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Positive patch test reactions in older individuals: Retrospective analysis from the North American Contact Dermatitis Group, 1994-2008 - 14/01/12

Doi : 10.1016/j.jaad.2010.12.022 
Erin M. Warshaw, MD, MS a, b, , Srihari I. Raju, MD a, Joseph F. Fowler, MD c, Howard I. Maibach, MD d, Donald V. Belsito, MD e, Kathryn A. Zug, MD f, Robert L. Rietschel, MD g, James S. Taylor, MD h, C. G. Toby Mathias, MD i, Anthony F. Fransway, MD j, Vincent A. DeLeo, MD k, James G. Marks, MD l, Frances J. Storrs, MD m, Melanie D. Pratt, MD n, Denis Sasseville, MD o
a Minneapolis Veterans Affairs Medical Center, Center for Chronic Disease Outcomes Research, Minneapolis, Minnesota 
b Department of Dermatology, University of Minnesota School of Medicine, Minneapolis, Minnesota 
c University of Louisville, Louisville, Kentucky 
d University of California–San Francisco, California 
e American Dermatology Associates LLC, Shawnee, Kansas 
f Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire 
g University of Arizona Departments of Veterans Affairs Health Care System, Tucson, Arizona 
h Cleveland Clinic, Cleveland, Ohio 
i University of Cincinnati, Cincinnati, Ohio 
j Private Practice, Fort Meyers, Florida 
k Columbia University, New York City, New York 
l Pennsylvania State University, Hershey, Pennsylvania 
m Oregon Health and Science University, Portland, Oregon 
n University of Ottawa, Ottawa, Ontario, Canada 
o Royal Victoria Hospital, McGill University, Montreal, Quebec, Canada 

Correspondence to: Erin M. Warshaw, MD, MS, Department 111 K, Departments of Veterans Affairs Medical Center, 1 Veterans Dr, Minneapolis, MN 55417.

Abstract

Background

Relatively little is known about the epidemiology of allergic contact dermatitis in older individuals.

Objectives

We sought to determine the frequency of positive and clinically relevant patch test reactions in older individuals (≥65 years old) referred for patch testing, and to compare these results with those of adults (≤64-19 years) and children (<18 years).

Design

This was a retrospective cross-sectional analysis of North American Contact Dermatitis Group data from 1994 to 2008.

Results

A total of 31,942 patients (older n = 5306; adults n = 25,028; children n = 1608) were patch tested. The overall frequency of at least one allergic reaction in older individuals was 67.3% as compared with 66.9% for adults (P = .5938) and 47% for children (P = .0011). Reaction rates that were statistically higher in older individuals as compared with both adults and children included: Myroxylon pereirae, fragrance mix I, quaternium-15, formaldehyde, imidazolidinyl urea, diazolidinyl urea, neomycin, bacitracin, methyldibromo glutaronitrile, methyldibromo glutaronitrile/phenoxyethanol, ethyleneurea melamine formaldehyde mix, and carba mix (P values < .0004). Patch test reaction rates that were significantly lower in older individuals than both comparison groups included: nickel, thimerosal, and cobalt (P values < .0001).

Limitations

Referral population was a limitation.

Conclusions

Older individuals were more likely to have at least one positive patch test reaction as compared with children, but had similar rates to adults. The frequency of positive reactions to specific allergens differed by age group, most likely as a result of exposures.

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Key words : contact dermatitis, elderly, older individuals, patch testing


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 Funding sources: None.
 Conflicts of interest: None declared.
 The views expressed in this article are those of the authors and do not necessarily represent the position or policy of the Department of Veterans Affairs or the US government.
 Reprints not available from the authors.


© 2011  American Academy of Dermatology, Inc.. Pubblicato da Elsevier Masson SAS. Tutti i diritti riservati.
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