Reproducibility of Patch Test Reactions and Interpretation of Doubtful Results: A Retrospective Study of Identical Haptens Tested Simultaneously in Different Series
- 1Dermato‐Allergology and Occupational Dermatology Amsterdam University Medical Center Amsterdam the Netherlands
Abstract
Background: Reproducibility of patch test reactions remains debated, and the clinical significance of doubtful (?+) reactions is unclear.
Objectives: To evaluate reproducibility of positive reactions to identical haptens tested simultaneously in different series and analyse doubtful reactions using paired co‐reactivity patterns.
Materials and Methods: Patch test data from consecutive patients tested during 2015–2025 were analysed retrospectively. Six haptens were evaluated at standard concentrations in petrolatum: hydroxyisohexyl 3‐cyclohexene carboxaldehyde (Lyral, HICC) 5% pet., Amerchol L‐101 50% pet., lanolin alcohol 30% pet., hydroxyethyl methacrylate (HEMA) 2% pet., mercaptobenzothiazole (MBT) 2% pet. and Myroxylon pereirae resin (balsam of Peru, MPR) 25% pet.
Results: Reproducibility was hapten‐dependent. HEMA and MBT showed substantial to almost perfect agreement. HICC showed substantial agreement but a significantly higher positivity rate in the perfume series than in the baseline series. Amerchol L‐101, lanolin alcohol and MPR showed lower positive agreement and fair‐to‐moderate kappa values. Most doubtful reactions were isolated, particularly for Amerchol L‐101 and lanolin alcohol, whereas 43.8% of doubtful HICC reactions in the baseline series were supported by perfume‐series reactivity.
Conclusions: Reproducibility was strongly hapten‐dependent. In this dataset, paired co‐reactivity provided clinical context for interpreting discordant positive and doubtful reactions.
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BibTeX
@article{ipenburg2026reproducibility,
title = {{Reproducibility of Patch Test Reactions and Interpretation of Doubtful Results: A Retrospective Study of Identical Haptens Tested Simultaneously in Different Series}},
author = {Norbertus A. Ipenburg and Anton C. de Groot and Thomas Rustemeyer},
journal = {Contact Dermatitis},
year = {2026},
month = sep,
doi = {10.1111/cod.70251},
url = {https://doi.org/10.1111/cod.70251},
note = {CC BY-NC-ND 4.0},
}
RIS
TY - JOUR
TI - Reproducibility of Patch Test Reactions and Interpretation of Doubtful Results: A Retrospective Study of Identical Haptens Tested Simultaneously in Different Series
AU - Norbertus A. Ipenburg
AU - Anton C. de Groot
AU - Thomas Rustemeyer
PY - 2026
DA - 2026/09/23
JO - Contact Dermatitis
DO - 10.1111/cod.70251
UR - https://doi.org/10.1111/cod.70251
AB - Background: Reproducibility of patch test reactions remains debated, and the clinical significance of doubtful (?+) reactions is unclear. Objectives: To evaluate reproducibility of positive reactions to identical haptens tested simultaneously in different series and analyse doubtful reactions using paired co‐reactivity patterns. Materials and Methods: Patch test data from consecutive patients tested during 2015–2025 were analysed retrospectively. Six haptens were evaluated at standard concentrations in petrolatum: hydroxyisohexyl 3‐cyclohexene carboxaldehyde (Lyral, HICC) 5% pet., Amerchol L‐101 50% pet., lanolin alcohol 30% pet., hydroxyethyl methacrylate (HEMA) 2% pet., mercaptobenzothiazole (MBT) 2% pet. and Myroxylon pereirae resin (balsam of Peru, MPR) 25% pet. Results: Reproducibility was hapten‐dependent. HEMA and MBT showed substantial to almost perfect agreement. HICC showed substantial agreement but a significantly higher positivity rate in the perfume series than in the baseline series. Amerchol L‐101, lanolin alcohol and MPR showed lower positive agreement and fair‐to‐moderate kappa values. Most doubtful reactions were isolated, particularly for Amerchol L‐101 and lanolin alcohol, whereas 43.8% of doubtful HICC reactions in the baseline series were supported by perfume‐series reactivity. Conclusions: Reproducibility was strongly hapten‐dependent. In this dataset, paired co‐reactivity provided clinical context for interpreting discordant positive and doubtful reactions.
SN - 0105-1873
SN - 1600-0536
ER -