Patch Test Reactions Associated With Nontopical Medications: A Retrospective Analysis of North American Contact Dermatitis Group Data, 2001–2018

Abstract

We recently presented data on contact dermatitis (CD) to topical medications. 1 Here, we present data on nontopical medications (NTMs) using the same methodology. 1 Nontopical medications included oral and parenteral (nontopical) routes of administration (eg, lidocaine in transdermal patch/ointment formulations was excluded, but lidocaine in intramuscular/ intravenous formulations was included). Patients with 1 or more positive patch test reactions associated with an NTM comprised the NTM group. RESULTSOf 43,722 patients, 234 (0.5%) had 1 or more NTM-associated positive patch test reactions. The majority were women (71.4%, 167 of 234) or older than 40 years (71.8%, 168 of 234; Table 1). The most common primary anatomic sites in the NTM patients were scattered generalized distribution (28.2%), the face (24.4%), and the hand (17.1%). Results were similar when up to 3 body sites were considered (Table 1).Of the 234 NTM patients, 174 (74.4%) had reactions to North American Contact Dermatitis Group (NACDG) screening allergens only; 60 (25.6%) had NTM-associated reactions to supplemental allergen/substances. Of the 182 NTM-associated reactions to NACDG screening allergens, most common were thimerosal, ethylenediamine dihydrochloride, cobalt chloride, carmine, potassium dichromate, lidocaine, tocopherol, and sodium metabisulfite (Table 2). Most reactions (64.3%, 117 of 182) were clinically relevant (definite, 9; possible, 58; probable, 50). Past clinical relevance was high for thimerosal (90.5%, 38 of 42), dibucaine (71.4%, 5 of 7), and lidocaine (57.1%, 8 of 14).A.R.A. received a Pfizer Independent Grant for Learning & Change and has consulted for Henkel. J.S.T. owns noncontrolling common shares of stock in AstraZeneca, Cigna, Merck, Johnson & Johnson, and OPKO Health. He has consulted for Kao Brands and Monsanto (Bayer), is a member of the Cosmetic Ingredient Review Steering Committee, and has a nondependent child employed by Pfizer, Inc. E.M.W. has received an investigator-initiated grant from and served as a consultant for Wen by Chaz Dean. She has also served as a consultant to Noven Pharmaceuticals. D.S. receives royalties from UpToDate

Neomycin: sources of contact and sensitization evaluation in 1162 patients treated at a tertiary service

“…In the United States, however, sensitization varied from 7% to 13% in the last two decades, with an average of 11.4%. 3 , 11 Canada has also shown a downward trend in this rate, influenced by the reduction in its availability to the public, sold only by medical prescription. 12 In Brazil, data from 2009 showed a frequency of 5.7%, very similar to what was found between 2009 and 2018 (6%), but during this period there were no changes in the rules for obtaining this medication as an over-the-counter drug.…”

“… 1 , 2 According to other studies, allergic contact dermatitis to topical medications usually becomes more common with advancing age. 3 …”

“…Among these are chronic venous insufficiency, external otitis, post-surgical wounds, chronic eczematous lesions, as observed here associated with allergic contact dermatitis to rubber and cement. 3 , 4 , 12 , 13 , 14 , 15 …”

“…In Brazil and the United States, it can be purchased without a prescription, which causes a high frequency of sensitization, unlike in European countries, where this frequency is low. 1 , 3 , 4 …”