Patch testing with aluminium Finn Chambers could give false-positive reactions in patients with contact allergy to aluminium.

BACKGROUND: Earlier laboratory studies have shown that sodium tetrachloropalladate, Myroxylon pereirae, caine mix II, and palladium chloride trigger the release of aluminium (Al) from Finn Chambers (FC). OBJECTIVES: To investigate whether aluminium realease from FC could influence the diagnostic outcome of patch testing with FC. METHOD: A retrospective analysis of patch test results from 2010 to 2019 was performed. A two-sided Fisher's exact test was used to calculate any overrepresentation of contact allergy to Al among patients with positive reactions to sodium tetrachloropalladate, Myroxylon pereirae, caine mix II, and palladium chloride. RESULTS: A total of 5446 patients had been tested with FC during the study period. There was a significant overrepresentation of contact allergy to Al among patients with positive reactions to sodium tetrachloropalladate, Myroxylon pereirae, caine mix II, and palladium chloride. Patients with a strong Al allergy had significantly higher amounts of concomitant reactions to sodium tetrachloropalladate, Myroxylon pereirae, caine mix II, and palladium chloride compared to patients with weak Al allergy. These results were not seen for patients tested with Finn Chambers AQUA. CONCLUSION: In patients with contact allergy to Al, patch testing with Finn chambers could give false-positive reactions to sodium tetrachloropalladate, Myroxylon pereirae, caine mix II, and palladium chloride.

A Novel Device that Reduces Preparation Times and Precision Mass Error in Patch Testing for Allergic Contact Dermatitis.

BACKGROUND: Patch test preparation for evaluation of allergic contact dermatitis is traditionally a slow process with inherent errors. OBJECTIVE: A novel device, referred to as a syringer, designed to dispense 10 unique petroleum-based haptens simultaneously, significantly reduces preparation time and increases the precision of the mass dispensed per well. METHODS: The syringer was custom designed and "printed" through the use of a 3-dimensional printer with a polylactic acid plastic medium. RESULTS: The syringer dispensed 10 haptens significantly (P < 0.05) faster: 6.9 seconds on average, compared with 29.6 seconds by the traditional method. The syringer demonstrated a significantly (P < 0.05) lower average deviation of each strip's per-well mass average compared with the traditional method. CONCLUSIONS: In practice, this syringer is ideal for preparing patient-ready patch tests in quantities of 2 identical strips or more.

Optoacoustic mesoscopy shows potential to increase accuracy of allergy patch testing.

BACKGROUND: Differentiation between irritant and allergic skin reactions in epicutaneous patch testing is based largely on subjective clinical criteria, with the risk of high intraobserver and interobserver variability. Novel dermatological imaging using optoacoustic mesoscopy allows quantitative three-dimensional assessment of microvascular biomarkers. OBJECTIVES: We investigated the potential of optoacoustic imaging to improve the precision of patch test evaluation. METHODS: Sixty-nine test reactions and 48 healthy skin sections in 52 patients with suspected type IV allergy were examined using raster-scan optoacoustic mesoscopy. RESULTS: We identified biomarkers from the optoacoustic images. Allergic reactions were associated with higher fragmentation of skin vasculature than irritant reactions (19.5 ± 9.7 vs 14.3 ± 3.7 fragments/100 pixels2 ; P < .05), as well as lower ratio of low- to high-frequency acoustic signals (1.6 ± 0.5 vs 2.0 ± 0.6, P < .05). Allergic reactions graded "++" showed higher vessel fragmentation than reactions graded "+" (25.4 ± 13.2 vs 17.1 ± 6.5 fragments/100 pixels2 ; P < .05). A linear model combining the biomarkers fragmentation and frequency ratio could differentiate allergic from irritant test reactions with an area under the receiving operator characteristic curve of 0.80 (95% confidence interval 0.64-0.91), reaching a sensitivity of 81% and specificity of 63%. CONCLUSIONS: Optoacoustic mesoscopy shows potential to help in differentiating between allergic and irritant test reactions based on novel biomarkers that may reflect vasodilation, vessel tortuosity, and edema.

