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Brumley C, Arora P, Hylwa SA. Characterization of Pediatric Patch Testing: A Retrospective Review, 2020-2023. Dermatitis 2024. [PMID: 38913333 DOI: 10.1089/derm.2024.0005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/25/2024]
Abstract
Background: Recent evidence shows similar rates of allergic contact dermatitis (ACD) among children and adults despite children accounting for less than 10% of patch testing subjects. With a need for in-depth analyses of pediatric ACD, we herein characterize a pediatric cohort at a large North American patch testing center. Methods: A retrospective chart review was conducted for 135 patients ages 1-17 years who underwent patch testing from July 2020 from August 2023. Data were stratified by age 1-5, 6-11, and 12-17 years. Significance-Prevalence Index Numbers (SPIN) were calculated. Results: A total of 86% were sensitized, 40% had a relevant reaction, and positivity rates were equal between males and females. Top allergens by SPIN differed with age, but overall were linalool hydroperoxides (SPIN = 11.01), propylene glycol (10.30), limonene hydroperoxides (10.27), fragrance mix I (5.62), and lanolin (4.90). In total, 14% of the top allergens were not represented on the North American Contact Dermatitis Group standard series. Of those tested to personal products, 45% had positive reactions and 72% of which were relevant. Conclusions: Emulsifiers and fragrances were the most relevant allergen categories, with the impact of emulsifiers not previously reported. ACD may affect males and females equally in this population. Supplemental allergens and personal products tested "as-is" contribute to conclusive pediatric patch testing.
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Affiliation(s)
- Caroline Brumley
- From the Department of Dermatology, Park Nicollet Health Services, Minneapolis, Minnesota, USA
- University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Puneet Arora
- From the Department of Dermatology, Park Nicollet Health Services, Minneapolis, Minnesota, USA
- University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Sara A Hylwa
- From the Department of Dermatology, Park Nicollet Health Services, Minneapolis, Minnesota, USA
- Department of Dermatology, Hennepin Healthcare, Minneapolis, Minnesota, USA
- Department of Dermatology, University of Minnesota, Minneapolis, Minnesota, USA
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2
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Slodownik D, Bar J, Solomon M, Lavy Y, Baum S, Mordechai Galed O, Cnaan R, Solomon-Cohen E, Horev L, Daniely D. Pediatric Contact Dermatitis: A 10-Year Multicenter Retrospective Study. Dermatitis 2023; 34:399-404. [PMID: 37192492 DOI: 10.1089/derm.2023.0009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
Background: Although allergic contact dermatitis (ACD) is relatively common in the adult and pediatric populations alike, few studies describe the special features of contact sensitization among the Israeli pediatric populations, none of them is multicenter. Our study aims to describe and analyze patch test results and trends in 4 tertiary care centers between 2012 and 2022. Methods: We assessed the results of 357 patch tests performed on children 0-18 years old between 2012 and 2022 in designated clinics in 4 tertiary medical centers. All patients were tested using the European baseline series and additional series as clinically indicated. We assessed the demographic features, atopic features, and influence, as well as the main allergens to cause sensitization and allergic contact dermatitis among the pediatric population. Results: In total 69% of the study population were females, mainly 12-18 years old, 35% of the study population were previously diagnosed with atopic dermatitis, and 57% had an atopic diathesis. Females were more commonly sensitized (P < 0.05). Patients without atopic dermatitis were more commonly diagnosed with ACD and had more reactions on patch test (P < 0.05). The most common allergens to cause ACD are preservatives and metals, as previously described, however, acrylate sensitivity is an emerging group that has not been described among the Israeli pediatric population in previous studies. Fragrance mix 2 and Mroxylon pereirae are relatively rare allergens among the Israeli pediatric population, whereas linalool hyperoxide might be considered an emerging allergen. Methylisothiazolinone causes ACD more frequently among patients without atopic dermatitis (P < 0.05). Conclusions: Among the Israeli pediatric population, ACD is more common in females without atopic dermatitis. Acrylates become a common culprit and should be included in baseline series. Patients with atopic dermatitis are less frequently sensitized by methylisothiazolinone.
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Affiliation(s)
- Dan Slodownik
- From the Department of Dermatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jonathan Bar
- From the Department of Dermatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michal Solomon
- Department of Dermatology, The Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Yaron Lavy
- Department of Dermatology, The Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Sharon Baum
- Department of Dermatology, The Chaim Sheba Medical Center, Tel Hashomer, Israel
| | | | - Roten Cnaan
- Department of Dermatology, The Chaim Sheba Medical Center, Tel Hashomer, Israel
| | | | - Liran Horev
- Department of Dermatology, Hadassah University Medical Center, Jerusalem, Israel; and
- Shamir Medical Center, Zerifin, Israel
| | - Danny Daniely
- From the Department of Dermatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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3
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Chamani S, Mobasheri L, Rostami Z, Zare I, Naghizadeh A, Mostafavi E. Heavy metals in contact dermatitis: A review. J Trace Elem Med Biol 2023; 79:127240. [PMID: 37331278 DOI: 10.1016/j.jtemb.2023.127240] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 06/01/2023] [Accepted: 06/06/2023] [Indexed: 06/20/2023]
Abstract
Contact dermatitis is an inflammatory skin reaction caused by direct contact with chemical substances in the environment and can either be irritant or allergic in nature. The clinical symptoms of contact dermatitis, include local skin rash, itching, redness, swelling, and lesions. Nowadays, 15-20% of people have some degree of contact dermatitis, which can be more or less severe. Immune responses in allergic contact dermatitis (ACD) are due to the effects of cytokines and allergen-specific CD4+ and CD8+ T cells on the skin. Acids and alkalis such as drain cleaners, plants such as poinsettias, hair colors, and nail polish remover, are all prominent causes of irritant contact dermatitis (ICDs). Heavy metals are metallic elements with a high atomic weight that are hazardous in low quantities and are known to cause dermatitis after systemic or local exposure. Nickel (Ni), chromium (Cr), lead (Pb), and copper (Cu) are among the most common heavy metals used in various industries. Metal allergies may cause ACD and also systemic contact dermatitis (SCD). Contact dermatitis is detected by laboratory tests such as patch testing, lymphocyte stimulation test (LST), and evaluation of cytokine production by primary cultures of peripheral blood mononuclear cells. This article presents an update on the epidemiological and clinical characteristics of ACD and SCD caused by three heavy metals (Cr, Cu, and Pb). Ni is not discussed due to recent coverage. Furthermore, the effects of contact sensitivity to some other heavy metals, such as gold (Au), cobalt (Co), palladium (Pd), and mercury (Hg) are discussed.
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Affiliation(s)
- Sajad Chamani
- Medical Toxicology and Drug Abuse Research Center (MTDRC), Birjand University of Medical Sciences, Birjand, Iran
| | - Leila Mobasheri
- Department of Pharmacology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Zeinab Rostami
- Student Research Committee, Mazandaran University of Medical Sciences, Sari, Iran
| | - Iman Zare
- Research and Development Department, Sina Medical Biochemistry Technologies Co. Ltd., Shiraz 7178795844, Iran
| | - Ali Naghizadeh
- Medical Toxicology and Drug Abuse Research Center (MTDRC), Birjand University of Medical Sciences, Birjand, Iran.
| | - Ebrahim Mostafavi
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA 94305, USA; Department of Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA.
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4
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Jenkins BA, Belsito DV. Lanolin. Dermatitis 2023; 34:4-12. [PMID: 36917502 DOI: 10.1089/derm.2022.0002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Lanolin is a complex mixture of high molecular weight esters, aliphatic alcohols, sterols, fatty acids, and hydrocarbons that has been widely used for centuries for its emollient properties. The purification of crude lanolin into lanolin wax and the processing of this wax into various derivatives began in 1882 and continue to this day with newer highly purified anhydrous lanolins. Controversy as to lanolin's allergenicity began in the 1920s and remains an issue. The most appropriate patch test preparation(s) for detecting allergy remain disputed. Detection of lanolin-induced contact dermatitis in diseased skin by patch testing on normal skin may lead to false negative results. Patients with a positive patch test to lanolin may tolerate use of lanolin on normal skin. Although lanolin is a weak sensitizer and the frequency of contact allergy to it in the European population reportedly is 0.4%, there are high-risk concomitant conditions: stasis dermatitis, leg ulcers, perianal/genital dermatitis, and atopic dermatitis (AD). Children and the elderly are also at greater risk of developing contact allergy to lanolin, partly because of comorbidities (AD and stasis dermatitis/leg ulcers, respectively). Finally, in the United States, non-Hispanic white patients are more likely than their non-Hispanic black counterparts to be lanolin allergic.
