アルコール関連遺伝子多型を妥当基準としたエタノールパッチテストの信頼性：季節差や測定者間誤差の視点から

To identify the pharmacological effectiveness of cyanamide, 144 alcoholics treated with cyanamide were subjected to a test that used an acetaldehyde dehydrogenase (ALDH) inhibitor, the ethanol patch test, which is considered to be a good indicator of ALDH2 phenotype. We placed 100 microl of 70% ethanol on a lint pad and, as a control, placed the same volume of distilled water on a second pad. The ethanol patch test was performed on 144 alcoholics more than 2 weeks after abstinence from alcohol before and after treatment with cyanamide for 1 week. The dose of cyanamide was increased up to 150 mg until the patch test yielded a positive result. In the ethanol patch test, 36 alcoholics (25.0%) gave a positive result before treatment with cyanamide and might have been ALDH2(1)/2(2) heterozygotes. Among 108 alcoholics who were not positive, the distribution of the cyanamide dose that yielded a positive ethanol patch test result was 30 mg in 42 cases (38.9%), 50 mg in 33 cases (30.6%), 70 mg in 5 cases (4.6%), 100 mg in 6 cases (5.6%), and 150 mg in 2 cases (1.9%). Prevalence of liver cirrhosis was significantly higher in alcoholics who showed a positive ethanol patch test result at doses of less than 50 mg cyanamide than those at doses more than 70 mg (p = 0.029). The prevalence of adverse effects was significantly higher in alcoholics who showed a positive ethanol patch test result at doses of more than 70 mg than at doses of less than 50 mg cyanamide (p = 0.002). The ethanol patch test is a useful method for identifying pharmacological effectiveness of cyanamide and may reduce the prevalence of side effects in cyanamide-treated alcoholics.

Screening for acetaldehyde dehydrogenase 2 genotype in alcohol-induced asthma by using the ethanol patch test

BACKGROUND AND OBJECTIVESContact allergy is associated with a significant morbidity all over the world. This study was performed to investigate the pattern of sensitization by contact allergens in the local population.DESIGN AND SETTINGRetrospective study to investigate patch test reactivity among patients with clinical diagnosis of contact dermatitis who were referred to the allergy clinic at the King Khalid University Hospital, Riyadh, between April 2008 and March 2010.PATIENTS AND METHODSOf the 196 patients referred to the allergy clinic over the 2-year period, 91 (46.4%) patients reacted to one or more patch test allergens, and these patients were included in this study. The study group included 82 (91.1%) of Saudi nationality and 9 (8.9%) patients of other nationalities. The patch test was performed using the T.R.U.E TEST, containing 24 allergens/allergen mixes.RESULTSOf the 91 cases who reacted positively to one or more allergens, 67 (73.6%) were females with a mean age of 37 (8.3 years) and 24 (26.4%) were males with a mean age of 34 (11.6 years). Thirty-three (36.2%) patients reacted to nickel sulfate, 14 (15.3%) to p-phenylenediamine, 13 (14.2%) to p-tert-butylphenol-formaldehyde resin, 13 (14.2%) to thimerosal, and 9 (9.8%) to colophony. Reactivity against the rest of the allergens was not remarkable. A significantly higher percentage of females reacted to nickel sulfate (84.8% vs 15.2% in males; P=.0001), p-tert-butylphenol-formaldehyde resin (92.3% vs 7.7%; P=.0001), and thimerosal (76.9% vs 23.1%; P=.03).CONCLUSIONSPatch test reactivity to nickel sulfate was high. The pattern of contact allergy observed in this study indicates the need for large-scale investigations to identify local allergens responsible for contact allergy and for formulation of policies directed towards avoidance of exposure.

