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Sandler M, Yu J. Contact Allergy Screening for Atopic Dermatitis. Dermatol Clin 2024; 42:601-609. [PMID: 39278713 DOI: 10.1016/j.det.2024.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/18/2024]
Abstract
Atopic dermatitis (AD) and allergic contact dermatitis (ACD) are common inflammatory skin diseases in both children and adults that present similarly and often coexist. Patch testing is the gold standard for establishing the diagnosis of ACD and can often help distinct between the 2 conditions. Patch testing is more challenging in patients with underlying AD due to potential for angry back reactions. In this review, we discuss the current evidence and guidelines regarding the screening for contact allergies in patients with AD. We also discuss the most frequent relevant allergens in adults and children with atopic dermatitis.
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Affiliation(s)
- Mykayla Sandler
- Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, 50 Staniford Street, Suite 200, Boston, MA 02114, USA
| | - JiaDe Yu
- Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, 50 Staniford Street, Suite 200, Boston, MA 02114, USA.
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Silverberg JI, Patel N, Warshaw EM, DeKoven JG, Atwater AR, Belsito DV, Dunnick CA, Houle MC, Reeder MJ, Maibach HI, Zug KA, Taylor JS, Sasseville D, Fransway AF, DeLeo VA, Pratt MD, Fowler JF, Zirwas MJ. Lanolin Allergic Reactions: North American Contact Dermatitis Group Experience, 2001 to 2018. Dermatitis 2022; 33:193-199. [PMID: 35481824 DOI: 10.1097/der.0000000000000871] [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: 11/25/2022]
Abstract
BACKGROUND Lanolin is an important cause of allergic contact dermatitis. OBJECTIVES The aims of this study were to describe the epidemiology of lanolin allergy and to assess trends in patch test reactions to lanolin over time. METHODS This study used a retrospective analysis of patients patch tested with lanolin alcohol 30% or Amerchol L-101 50% in petrolatum by the North American Contact Dermatitis Group between 2001 and 2018 (n = 43,691). RESULTS Overall, 1431 (3.3%) had a positive reaction, and 1238 (2.8%) were currently relevant. Prevalence of lanolin allergy was 4.63% between 2011 and 2018 (P < 0.0001). Most lanolin-allergic patients had + (52%) reactions; 18%, and 6% had ++ and +++ reactions, respectively. Common primary anatomic sites of dermatitis were the hands (20.7%), scattered/generalized distribution (19.6%), and face (17.0%). Allergic reactions to lanolin were more common in children (4.5%) than in adults (3.2%, P = 0.0018). Compared with nonallergic patients, lanolin-allergic patients were more likely to have history of eczema or hay fever, male sex, older than 40 years, or Black race (P < 0.05). Common lanolin sources were personal care products and drugs/medications. Only 2.24% of the positive reactions were linked to occupation. CONCLUSIONS Lanolin sensitivity was common. Reactions were often clinically relevant and linked to personal care products and medications.
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Affiliation(s)
- Jonathan I Silverberg
- From the Department of Dermatology, George Washington University School of Medicine, Washington, DC
| | - Nisha Patel
- From the Department of Dermatology, George Washington University School of Medicine, Washington, DC
| | | | - Joel G DeKoven
- Division of Dermatology, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada
| | - Amber R Atwater
- Department of Dermatology, Duke University Medical Center, Durham, NC
| | | | - Cory A Dunnick
- Department of Dermatology, University of Colorado Anschutz Medical Campus, Aurora
| | | | - Margo J Reeder
- Department of Dermatology, University of Wisconsin School of Medicine and Public Health, Madison
| | - Howard I Maibach
- Department of Dermatology, University of California San Francisco
| | - Kathryn A Zug
- Department of Dermatology, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | | | - Denis Sasseville
- Division of Dermatology, Montreal General Hospital, McGill University, Quebec, Canada
| | | | - Vincent A DeLeo
- Division of Dermatology, University of Ottawa, Ontario, Canada
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Bonamonte D, Hansel K, Romita P, Belloni Fortina A, Girolomoni G, Fabbrocini G, Patruno C, Napolitano M, Patrizi A, Argenziano G, Micali G, Pinton PC, Foti C, Stingeni L. Contact allergy in children with and without atopic dermatitis: an Italian multicenter study. Contact Dermatitis 2022; 87:265-272. [PMID: 35451136 PMCID: PMC9541036 DOI: 10.1111/cod.14130] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 04/12/2022] [Accepted: 04/13/2022] [Indexed: 11/30/2022]
Abstract
Background Contact allergy and atopic dermatitis (AD) are both common inflammatory T cell‐mediated diseases and many factors may influence the prevalence of contact allergy in AD patients. In children, their possible correlation was debated with conflicting results. Objectives The present study aimed to assess the prevalence of contact sensitivity in children and to investigate the association with AD. Materials and methods A retrospective multicentre study on children aged from 0 to 14 years patch tested between January 2017 and December 2018 was performed. Children were consecutively patch tested with the SIDAPA (Società Italiana Dermatologia Allergologica Professionale Ambientale) baseline series. Results Among the 432 children investigated for contact allergy, 125 (28.9%) showed a positive reaction to at least one of the allergens tested, with a higher prevalence of positive patch test reactions in girls (32.3%) than in boys (25.0%). The most frequent contact allergens were nickel sulphate (10.2%), cobalt chloride (6.7%), methylisothiazolinone (3.7%), fragrance mix‐2 (3.2%), potassium dichromate (2.8%), fragrance mix‐1 (2.1%) and methylchloroisothiazolinone/methylisothiazolinone (2.1%). One‐hundred‐three children (23.8%) suffered from AD showing a higher prevalence of positive patch test (36.9%) compared to children without AD (26.4%). Conclusions Despite the topic being still controversial, the present study suggests a consistent prevalence of contact allergy among children with higher sensitivity rate among children with AD than without AD.
