North American Contact Dermatitis Group Patch Test Results: 2017–2018. Issue 2 (March 2021)

• Record Type: Journal Article
• Authors: DeKoven, Joel G.; Silverberg, Jonathan I.; Warshaw, Erin M.; Atwater, Amber R.; Reeder, Margo J.; Sasseville, Denis; Taylor, James S.; Zug, Kathryn A.; Belsito, Donald V.; Maibach, Howard I.; Pratt, Melanie D.; CGT, Mathias; DeLeo, Vincent A.; Fowler, Joseph F.
• Is Part Of: Dermatitis. Volume 32:Issue 2(2021)
• Page Start: 111
• Page End: 123
• Publication Date: 2021-03
• Subjects: Skin -- Inflammation -- Periodicals; Skin -- Diseases -- Periodicals; Dermatology -- Periodicals; Dermatitis, Contact -- Periodicals; Dermatitis, Atopic -- Periodicals; Dermatitis, Occupational -- Periodicals; Drug Eruptions -- Periodicals; 616.51
• DOI: 10.1097/DER.0000000000000729
• Languages: English
• ISSNs: 1710-3568

Abstract

Abstract : Supplemental digital content is available in the text. Abstract : Background: Patch testing is an important diagnostic tool for assessment of allergic contact dermatitis (ACD). Objective: This study documented the North American Contact Dermatitis Group (NACDG) patch testing results from March 1, 2017, to December 31, 2018. Methods: At 14 centers in North America, patients with dermatitis were tested in a standardized manner with a screening series of 70 allergens and supplemental allergens as clinically indicated. Data were manually verified and entered into a central database. Descriptive statistics were estimated, and trends were analyzed using χ 2 test. Results: Overall, 4947 patients were tested. There were 3235 patients (65.4%) who had at least 1 positive reaction and 2495 patients (50.4%) had a primary diagnosis of ACD. Five hundred eighty-one patients (11.7%) had occupationally related dermatitis. There were 10, 122 positive patch test reactions. Nickel remained the most commonly detected allergen (16.2%), followed by methylisothiazolinone 0.2% aqueous (15.3%) and methylchloroisothiazolinone/methylisothiazolinone 0.02% aqueous (200 ppm, 11.0%). Compared with the previous reporting periods (2015–2016 and 2007–2016), the proportion of positive reactions for the top 20 screening allergens statistically increased for only 1 allergen, propolis (3.4%; risk ratios = 2.05 [confidence interval = 1.66–2.54] and 1.82 [confidence interval = 1.57–2.11]). Four newly added allergen preparations, hydroperoxides of linalool (8.9%), benzisothiazolinone (7.3%), sodium metabisulfite (2.7%), and hydroperoxides of limonene (2.6%), all had a prevalence of greater than 2%. Approximately 1 (19.7%) in 5 tested patients had 1 or more clinically relevant reactions to an allergen not on the NACDG screening series; 13.2% of these were occupationally related. T.R.U.E. TEST (SmartPractice Denmark, Hillerød, Denmark) would have hypothetically missed 30% to 40% of reactions detected by the NACDG screening series. Conclusions: These results demonstrate the importance of a regularly updated screening allergen series. Methylisothiazolinone continues to be a significant allergen in North America. Patch testing with allergens beyond a screening tray is necessary for complete evaluation of occupational and non-occupational ACD.