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Background: In recent years, skin reactions secondary to the use of medical devices (MD), such as allergic contact dermatitis have increasingly been observed (e.g. to continuous blood sugar monitoring systems, insulin pumps, wound dressings, medical gloves, etc.): this is regarded as a developing epidemic. Lack of labelling of the composition of MD, as well as frequent lack of cooperation of manufacturers to disclose this relevant information, even when contacted by the clinician for the individual case of an established adverse reaction, significantly impede patient care. Objectives: To advocate for full ingredient labelling in the implementation of EU regulation for MD. Methods: This position paper reviews the scientific literature, the current regulatory framework adopted for MD to date, and the likely impact, including some costs data in case of the absence of such labelling. Results: Efforts made by several scientific teams, who are trying to identify the culprit of such adverse effects, either via asking for cooperation from companies, or using costly chemical analyses of MD, can only partly, and with considerable delay, compensate for the absence of meaningful information on the composition of MD; hence, patient management is compromised. Indeed, without knowing the chemical substances present, physicians are unable to inform patients about which substances they should avoid, and which alternative MD may be suitable/tolerated. Conclusion: There is an urgent need for full and accurate labelling of the chemical composition of MD in contact with the human body. [ABSTRACT FROM AUTHOR]

Summary: Background: Changing patterns of exposure lead to changes in the spectrum of contact allergy in the general population and in patients patch tested for suspected contact allergy. The main contact allergens (haptens) are assembled in the so‐called 'baseline series'. Objectives: To present the current spectrum of contact allergy to baseline series allergens, and its temporal development over the last 12 years, based on data collected by the 56 active departments of the trinational Information Network of Departments of Dermatology (IVDK). Methods: Patch‐test data, along with core demographic and clinical information, subdivided into 4‐year periods for all patients patch tested with the baseline series in the IVDK, were analysed descriptively. Moreover, log‐binomial regression analysis addressed temporal trends of specific contact allergies, adjusted for potentially confounding factors. Results: Among the 125 436 patients tested with the German baseline series, the most common allergens were nickel (14·7%), fragrance mix I (8·1%), Myroxylon pereirae resin (7·5%) and cobalt (5·2%), with no conclusive trend. The rise and fall of contact allergy to methylchloroisothiazolinone/methylisothiazolinone (MI), following (self‐) regulation in the European Union, reflected the MI contact allergy epidemic. Propolis showed a marked upward trend with a prevalence of 3·94% during the period 2015–2018. Conclusions: Decreases in sensitization prevalence likely reflect reduced exposure, with some lag, as seen with hydroxyisohexyl 3‐cyclohexene carboxaldehyde. If no (sufficient) decrease can be observed despite interventions, such as for nickel and chromium, affected subgroups should be identified and their causative exposures explored. Finally, increases such as that observed with propolis, certainly warrant targeted investigation of the exposures driving sensitization, and possibly intervention. What is already known about this topic? Contact allergy is prevalent in the general population.Surveillance based on clinical data offers timely information on trends concerning certain allergens or subgroups at risk. What does this study add? This analysis provides an update of the current contact allergy prevalence in Central Europe, including time trends.This study describes the demographic and clinical profile of patients tested from 2007 to 2018.This research identifies contact allergens that require (further) preventive efforts. Linked Comment:Schuttelaar. Br J Dermatol 2020; 183:800–801. What is already known about this topic? Contact allergy is prevalent in the general population.Surveillance based on clinical data offers timely information on trends concerning certain allergens or subgroups at risk. What does this study add? This analysis provides an update of the current contact allergy prevalence in Central Europe, including time trends.This study describes the demographic and clinical profile of patients tested from 2007 to 2018.This research identifies contact allergens that require (further) preventive efforts. Linked Comment:Schuttelaar. Br J Dermatol 2020; 183:800–801. Plain language summary available online Respond to this article [ABSTRACT FROM AUTHOR]

Background: Methylisothiazolinone (MI) has caused an unprecedented epidemic of contact allergy in Europe and elsewhere. Subsequently, regulatory action has been taken, at least in Europe, aiming at reducing risk of MI sensitization. Objective: To follow‐up on the prevalence of contact allergy to MI in consecutively patch tested patients and assess the spectrum of products containing MI or methylchloroisothiazolinone (MCI)/MI in patients positive to MI which elicited current allergic contact dermatitis. Methods: A cross‐sectional survey was performed in 2016 and 2017, including all adult patients patch tested with the baseline series (including MI 0.2% aq.) between 1 May and 31 October at 14 centres in 11 European countries. Patients with positive reactions (+ to +++) to MI were further examined regarding history, clinical characteristics and eliciting products, which were categorized into 34 types and 4 classes (leave‐on, rinse‐off, household, occupational). The results were compared with the reference year 2015. Results: A total of 317 patients, n = 202 of 4278 tested in 2016 (4.72%) and n = 115 of 3879 tested in 2017 (2.96%), had positive reactions to MI; the previous result from 2015 was 5.97% (P < 0.0001). The share of currently relevant contact allergy among all positive reactions declined significantly as well (P = 0.0032). Concerning product classes, a relative decline of leave‐on and a relative increase of rinse‐off and household products was noted. Conclusion: The prevalence of MI contact allergy decreased by 50% from 2015 to 2017. As a consequence of regulation, the share of cosmetics products (leave‐on in particular) eliciting allergic contact dermatitis is decreasing. The chosen method of analysing causative products in sensitized patients has proven useful to monitor effects of intervention. Linked article: J.‐M. Lachapelle. J Eur Acad Dermatol Venereol 2020; 34: 218. https://doi.org/10.1111/jdv.16174. [ABSTRACT FROM AUTHOR]

Background Contact allergy is a common condition and can severely interfere with daily life or professional activities. Due to changes in exposures, such as introduction of new substances, new products or formulations and regulatory intervention, the spectrum of contact sensitization changes. Objective To evaluate the current spectrum of contact allergy to allergens present in the European baseline series ( EBS) across Europe. Methods Retrospective analysis of data collected by the European Surveillance System on Contact Allergies ( ESSCA, ) in consecutively patch-tested patients, 2013/14, in 46 departments in 12 European countries. Results Altogether, 31 689 patients were included in the analysis. Compared to a similar analysis in 2004, the prevalence of contact allergy to methylisothiazolinone went up to around 20% in several departments. In comparison, contact allergy to the metals nickel, cobalt and chromium remained largely stable, at 18.1%, 5.9% and 3.2%, respectively, similar to mostly unchanged prevalence with fragrance mix I, II and Myroxylon pereirae (balsam of Peru) at 7.3%, 3.8% and 5.3%, respectively. In the subgroup of departments diagnosing (mainly) patients with occupational contact dermatitis, the prevalence of work-related contact allergies such as epoxy resin or rubber additives was found to be increased, compared to general dermatology departments. Conclusion Continuous surveillance of contact allergy based on network data offers the identification of time trends or persisting problems, and thus enables focussing in-depth research (subgroup analyses, exposure analysis) on areas where it is needed. [ABSTRACT FROM AUTHOR]

