Analysis of patch test results in 716 pediatric patients with type IV hypersensitivity dermatosis

Abstract

Objective

This study presents a comprehensive analysis of patch test results in a cohort of 716 pediatric patients diagnosed with type IV hypersensitivity dermatosis. The aim is to provide valuable insights for the prevention and treatment of type IV hypersensitivity dermatosis in the pediatric population.

Methods

A prospective study was conducted from August 2021 to October 2023, enrolling pediatric patients with type IV hypersensitivity dermatosis attending the Department of Dermatology at the prestigious Air Force Medical Center. The patients were categorized into four distinct age groups based on World Health Organization guidelines: infants and young children (under 3 years), preschoolers (ages 3 to 5), school-age children (ages 6 to 11), and adolescents (ages 12 to 14). Patch testing was performed using a pediatric series of allergens, and the distribution patterns of allergens were meticulously analyzed based on the test results. Furthermore, variations in patch test positivity rates and allergen positivity rates were evaluated across different genders and age groups.

Results

Out of the 716 patients included in the study, the overall patch test positivity rate was found to be 86.87%. The top five allergens identified were textile dye mix, limonene hydroperoxide, nickel sulfate, cobalt chloride, and benzoyl peroxide. A comparative analysis of patch test positivity rates between males and females revealed no significant difference (87.85% vs. 86.19%, χ2 = 0.439, P > 0.05). Similarly, there was no statistically significant variation observed in the patch test positivity rates among the top three dermatoses, including eczema, facial dermatitis, and allergic contact dermatitis (ACD) (χ2 = 6.39, P > 0.05). Notably, within the top 10 allergens, textile dye mix, benzoyl peroxide, disperse blue 106/124, and potassium dichromate exhibited higher positivity rates in males (38.14%, 25.99%, 25.14%, and 13.56%, respectively) compared to females (29.56%, 18.23%, 17.40%, and 7.18%, respectively). Conversely, the positivity rate of cobalt chloride was higher in females (28.18%) than in males (19.49%). These gender-based differences were statistically significant (P < 0.05). In terms of age groups, there was no significant disparity observed in the overall patch test positivity rates (χ2 = 3.26, P > 0.05). However, when analyzing the top five allergens, namely textile dye mix, nickel sulfate, and cobalt chloride, distinct variations in positivity rates were discerned among different age groups (P < 0.05). For the specific case of ACD, sensitivity: 82.6%, specificity: 57.1%, false positive rate (FPR): 42.9% .

Conclusion

This study elucidates the primary allergens implicated in type IV hypersensitivity dermatosis among pediatric patients visiting our dermatology outpatient clinic, namely textile dye mix, limonene hydroperoxide, nickel sulfate, cobalt chloride, and benzoyl peroxide. Additionally, it highlights the influence of gender on the positivity rates of common allergens, such as textile dye mix, benzoyl peroxide, disperse blue 106/124, potassium dichromate, and cobalt chloride. Furthermore, age-related variations were noted in the positivity rates of textile dye mix, nickel sulfate, and cobalt chloride.