49_907_928 05.11.2005 12:13 Uhr Seite 907 Chapter 49 Patch Test Concentrations 49 and Vehicles for Testing Contact Allergens Anton C. De Groot, Peter J. Frosch Patch testing is a relatively safe and reasonably reli- Guidelines for testing the patient’s own contact able method for identifying contact allergens in pa- materials are provided in Chap. 50. tients with contact dermatitis. It has been clearly Table 2 lists alphabetically all chemicals men- shown that patch testing is necessary in the majority tioned in this book with their test concentrations and of patients with eczema [1]. The technique of patch vehicles (sometimes two concentrations are suggest- testing is described in Chap. 22. ed when insufficient data are available) as suggested All patients are tested with the European standard by the various authors. All allergens commercially series,containing the most frequent contact allergens available are also listed with their supplier(s), their in European countries (Table 1). Often, standard se- test concentrations, and vehicles as supplied. It ries patch testing is not enough, and additional aller- should be appreciated that for a considerable num- gens or potential allergens need to be tested, based ber of allergens, the concentrations vary between on the patient’s history and clinical examination. Ex- suppliers. Table 3 provides a list of test concentra- amples are products and chemicals to which the pa- tions for groups of chemicals as suggested by various tient is exposed occupationally or in his or her home authors in this book. Table 4 finally is an alphabetical environment. Test series containing the most fre- listing of commonly used abbreviations and their full quent allergens in certain products (preservatives, chemical synonyms. fragrances, dental materials, plastics and glues, me- dicaments) or in certain occupations (hairdressing, pesticides, oil and cooling fluid) are very helpful.Ap- References proximately 510 patch test materials are commercial- ly available from Hermal (Reinbek, Germany, www. 1. Rycroft RJG (1990) Is patch testing necessary? In: hermal.de), Chemotechnique Diagnostics (Malmö, Champion RH, Pye RJ (eds) Recent advances in dermatol- ogy, vol 8. Churchill Livingstone, Edinburgh, pp 101–111 Sweden, www.chemotechnique.se) and Brial Allergen 2. De Groot AC (1994) Patch testing. Test concentrations and (Greven, Germany, www.brial.com). vehicles for 3700 chemicals, 2nd edn. Elsevier, Amsterdam For other chemicals and products, the investigator 3. Rietschel RL, Fowler JF Jr (eds) (1995) Fisher’s contact der- must decide how to apply them as a patch test.Chem- matitis, 4th edn. Williams and Wilkins, Baltimore, Md. icals usually need to be diluted,and it is of the utmost 4. Adams RM (1990) Occupational skin disease, 2nd edn. Saunders, Philadelphia, Pa. importance to use an appropriate patch test concen- 5. De Groot AC, Weijland JW, Nater JP (1994) Unwanted tration and vehicle to avoid both false-negative and effects of cosmetics and drugs used in dermatology, 3rd false-positive (irritant) reactions. The most useful edn. Elsevier, Amsterdam reference source for documented test concentrations 6. Kanerva L, Elsner P,Wahlberg JE, Maibach HI (eds) (2000) Handbook of occupational dermatology. Springer, Berlin and vehicles of chemicals, groups of chemicals and Heidelberg New York products is the book Patch testing. Test concentra- tions and vehicles for 3700 chemicals [2]. Other useful lists are provided in recent textbooks on contact der- matitis [3–6]. 