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Affiliation(s)
- Blair A Jenkins
- From the Department of Dermatology, Columbia University Irving Medical Center, New York, New York, USA
| | - Donald V Belsito
- From the Department of Dermatology, Columbia University Irving Medical Center, New York, New York, USA.,D.V.B. is a member of the expert panel for cosmetic ingredient safety, Washington, DC, and the expert panel for fragrance safety, Woodcliff Lake, NJ
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5
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Silverberg JI, Patel N, Warshaw EM, Maibach HI, Belsito DV, DeKoven JG, Zug KA, Taylor JS, Sasseville D, DeLeo VA, Pratt MD, Reeder MJ, Atwater AR, Fowler JF, Houle MC. Patch testing with Cobalt in Children and Adolescents: North American Contact Dermatitis Group experience, 2001 to 2018. Contact Dermatitis 2022; 87:420-429. [PMID: 35801686 DOI: 10.1111/cod.14185] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 06/12/2022] [Accepted: 07/05/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Allergic contact dermatitis (ACD) to cobalt is more common in children and adolescents than adults. However, detailed information on sites and sources of cobalt ACD are limited. OBJECTIVES To assess trends in positive and clinically relevant patch test reactions to cobalt in children and associated patient characteristics, common sources, and body sites affected. METHODS A retrospective analysis of children (<18 years) patch tested to cobalt by the North American Contact Dermatitis Group between 2001-2018. RESULTS Of 1,919 children patch tested, 228 (11.9%) and 127 (6.6%) had a positive/allergic or currently relevant patch test reaction to cobalt, respectively. The most common primary body sites affected were scattered generalized (30.0%), face, not otherwise specified (NOS, 10.6%), and trunk (10.1%). Patients with allergic and currently relevant allergic patch test reactions were more likely to have a primary site of trunk (P=.0160 and P=.0008) ears (P=.0005 and P<.0001). Affected body site(s) varied by cobalt source among patients with currently relevant reactions, especially for less common sources. The most commonly identified sources of cobalt included jewelry, belts, and clothing. CONCLUSIONS Positive patch test reactions to cobalt were common in children. Most common body site was scattered generalized and the sources of cobalt varied by body site. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Jonathan I Silverberg
- Department of Dermatology, George Washington University School of Medicine, Washington D.C., USA; Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Nisha Patel
- Department of Dermatology, George Washington University School of Medicine, Washington, DC, USA
| | - Erin M Warshaw
- Department of Dermatology, Park Nicollet Health Services, Minneapolis, MN.,Department of Dermatology, University of Minnesota, Minneapolis, MN.,Department of Dermatology, Minneapolis Veterans Affairs Medical Center
| | - Howard I Maibach
- Department of Dermatology, University of California San Francisco
| | - Donald V Belsito
- Department of Dermatology, Columbia University Irving Medical Center, New York, NY
| | - Joel G DeKoven
- Division of Dermatology, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada
| | - Kathryn A Zug
- Department of Dermatology, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | | | - Denis Sasseville
- Division of Dermatology, Montreal General Hospital, McGill University, Montreal, Quebec, Canada
| | - Vincent A DeLeo
- Department of Dermatology, Keck School of Medicine, Los Angeles, CA
| | - Melanie D Pratt
- Division of Dermatology, University of Ottawa, Ontario, Canada
| | - Margo J Reeder
- Department of Dermatology, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Amber R Atwater
- Department of Dermatology, Duke University Medical Center, Durham, NC
| | | | - Marie-Claude Houle
- Division of Dermatology, Centre Hospitalier Universitaire (CHU) de Québec, Laval University, Quebec, Canada
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6
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Goossens A, Aerts O. Contact allergy to and allergic contact dermatitis from formaldehyde and -releasers: A clinical review and update. Contact Dermatitis 2022; 87:20-27. [PMID: 35229319 DOI: 10.1111/cod.14089] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 02/22/2022] [Accepted: 02/24/2022] [Indexed: 11/29/2022]
Abstract
This review aims to provide a clinically useful update regarding the role of formaldehyde (FA) and its five main releasers (FRs) quaternium-15, diazolidinyl urea, DMDM hydantoin, imidazolidinyl urea and 2-bromo-2-nitropropane-1,3-diol (bronopol) in contact allergy and allergic contact dermatitis. These ubiquitous preservatives are still often, and sometimes undeclared, present in cosmetics, pharmaceuticals, medical devices, household detergents and chemical (industrial) products. In Europe, the use of free FA and quaternium-15 in cosmetics is forbidden and contact allergy rates have been found to be stable to decreasing. However, FA/FRs still readily provoke localized (e.g., facial/hand), airborne and generalized dermatitis, and may also complicate atopic and stasis dermatitis, or result in nummular dermatitis. Seborrheic-, rosacea- and impetigo-like dermatitis have recently been reported. For a correct diagnosis, FA 2% aq. (0.60 mg/cm2 ) should be used, and particularly the FRs bronopol 0.5% pet. and diazolidinyl urea 2% should be patch tested separately in a baseline series. If sensitization to FA occurs, both FA and FRs should preferably be avoided, except perhaps for bronopol in case it tests negatively. If a patient reacts to one or more FRs (such as bronopol, or diazolidinyl/imidazolidinyl urea), but not to FA, then the specific FR(s) should be avoided. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- An Goossens
- Department of Dermatology, University Hospitals KU Leuven, Leuven, Belgium
| | - Olivier Aerts
- Department of Dermatology, University Hospital Antwerp (UZA) and Research group Immunology, INFLA-MED Centre of Excellence, University of Antwerp, Antwerp, Belgium
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7
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Wee C, Tan CH, Zhao X, Yew YW, Goon A. Pattern of contact sensitisation in patients with and without atopic dermatitis in an Asian dermatology centre. Contact Dermatitis 2022; 86:398-403. [PMID: 35133669 DOI: 10.1111/cod.14068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 01/28/2022] [Accepted: 02/07/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Although the traditional understanding is that contact sensitisation is less frequent in atopic dermatitis (AD) patients, recent studies have shown similar or higher rates of positive patch test results in AD patients. METHODS This was a single-centre, ten-year retrospective review on contact sensitisation in patients who underwent patch testing between 2007 and 2017. The aims were to characterise the pattern of contact sensitisation and to ascertain a link between contact sensitisation and AD. RESULTS There were 4903 patients (males:females = 1:1.4; mean age 40.1 years old) included. About half (2499, 51.0%) of all patients developed at least one positive reaction. The top five frequent reactions were to nickel sulfate (45.4%), potassium dichromate (16.0%), p-phenylenediamine (13.4%), Myroxylon pereirae (11.8%) and fragrance mix I (11.2%). The overall prevalence of contact sensitisation was not significantly different between patients with or without AD. Patients with AD were less likely to develop contact allergies to budesonide and thiuram mix, and more likely to develop contact allergies to potassium dichromate. CONCLUSIONS Contact sensitisation was detected in 50% of patients patch-tested. Nickel sulfate was the most frequently sensitising allergen. The prevalence of contact allergies in atopic patients is comparable to that in non-atopic patients. This article is protected by copyright. All rights reserved.
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Affiliation(s)
| | | | | | - Yik Weng Yew
- National Skin Centre, Singapore.,Lee Kong Chian School of Medicine, Singapore
| | - Anthony Goon
- National Skin Centre, Singapore.,Lee Kong Chian School of Medicine, Singapore
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8
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Silverberg JI, Hou A, Warshaw EM, DeKoven JG, Maibach HI, Belsito DV, Zug KA, Taylor JS, Sasseville D, Dunnick CA, Houle MC, Atwater AR, Reeder MJ, DeLeo VA, Pratt MD, Fowler JF, Zirwas MJ, Marks JG. Age-related differences in patch testing results among children: Analysis of North American Contact Dermatitis Group Data, 2001-2018. J Am Acad Dermatol 2021; 86:818-826. [PMID: 34314743 DOI: 10.1016/j.jaad.2021.07.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 07/08/2021] [Accepted: 07/15/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND An updated understanding of allergic contact dermatitis is needed, particularly in children. OBJECTIVES To compare positive and clinically relevant reactions in children versus adults referred for patch testing. METHODS Retrospective analysis of 1871 children and 41,699 adults from the North American Contact Dermatitis Group (NACDG) from 2001-2018. RESULTS Both final diagnosis of allergic contact dermatitis (55.2% versus 57.3%; chi square, P = .0716) and prevalence of ≥ 1 currently relevant reaction to a NACDG screening allergen (49.2% vs 52.2%; P = .1178) were similar between children and adults. Currently in children, the most common relevant allergens were nickel sulfate (17.3%), hydroperoxides of linalool (7.8%), methylisothiazolinone (7.7%), cobalt chloride (7.0%), and fragrance mix I (4.9%). Approximately a fifth of children had a positive reaction to a non-NACDG allergen. CONCLUSION Over half of children referred for patch testing were diagnosed with allergic contact dermatitis. The most common relevant allergens in children were nickel sulfate, cobalt chloride, and hydroperoxides of linalool. Twenty percent of children had at least 1 positive reaction to allergens/substances not on the NACDG screening series, underscoring the need for comprehensive testing.
