Expanded Series and Personalized Patch Tests for Children: A Retrospective Cohort Study
Expanded Series and Personalized Patch Tests for Children
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- In a retrospective cohort study, 29 children with suspected allergic contact dermatitis were evaluated with either a comprehensive, 80-allergen series or a limited, personalized series which included allergens not found on the TRUE test. Of the total 81 reactions, 49.4% were from allergens beyond those included in the TRUE test. Of the 10 most common reactions, 3 were not included on the TRUE test—cocamidopropyl betaine, benzoyl peroxide, and propylene glycol. All reactions to cocamidopropyl betaine occurred in patients with a history of atopic dermatitis compared with those without a history of atopic dermatitis (10/36 tests vs 0/22 tests; P=.0091).
- Based on these findings, the authors recommend that children with suspected allergic contact dermatitis, especially those with a history of atopic dermatitis, should be tested with a comprehensive or personalized series of allergens.
– Margaret Hammond, MD
- Written by
Allergic contact dermatitis is a common problem that is seen in pediatrics and adults. The standard for identifying an allergen and diagnosing allergic contact dermatitis is patch testing. There is one FDA-approved panel for patch testing, and there are several expanded series that have been developed to improve the detection of allergens responsible for allergic contact dermatitis. Studies have shown that these expanded series are more effective at more completely evaluating patients and identifying causative allergens, resulting in improvement or clearing of the presenting dermatitis. Although patch testing is performed in children, a standard series for patch testing in children has not been defined, and research in this area lags behind that in adults with allergic contact dermatitis.
This study included a small group of pediatric patients and was designed to evaluate how expanded patch testing compared with the FDA-approved allergen series, the TRUE test. The authors also assessed patients with and without a history of atopic dermatitis. The study confirmed what other studies in adults have shown—that an expanded series of allergens provides a more comprehensive evaluation of allergens than the TRUE test. They also found that many of the most common allergens detected in this pediatric population are not found in the TRUE test. Three of the most common allergens causing reactions were cocamidopropyl betaine (CAPB; second most common), benzoyl peroxide (fourth most common), and propylene glycol (seventh most common), which are all commonly found in personal care products. CAPB was more commonly found in patients with atopic dermatitis.
Although a small study, the authors' findings reinforce the benefits of expanded patch testing to more fully evaluate patients with allergic contact dermatitis in order to better identify their allergens and prevent continued use of products containing the causative allergens. The results also highlight the need for more research in pediatric patients with contact dermatitis.
BACKGROUND
Epicutaneous patch testing was developed as a simple and effective method for diagnosing allergic contact dermatitis (ACD). Despite its proven value in ACD diagnoses, there is no defined standard for patch testing in children.
OBJECTIVE
The aims of this study were to assess patch test positivity in pediatric patients with and without a history of atopic dermatitis suspected to have ACD, to compare these results with what the Thin-Layer Rapid Use Epicutaneous (T.R.U.E.) Test would have captured, and to evaluate likely exposures.
METHODS
Pediatric patients receiving a North American 80 Comprehensive Series patch test or a personalized patch test were analyzed for allergen sensitization 48 to 72 hours after patch removal. These data were analyzed for allergen inclusion in the North American 80 Comprehensive Series patch test compared with the T.R.U.E. Test, as well as compared with patients with and without a history of atopic dermatitis.
CONCLUSIONS
Expanded and personalized patch tests provide a more comprehensive allergen inventory than the traditional T.R.U.E. Test. Pediatric patients frequently have reactions to allergens not included in the T.R.U.E. Test, and these allergens are commonly found in household products. Cocamidopropyl betaine was a particularly relevant allergen in our population. Expanded series patch testing and appropriate counseling should be provided to pediatric patients with ACD.
Dermatitis 2019 Aug 21;[EPub Ahead of Print], RW Collis, GM Morris, DM Sheinbein, CC Coughlin
Skin Care Physicians of Costa Rica
Clinica Victoria en San Pedro: 4000-1054
Momentum Escazu: 2101-9574
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posted by dermatica at
October 08, 2019
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