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).

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.

Changing trends and allergens in the patch test standard series: a mayo clinic 5-year retrospective review, january 1, 2001, through december 31, 2005.

OBJECTIVE: To present and interpret results of patch testing with the Mayo Clinic standard series over 5 years. DESIGN: Retrospective study. A standardized patch testing technique was used. Data were recorded on a standardized computer program from January 1, 2001, to December 31, 2005, and analyzed. SETTING: Tertiary referral center. PATIENTS: Patients who were referred for patch testing. INTERVENTION: Patch testing with the "standard series," ie, a standard series of allergens used by most clinicians to identify the most common offending allergens in patients with allergic contact dermatitis. MAIN OUTCOME MEASURES: Number of patients patch tested, allergens used over this period, and rates of allergic patch test reactions to allergens. RESULTS: A total of 3854 patients (mean age, 55.1 years; age range, 6.2-99.4 years; 2576 female [66.8%]) were tested. All dermatologists in the department performed patch testing. The mean number of allergens included was 69.3 (range, 6-87). There were 2664 patients with at least 1 positive reaction (69.1%) and 1933 with 2 or more positive reactions (50.2%). Metals, fragrances, topical antibiotics, preservatives, and individual allergens used in hair-care products, topical corticosteroids, glues, plastics, and rubber were still the most common allergen groups associated with allergic patch test reactions. CONCLUSIONS: We describe the structure of the patch testing service at our referral center. Ongoing analysis of our patch test reaction rates allows us to recommend broad, clinically relevant, and up-to-date allergens for testing.

Allergic contact dermatitis to preservatives.

In summary, a wide variety of skin care products contain preservatives. Patients who are allergic to one of these preservatives may have either localized or widespread dermatitis. Affected patients may find it difficult to avoid thimerosal without the help of the health care provider because the use of these allergens is so widespread. Patch testing is an invaluable tool for patients who struggle with dermatitis. Antigen-avoidance lists that facilitate patient education about what products to avoid are available from the manufacturers of patch test allergens (for example, TRUE Test or Chemotechnique). These lists are helpful starting points for patients in that they provide general categories (for example, shampoos, soaps, or creams) of products that the patient should avoid. With these printed guidelines alone, patients must read skin care product labels carefully, looking for the names of their allergens as identified by patch tests as well as for any synonyms and cross-reactors of these allergens. Thus, patients may feel overwhelmed by hearing the names of allergens that are long and complex. After an allergen has been identified, the nurse can play a key role in helping patients understand their dermatitis and its management. Nurses are in a unique position to spend time educating patients about how to uncover the sources of specific allergens and, subsequently, how to avoid them. The Contact Allergen Replacement Database can help in this educational process by giving patients a shopping list of specific items that are free of the specific allergens causing their allergic contact dermatitis.

Patch test results from the Mayo Clinic Contact Dermatitis Group, 1998-2000.

BACKGROUND: Patch testing is a diagnostic tool for the evaluation of patients with suspected allergic contact dermatitis. A standard series of allergens similar to that used by the North American Contact Dermatitis Group (NACDG) is used at Mayo Clinic. OBJECTIVE: Our aim was to report the results of patch testing with a standard series at Mayo Clinic from July 1, 1998, to Dec 31, 2000 and to compare our findings with those of the NACDG during the same period. METHODS: The results of patch testing with the standard series at Mayo Clinic were examined. Positive reaction rates were compared between Mayo Clinic and the NACDG. RESULTS: During the 30-month period, 1324 Mayo Clinic patients were patch tested with a standard series of allergens (mean, 60 allergens), whereas the NACDG standard series during this period included 50 allergens. Overall, 917 patients (69.3%) had at least one positive reaction and 606 patients (45.8%) had two or more positive reactions. The 10 allergens used both by Mayo Clinic and by the NACDG that most frequently caused positive reactions were nickel sulfate hexahydrate, balsam of Peru (Myroxylon pereirae), neomycin sulfate, cobalt chloride, fragrance mix, potassium dichromate (0.25%), thimerosal, bacitracin, formaldehyde, and glutaraldehyde. Statistically significant differences in positive reaction rates (P < .05) were observed for 12 of the 43 allergens common to both Mayo Clinic and the NACDG. CONCLUSION: With large standard patch test series, one can identify commonly encountered and potentially relevant contact allergens.