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The Journal of Allergy and Clinical... Apr 2022Contact dermatitis is a common disease that is caused by repeated skin contact with contact allergens or irritants, resulting in allergic contact dermatitis (ACD) and/or... (Review)
Review
Contact dermatitis is a common disease that is caused by repeated skin contact with contact allergens or irritants, resulting in allergic contact dermatitis (ACD) and/or irritant contact dermatitis. Attempts have been made to identify biomarkers to distinguish irritant and allergic patch test reactions, which could aid diagnosis. Some promising candidates have recently been identified, but verification and validation in clinical cases still need to be done. New causes of ACD are constantly being recognized. In this review, 10 new contact allergens from recent years, several relating to anti-aging products, have been identified. Frequent allergens causing considerable morbidity in the population, such as the preservative methylisothiazolinone, have been regulated in the European Union. A significant drop in the number of cases has been seen, whereas high rates are still occurring in other areas such as North America. Other frequent causes are fragrance allergens, especially the widely used terpenes and acrylates found in medical devices for control of diabetes. These represent unsolved problems. Recent advances in immunology have opened the way for a better understanding of the complexity of contact dermatitis, especially ACD-a disease that may be more heterogenous that previous understood, with several subtypes. With the rapidly evolving molecular understanding of ACD, the potential for development of new drugs for personalized treatment of contact dermatitis is considerable.
Topics: Allergens; Dermatitis, Allergic Contact; Dermatitis, Irritant; Humans; Irritants; Patch Tests
PubMed: 35183605
DOI: 10.1016/j.jaci.2022.02.002 -
Dermatitis : Contact, Atopic,... 2023Patch testing is an important diagnostic tool for assessment of allergic contact dermatitis (ACD). This study documents the North American Contact Dermatitis Group...
Patch testing is an important diagnostic tool for assessment of allergic contact dermatitis (ACD). This study documents the North American Contact Dermatitis Group (NACDG) patch testing results from January 1, 2019, to December 31, 2020. At 13 centers in North America, patients were tested in a standardized manner with a screening series of 80 allergens, and, as indicated, supplemental allergens. Overall, 4121 patients were tested; 2871 (69.7%) had at least 1 positive/allergic patch test reaction and 2095 patients (51.2%) had a primary diagnosis of ACD. The most commonly positive allergens were nickel (18.2%), methylisothiazolinone (MI) (13.8%), fragrance mix (FM) I (12.8%), hydroperoxides of linalool (HPL) (11.1%), and benzisothiazolinone (BIT) (10.4%). Compared with that of 2017-2018, prevalence of top 20 allergens statistically increased for FM I, HPL, BIT, propolis, and hydroperoxides of limonene (3.5%). For the first time, MI positivity did not increase between reporting periods. Approximately one-fifth of patients (20.3%) had ≥1 clinically relevant reaction(s) to allergens/substances not on the NACDG series. The epidemic of MI contact allergy in North America may have reached a plateau. Patch testing using a robust screening series, and supplemental allergens as indicated, is necessary for comprehensive evaluation of ACD.
Topics: Humans; Patch Tests; Dermatitis, Allergic Contact; Allergens; Nickel; North America; Hydrogen Peroxide; Retrospective Studies
PubMed: 36917520
DOI: 10.1089/derm.2022.29017.jdk -
Journal of the American Academy of... Apr 2024Petrolatum, also known as petroleum jelly, is a widely used topical agent, with a variety of uses in dermatology. Despite its popularity, many myths surround this... (Review)
Review
Petrolatum, also known as petroleum jelly, is a widely used topical agent, with a variety of uses in dermatology. Despite its popularity, many myths surround this ubiquitous dermatologic staple. This review details the history of petrolatum and how it is manufactured as well as how its biologic properties make it a great moisturizer. Additionally, data on its potential for flammability, allergenicity, and comedogenicity are detailed, dispelling misconceptions about petrolatum use around oxygen and as a cause of acne. The uses and benefits of petrolatum in dermatology are wide-ranging-a patch test instrument, a vehicle for medicated ointments, and a wound care essential. Given its ubiquitous presence, it is important for dermatologists to understand the history, safety profile, and myths surrounding this humble skincare staple.
Topics: Humans; Petrolatum; Ointments; Allergens; Patch Tests
PubMed: 37315800
DOI: 10.1016/j.jaad.2023.06.010 -
Dermatitis : Contact, Atopic,... 2023Lanolin is a complex mixture of high molecular weight esters, aliphatic alcohols, sterols, fatty acids, and hydrocarbons that has been widely used for centuries for its...