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Affiliation(s)
- Domenico Bonamonte
- Section of Dermatology, Department of Biomedical Science and Human Oncology, University of Bari "Aldo Moro", Bari, Italy
| | - Katharina Hansel
- Section of Dermatology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Paolo Romita
- Section of Dermatology, Department of Biomedical Science and Human Oncology, University of Bari "Aldo Moro", Bari, Italy
| | - Anna Belloni Fortina
- Unit of Pediatric Dermatology, Department of Medicine DIMED, University of Padua, Padua, Italy
| | - Giampiero Girolomoni
- Section of Dermatology, Department of Medicine, University of Verona, Verona, Italy
| | - Gabriella Fabbrocini
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Italy
| | - Cataldo Patruno
- Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Maddalena Napolitano
- Department of Medicine and Health Sciences Vincenzo Tiberio, University of Molise, Campobasso, Italy
| | - Annalisa Patrizi
- Unit of Dermatology, IRCS Azienda Ospedaliero Universitaria, University of Bologna, Bologna, Italy
| | - Giuseppe Argenziano
- Dermatology Unit, Department of Mental and Physical Health and Preventive Medicine, University of Campania Luigi Vanvitelli, Naples, Italy
| | | | | | - Caterina Foti
- Section of Dermatology, Department of Biomedical Science and Human Oncology, University of Bari "Aldo Moro", Bari, Italy
| | - Luca Stingeni
- Section of Dermatology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
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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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Kunkiel K, Sojewska M, Feleszko W. Contact haptens in emollients marketed in two European countries (Poland and Spain). Allergol Immunopathol (Madr) 2020; 48:814-818. [PMID: 32460993 DOI: 10.1016/j.aller.2020.04.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 04/07/2020] [Accepted: 04/15/2020] [Indexed: 11/17/2022]
Abstract
INTRODUCTION AND OBJECTIVES Atopic dermatitis (AD) is the most common skin disease among pediatric patients, which affects up to 20% of children worldwide. Characterized by pruritus and eczema, it is also associated with improper skin barrier function and allergen sensitization. Here, we aimed to assess the presence of haptens in emollients marketed in two European countries: in Poland and Spain, as, firstly, these products are considered to be AD's basic therapy, and, secondly, frequent application of potent sensitizers on atopic skin may result in contact dermatitis. MATERIALS AND METHODS We systematically searched for moisturizers explicitly described as "Atopic skin care" products in the most frequently visited online pharmacies in Poland and Spain. Subsequently, we created a database of all products and compared their composition with 139 contact haptens listed in the European Baseline Series (EBS), Fragrance and Cosmetic Series. RESULTS As of December 2018, our list comprised 159 and 111 emollients available on the Polish and Spanish markets, respectively. There were no ingredients listed in 28 (17.5%) products in Poland and 24 (21.6%) in Spain. Only 23 (17.5%) and 13 (14.8%) products were hapten free. The pattern of most common haptens was similar in both countries, including phenoxyethanol, tocopherol and tocopheryl acetate, undefined parfum in Poland and tocopherol, phenoxyethanol, tocopheryl acetate and undefined parfum in Spain. CONCLUSIONS This study shows that a vast majority of products taken into consideration contain at least one potential contact hapten. These findings indicate a need for patient education about potentially allergenic ingredients and stronger cooperation between academia and cosmetic manufacturers.
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Affiliation(s)
- K Kunkiel
- Department of Pediatric Respiratory Diseases and Allergy, The Medical University of Warsaw, Żwirki i Wigury 63A, PL-02-091 Warsaw, Poland
| | - M Sojewska
- Department of Pediatric Respiratory Diseases and Allergy, The Medical University of Warsaw, Żwirki i Wigury 63A, PL-02-091 Warsaw, Poland
| | - W Feleszko
- Department of Pediatric Respiratory Diseases and Allergy, The Medical University of Warsaw, Żwirki i Wigury 63A, PL-02-091 Warsaw, Poland.
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Tamagawa-Mineoka R, Katoh N. Atopic Dermatitis: Identification and Management of Complicating Factors. Int J Mol Sci 2020; 21:E2671. [PMID: 32290423 PMCID: PMC7215488 DOI: 10.3390/ijms21082671] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 04/09/2020] [Accepted: 04/10/2020] [Indexed: 12/23/2022] Open
Abstract
Atopic dermatitis (AD) is a chronic relapsing inflammatory skin disease, associated with impaired skin barrier function and an atopic background. Various complicating factors, such as irritants, aeroallergens, food, microbial organisms, contact allergens, sweat, and scratching can induce the development of AD symptoms. Irritants, including soap/shampoo and clothes, can cause itching and eczematous lesions. In addition, young children with AD tend to become sensitized to eggs, milk, or peanuts, while older children and adults more often become sensitized to environmental allergens, such as house dust mites (HDM), animal dander, or pollen. Serum-specific IgE levels and skin prick test reactions to food tend to show high negative predictive values and low specificity and positive predictive values for diagnosing food allergy. On the other hand, AD adult patients tend to have severe skin symptoms and exhibit high HDM-specific IgE levels. Microbial organisms, e.g., Staphylococcus aureus and Malassezia furfur, might contribute to the pathogenetic mechanisms of AD. While sweat plays a major role in maintaining skin homeostasis, it can become an aggravating factor in patients with AD. Furthermore, scratching often exacerbates eczematous lesions. Several patient-specific complicating factors are seen in most cases. The identification and management of complicating factors are important for controlling AD.
