Patch Testing and Prick Testing : A Practical GuideOfficial Publication of the ICDRG

by Lachapelle, Jean-Marie; Maibach, Howard I.

• ISBN13: 9783540928058
• ISBN10: 3540928057
• Edition: 2nd
• Format: Hardcover
• Copyright: 2009-04-03
• Publisher: Springer Verlag

Summary

Knowledge in the field of allergic contact dermatitis has grown to a great extent, due to recent advances in the chemical, immunological and clinical fields. These advances include the improved techniques of patch testing and prick testing, e.g. additional tests such as open, semi-open, repeated open application test (ROAT) and use tests, photopatch tests, atopy patch tests and provocative tests. Further, due to the ongoing changes in our environment, the series of patch tests ' the so-called standards ' are also regularly renewed.This new edition is completely revised, updated and expanded, with more colour illustrations. It is a universally useful and superb guide in the management of positive and negative patch test and prick test reactions, for all practicing dermatologists, from the beginner to the well-trained expert.

Table of Contents

The International Contact Dermatitis Research Group	p. 1
Historical Background	p. 1
Current Tasks of the ICDRG	p. 2
ICDRG Members	p. 2
References	p. 3
Patch Testing
The Spectrum of Diseases for Which Patch Testing is Recommended	p. 7
Allergic Contact Dermatitis	p. 7
Pathomechanisms in Allergic Contact Dermatitis	p. 7
Clinical Signs and Symptoms	p. 9
Histopathological Features	p. 11
The Allergic Contact Dermatitis Syndrome	p. 12
Stage 1 of ACDS	p. 14
Stage 2 of ACDS	p. 16
Stage 3 of ACDS	p. 18
Allergic Contact Dermatitis vs. Irritant Contact Dermatitis: Criteria for Differential Diagnosis	p. 22
Other Skin Diseases in Which Patch Testing is of Major Interest	p. 23
An Algorithmic Approach: The Key Role of Patch Testing	p. 24
Hand Dermatitis: Procedures Applied in Differential Diagnosis	p. 24
Hand Dermatitis: Exogenous and Endogenous Factors	p. 24
A Classification of Hand Dermatitis	p. 24
Tools of Investigation	p. 29
Hand Dermatitis: Some Examples of an Algorithmic Approach	p. 29
Management of Chronic Hand Dermatitis	p. 29
References	p. 31
Patch Testing Methodology	p. 33
Historical Background	p. 33
Definition and Aims	p. 34
Requirements for an Ideal Patch Testing Procedure	p. 34
Is Patch Testing the "Gold Standard" to Investigate Patients with Allergic Contact Dermatitis?	p. 34
Patch Test Units	p. 35
Finn Chamber	p. 35
Plastic Square Chambers	p. 37
Reinforcement of Patch Test Units	p. 39
A General Overview of Allergens	p. 39
Allergens	p. 39
Bioavailability of Allergens	p. 41
Quality Control of Allergens	p. 42
Appropriate Amounts of Petrolatum to be Applied at Patch Testing	p. 42
Appropriate Amounts of Liquids to be Applied at Patch Testing	p. 42
Specific Recommendations when Considering Patch Testing Patients	p. 42
Patch Testing on Intact Skin is Critical	p. 43
Medicaments and Patch Testing	p. 43
Pregnancy and Patch Testing	p. 44
Patch Testing in Children	p. 44
Application of Patch Tests on the Skin: Some Practical Suggestions	p. 45
Test Sites	p. 45
Removal of Hair	p. 46
Degreasing of Test Site	p. 46
Application of Test Strips	p. 46
Instructions to Patients	p. 46
Reading Time	p. 46
Standard Patch Test Occlusion and Reading Time	p. 47
Conventional Patch Test Reading Time	p. 47
