Patch Test Reactions Associated With Topical Medications: A Retrospective Analysis of the North American Contact Dermatitis Group Data (2001-2018).
Journal
Dermatitis : contact, atopic, occupational, drug
ISSN: 2162-5220
Titre abrégé: Dermatitis
Pays: United States
ID NLM: 101207335
Informations de publication
Date de publication:
Historique:
pubmed:
19
8
2021
medline:
22
3
2022
entrez:
18
8
2021
Statut:
ppublish
Résumé
Topical medications may lead to allergic contact dermatitis. This study characterized positive patch test reactions associated with medications in patients evaluated by the North American Contact Dermatitis Group (NACDG). This study is a retrospective analysis of the NACDG data (2001-2018). Patients with at least 1 positive patch test reaction associated with a medication source were included. Allergens, reaction characteristics, clinical relevance, and source details were tabulated. Of 43,722 patients, 6374 (14.6%) had positive allergic patch test reactions associated with 1 or more topical medication sources. Patients with versus without allergic reactions to medications were more likely to be older than 40 years (P < 0.0001) and/or have primary sites of dermatitis on the legs, anal/genital region, or trunk (P < 0.0001). There were 8787 reactions to NACDG allergens; the most common were neomycin (29.4%), bacitracin (29.1%), propylene glycol 100% (10.6%), tixocortol-17-pivalate (10.0%), lidocaine (7.9%), budesonide (4.9%), and dibucaine (4.4%). Propylene glycol 100% was the most common inactive ingredient (10.6%). Current relevance was present in 61.0%. A total of 6.5% of the individuals with medication allergy would have had 1 or more positive patch test reactions missed if only tested to the NACDG screening series. Positive patch test reactions associated with topical medications were common (14.6%), and most were clinically relevant. Patients with topical medication allergy were twice as likely to have anal/genital involvement. Active ingredients, especially neomycin, bacitracin, and tixocortol-17-pivalate, were frequent culprits.
Sections du résumé
BACKGROUND/OBJECTIVES
OBJECTIVE
Topical medications may lead to allergic contact dermatitis. This study characterized positive patch test reactions associated with medications in patients evaluated by the North American Contact Dermatitis Group (NACDG).
METHODS
METHODS
This study is a retrospective analysis of the NACDG data (2001-2018). Patients with at least 1 positive patch test reaction associated with a medication source were included. Allergens, reaction characteristics, clinical relevance, and source details were tabulated.
RESULTS
RESULTS
Of 43,722 patients, 6374 (14.6%) had positive allergic patch test reactions associated with 1 or more topical medication sources. Patients with versus without allergic reactions to medications were more likely to be older than 40 years (P < 0.0001) and/or have primary sites of dermatitis on the legs, anal/genital region, or trunk (P < 0.0001). There were 8787 reactions to NACDG allergens; the most common were neomycin (29.4%), bacitracin (29.1%), propylene glycol 100% (10.6%), tixocortol-17-pivalate (10.0%), lidocaine (7.9%), budesonide (4.9%), and dibucaine (4.4%). Propylene glycol 100% was the most common inactive ingredient (10.6%). Current relevance was present in 61.0%. A total of 6.5% of the individuals with medication allergy would have had 1 or more positive patch test reactions missed if only tested to the NACDG screening series.
CONCLUSIONS
CONCLUSIONS
Positive patch test reactions associated with topical medications were common (14.6%), and most were clinically relevant. Patients with topical medication allergy were twice as likely to have anal/genital involvement. Active ingredients, especially neomycin, bacitracin, and tixocortol-17-pivalate, were frequent culprits.
Identifiants
pubmed: 34405832
doi: 10.1097/DER.0000000000000777
pii: 01206501-202203000-00008
doi:
Substances chimiques
Allergens
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
144-154Informations de copyright
Copyright © 2021 American Contact Dermatitis Society. All Rights Reserved.
