Patch test standard/ standardization

Dermal Effects. Five men who wore coveralls that were damp from dry cleaning with Stoddard solvent developed sores on the penis and buttocks (Nethercott et al. 1980). None had an allergic reaction in a patch test. Standard texts and review articles on industrial hygiene list Stoddard solvent or Varsol as a possible eye, skin, nose, and throat irritant (Birmingham 1988 McDermott 1975 NIOSH 1990 Sax and Lewis 1989). 

In standardized testing on rabbit eyes, amyl acetate was graded as only slightly injurious. No evidence of delayed contact hypersensitivity due to 20% amyl acetate was observed in repeat-insult skin patch tests of 211 human subjects. ... 

A retrospective study was performed of 3851 patients who presented at a clinic with suspected allergic contact dermatitis over a 5-year period. Workup of each case included standard patch tests for delayed-type sensitivity. Of the 3851 patients, 145 had type IV allergies to one or more rubber constituents. Five of the 145 were positive to MBT. 

A 57-year old Caucasian man with inflammatory bowel disease was given prednisolone metasulfobenzoate sodium enemas twice daily and oral mesalazine 800 mg tds for about 5 months, without improvement. He stopped using the prednisolone enemas but continued to take mesalazine. Within 48 hours of stopping prednisolone his symptoms resolved completely. The theoretical possibility of contact allergy was entertained. Patch tests with a standard battery of contact allergens, including tixocortol pivalate and budesonide, were ++ positive with budesonide. At follow up 3 months later he was symptom free. 

Albert, M.R., Gonzalez, S., and Gonzalez, E., Patch testing reactions to a standard series in 608 patients tested from 1990 to 1997 at Massachusetts General Hospital. Am. J. Contact Dermat. 9, 207-211, 1998. 

Taking the history of the patient and noting the clinical symptoms and localization of the lesions are critical. Allergen identification for a patient with a possible contact allergy to cosmetics is performed by means of patch testing with the standard series, specific cosmetic-test series, the product itself, and all of its ingredients. We can only find the allergens we look for. For skin tests with cosmetic products... 

Katsarou, A., Kalogeromitros, D., Armenaka, M., Koufou, V., Davou, E., and Koumantaki, E., Trends in the results of patch testing to standard allergens over the period 1984—1995, Contact Dermatitis, 37, 245, 1997. 

A 45-year-old nurse presented with a 6-month history of recurrent periorbital erythema with itching and runny eyes. Each episode lasted abont 5-6 days and settled on withdrawal from her place at work, where she handled a large nnmber of drugs, including meropenem. She was patch-tested with the Enropean standard series, and was negative to aU except meropenem. She had complete remission after qnitting her workplace. 

The formaldehyde concentration in patch-testing, which has been lowered to 1% in the standard series in recent years, has been studied in a comparison of concentrations of 1% and 2% in 3734 consecutively patch-tested patients (11). Since there was no significant difference between 1 and 2% formaldehyde with respect to the frequency of positive patch test reactions, while there were more irritant reactions with 2%, a 1% patch test concentration can still be recommended. 

Patients with chronic venous insufficiency and venous leg ulcers are at risk of sensitization to topical medications. The frequency of sensitization in these patients is up to 67% (11). In a study using an expanded European standard series and 20 different wound dressings for patch-testing in 36 patients with chronic venous insufficiency, sensitization to fragrance mix was found in three cases (12). 

She was treated with an oral antihistamine and a topical glucocorticoid. Two days later, the lesions worsened and systemic glucocorticoid therapy was needed. The lesions started to heal, leaving slight postinflammatory hyperpigmentation. Patch-testing was performed with a European standard series and commercial laurel oil 1 month later. There was a reaction to the oil... 

A 57-year-old man developed a pigmented contact dermatitis after using topical minoxidil 5% for 2 years (12). Patch tests were negative with the European standard series and with a textile and finishes series, but positive with minoxidil 5% on days 3 and 7. However, withdrawal of the minoxidil did not lead to improvement after 10 months. 

Of 1216 patients who were patch tested, 14 with eczema had used products (creams, hair products, and essential oils) containing tea tree oil (17). They were patch tested for a standard panel of allergens, topical emulgents, perfumes, plants, topical medications, metal, gloves, topical... 

Substances that are not listed in any standard table should be patch-tested with great caution control tests are mandatory when positive reactions are obtained, so as to exclude false-positive irritant patch test reactions. 

Patch tests in patients with anogenital eczema should include the standard series cinchocaine HCl, propolis, bufexamac, and other ingredients of topical formulations according to the patient s history. In cases of doubt, the repeated open application test (ROAT) is recommended. Patients should be advised to apply the suspected product three times a day for 3 days to an area of healthy skin on measuring 5 cm x 5 cm the flexural site of the forearm (35). 

Three Chinese national servicemen developed an itchy postauricular rash (3). None had a history of atopy and all three reported prior use of rubberized spectacle retainers as a curved pliable extension to the posterior ends of the earpieces of their spectacles, to stabilize them while undergoing rigorous military physical training. They were all patch-tested with the National Skin Center standard series and were positive to thiuram mix and the rubberized spectacle retainers. They were treated with topical corticosteroids and were advised to stop wearing their rubberized spectacle retainers. 

One hundred-sixty-seven doctors, 92 dentists, and 333 nurses were patch-tested with a standard panel of allergens plus allergens common to their work environment. Among nurses, formaldehyde was the disinfectant that most frequently caused allergic reactions (9.6%). Three doctors also had positive skin tests for formaldehyde. 

Edman B, Moller H. 1982. Trends and forecasts for standard allergens in a 12-year patch test material. Contact Dermatitis 8 95-104. 

Marks JGJ, Belsito DV, DeLeo VA, et al. 1995. North American contact dermatitis group standard tray patch test results (1992 to 1994). Am J Contact Dennatitis 6 160-165. 

Ingber, A., and T. Menne. 1990. Primin standard patch testing 5 years experience. Contact Dermat. 23(1) 15-19. 

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