Reading at Day 2, Day 3, Day 4	p. 47
Reading at Day 7	p. 47
Single Reading vs. Multiple Reading	p. 48
Day 3 vs. Day 4 Reading	p. 48
One-Day Occlusion vs. Two-Day Occlusion	p. 48
Marking the Skin	p. 48
Immediate Urticarial Reactions to Some Allergens	p. 49
Reading and Scoring Patch Test Results	p. 50
Nomenclature: Scoring Codes	p. 50
Rating Patch Test Reactions Based on Digital Images	p. 50
Some Remarks About Reading and Scoring	p. 50
Irritant Patch Test Reactions	p. 54
False-Positive Patch Test Reactions	p. 56
False-Negative Patch Test Reactions	p. 57
Compound Allergy	p. 57
Cross-Sensitization, Concomitant Sensitization, Polysensitization	p. 58
Cross-Sensitization	p. 58
Concomitant Sensitization	p. 59
Polysensitization	p. 59
Unwanted Adverse Reactions of Patch Testing	p. 59
Patch Test Sensitization ("Active Sensitization")	p. 61
Excited Skin Syndrome ("Angry Back")	p. 61
Patch Test Readings in Different Ethnic Populations	p. 62
Patch Test Reading in Oriental Populations	p. 62
Patch Test Reading in Black Populations	p. 63
Patch Testing Techniques in Different Climatic Environments	p. 64
Temperate Climates	p. 65
Tropical Climates	p. 65
Patch Testing Procedures in the Tropics	p. 65
Additional Note: Proposal for Modified Scoring Codes of Positive Patch Test Reactions	p. 66
References	p. 67
The Standard Series of Patch Tests	p. 71
Historical Background	p. 71
Advantages and Disadvantages of Using a Standard Series of Patch Tests	p. 72
Advantages	p. 72
Disadvantages	p. 72
The Three Major Standard Series Used Throughout the World	p. 72
Some Remarks About the "Mixes" of the Standard Series	p. 73
Proposal for an ICDRG Revised International Series of Patch Tests	p. 73
List of Allergens Proposed for an Extended ICDRG Series, Which May be Required According to Each Individual Situation	p. 77
List of Allergens Proposed to Be Deleted from the Revised and Extended ICDRG Series	p. 77
Succinct Information about Allergens	p. 78
Allergens Listed in Sect. 4.5	p. 78
Allergens Listed in Sect. 4.6	p. 80
Additional Series of Patch Tests	p. 81
References	p. 81
Photopatch Testing	p. 83
Definition and Aims	p. 83
Photoallergic Contact Dermatitis	p. 83
Photoallergic Contact Dermatitis vs. Airborne Allergic Contact Dermatitis: Criteria for Differential Diagnosis	p. 86
Photoallergic Drug Eruptions	p. 86
Photopatch Testing Methodology	p. 86
Light Sources	p. 87
Proposal for a Photopatch Test Series	p. 87
References	p. 88
The TRUE Test System	p. 89
Introduction	p. 89
The TRUE Test System	p. 89
The Standard TRUE Test Series	p. 90
Methodology of Use	p. 91
Regulatory Information	p. 92
Additional Practical Information	p. 94
Conventional Patch Testing vs. TRUE Test: The Current Situation	p. 94
References	p. 97
Additional Testing Procedures	p. 99
Stripping Test	p. 99
Open Test	p. 99
Semi-Open Test	p. 100
Repeated Open Application Test	p. 102
Testing Procedures with Unknown Substances	p. 103
Strategy	p. 104
Steps Required Prior to Any Testing Procedure	p. 104
Testing Procedures with Solid Products and Extracts	p. 105
Testing Procedures with Cosmetics and Other Related Products	p. 106
Oral Provocation Test (Oral Challenge)	p. 106
Other Investigations	p. 107
pH Measurement	p. 107
Spot Tests	p. 107
Chemical Analysis	p. 110
References	p. 110
Clinical Relevance of Patch Test Reactions	p. 113
Introduction	p. 113
