Abstract
Background and aims: Aging has been shown to be correlated with the rate and type of contact sensitization, but only a few studies have evaluated patch test reactivity in elderly subjects with an adequately large population. Methods: The response patterns to patch testing in 1444 elderly subjects (>65 years) with suspected allergic contact dermatitis were studied, and the results compared with a control group of individuals with suspected allergic contact dermatitis, aged between 20 and 40 years. Results: The prevalence of the positive patch test to at least one hapten was significantly lower in the group of elderly patients compared with adult patients (40.7 vs 47.8%, p<0.0001). However, some allergens, i.e., primin, diaminodiphenylmethane, neomycin, lanolin alcohols, paraben mix, Euxyl K400 and quinoline mix, showed an increased sensitization rate in elderly patients compared with adult patients. These allergens are now less frequently employed in the workplace, or are substances particularly used in the formulation of topical treatment of age-related diseases, i.e., leg ulcer and xerosis. It was also found that the intensity of positive patch test reactions was significantly lower in elderly patients compared with younger subjects, with higher proportions of weak (+) positive reactions. Moreover, elderly patients showed a dynamic pattern of increasing intensity of patch test reactions at the second reading after 3 days compared with the first reading after 2 days more frequently than younger patients (60 vs 53%, p<0.0001 ). Conclusions: These findings suggest an age-dependent decline of overall positive patch test reactions, but a higher sensitization rate to some allergens frequently used in the composition of topical treatments. The development of an allergic response in elderly patients was found to be delayed, and this may require an additional reading after 7 days and the interpretation of even weak reactions as valid positive patch test reactions.
Similar content being viewed by others
References
Kwangsukstith C, Maibach HI. Effect of age and sex on the induction and elicitation of allergic contact dermatitis. Contact Dermatitis 1995; 33: 289–98.
Waldorf DS, Willkens RF, Decker JL. Impaired delayed hypersensitivity in an aging population. JAMA 1968; 203: 111–4.
Wantke F, Hemmer W, Jarisch R, Gotz M. Patch test reactions in children, adults and the elderly. Contact Dermatitis 1996; 34: 316–9.
Uter W, Geier J, Pfahlberg A, Effendy I. The spectrum of contact allergy in elderly patients with and without lower leg dermatitis. Dermatology 2002; 204: 266–72.
Mangelsdorf HC, Fleischer AB, Sherertz EF. Patch testing in an aged population without dermatitis: high prevalence of patch test positivity. Am J Contact Dermatitis 1996; 7: 155–7.
Wahlberg JE. Patch testing. In: Rycroft RJG, Menné T, Frosch PJ, Benezra C, Eds. Textbook of Contact Dermatitis. Berlin: Springer-Verlag, 1992: 241–65.
Hanifin JM, Rajka G. Diagnostic features of atopic dermatitis. Acta Derm Venereol 1980; Suppl 92: 44–7.
Gupta G, Dawn G, Forsyth A. The trend of allergic contact dermatitis in the elderly population over a 15-year period. Contact Dermatitis 1999; 41: 48–9.
Walton S, Nayagam AT, Keczkes K. Age and sex incidence of allergic contact dermatitis. Contact Dermatitis 1986; 15: 136–9.
Bangha E, Elsner P. Sensitizations to allergens of the European standard series at the Department of Dermatology in Zurich 1990–1994. Dermatology 1996; 193: 17–21.
Sugai T, Takagi T, Yamamoto S, Takahashi Y. Age distribution of the incidence of contact sensitivity to standard allergens. Contact Dermatitis 1979; 5: 383–8.
Ginaldi L, De Martinis M, D’Ostilio A, Marini L, Loreto MF, Quaglino D. Immunological changes in the elderly. Aging Clin Exp Res 1999; 11: 281–6.
Globerson A. T lymphocytes and aging. Int Arch Allergy Immunol 1995; 107: 491–7.
Malaguarnera L, Ferlito L, Imbesi RM, et al. Immunosenescence: a review. Arch Gerontol Geriatr 2001; 32: 1–14.
Tarazona R, Solana R, Ouyang Q, Pawelec G. Basic biology and clinical impact of immunosenescence. Exp Gerontol 2002; 37: 183–9.
Gilchrest BA, Murphy GF, Soter NA. Effect of chronologic aging and ultraviolet irradiation on Langerhans cells in human epidermis. J Invest Dermatol 1982; 79: 85–8.
Keczkes K, Basheer AM, Wyatt EH. The persistence of allergic contact sensitivity: a 10-year follow-up in 100 patients. Br J Dermatol 1982; 107: 461–5.
Lintum JCTE, Nater JP. On the persistence of positive patch test reactions to balsam of Peru, turpentine and nickel. Br J Dermatol 1973; 89: 629–34.
Katsarou A, Baxevanis C, Armenaka M, Volonakis M, Balamotis A, Papamihail M. Study of persistence and loss of patch test reactions to dichromate and cobalt. Contact Dermatitis 1997; 36: 87–90.
Gomez-Orbaneja J, Barrientos E. Funktionelle Nachuntersuchungen bei Ekzematikern. Schweizerische medizinische Wochenschrift 1938; 24: 694.
Morgan JK. Observations on the persistence of skin sensitivity with reference to nickel eczema. Br J Dermatol 1953; 65: 84.
Wakelin SH, Smith H, White IR, Rycroft RJG, McFadden JP. A retrospective analysis of contact allergy to lanolin. Br J Dermatol 2001; 145: 28–31.
Schnuch A, Geier J, Uter W, Frosch PJ. Patch testing with preservatives, antimicrobials and industrial biocides. Results from multicentre study. Br J Dermatol 1998; 138: 467–76.
Mangelsdorf HC, Fleischer AB, Sherertz EF. Patch testing in an aged population without dermatitis: high prevalence of patch test positivity. Am J Contact Dermatitis 1996; 7: 155–7.
Grossman J, Baum J, Gluckman J, Fusner J, Condemi JJ. The effect of aging and acute illness on delayed hypersensitivity. J Allergy Clin Immunol 1975; 55: 268–75.
Catalona WJ, Taylor P, Chretien PB. Quantitative dinitrochlorobenzene sensitization in cancer patients. Clin Exp Immunol 1972; 12: 325–33.
Schwartz M. Eczematous sensitization in various age groups. J Allergy 1953; 24: 143–8.
Epstein WL, Jessar RA. Contact type delayed hypersensitivity in patients with rheumatoid arthritis. Arthritis Rheum 1959; 2: 178–81.
Lejman E, Stoudemayer T, Grove G, Kligman AM. Age differences in poison ivy dermatitis. Contact Dermatitis 1984; 11: 163–7.
Author information
Authors and Affiliations
Consortia
Corresponding author
Additional information
All investigators are members of the North-East Italy Contact Dermatitis Group (NEICDG).
Rights and permissions
About this article
Cite this article
Piaserico, S., Larese, F., Recchia, G.P. et al. Allergic contact sensitivity in elderly patients. Aging Clin Exp Res 16, 221–225 (2004). https://doi.org/10.1007/BF03327387
Published:
Issue Date:
DOI: https://doi.org/10.1007/BF03327387