Generic selectors
Exact matches only
Search in title
Search in content
Search in posts
Search in pages
Filter by Categories
15th National Conference of the IAOMFP, Chennai, 2006
Abstract
Abstracts from current literature
Acne in India: Guidelines for management - IAA Consensus Document
Addendum
Announcement
Art & Psychiatry
Article
Articles
Association Activities
Association Notes
Award Article
Book Review
Brief Report
Case Analysis
Case Letter
Case Letters
Case Notes
Case Report
Case Reports
Clinical and Laboratory Investigations
Clinical Article
Clinical Studies
Clinical Study
Commentary
Conference Oration
Conference Summary
Continuing Medical Education
Correspondence
Corrigendum
Cosmetic Dermatology
Cosmetology
Current Best Evidence
Current View
Derma Quest
Dermato Surgery
Dermatopathology
Dermatosurgery Specials
Dispensing Pearl
Do you know?
Drug Dialogues
e-IJDVL
Editor Speaks
Editorial
Editorial Remarks
Editorial Report
Editorial Report - 2007
Editorial report for 2004-2005
Errata
Erratum
Focus
Fourth All India Conference Programme
From Our Book Shelf
From the Desk of Chief Editor
General
Get Set for Net
Get set for the net
Guest Article
Guest Editorial
History
How I Manage?
IADVL Announcement
IADVL Announcements
IJDVL Awards
IJDVL AWARDS 2015
IJDVL Awards 2018
IJDVL Awards 2019
IJDVL Awards 2020
IJDVL International Awards 2018
Images in Clinical Practice
In Memorium
Inaugural Address
Index
Knowledge From World Contemporaries
Leprosy Section
Letter in Response to Previous Publication
Letter to Editor
Letter to the Editor
Letter to the Editor - Case Letter
Letter to the Editor - Letter in Response to Published Article
LETTER TO THE EDITOR - LETTERS IN RESPONSE TO PUBLISHED ARTICLES
Letter to the Editor - Observation Letter
Letter to the Editor - Study Letter
Letter to the Editor - Therapy Letter
Letter to the Editor: Articles in Response to Previously Published Articles
Letters in Response to Previous Publication
Letters to the Editor
Letters to the Editor - Letter in Response to Previously Published Articles
Letters to the Editor: Case Letters
Letters to the Editor: Letters in Response to Previously Published Articles
Medicolegal Window
Messages
Miscellaneous Letter
Musings
Net Case
Net case report
Net Image
Net Letter
Net Quiz
Net Study
New Preparations
News
News & Views
Obituary
Observation Letter
Observation Letters
Oration
Original Article
ORIGINAL CONTRIBUTION
Original Contributions
Pattern of Skin Diseases
Pearls
Pediatric Dermatology
Pediatric Rounds
Perspective
Presedential Address
Presidential Address
Presidents Remarks
Quiz
Recommendations
Regret
Report
Report of chief editor
Report of Hon : Treasurer IADVL
Report of Hon. General Secretary IADVL
Research Methdology
Research Methodology
Resident page
Resident's Page
Resident’s Page
Residents' Corner
Residents' Corner
Residents' Page
Retraction
Review
Review Article
Review Articles
Revision Corner
Self Assessment Programme
SEMINAR
Seminar: Chronic Arsenicosis in India
Seminar: HIV Infection
Short Communication
Short Communications
Short Report
Special Article
Specialty Interface
Studies
Study Letter
Supplement-Photoprotection
Supplement-Psoriasis
Symposium - Contact Dermatitis
Symposium - Lasers
Symposium - Pediatric Dermatoses
Symposium - Psoriasis
Symposium - Vesicobullous Disorders
SYMPOSIUM - VITILIGO
Symposium Aesthetic Surgery
Symposium Dermatopathology
Symposium-Hair Disorders
Symposium-Nails Part I
Symposium-Nails-Part II
Systematic Reviews and Meta-analysis
Tables
Technology
Therapeutic Guidelines
Therapeutic Guidelines - IADVL
Therapeutics
Therapy
Therapy Letter
View Point
Viewpoint
What’s new in Dermatology
View/Download PDF

Translate this page into:

