Patch-test results in children and adolescents: systematic review of a 15-year period

Rodrigues, Dulcilea Ferraz; Goulart, Eugênio Marcos Andrade

doi:10.1590/abd1806-4841.20163927

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Review • An. Bras. Dermatol. 91 (1) • Jan-Feb 2016 • https://doi.org/10.1590/abd1806-4841.20163927 copy

Patch-test results in children and adolescents: systematic review of a 15-year period^* * Work performed at the Universidade Federal de Minas Gerais (UFMG) and Santa Casa de Misericórdia de Belo Horizonte - Belo Horizonte (MG), Brazil.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

The number of studies on patch-test results in children and adolescents has gradually increased in recent years, thus stimulating reviews. This paper is a systematic review of a 15-year period devoted to studying the issue. Variations pertaining to the number and age groups of tested children and/or adolescents, the number of subjects with atopy/atopic dermatitis history, the quantity, type and concentrations of the tested substances, the test technique and type of data regarding clinical relevance, must all be considered in evaluating these studies, as they make it harder to formulate conclusions. The most common allergens in children were nickel, thimerosal, cobalt, fragrance, lanolin and neomycin. In adolescents, they were nickel, thimerosal, cobalt, fragrance, potassium dichromate, and Myroxylon pereirae. Knowledge of this matter aids health professionals in planning preventive programs aimed at improving children's quality of life and ensuring that their future prospects are not undermined.