49_907_928 05.11.2005 12:13 Uhr Seite 908 908 Anton C. De Groot, Peter J. Frosch Table 1. The European standard series Chemical Test concentration and vehicle Metals Cobalt chloride 1% pet. Nickel sulfate 5% pet. Potassium dichromate 0.5% pet. Rubber chemicals Thiuram mix 1% pet. Dipentamethylenethiuram disulfide (0.25%) Tetramethylthiuram disulfide (0.25%) 49 Tetraethylthiuram disulfide (0.25%) Tetramethylthiuram monosulfide (0.25%) N-Isopropyl-N´-phenyl-p-phenylenediamine 0.1% pet. Mercapto mix 2% pet. N-Cyclohexylbenzothiazyl sulfenamide (0.5%) Dibenzothiazyl disulfide (0.5%) Mercaptobenzothiazole (0.5%) Morpholinyl mercaptobenzothiazole (0.5%) Mercaptobenzothiazole 2% pet. Medicaments Budesonide 0.01% pet. Benzocaine 5% pet. Neomycin sulfate 20% pet. Clioquinol® 5% pet. Tixocortol pivalate 0.1% pet. Cosmetic ingredients Balsam of Peru (Myroxylon pereirae) 25% pet. 5-Chloro-2-methylisothiazol-3-one/2-methylisothiazol-3-one (MCI/MI) 0.01% aq. Colophonium (rosin) 20% pet. Formaldehyde 1% aq. Fragrance mix (incl. 5% sorbitan sesquioleate) 8% pet. α-Amylcinnamaldehyde (1%) Cinnamal(dehyde) (1%) Cinnamyl alcohol (1%) Eugenol (1%) Geraniol (1%) Hydroxycitronellal (1%) Iso-eugenol (1%) Oak moss absolute (Evernia prunastri) (1%) Paraben mix 16% pet. Butylparaben (4%) Ethylparaben (4%) Methylparaben (4%) Propylparaben (4%) p-Phenylenediamine free base 1% pet. Quaternium-15 1% pet. Wool wax alcohols (lanolin alcohol) 30% pet. Hydroxymethylpentylcyclohexenecarboxaldehyde (Lyral®) 5% pet. Miscellaneous p-tert-Butylphenol formaldehyde resin 1% pet. Epoxy resin 1% pet. Primin 0.01% pet. Sesquiterpene lactone mix 0.1% pet. Alantolactone (0.033%) Dehydrocostus lactone (0.033%) Costunolide (0.033%) 49_907_928 05.11.2005 12:13 Uhr Seite 909 Patch Test Concentrations and Vehicles Chapter 49 909 Table 2. Test concentrations, vehicles and commercial availability of contact allergens. [Alc. Alcohol, aq. water, DMSO dimethyl sulfoxide, Glyc. glycerine, MEK methyl ethyl ketone (butanone), o.o. olive oil, pet. petrolatum, prop. glyc. propylene glycol.] [icr Immediate contact reactions reported (Chaps 5 and 26), de drug eruption with positive patch test reported (Chap. 24), fde fixed drug eruption with positive patch test reported (Chap. 24), ph photosensitivity reported (Chaps 6, 17 and 27), phde photosensi- tive drug eruption with positive photopatch test reported (Chaps 6, 17, 24 and 27)] Allergen Test Concentration and vehicle Suppliers Trolab Chemo Brial Abietic acid (icr) 10% pet. + + + Acebutolol hydrochloride 2% pet. Aceclofenac 1% pet Acetylsalicylic acid (icr) 10% pet. Achillea millefolium (yarrow extract) 1% pet. + + Acid black 48 (CI 65005) 1% pet. Acid red 14 (azorubine) 0.1% alc. Acid red 118 (CI 26410) 5% pet. + Acid red 359 5% pet. + Acid violet 17 (CI 42650) 1% pet. Acid yellow 36 (CI 13065, metanil yellow) 