Brief Report
2008:74:5;467-470
doi: 10.4103/0378-6323.44301
PMID: 19052405

Atopic patch testing

DS Krupa Shankar, M Chakravarthi
 Manipal Hospital, Bangalore, India

Correspondence Address:
D S Krupa Shankar
Department of Dermatology, Manipal Hospital, 98, Rustom Bagh, Airport Road, Bangalore-560 017
India
How to cite this article:
Krupa Shankar D S, Chakravarthi M. Atopic patch testing. Indian J Dermatol Venereol Leprol 2008;74:467-470
Copyright: (C)2008 Indian Journal of Dermatology, Venereology, and Leprology

Abstract

Background: Atopic dermatitis is a major problem among the urban population and it can be aggravated or triggered by various allergens. Atopic patch test can be used as a diagnostic tool in characterizing patients with allergen triggered atopic dermatitis. Aims: 1. Patch testing to reproduce an eczematous reaction by applying prick test allergens under occlussion on intact skin. 2. To find the allergen associated with atopic dermatitis. 3. To find the specific allergen which causes or exacerbates atopic dermatitis in a given subject. Methods: Seventy five subjects with atopic dermatitis were included in our study and patch tests using prick test allergens were applied to the back. Reading was done after 48 and 72hours Results: Out of the 75 subjects tested, 47% showed positive reactions, parthenium accounted for 42% of all positive reactions. Conclusions: Epicutaneous application of prick test antigen on intact skin can produce a reaction. Parthenium is commonest allergen in Bangalore. Counselling based on patch test reports may help to reduce morbidity and improve quality of life.
Keywords: Atopic dermatitis, Atopic patch, Prick test allergen, Skin prick test

Introduction

Atopic dermatitis is a chronic inflammatory skin disorder characterized by intense itching and a relapsing course especially in infants and children with a personal or family history of atopic disorders.

Several new aspects with regard to the pathogenetic background as well as strategies for prevention, diagnosis and treatment in atopic dermatitis have emerged. There are ongoing studies on genetic susceptibility loci, as well as environmental and nutritional factors associated with an increase or a decrease of atopic dermatitis lesions. The atopic patch test is now available for identification of allergens in aeroallergen-triggered atopic dermatitis. [1]

Methods

Seventy five subjects with atopic dermatitis fitting Hanifin and Rajka′s criteria and elevated serum IgE were included in the study. Patients with active disease who had taken drugs like antihistamines during the last 1week, corticosteroids [2] systemically during the last 4 weeks and topically during the last 1 week or who were on immunomodulators-topical and oral, [3] beta blockers or tricyclic antidepressants or who had dermatitis over the test site or were pregnant were excluded from the study. Personal and family history of atopic disorder was sought.

Patch testing was done using prick test allergens in aluminium patch test chambers. The antigens are loaded in aluminium patch test chambers with filter paper using the dropper provided by the manufacturer. A drop from the dropper was approximately 1/16 ml. The test site was upper back. The antigens used were dust mites: D. farinae, D. pteronyssinus , [4] pollens of Cynodon dactylon and Parthenium hysterophorus , foods like rice, wheat, milk, egg and dog and cat epithelia. The reading was taken after 48 and 72 hours and interpretation and Grading of APT reaction was done according to the guidelines by European task force on atopic dermatitis consensus [Table - 1]. [5]

Test material

The patch test solutions were aqueous allergens supplied by Creative Drug Industries (Allergology division, Navi Mumbai) containing 50% glycerine as stabilizing factor and preserved with 0.4% phenol with their strengths expressed in protein nitrogen units (PNU) and for food series expressed in weight by volume.

Dust mites i.e. Dermatophagoides farinae and D. pteronyssinus has 1500 PNU, all others ( Cynodon dactylon, Parthenium hysterophorus , dog and cat dander) has 5000 PNU. All food antigens have 1% weight by volume (w/v).

Aluminium patch test chamber was supplied by Systopic Laboratories, New Delhi.

Results

Out of 75 subjects, 38 were males (51%) and 37 were females (49%) with mean age of 17.70 (1 to 64) years. Most of our study group belonged to the age group of 1 to 10 years [Figure - 1]. Seventy per cent of the subjects gave a personal or family history of an atopic disorder [Figure - 2]. The commonest site of involvement was cubital fossa followed by popliteal fossa [Figure - 3].

Out of the 75 subjects tested 46.66% (35) showed positive reactions, 50.66% (38) had no reaction [Figure - 4] and 2.66% (2) manifested angry back syndrome. While 28 subjects showed reaction to 1 antigen, 8 subjects showed reactions to 2 antigens.