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Affiliation(s)
- Risa Tamagawa-Mineoka
- Department of Dermatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan;
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Kolberg L, Forster F, Gerlich J, Weinmayr G, Genuneit J, Windstetter D, Vogelberg C, von Mutius E, Nowak D, Drexler H, Schäfer T, Radon K. Nickel allergy is associated with wheezing and asthma in a cohort of young German adults: results from the SOLAR study. ERJ Open Res 2020; 6:00178-2019. [PMID: 32039258 PMCID: PMC6995837 DOI: 10.1183/23120541.00178-2019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 12/04/2019] [Indexed: 11/05/2022] Open
Abstract
Background Nickel allergy is the most prevalent contact allergy. It belongs to a different hypersensitivity type to asthma and rhinoconjunctivitis. The aim of this analysis was to assess whether self-reported nickel allergy is associated with incident wheezing, asthma and rhinoconjunctivitis in young German adults, taking into account potential effect modification by sex. Methods In total, 2051 (70.6%) participants aged 19–24 years took part in the second phase of SOLAR (Study on Occupational Allergy Risks), a follow-up study of ISAAC II (the second phase of the International Study of Asthma and Allergies in Childhood) in Germany. Self-reported nickel allergy, as well as having pierced ears, and the three outcomes incident wheezing, asthma and rhinoconjunctivitis, were analysed stratified for sex. Logistic regression adjusted for potential confounders was performed. Results An association between self-reported nickel allergy and incident wheezing was observed for men and women, while only in males did pierced ears show a significant association with the outcome (adjusted OR 2.26, 95% CI 1.10–4.62). Also only in males, self-reported nickel allergy was associated with elevated odds for incident asthma (adjusted OR 4.34, 95% CI 1.22–15.41). Neither in men nor in women was a significant association observed for incident rhinoconjunctivitis. Conclusion Our results suggest that self-reported nickel allergy is associated with incident wheezing. Whether this association is due to environmental or genetic predisposition, or due to an overlap of the mechanisms of type I and type IV hypersensitivity, needs to be elucidated. Self-reported nickel allergy is associated with incident wheezing in young German males and females, and with incident asthma in males, whereas no significant association was observed for self-reported nickel allergy and incident rhinoconjunctivitishttp://bit.ly/2YHmwBA
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Affiliation(s)
- Laura Kolberg
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Munich, Germany.,Institute for Medical Informatics, Biometry, and Epidemiology, LMU Munich, Munich, Germany.,Comprehensive Pneumology Center Munich, Member of German Centre for Lung Research, Munich, Germany
| | - Felix Forster
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Munich, Germany.,Comprehensive Pneumology Center Munich, Member of German Centre for Lung Research, Munich, Germany
| | - Jessica Gerlich
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Munich, Germany.,Comprehensive Pneumology Center Munich, Member of German Centre for Lung Research, Munich, Germany
| | - Gudrun Weinmayr
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Jon Genuneit
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany.,Pediatric Epidemiology, Hospital for Children and Adolescents, University of Leipzig Medical Center, Leipzig, Germany
| | - Doris Windstetter
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Munich, Germany
| | - Christian Vogelberg
- Paediatric Dept, University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Erika von Mutius
- Comprehensive Pneumology Center Munich, Member of German Centre for Lung Research, Munich, Germany.,Dr. v. Haunersches Kinderspital, University Hospital, LMU Munich, Munich Germany
| | - Dennis Nowak
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Munich, Germany.,Comprehensive Pneumology Center Munich, Member of German Centre for Lung Research, Munich, Germany
| | - Hans Drexler
- Dept of Occupational, Social and Environmental Medicine, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Torsten Schäfer
- Dermatologische Praxis Prof. Dr. med. Torsten Schäfer, Immenstadt, Germany
| | - Katja Radon
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Munich, Germany.,Comprehensive Pneumology Center Munich, Member of German Centre for Lung Research, Munich, Germany.,Munich Center of Health Sciences (MC-Health), Munich, Germany
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Raffi J, Suresh R, Botto N, Murase JE. The impact of dupilumab on patch testing and the prevalence of comorbid allergic contact dermatitis in recalcitrant atopic dermatitis: A retrospective chart review. J Am Acad Dermatol 2020; 82:132-138. [DOI: 10.1016/j.jaad.2019.09.028] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 09/01/2019] [Accepted: 09/14/2019] [Indexed: 12/23/2022]
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Teo Y, McFadden JP, White IR, Lynch M, Banerjee P. Allergic contact dermatitis in atopic individuals: Results of a 30‐year retrospective study. Contact Dermatitis 2019; 81:409-416. [DOI: 10.1111/cod.13363] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 07/20/2019] [Accepted: 07/24/2019] [Indexed: 01/10/2023]
Affiliation(s)
- Ying Teo
- Department of DermatologyUniversity Hospital Southampton NHS Foundation Trust Southampton UK
- Department of Cutaneous AllergySt John's Institute of Dermatology, Guy's Hospital London UK
| | - John P. McFadden
- Department of Cutaneous AllergySt John's Institute of Dermatology, Guy's Hospital London UK
| | - Ian R. White
- Department of Cutaneous AllergySt John's Institute of Dermatology, Guy's Hospital London UK
| | - Magnus Lynch
- Department of Cutaneous AllergySt John's Institute of Dermatology, Guy's Hospital London UK
| | - Piu Banerjee
- Department of Cutaneous AllergySt John's Institute of Dermatology, Guy's Hospital London UK
- Department of DermatologyLewisham Hospital London UK
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Abstract
BACKGROUND Atopic dermatitis (AD) associated with respiratory atopy may represent a form of systemic contact dermatitis (SCD), whereby AD flares after ingestion or inhalation of allergens. OBJECTIVE The aim of the study was to compare the prevalence of positive patch tests to allergens known to cause SCD in AD patients with and without respiratory atopy. METHODS This is a retrospective study of patients with AD patch tested to 23 allergens known to cause SCD. Positive patch tests were compared between AD patients with and without respiratory atopy, stratified by age and wet or dry work occupation. CONCLUSIONS Children and adolescents, but not adults, with AD and respiratory atopy were more likely than age-matched AD patients without respiratory atopy to have positive patch tests to these allergens (odds ratio, 2.33; 95% confidence interval, 1.13-4.79). Moreover, AD patients with respiratory atopy and engaging in wet work, but not dry work, occupations were more likely than AD patients without respiratory atopy to have positive patch tests to allergens known to cause SCD (odds ratio, 1.47; 95% confidence interval, 1.05-2.06). Thus, respiratory atopy and wet work are associated with sensitization to allergens known to cause SCD in patients with AD, and patch testing may be valuable in identifying systemic triggers of dermatitis in these patients.
