Contact allergy to haptens in the Swedish baseline series: Results from the Swedish Patch Test Register (2010 to 2017).

BACKGROUND: Allergic contact dermatitis has considerable public health impact and causative haptens vary over time. OBJECTIVES: To report the prevalence of contact allergy to allergens in the Swedish baseline series 2010 to 2017, as registered in the Swedish Patch Test Register. METHODS: Results and demographic information for patients tested with the Swedish baseline series in 2010 to 2017 were analysed. RESULTS: Data for 21 663 individuals (females 69%) were included. Females had significantly more positive patch tests (54% vs 40%). The reaction prevalence rates were highest for nickel sulfate (20.7%), fragrance mix I (7.1%), Myroxylon pereirae (6.9%), potassium dichromate (6.9%), cobalt chloride (6.8%), methylchloroisothiazolinone/methylisothiazolinone (MCI/MI; 6.4%), MI (3.7%), colophonium (3.5%), fragrance mix II (3.2%), and formaldehyde (3.2%). Myroxylon pereirae reaction prevalence increased from 5% in 2010 to 9% in 2017 and that for methyldibromo glutaronitrile from 3.1% to 4.6%. MCI/MI and MI reactions decreased in prevalence after 2014. Nickel reaction prevalence decreased among females aged 10 to 19 years. CONCLUSIONS: Nickel remains the most common sensitizing agent, with reaction prevalence decreasing among females younger than 20 years. The changes in MCI/MI and MI reaction prevalence mirrored those in Europe. The register can reveal changes in contact allergy prevalence over time among patients patch tested in Sweden.

Patch testing with the Japanese baseline series 2015: A 4-year experience.

BACKGROUND: The Japanese baseline series (JBS), established in 1994, was updated in 2008 and 2015. The JBS 2015 is a modification of the thin-layer rapid-use epicutaneous (TRUE) test (SmartPractice Denmark, Hillerød, Denmark). No nationwide studies concerning the TRUE test have previously been reported. OBJECTIVES: To determine the prevalence of sensitizations to JBS 2015 allergens from 2015 to 2018. METHODS: We investigated JBS 2015 patch test results using the web-registered Skin Safety Care Information Network (SSCI-Net) from April 2015 to March 2019. RESULTS: Patch test results of 5865 patients were registered from 63 facilities. The five allergens with the highest positivity rates were gold sodium thiosulfate (GST; 25.7%), nickel sulfate (24.5%), urushiol (9.1%), p-phenylenediamine (PPD; 8.9%), and cobalt chloride (8.4%). The five allergens with the lowest positivity rates were mercaptobenzothiazole (0.8%), formaldehyde (0.9%), paraben mix (1.1%), mercapto mix (1.1%), and PPD black rubber mix (1.4%). CONCLUSIONS: Nickel sulfate and GST had the highest positivity rates. The JBS 2015, including a modified TRUE test, is suitable for baseline series patch testing.

Trends in Patch Testing by Health Care Providers Among US Medicare Beneficiaries.

BACKGROUND: Although patch testing has historically been done by dermatologists, allergists are also patch testing. Little is known about the current utilization of patch testing by medical specialists. OBJECTIVE: The aim was to determine trends in utilization of patch testing in Medicare beneficiaries by various clinicians and demographics. METHODS: Data from the 2012-2017 Medicare Public Use File were analyzed, including 82,241 total unique clinicians of whom 312 filed a patch testing claim. RESULTS: Dermatologists had a steady share of patch tests (annual clinicians; annual patches) from 2012 (158; 258,735) to 2017 (199; 351,994), an increase of 25.9% and 36.0%, respectively. Allergists, however, had a marked increase in utilization of patch tests from 2012 (84; 62,498) to 2017 (187; 182,480), an increase of 122.6% and 192.0%, respectively. In multivariable logistic regression models, male dermatologists and allergists had increased odds of patch testing (P < 0.001 for both), as did clinicians in the Northeast and Southern United States (P ≤ 0.003 for both). LIMITATIONS: Data are only available for Medicare Part B patients; changes in utilization may be different for individuals, private insurance, or Medicare Advantage Plans. CONCLUSIONS: Relative to dermatologists, patch testing is increasing among allergists. Addressing barriers to patch testing may increase rates of patch testing by dermatologists.

