Epicutaneous test

Sensitization. The skin irritation and sensitization potentials of 9.0% thioglycolic acid were evaluated usiag the open epicutaneous test. Reactions were not observed dutiag the challenge phase. ThioglycoHc acid was an irritant, but not a sensitizer (20). 

A 64-year-old woman with allergic alveolitis caused by parakeet feathers improved with intravenous methylprednisolone, and was given oral deflazacort 60 mg/day, to be reduced progressively. After 30 days she developed generalized itchy blotches and lip edema. At that time she was mistakenly taking deflazacort in a dose of 120 mg/day. She was given an antihistamine, without any improvement. Deflazacort was then replaced by prednisolone and her symptoms disappeared immediately. Skin tests (a prick test and an epicutaneous test) were positive with deflazacort. Oral provocation with deflazacort 30 mg was positive, with the immediate appearance of the same symptoms as in the initial episode. 

Voss W, Dermatest GmbH, Munster, Germany (2004) Special dermatological Report on a Sensitization Test According to Magnussen (Repetitive Epicutaneous Test)... 

Frosch, P.J. and Kligman, A.M. The Duhring chamber. An improved technique for epicutaneous testing of irritant and allergic reactions. Contact Derm. 1979 5 73-81. 

Feature of test Draize Open Epicutaneous Tests (OET) Beuher Assay Freund s Complete Adjuvant Test (FCA) Optimization Test Split Adjuvant Guinea Pig Maximization (GPMT)... 

These methods can be adopted to define dose relationships - as was the intent of the open epicutaneous test (OET). The availability of the threshold for induction (TIC) and elicitation (TEC) provides a valuable tool in clinical risk assessment. 

Klecak G (1983) Identification of contact allergens Predictive tests in animals. In Marzulli FN, Maibach HI (eds) Der-matotoxicology. Hemisphere, New York, pp 193-236 Klecak G (1985) The Freund s Complete Adjuvant Test and the Open Epicutaneous Test. A complementary test procedure for realistic assessment of allergenic potential. Curr Probl Dermatol 14 152-171... 

Novak M, Klezlova V. [Allergy to merthiolate (Thimerosalum) in a set of standard epicutaneous tests in patients with eczematous diseases and leg ulcer during three periods between 1979 and 1999.]Cesko-Slov Dermatol 2000 75 3-10. 

In the last two cases, epicutaneous tests with 1% chlorhexidine gluconate and acetate, and prick tests with 0.05 and 0.01% of the acetate solution were positive (48). 

Bauer A, Greif C, Gebhardt M, Eisner P. Schwere Epikutantestreaktion auf Bufexamac in einem Hamorrhoidal-Therapeutikum. [A severe epicutaneous test reaction to the bufexamac in a hemorrhoidal therapeutic preparation.] Dtsch Med Wochenschr 1999 124(40) 1168-70. 

Yawalkar N, HariY, Frutig K, Egli F, WendlandT, Braathen ER, PichlerWJ T cells isolated from positive epicutaneous test reactions to amoxicillin and ceftriaxone are drug specific and cytotoxic. J Invest Dermatol 2000 115 647-52. 

Freund s complete adjuvant test Maximization test Open epicutaneous test... 

The compound alantolactone demonstrated sensitizing activity in an epicutaneous test in mice. No sensitizing activity of isoalantolactone was observed (Alanso Blasi et al. 1992). 

Table 3. Results of epicutaneous tests with benzylpenicillin in patients with history of penicillin allergy...

Frequent absence of specific IgE or other BPO-specific antibodies (IgM, IgG), negative immediate skin tests but positive epicutaneous test to benzylpenicillin and lymphocyte culture (these tests may also be positive by clinical manifestations of the immediate type, such as urticaria and anaphylactic shock). 

Clinical form of reaction Immediate-type (20-30 min) skin tests with benzylpenicillin and/or PPL Epicutaneous test with benzylpenicillin 200000 U/ml (24-48 h reaction) Pos. Neg. ... 

