Patch test results in children and adolescents. Study from the Santa Casa de Belo Horizonte Dermatology Clinic, Brazil, from 2003 to 2010

Rodrigues, Dulcilea Ferraz; Goulart, Eugênio Marcos Andrade

doi:10.1590/abd1806-4841.20153902

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Investigation • An. Bras. Dermatol. 90 (5) • Sep-Oct 2015 • https://doi.org/10.1590/abd1806-4841.20153902 copy

Patch test results in children and adolescents. Study from the Santa Casa de Belo Horizonte Dermatology Clinic, Brazil, from 2003 to 2010^* * Work performed at the Outpatient Center of the Santa Casa de Belo Horizonte Dermatology Clinic – Belo Horizonte (MG), Brazil.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

BACKGROUND:

Patch testing is an efficient method to identify the allergen responsible for allergic contact dermatitis.

OBJECTIVE:

To evaluate the results of patch tests in children and adolescents comparing these two age groups' results.

METHODS:

Cross-sectional study to assess patch test results of 125 children and adolescents aged 1-19 years, with suspected allergic contact dermatitis, in a dermatology clinic in Brazil. Two Brazilian standardized series were used.

RESULTS:

Seventy four (59.2%) patients had "at least one positive reaction" to the patch test. Among these positive tests, 77.0% were deemed relevant. The most frequent allergens were nickel (36.8%), thimerosal (18.4%), tosylamide formaldehyde resin (6.8%), neomycin (6.4%), cobalt (4.0%) and fragrance mix I (4.0%). The most frequent positive tests came from adolescents (p=0.0014) and females (p=0.0002). There was no relevant statistical difference concerning contact sensitizations among patients with or without atopic history. However, there were significant differences regarding sensitization to nickel (p=0.029) and thimerosal (p=0.042) between the two age groups under study, while adolescents were the most affected.

CONCLUSION:

Nickel and fragrances were the only positive (and relevant) allergens in children. Nickel and tosylamide formaldehyde resin were the most frequent and relevant allergens among adolescents.

Keywords:
Adolescent; Allergens; Child; Dermatitis; Dermatitis, allergic contact; Patch tests

Variables	Category	Age	Age	Total	Statistical	p
		1 to 9 years	10 to 19 years		Test	value
		n=18	n=107	n=125
		n (%)	n (%)	n (%)
Gender	Female	12 (66.7)	84 (78.5)	96 (76.8)	Fisher^* * Fisher Exact Test;	0.36
	Male	6 (33.3)	23 (21.5)	29 (23.2)
Dermatitis	1 to < 6 months	1 (5.5)	9 (8.4)	10 (8.0)	χ²=10.50^† † Chi-Square Test	0.0328
evolution	6 months to <1year	0 (0.0)	15 (14.0)	15 (12.0)
time prior	1 year to < 5years	12 (66.7)	60 (56.0)	72 (57.6)
to the	5 years to10 years	5 (27.8)	9 (8.4)	14 (11.2)
Patch test	> 10 years	0 (0.0)	14 (13.0)	14 (11.2)
Personal	Yes	11 (61.1)	54 (50.5)	65 (52.0)	χ²=0.34	0.56
Atopy	No	7 (38.9)	53 (49.5)	60 (48.0)
Family	Yes	7 (38.9)	49 (45.8)	56 (44.8)	χ²=0.0	0.96
Atopy	No	9 (50.0)	56 (52.3)	65 (52.0)
	Not reported	2 (11.1)	2 (1.8)	4 (3.2)

Body	Dermatitis	1 to 9 years	10 to 19 years	Total	Statistical	p Value
Location		n=18	n=107	n=125	test
		n (%)	n (%)	n (%)
Head	Yes	7	50	57 (45.6)	χ²= 0.13^* * Chi-Square Test;	0.720
	No	11	57	68 (54.4)
Neck	Yes	1	39	40 (32.0)	χ²= 5.41	0.020
	No	17	68	85 (68.0)
Trunk	Yes	3	38	41 (32.8)	χ²= 1.70	0.190
	No	15	69	84 (67.2)
Feet	Yes	9	37	46 (36.8)	χ²= 0.98	0.320
	No	9	70	79 (63.2)
Hands	Yes	2	47	49 (39.2)	χ²= 5.65	0.017
	No	16	60	76 (60.8)
Forearms	Yes	2	33	35 (28.0)	χ²= 2.08	0.150
	No	16	74	90 (72.0)
Arms	Yes	2	23	25 (20.0)	Fisher^† † Fisher Exact Test	0.520
	No	16	84	100 (80.0)
Legs	Yes	3	20	23 (18.4)	Fisher	1.000
	No	15	87	102 (81.6)
Thighs	Yes	4	12	16 (12.8)	Fisher	0.240
	No	14	95	109 (87.2)