Parthenium accounted for 42.8%(15) of all positive reactions followed by Cynodon 20%(7), D. farinae 14%(5), D. pteronyssinus 11%(4), Milk 9%(3) and 6%(2) each to wheat, egg, dog dander and cat dander and only one subject reacted to rice - 3%. [Figure - 5].

Interestingly, among 15 parthenium APT positive subjects, 8 subjects were tested with the Indian Standard Series (ISS) and of these 6 subjects showed positive reaction to parthenium in ISS (delayed hypersensitivity).

Discussion

Recent studies show that there is a marked rise in the incidence and prevalence of atopic dermatitis in India. In India, the prevalence of atopic dermatitis ranges between 10 - 15.6%. [6]

Atopic dermatitis can be diagnosed with Hanifin and Rajka′s criteria. Kanwar and Handa had undertaken a study to validate Hanifin and Rajka′s criteria and to assess the comparative efficacy of their criteria and the UK working party′s diagnostic criteria in the diagnosis of atopic dermatitis in a hospital setting in North India. Hanifin and Rajka′s criteria [sensitivity 96%, specificity 93.75%, positive predictive value 97% (PPV) and negative predictive value (NPV) 91.84%] had a statistical advantage over the UK working party′s diagnostic criteria (sensitivity 86%, specificity 95.83%, PPV 97.75% and NPV 76.67%), with a P -value < 0.005. [7]

The correlation between the APT and the total and specific serum IgE suggests an important role for IgE in the reaction mechanism behind the APT. [8] Hence, we included only those subjects who had elevated total serum IgE.

Dust mites are considered to be the most important triggering agent for atopic dermatitis. [9] In a study conducted in Croatia by Kuljanac et al, on Dermatophagoides pteronyssinus with APT and concluded that APT may detect the trigger factor in atopic dermatitis patients. [10]

Cow milk and hen egg allergy are the most important food allergies in atopic dermatitis, [11],[12] avoidance resulted in the clinical improvement. Parthenium hysterophorus is the most important antigen in India with both type I and type IV hypersensitivity. [13] Both types I and IV hypersensitivity may play a role in parthenium associated atopic dermatitis as evidenced by reaction to both atopic patch test and to Indian standard series patch test. [13]

Cynodon dactylon , also called Bermuda grass, has the potency of triggering atopic dermatitis. [14] Pet dander especially cat and dog dander should also be considered. [14]

A study conducted in Germany regarding pre-treatment of atopic dermatitis with pimecrolimus cream concluded that APT can be used as a model for atopic dermatitis skin inflammation. [3] Pimecrolimus pre-treatment has a potential to suppress the development of lesions induced by aeroallergen exposure in patients with atopic dermatitis. [3]

The atopic patch test (APT) involves the epicutaneous application of intact protein allergens in a diagnostic patch test setting with an evaluation of the induced eczematous skin lesions after 48 and 72 hours. The APT targets the cellular component of atopic dermatitis and helps complete out the atopic dermatitis test spectrum. As a number of apparently minor test modifications greatly influence the sensitivity, specificity, and reproducibility of the APT, the European Task Force on Atopic Dermatitis (ETFAD) has developed a standardized APT technique. [15] Aeroallergens and food allergens are able to elicit eczematous skin reactions after epicutaneous application. [16]

Presence of at least seven papules after 72 h was the APT skin sign with the greatest diagnostic accuracy for food allergy in children with atopic dermatitis. [16]

Counselling on avoidance of allergen based on APT can reduce the morbidity and can reduce the drug load. Immunotherapy for aeroallergens can be considered.

Advantages of APT over skin prick tests are that: it can be tested at a younger age, risk of anaphylaxis is low and the specificity is high. Disadvantages are sensitivity is lower than SPT, it is time consuming and only a few antigens can be tested at a time.

To date, no "gold standard" exists for the provocation of reactions in aeroallergen triggered atopic dermatitis and APT has not been standardised. Further analysis and comparison with skin prick testing and RAST should be done in a controlled study.

The relevance of allergens for atopic dermatitis flares may be evaluated by APT in addition to skin prick test. Both immediate and delayed hypersensitivity may play a role in parthenium associated atopic dermatitis. Counselling based on patch test reports may help to reduce morbidity and improve quality of life. In our study, parthenium was found to be the commonest allergen in Bangalore.

