Patch testing of nickel sulfate and potassium dichromate with a standardized ready-to-use test system gives highly reproducible results: a double-blind multicentre study.

There is still some doubt about the reproducibility of patch tests. A sound assessment needs optimized and unbiased studies. This study analysed the results of a double-blind multicentre study with nickel sulfate and potassium dichromate patch tests attached synchronously to both sides of the back of patients with a history of nickel allergy, conducted with a highly standardized randomized test system (TRUE-test). Out of 589 patients tested, a total of 388 had responded with allergic reactions to nickel sulfate and 130 to potassium dichromate. The reproducibility of positive nickel (dichromate) patch tests was 99.2% (90.8%). The reaction index was also calculated, which relates the number of allergic reactions obtained with a test preparation to the number of questionable and irritant reactions; the reaction index can range from -1 (questionable and irritant reactions only occur) to 1 (allergic reactions only occur). For nickel sulfate the reaction index was 0.91, but it was only 0.23 for potassium dichromate, as a result of considerably more questionable reactions. In conclusion, a highly synchronous reproducibility of results can be achieved by using a well-standardized patch-test system, especially with nickel sulfate. However, distinct allergens and test systems need to be evaluated separately.

The true value of the TRUE Test for allergic contact dermatitis.

The development of the thin layer rapid use epicutaneous (TRUE) Test is a history of cooperation between scientists from academia and industry covering several disciplines: medicine, pharmaceutical chemistry, pharmacology, and statistics. The TRUE Test is today a patch test system with documented stability and allergen content. Allergens are incorporated in a dried-in-gel vehicle, which is coated onto a polyester backing to form a patch. Applied to the skin, the allergens are released when the gel becomes moisturized by transepidermal water. This may seem to be a simple technique, but its development required laborious research and solutions to stability and dosage problems. The test has been clinically standardized with serial dilution tests on sensitized patients and validated in comparative multicenter tests. The test is a significant step towards higher reliability of patch testing. Fifteen years of experience and critical investigations are discussed in this article, as are possible improvements such as expansion of the test with new allergens.

Positive nickel patch tests do not intensify positive reactions to adjacent patch tests with dichromate. Results from a double-blind multicentre study of the German Contact Dermatitis Research Group (Deutsche Kontaktallergie-Gruppe, DKG).

The possible interference of neighbouring allergic patch-test reactions is still an open question. In this study, we investigated whether there is a distance-related mutual modification of neighbouring allergic patch-test reactions to nickel sulfate and potassium dichromate. We used a double-blind multicentre study design with randomized attachment of special TRUE Tests with 1, 3 and 7 cm distance between nickel sulfate and potassium dichromate patches. 589 patients with a history of nickel allergy (523 female, 66 male) were tested, with a mean age of 35 years. A log-linear modelling approach was used for statistical assessment of the relation between the distance separating neighbouring patch tests with nickel and dichromate and the reactions to the allergens. Non-reproducibility coefficients were compared by the generalized version of Fisher's exact test for arbitrary 2-dimensional contingency tables. For the left side of the back, virtually no differences (p=0.70) were found in the reaction patterns obtained for the 3 distances separating nickel and dichromate patch tests. On the right side of the back, the number of reactions to dichromate patches with only 1 cm distance from moderate/strong nickel reactions was lower than the number of positive dichromate tests at larger distances from nickel tests (on the border of statistical significance: p= 0.05). Corresponding side-related results were obtained for subgroups of patients with and without a history of atopic dermatitis. The non-reproducibility of reactions to dichromate was not significantly related to the distance between neighbouring tests. Our data argue against a "spillover" effect of strong/moderate nickel reactions, but indicate that such reactions may, under certain conditions, attenuate adjacent reactions to an unrelated allergen. In the case of future verification, this will have implications for the interpretation of patch tests.

Aspects of pharmaceutical and chemical standardization of patch test materials.

The choice of vehicle for patch test materials is important for the bioavailability and stability of the allergens. Examples are given from the standardization of the TRUE Test and include caine mix, Kathon CG, and fragrance mix.

Chemical, pharmaceutical and clinical standardization of the TRUE Test caine mix.

The development of the caine mix patch of the TRUE TestTM involved extensive formulation work to obtain optimal release, stability and clinical function. Hydroxypropyl cellulose, ordinarily used in the TRUE TestTM, induced crystallization and inadequate release of benzocaine. Addition of the crystal poison glucose caused rapid degradation of the caines. Polyvinylpyrrolidone (PVP) proved to be a vehicle which incorporated the caines in a stable preparation on the patch. Rapid release of the caines from this vehicle when applied on membranes was confirmed by in vivo patch test studies.

Analysis of the prodrug 7-acetylacroninium perchlorate in presence of the parent compound acronine.

Analysis of acronine and the prodrug acetylacroninium perchlorate in parenteral solutions is described. The unstable prodrug reacts quantitatively with the nucleophilic agent aniline by an unusual mechanism to form a phenylimino derivative of acronine. This derivative and acronine itself were determined by a spectrophotometric two-component method.

Hydrolysis mechanism of 7-acetylacroninium perchlorate, a novel prodrug of acronine.

7-Acetylacroninium perchlorate was hydrolyzed at 25 degrees by both water enriched with 18O-labeled water and by unenriched water. The acronine obtained was examined by mass spectrometry, which indicated the unusual fact that hydrolysis of this ester proceeded by aryl oxygen cleavage to the extent of about 30% under those mild conditions.

Complexation in formulation of parenteral solutions: solubilization of the cytotoxic agent hexamethylmelamine by complexation with gentisic acid species.

The apparent solubility of hexamethylmelamine in aqueous solutions suitable for intravenous use was increased by complexation with gentisic acid. Studies were carried out in the pH 0-8 range. Unprotonated hexamethylmelamine did not form complexes with the gentisate ion, while the hexamethylmelammonium ion appeared to form several different complexes with both the gentidate ion and gentisic acid. Two different solid complexes were isolated and characterized. The solubility increases observed at pH 3.5-5.0 are described by mathematical relationships involving the stability constants of some postulated complex species. From these results, sultable formulations for use as parenteral solutions are proposed. The increase in the apparent aqueous solubility of hexamethylmelamine in such formulations may range from five- to 90-fold, depending upon the pH and total gentisateion concentrations.