Variables	Category	Negative	One or more	Statistical	p Value
		test	Positive tests	test
Gender	Female	30	66	χ²=13.97^* * Chi-Square Test	0.0002
	Male	21	8
Age groups	Children	14	4	χ²=10.18	0.0014
	Adolescents	37	70
Only Standard	Female	15	16	χ²= 4.32	0.0377
Series	Male	17	4
Standard Series	Female	15	50	Fisher	0.19
and Cosmetics	Male	4	4
Personal Atopy	Yes	25	40	χ²= 0.14	0.71
	No	26	34
Family Atopy	Yes	20	36	χ²= 1.78	0.41
	No	30	35
	Not reported	1	3

Substances/	Test Results	1 to 9 years	10 to 19 years	Total n=125 n (%)	p^* * Fisher Exact Test;†The vehicle used is solid petrolatum, except for formaldehyde, for which water is used. Value
Concentration		n=18 n (%)	n=107 n (%)
Nickel sulfatef	Positive	2 (11.1)	44 (41.1)	46 (36.8)	0.029
5.0%	Negative	16 (88.9)	63 (58.9)	79 (63.2)
Thimerosal	Positive	0 (0.0)	23 (21.5)	23 (18.4)	0.042
0.05%	Negative	18 (100.0)	84 (78.5)	102 (81.6)
Neomycin	Positive	0 (0.0)	8 (7.5)	8 (6.4)	0.60
20.0%	Negative	18 (100.0)	99 (92.5)	117 (93.6)
Cobalt chloride	Positive	0 (0.0)	5 (4.7)	5 (4.0)	1.00
1.0%	Negative	18 (100.0)	102 (95.3)	120 (96.0)
Fragrance mix	Positive	2 (11.1)	3 (2.8)	5 (4.0)	0.15
7.0%	Negative	16 (88.9)	104 (97.2)	120 (96.0)
Formaldehyde	Positive	0 (0.0)	4 (3.7)	4 (3.2)	1.00
1.0%	Negative	18 (100.0)	103 (96.3)	121 (96.8)
Potassium	Positive	0 (0.0)	3 (2.8)	3 (2.4)	1.00
dichromate 0.5%	Negative	18 (100.0)	104 (97.2)	122 (97.6)
Ethylenediamine	Positive	0 (0.0)	3 (2.8)	3 (2.4)	1.00
1.0%	Negative	18 (100.0)	104 (97.2)	122 (97.6)
Myroxylon	Positive	0 (0.0)	2 (1.9)	2 (1.6)	1.00
pereirae 25.0%	Negative	18 (100.0)	105 (98.1)	123 (98.4)
PPD mix	Positive	0 (0.0)	2 (1.9)	2 (1.6)	1.00
0.4%	Negative	18 (100.0)	105 (98.1)	123 (98.4)
Quinoline mix	Positive	0 (0.0)	2 (1.9)	2 (1.6)	1.00
6.0%	Negative	18 (100.0)	105 (98.1)	123 (98.4)
Antraquinone	Positive	0 (0.0)	1 (0.9)	1 (0.8)	1.00
2.0%	Negative	18 (100.0)	106 (99.1)	124 (99.2)
Hydroquinone	Positive	0 (0.0)	1 (0.9)	1 (0.8)	1.00
1.0%	Negative	18 (100.0)	106 (99.1)	124 (99.2)
Kathon CG	Positive	0 (0.0)	1 (0.9)	1 (0.8)	1.00
0.5%	Negative	18 (100.0)	106 (99.1)	124 (99.2)
Mercapto mix	Positive	0 (0.0)	1 (0.9)	1 (0.8)	1.00
2.0%	Negative	18 (100.0)	106 (99.1)	124 (99.2)