Pediatric contact dermatitis: what's new.

PURPOSE OF REVIEW: Allergic contact dermatitis (ACD) was once thought to be rare in children but recent studies have demonstrated that the prevalence of ACD is common and appears to be increasing in children. Current trends including toys, hobbies, and personal care products may play a role in potentially new allergen exposure or resurgence of certain allergens, making ACD a moving target in children. RECENT FINDINGS: ACD and atopic dermatitis can coexist and certain clinical features can help differentiate ACD from endogenous atopic dermatitis in children. It is important to consider ACD in children with recalcitrant atopic dermatitis or dermatitis with atypical distribution. Patch testing has become a more common practice in children. In 2018, the first expert consensus-derived pediatric baseline series consisting of 38 allergens was proposed to aid in the diagnosis of ACD in children. Comparing recent patch testing data in the pediatric population, the top allergens ubiquitously identified were nickel, cobalt, neomycin, Myroxylon pereirae (balsam of Peru), fragrance mix I, fragrance mix II, methylisothiazolinone, methylchloroisothiazolinone/ methylisothiazolinone, formaldehyde, and lanolin. SUMMARY: ACD is a common problem in children. Detection through patch testing, avoidance of offending allergens, and prevention of common allergens are the main focus of management of ACD in children.

American Contact Dermatitis Society Allergens of the Year 2000 to 2020.

Allergic contact dermatitis is a delayed type IV hypersensitivity skin reaction to external stimuli. Patterns of dermatitis depend on allergen exposure and patch testing is the gold standard to identify causal agents. The American Contact Dermatitis Society identifies an "Allergen of the Year" in order to highlight facts about particular allergens, which may range from showing increasing prevalence of disease, to documenting low levels of relevant allergic reactions. This article reviews the allergens of the year from 2000 to 2020 with an emphasis on clinical relevance. Categories of allergens include adhesives, dyes, medications, metals, preservatives, rubber accelerators, surfactants, and other skin care product ingredients.

Trends in Patch Testing With the Mayo Clinic Standard Series, 2011-2015.

BACKGROUND: Patch testing to a standard (baseline) series of allergens is the screening tool used to identify culprit allergens in patients with contact dermatitis. The allergens and concentrations used in a standard series are constantly evolving to be most relevant to the patients being patch tested. OBJECTIVE: The aim of this study was to analyze the 2011-2015 patch test results of the Mayo Clinic standard series. METHODS: We retrospectively reviewed patch test reactions of standard series allergens from 2011 through 2015 and compared these results with the 2011-2012 and 2013-2014 North American Contact Dermatitis Group (NACDG) reports. CONCLUSIONS: Of 2582 patients included, 1566 (60.7%) had at least 1 positive reaction, and 516 (20.0%) had at least 1 irritant reaction. The 15 allergens with the highest reaction rates (from highest to lowest) were nickel sulfate hexahydrate, methylisothiazolinone, Myroxylon pereirae resin, neomycin sulfate, cobalt (II) chloride hexahydrate, benzalkonium chloride, fragrance mix I, potassium dichromate, bacitracin, methylchloroisothiazolinone/methylisothiazolinone, carba mix, formaldehyde, p-phenylenediamine, quaternium-15, and methyldibromo glutaronitrile. Twelve (80%) of these allergens were also in the top 15 of the most recent NACDG report; the 3 allergens not in the NACDG top 15 allergens were potassium dichromate, benzalkonium chloride, and methyldibromo glutaronitrile (the latter 2 allergens are not included in their series).

Sobre la necesidad y el futuro de las Unidades de Eczema / About the Need and the Future of Eczema Units

No disponible

Trends and Scope of Dermatology Procedures Billed by Advanced Practice Professionals From 2012 Through 2015.

