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Background In 1975, Mitchell brought up a theory that false positive reactions can be due to skin hyperirritability, called it “angry back syndrome” (ABS). The phenomenon is observed in patch testing of patients with several positive patch tests, mostly along with one or more strong reactions. Later, Maibach rephrased ABS to “excited skin syndrome” (ESS) because of generalized involvement of the skin, not only the back. Aims In this paper, we tried to analyze the possible ESS‐related mechanisms and provide crucial information on how to deal with a suspected patient. Methods On July 2024, we made a wide systematic computer‐assisted search of PubMed and Google Scholar (Embase, Scopus) data base, using “excited skin syndrome” and “angry back syndrome” keywords. We scanned 350 studies. After removing duplicate studies, 31 studies concerning ESS/ABS were included in our review. Results Patch test results with more than a positive reaction can be due to EES development, particularly when the reactions are non‐relevant to the patient. Several factors can alter the chance of ESS including: positioning of the allergens during the patch testing procedure, poly‐sensitization, eczema/dermatitis. Conclusions We can consider the following points to manage ESS and minimize its occurrence chance: ESS should be suspected when multiple positive reactions are seen. In suspected cases of ESS, re‐examining and re‐taking history for any relevance of positive reactions is recommended. Retesting should be performed if positive reactions are clinically irrelevant. It is preferred to perform patch testing when no sign of dermatitis is present.

Dermatitis is one of the most common illnesses encountered by healthcare providers and the causes are numerous. Contact dermatitis is the form of dermatitis resulting from contact with the environment, and it may be either irritant or allergic in nature. Patch testing has been the gold standard for diagnosis of allergic contact dermatitis since its formal description over 100 years ago by Jadassohn. While this diagnostic tool may seem simple to us today, there are numerous potential points for error that the practitioner must keep in mind. Patient selection, technique of patch test placement, allergen selection, patch test reading and interpretation, and patient management all must be considered. To simply apply a given set of test allergens indiscriminately and not be prepared to interpret the results accurately with patient education and management in mind would be a great failure. Conversely, with experience and the proper knowledge base some of the most complex dermatitis questions can be answered.

Critical to the evaluation of non-animal tests are reference data with which to assess their relevance. Animal data are typically used because they are generally standardized and available. However, when regulatory agencies aim to protect human health, human reference data provide the benefit of not having to account for possible interspecies variability. To support the evaluation of non-animal approaches for skin sensitization assessment, we collected data from 2277 human predictive patch tests (HPPTs), i.e., human repeat insult patch tests and human maximization tests, for skin sensitization from 1555 publications. We recorded protocol elements and positive or negative outcomes, developed a scoring system to evaluate each test for reliability, and calculated traditional and non-traditional dose metrics. We also traced each test result back to its original report to remove duplicates. The resulting database, which contains information for 1366 unique substances, was characterized for physicochemical properties, chemical structure categories, and protein binding mechanisms. This database is publicly available on the National Toxicology Program Interagency Center for the Evaluation of Alternative Toxicological Methods website and in the Integrated Chemical Environment to serve as a resource for additional evaluation of alternative methods and development of new approach methodologies for skin sensitization assessments.

