Abstract：
BACKGROUND: Patch testing for multiple cross-reactive allergens for allergic contact dermatitis (ACD) may not be necessary because of copositivity.
OBJECTIVE: We evaluated the formaldehyde group allergens to determine the optimal, most cost-effective allergens to test.
METHODS: A retrospective analysis of Mayo Clinic (1997-2022) examined the well-established copositive formaldehyde group: formaldehyde, quaternium 15, hexahydro-1,3,5-tris(2-hydroxyethyl)triazine, diazolidinyl urea, imidazolidinyl urea, toluenesulphonamide formaldehyde resin, DMDM hydantoin, and ethyleneurea melamine formaldehyde mix. Patch Optimization Platform identified which single formaldehyde-related allergen optimally captures patients with clinically relevant ACD. Next, Patch Optimization Platform determined the optimal additional 1, 2, 3, etc. allergens. Cost per patch test was $5.19 (Medicare 2022).
RESULTS: A total of 9832 patients were tested for all listed allergens, with 830 having positive patch test results. Patch Optimization Platform determined that quaternium 15 alone captures 53% of patients with ACD to the formaldehyde group; adding the optimal second allergen (formaldehyde 1%) captures 78%; the optimal 5 top allergens capture >94% of patients. The incremental cost per additional diagnosis increased up to 44-fold as the number of allergens tested increased.
CONCLUSIONS: Data are from a single institution, and the cost per test was fixed according to Medicare Part B in 2022.
CONCLUSIONS: For diagnosing ACD, we recommend considering an optimized allergen selection algorithm.
OBJECTIVE: We evaluated the formaldehyde group allergens to determine the optimal, most cost-effective allergens to test.
METHODS: A retrospective analysis of Mayo Clinic (1997-2022) examined the well-established copositive formaldehyde group: formaldehyde, quaternium 15, hexahydro-1,3,5-tris(2-hydroxyethyl)triazine, diazolidinyl urea, imidazolidinyl urea, toluenesulphonamide formaldehyde resin, DMDM hydantoin, and ethyleneurea melamine formaldehyde mix. Patch Optimization Platform identified which single formaldehyde-related allergen optimally captures patients with clinically relevant ACD. Next, Patch Optimization Platform determined the optimal additional 1, 2, 3, etc. allergens. Cost per patch test was $5.19 (Medicare 2022).
RESULTS: A total of 9832 patients were tested for all listed allergens, with 830 having positive patch test results. Patch Optimization Platform determined that quaternium 15 alone captures 53% of patients with ACD to the formaldehyde group; adding the optimal second allergen (formaldehyde 1%) captures 78%; the optimal 5 top allergens capture >94% of patients. The incremental cost per additional diagnosis increased up to 44-fold as the number of allergens tested increased.
CONCLUSIONS: Data are from a single institution, and the cost per test was fixed according to Medicare Part B in 2022.
CONCLUSIONS: For diagnosing ACD, we recommend considering an optimized allergen selection algorithm.
摘要：
背景：对于过敏性接触性皮炎（ACD）的多重交叉反应性变应原，可能没有必要进行贴片检测。
目的：我们评估了甲醛组过敏原，以确定最佳的，最具成本效益的过敏原测试。
方法：对梅奥诊所（1997-2022）的回顾性分析检查了公认的共阳性甲醛组：甲醛，季铵15，六氢-1,3,5-三(2-羟乙基)三嗪，二唑烷基脲,咪唑烷基脲，甲苯磺酰胺甲醛树脂，DMDM乙内酰脲,和乙烯脲三聚氰胺甲醛混合。贴片优化平台（POP）确定了哪一种与甲醛相关的过敏原可最佳地捕获具有临床相关ACD的患者。接下来,POP确定了最佳的附加1、2、3等。过敏原。每次补丁测试的费用为5.19美元（Medicare2022）。
结果：9832名患者接受了所有列出的过敏原测试，830的补丁测试呈阳性。POP确定，单独使用Quaternium15可以捕获甲醛组的53％的ACD患者；添加最佳的第二种过敏原（甲醛1％）可以捕获78％；最佳的五种过敏原可以捕获超过94％的患者。随着测试的过敏原数量的增加，每次额外诊断的增量成本增加了44倍。
结论：数据来自单个机构，每次测试的费用在2022年固定到MedicareB部分。
结论：对于诊断ACD，我们建议考虑优化的过敏原选择算法。
目的：我们评估了甲醛组过敏原，以确定最佳的，最具成本效益的过敏原测试。
方法：对梅奥诊所（1997-2022）的回顾性分析检查了公认的共阳性甲醛组：甲醛，季铵15，六氢-1,3,5-三(2-羟乙基)三嗪，二唑烷基脲,咪唑烷基脲，甲苯磺酰胺甲醛树脂，DMDM乙内酰脲,和乙烯脲三聚氰胺甲醛混合。贴片优化平台（POP）确定了哪一种与甲醛相关的过敏原可最佳地捕获具有临床相关ACD的患者。接下来,POP确定了最佳的附加1、2、3等。过敏原。每次补丁测试的费用为5.19美元（Medicare2022）。
结果：9832名患者接受了所有列出的过敏原测试，830的补丁测试呈阳性。POP确定，单独使用Quaternium15可以捕获甲醛组的53％的ACD患者；添加最佳的第二种过敏原（甲醛1％）可以捕获78％；最佳的五种过敏原可以捕获超过94％的患者。随着测试的过敏原数量的增加，每次额外诊断的增量成本增加了44倍。
结论：数据来自单个机构，每次测试的费用在2022年固定到MedicareB部分。
结论：对于诊断ACD，我们建议考虑优化的过敏原选择算法。