Background: Psychological first aid is a common approach for providing support after potentially traumatic events (PTEs). In Germany, a peer support model is recommended by the German Statutory Accident Insurance (DGUV) to reduce sickness absence after occupational accidents, especially in public transportation. However, data on the effectiveness of peer support are very sparse. Aims: To analyse whether peer support has an impact on sickness absence after work-related traumatic events in public transportation. Methods: An analysis was conducted in two German public transportation corporations. Due to ethical requirements, we used a historical cohort study comparing peer support by colleagues (VAG-1), peer support at supervisor level (VGF) and a non-intervention group (VAG-0). The study period was from March 2003 to December 2012. We used a negative binominal regression model to estimate the relative risk associated with the interventions and potential confounders. Results: A total of 259 incident PTEs in employees were observed. A regression analysis identified the severity of PTE (severe and fatal events), VGF and age as significant factors in predicting duration of post-event sickness absence. In a stratified analysis, the mode of peer support (VGF) and age predicted sickness absence for less severe PTEs but this was not significant for severe PTEs. Conclusions: Severe and fatal PTEs had the strongest impact on sickness absence after PTEs. For less severe PTE, peer support provided by colleagues may be superior to supervisor support. [ABSTRACT FROM AUTHOR]

Background/purpose Different devices are used for the non-invasive measurement of (constitutive) skin pigmentation in (epidemiological) studies. Reproducibility of measurements with the Chromameter ( CM, model CR 300, Minolta, Osaka) and the Reflectometer ( RM, Courage & Khazaka, Cologne) has not yet been examined in detail and was addressed in a set of four experiments and studies respectively. Methods Regarding the CM, the Y value of the Yxy CIE 1931 colour system was utilized, representing lightness in this colour space, while the RM measured reflectance at 660 nm with a small bandwidth of 20 nm. Both devices measure reflectance on a scale from 0 to 100%, however, in different wavelength ranges. Between 3 and 20 repetitions were performed on standard grey scales and different sets of human volunteers, including RM measurements in a large epidemiological field study. Results While the coefficient of variation ( V) increases and the intraclass correlation coefficient decreases from controlled laboratory to field conditions, reproducibility remained in a range considered acceptable, if adequate study conditions were maintained. In a direct comparison on human skin, V of the RM was significantly smaller than that of the CM. Conclusion Both devices can be used confidently in field studies; however, based on considerations of skin optics and in view of slightly lesser variability, the RM may be preferable. [ABSTRACT FROM AUTHOR]

Summary Background Reducing exposure to ultraviolet (UV) radiation is the main effective measure for preventing skin cancer. Educational campaigns targeting sun protection have been focused either on behaviour on the beach during the summer holiday alone, or during everyday outdoor activities of the children. Little is known about the comparison between these different settings. Objectives To analyse whether parents apply similar protective measures to reduce UV exposure for their young children in different outdoor environments. Methods Families ( n = 2619) with children aged 3-6 years (response: 64·7%) were enrolled in a population-based survey in the German city of Erlangen and its surrounding rural county. Using a self-administered standardized questionnaire parents gave information about demographic and photosensitivity data of their children, their knowledge about risk factors for skin cancer and their typical instructions given to their children when these played outside on a summer day in different outdoor environments. Results Significant discrepancies regarding the four UV protective measures (clothes, shade, sunhat, sunscreen) for children between an everyday outdoor setting and a holiday setting on the beach were observed. A high level of parental risk factor knowledge was significantly associated with a better protection for children in all four measures only on the beach. Photosensitivity and demographic characteristics had some impact on protective behaviour, too. Measures of sun protection were reduced with children's increasing age. Conclusions Skin cancer prevention campaigns should target the encouragement of sun protection for children also in outdoor activities of daily living, not only during a summer holiday on the beach. [ABSTRACT FROM AUTHOR]

Abstract: A systematic classification of substances (or mixtures of substances) with regard to various toxicological endpoints is a prerequisite for the implementation of occupational safety strategies. As its principal task the “Commission for the Investigation of Health Hazards of Chemical Compounds in the Work Area” of the “Deutsche Forschungsgemeinschaft” (DFG-MAK Commission) derives and recommends maximum workplace concentrations and biological tolerance values (MAK and BAT values) based exclusively on scientific arguments. Several endpoints are evaluated separately in detail, e.g. carcinogenicity, risks during pregnancy, germ cell mutagenicity or contribution to systemic toxicity after cutaneous absorption. Skin- and airway sensitization is also considered; the present paper focuses on these two endpoints. [Copyright &y& Elsevier]

Background Patch test (PT) guidelines recommend classifying PT reactions based on morphological criteria only, i.e. irrespective of context information such as substance, concentration and vehicle. Objectives To analyse reclassification of PT reactions after revelation of context information subsequent to an initial blinded reading. Methods One hundred and twenty-two participants (experienced dermatologists and researchers) rated 20 digital images of different PT reactions twice, first blinded, then unblinded regarding substance, concentration and vehicle. Agreement between both ratings was quantified with Cohen’s kappa, and systematic differences statistically examined with tests for marginal homogeneity. Results Mostly, ratings remained stable, e.g. in > 90% of cases of images showing typical strong or extreme positive PT reactions. Reclassification was comparatively often observed in images depicting irritant reactions. Conversely, 16 of 122 participants re-rated doubtful reactions to thiuram mix and dichromate, respectively, as ‘allergic’ (weak or strong positive) after knowing the substance. Conclusions The considerable proportion of participants who choose an ‘allergic’ rating, despite a morphological presentation definitely not justifying this, points to a conceptual problem of the PT reading scale: the mixing up of morphological classification and interpretation. We therefore suggest amending the scale. Moreover, standardization of PT reading can be improved by continual PT training sessions. [ABSTRACT FROM AUTHOR]

