Positive concomitant test reactions to allergens in the standard patch test series.
BACKGROUND
Patch testing is performed to evaluate suspected allergic contact dermatitis. Common wisdom suggests that various allergens cross-react but only a few larger studies have published confirmations of this. The purpose of our study was to identify significant correlations between positive test reactions in a screening series.


METHODS
A total of 1235 patients undergoing patch testing to the Hermal standard series at the Massachusetts General Hospital, Contact Dermatitis Clinic between 1990 and 2006 were investigated.


RESULTS
Two or more positive reactions were seen in 411 patients (33.3%). Sensitizations to eight pairs of allergens were found to have significant correlation (P <or= 0.0001). A strong association was observed for cross reactions between formaldehyde and its releasers quaternium 15 and imidazolidinyl urea and between balsam of Peru and fragrance mix. Moreover, significant co-sensitization was identified for potassium dichromate and colophony. Three significant pairings in our study were associations between fragrances and metals. Our data confirm the previously published cross-reactions in the literature between fragrance components, and formaldehyde and formaldehyde-releasing preservatives. The increased numbers of patients with metal and fragrance sensitization can be considered as a random finding due to independent sensitization.


CONCLUSIONS
Being aware of cross-reacting allergens is essential to success in resolving allergic dermatitis when counseling patients.
Department of Dermatology, Harvard Medical School, Massachusetts General Hospital, Boston, MA 02114, USA.
Lilla
L
Landeck
Ernesto
E
González
Lynn
L
Baden
Konrad
K
Neumann
Peter
P
Schalock
D000328:Adult; D000485:Allergens; D001453:Balsams; D003035:Cobalt; D003429:Cross Reactions; D017449:Dermatitis, Allergic Contact / Q000175:diagnosis*; D005260:Female; D005557:Formaldehyde; D006801:Humans; D008297:Male; D008709:Methenamine / Q000031:analogs & derivatives; D008875:Middle Aged; D009532:Nickel; D010328:Patch Tests / Q000379:methods*; D010476:Perfume; D011192:Potassium Dichromate / Q000032:analysis / Q000276:immunology; D012116:Resins, Plant; D014508:Urea / Q000031:analogs & derivatives
D000485:Allergens; D001453:Balsams; D010476:Perfume; D012116:Resins, Plant; D005557:Formaldehyde; D003035:Cobalt; C029938:nickel sulfate; D009532:Nickel; C013893:rosin; C025080:Peruvian balsam; D014508:Urea; C018375:quaternium-15; C018021:cobaltous chloride; D008709:Methenamine; C006048:imidazolidinyl urea; D011192:Potassium Dichromate