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Experience in patch testing: A 6-year retrospective review from a single academic allergy practice. Ann Allergy Asthma Immunol 2019; 122:502-507. [PMID: 30851460 DOI: 10.1016/j.anai.2019.02.028] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Revised: 02/10/2019] [Accepted: 02/28/2019] [Indexed: 01/06/2023]
Abstract
BACKGROUND Patch testing is the "gold standard" to identify culprit allergen(s) causing allergic contact dermatitis (ACD), but there are limited studies of patch testing from allergy practice settings. OBJECTIVE We sought to explore patch test findings in a large academic allergy practice, including patch testing results, history of atopy, location of dermatitis, and referral source. We also wanted to determine whether patch testing using an extended panel, such as the North American screening series, compared with a limited series, such as the Thin-Layer Rapid-Use Epicutaneous (T.R.U.E.) Test, increased the sensitivity. METHODS A retrospective chart review was conducted of patients referred for patch testing over a 6-year period. RESULTS A total of 585 patients (mean age 48.7 years, 71.6 % female) underwent patch testing over the 6-year period, of which 369 (63%) had a positive test. Of those who tested positive, 202 (55%) reported a history of atopy. The extremities were the most commonly involved site, followed by the head/neck and trunk. The 5 most common positive allergens were nickel sulfate, gold sodium thiosulfate, methylchloroisothiazolinone, thimerosal, and bacitracin. Three hundred fourteen (53.6%) patients were positive to at least 1 allergen on TRUE testing. Extended screening series identified an additional 10.8% of patients with positive tests who were negative to T.R.U.E. test allergens. CONCLUSION Patch testing is a valuable diagnostic tool for the practicing allergist and provides early identification of culprit allergens in ACD. Performing an extended screening series such as the North American Contact Dermatitis Group (NACDG) or supplemental panel of allergens increased sensitivity when compared with a limited series.
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Prevalence of Atopic Dermatitis Criteria among Textile Workers with Occupational Allergic Contact Dermatitis and Effects of Having Atopic Dermatitis on Contact Antigenic Diversity. MEDICAL BULLETIN OF SISLI ETFAL HOSPITAL 2019; 53:58-69. [PMID: 33536829 PMCID: PMC7847731 DOI: 10.14744/semb.2018.67365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 08/16/2018] [Indexed: 11/20/2022]
Abstract
Objectives: Contact dermatitis (CD) is a common skin disease. Occupational contact dermatitis (OCD) is the most frequently seen occupational skin disease and includes both occupational allergic CD (OACD) and occupational irritant CD (OICD). One of the most common sources of OACD is textile products. Individuals with atopic dermatitis (AD) have an increased risk for development of allergic contact dermatitis (ACD). However, the role of AD in the etiopathogenesis of the development of OACD among textile industry workers is not well known. The aim of the present study was to determine the prevalence of AD among textile workers with OACD and to analyze contact antigenic diversity between the workers with and without AD. Methods: A prospective, cross-sectional study was conducted with 352 textile workers who had previously been diagnosed with OACD. The patients were questioned and examined with respect to AD criteria, demographic features, disease duration, duration of employment until first symptoms, phototype, workplace (subsectors), and location of lesions at control visits. Immediate skin test reactivity was evaluated with a commercial skin prick test panel. The data obtained and the patients’ previously recorded patch test results were compared in OACD groups with and without a diagnosis of AD. The results were statistically evaluated with a significance level of p value <0.05. Results: The study population consisted of 124 males and 227 females. The mean age was 35.69±13.65 years. The most commonly seen employment duration, phototype, subsector, and location were 4 to 8 months (26.14%), 9 to 12 months (34.66%), Fitzpatrick type-III (37.50%), dyeing (33.52%), and exclusively the hands (60.51%), respectively. In all, 193 patients (54.83%) met the criteria for the diagnosis of AD. In the OACD group with AD, there was a significant number with 4 major and 16 minor criteria, as well as positivity for 14 contact allergens. Conclusion: Most AD criteria, or a diagnosis of AD, are highly detectable among workers with textile-related OACD. The results for patch test allergens may be significantly higher than those of individuals without AD. Textile workers with AD should be warned about the possibility of the early development of OACD.
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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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Kirchhof MG, de Gannes GC. Atopy Associated With Positive Patch Test and Possible Allergic Contact Dermatitis. J Cutan Med Surg 2018; 22:405-410. [PMID: 29457485 DOI: 10.1177/1203475418758988] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Atopy is a genetic predisposition to the development of allergic reactions and the increased production of immunoglobulin E (IgE) upon exposure to environmental antigens. Clinical manifestations of atopy include asthma, atopic dermatitis (AD), and allergic rhinoconjunctivitis (ARC). OBJECTIVE To determine if cutaneous delayed hypersensitivity reactions (CDHRs) as assessed by patch testing are higher among patients with a history of atopy and with a familial predisposition to atopy. METHODS For this study, we reviewed the patch test database of the UBC Contact Dermatitis Clinic over a 4-year time span. A personal history of asthma, AD, and ARC was recorded. In addition, a family history was obtained and manifestations of atopy in family members were noted. RESULTS A total of 1515 patients were included in this study. Our data show that the odds ratio (OR) of a positive patch test with a personal history of atopy was 1.39, while the OR of a positive patch test with a family history of atopy was 1.69. Conversely, a personal history of respiratory atopy did not significantly affect the probability of a positive patch test, with an OR of 1.03. CONCLUSION We conclude from our study that patients with a personal or family history of atopy have an increased risk of allergic contact dermatitis (ACD). These results provide further evidence for the link between atopy and ACD and suggest that children of atopic parents should avoid potential contact allergens and would likely benefit from prophylactic emollient use.