Lichen planus pigmentosus (LPP) is a common cause of facial melanosis in the dark-skinned population. At present, information on dermoscopy and patch testing in LPP is limited. To describe dermoscopic findings and study the role of patch testing in patients with LPP on the face. Facial lesions of 50 patients with LPP were studied dermoscopically, followed by histological evaluation. Patch and photopatch tests with the Indian Standard Series and Scandinavian series, respectively, and patient's own cosmetics were performed on all patients. The most common dermoscopic finding was dots and/or globules (43/50, 86%) in different patterns: hem-like (20.9%), arcuate (18.6%), incomplete reticular (39.5%), complete reticular (7%), and not otherwise specified (14%). Other patterns were exaggerated pseudoreticular pattern, accentuation of pigmentation around follicular openings, targetoid appearance, and obliteration of the pigmentary network. There were 26 relevant patch tests in 17 (34%) patients: para-phenylenediamine (n = 5), nickel (n = 3), colophony, perfume mix and fragrance mix (n = 2 each), thiuram mix and 3,3,4,5-tetrachlorosalicylanilide (n = 1 each), and patients' own products (n = 9). The only positive photopatch test was to fentichlor. No clinical or histological finding differed significantly based on patch test results. The only dermoscopic finding to be statistically associated with a positive patch test was the non-characteristic arrangement of dots/globules (P = 0.042). Dermoscopic features were not correlated with clinical features or disease duration. Implications of patch testing on the management of LPP cannot be commented upon as ours was a cross-sectional study. The present study describes the dermoscopic findings of facial lesions in LPP. Our patch test results suggest a probable role of allergens in causing LPP on the face.

In Japan there are many people who are intolerant to alcohol. Known as flushers, they do not genetically have low Km acetaldehyde dehydrogenase (AlDH2). Flushers are judged easily and accurately by the alcohol patch test. An ethanol patch test carried out on agricultural and fishing populations in Japan showed that approx. 40% were deficient in AlDH2. A questionnaire survey of the drinking behavior of many people showed significant differences between the normal AlDH2 and AlDH2-deficient groups. The normal group drinks positively and actively, while the deficient group drinks negatively and passively. As a result, there were significant differences in subjective and objective symptoms that result from drinking between the two groups: More frequent hangovers, abnormal physical conditions and higher KAST scores were seen in the normal group, and health examination showed higher values in liver function tests, including γ-GTP, and higher levels of blood pressure, HDL-cholesterol (HDL-C), etc., in the normal AlDH2group.It may be very useful for prevention of alcohol-related health disorders to help Mongoloid peoples, such as the Japanese, recognize whether their AlDH2 is normal or deficient, which is as determined by the ethanol patch test.

Background:Allergic contact dermatitis (ACD) is a delayed type of hypersensitivity from contact with a specific allergen to which the patients has developed a specific sensitivity. The aim of the study was to evaluate the results of epicutaneous patch testing with standard series of contact allergen in patients suspected to have ACD.Methods:355 cases of ACD were included in the study. Test substances were applied on the upper part of the patient’s back, on clinically uninvolved and untreated skin. All patients were free from therapy with oral antihistamines, steroids and immunosuppressants. The patch test was removed and reaction were evaluated after 48 h and 72 h. Grading of negative (-) to positive (+ to ++++) patch test was done according to the International Contact Dermatitis Research Group. Statistical data analysis was performed by using χ2–test.Results:Of the 355 cases, 146 patients were male (41.1%) and 209 were female (58.9%). The youngest patients in the study was 16 years of age and the oldest was 67 years of age. The commonest age group affected was 41-50 years. Hands were the most common site of involvement. The occupational character of skin lesions was find in 75 (21.1%). The most common positive reactions were recorded to nickel sulphate 99 (27.8%), cobalt chloride 46 (12.9%), thimerosal 31 (8.7%), colophony 23 (6.5%), carba mix 21 (5.9%), potassium dichromate 20 (5.6%), acid chromici 19 (5.3%), fragrance mix 18 (5%), balsam of Peru 13 (3.7%), formaldehyde 9 (2.5%), and other allergens 26 (7.3%). Females were significantly more likely to show a positive response to two or more allergens (p<0.05). There was no statistically significant impact of age, occupation and duration of disease on results of patch testing (p>0.05).Conclusions:Our results indicate that nickel sulphate, cobalt chloride and thimerosal are the most common allergens responsible for induction of ACD. These findings are crucial in the treatment, long term management, an education of patients with ACD.

