Patient-Reported Association Between COVID-19 Infection or Vaccination and Onset of Allergic Contact Dermatitis.

Background: Over the course of the COVID-19 pandemic, our clinic has encountered numerous patients who report that either COVID-19 vaccination or infection was the precipitating event for their development of allergic contact dermatitis (ACD). Up to this time, there is no formal investigation regarding COVID-19 vaccination or infection causing ACD. However, there have been several registry-based case series of associated dermatoses after COVID-19 infection or vaccination. Objective: This study aimed to describe patient-reported associations between COVID-19 infection or vaccination and onset of ACD. Methods: A single-center retrospective noncomparative chart review of 1073 patients patch tested at the Park Nicollet Contact Dermatitis Clinic (Minneapolis, MN) from March 1, 2020, to March 1, 2022, was performed. Results: Of 1073 patients included in our study, 5 patients (0.47%) reported ACD symptom onset after COVID-19 infection and 12 patients (1.11%) reported onset after COVID-19 vaccination. Rates of clinical relevance were not significantly different than the general population for those who attributed ACD to COVID-19 infection or vaccination. Conclusions: To our knowledge, this is the first study in the literature investigating the potential association between COVID-19 vaccination or infection and the development of ACD through extensive retrospective chart review.

Cross-Reactivity Between Propylene Glycol and Butylene Glycol.

Background: Propylene glycol (PG) and butylene glycol (BG) are not known to be cross-reactors. However, no large-scale studies have assessed the cross-reactivity rate (CRR) between these 2 structurally and functionally similar compounds. Objectives: The aim of this study was to determine whether PG and BG demonstrate cross-reactivity. Methods: This is a retrospective chart review of 893 patients who underwent patch testing for both PG and BG from 2020 to 2022. The frequencies of positive reactions and concomitant reaction rates were calculated. Results: In our cohort, 53 (5.94%) patients reacted to PG and 13 patients (1.46%) reacted to BG. Of the patients who reacted to PG, 6 reacted to BG representing a CRR of 11.3%, whereas the CRR to PG in BG-allergic patients was 46.2%. Conclusions: For those allergic to BG, PG should be considered a cross-reactor. This relationship is somewhat unidirectional, as patients allergic to PG demonstrated a CRR to BG of only 11.3%, significantly lower than the 46.2% CRR to PG among BG-allergic patients.

Patch Testing: The Patient Experience.

BACKGROUND: Data regarding patient-reported symptoms during patch testing are limited. OBJECTIVE: To provide frequency of symptoms (pain, sleep difficulty, medication need, site itching, itch elsewhere, and worsening rash) experienced by patients undergoing extensive patch testing and to determine association of these symptoms with patient characteristics. METHODS: This was a retrospective chart review of patients who underwent patch testing at a tertiary referral, contact dermatitis clinic over 15 months. Demographics, number of patches placed, patch location(s), and number of reactions (total and ++/+++) were extracted by chart review. Frequency of symptoms reported on a questionnaire administered at the 48-hour (48H) and final (F) visits was tabulated, and associations were evaluated using χ2 and Fisher exact tests. RESULTS: Six hundred forty-one patient records were accessed. The most common symptom was patch site itching (48H, 77.4%; F, 76.5%). Frequency of pain and sleep difficulty were significantly higher at 48H compared with F (P < 0.0001). Worsening of rash was significantly higher at F compared with 48H (P < 0.0001). The number of patches was significantly associated with all symptoms except sleep difficulty (P ≤ 0.0141). Patch location was significantly associated with pain, medication need, itch elsewhere, and worsening rash but not sleep difficulty or site itch (P ≤ 0.0257). The number of reactions (total and ++/+++) was significantly associated with all symptoms except itch elsewhere (total P ≤ 0.0316; ++/+++: P ≤ 0.0445). CONCLUSIONS: Most patients reported symptoms during patch testing, most commonly itching (at patch site and elsewhere), sleep difficulty, and need for medication. The number of positive patch test reactions (total and ++/+++) was the most common characteristic associated with the symptoms.

Cutaneous Reactions to Aluminum.

: Cutaneous exposure to aluminum may occur via contact with metal items, medications, and personal care products. Despite the widespread use of aluminum, allergic contact dermatitis is relatively rare. Sensitization is often incidentally identified during patch testing with aluminum-based chambers. This article presents several cases along with a literature review summarizing prevalence and clinical manifestations of cutaneous reactions to aluminum, recommendations for patch testing, sources of aluminum, and reproducibility of aluminum allergy over time.