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Hon KL, Leung AKC, Cheng JWCH, Luk DCK, Leung ASY, Koh MJA. Allergic Contact Dermatitis in Pediatric Practice. Curr Pediatr Rev 2024; 20:478-488. [PMID: 37365784 DOI: 10.2174/1573396320666230626122135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 04/10/2023] [Accepted: 05/16/2023] [Indexed: 06/28/2023]
Abstract
BACKGROUND Allergic contact dermatitis (ACD) is prevalent among pediatric population, adolescent and young adults. Patients with ACD experience a lot of sociopsychological and qualityof- life (QoL) difficulties. Children and their caregivers alike are vulnerable to the burden of ACD. OBJECTIVES We have, in this paper, provided an overview of ACD and discussed common and unusual causes of ACD. METHODS We performed an up-to-date literature review in the English language on "allergic contact dermatitis" via PubMed Clinical Queries, using the keywords "allergic contact dermatitis" in August 2022. The search included meta-analyses, randomized controlled trials, clinical trials, casecontrol studies, cohort studies, observational studies, clinical guidelines, case series, case reports, and reviews. The search was restricted to English literature and children. RESULTS ACD may be acute or chronic and it affects more than 20% of children and adults with significant quality-of-life impairments. ACD is manifested by varying degrees of cutaneous edema, vesiculation, and erythema. The hypersensitivity reaction is one of the most prevalent forms of immunotoxicity in humans. Localized acute ACD lesions can be managed with high-potency topical steroids; if ACD is severe or extensive, systemic corticosteroid therapy is often required to provide relief within 24 hours. In patients with more severe dermatitis, oral prednisone should be tapered over 2-3 weeks. Rapid discontinuation of corticosteroids can result in rebound dermatitis. Patch testing should be performed if treatment fails and the specific allergen or diagnosis remains unknown. CONCLUSION ACD is common and can be a physically, psychologically, and economically burdensome disease. Diagnosis of ACD is primarily based on history (exposure to an allergen) and physical examination (morphology and location of the eruption). Skin patch test can help determine the causative allergen. Allergen avoidance is the cornerstone of management. Topical mid- or highpotency corticosteroids are the mainstay of treatment for lesions on less than 20% of the body area. Severe cases of ACD may require treatment with systemic corticosteroids.
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Affiliation(s)
- Kam Lun Hon
- Department of Paediatrics, CUHKMC, The Chinese University of Hong Kong, Hong Kong, China
| | - Alexander K C Leung
- Department of Pediatrics, The University of Calgary, The Alberta Children's Hospital, Calgary, Alberta, Canada
| | - James W C H Cheng
- Department of Paediatrics and Adolescent Medicine, United Christian Hospital, Kwun Tong, Hong Kong, China
| | - David C K Luk
- Department of Paediatrics and Adolescent Medicine, United Christian Hospital, Kwun Tong, Hong Kong, China
| | - Agnes S Y Leung
- Department of Paediatrics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China
- Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Mark J A Koh
- Department of Dermatology, KK Women's and Children's Hospital, Bukit Timah Road, Singapore
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2
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Abstract
Allergic contact dermatitis is a prevalent burdensome condition affecting millions of Americans. Patch testing, the criterion-standard allergic contact dermatitis diagnostic tool, is underused by US dermatologists. Incorporating patch testing into modern dermatology practices is achievable with utilization of accurate resources and sustainable support. This review focuses on the basics of patch testing and provides practical pearls to assist novice providers in establishing a contact dermatitis specialty practice.
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Balato A, Scala E, Ayala F, Bauer A, Crépy MN, Gonçalo M, Duus Johansen J, John SM, Rustemeyer T, Wagner N, Wilkinson M, Giménez-Arnau A. Patch test informed consent form: position statement by European Academy of Dermatology and Venereology Task Force on Contact Dermatitis. J Eur Acad Dermatol Venereol 2021; 35:1957-1962. [PMID: 34286888 DOI: 10.1111/jdv.17483] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 05/27/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND To our knowledge, an international consensus is lacking regarding the development of an adequate informed consent form for a patch test (PT) and the information that should be included in such document. OBJECTIVES The aim of the study was to reach a consensus on the specific points that need to be addressed in a PT consent form. METHODS A Delphi survey, comprising 2 rounds and 1 final discussion, was used to gather and analyse data, which was conducted over the Internet. Each statement that reached a consensus with the respondents (9 expert dermatologists from Europe) was defined as a median consensus score (MED) of ≥7 and agreement among panelists as an interquartile range (IQR) of ≤3. All study participants were members of the EADV task force on contact dermatitis. RESULTS The expert panel addressed several topics that should be included in an informed consent form for a PT: introduction, preparation for PT, testing procedure, allowed activities, adverse events and additional authorizations. CONCLUSIONS Our results assess recommendations regarding points to be contained in an informed consent form for a PR. Future actions towards standardization and harmonization of this specific consent form are needed.
