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

I. Leonard Bernstein, MD; James T. Li, MD, PhD; David I. Bernstein, MD; Robert Hamilton, PhD, DABMLI; Sheldon L. Spector, MD; Ricardo Tan, MD; Scott Sicherer, MD; David B. K. Golden, MD; David A. Khan, MD; Richard A. Nicklas, MD; Jay M. Portnoy, MD; Joann Blessing-Moore, MD; Linda Cox, MD; David M. Lang, MD; John Oppenheimer, MD; Christopher C. Randolph, MD; Diane E. Schuller, MD; Stephen A. Tilles, MD; Dana V. Wallace, MD; Estelle Levetin, PhD; and Richard Weber, MD

/pdf/allergy-diagnostic-testing-an-updated-practice-parameter-21api4satq.pdf

Allergy diagnostic testing: An updated practice parameter

Skin testing with a suspected drug has been reported to be helpful in determining the cause of cutaneous adverse drug reactions (CADR). Many isolated reports of positive drug skin tests are published, but without detailed information concerning the clinical features of the CADR and the method used in performing drug skin tests, such data are not very informative. A working party of the European Society of Contact Dermatitis (ESCD) for the study of skin testing in investigating cutaneous adverse drug reactions, has proposed the herein-reported guidelines for performing skin testing in CADR in order to standardize these procedures. In each reported case, the imputability of each drug taken at the onset of the CADR and a highly detailed description and characterization of the dermatitis need to be given. Drug skin tests are performed 6 weeks to 6 months after complete healing of the CADR. Drug patch tests are performed according to the methods used in patch testing in studying contact dermatitis. The commercialized form of the drug used by the patient is tested diluted at 30% pet. (pet.) and/or water (aq.). The pure drug is tested diluted at 10% in pet. or aq. In severe CADR, drug patch tests are performed at lower concentrations. It is also of value to test on the most affected site of the initial CADR. Drug prick tests are performed on the volar forearm skin with the commercialized form of the drug, but with sequential dilutions in cases of urticaria. Intradermal tests (IDT) are performed with sterile sequential dilutions (10-4, 10-3, 10-2, 10-1) of a pure sterile or an injectable form of the suspected drug with a small volume of 0.04 ml. Drug skin tests need to be read at 20 min and also later at D2 and D4 for patch tests, at D1 for prick tests and IDT. All these tests also need to be read at 1 week. The success of skin tests varies with the drug tested, with a high % of positive results, for example, with betalactam antibiotics, pristinamycin, carbamazepine and tetrazepam on patch testing, or with betalactam antibiotics and heparins on delayed readings of IDT. The results of drug skin tests also depend on the clinical features of the CADR. The use of appropriate control patients is necessary to avoid false-positive results.

https://onlinelibrary.wiley.com/doi/pdf/10.1034/j.1600-0536.2001.450601.x

Guidelines for performing skin tests with drugs in the investigation of cutaneous adverse drug reactions.

s, 61: 4784 (1964). 5. MONIER-WILLIAMS, G. W. A/umimum in food. London, Ministry of Health, 1935 (Reports on Public Health and Medical Subjects). 6. SYLVESTER, R. 0. ET AL. Factors involved in the locatiOn and operation of an aluminium reduction plant. Proceedings of the 22nd Industrial Waste Conference. Lafayette, IN, Purdue University, 1967, pp. 441-454. 7. RIDGWAY, J. ET AL. Water quality changes-chemical and microbiological studies. In: Water distrzbution systems. Medmenham, England, Water Research Centre, 1979. 8. AINSWORTH, R. G. ET AL. Deposits, corrosion products and corrosion mechanisms in iron mains. In: Water distribution systems. Medmenham, England, Water Research Centre, 1979. 9. AINSWORTH, R. G. ET AL. The introduction of new water mto old distribution systems. Medmenham, England, Water Research Centre, 1980 (TR 146). 10. VozAR, L. Content of aluminium in the diet and its biological action. Voprosy pitanija, 21: 28 (1962). II. ZooK, E. G. & LEHMANN, J. Total diet study: content of ten minerals-aluminium, calcium, phosphorus, sodium, potassium, boron, copper, iron, manganese and magnesium. Journal of the AssociatiOn of Official Agricultural Chemists, 48: 850 (1965). 12. GABOVICH, R. D.

https://www.jstage.jst.go.jp/article/jhs1956/35/5/35_5_307/_pdf

WHO guidelines for drinking-water quality.