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Affiliation(s)
- Mark G Kirchhof
- 1 Division of Dermatology, Department of Medicine, University of Ottawa and The Ottawa Hospital, Ottawa, ON, Canada
| | - Gillian C de Gannes
- 2 Department of Dermatology and Skin Science, University of British Columbia, Vancouver, BC, Canada.,3 Division of Dermatology, Department of Medicine, St. Paul's Hospital, Vancouver, BC, Canada
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15
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Fransen M, Overgaard LEK, Johansen JD, Thyssen JP. Contact allergy to lanolin: temporal changes in prevalence and association with atopic dermatitis. Contact Dermatitis 2017; 78:70-75. [DOI: 10.1111/cod.12872] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 07/09/2017] [Accepted: 07/12/2017] [Indexed: 02/06/2023]
Affiliation(s)
- Marloes Fransen
- Department of Dermatology and Allergy, National Allergy Research Centre, Herlev and Gentofte Hospital; University of Copenhagen; 2900 Hellerup Denmark
- Department of Dermatology; Maastricht University Medical Centre; P.O. Box 5800, 6202 AZ Maastricht The Netherlands
| | - Line E. K. Overgaard
- Department of Dermatology and Allergy, National Allergy Research Centre, Herlev and Gentofte Hospital; University of Copenhagen; 2900 Hellerup Denmark
| | - Jeanne D. Johansen
- Department of Dermatology and Allergy, National Allergy Research Centre, Herlev and Gentofte Hospital; University of Copenhagen; 2900 Hellerup Denmark
| | - Jacob P. Thyssen
- Department of Dermatology and Allergy, National Allergy Research Centre, Herlev and Gentofte Hospital; University of Copenhagen; 2900 Hellerup Denmark
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16
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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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17
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Halling-Overgaard AS, Kezic S, Jakasa I, Engebretsen K, Maibach H, Thyssen J. Skin absorption through atopic dermatitis skin: a systematic review. Br J Dermatol 2017; 177:84-106. [DOI: 10.1111/bjd.15065] [Citation(s) in RCA: 73] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/22/2016] [Indexed: 02/06/2023]
Affiliation(s)
- A.-S. Halling-Overgaard
- Department of Dermatology and Allergy; Herlev and Gentofte Hospital; University of Copenhagen; DK-2900 Hellerup Denmark
- National Allergy Research Centre; Herlev and Gentofte Hospital; University of Copenhagen; DK-2900 Hellerup Denmark
| | - S. Kezic
- Coronel Institute of Occupational Health; Academic Medical Centre; Amsterdam the Netherlands
| | - I. Jakasa
- Laboratory for Analytical Chemistry; Department of Chemistry and Biochemistry; Faculty of Food Technology and Biotechnology; University of Zagreb; Zagreb Croatia
| | - K.A. Engebretsen
- Department of Dermatology and Allergy; Herlev and Gentofte Hospital; University of Copenhagen; DK-2900 Hellerup Denmark
- National Allergy Research Centre; Herlev and Gentofte Hospital; University of Copenhagen; DK-2900 Hellerup Denmark
| | - H. Maibach
- Department of Dermatology; University of California San Francisco; San Francisco CA U.S.A
| | - J.P. Thyssen
- Department of Dermatology and Allergy; Herlev and Gentofte Hospital; University of Copenhagen; DK-2900 Hellerup Denmark
- National Allergy Research Centre; Herlev and Gentofte Hospital; University of Copenhagen; DK-2900 Hellerup Denmark
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18
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Osinka K, Karczmarz A, Krauze A, Feleszko W. Contact allergens in cosmetics used in atopic dermatitis: analysis of product composition. Contact Dermatitis 2017; 75:241-3. [PMID: 27620120 DOI: 10.1111/cod.12604] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Revised: 03/15/2016] [Accepted: 03/21/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Katarzyna Osinka
- Department of Paediatric Respiratory Diseases and Allergy, The Medical University of Warsaw, 02-091, Warsaw, Poland
| | - Agnieszka Karczmarz
- Department of Paediatric Respiratory Diseases and Allergy, The Medical University of Warsaw, 02-091, Warsaw, Poland
| | - Agnieszka Krauze
- Department of Paediatric Respiratory Diseases and Allergy, The Medical University of Warsaw, 02-091, Warsaw, Poland
| | - Wojciech Feleszko
- Department of Paediatric Respiratory Diseases and Allergy, The Medical University of Warsaw, 02-091, Warsaw, Poland.
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19
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Rivers DA, Stern R, Maibach HI. A defective inflammatory response may underlie cases of atopic dermatitis. J Eur Acad Dermatol Venereol 2017; 31:e313-e315. [PMID: 28000285 DOI: 10.1111/jdv.14099] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- D A Rivers
- Department of Biomedical Sciences, Touro College of Osteopathic Medicine, New York, NY, USA
| | - R Stern
- Department of Biomedical Sciences, Touro College of Osteopathic Medicine, New York, NY, USA
| | - H I Maibach
- Department of Dermatology, University of California at San Francisco, San Francisco, CA, USA
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20
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Admani S, Goldenberg A, Jacob SE. Contact Alopecia: Improvement of Alopecia with Discontinuation of Fluocinolone Oil in Individuals Allergic to Balsam Fragrance. Pediatr Dermatol 2017; 34:e57-e60. [PMID: 27778425 DOI: 10.1111/pde.13011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Inflammatory scalp dermatoses can be associated with alopecia, which is nonscarring and reversible in its early stages. This association has been described in seborrheic dermatitis, psoriasis, and atopic dermatitis. We describe three girls with alopecia aggravated by contact allergy to balsam fragrances. All three had complete resolution with avoidance of balsam of Peru and other balsam derivatives (including discontinuation of fluocinolone oil, which contains balsam of pine).
