261 DOI: 10.1111/cod.13996] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 10/20/2021] [Accepted: 10/21/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND Allergic contact dermatitis has considerable public health impact and causative haptens vary over time. OBJECTIVES To report the prevalence of contact allergy to allergens in the Swedish baseline series 2010 to 2017, as registered in the Swedish Patch Test Register. METHODS Results and demographic information for patients tested with the Swedish baseline series in 2010 to 2017 were analysed. RESULTS Data for 21 663 individuals (females 69%) were included. Females had significantly more positive patch tests (54% vs 40%). The reaction prevalence rates were highest for nickel sulfate (20.7%), fragrance mix I (7.1%), Myroxylon pereirae (6.9%), potassium dichromate (6.9%), cobalt chloride (6.8%), methylchloroisothiazolinone/methylisothiazolinone (MCI/MI; 6.4%), MI (3.7%), colophonium (3.5%), fragrance mix II (3.2%), and formaldehyde (3.2%). Myroxylon pereirae reaction prevalence increased from 5% in 2010 to 9% in 2017 and that for methyldibromo glutaronitrile from 3.1% to 4.6%. MCI/MI and MI reactions decreased in prevalence after 2014. Nickel reaction prevalence decreased among females aged 10 to 19 years. CONCLUSIONS Nickel remains the most common sensitizing agent, with reaction prevalence decreasing among females younger than 20 years. The changes in MCI/MI and MI reaction prevalence mirrored those in Europe. The register can reveal changes in contact allergy prevalence over time among patients patch tested in Sweden.
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Affiliation(s)
- Daniel Andernord
- Department of Dermatology, Central Hospital, Karlstad, Sweden.,Centre for Clinical Research and Education, Region Värmland, Karlstad, Sweden
| | - Magnus Bruze
- Department of Occupational and Environmental Dermatology, Skåne University Hospital, Lund University, Malmö, Sweden
| | - Ing-Liss Bryngelsson
- Department of Occupational and Environmental Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Johanna Bråred Christensson
- Department of Dermatology and Venereology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Dermatology and Venereology, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
| | - Bo Glas
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Lina Hagvall
- Department of Dermatology and Venereology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Dermatology and Venereology, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
| | - Marléne Isaksson
- Department of Occupational and Environmental Dermatology, Skåne University Hospital, Lund University, Malmö, Sweden
| | - Mihály Matura
- Department of Dermatology, Skaraborg Hospital Skövde, Skövde, Sweden
| | - Gunnar Nyman
- Department of Dermatology and Venereology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Dermatology and Venereology, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
| | - Berndt Stenberg
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Cecilia Svedman
- Department of Occupational and Environmental Dermatology, Skåne University Hospital, Lund University, Malmö, Sweden
| | - Magnus Lindberg
- Department of Dermatology, Örebro University Hospital and Department of Dermatology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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6
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Bruze M, Engfeldt M, Elsner P, Gonçalo M, Naldi L, Schuttelaar MLA, Svedman C, Svensson Å, Ofenloch R. Validation of questionnaire algorithm based on repeated open application testing with the constituents of fragrance mix II: the EDEN Fragrance Study. J Eur Acad Dermatol Venereol 2021; 35:1692-1701. [PMID: 33914959 DOI: 10.1111/jdv.17315] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 03/16/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND In a European study on contact allergy in the general population, it has been hypothesized that the combination of contact allergy to a fragrance together with a history indicating dermatitis at exposure and thereafter subsequent avoidance of scented products implied a diagnosis of allergic contact dermatitis. OBJECTIVES The primary aim of this study was to validate this hypothesis/algorithm. The secondary aim was to investigate whether there was any association between the outcome of the recent repeated open application test (ROAT) and the patch test reactivity. METHODS One hundred nine subjects with and without contact allergy to fragrance mix II (FM II) were recruited. Volunteers from six European dermatology clinics participated in the study including a patch test and a ROAT. RESULTS Twenty-four positive ROAT reactions were noted in total including 20 of those 32 with contact allergy to FM II. None of the volunteers reacted to the vehicle (P < 0.001). More individuals with a positive algorithm had positive ROATs when compared with those with a negative algorithm. However, the difference was not statistically significant (P = 0.12). The lower the patch test concentration eliciting a positive test reaction, the more likely was a positive ROAT and the more likely that the positive ROAT appeared early during the investigative period. CONCLUSIONS The algorithm used in this study was not validated but it was indicated in this ROAT setup. The stronger the patch test reactivity the more likely was a positive ROAT and the more likely it was that the positive ROAT appeared early during the application period.
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Affiliation(s)
- M Bruze
- Department of Occupational and Environmental Dermatology, Lund University, Skåne University Hospital, Malmö, Sweden
| | - M Engfeldt
- Department of Occupational and Environmental Dermatology, Lund University, Skåne University Hospital, Malmö, Sweden
| | - P Elsner
- Department of Dermatology, University Hospital Jena, Jena, Germany
| | - M Gonçalo
- Department of Dermatology, University Hospital and Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - L Naldi
- Centro Studi GISED - FROM Presidio Ospedaliero Matteo Rota, Bergamo, Italy
| | - M L A Schuttelaar
- Department of Dermatology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - C Svedman
- Department of Occupational and Environmental Dermatology, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Å Svensson
- Department of Dermatology, Lund University, Skåne University Hospital, Malmö, Sweden
| | - R Ofenloch
- Occupational Dermatology, Department of Dermatology, University Hospital Heidelberg, Heidelberg, Germany
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7
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Goodier MC, DeKoven JG, Taylor JS, Sasseville D, Fowler JF, Fransway AF, DeLeo VA, Marks JG, Zug KA, Hylwa SA, Warshaw EM. Inter-rater variability in patch test readings and final interpretation using store-forward teledermatology. Contact Dermatitis 2021; 85:274-284. [PMID: 33837533 DOI: 10.1111/cod.13856] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 03/11/2021] [Accepted: 04/06/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Data regarding teledermatology for patch testing are limited. OBJECTIVES Compare patch test readings and final interpretation by two in-person dermatologists (IPDs) with eight teledermatologists (TDs). METHODS Patch tested patients had photographs taken of 70 screening series of allergens at 48 hours and second readings. Eight TDs reviewed photos and graded reactions (negative, irritant, doubtful, +, ++, +++) at 48 hours and second readings; in addition, they coded a final interpretation (allergic, indeterminant, irritant, negative) for each reaction. TDs rated overall image quality and confidence level for each patient and patch test reaction, respectively. Percentage of TD-IPD agreement based on clinical significance (success, indeterminate, and failure) was calculated. Primary outcome was agreement at the second reading. RESULTS Data were available for 99, 101, and 66 participants at 48 hours, second reading, and final interpretation, respectively. Pooled failure (+/++/+++ vs negative) at second reading was 13.6% (range 7.9%-20.4%). Pooled failure at 48 hours and final interpretation was 5.4% (range 2.9%-6.8%) and 24.6% (range 10.2%-36.8%), respectively. Confidence in readings was statistically correlated with quality of images and disagreement. CONCLUSION For patch testing, teledermatology has significant limitations including clinically significant pooled failure percentages of 13.6% for second readings and 24.6% for final interpretation.
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Affiliation(s)
- Molly C Goodier
- Department of Dermatology, Minneapolis Veterans Affairs Medical Center, Minneapolis, Minnesota, USA.,Department of Dermatology, Health Partners Institute Dermatology, St. Louis Park, Minnesota, USA
| | - Joel G DeKoven
- Department of Dermatology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - James S Taylor
- Department of Dermatology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Denis Sasseville
- Department of Dermatology, Montreal General Hospital, McGill University, Montreal, Québec, Canada
| | - Joseph F Fowler
- Department of Dermatology, University of Louisville, Louisville, Kentucky, USA
| | | | - Vincent A DeLeo
- Department of Dermatology, Keck School of Medicine, Los Angeles, California, USA
| | - James G Marks
- Department of Dermatology, Pennsylvania State University, State College, Pennsylvania, USA
| | - Kathryn A Zug
- Department of Dermatology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Sara A Hylwa
- Department of Dermatology, University of Minnesota, Minneapolis, Minnesota, USA.,Contact Dermatitis Clinic, Park Nicollet, Minneapolis, Minnesota, USA.,Department of Dermatology, Hennepin County Medical Center, Minneapolis, Minnesota, USA
| | - Erin M Warshaw
- Department of Dermatology, Minneapolis Veterans Affairs Medical Center, Minneapolis, Minnesota, USA.,Department of Dermatology, University of Minnesota, Minneapolis, Minnesota, USA.,Contact Dermatitis Clinic, Park Nicollet, Minneapolis, Minnesota, USA
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8
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Rosholm Comstedt L, Dahlin J, Bruze M, Hedberg Y, Matura M, Svedman C. Patch testing with aluminium Finn Chambers could give false-positive reactions in patients with contact allergy to aluminium. Contact Dermatitis 2021; 85:407-414. [PMID: 33896001 DOI: 10.1111/cod.13870] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 04/11/2021] [Accepted: 04/12/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Earlier laboratory studies have shown that sodium tetrachloropalladate, Myroxylon pereirae, caine mix II, and palladium chloride trigger the release of aluminium (Al) from Finn Chambers (FC). OBJECTIVES To investigate whether aluminium realease from FC could influence the diagnostic outcome of patch testing with FC. METHOD A retrospective analysis of patch test results from 2010 to 2019 was performed. A two-sided Fisher's exact test was used to calculate any overrepresentation of contact allergy to Al among patients with positive reactions to sodium tetrachloropalladate, Myroxylon pereirae, caine mix II, and palladium chloride. RESULTS A total of 5446 patients had been tested with FC during the study period. There was a significant overrepresentation of contact allergy to Al among patients with positive reactions to sodium tetrachloropalladate, Myroxylon pereirae, caine mix II, and palladium chloride. Patients with a strong Al allergy had significantly higher amounts of concomitant reactions to sodium tetrachloropalladate, Myroxylon pereirae, caine mix II, and palladium chloride compared to patients with weak Al allergy. These results were not seen for patients tested with Finn Chambers AQUA. CONCLUSION In patients with contact allergy to Al, patch testing with Finn chambers could give false-positive reactions to sodium tetrachloropalladate, Myroxylon pereirae, caine mix II, and palladium chloride.
