Relevance of patch testing in patients of chronic spontaneous urticaria and its correlation with serum IgE level

Objectives: Chronic spontaneous urticaria (CSU) is defined as short lived (< 24h) wheals occurring spontaneously without any triggering factors, daily or almost daily for at least 6 weeks. Though CSU is mainly a Type 1 hypersensitivity reaction, earlier studies suggested contact allergy may have some role to play an important role in the etiopathogenesis of CSU. The objective of the study is to find out the relevance of patch test in the etiopathogenesis of and its correlation with serum IgE level. Materials and Methods: Thirty-one patients of CSU were thoroughly evaluated for clinical and laboratory parameters. We conducted patch testing with Indian Standard Series (ISS) in all of them and tried to find out the relevance of every positive reaction. Relevant positive cases were asked to avoid exposure for 2 months and were maintained only in breakthrough antihistamines. Furthermore, correlation of positive patch test reaction with high IgE and eosinophil count were studied. Results: Seventeen (55%) cases came positive for patch test. Potassium dichromate, lanolin, benzocaine, and fragrance mix were the most common offenders. Patients with very high IgE count had patch test positivity with multiple allergens. Seven of the fifteen patients who had relevant positive patch results could be followed up to remission; three were lost to follow-up. Conclusion: Patch test with ISS may give important clue to in a subset of patients of CSU and thus may be considered an important part of routine investigations of CSU.

Mucosal Fixed Drug Eruption to Levetiracetam with Early Positive Patch Test on Non-Lesional Skin

Levetiracetam (LEV) is a second-generation antiepileptic drug (AED) that is well tolerated, has a broad spectrum of action, low protein binding, and minimal hepatic metabolism. The incidence of hypersensitivity to LEV in children and adults is 0.6%. This is the first reported fixed drug eruption (FDE) identified using a patch test in a pediatric case associated with LEV

Prevalence of dermatoses among hairdressers and beauticians in Srinagar, the capital city of Kashmir, India

Background: Skin disorders among hairdressers and beauticians have been recognized as a common problem, owing to the prolonged exposure to a variety of irritants and allergens. Objectives: The aim was to study the prevalence of dermatoses among hairdressers and beauticians in Srinagar, the capital city of Kashmir, India. Methods: The study was conducted on 100 respondents from 57 salons and parlors located within the borders of the city. Detailed history taking and complete examination were performed during personal visits. Patch tests were performed with the Indian standard series on all participants. Results: The mean age of the study sample was 24.3 ± 6.3 years. 54% of the studied cases were found to suffer from one or more skin disorders. Hand eczema was the most commonly encountered dermatosis, observed in 32% of the cases. Three patterns of hand eczema were recognized: classic (14%), interdigital (6%), and threading (8%). Callosities were seen in 19% of the cases. We employed the term scissor nodule for the typical pattern of a callosity caused by the finger rings of scissors. Nail staining was encountered in 19%. The most common allergens leading to a positive patch test were found to be paraphenylenediamine (PPD) in thirteen cases, followed by a fragrance mix in nine, nickel sulfate in nine, thiuram in three, and formaldehyde in one. Conclusion: Skin disorders are common among hairdressers and beauticians. Raising awareness of these disorders and methods of their prevention among this group is imperative.

EVALUATION OF PATCH TESTING IN CONTACT DERMATITIS PATIENTS ATTENDING TERTIARY CARE CENTRE IN KARAIKAL

Introduction: Allergic contact dermatitis (ACD) is a growing concern due to increased use of cosmetics and topical medications routinely and exposure to a large number of allergens on day-to-day basis. Patch testing is a reliable method for detecting the causative antigens in suspected cases. Aims And Objectives: To assess the demographic profile, pattern of ACD, and patch test profile of suspected cases of ACD attending contact dermatitis clinic of our department. Materials And Methods: It was a prospective study in which all the patients with suspected ACD attending OPD of department of dermatology over a 3 month period were analysed. Patch testing was done using the most common antigens primarily, and other batteries were used depending on patient requirement and availability. Results: A total of 50 patients were enrolled in the contact dermatitis clinic over a period of 3 months. Hand eczema was the most common pattern seen in 23 cases followed by feet eczema, hand and foot eczema, facial eczema, forearm and leg eczema and photoallergic contact eczema. A total of 32 (64%) gave positive patch test results, with nickel sulfate being the most common allergen identified followed by cobalt sulfate & potassium dichromate. Conclusion: Common allergens identified in our study were more or less similar to studies from other parts of India

