Is a 5% nickel sulphate patch test concentration adequate?

Dooms‐Goossens, A.; Naert, C.; Chrispeels, M. T.; Deoreef, H.

doi:10.1111/j.1600-0536.1980.tb05620.x

Cited by 18 publications

(11 citation statements)

References 2 publications

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“…The skin penetration of nickel has been extensively studied in vitro Concerning concentrations, 10 YO NiS04 was used (30). when the testing with 5 Yo was negative (7,12). Other alternativesusing still higher concentrations up to 30% -are occluded patch testing for 5h and open application (13,15,22).…”

Section: Discussionmentioning

confidence: 99%

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Nickel: the search for alternative, optimal and non‐irritant patch test preparations

Wahlberg

1996

Skin Research and Technology

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Section: Discussionmentioning

confidence: 99%

“…The current patch test preparation for diagnosing nickel contact allergy (5 YO nickel sulfate; 0.19 molal) in petrolatum (pet. ) is sometimes irritating to the skin and has also been claimed to miss cases of allergy (7,12). It can be considered a compromise (1).…”

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confidence: 99%

Nickel: the search for alternative, optimal and non‐irritant patch test preparations

Wahlberg

1996

Skin Research and Technology

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“…Oral provocation with the allergen may also give positive reactions in patch-test-negative cases (11). We preferred to repeat the patch tests, doubling the concentrations, which in some cases may disclose false negatives (12). Hereby, nickel allergy was diagnosed in 1 of the original 20 patients, thereafter excluded from the study.…”

Section: Discussionmentioning

confidence: 99%

Metal sensitivity: positive history but negative test indicates atopy

Möller

Svensson

1986

Contact Dermatitis

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Among patients with a history of metal sensitivity, 50 were patch-test-negative to nickel, cobalt and chromate. 20 of them were further examined epicutaneously and intracutaneously. They were also studied with a clinical diagnostic method for symptoms and signs of atopy. Most patients in this category were found to be atopic. Key words:Metal sensitivity -atopy -nickel allergy.Acceptedfor publication September 16,1985 Patients with a contact allergy to metals are generally characterized by good agreement between a history of metal hypersensitivity and the result of patch tests. It has even been suggested that patch testing should be omitted in cases with a typical history and reserved for doubtful cases (1, 2).We advocate patch testing in patients with a clear history of metal hypersensitivity for several reasons. First, it is difficult to tell which metal or metals are implicated. Second, the patient may have additional allergens not obvious from the history. Third, from legal and prognostic aspects, metal allergy should be confirmed. Fourth, patch tests to metals may be negative in spite of a positive history.Such negative test results are far from unusual. Kieffer (3) tested healthy subjects of both sexes and found a negative nickel test in 13/28 subjects with a history of metal contact dermatitis. For Menne (4), testing healthy females with nickel, cobalt and chromate, the metal tests were negative in 26/91 cases with a history of nickel allergy. Lantinga et al. (5) studied subjects with hand eczema selected from an age-defined population and found 18/ 43 females to be negative.For the discrepancy between a positive history and negative metal tests, several explanations have been suggested (6). Like many other eczematous reactions, we thought metal sensitivity might be connected with an atopic background. To test this hypothesis, we applied a recently developed diagnostic instrument for atopic dermatitis (7) to this subgroup of patients. Material and MethodsAt our test laboratory, 500--600 patients are patch tested with a standard series each year. During a 2-year period, 50 consecutive patients with a history of metal sensitivity but with a negative patch test to nickel, cobalt and chromate in a standard series were offered further investigations. Out of the 50 patients, 15 could not be traced, and another 15 declined further examination. The remaining 20 patients were questioned on their metal sensitivity, were more thoroughly tested (epicutaneously and intracutaneously) and were studied by history and examination with regard to the presence of atopy.A positive history of metal sensitivity implied repeated reactions of an eczematous na-

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“…However, for (the majority of) patients with a 'strong' or 'medium' sensitization, our conclusions seem justified. Only in those patients suspected of being false-negative to a patch test concentration of 0.2% or 0.3%, based on compelling exposure information, could higher concentrations be usefully patch-tested, as with other allergens (43), because in these patients the a priori likelihood of sensitization is high, and the probability of false-positive reactions to these higher concentrations sufficiently low, compared to the standard screening setting.…”

Section: Concentration Of Mdbgn In Diagnostic Patch Testingmentioning

confidence: 96%

Quantitative patch and repeated open application testing in methyldibromo glutaronitrile‐sensitive patients

et al. 2005

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Contact allergy to methyldibromo glutaronitrile (MDBGN), often combined with phenoxyethanol (PE) (e.g., Euxyl K 400), increased throughout the 1990s in Europe. Consequently, in 2003, the European Commission banned its use in leave-on products, where its use concentration was considered too high and the non-sensitizing use concentration as yet unknown. The 2 objectives of the study are (a) to find a maximum non-eliciting concentration in a leave-on product in MDBGN/PE-sensitized patients, which could possibly also be considered safe regarding induction and (b) to find the best patch test concentration for MDBGN. We, therefore, performed a use-related test (ROAT) in patients sensitized to MDBGN/PE (n = 39) with 3 concentrations of MDBGN/PE (50, 100 and 250 p.p.m. MDBGN, respectively). A subset of these patients (n = 24) was later patch-tested with various concentrations (0.1, 0.2, 0.3 and 0.5% MDBGN, respectively). 15 patients (38%, 95% confidence interval (CI) = 23-55%) had a negative and 24 (62%; 95% CI = 45-77%) a positive overall repeated open application test (ROAT) result. 13 reacted to the lowest (50 p.p.m.), 8 to the middle (100 p.p.m.) and 3 to the highest concentration (250 p.p.m.) only. In those 13 reacting to the lowest ROAT concentration, dermatitis developed within a few days (1-7). The strength of the initial and the confirmatory patch test result, respectively, and the outcome of the ROAT were positively associated. Of the 24 patients with a use and confirmatory patch test, 15 reacted to 0.1% MDBGN, 16 to 0.2%, 17 to 0.3% and 22 to 0.5%. With the patch test concentration of 0.5%, the number of ROAT-negative patients but patch-test-positive patients increases considerably, particularly due to + reactions. A maximum sensitivity of 94% (95% CI = 70-100%) is reached with a patch test concentration of 0.2%, and is not further improved by increasing the concentration. However, the specificity decreases dramatically from 88 (95% CI = 47-100%) with 0.2% to a mere 12.5% (95% CI = 0-53%) with 0.5%. It can be concluded (a) that for MDBGN 0.2% is very likely the best patch test concentration and (b) that 50 p.p.m. in a leave-on product can elicit contact dermatitis in sensitized persons. We were, therefore, unable to find a safe, still microbicidal, concentration for leave-on products. By contrast, with other contact allergens, dose-response use tests may be able to identify a non-eliciting concentration, which could give valuable clues to a non-inducing (i.e., safe) concentration in products.

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Is a 5% nickel sulphate patch test concentration adequate?

Cited by 18 publications

References 2 publications

Nickel: the search for alternative, optimal and non‐irritant patch test preparations

Nickel: the search for alternative, optimal and non‐irritant patch test preparations

Metal sensitivity: positive history but negative test indicates atopy

Quantitative patch and repeated open application testing in methyldibromo glutaronitrile‐sensitive patients

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