Importance: Advanced practice professionals (APPs) such as nurse practitioners and physician assistants independently perform a large number and variety of dermatologic procedures, but little is known about how the number and scope of these procedures have changed over time. Objective: To examine the trends in scope and volume of dermatology procedures billed by APPs over time. Design, Setting, and Participants: A longitudinal study was conducted using the Medicare Provider Utilization and Payment Data: Physician and Other Supplier Public Use File from 2012 through 2015. The data encompass nearly all outpatient procedures paid by Medicare Part B in the United States and include the type of clinician under which procedures were billed. Main Outcomes and Measures: For each type of dermatology procedure, the total number performed by APPs and the total number performed by dermatologists each year. Results: The total number (and percentage) of all dermatologic procedures performed by APPs increased from 2.69 million of 30.7 million (8.8%) in 2012 to 4.54 million of 33.9 million (13.4%) in 2015. The most common procedures performed by APPs in 2015 were destructions of benign neoplasms (3.6 million), biopsies (788 834), and destructions of malignant neoplasms (48 982). The numbers of patch tests, removals of benign and malignant neoplasms, intermediate and complex repairs, flaps, and surgical pathologic specimen examinations by APPs also increased each year from 2012 through 2015. Conclusions and Relevance: The number and scope of dermatologic procedures performed by APPs appear to be increasing over time. These procedures can be difficult and invasive. This study suggests that further studies are needed to determine what association these procedures have with patient outcomes and the potential need for more formal training.

Time trends of contact allergy to the European baseline series in Lithuania.

BACKGROUND: Monitoring trends of positive patch test reactions is useful for epidemiological surveillance and contact allergy prevention, and has not previously been reported in Lithuania. OBJECTIVES: To examine and compare changes in the prevalence of contact allergy to European baseline series allergens in adults with suspected contact dermatitis during a 9-year period. METHODS: In this retrospective study, patch test results of 297 consecutive patients, tested with the European baseline series in 2014-2015, were analysed and compared with the data published earlier in Lithuania. RESULTS: The most common allergens were nickel sulfate (30.6%), methylisothiazolinone (MI) (13.5%), methylchloroisothiazolinone (MCI)/MI (7.4%), potassium dichromate (6.1%), cobalt chloride (6.1%), Myroxylon pereirae resin (5.4%), p-phenylenediamine (5.4%), fragrance mix I (4.7%), formaldehyde (4.4%), and methyldibromo glutaronitrile (3.7%). Increases in the prevalence of sensitization to MCI/MI (2.3% in 2006-2008 and 7.4% in 2014-2015; p < 0.0001) and nickel sulfate (16.4% in 2006-2008 and 30.6% in 2014-2015; p < 0.0001) and decreases in the prevalence of sensitization to paraben mix (3.2% in 2006-2008 and 0.3% in 2014-2015; p = 0.006) were observed. Prevalences for the other allergens remained stable or showed a decreasing trend (Myroxylon pereirae resin; p = 0.06). CONCLUSION: This study provides current information on the prevalence of contact allergy in Lithuania. Changing trends in sensitivity to some allergens probably reflect changes in exposure.

Drug reaction with eosinophilia and systemic Symptoms (DRESS) Syndrome in children: a case report

No disponible

Protein contact dermatitis to chrysanthemum

No disponible

[Metal implant allergy update]. / Update Metallimplantatallergie.

Intolerance reactions to metal implants may also be caused by metal allergy. A differential diagnostic workup must be performed based on the complaints of the patient. For patch testing the standard series with its nickel, cobalt, chromium preparations is used. There is no consensus regarding implant metal test series or, for example, bone cement test series; however, progress is being made. The combination of several diagnostic tools including histology is useful. The lymphocyte transformation test (LTT) must be performed by experienced laboratories and results must be carefully evaluated. New insights into pathomechanisms of intolerance reactions to metal implants and identification of potential biomarkers are expected.

Estudio de sensibilización a corticoides en una consulta de alergia cutánea / Corticosteroid hypersensitivity studies in a skin allergy clinic

