Allergic contact dermatitis in children and adolescents

Abstract

From a clinical point of view, the prevalence of allergic contact dermatitis (ACD) among children and adolescents seems to be low. However, many children have dermatitis, most often atopic dermatitis. In selected cases, ACD is suspected, and the child is tested. The question remains, whether the prevalence of ACD in children really is low or whether the possibility of ACD is not sufficiently considered. During the last decade, reports have appeared on series of children and adolescents with contact allergy and ACD. Few cases have been reported in infants, but the development of contact allergy and ACD increases with age. Most studies include selected groups of children and adolescents with suspected ACD. Few studies have examined unselected populations, and most consider only the prevalence of contact allergy without evaluating the clinical relevance, e.g., the prevalence of ACD. Furthermore, no follow-up studies exist. Therefore, the incidence and prevalence of contact allergy and ACD in children and adolescents is largely unknown.Key words: allergic contact dermatitis; contact allergy; Type IV allergy; patch testing; allergens; clinical relevance; children; adolescents; epidemiology; incidence; prevalence; atopic dermatitis; IgE-mediated hypersensitivity; Type I allergy. C Munksgaard, 1999. Accepted for publication 1 April 1999Allergic contact dermatitis (ACD) in children and adolescents is seen occasionally, and several reports on series of children and adolescents with ACD have appeared in the literature (1-7). The frequency of unselected children and adolescents with positive patch tests to standard series allergens is not negligible (8-10). About 8% of unselected adolescents are nickel allergic and about 2% react to fragrance mix (11). When the contact allergy develops, and what the consequences of a positive patch test result are for the individual child, is less clear. This review summarizes the current knowledge from an epidemiological and clinical point of view. Epidemiology Definitions and study designsThere are many definitions of epidemiology: one of the clearest is the study of occurrence of illness (12). The frequency of ACD can be expressed in terms of its incidence (the number of new cases of ACD during a defined period in a specific population) or its prevalence (the number of persons in the population with ACD at a certain point in time or during a certain period of time).The 3 most important types of observational study in the epidemiology of ACD are follow-up (cohort) studies, case-control studies and crosssectional studies.(i) In follow-up studies, selection of subjects is based upon exposure to factors of interest. In the prospective follow-up study, the person is exposed but free of the disease at the beginning of the study and is followed over a certain period of time. When both exposure and disease are historical, the study is described as a retrospective follow-up study. This design is less expensive than the prospective study. The measurement in follow-up studies is incidence.(ii) In ...

Contact Dermatitis in Children

“…In 1979, Leyden and Kligman reported that intermittent use of the agent was not associated with excessive sensitization, as only 1 of 653 subjects less than 12 years old was sensitive to neomycin (Leyden & Kligman, 1979). Since then, however, others have supported its status as a relevant contact allergen (Mortz & Andersen, 1999). In 1986, Weston identified it as the most common allergen causing positive patch test results and attributed this to the prominent use of this agent for bacterial infections and diaper dermatitis (Weston et al, 1986).…”

“…For example, Fisher recommended using half the recommended concentration (Fisher, 1975). This was due the concern that children are at higher risk of developing irritant reactions and thus, false positive tests (Mortz & Andersen, 1999). However, recent studies suggest that the incidence of irritant reactions is low.…”

“…Brasch and Geier reported a 9% incidence of irritant reactions (Brasch & Geier, 1997). Most experts recommend the use of the same allergen concentration in children as in adults (Brasch & Geier, 1997;Mortz & Andersen, 1999;Roul et al, 1997;Worm, 2006).…”

Allergic Contact Dermatitis in Children

“…Of these, about 56-93% was of current relevance (Weston & Weston, 1984;Pevny et al, 1984b;Fisher, 1994a;Rudzki & Rebandel, 1996;Stables et al, 1996;Manzini et al, 1998;Bruckner et al, 2000;Machovcová et al, 2001;Wöhrl et al, 2003;Heine et al, 2004;Lewis et al, 2004;Jøhnke et al, 2004;Vozmediano & Hita, 2005;Wahlberg & Lindberg, 2006;Goossens & Morren, 2006;Jacob et al, 2008). Among the children with a positive patch test 3.2% to 54.4% had multiple contact allergies (Mortz & Andersen, 1999).…”

Gene Expression Changes Induced by Type IV Allergy-Inducible Chemicals in Dendritic Cells

“…Sci. 70 (7): [673][674][675][676][677][678][679][680] 2008 Allergic contact dermatitis (ACD), a type IV allergy, is one of the most common inflammatory diseases of the skin with unknown genetic basis and is often an occupationally related disorder in industrialized countries with an important socio-medical impact [14,28]. At present, many chemicals are considered to have allergenic potency and thus risk assessment of such chemical substances is important.…”