How good is the Australian baseline series at detecting allergic contact dermatitis?

Abstract

Background Patch testing is the gold standard for the diagnosis of allergic contact dermatitis (ACD). The Australian Baseline Series (ABS) was formulated by our group to include the 60 most common and relevant allergens in our patient population. The aim of this study was to assess the efficacy of testing with the Australian Baseline Series in order to diagnose allergic contact dermatitis. Methods We conducted a retrospective study of 964 patients with ACD diagnosed at our centre from 1 January 2012 to 31 December 2018. Patients with at least one relevant positive reaction were stratified into three groups: i) reactions only to allergens in the Australian Baseline Series; ii) reactions to allergens in the Australian Baseline Series and to additional allergens; and iii) reactions only to allergens not present in the Australian Baseline Series. Results The Australian Baseline Series alone was successful in identifying the cause of allergic contact dermatitis in 63.4% (611/964) of patients. In 23.0% (222/964), the Australian Baseline Series detected at least one relevant allergen, but there were relevant allergens outside of the Australian Baseline Series as well. In 13.6% (141/964), no relevant allergens were detected in the Australian Baseline Series, but allergens were detected in additional series or by testing patients’ own products. The most frequently occurring allergens not included in the Australian Baseline Series were citral, ammonium persulfate, geraniol, oakmoss absolute and chlorhexidine diacetate. Conclusions The Australian Baseline Series is an adequate screening tool for identifying patients with ACD. Nevertheless, females should be additionally routinely tested with the fragrance series. Patients with suspected occupationally related dermatitis should always be tested with additional allergens and own products.

Australian baseline series allergens in assessment of allergic contact dermatitis in New South Wales

“…As found in the Victorian study, fragrance allergens were frequently missed relevant reactions. 2 Fragrance allergy is not reliably detected by testing with the fragrance mixes. 8 Toluenesulfonamide formaldehyde resin, a cause of contact allergy to nail polish, was recently removed from the Letters to the Editors e79 ABS.…”

A baseline patch test series for New Zealand

“…A recent Australian paper showed that sensitivity to fragrances was frequently missed by the Australian baseline series, particularly for women 3 . Likewise, almost 10% of another study population had relevant reactions to individual fragrance allergens while being negative to fragrance mix I 8 .…”

“…A recent Australian paper showed that sensitivity to fragrances was frequently missed by the Australian baseline series, particularly for women. 3 Likewise, almost 10% of another study population had relevant reactions to individual fragrance allergens while being negative to fragrance mix I. 8 A Swedish study showed that 27% of patients who were positive to an individual allergen in fragrance mix I were negative to the fragrance mix I itself, while 36% demonstrated similar discordance when studying fragrance mix II.…”

“…The Australian baseline series of 60 allergens was published in 2012, based on the more relevant positive allergens from a large Melbourne‐based contact dermatitis unit 2 . The same group recently published an audit of their series showing 86% of relevant allergens were detected by the Australian baseline series alone 3 . By tailoring the baseline series to their population, they have improved the diagnostic accuracy of patch testing in Melbourne.…”

“…2 The same group recently published an audit of their series showing 86% of relevant allergens were detected by the Australian baseline series alone. 3 By tailoring the baseline series to their population, they have improved the diagnostic accuracy of patch testing in Melbourne.…”