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Affiliation(s)
- Lisbeth Rosholm Comstedt
- Department of Occupational and Environmental Dermatology, Skåne University Hospital, Lund University, Malmö, Sweden
| | - Jakob Dahlin
- Department of Occupational and Environmental Dermatology, Skåne University Hospital, Lund University, Malmö, Sweden
| | - Magnus Bruze
- Department of Occupational and Environmental Dermatology, Skåne University Hospital, Lund University, Malmö, Sweden
| | - Yolanda Hedberg
- Department of Chemistry, The University of Western Ontario, London, Ontario, Canada
| | - Mihály Matura
- Department of Dermatology, Skaraborg Hospital Skövde, Skövde, Sweden
| | - Cecilia Svedman
- Department of Occupational and Environmental Dermatology, Skåne University Hospital, Lund University, Malmö, Sweden
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9
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Chan WH, Srivastava R, Damaraju N, Do H, Burnett G, MacFarlane J, Xie SM, Chen JK, Honari G, Sarin KY. Automated detection of skin reactions in epicutaneous patch testing using machine learning. Br J Dermatol 2021; 185:456-458. [PMID: 33829497 DOI: 10.1111/bjd.20141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Revised: 04/04/2021] [Accepted: 04/06/2021] [Indexed: 11/29/2022]
Affiliation(s)
- W H Chan
- Dermatology, Stanford University School of Medicine, Stanford, CA, USA.,Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - R Srivastava
- Dermatology, Stanford University School of Medicine, Stanford, CA, USA
| | - N Damaraju
- Biomedical Informatics, Stanford University School of Medicine, Stanford, CA, USA
| | - H Do
- Dermatology, Stanford University School of Medicine, Stanford, CA, USA
| | - G Burnett
- Biomedical Informatics, Stanford University School of Medicine, Stanford, CA, USA
| | - J MacFarlane
- Biomedical Informatics, Stanford University School of Medicine, Stanford, CA, USA
| | - S M Xie
- Computer Science, Stanford University School of Medicine, Stanford, CA, USA
| | - J K Chen
- Dermatology, Stanford University School of Medicine, Stanford, CA, USA
| | - G Honari
- Dermatology, Stanford University School of Medicine, Stanford, CA, USA
| | - K Y Sarin
- Dermatology, Stanford University School of Medicine, Stanford, CA, USA
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10
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Atwater AR, Petty AJ, Liu B, Green CL, Silverberg JI, DeKoven JG, Belsito DV, Reeder MJ, Sasseville D, Taylor JS, Maibach HI, Zirwas MJ, Marks JG, Zug KA, Fowler JF, Pratt MD, DeLeo VA, Warshaw EM. Contact dermatitis associated with preservatives: Retrospective analysis of North American Contact Dermatitis Group data, 1994 through 2016. J Am Acad Dermatol 2021; 84:965-976. [PMID: 33579596 PMCID: PMC8087451 DOI: 10.1016/j.jaad.2020.07.059] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 06/28/2020] [Accepted: 07/05/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Preservatives are often necessary components of commercial products. Large-scale North American studies on preservative allergy are limited. OBJECTIVE To evaluate demographics, positive patch test reactions (PPTRs), clinical relevance, and trends for preservatives tested by the North American Contact Dermatitis Group. METHODS We conducted a retrospective cross-sectional analysis of North American Contact Dermatitis Group patch testing results of preservatives from 1994 through 2016. RESULTS A total of 50,799 patients were tested; 11,338 (22.3%) had a PPTR to at least 1 preservative. The most frequent reactions were to methylisothiazolinone 0.2% aqueous (aq) (12.2%), formaldehyde 2% aq (7.8%), formaldehyde 1% aq (7.8%), quaternium-15 2% petrolatum (pet) (7.7%), and methyldibromo glutaronitrile/phenoxyethanol 2% pet (5.1%). Paraben mix 12% pet (1%), iodopropynyl butylcarbamate 0.1% pet (0.4%), benzyl alcohol 1% pet (0.3%), and phenoxyethanol 1% pet (0.2%) had the lowest PPTRs. Linear regression analysis of preservatives tested showed that only methylchloroisothiazolinone/methylisothiazolinone 0.01% aq (parameter estimate, 0.42; 95% CI, 0.17-0.66; P < .005) had a significant increase in PPTRs over time. LIMITATIONS Collected variables are dependent on clinical judgment. Results may be prone to referral selection bias. CONCLUSIONS This large North American study provides insight on preservative PPTRs and trends from 1994 through 2016.
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Affiliation(s)
- Amber Reck Atwater
- Department of Dermatology, Duke University Medical Center, Durham, North Carolina.
| | - Amy J Petty
- Duke University School of Medicine, Durham, North Carolina
| | - Beiyu Liu
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, North Carolina
| | - Cynthia L Green
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, North Carolina
| | - Jonathan I Silverberg
- Department of Dermatology, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Joel G DeKoven
- Division of Dermatology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Donald V Belsito
- Department of Dermatology, Columbia University Medical Center, New York, New York
| | - Margo J Reeder
- Department of Dermatology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Denis Sasseville
- Division of Dermatology, McGill University Health Centre, Montréal General Hospital, Montréal, Canada
| | - James S Taylor
- Department of Dermatology, Cleveland Clinic, Cleveland, Ohio
| | - Howard I Maibach
- Department of Dermatology, University of California Medical School, San Francisco, California
| | - Matthew J Zirwas
- Probity Medical Research, Dermatologists of the Central States, Columbus, Ohio
| | - James G Marks
- Department of Dermatology, Penn State College of Medicine, Hershey, Pennsylvania
| | - Kathryn A Zug
- Department of Dermatology, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire
| | - Joseph F Fowler
- Division of Dermatology, University of Louisville, Louisville, Kentucky
| | - Melanie D Pratt
- Division of Dermatology, University of Ottawa, The Ottawa Hospital, Ottawa, Canada
| | - Vincent A DeLeo
- Department of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Erin M Warshaw
- Department of Dermatology, Minneapolis Veterans Affairs Medical Center, Minneapolis, Minnesota; Department of Dermatology, University of Minnesota, Minneapolis, Minnesota
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11
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Luu H, Mowitz M, Bruze M, Engfeldt M, Isaksson M, Svedman C. A comparative study between the two patch test systems Finn chambers and Finn chambers AQUA. Contact Dermatitis 2021; 84:290-298. [PMID: 33368411 DOI: 10.1111/cod.13766] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 12/17/2020] [Accepted: 12/20/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Finn Chambers AQUA (FCA) is a development of the Finn Chambers (FC) test system in which the test chambers are mounted on a moisture-resistant adhesive patch. FCA has pre-fixed filter papers. Because the use of FCA does not require any extra taping or use of separate filter papers, a change from FC to FCA chambers may be beneficial for both patients and patch test technicians. OBJECTIVES To investigate whether there are any differences regarding detection of contact allergy when simultaneous patch testing is performed with FC and FCA. MATERIALS AND METHODS Results from 434 dermatitis patients simultaneously tested with 10 allergens in both FC and FCA were evaluated. RESULTS There were no significant differences regarding detection of positive reactions between the two test systems. There were significantly more doubtful reactions to methylisothiazolinone, fragrance mix I and hydroperoxides of linalool when testing with FCA. We only observed significantly more doubtful reactions in FC regarding nickel(II)sulfate. Irritant reactions to formaldehyde were also significantly more common when using FCA. CONCLUSION The FC and FCA had good agreement in detection of positive reactions. However, the results including doubtful and irritant reactions justify further research regarding optimization of the dose.