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Affiliation(s)
- Jonathan I Silverberg
- Department of Dermatology, George Washington University School of Medicine, Washington, DC; Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
| | - Alexander Hou
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Erin M Warshaw
- Department of Dermatology, Park Nicollet Health Services, Minneapolis, Minnesota; Department of Dermatology, University of Minnesota, Minneapolis, Minnesota; Department of Dermatology, Minneapolis Veterans Affairs Medical Center, Minneapolis, Minnesota
| | - Joel G DeKoven
- Division of Dermatology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Howard I Maibach
- Department of Dermatology, University of California San Francisco, San Francisco, California
| | - Donald V Belsito
- Department of Dermatology, Columbia University Irving Medical Center, New York, New York
| | - Kathryn A Zug
- Department of Dermatology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - James S Taylor
- Department of Dermatology, Cleveland Clinic, Cleveland, Ohio
| | - Denis Sasseville
- Division of Dermatology, Montreal General Hospital, McGill University, Montreal, Quebec, Canada
| | - Cory A Dunnick
- Department of Dermatology, University of Colorado, Aurora, Colorado
| | - Marie-Claude Houle
- Division of Dermatology, Centre Hospitalier Universitaire de Quebec, Laval University, Quebec City, Quebec, Canada
| | - Amber R Atwater
- Department of Dermatology, Duke University Medical Center, Durham, North Carolina
| | - Margo J Reeder
- Department of Dermatology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Vincent A DeLeo
- Department of Dermatology, Keck School of Medicine, Los Angeles, California
| | - Melanie D Pratt
- Division of Dermatology, University of Ottawa, Ottawa, Ontario, Canada
| | - Joseph F Fowler
- Division of Dermatology University of Louisville, Louisville, Kentucky
| | - Matthew J Zirwas
- Department of Dermatology, Ohio State University, Columbus, Ohio
| | - James G Marks
- Department of Dermatology, Pennsylvania State University, State College, Hershey, Pennsylvania
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9
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Brown C, Yu J. Pediatric Allergic Contact Dermatitis. Immunol Allergy Clin North Am 2021; 41:393-408. [PMID: 34225896 DOI: 10.1016/j.iac.2021.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Allergic contact dermatitis (ACD) affects up to 20% of adults and children, although children are infrequently patch tested. Available data suggest that children and adults, with or without atopic dermatitis, have the same prevalence of ACD. Patch testing is the gold standard for evaluation of ACD. The Pediatric Baseline Series was recently published by expert consensus for use in pediatric patch testing, with additional allergens tested as guided by history. This article examines methods of patch testing and up-to-date data on pediatric ACD. The top allergens are reviewed, and avoidance strategies are discussed.
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Affiliation(s)
- Christen Brown
- Tulane University School of Medicine, 1430 Tulane Avenue, New Orleans, LA 70112, USA
| | - JiaDe Yu
- Department of Dermatology, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
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10
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Clinical Features of Contact Dermatitis. Contact Dermatitis 2021. [DOI: 10.1007/978-3-030-36335-2_15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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11
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Neale H, Garza-Mayers AC, Tam I, Yu J. Pediatric allergic contact dermatitis. Part 2: Patch testing series, procedure, and unique scenarios. J Am Acad Dermatol 2020; 84:247-255. [PMID: 33217511 DOI: 10.1016/j.jaad.2020.11.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 10/27/2020] [Accepted: 11/02/2020] [Indexed: 12/19/2022]
Abstract
Patch testing is the criterion standard for diagnosing allergic contact dermatitis. Causative allergens differ between children and adults, necessitating the development of pediatric-specific patch test series. The Pediatric Baseline Series was developed in 2018 through expert consensus and includes relevant pediatric allergens that dermatologists can use in practice. Obstacles in patch testing, such as the need for multiple office visits, length of patch application, and avoidance of sweat and water on the testing area, are particularly challenging for the pediatric population, and several strategies are proposed. Aside from formal patch testing, alternatives like the repeat open application test and empiric allergen avoidance can be helpful in children. The key to management of allergic contact dermatitis is allergen avoidance, with emphasis on the need to properly identify causative allergens. Continued data collection through registries allows for a better understanding of the diagnosis and management of pediatric allergic contact dermatitis.
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Affiliation(s)
- Holly Neale
- University of Massachusetts School of Medicine, Worcester, Massachusetts; Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts
| | - Anna Cristina Garza-Mayers
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Idy Tam
- Tufts University School of Medicine, Boston, Massachusetts
| | - JiaDe Yu
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
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12
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Neale H, Garza-Mayers AC, Tam I, Yu J. Pediatric allergic contact dermatitis. Part I: Clinical features and common contact allergens in children. J Am Acad Dermatol 2020; 84:235-244. [PMID: 33217510 DOI: 10.1016/j.jaad.2020.11.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 10/27/2020] [Accepted: 11/02/2020] [Indexed: 12/12/2022]
Abstract
Allergic contact dermatitis (ACD), a delayed hypersensitivity skin reaction to environmental allergens, has a prevalence that is similar in children and adults. However, diagnostic testing for ACD in pediatric populations accounts for less than one tenth of all patch tests. The relative infrequency of pediatric patch testing may be attributed to the difficulty in testing in this population, which includes a smaller surface area for patch test placement and maintaining cooperation during patch testing, especially in younger children. Diagnosis can be difficult in children because the appearance of ACD can mimic other common pediatric skin conditions, particularly atopic dermatitis and irritant contact dermatitis. Comprehensive history taking, guided by patient presentation, age group, and location of dermatitis, helps build clinical suspicion. Such clinical suspicion is one of the major reasons behind patch testing, with additional indications being recalcitrant dermatitis and dermatitis with atypical distribution. US pediatric data have shown the top allergens to be metals, fragrances, topical antibiotics, preservatives, and emollients. These trends are important to recognize to guide management and accurate diagnosis, because ACD tends to persist if the allergen is not identified and can affect patients' quality of life.
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Affiliation(s)
- Holly Neale
- University of Massachusetts School of Medicine, Worcester, Massachusetts; Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts
| | - Anna Cristina Garza-Mayers
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Idy Tam
- Tufts University School of Medicine, Boston, Massachusetts
| | - JiaDe Yu
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
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13
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Uldahl A, Engfeldt M, Svedman C. Clinical relevance of positive patch test reactions to lanolin: A ROAT study. Contact Dermatitis 2020; 84:41-49. [PMID: 32844454 PMCID: PMC7756495 DOI: 10.1111/cod.13689] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 08/20/2020] [Accepted: 08/23/2020] [Indexed: 11/30/2022]
Abstract
Background Lanolin is often included when patch testing for common contact allergens. The clinical relevance of a positive patch test reaction to lanolin markers is, however, still a subject for debate. Objectives To evaluate Amerchol L101 as a marker of lanolin allergy and investigate the clinical impact of lanolin‐containing moisturizers on healthy and damaged skin using the repeated open application test (ROAT). Methods Twelve test subjects and 14 controls were patch tested with Amerchol L 101 and additional lanolin markers. Subsequently, a blinded ROAT was performed on the arms of the study participants for 4 weeks. Each participant applied a lanolin‐free cream base and two different lanolin‐containing test creams twice daily on one arm with intact skin and on the other arm with irritant dermatitis, induced by sodium lauryl sulfate (SLS). Results Eleven test subjects (92%) had positive patch test reactions to Amerchol L 101 when retested and one test subject (8%) had a doubtful reaction. None of the study participants had any skin reactions to the ROAT on intact skin and all participants healed during the ROAT on damaged skin. Conclusions Lanolin‐containing emollients do not cause or worsen existing dermatitis when performing ROAT in volunteers patch test positive to Amerchol L101.
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Affiliation(s)
- Ada Uldahl
- Department of Dermatology and Venereology, Skåne University Hospital, Lund University, Malmö, Sweden.,Department of Occupational and Environmental Dermatology, Skåne University Hospital, Lund University, Malmö, Sweden
| | - Malin Engfeldt
- Department of Occupational and Environmental Dermatology, Skåne University Hospital, Lund University, Malmö, Sweden.,Current Address: Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, Lund, Sweden
| | - Cecilia Svedman
- Department of Occupational and Environmental Dermatology, Skåne University Hospital, Lund University, Malmö, Sweden
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14
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Pediatric contact allergens in the neonatal intensive care unit. J Perinatol 2020; 40:1554-1559. [PMID: 32807911 DOI: 10.1038/s41372-020-00769-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 07/15/2020] [Accepted: 08/03/2020] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The degree of neonatal exposure to potentially sensitizing agents on neonatal intensive care units (NICUs) and the process by which personal care products are selected for use in the NICU are poorly documented. STUDY DESIGN We evaluated personal care products used in three NICUs for potentially sensitizing agents. We interviewed NICU staff to analyze how products are selected and approved for use. RESULTS Twenty-four personal care products were evaluated. 75% contained one or more potential contact allergen, with fragrances being most common. Staff preference, brand loyalty, cost, and small product size were often considered when approving NICU products. CONCLUSIONS The prevalence of potentially sensitizing agents in the products indicates a need for improvement in the evaluation and acquisition process of over-the-counter products used for neonatal skin care. The involvement of dermatology in this process may be beneficial.
