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

Summary: Infection of humans with the nematode worm parasite Anisakis simplex was first described in the 1960s in association with the consumption of raw or undercooked fish During the 1990s it was realized that even the ingestion of dead worms in food fish can cause severe hypersensitivity reactions, that these may be more prevalent than infection itself, and that this outcome could be associated with food preparations previously considered safe Not only may allergic symptoms arise from infection by the parasites (“gastroallergic anisakiasis”), but true anaphylactic reactions can also occur following exposure to allergens from dead worms by food-borne, airborne, or skin contact routes This review discusses A simplex pathogenesis in humans, covering immune hypersensitivity reactions both in the context of a living infection and in terms of exposure to its allergens by other routes Over the last 20 years, several studies have concentrated on A simplex antigen characterization and innate as well as adaptive immune response to this parasite Molecular characterization of Anisakis allergens and isolation of their encoding cDNAs is now an active field of research that should provide improved diagnostic tools in addition to tools with which to enhance our understanding of pathogenesis and controversial aspects of A simplex allergy We also discuss the potential relevance of parasite products such as allergens, proteinases, and proteinase inhibitors and the activation of basophils, eosinophils, and mast cells in the induction of A simplex-related immune hypersensitivity states induced by exposure to the parasite, dead or alive

Anisakis simplex: from Obscure Infectious Worm to Inducer of Immune Hypersensitivity

The Textbook of Contact Dermatitis covers every conceivable aspect of modern day management of contact dermatitis. Both irritatnt and allergic types of contact dermatitis are dealt with clearly and comprehensively, special emphasis being given to occupational aspects as well as to prevention, diagnosis and treatment. Also covered are epidemiological aspects, computerization of patch test data and patient imformation systems, noninvasive bioengineering measurement techniques, methods of skin testing other than patch testing, histopathology of both irritant and allergic contact dermatitis, and subjective reactions. The editors and contributing authors are all leading practitioners in the field. Their expertise has been brought to bear to

Textbook of Contact Dermatitis

https://www.cdc.gov/hicpac/pdf/InfectControl98.pdf

Guideline for infection control in health care personnel, 1998

European Union Risk Assessment Report

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.

Background : Rubber additives, mainly vulcanizers and antioxidants, are increasingly a cause of contact dermatitis. Objective : The aim of the present study was to determine the frequency of type IV allergy to rubber additives. Methods : Seven thousand patients seen during a 10-year period were evaluated. Of them, 4680 were patch tested with the standard series recommended by the Spanish Group for Research of Contact Dermatitis (GEIDC) and a series of individual rubber additives. Results : A total of 686 patients (14.7% of those patch tested) had one or more positive reactions to rubber additives. Of these, 582 (84.8%) were men and 104 (15.2%) were women. The incidence of rubber sensitization was especially high among construction workers (47.0%). Conclusion : Rubber additives are a common cause of occupational contact dermatitis, particularly in construction workers. We postulate that rubber gloves and boots (utilized to avoid contact with sensitizing substances) themselves may be a common cause of contact dermatitis. The high incidence of allergy to some rubber additives, such as thiurams and carbas, indicates that their replacement by other less sensitizing vulcanizers is advisable.

Type IV allergy to rubber additives: A 10-year study of 686 cases

230 patients with occupational dermatitis in I ho metallurgic industry were studied with standard patch tests (GEIDC) and an oil series. An occupational and clinical questionnaire survey was carried out, Responses to paraphenylenediamine, chrome, cobalt in the standard series, and benzisothiazolone, triethanolamine, and Grotan BK® were the main positive results.

Occupational dermatoses from cutting oils

Estudio epidemiológico de la dermatitis alérgica de contacto en España (2001)

Background In the last 20 years, the hairdressing profession has undergone important modifications, mainly because of a change in the substances and techniques used and improved occupational education. Objective To evaluate the modifications in the hairdressing profession and its actual risk of occupational allergic contact dermatitis (OACD). Methods We studied all 300 hairdressers seen in our department from 1994 to 2003 and compared the results with those of a previous study of 379 hairdressers who attended our department from 1980 to 1993. All were patch-tested with the European Standard series and specific hairdressing products. As previously, most of the workers were women (93%), with a mean age (23.7 years) slightly higher than that of the workers in our previous study. Results We found a significant increase in the frequency of positive patch-test responses (78.3% vs 58.8%) and OACD (58% vs 48.8%) with respect to our previous study. We also observed a significant increase in sensitization to most allergens, including p-phenylenediamine base (54% vs 45.9%), 4-aminobenzene (40.7% vs 31.9%), ammonium thioglycolate (2.7% to 12.3%), ammonium persulfate (7.9% to 14.3%), p-toluenediamine sulfate (6.8% to 15.3%), p-aminodiphenylamine (2.9% to 7.7%), o-nitro-4-phenylenediamine (2.1% to 7.3%), and aminophenols (0% to 9%), whereas a decrease was found in sensitization to Disperse Orange (17% vs 32.7%) and thioglycolic acid (15.3% to 3%). Conclusion The high frequency and increase of sensitizations among hairdressers require urgent measures to improve protective measures and their application.

Luis Conde-Salazar

Papers

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

Type IV allergy to rubber additives: A 10-year study of 686 cases

Occupational dermatoses from cutting oils

Estudio epidemiológico de la dermatitis alérgica de contacto en España (2001)

Contact dermatitis in hairdressers, 10 years later: patch-test results in 300 hairdressers (1994 to 2003) and comparison with previous study.