Patient Reported Improvement After Patch Testing and Allergen Avoidance Counseling: A Retrospective Analysis

Abstract

IntroductionOur objectives were to assess patient-reported improvement after patch testing at the 2–3-month follow-up visit in patients referred for patch testing with relevant positive patch test reactions at the University of California, San Francisco.MethodsCross-sectional analyses of patients patch tested between 2013 and 2016 who returned for a follow-up visit approximately 2–3 months after patch testing. We examined positive patch test results considered of definite, probable or possible relevance to the patient’s eczematous eruptions. Patients reported improvement after patch testing as a percentage: 0–100%. Patients were categorized into four groups: (1) those that reported no improvement or worsened, (2) those that reported > 0% and ≤ 60% improvement, (3) those that reported > 60% but < 100% improvement and (4) those that reported 100% improvement. Secondary measures included the association of allergens, gender, age and location of the rash.ResultsThe majority (81%) of patients seen at follow-up reported improvement after patch testing. Women reported more improvement than men with statistical significance. Notably, there does not appear to be a statistically significant relationship in patient-reported improvement and age, atopy, strength of a the patient’s positive reactions, number of positive reactions and follow-up time or with potential systemic contact allergens (i.e., balsam of Peru, nickel, chrome and cobalt).ConclusionWe find the large percentage of patients that self-report global benefit from patch testing encouraging, as we believe this to be a powerful measure of disease and symptom activity, as well as quality of life. The gender differences we found contradict the previous literature.

Improved or not improved, that is the question: Patch testing outcomes from the Massachusetts General Hospital

“…Consistent with prior findings, women improved more often than men, possibly due to better adherence to avoidance strategies or higher likelihood of having ACD. 1,4 Only White patients were more likely to see CI than NI with avoidance. This may be due to disparities in health literacy and ability to buy hypoallergenic alternatives.…”

“…Explanatory handouts containing information on the PPT allergens, where they could be found, and how they could be avoided were provided at the 96‐h PT interpretation visit. A personalized safe list containing personal care products free of the patient's PPT allergens was generated using the American Contact Dermatitis Society's Contact Allergen Management Program (CAMP) database 1 . Patients were counselled on how to use CAMP and avoidance of their PPT allergens was discussed.…”

“…Few studies report follow‐up results after PT. The limited data that exists suggests 70%–80% of patients will see some degree of improvement in their rash or symptoms after PT, though these studies are limited by small sample sizes and the inability to verify use of other medications 1,2 . Herein, we report patient follow‐up data after PT.…”

Translating Allergic Contact Dermatitis Data to the Patients and Populations We Serve

“…Accurately diagnosing the cause of allergic contact dermatitis and providing effective avoidance strategies can greatly improve patients' quality of life. 3 Identifying an allergen allows for a cure without drugs, without surgery, and without the need for any follow-up appointments. In the tables accompanying each article, there are dozens of allergens that were clinically relevant to patients in the cohort studied.…”

“…The value of these data are in the detailed list of allergens found to be clinically relevant. Accurately diagnosing the cause of allergic contact dermatitis and providing effective avoidance strategies can greatly improve patients’ quality of life . Identifying an allergen allows for a cure without drugs, without surgery, and without the need for any follow-up appointments.…”