Atopic skin diathesis rather than atopic dermatitis is associated with specific contact allergies

Abstract

Summary Background The association of atopic dermatitis (AD) and allergic contact dermatitis has been a matter of considerable uncertainty. Study results range from lack of any association to increased sensitization for multiple allergens, but fail to identify consistent allergen associations. Objective We studied a large patch test cohort of patients stratified by their atopic skin diathesis using the Erlangen Atopy Score (EAS), independent of active skin disease. Methods Retrospective multi‐center data analysis from five departments of dermatology in Germany with 4,509 patients. Patients were grouped as “no atopic skin diathesis” (n = 2,165) and “atopic skin diathesis” (n = 1,743), according to EAS. Results Significantly more individuals with atopic skin diathesis showed at least one positive patch test reaction to the baseline series compared to individuals without atopic skin diathesis (49.1 % vs. 38.3 %). In logistic regression analyses, atopic skin diathesis was associated with a significantly higher risk of sensitization to methylchloroisothiazolinone/methylisothiazolinone (OR 2.383) and methylisothiazolinone (OR 1.891), thiuram mix (OR 1.614), as well as nickel (OR 1.530), cobalt (OR 1.683), and chromium (OR 2.089). Conclusions Atopic skin diathesis proved to be the most important intrinsic risk factor for contact sensitization to few, specific allergens. Past or present AD was a less relevant variable.

Pattern of contact sensitization in patients with and without atopic dermatitis in an Asian dermatology center

“…There is limited literature on the association of AD and contact sensitization to thiuram mix. In a cohort study conducted in Germany, atopic skin diathesis was associated with a significantly higher risk of sensitization to thiuram mix 13 . This is in contrast to what we found in our study and may be attributed to differences in use and exposure to rubber products in various countries.…”

Skin symptoms in veterinary assistant staff and veterinarians: A cross‐sectional study

“…Irritant HE, as well as atopic skin diathesis increases the risk of developing an ACD. [16][17][18] Typical contact allergens in veterinarians might cause immediate and/or delayed type allergic reactions. Immediate type allergens include, for example, animal proteins (dander/ hair/urine/serum) and proteins of natural rubber latex, while delayed type allergens include rubber chemicals, topical medication (e.g., antibiotics), disinfectants and biocides.…”

The benefit of late readings in patch testing depends both on allergen and patient characteristics

“…It is well established that patients with SLS positivity present with more irritant reactions during PTs, despite the lack of an association with atopic skin diathesis and atopic diseases. [31][32][33] Importantly, the SLS response is a snapshot of the patient's skin reactivity at the time of the PT, and a positive reaction suggests increased 'irritability' of the skin. It may be hypothesized that a negative irritant control in turn suggests intact and resilient skin, and therefore allergen penetration may be delayed, resulting in likewise delayed skin reactions.…”

“…However, the pathophysiology of irritant skin reactions is not completely understood. It is well established that patients with SLS positivity present with more irritant reactions during PTs, despite the lack of an association with atopic skin diathesis and atopic diseases 31‐33 . Importantly, the SLS response is a snapshot of the patient's skin reactivity at the time of the PT, and a positive reaction suggests increased ‘irritability’ of the skin.…”