9783540928058

Table of Contents


1	The International Contact Dermatitis Research Group J.-M. Lachapelle and H.I. Maibach	1
1.1	Historical Background	1
1.2	Current Tasks of the ICDRG	2
1.3	ICDRG Members	2
	References	3
PART I	PATCH TESTING
2	The Spectrum of Diseases for Which Patch Testing is Recommended J.-M. Lachapelle	7
2.1	Allergic Contact Dermatitis	7
2.1.1	Pathomechanisms in Allergic Contact Dermatitis	7
2.1.2	Clinical Signs and Symptoms	9
2.1.3	Histopathological Features	11
2.2	The Allergic Contact Dermatitis Syndrome	12
2.2.1	Stage 1 of ACDS	14
2.2.2	Stage 2 of ACDS	16
2.2.3	Stage 3 of ACDS	18
2.3	Allergic Contact Dermatitis vs. Irritant Contact Dermatitis: Criteria for Differential Diagnosis	22
2.4	Other Skin Diseases in Which Patch Testing is of Major Interest	23
2.5	An Algorithmic Approach: The Key Role of Patch Testing	24
2.6	Hand Dermatitis: Procedures Applied in Differential Diagnosis	24
2.6.1	Hand Dermatitis: Exogenous and Endogenous Factors	24
2.6.2	A Classification of Hand Dermatitis	24
2.6.3	Tools of Investigation	29
2.6.4	Hand Dermatitis: Some Examples of an Algorithmic Approach	29
2.6.5	Management of Chronic Hand Dermatitis	29
	References	31
3	Patch Testing Methodology J.-M. Lachapelle and H.I. Maibach	33
3.1	Historical Background	33
3.2	Definition and Aims	34
3.2.1	Requirements for an Ideal Patch Testing Procedure	34
3.2.2	Is Patch Testing the �Gold Standard� to Investigate Patients with Allergic Contact Dermatitis?	34
3.3	Patch Test Units	35
3.3.1	Finn Chamber	35
3.3.2	Plastic Square Chambers	37
3.3.3	Reinforcement of Patch Test Units	39
3.4	A General Overview of Allergens	39
3.4.1	Allergens	39
3.4.2	Bioavailability of Allergens	41
3.4.3	Quality Control of Allergens	42
3.4.4	Appropriate Amounts of Petrolatum to be Applied at Patch Testing	42
3.4.5	Appropriate Amounts of Liquids to be Applied at Patch Testing	42
3.5	Specific Recommendations when Considering Patch Testing Patients	42
3.5.1	Patch Testing on Intact Skin is Critical	43
3.5.2	Medicaments and Patch Testing	43
3.5.3	Pregnancy and Patch Testing	44
3.5.4	Patch Testing in Children	44
3.6	Application of Patch Tests on the Skin: Some Practical Suggestions	45
3.6.1	Test Sites	45
3.6.2	Removal of Hair	46
3.6.3	Degreasing of Test Site	46
3.6.4	Application of Test Strips	46
3.6.5	Instructions to Patients	46
3.7	Reading Time	46
3.7.1	Standard Patch Test Occlusion and Reading Time	47
3.7.2	Conventional Patch Test Reading Time	47
3.7.3	Reading at Day 2, Day 3, Day 4	47
3.7.4	Reading at Day 7	47
3.7.5	Single Reading vs. Multiple Reading	48
3.7.6	Day 3 vs. Day 4 Reading	48
3.7.7	One-Day Occlusion vs. Two-Day Occlusion	48
3.7.8	Marking the Skin	48
3.7.9	Immediate Urticarial Reactions to Some Allergens	49
3.8	Reading and Scoring Patch Test Results	50
3.8.1	Nomenclature: Scoring Codes	50
3.8.2	Rating Patch Test Reactions Based on Digital Images	50
3.8.3	Some Remarks About Reading and Scoring	50
3.9	Irritant Patch Test Reactions	54
3.10	False-Positive Patch Test Reactions	56
3.11	False-Negative Patch Test Reactions	57
3.12	Compound Allergy	57
3.13	Cross-Sensitization, Concomitant Sensitization, Polysensitization	58
3.13.1	Cross-Sensitization	58
3.13.2	Concomitant Sensitization	59
3.13.3	Polysensitization	59
