Patch test in Brazilian children with a clinical diagnosis of atopic dermatitis: a cross-sectional study using an extended patch test battery.

INTRODUCTION: Atopic dermatitis (AD) is a chronic and relapsing inflammatory skin disease mainly affecting children. Similarly, Allergic contact dermatitis (ACD) is an inflammatory skin disease, but unlike AD it results from direct exposure to an external agent. Theoretically, the impaired skin barrier facilitates the penetration of potential allergens. Therefore, AD patients are at risk for an associated ACD, exacerbating their skin condition. Because eczema is similar, performing a patch test (PT) for the differential diagnosis is essential. METHODS: In this cross-sectional transversal study, we performed a PT with 30 sensitizers in 26 children with AD, selected according to established criteria for suspected ACD, and treated at an AD center of a pediatric university hospital in Rio de Janeiro. Clinical presentation, patient profile, main sensitizers, and frequency of ACD caused by therapeutic skincare products were evaluated. RESULTS: In all, 23 (88.5%) patients reacted to at least one allergen, 21 (80.7%) had a relevant positive patch test, and 15 (57.7%) were polysensitized. The main positive sensitizers were nickel (38.5%), blue disperse (30.8%), fragrance mix (30.8%), and neomycin (23.1%). Nineteen (73%) patients reacted to substances present in therapeutic or skincare products. CONCLUSION: Our data underscore the importance of performing a PT in AD children whose eczema has atypical distribution. The expressive percentage of positive tests, especially of allergens in skincare products, indicates the constant need to review the proposed treatments. Therefore, we recommend a specific and expanded PT battery for pediatric AD patients, including a negative control, to increase sensitivity for diagnosing ACD.

Perfil de sensibilização de pacientes submetidos ao teste de contato no Instituto Lauro de Souza Lima no período de 2017 a 2023 / Sensitization profile of patients undergoing patch testing at the Lauro de Souza Lima Institute from 2017 to 2023

Introdução: O teste de contato (patch teste) é o padrão ouro para diagnóstico de dermatites alérgicas de contato (DACs), possibilitando a identificação do agente desencadeante. Mudanças nos hábitos de vida e exposição a novos agentes sensibilizantes presentes em medicamentos, cosméticos e outros produtos podem induzir mudanças no perfil de sensibilização da população. Objetivo: Realizar um levantamento do perfil dos pacientes que efetuaram o teste de contato no Instituto Lauro de Souza Lima (ILSL) no período entre 2017 e 2023, bem como a frequência de sensibilização aos elementos testados, para identificar alterações devido à pandemia de COVID-19. Material e Métodos: Foi realizado um estudo retrospectivo no ILSL, analisando os registros dos testes realizados de julho de 2017 a junho de 2023. Parâmetros como sexo, idade, atividade profissional, localização das lesões e sensibilização aos elementos testados da bateria padrão (n=30) e de cosméticos (n=10) foram avaliados. As reações foram classificadas de acordo com as recomendações do International Contact Dermatitis Research Group e os dados foram analisados usando o teste do qui-quadrado. Resultados: O estudo incluiu 738 indivíduos, sendo 67,9% do sexo feminino, com idade média de 45,4 anos. As regiões mais afetadas foram mãos (62,45%), pés (45,99%) e braços (26,58%). 75,80% apresentaram reação positiva a pelo menos uma das 40 substâncias testadas. O sulfato de níquel foi o elemento mais prevalente (35,91%), seguido por cloreto de cobalto (24,12%) e timerosol (15,04%). Na análise da bateria de cosméticos, verificamos maior prevalência de sensibilização ao amerchol L-101 (11,24%), bronopol (3,79%) e tonsilamida (3,11%). A sensibilização ao amerchol L-101 mostrou-se crescente a partir de 2020 com maior incidência em 2021 e permaneceu elevada até o final do período avaliado. Conclusão: O perfil de sensibilização a substâncias da bateria padrão no ILSL permaneceu semelhante ao observado em estudo anterior. Entretanto, houve um aumento na sensibilização ao amerchol L-101 no período da pandemia de COVID-19 o que pode estar associado a mudança de hábitos de higiene como aumento da frequência de lavagem de mãos e uso de produtos antissépticos