General Principles	p. 113
Past and Current Relevance	p. 114
Scoring System	p. 114
Strategies	p. 115
Clinical History	p. 116
Environmental Evaluation	p. 117
Further Correlations	p. 118
Additional Investigations	p. 118
Suggestions for Improved Evidence-Based Diagnosis of Relevance	p. 119
References	p. 120
The Atopy Patch Test in Atopic Dermatitis	p. 121
Introduction	p. 121
Atopy Patch Test Technique	p. 122
Atopy Patch Test Reading	p. 123
Atopy Patch Test Relevance, Patient Subgroups, and Pitfalls	p. 124
References	p. 126
Prick Testing
The Spectrum of Diseases for Which Prick Testing and Open (Non-Prick) Testing are Recommended	p. 131
The Contact Urticaria Syndrome	p. 131
Clinical Symptoms and Stages of CUS	p. 131
Etiology and Mechanisms of CUS	p. 134
Contact Urticaria to Natural Rubber Latex	p. 136
Protein Contact Dermatitis	p. 137
References	p. 139
The Methodology of Open (Non-Prick) Testing, Prick Testing, and its Variants	p. 141
Open (Non-Prick) Testing	p. 141
Prick Test: Technical Modalities and Reading	p. 141
Technique of Puncture	p. 142
Control Solutions	p. 143
Reading Time	p. 143
Reading Prick Test Results	p. 143
Medicaments and Prick Testing	p. 144
False-Negative Reactions	p. 144
False-Positive Reactions	p. 145
Prick Tests in Children and Babies	p. 145
Prick-by-Prick Test	p. 145
Scratch Test	p. 145
Scratch-Chamber Test	p. 146
Comparative Indications of Open (Non-Prick) Testing, Prick Testing, and Other Related Tests	p. 146
Intradermal Testing	p. 146
Prick Testing: Allergens of Interest for Skin Problems	p. 147
Latex	p. 147
Airborne Environmental per Annum Allergens	p. 148
Airborne Environmental Seasonal Allergens	p. 148
Food Allergens (Trophallergens)	p. 149
Occupational Allergens	p. 149
Fungi	p. 149
Miscellaneous (Immunological and/or Non-Immunological) Urticariogens	p. 150
References	p. 151
Testing in Cutaneous Systemic Adverse Drug Reactions: Interest and Limitations
Testing Procedures in Cutaneous Systemic Adverse Drug Reactions	p. 155
General Considerations	p. 155
Tools of Investigation in CADR	p. 155
Histopathological Limitations in Diagnosis of a CADR	p. 156
Patch Testing in CADR	p. 156
The Spectrum of CARDs for Which Patch Testing is Recommended	p. 157
The Spectrum of CARDs for Which Patch Testing can be Performed (Being Still Controversial)	p. 160
The Spectrum of CARDs for Which Patch Testing is of No Interest	p. 160
Guidelines in Drug Patch Testing: General Rules	p. 160
Technical Aspects of Drug Patch Testing	p. 161
Readings of Drug Patch Tests	p. 163
False-nagative Patch Test Reactions	p. 163
False-Positive Patch Test Reactions	p. 164
Prick Testing in CADR	p. 165
Intradermal Testing in CADR	p. 165
Oral Provocation Test (Oral Challenge) in CADR	p. 165
References	p. 166
Appendix	p. 167
Introductory Remarks	p. 167
Bakery Series	p. 168
Corticosteroid Series	p. 169
Cosmetic Series	p. 171
Epoxy Resin Series	p. 173
Hairdressing Series	p. 175
Isocyanate Series	p. 176
Metals Series	p. 177
(Meth) Acrylate Series	p. 177
Plastics and Glues Series	p. 178
Rubber Additives Series	p. 179
Textile Dyes and Finish Series	p. 180
Disperse Dyes	p. 182
Other Dyes	p. 183
Textile Finish Resin Allergens	p. 183
Other Series	p. 183
Shoe Dermatitis	p. 183
Plant Dermatitis	p. 184
References	p. 188
Suggested Reading	p. 189
Index	p. 191
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