Department of Adult Allergy, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom.
Department of Medicine, East Surrey Hospital, Redhill, Surrey, United Kingdom.
J Allergy Clin Immunol Pract. 2019 Jan;7(1):89-95. doi: 10.1016/j.jaip.2018.08.030. Epub 2018 Sep 7.
Patch testing is the gold standard diagnostic tool for investigating allergic contact dermatitis (ACD). In the United Kingdom, patch testing has been historically confined to the dermatologist's office. Furthermore, detailed studies on patch testing by allergists are significantly underrepresented at the international level.
The objective of this study was to undertake a comprehensive evaluation of a patch testing initiative from an allergy practice; we report on various patient characteristics, prevalence and relevance data, in addition to immediate hypersensitivity testing.
We undertook a retrospective analysis of 156 patients suspected of having contact dermatitis seen in our UK allergy practice between October 2016 and April 2018.
Of the 156 patients patch tested (mean age 36.9 years, female 88%, white ethnicity 71.8%, atopy 68.6%), ACD was diagnosed overall in 49% of the cohort and ACD of current relevance was assigned to 31%. Our extended British standard series alone detected the responsible allergen in 87% of patients, and the remaining 13% were detected from supplementary or own material testing alone. Most prevalent contact allergens were nickel (28.2%), p-phenylenediamine (8.3%), cobalt (8.3%), methylisothiazolinone (5.8%), and hydroperoxides of linalool (4.5%) and limonene (4.5%). A history of occupationally related dermatitis (P = .004) and initial (pretest) diagnosis of ACD (P < .001) were both significantly associated with relevant positive patch test reactions (atopy status was not associated P > .05).
ACD was detected in almost 50% of assessed patients, and we highlight the importance of assessing relevance. Hydroperoxides of limonene and linalool are notable additions to the prevalence data. Patch testing should be incorporated into more allergy practices, although availability of training is a limiting factor.
斑贴试验是诊断变应性接触性皮炎（ACD）的金标准诊断工具。在英国，斑贴试验历来局限于皮肤科医生的诊室。此外，过敏症医生进行的斑贴试验详细研究在国际层面上明显代表性不足。
本研究的目的是对过敏症实践中的斑贴试验计划进行全面评估；我们报告了各种患者特征、患病率和相关性数据，以及即刻过敏反应测试。
我们对 2016 年 10 月至 2018 年 4 月期间在我们英国过敏症实践中就诊的 156 例疑似接触性皮炎患者进行了回顾性分析。
在接受斑贴试验的 156 例患者中（平均年龄 36.9 岁，女性占 88%，白种人占 71.8%，特应性占 68.6%），总体上诊断出 ACD 占 49%，且 31%的 ACD 与当前相关。仅我们的扩展英国标准系列就检测到了 87%患者的致病过敏原，其余 13%仅通过补充或自身材料检测即可检测到。最常见的接触过敏原是镍（28.2%）、对苯二胺（8.3%）、钴（8.3%）、甲基异噻唑啉酮（5.8%）以及芳樟醇和柠檬烯的过氧化物（4.5%）。职业相关性皮炎病史（P =.004）和初始（测试前）ACD 诊断（P <.001）均与相关阳性斑贴试验反应显著相关（特应性状态无显著相关性，P >.05）。
在所评估的患者中，近 50%检测到 ACD，我们强调评估相关性的重要性。芳樟醇和柠檬烯的过氧化物是患病率数据中的显著新增内容。尽管培训的可用性是一个限制因素，但应将斑贴试验纳入更多的过敏症实践中。
