Prick testing with chemicals in the diagnosis of occupational contact urticaria and respiratory diseases

Abstract

Prick tests can be safely used for diagnosing contact urticaria, asthma and rhinitis caused by isocyanates, chloramine-T, persulfates, and chlorhexidine, but the results should be carefully interpreted and related to clinical symptoms and other diagnostic tests.

Contact urticaria: Frequency, elicitors and cofactors in three cohorts (Information Network of Departments of Dermatology; Network of Anaphylaxis; and Department of Dermatology, University Hospital Erlangen, Germany)

“…Low molecular weight agents are classic elicitors of NICU and were also observed in the Erlangen cohort (Table ); however, a few low molecular weight chemicals can also induce ICU. This was shown for cyclic acid anhydrides, isocyanates, chloramine‐T, other chemicals and drugs by positive prick test results for the corresponding agent conjugated to human serum albumin, as well as specific IgE measurement. It is therefore important to consider both NICU and ICU in the context of occupational exposure to chemicals, and to adapt the diagnostic algorithm accordingly …”

“…More than 250 occupational agents have been identified as potential sensitizers of immediate reactions, such as (immunological) CU, rhinitis, conjunctivitis, and bronchial asthma . Concomitant disease manifestation is not uncommon.…”

“…8 More than 250 occupational agents have been identified as potential sensitizers of immediate reactions, such as (immunological) CU, rhinitis, conjunctivitis, and bronchial asthma. 5,[9][10][11][12][13][14][15] Concomitant disease manifestation is not uncommon. For example, in a retrospective review of 291 cases diagnosed with CU or protein contact dermatitis (PCD) at the Finnish Institute of Occupational Health during 1995 to 2011, almost half of the patients (46%) with occupational CU and PCD had concomitant occupational airway disease: concomitant occupational asthma caused by the same agent as the skin disease was detected in 21% of patients, and concomitant occupational rhinitis was detected in 38% of patients.…”

Contact urticaria with anaphylaxis caused by chlorocresol, chloroxylenol, and thiourea

“…The exact mechanism of CU caused by chemicals is unknown, although it is thought most likely to be IgE‐mediated. Prick tests have been shown to be useful for diagnosing CU caused by some chemicals, including chlorhexidine, chloramine‐T, and isocyanates . We present a unique case of CU with anaphylaxis caused by chlorocresol ( p ‐chloro‐ m ‐cresol, CAS no.…”

“…Prick tests have been shown to be useful for diagnosing CU caused by some chemicals, including chlorhexidine, chloramine-T, and isocyanates. 8 We present a unique case of CU with anaphylaxis caused by chlorocresol (p-chloro-m-cresol, CAS no. 59-50-7), chloroxylenol (CAS no.…”