INTRODUCCIÓN: Los corticoides pueden producir reacciones de hipersensibilidad, sobre todo retardadas. Se ha propuesto una nueva clasificación para el estudio de la alergia a corticoides que los divide en 3 grupos según su estructura molecular y establece 2 perfiles de pacientes según estén sensibilizados a uno o varios grupos. Los objetivos de este estudio son describir las características clínicas de nuestros pacientes alérgicos a corticoides, compararlas con las del resto de la población estudiada y analizar su distribución según la nueva clasificación. MATERIAL Y MÉTODOS: Estudio retrospectivo de 11 años que incluye los casos de pacientes con reacciones de hipersensibilidad retardada a corticoides en la Unidad de Alergia Cutánea del Servicio de Dermatología de un hospital terciario. RESULTADOS: Estudiamos a 2.857 pacientes, de los cuales 33 presentaron uno o más parches positivos a los corticoides. Estos pacientes presentaron menos dermatitis atópica y menor afectación de las manos. Todos fueron alérgicos a algún corticoide del grupo 1 y la budesonida fue el más frecuente (87,9%). Con la batería específica de corticoides observamos que 14 (42,4%) eran, además, alérgicos a corticoides del grupo 2 o 3. Ninguno fue alérgico solo a corticoides del grupo 2 o 3. El 61,9% (13/21) de los pacientes que fueron testados con cremas con un corticoide del grupo al cual era alérgicos no presentó reacción a aquellas. CONCLUSIONES: La batería estándar española tiene solo marcadores para la alergia a corticoides del grupo 1. Recomendamos aplicar una batería específica de corticoides y los fármacos propios si los marcadores son positivos para poder clasificarlos mejor y adecuar su manejo terapéutico

INTRODUCTION: Corticosteroids can cause hypersensitivity reactions, particularly delayed-type allergic reactions. A new classification system for testing hypersensitivity to corticosteroids distributes the drugs into 3 groups according to molecular structure; patients are classified according to whether they are allergic to agents in 1 or more of the groups. We aimed to describe the clinical characteristics of corticosteroid-allergic patients treated at our clinic and apply the new classification system to them; we also compared these patients' characteristics to those of others treated at our clinic. MATERIAL AND METHODS: Retrospective study of cases of delayed-type corticosteroid hypersensitivity treated in the skin allergy clinic of a tertiary level hospital over an 11-year period. RESULTS: We reviewed the records of 2857 patients, finding 33 with at least one positive patch test result showing corticosteroid hypersensitivity. Atopic dermatitis and hand involvement were less common in our corticosteroid-allergic patients. All were allergic to a group 1 corticosteroid (most often, budesonide, the culprit in 87.9%). Testing with a specific corticosteroid series revealed that 14 (42.4%) were also allergic to corticosteroids in group 2 and/or group 3. None were allergic exclusively to group 2 or group 3 agents. Twenty-one patients were exposed to a corticosteroid cream from a group their patch test results indicated allergy to; 13 of them (61.9%) did not develop a hypersensitivity reaction. CONCLUSIONS: The Spanish standard series only contains group 1 corticosteroids. In the interest of improving allergy management, we recommend testing with a specific corticosteroid series and a patient's own creams whenever patch testing with a standard series reveals a hypersensitivity reaction to corticosteroids

Contact allergy trends in Sweden - a retrospective comparison of patch test data from 1992, 2000, and 2009.

BACKGROUND: Contact allergy prevalence rates change over time as a result of variations in allergen exposure. Data from patch test clinics are often used as markers for allergy trends. OBJECTIVES: The aim of the present retrospective study was to describe trends in rates of sensitization to allergens in the Swedish baseline series. PATIENTS/MATERIALS/METHODS: Prevalence rates are described by comparing consecutive patch test data from 1992, 2000 and 2009 in Swedish patch test clinics. In total, 3680 patients were included in 1992, 3825 in 2000, and 3112 in 2009. RESULTS: Among test substances with a sensitization rate above 2% in 2009, significant decreases were noted for nickel sulfate, cobalt chloride, colophonium, and methylchloroisothiazolinone (MCI)/methylisothiazolinone (MI), and a significant increase for p-phenylenediamine, as compared with 1992. Potassium dichromate reactions had increased among younger women, whereas reactions to nickel and cobalt had decreased in this group. Sensitization to chromium, cobalt and fragrance mix I had decreased among older men, and sensitization to nickel had decreased among younger men. CONCLUSIONS: It is probable that these changes in 1992-2009 reflect both changes in regulations for nickel, lower levels of chromium in cement and of MCI/MI in cosmetics, and increasing use of hair dyes.

A new occlusive patch test system comparable to IQ and Finn chambers.

