Patch-test results in terms of the recently recommended allergens in children and adolescents: A retrospective cohort study over 22 years from Turkey

The Contact Sensitivity of Turkish Children and Adolescents to European Baseline Series Allergens between 2013 and 2023

INTRODUCTION

Increasing the numbers of patch testing in suspected children increases the rate of diagnosis of allergic contact dermatitis and the identification of clinically relevant allergens.

OBJECTIVE

The aim of this study was to identify the most frequently observed allergens among Turkish children and adolescents patch-tested in 2013-2023.

METHODS

The patch test results of 160 patients (age ≤18) were analyzed retrospectively. The frequency of contact allergens and distribution of positive results in terms of sex, age group (children and adolescents), and the presence of atopic dermatitis (AD) were identified.

RESULTS

Forty-nine patients (30.6%) (34 girls and 15 boys) exhibited positive patch test reactions to a minimum of one allergen, and contact sensitivity was statistically significantly higher in girls (P=0.034). The five most frequent allergens were nickel sulfate (10.6%), MCI/MI (8.1%), cobalt chloride (5.6%), p-phenylenediamine (PPD) (5%), and MI (3.5%). No significant association was observed between patch test positivity and age groups (P>.05). Nickel sulfate sensitivity was significantly higher in girls than in boys (P=.043). A positive reaction was detected in 31.3% of patients with AD and in 33.7% of those without (P>.05), and a statistically significant relationship was observed between contact sensitivity to fragrance allergens and AD (P=.046).

CONCLUSION

Metals and preservatives represent the most frequent allergens in Turkish children and adolescents. Metal sensitivity is expected to decrease as legislation is enforced. Regulatory measures are now required to reduce MI and MCI/MI contact allergy in Turkey.

Heavy metals in contact dermatitis: A review

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.

Results of the patch tests with European baseline series in children: Five years of experience from a single center in Turkey and a review of the literature

BACKGROUND

Pediatric allergic contact dermatitis (ACD) is increasingly prevalent. Patch testing is the gold-standard diagnostic method.

AIMS

Our study aimed to identify common contact-sensitizing allergens in Turkish children.

PATIENTS/METHODS

We retrospectively analyzed the patch test results and characteristics of 191 pediatric patients [114 (59.7%) females, 77 (40.3%) males], who received the diagnosis of allergic contact dermatitis between 2015 and 2019.

RESULTS

The mean age of the patients was 12.2 years (range 4-18 years). Thirty-six (18.8%) of the patients in the study group had positive patch test outcomes with 56 positive allergens. Girls had a significantly higher rate of total positive patch test results than boys (75%/25%; p = 0.003, p < 0.05). The most frequent four allergens were nickel sulfate (n = 20, 10.4%), cobalt chloride (n = 6, 3.14%), p-phenylenediamine (n = 5, 2.61%), Methylchloroisothiazolinone/methylisothiazolinone (n = 5, 2.61%), respectively.

CONCLUSIONS

In our study, we discovered that in addition to the frequently encountered metal allergens such as nickel and cobalt, p-phenylenediamine and Methylchloroisothiazolinone/methylisothiazolinone sensitivities were frequent in the Turkish population. p-phenylenediamine sensitization can cause serious systemic dermatitis during the lifetime of children. We suggest that in Turkey personal care and hygiene products containing Methylchloroisothiazolinone/methylisothiazolinone should be legally regulated. Since childhood contact dermatitis may have an impact on the quality of life by influencing family and social life, suspected allergens should be detected as early as possible.

Patch test results in a Dutch paediatric population with suspected contact allergy: A retrospective cohort study

BACKGROUND

Allergic contact dermatitis (ACD) in paediatric patients is on the rise. Continuous identification of emerging allergens is of great importance to ensure accurate patch testing.

OBJECTIVES

To assess the frequency and relevance of contact sensitivity in children and adolescents and evaluate changes in sensitization rates in the last decade.

METHODS

All patients with suspected ACD who underwent patch testing at the Amsterdam University Medical Centers between 2015 and 2021 were included.

RESULTS

Of 439 patients tested with the European Baseline Series (EBS) and additional series, 334 (76%) patients had at least 1 positive reaction and 172 patients (39%) had 1 or more relevant positive reactions. If additional series would have been omitted, 20% of patients would have been underdiagnosed. Compared to patients tested between 1996 and 2013, reactions to metal allergens, isothiazolinones, methyldibromo glutaronitrile, carba mix, amerchol L-101, and benzophenone-4 were more frequently observed.

CONCLUSIONS

This study confirms the need for patch testing in paediatric patients suspected of having ACD. For accurate patch testing, it is advised to include additional series.