Background Staphylococcus aureus (S. aureus) is a well-known trigger factor of atopic dermatitis (AD). Besides staphylococcal superantigens, α-toxin may influence cutaneous inflammation via induction of T-cell proliferation and cytokine secretion. Objectives To investigate the association between sensitization to inhalant allergens and skin colonization with α-toxin-producing S. aureus in AD. Patients and methods We investigated 127 patients with AD, aged 14–65 years, who were on standard anti-inflammatory and antiseptic treatment before investigation. We evaluated skin colonization, medical history, severity of AD and sensitization to inhalant allergens. Results Forty-eight of 127 patients were colonized with S. aureus, suffered from more severe AD, had asthma more often and showed higher sensitization levels to inhalant allergens. Thirty of 48 patients with S. aureus skin-colonizing strains produced α-toxin and had higher total IgE and specific IgE to birch pollen and timothy grass pollen. Conclusions Under topical treatment with antiseptic and anti-inflammatory agents the colonization of lesional skin with S. aureus was clearly lower than commonly found in untreated patients with AD. Colonization with S. aureus was associated with a higher severity of AD, higher degree of sensitization, and a higher frequency of asthma. The proportion of patients whose skin was colonized with α-toxin-producing S. aureus was higher than expected from a former study. Cutaneous colonization with α-toxin-producing S. aureus was associated with a higher sensitization level to birch pollen allergen in AD. This may point to a higher susceptibility of patients with higher T-helper 2 polarization towards α-toxin-producing S. aureus. [ABSTRACT FROM AUTHOR]

Background Fluctuating irritability of the skin induced by low ambient temperature and humidity may compromise the reproducibility of patch testing. Objectives To assess the impact of temperature and absolute humidity at the time of patch testing on the occurrence of irritant or doubtful (IR/?), weak positive (+) and (strong) positive (++/+++) reactions, respectively, among 12 allergens included in the German Standard Series. Methods Analysis of clinical data collected in the surveillance network IVDK ( ) between January 1993 and December 2001 ( n = 73 691 patients) combined with meteorological data obtained by the national services in Germany and Austria. Multinomial logistic regression analysis was used to estimate the risk associated with temperature, absolute humidity and vapour pressure, respectively, adjusted for sex, age, atopic dermatitis and duration of patch test application. Results For low temperature and humidity, a relevant increase of IR/? reaction frequency was observed in the cases of paraben mix and (chloro-) methylisothiazolinone. Both IR/? and + reactions were significantly increased with respect to the allergens fragrance mix, oil of turpentine, methyldibromo glutaronitrile + phenoxyethanol and particularly formaldehyde, while ++/+++ reactions were hardly affected by weather conditions. Conclusions The observed increase of IR/? reactions may be due to epidermal barrier function impairment. The impact of dry/cold weather on + reactions in terms of possibly false-positive reactions is restricted to few allergens. In the case of + reactions of unknown relevance, a re-test under warm conditions or verification tests such as the repeated open application test or the provocative use test may be recommendable. [ABSTRACT FROM AUTHOR]

Objective Assessment of the value of patch testing patients’ own perfumes, eau de toilette, deodorants and shaving lotions with regard to diagnosing contact allergy to fragrances, and an analysis of the spectrum of concurrent patch test reactions to single fragrance allergens. Study design Data of the Information Network of Departments of Dermatology (IVDK; ) regarding patch test results with above products brought in by the patient, considered as possible cause of contact dermatitis, were retrospectively analysed. Between 1998 and 2002, 1468 patients were patch tested with 2557 single products (deodorants, n = 1094; eau de toilette, n = 598; perfume, n = 530; and pre- or after-shave, n = 325; remainder not classifiable), mostly ‘as is’. Results Positive reactions were observed in 129 patients (to 191 products). In 58 of these patients, no further patch test reactions to the fragrance mix (FM-I), Myroxylon pereirae resin (balsam of Peru) or 4-(4-hydroxy-4-methyl-pentyl)-3-cyclohexencarboxaldehyde (e.g. Lyral®) were found. A strong association between contact sensitivity to the above commercial allergens and positive reactions to products was observed. Some single compounds such as ylang-ylang oil, propolis and especially oak moss absolute are important allergens in the ‘perfume-positive’ subgroup, but less in a subgroup positive to own deodorants. Discussion Patch testing this scope of products, brought in by the patient, can be regarded as a simple, safe and effective method to diagnose clinically relevant contact sensitization – the more so, as the composition of such products is ever-changing, and the sensitivity of established ‘screening allergens’ is thus insufficient. [ABSTRACT FROM AUTHOR]

Linked article: Bruze et al. Br J Dermatol 2020; 182:955–964. [ABSTRACT FROM AUTHOR]

Since January 2001, the European Surveillance System on Contact Allergies (ESSCA), supported by European Union funding (contract QLK4-CT-2001-00343), has started to collect patch-test data. This comprises a standardized clinical history and the patch-test results using the European standard series, from 17 centres in 9 European countries listed above. In 2002 and 2003, 10 511 patients' test results have been pooled and analysed. The anamnestic data partly reflect the subspecialties of some centres. The most common allergen was nickel sulfate (17.3%); however, large international variations were observed. The prevalence of contact allergy to Myroxylon pereirae resin (balsam of Peru) (5.8%) is coming close to the frequency found with the fragrance mix (6.4%). Regarding contact allergy to chromium compounds, different frequencies were noted in the 2 centres focused on occupational dermatitis (2.3% in the FIOH versus 7.4% in the Nofer Institute). These most likely reflect the beneficial effect of addition of ferrous sulfate in one, but not the other country. As differences may partly be due to different patch-test reading, standardization may need to be refined further. By providing post-marketing surveillance in the field of contact allergy, ESSCA will meet its objective of increased consumer safety across Europe. [ABSTRACT FROM AUTHOR]

Previous research indicates that positive patch tests to nickel (II) sulphate, cobalt (II) chloride and potassium dichromate commonly occur together.To further examine the relationship between nickel, cobalt, chromate, and the factors that may potentially be related to concurrent sensitizations to two or all three metal allergens, data from the Information Network of Dermatology Departments (IVDK,) have been investigated.Women had a higher conditional odds of concurrent nickel–cobalt (OR = 6.80; 95% CI: 5.65–8.19) and nickel–chromate (OR = 2.13; 95% CI: 1.67–2.72) reactions than men. Construction workers had a significantly higher odds of cobalt–chromate reactions (OR = 13.89; 95% CI: 10.36–18.64), while the odds of isolated cobalt allergy was only 0.92 (95% CI: 0.48–1.74). Patients with underlying atopic eczema/dermatitis syndrome had a 40–90% higher chance of any positive outcome, which involved chromate. Polysensitization, defined as the number of positive reactions to standard series substances other than nickel, cobalt, and chromate, was also significantly associated with the concurrent reactions; moreover, steady and significant effect gradients were noted.This research confirms the occupational nature of cobalt–chromate concurrent reactions, in particular, in construction workers. Polysensitization, which is considered to represent susceptibility to delayed-hypersensitivity in general, is also associated with the concurrent reactions to the metals. Hence, not only coupled exposure, but also individual susceptibility may be responsible for concurrent reactions to metals in man. [ABSTRACT FROM AUTHOR]