ABSTRACT: Patch testing is considered the gold standard for the diagnosing allergic contact dermatitis (ACD) and allows the identification of triggering allergens. Changes in lifestyle as well as exposure to new sensitizers present in medications, cosmetics, and other products, may induce changes in the sensitization profile of the population. Objective: To investigate the sensitization profile of patients who underwent patchtesting at the Lauro de Souza Lima Institute (ILSL) between 2017 and 2023, and the frequency of sensitization to the elements tested, to identify changes due to the COVID-19 pandemic. Materials and Methods: A retrospective study was conducted at the ILSL, analyzing medical records of tests performed from July 2017 to June 2023. Parameters such as sex, age, occupation, location of the lesion, and sensitization to the elements of the standard battery (n=30) and the cosmetic battery (n=10) were evaluated. Reactions were classified according to the recommendations of the International Contact Dermatitis Research Group, and the data were analyzed using the chi-squared test. Results: The study included 738 subjects, 67.9% female, mean age 45.4 years. The most commonly affected areas were the hands (62,4%), feet (46.0%), and arms (26.6%). 75.8% had a positive reaction to at least one of the 40 substances tested. Nickel sulfate was the most prevalent element (35.9%), followed by cobalt chloride (24.1%) and thimerosal (15.0%). Regarding the cosmetic battery, we found a higher prevalence of sensitization to amerchol L-101 (11.2%), bronopol (3.8%), and tonsilamide (3.1%). There was an increasing trend for sensitization to amerchol L-101 from 2020 onwards, reaching a peaking in 2021 and remaining at an elevated level until the end of the evaluated period. Conclusion: The sensitization profile to the standard series at ILSL remained similar to that observed in a previous study. However, there was an increase in sensitization to amerchol L-101 during the pandemic period, possibly related to changes in hygiene habits such as increased hand washing and the use of antiseptic products

[A drink with an unexpected ending... Adverse reaction by tonic water: A case report]. / Una copa con final inesperado... Reacción adversa por agua tónica: reporte de un caso.

BACKGROUND: Quinine is an alkaloid with antipyretic and anti-infective properties, and also an ingredient in tonic waters. Adverse reactions have been reported with this product, such as photosensitivity, vasculitis, and contact dermatitis. CASE REPORT: A 31-year-old male patient who, after 3-4 hours of consuming "Schweppes®" gin with tonic water, manifested ulcers on the lips and oral cavity, and a fixed erythematous lesion on the second phalanx of the hand, 24 hours later. Skin tests with aeroallergens and food were negative, and 48-hour patch tests were positive (quinine [++] and "Schweppes®" [++]). Based on the test findings, the diagnosis of an adverse reaction to quinine, contained in the tonic water, will be established. CONCLUSIONS: Quinine can be found in other types of foods or medications, so it is important to establish an accurate diagnosis and offer adequate recommendations to the patient with the consumption of this product.

ANTECEDENTES: La quinina es un alcaloide con propiedades antipiréticas, antiinfecciosas y, además, un ingrediente del agua tónica. Se han descrito reacciones adversas con este producto, como fotosensibilidad, vasculitis y dermatitis de contacto. REPORTE DE CASO: Paciente masculino de 31 años, que luego de 3-4 horas de consumir ginebra con agua tónica "Schweppes®" manifestó úlceras en los labios y la cavidad bucal, y una lesión eritematosa fija en la segunda falange de la mano, 24 horas después. Las pruebas cutáneas con aeroalérgenos y alimentos resultaron negativas, y las pruebas epicutáneas de 48 horas positivas (quinina [++] y "Schweppes®" [++]). Con base en los hallazgos de las pruebas, se estableció el diagnóstico de reacción adversa por quinina, contenida en el agua tónica. CONCLUSIÓN: La quinina puede encontrarse en diferentes alimentos o medicamentos, por lo que es importante establecer el diagnóstico preciso y ofrecer recomendaciones adecuadas por el consumo de este producto.

Neomycin: sources of contact and sensitization evaluation in 1162 patients treated at a tertiary service.