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Affiliation(s)
- Henrik Luu
- Department of Occupational and Environmental Dermatology, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Martin Mowitz
- Department of Occupational and Environmental Dermatology, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Magnus Bruze
- Department of Occupational and Environmental Dermatology, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Malin Engfeldt
- Department of Occupational and Environmental Medicine, Lund University, Skåne University Hospital, Lund, Sweden
| | - Marléne Isaksson
- Department of Occupational and Environmental Dermatology, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Cecilia Svedman
- Department of Occupational and Environmental Dermatology, Lund University, Skåne University Hospital, Malmö, Sweden
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13
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Isaksson M, Hagvall L, Glas B, Lagrelius M, Lidén C, Matura M, Nyman G, Stenberg B, Svedman C, Bruze M. Suitable test concentration of cobalt and concomitant reactivity to nickel and chromium: A multicentre study from the Swedish Contact Dermatitis Research Group. Contact Dermatitis 2020; 84:153-158. [PMID: 32996589 DOI: 10.1111/cod.13710] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 09/17/2020] [Accepted: 09/27/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND In Sweden, cobalt chloride 0.5% has been included in the baseline series since the mid-1980s. A recent study from Stockholm showed that cobalt chloride 1% petrolatum (pet.) was more suitable than 0.5%. Cobalt chloride at 1.0% has been patch tested for decades in many European countries and around the world. OBJECTIVES To study the suitability of patch testing to cobalt 1.0% vs 0.5% and to analyze the co-occurrence of allergy to cobalt, chromium, and nickel. RESULTS Contact allergy to cobalt was shown in 90 patients (6.6%). Eighty (5.9%) patients tested positive to cobalt 1.0%. Thirty-seven of the 90 patients (41.1%) with cobalt allergy were missed by cobalt 0.5% and 10 (0.7%) were missed by cobalt 1.0% (P < .001). No case of patch test sensitization was reported. Allergy to chromium was seen in 2.6% and allergy to nickel in 13.3%. Solitary allergy to cobalt without nickel allergy was shown in 61.1% of cobalt-positive individuals. Female patients had larger proportions of positive reactions to cobalt (P = .036) and nickel (P < .001) than males. CONCLUSION The results speak in favor of replacing cobalt chloride 0.5% with cobalt chloride 1.0% pet. in the Swedish baseline series, which will be done 2021.
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Affiliation(s)
- Marléne Isaksson
- Lund University, Department of Occupational and Environmental Dermatology, Skåne University Hospital, Malmö, Sweden
| | - Lina Hagvall
- Department of Dermatology and Venereology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Dermatology and Venereology, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
| | - Bo Glas
- Department of Public Health and Clinical Medicine, Dermatology and Venereology, Umeå University, Umeå, Sweden
| | - Maria Lagrelius
- Institute of Environmental Medicine, Karolinska Institutet and Centre for Occupational and Environmental Medicine, Stockholm, Sweden
| | - Carola Lidén
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Mihaly Matura
- Institute of Environmental Medicine, Karolinska Institutet and Centre for Occupational and Environmental Medicine, Stockholm, Sweden.,Department of Dermatology, Skaraborg's Hospital, Skövde, Sweden
| | - Gunnar Nyman
- Department of Dermatology and Venereology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Dermatology and Venereology, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
| | - Berndt Stenberg
- Department of Public Health and Clinical Medicine, Dermatology and Venereology, Umeå University, Umeå, Sweden
| | - Cecilia Svedman
- Lund University, Department of Occupational and Environmental Dermatology, Skåne University Hospital, Malmö, Sweden
| | - Magnus Bruze
- Lund University, Department of Occupational and Environmental Dermatology, Skåne University Hospital, Malmö, Sweden
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Mahler V, Nast A, Bauer A, Becker D, Brasch J, Breuer K, Dickel H, Drexler H, Elsner P, Geier J, John SM, Kreft B, Köllner A, Merk H, Ott H, Pleschka S, Portisch M, Spornraft-Ragaller P, Weisshaar E, Werfel T, Worm M, Schnuch A, Uter W. S3 guidelines: Epicutaneous patch testing with contact allergens and drugs - Short version, Part 1. J Dtsch Dermatol Ges 2020; 17:1076-1093. [PMID: 31631537 DOI: 10.1111/ddg.13956] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Epicutaneous patch testing is the diagnostic standard for the detection of allergic contact dermatitis. The present guidelines are aimed at residents and board-certified physicians in the fields of dermatology and allergology as well as other medical specialties involved in establishing the indication for patch testing and its execution in patients with contact dermatitis and other forms of delayed-type hypersensitivity. The target audience also includes other health care providers and insurance funds. Based on a systematic literature search and a formal consensus process (S3), the guidelines were developed by dermatologists in collaboration with pediatricians, occupational medicine physicians, nursing staff as well as patient representatives. The systematic methodological approach and appraisal of evidence upon which the recommendations are based are outlined in a separate method report that also contains evidence tables. The guidelines address general aspects of patch testing as well as medicolegal issues. The recommendations given relate to topics such as the indication for patch testing, informed patient consent, as well as the choice of test substances, test chambers and test site, duration of exposure, reading times and interpretation of test reactions. Furthermore, recommendations are provided with respect to endogenous and exogenous factors, specific patient groups (children, pregnant women, immunosuppressed individuals) as well as possible risks and adverse events associated with patch testing using contact allergens. Note: This publication is part 1 of the short version of the S3 guidelines for "Epicutaneous patch testing using contact allergens and drugs" (registry no. 013 - 018; date: March 20, 2019; valid until December 31, 2021). Part 2 of the short version will be published in the next issue. The long version of these guidelines can be accessed at www.awmf.org. The method report is available as online publication (https://www.awmf.org/leitlinien/detail/ll/013-018.html) and contains the evidence tables in its appendix.
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Affiliation(s)
- Vera Mahler
- Department of Dermatology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany.,Paul-Ehrlich-Institut, Langen, Germany
| | - Alexander Nast
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt University of Berlin, and Berlin Institute of Health, Department of Dermatology, Venereology und Allergology, Division of Evidence-based Medicine (dEBM), Berlin, Germany
| | - Andrea Bauer
- Department of Dermatology, University Medical Center, Dresden Technical University, Dresden, Germany
| | - Detlef Becker
- Department of Dermatology, University Medical Center, Mainz, Germany
| | - Jochen Brasch
- Department of Dermatology, Venereology und Allergology, University Medical Center, Kiel, Germany
| | - Kristine Breuer
- Dermatology Practice (Dermatologie Reinbek), Reinbek, Germany
| | - Heinrich Dickel
- Department of Dermatology, Venereology und Allergology, St. Josef Hospital, Ruhr University Bochum, Bochum, Germany
| | - Hans Drexler
- Institute for Occupational, Social and Environmental Medicine, Friedrich--Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Peter Elsner
- Department of Dermatology, University Hospital Jena, Jena, Germany
| | - Johannes Geier
- Information Network of Departments of Dermatology (IVDK), Institute at the University Medical Centre Göttingen, Göttingen, Germany
| | - Swen Malte John
- Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm), University of Osnabrück, Osnabrück, Germany
| | - Burkhard Kreft
- Department of Dermatology and Venereology, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | | | - Hans Merk
- Professor of Dermatology and Allergology, Former Chairman of the Department of Dermatology, RWTH University, Aachen, Germany
| | - Hagen Ott
- Division of Pediatric Dermatology and Allergology, Children's Hospital Auf der Bult, Hannover, Germany
| | - Silvia Pleschka
- German Allergy and Asthma Foundation (Deutscher Allergie- und Asthmabund e.V.), Mönchengladbach, Germany
| | - Maria Portisch
- Department of Dermatology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Petra Spornraft-Ragaller
- Department of Dermatology, University Medical Center, Dresden Technical University, Dresden, Germany
| | - Elke Weisshaar
- Division of Occupational Dermatology, Department of Dermatology, University Medical Center, Heidelberg, Germany
| | - Thomas Werfel
- Department of Dermatology and Allergy, , Hannover Medical School, Hannover, Germany
| | - Margitta Worm
- Department of Dermatology, Venereology und Allergology, Charité - UniversityMedicine, Berlin, Germany
| | - Axel Schnuch
- Information Network of Departments of Dermatology (IVDK), Institute at the University Medical Centre Göttingen, Göttingen, Germany
| | - Wolfgang Uter
- Institute for Medical Informatics, Biometrics and Epidemiology (IMBE), Medical Faculty, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
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15
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Hindelang B, Aguirre J, Berezhnoi A, He H, Eyerich K, Ntziachristos V, Biedermann T, Darsow U. Optoacoustic mesoscopy shows potential to increase accuracy of allergy patch testing. Contact Dermatitis 2020; 83:206-214. [DOI: 10.1111/cod.13563] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 04/11/2020] [Accepted: 04/16/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Benedikt Hindelang
- Department of Dermatology and Allergy, Faculty of MedicineTechnical University of Munich Munich Germany
- Chair of Biological Imaging and TranslaTUMTechnical University of Munich Munich Germany
- Institute of Biological and Medical ImagingHelmholtz Zentrum München Munich Germany
| | - Juan Aguirre
- Chair of Biological Imaging and TranslaTUMTechnical University of Munich Munich Germany
- Institute of Biological and Medical ImagingHelmholtz Zentrum München Munich Germany
| | - Andrei Berezhnoi
- Chair of Biological Imaging and TranslaTUMTechnical University of Munich Munich Germany
- Institute of Biological and Medical ImagingHelmholtz Zentrum München Munich Germany
| | - Hailong He
- Chair of Biological Imaging and TranslaTUMTechnical University of Munich Munich Germany
