Diagnosis of allergic contact dermatitis: Patch test and beyond.

Allergic contact dermatitis (ACD) is inflammatory disease of the skin triggered by exposure to small molecular substances (haptens) in people who have acquired hypersensitivity to these substances during prior exposures. In general population, the lifetime prevalence of ACD is estimated at approximately 10%. Contact allergy - alteration of immune response that is prerequisite of ACD is found in 40% adults and 30% children. Suspicion of ACD should always be followed by identification of the offending hapten with the means of patch test (epicutaneous test). Patch test is the gold standard in the diagnosis of contact allergy, it increases probability of accurate diagnosis, shortens the time lapse to final diagnosis by more than 20 times, reduces costs of treatment, and increases the chances for complete remission. Altogether, performing patch tests is beneficial to patients' quality of life. The disadvantage of patch test is that several visits at the doctor's office are required, and the results may be influenced by patient's medication and health status. Interpretation of patch tests requires specialist knowledge and experience. Other in vivo diagnostic methods available are more laborious and not validated. An in vitro test is not yet available, though promising progress has been achieved in this area.

Related articles:

1. Spiewak R. Patch testing for contact allergy and allergic contact dermatitis. Open Allergy J 2008, 1: 42-51.
2. Spiewak R. Atopy and contact hypersensitivity: a reassessment of the relationship using objective measures. Ann Allergy Asthma Immunol 2005, 95 (1): 61-65.
3. Spiewak R. Allergic contact dermatitis in childhood - a review and meta-analysis. Allergologie 2002, 25 (7): 374-381.
4. Spiewak R, Pietowska J, Curzytek K. Nickel: a unique allergen - from molecular structure to European legislation. Expert Rev Clin Immunol 2007, 3 (6): 851-859.
5. Spiewak R, Moed H, von Blomberg BME, Bruynzeel DP, Scheper RJ, Gibbs S, Rustemeyer T. Allergic contact dermatitis to nickel: Modified in vitro test protocols for better detection of allergen-specific response. Contact Dermatitis 2007, 56 (2): 63-69.

Links:

Institute of Dermatology, Krakow, Poland

International Photopatch Test Course, Krakow 2009

English-speaking dermatologist in Krakow (Cracow), Poland

Deutschsprechender Hautarzt in Krakow (Krakau), Polen

Sensimun Biomedical Research - outsourcing in allergy and immunology

ELISpot - training, implementation, outsourcing