North American contact dermatitis group patch test results: 2011-2012

Erin M. Warshaw, Howard I. Maibach, James S. Taylor, Denis Sasseville, Joel G. DeKoven, Matthew J. Zirwas, Anthony F. Fransway, C. G Toby Mathias, Kathryn A. Zug, Vincent A. DeLeo, Joseph F. Fowler, James G. Marks, Melanie D. Pratt, Frances J. Storrs, Donald V. Belsito

Research output: Contribution to journalArticle

Abstract

BACKGROUND: Patch testing is an important diagnostic tool for assessment of allergic contact dermatitis (ACD).

OBJECTIVE: This study documents the North American Contact Dermatitis Group (NACDG) patch-testing results from January 1, 2011, to December 31, 2012.

METHODS: At 12 centers in North America, patients were tested in a standardized manner with a series of 70 allergens. Data were manually verified and entered into a central database. Descriptive frequencies were calculated, and trends analyzed using χ statistics.

RESULTS: Four thousand two hundred thirty-eight patients were tested; of these, 2705 patients (63.8%) had at least 1 positive reaction, and 2029 (48.0%) were ultimately determined to have a primary diagnosis of ACD. Four hundred eight patients (9.6%) had occupationally related skin disease. There were 7532 positive allergic reactions. As compared with previous reporting periods (2009-2010 and 2000-2010), positive reaction rates statistically increased for 6 allergens: methylchloroisothiazolinone/methylisothiazolinone (5.0%; risk ratios [RRs]: 2.01 [1.60-2.52], 1.87 [1.61-2.18]), lanolin alcohol (4.6%; RRs 1.83 [1.45-2.30], 2.10 [1.79-2.47]), cinnamic aldehyde (3.9%; 1.69 [1.32-2.15], 1.53 [1.28-1.82]), glutaral (1.5%; 1.67 [1.13-2.48], 1.31 [1.00-1.71]), paraben mix (1.4%; 1.77 [1.16-2.69], 1.44 [1.09-1.92]), and fragrance mix I (12.1%; RRs 1.42 [1.25-1.61], 1.24 [1.14-1.36]). Compared with the previous decade, positivity rates for all formaldehyde-releasing preservatives significantly decreased (formaldehyde 6.6%; RR, 0.82 [0.73, 0.93]; quaternium-15 6.4% RR 0.75 [0.66, 0.85]; diazolidinyl urea 2.1%; RR, 0.67 [0.54, 0.84]; imidazolidinyl urea 1.6%, 0.60 [0.47, 0.77]; bronopol 1.6%; RR, 0.60 [0.46, 0.77]; DMDM hydantoin 1.6%; RR, 0.59 [0.54, 0.84]). Approximately a quarter of patients had at least 1 relevant allergic reaction to a non-NACDG allergen. In addition, approximately one-fourth to one-third of reactions detected by NACDG allergens would have been hypothetically missed by T.R.U.E. TEST (SmartPractice Denmark, Hillerød, Denmark).

CONCLUSIONS: These data document the beginning of the epidemic of sensitivity to methylisothiazolinones in North America, which has been well documented in Europe. Patch testing with allergens beyond a standard screening tray is necessary for complete evaluation of occupational and nonoccupational ACD.

Original languageEnglish (US)
Pages (from-to)49-59
Number of pages11
JournalDermatitis : contact, atopic, occupational, drug
Volume26
Issue number1
DOIs
StatePublished - Jan 1 2015

ASJC Scopus subject areas

  • Medicine(all)

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    Warshaw, E. M., Maibach, H. I., Taylor, J. S., Sasseville, D., DeKoven, J. G., Zirwas, M. J., Fransway, A. F., Mathias, C. G. T., Zug, K. A., DeLeo, V. A., Fowler, J. F., Marks, J. G., Pratt, M. D., Storrs, F. J., & Belsito, D. V. (2015). North American contact dermatitis group patch test results: 2011-2012. Dermatitis : contact, atopic, occupational, drug, 26(1), 49-59. https://doi.org/10.1097/DER.0000000000000097