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December 1996

Allergic Contact Dermatitis From Doxepin Cream-Reply

Author Affiliations

Section of Industrial Dermatology Cleveland Clinic Foundation Cleveland, OH 44195-5032

Youngstown, Ohio

Wooster, Ohio

Arch Dermatol. 1996;132(12):1517-1518. doi:10.1001/archderm.1996.03890360111025

Rapaport's assertions about predictive patch testing and challenges to the validity of our article are not supported by published facts or careful review of our results. Despite GenDerm Corp's negative predictive patch test data for irritation and allergy to doxepin hydrochloride cream (Zonalon, GenDerm Corp, Lincolnshire, Ill) in 494 patients, the Zonalon monograph continues, "[there was] one subject with a mild reaction (<0.2% sensitization)" and concludes, "[there was] low risk of irritation and sensitization."1 It does not state that no contact allergy would be expected. According to Jordan's review2 of Henderson and Riley's3 1945 article on predictive patch testing statistics, "A test panel would have to employ thirty thousand subjects to ensure statistically that there would be no more than one sensitization per 1000 users."2 Jordan further shows that in some cases exaggerated test concentrations can increase the number of test subjects who become positive and

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