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Affiliation(s)
- A Balato
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - E Scala
- Division of Dermatology and Venereology, Department of Medicine Solna, and Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
| | - F Ayala
- Professor Emeritus of Dermatology, University of Naples Federico II, Naples, Italy
| | - A Bauer
- Department of Dermatology, University Allergy Center, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | - M-N Crépy
- Department of Occupational and Environmental Diseases, Hôtel-Dieu Hospital, AP-HP, University Hospital of Centre of Paris, Paris, France.,Department of Dermatology, Cochin Hospital, AP-HP, University Hospital of Centre of Paris, Paris, France
| | - M Gonçalo
- Department of Dermatology, University Hospital and Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - J Duus Johansen
- National Allergy Research Centre, Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
| | - S M John
- Department of Dermatology, Environmental Medicine, Health Theory, Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm) at the University of Osnabrück, University of Osnabrück, Osnabrück, Germany
| | - T Rustemeyer
- Department of Dermatology-Allergology and Occupational Dermatology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - N Wagner
- Department of Dermatology, Universitätsklinikum Erlangen-Nürnberg, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - M Wilkinson
- Department of Dermatology, Chapel Allerton Hospital, Leeds, UK
| | - A Giménez-Arnau
- Department of Dermatology, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, Spain
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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: 5] [Impact Index Per Article: 1.3] [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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5
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Mahler V, Nast A, Bauer A, Becker D, Brasch J, Breuer K, Dickel H, Drexler H, Elsner P, Geier J, John SM, Kreft B, Köllner A, Merk H, Ott H, Pleschka S, Portisch M, Spornraft-Ragaller P, Weisshaar E, Werfel T, Worm M, Schnuch A, Uter W. S3 Guidelines: Epicutaneous patch testing with contact allergens and drugs - Short version, Part 2. J Dtsch Dermatol Ges 2020; 17:1187-1207. [PMID: 31765083 DOI: 10.1111/ddg.13971] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Epicutaneous patch testing is the diagnostic standard for the detection of allergic contact dermatitis. The present guidelines are aimed at residents and board-certified physicians in the fields of dermatology and allergology as well as other medical specialties involved in establishing the indication for patch testing and its execution in patients with contact dermatitis and other forms of delayed-type hypersensitivity. The target audience also includes other health care providers and insurance funds. Based on a systematic literature search and a formal consensus process (S3), the guidelines were developed by dermatologists in collaboration with pediatricians, occupational medicine physicians, nursing staff as well as patient representatives. The systematic methodological approach and appraisal of evidence upon which the recommendations are based are outlined in a separate method report that also contains evidence tables. The guidelines address general aspects of patch testing as well as medicolegal issues. The recommendations given relate to topics such as the indication for patch testing, informed patient consent, as well as the choice of test substances, test chambers and test site, duration of exposure, reading times and interpretation of test reactions. Furthermore, recommendations are provided with respect to endogenous and exogenous factors, specific patient groups (children, pregnant women, immunosuppressed individuals) as well as possible risks and adverse events associated with patch testing using contact allergens.
