Search

Background: There is controversy over late and long-lasting reactions to gold sodium thiosulfate (GST). Objectives: To study the GST patch test reaction by observing the application site after 1 month, and to clarify the relevance of GST sensitization by piercings and dental metals. Patients: A retrospective analysis was performed on 746 patients (143 male; 603 female) who were patch tested using GST of the TRUE Test. We conducted a questionnaire on the presence of piercings or dental metals in these patients. Results: The GST positive rate was 27.9% at day (D)3 and/or D7 and 40.3% up to the 1-month reading. The positive rate was significantly higher in female patients and increased with age. Sixty-two percent of cases with a positive reaction at D7 continued to show a positive reaction after 1 month. Eleven percent of cases with a negative reaction at D3 and D7 showed a late reaction. Both piercings and dental metals were related to gold sensitization. Conclusions: The GST of the TRUE Test had a high positive and low false-negative rate. The 1-month reading after the patch test was important for identifying late reactions. Piercing history and dental metal were associated with gold sensitization. [ABSTRACT FROM AUTHOR]

Background: It is recommended that patch test readings include a day (D)7 reading. Substitution of the D7 reading with a photo may be a valid option. Objectives: To compare the sensitivity of digital photos at D7 to clinical readings, to assess the number of positive reactions appearing at D7 only (late reactions), and after D7 only (delayed reactions). Methods: Patients patch tested in six European clinics were instructed to forward photos of the patch test reactions to the respective clinics at D7 (before attending the clinic) and at D21. Only allergens in the baseline series or TRUE Test were included in the data analysis. Results: Two hundred ninety‐three of 629 patients had a total of 599 positive reactions, with 6.3% occurring at D7 only. When substituting the D7 reading with a photo (90% submitted), 26.3% of late reactions were missed and nine false‐positive reactions were found. Delayed reactions were detected in four patients at D21 (65.3% submitted). Conclusion: Our data show that if the D7 reading is not performed, 6.3% of positive reactions from the baseline series would be missed, and if substituting the D7 reading by digital photo, 26.3% late reactions would be missed. Delayed reactions seemed rare. [ABSTRACT FROM AUTHOR]

Background: A late‐appearing patch test reaction may be a sign of active sensitization or represent a delayed elicitation reaction. Objectives: To retrospectively study the effect of concentration on the time course of allergic reactions to routine concentration dilution series of formaldehyde and nickel sulfate. Methods: We tested concentration dilution series of 2%, 1%, 0.32% and 0.1% formaldehyde and 5%, 1.6%, 0.5% and 0.16% nickel sulfate, respectively. The last readings were performed on day 4 to day 6. We included patients with allergic reactions to either of the two lowest concentrations in each dilution series and whose tests had been read three times. Results: Forty‐two nickel‐allergic and 23 formaldehyde‐allergic patients fulfilled the inclusion criteria. In 26 (62%) of the nickel‐sensitive patients, reactions to lower concentrations appeared later than reactions to the highest concentration. Of the formaldehyde‐sensitive patients, 17 (74%) developed one or two allergic reactions to lower concentrations later than reactions to the highest concentration, and one (4%) patient developed allergic reactions to lower concentrations sooner than a reaction to the highest concentration. The remaining patients showed all allergic reactions at the same reading. Conclusions: In these selected, relatively strongly sensitized patients, allergic reactions to lower concentrations quite regularly appeared later than reactions to higher concentrations. [ABSTRACT FROM AUTHOR]

Background: The proportion of positive test results with gold sodium thiosulfate included in a patch test panel (P‐GST) had been found to be greater than that with gold sodium thiosulfate 0.5% pet. by allergEAZE (A‐GST). Objectives: To compare positive reactions to P‐GST and A‐GST, and to evaluate late reactions after the day (D) 7 reading. Methods: A retrospective analysis was performed of 588 patients at participating departments (119 males; 469 females) who were patch tested with P‐GST and A‐GST in May 2015 to March 2016. Results: Positive test reactions to P‐GST and A‐GST were observed in 15% and 6% of patients, respectively. Three patients reported a positive reaction occurring after the D7 reading. Conclusions: Gold sodium thiosulfate often gives a positive reaction after 2 to 3 weeks, and, in such cases, the positive reaction may be sustained, so it is recommended to assess the reaction for up to 1 month after application. [ABSTRACT FROM AUTHOR]