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Affiliation(s)
- Shehla Admani
- Department of Dermatology, University of California, San Diego, La Jolla, California
| | - Alina Goldenberg
- Department of Dermatology, University of California, San Diego, La Jolla, California
| | - Sharon E Jacob
- Department of Dermatology, Loma Linda University, Loma Linda, California
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21
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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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22
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Kohli N, Nedorost S. Inflamed skin predisposes to sensitization to less potent allergens. J Am Acad Dermatol 2016; 75:312-317.e1. [DOI: 10.1016/j.jaad.2016.03.010] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Revised: 03/08/2016] [Accepted: 03/09/2016] [Indexed: 10/21/2022]
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23
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A Pragmatic Approach to Patch Testing Atopic Dermatitis Patients: Clinical Recommendations Based on Expert Consensus Opinion. Dermatitis 2016; 27:186-92. [DOI: 10.1097/der.0000000000000208] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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24
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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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25
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Agner T, Aalto-Korte K, Andersen K, Foti C, Gimenéz-Arnau A, Goncalo M, Goossens A, Le Coz C, Diepgen T. Classification of hand eczema. J Eur Acad Dermatol Venereol 2015; 29:2417-22. [DOI: 10.1111/jdv.13308] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Accepted: 06/18/2015] [Indexed: 11/27/2022]
Affiliation(s)
- T. Agner
- Department of Dermatology; Bispebjerg Hospital; University of Copenhagen Copenhagen Denmark
| | - K. Aalto-Korte
- Occupational Medicine; Finnish Institute of Occupational Health; Helsinki Finland
| | - K.E. Andersen
- Department of Dermatology and Allergy Centre; Odense University Hospital; University of Southern Denmark; Odense Denmark
| | - C. Foti
- Unit of Dermatology; Department of Biomedical Science and Human Oncology; University of Bari; Bari Italy
| | - A. Gimenéz-Arnau
- Department of Dermatology; Hospital del Mar; Institut Mar d′Investigations Mediques; Universitat Autònoma; Barcelona Spain
| | - M. Goncalo
- Department of Dermatology; University Hospital and Faculty of Medicine; University of Coimbra; Coimbra Portugal
| | - A. Goossens
- Department of Dermatology; University Hospital; K. U. Leuven; Leuven Belgium
| | - C. Le Coz
- Cabinet de Dermatologie and Laboratoire de Dermatochimie; Strasbourg France
| | - T.L. Diepgen
- Department of Social Medicine, Occupational and Environmental Dermatology; University Hospital; Heidelberg Germany
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26
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Belloni Fortina A, Cooper SM, Spiewak R, Fontana E, Schnuch A, Uter W. Patch test results in children and adolescents across Europe. Analysis of the ESSCA Network 2002-2010. Pediatr Allergy Immunol 2015; 26:446-55. [PMID: 25939691 DOI: 10.1111/pai.12397] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/29/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND Contact sensitization in children is more frequent than previously thought. METHODS The ESSCA collected patch test data from 11 European countries aggregated to 4 European regions. RESULTS Six thousand and eight patients aged 1-16 years old with suspected allergic contact dermatitis were analyzed during a period of 8 years (2002-2010). The overall prevalence of at least one positive reaction to a hapten was 36.9%. The 10 most frequent haptens were as follows: nickel sulfate, cobalt chloride and potassium dichromate, neomycin sulfate, Myroxylon pereirae resin (balsam of Peru), para-phenylenediamine, chloromethylisothiazolinone/methylisothiazolinone 3:1, fragrance mix, lanolin alcohols, and colophony. No difference was found in the prevalence of at least one positive reaction to at least one hapten between boys and girls and between children with atopic dermatitis and children without. Children without atopic dermatitis, when compared with those with, had a significantly higher prevalence of contact sensitization for nickel sulfate (20.91% vs 16.87%, respectively), 4-tert. butylphenol formaldehyde resin (1.61% vs. 0.7%), and para-phenylenediamine (2.49% vs. 1.3%). LIMITATIONS OF THE STUDY Chamber loading is not an exact science and variation may occur between staff and departments. Interinstitution variations in readings can occur. A possible geographic confounder is that the southern regions tested more children in the younger age group. Relevance was not addressed due to difficulties in the application of a set of uniform definitions. CONCLUSIONS Our study adds information on the most common contact allergens detected in children which could help to define a Standard European Pediatric Baseline Series.
