Prevalence of reactive allergens in contact patch testing studies using the Brazilian standard battery: a systematic review<sup/>

Bueno, Ana Laura Andrade; Aguzzoli, Nathalia Hoffmann Guarda; Bonamigo, Renan Rangel

doi:10.1016/j.abd.2025.501126

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ORIGINAL ARTICLE • An. Bras. Dermatol. 100 (4) • 2025 • https://doi.org/10.1016/j.abd.2025.501126 linkcopy

Prevalence of reactive allergens in contact patch testing studies using the Brazilian standard battery: a systematic review^*

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Background: Contact dermatitis is a common dermatosis in dermatology. The patch test is the gold standard for diagnosis, using a panel of common allergens and irritants. In Brazil, a standardized battery of 30 substances is used. However, comprehensive epidemiological data on contact dermatitis are limited, and no studies have compiled and compared nationwide results. Objectives: This study aimed to assess the positivity rate of patch tests using the Brazilian Standard Battery in suspected contact dermatitis cases from 2000 to 2022. We also evaluated associations between reactive substances and clinical and demographic variables and examined the variation in reactivity frequency to allergenic substances over the study period.

Methods: A systematic literature review was conducted using PubMed, Scielo, and LILACS. We evaluated the prevalence of positive tests for each substance, examined associations between variables such as gender, region, and age, and assessed variations in patch test positivity over time.

Results: Initially, 55 articles were identified, and 10 were included in the review. Nickel sulfate was the most frequently positive allergen, while triclosan, P-tertiary buthyphenol, and anthraquinone were the least prevalent. Test positivity increased every 5-years for kathon CG, neomycin, and nickel sulfate, while it decreased for quaternion 15 and thimerosal.

Study limitations: The results were limited by the small number of articles included in the review.

Conclusions: This pioneering study in Brazil provides valuable insights for dermatological allergy practitioners into the prevalence of patch test positivity for each substance in the Brazilian Standard Battery, aiding in informed decision-making and patient management.

