title: International survey on skin patch test procedures, attitudes and interpretation.
abstract: BACKGROUND
  Skin patch test is the gold standard method in diagnosing contact allergy. Although used for more than 100 years, the patch test procedure is performed with variability around the world. A number of factors can influence the test results, namely the quality of reagents used, the timing of the application, the patch test series (allergens/haptens) that have been used for testing, the appropriate interpretation of the skin reactions or the evaluation of the patient's benefit.
  
  
  METHODS
  We performed an Internet -based survey with 38 questions covering the educational background of respondents, patch test methods and interpretation. The questionnaire was distributed among all representatives of national member societies of the World Allergy Organization (WAO), and the WAO Junior Members Group.
  
  
  RESULTS
  One hundred sixty-nine completed surveys were received from 47 countries. The majority of participants had more than 5 years of clinical practice (61 %) and routinely carried out patch tests (70 %). Both allergists and dermatologists were responsible for carrying out the patch tests. We could observe the use of many different guidelines regardless the geographical distribution. The use of home-made preparations was indicated by 47 % of participants and 73 % of the respondents performed 2 or 3 readings. Most of the responders indicated having patients with adverse reactions, including erythroderma (12 %); however, only 30 % of members completed a consent form before conducting the patch test.
  
  
  CONCLUSIONS
  The heterogeneity of patch test practices may be influenced by the level of awareness of clinical guidelines, different training backgrounds, accessibility to various types of devices, the patch test series (allergens/haptens) used for testing, type of clinical practice (public or private practice, clinical or research-based institution), infrastructure availability, financial/commercial implications and regulations among others.
  
  
  CONCLUSIONS
  There is a lack of a worldwide homogeneity of patch test procedures, and this raises concerns about the need for standardization and harmonization of this important diagnostic procedure.
authors.affiliation: Hospital Sírio Libanês and Post-graduation Program in Health Sciences of IAMSPE, Rua Prof Arthur Ramos, 183, cj 21 01454-011, São Paulo, SP Brazil.
authors.forename: Luciana K
authors.initials: LK
authors.lastname: Tanno
authors.affiliation: Department of Dermatolgy and Venereology, Tokuda Hospital Sofia, Sofia, Bulgaria.
authors.forename: Razvigor
authors.initials: R
authors.lastname: Darlenski
authors.affiliation: Allergy Department. Hospital Infantil Universitario Niño Jesús, Madrid, Spain.
authors.forename: Silvia
authors.initials: S
authors.lastname: Sánchez-Garcia
authors.affiliation: Department of Public Health and Infectious Diseases, "Sapienza" University of Rome, Rome, Italy.
authors.forename: Matteo
authors.initials: M
authors.lastname: Bonini
authors.affiliation: Allergy Clinic, Paris, 75015 France.
authors.forename: Andrea
authors.initials: A
authors.lastname: Vereda
authors.affiliation: Department of Dermatology and Venereology, Sechenov First Moscow State Medical University, Moscow, Russia.
authors.forename: Pavel
authors.initials: P
authors.lastname: Kolkhir
authors.affiliation: Immune System Diseases and Oncology Service-Allergy Unit. Hospital Universitario Príncipe de Asturias, Medicine and Medical Specialities Department, Universidad de Alcalá. Alcalá de Henares, Madrid, Spain.
authors.forename: Dario
authors.initials: D
authors.lastname: Antolin-Amerigo
authors.affiliation: Department of Allergy and Immunology, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd Weston, Florida, FL 33331 USA.
authors.forename: Vesselin
authors.initials: V
authors.lastname: Dimov
authors.affiliation: Medicine Faculty, Xochicalco University, Tijuana, Mexico.
authors.forename: Claudia
authors.initials: C
authors.lastname: Gallego-Corella
authors.affiliation: Allergy and Immunology Division, Hospital Nacional Edgardo Rebagliati Martins, Lima, Peru.
authors.forename: Juan Carlos Aldave
authors.initials: JC
authors.lastname: Becerra
authors.affiliation: Department of Allergy, Medical Center, Guira de Melena, Havana, Cuba.
authors.forename: Alexander
authors.initials: A
authors.lastname: Diaz
authors.affiliation: Intercenter Allergy Unit, Virgen Macarena University Hospital, Seville, Spain.
authors.forename: Virginia Bellido
authors.initials: VB
authors.lastname: Linares
authors.affiliation: Sanatorio Privado San Roque, Marcos Juárez, Córdoba Argentina.
authors.forename: Leonor
authors.initials: L
authors.lastname: Villa
authors.affiliation: Department of Pediatrics, Division of Immunology Research, Children's Mercy Hospitals & Clinics, Kansas City, MO 64108 USA.
authors.forename: Lanny J
authors.initials: LJ
authors.lastname: Rosenwasser
authors.affiliation: Allergy and Clinical Immunology Department, Centro Medico Docente La Trinidad, Caracas, Venezuela.
authors.forename: Mario
authors.initials: M
authors.lastname: Sanchez-Borges
authors.affiliation: Department of Allergy and Immunology, Hospital Quirón Bizkaia, Bizkaia, Spain.
authors.forename: Ignacio
authors.initials: I
authors.lastname: Ansotegui
authors.affiliation: Division of Allergy, Department of Pediatrics, Nippon Medical School, Tokyo, Japan.
authors.forename: Ruby
authors.initials: R
authors.lastname: Pawankar
authors.affiliation: Department of Dermatology and Allergy, Rheinische Friedrich-Wilhelms-University Bonn, Bonn, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Bieber
keywords: Allergy; Contact dermatitis; Sensitization; Skin patch test; Survey