BACKGROUND: Neomycin is used in several over-the-counter pharmaceutical formulations in Brazil. In Europe and Canada, where it is not freely available, its sensitization frequency is lower than in the United States, where this does not occur. OBJECTIVE: To present the frequency of sensitization to neomycin observed in a tertiary hospital and the pharmaceutical formulations sold in Brazil containing neomycin. METHOD: Retrospective analysis of positive results to neomycin, obtained through patch tests performed in a tertiary hospital, from 2009 to 2018 and investigation of topical drugs and vaccines containing neomycin in Brazilian databases available on the internet. RESULTS: Among 1,162 patients, 71 (6%) had positive reactions to neomycin, 65% female and 35% male individuals, 46% were over 50 years old, and 24% had a personal history of atopy. The dermatitis lasted from four months to 20 years. Lesions were located in 69% of the patients on the upper limbs, in 55% they were on the lower limbs, and in 42% they were disseminated in more than 4 sites. Polysensitization was detected in 55% of cases. Of these, 28% were linked to sensitization to rubber allergens and 27% to potassium bichromate. A total of 158 topical presentations of neomycin were found: 79 ointments, 58 creams, 10 ophthalmic solutions, seven otological solutions, one oral solution, two nasal solutions, and one antiseptic powder, in addition to 11 types of vaccines. STUDY LIMITATIONS: Retrospective study. CONCLUSION: Sensitization to neomycin occurred in 6% of the studied population, affecting more females aged over 50 years, with skin lesions located mainly on the upper and lower limbs, in the context of chronic contact dermatitis. Neomycin was found in 135 formulations, most of them available over the counter, as well as in 11 miscellaneous vaccines.

Patch tests and hand eczema: retrospective study in 173 patients and literature review.

BACKGROUND: Hand eczema (HE) is a highly prevalent, recurrent, and multifactorial disease. It encompasses a group of eczematous diseases that affect the hands, etiologically classified into irritant contact dermatitis (ICD), allergic contact dermatitis (ACD) and atopic dermatitis (AD). Few epidemiological studies in Latin America have investigated the characteristics of patients with this condition and the origin of the disease. OBJECTIVES: To analyze the profile of patients diagnosed with HE submitted to patch tests aiming to determine its etiology. METHODS: A retrospective descriptive study was carried out on epidemiological data and patch tests of patients with HE treated at a tertiary hospital in the city of São Paulo from January 2013 to December 2020. RESULTS: A total of 173 patients were studied, whose final diagnosis was 61.8% of ICD, 23.1% of ACD and 5.2% of AD, with diagnostic overlap in 42.8% of the cases. The main positive and relevant patch tests were: Kathon CG (42%), nickel sulfate (33%), and thiuram mix (18%). STUDY LIMITATIONS: The number of treated cases and socioeconomic profile was limited to a vulnerable population group. CONCLUSION: HE is a diagnosis in which overlapping etiologies are frequent, with the main sensitizers identified in ACD being Kathon CG, nickel sulfate and thiuram mix.

Prospective study of consecutive patch testing in patients with contact dermatitis using an adapted Latin American baseline series.

Summary: Background. Contact dermatitis is characterized by pruritic skin lesions with high prevalence rates. Our objective is to describe the clinical and epidemiological characteristics of a population with suspected contact dermatitis who underwent to a patch testing using an adapted Latin American baseline series.Methods. Observational, descriptive, analytical clinical study with prospective data collection was performed. 208 participants who underwent patch testing using an adapted Latin American baseline series containing 40 allergens were analyzed. The prevalence of contact allergies was compared with data from the literature. Pearson's chi-square test was used for qualitative variables. Quantitative variables were compared using the Mann-Whitney U test. The significance of the regression parameters was tested using the Wald statistical test. Results. A total of 69.7% had one or more positive tests. Among those, 82.8% were women (OR 1.371; p = 0.398). The hands were the most commonly affected site at 43%. An occupational history was detected in 19.2%. The most common allergens were nickel sulfate (32.2%), sodium tetrachloropalladate (19.7%), fragrance mix I (15.4%), and methylisothiazolinone (13.5%). In multivariate logistic regression models, nickel was significantly related to female sex, as well as palladium. Fragrance mix I was related to a family history of allergy (p less than 0.05). Methylisothiazolinone was statistically significantly related to face and hand lesions. Conclusions. This study demonstrated a detailed profile of a population with suspected allergic contact dermatitis. Our patch test results, using an adapted Latin American baseline series, represent a significant update of this important diagnostic tool.

[Patch test in the diagnosis of food allergy]. / Prueba de parche en el diagnóstico de alergia alimentaria.