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15
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Dear K, Bala H, Palmer A, Nixon RL. How good is the Australian baseline series at detecting allergic contact dermatitis? Australas J Dermatol 2020; 62:51-56. [DOI: 10.1111/ajd.13456] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 08/04/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Kate Dear
- Occupational Dermatology Research and Education Centre Skin Health Institute Melbourne Australia
| | - Harini Bala
- Occupational Dermatology Research and Education Centre Skin Health Institute Melbourne Australia
| | - Amanda Palmer
- Occupational Dermatology Research and Education Centre Skin Health Institute Melbourne Australia
| | - Rosemary Louise Nixon
- Occupational Dermatology Research and Education Centre Skin Health Institute Melbourne Australia
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16
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Sindle A, Jacob SE, Martin K. Common Allergens and Considerations When Performing Pediatric Patch Testing. Dermatol Clin 2020; 38:321-327. [DOI: 10.1016/j.det.2020.02.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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17
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A Hands-on Approach to Contact Dermatitis and Patch Testing. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2020; 8:1883-1893. [DOI: 10.1016/j.jaip.2020.02.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Revised: 01/28/2020] [Accepted: 02/13/2020] [Indexed: 12/16/2022]
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18
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Silverberg NB, Pelletier JL, Jacob SE, Schneider LC. Nickel Allergic Contact Dermatitis: Identification, Treatment, and Prevention. Pediatrics 2020; 145:e20200628. [PMID: 32341178 DOI: 10.1542/peds.2020-0628] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Nickel is a ubiquitous metal added to jewelry and metallic substances for its hardening properties and because it is inexpensive. Estimates suggest that at least 1.1 million children in the United States are sensitized to nickel. Nickel allergic contact dermatitis (Ni-ACD) is the most common cutaneous delayed-type hypersensitivity reaction worldwide. The incidence among children tested has almost quadrupled over the past 3 decades. The associated morbidities include itch, discomfort, school absence, and reduced quality of life. In adulthood, individuals with Ni-ACD may have severe disabling hand eczema. The increasing rate of Ni-ACD in children has been postulated to result from early and frequent exposure to metals with high amounts of nickel release (eg, as occurs with ear piercing or with products used daily in childhood such as toys, belt buckles, and electronics).To reduce exposure to metal sources with high nickel release by prolonged and direct contact with human skin, Denmark and the European Union legislated a directive several decades ago with the goal of reducing high nickel release and the incidence of Ni-ACD. Since then, there has been a global reduction in incidence of Ni-ACD in population-based studies of adults and studies of children and young adults being tested for allergic contact dermatitis. These data point to nickel exposure as a trigger for elicitation of Ni-ACD and, further, provide evidence that legislation can have a favorable effect on the economic and medical health of a population.This policy statement reviews the epidemiology, history, and appearances of Ni-ACD. Examples of sources of high nickel release are discussed to highlight how difficult it is to avoid this metal in modern daily lives. Treatments are outlined, and avoidance strategies are presented. Long-term epidemiological interventions are addressed. Advocacy for smarter nickel use is reviewed. The American Academy of Pediatrics supports US legislation that advances safety standards (as modeled by the European Union) that protect children from early and prolonged skin exposure to high-nickel-releasing items. Our final aim for this article is to aid the pediatric community in developing nickel-avoidance strategies on both individual and global levels.
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Affiliation(s)
- Nanette B Silverberg
- Departments of Dermatology and Pediatrics, Mt Sinai Hospital and Icahn School of Medicine at Mt Sinai, New York, New York;
| | - Janice L Pelletier
- Northern Light Health, Bangor, Maine
- College of Medicine, University of New England, Biddeford, Maine
| | - Sharon E Jacob
- Department of Dermatology, Loma Linda University, Loma Linda, California
- Departments of Medicine and Pediatrics, University of California, Riverside, California; and
| | - Lynda C Schneider
- Department of Pediatrics, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
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19
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Felmingham C, Davenport R, Bala H, Palmer A, Nixon R. Allergic contact dermatitis in children and proposal for an Australian Paediatric Baseline Series. Australas J Dermatol 2019; 61:33-38. [PMID: 31630402 DOI: 10.1111/ajd.13169] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 08/22/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND Allergic contact dermatitis (ACD) is an increasingly common diagnosis in children. The objectives of this study were to review our experience with ACD in children in tertiary settings, to ascertain the spectrum of allergens in this population and to subsequently propose the first Australian Paediatric Baseline Series for patch testing. METHODS We conducted a retrospective analysis of patch test data from 1993 to 2017 from two tertiary referral patch-testing centres in Melbourne, Victoria. RESULTS A total of 511 children were patch tested during the study period. Of these, 58.3% (298/511) of children tested had a positive patch test, and 65.1% (194/298, or 38.0% of the total) had a relevant positive patch test. The most common relevant patch test reactions were fragrance mix, methylchloroisothiazolinone/methylisothiazolinone (MCI/MI) and methylisothiazolinone (MI), Myroxylon pereirae, nickel sulphate, and colophonium. CONCLUSION Allergic contact dermatitis is not uncommon in children, and patch testing should be considered in children with suspected ACD or with recalcitrant atopic dermatitis. Based on our experience over 25 years, we propose the first Australian Paediatric Baseline Series.
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Affiliation(s)
- Claire Felmingham
- Occupational Dermatology Research and Education Centre, Skin and Cancer Foundation Inc., Carlton, Victoria, Australia
| | - Rachael Davenport
- Occupational Dermatology Research and Education Centre, Skin and Cancer Foundation Inc., Carlton, Victoria, Australia
| | - Harini Bala
- Occupational Dermatology Research and Education Centre, Skin and Cancer Foundation Inc., Carlton, Victoria, Australia
| | - Amanda Palmer
- Occupational Dermatology Research and Education Centre, Skin and Cancer Foundation Inc., Carlton, Victoria, Australia
| | - Rosemary Nixon
- Occupational Dermatology Research and Education Centre, Skin and Cancer Foundation Inc., Carlton, Victoria, Australia
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20
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Janetos TM, Akintilo L, Xu S. Overview of high-risk Food and Drug Administration recalls for cosmetics and personal care products from 2002 to 2016. J Cosmet Dermatol 2019; 18:1361-1365. [PMID: 30565865 DOI: 10.1111/jocd.12824] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2018] [Revised: 09/08/2018] [Accepted: 10/23/2018] [Indexed: 01/24/2023]
Abstract
BACKGROUND There have been several recent controversies surrounding cosmetic products that have impacted health. Dermatologists are often the first to encounter these issues, and recalls are one metric of a safety profile of cosmetics and their impact on health. OBJECTIVE To analyze all recalls of cosmetic and personal care products from 2002 to 2016. METHODS This observational study describes all FDA cosmetic and personal care product recalls, acquired via a Freedom of Information Act request, from 2002 to 2016. The total number of Class I, Class II, and Class III recalls, number and origin of manufacturers, number of products affected, and main reason for recall were collected. RESULTS A total of 14 Class I, 266 Class II, and 33 Class III recalls were recorded. Baby products comprised the largest product category accounting for 24% of all recalls (76/313). 76% of recalls were due to bacterial contamination (237/313), followed by unapproved components, labeling issues, and skin irritation. The 14 Class I recalls accounted for 1.9 million products in distribution. CONCLUSIONS Cosmetic recalls impacted millions of products and had the potential to cause serious harm. Dermatologists have the ability to strengthen public safety by reporting adverse events, encouraging recalls of harmful products, and lobbying through dermatology organizations for meaningful change to current cosmetic regulation.
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Affiliation(s)
- Timothy M Janetos
- Department of Ophthalmology, McGaw Medical Center of Northwestern University, Chicago, Illinois
| | - Lisa Akintilo
- Department of Dermatology, McGaw Medical Center of Northwestern University, Chicago, Illinois
| | - Shuai Xu
- Department of Dermatology, McGaw Medical Center of Northwestern University, Chicago, Illinois
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21
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Toklu HZ, Antigua A, Lewis V, Reynolds M, Jones J. Cosmetovigilance: A review of the current literature. J Family Med Prim Care 2019; 8:1540-1545. [PMID: 31198710 PMCID: PMC6559068 DOI: 10.4103/jfmpc.jfmpc_447_18] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The term "pharmacovigilance" defines the activities related to the collection, detection, assessment, monitoring, and prevention of adverse reactions occurring with medications. Recently, the spectrum of "-vigilance" has broadened to include safety of herbal products and cosmetic products as well. "Cosmetovigilance" was introduced as a new term used for defining surveillance carried out by industry to address the safety of cosmetic products. It was first used in literature by Vigan (1997) to refer to the monitoring of cosmetic product safety. Today, it is recognized globally as a concept of public health. For this systematic review, a PubMed search was conducted in July 2018 for the term "cosmetovigilance."
