Abstract:Background: Extended patch testing beyond the standard series is commonly performed in patients with allergic contact dermatitis. This broader testing allows for more precise and complete allergen identification, ultimately leading to improved clinical outcomes.
Objective: To report the Mayo Clinic Contact Dermatitis Group (MCCDG) patch testing results using a custom extended series from 2010 to 2023.
Methods: A retrospective review of patch testing results using the MCCDG extended standard series at the Mayo Clinic was conducted. Data from 2010 to 2023 were analyzed.
Results: Patch testing with the extended standard series was performed in 3,767 unique patients, with a total of 3834 extended standard patch tests administered (81.8% in women, 18.2% in men). The top 5 allergens eliciting positive reactions were gold (I) sodium thiosulfate (10.4%), benzisothiazolinone (10.4%), carmine (9.4%), thimerosal (9.3%), and hydroperoxides of linalool (8.8%).
Conclusions: The extended standard series expands the diagnostic scope for patients in whom the standard series incompletely identifies relevant allergens. Preservatives and fragrances remain among the most common sensitizers, emphasizing the need for ongoing allergen surveillance, periodic review, and updates to patch test series to enhance diagnostic accuracy and patient care.
Get full access to this article
View all access options for this article.
References
1.
TramontanaM, HanselK, BianchiL, et al.Advancing the understanding of allergic contact dermatitis: From pathophysiology to novel therapeutic approaches. Front Med (Lausanne). 2023; 10:1184289; doi: 10.3389/fmed.2023.1184289
2.
AristizabalMA, BruceCJ, CarusoMA, et al.Allergic contact dermatitis revisited: A comprehensive review. JAAD Reviews. 2025; 4:92–103; doi: 10.1016/j.jdrv.2025.03.011
3.
WetterD, DavisMP, YianniasJ, et al.Patch test results from the Mayo Clinic Contact Dermatitis Group, 1998–2000. J Am Acad Dermatol. 2005; 53(3):416–421; doi: 10.1016/j.jaad.2005.04.077
4.
DavisMDP, ScalfLA, YianniasJA, et al.Changing trends and allergens in the patch test standard series: A Mayo Clinic 5-year retrospective review, January 1, 2001, through December 31, 2005. Arch Dermatol. 2008; 144(1):67–72; doi: 10.1001/archdermatol.2007.2
5.
WentworthAB, YianniasJA, KeelingJH, et al.Trends in patch-test results and allergen changes in the standard series: A Mayo Clinic 5-year retrospective review (January 1, 2006, to December 31, 2010). J American Academy Dermatol. 2014; 70(2):269–275.e4; doi: 10.1016/j.jaad.2013.09.047
6.
VeverkaK, HallM, YianniasJ, et al.Trends in patch testing with the Mayo Clinic standard series, 2011–2015. Dermatitis. 2018; 29(6):310–315; doi: 10.1097/DER.0000000000000411
7.
ZawawiS, YangY, CantwellH, et al.Trends in patch testing with the Mayo Clinic standard series, 2017–2021. Dermatitis. 2023; 34(5):405–412; doi: 10.1089/derm.2023.0063
8.
LlanosAAM, RocksonA, GetzK, et al.Assessment of personal care product use and perceptions of use in a sample of US adults affiliated with a university in the Northeast. Environ Res. 2023; 236(Pt 1):116719; doi: 10.1016/j.envres.2023.116719
9.
GoldbergM, ChangCJ, OgunsinaK, et al.Personal care product use during puberty and incident breast cancer among Black, Hispanic/Latina, and White women in a prospective US-wide cohort. Environ Health Perspect. 2024; 132(2):27001; doi: 10.1289/ehp13882
10.
ParkGH, NamC, HongS, et al.Socioeconomic factors influencing cosmetic usage patterns. J Expo Sci Environ Epidemiol. 2018; 28(3):242–250; doi: 10.1038/jes.2017.20
11.
WarshawEM, SchlarbaumJP, SilverbergJI, et al.Contact dermatitis to personal care products is increasing (but different!) in males and females: North American Contact Dermatitis Group data, 1996-2016. J Am Acad Dermatol. 2021; 85(6):1446–1455; doi: 10.1016/j.jaad.2020.10.003
12.
WarshawEM, BuchholzHJ, BelsitoDV, et al.Allergic patch test reactions associated with cosmetics: Retrospective analysis of cross-sectional data from the North American contact dermatitis group, 2001–2004. J Am Acad Dermatol. 2009; 60(1):23–38; doi: 10.1016/j.jaad.2008.07.056
13.