Background: The clinical relevance of patch test reaction is often difficult to determine. Repeated Open Application Test (ROAT) have been developed to further evaluate the significance of patch test result. Purpose: Understanding methods, procedures, and reactivity of patch test and ROAT, so thatmay be used to help identify with a high risk of developing allergic contact dermatitis. Reviews: The validity of patch test is limited. Various attempts have been made at modifying the patch test, primarily in order to increase the sensitivity of the skin and thus enhance the reliability and validity of the results, such as ROAT. Several experimental studies have compare the result of patch testing with the outcome of ROATs and these have defined correlations between the threshold concentration at patch testing (MEC) and outcome of ROAT, and also shed light on some factors that may influence the outcome of ROATs. Results of patch testing with serial dilutions of colophony, cinnamic aldehyde, and isoeugenol have shown concordance with the outcome of ROATs. On the other hand, poor correlation between patch test reactivity and ROAT were demonstrated in another study on isoeugenol,hydoxycitronellal, formaldehyde dan chromium. Conclusion: Patch test and ROAT are two methods that may be used toidentify allergen exposure and MEC Allergic Contact Dermatitis reaction. Key words: patch test, repeated open application test (ROAT), allergic contact dermatitis (ACD).

Anaphylaxis to 6-α-methylprednisolone in an eight-year-old child

Patch test has been used to determine the existance of metal allergy, and the severity thereof has been determined by the change in skin color.In order to obtain an accurate judgment of the change in skin color, the statistical formulation was calculated based on colorimetric investigation into 9 kinds of color characteristics: 1) Spectral reflectance curve, 2) Color difference, 3) Depth of shade, 4) CIE Lab-L*, 5) CIE Lab-a*, 6) CIE Lab-b*, 7) Munsell-H, 8) Munsell-C, and 9) Munsell-V.The rate of the agreement with statistical judgment and that of conventional subjective was 100% in positive reaction, and ranged from 90% to 94% in negative reaction.In conclusion, the original statistical formulation based on colorimetric characteristics showed high level accuracy for determining the change in skin color reaction by the patch test.

ENWEndNote BIBJabRef, Mendeley RISPapers, Reference Manager, RefWorks, Zotero AMA Obtułowicz A, Nowak-Ślusarczyk M, Pirowska M, Lipko-Godlewska S, Wojas-Pelc A. The flare-up phenomenon: recurrence of distant dermatitis during patch testing. Advances in Dermatology and Allergology/Postępy Dermatologii i Alergologii. 2016;33(1):68-69. doi:10.5114/pdia.2016.57765. APA Obtułowicz, A., Nowak-Ślusarczyk, M., Pirowska, M., Lipko-Godlewska, S., & Wojas-Pelc, A. (2016). The flare-up phenomenon: recurrence of distant dermatitis during patch testing. Advances in Dermatology and Allergology/Postępy Dermatologii i Alergologii, 33(1), 68-69. https://doi.org/10.5114/pdia.2016.57765 Chicago Obtułowicz, Aleksander, Magdalena Nowak-Ślusarczyk, Magdalena Pirowska, Sylwia Lipko-Godlewska, and Anna Wojas-Pelc. 2016. "The flare-up phenomenon: recurrence of distant dermatitis during patch testing". Advances in Dermatology and Allergology/Postępy Dermatologii i Alergologii 33 (1): 68-69. doi:10.5114/pdia.2016.57765. Harvard Obtułowicz, A., Nowak-Ślusarczyk, M., Pirowska, M., Lipko-Godlewska, S., and Wojas-Pelc, A. (2016). The flare-up phenomenon: recurrence of distant dermatitis during patch testing. Advances in Dermatology and Allergology/Postępy Dermatologii i Alergologii, 33(1), pp.68-69. https://doi.org/10.5114/pdia.2016.57765 MLA Obtułowicz, Aleksander et al. "The flare-up phenomenon: recurrence of distant dermatitis during patch testing." Advances in Dermatology and Allergology/Postępy Dermatologii i Alergologii, vol. 33, no. 1, 2016, pp. 68-69. doi:10.5114/pdia.2016.57765. Vancouver Obtułowicz A, Nowak-Ślusarczyk M, Pirowska M, Lipko-Godlewska S, Wojas-Pelc A. The flare-up phenomenon: recurrence of distant dermatitis during patch testing. Advances in Dermatology and Allergology/Postępy Dermatologii i Alergologii. 2016;33(1):68-69. doi:10.5114/pdia.2016.57765.