- Institute of Biological and Medical ImagingHelmholtz Zentrum München Munich Germany
| | - Kilian Eyerich
- Department of Dermatology and Allergy, Faculty of MedicineTechnical University of Munich Munich Germany
| | - Vasilis Ntziachristos
- Chair of Biological Imaging and TranslaTUMTechnical University of Munich Munich Germany
- Institute of Biological and Medical ImagingHelmholtz Zentrum München Munich Germany
| | - Tilo Biedermann
- Department of Dermatology and Allergy, Faculty of MedicineTechnical University of Munich Munich Germany
| | - Ulf Darsow
- Department of Dermatology and Allergy, Faculty of MedicineTechnical University of Munich Munich Germany
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16
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Cheraghlou S, Watsky KL, Cohen JM. Utilization, cost, and provider trends in patch testing among Medicare beneficiaries in the United States from 2012 to 2017. J Am Acad Dermatol 2020; 85:1218-1226. [PMID: 32387633 DOI: 10.1016/j.jaad.2020.04.163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Revised: 04/10/2020] [Accepted: 04/17/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Patch testing is the best diagnostic test for allergic contact dermatitis. However, there is presently a lack of data on the test's geographic availability and the characteristics of the providers offering this test across the United States. OBJECTIVE To evaluate the geographic variation in the availability of patch testing for the Medicare population and to characterize the temporal trends of patch testing cost, use, and provider specialty from 2012 to 2017. METHODS Retrospective cohort study of the Medicare Provider Utilization and Payment Data from 2012 to 2017. RESULTS As of 2017, patch testing was available in 20.3% of metropolitan counties and in 1.1% of nonmetropolitan counties. From 2012 to 2017 in metropolitan regions, the number of beneficiaries tested by dermatologists grew by an average annual growth rate of 1.84%, whereas those tested by allergists grew by an average annual growth rate of 20.31%. Most providers that averaged use of 80 or more patches per beneficiary were dermatologists (76.3%). LIMITATIONS Analysis was restricted to Medicare Part B claims; data were unavailable on individuals with commercial insurance. CONCLUSIONS Most of the increase in patch testing utilization from 2012 to 2017 has been in metropolitan regions. Although growth was especially prominent among allergists in metropolitan counties, the majority of providers performing comprehensive patch testing were dermatologists.
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Affiliation(s)
- Shayan Cheraghlou
- Department of Dermatology, Yale School of Medicine, New Haven, Connecticut
| | - Kalman L Watsky
- Department of Dermatology, Yale School of Medicine, New Haven, Connecticut
| | - Jeffrey M Cohen
- Department of Dermatology, Yale School of Medicine, New Haven, Connecticut.
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17
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Veverka KK, Davis MDP. Dubiously Doubtful: An Exploration of the Literature Concerning Doubtful, Macular Erythema, “?+,” and “+/−” Patch Test Reactions. Dermatitis 2020; 31:36-41. [DOI: 10.1097/der.0000000000000533] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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18
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Mahler V, Nast A, Bauer A, Becker D, Brasch J, Breuer K, Dickel H, Drexler H, Elsner P, Geier J, John SM, Kreft B, Köllner A, Merk H, Ott H, Pleschka S, Portisch M, Spornraft‐Ragaller P, Weisshaar E, Werfel T, Worm M, Schnuch A, Uter W. S3‐Leitlinie: Durchführung des Epikutantests mit Kontaktallergenen und Arzneimitteln – Kurzfassung Teil 1. J Dtsch Dermatol Ges 2019; 17:1075-1093. [DOI: 10.1111/ddg.13956_g] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Affiliation(s)
- Vera Mahler
- Hautklinik Universitätsklinikum ErlangenFriedrich‐Alexander‐Universität Erlangen‐Nürnberg Erlangen
- Paul‐Ehrlich‐Institut Langen
| | - Alexander Nast
- Division of Evidence‐Based Medicine (dEBM)Klinik für DermatologieVenerologie und AllergologieCharité – Universitätsmedizin Berlin Berlin
| | - Andrea Bauer
- Klinik und Poliklinik für Dermatologie Universitätsklinikum Carl Gustav CarusTechnische Universität Dresden Dresden
| | | | - Jochen Brasch
- Klinik für DermatologieVenerologie und AllergologieUniversitätsklinikum Schleswig‐Holstein Kiel
| | | | - Heinrich Dickel
- Klinik für DermatologieVenerologie und AllergologieSt. Josef‐Hospital Ruhr‐Universität Bochum Bochum
| | - Hans Drexler
- Institut für Arbeits‐, Sozial‐ und Umweltmedizin der Friedrich‐Alexander‐Universität Erlangen‐Nürnberg Erlangen
| | - Peter Elsner
- Klinik für HautkrankheitenUniversitätsklinikum Jena Jena
| | - Johannes Geier
- Informationsverbund Dermatologischer Kliniken (IVDK) e.V. an der Universitätsmedizin Göttingen Göttingen
| | - Swen Malte John
- Institut für interdisziplinäre Dermatologische Prävention und Rehabilitation (iDerm) an der Universität Osnabrück Osnabrück
| | - Burkhard Kreft
- Klinik und Poliklinik für Dermatologie und VenerologieUniversitätsklinikum Halle (Saale) Halle
| | | | - Hans Merk
- Univ.‐Professor für Dermatologie & AllergologieDirektor (em.) der Hautklinik – RWTH Aachen University Aachen
| | - Hagen Ott
- Hannoversche Kinderheilanstalt (HKA): Kinder‐ und Jugendkrankenhaus auf der Bult Hannover
| | | | - Maria Portisch
- Hautklinik Universitätsklinikum ErlangenFriedrich‐Alexander‐Universität Erlangen‐Nürnberg Erlangen
| | - Petra Spornraft‐Ragaller
- Klinik und Poliklinik für Dermatologie Universitätsklinikum Carl Gustav CarusTechnische Universität Dresden Dresden
| | - Elke Weisshaar
- Berufsdermatologie, Hautklinik, Universitätsklinikum Heidelberg Heidelberg
| | - Thomas Werfel
- Klinik für Dermatologie, Allergologie und VenerologieMedizinische Hochschule Hannover Hannover
| | - Margitta Worm
- Klinik für Dermatologie, Venerologie und Allergologie Charité ‐ Universitätsmedizin Berlin Berlin
| | - Axel Schnuch
- Informationsverbund Dermatologischer Kliniken (IVDK) e.V. an der Universitätsmedizin Göttingen Göttingen
| | - Wolfgang Uter
- Institut für Medizininformatik, Biometrie und Epidemiologie (IMBE)Medizinische Fakultät der Friedrich‐Alexander‐Universität Erlangen‐Nürnberg Erlangen
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19
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Bruze M, Engfeldt M, Ofenloch R, Elsner P, Goncalo M, Isaksson M, Naldi L, Schuttelaar M, Svensson Å, Diepgen T. Validation of a questionnaire algorithm based on repeated open application testing with the constituents of fragrance mix I. Br J Dermatol 2019; 182:955-964. [DOI: 10.1111/bjd.18224] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/10/2019] [Indexed: 01/10/2023]
Affiliation(s)
- M. Bruze
- Department of Occupational and Environmental Dermatology Lund University Skåne University Hospital Malmö Sweden
| | - M. Engfeldt
- Department of Occupational and Environmental Dermatology Lund University Skåne University Hospital Malmö Sweden
| | - R. Ofenloch
- Department of Clinical Social Medicine University Hospital Heidelberg Heidelberg Germany
| | - P. Elsner
- Department of Dermatology University Hospital Jena Jena Germany
| | - M. Goncalo
- Department of Dermatology University Hospital and Faculty of Medicine University of Coimbra Coimbra Portugal
| | - M. Isaksson
- Department of Occupational and Environmental Dermatology Lund University Skåne University Hospital Malmö Sweden
| | - L. Naldi
- Centro Studi GISED – FROM Presidio Ospedaliero Matteo Rota Bergamo Italy
| | - M.‐L. Schuttelaar
- Department of Dermatology University of Groningen University Medical Center Groningen Groningen the Netherlands
| | - Å. Svensson
- Department of Dermatology Lund University Skåne University Hospital Malmö Sweden
| | - T. Diepgen
- Department of Clinical Social Medicine University Hospital Heidelberg Heidelberg Germany
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20
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Zondervan RL, Vaux JJ, Blackmer MJ, Brazier BG, Taunt CJ. Improved outcomes in patients with positive metal sensitivity following revision total knee arthroplasty. J Orthop Surg Res 2019; 14:182. [PMID: 31208448 PMCID: PMC6580588 DOI: 10.1186/s13018-019-1228-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 06/05/2019] [Indexed: 02/06/2023] Open
Abstract
Background Metal sensitivity as a cause for painful joint replacement has become increasingly prevalent; however, there is a lack of reported clinical outcome data from total knee arthroplasty patients with metal allergies. The purpose of this study was to determine whether patients presenting with a painful total knee arthroplasty with a positive metal sensitivity have improved outcomes following revision to a hypoallergenic implant. Methods A retrospective review was conducted for patients that underwent a revision total knee arthroplasty after metal sensitivity testing over a 3-year period from January 1, 2015, to December 31, 2017. Based on the results of sensitivity testing, patients underwent revision total knee arthroplasty to a hypoallergenic component or a standard component. Following revision, patients returned to the clinic at an interval of 6 weeks, 5 months, and 12 months for functional, pain, and satisfaction assessment. Outcomes were compared within and between sensitivity groups. Results Of the included patients, 78.3% (39/46) were positive for metal sensitivity. The most common metal sensitivity was to nickel (79.5%, 32/39). Both non-reactive and reactive patients significantly improved in range of motion after revision arthroplasty. The reactive group saw a 37.8% decrease in pain at 6 weeks post-revision (p < 0.001) Whereas, the non-reactive group only saw a moderate, non-significant improvement in pain reduction at 6 weeks post-revision (27.0%; p = 0.29). Frequency of pain experienced did not vary significantly between groups. Maximum metal lymphocyte transformation test (LTT) sensitivity score did not correlate with pain level at the time of revision (R2 = 0.02, p = 0.38) or percent improvement after revision (R2 = 0.001, p = 0.81). Overall, all patients reported being very satisfied after revision total knee arthroplasty; there was no difference between positive and negative sensitivity groups (W = 62, p = 0.89). Conclusions Patients presenting with a painful knee arthroplasty and positive metal LTT have improved pain scores, walking function, and range of motion following revision to a hypoallergenic component. This study also provides a treatment algorithm for patients presenting with a painful knee replacement, in order to provide effective and timely diagnosis and management. Electronic supplementary material The online version of this article (10.1186/s13018-019-1228-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Robert L Zondervan
- Michigan State University College of Osteopathic Medicine, 965 Wilson Rd, East Lansing, MI, 48824, USA.
