Positive patch test reactions in older individuals: retrospective analysis from the North American Contact Dermatitis Group, 1994-2008

Erin M Warshaw, Srihari I Raju, Joseph F Fowler, Howard I Maibach, Donald V Belsito, Kathryn A Zug, Robert L Rietschel, James S Taylor, C G Toby Mathias, Anthony F Fransway, Vincent A DeLeo, James G Marks, Frances J Storrs, Melanie D Pratt, Denis Sasseville
Journal of the American Academy of Dermatology 2012, 66 (2): 229-40

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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