Background. Arthroplasty patients with complications may be sensitized to implant components. Objectives. To quantify patch test reactions to implant materials in aseptic cemented arthroplasty patients with complications, and to evaluate the benefit of late patch test reading at D6. Methods. Analyses of patch test reactions to baseline series and bone cement components and of the questionnaire-aided histories of 250 consecutive patientswith suspected implant allergy were performed. Patch tests were read at D2, D3, and D6. Results. There were 187 positive reactions to the 29 allergens of the baseline series, and 52 to the seven allergens of the bone cement series. Forty-nine of 250 patients reacted to the bone cement series. In contrast to 'early allergens' such as fragrance mix, late reading at D6 increased the number of positive reactions by 11/32 for nickel, 1/5 for cobalt, and 2/4 for chromium. With bone cement components, most reactions were to gentamicin (25 of 250 patients), and 17 of 25 appeared only at D6. Conclusion. Late reading is useful for patch tests with metals and bone cement components. With only D2/D3 readings, 32 reactions to nickel, cobalt, chromium and bone cement componentswould have been missed. This underlines the utility of late reading in general and in complicated cemented arthroplasty patients, given the unexpectedly high number of gentamicin reactions. [ABSTRACT FROM AUTHOR]

We present the case of a 52-year-old woman with a topic dermatitis since adolescence who developed work-related hand eczema, cough and runny nose 12 years after she had started working as a laboratory technician at a precious metals refinery. While skin prick test with sodium hexachloroplatinate (SPTPt) was negative, patch testing with ammonium tetrachloroplatinate was positive after 24, 48, 72, and 96 hr. Inhalation challenge with sodium hexachloroplatinate yielded cough, mild shortness of breath, and a maximal decrease of FEV1 of 8% from baseline 24 hr after the challenge. Significant increases of bronchial hyperresponsiveness, exhaled nitric monoxide and sputum eosinophils were documented after the challenge. We conclude that eosinophilic airway disease due to platinum salts may occur in SPTPt negative subjects. Both, patch testing and inhalation challenge with platinum salts should be considered in SPT negative subjects with occupational exposure to precious metal salts and work-related allergic symptoms. Am. J. Ind. Med. 58:1008-1011, 2015. © 2015 Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]

The standard method of patch test reading is to read the test site for any positive allergy at 48hr and then again at 72/96 hr. A late reading on the seventh day is also advised to exclude the irritant reaction (IR) and to notice some delayed development of allergic reaction. However, multiple visits are often difficult for the patient; therefore, this late reading is sometimes omitted. Here a case of plantar hyperkeratosis, due to allergic contact dermatitis, is reported with some insight into interpretation of the patch test. The patient showed delayed patch test reaction to formaldehyde and colophony, which has never been reported before.

p-Phenylenediamine (PPD) 1% in petrolatum has been shown in a prospective study to elicit late reactions in 1.5% of routine patch tests, which may be indicative of patch test sensitization. To assess the frequency of late reactions to reduced PPD patch test concentrations. In 1838 patients, PPD was tested at three concentrations (0.5% pet., group I; 0.4% pet., group II; and 0.35% pet., group III). Patch tests were read on D1 (D2) to D3 (D4); additional late readings were performed on D7, D14, and D21. Patients who were not able to return for all scheduled late readings were telephoned on D7, D14, and D21, and questioned about a reaction at the patch test sites. Data of 1666 patients (1069 women and 597 men) were eligible. Late reactions were observed in 9 patients, 3 in group I (0.49%) and 5 in group II (0.63%). In 7 of 8 of the patients with late reactions, patch tests were applied for 48 hr. On retesting, 4 of 5 patients became positive at D2 or D3. The occurrence of late reactions to PPD may be influenced by patch test concentration and duration. PPD 0.4-0.5% pet. may cause late reactions indicative of active sensitization. [ABSTRACT FROM AUTHOR]