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

Author Country	Data Collection, years	N° of children and adolescents tested	Age	Adolescents and children with >1 positive reaction (%)	Relevance^* * Relevance: current and/or past; of positive tests (%)	Two most common allergens Frequency of positive reactions
Goon et al.¹¹11 Goon AT, Goh CL. Patch testing of Singapore children and adolescents: our experience over 18 years. Pediatr Dermatol. 2006;23:117-20.	1986-2003	2340	< 20 years	45.4	Calculated per substance	Nickel 40.0%
Singapore						Thimerosal 15.0%
Manzini et al.¹²12 Manzini BM, Ferdani G, Simonetti V, Donini M, Seidenari S. Contact sensitization in children. Pediatr Dermatol. 1998;15:12-7.	1988-1994	670	6 months-12 years	42.0	not reported	Thimerosal 12.2%
Italy						Nickel 7.7%
Brash et al.¹³13 Brasch J, Geier J. Patch test results in schoolchildren. Results from the information Network of Departments of Dermatology (iVDK) and the German Contact Dermatitis Research Group (DKG). Contact Dermatitis. 1997;37:286-93.	1990-1995	416	6-15 years	40.9	not reported	Nickel 15.9%
Germany						Thimerosal 11.3%
Fernandez et al.¹⁴14 Fernández Vozmediano JM, Armario Hita JC. Allergic contact dermatitis in children. J Eur Acad Dermatol Venereol. 2005;19:42-6.	1990-2000	96	< 15 years	54.2	57.7	Thimerosal 21.0%
Spain						Mercury 19.0%
Shah et al.¹⁵15 Shah M, Lewis FM, Gawkrodger DJ. Ratch testing in children and adolescents: five years' experience and follow-up. J Am Acad Dermatol. 1997;37:964-8.	1991-1995	83	6-16 years	49.0	100.0	Nickel 14.0%
UK						Fragrance mix I 7.2%
Romaguera et al.¹⁶16 Romaguera C, Vilaplana J. Contact dermatitis in children: 6 years' experience (1992-1997). Contact Dermatitis. 1998;39:277-80.	1992-1997	141	< 14 years	50.0	calculated per substance	Nickel 19.1%
Spain						Cobalt 11.3%
Lewis et al.¹⁷17 Lewis VJ, Statham BN, Chowdhury MM. Allergic contact dermatitis in 191 consecutively patch tested children. Contact Dermatitis. 2004;51:155-6.	1993-2003	191	< 16 years	41.0	51.7	Nickel 13.0%
UK						Fragrance mix I 9.0%
Onder et al.¹⁸18 Onder M, Adisen E. Patch test results in a Turkish paediatric population. Contact Dermatitis. 2008;58:63-5.	1993-2005	360	2-16 years	32.0	30.5%	Nickel 46.0%
Turkey						Cobalt 9.5%
Milingou et al.¹⁹19 Milingou M, Tagka A, Armenaka M, Kimpouri K, Kouimintzis D, Katsarou A. Patch tests in children: a review of 13 years of experience in comparison with previous data. Pediatr Dermatol. 2010;27:255-9.	1994-2007	255	<16 years	60.0	not reported	Nickel 21.6%
Greece						Thimerosal 18.3%
Kuljanac et al.²⁰20 Kuljanac I, Knežević E, Cvitanovic H. Epicutaneous patch test results in children and adults with allergic contact dermatitis in Karlovac county: a retrospective survey. Acta Dermatovenerol Croat. 2011;19:91-7.	1994-2009	412	4-18 years	26.0	not reported	Nickel 25.4%
Croatia						Thimerosal 17.8%
Roul et al.²¹21 Roul S, Ducombs G, Taieb A. Usefulness of the European standard series for patch testing in children. A 3-year single-centre study of 337 patients. Contact Dermatitis. 1999;40:232-5.	1995-1997	337	1-15 years	67.0	not reported	Nickel 23.7%
France						Fragrance mix I 9.5%
Seidenari et al.²²22 Seidenari S, Giusti F, Pepe P, Mantovani L. Contact sensitization in 1094 children undergoing patch testing over a 7-year period. Pediatr Dermatol. 2005;22:1-5.	1995-2001	1094	7 months-12 years	52.1	70.0	Neomycin 13.2%
Italy						Nickel 10.9%
Heine et al.²³23 Heine G, Schnuch A, Uter W, Worm M. Frequency of contact allergy in German children and adolescents patch tested between 1995 and 2002: results from the information Network of Departments of Dermatology and the German Contact Dermatitis Research Group. Contact Dermatitis . 2004;51:111-7.	1995-2002	2460	6-12 years	52.6	not reported	Thimerosal 18.2%
Germany			13-18 years	49.7	not reported	Nickel 16.7%
Clayton et al.²⁴24 Clayton TH, Wilkinson SM, Rawcliffe C, Pollock B, Clark SM. Allergic contact dermatitis in children: should pattern of dermatitis determine referral? A retrospective study of 500 children tested between 1995 and 2004 in one U.K. centre. Br J Dermatol. 2006;154:114-7.	1995-2004	500	< 16 years	27.0	61.0	Nickel 33.0%
UK						Fragrance mix I 18.0%
Duarte et al.²⁵25 Duarte I, Lazzarini R, Kobata CM. Contact Dermatitis in Adolescents. Am J Contact Dermat. 2003;14:200-2.	1996-2001	102	10-19 years	56.0	100.0	Nickel 31.0%
Brazil						Tosylamide 12.0%^† † tosylamide formaldehyde resin;
Hogeling et al.²⁶26 Hogeling M, Pratt M. Allergic contact dermatitis in children: the Ottawa Hospital patch-testing clinic experience, 1996 to 2006. Dermatitis. 2008;19:86-9.	1996-2006	100	4-18 years	70.0	55.8	Nickel 26.0%
Canada						Cobalt 14.0%
Wohrl et al.²⁷27 Wöhrl S, Hemmer W, Focke M, Götz M, Jarisch R. Patch testing in children, adults, and the elderly: influence of age and sex on sensitization patterns. Pediatr Dermatol. 2003;20:119-23.	1997-2000	79	1-10 years	62.0	not reported	Nickel 34.2%
Austria						Ethylmercury 25.3%^‡ ‡ cloreto ethylmercuric chloride;