3.14	Unwanted Adverse Reactions of Patch Testing	59
3.14.1	Patch Test Sensitization (�Active Sensitization�)	61
3.14.2	Excited Skin Syndrome (�Angry Back�)	61
3.15	Patch Test Readings in Different Ethnic Populations	62
3.15.1	Patch Test Reading in Oriental Populations	62
3.15.2	Patch Test Reading in Black Populations	63
3.16	Patch Testing Techniques in Different Climatic Environments	64
3.16.1	Temperate Climates	65
3.16.2	Tropical Climates	65
3.16.3	Patch Testing Procedures in the Tropics	65
3.17	Additional Note: Proposal for Modified Scoring Codes of Positive Patch Test Reactions	66
	References	67
4	The Standard Series of Patch Tests J.-M. Lachapelle	71
4.1	Historical Background	71
4.2	Advantages and Disadvantages of Using a Standard Series of Patch Tests	72
4.2.1	Advantages	72
4.2.2	Disadvantages	72
4.3	The Three Major Standard Series Used Throughout the World	72
4.4	Some Remarks About the �Mixes� of the Standard Series	73
4.5	Proposal for an ICDRG Revised International Series of Patch Tests	73
4.6	List of Allergens Proposed for an Extended ICDRG Series, Which may be Required According to Each Individual Situation	77
4.7	List of Allergens Proposed to Be Deleted from the Revised and Extended ICDRG Series	77
4.8	Succinct Information About Allergens	78
4.8.1	Allergens Listed in Sect. 4.5	78
4.8.2	Allergens Listed in Sect. 4.6	80
4.9	Additional Series of Patch Tests	81
	References	81
5	Photopatch Testing J.-M. Lachapelle and A. Goossens	83
5.1	Definition and Aims	83
5.2	Photoallergic Contact Dermatitis	83
5.3	Photoallergic Contact Dermatitis vs. Airborne Allergic Contact Dermatitis: Criteria for Differential Diagnosis	86
5.4	Photoallergic Drug Eruptions	86
5.5	Photopatch Testing Methodology	86
5.6	Light Sources	87
5.7	Proposal for a Photopatch Test Series	87
	References	88
6	TheTRUE Test System J.-M. Lachapelle and H.I. Maibach	89
6.1	Introduction	89
6.2	The TRUE Test System	89
6.3	The Standard TRUE Test Series	90
6.4	Methodology of Use	91
6.5	Regulatory Information	92
6.6	Additional Practical Information	94
6.7	Conventional Patch Testing vs. TRUE Test: The Current Situation	94
	References	97
7	Additional Testing Procedures J.-M. Lachapelle and H.I. Maibach	99
7.1	Stripping Test	99
7.2	OpenTest	99
7.3	Semi-Open Test	100
7.4	Repeated Open Application Test	102
7.5	Testing Procedures with Unknown Substances	103
7.5.1	Strategy	104
7.5.2	Steps Required Prior to Any Testing Procedure	104
7.5.3	Testing Procedures with Solid Products and Extracts	105
7.5.4	Testing Procedures with Cosmetics and Other Related Products	106
7.6	Oral Provocation Test (Oral Challenge)	106
7.7	Other Investigations	107
7.7.1	pH Measurement	107
7.7.2	Spot Tests	107
7.7.3	Chemical Analysis	110
	References	110
8	Clinical Relevance of Patch Test Reactions J.-M. Lachapelle and H.L. Maibach	113
8.1	Introduction	113
8.2	General Principles	113
8.3	Past and Current Relevance	114
8.4	Scoring System	114
8.5	Strategies	115
8.5.1	Clinical History	116
8.5.2	Environmental Evaluation	117
8.5.3	Further Correlations	118
8.5.4	Additional Investigations	118
8.6	Suggestions for Improved Evidence-Based Diagnosis of Relevance	119
	References	120
9	The Atopy Patch Test in Atopic Dermatitis U. Darsow and J. Ring	121