To cite this article: Hatzivlassiou M, Grainge C, Kehagia V, Lau L, Howarth PH. The allergen specificity of the late asthmatic reaction. Allergy 2010; 65: 355–358. Background: Allergen inhalation challenge in asthma may induce both early (EAR) and late (LAR) asthmatic reactions. The EAR is IgE and mast cell dependent. The mechanism of the LAR is less well defined and we have hypothesized may be allergen dependent. The aim of this study was to investigate the allergen specificity of the LAR to allergen inhalation in asthma. Methods: In a randomized, double-blind, crossover design six asthmatic volunteers with dual sensitization to house dust mite (HDM) allergen and grass pollen (GP) allergen underwent inhalation allergen challenge with these separate allergens on two occasions separated by 14 days. Lung function changes were followed for 8-h postchallenge. Bronchial reactivity (histamine PC20) and airway inflammation, assessed by induced sputum differential cell count, were measured 24-h pre and postallergen challenge. The allergen inhalation challenges were matched to achieve the same magnitude of EAR. Results: Despite comparable group mean EAR percent falls in FEV1 (25.8% following GP and 28.0% following HDM ( P = 0.917), the LAR was statistically greater on the HDM challenge day (13.0% vs 22.8% [ P = 0.046]) and was associated with a significant airway eosinophil recruitment (mean (SD) of 5.4 (4.8)% to 22.1 (18.2)% ( P = 0.028) that was not evident on the GP allergen challenge day. Conclusions: These findings identify the allergen specificity of the LAR and indicate that factors independent of IgE contribute to the LAR. Such findings have relevance both to the understanding of the allergen-induced airway responses in asthma and the need for homogeneity in inhaled-allergen challenge studies in asthma. [ABSTRACT FROM AUTHOR]

Background Late patch-test reactions, developing at day (D) 7 or later have been described for several allergens. Late reactions may reflect patch-test sensitization. Para-phenylenediamine (PPD) and epoxy resins (ER) are potent allergens and therefore may potentially induce patch-test sensitization. Up to now, there has been no prospective study on the frequency of late reactions in routine patch testing with these allergens. Objectives To assess the frequency of late reactions to PPD and ER. Patients/methods In 1748 patients PPD (PPD-base, 1% pet.) and ER [based on diglycidylether of bisphenol A (DGEBA, 1% pet.)], and in 812 patients, nickel sulphate (5% pet.) were removed from the test panel of the standard series and applied on the medial side of the upper arm. Patch-test occlusion time was 24 h in 588 (PPD and ER) and 241 patients (nickel sulphate), respectively, and 48 h in 1160 (PPD and ER) and 571 (nickel sulphate) patients, respectively. Patch tests were read on D1–3 and D2–3, respectively; additional late readings were performed on D7, D14 and D21 after patch-test application. Patients who were not able to return for all scheduled late readings were telephoned on D7, D14 or D21, and questioned about a reaction at the test sites. Patients were instructed to perform daily self-examination from D4 onwards and to return immediately to the clinic if a reaction at the upper arm became visible. Results Data of 1428 patients (ER and PPD) and 638 patients (nickel) were evaluable. In 25 patients (1·8%), patch tests became positive not before D7, among them 21 reactions to PPD (1·5%) and four reactions to ER (0·3%). In five of seven patients, repeated patch tests with PPD disclosed patch-test sensitization as the cause of the late reaction. All late reactions, except for one, occurred in patients in whom patch tests were applied for 48 h. No late reactions were seen with nickel sulphate. Conclusions PPD (1% pet.) elicited late reactions in 1·5% of routine patch tests, the majority of them probably being caused by patch-test sensitization. Therefore, the German Contact Dermatitis Research Group decided to remove PPD 1% pet. from the German standard series and to take efforts to optimize the patch-test conditions of PPD. One way to optimize PPD testing could be to reduce the exposure of PPD 1% to 24 h. Alternatively the patch-test concentration of PPD might be reduced. [ABSTRACT FROM AUTHOR]