Déclaration de conflit d'intérêts
A.R.A. received a Pfizer Independent Grant for Learning & Change and has consulted for Henkel. J.S.T. owns noncontrolling common shares of stock in AstraZeneca, Cigna, Merck, Johnson & Johnson, and Opko Health. He has consulted for Kao Brands and Monsanto (Bayer), is a member of the Cosmetic Ingredient Review Steering Committee, and has a nondependent child employed by Pfizer. E.M.W. has received an investigator-initiated grant from and served as a consultant for Wen by Chaz Dean. She has also served as a consultant to Noven Pharmaceuticals. D.S. receives royalties from UpToDate (Wolters Kluwer Health). The other authors have no funding or conflicts of interest to declare.
Références
Angelini G, Vena GA, Meneghini CL. Allergic contact dermatitis to some medicaments. Contact Dermatitis 1985;12(5):263–269. doi:10.1111/j.1600-0536.1985.tb01133.x.
Durocher LP. Allergic reaction to topical drugs [in French]. Can Med Assoc J 1978;118(2):162–164.
Spring S, Pratt M, Chaplin A. Contact dermatitis to topical medicaments: a retrospective chart review from the Ottawa Hospital Patch Test Clinic. Dermatitis 2012;23(5):210–213. doi:10.1097/DER.0b013e31826e443c.
Lazzarini R, Duarte I, Braga JC, et al. Allergic contact dermatitis to topical drugs: a descriptive analysis [in Portuguese]. An Bras Dermatol 2009;84(1):30–34. doi:10.1590/s0365-05962009000100004.
Uter W, Spiewak R, Cooper SM, et al. Contact allergy to ingredients of topical medications: results of the European Surveillance System on Contact Allergies (ESSCA), 2009–2012. Pharmacoepidemiol Drug Saf 2016;25(11):1305–1312. doi:10.1002/pds.4064.
Goossens RA. Allergic contact dermatitis from the vehicle components of topical pharmaceutical products. Immunol Allergy Clin North Am 2014;34(3):663–70, ix–x. doi:10.1016/j.iac.2014.04.010.
DeKoven JG, Warshaw EM, Belsito DV, et al. North American Contact Dermatitis Group patch test results 2013–2014. Dermatitis 2017;28(1):33–46. doi:10.1097/DER.0000000000000225.
Subhadarshani S. Response to: “Patients with negative patch tests: retrospective analysis of North American Contact Dermatitis Group (NACDG) data 2001–2016”. J Am Acad Dermatol 2019;81(6):e179. doi:10.1016/j.jaad.2019.06.1315.
Uter W, Schnuch A, Gefeller O; ESCD Working Group: European Surveillance System on Contact Allergies. Guidelines for the descriptive presentation and statistical analysis of contact allergy data. Contact Dermatitis 2004;51(2):47–56. doi:10.1111/j.0105-1873.2004.00406.x.
Warshaw EM, Kullberg SA, DeKoven JG, et al. Scalp involvement in patients referred for patch testing: retrospective cross-sectional analysis of North American Contact Dermatitis Group data, 1996 to 2016. J Am Acad Dermatol 2021;84(4):977–988. doi:10.1016/j.jaad.2020.08.046.
Jean SE, Moreau L. Contact dermatitis in leg ulcer patients. J Cutan Med Surg 2009;13(Suppl 1):S38–S41. doi:10.2310/7750.2009.00009.
Saap L, Fahim S, Arsenault E, et al. Contact sensitivity in patients with leg ulcerations: a North American study. Arch Dermatol 2004;140(10):1241–1246. doi:10.1001/archderm.140.10.1241.
Prakash AV, Davis MD. Contact dermatitis in older adults: a review of the literature. Am J Clin Dermatol 2010;11(6):373–381. doi:10.2165/11319290-000000000-00000.
Warshaw EM, Kimyon RS, Silverberg JI, et al. Evaluation of patch test findings in patients with anogenital dermatitis. JAMA Dermatol 2020;156(1):85–91. doi:10.1001/jamadermatol.2019.3844.
Amazon. Amazon best sellers. Best sellers in hemorrhoid pain relief products. Available at: https://www.amazon.com/Best-Sellers-Health-Personal-Care-Hemorrhoid-Pain-Relief-Products/zgbs/hpc/3763781. Accessed December 15, 2020.
Target. Anti itch vaginal. Available at: https://www.target.com/s?searchTerm=anti+itch+vaginal&sortBy=bestselling&Nao=0. Accessed December 15, 2020.