Food allergens are capable of producing adverse reactions through multiple mechanisms of an allergic or non-allergic nature, and through different routes of exposure; generally by ingestion or contact, as in protein contact dermatitis or contact urticaria, including inhalation. Food allergy reactions, in turn, can be mediated by immediate hypersensitivity mechanisms, delayed hypersensitivity or mixed immediate-delayed mechanisms. The reference diagnostic method in food allergy is the double-blind placebo-controlled food challenge test (DBPCFC), but skin and serological tests are important in the clinical context. The diagnosis of immediate food allergy depends on well-standardized allergological tests, such as the skin prick test (SPT) or specific IgE dosing, which are ideally tested by food challenge testing. However, the diagnosis of delayed mechanism food allergy and mixed allergies, which combine both immune mechanisms, is more complex. Delayed hypersensitivity reactions are evaluated with the epicutaneous patch test, or patch testing, for the diagnosis of contact dermatitis. The atopy patch test is initially used for the investigation of inflammatory reactions, which may be linked to food allergens in patients with atopic dermatitis. It was later applied in other diseases, whose pathogenesis is mainly mediated by a mechanism of delayed hypersensitivity to protein allergens: eosinophilic esophagitis, enterocolitis induced by food proteins, protein contact dermatitis, contact urticaria, among other disorders.

Los alergenos alimentarios son capaces de producir reacciones adversas por múltiples mecanismos de naturaleza alérgica o no, y mediante distintas vías de exposición; generalmente por ingestión o por contacto, como en la dermatitis por contacto a proteínas o urticaria por contacto, incluso por inhalación. Las reacciones de alergia alimentaria, a su vez, pueden ser mediadas por mecanismos de hipersensibilidad inmediata, hipersensibilidad retardada o mecanismos mixtos inmediato-retardados. El método diagnóstico de referencia en alergia alimentaria es la prueba de desafío con alimentos a doble ciego controlado con placebo (DBPCFC), pero las pruebas cutáneas y serológicas son importantes en el contexto clínico. El diagnóstico de alergia alimentaria inmediata depende de pruebas alergológicas bien estandarizadas, como la prueba de prick (skin prick test-SPT) o la dosificación de IgE específica, que idealmente se comprueban mediante la prueba de provocación con alimentos. Sin embargo, el diagnóstico de alergia alimentaria de mecanismo retardado y alergias mixtas, que combinan ambos mecanismos inmunes, resulta más complejo. Las reacciones de hipersensibilidad retardada se evalúan con la prueba de parche epicutáneo, o patch testing, para el diagnóstico de las dermatitis por contacto. La prueba de parche de atopia se utiliza, inicialmente, para la investigación de reacciones inflamatorias, que pueden vincularse con alergenos alimentarios en pacientes con dermatitis atópica. Posteriormente fue aplicada en otras enfermedades, cuya patogenia es principalmente mediada por un mecanismo de hipersensibilidad retardada a alérgenos proteicos: esofagitis eosinofílica, enterocolitis inducida por proteínas alimentarias, dermatitis por contacto a proteínas, urticaria por contacto, entre otras alteraciones.

Importância e aspectos clínicos da dermatite de contato por própolis / Importance and clinical aspects of propolis contact dermatitis

Objetivos: própolis é a substância resinosa que as abelhas coletam de plantas para a construção de suas colmeias. O objetivo dessa revisão foi ressaltar a importância do diagnóstico de dermatite de contato relacionada com própolis e aspectos clínicos relevantes dessa doença. Métodos: revisão narrativa da literatura realizada através da pesquisa nas bases de dados National Library of Medicine (PubMed) e Scientific Eletronic Library Online (SciELO). Resultados: foram encontrados 246 artigos e, após o processo de seleção e leitura, foram incluídas 32 publicações. Conclusões: a hipersensibilidade tardia ao própolis é de extrema importância pois a prevalência dessa alergia é crescente em diversas partes do mundo. Precisamos de estudos nacionais para avaliar nossa realidade. A comprovação de alta prevalência em nosso meio permitirá a inclusão desta substância em outras baterias de testes de contato em nosso país

Aims: propolis is the resinous substance that bees collect from plants to build their hives. The aim of this review was to highlight the importance of diagnosing propolis-related contact dermatitis and relevant clinical aspects of this disease. Methods: narrative literature review carried out by searching the National Library of Medicine (PubMed) and Scientific Electronic Library Online (SciELO) databases. Results: a total of 246 articles were found and, after the selection and reading process, 32 publications were included. Conclusions: delayed-type hypersensitivity to propolis is extremely important because the prevalence of this allergy is increasing in various parts of the world. We need national studies to assess our reality. Proof of the high prevalence in our country will allow this substance to be included in other patch tests series in our country

Effects of slime toy poisoning in children and teenagers.

