The present guideline summarizes all aspects of patch testing for the diagnosis of contact allergy in patients suspected of suffering, or having been suffering, from allergic contact dermatitis or other delayed-type hypersensitivity skin and mucosal conditions. Sections with brief descriptions and discussions of different pertinent topics are followed by a highlighted short practical recommendation. Topics comprise, after an introduction with important definitions, materials, technique, modifications of epicutaneous testing, individual factors influencing the patch test outcome or necessitating special considerations, children, patients with occupational contact dermatitis and drug eruptions as special groups, patch testing of materials brought in by the patient, adverse effects of patch testing, and the final evaluation and patient counselling based on this judgement. Finally, short reference is made to aspects of (continuing) medical education and to electronic collection of data for epidemiological surveillance.

https://onlinelibrary.wiley.com/doi/pdf/10.1111/cod.12432

European Society of Contact Dermatitis guideline for diagnostic patch testing – recommendations on best practice

The incidence of nickel sensitivity in a population above the age of 10 was examined through epicutaneous tests with 5% nickel sulphate performed on certain school and occupational test subjects and on subjects at a home for elderly people. Nickel sensitivity was observed in 4.5% (in 44 cases of 980 tested subjects), in 8% of the females and in 0.8% of the males. In 42 of the 44 nickel-sensitive subjects there was a history of dermatitis from metal contact. At the time of testing, 16 (34%) of the nickel-sensitive subjects revealed eczema. A manifest nickel sensitivity was thus found in 1.6% of all tested subjects, in 2.8% of females and in 0.4% of males. Nickel sensitivity and a simultaneous hand eczema was noted in 0.9% of the tested population, in 1.6% of females and in 0.2% of males. Hand eczemas were rarer (20.5%) in the nickel-sensitive subjects in the population study than in the nickel-sensitive patients tested at the same time in the clinic (56.6%). No case of nickel sensitivity was occupationally related.

Nickel sensitivity in the general population.

Patch testing is the predominant method of establishing contact allergy. The present patch test technique is the result of a continuous process of development and improvement since its first application in the late 19th century. The perfect patch test should give no false-positive and no false-negative reactions. The ideal patch test should also cause as few adverse reactions as possible, particularly no patch test sensitization. Even though the history and examination of a patient with suspected allergic contact dermatitis will give clues to possible sensitizers, it is not sufficient to patch test only with initially suspected sensitizers; unsuspected sensitizers used for patch testing frequently turn out to be the real cause of the dermatitis. Fortunately, a small number of substances are considered to account for the majority of delayed hypersensitivity reactions. Therefore, generally 20-25 test preparations consisting of chemically defined compounds, mixes of allergens, and natural and synthetic compounds, are grouped into a standard test series. The requirements to be fulfilled by a sensitizer in a standard patch test series are discussed in this article. A procedure of investigations is proposed before a sensitizer is included in a standard series.

Thoughts on sensitizers in a standard patch test series. The European Society of Contact Dermatitis.

A study was made of possible reasons for workers losing time from work at the Maritime Administration Reserve Fleets at Benicia, California and Fort Eustis, Virginia. At these worksites, activities associated with the mooring, preservation and maintenance of ships in the National Defense Reserve were undertaken. Most of the work involved manual materials handling tasks associated with the movement of ships in and out of the fleet, such as the handling of anchors, anchor inspecting and maintaining the engine room, cargo holds, and deck machinery with time spent in welding, metal working, painting, and other maintenance activities. The most frequent injuries occurring to workers at these sites included back muscle strains and sprains, groin pulls and hernias. Less prevalent injuries included eye injuries due to foreign objects, nail punctures to the soles of the feet, and muscle strains and sprains. There was also potential exposure to asbestos observed at both sites. A potential health hazard existed from pulling steel cable and nylon rope, lifting and carrying marine batteries, nail punctures, slips and falls, vibrating handtools, and foreign bodies in the eyes. Measures for lowering the risks of musculoskeletal and traumatic injuries and for reducing possible asbestos exposures are recommended.

Health hazard evaluation report

DISCLAIMER The use of company or product name(s) is for identification only and does not imply endorsement by the Agency for Toxic Substances and Disease Registry. A Toxicological Profile for pyrethrins and pyrethroids, Draft for Public Comment was released in September, 2001. This edition supersedes any previously released draft or final profile. Toxicological profiles are revised and republished as necessary, but no less than once every three years. For information regarding the update status of previously released profiles, contact ATSDR at: Toxicological Profiles are a unique compilation of toxicological information on a given hazardous substance. Each profile reflects a comprehensive and extensive evaluation, summary, and interpretation of available toxicologic and epidemiologic information on a substance. Health care providers treating patients potentially exposed to hazardous substances will find the following information helpful for fast answers to often-asked questions. Chapter 1: Public Health Statement: The Public Health Statement can be a useful tool for educating patients about possible exposure to a hazardous substance. It explains a substance's relevant toxicologic properties in a nontechnical, question-and-answer format, and it includes a review of the general health effects observed following exposure. Chapter 3: Health Effects: Specific health effects of a given hazardous compound are reported by type of health effect (death, systemic, immunologic, reproductive), by route of exposure, and by length of exposure (acute, intermediate, and chronic). In addition, both human and animal studies are reported in this section. NOTE: Not all health effects reported in this section are necessarily observed in the clinical setting. Please refer to the Public Health Statement to identify general health effects observed following exposure. The following additional material can be ordered through the ATSDR Information Center: Case Studies in Environmental Medicine: Taking an Exposure History—The importance of taking an exposure history and how to conduct one are described, and an example of a thorough exposure history is provided. Other case studies of interest include Reproductive and Developmental Hazards; Skin Lesions and Environmental Exposures; Cholinesterase-Inhibiting Pesticide Toxicity; and numerous chemical-specific case studies. viii PYRETHRINS AND PYRETHROIDS Managing Hazardous Materials Incidents is a three-volume set of recommendations for on-scene (prehospital) and hospital medical management of patients exposed during a hazardous materials incident. Volumes I and II are planning guides to assist first responders and hospital emergency department personnel in planning for incidents that involve hazardous materials. Volume III— Medical Management Guidelines for Acute Chemical Exposures—is a guide for health care professionals …

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Papers

Routine patch testing. IV. Supplementary series of test substances for Scandinavian countries.

Routine Patch Testing III

Routine patch testing. II. Proposed basic series of test substances for Scandinavian countries and general remarks on testing technique.

Routine patch testing 3. Frequency of contact allergy at six Scandinavian clinics.