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Affiliation(s)
- Vera Mahler
- Department of Dermatology, University Medical Center, Friedrich Alexander University, Erlangen, Germany.,Paul Ehrlich Institute, Langen, Germany
| | - Alexander Nast
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt University of Berlin, and Berlin Institute of Health, Department of Dermatology, Venereology und Allergology, Division of Evidence-based Medicine (dEBM), Berlin, Germany
| | - Andrea Bauer
- Department of Dermatology, University Medical Center, Dresden Technical University, Dresden, Germany
| | - Detlef Becker
- Department of Dermatology, University Medical Center, Mainz, Germany
| | - Jochen Brasch
- Department of Dermatology, Venereology und Allergology, University Medical Center, Kiel, Germany
| | - Kristine Breuer
- Dermatology Practice (Dermatologie Reinbek), Reinbek, Germany
| | - Heinrich Dickel
- Department of Dermatology, Venereology und Allergology, St. Josef Hospital, Ruhr University Bochum, Bochum, Germany
| | - Hans Drexler
- Institute for Occupational, Social and Environmental Medicine, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Peter Elsner
- Department of Dermatology, University Hospital Jena, Jena, Germany
| | - Johannes Geier
- Information Network of Dermatology Departments in Germany (IVDK), Göttingen University Medical Center, Göttingen, Germany
| | - Swen Malte John
- Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm), University of Osnabrück, Osnabrück, Germany
| | - Burkhard Kreft
- Department of Dermatology and Venereology, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | | | - Hans Merk
- Professor of Dermatology and Allergology, Former Chairman of the Department of Dermatology, RWTH University, Aachen, Germany
| | - Hagen Ott
- Division of Pediatric Dermatology and Allergology, Children's Hospital Auf der Bult, Hannover, Germany
| | - Silvia Pleschka
- German Allergy and Asthma Foundation (Deutscher Allergie- und Asthmabund e.V.), Mönchengladbach, Germany
| | - Maria Portisch
- Department of Dermatology, University Medical Center, Friedrich Alexander University, Erlangen, Germany
| | | | - Elke Weisshaar
- Division of Occupational Dermatology, Department of Dermatology, University Medical Center, Heidelberg, Germany
| | - Thomas Werfel
- Department of Dermatology and Allergy, Hannover Medical School, Hannover, Germany
| | - Margitta Worm
- Department of Dermatology, Venereology und Allergology, Charité - University Medicine, Berlin, Germany
| | - Axel Schnuch
- Information Network of Dermatology Departments in Germany (IVDK), Göttingen University Medical Center, Göttingen, Germany
| | - Wolfgang Uter
- Institute for Medical Informatics, Biometrics and Epidemiology (IMBE), Medical Faculty, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
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Belloni Fortina A, Caroppo F, Tadiotto Cicogna G. Allergic contact dermatitis in children. Expert Rev Clin Immunol 2020; 16:579-589. [DOI: 10.1080/1744666x.2020.1777858] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Anna Belloni Fortina
- Pediatric Dermatology Unit, Department of Medicine DIMED, University of Padova, Padova, Italy
| | - Francesca Caroppo
- Pediatric Dermatology Unit, Department of Medicine DIMED, University of Padova, Padova, Italy
| | - Giulia Tadiotto Cicogna
- Pediatric Dermatology Unit, Department of Medicine DIMED, University of Padova, Padova, Italy
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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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Wootton CI, Sodaly MK, Billamay SX, English JSC, Mayfong M. Patch test results in paediatric patients with atopic dermatitis in Laos. PLoS One 2020; 15:e0231455. [PMID: 32287282 PMCID: PMC7156065 DOI: 10.1371/journal.pone.0231455] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Accepted: 03/24/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Dermatological services in Laos, South East Asia are limited mainly to the capital and patch testing is currently not available, so no data exists regarding the common cutaneous allergens in this population. OBJECTIVES The aim of this study was to document common allergens in paediatric patients with atopic dermatitis attending the allergy clinic in the capital, Vientiane. PATIENTS/MATERIALS/METHODS Fifty paediatric patients with atopic dermatitis were patch tested using TRUE Test® panels 1 to 3 (35 allergens). Readings were taken at Days 2 and 4. RESULTS Twenty-six positive patch tests were recorded on Day 4 in 15 children (30%). The most common allergens were: gold (18%), nickel (10%), formaldehyde (6%) and p-Phenylenediamine (6%). Other positive allergens were potassium dichromate (2%), cobalt dichloride (2%), Bronopol (2%), paraben mix (2%), fragrance mix 1 (2%) and neomycin (2%). The majority of the patients with positive reactions were female. CONCLUSIONS This study represents the first documented patch test results in the Lao population. It is hoped that these findings will help clinicians to advise the families of children with atopic dermatitis on common allergens to avoid and inform future work on contact dermatitis in this population.