Periorbital dermatitis is common and can be due to the external use of ophthalmic drugs. We evaluated patch test results of the Information Network of the Departments of Dermatology. During a 5-year period (1995–99), of a total 49 256 patch-tested patients, 1053 (2.1%) were eventually diagnosed as allergic periorbital contact dermatitis (APD) and 588 (1.2%) as non-allergic periorbital dermatitis (NAPD). Patient characteristics between APD, NAPD and other cases (OCs) differed with respect to sex (19.7% male in both periorbital groups versus 36.3% in OCs), atopic dermatitis (10.4% in APD versus 60.2% in NAPD versus 16.9% in OCs) and age, APD being substantially more often (68.2%) aged 40 and above than NAPD (52.6%). Several of the top allergens in OCs [such as fragrance mix, Myroxylon pereirae resin (balsam of Peru), lanolin alcohol and potassium dichromate] caused significantly fewer positive test reactions in both periorbital groups. In contrast, thimerosal, phenylmercuric acetate, sodium disulfite, gentamicin sulfate, phenylephrine hydrochloride and benzalkonium chloride tested positively significantly more often in APD but not in NAPD, verifying them as true ophthalmic allergens. Finally, in 42 cases (4%) of APD patients, additional allergens were identified by testing of the patients' own substances (mostly β-blockers, oxybuprocaine and dexpanthenol), supporting the necessity of testing with ophthalmic drugs as is where individual substances are not readily available. [ABSTRACT FROM AUTHOR]

Background. Nevus density in children, a well-known risk factor for malignant melanoma, depends both on constitutional factors and on previous ultraviolet (UV) exposure. Secular trends of childhood UV exposure could thus be indirectly monitored by repeated standardized surveys assessing nevus density in children, such as the “childhood monitoring of nevus density (CMONDE-Study)”.Methods. Two complete surveys comprising all children at the time of school enrolment were performed in the city and county of Go¨ttingen, Germany, during the years 1999 and 2000. A total of 4252 children with a median age of 6.25 years were examined as part of the mandatory school enrolment health assessment, and complete data were available for 3881 children.Results. Median nevus density was 5.8/m2 in the entire study group. The subgroup-specific median increased from “Fitzpatrick skin type” IV to II, but the density was not increased for the type I subgroup. Similarly, nevus density rose with increasing lightness of hair color, but was very low in red-haired individuals. While the number of freckles was also strongly associated with nevus density, the association between iris color and skin reflectance, respectively, was weak. The duration of the additional examination for CMONDE was on average 3–5 min per child.Conclusion. We regard CMONDE as a highly feasible surveillance instrument, which should be implemented as an important addition to regular regional or national health reporting. [Copyright &y& Elsevier]

Sensitivity to ultraviolet (UV) light is associated with phenotypic variables like iris or hair colour or freckling, which are all strongly inter-related. We assessed the pattern of association among these factors to construct a summary measure reflecting constitutional UV sensitivity in a simple one-dimensional score with sufficient discriminating power. Information on iris and hair colour (3 and 4 categories, respectively), freckling (none vs. any) and the reaction to mid-day summer sunlight as an outcome (dichotomized into ‘burn’ and ‘tan’) was collected in a cross-sectional study among children at school enrolment in 1999 and 2000 in Göttingen, Germany ( n=3765 with complete data). Chi-squared automatic interaction detector (CHAID) analysis and log-linear modelling was used to assess the pattern of mutual inter-relations. Hair colour turned out to be the factor most strongly associated with UV sensitivity. In case of blonde or brown hair (the most common phenotypes in our sample), the consideration of freckling further refined the classification system, whereas iris colour did not contribute additional information. The results of the CHAID and log-linear analyses suggest a simple five-point score capturing constitutional UV sensitivity. The discriminating power of this score was high in our sample, with the proportion of persons who burned ranging from 7.7 (lowest category) to 73% (highest category). The new scoring system summarized efficiently relevant information on individual constitutional UV sensitivity in our sample. Its further validation in independent studies comprising Caucasian children or adults is necessary to assess objectively its properties for future applications. [ABSTRACT FROM AUTHOR]

Background: This study assessed the hypothesis that a decreased exposure to childhood infectious diseases is associated with signs and symptoms of ‘atopic’ hypersensitivity diseases. Methods: A cross-sectional survey was performed among 1368 Spanish and German first-year university students between 1997 and 1999, including self-administered questionnaire data and serological tests. Results: No association between the disease outcomes and hepatitis A, Helicobacter pylori infection and herpes simplex infection was observed in logistic regression analyses, adjusting for potential confounders (centre, sex, smoking, parental education). In contrast, vaccination against hepatitis B was associated with a decreased risk for the outcomes allergic rhinitis (OR 0.63, 95% CI: 0.42–0.95) and total serum IgE above 100 U/ml (OR 0.56, 95% CI: 0.39–0.81). Conversely, seropositivity to HBc antigen was significantly associated with high total serum IgE (OR 2.04, 95% CI: 1.34–3.06). Conclusions: Our study partly confirmed and partly contradicted previous evidence and hypotheses, respectively, concerning the role of the infections considered. The observation of a decreased risk in persons vaccinated against hepatitis B warrants further, prospective investigation. [ABSTRACT FROM AUTHOR]

Several contact allergens are tested at concentrations which might cause irritant reactions. In this study we investigated whether the reactivity to a standard irritant is useful in identifying subjects with hyperreactive skin yielding a higher rate of doubtful or irritant reactions. Sodium lauryl sulfate (SLS) 0.5% (aqua) was tested in addition to the standard series routinely for 5 years in the Department of Dermatology, Dortmund. For data analysis, we compared reactions at D3 to the standard series, the vehicle/emulsifier and preservative series and benzoyl peroxide to the reactions obtained with SLS. Proportions were standardized for age and sex. The association between reactivity to a certain allergen and SLS reactivity as a dichotomous outcome, controlled for age and sex as potential confounders, was assessed with logistic regression analysis. Results showed that of the 1600 tested patients, 668 (41.8%) had an irritant reaction to SLS which exceeded 2 + in only 41 patients. Seasonal variation was statistically significant, showing reduced SLS reactivity in summer vs. winter. Patients with irritant reactions to SLS showed significantly more erythematous reactions to the following 10 allergens of the standard series: fragrance mix, cobalt chloride, balsam of Peru (Myroxylon pereirae), lanolin alcohol, 4-phenylenediamine base (PPD), propolis, formaldehyde, N -isopropyl-N ′-phenyl-p -phenylenediamine (IPPD), benzocaine, and 4-tert -butylphenol-formaldehyde resin. No significant differences regarding strong positive allergic reactions were observed. Concerning other allergens, significantly more erythematous reactions were observed in SLS-reactive patients to benzoyl peroxide, octyl gallate, cocamidopropyl betaine, Amerchol L-101, tert -butylhydroquinone, and triethanolamine. In the SLS-reactive group of patients, the reaction index was negative for 10 allergens of the standard series compared to only 5 in the SLS non-responder group. For the first... [ABSTRACT FROM AUTHOR]

