1、Designation: D6355 07 (Reapproved 2017)Standard Test Method forHuman Repeat Insult Patch Testing of Medical Gloves1This standard is issued under the fixed designation D6355; the number immediately following the designation indicates the year oforiginal adoption or, in the case of revision, the year
2、of last revision. A number in parentheses indicates the year of last reapproval. Asuperscript epsilon () indicates an editorial change since the last revision or reapproval.1. Scope1.1 This test method is designed to evaluate the potential ofglove materials under test to induce and elicit Type IV sk
3、insensitization reactions (that is, allergic contact dermatitis) inhumans.1.2 This test method should be used by individuals experi-enced in or under the supervision of those experienced in theuse of good clinical practice procedures.1.3 During the performance of the Human Repeat InsultPatch Test (R
4、IPT) for determining sensitization, investigatorsare confronted with skin responses that represent skin irritation(non-immunologic responses) or allergic contact dermatitis(ACD). The numerical scoring system for grading the intensityof both are similar and test facilities may vary in their scorestha
5、t describe intensities of allergic and irritant skin responses.The hallmark of a mild allergic contact dermatitis is a sustainedpalpable erythematous reaction. Delayed-type allergic contactreactions from patch tests have intensity characteristics thatfavor scores of higher values for longer periods
6、of time andtypically do not produce a minimal score (score of 1, ajust-perceptible erythema) for short durations (less than 48 h).It is the responsibility of the investigator to evaluate the scoresin light of irritant reactions so that the responses are allergic innature and not irritant. The invest
7、igator should denote a finalscore as either due to contact allergy or irritation. Paragraphs9.5 9.5.5 describe a commonly used scoring system anddiscuss allergic and irritant responses in detail.1.4 The Draize RIPT was published in 1944 as an attempt todecrease the frequency ACD.2The test techniques
8、 at that timewere just being validated and this experimental design waslargely empiric.3The principle of the test is as follows:1.4.1 Multiple inductions of the study material at relativelynon or low irritancy levels,1.4.2 Approximately a two-week rest period, and1.4.3 Astandard diagnostic challenge
9、 of approximately 48 hand a delayed reading at approximately 96 h after patchapplication.1.5 In the intervening years, with further experimentationadded to this empiric approach, three additional principles havebeen learned:1.5.1 Increasing the concentration of the study material,1.5.2 Defining a no
10、 effect level (this is possible with onlyindividual ingredients and not the final study material), and1.5.3 The enhanced sensitivity and the use of occlusion(where occlusion would not ordinarily be present).1.6 In 1945, Henderson and Riley4demonstrated that a testpanel sample size of 30 000 subjects
11、 would have to beemployed to ensure statistically that there would be no morethan 0.1 % sensitization. If there are no allergic responses in atest panel of 200 subjects with exposures comparable to thoseof the population, then there could be as many as 1.5 allergicreactions per 100 users.1.7 All med
12、ical devices must be safe and effective for theirintended use. Since medical devices such as gloves come incontact with human tissue, they should be tested for biocom-patibility in animals first. The human repeat insult patch test(RIPT) is one test that can be used to test rubber gloves for skinsens
13、itization to chemicals used in the manufacture of gloves.1.7.1 Since various forms of the RIPT exist, a singlestandardized test method that outlines the testing protocol,scoring system, and the criteria for skin sensitization should bedeveloped.1.8 This standard does not purport to address all of th
14、esafety concerns, if any, associated with its use. It is theresponsibility of the user of this standard to establish appro-priate safety and health practices and determine the applica-bility of regulatory limitations prior to use.1.9 This international standard was developed in accor-dance with inte
15、rnationally recognized principles on standard-ization established in the Decision on Principles for the1This test method is under the jurisdiction of ASTM Committee D11 on Rubberand Rubber-like Materials and is the direct responsibility of Subcommittee D11.40on Consumer Rubber Products.Current editi
16、on approved May 1, 2017. Published July 2017. Originally approvedin 1998. Last previous edition approved in 2012 as D6355 07 (2012). DOI:10.1520/D6355-07R17.2Draize, J.H., Woodward, G., and Calvery, H.O., “Methods for the Study ofIrritation and Toxicity of Substances Applied Topically to the Skin an
17、d MucousMembranes,” Journal of Pharmacology and Experimental Therapeutics, Vol 83,1944, pp. 377-390.3Shelanski, H. A., and Shelanski, M. V., “A New Technique of Human PatchTest,” Proc. Sci. Sect. Toilet Goods Assoc. , Vol 19, 1953, pp. 46-49.4Henderson, C. R., and Riley, E. C., “Certain Statistical