Lanolin is a complex mixture of high molecular weight esters, aliphatic alcohols, sterols, fatty acids, and hydrocarbons that has been widely used for centuries for its emollient properties. The purification of crude lanolin into lanolin wax and the processing of this wax into various derivatives began in 1882 and continue to this day with newer highly purified anhydrous lanolins. Controversy as to lanolin's allergenicity began in the 1920s and remains an issue. The most appropriate patch test preparation(s) for detecting allergy remain disputed. Detection of lanolin-induced contact dermatitis in diseased skin by patch testing on normal skin may lead to false negative results. Patients with a positive patch test to lanolin may tolerate use of lanolin on normal skin. Although lanolin is a weak sensitizer and the frequency of contact allergy to it in the European population reportedly is 0.4%, there are high-risk concomitant conditions: stasis dermatitis, leg ulcers, perianal/genital dermatitis, and atopic dermatitis (AD). Children and the elderly are also at greater risk of developing contact allergy to lanolin, partly because of comorbidities (AD and stasis dermatitis/leg ulcers, respectively). Finally, in the United States, non-Hispanic white patients are more likely than their non-Hispanic black counterparts to be lanolin allergic.
Topics: Child; Humans; Aged; Lanolin; Dermatitis, Allergic Contact; Allergens; Dermatitis, Atopic; Patch Tests; Leg Ulcer
PubMed: 36917502
DOI: 10.1089/derm.2022.0002 -
Actas Dermo-sifiliograficas Apr 2023Atopic dermatitis is a chronic inflammatory disease that is multifactorial in nature. Allergic contact dermatitis and protein contact dermatitis are allergic conditions... (Review)
Review
Atopic dermatitis is a chronic inflammatory disease that is multifactorial in nature. Allergic contact dermatitis and protein contact dermatitis are allergic conditions that may occur in the context of atopic dermatitis and be the cause of exacerbations. Although the prevalence of allergic contact dermatitis is similar in atopic patients and the general population, these 2 conditions are frequently associated because atopic inflammation disrupts the skin barrier. Skin tests are therefore recommended in atopic individuals. Dupilumab could be useful for treating allergic contact dermatitis if it is mediated by type 2 helper T cells but could exacerbate inflammation if mediated by T1 cells: further study is needed before conclusions can be drawn. Although the mechanism by which exposure to environmental proteins exacerbates atopic dermatitis remains under discussion, such exacerbations are routinely seen in clinical practice. Prick testing is recommended in symptomatic atopic dermatitis. When prick-test findings are positive, patients should be advised to avoid the culprit substances.
Topics: Humans; Dermatitis, Atopic; Haptens; Patch Tests; Dermatitis, Allergic Contact; Inflammation; Allergens
PubMed: 36529271
DOI: 10.1016/j.ad.2022.11.009 -
Dermatitis : Contact, Atopic,...Exposure to elemental aluminum and its salts is unavoidable. Aluminum as a metal is present in transport, construction, packaging, and electronic equipment. Aluminum...
Exposure to elemental aluminum and its salts is unavoidable. Aluminum as a metal is present in transport, construction, packaging, and electronic equipment. Aluminum salts are present in consumer products, food items and drinking water, vaccines, drugs, and antiperspirants. Aluminum in vaccines and preparations for allergen-specific immunotherapy are the major sensitization sources. The predominent clinical manifestations of aluminum allergy are pruritic subcutaneous nodules and eczematous dermatitis. Patch testing shall be performed with aluminum chloride hexahydrate (ACH) in petrolatum. The preparation with ACH 10% detects substantially more aluminum allergy than ACH 2%. A patch test with elemental aluminum, for example, an empty Finn Chamber, is only positive when there is a strong aluminum allergy. A patch test reading should be performed 1 week after the application so as not to miss 15% to 20% of aluminum allergy. Aluminum should be included in any baseline patch test series for children and investigated for a possible inclusion in baseline series for adults. Aluminum test chambers can interfere with the testing resulting in both false-negative and false-positive patch test reactions to nonaluminum contact sensitizers.
