Atopy patch tests may identify patients at risk for systemic contact dermatitis
Abstract Background A subset of patients with positive patch tests demonstrates systemic contact dermatitis (SCD) upon ingestion or inhalation of the allergen. Concern has been raised about the use of patch tests for protein allergens (APTs) to detect SCD in atopic dermatitis (AD) patients. Methods...
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doaj-105c3c1d075b4d4384a8ffa2162b06c52020-11-25T01:25:21ZengWileyImmunity, Inflammation and Disease2050-45272020-03-0181242910.1002/iid3.280Atopy patch tests may identify patients at risk for systemic contact dermatitisSuwimon Pootongkam0Sonia A. Havele1Hanna Orillaza2Eli Silver3Douglas Y. Rowland4Susan T. Nedorost5Department of Dermatology University Hospitals Cleveland Medical Center, Case Western Reserve University Cleveland OhioCase Western Reserve University School of Medicine Cleveland OhioDepartment of Dermatology University Hospitals Cleveland Medical Center, Case Western Reserve University Cleveland OhioDivision of Allergy and Immunology University Hospitals Cleveland Cleveland OhioDepartment of Population and Quantitative Health Sciences (PQHS) Case Western Reserve University School of Medicine Cleveland OhioDepartment of Dermatology University Hospitals Cleveland Medical Center, Case Western Reserve University Cleveland OhioAbstract Background A subset of patients with positive patch tests demonstrates systemic contact dermatitis (SCD) upon ingestion or inhalation of the allergen. Concern has been raised about the use of patch tests for protein allergens (APTs) to detect SCD in atopic dermatitis (AD) patients. Methods We present atopy patch test (APT) data for 97 people. We reviewed APTs and tests for antigen‐specific immunoglobulin E (IgE) to the same allergen in pediatric AD patients. We compared the frequency of APTs as a function of age in AD patients. To study the irritancy potential of APTs, we prospectively tested consenting non‐AD dermatitis patients undergoing evaluation for allergic contact dermatitis and healthy controls to an APT panel. Results APT demonstrated fewer positive results than serum‐specific IgE or skin prick tests to the same allergen. Positive APT to food was more common in children under 3 years, whereas positive APT to aeroallergens were more common in teens and adults. Only positive APTs to dust mite were significantly more common positive in subjects without AD. Conclusion Our aggregate findings suggest that most APTs, but not dust mite, behave like conventional patch tests to low‐potency allergens. They are more likely to be positive in patients with chronically inflamed skin and to identify allergens that cause SCD. The higher prevalence of APT positivity to foods in young children is consistent with food allergy as a trigger of AD (also known as SCD) being more common in children than adults. Positive APTs define patients who may have SCD; negative APTs may guide elimination diets.https://doi.org/10.1002/iid3.280atopic dermatitisatopy patch testselimination dietsprotein contact dermatitissystemic contact dermatitis |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Suwimon Pootongkam Sonia A. Havele Hanna Orillaza Eli Silver Douglas Y. Rowland Susan T. Nedorost |
spellingShingle |
Suwimon Pootongkam Sonia A. Havele Hanna Orillaza Eli Silver Douglas Y. Rowland Susan T. Nedorost Atopy patch tests may identify patients at risk for systemic contact dermatitis Immunity, Inflammation and Disease atopic dermatitis atopy patch tests elimination diets protein contact dermatitis systemic contact dermatitis |
author_facet |
Suwimon Pootongkam Sonia A. Havele Hanna Orillaza Eli Silver Douglas Y. Rowland Susan T. Nedorost |
author_sort |
Suwimon Pootongkam |
title |
Atopy patch tests may identify patients at risk for systemic contact dermatitis |
title_short |
Atopy patch tests may identify patients at risk for systemic contact dermatitis |
title_full |
Atopy patch tests may identify patients at risk for systemic contact dermatitis |
title_fullStr |
Atopy patch tests may identify patients at risk for systemic contact dermatitis |
title_full_unstemmed |
Atopy patch tests may identify patients at risk for systemic contact dermatitis |
title_sort |
atopy patch tests may identify patients at risk for systemic contact dermatitis |
publisher |
Wiley |
series |
Immunity, Inflammation and Disease |
issn |
2050-4527 |
publishDate |
2020-03-01 |
description |
Abstract Background A subset of patients with positive patch tests demonstrates systemic contact dermatitis (SCD) upon ingestion or inhalation of the allergen. Concern has been raised about the use of patch tests for protein allergens (APTs) to detect SCD in atopic dermatitis (AD) patients. Methods We present atopy patch test (APT) data for 97 people. We reviewed APTs and tests for antigen‐specific immunoglobulin E (IgE) to the same allergen in pediatric AD patients. We compared the frequency of APTs as a function of age in AD patients. To study the irritancy potential of APTs, we prospectively tested consenting non‐AD dermatitis patients undergoing evaluation for allergic contact dermatitis and healthy controls to an APT panel. Results APT demonstrated fewer positive results than serum‐specific IgE or skin prick tests to the same allergen. Positive APT to food was more common in children under 3 years, whereas positive APT to aeroallergens were more common in teens and adults. Only positive APTs to dust mite were significantly more common positive in subjects without AD. Conclusion Our aggregate findings suggest that most APTs, but not dust mite, behave like conventional patch tests to low‐potency allergens. They are more likely to be positive in patients with chronically inflamed skin and to identify allergens that cause SCD. The higher prevalence of APT positivity to foods in young children is consistent with food allergy as a trigger of AD (also known as SCD) being more common in children than adults. Positive APTs define patients who may have SCD; negative APTs may guide elimination diets. |
topic |
atopic dermatitis atopy patch tests elimination diets protein contact dermatitis systemic contact dermatitis |
url |
https://doi.org/10.1002/iid3.280 |
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