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Affiliation(s)
- Catriona I. Wootton
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Vientiane, Laos
- Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
- * E-mail:
| | - Mong K. Sodaly
- Allergy Clinic, Lao-Korea Childrens’ Hospital, Vientiane, Laos
| | | | | | - Mayxay Mayfong
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Vientiane, Laos
- Institute of Research and Education Development (IRED), University of Health Sciences, Ministry of Health, Vientiane, Laos
- Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, Churchill Hospital, Oxford, United Kingdom
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Mahler V, Nast A, Bauer A, Becker D, Brasch J, Breuer K, Dickel H, Drexler H, Elsner P, Geier J, John SM, Kreft B, Köllner A, Merk H, Ott H, Pleschka S, Portisch M, Spornraft‐Ragaller P, Weisshaar E, Werfel T, Worm M, Schnuch A, Uter W. S3‐Leitlinie: Durchführung des Epikutantests mit Kontaktallergenen und Arzneimitteln – Kurzfassung Teil 2. J Dtsch Dermatol Ges 2019; 17:1187-1207. [DOI: 10.1111/ddg.13971_g] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Vera Mahler
- Hautklinik Universitätsklinikum ErlangenFriedrich‐Alexander‐Universität Erlangen‐Nürnberg Erlangen
- Paul‐Ehrlich‐Institut Langen
| | - Alexander Nast
- Division of Evidence‐based Medicine (dEBM)Klinik für DermatologieVenerologie und AllergologieCharité – Universitätsmedizin Berlin Berlin
| | - Andrea Bauer
- Klinik und Poliklinik für Dermatologie Universitätsklinikum Carl Gustav CarusTechnische Universität Dresden Dresden
| | | | - Jochen Brasch
- Klinik für DermatologieVenerologie und AllergologieUniversitätsklinikum Schleswig‐Holstein Kiel
| | | | - Heinrich Dickel
- Klinik für DermatologieVenerologie und AllergologieSt. Josef‐Hospital, Ruhr‐Universität Bochum Bochum
| | - Hans Drexler
- Institut für Arbeits‐Sozial‐ und Umweltmedizin der Friedrich‐Alexander‐Universität Erlangen‐Nürnberg Erlangen
| | - Peter Elsner
- Klinik für HautkrankheitenUniversitätsklinikum Jena Jena
| | - Johannes Geier
- Informationsverbund Dermatologischer Kliniken (IVDK) e.V. an der Universitätsmedizin Göttingen Göttingen
| | - Swen Malte John
- Institut für interdisziplinäre Dermatologische Prävention und Rehabilitation (iDerm) an der Universität Osnabrück Osnabrück
| | - Burkhard Kreft
- Klinik und Poliklinik für Dermatologie und VenerologieUniversitätsklinikum (Saale) Halle
| | | | - Hans Merk
- Univ.‐Professor für Dermatologie & AllergologieDirektor (em.) der Hautklinik – RWTH Aachen University Aachen
| | - Hagen Ott
- Hannoversche Kinderheilanstalt (HKA): Kinder‐ und Jugendkrankenhaus auf der Bult Hannover
| | | | - Maria Portisch
- Hautklinik Universitätsklinikum ErlangenFriedrich‐Alexander‐Universität Erlangen‐Nürnberg Erlangen
| | | | - Elke Weisshaar
- BerufsdermatologieHautklinikUniversitätsklinikum Heidelberg Heidelberg
| | - Thomas Werfel
- Klinik für DermatologieAllergologie und VenerologieMedizinische Hochschule Hannover Hannover
| | - Margitta Worm
- Klinik für DermatologieVenerologie und Allergologie Charité – Universitätsmedizin Berlin Berlin
| | - Axel Schnuch
- Informationsverbund Dermatologischer Kliniken (IVDK) e.V. an der Universitätsmedizin Göttingen Göttingen
| | - Wolfgang Uter
- Institut für MedizininformatikBiometrie und Epidemiologie (IMBE)Medizinische Fakultät der Friedrich‐Alexander‐Universität Erlangen‐Nürnberg Erlangen
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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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Abstract
PURPOSE OF REVIEW The environment for the developing children is complex as they are exposed to a variety of activities and settings where potential environmental allergens may be encountered. Recent evidence supports the clinical benefit of patch testing young children suffering from recalcitrant dermatitis. While patch testing has been recently approved by the Food and Drug Administration in children ages 6-18 years old, patch testing strategies for young children of preschool age (between 2 and 6 years old) have yet to be defined. RECENT FINDINGS Allergic contact dermatitis is underdiagnosed among pediatric patients, particularly those suffering from concomitant atopic dermatitis as the interplay between the two diseases is complex. Recent reports in literature supported the clinical value, safety, and efficacy of patch testing pediatric patients. This review provides an overview of specific pediatric allergens, special considerations, practical modifications, and systematic exposure-driven guidance approaches toward patch testing preschoolers.