9.1	Introduction	121
9.2	Atopy Patch Test Technique	122
9.3	Atopy Patch Test Reading	123
9.4	Atopy Patch Test Relevance, Patient Subgroups, and Pitfalls	124
	References	126
PART II	PRICK TESTING
10	The Spectrum of Diseases for Which Prick Testing and Open (Non-Prick) Testing are Recommended J.-M. Lachapelle and H.I. Maibach	131
10.1	The Contact Urticaria Syndrome	131
10.1.1	Clinical Symptoms and Stages of CUS	131
10.1.2	Etiology and Mechanisms of CUS	134
10.1.3	Contact Urticaria to Natural Rubber Latex	136
10.2	Protein Contact Dermatitis	137
	References	139
11	The Methodology of Open (Non-Prick) Testing, Prick Testing, and its Variants J.-M. Lachapelle and H.I. Maibach	141
11.1	Open (Non-Prick) Testing	141
11.2	Prick Test: Technical Modalities and Reading	141
11.2.1	Technique of Puncture	142
11.2.2	Control Solutions	143
11.2.3	Reading Time	143
11.2.4	Reading Prick Test Results	143
11.2.5	Medicaments and Prick Testing	144
11.2.6	False-Negative Reactions	144
11.2.7	False-Positive Reactions	145
11.2.8	Prick Tests in Children and Babies	145
11.3	Prick-by-Prick Test	145
11.4	Scratch Test	145
11.5	Scratch-Chamber Test	146
11.6	Comparative Indications of Open (Non-Prick) Testing, Prick Testing, and Other Related Tests	146
11.7	Intradermal Testing	146
11.8	Prick Testing: Allergens of Interest for Skin Problems	147
11.8.1	Latex	147
11.8.2	Airborne Environmental per Annum Allergens	148
11.8.3	Airborne Environmental Seasonal Allergens	148
11.8.4	Food Allergens (Trophallergens)	149
11.8.5	Occupational Allergens	149
11.8.6	Fungi	149
11.8.7	Miscellaneous (Immunological and/or Non-Immunological) Urticariogens	150
	References	151
PART III	TESTING IN CUTANEOUS SYSTEMIC ADVERSE DRUG REACTIONS: INTEREST AND LIMITATIONS
12	Testing Procedures in Cutaneous Systemic Adverse Drug Reactions J.-M. Lachapelle	155
12.1	General Considerations	155
12.2	Tools of Investigation in CADR	155
12.3	Histopathological Limitations in Diagnosis of a CADR	156
12.4	Patch Testing in CADR	156
12.4.1	The Spectrum of CADRs for Which Patch Testing is Recommended	157
12.4.2	The Spectrum of CADRs for Which Patch Testing can be Performed (Being Still Controversial)	160
12.4.3	The Spectrum of CADRs for Which Patch Testing is of No Interest	160
12.4.4	Guidelines in Drug Patch Testing: General Rules	160
12.4.5	Technical Aspects of Drug Patch Testing	161
12.4.6	Readings of Drug Patch Tests	163
12.4.7	False-Negative Patch Test Reactions	163
12.4.8	False-Positive Patch Test Reactions	164
12.5	Prick Testing in CADR	165
12.5.1	Intradermal Testing in CADR	165
12.5.2	Oral Provocation Test (Oral Challenge) in CADR	165
	References	166
	Appendix J.-M. Lachapelle	167
A.1	Introductory Remarks	167
A.2	Bakery Series	168
A.3	Corticosteroid Series	169
A.4	Cosmetic Series	171
A.5	Epoxy Resin Series	173
A.6	Hairdressing Series	175
A.7	Isocyanate Series	176
A.8	Metals Series	177
A.9	(Meth)Acrylate Series	177
A.10	Plastics and Glues Series	178
A.11	Rubber Additives Series	179
A.12	Textile Dyes and Finish Series	180
A.12.1	Disperse Dyes	182
A.12.2	Other Dyes	183
A.12.3	Textile Finish Resin Allergens	183
A.13	Other Series	183
A.13.1	Shoe Dermatitis	183
A.13.2	Plant Dermatitis	184
	References	188
	Suggested Reading	189
	Index	191