Giordano et al.²⁸28 Giordano-Labadie F, Rancé F, Pellegrin F, Bazex J, Dutau G, Schwarze HP. Frequency of contact allergy in children with atopic dermatitis: results of a prospective study of 137 cases. Contact Dermatitis . 1999;40:192-5.	not reported	137	4 months-16 years	43.0	100.0	Nickel 14.9%
France						Fragrance mix I 4.4%
Beattie et al.²⁹29 Beattie PE, Green C, Lowe G, Lewis-Jones MS. Which children should we patch test? Clin Exp Dermatol. 2007;32:6-11.	1999-2002	114	3-15 years	54.0	54.0	Nickel 20.0%
UK						Fragrance mix I 7.2%
Hammonds et al.³⁰30 Hammonds LM, Hall VC, Yiannias JA. Allergic contact dermatitis in 136 children patch tested between 2000 and 2006. Int J Dermatol. 2009 ;48:271-4.	2000-2006	136	3-18 years	61.0	53.0	Nickel 22.0%
USA						Cobalt 17.0%
Zug et al.³¹31 Zug KA, McGinley-Smith D, Warshaw EM, Taylor JS, Rietschel RL, Maibach HI, et al. Contact allergy in children referred for patch testing: North American Contact Dermatitis Group data, 2001-2004. Arch Dermatol. 2008;144:1329-36.	2001-2004	391	0-18 years	65.7	51.2^§ § calculated from number of tested patients;	Nickel 28.3%
USA, Canada						Cobalt 17.8%
Jacob et al.³²32 Jacob SE, Brod B, Crawford GH. Clinically relevant patch test reactions in children-a United States based study. Pediatr Dermatol. 2008;25:520-7.	2001-2006	65	1-18 years	83.0	77.0	Nickel 17.5%
USA						Thimerosal 12.5%
Fortina et al.³³33 Belloni Fortina A, Romano I, Peserico A, Eichenfield LF. Contact sensitization in very young children. J Am Acad Dermatol. 2011;65:772-9.	2002-2008	321	3-36 months	62.3	calculated per substance	Nickel 26.8%
Italy					substance	Potassium dich.9.0%^\| \| potassium dichromate;
Moustafa et al.³⁴34 Moustafa M, Holden CR, Athavale P, Cork MJ, Messenger AG, Gawkrodger DJ. Patch testing is a useful investigation in children with eczema. Contact Dermatitis . 2011;65:208-12.	2002-2008	110	2-18 years	44.0	44.0	Drugs 15.4%
UK						Nickel 10.0%
de Waard-van der Spek et al.³⁵35 de Waard-van der Spek FB, Oranje AP. Patch tests in children with suspected allergic contact dermatitis: a prospective study and review of the literature. Dermatology. 2009;218:119-25.	2003-2008	79	1-18 years	51.0	calculated per substance	Nickel 21.5%
Netherlands						Potassium dich. 6.0%^\| \| potassium dichromate;
Jacob et al.³⁶36 Jacob SE, Yang A, Herro E, Zhang C. Contact allergens in a pediatric population: association with atopic dermatitis and comparison with other north american referral centers. J Clin Aesthet Dermatol. 2010;3:29-35.	2004-2006	69	6 months-18 years	95.6	76.7	Nickel 23.3%
USA						Cocamido 23.3%^¶ ¶ cocamidopropyl betaine;
Stoskute et al.³⁷37 Stoskute L, Dubakiene R, Tamosiunas V. Allergic contact dermatitis and patch testing in children. Acta Medica Lituanica. 2005;12:71-4.	not reported^# # published in 2005;	194	3-17 years	55.0	not reported	Nickel 18.0%
Lithuania						Cobalt 13.8%
Belhadjalli et al.³⁸38 Belhadjali H, Mohamed M, Youssef M, Mandhouj S, Chakroun M, Zili J. Contact sensitization in atopic dermatitis: results of a prospective study of 89 cases in Tunisia. Contact Dermatitis. 2008;58:188-9.	2005-2006	63	mean: 69 months	39.7	38.2^§ § calculated from number of tested patients;	Nickel 24.7%
Tunisia						Potassium dich. 7.9%^\| \| potassium dichromate;
Sarma et al.³⁹39 Sarma N, Ghosh S. Clinico-allergological pattern of allergic contact dermatitis among 70 Indian children. Indian J Dermatol Venereol Leprol. 2010;76:38-44.	2005-2008	70	1-15 years	80.0	60.7	Paraben 43.0%
India						Potassium dich. 27.0%^\| \| potassium dichromate;
Czarnobilska et al.⁴⁰40 Czarnobilska E, Obtulowicz K, Dyga W, Wsolek-Wnek K, Spiewak R. Contact hypersensitivity and allergic contact dermatitis among school children and teenagers with eczema. Contact Dermatitis. 2009;60:264-9	2007	229	7 years	43.8	not reported	Nickel 30.2%
Poland			16 years	52.6	not reported	Thimerosal 27.8%
Kobata⁴¹41 Kobata CM. Testes de contato em crianças com eczema [dissertação]. São Paulo (SP): Universidade de São Paulo; 2010.79p	2007-2009	62	2-12 years	61.0	70.0	Nickel 27.4%
Brazil						Thimerosal 17.7%
Czarnobilska et al.⁴²42 Czarnobilska E, Obtulowicz K, Dyga W, Spiewak R. The most important contact sensitizers in Polish children and adolescents with atopy and chronic recurrent eczema as detected with the extended European Baseline Series. Pediatr Allergy Immunol. 2011;22:252-6.	2008-2009	196	7-8 years	67.0	not reported	Nickel 35.9%
Poland			16-17 years	58.1	not reported	Thimerosal 37.6%
Jacob et al.⁴³43 Jacob SE, Herro EM, Sullivan K, Matiz C, Eichenfield L, Hamann C. Safety and efficacy evaluation of TRUE TEST panels 1.1, 2.1, and 3.1 in children and adolescents. Dermatitis. 2011;22:204-10.	2008-2009	102	6-18 years	76.2	not reported	Nickel 29.7%
USA						p-tert-Butylphenol 16.8%^ p-tert-Butylphenol formaldehyde resin;
Herro et al.⁴⁴44 Herro EM, Matiz C, Sullivan K, Hamann C, Jacob SE. Frequency of contact allergens in pediatric patients with atopic dermatitis. J Clin Aesthet Dermatol. 2011;4:39-41.	not reported^†† †† published in 2011.	101	6-18 years	78.0	not reported	Nickel 31.0%
USA						Lanolin 18.0%