BackgroundAllergen challenge in some patients with respiratory allergy is followed by an early and a late reaction. ObjectiveTo evaluate the duration of mediator release and inflammatory cell recruitment during the late antigen-induced nasal response. MethodsEight patients with seasonal allergic rhinitis due to grass pollen underwent local challenge with the relevant allergen, a non-relevant allergen (Parietaria judaica), and nebulized saline solution. Nasal lavages were performed at baseline and 6, 24, 48, 72 h after challenge. Eosinophil cationic protein (ECP), leukotriene C4 (LTC4), leukotriene B4 (LTB4) myeloperoxidase (MPO) and prostaglandin D2 (PGD2) levels were radioimmunoassayed and histamine concentration was measured by an automated fluorometric method. ResultsNasal challenge with the relevant antigen induced a response 6 h after stimulation, which subsided within 24 h. Eosinophilia, observed in the nasal lavages collected from 6 to 24 h after this challenge, was accompanied by ECP release. Neutrophilia were found in the nasal lavages collected from 6 to 24 h after challenge. The increase in neutrophil number correlated with MPO levels and LTB4 concentrations, but not with the intensity of nasal obstruction. Antigen challenge also induced significant recruitment of mononuclear cells 48 h after provocation. The challenge significantly raised histamine, but not PGD2, levels in the nasal lavages collected 6 h after provocation. A trend towards an increase in LTC4 levels in the nasal lavages collected 6 h after specific antigen challenge was also found. Nasal challenge with a non-relevant allergen or with saline solution did not cause either inflammatory cell recruitment or mediator release. ConclusionNasal challenge with the relevant antigen can induce a late response characterized by local accumulation of eosinophils, neutrophils and mononuclear cells... [ABSTRACT FROM AUTHOR]

The relationship between the immediate and late responses to repeated inhalations of allergen was studied. Sixteen male atopic asthmatics were challenged twice with an interval of 2 weeks. Forced expiratory volume in 1 s (FEV1) was measured serially over an 8-hour period after challenge. The method of provocation used implied that only slight differences between the immediate responses on the two provocation days were observed. However, differences in the late responses were demonstrated. Thus, the maximum percent change in FEV1 at the first and second provocation differed significantly in the late (P < 0.01), but not in the immediate phase. The increase in maximal late response was greater than the small change in maximal immediate response (P < 0.05). Further, the FEV1 values from 4 to 8 h post-challenge were in each recording significantly lower on the second day suggesting a more pronounced late bronchial response to repeat challenge. The results suggest that after one challenge specific airway reactivity, i.e., reactivity to allergen, at a subsequent rechallenge is increased in the late phase. This late phase hyperreactivity seems to persist for at least 2 weeks after allergen provocation. [ABSTRACT FROM AUTHOR]

We examined the ability of the inhaled leukotriene D4 antagonist (L-648,051) to inhibit antigen-induced asthmatic responses. Twelve patients with stable exogenous asthma participated in two separate double-blind, placebo-controlled, cross-over trials. The ability of the antagonist to reverse or inhibit antigen-induced bronchoconstrictor response was examined; both the immediate and the late phases were studied. In the reversal study, patients inhaled 800 μg of L-648,051 during the immediate phase (15 min after antigen challenge) and again during in the late phase (7 h after antigen challenge). In the prevention study, the same dose (800 μg) of L-648,051 was inhaled before the expected immediate reaction (5 min before antigen challenge) as well as before the expected late reaction (2.5 h after antigen challenge). The LTD4 antagonist was not effective in reversing the airway response to inhaled antigen, as measured by airway resistance (Rt), forced expiratory volume in 1 s (FEV1) or forced vital capacity (FVC). When the antagonist was given prior to antigen challenge, a slight reduction in Rt was observed during the immediate phase, but not during the late phase. Some improvement in FEV1 and FVC during the immediate phase was also observed, but these changes did not reach statistical significance. These results suggest that LTD4 plays a role in the immediate phase of antigen-induced asthma. [ABSTRACT FROM AUTHOR]