Government of Canada. Recalls and safety alerts. Available at: https://www.healthycanadians.gc.ca/recall-alert-rappel-avis/hc-sc/2020/73935a-eng.php. Accessed December 15, 2020.
Both L, Botgros R, Cavaleri M. Analysis of licensed over-the-counter (OTC) antibiotics in the European Union and Norway, 2012. Euro Surveill 2015;20(34):30002. doi:10.2807/1560-7917.ES.2015.20.34.30002.
Montanari L, Minghetti P, Giudici EM. Presentation and distribution of medicinal products after the new E.U. marketing procedures. Pharmacol Res 1997;35(1):37–42. doi:10.1006/phrs.1996.0100.
Bahrani B, DeKoven J. Not all polysporin products contain lidocaine. CMAJ 2018;190(3):E85. doi:10.1503/cmaj.733515.
ACDS. ACDS CAMP. Available at: https://www.contactderm.org/resources/acds-camp. Accessed December 1, 2020.
Warshaw EM, Botto NC, Maibach HI, et al. Positive patch-test reactions to propylene glycol: a retrospective cross-sectional analysis from the North American Contact Dermatitis Group, 1996 to 2006. Dermatitis 2009;20(1):14–20.
Iammatteo M, Akenroye A, Jariwala S, et al. Severe contact dermatitis due to ethylenediamine dihydrochloride in nystatin cream. J Allergy Clin Immunol Pract 2017;5(5):1448–1450. doi:10.1016/j.jaip.2017.03.006.
Pastor-Nieto MA, Alcántara-Nicolás F, Melgar-Molero V, et al. Preservatives in personal hygiene and cosmetic products, topical medications, and household cleaners in Spain [in English, Spanish]. Actas Dermosifiliogr 2017;108(8):758–770. doi:10.1016/j.ad.2017.04.003.
Boyd AH, Warshaw EM. Sulfites: no longer a zebra? Dermatitis 2017;28(6):364–366. doi:10.1097/DER.0000000000000312.
Goossens A, Medeiros S. Allergic contact dermatitis from topical medicaments. Expert Rev Dermatol 2008;3(1):37–42. doi:10.1586/17469872.3.1.37.
Foti C, Romita P, Borghi A, et al. Contact dermatitis to topical acne drugs: a review of the literature. Dermatol Ther 2015;28(5):323–329. doi:10.1111/dth.12282.
Voller LM, Kullberg SA, Warshaw EM. Axillary allergic contact dermatitis to topical clindamycin. Contact Dermatitis 2020;82(5):313–314. doi:10.1111/cod.13465.
Nagarajan H, Rai R. Contact dermatitis to minoxidil. Contact Dermatitis 2021;84(1):57. doi:10.1111/cod.13670.
Shaw DW, Eichenfield LF, Shainhouse T, et al. Allergic contact dermatitis from tacrolimus. J Am Acad Dermatol 2004;50(6):962–965. doi:10.1016/j.jaad.2003.09.013.
Zhang AJ, Warshaw EM. Allergic contact dermatitis caused by mupirocin and pimecrolimus. Contact Dermatitis 2019;80(2):132–133. doi:10.1111/cod.13142.
Kimyon RS, Schlarbaum JP, Liou YL, et al. Allergic contact dermatitis to crisaborole. Dermatitis 2019;30(4):272–274. doi:10.1097/DER.0000000000000488.
Thaiwat S, Ubol T. Allergic contact dermatitis to topical medicaments: revisited. Asian Pac J Allergy Immunol 2020. doi:10.12932/AP-180820-0944. [Epub ahead of print].
Romita P, Foti C, Calogiuri G, et al. Contact dermatitis due to transdermal therapeutic systems: a clinical update. Acta Biomed 2019;90(1):5–10. doi:10.23750/abm.v90i1.6563.
Bershow A, Warshaw EM. Cutaneous reactions to transdermal therapeutic systems. Dermatitis 2011;22(4):193–203.
Musel AL, Warshaw EM. Cutaneous reactions to transdermal therapeutic systems. Dermatitis 2006;17(3):109–122.