Since the 1940s, patch tests in healthy volunteers (Human Predictive Patch Tests, HPPTs) have been used to identify chemicals that cause skin sensitization in humans. Recently, we reported the results of a major curation effort to support the development of OECD Guideline 497 on Defined Approaches (DAs) for skin sensitization (OECD in Guideline No. 497: Defined Approaches on Skin Sensitisation, 2021a. https://doi.org/10.1787/b92879a4-en). In the course of this work, we compiled and published a database of 2277 HPPT results for 1366 unique test substances (Strickland et al. in Arch Toxicol 97:2825–2837, 2023. https://doi.org/10.1007/s00204-023-03530-3). Here we report a detailed analysis of the value of HPPT data for classification of chemicals as skin sensitizers under the United Nations’ Globally Harmonized System of Classification and Labelling of Chemicals (GHS). As a result, we propose the dose per skin area (DSA) used for classification by the GHS to be replaced by or complemented with a dose descriptor that may better reflect sensitization incidence [e.g., the DSA causing induction of sensitization in one individual (DSA1+) or the DSA leading to an incidence of induction in 5% of the tested individuals (DSA05)]. We also propose standardized concepts and workflows for assessing individual HPPT results, for integrating multiple HPPT results and for using them in concert with Local Lymph Node Assay (LLNA) data in a weight of evidence (WoE) assessment. Overall, our findings show that HPPT results are often not sufficient for deriving unambiguous classifications on their own. However, where they are, the resulting classifications are reliable and reproducible and can be integrated well with those from other skin sensitization data, such as the LLNA.

The “Atopy Patch Test” (APT) has been proposed as a diagnostic tool for food allergies (FA), especially in children with FA-related gastrointestinal symptoms. However, its diagnostic accuracy is debated, and its usefulness is controversial. The aim of this systematic review was to evaluate the APT diagnostic accuracy compared with the diagnostic gold standard, i.e., the oral food challenge (OFC), in children affected by non-IgE mediated gastrointestinal food allergies, including the evaluation in milk allergic subgroup. Both classical non-IgE mediated clinical pictures and food induced motility disorders (FPIMD) were considered. The search was conducted in PubMed and Scopus from January 2000 to June 2022 by two independent researchers. The patient, intervention, comparators, outcome, and study design approach (PICOS) format was used for developing key questions, to address the APT diagnostic accuracy compared with the oral food challenge (OFC). The quality of the studies was assessed by the QUADAS-2 system. The meta‐analysis was performed to calculate the pooled sensitivity, specificity, DOR (diagnostic odds ratio), PLR (positive likelihood ratio), and NLR (negative likelihood ratio) with their 95% confidence intervals (CI). Out of the 457 citations initially identified via the search (196 on PubMed and 261 on Scopus), 37 advanced to full-text screening, and 16 studies were identified to be included in the systematic review. Reference lists from relevant retrievals were searched, and one additional article was added. Finally, 17 studies were included in the systematic review. The analysis showed that APT has a high specificity of 94% (95%CI: 0.88–0.97) in the group of patients affected by FPIMD. Data showed a high pooled specificity of 96% (95% CI: 0.89–0.98) and the highest accuracy of APT in patients affected by cow’s milk allergy (AUC = 0.93).       Conclusion : APT is effective in identifying causative food in children with food-induced motility disorders.  What is Known: • Atopy patch test could be a useful diagnostic test for diagnosing food allergy, especially in children with food allergy-related gastrointestinal symptoms. What is New: • Atopy patch test may be a useful tool in diagnosing non IgE food allergy, especially in children with food-induced gastrointestinal motility disorders and cow's milk allergy.

A 49-year-old male presented with the complaints of sudden-onset redness and watering of both the eyes following the intake of fixed drug combination of ofloxacin-ornidazole for diarrhea. Following this, he developed redness of both the lips and blisters in the upper lip. He also developed erythematous macules in the medial aspects of the right lower thigh and ventral aspects of the right leg. Ocular examination showed conjunctival redness with diffuse corneal punctate epithelial erosions in both the eyes. The patient had a similar history affecting the same region 1 year back following the intake of the same combination medicine. To find out the specific inciting agent and owing to unavailability of Finn chamber, we developed a new modified skin patch test using empty tablet cover with three chambers, incorporated with ornidazole, Vaseline (petroleum jelly), and ofloxacin, respectively, and applied on the healed affected lesions. Modified patch test was positive for ornidazole at 48 h. Ornidazole-induced fixed drug eruption (FDE) affecting cornea is a rare and unique in our case report. The patient was then educated about the offending medication and advised to avoid in the future. We also conducted a systematic review of FDEs associated with ornidazole exposure. We searched PubMed and Google Scholar with specific keywords to finally retrieve 14 case reports of ofloxacin induced FDEs, which were further reviewed.