1% pet. + + + Acid yellow 61 (CI 18968) 5% pet. Actarit (phde) 1% pet Aciclovir (fde) 5% pet. Alantolactone (icr) 0.33% pet. Alclometasone-17,21-dipropionate 1% alc. 1% pet. Alcohol, ethyl (icr) 10% aq. Alimemazine tartrate see Trimeprazine tartrate Allantoin 0.5% aq. Althiazide (phde) 10% pet. or aq. Aluminum (icr) Pure Aluminum chloride hexahydrate 2% pet. Allylisopropylacetylurea See Apronalide Amalgam 5% pet. Amalgam alloying metals 20% pet. + + Amalgam non gamma 2 5% pet. Amcinonide 1% alc. 0.1% pet. 0.1% pet. Amerchol ® L-101 See Lanolin alcohol and paraffinum liquidum Amethocaine See Tetracaine hydrochloride Amikacin sulfate 20% pet. 4-Aminoantipyrine See Ampyrone p-Aminoazobenzene (Solvent yellow 1, CI 11000) 0.25% pet 1% pet. + 1% pet. ε-Aminocaproic acid 1% aq. Amino-4-N, N-diethylaniline sulfate (TSS Agfa®) 1% pet. 2-2-(Aminoethoxy)ethanol See Diglycolamine Amino-4-N-ethyl-N-(methanesulfon- 1% pet. + + aminoethyl)-m-toluidine (CD 3) Aminoglycosides (de) 20% pet. m-Aminophenol 1% pet. + + + p-Aminophenol (CI 76550) (icr) 1% pet. + + + Aminophylline (fde) 10% pet. Amitriptyline (phde) 5% pet. Amlexanox (fde) 1% pet. Ammoniated mercury 1% pet. + + + Ammonium bituminosulfonate See Ichthammol Ammonium heptamolybdate 1% aq. Ammonium hexachloroplatinate (icr) 0.1% aq. + Ammonium persulfate (icr) 2.5% pet. + + + Ammonium tetrachloroplatinate (icr) 0.25% pet. + 0.25% aq. + Ammonium thioglycolate 1% pet., fresh 2.5% aq. 1% pet. Amorolfine 1% pet. Ampicillin (icr) 5% pet. + Ampiroxicam (phde) 1% pet. Amprolium hydrochloride 10% aq. Ampyrone (4-aminoantipyrine) (icr) 10% pet. 49_907_928 05.11.2005 12:13 Uhr Seite 910 910 Anton C. De Groot, Peter J. Frosch Table 2. Continued Allergen Test Concentration and vehicle Suppliers Trolab Chemo Brial α-Amylcinnamaldehyde (icr) 2% pet. 1% pet. + 1% pet. Amylocaine hydrochloride 5% pet + Anethole 5% pet. Aniline 1% pet. + Antazoline 1% pet. Anthemis nobilis (chamomilla romana) 1% pet. Antipyrine (phenazone) (de) 5% pet. 49 Apronalide (allylisopropylacetylurea) (fed) 5% pet. Arnica montana (arnica extract) 0.5% pet. + + Arsanilic acid 10% pet. Atenolol (de) 10% pet. Atranorin (ph) 0.1% pet. Atropine sulfate 1% aq. or pet + (aq.) + (aq.) Azathioprine 1% pet. Azidamfenicol 2% pet. Azodicarbonamide 0.5% pet. Azodiisobutyrodinitrile 1% pet. Azorubine See Acid red 14 Bacitracin (icr) 20% pet. + 5% pet. + Bacitracin zinc 20% pet. Balsam of Peru See Myroxylon pereirae Balsam of Tolu See Myroxylon toluiferum Basic brown 1 See Bismarck Brown R Basic red 46 1% pet. Beech tar See Fagus sylvatica Befunolol 1% aq. Benomyl 0.1–1% pet. Benoxinate See Oxybuprocaine Benzaldehyde (icr) 5% pet. + + Benzalkonium chloride (BAK) 0.01–0.1% aq. 0.1% pet. 0.1% aq. 0.1% pet. Benzamine lactate 1% pet. 2-Benzimidazolethiol 1% pet. (2-mercaptobenzimidazole) Benzisothiazolinone (BIT) (ph) 0.1% pet. + 0.05% pet. + Benzocaine (icr) (ph) 5% pet. + + + Benzodiazepines (de) 1–5% aq. or pet. Benzoic acid (icr) (ph) 5% pet. 5% pet.; 1% alc./glyc. Benzoin resin see Styrax benzoin Benzophenone-3 (oxybenzone) (ph) 10% pet. + + + Benzophenone-4 (sulisobenzone) (ph) (icr) 10% pet. + + + Benzophenone-10 (mexenone) (ph) 10% pet. + IH-Benzotriazole 1% pet.