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Affiliation(s)
- Hale Z. Toklu
- Department of Clinical Sciences, University of Central Florida College of Medicine, Orlando, FL, USA
| | - Abigail Antigua
- Clinical Pharmacy, North Florida Regional Medical Center, Gainesville, FL, USA
| | - Vanessa Lewis
- Family Medicine, North Florida Regional Medical Center, Gainesville, FL, USA
| | - Mar’Tina Reynolds
- Family Medicine, North Florida Regional Medical Center, Gainesville, FL, USA
| | - Jennifer Jones
- Department of Clinical Sciences, University of Central Florida College of Medicine, Orlando, FL, USA
- Family Medicine, North Florida Regional Medical Center, Gainesville, FL, USA
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22
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Veien NK. Clinical Features of Contact Dermatitis. Contact Dermatitis 2019. [DOI: 10.1007/978-3-319-72451-5_15-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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23
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Ozceker D, Haslak F, Dilek F, Sipahi S, Yucel E, Guler N, Tamay Z. Contact sensitization in children with atopic dermatitis. Allergol Immunopathol (Madr) 2019; 47:47-51. [PMID: 30193890 DOI: 10.1016/j.aller.2018.06.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2018] [Accepted: 06/13/2018] [Indexed: 01/30/2023]
Abstract
BACKGROUND Atopic dermatitis is a common illness in childhood. Children with atopic dermatitis are prone to develop cutaneous sensitization due to skin barrier dysfunction. AIM The aim of this study was to evaluate the frequency of cutaneous sensitizations in patients with atopic dermatitis and to identify the most frequent causative allergens. STUDY DESIGN The study group consisted of 112 children with atopic dermatitis, aged 1-18 years (median 88.5 months) and 39 healthy controls, aged 1-8 years (median 88.48 months). METHODS The diagnosis of atopic dermatitis was established by modified Hanifin and Rajka criteria; severity of the disease was assessed by scoring of atopic dermatitis. Serum blood eosinophil count, total IgE and skin prick tests for common aeroallergens and food allergens were performed. Patch tests with cosmetic series and European standard patch test series (Stallegenes© Ltd, Paris, France) were applied. RESULTS Of the children with atopic dermatitis, 17% (n=19) were sensitized to either cosmetic or standard series or both of them; no children in the control group had a positive patch test (p=0.001). Atopy and severity of atopic dermatitis was not a significant risk factor for cutaneous sensitization. The most common allergens were Nickel sulphate and Methychloroisothiazinolone (4.5% and 4.5%) in the European standard patch test and cocamidoproplybetaine (12.5%) in the cosmetic series patch test. CONCLUSION Cutaneous sensitization can develop in children with atopic dermatitis, therefore allergic contact dermatitis should be kept in mind.
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24
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Warshaw EM, Aschenbeck KA, DeKoven JG, Maibach HI, Taylor JS, Sasseville D, Belsito DV, Fowler JF, Zug KA, Zirwas MJ, Fransway AF, DeLeo VA, Marks JG, Pratt MD, Mathias T. Epidemiology of pediatric nickel sensitivity: Retrospective review of North American Contact Dermatitis Group (NACDG) data 1994-2014. J Am Acad Dermatol 2018; 79:664-671. [DOI: 10.1016/j.jaad.2018.02.071] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2017] [Revised: 02/02/2018] [Accepted: 02/09/2018] [Indexed: 11/29/2022]
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25
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Contact Dermatitis in Atopic Dermatitis Children—Past, Present, and Future. Clin Rev Allergy Immunol 2018; 56:86-98. [DOI: 10.1007/s12016-018-8711-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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26
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Zafrir Y, Trattner A, Hodak E, Eldar O, Lapidoth M, Ben Amitai D. Patch testing in Israeli children with suspected allergic contact dermatitis: A retrospective study and literature review. Pediatr Dermatol 2018; 35:76-86. [PMID: 29143366 DOI: 10.1111/pde.13333] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND/OBJECTIVES Childhood allergic contact dermatitis is recognized as a significant clinical problem. The objective was to evaluate the rate of positive patch tests in Israeli children with clinically suspected allergic contact dermatitis, identify possible sex and age differences, compare results with those in Israeli adults, and review pediatric studies in the literature. METHODS The study sample included 343 children and adolescents (197 female, 146 male; 1-18 years of age, mean age 11.8 years) with clinically suspected allergic contact dermatitis who underwent patch testing with a standard pediatric series of 23 allergens at a tertiary medical center from 1999 to 2012. Data on clinical characteristics and test results were collected retrospectively from the medical files. RESULTS Ninety-eight subjects (28.6%) (75 girls [38.1%], 23 boys [15.8%]) had at least one positive reaction. The most frequent reactions were to nickel sulfate, followed by potassium dichromate and cobalt chloride. Nickel sulfate sensitivity was more common in girls, especially those younger than 3 years and older than 12 years. The prevalence of contact sensitization was similar in subjects with and without atopic dermatitis (50% and 51%, respectively). CONCLUSION Nickel is the most common allergen in Israeli children, especially girls. Patch testing should be performed in children with clinically suspected allergic contact dermatitis regardless of atopic background.
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Affiliation(s)
- Yaron Zafrir
- Department of Dermatology, Sheba Medical Center, Tel Hashomer, Israel
| | - Akiva Trattner
- Department of Dermatology, Rabin Medical Center-Beilinson Hospital, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Emmillia Hodak
- Department of Dermatology, Rabin Medical Center-Beilinson Hospital, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Oren Eldar
- Department of Dermatology, Rabin Medical Center-Beilinson Hospital, Petach Tikva, Israel
| | - Moshe Lapidoth
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Laser Unit, Rabin Medical Center-Beilinson Hospital, Petach Tikva, Israel
| | - Dan Ben Amitai
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Pediatric Dermatology Unit, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
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Jacob SE, McGowan M, Silverberg NB, Pelletier JL, Fonacier L, Mousdicas N, Powell D, Scheman A, Goldenberg A. Pediatric Contact Dermatitis Registry Data on Contact Allergy in Children With Atopic Dermatitis. JAMA Dermatol 2017; 153:765-770. [PMID: 28241280 PMCID: PMC5817590 DOI: 10.1001/jamadermatol.2016.6136] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 12/22/2016] [Indexed: 01/20/2023]
Abstract
Importance Atopic dermatitis (AD) and allergic contact dermatitis (ACD) have a dynamic relationship not yet fully understood. Investigation has been limited thus far by a paucity of data on the overlap of these disorders in pediatric patients. Objective To use data from the Pediatric Contact Dermatitis Registry to elucidate the associations and sensitizations among patients with concomitant AD and ACD. Design, Setting, and Participants This retrospective case review examined 1142 patch test cases of children younger than 18 years, who were registered between January 1, 2015, and December 31, 2015, by 84 health care providers (physicians, nurse practitioners, physician assistants) from across the United States. Data were gathered electronically from multidisciplinary providers within outpatient clinics throughout the United States on pediatric patients (ages 0-18 years). Exposures All participants were patch-tested to assess sensitizations to various allergens; history of AD was noted by the patch-testing providers. Main Outcomes and Measures Primary outcomes were sensitization rates to various patch-tested allergens. Results A total of 1142 patients were evaluated: 189 boys (34.2%) and 363 girls (65.8%) in the AD group and 198 boys (36.1%) and 350 girls (63.9%) in the non-AD group (data on gender identification were missing for 17 patients). Compared with those without AD, patch-tested patients with AD were 1.3 years younger (10.5 vs 11.8 years; P < .001) and had longer history of dermatitis (3.5 vs 1.8 years; P < .001). Patch-tested patients designated as Asian or African American were more likely to have concurrent AD (odds ratio [OR], 1.92; 95% CI, 1.20-3.10; P = .008; and OR, 4.09; 95% CI, 2.70-6.20; P <.001, respectively). Patients with AD with generalized distribution were the most likely to be patch tested (OR, 4.68; 95% CI, 3.50-6.30; P < .001). Patients with AD had different reaction profiles than those without AD, with increased frequency of reactions to cocamidopropyl betaine, wool alcohol, lanolin, tixocortol pivalate, and parthenolide. Patients with AD were also noted to have lower frequency of reaction to methylisothiazolinone, cobalt, and potassium dichromate. Conclusions and Relevance Children with AD showed significant reaction patterns to allergens notable for their use in skin care preparations. This study adds to the current understanding of AD in ACD, and the continued need to investigate the interplay between these disease processes to optimize care for pediatric patients with these conditions.
