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• W2072366788 abstract "To the Editor: We read with interest the article by Guerra et al1Guerra L. Rogkakou A. Massacane P. Gamalero C. Compalati E. Zanella C. et al.Role of contact sensitization in chronic urticaria.J Am Acad Dermatol. 2007; 56: 88-90Abstract Full Text Full Text PDF PubMed Scopus (32) Google Scholar in the January 2007 issue of the Journal, which recommended patch testing for the diagnosis of chronic urticaria. The authors wrote that their “tests were performed with commercial diagnostics (Laforma, SpA, Milan, Italy) and read at 2 and 4 days” in reference to the article “The contact urticaria syndrome—An updated review” by von Krogh and Maibach.2von Krogh G. Maibach H.I. The contact urticaria syndrome-an updated review.J Am Acad Dermatol. 1981; 5: 328-342Abstract Full Text PDF PubMed Scopus (235) Google Scholar The von Krogh and Maibach article read that “when cutaneously evaluating a suspected case of contact urticaria […] immediate and delayed responses should both be noted.” They recommended that a closed patch be “removed after 15 to 20 minutes” to test for an immediate reaction on the ventral forearm, while simultaneous delayed-type hypersensitivity testing is performed on the back, which is “read after 48 to 96 hours.” This dual testing method was suggested because delayed-type hypersensitivity may simultaneously occur in patients with contact urticaria. They proposed the term “contact dermatitis of immediate and delayed type” be used for patients who exhibit these combined reactions in patch test situations.2von Krogh G. Maibach H.I. The contact urticaria syndrome-an updated review.J Am Acad Dermatol. 1981; 5: 328-342Abstract Full Text PDF PubMed Scopus (235) Google Scholar We write to emphasize the algorithm for evaluating patients with contact urticaria because “Unlike the standard patch test, when evaluation time is at 48 and 72 hours, an evaluation for immunologic contact urticaria should be made within 60 minutes, the typical time frame for the reaction.”3Katchen B.R. Maibach H.I. Immediate-type contact reaction: immunologic contact urticaria.in: Menne T. Maibach H.I. Exogenous dermatoses: environmental dermatitis. CRC Press, Boca Raton1991: 51-63Google Scholar, 4Karamfilow T. Contact urticaria and protein contact dermatitis.in: Gebhardt M. Elsner P. Marks J. Handbook of contact dermatitis. Martin Dunitz Ltd, London2000: 35-44Google Scholar That being said, patch testing, however, is not routinely warranted for the evaluation of contact urticaria, as many standard allergens stimulate an immediate positive response (ie, balsam of Peru, fragrance mix, paraben mix, sorbic acid, formaldehyde, cinnamaldehyde, etc).5Dikeakou T. Katsarou-Katsari A. Hatziolou E. Katsambas A. Relative frequency of immediate and delayed patch test reactions.Contact Dermatitis. 1988; 19: 151-152Crossref PubMed Scopus (8) Google Scholar In our clinic, we generally follow the standardized protocol outlined by von Krogh and Maibach to evaluate contact urticaria (Table I).2von Krogh G. Maibach H.I. The contact urticaria syndrome-an updated review.J Am Acad Dermatol. 1981; 5: 328-342Abstract Full Text PDF PubMed Scopus (235) Google ScholarTable IProtocol to evaluate immediate-type responses∗If a positive reaction is observed at any point, further evaluation on the positive individual should be stopped. When testing for contact urticaria, epinephrine and resuscitation equipment should be readily available.1. Test the unknown substance (open application) on normal skin (epidermally)2. If test #1 is negative, test the unknown on affected (or previously affected) skin3. If test #2 is negative, close the patch (occlusive application) on normal skin.4. If test #3 is negative, close the patch on affected (or previously affected) skin5. If test #4 is negative, consider prick testing (intradermally) or RAST testing6. If any test is positive, test controls to rule out nonimmunologic contact urticariaData from von Krogh and Maibach.2von Krogh G. Maibach H.I. The contact urticaria syndrome-an updated review.J Am Acad Dermatol. 1981; 5: 328-342Abstract Full Text PDF PubMed Scopus (235) Google ScholarRAST, Radioallergosorbent test.∗ If a positive reaction is observed at any point, further evaluation on the positive individual should be stopped. When testing for contact urticaria, epinephrine and resuscitation equipment should be readily available. Open table in a new tab Data from von Krogh and Maibach.2von Krogh G. Maibach H.I. The contact urticaria syndrome-an updated review.J Am Acad Dermatol. 1981; 5: 328-342Abstract Full Text PDF PubMed Scopus (235) Google Scholar RAST, Radioallergosorbent test. Role of contact sensitization in chronic urticariaJournal of the American Academy of DermatologyVol. 56Issue 1PreviewWe tested the hypothesis that contact allergy plays a role in chronic urticaria, and included the Italian series of patch tests in the diagnostic workup. Of 121 patients with chronic urticaria, 50(41%) tested positive to contact allergens. In all patients, avoidance measures led to a complete remission within 1 month. We suggest that testing for contact sensitization can be helpful in the management of chronic urticaria. Full-Text PDF" @default.
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• W2072366788 title "The role of patch testing in contact urticaria" @default.
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