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13
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14
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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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15
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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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Abstract
BACKGROUND/OBJECTIVE The isothiazolinones methylchloroisothiazolinone (MCI) and methylisothiazolinone (MI) are prevalent pediatric contact sensitizers. MI allergic contact dermatitis (ACD) is underreported in the literature. The objective of the current study was to use a database of provider-reported U.S. pediatric patch test cases to evaluate the positive patch test (PPT) prevalence rates of the combined preservative test substrate MCI/MI and of MI alone. METHODS U.S. pediatric patch test providers in all 50 states who had joined the registry were invited to submit deidentified cases to the database. More than 1100 logged cases in the database were evaluated for PPTs to MCI/MI combination, MCI/MI and MI, and MI alone. RESULTS Within 1 year of data collection, 96 cases with a PPT for MCI/MI, MCI/MI and MI, and MI alone were identified; 37 of these were positive to MCI/MI, with MI alone not tested or negative, and 39 were positive to MI only, with MCI/MI and MI tested. Fifteen (41%) of the MCI/MI cases were detected using an epicutaneous patch test alone and 22 cases (59%) using comprehensive patch testing. Only one case (3%) of MI alone sensitization was detected using T.R.U.E. plus a supplemental panel of tests; the remaining 38 cases (97%) were detected using comprehensive testing. Testing with only the combined MCI/MI preservative substrate may miss 51% of MI allergies. CONCLUSION Appropriate testing of isothiazolinones is needed to clarify the true prevalence of sensitization to these allergens and the burden of pediatric ACD. Patch testing for MI alone in addition to MCI/MI combination is warranted in children with recalcitrant dermatitis.
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Affiliation(s)
- Alina Goldenberg
- Department of Dermatology, University of California at San Diego, San Diego, California
| | - Michael Lipp
- Lake Erie Consortium for Osteopathic Medical Training (LECOMT)/Larkin Community Hospital-Palm Springs Campus, Hialeah, Florida
| | - Sharon E Jacob
- Department of Dermatology, Loma Linda University, Loma Linda, California
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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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19
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Abstract
Contact dermatitis is an umbrella term that describes the skin's reaction to contacted noxious or allergenic substances. The two main categories of contact dermatitis are irritant type and allergic type. This review discusses the signs, symptoms, causes, and complications of contact dermatitis. It addresses the testing, treatment, and prevention of contact dermatitis. Proper management of contact dermatitis includes avoidance measures for susceptible children. Implementation of a nickel directive (regulating the use of nickel in jewelry and other products that come into contact with the skin) could further reduce exposure to the most common allergens in the pediatric population. [Pediatr Ann. 2016;45(8):e287-e292.].
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Abstract
With the popularity of soccer among American youth and the associated use of protective shin guards, dermatitis from the guard components has emerged. Awareness and protective measures may help prevent irritation and the development of contact sensitization from the guards.
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Affiliation(s)
- Hannah Hill
- Department of Dermatology, Loma Linda University, Loma Linda, California
| | - Sharon E Jacob
- Department of Dermatology, Loma Linda University, Loma Linda, California
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21
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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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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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25
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Goldenberg A, Admani S, Pelletier JL, Jacob SE. Belt Buckles-Increasing Awareness of Nickel Exposure in Children: A Case Report. Pediatrics 2015; 136:e691-3. [PMID: 26240212 DOI: 10.1542/peds.2015-0794] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/19/2015] [Indexed: 11/24/2022] Open
Abstract
Children, especially those with atopic dermatitis, are at risk for nickel sensitization and subsequent dermatitis from metal-containing objects, namely belt buckles. We describe allergic contact dermatitis in 12 children with peri-umbilical nickel dermatitis (with and without generalized involvement) caused by dimethylglyoxime-positive belt buckles. The patients' symptoms resolved with avoidance of the nickel-containing products.