Quaternium-15	Positive	0 (0.0)	1 (0.9)	1 (0.8)	1.00
0.5%	Negative	18 (100.0)	106 (99.1)	124 (99.2)
Carba mix	Positive	0 (0.0)	1 (0.9)	1 (0.8)	1.00
3.0%	Negative	18 (100.0)	106 (99.1)	124 (99.2)
Promethazine	Positive	0 (0.0)	1 (0.9)	1 (0.8)	1.00
1.0%	Negative	18 (100.0)	106 (99.1)	124 (99.2)
Colophony	Positive	0 (0.0)	1 (0.9)	1 (0.8)	1.00
20.0%	Negative	18 (100.0)	106 (99.1)	124 (99.2)
Propylene glycol	Positive	0 (0.0)	0 (0.0)	0 (0,0)	-^‡ ‡ Statistical Test not applicable MIX composition: PPD mix (N-isopropyl, N-phenyl, paraphenylenediamine, N-N-diphenyl-, paraphenylenediamine); Kathon CG (methylchloroisothiazolinone, methylisothiazolinone); Thiuram mix (tetramethylthiuram disulfite, tetramethyltiuram monosulfite); Fragrance mix I (eugenol, isoeugenol, geraniol, cinnamic alcohol, alpha aldehyde amyl cinnamic, absolute oak moss, hydroxycitronellal; Mercapto mix (NCyclohexyl 2 benzothiazolesulfenamide, morpholinylmercaptobenzothiazole, dibenzothiazyl disulfide, mercaptobenzothiazole); Quinoline mix (clioquinol, clorquinaldol); Paraben mix (butyl, ethyl, propyl, benzyl, methyl parabens); Carba mix (diphenylguanidine, zinc dimethhylcarbamate, zinc diethylcarbamate).
10.0%	Negative	18 (100.0)	107 (100.0)	125(100,0)
p-tert-Butylphenol	Positive	0 (0.0)	0 (0.0)	0 (0.0)	-
1.0%	Negative	18 (100.0)	107 (100.0)	125 (100,0)
Irgasan	Positive	0 (0.0)	0 (0.0)	0 (0.0)	-
1.0%	Negative	18 (100.0)	107 (100.0)	125 (100.0)
Lanolin	Positive	0 (0.0)	0 (0.0)	0 (0.0)	-
30.0%	Negative	18 (100.0)	107 (100.0)	125 (100.0)
Thiuram mix	Positive	0 (0.0)	0 (0.0)	0 (0.0)	-
1.0%	Negative	18 (100.0)	107 (100.0)	125 (100.0)
Benzocaine	Positive	0 (0.0)	0 (0.0)	0 (0.0)	-
5.0%	Negative	18 (100.0)	107 (100.0)	125 (100.0)
Nitrofurazone	Positive	0 (0.0)	0 (0.0)	0 (0.0)	-
1.0%	Negative	18 (100.0)	107 (100.0)	125 (100.0)
Paraben mix	Positive	0 (0.0)	0 (0.0)	0 (0.0)	-
15.0%	Negative	18 (100.0)	107 (100.0)	125 (100.0)
Epoxy resin	Positive	0 (0.0)	0 (0.0)	0 (0.0)	-
1.0%	Negative	18 (100.0)	107 (100.0)	125 (100.0)
Turpentine	Positive	0 (0.0)	0 (0.0)	0 (0.0)	-
10.0%	Negative	18 (100.0)	107 (100.0)	125 (100.0)
para-Phenylene	Positive	0 (0.0)	0 (0.0)	0 (0.0)	-
diamine 1.0%	Negative	18 (100.0)	107 (100.0)	125 (100.0)