Impact of Anxiety on Patch Testing Results for Allergic Contact Dermatitis.

Skin testing with the suspected compound has been reported to be helpful in determining the cause of cutaneous adverse drug reactions (ADRs), but the value and specificity of these tests need to be determined. In this study, 72 patients with presumed drug eruptions (27 maculopapular, 18 urticarial, seven erythrodermic, nine eczematous, four photosensitivity, three fixed drug eruptions, three with pruritus and one with acute generalized exanthematous pustulosis) were assessed. All had drug patch tests; 46 also had prick tests and 30 had intradermal tests (performed on hospitalized patients using a sterile solution of the suspected drug, diluted sequentially) with immediate and delayed readings. Among these patients, 52 (72%) had a positive skin test reaction, 43%, 24% and 67% in patch, prick and intradermal skin tests, respectively. The results of skin tests varied with the drug tested and with the clinical type of cutaneous ADR, as a significantly higher number of positive patch tests was observed in maculopapular rashes than in urticarial reactions (P = 0.001). This study supports the value of careful sequential drug skin testing in establishing the cause of cutaneous ADR. Guidelines are proposed for performing these tests, and these include the use of appropriate negative control patients to avoid false-positive results.

Chelation Deactivation of Nickel Ion in Allergic Eczematous Sensitivity

Dear Editor, Coronavirus disease 2019 (COVID-19) vaccination is expected to play a crucial role in improving global health outcomes during the COVID-19 pandemic. Various COVID-19 vaccine-related adverse events have been reported, including cutaneous reactions.1 Most cases of cutaneous adverse reactions have involved administration of mRNA vaccines such as the Pfizer/BioNTech (BNT162b2) and Moderna (mRNA 1273) vaccines. However, only a few cases of cutaneous adverse events have been reported after the administration of an adenoviral vector vaccine such as the Oxford–AstraZeneca (ChAdOx1 nCOV-19) vaccine.2 Wells’ syndrome manifests as a rare inflammatory dermatitis that resembles cellulitis. Its pathogenesis remains unclear; however, several reports suggest that it might be triggered by vaccination.3, 4 Herein, we report the first case of Wells’ syndrome, a new post-vaccination adverse event, after Oxford–AstraZeneca COVID-19 vaccination. An otherwise healthy 63-year-old woman presented with a 3-day history of multiple 5-cm-sized, scattered, ill-defined, oedematous, erythematous patches on her extremities (Fig. 1). She complained of pruritus at the lesion sites but had no other symptoms. She had no experience of local injection site reaction after both doses of injection. One week prior to symptom onset, she had received her second dose of the Oxford–AstraZeneca COVID-19 vaccine. She reported no recent history of infection or medication use and no any cutaneous reaction after the first dose of Oxford–AstraZeneca COVID-19 vaccine. Punch biopsy of a calf lesion was performed. Histological findings showed superficial and deep perivascular and interstitial inflammatory cell infiltration, eosinophilic predominance and flame figures, which was suggestive of Wells’ syndrome (Fig. 2). The patient was treated with oral prednisolone 10 mg daily. The prednisolone dose was gradually tapered over 3 weeks, and the patient completely recovered. Wells’ syndrome is a rare inflammatory dermatitis that was first described by Wells in 1971 as recurrent granulomatous dermatitis with eosinophilia.5 Wells’ syndrome is diagnosed based on histological findings of eosinophilia and characteristic flame figures.5 Fortunately, it responds well to systemic glucocorticoids, and there is no residual scarring.6 However, since recurrence is quite common and may occur for several years, the underlying conditions and triggering factors must be evaluated. Insect bites, infections, drugs and vaccines have been reported as factors that trigger Wells’ syndrome.6 Vaccine-related Wells’ syndrome has rarely been reported, and most cases occur in children.3 Only two cases have been reported in adults: after tetanus vaccination in a 69-year-old woman and after influenza vaccination in an 86-year-old man.4, 7 This is the first report of an adult presenting with Wells’ syndrome after COVID-19 vaccination. Koh et al. reported a case of Wells’ syndrome diagnosed by patch testing following the thimerosal-containing vaccine administration and suggested a delayed type IV hypersensitivity reaction to be the mechanism.8 Type IV hypersensitivity reactions to non-thimerosal agents such as neomycin and aluminium hydroxide have been noted on patch testing in patients with Wells’ syndrome.3 The aetiology is still unknown; one study revealed that CD4-predominant T cell was infiltrated into a skin biopsy tissue of Wells’ syndrome patient.9 CD4+ T cells are considered to play an important role in the mechanism of type IV hypersensitivity; thus, we suggested that delayed type IV hypersensitivity reaction associated with Wells’ syndrome might be related to the activity of CD4+ T cells. Although the COVID-19 vaccine does not contain these ingredients, polyethylene glycol, which is present in the two mRNA vaccines, and polysorbate 80, which is found in the Oxford–AstraZeneca vaccine, have been reported as potential causes of delayed-type hypersensitivity.1 Delayed hypersensitivity reaction-mediated local cutaneous reactions have been reported following Oxford–AstraZeneca vaccination.10 Based on these findings, we hypothesize that delayed-type hypersensitivity reaction associated with polysorbate 80 can contribute to the occurrence of Wells’ syndrome. Further studies involving patch test for polysorbate 80 are necessary to confirm Oxford–AstraZeneca vaccine-induced delayed hypersensitivity reaction as the underlying mechanism. In conclusion, the development of Wells’ syndrome and Oxford–AstraZeneca COVID-19 vaccination may be related, with delayed-type hypersensitivity reaction as a possible mechanism. We believe that this rare case will broaden the understanding of Wells’ syndrome and raise awareness of the cutaneous side-effects of the Oxford–AstraZeneca COVID-19 vaccine. The patient in this manuscript has given written informed consent to the publication of their case details. Yul Hee Kim and You Chan Kim declare to have no conflicts of interest to disclose. The data that support the findings of this study are available from the corresponding author upon reasonable request.

