Pediatric Contact Dermatitis Registry Data on Contact Allergy in Children With Atopic Dermatitis

Abstract

IMPORTANCE Atopic dermatitis (AD) and allergic contact dermatitis (ACD) have a dynamic relationship not yet fully understood. Investigation has been limited thus far by a paucity of data on the overlap of these disorders in pediatric patients.OBJECTIVE To use data from the Pediatric Contact Dermatitis Registry to elucidate the associations and sensitizations among patients with concomitant AD and ACD. DESIGN, SETTING, AND PARTICIPANTSThis retrospective case review examined 1142 patch test cases of children younger than 18 years, who were registered between January 1, 2015, and December 31, 2015, by 84 health care providers (physicians, nurse practitioners, physician assistants) from across the United States. Data were gathered electronically from multidisciplinary providers within outpatient clinics throughout the United States on pediatric patients (ages 0-18 years).EXPOSURES All participants were patch-tested to assess sensitizations to various allergens; history of AD was noted by the patch-testing providers. MAIN OUTCOMES AND MEASURESPrimary outcomes were sensitization rates to various patch-tested allergens.RESULTS A total of 1142 patients were evaluated: 189 boys (34.2%) and 363 girls (65.8%) in the AD group and 198 boys (36.1%) and 350 girls (63.9%) in the non-AD group (data on gender identification were missing for 17 patients). Compared with those without AD, patch-tested patients with AD were 1.3 years younger (10.5 vs 11.8 years; P < .001) and had longer history of dermatitis (3.5 vs 1.8 years; P < .001). Patch-tested patients designated as Asian or African American were more likely to have concurrent AD (odds ratio [OR], 1.92; 95% CI, 1.20-3.10; P = .008; and OR, 4.09; 95% CI, 2.70-6.20; P <.001, respectively). Patients with AD with generalized distribution were the most likely to be patch tested (OR, 4.68; 95% CI, 3.50-6.30; P < .001). Patients with AD had different reaction profiles than those without AD, with increased frequency of reactions to cocamidopropyl betaine, wool alcohol, lanolin, tixocortol pivalate, and parthenolide. Patients with AD were also noted to have lower frequency of reaction to methylisothiazolinone, cobalt, and potassium dichromate.CONCLUSIONS AND RELEVANCE Children with AD showed significant reaction patterns to allergens notable for their use in skin care preparations. This study adds to the current understanding of AD in ACD, and the continued need to investigate the interplay between these disease processes to optimize care for pediatric patients with these conditions.

Both children and adult patients with difficult‐to‐treat atopic dermatitis have high prevalences of concomitant allergic contact dermatitis and are frequently polysensitized

“…As the presence of these surfactants is frequent in daily cosmetic products (shampoo, liquid soap, toothpaste), sensitization to the agents could easily occur. High prevalences of CAPB/DMAPA contact allergies have been found by other authors as well, but are underreported as they are often not tested, as they are not in the EBS and only tested on indication 25, 48, 49. The allergenic potential of CAPB has been disputed, and it is argued whether CAPD is a true allergen or only an irritant 50.…”

“…High prevalences of CAPB/DMAPA contact allergies have been found by other authors as well, but are underreported as they are often not tested, as they are not in the EBS and only tested on indication. 25,48,49 The allergenic potential of CAPB has been disputed, and it is argued whether CAPD is a true allergen or only an irritant. 50 As CAPB and DMAPA only show crescendo and plateau patterns in our dynamic pattern analysis, we think that at least in this population they reflected true allergic reactions.…”

Pediatric “pet consort dermatitis”—Allergic contact dermatitis from transfer of bronopol from a pet cat

“…The prevalence of allergic contact dermatitis (ACD) is higher in children than previously recognized . Consort dermatitis refers to an allergic contact dermatitis caused by transfer from an intimate contact to a sensitized patient .…”

Atopic dermatitis at preschool age and contact allergy in adolescence: a population‐based cohort study

“…In contrast, it has also been suggested that the impaired skin barrier function in AD could increase the risk of sensitization to contact allergens. Frequent skin exposure to chemical substances in topical treatments, for example moisturizers and topical medicaments, at an early age and for long periods may also contribute to a heightened risk for skin sensitization among individuals with AD . Moisturizers often contain contact allergens such as preservatives and fragrances .…”

“…Frequent skin exposure to chemical substances in topical treatments, for example moisturizers and topical medicaments, at an early age and for long periods may also contribute to a heightened risk for skin sensitization among individuals with AD . Moisturizers often contain contact allergens such as preservatives and fragrances . This is true also for products labelled as hypoallergenic .…”