Allergy & Immunology Training Program, Winthrop University Hospital, Mineola, NY and Department of Medicine, State University of New York at Stony Brook, Stony Brook, NY.
J Allergy Clin Immunol Pract. 2015 Sep-Oct;3(5):669-75. doi: 10.1016/j.jaip.2015.05.001. Epub 2015 Jun 6.
Contact dermatitis is a common disease seen by allergists, dermatologists, and primary care physicians. The gold standard for diagnosing allergic contact dermatitis (ACD) is patch testing and is indicated in any patient with a chronic, pruritic, eczematous, or lichenified dermatitis if underlying or secondary ACD is suspected. Patients with acute generalized dermatitis who have extensive eczema on the back, are on immunosuppressant medications, and have applied topical corticosteroids, topical calcineurin inhibitors, or ultraviolet radiation to the patch test (PT) site may have suppressed PT reactions. The procedure of patch testing is not a difficult one to perform, but the interpretation of the PT needs some critical components, including having an appropriate level of suspicion for the diagnosis of ACD, testing the relevant allergens in their proper vehicle and concentration, and the necessary experience to properly interpret the results. Careful history and physical examination must be correlated with the result of the PT to establish clinical relevance. Once the PT is completed, allergens are identified, and relevance has been established, educating the patient about the avoidance of exposure is critical. The Joint Task Force of the American Academy of Allergy, Asthma and Immunology and American College of Allergy, Asthma and Immunology has developed updated practice parameters for contact dermatitis and patch testing, and their recommendations will be discussed (Fonacier LF, Bernstein DI, Pacheco K, Holness DL. Contact dermatitis: a practice parameter update 2015. J Allergy Clin Immunol Pract 2015; 3(3S):S1-S40.).
接触性皮炎是过敏科医生、皮肤科医生和初级保健医生常见的疾病。诊断变应性接触性皮炎（ACD）的金标准是斑贴试验，如果怀疑潜在或继发 ACD，则适用于任何患有慢性、瘙痒、湿疹样或苔藓样皮炎的患者。患有急性泛发性皮炎、背部有广泛湿疹、正在服用免疫抑制剂药物、并在斑贴试验（PT）部位应用了局部皮质类固醇、局部钙调神经磷酸酶抑制剂或紫外线辐射的患者，可能会抑制 PT 反应。斑贴试验的程序并不难执行，但 PT 的解释需要一些关键成分，包括对 ACD 诊断有适当的怀疑水平、在适当的载体和浓度下测试相关过敏原，以及正确解释结果的必要经验。必须仔细将病史和体格检查与 PT 结果相关联，以确定临床相关性。一旦完成 PT，确定过敏原并建立相关性后，教育患者避免接触过敏原至关重要。美国过敏、哮喘和免疫学学会和美国过敏、哮喘和免疫学学会联合工作组制定了接触性皮炎和斑贴试验的更新实践参数，将讨论其建议（Fonacier LF、Bernstein DI、Pacheco K、Holness DL. Contact dermatitis: a practice parameter update 2015. J Allergy Clin Immunol Pract 2015; 3(3S):S1-S40.）。
