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Expanded Series and Personalized Patch Tests for Children: A Retrospective Cohort Study
Reid W Collis1, Gabriela M Morris2, David M Sheinbein3
1From the Washington University in St Louis School of Medicine.
Insights
Expanded patch testing in children reveals common reactions to allergens not found in the T.R.U.E. Test, highlighting the need for broader diagnostic approaches for allergic contact dermatitis (ACD). Cocamidopropyl betaine was a frequent culprit.
Area of Science:
- Dermatology
- Pediatric Allergy
- Contact Dermatitis Research
Background:
- Epicutaneous patch testing is crucial for diagnosing allergic contact dermatitis (ACD).
- A standardized approach to patch testing in pediatric populations is currently lacking.
- Existing diagnostic tools may not capture all relevant allergens in children.
Purpose of the Study:
- To evaluate patch test positivity in pediatric patients with suspected ACD, differentiating between those with and without atopic dermatitis history.
- To compare the diagnostic yield of the North American 80 Comprehensive Series and personalized patch tests against the Thin-Layer Rapid Use Epicutaneous (T.R.U.E.) Test.
- To identify common allergen exposures in pediatric ACD cases.
Main Methods:
- Analysis of pediatric patients undergoing North American 80 Comprehensive Series or personalized patch testing.
- Assessment of allergen sensitization 48–72 hours post-patch removal.
- Comparison of results between comprehensive/personalized tests and the T.R.U.E. Test, stratified by atopic dermatitis history.
Main Results:
- Out of 29 pediatric patients, 25 showed at least one positive reaction (81 total reactions).
- Nearly half (49.4%) of reactions were from allergens not included in the T.R.U.E. Test.
- Cocamidopropyl betaine was a significant allergen, particularly in patients with atopic dermatitis.
Conclusions:
- Expanded and personalized patch testing offer a more thorough allergen inventory than the T.R.U.E. Test for pediatric ACD.
- Pediatric patients frequently react to allergens found in household products but absent from standard T.R.U.E. Test panels.
- Enhanced patch testing and patient counseling are recommended for managing pediatric ACD.
Background:
Epicutaneous patch testing was developed as a simple and effective method for diagnosing allergic contact dermatitis (ACD). Despite its proven value in ACD diagnoses, there is no defined standard for patch testing in children.
Objective:
The aims of this study were to assess patch test positivity in pediatric patients with and without a history of atopic dermatitis suspected to have ACD, to compare these results with what the Thin-Layer Rapid Use Epicutaneous (T.R.U.E.) Test would have captured, and to evaluate likely exposures.
Methods:
Pediatric patients receiving a North American 80 Comprehensive Series patch test or a personalized patch test were analyzed for allergen sensitization 48 to 72 hours after patch removal. These data were analyzed for allergen inclusion in the North American 80 Comprehensive Series patch test compared with the T.R.U.E. Test, as well as compared with patients with and without a history of atopic dermatitis.
Results:
Of the 29 patients (mean ± SD age = 10.9 ± 5.1 years), 25 children demonstrated at least 1 positive reaction, with a total of 81 reactions overall. 40 (49.4%) of the reactions came from allergens outside of the T.R.U.E. Test, including cocamidopropyl betaine, which was frequent in patients with atopic dermatitis.
Conclusions:
Expanded and personalized patch tests provide a more comprehensive allergen inventory than the traditional T.R.U.E. Test. Pediatric patients frequently have reactions to allergens not included in the T.R.U.E. Test, and these allergens are commonly found in household products. Cocamidopropyl betaine was a particularly relevant allergen in our population. Expanded series patch testing and appropriate counseling should be provided to pediatric patients with ACD.
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