KEYWORDS
Brazil; Dermatitis; contact; Patch test

First Author/Year	Study design	City/Region	Evaluated period	Sample	Size	Sex (%)	Results: positive substances (%)
Oppermann et al. 2021 Rodrigues et al. 2015	Cohort (prospective) Cross-sectional	Porto Alegre South Belo Horizonte Southest	2018 to 2019 2003 to 2010	77 125	41.3 ^Unrepresented Variability ^Minimum-maximum: 3-75 years 14.3 ± 3.8	F: 77.9 M: 22.1 F: 76.8 M: 23.2	Nickel sulfate 38 Kathon CG 15 Perfume mix 14 Paraphenylenediamine 9 Neomycin, Thimerosal 8 Cobalt chloride 7 PPD mix, Carba mix 6 Balsam-of-Peru, Potassium dichromate, P-tertiary Buthylphenol 5 Thiuram mix, Colophony 4 Etilenodiamine 3 Propylene Glycol, Benzocaine, Epoxi-resine 2 Anthraquinone, Hydroquinone, Mercapto mix, Quaternium-15, Quinine mix, Nitrofurazone, Paragon mix, Terebentine 1 Nickel sulfate 46 Thimerosal 23 Neomycin 8 Cobalt chloride, Perfume mix 5 Formaldehyde 4 Potassium dichromate, Etilenodiamine 3 PPD mix, Balsam-of-Peru, Quinine mix Anthraquinone, Kathon CG, Hydroquinone, Mercapto mix 2 Quaternium-15, Promethazine 1 Colophony, Carba mix
Duarte et al. 2013	Cohort (restrospective)	São Paulo Southest	2006 to 2011	618	^*Unrepresented variability	F: 68.4	Nickel sulfate 174
					^*Predominant age group: 30-49 years	M: 31.6	Thimerosal 99
							Potassium dichromate 69
							Cobalt chloride 65
							Perfume mix 54
							Neomycin, PPD mix 45
							Paraphenylenediamine 43
							Carba mix 41
							Thiuram mix 38
							Etilenodiamine 27
							Promethazine 21
							Balsam-of-Peru, Formaldehyde 20
							Mercapto mix 19
							Hydroquinone, Quaternium 15
							Colophony 17
							Quinine mix, Lanoline 16
							Kathon CG, Benzocaine 15
							Paragon mix, Nitrofurazone 14
							Terebentine 11
							Propylene Glycol 10
							Epoxi-resine 9
							Irgasan, P-tertiary Buthylphenol 5
							Anthraquinone 4
Rodrigues et al. 2012	Cohort (restrospective)	Belo Horizonte Southest	2003 to 2010	1406	42 ± 16	F: 69.7	Nickel sulfate 442
						M: 30.3	Thimerosal 207
							Potassium dichromate 114
							Paraphenylenediamine 99
							Cobalt chloride 97
							Perfume mix 94
							Neomycin 88
							Balsam-of-Peru, Formaldehyde 72
							Etilenodiamine 67
							PPD mix 60
							Carba mix 40
							Thiuram mix 37
							Colophony 30
							Hydroquinone 25
							Paragon mix 22
							Kathon CG 20
							Quaternium 15, Nitrofurazone 19
							Propylene Glycol 10
							Benzocaine 16
							Epoxi-resine 12
							Mercapto mix 14
							Quinine mix 14
							Terebentine, triclosan 11
							Promethazine 17
							Anthraquinone 7
							Lanoline, P-tertiary Buthylphenol 6
Silva et al. 2020	Cohort (restrospective)	São Paulo Southest	2015 to 2017	267	43 ± 16	F:72.9	Nickel sulfate 108
						M:27.1	Cobalt chloride 45
							Neomycin 35
							Potassium dichromate 34
							Kathon CG 29
							Thimerosal 28
							Formaldehyde 25
							Paraphenylenediamine 18
							Perfume mix 16
							Colophony 11
							Balsam-of-Peru 9
							Triclosan 8
							Carba mix, Thiuram mix 6
							Etilenodiamine, Paragon mix 5
							Quaternium 15, Quinine mix, 4
							Nitrofurazone, Epoxi-resine
							Lanoline, Mercapto mix 3
							Promethazine, Hydroquinone, 2
							Benzocaine, PPD mix
							Terebentine, P-tertiary Buthylphenol 1
GBEDC et al. 2000	Cohort (prospective)	São Paulo Southest	1995 to 1996	967	37.1 ± 15	F: 62.5	Nickel sulfate 243
						M: 37.5	Thimerosal 158
							Quaternium 15 109
							Cobalt chloride 106
							Paraphenylenediamine 84
							Perfume mix 81
							Potassium dichromate 78
							Quinine mix 58
							Thiuram mix 53
							Neomycin 42
							Formaldehyde 37
							Carba mix, Mercapto mix,
							Nitrofurazone 36
							Balsam-of-Peru 31
							Etilenodiamine 30
							Paragon mix 26
							Colophony 25
							Epoxi-resine, PPD mix, Promethazine
							17
							Kathon CG 21
							Terebentine 14
							Hydroquinone 13
							Lanoline 11
							triclosan, P-tertiary Buthylphenol 7
							Anthraquinone 5
Correa et al. 2018 Fernandes et al. 2007	Cross-sectional Cohort (prospective)	Santa Catarina South São Paulo Southest	2004 to 2013 2001 to 2002	539 65	38.8 ^Unrepresented variability 45.1 ^Unrepresented variability	F: 75,9 M: 24.1 F: 90.7 M: 9.23	Nickel sulfate 196 Cobalt chloride 95 Thimerosal 81 Paraphenylenediamine 44 Potassium dichromate 43 Kathon CG 42 Carba mix 39 Formaldehyde 38 Perfume mix 37 PPD mix 35 Promethazine 32 Neomycin 28 Colophony 24 Terebentine 22 Etilenodiamine 18 Hydroquinone 15 Epoxi-resine 14 Nitrofurazone, Paragon mix 12 Propylene Glycol, P-tertiary Buthylphenol 11 Balsam-of-Peru, Thiuram mix 10 Irgasal 9 Anthraquinone, Quinine mix 7 Quaternium 15 6 Benzocaine 5 Mercapto mix 4 Lanoline 4 Nickel sulfate 24 Thimerosal 13 Neomycin 6 Formaldehyde 5 Cobalt chloride 3 Mercapto mix, Lanolin, Perfume mix, PPD mix, Paraphenylenediamin 2 Balsam-of-Peru, Thiuram mix P-tertiary Buthylphenol, Etilenodiamine, Epoxi-resine 1
Duarte et al. 2007 Artus et al.	Cohort (prospective) Cross-sectional	São Paulo Southest Porto Alegre/South	1998 to 2003 2007 to 2010	506 133	^*Unrepresented mean and variability 42 ± 15	F: 64 M:36 F: 69.2 M: 68.7	Nickel sulfate 180 Cobalt chloride 85 Thimerosal 64 Potassium dichromate 61 Perfume mix 58 Paraphenylenediamine, Neomycin, Thiuram mix 47 Quaternium-15 45 Carba mix, Nitrofurazone 34 Etilenodiamine 27 Quinine mix 23 PPD mix 22 Balsam-of-Peru, Epoxi-resine 21 Paragon mix, Promethazine 20 Colophony 18 Lanoline 12 Hydroquinone 10 Benzocaine 9 Formaldehyde 7 Propylene Glycol 6 Anthraquinone 3 P-tertiary Buthylphenol triclosan 2 Nickel sulfate Thimerosal 45 Paraphenylenediamine 25 Neomycin 22 Cobalt chloride 19 PPD mix 17 Potassium dichromate 16 Carba mix 14 Perfume mix, Thiuram mix 12 Kathon CG, Mercapto mix, Paragon mix, 10 Promethazine, Hydroquinone 8 Balsam-of-Peru, Colophony, Epoxi-resine, Terebentine 7 Etilenodiamine, Formaldehyde, triclosan, 6 Anthraquinone, Nitrofurazone 5 Mercapto mix 4 Lanoline, Quaternium 15, Quinine mix, Propylene Glycol, Benzocaine, P-tertiary Buthylphenol 3

