Minimizing the Risks of Missing a Contact Allergy

Abstract

The diagnosis of a contact allergy can be missed in the various stages of the allergological investigation: the clinical examination of the patients, the anamnesis, the skin testing as well as the determination of the relevance of a positive test. This is illustrated by means of examples from the literature.

Allergic Contact Dermatitis in Children

“…Cosmetic allergens tend to produce facial, neck or periorbital dermatitis. Shoe allergens often present on the dorsum of the feet (Goossens, 2001;Militello et al, 2006;Goossens & Morren, 2006). Spreading of the dermatitis, often in the form of small papules, may occur far from the original contact site and may be generalized.…”

“…Spreading of the dermatitis, often in the form of small papules, may occur far from the original contact site and may be generalized. This can be explained by hematogenous dissemination of the allergens (Goossens, 2001) or by contact with allergenic or allergen-contaminated surfaces, transfer of an allergen via the hands to the face or other sites, which gives rise to an 'ectopic' contact dermatitis. CA can be caused also by products that have come in contact with the parents or other persons in the environment of the children ('connubial' or 'consort' dermatitis).…”

“…The 'ectopic' or 'connubial' reactions are commonly involved the skin of the eyelids or neck. Additionally, distant or widespread eruptions (commonly referred to as 'Id' reactions) can often be triggered by localized ACD to such chemicals as nickel and poison ivy (Goossens, 2001;Militello et al, 2006;Goossens & Morren, 2006). Untreated reactions from highly potent allergens, such a poison ivy, can be severe and last for several weeks (Militello et al, 2006).…”

“…Recognizing potential pediatric patients with ACD either as the primary diagnosis or the confounding factor is crucial. Often the findings are difficult to distinguish, clinically and histopathologically, from AD or irritant dermatitis (Goossens, 2001;Militello et al, 2006;Goossens & Morren, 2006).…”

“…Essential is an extensive and standardized anamnesis that covers all possible etiological factors like hobbies, leisure time activities, use of topical pharmaceutical products and cosmetics and contact with plants (Goossens, 2001). The children and their parents can themselves provide many indications but often need to be convinced that the allergenic product may not have been introduced only recently into their environment.…”