To quantify the independent impact of potential risk factors for nickel contact allergy (NCA), a multifactorial Poisson regression analysis of standardized anamnestic and patch test data (with nickel sulfate, 5% in petrolatum) was performed, comprising 74 940 patients assessed in the 33 German and Austrian contact dermatitis units of the Information Network of Departments of Dermatology (IVDK) between 1992 and 2000. NCA was observed in 15.5% patients. Female sex was the strongest risk factor (prevalence ratio 3.74, 95% CI: 3.51–3.98). Risk increased monotonically and significantly with decreasing age. Atopic dermatitis was not a risk factor. The year of patch test had no influence on NCA risk. Significant variation of risk between occupations was observed. In conclusion, our multifactorial analysis was able to quantify the impact of established risk factors and additionally address other, e.g. occupational, factors yet unidentified. [ABSTRACT FROM AUTHOR]

Clinical epidemiology (CE) is considered unable to estimate morbidity concerning either contact sensitization (CS) or allergic contact dermatitis (ACD) at the population level. Drug-utilization research (DUR) methods estimate the morbidity of suitable diseases based on prescription data for disease-specific drugs. Our objective was to estimate population figures for incidence and prevalence of ACD and CS based on sales data for patch test material in Germany and on patient data from the Information Network of Departments of Dermatology (IVDK). Approximately 600,000 standard series are sold per year in Germany, according to the 2 main manufacterers. This raw sales figure was corrected for certain effects (discarded preparations, proportion of formerly patch-tested patients, proportion of patients with ACD seeking medical advice) to obtain an estimate of the denominator of patients eligible for patch testing annually, and combined with patch test results from the Information Network of Departments of Dermatology (IVDK). In 17.8% (of 9,266 IVDK patients) ACD was established. Extrapolated to the general population, an incidence of ACD of between 1.7 and 7 per 1000 per year was estimated, depending on whether conservative or more liberal assumptions concerning the above effects were made. Of 78,067 IVDK patients tested between 1992 and 2000, 46.8% had at least 1 positive reaction (+ to + + +), and 22.7% had at least 1 stronger positive reaction (+ + or + + +).The 9-year prevalence of CS was estimated to lie between 4.0% and 16.6% for the first outcome, and between 2.0% and 8.1% for the second. Concerning single allergens, 1.9–4.5 million individuals are probably sensitized to nickel, and 1.4–3.4 million to fragrance mix among the German population of 82 million inhabitants. The morbidity data found in this study are in good accordance with data from population-based epidemiological studies. In comparison to these, the CE-DUR approach seems... [ABSTRACT FROM AUTHOR]

Background: Allergic contact sensitization to ‘para amino’ compounds is frequent and the spectrum of cross-reactivity between members of this chemical group is variable. Methods: A retrospective analysis of clinical patch test data obtained with a special test series in the centres of the Information Network of Departments of Dermatology (IVDK) between 1995 and 1999. Results: In the 638 patients tested with the above test panel positive reactions were observed most often to p- aminoazobenzene (16.2%), p- phenylenediamine (14.1%), p- toluylenediamine (10.0%), followed by 4,4′-diaminodiphenylmethane (8.5%), Disperse Orange 3 (8.4%) and p- aminophenol (3.1%). Among the 544 patients tested with p- phenylenediamine and all seven additional ‘para amino’ compounds, concordance between reactions varied greatly. The stronger the positive test reaction to p- phenylenediamine, p- toluylenediamine or p- aminoazobenzene, the more frequently additional positive reactions to the other compounds were observed. Conclusions: A screening employing several ‘para amino’ compounds is necessary to describe the individual spectrum of allergic contact sensitization, as there is no reliable marker substance. Further research should aim at (i) establishing the mechanism of cross-reactivity to ‘para amino’ compounds and (ii) identifying exposures in the environment. Background: Allergic contact sensitization to ‘para amino’ compounds is frequent and the spectrum of cross-reactivity between members of this chemical group is variable. Methods: A retrospective analysis of clinical patch test data obtained with a special test series in the centres of the Information Network of Departments of Dermatology (IVDK) between 1995 and 1999. Results: In the 638 patients tested with the above test panel positive reactions were observed most often to p- aminoazobenzene (16.2%), p- phenylenediamine (14.1%), p- toluylenediamine... [ABSTRACT FROM AUTHOR]

Several epidemiological parameters have been introduced for quantifying the population impact of a certain exposure on morbidity on a population level, termed 'attributable risk' (AR). Of these definitions, the AR as suggested by Levin in 1953 or some algebraic transformations of it are most commonly used. A structured literature search, based on the Medline database, identified 334 original epidemiological studies dealing with this AR published between 1966 and 1996 (mostly case-control studies). A considerable increase in the number of published studies incorporating some quantification of the exposure impact on the population level in terms of the AR was observed in the last decade. However, in 64.5% of these studies no exact definition of the AR used was given. Adjustment procedures necessary in multifactorial situations were performed by only 37.5%, confidence intervals for the AR were given by only 19.3% of authors. Thus, although the increasing popularity of this important epidemiological measure is encouraging, its correct application and comprehensive reporting in medical practice should be promoted further. [ABSTRACT FROM AUTHOR]

Investigates the seasonal variability of patch test results in contact dermatitis. Influence of irritant reactions on the variability; Surveillance data on seasonal variations from the German Information Network of Departments of Dermatology; Association between allergen reactivity and environmental factors.