Substance	Positive tests^*	Mean (%)	Standard Deviation	Standard Error	Confidence Interval (90%)
Substance	Positive tests^*	Mean (%)	Standard Deviation	Standard Error	Lower Limit (%)	Upper Limit (%)
Nickel sulfate	1.496	31.8	25.3	8.00	17.2	46.5
Thimerosal	727	15.5	3.2	1.02	13.6	17.3
Cobalt chloride	504	10.7	14.3	4.51	2.4	19.0
Potassium dichromate	421	9.0	5.4	1.71	5.8	12.1
Para-phenylenediamine	368	7.8	5.1	1.61	4.9	10.8
Perfume mix	362	7.7	5.4	1.71	4.6	10.8
Neomycin	335	7.1	6.1	1.92	3.6	10.6
Carba mix	219	4.7	5.0	1.58	1.8	7.6
Formaldehyde	214	4.6	4.1	1.29	2.2	6.9
Thiuram mix	206	4.4	6.1	1.92	0.9	7.9
Quaternium 15	204	4.3	17.7	5.60	0.0	14.6
PPD mix	203	4.3	5.4	1.71	1.2	7.5
Ethylenediamine	187	4.0	1.0	0.32	3.4	4.6
Balsam of Peru	178	3.8	1.5	0.47	2.9	4.6
Kathon CG	151	3.2	12.9	4.10	0.0	10.7
Colophony	137	2.9	1.1	0.34	2.3	3.5
Nitrofurazone	125	2.7	3.0	0.94	0.9	4.4
Quinoline mix	122	2.6	4.1	1.29	0.2	5.0
Promethazine	118	2.5	3.1	0.98	0.7	4.3
Paraben mix	113	2.4	1.2	0.38	1.7	3.1
Hydroquinone	94	2.0	1.0	0.31	1.4	2.6
Epoxy resin	87	1.8	1.4	0.44	1.0	2.7
Mercapto mix	85	1.8	1.8	0.58	0.8	2.9
Turpentine	67	1.4	1.7	0.55	0.4	2.4
Benzocaine	57	1.2	0.5	0.15	0.9	1.5
Lanolin	56	1.2	0.8	0.24	0.7	1.6
Propylene glycol	50	1.1	0.4	0.12	0.8	1.3
Triclosan	47	1.0	0.8	0.25	0.5	1.5
p-Tertiary butylphenol	41	0.9	0.9	0.27	0.4	1.4
Anthraquinone	33	0.7	0.4	0.12	0.5	0.9

