Resposta ao teste de contato com bateria latino-americana adaptada em indivíduos atendidos em hospital de referência em dermatologia e alergologia no Sistema Único de Saúde do Distrito Federal

Abstract

Background: Contact dermatitis is an inflammatory pruritic skin reaction that occurs through direct or indirect contact with substances harmful to the skin. It is the most common form of eczema, the main characteristic of which is that it is preventable. Patch testing is the main investigative tool in the diagnosis of allergic contact dermatitis. In Brazil, a baseline series is commonly used, based on a study carried out 25 years ago. Currently, the Colegio Ibero-Latinoamericano de Dermatología proposes a more comprehensive series, with relevant substances and in concentrations updated in the most recent scientific papers that could be adopted by all Latin American countries, but there aren't national studies on it. Objectives: General - To analyze the clinical and epidemiological characteristics of individuals with suspected contact dermatitis and to establish the etiologic diagnosis using the Latin American series adapted in a hospital and public service, a reference in allergology and dermatology in the Sistema Único de Saúde of the Distrito Federal. Specifics - To describe the clinical results and outcomes of case reports of individuals with allergic manifestations, aiming to demonstrate to the medical-scientific community the importance of performing this diagnostic procedure. Method: A cross-sectional, observational, descriptive, and analytical clinical study was performed. A total of 252 individuals were recruited at the Hospital Regional da Asa Norte (Brasília-DF) from March to December 2020. Of this total, 44 participants dropped out of the procedure due to fear of the pandemic situation of COVID-19. The results of 208 participants who underwent patch testing using an adapted Latin American baseline series containing 40 allergens were analyzed, and the prevalence of contact allergies was compared with data from the literature. Pearson's chi-square test was used to calculate the odds ratio and respective 95% confidence interval for qualitative variables. Quantitative variables were compared using the Mann-Whitney U test. The four most prevalent allergens were entered into multiple binary logistic regression models as response variables to identify the main explanatory variables associated with these allergies. The significance of the regression parameters was tested using the Wald statistical test. Multivariate logistic regression analysis was performed to assess risk factors associated with positive contact test. Results: The mean age among those who underwent the procedure was 42.6 years. Most participants were white (66.3%). A time of disease evolution of more than three years was the most frequent (36.5%). An occupational history was detected in 19.2%. A total of 69.7% had one or more positive tests. Among those with positive tests, 82.8% were women (OR = 1.371; p = 0.398). The hands were the most commonly affected site at 43%. Among participants with a positive patch test, 57.3% (OR = 0.793; p = 0.457) reported a personal history of atopy and 58.74% (OR = 1.208; p = 0.539) reported some family history of atopy. Regarding the number of positive reactions, most participants had one to three reactions. The most common allergen was nickel sulfate (32.2%), followed by sodium tetrachloropalladate (19.7%), fragrance mix I (15.4%), and methylisothiazolinone (13.5%). In multivariate logistic regression models, nickel was significantly related to female sex (p < 0.05), as well as palladium (p < 0.05). Fragrance mix I was related to a family history of allergy (p < 0.05). On the other hand, methylisothiazolinone was statistically significantly related to face (p < 0.05) and hand (p < 0.001) lesions. Conclusion: This research allowed the understanding of the profile of the evaluated population with suspected contact allergy, during the COVID-19 pandemic that occurred during the course of the study.