Patch Testing During Immunosuppressive Therapy: A Systematic Review

Abstract

Patch testing, used in the assessment of allergic contact dermatitis, is ideally avoided in patients receiving immunosuppressive therapy because of concerns with reductions in accuracy; however, this is not well characterized in the literature. This systematic review summarizes patch testing results in patients receiving immunosuppressive therapy. We identified 16 studies, comprising 195 patients with dermatitis or psoriasis, who were patch tested while receiving immunosuppressants. Of these, 7 studies, comprising 85 patients with dermatitis, patch tests were performed before and during immunosuppression. Overall, 67.9% (n = 19) of the dermatitis patients receiving dupilumab maintained positive reactions to an allergen that previously graded as a 2+/3+ reaction. Several immunosuppressants were also associated with positive patch test results for various allergens. These include dupilumab, cyclosporine, and low-dose prednisone (≤10 mg/d) for dermatitis, and tumor necrosis factor α inhibitors, ustekinumab, and methotrexate for psoriasis. Ideally, it is preferable to patch test when patients are not receiving oral immunosuppressants or immunomodulators. However, clinicians may choose to assess the risks and benefits of patch testing for each patient given the impact of allergic contact dermatitis on patient quality of life.

Allergic Contact Cell-Mediated Hypersensitivity in Psoriasis: A Narrative Minireview

“…This type of psoriasis appears to be immunologically distinct from classical psoriasis, and some cases were described as ‘‘psoriasiform’’ because they did not necessarily meet the definition of psoriasis [ 66 , 67 , 68 , 69 , 70 ]. Although a switch in the polarization of the predominant immune response from Th 2 to Th 17 was hypothesized, a deeper understanding of the mechanism behind this reaction to dupilumab will lead to the complete comprehension of the immunopathogeneses of psoriasis and atopic dermatitis [ 71 ]. A recent systematic review by Mufti et al assessing studies with dermatitis patients patch-tested before and during various treatments reported that almost 68% of the patients who received dupilumab maintained positive patch testing results to an allergen that was previously graded as a significant positive reaction [ 72 ].…”

A case of hair dye‐induced allergic contact dermatitis in the context of nivolumab

“…There are no data about the efficacy or safety of patch testing under ICPI conditions. Just as immunosuppression risks false‐negative results, 7 an immune‐enhanced anti‐PD‐1 state could theoretically cause allergy induction, severe patch test reactions and false positives. We considered titrated PPD patch testing at 0.01% 8 .…”

Expert Opinion on Patch Testing While Receiving Immunomodulatory Therapy Results of an International Survey Study

“…All Although there was variability in reported minimum withdrawal times from topical anti-inflammatory use at test site, UV exposure, and intramuscular or oral corticosteroid use, the consensus was consistent with previously published practices (Table 1). 4 A majority (>50%) reported that they would patch test during traditional dosing of tumor necrosis factor α inhibitors, apremilast, antihistamines, and omalizumab without reservation (Fig. 1; Supplementary Figure 1, http://links.lww.com/ DER/A96).…”