Positive patch test reaction without clinical contact dermatitis - what is the best approach in medico-legal evaluation

Abstract

Background: A clinically''silent''sensitization is a positive reaction (considered as allergic) in an epicutaneous patch test (ECT), but without evidence for a current or former clinical relevance in terms of a manifest allergic contact dermatitis. Patients and Methods: Sensitizations without clinical manifestations (''silentsen-sitizations''), secondary allergic sensitizations (after initial irritant dermatitis) and group allergies were analyzed in a cohort of medico-legal evaluations (n = 217) and by 6 typical case-constellations. Results and Conclusion: If a clinically (yet) silent sensitization is likely to be acquired in a causal relationship with a skin disease acknowledged as an ``industrial disease'' (Berufskrankheit Nr. 5101 according to German Law) it has to be considered for the estimation of the degree of impairment of working ability (MdE) and for preventive measures ( 3 BKV) by the German statutory accident insurance.