Environmental contact factors in eczema were investigated in China by clinical questionnaire and patch testing patients with a modified European standard series of allergens. 217 consecutive eczema patients were studied. Contact dermatitis (CD) was clinically diagnosed in 30% of the patients. Among the patients patch tested, 46 patients had clinically diagnosed allergic CD (ACD), 20 patients clinically had non-ACD (NACD) (including 16 cases of irritant contact dermatitis, 1 case of phototoxic contact reaction and 3 cases of asteatotic eczema) and 115 patients had clinically suspected ACD. 45 patients (98%) in the ACD group went on to have relevant patch test results. The most common ACD was from metals, fragrance materials, cosmetics and rubber materials. The most common contact allergens identified were nickel, fragrance mix, para-phenylenediamine (PPD), carba mix and thimerosal. No adverse reactions were observed to patch testing, except for pruritus in patch-test-positive patients. The positive rate of patch testing in ACD was much higher than that in NACD (98% versus 15%, P < 0.05, chi(2)-test). 60 (28%) patients had facial dermatitis (FD). Among these, 20 (33%) were confirmed as having ACD. 48 (22%) patients had hand dermatitis (HD). Among these, 7 (15%) were confirmed as having ACD. Fewer patients were confirmed as having ACD in the HD group than in the FD (15% versus 33%, P < 0.05, chi(2)-test). Although the difference was not significant, the total positivity rate in the HD group (55%) was lower than in the other groups. 65 (30%) patients had unclassified endogenous eczema (UEE). The total positive rate of patch testing in the UEE group (56%) was no different from that in the FD or HD groups. However, the relevance of positive patch tests was hard to determine in UEE. These results indicate that CD is common in eczema; relatively more patients with FD have ACD, while other factors, such as irritation, may play more of a role in HD. The total positive rate of patch testing in the UEE group was no different from that in the FD or HD groups, suggesting that patch testing should be stressed in UEE and the relevance of positive patch test results in UEE should be studied further. It is effective and safe to patch eczema patients with a modified European standard series of allergens in China.