Dermatitis alérgica de contacto a parafenilendiamina por tatuajes con henna en población pediátrica / Para-phenylenediamine allergic contact dermatitis due to henna tattoos in a child and adolescent population

INTRODUCCIÓN: Los tatuajes con henna son una práctica común en la población adolescente. En la mayoría de las ocasiones, la henna se mezcla con parafenilendiamina (PPDA) para mejorar las características del tatuaje. La PPDA es un potente alérgeno que causa con frecuencia dermatitis alérgica de contacto. MATERIAL Y MÉTODO: Se recogió a 726 niños parcheados en la Unidad de Alergia del Hospital General Universitario de Valencia entre 1980 y 2015, identificándose los casos y revisando los resultados de las pruebas, así como datos clínicos y epidemiológicos. RESULTADOS: Trescientos sesenta y un niños (49,7%) demostraron sensibilización a al menos un alérgeno y 34 fueron alérgicos a la PPDA (4,68%). La edad media de los pacientes alérgicos a PPDA fue de 12,4 años. El 44,2% de los niños alérgicos eran varones. Dos pacientes (5,9%) presentaron antecedentes personales de atopia. El 73,5% de reacciones positivas a PPDA se consideraron de relevancia presente. El origen de la sensibilización fue la realización de un tatuaje con henna en el 50% de los pacientes. CONCLUSIÓN: La sensibilización a PPDA es relativamente frecuente en la población pediátrica. El origen más frecuente es la realización de tatuajes con henna adulterada. Los adolescentes son la población con mayor riesgo de presentar este tipo de reacciones. Se debe desaconsejar activamente la práctica de tatuajes con henna negra en la población pediátrica

INTRODUCTION: Henna tattoos are a very common practice in the adolescent population. Henna is very often admixed with para-phenylenediamine (PPDA) to improve the appearance of the tattoo. PPDA is a potent allergen, and is a frequent cause of allergic contact dermatitis (ACD). Material and method. A study was conducted on the results of 726 consecutive children who had been patch tested in the University General Hospital Consortium of Valencia between 1980 and 2015. RESULTS: Almost half (49.7%; (361 cases) of the children had one or more positive patch test findings, with 4.7% (34) being allergic to PPDA. Mean age of patients allergic to PPDA was 12.4 years, and 44.2% were male. There were 2 cases (5.9%) of atopic dermatitis. Of the positive reactions, 73.5% were considered to be current clinically relevant. The sensitisation origin was a Henna tattoo in 50% of cases. CONCLUSION: PPDA sensitisation is relatively common in the child and adolescent population. The most frequent origin is the performing of Henna tattoos adulterated with PPDA. Adolescents are at the higher risk of developing ACD due to Henna tattoos. Henna tattooing should be strongly discouraged in children

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

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La serie estándar en las pruebas alérgicas de contacto / The Spanish Standard Patch Test Series

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Complicaciones mecánicas asociadas a la localización de la punta de catéteres centrales en una unidad neonatal / Catheter tip position and risk of mechanical complications in a neonatal unit

INTRODUCCIÓN: El uso de catéteres centrales (CC) está asociado a complicaciones mecánicas (CM). Nuestro objetivo fue conocer si la posición incorrecta de la punta se asociaba con mayor incidencia de CM. Material: Estudio descriptivo de 6 años en la UCIN del Hospital Universitario Santa Lucía de Cartagena. Se recogieron los CC, la indicación, el motivo de retirada, la posición en las pruebas de imagen, las CM y el tratamiento derivado. RESULTADOS: Se estudiaron 604 CC, la mayoría (347) de vena umbilical, epicutáneos (193) y de vena femoral (34). El 14,2% tuvo CM. La posición incorrecta de la punta se asoció a mayores CM (21,1 vs. 8,2%; p < 0,001), retirada por problemas mecánicos (8,4 vs. 3,1%; p < 0,01), extravasación (4,9 vs. 1,9%; p < 0,05), derrames pleurales y pericárdicos (1,4 vs. 0,0%; p < 0,05), hematomas hepáticos (4,6 vs. 0,6%; p < 0,01) y ascitis (2,8 vs. 0,0%; p < 0,01). Los epicutáneos medioclaviculares se asociaron a mayores CM (18,5 vs. 6,8%; p < 0,05) que los localizados en posición braquiocefálica (0 vs. 6,8%; NS) respecto a las localizaciones correctas. La posición baja o en ductus del catéter venoso umbilical se asoció a mayores CM respecto a la posición correcta (24,5 vs. 6%; p < 0,001. y 27 vs. 6%; p < 0,001). La complicación más frecuente fue la salida accidental. CONCLUSIONES: Las localizaciones incorrectas de la punta de los CC se asociaron a más CM. Los epicutáneos medioclaviculares tuvieron más riesgo que los localizados en cavas o braquiocefálicos. La posición baja o en ductus del catéter venoso umbilical se asoció a mayores CM