| | - Jonathan J Vaux
- McLaren Orthopedic Hospital, 2727 S Pennsylvania Ave, Lansing, MI, 48910, USA
| | - Michael J Blackmer
- McLaren Orthopedic Hospital, 2727 S Pennsylvania Ave, Lansing, MI, 48910, USA
| | - Brett G Brazier
- Michigan State University College of Osteopathic Medicine, 965 Wilson Rd, East Lansing, MI, 48824, USA
| | - Charles J Taunt
- McLaren Orthopedic Hospital, 2727 S Pennsylvania Ave, Lansing, MI, 48910, USA
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21
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Balato A, Raimondo A, Arenberger P, Bruze M, Czarnecka-Operacz M, Johanssen JD, Gonçalo M, Ranki A, Uter W, Wilkinson M, Ayala F, John SM, Giménez-Arnau A, Gollnick H. The role of the dermatologist in the immune-mediated/allergic diseases - position statement of the EADV task force on contact dermatitis, EADV task force on occupational skin diseases, UEMS-EBDV subcommission allergology and European Dermatology Forum. J Eur Acad Dermatol Venereol 2019; 33:1459-1464. [PMID: 31062452 DOI: 10.1111/jdv.15610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 02/28/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND The members of the Task Force on Contact Dermatitis and the Task Force on Occupational Dermatoses of the European Academy of Dermatology and Venereology (EADV), of the European Dermatology Forum (EDF), and the members of the UEMS Section of Dermatology-Venereology (UEMS-EBDV) we want to vindicate the fundamental role that the specialist in Dermatology has in the diagnosis and management of Immuno-mediated /allergic Diseases. OBJECTIVE In disagreement with the blueprint paper of the UEMS section of Allergology (2013), in which dermatologists are excluded from one of their core activities it was decided to write this consensus paper. DISCUSSION The skin occupies a crucial place in the broad spectrum of allergic diseases; there is no other organ with such a multitude of different clinical conditions mediated by so many pathogenetic immune mechanisms. Subsequently, dermatologists play a fundamental role in the management of immune-mediated diseases including among others contact dermatitis, atopic dermatitis, urticaria and angioedema or cutaneous adverse drug, food and arthropod reactions. The essential role of dermatology in the diagnostic, therapeutic and preventive management of immune mediated /allergic diseases which is crucial for patient management is justified from both the academic and professional point of view. CONCLUSION Based on the best care of the patient with cutaneous immune allergic disease a multidisciplinary approach is desirable and the dermatologist has a pivotal role in patient management. Be so good and no one will not ignore you, dermatologist. Ideally Dermatology should be governed according the following Henry Ford statement: "Arriving together is the beginning; keeping together is progress; working together is success."
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Affiliation(s)
- A Balato
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - A Raimondo
- Department of Medicine, Surgery and Dentistry, 'Scuola Medica Salernitana', University of Salerno, Salerno, Italy
| | - P Arenberger
- Department of Dermatology, Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - M Bruze
- Department of Occupational and Environmental Dermatology, Skåne University Hospital, Lund University, Malmö, Sweden
| | - M Czarnecka-Operacz
- Department of Dermatology, Poznan University of Medical Sciences, Poznan, Poland
| | - J D Johanssen
- Department of Dermatology and Allergy, National Allergy Research Centre, Herlev-Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - M Gonçalo
- Department of Dermatology, University Hospital and Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - A Ranki
- Department of Dermatology, Allergology and Venereology, University of Helsinki and Skin and Allergy Hospital, Helsinki University Central Hospital, Helsinki, Finland
| | - W Uter
- Department of Medical Informatics, Biometry and Epidemiology, University of Erlangen-Nürnberg, Erlangen, Germany
| | - M Wilkinson
- Dermatology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - F Ayala
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - S M John
- Department of Dermatology, Environmental Medicine, University of Osnabrueck, Osnabrueck, Germany
| | - A Giménez-Arnau
- Department of Dermatology, Hospital del Mar. Universitat Autònoma de Barcelona, Barcelona, Spain
| | - H Gollnick
- Department of Dermatology and Venereology, Otto-von-Guericke Universität, Magdeburg, Germany
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22
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Stingeni L, Bianchi L, Hansel K, Corazza M, Gallo R, Guarneri F, Patruno C, Rigano L, Romita P, Pigatto PD, Calzavara-Pinton P. Italian Guidelines in Patch Testing - adapted from the European Society of Contact Dermatitis (ESCD). GIORN ITAL DERMAT V 2019; 154:227-253. [DOI: 10.23736/s0392-0488.19.06301-6] [Citation(s) in RCA: 72] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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23
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Corrêa-Fissmer M, Dalazen CC, Ferreira BP, Iser BPM. Assessment of patch test results carried out during ten years in a city in southern Brazil. An Bras Dermatol 2019; 93:807-812. [PMID: 30484523 PMCID: PMC6256204 DOI: 10.1590/abd1806-4841.20185023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Accepted: 08/24/2017] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Contact dermatitis affects up to 20% of the population. Patch testing for contact allergy may be needed to confirm the diagnosis. OBJECTIVES To describe and discuss the results of patch tests performed in a city in southern Brazil. METHODS A cross-sectional analysis was performed on all skin test results over ten years. Variables such as gender, age at the time of testing, and test results were evaluated. Triggering factors, duration of complain, and previous medications used related to the clinical history were retrieved for some patients by reviewing their medical records. RESULTS The sample was composed of 539 patch tests, of which 411 (76.2%) were from women. The age of the tested subjects ranged from 5 to 87 years. The prevalence of positive reactions in the patch tests was 391 (72.5%). The most prevalent positive reaction was to nickel sulfate (196; 36.4%), which had statistical significance when associated with female gender (p<0,001). STUDY LIMITATIONS Database obtained through secondary sources (the reports of the exams and the medical records), occurring the incomplete registration of some information. CONCLUSIONS Data analysis at the local level is important to define preventive policies.
