A new modification of the chamber test for epicutaneous testing, and improved auxiliary equipment are presented. Compared with the customary patch test, the chamber test in its present form has several remarkable advantages, which are described in detail.
Common emulsifiers were tested in over 1,200 patients with eczema. Triethanolamine stearate tested at 5% in petrolatum caused irritant reactions in 9.5% of the patients. On the other hand, non-ionic emulsifying agents tested at 10-20% produced irritation in only a few cases. Allergic reactions were found in 2.1% of those tested. Lanette, sorbitan sesquioleate, the Spans, polyoxyethylene oxypropylene stearate, polyoxyethylene sorbitol lanolin derivative, and triethanolamine stearate each elicited allergic reactions in 0.3-0.7% of the cases. The Tweens caused an allergy in only two cases, but glycerol monostearate caused no reaction at all. Five out of six patients sensitive to sorbitan sesquioleate reacted positively to the Spans as well. The patients allergic to one or more emulsifiers were also sensitive to several other substances included in our routine test series with the exception of four patients who reacted only to the emulsifying agents.
Propylene glycol (PG), ethylene glycol (EG), and polyethylene glycol 400 (PEG 400) were tested, as is, in a total of 1,556 cases of eczema using the chamber test method. All the year round, the number of positive reactions to PG was 12.5% to EG 4.9%, and to PEG 400 0.3%. A total of 30% of the positive reactions to PG were allergic in appearance. Also the new fatty alcohol-PG bases of Metosyn ointment and Topilar ointment as well as Metosyn ointment (fluocinonide) itself provoked reactions in a great number of patients with positive reactions to PG, as is. The reactions to PG were considered to be truly allergic in four cases. In them, positive reactions were elicited by testing with high dilutions of PG and by applying the glycol in the patients' armpits as an open test. It is concluded that PG and topical preparations containing it in high concentrations should not be used with occlusion, and that allergic reactions must be watched.
Common ingredients of vehicles such as perfumes, antibacterial agents, emulsifiers and other surface active agents, propylene glycol, lanolin and wool alcohols were tested in eczema patients over a three-year period. Perfume allergy was detected in 3.6% of the cases, sensitivity to thiomersal in 2%, to sorbic acid in 0.8%, to parabens in only 0.3%, and to wool alcohols in 1.2%. Reactions to emulsifiers were seen over 1% of those tested.
SUMMARY.— In a series of 4000 patients patch tested in 5 European clinics, 1000 were engaged in domestic work only; they included 281 women with contact dermatitis of the hands. There were no significant differences between the 2 groups as regards age, duration of dermatitis and patch test results. Half of the 281 women had a positive patch test, the responsible allergens in order of rank being balsams, nickel, medicaments, cobalt, rubber, chromate, benzocaine and paraphenylenediamine. But 78% of them were diagnosed as contact dermatitis, 5% atopic and 13% were unclassified. An allergic cause (42%) was as frequent as an irritant (45%) among those with contact dermatitis.
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