Joel G DeKoven1, Erin M Warshaw, Donald V Belsito, Denis Sasseville, Howard I Maibach, James S Taylor, James G Marks, Joseph F Fowler, C G Toby Mathias, Vince A DeLeo, Melanie D Pratt, Matthew J Zirwas, Kathryn A Zug. 1. From the *Division of Dermatology, Department of Medicine, University of Toronto, Canada; †Department of Dermatology, University of Minnesota; ‡Minneapolis VAMC, Minnesota; §Columbia University Medical Center, New York, NY; ∥Department of Medicine, Division of Dermatology, McGill University Health Centre, Montreal, Canada; ¶University of California, San Francisco; #Department of Dermatology, Cleveland Clinic Lerner College of Medicine, Ohio; **Department of Dermatology, Pennsylvania State University, Hershey; ††DS Research, Louisville, KY; ‡‡Division of Dermatology, Group Health Associates, Cincinnati, Ohio; §§Department of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles; ∥∥Department of Medicine, Division of Dermatology, University of Ottawa, Canada; ¶¶The Ohio State University, Columbus; ##Section of Dermatology, Dartmouth Medical Center, Lebanon, NH.
Abstract
BACKGROUND: Patch testing is the most important diagnostic tool for the assessment of allergic contact dermatitis. OBJECTIVE: This study documents the North American Contact Dermatitis Group (NACDG) patch testing results from January 1, 2013, to December 31, 2014. METHODS: At 13 centers in North America, patients were tested in a standardized manner with a screening series of 70 allergens. Data were manually verified and entered into a central database. Descriptive frequencies were calculated, and trends were analyzed using χ test. RESULTS: A total of 4871 patients were tested. There were 3255 patients (66.8%) who had at least 1 positive reaction and 2412 patients (49.5%) who were ultimately determined to have a primary diagnosis of allergic contact dermatitis. A total of 434 patients (8.9%) had occupationally related skin disease. There were 9726 positive allergic reactions. Compared with the previous reporting periods (2011-2012 and 2001-2012, including at least three 2-year cycles), positive reaction rates for the top 25 screening allergens statistically increased for 2 allergens: methylchloroisothiazolinone/methylisothiazolinone (6.4%; risk ratios, 1.26 [1.07-1.50] and 2.08 [1.84-2.37]) and hydroxyethyl methacrylate (2.6%; risk ratios, 1.34 [1.02-1.76] and 1.23 [1.00-1.51]). Methylisothiazolinone, which was added to the screening series for this 2013-2014 cycle, had the third highest positive reaction rate of allergens tested (10.9%). Four other newly added allergen preparations-formaldehyde 2% (7%), diphenylguanidine (3.8%), propylene glycol 100% (2.8%), and benzophenone-4 (2.1%)-all had reaction rates greater than 2%. Twenty-one percent of tested patients had at least 1 relevant allergic reaction to an allergen not on the NACDG series; 14.6% of these were occupationally related. The T.R.U.E. TEST (SmartPractice Denmark, Hillerød, Denmark) would have hypothetically missed one quarter to one third of reactions detected by the NACDG screening series. CONCLUSIONS: These results confirm that the epidemic of sensitivity to methylisothiazolinone previously documented in Europe is also occurring in North America. Patch testing with allergens beyond a standard screening tray is necessary for the complete evaluation of occupational and nonoccupational allergic contact dermatitis.
BACKGROUND: Patch testing is the most important diagnostic tool for the assessment of allergic contact dermatitis. OBJECTIVE: This study documents the North American Contact Dermatitis Group (NACDG) patch testing results from January 1, 2013, to December 31, 2014. METHODS: At 13 centers in North America, patients were tested in a standardized manner with a screening series of 70 allergens. Data were manually verified and entered into a central database. Descriptive frequencies were calculated, and trends were analyzed using χ test. RESULTS: A total of 4871 patients were tested. There were 3255 patients (66.8%) who had at least 1 positive reaction and 2412 patients (49.5%) who were ultimately determined to have a primary diagnosis of allergic contact dermatitis. A total of 434 patients (8.9%) had occupationally related skin disease. There were 9726 positive allergic reactions. Compared with the previous reporting periods (2011-2012 and 2001-2012, including at least three 2-year cycles), positive reaction rates for the top 25 screening allergens statistically increased for 2 allergens: methylchloroisothiazolinone/methylisothiazolinone (6.4%; risk ratios, 1.26 [1.07-1.50] and 2.08 [1.84-2.37]) and hydroxyethyl methacrylate (2.6%; risk ratios, 1.34 [1.02-1.76] and 1.23 [1.00-1.51]). Methylisothiazolinone, which was added to the screening series for this 2013-2014 cycle, had the third highest positive reaction rate of allergens tested (10.9%). Four other newly added allergen preparations-formaldehyde 2% (7%), diphenylguanidine (3.8%), propylene glycol 100% (2.8%), and benzophenone-4 (2.1%)-all had reaction rates greater than 2%. Twenty-one percent of tested patients had at least 1 relevant allergic reaction to an allergen not on the NACDG series; 14.6% of these were occupationally related. The T.R.U.E. TEST (SmartPractice Denmark, Hillerød, Denmark) would have hypothetically missed one quarter to one third of reactions detected by the NACDG screening series. CONCLUSIONS: These results confirm that the epidemic of sensitivity to methylisothiazolinone previously documented in Europe is also occurring in North America. Patch testing with allergens beyond a standard screening tray is necessary for the complete evaluation of occupational and nonoccupational allergic contact dermatitis.
Authors: Shuai Xu; Michael Kwa; Mary E Lohman; Rachel Evers-Meltzer; Jonathan I Silverberg Journal: JAMA Dermatol Date: 2017-11-01 Impact factor: 10.282
Authors: Cara Symanzik; Patricia Weinert; Željka Babić; Sarah Hallmann; Martin Stibius Havmose; Jeanne Duus Johansen; Sanja Kezic; Marija Macan; Jelena Macan; Julia Strahwald; Rajka Turk; Henk F van der Molen; Swen Malte John; Wolfgang Uter Journal: Int J Environ Res Public Health Date: 2022-06-21 Impact factor: 4.614
Authors: Amber Reck Atwater; Amy J Petty; Beiyu Liu; Cynthia L Green; Jonathan I Silverberg; Joel G DeKoven; Donald V Belsito; Margo J Reeder; Denis Sasseville; James S Taylor; Howard I Maibach; Matthew J Zirwas; James G Marks; Kathryn A Zug; Joseph F Fowler; Melanie D Pratt; Vincent A DeLeo; Erin M Warshaw Journal: J Am Acad Dermatol Date: 2021-02-09 Impact factor: 15.487