There is conflicting evidence concerning predictors of individual susceptibility to develop irritant contact dermatitis in wet work. A cohort of initially 92 hairdresser apprentices was prospectively followed for 3 years. The association between anamnestic and clinical findings, and multiparametric skin bioengineering data (transepidermal water loss [TEWL], microcirculation, capacitance, pH, sebum, temperature) was investigated. The observation intervals were 3 months in the 1st year of training and 12 months thereafter. Of the 92 apprentices, 6 had already developed hand dermatitis on 1st examination, 20 dropped out or had occupational exposure longer than 7 weeks prior to investigation. Of the remaining 66 participants considered here, 19 (29%) developed moderate or severe dermatitis (“cases”), 32 minimal skin changes, 15 none within the observation period. Average incidence rate of hand dermatitis was 21.1 cases per 100 person years. Atopy score was not associated with the development of dermatitis, nor were the investigated basal bioengineering parameters, including TEWL, in a multivariable model. However, there was a significant increase in TEWL within the 1st year of training in presumptive “cases”. The aim to develop an objective and predictive instrumentary for pre-employment counselling in wet work, by a combination of (a) clinical and (b) relevant non-invasive bioengineering parameters, has not yet been accomplished. Skin-provocation tests employing bioengineering seem to be required. Notwithstanding, work-related monitoring of basal biophysical skin-functions may become useful in the secondary prevention of occupational dermatitis. [ABSTRACT FROM AUTHOR]

Healthcare workers often suffer from occupational skin disease frequently caused by allergic sensitization. Therefore the patch-test results and important patient history items of 31,849 patients recorded between 1992 and 1995 in the 24 allergy departments participating in the Information Network of Departments of Dermatology (IVDK) were evaluated. Significantly increased sensitization rates common to the healthcare sector as a whole were found for the vaccine preservative thiomersal (12.6% vs. 4.9%), the surface and instrument disinfectants glutardialdehyde (9.9% vs. 2.6%), formaldehyde (3.6% vs. 2.1%) and glyoxal (4.2% vs. 1.4%), and for the compounds of the thiuram mix (6.7% vs. 2.6%) present in protective gloves. Formaldehyde seems to lose its importance, but glyoxal must be added to the list of occupational allergens in the healthcare sector. In addition, occupation-specific sensitization was observed, with fragrances in massage therapists (16.1% vs. 10.6%) and nurses (13.8% vs. 11.4%), as well as with methacrylates in dental technicians. The often assumed importance of drugs as type-IV allergens was not confirmed, at least in terms of quantity. The identification of subgroups of increased risk and of occupation- specific allergens could be the basis of targeted preventive action in the healthcare sector. [ABSTRACT FROM AUTHOR]

A cohort of initially 111 office apprentices was prospectively followed for the duration of their training (2 and 3 years, respectively). The point prevalence of (slight) irritant or atopic hand eczema was 18.9% in the initial and 25.0% in the final examinations. Altogether, 37 cases of (slight) hand eczema were noted within the study period; of these, 10 qualified for a more conservative definition of "hand eczema". Expressed in a person-time-model, the incidence rates were 18.4 and 4.1 cases per 100 persons per year, respectively. The only significant risk factor for the development of (slight) irritant or atopic hand eczema within the study period was previous hand eczema — partly as a child, partly during a preceding occupation (e.g., hairdressing). Compared to one retrospective study in a cohort of older office employees and to a study sampling the general population, incidence rates were slightly higher in this study. Such differences may partly be due to different definitions of what has to be considered "a case of hand eczema". The necessity to (i) communicate on the method of case definition and (ii) develop guidelines for case definition in epidemiological studies is emphasised. [ABSTRACT FROM AUTHOR]

A letter to the editor in response to "Both mercaptobenzothiazole and mercapto mix should be part of the standard series", by Diepgen T L and his colleagues, published in vol 55 of 2006, is presented.

Reports on studies on the relation between age and contact allergy to fragrance mix. Aim of confirming the findings by Buckley and his colleagues in an identical descriptive, age- and sex-stratified analysis of another set of patch test data; Increase sensitization to fragrance mix up to a certain age; Higher prevalence in female patients; Role of endocrine factors in contact allergy; Adjustment for dermatitis.

The author reflects on the scarcity of epidemiological studies focusing on the burden of contact allergy on the population level and recognizes the publication of results from the industry-sponsored EDEN study conducted from 2008 to 2011 in 5 European countries. He references the article "Prevalence of fragrance contact allergy in the general population of five European countries: a cross-sectional study" by TL Diepgen and colleagues which appeared within the issue.

The article examines the accuracy of reading patch test reaction. It states that reading of patch tests is based on morphological criteria. It lays out the three successive steps of reading of a patch test such as reading, interpretation and the evaluation of clinical relevance in those patch test reactions. It notes that patch test quiz ratings comparison may compromise the application of objective criteria of the first step.

An abstract of the article "Contact allergy to topical antifungal agents," by C. A. Menezes de P ádua, W. Uter, J. Geier, A. Schnuch and I. Effendy is presented.

Replies to a comment on an article exploring the relationship between different demographic and clinical factors assembled in the MOAHLFA index and irritant patch test reactions to sodium lauryl sulfate. Use of the SLS patch test in conjunction with diagnostic allergen patch testing as an aid in the interpretation of certain patch test reactions to allergens as allergic or irritant; Conceptual background of the analysis.

Analyzes the frequency of allergic sensitization to ammonium thiolactate and thiolactic acid among hairdressers. Methods used in determining the subjects' allergic reactions; Stability of the Hermal patch test material.

In the course of a cohort study, 2275 hairdressing apprentices were examined a median of 6 weeks after the start of their training in the years 1992, 1993 and 1994. Skin changes were noted in 821 (36%). The site most often affected was the interdigital web space (664 of those with skin changes: 81%). The proportion of participants with a high atopy score and previous hand and flexural dermatitis was larger in the subset with interdigital dermatitis than in healthy persons, but was particularly elevated in those affected by dermatitis involving other sites. Interdigital dermatitis can be regarded as a potential precursor of more severe hand dermatitis in hairdressers, and probably of irritant hand dermatitis in wet work occupations in general. Thus, it is an important ‘sentinel’ for secondary prevention, e.g. regular and thorough application of emollients. [ABSTRACT FROM AUTHOR]

This article presents a case report of a 60-year-old man, who on after repeated long-term electrocardiography-monitoring, developed a pruritic eruption at the sites of the self-adhesive electrodes. Before application of electrodes, body hair was shaved with single-use razors at the sites, which the patient had continued to do. Physical examination revealed multiple follicular papules, many excoriated and well-defined erythmatous scaly patches, with little inflitration on the chest. A serial dilution and a blind repeated open application test with water as control in the other antecubital fossa, were performed.

The author discusses the study by J. P. Thyssen and colleagues on the relation between hand fissures and vesicles and filaggrin gene mutations R501X o 2282del4. The author says that the study has identified a significant association only with the former morphology. Moreover, it suggests that filaggin mutation was associated with dry, fissured skin in patients without atopic eczema.

