Contact dermatitis and patch testing for the allergist

Publication date: Available online 6 March 2018
Source:Annals of Allergy, Asthma & Immunology
Author(s): Luz Fonacier, Irum Noor
ObjectiveContact dermatitis (CD) is a common disease seen by allergists. Although underutilized, patch testing (PT) remains the gold standard in the diagnosis of allergic CD. It is not difficult to perform, however, the interpretation of the PT, proper classification of the results and determination of their relevance, need an appropriate level of expertise. The objective of this article is to provide a review of CD and its key allergens and provide updates and recommendations for the practicing allergist.Data SourcesThrough the use of various scientific search engines (e.g., PubMed and Medline) we reviewed literature on CD, PT, key allergens, occupational dermatitis and treatment. Study Selections: Studies on CD, important allergens, and PT were considered.ResultsContact induced dermatitis may be due to allergic CD, irritant CD, systemic CD, contact urticaria and protein CD. Key allergens include metals (nickel, gold), topical medicaments (topical corticosteroids), and cosmetics and personal care products (fragrances and preservatives such as methyl- and methylchloro-isothiazolinone). Present relevance of a positive PT is the combination of definite, probable, and possible relevance and should be correlated with the patient's history and physical examination. Treatment of allergic CD includes identification of relevant allergens, patient education, avoidance and provision of alternative products the patient can use.ConclusionCD is a common inflammatory skin disease and should be suspected in patients presenting acute, subacute or chronic dermatitis. The gold standard for diagnosing allergic CD is PT. This article provides practical recommendations for the diagnosis and management of CD commonly seen by the allergist in their practice.



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