18、Considerations in PatchTesting,” Journal of Investigative Dermatology , Vol 6, 1945, pp. 227-232.Copyright ASTM International, 100 Barr Harbor Drive, PO Box C700, West Conshohocken, PA 19428-2959. United StatesThis international standard was developed in accordance with internationally recognized pr
19、inciples on standardization established in the Decision on Principles for theDevelopment of International Standards, Guides and Recommendations issued by the World Trade Organization Technical Barriers to Trade (TBT) Committee.1Development of International Standards, Guides and Recom-mendations issu
20、ed by the World Trade Organization TechnicalBarriers to Trade (TBT) Committee.2. Terminology2.1 Definitions:2.1.1 allergen, na substance capable of causing an allergicreaction.2.1.2 allergic contact dermatitis (ACD), n a Type IVdelayed-in-time dermatitis that is caused by skin contact witha hapten t
21、hat evokes a cell-mediated (delayed-type hyersensi-tivity) immune response.2.1.3 allergic contact dermatitis reaction, nan adverseimmune response following exposure to chemical (non-protein) allergens.2.1.4 antigen, nany substance that provokes an immuneresponse when introduced into the body.2.1.5 a
22、topic dermatitis, nthe most common form ofchronic inflammatory dermatitis.2.1.5.1 DiscussionAlthough immunologic mechanismsmay play a role in producing this dermatitis, the role of anyallergen in producing and sustaining this morphologicallysimilar dermatitis is not proven or as clearly understood a
23、sclassical allergic contact dermatitis.2.1.6 blister, na vesicle containing serum.2.1.7 bullae, nsynonymous with blister.2.1.8 cell-mediated immunity, nthat portion of the im-mune system mediated by white blood cells called T-cells orT-lymphocytes.2.1.9 challenge test, na medical procedure used to i
24、den-tify a substance to which a person is sensitive by deliberatelyre-exposing them to that substance in an attempt to reproducethe reaction.2.1.10 dermatitis, ninflammation of the skin evidenced byitching, redness, and various skin lesions.2.1.11 diagnostic patch tests, na form of skin testing inwh
25、ich suspected allergens are applied to the skin, covered, andobserved 48 to 96 h or more later to see if a reaction occurs.2.1.11.1 DiscussionThis test is often used to identifypossible causes of allergic contact dermatitis.2.1.12 eczema, nsynonymous with dermatitis.2.1.13 edema, nswelling caused by
26、 excessive infiltrationof fluid into the skin.2.1.14 erythema, nsynonymous with redness of the skin.2.1.15 immune response, nthe activity of specialized cellsor their products against antigens and allergens introduced tothe body.2.1.16 immunize, vto render a patient immune from for-eign substances.2
27、.1.17 induration, nhardening of a tissue due to edemaand cellular infiltration.2.1.18 inflammation, na basic response of the body toinjury, usually characterized by redness of the skin, warmth,swelling, and pain.2.1.19 irritation, na chemically induced dermatosis with-out immunological involvement.2
28、.1.20 mast cells, ntissue cells that contain packets ofbiochemicals responsible for the symptoms of allergy.2.1.20.1 DiscussionWhen allergens attach to IgE antibod-ies sitting on the surface of these cells, a signal is sent, causingthem to release these biochemical mediators of allergy.2.1.21 mediat
29、ors, nsoluble products of immune cells thatinteract and/or activate other parts of the immune system.2.1.22 mild irritant control, na substance that will pro-duce a minimally perceptible dermatitis.2.1.23 neutral control, na substance, such as water, thatthrough clinical usage, has not been found to
30、 be an allergen.2.1.24 papules, nsmall, solid red elevations of the skin.2.1.25 predictive patch test, na repeat insult patch test(RIPT) used as a toxicology test to determine the potential forACD.2.1.26 sensitive, vto expose to an antigen, provoking animmune response so that on re-exposure to that
31、antigen, a moreadvanced secondary response occurs. Synonymous with im-munize.2.1.27 study material, na synthetic or natural polymermaterial used as a medical glove or as a part of a medicalglove.2.1.28 vesicles, nsmall circumscribed fluid-filled eleva-tions of the skin smaller than a blister.3. Summ
32、ary of Test Method3.1 A general medical history of the study subjects shouldbe taken and include information on dermatologic conditionsand sensitivities to specific compounds. Studies conducted inaccordance with this human RIPT protocol will employ aminimum of 200 study subjects. Prior to evaluating
33、 thematerial in a human RIPT, acceptable toxicology data shouldbe obtained. The sensitization potential of the study material isevaluated in a test panel of a minimum group size of 200subjects. The study panel should include men and women. Theinduction phase of the human RIPT includes 10 multiple 48