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Affiliation(s)
- Anna Belloni Fortina
- Pediatric Dermatology Unit, Department of Medicine, University of Padova, Padova, Italy
| | - Susan M Cooper
- Department of Dermatology, Churchill Hospital, Oxford, UK
| | - Radoslaw Spiewak
- Department of Experimental Dermatology and Cosmetology, Faculty of Pharmacy, Jagiellonian University Medical College, Krakow, Poland
| | - Elena Fontana
- Pediatric Dermatology Unit, Department of Medicine, University of Padova, Padova, Italy
| | - Axel Schnuch
- Information Network of Departments of Dermatology (IVDK), University Medicine, Göttingen, Germany
| | - Wolfgang Uter
- Department of Medical Informatics, Biometry and Epidemiology, University of Erlangen/Nürnberg, Erlangen, Germany
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27
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Bregnbak D, Johansen JD, Jellesen MS, Zachariae C, Menné T, Thyssen JP. Chromium allergy and dermatitis: prevalence and main findings. Contact Dermatitis 2015; 73:261-80. [DOI: 10.1111/cod.12436] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Revised: 05/12/2015] [Accepted: 05/12/2015] [Indexed: 12/14/2022]
Affiliation(s)
- David Bregnbak
- Department of Dermato-Allergology; National Allergy Research Centre, Copenhagen University Hospital Gentofte; Hellerup 2900 Denmark
| | - Jeanne D. Johansen
- Department of Dermato-Allergology; National Allergy Research Centre, Copenhagen University Hospital Gentofte; Hellerup 2900 Denmark
| | - Morten S. Jellesen
- Materials and Surface Engineering, Department of Mechanical Engineering; Technical University of Denmark; DK-2800 Lyngby Denmark
| | - Claus Zachariae
- Department of Dermato-Allergology; Gentofte University Hospital; Hellerup 2900 Denmark
| | - Torkil Menné
- Department of Dermato-Allergology; National Allergy Research Centre, Copenhagen University Hospital Gentofte; Hellerup 2900 Denmark
| | - Jacob P. Thyssen
- Department of Dermato-Allergology; National Allergy Research Centre, Copenhagen University Hospital Gentofte; Hellerup 2900 Denmark
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28
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Tamagawa-Mineoka R, Masuda K, Ueda S, Nakamura N, Hotta E, Hattori J, Minamiyama R, Yamazaki A, Katoh N. Contact sensitivity in patients with recalcitrant atopic dermatitis. J Dermatol 2015; 42:720-2. [PMID: 25808093 DOI: 10.1111/1346-8138.12866] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2014] [Accepted: 02/16/2015] [Indexed: 11/28/2022]
Abstract
Patients with atopic dermatitis are usually responsive to conventional treatment such as topical steroids; however, they are sometimes refractory to the treatment. The influence of contact sensitivities on the course of patients with recalcitrant atopic dermatitis is not known. The aim of this study was to investigate whether contact sensitivities affect the course of patients with recalcitrant atopic dermatitis. We evaluated 45 patients with atopic dermatitis who had failed conventional therapy. Patch testing was performed with the Japanese standard series, metal series and/or suspected items. A total of 15 patients had a positive patch test reaction to at least one allergen. The most common allergens were nickel, topical drugs and rubber accelerators. Avoidance of products or food containing allergic substances greatly or partially improved skin symptoms in nine patients. These results suggest that contact allergens and metals may be critical factors causing eczematous lesions in patients with recalcitrant atopic dermatitis.
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Affiliation(s)
- Risa Tamagawa-Mineoka
- Department of Dermatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Koji Masuda
- Department of Dermatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Sachiko Ueda
- Department of Dermatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Naomi Nakamura
- Department of Dermatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Eri Hotta
- Department of Dermatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Junko Hattori
- Department of Dermatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Rina Minamiyama
- Department of Dermatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Akiko Yamazaki
- Department of Dermatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Norito Katoh
- Department of Dermatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
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29
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Fonacier LS, Sher JM. Allergic contact dermatitis. Ann Allergy Asthma Immunol 2014; 113:9-12. [PMID: 24950843 DOI: 10.1016/j.anai.2014.03.018] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Revised: 02/14/2014] [Accepted: 03/24/2014] [Indexed: 12/13/2022]
Affiliation(s)
- Luz S Fonacier
- Department of Clinical Medicine, State University of New York at Stony Brook, and Allergy & Training Program, Winthrop University Hospital, Mineola, New York.
| | - Janelle M Sher
- Allergy and Immunology Fellow in Training, Winthrop University Hospital, Mineola, New York
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30
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Clemmensen KKB, Thomsen SF, Jemec GBE, Agner T. Pattern of contact sensitization in patients with and without atopic dermatitis in a hospital-based clinical database. Contact Dermatitis 2014; 71:75-81. [PMID: 24697272 DOI: 10.1111/cod.12229] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2013] [Revised: 01/24/2014] [Accepted: 01/26/2014] [Indexed: 01/09/2023]
Abstract
BACKGROUND Both atopic dermatitis and contact sensitization are common conditions; however, a definite understanding of the relationship between contact sensitization and atopic dermatitis has not been reached. OBJECTIVES In this descriptive study, we investigated the differences between positive patch test reactions in patients with and without atopic dermatitis in a patch test cohort, and explored the influence of disease severity. PATIENTS/MATERIALS/METHODS Patch test results, information on atopic dermatitis and demographic variables were taken from a database, including all patients patch tested at Bispebjerg and Roskilde Hospitals from January 2009 to January 2013. Severe atopic dermatitis was defined as systemic therapy or hospitalization resulting from atopic dermatitis. All other patients with atopic dermatitis were defined as having mild/moderate disease. RESULTS The study included 2221 patients: 293 patients with atopic dermatitis and 1928 without. Forty-one per cent of patients with and 46.2% of patients without atopic dermatitis had at least one positive patch test reaction (p = 0.092). More patients with severe atopic dermatitis than patients with non-severe atopic dermatitis had multiple positive patch test reactions (19.4% versus 10.0%, p = 0.046). CONCLUSIONS Overall, we found similar frequencies of positive patch test reactions in patients with and without atopic dermatitis. However, a higher frequency of multiple sensitizations was found in patients with severe atopic dermatitis.
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31
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Abstract
Systemic therapy for atopic dermatitis (AD) is indicated in patients with severe disease refractory to adequate topical treatment. Currently available drugs aim to decrease inflammation by suppressing and/or modulating immune responses and thus may indirectly improve skin barrier function, resulting in a decrease in clinical signs and symptoms in particular pruritus. Before considering systemic treatment, patient adherence to topical treatment including skin care has to be ensured. The selection of the drug depends on the disease severity, localization, complications, concomitant diseases, and age of the patient, but also on their availability and costs as well as the doctor's experience. Bearing in mind the potential risk of resistance, systemic therapy with antibiotics should be exclusively considered in clinically manifest infections such as in children. Here, we review recently published clinical trials and case reports on systemic therapy of pediatric and adult patients with AD to draw conclusions for clinical practice. Although AD is a common disease, controlled clinical studies investigating the efficacy of systemic drugs are scarce, except for cyclosporine, which has been approved for the therapy of severe AD.