OBJECTIVE: The aim of this study was to identify which types of skin reactions are associated with slime toys and which of their ingredients are most frequently involved in cases of poisoning. DATA SOURCE: Between January and July 2021, articles were selected using PubMed, SciELO, and LILACS databases. The following descriptors were used: (dermatitis OR rash OR eczema OR inflammation) AND slime. Inclusion criteria were articles available in full, in either Portuguese, English, or Spanish, published between January 2000 and July 31, 2021, and articles reporting cases of contact dermatitis or eczema potentially or directly attributed to slime toys. Articles not meeting these criteria and duplicate texts in the databases were excluded. DATA SYNTHESIS: In total, 65 publications were identified, of which 16 were included in this review. This resulted in a total of 22 children (2 males, 20 females), aged between 4 and 13 years, who were reportedly intoxicated by slime toys, most of these being linked to homemade preparations. Studies reported the occurrence of contact or allergic dermatitis on hands, fingers, nails, forearms, and cheeks. The most allergenic and/or irritant ingredients included liquid detergent and soap. Additionally, patch tests identified positive reactions to methylisothiazolinone and methylchloroisothiazolinone, the preservatives used by chemical industries on preparation of glue, soap, detergents, etc. CONCLUSIONS: Although slime toys might be important for improving motor development and parental relationships, homemade slime toy recipes include several allergenic and irritant ingredients which might be exposed to vulnerable children and cause intoxications. Therefore, homemade slime toys preparations should be used cautiously and under the supervision of adults.

Sensitizing agents found in children and adolescents with recalcitrant atopic dermatitis: a cross-sectional study with a pediatric battery.

BACKGROUND: Atopic dermatitis is the most common inflammatory skin disease in childhood and has an important impact on quality of life, especially severe cases or those that are recalcitrant to treatments. Sensitization to allergens with the potential for allergic contact dermatitis is a factor associated with cases of recalcitrant atopic dermatitis. Understanding the relationship between atopic dermatitis, allergens, and allergic contact dermatitis is essential. In Brazil, there are no studies on sensitization to allergens found in patch tests with pediatric batteries in patients with atopic dermatitis. OBJECTIVES: To verify the main sensitizing agents, the prevalence of allergic contact dermatitis and the epidemiological and clinical profile of children and adolescents with atopic dermatitis. METHODS: Cross-sectional, prospective study in patients between 4 and 18 years of age, with recalcitrant atopic dermatitis, treated at the Sanitary Dermatology Outpatient Clinic (RS). All patients underwent patch tests with a battery of pediatric allergens. RESULTS: The prevalence of sensitization and allergic contact dermatitis in the evaluated patients was 37.07% (20/54) and 27.7% (15/54), respectively. The most frequent allergens were: nickel sulfate (16.7%), disperse blue (5.6%), and fragrance mix I (5.6%). Nickel was associated with the female sex (p = 0.019). STUDY LIMITATIONS: Sample size and selection, absence of a control group. CONCLUSIONS: A proportion of patients with recalcitrant atopic dermatitis may be sensitized to different allergens and may even have developed allergic contact dermatitis. Recognizing this context is important in the prevention strategy and management of the disease.

Combined prick and patch tests for diagnosis of food hypersensitivity in dogs with chronic pruritus.

BACKGROUND: Previous studies have shown that patch testing with food extracts can assist formulation of elimination diets (ED) in human patients with suspected adverse food reactions (AFR). Little is known about the use of these tests in dogs. OBJECTIVES: To evaluate the effectiveness of a combination of prick and patch testing in current protocols, and food challenge (FC) tests in dogs with AFR. METHODS AND MATERIALS: Prick and patch tests were performed on 21 dogs with chronic, nonseasonal pruritus. Dogs then were fed an ED formulated on the basis of the results. All dogs with improved clinical signs then were challenged with a food to which there had been a positive reaction in the tests. Six dogs subsequently were challenged with a food to which they had been negative on testing. Pruritus Visual Analog Scale (pVAS) and Canine Atopic Dermatitis Extent and Severity Index, 4th iteration (CADESI-04) were evaluated on Day (D)0, D30 and D60 of the ED. Sensitivity (SE), specificity (SP), positive (PPV) and negative (NPV) predictive values, and the Kappa (κ)value were calculated. RESULTS: Of the 21 dogs, there was a significant mean improvement in pVAS and CADESI-04 scores in 16 (76%) dogs after D30 (P < 0.01) and D60 (P < 0.01) of the ED. There were no statistical differences between D30 and D60. The combination of tests had SE, SP, PPV, NPV and κ values of 80%, 66.7%, 66.7%, 80% and -0.17, respectively. CONCLUSIONS AND CLINICAL RELEVANCE: The combination of prick and patch testing reached high values of SE and NPV. A diagnosis of AFR was made in 76% of the dogs, and test results were useful for the selection of an ED.