Author	Data collection years	N° of children and adolescents tested	Age	Adolescents and Children with >1 positive reaction (%)	Relevance^* * Relevance: current and/or past; of positive tests (%)	Three most common allergens.
Country						Frequency of positive reactions
N° of centers						Frequency of positive reactions
Mortz et al.⁴⁵45 Hanifin JM, Rajka G. Diagnostic features of atopic dermatitis. Acta Dermatol Venereol 1980; 92:44-47.	1995-1996	1146	12-16 years	15.2	47.7	Nickel 8.6%
Denmark						Fragrance mix I 1.8%
40 centers						Cobalt 1.0%
						Thimerosal 1.0%
Bruckner et al.⁴⁶46 Spiewak R. Patch testing for contact allergy and allergic contact dermatitis. Open Allergy J. 2008;1:42-51.	not reported^† † published in 2000;	85	6 months-5 years	24.5	not reported	Nickel 12.9%
USA						Thimerosal 9.4%
1 center						Kathon CG 2.4%^‡ ‡ methylchloroisothiazolinone/methylisothiazolinone
						Neomycin 1.2%

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Patch-test results in children and adolescents: systematic review of a 15-year period* * Work performed at the Universidade Federal de Minas Gerais (UFMG) and Santa Casa de Misericórdia de Belo Horizonte - Belo Horizonte (MG), Brazil.

Abstract

Patch-test results in children and adolescents: systematic review of a 15-year period^* * Work performed at the Universidade Federal de Minas Gerais (UFMG) and Santa Casa de Misericórdia de Belo Horizonte - Belo Horizonte (MG), Brazil.