INTRODUCTION: The use of central catheters (CC) is associated with mechanical complications (MC). OBJECTIVE: Our objetive was to determine the relationship between CC positions and associated MC in neonates. Material: A descriptive analytical study was performed over a six year period in the NICU of the University Hospital Santa Lucía de Cartagena. Details were collected on the CC used, indication, reason for withdrawal, position in the imaging, MC, and treatment arising from them, as well as epidemiological data. RESULTS: Of the total of 604 CC studied, the majority (347) were via the umbilical vein, followed by epicutaneous (193), and femoral vein (34). There were MC in 14.2% of catheters. Incorrect position of the tip was associated with greater MC (21.1 vs 8.2%; P < .001), including withdrawal due to MC (8.4 vs 3.1%; P < .01), extravasation (4.9 vs 1.9%; P < .05), pleural and pericardial effusions (1.4 vs 0.0%; P < .05), liver haematomas (4.6 vs 0.6%; P < .01), and ascites (2.8 vs 0.0%; P < .01). The midclavicular epicutaneous position of the tip was associated with greater MC (18.5 vs 6.8%; P < .05) than the brachiocephalic (0 vs 6.8%;NS). The low and ductal position of the umbilical vein catheter was also associated with higher rates of MC (24.5 vs 6%; P < .001 and 27 vs 6%; P<.001) due to the position of the tip. The most common complication was accidentally dislodged catheter. CONCLUSIONS: The incorrect location of the tip was associated with more MC. The midclavicular epicutaneous had more risk than centrally or brachiocephalic locations. The low and ductal positions of the umbilical vein catheter were associated with higher rates of MC

Dermatitis alérgica de contacto a cosméticos, estudio clínico-epidemiológico en un hospital terciario / Allergic contact dermatitis due to cosmetics: A clinical and epidemiological study in a tertiary hospital

La dermatitis alérgica de contacto (DAC) a cosméticos es una dolencia con una incidencia creciente en la población, paralelamente a la generalización del uso de cosméticos en la sociedad, así como a su proliferación y diversificación. El objetivo del estudio es determinar la prevalencia de DAC a cosméticos en nuestro medio, analizar su evolución temporal y sus características clínico-epidemiológicas, así como definir los alérgenos y los cosméticos implicados. Se ha realizado un estudio prospectivo durante los años 2005-2013 en la Unidad de Alergia Cutánea del Hospital General Universitario de Valencia, y se ha comparado de forma retrospectiva con el periodo previo de 1996-2004. Se ha incluido a 5.419 pacientes estudiados con pruebas epicutáneas durante el periodo total del estudio. La prevalencia media de DAC a cosméticos ha aumentado de 9,8% en el periodo 1996-2004 a 13,9% en el periodo 2005-2013. La DAC a cosméticos se ha correlacionado con el sexo femenino, pero no con la atopia. El kathon CG (mezcla de metilcloroisotiazolinona y metilisotiazolinona), las fragancias y la parafenilendiamina (PPDA) se han mantenido como las causas más frecuentes, aunque en los últimos años los acrilatos y los filtros solares han sido alérgenos emergentes

