Radoslaw Spiewak

European Society of Contact Dermatitis guideline for diagnostic patch testing – recommendations on best practice

The present guideline summarizes all aspects of patch testing for the diagnosis of contact allergy in patients suspected of suffering, or having been suffering, from allergic contact dermatitis or other delayed‐type hypersensitivity skin and mucosal conditions. Sections with brief descriptions and discussions of different pertinent topics are followed by a highlighted short practical recommendation. Topics comprise, after an introduction with important definitions, materials, technique, modifications of epicutaneous testing, individual factors influencing the patch test outcome or necessitating special considerations, children, patients with occupational contact dermatitis and drug eruptions as special groups, patch testing of materials brought in by the patient, adverse effects of patch testing, and the final evaluation and patient counselling based on this judgement. Finally, short reference is made to aspects of (continuing) medical education and to electronic collection of data for epidemiological surveillance.

A European multicentre photopatch test study

Background  The two most common agent groups currently responsible for photoallergic contact dermatitis (PACD) are organic ultraviolet (UV) absorbers in sunscreens and topical nonsteroidal anti‐inflammatory drugs (NSAIDs). However, availability of information on the photoallergenic potential of these agents is scarce.

Current patch test results with the European baseline series and extensions to it from the 'European Surveillance System on Contact Allergy' network, 2007-2008

Background. The pattern of contact sensitization to the supposedly most important allergens assembled in the baseline series differs between countries, presumably at least partly because of exposure differences.

The EU Nickel Directive revisited—future steps towards better protection against nickel allergy

In July 2001, the EU Nickel Directive came into full force to protect European citizens against nickel allergy and dermatitis. Prior to this intervention, Northern European governments had already begun to regulate consumer nickel exposure. According to part 2 of the EU Nickel Directive and the Danish nickel regulation, consumer items intended to be in direct and prolonged contact with the skin were not allowed to release more than 0.5 µg nickel/cm2/week. It was considered unlikely that nickel allergy would disappear altogether as a proportion of individuals reacted below the level defined by the EU Nickel Directive. Despite this, the EU Nickel Directive part 2 was expected to work as an operational limit that would sufficiently protect European consumers against nickel allergy and dermatitis. This review presents the accumulation of epidemiological studies that evaluated the possible effect of this major public health intervention. Also, it evaluates recent exposure assessment studies that have been performed using the dimethyl glyoxime test. It is concluded that the EU Nickel Directive has started to change the epidemiology of nickel allergy in Europe but it should be revisited to better protect consumers and workers since nickel allergy and dermatitis remain very frequent.

Contact hypersensitivity and allergic contact dermatitis among school children and teenagers with eczema

Background:  Patch testing is an essential procedure in the investigation of eczema in children.

Atopy and contact hypersensitivity: a reassessment of the relationship using objective measures

BACKGROUND There is a big contradiction in the medical literature regarding the relationship between atopy and contact hypersensitivity. Some researchers believe that atopy would prevent, whereas others believe that it would promote, the development of contact allergy. Possible causes of this confusion range from different study populations to different definitions of atopy. OBJECTIVE To evaluate the relationship between atopy and contact hypersensitivity in a well-defined general population sample using objectively measurable markers. METHODS I studied 135 randomly selected students from 5 vocational schools: 73 women and 62 men aged 18 to 19 years. The following atopy markers were tested: positive skin prick test results, positive Phadiatop test results, and total IgE levels greater than 120 kU/L. Contact hypersensitivity was detected by using patch tests. Statistical analyses included the Fisher exact test, the Mann-Whitney U test, and calculation of odds ratios. RESULTS At least 1 positive skin prick test result was found in 23.7% (95% confidence interval [CI], 16.5%-30.9%) of study participants, positive Phadiatop test results were found in 20.0% (95% CI, 13.3%-26.7%), and total IgE levels greater than 120 kU/L were found in 23.7% (95% CI, 16.5%-30.9%). Positive patch test reactions were found in 28.1% (95% CI, 20.6%-35.7%) of participants, most frequently to thimerosal (18.5%; 95% CI, 12.0%-25.1%) and nickel (9.6%; 95% CI, 4.6%-14.6%). For persons with atopy markers, odds ratios for contact hypersensitivity ranged from 1.0 to 3.2, the highest being for nickel hypersensitivity among those with total IgE levels greater than 120 kU/L. None of these relationships were statistically significant. CONCLUSION Atopy and contact hypersensitivity are independent phenomena.

Patch test results in children and adolescents across Europe. Analysis of the ESSCA Network 2002–2010†

Contact sensitization in children is more frequent than previously thought.

The most important contact sensitizers in Polish children and adolescents with atopy and chronic recurrent eczema as detected with the extended European Baseline Series

To cite this article: Czarnobilska E, Obtulowicz K, Dyga W, Spiewak R. The most important contact sensitizers in Polish children and adolescents with atopy and chronic recurrent eczema as detected with the extended European Baseline Series. Pediatr Allergy Immunol 2011; 22:252–256.

Allergic contact dermatitis to nickel: modified in vitro test protocols for better detection of allergen-specific response

To date, no in vitro test is suitable for routine diagnosis of contact allergy. The aim of our study was to establish improved in vitro test protocol for the detection of antigen‐specific responses of lymphocytes from patients with allergic contact dermatitis to nickel (Ni‐ACD). Blood leucocytes from 14 Ni‐ACD patients and 14 controls were cultured in the presence of ‘cytokine cocktails’ skewing lymphocytes towards ‘type 1’ [interferon‐γ (IFN‐γ)‐secreting] or ‘type 2’ [interleukin (IL)‐5 and IL‐13‐secreting] phenotypes. The cocktails consisted of IL‐7 and, respectively, either IL‐12 or IL‐4. Cell responses to nickel were measured with enzyme‐linked immunospot assay (ELISpot), enzyme‐linked immunosorbent assay (ELISA), and lymphocyte proliferation test (LPT). Significant differences between patients with Ni‐ACD and controls were found for the ‘type 2’ cytokines IL‐13 and IL‐5, with further increase of allergen‐specific responses occurring when cultures were supplemented with IL‐7 and IL‐4. No significant differences were found for IFN‐γ. The best correlate to clinical diagnosis was LPT with ‘type 2’ skewing (r= 0.739, P < 0.001), followed by IL‐13 ELISpot with ‘type 2’ skewing (r= 0.654, P < 0.001). The non‐radioactive method that correlated best with LPT was IL‐2 ELISpot (r= 0.809, P < 0.001). Overall, we conclude that combining ELISpot assay with proposed modifications of culture conditions improves detection of specific lymphocyte responses in contact allergy to nickel.

A half of schoolchildren with 'ISAAC eczema' are ill with allergic contact dermatitis

Background  Similarity in clinical symptoms between atopic eczema (AE) and allergic contact dermatitis (ACD) may lead to misdiagnoses in both clinical practice and epidemiological studies. As patch testing for contact allergy does not seem popular among paediatric allergists, the resulting bias leads mainly to under diagnosing of ACD and over diagnosing of AE in children and adolescents.