A multi-center, retrospective review of patch testing for contact dermatitis in allergy practices

Camacho-Halili, Marie; Axelrod, Sara; Michelis, Mary Ann; Lighvani, Sebastian; Khan, Farah; Leon, Scherly; Aquino, Marcella R.; Davis-Lorton, Mark; Fonacier, Luz S.

doi:10.1016/j.anai.2011.09.004

« Previous Next »Annals of Allergy, Asthma & Immunology
Volume 107, Issue 6 , Pages 487-492, December 2011

A multi-center, retrospective review of patch testing for contact dermatitis in allergy practices

Marie Camacho-Halili, MD
- Section of Allergy and Clinical Immunology, Winthrop University Hospital, Mineola, New York
Sara Axelrod, MD
- Section of Allergy and Clinical Immunology, Winthrop University Hospital, Mineola, New York
Mary Ann Michelis, MD
- Division of Allergy and Immunology, Hackensack University Medical Center, Hackensack, New Jersey
Sebastian Lighvani, MD
- New York Allergy and Asthma, Clinical Assistant Professor, Weill Cornell Medical College, New York, New York
Farah Khan, DO
- Department of Medicine, Winthrop University Hospital, Mineola, New York
Scherly Leon, MD
- Department of Internal Medicine, New York Hospital Queens, Flushing, New York
Marcella R. Aquino, MD
- Section of Allergy and Clinical Immunology, Winthrop University Hospital, Mineola, New York
Mark Davis-Lorton, MD
- Section of Allergy and Clinical Immunology, Winthrop University Hospital, Mineola, New York
Luz S. Fonacier, MD
- Section of Allergy and Clinical Immunology, Winthrop University Hospital, Mineola, New York
- Requests for reprints should be sent to: Luz S. Fonacier, MD, 120 Mineola Blvd, Suite 410, Mineola, NY 11501

Received 23 June 2011; received in revised form 26 August 2011; accepted 12 September 2011. published online 05 October 2011.

Background

Studies assessing patch testing (PT) in allergy practices are limited.

Objectives

To determine whether PT results using a limited panel of allergens such as in the Thin-Layer Rapid-Use Epicutaneous Test (TT) as compared with an expanded panel, such as the addition of supplemental allergens (North American Contact Dermatitis [NACD] Panel, Dormer Cosmetics, hairdressing series, corticosteroid series, and personal products) will miss a significant number of positive PTs. To compare our PT results with published data from dermatology practices.

Methods

This is a 5-year multicenter retrospective chart review of PT at 3 separate allergy practices.

Results

Four hundred twenty-seven patients (mean age, 49.8 years) were patch tested. Eighty-two percent were female; 54% reported an atopic history. Of the standardized allergens, the 5 most common positives were nickel sulfate, fragrance mix I, p-phenylenediamine (PPD), thimerosal, and cobalt chloride. Two hundred eighteen (56.9%; 95% CI = 51.9–61.8%) patients were positive to at least 1 TT allergen. Ninety-eight (25.6%; 95% CI = 21.5–30.2%) patients were positive to both a TT and a supplemental allergen. Forty-eight (12.5%; 95% CI = 9.6–16.2%) patients were negative to a TT allergen but positive to a supplemental allergen.

Conclusion

Positive allergens would have been missed in 12.5% of patients when evaluating with TT allergens alone, whereas 25.6% would be partially evaluated. Patch test performance characteristics for these allergy practices appear to parallel that seen for dermatology. The TT remains an adequate screening tool in an allergy practice, but a more comprehensive panel may be needed to fully evaluate contact dermatitis.