Presents a letter to the editor about a special case of subungual haematoma.

The need for the introduction of computer-based systems to record and efficiently analyse data on contact allergic patients is widely accepted. In West Germany, efforts are made to standardize patch test series and readings and to develop appropriate software. During the first year, the software product, which is presently used in 8 participating clinics to record patch-test results and detailed patient histories. Copies of all data are periodically sent to the IVDK-center for statistical analysis using SAS software.

Background Nickel allergy is common worldwide. It is associated with hand dermatitis, and sensitization is often induced by nickel-releasing jewellery. The European Union ( EU) introduced legislation to control nickel content and release from jewellery and other consumer items through the EU Nickel Directive 1994, which came into force in 2001 and is now part of the REACH regulation. Objectives To examine the effects of the EU nickel regulations on the prevalence of nickel allergy in four European countries. Methods Nickel patch-test data from 180 390 patients were collected from national databases in Denmark, Germany, Italy and the U.K. from between 1985 and 2002 to 2010. Patients with suspected allergic contact dermatitis who had been patch tested with nickel sulfate 5% in petrolatum were included in the analysis. The main outcomes studied were the percentage of positive results to nickel patch tests, and changes in trends with time in an age- and sex-stratified analysis. Results A statistically significant decrease in nickel allergy was observed in Danish, German and Italian women aged below 30 years. In female patients in the U.K. this was observed between 2004 and 2010. In young men, a statistically significant decrease in nickel allergy was observed in Germany and the U.K., whereas a nonsignificant increase was observed in Italy. Conclusions There has been a reduction in the prevalence of nickel allergy in young women, contemporaneous with the introduction of the nickel regulation. A reduction is also suggested in men in Germany and the U.K. A causative effect of the regulatory intervention is the most likely explanation. [ABSTRACT FROM AUTHOR]

In Lithuania, data on patch testing are lacking and the applicability of the European baseline series needs to be evaluated. The aim of the study was to examine the prevalence of contact allergy to the European baseline series in the population of patients with suspected allergic contact dermatitis in Lithuania. Between April 2006 and October 2008, 816 consecutive adult patients referred to the Department of Skin and Venereal Diseases, Kaunas University of Medicine, with suspected allergic contact dermatitis were patch tested with the European baseline series. Demographic data were collected in accordance with the European Surveillance System on Contact Allergies 'minimal data set'. The positive patch test was observed in 384 (47.4%) patients. The most prevalent contact allergens were nickel sulphate (17.1%), Myroxylon pereirae resin (8.0%), p-phenylenediamine (6.0%), methyldibromo glutaronitrile (5.5%) and colophonium (5.0%). The sex and age factors strongly influenced the prevalence of nickel sensitization. The lowest sensitization prevalences were found to N-isopropyl- N′-phenyl- p-phenylene diamine (0.1%) and 2-mercaptobenzothiazole (0.1%). Differences in the sensitization prevalences to some allergens of the European baseline series compared with other European countries were recognized. The current European baseline series is a suitable diagnostic tool for contact allergy in Lithuania. [ABSTRACT FROM AUTHOR]

Background: Although the percentage of obese nursing home residents is increasing, few longitudinal studies have reported on functionality and mortality in this subpopulation. The aim of the present study was to explore functionality and mortality in obese nursing home residents during a 1-year follow-up and to compare these results with those of residents within the normal and low BMI range. Methods: Two hundred residents (147 female, 53 male, mean age 85.6 ± 7.8 years) from 2 Nuremberg nursing homes were included. Body weight and height were measured in all participants. BMI was calculated and categorized as low (<20 kg/m2), normal (20–30 kg/m2), and high (>30 kg/m2). Handgrip strength, timed “up and go” test, and Barthel''s Activities of Daily Living were applied as functional parameters. All measurements were done at baseline and after a 1-year follow-up. Results: At baseline, the prevalence of obesity was 23.5%, whereas low BMI values were present in 8.5% of the residents. After 1 year, there was no significant decline of functionality in the obese group, whereas functional parameters deteriorated significantly in study participants with normal BMI. One-year mortality was lowest in the obese (12.8%), with no deaths in residents with BMI of 35 kg/m2 or higher. Mortality was highest in residents with low BMI (58.8%). Conclusion: In nursing home residents, obesity is associated with increased survival and stable functionality. These observations may therefore be regarded as an expression of “risk factor paradox” in this specific population of older individuals. [ABSTRACT FROM AUTHOR]

Background Allergies to latex or ‘rubber chemicals’ in medical or other occupationally used gloves are not uncommon. In contrast, very few articles have reported on latex allergy (type I) or allergic contact sensitization to additives (type IV) associated with household gloves, in spite of some 44 million pairs sold in Germany in, e.g., 2006. Objective We seek to determine the frequency of allergies to household gloves by providing own data and we reviewed the literature. Methods The study was based on 105083 consultations of patients with suspected contact allergy (Type IV) in the Information Network of Departments of Dermatology (IVDK) in Germany in the years 1995 to 2006 and on the PubMed databases (last access 7/2008). Results 1221 patients were identified in whom protective gloves were considered as a possible cause of contact dermatitis and who did not work in occupations associated with above average risk of contact allergy to rubber chemicals. In 178 cases positive reactions to rubber components were reported, while 13 additional cases reacted only to a previously used rubber glove brand, but not to commercial allergens. In the literature only two publications on type I and two on type IV reactions were found in which allergies to rubber household gloves were explicitly reported. Conclusions Allergies to rubber household gloves seem to be rare. Factors presumably counteracting contact sensitization by household gloves, compared to occupational use, comprise short intermediate use, loose fitting and the incorporation of e.g. an inner cotton surface reducing skin contact with rubber chemicals. Conflict of interest Ehrhardt Proksch has acted as consultant to Wirtschaftsverband der deutschen Kautschukindustrie e.V. (WDK). [ABSTRACT FROM AUTHOR]

Genetic factors presumably play a role in contact allergy (CA). There is, however, a lack of conclusive evidence from clinical studies. This may be on account of the strongly competing or modifying impact of exogenous factors, namely the potency of allergens and the intensity of exposure, and the fact that – in principle – everybody can be sensitized. Regarding phenotype, in contrast, polysensitization (PS) seems to indicate a subset of individuals at greater risk. In human sensitization experiments with dinitrochlorobenzene, induction was facilitated in PS, and elicitation enhanced. Recent clinical epidemiological data, taking confounders for PS, such as age, sex, and other skin diseases into account, demonstrated the following: (i) PS was the greatest risk factor to be sensitized to a number of (even weak) index allergens, indicating higher susceptibility on the level of induction; (ii) patch test reactions in PS patients were generally stronger indicating higher susceptibility on the level of elicitation. These findings are complemented by reports on polymorphisms of TNF-α and IL-16 in PS patients. Future studies on the genetics of CA should be performed in subgroups with PS, focussing on polymorphisms relevant for CA-specific and nonspecific (inflammatory) processes. [ABSTRACT FROM AUTHOR]

