Patch test results in terms of the recently recommended allergens in children and adolescents: A retrospective cohort study over 22 years from Turkey

Abstract

BackgroundA European pediatric patch test series was suggested recently.ObjectivesTo evaluate the patch test results in children (<10‐years‐old) and adolescents (10‐ to 18‐years‐old) in Turkey, focusing on the clinical/occupational relevance and the diagnostic value of the recently suggested series.Patients and MethodsA retrospective cohort study on 317 consecutively patch tested patients ≤18 years of age, between 1996 and 2017.ResultsThe contact sensitization rate was 46.1%. Allergic contact dermatitis (ACD) was diagnosed in 30.9%, comprising non‐occupational (84.7%) and occupational (15.3%) ACD. Nickel was the leading allergen in almost every age group. Methylchloroisothiazolinone/methylisothiazolinone (MCI/MI) was the clinically most relevant allergen, followed by p‐phenylenediamine (PPD), ammonium persulfate, fragrance mix I, nickel sulfate, and mercury/mercury(II)amidochloride. Occupational ACD was most frequently seen in hairdresser apprentices (adolescents only) who were sensitized with PPD ± ammonium persulfate. ACD from MCI/MI increased to 5‐fold, ammonium persulfate and mercurial compounds to 2‐fold, and PPD to 1.7‐fold after 2007. Almost one third of patients would be missed by testing only with the recommended allergens.ConclusionsFor patch testing in Turkish children and adolescents, we suggest additionally testing with ammonium persulfate, mercury/mercury(II)amidochloride, toluenesulfonamide formaldehyde resin, and polyethylene glycol, the latter as a marker for nitrofurazone allergy, in appropriate patients.

Patch test results in a Dutch paediatric population with suspected contact allergy: A retrospective cohort study

“…The largest increase was observed for MI. A sensitization prevalence of 1.9% to 6% for MCI/MI has been described in other studies, including paediatric patients 2,11–13,15,21 . MCI and MI have been widely used as preservatives in care products for children, such as baby wipes, creams, shampoos and moisturizers 25 .…”

“…The present study found that 20.3% of patients would have been underdiagnosed if tested with the EBS only. Turkish researchers have found the diagnosis of ACD would have been missed in more than one fourth of the children if not tested with additional series and the patient's own material 21 . Similarly, of 883 children patch tested by the North American Contact Dermatitis Group, 23.6% had a relevant positive reaction to allergens not included in the standard screening panels 6 …”

“…Turkish researchers have found the diagnosis of ACD would have been missed in more than one fourth of the children if not tested with additional series and the patient's own material. 21 Similarly, of 883 children patch tested by the North American Contact Dermatitis Group, 23.6% had a relevant positive reaction to allergens not included in the standard screening panels. 6 If not tested with hydroperoxides of linalool and limonene in each of the two dilutions, fragrance allergy would have been missed in 5% of patients.…”

“…24 Remarkable differences in sensitization rates were observed for including paediatric patients. 2,[11][12][13]15,21 MCI and MI have been widely used as preservatives in care products for children, such as baby wipes, creams, shampoos and moisturizers. 25 Regulatory measures of the European commission that banned the use of MI in leave-on cosmetics and limited its use to 15 ppm in rinse-off products became fully effective in 2018.…”

Results of the patch tests with European baseline series in children: Five years of experience from a single center in Turkey and a review of the literature

“…7 Studies from Turkey report that contact sensitization rates in the pediatric population are 32%-57%. 8,9 In our study, we established that the contact sensitization rate in the Turkish pediatric population is 18.8%. The small percentage in our study compared with others in Turkey might be due to the fact that we only used European baseline series allergens in our patch test.…”