Results of patch tests (using Indian standard battery of allergens) in cement workers with clinically diagnosed allergic contact dermatitis to cement: A cross-sectional study

Objectives: The objective of the study was to identify the allergens showing positive patch test reaction (using Indian standard battery of allergens) in cement workers with clinically diagnosed allergic contact dermatitis (CD) to cement attending a tertiary referral center. Materials and Methods: We included cement workers with clinically diagnosed allergic CD to cement who attended the dermatology outpatient clinic of our tertiary referral center from January 2013 to December 2013. We did patch testing in all the cases ( after subsidence of active dermatitis) with Indian standard battery of patch test allergens and documented the allergens that showed a positive reaction. Results: Forty-seven (94%) of the 50 study participants showed a positive reaction to one or more of the allergens. The most common allergen that showed a positive reaction was potassium dichromate (43/50, 86%). Twenty-five patients (50%) showed positive reactions to more than 1 allergen. Four patients (8%) showed positive reactions only to allergens that were not seen in cement. Limitations: Small sample size and lack of information on clinical response of dermatitis to avoidance of identified allergen were the major limitations. Conclusion: Twenty-five (50%) patients showing positive reactions to more than 1 allergen tested and 4 (8%) showing positive patch test reaction to none of the allergens in cement (but to other allergens) highlight the role of patch testing in identifying the probable allergens in patients with clinically diagnosed allergic CD to cement.

Generalized Bullous Fixed Drug Eruption to Fluconazole with Positive Patch Testing and Confirmed Tolerance to Itraconazole

Generalized bullous fixed drug eruption (GBFDE) is a specific variant of fixed drug eruption that belongs to severe cutaneous adverse reactions (SCARs) and its diagnosis is based mainly on clinical course and especially on the reoccurrence of typical bullous lesions in previous and new sites after re-administration of the offending drug. We present a well-documented case of fluconazole-induced GBFDE, with a positive patch test to fluconazole (30% weight/volume preparation) and clinical tolerance to itraconazole proven by negative oral provocation. Even in SCARs, patch testing represents a useful diagnostic tool, while oral provocation remains the gold standard in cases that an alternative but the chemically relevant drug must be administered.

Study of Common Allergens in Patients with Allergic Contact Dermatitis: A Hospital Based Study

Allergic contact dermatitis (ACD) is one of the most common diseases presenting to the Dermatology department. The one and only method of preventing as well as treating this disease is avoidance of the allergen causing it. The identification of the allergen causing the ACD is possible by performing patch testing. The purpose of this study was to identify common allergens among patients with ACD using Indian standard series (ISS) of patch test. Clinically suspected cases of ACD were included in the hospital based cross-sectional study from January to December 2017. These cases underwent patch testing with the ISS. The study assessed the following variables: sex, age, occupation, site and positive patch test results. There were a total of 58 patients among which, 36.2% were males and 63.8% were females with a mean age of 32.36±12.51 years. Positive patch test reactions were seen in 63.0% of patients. The most common allergens were nickel sulphate (51.4%), fragrance mix (37.8%), potassium dichromate (8.1%), colophony (8.1%) and black rubber mix (8.1%). Among male, most common allergens were fragrance mix (57.1%), nickel sulphate (28.6%) and potassium dichromate (21.4%) while in female, most common allergens were nickel sulphate (65.2%) and fragrance mix (26.1%). In our study, majority of the allergens were positive. Hence, the ISS used in the study might be suitable in the context of Nepalese population. However, further similar studies on large number of patients with multiple allergens are required to determine the exact number of contact allergens prevalent in our population.