References
1.
Mφhrenschlager M, Darsow U, Schnopp C, Ring J. Atopic eczema: What's new? J Eur Acad Dermatol Venereol 2006;20:503-11,513.
[Google Scholar]
2.
Langeveld-Wildschut EG, Riedl H, Thepen T, Bihari IC, Bruijnzeel PL, Bruijnzeel-Koomen CA. Modulation of the atopy patch test reaction by topical corticosteroids and tar. J Allergy Clin Immunol 2000;106:737-43.
[Google Scholar]
3.
Weissenbacher S, Traidl-Hoffmann C, Eyerich K, Katzer K, Braeutigam M, Loeffler H, et al . Modulation of atopy patch test and skin prick test by pre-treatment with 1% pimecrolimus cream. Int Arch Allergy Immunol 2006;140:239-44.
[Google Scholar]
4.
Ingordo V, Dalle Nogare R, Colecchia B, D'Andria C. Is the atopy patch test with house dust mites specific for atopic dermatitis? Dermatology 2004;209:276-83.
[Google Scholar]
5.
Darsow U, Ring J. The atopy patch test in atopic dermatitis. In: Lachapelle JM, Maibach HI, editors. Patch testing and Prick testing A practical guide. 1 st ed. New York: Springer-Verlag Berlin Heidelberg; 2003. p. 103-10.
[Google Scholar]
6.
Sarkar R, Kanwar AJ. Atopic Dermatitis. Indian Pediatr 2002;39:922-30.
[Google Scholar]
7.
De D, Kanwar AJ, Handa S. Comparative efficacy of Hanifin and Rajka's criteria and the UK working party's diagnostic criteria in diagnosis of atopic dermatitis in a hospital setting in North India. J Eur Acad Dermatol Venereol 2006;20:853-9.
[Google Scholar]
8.
Langeveld-Wildschut EG, van Marion AM, Thepen T, Mudde GC, Bruijnzeel PL, Bruijnzeel-Koomen CA. Evaluation of variables influencing the outcome of the atopy patch test. J Allergy Clin Immunol 1995;96:66-73.
[Google Scholar]
9.
Barnetson RS, Macfarlane HA, Benton EC. House dust mite allergy and atopic eczema: A case report. Br J Dermatol 1987;116:857-60.
[Google Scholar]
10.
Kuljanac I, Milavec-Puretiζ V. Atopy patch test with Dermatophagoides pteronyssinus (Dp 1) in atopic dermatitis patients. Coll Antropol 2006;30:181-3.
[Google Scholar]
11.
Burks AW, James JM, Hiegel A, Wilson G, Wheeler JG, Jones SM, et al . Atopic dermatitis and food hypersensitivity reactions. J Pediatr 1998;132:132-6.
[Google Scholar]
12.
Heine RG, Verstege A, Mehl A, Staden U, Rolinck-Werninghaus C, Niggemann B. Proposal for a standardized interpretation of the atopy patch test in children with atopic dermatitis and suspected food allergy. Pediatr Allergy Immunol 2006;17:213-7.
[Google Scholar]
13.
Lakshmi C, Srinivas CR. Type I hypersensitivity to Parthenium hysterophorus in patients with parthenium dermatitis. Indian J Dermatol Venereol Leprol 2007;73:103-5.
[Google Scholar]
14.
Montealegre F, Meyer B, Chardon D, Vargas W, Zavala D, Hart B, et al . Comparative prevalence of sensitization to common animal, plant and mould allergens in subjects with asthma, or atopic dermatitis and/or allergic rhinitis living in a tropical environment. Clin Exp Allergy 2004;34:51-8.
[Google Scholar]
15.
Kerschenlohr K, Darsow U, Burgdorf WH, Ring J, Wollenberg A. Lessons from atopy patch testing in atopic dermatitis. Curr Allergy Asthma Rep 2004;4:285-9.
[Google Scholar]
16.
Weissenbacher S, Bacon T, Targett D, Behrendt H, Ring J, Darsow U. Atopy patch test--reproducibility and elicitation of itch in different application sites. Acta Dermatol Venereol 2005;85:147-51.
[Google Scholar]

Fulltext Views
1,010

PDF downloads
158
Show Sections