FonacierL, BernsteinDI, PachecoK, et al.; Joint Council of Allergy, Asthma & Immunology. Contact dermatitis: A practice parameter-update 2015. J Allergy Clin Immunol Pract. 2015; 3(3 Suppl):S1–S39; doi: 10.1016/j.jaip.2015.02.009
14.
HaldM, BergND, ElberlingJ, et al.Medical consultations in relation to severity of hand eczema in the general population. Br J Dermatol. 2008; 158(4):773–777; doi: 10.1111/j.1365-2133.2007.08431.x
15.
TripathiR, KnuselKD, EzaldeinHH, et al.Association of demographic and socioeconomic characteristics with differences in use of outpatient dermatology services in the United States. JAMA Dermatol. 2018; 154(11):1286–1291; doi: 10.1001/jamadermatol.2018.3114
16.
AhnlideI, BjörknerB, BruzeM, et al.Exposure to metallic gold in patients with contact allergy to gold sodium thiosulfate. Contact Dermatitis. 2000; 43(6):344–350; doi: 10.1034/j.1600-0536.2000.043006344.x
17.
DeKovenJ, WarshawE, ReederM, et al.North American contact dermatitis group patch test results: 2019–2020. Dermatitis. 2023; 34(2):90–104; doi: 10.1089/derm.2022.29017.jdk
18.
AhlgrenC, AhnlideI, BjörknerB, et al.Contact allergy to gold is correlated to dental gold. Acta Derm Venereol. 2002; 82(1):41–44; doi: 10.1080/000155502753600876
19.
AhlgrenC, BruzeM, MöllerH, et al.Contact allergy to gold in patients with oral lichen lesions. Acta Derm Venereol. 2012; 92(2):138–143; doi: 10.2340/00015555-1247
20.
JensenMB, Kursawe LarsenC, IsufiD, et al.Prevalence of contact allergy to gold in dermatitis patients from 2010 to 2024: A systematic review and meta-analysis. Contact Dermatitis. 2024; 91(6):451–458; doi: 10.1111/cod.14707
21.
LidénC, WhiteIR. Increasing non-cosmetic exposure and sensitization to isothiazolinones require action for prevention: Review. Contact Dermatitis. 2024; 90(5):445–457; doi: 10.1111/cod.14523
22.
JoSJ, BaeSH, HuangZ, et al.Benzisothiazolinone: Pharmacokinetics, tissue distribution, and mass balance studies in rats. Metabolites. 2023; 13(5); doi: 10.3390/metabo13050584
23.
KingN, LatheefF, WilkinsonM. Trends in preservative allergy: Benzisothiazolinone emerges from the pack. Contact Dermatitis. 2021; 85(6):637–642; doi: 10.1111/cod.13968
24.
LeeJ-G, MaruthupandyM, ParkC, et al.Dermal toxicity studies of 1,2-benzisothiazolin-3-one (CAS number: 2634-33-5) in Sprague-Dawley rats. Food Chem Toxicol. 2024; 193:115054; doi: 10.1016/j.fct.2024.115054
25.
ReederMJ, ZhangD, AravamuthanSR, et al.More than just methylisothiazolinone: Retrospective analysis of patients with isothiazolinone allergy in North America, 2017–2020. J Am Acad Dermatol. 2024; 90(2):319–327; doi: 10.1016/j.jaad.2023.10.032
26.
SchwensenJFB, UterW, AertsO, et al.; European Environmental Contact Dermatitis Research Group. Current frequency of contact allergy to isothiazolinones (methyl-, benz- and octylisothiazolinone) across Europe. Contact Dermatitis. 2024; 91(4):271–277; doi: 10.1111/cod.14641
27.
GeierJ, BransR, WeisshaarE, et al.; IVDK. Contact sensitization to benzisothiazolinone: IVDK-data of the years 2002 to 2021. Contact Dermatitis. 2023; 88(6):446–455; doi: 10.1111/cod.14300
WarshawEM, MaibachHI, TaylorJS, et al.North American contact dermatitis group patch test results: 2011–2012. Dermatitis. 2015; 26(1):49–59; doi: 10.1097/der.0000000000000097
30.
ZugK, PhamA, BelsitoD, et al.Patch testing in children from 2005 to 2012. Dermatitis. 2014; 25(6):345–355; doi: 10.1097/DER.0000000000000083
31.
