10%of patch-tested patients have a positive reaction to gold.Most lack clinical symptoms,but allergic contact dermatitis(ACD)to gold is increasing.In this study,77 dermatological outpatients were divided into 3 groups depending on epicutaneous patch test outcomes:a group positive to gold(EPI+),a group negative to gold(EPI-),and a group with irritant reactions to gold(EPI-IR).Lymphocytes were stimulated in vitro with gold sodium thiosulfate.Proliferation was assessed using the lymphocyte transformation test(LTT),and cytokine secretion was assessed using a multi bead array(Luminex;Linco Research Inc.,St.Charles,MO,USA),in order to evaluate whether an in vitro method with high diagnostic accuracy could be devised.The EPI+group showed a significantly increased secretion of interferon(IFN)-γ,interleukin(IL)-2,and IL-13 and also showed a significantly higher stimulation indexes for LTT,compared to the other 2 subject groups.Sensitivity and specificity were calculated for all methods individually and combined,but IFN-γassessment alone was the most accurate method for identifying ACD to gold,with sensitivity and specificity of 81.8%and 82.1%,respectively.This method also identified 87.5%of the EPI-IR subjects as non-allergic.Therefore,assessment of secretion of IFN-γshould be a valuable complement to patch test for diagnosing gold allergy.
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