Patch testing in New Zealand: Barriers to evidence‐based care

Abstract

Allergic contact dermatitis is a disabling condition, significantly impacting on quality of life, which can only be alleviated by identification and avoidance of a relevant allergen. Patch testing remains the gold standard diagnostic test for allergic contact dermatitis. The consistency with which patch testing is used varies throughout the world. The purpose of this study was to look at the adequacy of current patch testing practice in New Zealand. We undertook literature review of current guidance regarding patch testing and created a web‐based survey to evaluate use of patch testing in New Zealand. This was sent to all 75 vocationally registered New Zealand dermatologists. Of respondents, 46% do not perform patch testing. The most commonly cited barriers were lack of nursing support, poor remuneration, time pressure and lack of facilities. 23% noted that public patch testing services are not available in their region. The majority do not record patch test results in a database. Access to and utilisation of patch testing in New Zealand is suboptimal. Increasing services in the public sector requires investment by health boards, as there remains a dermatology workforce shortage in New Zealand. In private practice, patients often find it unsatisfactory to pay for negative tests, and adequate remuneration of patch testing by private insurers is necessary. Surveillance of patch test results at a national level is lacking, and the development of a centralised database to identify common allergens affecting our population is recommended.

Topical corticosteroid allergy: Results of sequential testing to a corticosteroid series in New Zealand

“…Patch testing in New Zealand is a limited service; only the most severe cases are accepted for testing and patients have a long period of symptomatology and treatment prior to testing 3 . Both the chronicity of disease in the patch tested population and low cost of topical CS in New Zealand may contribute to increased CS exposure and the potential risk of sensitization.…”

A baseline patch test series for New Zealand

“…â test, SmartPractice, Hillerød, Denmark), and to reduce the cost of stocking multiple additional, specialised series, which are seldom used in centres with smaller patch test volumes. 5 However, there are potential practical issues with a large series, such as the space to apply additional series. Therefore, the first 30 allergens of the NZBS form a core series, which can be used in isolation and supplemented with additional series at the discretion of the supervising dermatologist.…”

“…The group opted for a larger series of 60 allergens, and our hope is that the NZBS can be used as an alternative to more limited panels such as the Thin‐Layer Rapid Use Epicutaneous Test (T.R.U.E. ® test, SmartPractice, Hillerød, Denmark), and to reduce the cost of stocking multiple additional, specialised series, which are seldom used in centres with smaller patch test volumes 5 . However, there are potential practical issues with a large series, such as the space to apply additional series.…”

“…4 In New Zealand, patch testing is mainly carried out by dermatologists, using various baseline seriesmostly the European baseline serieswith little national surveillance. 5 Therefore, we have reviewed patch test results across New Zealand to determine the more relevant allergens to include in a New Zealand baseline series (NZBS).…”

Revisiting patch test data reporting: Towards equity

“…These barriers perpetuate racial inequity with corresponding poor utilization of healthcare services and poor health outcomes. 5,6 In New Zealand, the "Reducing Inequalities in Health Framework" advocates a strong emphasis on ethnicity data recording to provide academics and policy makers with evidence on which programmes can be based regionally and globally to reduce health inequity. 7 The WHO has outlined that epidemiological health research is required for ethnic minorities and this work should be given high priority.…”