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Affiliation(s)
- Sharon E. Jacob
- Department of Dermatology, Loma Linda University, Loma Linda, California
| | - Maria McGowan
- Department of Internal Medicine, Loma Linda University, Loma Linda, California
| | - Nanette B. Silverberg
- Departments of Dermatology and Pediatrics, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Janice L. Pelletier
- Department of Pediatric Dermatology, Eastern Maine Medical Center, Bangor
- University of Vermont School of Medicine, Burlington
| | - Luz Fonacier
- Department of Allery Immunology, State University of New York at Stony Brook, Stony Brook
- Department of Allery Immunology, Winthrop University Hospital, Mineola, New York
| | - Nico Mousdicas
- Department of Dermatology, Indiana University Health, Indianapolis
| | - Doug Powell
- Department of Dermatology, University of Utah, Salt Lake City
| | - Andrew Scheman
- Clinical Dermatology, Northwestern University, Chicago, Illinois
| | - Alina Goldenberg
- Department of Dermatology, University of California–San Diego, San Diego
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Ascha M, Irfan M, Bena J, Taylor JS, Sood A. Pediatric patch testing: A 10-year retrospective study. Ann Allergy Asthma Immunol 2017; 117:661-667. [PMID: 27979024 DOI: 10.1016/j.anai.2016.09.445] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 09/27/2016] [Accepted: 09/28/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Patch testing is the gold standard for diagnosing allergic contact dermatitis in children. OBJECTIVE To present a 10-year retrospective review of pediatric patch testing at our institution. METHODS Data from patients 18 years or younger who presented for patch testing from February 1, 2005, to May 31, 2015, were entered into a database. Patch testing was performed according to North American Contact Dermatitis Group standards. A positive reaction was defined as any allergen for which the patient had a 1+ or greater reaction and provided avoidance information. RESULTS A total of 157 patients with a mean (SD) age of 12.3 (4.1) years were evaluated. The 2 most frequent allergens were nickel and cobalt. Most patients were referred by dermatologists for suspected allergic contact dermatitis (72.3%). Dermatitis was present for more than 2 years in most cases (n = 67 [46.2%]), from 6 months to 2 years (n = 49 [33.8%]), and for less than 6 months (n = 29 [20.0%]). Males were more likely to have a positive reaction to fragrance mix 1 compared with females (P = .02). No significant association was found between age and allergen sensitivity. Those with a history of atopy were more likely to have a positive reaction to cobalt (P = .008) and chromium (P = .03). Sixty patients (38.2%) returned for follow-up, and 37 (60.7%) reported improvement; most (n = 54 [88.5%]) were being treated with topical corticosteroids. CONCLUSION Our study of pediatric patch testing can provide information regarding common allergens in children, which can enhance patient care. Primary care practitioners may benefit from awareness of patch testing as an alternative to prescribing systemic immunosuppressants.
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Affiliation(s)
- Mona Ascha
- Case Western Reserve University School of Medicine, Cleveland, Ohio.
| | - Mahwish Irfan
- Department of Dermatology, Cleveland Clinic Foundation and Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio
| | - James Bena
- Department of Quantitative Health Sciences, Cleveland Clinic Foundation, Cleveland, Ohio
| | - James S Taylor
- Department of Dermatology, Cleveland Clinic Foundation and Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio
| | - Apra Sood
- Department of Dermatology, Cleveland Clinic Foundation and Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio
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29
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Hamann CR, Hamann D, Egeberg A, Johansen JD, Silverberg J, Thyssen JP. Association between atopic dermatitis and contact sensitization: A systematic review and meta-analysis. J Am Acad Dermatol 2017; 77:70-78. [DOI: 10.1016/j.jaad.2017.02.001] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Revised: 01/31/2017] [Accepted: 02/01/2017] [Indexed: 01/11/2023]
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30
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Jacob SE, Lipp MB, Suh E, Goldenberg A. Practice Patterns of Dermatologists in the Pediatric Contact Dermatitis Registry. Pediatr Dermatol 2017; 34:408-412. [PMID: 28543809 DOI: 10.1111/pde.13154] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND/OBJECTIVES U.S. adults and children are equally likely to have allergic contact dermatitis. Historically the narrow geographic location of data-reporting providers has quantitatively and qualitatively limited the pediatric contact dermatitis data. The Pediatric Contact Dermatitis Registry was used to evaluate self-identified pediatric patch test providers within the United States with regard to demographic characteristics, geographic location, and practice patterns. METHODS A wide range of U.S. providers were invited to join the registry by completing a secure online 11-question registration survey. RESULTS There were 252 respondents from 50 states and the District of Columbia; 28.6% were pediatric dermatologists and members of the Society for Pediatric Dermatology (SPD), and 38% were members of the American Contact Dermatitis Society. The cumulative range of pediatric patch-test evaluations performed each year was 1,726 to 4,613 children. SPD members had a significantly greater likelihood of performing a commercially available patch test (odds ratio 7.14 [95% confidence interval 5.11, 9.97], p < .001) than those who were not SPD members. SPD members also had significantly lower odds of performing North American Contact Dermatitis Group standard tests than nonmembers. CONCLUSIONS The frequency of patch test evaluations in children is significantly underreported. This study provides insight into the practice patterns of various providers who are patch testing children and makes recommendations for evidence-based modifications regarding these practices. Limitations of the study include survey responder selection bias and small sample size.
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Affiliation(s)
- Sharon E Jacob
- Department of Dermatology, Loma Linda University, Loma Linda, California
| | - Michael B Lipp
- Department of Dermatology, Larkin Community Hospital Palm Springs, Hialeah, Florida.,Dermatitis Academy, Redlands, California
| | - Eric Suh
- School of Public Health, Loma Linda University, Loma Linda, California
| | - Alina Goldenberg
- Department of Dermatology, University of California, San Diego, San Diego, California
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Tan KW, Haylett AK, Ling TC, Rhodes LE. Comparison of Demographic and Photobiological Features of Chronic Actinic Dermatitis in Patients With Lighter vs Darker Skin Types. JAMA Dermatol 2017; 153:427-435. [PMID: 28329062 DOI: 10.1001/jamadermatol.2016.5861] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Chronic actinic dermatitis (CAD) is classically described in older, white men, although increasing reports describe younger patients with darker skin types, particularly South Asians. Photocontact allergy occurs in CAD but is less studied than contact allergy in this exquisitely photosensitive condition. Objective To evaluate for differences in demographic and photobiological features between persons with darker and lighter skin types who have CAD. Design, Setting, and Participants This retrospective review included 70 consecutive adult patients (≥18 years) undergoing investigation for photosensitivity who were diagnosed with CAD from November 1, 2000, through August 31, 2015, at the specialist Photobiology Unit of a tertiary academic referral center. Main Outcomes and Measures Patient age, sex, ethnicity, clinical features, and phototesting outcomes. Results A total of 70 patients (37 men [53%] and 33 women [47%]; mean [SD] age, 50.9 [2.3] years) were diagnosed with CAD. Of these, 36 were non-Hispanic and non-Latino white, 31 were Asian (including 24 South Asian, 4 East Asian, and 3 Middle Eastern), and 3 were black. Patients were aged 9 to 83 years at diagnosis, with a mean (SD) age at onset of 42.6 (2.4) years and duration of disease of 8.8 (1.3) years. Forty-one had lighter skin types (Fitzpatrick skin types I-IV), and 29 had darker skin types (Fitzpatrick skin types V and VI). Patients with darker skin types and CAD were younger at diagnosis (mean [SD] age, 40.7 [3.5] vs 58.1 [2.5] years; P < . 001) and had earlier onset of photosensitivity (mean [SD] age, 35.5 [3.9] vs 47.5 [2.9] years; P = .01) compared with patients with lighter skin types. Of note, the male to female ratio in the lighter skin group was 2:1 compared with 1:2 in the darker skin group. Phototest reactions were equally severe in Fitzpatrick skin types V to VI and I to IV, with minimal erythemal doses to monochromatic UV-B, UV-A, and visible radiation and broadband provocation testing showing similar results. Photoallergic contact reactions to UV filters, personal sunscreen products, and nonsteroidal anti-inflammatory drugs were seen in both groups; 14 of 61 patients (23%) undergoing photopatch testing showed positive photopatch reactions. Conclusions and Relevance Chronic actinic dermatitis presents with an earlier age at onset and an inverted male to female ratio in patients with darker compared with lighter skin types. Clinicians should thus be cognizant of CAD in younger women with darker skin types. Photopatch testing should be considered in patients with CAD, with coexistent photocontact allergy occurring in a substantial proportion.
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Affiliation(s)
- Ki-Wei Tan
- Photobiology Unit, Dermatology Centre, University of Manchester, Manchester, England2Academic Health Science Centre, Salford Royal NHS (National Health Service) Foundation Trust, Salford, England3Department of Dermatology, Changi General Hospital, Singapore
| | - Ann K Haylett
- Photobiology Unit, Dermatology Centre, University of Manchester, Manchester, England2Academic Health Science Centre, Salford Royal NHS (National Health Service) Foundation Trust, Salford, England
| | - Tsui C Ling
- Photobiology Unit, Dermatology Centre, University of Manchester, Manchester, England2Academic Health Science Centre, Salford Royal NHS (National Health Service) Foundation Trust, Salford, England
| | - Lesley E Rhodes
- Photobiology Unit, Dermatology Centre, University of Manchester, Manchester, England2Academic Health Science Centre, Salford Royal NHS (National Health Service) Foundation Trust, Salford, England
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Dórea JG. Abating Mercury Exposure in Young Children Should Include Thimerosal-Free Vaccines. Neurochem Res 2017; 42:2673-2685. [PMID: 28439753 DOI: 10.1007/s11064-017-2277-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 04/11/2017] [Accepted: 04/19/2017] [Indexed: 12/27/2022]
Abstract
Pediatric immunization is essential to prevent, control and eradicate children`s infectious diseases. Newborns and infants in less developed countries have a concentrated schedule of Thimerosal-containing vaccines (TCVs); pregnant mothers are also immunized with TCVs. Metabolic changes during early development are demonstrably an important risk factor for ethylmercury (EtHg) effects on neurodevelopment, while exposure to Thimerosal sensitizes susceptible individuals to life-long contact dermatitis. Concerns regarding toxicity of Hg have moved rich nations to withdraw it from medicines and, in particular, Thimerosal from pediatric vaccines; it has been more than 20 years since rich countries started using Thimerosal-free vaccines. TCVs and Thimerosal-free vaccines show dissimilar profiles of adverse effects. Thimerosal-free vaccines have shown a decrease in contact dermatitis, while TCVs showed a significant association with increased risk of tic disorders; in some circumstances, EtHg in combination with other neurotoxic substances negatively impacted neurobehavioral tests. In studies that explored vaccines and risk of tics, Thimerosal was a necessary factor. However, when the binary exposure to organic Hg forms (TCV-EtHg and fish-MeHg) was considered, effects on neurobehavioral tests were inconsistent. CONCLUSIONS (a) The indiscriminate use of pediatric-TCVs in less developed countries carries an unjustifiable and excessive EtHg exposure with an unnecessary risk of neurotoxicity to the developing brain; (b) measurable benefits (of Thimerosal-free) and measurable risks of tic disorders have been associated with the (Thimerosal-containing) type of vaccine;
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Affiliation(s)
- José G Dórea
- Professor Emeritus, Faculty of Health Sciences, Universidade de Brasília, 70919-970, Brasília, DF, Brazil.
