The exposure of atopic eczema (AE) patients to their relevant protein allergens (eg, from house dust mite, cat dander, grass pollen, or food allergens) can trigger an exacerbation or maintain the disease. Diagnostic procedures are needed to specify allergen avoidance recommendations for the individual patient. Skin prick tests and specific serum IgE tests might be helpful in pointing out potential trigger factors, but relevance needs to be confirmed (eg, with food provocation tests). The atopy patch test (APT) involves the epicutaneous application of intact protein allergens in a diagnostic patch test setting with an evaluation of the induced eczematous skin lesions after 24 to 72 hours. The APT targets the cellular component of AE and helps round out the AE test spectrum. As a number of apparently minor test modifications greatly influence the sensitivity, specificity, and reproducibility of the APT, the European Task Force on Atopic Dermatitis (ETFAD) has developed a standardized APT technique. It consists of purified allergen preparations in petrolatum, applied in 12-mm diameter Finn chambers mounted on Scanpor tape to non-irritated, non-abraded, or tape-stripped skin of the upper back. The APT is read at 48 and 72 hours according to the test criteria and reading key of the ETFAD for appearance of erythema, and number and distribution pattern of the papules. In contrast with skin prick tests, the APT might even detect a relevant sensitization in the absence of specific IgE. Many studies have been undertaken to objectify the sensitivity and specificity of the APT to show its diagnostic use in clinical practice.

Lessons from atopy patch testing in atopic dermatitis.

Irritant contact dermatitis (ICD) is more common than allergic contact dermatitis (ACD). It ranges from acute irritant reactions to chronic forms, often morphologically indistinguishable from ACD. Numerous exogenous and endogenous factors are involved in the pathogenesis. Major irritants are water, detergents, acidic and alkaline substances of various nature. Mechanical and thermal influences are important cofactors. Sensitive skin does exist and is frequently associated with previous atopic dermatitis. Chronic ICD is a diagnostic challenge and may be complicated by secondary sensitization to environmental allergens. Therapy and prevention require identification of irritants and reduction of skin contact by gloves or technical measures. Some topical medications and skin care products (e.g., sunscreens) may cause subjective discomfort without clinical signs of irritation: sharp stinging pain or burning of the skin develop several minutes after application in a crescendo pattern. This is considered to be a special form of neurosensory irritation

Clinical Aspects of Irritant Contact Dermatitis

Human health hazard assessment of quaternary ammonium compounds: Didecyl dimethyl ammonium chloride and alkyl (C12-C16) dimethyl benzyl ammonium chloride.

Didecyldimethylammonium chloride (DDAC) is a dialkyl-quaternary ammonium compound that is used in numerous products for its bactericidal, virucidal and fungicidal properties. There have been clinic...

/pdf/evaluation-of-the-irritancy-and-hypersensitivity-potential-4w2clqfhag.pdf

Evaluation of the irritancy and hypersensitivity potential following topical application of didecyldimethylammonium chloride.

Quaternary ammonium compounds are antimicrobial chemicals that provide significant public health benefits by controlling bacteria and viruses that cause infections such as colds, flu, and COVID. Th...

https://journals.sagepub.com/doi/pdf/10.1177/23978473211049085

Quaternary ammonium compounds: perspectives on benefits, hazards, and risk:

Keywords:

patch tests;
disinfectants;
antiseptics;
Gigasept;
antibacterials;
preservatives;
biocides;
occupational;
hospital personnel;
allergic contact dermatitis;
dimethyldidecylammoniumchloride;
N,N-bis(3-aminoprophyl)dodecylamine

Occupational allergic contact dermatitis from N,N-bis(3-aminopropyl)dodecylamine and dimethyldidecylammonium chloride in 2 hospital staff.

The diagnostic meaningfulness of patch tests with house dust mite allergens is still questionable. Our own impression has been that positive results with a dermatophagoides mix may occur preferentially in patients with a generally enhanced responsiveness to contact allergens. To check this, all of our patients allocated to patch testing with the standard series were additionally patch tested with a dermatophagoides mix by the same technique that was used for standard contact allergens. Out of 571 patients tested, 188 showed delayed responses to this mix that were indistinguishable from typical allergic patch test reactions but of no apparent clinical relevance. No relationship was found between positive dermatophagoides patch tests and an atopic disposition of the patients or characteristics of their eczema. However, 64.4% of the patients with a positive dermatophagoides patch test showed a response to at least 1 contact allergen of the standard series, compared to only 56.4% of the patients without a positive dermatophagoides reaction (p < 0.05). The reactivity to the mite mix was not related to the responsiveness towards any particular contact allergens. We suppose that some unidentified factors may contribute to positive reactions to the dermatophagoides mix that may also favour an enhanced general responsiveness to contact allergens.

Positive patch tests with a dermatophagoides mix relate to an increased responsiveness to standard patch test allergens.

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Occupational allergic contact dermatitis from N,N-bis(3-aminopropyl)dodecylamine and dimethyldidecylammonium chloride in 2 hospital staff.

Positive patch tests with a dermatophagoides mix relate to an increased responsiveness to standard patch test allergens.