The article presents a study on the late reactions experienced by patients who undergone patch testing. A review of 2000 patients who attended patch testing from 2000-2005 is presented. The result of the review shows that less than 1% of the patients experience late reactions wherein most of these responses in not due to active sensitization. Tables of the research, including one on the allergens in 11 patients and another on the results of repeat patch testing, are presented.

Gold sodium thiosulfate (GSTS) is reputed to be the most reliable gold antigen, but control studies are still required. Although Koreans have more varied sources of contact with gold, such as herbal medicines with gold coatings and indwelling gold acupuncture needles, no epidemiological studies have been performed. This study examined the frequency and sources of contact allergy to gold in South Korea by a multicenter study. Patch testing with 0.5% GSTS in pet. was conducted in 255 eczema patients and 58 control subjects. Results were observed at 21 days (D) to ensure there were no undetected late reactions in 54 observed patients and 47 controls. 8 (3.1%) of the 255 patients reacted positively to GSTS, including 1 with a late reaction. 1 of the 58 controls showed a positive reaction to GSTS on D4 with a negative reaction on D14. Clinical relevance was lacking in the patients with positive reactions. Unexpectedly, the above particular sources of gold contact gave rise to few allergic reactions in our patients. [ABSTRACT FROM AUTHOR]

Twenty-three children with severe asthma who had been resident at high altitude for at least 3 months, considerably reduced their requirement for regular anti-asthma therapy. On a standard exercise challenge in low humidity, ten had no response, seven had isolated immediate bronchospasm and six had biphasic responses with immediate bronchospasm followed 4-10 h later by a late reaction sustained for at least 2 h. The existence of biphasic responses after exercise, similar to those observed after antigen challenge, supports the concept of mast cell involvement in exercise-induced asthma. [ABSTRACT FROM AUTHOR]

The article presents the case study of 45-year-old Turkish woman presented with fever and a pustular eruption on an erythematous base on the trunk and extremities. It mentions that eruption started from intertriginous areas while she was using varenicline. It states that histopathology was consistent with the diagnosis of acute generaized exanthematous pustulosis (AGEP).

The article presents a case study of a 34-year-old woman presented with eczematous lesions on the arms and dorsum of the hands, considered to be atopic dermatitis. She was tested with the textile dyes Disperse Orange 1 and Disperse Yellow 3. It shows that the patient is allergic to Disperse Orange 1 on an earlier patch test occasion. It presents the causes of the allergy which include the physico-chemical features of the substance and its metabolism/degradation by skin bacteria.

The article presents case studies of a 10-year-old girl who has eczematous areas because of the jewelry she wore and a 25-year-old man who has a 2-month history of generalized eczema which began on his feet. Both patients underwent patch tests, using metal series. The tests of the two resulted a ++/++ reaction at D2/D4 to beryllium chloride 1% pet. Both cases are reported of late reactions to beryllium which is caused by active sensitization.

Describes a case of an unusual immunoglobulin E-mediated allergy to fish bait. Delayed appearance of symptoms; Allergen absorption; Indications for skin prick testing.

It is generally accepted that a patch test reaction as late as 2-3 weeks after testing indicates active sensitization. The article reports a patient with a consistent 21-day late reaction to 2% para-tertiary-butylphenol (PTBP). In April 1990, a 53-year old female with no previous history of skin disease or atopy developed a heel dermatitis. She was patch tested with the European standard series and shoe series with negative results. 21 days after patch testing, the patient noted discomfort in the patch test area. At 23 days, a positive reaction was confirmed in a position strongly suggestive of a reaction to PTBP 2% pet, in the shoe series.