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Affiliation(s)
- D. Simon
- Department of Dermatology; Inselspital; Bern University Hospital; University of Bern; Bern Switzerland
| | - T. Bieber
- Department of Dermatology and Allergy; University of Bonn; Bonn Germany
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32
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Thyssen JP, McFadden JP, Kimber I. The multiple factors affecting the association between atopic dermatitis and contact sensitization. Allergy 2014; 69:28-36. [PMID: 24372195 DOI: 10.1111/all.12358] [Citation(s) in RCA: 98] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2013] [Indexed: 02/06/2023]
Abstract
Atopic dermatitis and allergic contact dermatitis are both common skin diseases having an immune pathogenesis. There has been considerable interest about their inter-relationships with regard to altered susceptibility. Recent investigations have shed new light on this important question, and in this article, we explore whether there is evidence that atopic dermatitis affects the risk of contact sensitization and allergic contact dermatitis. The use of topical products to treat xerotic and inflamed skin in atopic dermatitis often results in a higher prevalence of sensitization to, for example, fragrances and other ingredients in emollients. Moreover, the prevalence of metal allergy seems to be increased, probably due to compromised chelation of the metals in the stratum corneum of patients with atopic dermatitis. However, conversely, the T-helper cell 2 bias that characterizes immune responses in atopic dermatitis appears to lower the risk of contact sensitization compared to healthy controls. Based on these observations, we conclude that multiple factors affect the association between atopic dermatitis and contact sensitization, and that these need to be appreciated in the clinical management of atopic dermatitis patients.
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Affiliation(s)
- J. P. Thyssen
- National Allergy Research Centre; Department of Dermato-Allergology; Gentofte University Hospital; Hellerup Denmark
| | - J. P. McFadden
- St John's Institute of Dermatology; King's College; St Thomas' Hospital; London UK
| | - I. Kimber
- Faculty of Life Sciences; University of Manchester; Manchester UK
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33
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Wollenberg A, Feichtner K. Atopic dermatitis and skin allergies - update and outlook. Allergy 2013; 68:1509-19. [PMID: 24410780 DOI: 10.1111/all.12324] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/12/2013] [Indexed: 12/20/2022]
Abstract
During the last few years, an impressive amount of experimental studies and clinical trials have dealt with a variety of distinct topics in allergic skin diseases - especially atopic dermatitis. In this update, we discuss selected recent data that provide relevant insights into clinical and pathophysiological aspects of allergic skin diseases or discuss promising targets and strategies for the future treatment of skin allergy. This includes aspects of barrier malfunction and inflammation as well as the interaction of the cutaneous immune system with the skin microbiome and diagnostic procedures for working up atopic dermatitis patients. Additionally, contact dermatitis, urticaria, and drug reactions are addressed in this review. This update summarizes novel evidence, highlighting current areas of uncertainties and debates that will stimulate scientific discussions and research activities in the field of atopic dermatitis and skin allergies in the future.
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Affiliation(s)
- A. Wollenberg
- Department of Dermatology and Allergy; Ludwig Maximilian University; Munich Germany
| | - K. Feichtner
- Department of Dermatology and Allergy; Ludwig Maximilian University; Munich Germany
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Macan J, Rimac D, Kežić S, Varnai VM. Occupational and non-occupational allergic contact dermatitis: a follow-up study. Dermatology 2013; 227:321-9. [PMID: 24193097 DOI: 10.1159/000354763] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2013] [Accepted: 08/03/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS The aim of this study was to obtain insight into the clinical course and prognosis of allergic contact dermatitis (ACD), including potential effects of genetic and environmental factors. METHODS Eighty-two patients with previously defined ACD acquired occupationally (OACD) or non-occupationally (NOACD) were patch retested and evaluated for the presence of persistent eczema, atopy and filaggrin mutations. RESULTS The crude risk for the persistence of a positive patch test (PT) reaction was 6.3 times higher (95% CI 3.63-11.0) for PT reactions assessed as '+++' compared to '++' reactions at the first PT. Among the categories of OACD, NOACD, age, gender, atopy, and the number of positive PT reactions at the first and second PT, only OACD (OR 10.0, 95% CI 1.95-51.2) and number of positive PT reactions at retesting (OR 3.85, 95% CI 1.57-9.44) were found to be predictors of persistent eczema. CONCLUSIONS Occupationally acquired contact allergy was emphasized as the most important factor in predicting poor prognosis of ACD.
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Affiliation(s)
- Jelena Macan
- Institute for Medical Research and Occupational Health, Zagreb, Croatia
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Paulsen E, Andersen KE. Sensitization patterns in Compositae-allergic patients with current or past atopic dermatitis. Contact Dermatitis 2013; 68:277-85. [DOI: 10.1111/cod.12035] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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von Gunten S, Marsland BJ, von Garnier C, Simon D. Update in clinical allergy and immunology. Allergy 2012; 67:1491-500. [PMID: 23110377 DOI: 10.1111/all.12067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2012] [Indexed: 01/08/2023]
Abstract
In the recent years, a tremendous body of studies has addressed a broad variety of distinct topics in clinical allergy and immunology. In this update, we discuss selected recent data that provide clinically and pathogenetically relevant insights or identify potential novel targets and strategies for therapy. The role of the microbiome in shaping allergic immune responses and molecular, as well as cellular mechanisms of disease, is discussed separately and in the context of atopic dermatitis, as an allergic model disease. Besides summarizing novel evidence, this update highlights current areas of uncertainties and debates that, as we hope, shall stimulate scientific discussions and research activities in the field.
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Affiliation(s)
- S. von Gunten
- Institute of Pharmacology; University of Bern; Bern; Switzerland
| | - B. J. Marsland
- Department of Respiratory Medicine; Hospitalier Universitaire Vaudois; Lausanne; Switzerland
| | - C. von Garnier
- Department of Respiratory Medicine, Inselspital; Bern University Hospital; Bern; Switzerland
| | - D. Simon
- Department of Dermatology, Inselspital; Bern University Hospital; Bern; Switzerland
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