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 ...