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Affiliation(s)
- Mariane Corrêa-Fissmer
- Outpatient Clinic of Medical Specialties, Universidade do Sul de
Santa Catarina, Tubarão (SC), Brazil
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24
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Patch Testing: Technical Details and Interpretation. Contact Dermatitis 2019. [DOI: 10.1007/978-3-319-72451-5_62-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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25
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Schuttelaar MLA, Ofenloch RF, Bruze M, Cazzaniga S, Elsner P, Gonçalo M, Naldi L, Svensson Å, Diepgen TL. Prevalence of contact allergy to metals in the European general population with a focus on nickel and piercings: The EDEN Fragrance Study. Contact Dermatitis 2018; 79:1-9. [PMID: 29635802 PMCID: PMC6001707 DOI: 10.1111/cod.12983] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 01/26/2018] [Indexed: 01/01/2023]
Abstract
Background Studies on sensitization to metals in the general population are scarce. Objectives To determine the prevalence of sensitization to metals in the general population, and factors associated with nickel sensitization. Methods In 5 European countries (The Netherlands, Germany, Italy, Portugal and Sweden), a random sample (N = 3119) from the general population (aged 18‐74 years) was patch tested and interviewed by use of a questionnaire on exposure to metals, piercing, and jewellery. Results Overall, the age‐standardized prevalences of sensitization to nickel, cobalt and chromium were, respectively, 14.5%, 2.1%, and 0.8%. The highest prevalence of nickel sensitization was seen in Portugal (18.5%) and the lowest (8.3%) in Sweden. The prevalence of cobalt sensitization varied between 3.8% (The Netherlands) and 0.9% (Italy), and the prevalence of chromium sensitization varied between 1.3% (Portugal) and 0.2% (Sweden). Significant associations were observed between nickel allergy and female sex (odds ratio [OR] 5.19; 95% confidence interval [95%CI]: 3.99‐6.74), past piercing use (OR 3.86; 95%CI: 2.85‐5.24), and currently having ≥3 piercings (OR 5.58; 95%CI: 4.02‐7.76). Conclusions The prevalence of sensitization to metals in the European general population was high, mostly because of nickel. The lowest prevalence of contact allergy to nickel and chromium observed in Sweden supports the effectiveness of long‐standing regulation.
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Affiliation(s)
- Marie L A Schuttelaar
- Department of Dermatology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Robert F Ofenloch
- Department of Social Medicine, Occupational and Environmental Dermatology, University Heidelberg, Heidelberg, Germany
| | - Magnus Bruze
- Department of Occupational and Environmental Dermatology, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Simone Cazzaniga
- Centro Studi GISED, Bergamo, Italy.,Dermatology Department, Inselspital University Hospital, Bern, Switzerland
| | - Peter Elsner
- Department of Dermatology, University Hospital Jena, Jena, Germany
| | - Margarida Gonçalo
- Department of Dermatology, Faculty of Medicine, Coimbra University Hospital, University of Coimbra, Coimbra, Portugal
| | - Luigi Naldi
- Centro Studi GISED, Bergamo, Italy.,Department of Dermatology, AULSS8 Berica, Ospedale San Bortolo, Vicenza, Italy
| | - Åke Svensson
- Department of Dermatology, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Thomas L Diepgen
- Department of Social Medicine, Occupational and Environmental Dermatology, University Heidelberg, Heidelberg, Germany
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26
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Aerts O, Naessens T, Dandelooy J, Leysen J, Lambert J, Apers S. Allergic contact dermatitis caused by wet wipes containing steareth-10: Is stearyl alcohol to blame? Contact Dermatitis 2017; 77:117-119. [DOI: 10.1111/cod.12776] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Revised: 01/10/2017] [Accepted: 01/13/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Olivier Aerts
- Contact Allergy Unit, Department of Dermatology; University Hospital Antwerp (UZA) and University of Antwerp (UA); 2650 Edegem Antwerp, Belgium
| | - Tania Naessens
- Department of Pharmaceutical Sciences, Research group Natural Products and Food - Research and Analysis (NatuRA); University of Antwerp (UA); 2610 Wilrijk Antwerp, Belgium
| | - Julie Dandelooy
- Contact Allergy Unit, Department of Dermatology; University Hospital Antwerp (UZA) and University of Antwerp (UA); 2650 Edegem Antwerp, Belgium
| | - Julie Leysen
- Contact Allergy Unit, Department of Dermatology; University Hospital Antwerp (UZA) and University of Antwerp (UA); 2650 Edegem Antwerp, Belgium
| | - Julien Lambert
- Contact Allergy Unit, Department of Dermatology; University Hospital Antwerp (UZA) and University of Antwerp (UA); 2650 Edegem Antwerp, Belgium
| | - Sandra Apers
- Department of Pharmaceutical Sciences, Research group Natural Products and Food - Research and Analysis (NatuRA); University of Antwerp (UA); 2610 Wilrijk Antwerp, Belgium
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27
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Johnston G, Exton L, Mohd Mustapa M, Slack J, Coulson I, English J, Bourke J, McHenry P, Gibbon K, Buckley D, Leslie T, Mallon E, Wakelin S, Ungureanu S, Hunasehally R, Cork M, Natkunarajah J, Worsnop F, Chiang N, Donnelly J, Saunders C, Brain A, Exton LS. British Association of Dermatologists’ guidelines for the management of contact dermatitis 2017. Br J Dermatol 2017; 176:317-329. [DOI: 10.1111/bjd.15239] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/19/2016] [Indexed: 12/18/2022]
Affiliation(s)
- G.A. Johnston
- Department of Dermatology University Hospitals of Leicester NHS Trust Infirmary Square Leicester LE1 5WW U.K
| | - L.S. Exton
- British Association of Dermatologists Willan House, 4 Fitzroy Square London W1T 5HQ U.K
| | - M.F. Mohd Mustapa
- British Association of Dermatologists Willan House, 4 Fitzroy Square London W1T 5HQ U.K
| | - J.A. Slack
- Department of Dermatology University Hospitals of Leicester NHS Trust Infirmary Square Leicester LE1 5WW U.K
| | - I.H. Coulson
- Department of Dermatology Burnley General Hospital Casterton Avenue Burnley BB10 2PQ U.K
| | | | - J.F. Bourke
- Department of Dermatology South Infirmary Victoria University Hospital Old Blackrock Road Cork City Ireland
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Lubbes S, Rustemeyer T, Sillevis Smitt JH, Schuttelaar ML, Middelkamp-Hup MA. Contact sensitization in Dutch children and adolescents with and without atopic dermatitis - a retrospective analysis. Contact Dermatitis 2016; 76:151-159. [DOI: 10.1111/cod.12711] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Revised: 09/10/2016] [Accepted: 09/20/2016] [Indexed: 02/06/2023]
Affiliation(s)
- Stefanie Lubbes
- Department of Dermatology; Academic Medical Centre, University of Amsterdam; 1100 DD Amsterdam The Netherlands
| | - Thomas Rustemeyer
- Department of Dermatology; VU University Medical Centre; 1081 HV Amsterdam The Netherlands
| | - Johannes H. Sillevis Smitt
- Department of Dermatology; Academic Medical Centre, University of Amsterdam; 1100 DD Amsterdam The Netherlands
| | - Marie Louise Schuttelaar
- Department of Dermatology; University Medical Centre Groningen; 9700 RB Groningen The Netherlands
| | - Maritza A. Middelkamp-Hup
- Department of Dermatology; Academic Medical Centre, University of Amsterdam; 1100 DD Amsterdam The Netherlands
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29
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Björk AK, Bruze M, Engfeldt M, Nielsen C, Svedman C. The reactivity of the back revisited. Are there differences in reactivity in different parts of the back? Contact Dermatitis 2016; 76:19-26. [PMID: 27593358 DOI: 10.1111/cod.12657] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Revised: 06/15/2016] [Accepted: 06/15/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND In the contact dermatitis literature, it is regularly stated that the patch test reactivity on various areas of the back differs, which might have a large impact on the reproducibility of patch testing. OBJECTIVES To investigate the reproducibility of patch testing on the upper back with regard to the left as opposed to the right side, and the medial as opposed to the lateral part of the upper back. The reproducibility over time and with regard to the reactivity pattern was also investigated. METHODS Thirty-one subjects with contact allergy to the metals gold (n = 19) or nickel (n = 12) were patch tested with serial dilutions, in triplicate applications, on different locations on the upper back. The Friedman test was used for statistical calculations. RESULTS No significant differences in the reactivity of the back were found. In all gold-allergic patients and 11 of 12 nickel-allergic patients, the allergy could be reproduced with regard to previous patch testing, but the degree of reactivity differed. CONCLUSIONS When a high level of standardization of the patch test technique with the same test system was used, there were no differences in patch test reactions and sites of application on the upper back.
