Enf.ª Célia Nogueira

Immunology Nursing Consultation

Epicutaneous tests

HPA Magazine 22 // 2024

Within the scope of the Immunoallergology Consultation, several complementary diagnostic methods are prescribed. Most of the techniques and procedures require exposure to allergenic products, which is why they must be prepared and carried out in the Immunoallergology Nursing consultation by a nurse with skills and experience in this area.
Personalized monitoring, continuous observation, and careful assessment are the foundation for an adequate response in the evaluation and management of possible reactions. Depending on the risk of reaction and degree of complexity, these procedures can be carried out in different spaces.

The time required to perform the procedure/technique must take into account the time spent on it directly, as well as that necessary for preparation, observation, resolution of complications, recording, and adequate teaching. This teaching must be personalized and according to the identified individual age and maturity. In this consultation, users of all age groups are served.
Teamwork is essential to providing quality care.
Complaints related to the skin are common in Immunoallergology Consultations. Two diseases, in particular, are related to possible allergic disease: atopic eczema and contact dermatitis. Both are characterized by the appearance of areas of redness, with peeling and crusting. The extent, location, and severity of the injuries are variable. Pruritus (itching) is the dominant symptom, often with great repercussions on quality of life. Scratching contributes to inflaming the skin and making the itching even worse. In the chronic phase of the disease, dry, scaly skin with abrasions (scratches) and skin thickening are observed.
In the case of contact dermatitis, direct and continuous contact with an allergenic agent causes the signs and symptoms. The symptoms of both diseases are not, however, the same in everyone, and in the same person, they can vary over time, whether in their severity or location.
Occupational contact dermatitis is related to professions where there is greater contact with allergens. Examples include hairdressing workers, fishing, agriculture, horticulture, and forestry, food and hospitality industry, cleaning, painting, and printing workers, healthcare professionals, dentists and veterinarians, metallurgical industry, mechanical engineering, and construction workers.
Products such as nickel (jewelry, coins, cutlery), fragrances (perfumes, creams), paraphenylenediamine (hair dyes), chromium (fresh cement, glues, adhesives), formaldehyde (creams and other topical products), parabens (preservatives in creams and sunscreens) are some of the most common contact allergens.
The diagnosis of contact allergy is made through clinical history (data collected during the consultation, signs, symptoms, and complaints from users) and the positivity of epicutaneous tests, also known as patch tests. These consist of applying a small amount of allergen into occluded chambers of skin adhesive.
There are sets of products that are strategically aggregated to be tested simultaneously. These groups of allergen presuppositions batteries. In our consultation, we use several, namely the standard Portuguese battery or batteries made from metals, cosmetics, fragrances, corticosteroids, acrylates, or hairdressing products.

The stickers with the specific prescribed products are placed on the upper part of the back and must be kept on for 48 hours. Education is provided on the care to be taken during the period from placement to removal. The teaching focuses mainly on the importance of not getting them wet, and physical exertion activities and exposure to heat also interfere with the integrity of the tests, due to perspiration. After this period, the stickers are removed, a first reading is taken, and a second reading will be carried out at 96 hours. The tests are prepared, placed, and removed by the nurse with experience in this field, as well as appropriate teaching. The reading, interpretation, and report are carried out by the immunoallergologist.

In summary:
· In the Immunoallergology Nursing consultation, several procedures prescribed in the medical consultation are carried out;
· Most procedures involve exposure to the allergenic product;
· Users with skin-related complaints are frequent. One of the causes is contact dermatitis;
· The signs and symptoms of contact dermatitis contribute negatively to the user's quality of life;
· In the diagnosis of contact dermatitis, the positivity of the skin patch test is decisive;
· Epicutaneous tests - patch tests - consist of applying a small amount of allergen to occluded chambers;
· The diagnosis of contact dermatitis leads to appropriate and targeted treatment, which results in an improvement in the user's quality of life.