Risk factors for common contact allergens and patch test results using a modified European baseline series in patients tested during between 2000 and 2009 at Siriraj Hospital

Prevalence of contact allergy to gold in dermatitis patients from 2010 to 2024: A systematic review and meta-analysis

Gold contact allergy is diagnosed by patch testing using gold chloride or gold sodium thiosulfate. These tests often show high positivity rates, but a direct correlation with dermatitis from everyday gold exposure is rare. The aim of this study was to investigate and estimate the current prevalence of gold contact allergy in dermatitis patients. We performed a systematic literature search in PubMed, Embase and Web of Science for studies reporting the prevalence of gold contact allergy in dermatitis patients and published between January 2010 and May 2024. Data extraction and quality assessment were performed, and pooled proportions were calculated using random effects models. Sixteen studies with 14 887 dermatitis patients were included. The pooled prevalence of gold contact allergy was 14.1% (95% confidence intervals: 9.5%-19.4%) with significant heterogeneity (I2 = 98.3%). High positivity rates with limited clinical relevance highlight the need for cautious interpretation. Even within the same country, studies find different prevalence rates. Standardized testing protocols and further research are needed to better understand and manage this allergy.

Gender differences in allergic contact dermatitis to common allergens

BACKGROUND

Gender-based differences in skin structure, physiology, and allergen exposure can influence contact dermatitis development.

OBJECTIVE

This study investigated the differences and trends in contact sensitizers, focusing on the top 10 allergens and personal care product (PCP) contact allergies from a gender perspective.

METHODS

We conducted a retrospective chart review of 5998 patients undergoing patch testing at an occupational and contact dermatitis clinic in a Thai, university-based, tertiary referral hospital from January 2001 to December 2021. Patients' characteristics and patch test results were collected.

RESULTS

Females had a higher positive patch test rate than males (71.8% vs. 65%, p < 0.001). However, males showed a greater prevalence of occupationally related allergic contact dermatitis (15.9%). Multivariate analysis revealed associations between being female and allergies to colophonium (aOR 1.46, 95% CI 1.07-1.99, p = 0.019), formaldehyde (aOR 1.97, 95% CI 1.17-13.31, p = 0.010), fragrance mix I (aOR 1.66, 95% CI 1.34-2.07, p < 0.001), MCI/MI (aOR 2.55, 95% CI 1.90-3.44, p < 0.001), neomycin (aOR 4.15, 95% CI 2.54-6.80, p < 0.001), and nickel (aOR 2.62, 95% CI 2.17-3.15, p < 0.001). Conversely, being male correlated with allergies to carba mix (aOR 0.51, 95% CI 0.41-0.64, p < 0.001), epoxy resin (aOR 0.26, 95% CI 0.14-0.47, p < 0.001), n-isopropyl-n-phenyl-4-phenylenediamine (aOR 0.41, 95% CI 0.20-0.83, p = 0.014), paraben mix (aOR 0.42, 95% CI 0.32-0.56, p < 0.001), and potassium dichromate (aOR 0.70, 95% CI 0.58-0.84, p < 0.001). Positive reactions to PCPs stood at 13% overall (males 17.1%, females 12.2%, p < 0.001).

CONCLUSIONS

Gender plays a pivotal role in contact dermatitis. This work emphasises the importance of considering gender-specific factors when diagnosing and managing contact allergies.

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

Objectives:

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

Methods:

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

Results:

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

Conclusion:

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

Patch test results in paediatric patients with atopic dermatitis in Laos

BACKGROUND

Dermatological services in Laos, South East Asia are limited mainly to the capital and patch testing is currently not available, so no data exists regarding the common cutaneous allergens in this population.

OBJECTIVES

The aim of this study was to document common allergens in paediatric patients with atopic dermatitis attending the allergy clinic in the capital, Vientiane.

PATIENTS/MATERIALS/METHODS

Fifty paediatric patients with atopic dermatitis were patch tested using TRUE Test® panels 1 to 3 (35 allergens). Readings were taken at Days 2 and 4.

RESULTS

Twenty-six positive patch tests were recorded on Day 4 in 15 children (30%). The most common allergens were: gold (18%), nickel (10%), formaldehyde (6%) and p-Phenylenediamine (6%). Other positive allergens were potassium dichromate (2%), cobalt dichloride (2%), Bronopol (2%), paraben mix (2%), fragrance mix 1 (2%) and neomycin (2%). The majority of the patients with positive reactions were female.

CONCLUSIONS

This study represents the first documented patch test results in the Lao population. It is hoped that these findings will help clinicians to advise the families of children with atopic dermatitis on common allergens to avoid and inform future work on contact dermatitis in this population.