The incidence of allergic contact dermatitis (ACD) to cosmetics in the general population is rising with the increasing use of cosmetic products and their proliferation and diversification. The aims of this study were to determine the prevalence of ACD to cosmetics in our setting, analyze changes over time, describe the clinical and epidemiological features of this allergic reaction, and identify the allergens and cosmetics involved. We performed a prospective study at the skin allergy unit in Hospital General Universitario de Valencia in Spain between 2005 and 2013 and compared our findings with data collected retrospectively for the period 1996 to 2004. The 5419 patients who underwent patch testing during these 2 periods were included in the study. The mean prevalence of ACD to cosmetics increased from 9.8% in the first period (1996-2004) to 13.9% in the second period (2005-2013). A significant correlation was found between ACD to cosmetics and female sex but not atopy. Kathon CG (blend of methylchloroisothiazolinone and methylisothiazolinone), fragrances, and paraphenylenediamine were the most common causes of ACD to cosmetics during both study periods, and acrylates and sunscreens were identified as emerging allergens during the second period

Thoughts on how to improve the quality of multicentre patch test studies.

Multicentre patch test studies (MPTSs) can contribute useful information for diagnostic and preventive measures. The aim of the present paper is to propose how to perform high-quality MPTSs. To this end, factors of significance for the patch test result are discussed with regard to the standardization and calibration of high-quality MPTSs. The 16 factors discussed are scored 0, 1, 2, or 3, depending on the relative importance of a particular factor for the patch test result. The total score of an MPTS allows it to be ranked as having doubtful, acceptable, high or excellent quality. A total score of 30 is possible. Depending on the total score the MPTSs are grouped into those with a doubtful, acceptable, high, and excellent quality. In conclusion, high-quality MPTSs can be performed and are facilitated if a guideline and check list are followed when the study is being planned. The scoring enables the calculation of a total score, which can be used for quality ranking.

Positive allergy study (Intradermal, patch, and lymphocyte transformation tests) in a case of isoniazid-Induced DRESS

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Exudative erythema multiforme due to cyclobenzaprine

No disponible

[Should metal alloy discs be used for patch testing in suspected metal implant intolerance reaction?]. / DKG-Stellungnahme zur Epikutantestung von Metalllegierungsplättchen bei Verdacht auf Metallimplantat-Unverträglichkeit.

Intolerance reactions to metal implants may be caused by metal allergy. However, prior to implantation, patch testing should not be done in a prophylactic-prophetic approach. Pre-implant patch testing should only be performed to verify or exclude metal allergy in patients with a reported respective history. In the case of implant-in particular arthroplasty-related complications like, for example, pain, effusion, skin changes, reduced range of motion, or loosening, orthopedic-surgical differential diagnostics should be performed first. Allergological workup of suspected metal implant allergy should be done with the DKG baseline series which contains nickel-, cobalt- and chromium-preparations. Various studies assessing the usefulness of metal alloy discs for patch testing proved that this approach does not give reliable information about metal allergy. Positive patch test reactions to the discs cannot be assigned to a specific metal within the disc alloy components. Furthermore, availability of such metal discs might be an invitation to uncritical testing. Accordingly, due to lack of benefit in comparison to patch testing with standardized metal salt preparations, we do not recommend patch testing with metal alloy discs.

Diagnostic performance of the atopy patch test with inhalant allergens

Background: This study evaluated the diagnostic performance of the atopy patch test (APT) compared with skin prick testing (SPT) and in vitro IgE measurement in a large group of patients with atopic dermatitis (AD) with or without respiratory symptoms (RS). Methods: The study included 521 patients (292 males, 229 females; age, 0.5-18 years; median age, 6 years) with AD and RS with different clinical presentations: current AD, 47 patients (Group A); current AD and RS, 72 patients (Group B), past AD and RS, 69 patients (Group C); and RS only, 280 patients (Group D). Fifty-three healthy individuals served as controls. All participants underwent the APT, SPT, and CAP/RAST with the most common inhalant allergens. The presence of a control group allowed calculation of specificity and positive and negative predictive values. Results: A significant difference was found for a positive APT versus both SPT and CAP/RAST (P<.0001) but not for SPT versus CAP/RAST. The differences for APT were significant in all group comparisons except group B vs C and group C vs D. In the control group, the APT was positive in 2% of cases (specificity of 96.2%), SPT was positive in 6% of cases (specificity of 88.4%), and CAP/RAST was positive in 4% of cases (specificity of 92.5%). Conclusions: In young patients sensitized to inhalant allergens with AD in addition to RS, the APT has a superior diagnostic performance to SPT and in vitro IgE measurement (AU)