The role of atopic eczema (AE) as risk factor for the development of allergic contact dermatitis is discussed controversially, as well as its influence on patch test results due to increased irritability. In this study, we analysed the pattern of positive patch test results to most frequent contact allergens in patients with AE ( n = 9020) and age matched nonatopic ( n = 15 263) individuals. The pattern and the frequencies of the observed sensitizations did not differ greatly from nonatopic individuals. Bufexamac is an exception: in AE patients sensitization is observed three times more often. For the other substances tested only minor differences were detected. Moreover, the frequencies of single, double or polyvalent sensitizations were nearly identical between the two groups. The analysis of the anatomical sites of dermatitis shows differences between the groups: in AE patients, the face (7.2%) and hand dermatitis (6.6%) was more common, and leg dermatitis (4.0%) less common. Analysis of occupation, suspected allergen source, and accompanying factors revealed no major differences between the both groups. Conclusion: The chronic and long-term exposure to external drugs and emollients presumably carries a risk for sensitization against specific contact allergens in AE patients. However, the sensitization of contact allergens differs surprisingly little between patients with or without AE. [ABSTRACT FROM AUTHOR]

Background: Patch test patients have two or more positive reactions to unrelated allergens more often than to be expected by chance. This study evaluates synchronous patch test reactions to test the hypothesis that in such cases an allergen-independent disposition for contact sensitization may be involved. Methods: Data of 87 834 patients tested with a standard patch test series in 42 centers of a Central European Network were retrospectively evaluated. Analyses were done for synchronous positive reactions of graded strength to nickel sulfate, fragrance mix, and to those five allergens that followed in frequency of positive results. All seven allergens selected were not related by chemical structure or exposure. Descriptive univariate and bivariate analyses as well as a polytomous logistic regression analysis were performed. Odds ratios with 95% confidence intervals were calculated. Results: With an increasing strength of a positive reaction to nickel or to fragrance mix the likelihood of further positive reactions to unrelated contact allergens increased significantly, and the mean strength of such additional reactions raised steadily with an increasing strength of a nickel or fragrance reaction. Conclusions: Our findings support the idea that patients who respond with a strong patch test reaction may have a particular general disposition to acquire contact sensitivity to additional unrelated allergens. They should therefore not only be advised to avoid their known allergen but in addition to minimize exposure other contact allergens. [ABSTRACT FROM AUTHOR]

The role of contact allergy in rosacea has rarely been investigated. In this retrospective study, 361 out of 76 697 patients tested and documented by the Information Network of Departments of Dermatology between 1995 and 2002 had rosacea. Patch tests included standard series and constituents of cosmetics and topical medicaments. 118/361 had additionally been patch tested with their own cosmetics/medicaments. Positive reactions occurred to nickel (II) sulfate in 9.3%, fragrance mix in 8.8%, thimerosal in 6.9%, Myroxylon pereirae resin in 5.9%, potassium dichromate in 4.6% and propolis in 2.8%. Whereas rosacea patients had a significantly higher risk of contact allergy to propolis compared to the remaining patients, in an age- and sex-adjusted analysis, contact allergy to nickel was significantly less frequent in this group. For Lyral®, the risk was elevated, albeit not significantly. Only 2/329 patients were positive to neomycin sulfate and 1/100 to gentamicin sulfate, among the panel of (topical) antibiotics tested. Among 118 patients tested with their own products, 3 were tested to metronidazole, 1 reacting positively. Irritant or doubtful patch test reactions were provoked by various substances (vehicles, oxidants and preservatives of various creams), which might also be clinically important, considering the heightened sensitivity of rosaceous skin. [ABSTRACT FROM AUTHOR]

Summary Background Atopic eczema, a multifactorial disease, is influenced by bacterial factors, particularly Staphylococcus aureus . Consequently, treatment includes therapy with antibiotics and nonantibiotic antimicrobials. Objectives In our study the sensitizing potential of some topical antimicrobials was investigated by comparing proportions sensitized to various antibiotics and antiseptics between patients with current or past atopic eczema, and patients who had never had atopic eczema. Methods Data of all patients patch tested in the Departments of Dermatology participating in the Information Network of Departments of Dermatology (IVDK) between 1995 and 1999 were analysed. Patients with a current leg ulcer or stasis dermatitis that might cause a confounding effect were excluded. Results Controlling for the additional confounding effect of sex and particularly age, we did not find that patients with atopic eczema had a generally higher risk compared with nonatopic individuals. Conclusions While the risk of sensitization should always be considered when applying topical therapy, our data—within the methodological limitations of this type of study—would not support a very restrictive use of these agents in the management of atopic eczema. [ABSTRACT FROM AUTHOR]

Sensitization rates to contact allergens vary between centers and are influenced by sex and age. Eliminating the latter 2 factors by standardization of data by age and sex, the present analysis adresses possible differences between centers remaining after elimination of these confounders and analyzes other factors which might influence rates e.g., the MOAHL index. Overall standardized rates were well within the range reported in previous studies and may be regarded as representing the rates were well within the range reported in previous studies and my be regarded as representing the rates of the "patch test population" in Central Europe (e.g., nickel sulfate 12.9% of fragrance mix 10.5%,balsam of Peru 7.3%, thimerosal 5.6%). For this analysis data of those departments which contributed more than 2000 patients, or of those with extreme proportions concerning sex, age and occupational cases were selected. Patients from these 10 departments differed considerably with regard to the items of the MOAHL index and with regard to standarized rates. The items of the MOAHL index proved to be suitable for describing different patch test populations and for explaining some differences between centers. Only 'atopic dermatitis' seems to have little influence on (standardized ) rate. Face dermatitis is not yet represented in the MOAHL index, but should be included, together with age >40 years in an extended index (acronym: MOAHLFA). Regional allergen exposure (with striking differences between East Germany, West Germany and to a lesser extent. In addition, sociological factors may influence sensitization rates, which is exemplified by high rates of nickel allergy in a socially defined subgroup. Future studies should focus on these factors as well as on factors concerning patch test practices and quality control. [ABSTRACT FROM AUTHOR]