The patterns and clinical relevance of contact allergen sensitization in a pediatric population with atopic dermatitis

Abstract

Background/aim: Data about contact allergen sensitization (CAS) in children with atopic dermatitis (AD) are limited. The purpose of this study was to identify the frequency and patterns of CAS in children with AD by using a ready-to-use patch test system. Materials and methods:After receiving the history of CAS in the patients, the severity of AD and IgE-mediated allergen sensitization were determined.Results: Of 134 children with AD, 33.8% (n = 45) had at least 1 positive reaction. The most frequent positive reaction was to nickel sulfate (NS) (37.8%, 17/45), followed by methylchloroisothiazolinone (20.0%, 9/45) and thimerosal (15.6%, 7/45). The total Scoring Atopic Dermatitis (SCORAD) score was significantly higher in the NS-sensitized group (P = 0.036). The patients with NS sensitization had moderate-severe AD more frequently than those without any reaction (P = 0.020). When the SCORAD score was evaluated in detail, extent of eczema, score of sleep loss, and pruritus were significantly higher in the patients with NS sensitization than those without any reaction (P = 0.002, P = 0.001, and P = 0.002, respectively). Conclusion:Our study confirms the necessity of CAS in the management of AD. In particular, NS sensitization should be considered for children with severe AD or larger extent of eczema and trunk involvement.

Contact allergy in children with atopic dermatitis: a systematic review

“…In previous studies an association between AD and contact allergy to topical corticosteroids was suggested . It does not seem to constitute a significant problem among children with AD, although delayed positive reactions may have been missed in the reviewed studies . In the study by Mailhol et al ., only one of 641 children reacted to one of the corticosteroid markers.…”

“…Although the correlation was not significant, the authors found the lowest frequency of contact sensitization among children with severe AD (13·9%), compared with children with moderate (55·6%) and mild (30·6%) AD. Akan et al . found no association between the severity of AD and the overall risk of contact sensitization.…”

“…In studies comparing children with and without AD, few children with AD were sensitized to tixocortol pivalate ( n = 23) or budesonide ( n = 6), and the weighted average sensitization rates for the two markers did not differ significantly between the two groups (tixocortol pivalate 0·8%, n = 23 vs. 0·5%, n = 14; P = 0·16, budesonide 0·2%, n = 6 vs. 0·08%, n = 2; P = 0·24). In the eight studies on patients with AD only, three children were sensitized, all to tixocortol‐21‐pivalate …”

“…Overall two children reacted to compositae mix and both had AD. Four of the studies testing only children with AD reported on sesquiterpene lactone mix sensitization rates, and found a positive reaction in three of 434 tested children (0·7%) …”

“…The three metal allergens are known to occur concomitantly, and the irritating properties of potassium dichromate could in theory cause a false‐positive reaction in AD skin . However, especially reactions to potassium dichromate were relevant in a substantial proportion of the reviewed cases . As chromium is rarely released from jewellery, the exposure to chromium is primarily percutaneous and the bypass theory therefore does not apply.…”