Substance	Female		Age (mean)		Region^*
Substance	coeficient	p-value	coeficient	p-value	coeficient	p-value	p-value (global)
Anthraquinone	-0.020	0.062	-	-	1.82	0.006	0.002
Peru Balsam	-	-	-	-	2.60	<0.001	<0.001
Benzocaine	-0.006	0.628	-	-	1.25	0.075	0.005
Potassium Bichromate	-0.388	0.025	0.166	0.187	0.93	0.664	0.081
Carba mix	-0.084	0.072	0.091	0.244	5.41	0.008	0.001
Cobalt Chloride	-0.059	0.550	0.234	0.218	4.24	0.246	0.003
Colophony	-0.047	0.072	0.065	0.148	2.97	0.008	<0.001
Epoxy resin	-0.039	0.064	0.053	0.144	2.12	0.013	0.001
Ethylenediamine	0.047	<0.001	-	-	-	-	<0.001
Formaldehyde	0.088	0.041	-	-	-1.42	0.482	0.003
Hydroquinone	-0.106	0.079	-	-	2.21	0.039	0.050
Irgasan	-	-	-	-	0.94	0.016	0.016
Kathon CG	-0.073	0.293	-	-	8.09	0.047	0.012
Lanolin	0.028	0.097	-	-	-0.56	0.503	0.018
Mercapto mix	0.024	0.002	-	-	-	-	0.002
Neomycin	0.075	0.097	-	-	2.53	0.266	<0.001
Nitrofurazone	-0.138	0.007	0.042	0.184	0.91	0.134	0.021
Paraben mix	-0.161	0.016	-	-	1.65	0.097	0.029
Para-phenylenediamine	-0.150	0.016	0.262	0.019	6.45	0.007	<0.001
Perfume mix	-	-	-	-	5.80	<0.000	<0.001
PPD mix	-0.069	0.208	0.068	0.474	5.57	0.018	0.003
Promethazine	-0.021	0.447	-	-	2.95	0.071	0.012
Propylene glycol	-0.027	0.040	0.018	0.360	1.78	0.003	0.001
P-Tertiary Butylphenol	-0.027	0.443	0.007	0.913	2.57	0.069	0.046
Quaternium 15	-0.330	0.024	-	-	-1.50	0.466	0.049
Quinoline mix	-0.169	0.014	-	-	-0.34	0.712	0.034
Nickel sulfate	0.410	0.011	-0.083	0.702	6.28	0.170	<0.001
Turpentine	-0.048	0.088	0.033	0.468	2.92	0.012	0.008
Thimerosal	0.232	0.001	-	-	-1.01	0.695	<0.001
Thiuram mix	0.054	0.004	-	-	-	-	0.004

Substance	-\| 1999a	2000-2005	2005-2010	2011 \|-	ß (pp)b
Antraquinone	0.5	0.3	1.4	0.6	0.07
Benzocaine	0.5	0.9	1.3	1.7	0.28
Potassium Dichromate	8.1	6.0	8.0	9.6	0.73
Peru Balsam	3.2	2.8	3.4	4.9	0.54
Carba mix	3.7	3.4	5.4	5.0	0.42
Cobalt Chloride	11.0	8.6	10.4	13.0	0.91
Colophony	2.6	1.8	3.1	4.7	0.71
Epoxy Resin	1.8	2.8	2.0	2.0	-0.07
Ethylenediamine	3.1	3.4	3.9	2.9	-0.11
Formaldehyde	3.8	4.5	4.6	4.7	0.14
Hydroquinone	1.3	1.0	2.9	1.0	-0.04
Triclosan	0.7	0.1	1.6	1.5	0.31
Kathon CG	2.2	0.0	3.7	15.2	4.02
Lanolin	1.1	2.7	1.2	0.6	-0.39
Mercapto mix	3.7	1.5	1.8	1.2	-0.41
Neomycin	4.3	9.3	8.2	11.7	1.41
Nitrofurazone	3.7	3.4	1.9	1.4	-0.61
P-Tertiary Butylphenol	0.7	1.0	1.1	3.4	0.74
PPD mix	1.8	3.7	6.2	4.3	0.44
Paraben mix	2.7	2.0	2.6	1.6	-0.21
Paraphenylenediamine	8.7	6.2	7.7	9.2	0.51
Perfume mix	8.4	7.3	6.4	12.1	1.22
Promethazine	1.8	2.0	3.5	0.4	-0.43
Propylene Glycol	0.8	0.6	1.3	1.3	0.17
Quaternium 15	11.3	4.4	1.6	1.4	-1.85
Quinoline mix	6.0	2.3	1.6	1.4	-0.78
Nickel Sulfate	25.1	36.2	33.3	44.9	4.06
Turpentine	1.4	0.0	2.4	0.8	0.03
Thimerosal	16.3	18.4	16.6	10.4	-1.98
Thiuram mix	5.5	5.4	3.6	3.7	-0.49

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[1] Blue: As the proportion of the variable increases, the proportion of positive tests decreases. Pink: As the proportion of the variable increases, the proportion of positive tests increases. Yellow: Statistically significant associations.

[TFN1] ^a
Southeast region considered as the reference.

Prevalence of reactive allergens in contact patch testing studies using the Brazilian standard battery: a systematic review*

Abstract

Prevalence of reactive allergens in contact patch testing studies using the Brazilian standard battery: a systematic review^*