title: A high-positive patch test load correlates with further positive patch test reactions irrespective of their location.
abstract: BACKGROUND
  Patch testing is the standard clinical procedure to prove contact sensitization. It is a common practice to attach multiple patch tests at the same time. However, synchronous reactions to unrelated allergens may not be completely unassociated. If so, the reaction in a given test field might be influenced by other positive test reactions in a distance-related degree. This article analyses whether there is a distance-related effect of synchronous positive patch test reactions on the outcome of a target patch test.
  
  
  METHODS
  Data collected from patients patch tested for diagnostic purposes with 15 standard allergens attached in a specific pattern between 1992 and 2004 in 20 centres in a Central European network were retrospectively evaluated. The association between the target patch test result (allergic vs negative reaction to the thiuram mix) and the number and cumulated strength of synchronous positive reactions (positive patch test load) to allergens placed in nearby or distant positions to the target patch was analysed by using logistic regression analysis.
  
  
  RESULTS
  The likelihood of a positive reaction to thiuram mix significantly increased with an increasing synchronous positive patch test load generated by positive reactions to allergens unrelated to thiuram mix. The effect of allergens neighbouring the target allergen was not significantly stronger than that of allergens placed in distant positions.
  
  
  CONCLUSIONS
  For the interpretation of patch test results, the potentially enhancing effects of a synchronous positive patch test load should be considered. The local distribution of the patches on the back is, however, not critical.
authors.affiliation: Department of Dermatology, University Hospitals of Schleswig-Holstein, Campus Kiel, Kiel, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Brasch
authors.forename: J
authors.initials: J
authors.lastname: Geier
authors.forename: A
authors.initials: A
authors.lastname: Schnuch
authors.forename: W
authors.initials: W
authors.lastname: Uter
mesh_terms: D003877:Dermatitis, Contact / Q000175:diagnosis*; D006801:Humans; D010328:Patch Tests