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33
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Overgaard LEK, Engebretsen KA, Jensen P, Johansen JD, Thyssen JP. Nickel released from children's toys is deposited on the skin. Contact Dermatitis 2017; 74:380-1. [PMID: 27133630 DOI: 10.1111/cod.12553] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Accepted: 01/15/2016] [Indexed: 11/26/2022]
Affiliation(s)
- Line E K Overgaard
- National Allergy Research Centre, Department of Dermato-Allergology, Herlev and Gentofte University Hospital, University of Copenhagen, 2900 Hellerup, Denmark
| | - Kristiane A Engebretsen
- National Allergy Research Centre, Department of Dermato-Allergology, Herlev and Gentofte University Hospital, University of Copenhagen, 2900 Hellerup, Denmark
| | - Peter Jensen
- National Allergy Research Centre, Department of Dermato-Allergology, Herlev and Gentofte University Hospital, University of Copenhagen, 2900 Hellerup, Denmark
| | - Jeanne D Johansen
- National Allergy Research Centre, Department of Dermato-Allergology, Herlev and Gentofte University Hospital, University of Copenhagen, 2900 Hellerup, Denmark
| | - Jacob P Thyssen
- National Allergy Research Centre, Department of Dermato-Allergology, Herlev and Gentofte University Hospital, University of Copenhagen, 2900 Hellerup, Denmark
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Lubbes S, Rustemeyer T, Sillevis Smitt JH, Schuttelaar ML, Middelkamp-Hup MA. Contact sensitization in Dutch children and adolescents with and without atopic dermatitis - a retrospective analysis. Contact Dermatitis 2016; 76:151-159. [DOI: 10.1111/cod.12711] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Revised: 09/10/2016] [Accepted: 09/20/2016] [Indexed: 02/06/2023]
Affiliation(s)
- Stefanie Lubbes
- Department of Dermatology; Academic Medical Centre, University of Amsterdam; 1100 DD Amsterdam The Netherlands
| | - Thomas Rustemeyer
- Department of Dermatology; VU University Medical Centre; 1081 HV Amsterdam The Netherlands
| | - Johannes H. Sillevis Smitt
- Department of Dermatology; Academic Medical Centre, University of Amsterdam; 1100 DD Amsterdam The Netherlands
| | - Marie Louise Schuttelaar
- Department of Dermatology; University Medical Centre Groningen; 9700 RB Groningen The Netherlands
| | - Maritza A. Middelkamp-Hup
- Department of Dermatology; Academic Medical Centre, University of Amsterdam; 1100 DD Amsterdam The Netherlands
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Rodrigues DF, Goulart EMA. Patch-test results in children and adolescents: systematic review of a 15-year period. An Bras Dermatol 2016; 91:64-72. [PMID: 26982781 PMCID: PMC4782649 DOI: 10.1590/abd1806-4841.20163927] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2014] [Accepted: 09/01/2014] [Indexed: 12/31/2022] Open
Abstract
The number of studies on patch-test results in children and adolescents has
gradually increased in recent years, thus stimulating reviews. This paper is a
systematic review of a 15-year period devoted to studying the issue. Variations
pertaining to the number and age groups of tested children and/or adolescents,
the number of subjects with atopy/atopic dermatitis history, the quantity, type
and concentrations of the tested substances, the test technique and type of data
regarding clinical relevance, must all be considered in evaluating these
studies, as they make it harder to formulate conclusions. The most common
allergens in children were nickel, thimerosal, cobalt, fragrance, lanolin and
neomycin. In adolescents, they were nickel, thimerosal, cobalt, fragrance,
potassium dichromate, and Myroxylon pereirae. Knowledge of this matter aids
health professionals in planning preventive programs aimed at improving
children's quality of life and ensuring that their future prospects are not
undermined.
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36
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Mortazavi H, Ehsani A, Sajjadi SS, Aghazadeh N, Arian E. Patch testing in Iranian children with allergic contact dermatitis. BMC DERMATOLOGY 2016; 16:10. [PMID: 27405224 PMCID: PMC4943022 DOI: 10.1186/s12895-016-0047-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Accepted: 06/30/2016] [Indexed: 12/23/2022]
Abstract
Background Allergic contact dermatitis is a common disorder in adults and children alike and appears to be on the increase. The purpose of this study was to determine the sensitization trends in Iranian children with contact dermatitis. Methods The result of 109 patch tests performed using the 24 allergens of the European Standard Series in patients below 18 years old from September 2007 to March 2009 were recorded and analyzed. The tests were evaluated at 48 and 72 h after performing. Results The study population consisted of 72 (66.1 %) females and 37 (33.9 %) males. Hands were the most commonly affected anatomic site. In the final evaluation of the tests on day three, 51 (46.8 %) individuals showed a positive reaction to at least one allergen. Females were significantly more likely to show a positive response to at least one allergen (p-value = 0.031, odds ratio: 2.46). The most common allergens were nickel sulfate, cobalt, methylisothiazolinone, and colophony with 21 (19.3 %), 11 (10.1 %), 7 (6.4 %), and 6 (5.5 %) positive reactions, respectively. Contact allergy to nickel sulfate was more common in females than males (23.6 % vs. 10.8 %). There was no statistically significant relationship between personal or family history of atopy and a positive reaction to patch testing. The clinical and practical relevance were assessed for nickel and cobalt with a clinical current relevance in 11 (52.3 %) and 4 (36.4 %), respectively. Conclusions Nickel sulfate, cobalt, methylisothiazolinone, and colophony are the most common allergens responsible for induction of allergic contact dermatitis in Iranian children and adolescents. Females tended to show more positive reactions to allergens. Electronic supplementary material The online version of this article (doi:10.1186/s12895-016-0047-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Hossein Mortazavi
- Autoimmune Bullous Diseases Research Center, Razi Dermatology Hospital, Tehran University of Medical Sciences, Tehran, Iran.,Razi Dermtology Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Amirhooshang Ehsani
- Autoimmune Bullous Diseases Research Center, Razi Dermatology Hospital, Tehran University of Medical Sciences, Tehran, Iran.,Razi Dermtology Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Sajed Sajjadi
- Razi Dermtology Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Nessa Aghazadeh
- Autoimmune Bullous Diseases Research Center, Razi Dermatology Hospital, Tehran University of Medical Sciences, Tehran, Iran. .,Razi Dermtology Hospital, Tehran University of Medical Sciences, Tehran, Iran. .,Children's Medical Hospital, Tehran University of Medical Sciences, Tehran, Iran.
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37
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Potential Allergens in Disposable Diaper Wipes, Topical Diaper Preparations, and Disposable Diapers. Dermatitis 2016; 27:110-8. [DOI: 10.1097/der.0000000000000177] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
BACKGROUND Children are as likely as adults to be sensitized and reactive to contact allergens. However, the prevailing data on pediatric allergic contact dermatitis are quantitatively and qualitatively limited because of a narrow geographic localization of data-reporting providers. OBJECTIVE The aim of the study was to present the first quarter results from the Loma Linda Pediatric Contact Dermatitis Registry focused on registered providers who self-identified as providing care for pediatric allergic contact dermatitis (ACD) within the United States. METHODS The US providers were invited to join the registry via completion of an online, secure, 11-question registration survey addressing demographics and clinical practice essentials. The presented results reflect data gathered within the first quarter of registry recruitment; registration is ongoing. RESULTS Of 169 responders from 48 states, the majority of providers were female (60.4%), academic (55.6%), and dermatologists (76.3%). Based on individual provider averages, the minimum cumulative number of pediatric patch-test evaluations performed each year ranged between 1372 and 3468 children. CONCLUSIONS The Pediatric Contact Dermatitis Registry provides a description of the current leaders in the realm of pediatric ACD and gaps, which are in need of attention. The registry allows for a collaborative effort to exchange information, educate providers, and foster investigative research with the hope of legislation that can reduce the disease burden of ACD in US children.