Context Use of a chlorhexidine gluconate–impregnated sponge (CHGIS) in intravascular catheter dressings may reduce catheter-related infections (CRIs). Changing catheter dressings every 3 days may be more frequent than necessary. Objective To assess superiority of CHGIS dressings regarding the rate of major CRIs (clinical sepsis with or without bloodstream infection) and noninferiority (less than 3% colonization-rate increase) of 7-day vs 3-day dressing changes. Design, Setting, and Patients Assessor-blind, 2 × 2 factorial, randomized controlled trial conducted from December 2006 through June 2008 and recruiting patients from 7 intensive care units in 3 university and 2 general hospitals in France. Patients were adults (>18 years) expected to require an arterial catheter, central-vein catheter, or both inserted for 48 hours or longer. Interventions Use of CHGIS vs standard dressings (controls). Scheduled change of unsoiled adherent dressings every 3 vs every 7 days, with immediate change of any soiled or leaking dressings. Main Outcome Measures Major CRIs for comparison of CHGIS vs control dressings; colonization rate for comparison of 3- vs 7-day dressing changes. Results Of 2095 eligible patients, 1636 (3778 catheters, 28 931 catheter-days) could be evaluated. The median duration of catheter insertion was 6 (interquartile range [IQR], 4-10) days. There was no interaction between the interventions. Use of CHGIS dressings decreased the rates of major CRIs (10/1953 [0.5%], 0.6 per 1000 catheter-days vs 19/1825 [1.1%], 1.4 per 1000 catheter-days; hazard ratio [HR], 0.39 [95% confidence interval {CI}, 0.17-0.93]; P = .03) and catheter-related bloodstream infections (6/1953 catheters, 0.40 per 1000 catheter-days vs 17/1825 catheters, 1.3 per 1000 catheter-days; HR, 0.24 [95% CI, 0.09-0.65]). Use of CHGIS dressings was not associated with greater resistance of bacteria in skin samples at catheter removal. Severe CHGIS-associated contact dermatitis occurred in 8 patients (5.3 per 1000 catheters). Use of CHGIS dressings prevented 1 major CRI per 117 catheters. Catheter colonization rates were 142 of 1657 catheters (7.8%) in the 3-day group (10.4 per 1000 catheter-days) and 168 of 1828 catheters (8.6%) in the 7-day group (11.0 per 1000 catheter-days), a mean absolute difference of 0.8% (95% CI, −1.78% to 2.15%) (HR, 0.99; 95% CI, 0.77-1.28), indicating noninferiority of 7-day changes. The median number of dressing changes per catheter was 4 (IQR, 3-6) in the 3-day group and 3 (IQR, 2-5) in the 7-day group (P  Conclusions Use of CHGIS dressings with intravascular catheters in the intensive care unit reduced risk of infection even when background infection rates were low. Reducing the frequency of changing unsoiled adherent dressings from every 3 days to every 7 days modestly reduces the total number of dressing changes and appears safe. Trial Registration clinicaltrials.gov Identifier: NCT00417235

https://jamanetwork.com/journals/jama/articlepdf/183597/jce90000_1231_1241.pdf

Chlorhexidine-Impregnated Sponges and Less Frequent Dressing Changes for Prevention of Catheter-Related Infections in Critically Ill Adults: A Randomized Controlled Trial

Terminology of contact dermatitis.

Epidemiology of contact dermatitis.

Contact Dermatitis in the Atopic

Contact dermatitis in the atopic.

SUMMARY.— In a series of 4000 patients patch tested in 5 European clinics, 1000 were engaged in domestic work only; they included 281 women with contact dermatitis of the hands. There were no significant differences between the 2 groups as regards age, duration of dermatitis and patch test results.

Half of the 281 women had a positive patch test, the responsible allergens in order of rank being balsams, nickel, medicaments, cobalt, rubber, chromate, benzocaine and paraphenylenediamine. But 78% of them were diagnosed as contact dermatitis, 5% atopic and 13% were unclassified. An allergic cause (42%) was as frequent as an irritant (45%) among those with contact dermatitis.

Magnusson B

Papers

Terminology of contact dermatitis.

Epidemiology of contact dermatitis.

Contact Dermatitis in the Atopic

Contact dermatitis in the atopic.

Hand dermatitis in housewives.