This paper deals with the presentation of a general, variational principle as theoretical support for the development of simple and efficient triangular elements having only one displacement and two rotations at the corner nodes to model thin to thick plates based on the first order Reissner- Mindlin plate theory. The functional is a modified Hellinger–Reissner mixed expression in terms of the kinematic variables (transverse displacement w and rotations βx and βy ), and independent transverse shear strains ( γx and γy ). The approximations of the five independent variables of the mixed formulation take into account the accumulated knowledge on existing performing 2D Timoshenko beams and triangular elements such as T3γ s , MITC3, DKT, DST, DKMT. The present mixed variational support is useful, not only to give a unique theoretical support to the above existing elements, usually based on assumed natural strain formulations, but it allows also to propose new simple and efficient elements, here called BAK1, BAK2 and BAK3. The paper includes a detailed presentation of results of patch tests for very thin and very thick plates, for convergence of displacements, bending moments and shear forces, for clamped circular and simply supported square plates and for s-norm convergence tests considering regular and irregular meshes. Shear force distribution is also considered for situations with boundary layer effects.

Studies have found that the widely-used one-pass node-to-segment (NTS) algorithm for contacts fails to pass the contact patch test. Solution errors at the contacting surfaces resulting from the classical NTS algorithm do not necessarily decrease with the mesh refinement. This paper presents a novel NTS with the explicit dynamic formulation in detail, which can pass the contact patch test. The proposed algorithm consists of the following technical ingredient: (1) A weighted smoothing technique is developed to accurately evaluate contact forces for contact problems; (2) The central difference time integration scheme is utilized for efficiency, to save storage space, and to avoid the use of tangent stiffness matrix; (3) the penalty method is used for ease in implementation; (4) Our NTS algorithm is coded in the smoothed finite element method (S-FEM). Two S-FEM models are adopted for the proposed NTS algorithm: the node-based smoothed finite element method (NS-FEM) and the edge-based smoothed finite element method (ES-FEM) so that automatically generable triangular elements can be used for excellent adaptation. Numerical examples of the proposed algorithm are presented to examine the performance. It is found that the present algorithm alleviates the nonuniformity of contact pressure on both flat and curve boundaries. ES-FEM and NS-FEM combined with the new NTS algorithm have higher convergence rates. In addition, the ES-FEM has more accurate displacement and stress solutions at the same grid level. NS-FEM can even provide an upper bound solution in the strain energy for contact problems.

Introduction and aim Celiac disease is one of the most common autoimmune disorders. This study aimed to evaluate the relationship between celiac disease and wheat sensitization. Subjects and methods In the current study, children aged < 18 years with confirmed celiac disease were included. Data were analyzed using SPSS. Results Gastrointestinal problems were the most common indication for evaluation in terms of celiac disease. Prick and patch tests were positive in 43.4% and 34% respectively. Conclusion Prick test and patch test for wheat sensitization were positive in about 30–45% of the children for celiac disease.

Allergic reactions caused by local anesthetics are quite rare and these reactions often manifest as Type I (immediate-type) hypersensitivity; however, Type IV (delayed-type) hypersensitivity reactions also hold clinical significance. Type IV reactions are generally T-lymphocyte mediated and symptoms appear hours or days after antigen exposure. In this case report, a rare Type IV hypersensitivity reaction to prilocaine, an amide-type local anesthetic, is described. The patient presented to our center due to the delayed-onset skin lesions that developed after previous surgical procedures and was evaluated through comprehensive allergy testing. A positive delayed-type reaction to prilocaine was observed in the intradermal and patch tests; however, no reaction was detected in the provocation test performed with mepivacaine. This highlights the importance of careful selection of local anesthetics and consideration of Type IV hypersensitivity. Sharing such cases contributes to increased clinical awareness.