THE STANDARD SERIES IN THE EPICUTANEOUS PATCH TEST - 1ST RESULTS OF THE PROJECT INFORMATION NETWORK OF DERMATOLOGICAL CLINICS (IVDK)

Presented are the patch test results of 4140 patients from eight skin hospitals, which were gathered during the pilot phase of the multicent er project ''Information Network of Dermatological Clinics'' (IVDK). A sensitization was found in 47% of the people tested. This proportion varies between 30 and 64% from clinic to clinic. Two factors can be co nsidered as the main cause for the great deviations in test results: t he indication for testing which differs from hospital to hospital and a difference in the clinics' rating of reactions (''inter-observer var iability'') which is revealed in this study. Even if the hit list does not differ from other studies with regard to its qualitative composit ion, the multivariate analysis - taking into consideration characteris tics such as age, sex, occupation, neurodermitis, and location of the eczemas - shows considerable quantitative shifts among the sensitizati on frequencies in the case of certain subgroups. So, eg., the importan ce of sensitizations against nickel becomes apparent only after paying regard to age and sex: no less than 41% of the tested women under 30 had a sensitization against nickel - compared to a sensitization frequ ency against nickel of 16.9% in the final hit list. Elder patients, ev en without leg dermatitis, run a considerably higher risk of being sen sitized against externa-associated allergens, eg with a risk factor of 9.9 for neomycin. If additionally, the patient suffers from leg derma titis, the risk increases - in the case of neomycin to 19.9. Since the standard series does not contain any individual or epidemiologic char acteristics, it is limited in its individual diagnostic sensitivity as well as in its epidemiologic relevance. Therefore, eg, 20%, of the po sitive reactions resulted exclusively from additional tests; the hit l ists, the numerical-statistical correlate of the standard series lacks above all a satisfying definition of the epidemiologic reference, the ''denominator'' (x positive cases per defined population unit). Moreo ver, there are considerable fluctuations among the ''numerator quantit ies'', which are due to the distinct observer variability. In spite of this, however, the standard series as well as the hit list maintain t heir value for individual diagnostics and the general frequency balanc ing of the most important allergens.