Antecedentes: En este estudio se ha evaluado la capacidad diagnóstica de las pruebas epicutáneas con alérgenos inhalantes comparadas con las pruebas cutáneas en "prick" y con la determinación de IgE específica, en una población pediátrica numerosa de pacientes sensibilizados a inhalantes con dermatitis atópica con o sin síntomas respiratorios asociados. Métodos: En el estudio se incluyeron un total de 521 pacientes (292 varones, 229 mujeres, rango de edad 0,5 a 18 años, mediana 6 años) que presentaban los siguientes cuadros clínicos: dermatitis atópica activa, 47 pacientes (grupo A), dermatitis atópica y síntomas respiratorios activos, 72 pacientes (grupo B), antecedentes de dermatitis atópica y síntomas respiratorio no activos en la actualidad, 69 pacientes (grupo C) y solo síntomas respiratorios activos, 280 pacientes (grupo D); también se incluyeron como controles 53 sujetos sanos. A todos ellos se les realizaron pruebas epicutáneas con inhalantes, pruebas cutáneas en prick y determinación de IgE específica mediante técnica de CAST/RAST con una batería de inhalantes habituales de la zona. Se determinaron la especificidad y los valores predictivos positivos y negativos de la prueba. Resultados: Encontramos diferencia significativas en el rendimiento diagnóstico entre las pruebas epicutáneas con inhalantes tanto frente a las pruebas cutáneas en prick, como frente a la determinación de IgE específica (p< 0,001). No encontramos, por el contrario, diferencias entre las pruebas cutáneas en prick y la determinación de IgE específica. Cuando comparamos los grupos, en el caso de las pruebas epicutáneas con inhalantes todas las diferencias fueron significativas excepto las comparaciones entre el grupo B frente al grupo C y el grupo C frente al grupo D. Las pruebas epicutáneas con inhalantes fueron positivas en el 2% de los controles sanos, las pruebas cutáneas en prick en el 6% y la determinación de IgE específica en el 4%, lo que corresponde a una especificidad del 96,2% para las pruebas epicutáneas, del 88,4% para las pruebas en prick y del 92,5% para la determinación de IgE específica. Conclusiones: En pacientes pediátricos sensibilizados a inhalantes, no solo con dermatitis atópica sino también con síntomas respiratorios, las pruebas epicutáneas tienen una capacidad diagnóstica superior a las pruebas en prick o la determinación de IgE específica (AU)

Novel metal allergy patch test using metal nanoballs.

BACKGROUND: Patch tests are often used in the clinical diagnosis of metal allergies. In currently available patch tests, high concentrations of metal salt solutions are used. However, diagnosis accuracy can be influenced not only by acute skin reactions to high concentrations of metal salt, but also by skin reactions to other components present in the patch or to pH changes. In this study, we developed Ni nanoparticles (termed "nanoballs") for use in patch-test solutions. FINDINGS: Highly soluble, spherical Ni nanoballs were prepared using plasma electrolysis. The Ni released from the nanoballs permeated through a dialysis membrane, and the nanoball-containing solution's pH was maintained constant. Ni ions were released slowly at low concentrations in a time-dependent manner, which contrasted the rapid release observed in the case of a commercial patch test. Consequently, in the new test system, reactions caused by high concentrations of metal salts were avoided. CONCLUSIONS: By exploiting the high specific surface area of Ni nanoballs, we obtained an effective dissolution of Ni ions that triggered Ni allergy in the absence of direct contact between the nanoballs and mouse skin. This novel patch system can be applied to other metals and alloys for diagnosing various types of metal-induced contact dermatitis.