BACKGROUND: A good patch test system should have good adhesion and contact, and minimal leakage; Finn and IQ patch test system have these properties but are expensive. AIMS: To develop a new cost-effective occlusive patch test system that had good contact with the skin and was non-irritant. METHODS: The system (designated Chamber X) was fabricated using a semi-permeable tape and a flexible virgin plastic chamber. Chamber X was developed by (i) selecting adhesive tape based on its non irritancy and adhesive potential (ii) testing plastic chamber material for its skin irritancy (iii) testing the assembled system against Finn, IQ and locally available chambers for irritancy, contact, leakage and occlusivity. RESULTS: Chamber X showed better occlusion than IQ, Finn and locally available chambers and was comparable to, (P > 0.05) IQ and Finn in terms of irritancy, contact and leakage. CONCLUSIONS: The results demonstrate that the Chamber X offers a cost effective patch test system comparable to IQ and Finn chambers in terms of safety, adhesion, leakage and occlusivity.

Current trends in patch testing - new data from the German Contact Dermatitis Research Group (DKG) and the Information Network of Departments of Dermatology (IVDK).

BACKGROUND AND OBJECTIVES: The relevance of contact allergens is subject to constant change due to changing exposures according to consumers' preferences and legal requirements. The objective of this paper is to present trends in contact sensitization from the DKG and IVDK patch test clinics, which have led to changes in the DKG standard series (as of 1.1.2014), as well as the current legal framework which has influenced these trends and the way patch testing is performed. PATIENTS AND METHODS: The patients from 56 DKG and IVDK patch test clinics from 2010 (n = 13,117), 2011 (n = 13,320) and 2012 (n = 12,529) were analyzed with regard to frequencies of sensitization (hit list) to contact allergens as well as the location of allergic contact dermatitis. RESULTS: With a sensitization rate of 15 % nickel is still the most frequently recognized contact allergen. An increase can be observed for fragrance mix I (9.1 %), the preservative composition of methylchloroisothiazolinone/methylisothiazolinone (MCI/MI) (4.5 %) and methylisothiazolinone (MI) alone (6.8 %). A decline is present for potassium dichromate from above 6 % (2007) to 3 % (2012) and for bufexamac (currently at 0.6 %). Backgrounds, legal requirements and resulting changes to the DKG standard series are illustrated. CONCLUSIONS: The indicated trends demonstrate the relevance of clinical epidemiology and the "sentinel function" of DKG and IVDK with regard to public health and prevention of contact allergies.

Trends in patch-test results and allergen changes in the standard series: a Mayo Clinic 5-year retrospective review (January 1, 2006, to December 31, 2010).

BACKGROUND: Patch testing is essential for identification of culprits causing allergic contact dermatitis. OBJECTIVE: We sought to identify trends and allergen changes in our standard series during 2006 to 2010, compared with our previous report (2001-2005). METHODS: We conducted a retrospective review of patch-test results. RESULTS: A total of 3115 patients were tested with a mean of 73.0 allergens. Since our prior report, 8 allergens were added to the standard series; 14 were deleted. Significantly higher rates of allergic positive reaction were documented for carba mix, 3%, and Disperse Orange 3, 1%. Rates were lower for 10 allergens: neomycin sulfate, 20%; gold sodium thiosulfate, 0.5%; hexahydro-1,3,5-tris(2-hydroxyethyl)triazine, 1%; disperse blue 124, 1%; disperse blue 106, 1%; diazolidinyl urea, 1%; hexylresorcinol, 0.25%; diazolidinyl urea, 1% aqueous; 2-bromo-2-nitropropane-1,3-diol, 0.25%; and lidocaine, 5%. Many final patch-test readings for many allergens were categorized as mild reactions (erythema only). Overall allergenicity and irritancy rates declined significantly since our prior report. Results were generally comparable with those in a North American Contact Dermatitis Group report from 2005 to 2006. LIMITATIONS: This was a retrospective study; there is a lack of long-term follow-up. CONCLUSIONS: Since our previous report, our standard series composition has changed, and overall rates of allergenicity and irritancy have decreased. Notably, many final patch-test readings showed mild reactions.