Fawcett and Pepys (1976) reported the case of a patient who developed immediate bronchospasm and an urticarial reaction after ingestion of a commercial combination of three tetracyclines no reactions could be elicited by oral challenge with the different tetracyclines, tartrazine, or the blue coating of the drug, whereas a provocation test with the commercial preparation was positive. Other clinical patterns, such as fixed drug eruptions (Kandil 1969 Delaney 1970 Csonka et al. 1971 Brown 1974 Shimizu and Shimao 1977 Pasricha and Shukla 1979), vascular purpura (Schoenfeld 1964) and a picture similar to systemic lupus erythematosus (SLE) (Sulkowski and Haserick 1964) have also been described. Contact dermatitis seems to be a very rare complication it was, however, observed after contact with oxytetracycline (Dohn 1962 Bojs and Moller 1974) and minocycline. In the latter case subsequent oral therapy with the same drug was followed by a systemic reaction and the sensitivity was confirmed by epicutaneous tests (Shelley and Heaton 1973). 

Epicutaneous tests with 1 % chloramphenicol ointment have been performed by various investigators and relevant results have been obtained. A sensitization occurrence of 0.18%-8.9% is reported, depending on local conditions in countries which are either in favor of or against the topical use of chloramphenicol in drops and ointments (Robinson et al. 1951 Schwank and Jirasek 1963 Eberhartinger and Ebner 1966 Korossy et al. 1966,1969 Ebner 1973 Pevny and Rockl 1975). These results suggest a possible role for cell-mediated allergic reactions. 

On suspicion of a drug allergy, the first step is discontinuation of the responsible agent a subsequent rapid regression can be taken as proof that the drug was indeed responsible. In serious hypersensitivity reactions, for example Lyelfs syndrome, anaphylactic shock, thrombocytopenic purpura, periarteritis nodosa, and lupus erythematosus medicamentosus, functional tests in the sense of a provocation test are extremely dangerous and are to be avoided. In epicutaneous tests too we have to proceed with extreme care. 

In every case of drug allergy we should proceed systematically, carrying out first an epicutaneous test and a friction test and then a prick test, a scratch test, and perhaps an intracutaneous test. Active substances are taken in a 1%-10% solution in physiological NaCl solution. In especially high sensitization, general reactions (including the anaphylactic shock) are yielded by the epicutaneous and intracutaneous tests. If one test is positive, other tests can mostly be dispensed with. 

The scratch test or the epicutaneous test is used as a rule in testing the sulfonamides. However, false negative results are found frequently in the latter case (exception contact allergy). Lobule tests with sulfonamides showed a positive reaction only in one-third of the patients, but all patients with serious reactions were positive (Sulzberger et al. 1947 Cronin 1978)... 

The epicutaneous test can be used as an experienced test, but its results are very weak. 

Laubstein and Niedergesass (1970) report on 24 patients with nitrofurazone sensitization. Except in one case continuation of the sensitization for 4 years could be demonstrated. The latency periods up to the manifestation of a contact allergy, were between a few weeks and 4 years. In epicutaneous tests with Nifucin, delayed reactions were seen relatively often. Group reactions against other nitrofuranes were not observed in patients sensitized by Nifucin. 

In Ippen s (1978) case of contact eczema, the epicutaneous test, with isoniazid as substance or as pulverized tablets (from several manufacturers), showed in all instances definite eczema reactions which exceeded the test areas and required local treatment with corticosteroids. Wang and Schmeo (1974) report the case of a patient with occupational allergy to isoniazid. Beside the allergic reaction of the immediate type (asthma bronchiale) there was a latent sensitization of the delayed reaction type (eczema reaction). This latent sensitization was manifested in a circumscribed area by the epicutaneous test. Reexposure to the allergen led to an asthmatic spasm of the bronchi and to recrudescence of the eczematous cutaneous efflorescences when it was inhaled. 

No allergic reaction or irritation resulted from the epicutane test. 

Several randomized studies with humans have been realized a human patch test for 72 h and a repetitive epicutaneous test for 6 weeks, as well as tests on the influence of nanocellulose on the moistness of the skin after short-term treatment (20 min, measuring of moistness up to 12 h after treatment). The results demonstrate that the applied nanocellulose will not cause any unwanted skin reactions due to irritating, sensitizing, or early allergic effects and the moistness of the treated... 

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