Patch testing for multiple cross-reactive allergens for allergic contact dermatitis (ACD) may not be necessary because of copositivity. We evaluated the formaldehyde group allergens to determine the optimal, most cost-effective allergens to test. 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). 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. Data are from a single institution, and the cost per test was fixed according to Medicare Part B in 2022. For diagnosing ACD, we recommend considering an optimized allergen selection algorithm.

中文翻译：

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同一组内斑贴测试过敏原的成本效益：优化甲醛相关过敏原选择的计算方法


由于过敏性接触性皮炎 (ACD) 的多种交叉反应性过敏原的共阳性性，可能不需要进行斑贴试验。我们评估了甲醛组过敏原，以确定要测试的最佳、最具成本效益的过敏原。 Mayo Clinic (1997-2022) 的回顾性分析检查了成熟的共阳性甲醛组：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乙内酰脲和亚乙基脲三聚氰胺甲醛的混合物。贴片优化平台确定了哪种单一甲醛相关过敏原最能捕获患有临床相关 ACD 的患者。接下来，补丁优化平台确定了最佳的附加 1、2、3 等过敏原。每次斑贴测试的成本为 5.19 美元（Medicare 2022）。共有 9832 名患者接受了所有列出的过敏原测试，其中 830 名患者斑贴试验结果呈阳性。贴片优化平台确定仅使用季铵盐 15 即可将 53% 的 ACD 患者纳入甲醛组；添加最佳第二种过敏原（甲醛 1%）可捕获 78%；最佳的 5 种顶级过敏原覆盖了 >94% 的患者。随着检测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。数据来自单一机构，每次测试的成本根据 2022 年 Medicare B 部分固定。为了诊断 ACD，我们建议考虑优化的过敏原选择算法。