Sensibilización de contacto a alérgenos de la serie estándar en el Hospital Costa del Sol: Estudio retrospectivo (2005-2010) / Contact Sensitization to Allergens in the Spanish Standard Series at Hospital Costa del Sol in Marbella, Spain: a Retrospective Study (2005-2010)

La prevalencia de la alergia de contacto a los diferentes compuestos puede variar dependiendo de la población estudiada, de la técnica y del material empleado en las pruebas epicutáneas. En España el Grupo Español de Investigación en Dermatitis de Contacto y Alergia Cutánea (GEIDAC) ha propuesto una batería de 29 alérgenos para estudiar a los pacientes con sospecha de dermatitis de contacto alérgica. Material y métodos: Análisis retrospectivo de 839 pacientes con sospecha de dermatitis de contacto, realizado en el Hospital Costa del Sol desde el 1 de enero de 2005 hasta el 31 de diciembre de 2010. Para ello se utilizaron pruebas epicutáneas estándar de 34 alérgenos en las que estuvieron incluidos los 29 compuestos de la batería estándar española propuesta por el GEIDAC. Objetivo: Valorar la prevalencia de la sensibilización de contacto entre los pacientes estudiados y estudiar su asociación con factores sociodemográficos (sexo, edad, localización, ocupación) y clínicos (dermatitis atópica). Resultados: El 48% de los pacientes presentó sensibilización al menos a uno de los alérgenos testados. Las mujeres presentaron una frecuencia de sensibilización más elevada que los hombres (56,9 vs. 33,1%). La localización afectada con mayor frecuencia fue la mano (36,1%). Los alérgenos más frecuentes fueron sulfato de níquel (25,9%), dicromato potásico (7,6%), tiomersal (5,1%), cloruro de cobalto (4,5%) y mezcla de fragancias I (3,8%). Por el contrario, se detectó una baja frecuencia de sensibilización a conservantes como mezcla de parabenos (0,1%), imidazolidinil urea (0,1%), diazolidinil urea (0,2%) y mezcla de quinoleínas (0,2%). No se registraron sensibilizaciones para lactonas sesquiterpénicas y metildibromoglutaronitrilo (euxyl K400). Conclusiones: Nuestros resultados son similares a los previamente publicados a nivel nacional. La baja sensibilización a ciertos alérgenos, como la mayoría de conservantes y las lactonas sesquiterpénicas, podría hacer necesario reconsiderar su utilidad como alérgenos en futuras series estándar (AU)

Background: The prevalence of contact allergy to different compounds can vary according to the population studied, the technique used, and the materials employed in patch tests. The Spanish Contact Dermatitis and Skin Allergy Research Group (GEIDAC) has proposed a panel of 29 allergens for use in patients with suspected allergic contact dermatitis. Objective: To determine the prevalence of contact sensitization in a group of Spanish patients and to analyze potential associations with sociodemographic and clinical variables (sex, age, site of lesions, occupation, and diagnosis of atopic dermatitis). Material and methods: A retrospective study of patients with suspected contact dermatitis was undertaken at Hospital Costa del Sol in Marbella, Spain, for the period between January 1, 2005 and December 31, 2010; 839 patients were included in the analysis. Patch tests were carried out with 34 allergens, including the 29 compounds that comprise the Spanish standard panel proposed by the GEIDAC. Results: Sensitization to at least 1 allergen in the panel was observed in 48% of patients. Women had a higher frequency of sensitization than men (56.9% vs 33.1%). The hands were the most commonly affected site (36.1%). The most frequently involved allergens were nickel sulfate (25.9%), potassium dichromate (7.6%), thiomersal (5.1%), cobalt chloride (4.5%), and fragrance mix I (3.8%). In contrast, preservatives such as paraben mix (0.1%), imidazolidinyl urea (0.1%), diazolidinyl urea (0.2%), and quinoline mix (0.2%) had low rates of sensitization. Sensitization to sesquiterpene lactones and methyldibromo glutaronitrile (euxyl K 400) were not observed. Conclusions: Our results are similar to those previously reported for Spanish patients. The low level of sensitization to certain allergens such as most preservatives and sesquiterpene lactones may suggest that their use in standard patch test series should be reconsidered(AU)