MorinCB, SassevilleD. Expanding patch testing beyond the baseline series: Usefulness of customized antimicrobials, vehicles, and cosmetics series. Dermatitis. 2020; 31(6):367–372; doi: 10.1097/der.0000000000000674
SilverbergJI, HouA, WarshawEM, et al.Prevalence and trend of allergen sensitization in adults and children with atopic dermatitis referred for patch testing, North American contact dermatitis group data, 2001–2016. J Allergy Clin Immunol Pract. 2021; 9(7):2853–2866.e14; doi: 10.1016/j.jaip.2021.03.028
ÜnalA. Analysis of patch testing results in patients with contact dermatitis in Istanbul, Turkey, from 2012 to 2022. J Cosmet Dermatol. 2023; 22(10):2831–2838; doi: 10.1111/jocd.15791
36.
SundquistBK, YangB, PashaMA. Experience in patch testing: A 6-year retrospective review from a single academic allergy practice. Ann Allergy Asthma Immunol. 2019; 122(5):502–507; doi: 10.1016/j.anai.2019.02.028
37.
de GrootA. Linalool hydroperoxides. Dermatitis. 2019; 30(4):243–246; doi: 10.1097/der.0000000000000471
38.
DittmarD, SchuttelaarMLA. Contact sensitization to hydroperoxides of limonene and linalool: Results of consecutive patch testing and clinical relevance. Contact Dermatitis. 2019; 80(2):101–109; doi: 10.1111/cod.13137
39.
Llamas-VelascoM, Martos-CabreraL, ButrónB, et al.Low clinical relevance of positive patch test reactions to limonene and/or linalool hydroperoxides in 247 consecutive patients with eczema. Actas Dermosifiliogr. 2024; 115(3):T309–T311; doi: 10.1016/j.ad.2023.05.035 Escasa relevancia clínica en los parches positivos a limoneno y/o linalool en 247 pacientes consecutivos con eccema
40.
DezaG, García-BravoB, SilvestreJF, et al.; GEIDAC. Contact sensitization to limonene and linalool hydroperoxides in Spain: A GEIDAC(*) prospective study. Contact Dermatitis. 2017; 76(2):74–80; doi: 10.1111/cod.12714
41.
SchubertS, GeierJ, BransR, et al.; IVDK. Patch testing hydroperoxides of limonene and linalool in consecutive patients—Results of the IVDK 2018–2020. Contact Dermatitis. 2023; 89(2):85–94; doi: 10.1111/cod.14332
42.
WangKL, RainosekEM, YangYW, et al.Pediatric patch testing at Mayo Clinic between 2016 and 2020. Dermatitis. 2024; 35(4):355–360; doi: 10.1089/derm.2023.0353
43.
AjayiA, HallM, YianniasJ, et al.Trends in patch testing of black patients: The Mayo Clinic decade experience (January 1, 2011, to December 31, 2020). Dermatitis. 2023; 34(2):113–119; doi: 10.1089/derm.2022.29000.aaj
44.
Mercader-GarcíaP, Ruiz-GonzalezI, Gonzalez-PerezR, et al.Contact allergy to shellac. Retrospective cross-sectional study with data from the Spanish Registry of Research in Contact Dermatitis and Cutaneous Allergy (REIDAC). Actas Dermosifiliogr. 2023; 114(5):Tt377–Tt381; doi: 10.1016/j.ad.2023.04.010 [Artículo traducido] Alergia de contacto a shellac. Estudio transversal retrospectivo con datos del Registro Español de Investigación en Dermatitis de Contacto y Alergia Cutánea (REIDAC)
45.
VeverkaK, KillianJ, YianniasJ, et al.Shellac: A tertiary care center experience. Dermatitis. 2018; 29(4):226–227; doi: 10.1097/DER.0000000000000394
46.
GhadiriSJ, SambiP, WilkinsonSM, et al.Contact sensitisation to shellac: A possible marker of fragrance allergy. Contact Dermatitis. 2023; 89(3):205–206; doi: 10.1111/cod.14364
47.
ShelanskiHA, ShelanskiMV. PVP-iodine: History, toxicity and therapeutic uses. J Int Coll Surg. 1956; 25(6):727–734.
48.
ForkelS, BeutnerC, AmschlerK, et al.Improving povidone‐iodine and iodine preparations for patch testing. Contact Dermatitis. 2021; 84(5):332–337; doi: 10.1111/cod.13760
49.
KennedyH. Contact dermatitis secondary to povidone‐iodine: A systematic review. Contact Dermatitis. 2025; 92(1):2–8; doi: 10.1111/cod.14712