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Affiliation(s)
- Ann-Kristin Björk
- Department of Occupational and Environmental Dermatology, Skåne University Hospital, Lund University, 205 02, Malmö, Sweden
| | - Magnus Bruze
- Department of Occupational and Environmental Dermatology, Skåne University Hospital, Lund University, 205 02, Malmö, Sweden
| | - Malin Engfeldt
- Department of Occupational and Environmental Dermatology, Skåne University Hospital, Lund University, 205 02, Malmö, Sweden
| | - Christel Nielsen
- R&D Centre Skåne, Skåne University Hospital, 22185, Lund, Sweden
| | - Cecilia Svedman
- Department of Occupational and Environmental Dermatology, Skåne University Hospital, Lund University, 205 02, Malmö, Sweden
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30
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Belloni Fortina A, Fontana E, Peserico A. Contact Sensitization in Children: A Retrospective Study of 2,614 Children from a Single Center. Pediatr Dermatol 2016; 33:399-404. [PMID: 27241536 DOI: 10.1111/pde.12873] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Contact sensitization in children is more common than previously thought, but few studies have been performed on a large population assessed by the same team. The objective was to evaluate contact sensitization in children with suspected contact dermatitis, the relationship with atopic dermatitis (AD), and the most common allergens. METHODS The same team patch tested 2,614 children younger than 11 years old with a standard series of 30 allergens. RESULTS A total of 1220 children (46.7%) developed at least one positive reaction, 606 of which were clinically relevant (49.7%). The most frequent reactions were to nickel sulfate (22.7%), cobalt chloride (11.1%), potassium dichromate (9.9%), neomycin sulfate (5.2%), thimerosal (4.2%), cocamidopropyl betaine (3.4%), and methylchloroisothiazolinone/methylisothiazolinone (3.2%). The prevalence of contact sensitization was similar in children with (47.3%) and without (46.1%) AD. Children with AD had a higher prevalence of positive reactions to potassium dichromate (p < 0.001), Compositae mix (p = 0.01), and disperse blue (p = 0.03). CONCLUSIONS Contact sensitization is quite common in young children. This study adds some information on the most common contact allergens. A similar prevalence of positive patch test reactions was found in children with and without AD, but children with AD had a greater prevalence of positive patch test reactions to potassium dichromate, Compositae mix, and disperse blue.
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Affiliation(s)
- Anna Belloni Fortina
- Pediatric Dermatology Unit, Department of Medicine, University of Padova, Padova, Italy
| | - Elena Fontana
- Pediatric Dermatology Unit, Department of Medicine, University of Padova, Padova, Italy
| | - Andrea Peserico
- Dermatology Unit, Department of Medicine, University of Padova, Padova, Italy
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31
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Uter W, Gefeller O, Mahler V. Does a short patch test training course have an impact? Contact Dermatitis 2016; 74:317-9. [DOI: 10.1111/cod.12521] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Revised: 11/17/2015] [Accepted: 11/21/2015] [Indexed: 11/26/2022]
Affiliation(s)
- Wolfgang Uter
- Department of Medical Informatics, Biometry and Epidemiology; Friedrich-Alexander-University Erlangen/Nürnberg; 91054 Erlangen Germany
| | - Olaf Gefeller
- Department of Medical Informatics, Biometry and Epidemiology; Friedrich-Alexander-University Erlangen/Nürnberg; 91054 Erlangen Germany
| | - Vera Mahler
- Allergy Unit, Department of Dermatology; University Hospital Erlangen; 91054 Erlangen Germany
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Tanno LK, Darlenski R, Sánchez-Garcia S, Bonini M, Vereda A, Kolkhir P, Antolin-Amerigo D, Dimov V, Gallego-Corella C, Becerra JCA, Diaz A, Linares VB, Villa L, Rosenwasser LJ, Sanchez-Borges M, Ansotegui I, Pawankar R, Bieber T. International survey on skin patch test procedures, attitudes and interpretation. World Allergy Organ J 2016; 9:8. [PMID: 26962386 PMCID: PMC4778281 DOI: 10.1186/s40413-016-0098-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Accepted: 01/27/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Skin patch test is the gold standard method in diagnosing contact allergy. Although used for more than 100 years, the patch test procedure is performed with variability around the world. A number of factors can influence the test results, namely the quality of reagents used, the timing of the application, the patch test series (allergens/haptens) that have been used for testing, the appropriate interpretation of the skin reactions or the evaluation of the patient's benefit. METHODS We performed an Internet -based survey with 38 questions covering the educational background of respondents, patch test methods and interpretation. The questionnaire was distributed among all representatives of national member societies of the World Allergy Organization (WAO), and the WAO Junior Members Group. RESULTS One hundred sixty-nine completed surveys were received from 47 countries. The majority of participants had more than 5 years of clinical practice (61 %) and routinely carried out patch tests (70 %). Both allergists and dermatologists were responsible for carrying out the patch tests. We could observe the use of many different guidelines regardless the geographical distribution. The use of home-made preparations was indicated by 47 % of participants and 73 % of the respondents performed 2 or 3 readings. Most of the responders indicated having patients with adverse reactions, including erythroderma (12 %); however, only 30 % of members completed a consent form before conducting the patch test. DISCUSSION The heterogeneity of patch test practices may be influenced by the level of awareness of clinical guidelines, different training backgrounds, accessibility to various types of devices, the patch test series (allergens/haptens) used for testing, type of clinical practice (public or private practice, clinical or research-based institution), infrastructure availability, financial/commercial implications and regulations among others. CONCLUSION There is a lack of a worldwide homogeneity of patch test procedures, and this raises concerns about the need for standardization and harmonization of this important diagnostic procedure.
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Affiliation(s)
- Luciana K. Tanno
- />Hospital Sírio Libanês and Post-graduation Program in Health Sciences of IAMSPE, Rua Prof Arthur Ramos, 183, cj 21 01454-011, São Paulo, SP Brazil
| | - Razvigor Darlenski
- />Department of Dermatolgy and Venereology, Tokuda Hospital Sofia, Sofia, Bulgaria
| | | | - Matteo Bonini
- />Department of Public Health and Infectious Diseases, “Sapienza” University of Rome, Rome, Italy
| | | | - Pavel Kolkhir
- />Department of Dermatology and Venereology, Sechenov First Moscow State Medical University, Moscow, Russia
| | - Dario Antolin-Amerigo
- />Immune System Diseases and Oncology Service-Allergy Unit. Hospital Universitario Príncipe de Asturias, Medicine and Medical Specialities Department, Universidad de Alcalá. Alcalá de Henares, Madrid, Spain
| | - Vesselin Dimov
- />Department of Allergy and Immunology, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd Weston, Florida, FL 33331 USA
| | | | | | - Alexander Diaz
- />Department of Allergy, Medical Center, Guira de Melena, Havana, Cuba
| | | | - Leonor Villa
- />Sanatorio Privado San Roque, Marcos Juárez, Córdoba Argentina
| | - Lanny J. Rosenwasser
- />Department of Pediatrics, Division of Immunology Research, Children’s Mercy Hospitals & Clinics, Kansas City, MO 64108 USA
| | - Mario Sanchez-Borges
- />Allergy and Clinical Immunology Department, Centro Medico Docente La Trinidad, Caracas, Venezuela
| | - Ignacio Ansotegui
- />Department of Allergy and Immunology, Hospital Quirón Bizkaia, Bizkaia, Spain
| | - Ruby Pawankar
- />Division of Allergy, Department of Pediatrics, Nippon Medical School, Tokyo, Japan
| | - Thomas Bieber
- />Department of Dermatology and Allergy, Rheinische Friedrich-Wilhelms-University Bonn, Bonn, Germany
| | - on behalf of the WAO Junior Members Group
- />Hospital Sírio Libanês and Post-graduation Program in Health Sciences of IAMSPE, Rua Prof Arthur Ramos, 183, cj 21 01454-011, São Paulo, SP Brazil
- />Department of Dermatolgy and Venereology, Tokuda Hospital Sofia, Sofia, Bulgaria
- />Allergy Department. Hospital Infantil Universitario Niño Jesús, Madrid, Spain
- />Department of Public Health and Infectious Diseases, “Sapienza” University of Rome, Rome, Italy
- />Allergy Clinic, Paris, 75015 France
- />Department of Dermatology and Venereology, Sechenov First Moscow State Medical University, Moscow, Russia
- />Immune System Diseases and Oncology Service-Allergy Unit. Hospital Universitario Príncipe de Asturias, Medicine and Medical Specialities Department, Universidad de Alcalá. Alcalá de Henares, Madrid, Spain
- />Department of Allergy and Immunology, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd Weston, Florida, FL 33331 USA
- />Medicine Faculty, Xochicalco University, Tijuana, Mexico
- />Allergy and Immunology Division, Hospital Nacional Edgardo Rebagliati Martins, Lima, Peru
- />Department of Allergy, Medical Center, Guira de Melena, Havana, Cuba
- />Intercenter Allergy Unit, Virgen Macarena University Hospital, Seville, Spain
- />Sanatorio Privado San Roque, Marcos Juárez, Córdoba Argentina
- />Department of Pediatrics, Division of Immunology Research, Children’s Mercy Hospitals & Clinics, Kansas City, MO 64108 USA
- />Allergy and Clinical Immunology Department, Centro Medico Docente La Trinidad, Caracas, Venezuela
- />Department of Allergy and Immunology, Hospital Quirón Bizkaia, Bizkaia, Spain
- />Division of Allergy, Department of Pediatrics, Nippon Medical School, Tokyo, Japan
- />Department of Dermatology and Allergy, Rheinische Friedrich-Wilhelms-University Bonn, Bonn, Germany
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33
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Bruze M. Thoughts on how to improve the quality of multicentre patch test studies. Contact Dermatitis 2016; 74:168-74. [DOI: 10.1111/cod.12507] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Accepted: 10/21/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Magnus Bruze
- Department of Occupational and Environmental Dermatology; Skåne University Hospital, Lund University; S-205 02 Malmö Sweden
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34
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Johansen JD, Aalto-Korte K, Agner T, Andersen KE, Bircher A, Bruze M, Cannavó A, Giménez-Arnau A, Gonçalo M, Goossens A, John SM, Lidén C, Lindberg M, Mahler V, Matura M, Rustemeyer T, Serup J, Spiewak R, Thyssen JP, Vigan M, White IR, Wilkinson M, Uter W. European Society of Contact Dermatitis guideline for diagnostic patch testing - recommendations on best practice. Contact Dermatitis 2015; 73:195-221. [PMID: 26179009 DOI: 10.1111/cod.12432] [Citation(s) in RCA: 928] [Impact Index Per Article: 103.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Revised: 04/29/2015] [Accepted: 05/06/2015] [Indexed: 11/27/2022]
Abstract
The present guideline summarizes all aspects of patch testing for the diagnosis of contact allergy in patients suspected of suffering, or having been suffering, from allergic contact dermatitis or other delayed-type hypersensitivity skin and mucosal conditions. Sections with brief descriptions and discussions of different pertinent topics are followed by a highlighted short practical recommendation. Topics comprise, after an introduction with important definitions, materials, technique, modifications of epicutaneous testing, individual factors influencing the patch test outcome or necessitating special considerations, children, patients with occupational contact dermatitis and drug eruptions as special groups, patch testing of materials brought in by the patient, adverse effects of patch testing, and the final evaluation and patient counselling based on this judgement. Finally, short reference is made to aspects of (continuing) medical education and to electronic collection of data for epidemiological surveillance.