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Affiliation(s)
- Alina Goldenberg
- Division of Dermatology, University of California-San Diego, San Diego, California
| | - Shehla Admani
- Division of Dermatology, University of California-San Diego, La Jolla, California
| | - Janice L Pelletier
- Pediatric Dermatology of Maine, Eastern Maine Medical Center, Bangor, Maine; and
| | - Sharon E Jacob
- Department of Dermatology and Contact Dermatitis Clinic, Loma Linda University, Loma Linda, California
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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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Abstract
Isothiazolinone is known to be a sensitizer and a frequent cause of contact dermatitis in adults. Cases of contact dermatitis have also recently been reported in children. Derivatives of isothiazolinone, such as methylisothiazolinone (MI) and methylchloroisothiazolinone (MCI), are commonly used in the care products of babies and children. This allergen should not be missed.
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Affiliation(s)
- Sandrine Quenan
- Department of Dermatology, University Hospital of Geneva, Geneva, Switzerland
| | - Pierre Piletta
- Department of Dermatology, University Hospital of Geneva, Geneva, Switzerland
| | - Anne-Marie Calza
- Department of Dermatology, University Hospital of Geneva, Geneva, Switzerland
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Abstract
We discuss allergic contact dermatitis to the iPad to highlight a potential source of nickel exposure in children.
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Affiliation(s)
- Sharon E Jacob
- Division of Dermatology, University of California, San Diego, Rady Children's Hospital, San Diego, California
| | - Shehla Admani
- Division of Dermatology, University of California, San Diego, Rady Children's Hospital, San Diego, California
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29
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Invited commentary: recommendation for a north american pediatric patch test series. Curr Allergy Asthma Rep 2014; 14:444. [PMID: 24744270 DOI: 10.1007/s11882-014-0444-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Given the increased recognition of pediatric allergic contact dermatitis and lack of patch testing consensus in children, we present a minimum basic 20-allergen North American pediatric series, for screening children ages 6-12 with suspected contact allergy.
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Abstract
Allergic contact dermatitis (ACD) is a type IV delayed hypersensitivity reaction. During the last decade, there has been a heightened awareness of this disease in the pediatric population. The gold standard for diagnosis is patch testing. The prevalence of positive patch tests in referred children with suspected ACD ranges from 27 to 95.6 %. The most common allergens in children in North America are nickel, neomycin, cobalt, fragrance, Myroxylon pereirae, gold, formaldehyde, lanolin/wool alcohols, thimerosal, and potassium dichromate. The relationship between ACD and atopic dermatitis (AD) is complicated with conflicting reports of prevalence in the literature; however, in a patient with dermatitis not responding to traditional therapies, or with new areas of involvement, ACD should be considered as part of the work-up.
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31
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What's new in pediatric dermatology? J Am Acad Dermatol 2013; 68:885.e1-12; quiz 897-8. [DOI: 10.1016/j.jaad.2013.03.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2013] [Revised: 03/13/2013] [Accepted: 03/15/2013] [Indexed: 11/22/2022]
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Fonacier LS, Aquino MR, Mucci T. Current strategies in treating severe contact dermatitis in pediatric patients. Curr Allergy Asthma Rep 2013; 12:599-606. [PMID: 22993109 DOI: 10.1007/s11882-012-0305-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Allergic contact dermatitis in children is underdiagnosed and undertreated, and its incidence is increasing. Appropriate history taking and the suspicion for allergic contact dermatitis is essential, and patch testing remains the gold standard in diagnosis. Avoidance of the offending allergen, once identified, is the first goal of treatment. Medical therapies include topical corticosteroid and topical immunomodulators. In severe cases, oral corticosteroids or immunomodulators are utilized, although prospective randomized trials for the treatment of this disease in children are lacking. A PubMed literature search was performed to identify publications on allergic contact dermatitis in the pediatric population with the keywords: dermatitis, children, allergic contact dermatitis, pediatrics, contact hypersensitivity, contact allergy, treatment, and management. This review will address the major principles behind the diagnosis and management of this disease in the pediatric population, and highlight useful strategies that may result in improved treatment of this condition.
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Affiliation(s)
- Luz S Fonacier
- Section of Allergy and Immunology, Winthrop University Hospital, Mineola, NY 11501, USA.
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