34、-h(72-h on weekends) patches at the same site typically on theupper back with no rest between repatching except for scoring.The patch site is graded for skin responses prior to eachsubsequent patch application. In the event of any significanterythema, the site of patch application should be moved to
35、another location to confirm the reaction. Following the comple-tion of the induction phase, there is approximately a 21 day restperiod to allow the development of latent sensitization. This isfollowed by two consecutive 48-h challenge patches applied tonaive sites. Responses are evaluated after the
36、removal of eachconsecutive 48-h patch application.Aminimum of two delayedskin site gradings is required to differentiate irritation fromsensitization reactions. If the results are equivocal, a secondchallenge, after the original challenge dermatitis has cleared,may be conducted to ensure that sensit
37、ization was not over-looked.D6355 07 (2017)24. Significance and Use4.1 This RIPT method assesses the potential of skin sensi-tization with a particular medical product by repeated topicalapplications to the skin of selected subjects. This is a procedurethat has the potential to detect many, but not
38、all, sensitzers.This requires multiple applications to induce a cell-mediatedType IV immune response sufficient to cause an allergicreaction.4.2 In general, the sensitization procedure requires 10 mul-tiple 48-h (72-h on weekends) applications of patches contain-ing the study material over a three-w
39、eek induction phase.Induction is followed by approximately a 21 day rest phase toallow the development of any latent sensitization. Studysubjects are then challenged by the application of two consecu-tive 48-h patches of the study material to naive sites. Re-sponses are evaluated and graded after th
40、e removal of eachconsecutive 48-h patch application.4.3 Although this test method is a clinical method, it may beused as part of a risk analysis to determine the potential forType IV allergic contact dermatitis.4.4 This test method assumes that good clinical practiceswill be utilized, including adeq
41、uate training of practitioners.5. Interferences and Precautions5.1 During the course of the study, the area of the studysubjects where the patch is applied should not be bathed,showered, or washed. The patch area must stay dry. Wetpatches can be a source of mild irritation reactions.5.2 Caution: Pat
42、ch testing can involve a certain risk to thesubject due to sensitization or raising of the level of sensitivityto the study material.6. Experimental Plan6.1 Subject Inclusion/Selection Criteria:6.1.1 Subjects ranging from 18 to 65 years.6.1.2 Subjects who complete a medical/personal historyform.6.1.
43、3 Subjects who have read, understood, and signed aninformed consent agreement.6.1.4 Subjects should include both male and female.6.2 Subject Exclusion/Rejection Criteria:6.2.1 Subjects with skin disease that, in the opinion of theinvestigator, could interfere with the evaluation.6.2.2 Subjects takin
44、g medications that, in the opinion of theinvestigator, would interfere with the study.6.2.3 Subjects with clinically significant psoriasis, eczema,or atopic dermatitis.6.2.4 Subjects who are pregnant or become pregnant duringthe study.6.2.5 Subjects with known sensitivity to natural rubber andrubber
45、 chemicals.6.2.6 Subjects who have acquired a recent marked skintanning or sunburn that, in the opinion of the investigator,would interfere with the study.6.2.7 Subjects who have undergone any type of sensitizationtesting within the last thirty days.6.2.8 Subjects who are lactating women.6.2.9 Subje
46、cts exogenously or endogenously immunosup-pressed.6.3 Study Group:6.3.1 Sample SizeA minimum of 200 subjects will com-plete the study.6.3.2 Clinical Sites:6.3.2.1 One clinical location with a minimum total samplesize of 200 subjects.6.3.2.2 The testing may be done in a single clinical locationbut av
47、oiding extreme climatic conditions.7. Institutional Review and Informed Consent7.1 Institutional ReviewThe method for this study shouldbe reviewed by an appropriate Institutional Review Board(IRB).7.2 Informed ConsentAn informed consent documentshould be obtained from each study subject prior to ini
48、tiatingthe study.8. Study Materials and Patch8.1 The patch will be an adhesive bandage witha2by2-cmor larger Webril pad (or equivalent) affixed.8.2 All study materials should be applied in an amountproportionate to the size of the 2 by 2-cm or larger patch.8.3 ANeutral Control patch will be a adhesi
49、ve bandage witha 2 by 2-cm or larger Webril pad (or equivalent) wetted with0.2 mL of distilled or deionized water.8.4 The study glove material should be applied so that theinside glove surface is exposed to the skin of the test subject.9. Study Design9.1 The human RIPT is performed to determine the poten-tial of the product for sensitization under conditions relative toanticipated consumer exposure.9.2 Patch Site:9.2.1 Patches should be applied to the upper back area,either to the right or left of the midline. (The arm may be usedas an alternative p