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Affiliation(s)
- Jeanne D Johansen
- Department of Dermato-Allergology, National Allergy Research Centre, Gentofte Hospital, University of Copenhagen, 2900 Hellerup, Denmark
| | - Kristiina Aalto-Korte
- Occupational Medicine, Finnish Institute of Occupational Health, 00250 Helsinki, Finland
| | - Tove Agner
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, 2400 Copenhagen, Denmark
| | - Klaus E Andersen
- Department of Dermatology and Allergy Centre, Odense University Hospital, University of Southern Denmark, 5000 Odense, Denmark
| | - Andreas Bircher
- Allergy Unit, Department of Dermatology, University Hospital and University of Basel, 4031 Basel, Switzerland
| | - Magnus Bruze
- Department of Occupational and Environmental Dermatology, Skåne University Hospital, Lund University, SE-20502 Malmö, Sweden
| | - Alicia Cannavó
- Hospital Municipal de Vicente López 'Profesor Bernard Houssay', Buenos Aires, Argentina
| | - Ana Giménez-Arnau
- Department of Dermatology, Hospital del Mar, Universitat Autónoma de Barcelona, 08003 Barcelona, Spain
| | - Margarida Gonçalo
- Department of Dermatology, University Hospital and Faculty of Medicine, University of Coimbra, 3000-075 Coimbra, Portugal
| | - An Goossens
- Contact Allergy Unit, Department of Dermatology, University Hospital K. U. Leuven, B-3000 Leuven, Belgium
| | - Swen M John
- Department of Dermatology, Environmental Medicine, Health Theory, University of Osnabrueck, D-49069 Osnabrueck, Germany
| | - Carola Lidén
- Institute of Environmental Medicine, Karolinska Institutet, SE-17177 Stockholm, Sweden
| | - Magnus Lindberg
- Department of Dermatology, University Hospital Örebro, SE-70185 Örebro, Sweden
| | - Vera Mahler
- Allergy Unit, Department of Dermatology, University Hospital Erlangen, 91054 Erlangen, Germany
| | - Mihály Matura
- Unit of Occupational and Environmental Dermatology, Centre for Occupational and Environmental Medicine, SLSO, SE-11365 Stockholm, Sweden
| | - Thomas Rustemeyer
- Department of Dermatology, VU University Medical Centre, 1081 HV Amsterdam, The Netherlands
| | - Jørgen Serup
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, 2400 Copenhagen, Denmark
| | - Radoslaw Spiewak
- Department of Experimental Dermatology and Cosmetology, Jagiellonian University Medical College, 30-688 Krakow, Poland
| | - Jacob P Thyssen
- Department of Dermato-Allergology, National Allergy Research Centre, Gentofte Hospital, University of Copenhagen, 2900 Hellerup, Denmark
| | - Martine Vigan
- Department of Dermatology, CHRU Besançon, 25030 Besançon Cedex, France
| | - Ian R White
- Department of Cutaneous Allergy, St John's Institute of Dermatology, St Thomas' Hospital, London, SE1 7EH, UK
| | | | - Wolfgang Uter
- Department of Medical Informatics, Biometry and Epidemiology, University of Erlangen/Nürnberg, 91054 Erlangen, Germany
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[Bullous rash around a peritoneal dialysis catheter exit site]. Ann Dermatol Venereol 2015; 142:438-42. [PMID: 25999261 DOI: 10.1016/j.annder.2015.04.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2014] [Revised: 01/12/2015] [Accepted: 04/09/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Cutaneous eruption around a peritoneal dialysis (PD) catheter exit site is a rare complication. Herein we report a case of bullous eruption; we discuss the diagnostic approach and the related therapeutic implications. PATIENTS AND METHODS A 63-year-old man presented a bullous periumbilical eruption two months after initiation of PD. Cultures of laboratory samples ruled out an infectious origin and systemic corticosteroids initiated at 0.5mg/kg for suspected eosinophilic peritonitis produced significant improvement of the cutaneous eruption. Recurrence of the bullous eruption was observed upon dose-reduction of the corticosteroid. Skin histology showed a clinical picture of eczema and direct immunofluorescence was negative. Patch testing was carried out using the European Standard Battery comprising antiseptic, cosmetic and plastic series; a semi-open test was performed with the dressing used for PD, and ROAT was carried out on the povidone iodine (Betadine™) 10% used for topical care during PD. The patch testing and ROAT were positive (++), confirming contact dermatitis due to Betadine™. The eruption totally disappeared on substitution of Betadine™ by chlorhexidine for topical antisepsis of the PD catheter, thus enabling PD to be continued rather than instituting hemodialysis. DISCUSSION Allergic contact dermatitis around a PD catheter is a rare and little-known complication. In the present case, ROAT testing showed sensitization to Betadine™ and enabled an alternative antisepsis solution to be found, allowing PD to be continued.
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Noninvasive in vivo confocal laser scanning microscopy is effective in differentiating allergic from nonallergic equivocal patch test reactions. Lasers Med Sci 2015; 30:1081-7. [DOI: 10.1007/s10103-015-1714-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Accepted: 01/09/2015] [Indexed: 02/03/2023]
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Christoffers WA, Blömeke B, Coenraads PJ, Schuttelaar MLA. The optimal patch test concentration for ascaridole as a sensitizing component of tea tree oil. Contact Dermatitis 2014; 71:129-37. [DOI: 10.1111/cod.12199] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Revised: 11/27/2013] [Accepted: 12/11/2013] [Indexed: 11/29/2022]
Affiliation(s)
- Wietske Andrea Christoffers
- Department of Dermatology; University Medical Center Groningen, University of Groningen 9700RB; Groningen The Netherlands
| | - Brunhilde Blömeke
- Department of Environmental Toxicology; University of Trier; 54286 Trier Germany
| | - Pieter-Jan Coenraads
- Department of Dermatology; University Medical Center Groningen, University of Groningen 9700RB; Groningen The Netherlands
| | - Marie-Louise Anna Schuttelaar
- Department of Dermatology; University Medical Center Groningen, University of Groningen 9700RB; Groningen The Netherlands
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Meteorology and ethnicity as critical factors in HRIPT: Comparing responses between Chinese and Indian ethnicities. Regul Toxicol Pharmacol 2013; 66:59-65. [DOI: 10.1016/j.yrtph.2013.02.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2012] [Revised: 02/12/2013] [Accepted: 02/14/2013] [Indexed: 11/19/2022]
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Bråred Christensson J, Andersen KE, Bruze M, Johansen JD, Garcia-Bravo B, Giménez-Arnau A, Goh CL, Nixon R, White IR. An international multicentre study on the allergenic activity of air-oxidizedR-limonene. Contact Dermatitis 2013; 68:214-23. [DOI: 10.1111/cod.12036] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Torp Madsen J, Andersen KE. Outcome of a second patch test reading of TRUE Tests® on D6/7. Contact Dermatitis 2013; 68:94-7. [DOI: 10.1111/cod.12004] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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