Goldenberg Alina, Lipp Michael, Jacob Sharon E
Department of Dermatology, University of California at San Diego, San Diego, California.
Lake Erie Consortium for Osteopathic Medical Training (LECOMT)/Larkin Community Hospital-Palm Springs Campus, Hialeah, Florida.
Pediatr Dermatol. 2017 Mar;34(2):138-143. doi: 10.1111/pde.13063. Epub 2017 Jan 23.
BACKGROUND/OBJECTIVE: The isothiazolinones methylchloroisothiazolinone (MCI) and methylisothiazolinone (MI) are prevalent pediatric contact sensitizers. MI allergic contact dermatitis (ACD) is underreported in the literature. The objective of the current study was to use a database of provider-reported U.S. pediatric patch test cases to evaluate the positive patch test (PPT) prevalence rates of the combined preservative test substrate MCI/MI and of MI alone.
U.S. pediatric patch test providers in all 50 states who had joined the registry were invited to submit deidentified cases to the database. More than 1100 logged cases in the database were evaluated for PPTs to MCI/MI combination, MCI/MI and MI, and MI alone.
Within 1 year of data collection, 96 cases with a PPT for MCI/MI, MCI/MI and MI, and MI alone were identified; 37 of these were positive to MCI/MI, with MI alone not tested or negative, and 39 were positive to MI only, with MCI/MI and MI tested. Fifteen (41%) of the MCI/MI cases were detected using an epicutaneous patch test alone and 22 cases (59%) using comprehensive patch testing. Only one case (3%) of MI alone sensitization was detected using T.R.U.E. plus a supplemental panel of tests; the remaining 38 cases (97%) were detected using comprehensive testing. Testing with only the combined MCI/MI preservative substrate may miss 51% of MI allergies.
Appropriate testing of isothiazolinones is needed to clarify the true prevalence of sensitization to these allergens and the burden of pediatric ACD. Patch testing for MI alone in addition to MCI/MI combination is warranted in children with recalcitrant dermatitis.
背景/目的：异噻唑啉酮类中的甲基氯异噻唑啉酮（MCI）和甲基异噻唑啉酮（MI）是常见的儿童接触性致敏原。文献中关于MI过敏性接触性皮炎（ACD）的报道较少。本研究的目的是利用一个由医疗服务提供者报告的美国儿童斑贴试验病例数据库，评估联合防腐剂测试底物MCI/MI以及单独MI的斑贴试验阳性（PPT）患病率。
邀请加入登记系统的美国50个州的儿童斑贴试验医疗服务提供者向数据库提交去识别化病例。对数据库中超过1100例已记录病例进行了针对MCI/MI组合、MCI/MI和MI以及单独MI的PPT评估。
在数据收集的1年内，识别出96例对MCI/MI、MCI/MI和MI以及单独MI呈PPT的病例；其中37例对MCI/MI呈阳性，单独MI未检测或呈阴性，39例仅对MI呈阳性，MCI/MI和MI均进行了检测。15例（41%）MCI/MI病例仅通过表皮斑贴试验检测到，22例（59%）通过综合斑贴试验检测到。仅使用TRUE加一组补充试验检测到单独MI致敏的病例仅1例（3%）；其余38例（97%）通过综合试验检测到。仅使用联合MCI/MI防腐剂底物进行检测可能会遗漏51%的MI过敏病例。
需要对异噻唑啉酮进行适当检测，以明确这些变应原致敏的真实患病率以及儿童ACD的负担。对于患有顽固性皮炎的儿童，除了MCI/MI组合外，单独进行MI的斑贴试验是必要的。
