Reproducibility of patch tests

Brasch, Jochen; Henseler, Tilo; Aberer, Werner; Bäuerle, Gabriele; Frosch, Peter J.; Fuchs, Thomas; Fünfstück, V.; Kaiser, Gabriele; Lischka, G; Pilz, Beate; Sauer, Christine; Schaller, Jörg; Scheuer, B; Szliska, Christiane

doi:10.1016/s0190-9622(94)70220-9

Cited by 126 publications

(38 citation statements)

References 25 publications

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“…This costeffective and safe diagnostic tool is easily used, but the results are influenced by method and individual variability. Continuing standardization of the patch test substances and procedures over the last few years has enormously improved the reproducibility of test results (27). However, false-positive and false-negative test reactions frequently cannot be ruled out, and still have to be taken into consideration in the interpretation of patch test reactions (9).…”

Section: Discussionmentioning

confidence: 99%

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Macro‐video documentation patch tests

et al. 2005

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An unequivocal distinction between allergic and irritant patch test reactions is often difficult with patch tests. This study was designed to evaluate the worth of video-macro camera documentation for differentiation between allergic and irritant test reactions and to investigate whether there are characteristic clinical differences in patch test responses between metal salts and fragrances. Patch testing was performed with nickel sulfate, fragrance mix and an irritant, sodium lauryl sulfate 1% aq., on the upper back of 82 patients, with evaluation and computer-aided video documentation after 48 and 72 hr. No reliable clinicomorphological criterion was found for assessing a weak patch test reaction as being definitely allergic. Even characteristic papules and vesicles were not regularly found in allergic reactions. However, unlike fragrance mix, patch test reactions to nickel sulfate were characteristic in that they showed a heterogeneous spread and an association with hair follicle openings, independent of reaction intensity. Evaluation based on additional computer-aided video-macro camera documentation did not add further advantage for the differentiation of allergic and irritant reactions. But well-defined clinicomorphological features and reaction patterns to single test substances or even whole substance categories could be helpful additional criteria for evaluating patch test responses in clinical practice.

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Section: Discussionmentioning

confidence: 99%

“…We chose 2 common contact allergens, nickel sulfate and fragrance mix, because of their good patch test reproducibility (25)(26)(27). For the examination of irritant reaction patterns, sodium lauryl sulfate (SLS), a standard irritant substance, was used (6,7).…”

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Macro‐video documentation patch tests

et al. 2005

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“…What may constitute a gold standard for the patch test is not obvious. In one study [8], concomitant duplicate left- versus right-sided patch tests were performed. True-positive reactions were assumed as concordant allergic reactions on both sides, while true-negative reactions were concordant negative reactions on both sides.…”

Section: The Assessment Of Patch Testing As a Diagnostic Toolmentioning

confidence: 99%

The Epidemiology of Fragrance Allergy: Questions and Needs

Naldi

2002

Dermatology

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Background: There are still open questions about the safety of fragrances. Objectives: To evaluate the evidence concerning the frequency of contact dermatitis to fragrances in the general population and selected subgroups and the risk factors for sensitization and clinical manifestations. Methods: Review of published data. Results: No criteria for a reliable diagnosis of ‘contact dermatitis’ are available. International recommendations and standardization for patch test methods exist; however, the question whether agents that are positive are causally linked to contact dermatitis remain fraught with uncertainties concerning false-positive rates and clinical relevance. Most of the discussion concerning prevalence or incidence variations of allergic contact dermatitis to fragrances concentrate on the frequency of positive patch tests in clinical series, i.e. ‘floating numerators’. Conclusions: Risk assessment requires that data from different sources are integrated and compared. Both a ‘sentinel surveillance’ system and more refined epidemiological studies in well-defined populations are needed to reliably assess the risks associated with fragrance exposure.

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“…Whenever the clinical history of a patient suggested strongly that either one of these common allergens may produce a positive reaction, he placed the nickel or dichromate on the patient's arm away from the other patches and thus avoided the "crazy back". Spillover was observed clinically (4,23,28,34,35) and experimentally (36) in eczema patients but could not be demonstrated in non-eczematous subjects (18,37). A zone of hyperirritability was demonstrated around a positive patch test reaction (38) but positive TRUE Test™ reactions to higher doses of nickel sulfate did not enhance adjacent patch test reactions (19) to lower doses of nickel.…”

Section: Spillovermentioning

confidence: 99%

Managing the excited skin syndrome: patch testing hyperirritable skin

Mitchell¹,

Maibach²

1997

Contact Dermatitis

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Inflammation-modulating phenomena (IMPs), humoral and cellular, fluctuate during the course of irritant and allergic contact dermatitis influencing irritability of the skin. The patch test procedure is a biological assay, a titration of responses to IMPs which can produce hyporeactivity or hyperirritability of the skin of patients who have dermatitis (PDs) and a single patch test is a 'snapshot' of the tempo of an evolving process. The excited skin syndrome (ESS) refers to hyperirritability from clinical and patch test dermatitis creating false-positive patch test reactions which are not reproducible when dermatitis and IMPs have subsided. During ESS, the threshold for irritancy decreases and irritant reactions increase. Patch test concentrations should be determined and ESS investigated in PDs having enhanced IMPs, not in 'normal' individuals, and if a patch test result is important to a patient the test should be performed more than once. Variable reproducibility is inherent in the patch test method, but ESS can be managed by appropriate testing and retesting, and search for relevance.

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Reproducibility of patch tests

Cited by 126 publications

References 25 publications

Macro‐video documentation patch tests

Macro‐video documentation patch tests

The Epidemiology of Fragrance Allergy: Questions and Needs

Managing the excited skin syndrome: patch testing hyperirritable skin

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