Substances/	Test Results	1 to 9 years	10 to 19 years	Total	p^* * Fisher Exact Test; †the vehicle used is solid petrolatum, except for chlorhexidine, for which water is applied;
Concentration		n= 4 n (%)	n= 69 n (%)	n=73 n (%)	Value
Tosylamide	Positive	0 (0.0)	5 (7.2)	5 (6.8)	1.00
formaldehyde resin10.0%f	Negative	4 (100.0)	64 (92.8)	68 (93.2)
Chloroacetamide 0.2%	Positive	0 (0.0)	1 (1.4)	1 (1.4)	1.00
	Negative	4 (100.0)	68 (98.6)	72 (98.6)
Germal 115	Positive	0 (0.0)	0 (0.0)	0 (0.0)	-^‡ ‡ Statistical Test not applicable
(imidazolidinylurea) 2.0%	Negative	4 (100.0)	69 (100.0)	73(100.0)
BHT (Butylhydroxy-	Positive	0 (0.0)	0 (0.0)	0 (0.0)	-
toluene) 2.0%	Negative	4 (100.0)	69 (100.0)	73(100.0)
Triethanolamine 2.5%	Positive	0 (0.0)	0 (0.0)	0 (0.0)	-
	Negative	4 (100.0)	69 (100.0)	73(100.0)
Bronopol (2-Bromo-2-	Positive	0 (0.0)	0 (0.0)	0 (0.0)	-
nitropropane-1,3-diol) 0.5%	Negative	4 (100.0)	69 (100.0)	73(100.0)
Sorbic acid 2.0%	Positive	0 (0.0)	0 (0.0)	0 (0.0)	-
	Negative	4 (100.0)	69 (100.0)	73(100.0)
Ammonium thioglycolate	Positive	0 (0.0)	0 (0.0)	0 (0.0)	-
2.5%	Negative	4 (100.0)	69 (100.0)	73(100.0)
Amerchol L- 101 100.0%	Positive	0 (0.0)	0 (0.0)	0 (0.0)	-
	Negative	4 (100.0)	69 (100.0)	73(100.0)
Chlorhexidine 0.5%	Positive	0 (0.0)	0 (0.0)	0 (0.0)	-
	Negative	4 (100.0)	69 (100.0)	73(100.0)

Allergens	Allergen sources	Number of children and adolescents
Nickel sulfate	jewelry, piercings	13
	metals on clothes and shoes	6
	nail clippers	1
	razor blade	3
	cosmetics	1
Thimerosa!	vaccines	23
Tosylamide formaldehyde^* * tosylamide formaldehyde resin	nail polish	5
Neomycin	topical medicine	8
Cobalt chloride	jewelry	4
	metals on clothes	1
Fragrance mix	cosmetics, fragrances	2
Formaldehyde	cosmetics, nail polish	3
Potassium dichromate	cement	1
	magnet	1
	shoes	1
Ethylenediamine	cosmetics	2
Myroxylon pereirae	cosmetics, fragrances	2
Carba mix, PPD mix	rubber glove	2

Substances	Patients	Positive	Positive		Positive	Relevance*
	tested	tests	tests		tests	present
			F^† † female;	M^‡ ‡ male;
	n	n	n	n	%	n (%)
Nickel sulfate	125	46	43	3	36.8	37 (80.4)
Thimerosal	125	23	20	3	18.4	0 (0.0)
Tosylamide resin^§ § tosylamide formaldehyde resin;	73	5	5	0	6.8	5 (100.0)
Neomycin	125	8	6	2	6.4	0 (0.0)
Cobalt chloride	125	5	3	2	4.0	5 (100.0)^\| \| relevance of cobalt together with another metal: relevance questioned
Fragrance mix	125	5	4	1	4.0	2 (40.0)
Formaldehyde	125	4	3	1	3.2	3 (75.0)
Potassium dichromate	125	3	1	2	2.4	3 (100.0)
Ethylenediamine	125	3	3	0	2.4	2 (66.7)
Myroxylon pereirae	125	2	2	0	1.6	2 (100.0)

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Patch test results in children and adolescents. Study from the Santa Casa de Belo Horizonte Dermatology Clinic, Brazil, from 2003 to 2010* * Work performed at the Outpatient Center of the Santa Casa de Belo Horizonte Dermatology Clinic – Belo Horizonte (MG), Brazil.

Abstract

BACKGROUND:

OBJECTIVE:

METHODS:

RESULTS:

CONCLUSION:

Patch test results in children and adolescents. Study from the Santa Casa de Belo Horizonte Dermatology Clinic, Brazil, from 2003 to 2010^* * Work performed at the Outpatient Center of the Santa Casa de Belo Horizonte Dermatology Clinic – Belo Horizonte (MG), Brazil.