Patch testing in Lao medical students

Background

Dermatological services in Laos, South East Asia are limited to the capital and patch testing is currently not available, so no data exists regarding the common cutaneous allergens in this population.

Objectives

The aim of this study was to document positive patch tests in medical students without evidence of contact dermatitis in Laos.

Patients/Materials/Methods

One hundred and fifty medical students were patch tested using TRUE Test^® panels 1 to 3 (35 allergens). Readings were taken at Days 2 and 4.

Results

Thirty-eight students (25.3%) had a positive reaction to at least one allergen, accounting for 52 reactions in total. The proportion of the students with positive patch test reading was significantly higher in the female [33/96 (34%)] than in the male [5/54 (9%)], p<0.001. The most common allergens were: nickel (10%), gold (6.6%), thiomersal (6.6%), cobalt dichloride (2%) and p-tert-Butylphenol formaldehyde resin (2%). Balsam of Peru (0.66%), black rubber mix (0.66%), Cl+Me-Isothiazolinone (0.66%), fragrance mix 1 (0.66%), quinolone mix (0.66%), methyldibromo glutaronitrile (0.66%), mercapto mix (0.66%), epoxy resin (0.66%), paraben mix (0.66%), thiuram (0.66%) and wool alcohols (0.66%) accounted for all of the other positive reactions.

Conclusion

This study represents the first documented patch test results in Lao medical students and in the adult Lao population. The results of this study will inform any future research into contact allergy in Laos and give an insight into the background level of contact sensitivity in this population.

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

Background

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

Methods

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

Results

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

Conclusion

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

Electronic supplementary material

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

Assessment of patch test results carried out during ten years in a city in southern Brazil

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.

Nickel, chromium and cobalt: the relevant allergens in allergic contact dermatitis. Comparative study between two periods: 1995-2002 and 2003-2015

BACKGROUND

Metals are common agents of allergic contact dermatitis, occupational or not, with decreasing incidence over the last years in some countries that have regulated the amount of nickel in objects.

OBJECTIVES

To analyze and compare with previous studies the profile of metal sensitization between 2003-2015.

METHODS

Patients who underwent patch testing between 2003-2015 were evaluated retrospectively regarding the sensitization rates to metals, the associations between them, the relationship with profession and epidemiology.

RESULTS

Of the 1,386 patients tested, 438 (32%) had positive test to some metal, similar results to the 404/1,208 (33%) of the previous study (1995-2002) performed at the same service (p=0.32). The frequency of nickel (77%), cobalt (32%) and chromium (29%) changed slightly (p=0.20). Most cases of sensitization to chromium were related to the occupation (64%), in contrast to nickel and cobalt (p<0.0001). There was a predominance of females among those sensitized to metal in both studies (p=0.63) and the age group of 20-49 years old (p=0.11); the number of fair-skinned individuals increased (p<0.001), as well as the lesions in the cephalic segment (50.5%; p<0.0001) and hands (45%; p<0.0001), which are not the most frequent location anymore. The number of cleaners decreased (39% vs. 59%; p<0.0001), which still lead in front of bricklayers/painters, which increased (14% vs. 9%; p=0.013). The frequency of wet work reduced (65% vs. 81%; p<0.0001).

STUDY LIMITATIONS

The study included a single population group; only patients with positive tests to metals were considered - the others were not evaluated for the possibility of false negatives.

CONCLUSION

The sensitization to metals, occupational or not, has been significant over the last 21 years, with few epidemiological changes.

Screening for skin-sensitizing allergens among patients with clinically suspected allergic contact dermatitis

Objectives:

To detect common skin-sensitizing agents among patients experiencing allergic contact dermatitis (ACD).

Methods:

This was a retrospective study of 152 patients with clinically suspected ACD who underwent patch testing in an allergy clinic at King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia between January 2012 and February 2015. Of these patients, only 74 (48%) patients reacted to one or more contact allergens. This group of patients included 58 (78.4%) women and 16 (21.6%) men (mean age: 37.8±13.8 years). Patch testing was performed using the thin-layer rapid-use epicutaneous patch test panels.

Results:

Nickel sulfate was the most common sensitizing agent, with 26 (35.1%) patients yielding a positive result; followed by p-phenylenediamine in 17 (22.9%), butyl-tetra-phenol formaldehyde in 12 (16.2%), gold sodium thiosulfate in 10 (13.5%), and thimerosal in 6 (8.1%) patients. Nickel reactivity was significantly higher among women (41.4%) than among men (12.5%) (p<0.0001). Similarly, gold reactivity among women (15.5%) was also higher than among men (6.2%) (p≤0.02).

Conclusion:

The high level of skin sensitization due to nickel, PPD, and gold in patients with ACD emphasizes the need for measures to decrease exposure to these sensitizing agents.