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39
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Rodrigues DF, Goulart EMA. Patch test results in children and adolescents. Study from the Santa Casa de Belo Horizonte Dermatology Clinic, Brazil, from 2003 to 2010. An Bras Dermatol 2016; 90:671-83. [PMID: 26560213 PMCID: PMC4631233 DOI: 10.1590/abd1806-4841.20153902] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2014] [Accepted: 11/12/2014] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Patch testing is an efficient method to identify the allergen responsible for
allergic contact dermatitis. OBJECTIVE To evaluate the results of patch tests in children and adolescents comparing these
two age groups' results. METHODS Cross-sectional study to assess patch test results of 125 children and adolescents
aged 1-19 years, with suspected allergic contact dermatitis, in a dermatology
clinic in Brazil. Two Brazilian standardized series were used. RESULTS Seventy four (59.2%) patients had "at least one positive reaction" to the patch
test. Among these positive tests, 77.0% were deemed relevant. The most frequent
allergens were nickel (36.8%), thimerosal (18.4%), tosylamide formaldehyde resin
(6.8%), neomycin (6.4%), cobalt (4.0%) and fragrance mix I (4.0%). The most
frequent positive tests came from adolescents (p=0.0014) and females (p=0.0002).
There was no relevant statistical difference concerning contact sensitizations
among patients with or without atopic history. However, there were significant
differences regarding sensitization to nickel (p=0.029) and thimerosal (p=0.042)
between the two age groups under study, while adolescents were the most
affected. CONCLUSION Nickel and fragrances were the only positive (and relevant) allergens in children.
Nickel and tosylamide formaldehyde resin were the most frequent and relevant
allergens among adolescents.
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Hill H, Goldenberg A, Golkar L, Beck K, Williams J, Jacob SE. Pre-Emptive Avoidance Strategy (P.E.A.S.) – addressing allergic contact dermatitis in pediatric populations. Expert Rev Clin Immunol 2016; 12:551-61. [DOI: 10.1586/1744666x.2016.1142373] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Fonacier L, Bernstein DI, Pacheco K, Holness DL, Blessing-Moore J, Khan D, Lang D, Nicklas R, Oppenheimer J, Portnoy J, Randolph C, Schuller D, Spector S, Tilles S, Wallace D. Contact dermatitis: a practice parameter-update 2015. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2016; 3:S1-39. [PMID: 25965350 DOI: 10.1016/j.jaip.2015.02.009] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Accepted: 02/26/2015] [Indexed: 01/08/2023]
Abstract
This parameter was developed by the Joint Task Force on Practice Parameters, which represents the American Academy of Allergy, Asthma & Immunology (AAAAI); the American College of Allergy, Asthma & Immunology (ACAAI); and the Joint Council of Allergy, Asthma & Immunology. The AAAAI and the ACAAI have jointly accepted responsibility for establishing "Contact Dermatitis: A Practice Parameter-Update 2015." This is a complete and comprehensive document at the current time. The medical environment is changing and not all recommendations will be appropriate or applicable to all patients. Because this document incorporated the efforts of many participants, no single individual, including members serving on the Joint Task Force, are authorized to provide an official AAAAI or ACAAI interpretation of these practice parameters. Any request for information or interpretation of this practice parameter by the AAAAI or ACAAI should be directed to the Executive Offices of the AAAAI, the ACAAI, and the Joint Council of Allergy, Asthma & Immunology. These parameters are not designed for use by the pharmaceutical industry in drug development or promotion. Previously published practice parameters of the Joint Task Force on Practice Parameters for Allergy & Immunology are available at http://www.JCAAI.org or http://www.allergyparameters.org.
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Smith VM, Clark SM, Wilkinson M. Allergic contact dermatitis in children: trends in allergens, 10 years on. A retrospective study of 500 children tested between 2005 and 2014 in one UK centre. Contact Dermatitis 2015; 74:37-43. [DOI: 10.1111/cod.12489] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Revised: 09/07/2015] [Accepted: 09/21/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Vanessa M. Smith
- Dermatology Department; Chapel Allerton Hospital; Leeds LS7 4SA UK
| | - Sheila M. Clark
- Dermatology Department; Chapel Allerton Hospital; Leeds LS7 4SA UK
| | - Mark Wilkinson
- Dermatology Department; Chapel Allerton Hospital; Leeds LS7 4SA UK
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Jacob SE, Goldenberg A, Pelletier JL, Fonacier LS, Usatine R, Silverberg N. Nickel Allergy and Our Children's Health: A Review of Indexed Cases and a View of Future Prevention. Pediatr Dermatol 2015. [PMID: 26212605 DOI: 10.1111/pde.12639] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Nickel is the leading cause of allergic contact dermatitis (ACD) from early childhood through adolescence. Studies have shown that skin piercings and other nickel-laden exposures can trigger the onset of nickel ACD in those who are susceptible. Nickel ACD causes a vast amount of cutaneous disease in children. Cases of nickel ACD in children have been reported in peer-reviewed literature from 28 states. Common items that contain inciting nickel include jewelry, coins, zippers, belts, tools, toys, chair studs, cases for cell phones and tablets, and dental appliances. The diagnosis of nickel ACD has been routinely confirmed by patch testing in children older than 6 months suspected of ACD from nickel. Unlike in Europe, there are no mandatory restrictions legislated for nickel exposure in the United States. Denmark has demonstrated that regulation of the nickel content in metals can lower the risk of ACD and the associated health care-related costs that arise from excess nickel exposure. To further awareness, this article reviews the prominent role of nickel in pediatric skin disease in the United States. It discusses the need for a campaign by caretakers to reduce nickel-related morbidity. Lastly, it promotes the model of European legislation as a successful intervention in the prevention of nickel ACD.
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Affiliation(s)
| | | | | | - Luz S Fonacier
- Department of Clinical Medicine, State University of New York at Stony Brook, Stony Brook, New York.,Allergy and Immunology Training Program, Winthrop University Hospital, Mineola, New York
| | - Richard Usatine
- University of Texas Health Science Center, San Antonio, Texas
| | - Nanette Silverberg
- Icahn School of Medicine at Mt. Sinai, Mt. Sinai St. Luke's-Roosevelt Hospital Center, New York, New York
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Pediatric Allergic Contact Dermatitis: Lessons for Better Care. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2015; 3:661-7; quiz 668. [DOI: 10.1016/j.jaip.2015.02.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Revised: 02/17/2015] [Accepted: 02/17/2015] [Indexed: 11/22/2022]
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Jacob SE, Hamann D, Goldenberg A, Connelly EA. Easter egg hunt dermatitis: systemic allergic contact dermatitis associated with chocolate ingestion. Pediatr Dermatol 2015; 32:231-3. [PMID: 25529404 DOI: 10.1111/pde.12490] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Pediatric systemic allergic contact dermatitis to nickel has previously been reported in association with cocoa. We present four clinical cases of hypersensitivity temporally associated with chocolate consumption at Easter. Clinicians should be aware of the potential for foods high in nickel to provoke patients with known nickel sensitivity and systemic dermatitis.
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Affiliation(s)
- Sharon E Jacob
- Department of Dermatology, Loma Linda University, Loma Linda, California; Division of Dermatology, University of California at San Diego, La Jolla, California
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Young individuals with atopic disease and asthma or rhinoconjunctivitis may have clinically relevant contact allergies. Dermatitis 2015; 25:115-9. [PMID: 24819284 DOI: 10.1097/der.0000000000000037] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Children and adolescents with atopic disease who have allergic asthma and/or rhinitis with and without atopic dermatitis may have hidden, clinically relevant contact allergies. OBJECTIVE The objective of this study was to survey contact allergies in children and adolescents who had been offered allergen-specific immunotherapy and accepted (exposed)/not accepted (unexposed) such treatment. METHODS Thirty-seven exposed and 24 unexposed individuals with atopic disease were patch tested with a standard series supplemented with aluminum chloride hexahydrate, an empty Finn Chamber, and 8 antigen preparations. RESULTS In the exposed group, 18 allergies were detected in 13 individuals with atopic disease when excluding reactions to aluminum and antigen preparations, whereas the corresponding figures for the unexposed group were 9 and 6, respectively (non-significant difference). Independent of the allergen-specific immunotherapy, significantly more (P = 0.013) individuals with atopic dermatitis had at least 1 contact allergy. Clinically relevant allergies were represented by sesquiterpene lactone mix, para-tertiary butylphenol-formaldehyde resin, tixocortol pivalate, and colophony. CONCLUSIONS Clinically relevant contact allergies are not uncommon in children and adolescents with atopic disease, which is why patch testing always should be considered in the management of dermatitis in individuals with atopic disease.
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50
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Nickel and Cobalt Release From Children’s Toys Purchased in Denmark and the United States. Dermatitis 2014; 25:356-65. [DOI: 10.1097/der.0000000000000084] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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