Topics: Adult; Allergens; Aluminum; Aluminum Compounds; Child; Dermatitis, Allergic Contact; Humans; Patch Tests
PubMed: 35029347
DOI: 10.1097/DER.0000000000000836 -
Expert Review of Clinical Immunology Jun 2020Allergic contact dermatitis is an inflammatory skin disease which accounts for up to 20% of all childhood dermatitis. Childhood allergic contact dermatitis is more... (Review)
Review
INTRODUCTION
Allergic contact dermatitis is an inflammatory skin disease which accounts for up to 20% of all childhood dermatitis. Childhood allergic contact dermatitis is more frequent than previously thought and today early diagnosis is considered very important. Patch testing represents the gold standard method used to confirm the diagnosis of allergic contact dermatitis. The knowledge of the most common allergens involved in allergic contact dermatitis in pediatric age is important considering that the first-line management of allergic contact dermatitis in children is to avoid the involved allergens.
AREAS COVERED
We reviewed the literature on PubMed® and SciVerse Scopus® medical database about allergic contact dermatitis and emerging contact allergens in children. In this review, we summarize the clinical characteristics, differential diagnoses, and epidemiology of allergic contact dermatitis in children, underlying the most recent pieces of evidence about the most frequent and emerging contact allergens.
EXPERT OPINION
We believe that persistent, well localized and recurrent eczematous lesions in children should suggest an allergic contact dermatitis, inducing physicians to refer patients for patch testing. Physicians should be acquainted with the current trends and the emerging contact allergens in children, in order to provide not only the best treatment but also the best management and prevention.
Topics: Child; Dermatitis, Allergic Contact; Diagnosis, Differential; Humans; Patch Tests
PubMed: 32490693
DOI: 10.1080/1744666X.2020.1777858 -
Dermatitis : Contact, Atopic,... 2023Although allergic contact dermatitis is a type IV hypersensitivity reaction, type I hypersensitivity reactions, such as anaphylaxis, have been reported during patch... (Review)
Review
Although allergic contact dermatitis is a type IV hypersensitivity reaction, type I hypersensitivity reactions, such as anaphylaxis, have been reported during patch testing. The aim of this study was to identify reported cases of anaphylaxis from patch testing and estimate its rate. A literature review was conducted on PubMed to identify previously reported cases of anaphylaxis after patch testing and suspected allergens. In addition, a survey was distributed to expert patch testing dermatologists to determine the rate of anaphylaxis after patch testing. Three anaphylaxis cases due to patch testing were found in the literature. Twenty-seven of 36 expert patch testers completed the survey for a 75% response rate. These dermatologists have tested an estimated 201,720 patients in their combined careers. From them, 2 cases of patch test anaphylaxis were reported. The rate of anaphylaxis from patch testing was calculated to be 1 in 100,860 tests among our cohort. Patch testing induced anaphylaxis is rare and may be more likely in patients with a history of anaphylaxis. Although rare, dermatologists should have a management plan in place.
Topics: Humans; Patch Tests; Anaphylaxis; Dermatitis, Allergic Contact; Allergens; Hypersensitivity, Delayed
PubMed: 36705647
DOI: 10.1089/DERM.0000000000000956 -
Dermatologic Clinics Jul 2020Education is the keystone of successful management of allergic contact dermatitis. This article outlines practical tips to manage patients' expectations of the patch... (Review)
Review
Education is the keystone of successful management of allergic contact dermatitis. This article outlines practical tips to manage patients' expectations of the patch test process and understand their results. The considerations are outlined in a stepwise fashion from before, during, and after patch testing. Resources for patient information are highlighted, and an update on provider education is also included.
Topics: Dermatitis, Allergic Contact; Diagnostic Errors; Health Knowledge, Attitudes, Practice; Humans; Patch Tests; Patient Education as Topic
PubMed: 32475513
DOI: 10.1016/j.det.2020.02.004 -
Dermatologic Clinics Jul 2020Allergic contact dermatitis to fragrance is common. The prevalence of fragrance allergy in the general population is between 0.7% and 2.6%. In patch-test populations,... (Review)
Review
Allergic contact dermatitis to fragrance is common. The prevalence of fragrance allergy in the general population is between 0.7% and 2.6%. In patch-test populations, the positive reaction rate to fragrances ranges from 5% to 11%. The most common fragrance screeners in most baseline series include fragrance mix 1, fragrance mix 2, and Balsam of Peru. The addition of hydroxyisohexyl 3-cyclohexene carboxaldehyde, hydroperoxides of limonene, and hydroperoxides of linalool to screening series can further aid in the diagnosis of fragrance allergy. In the proper clinical setting, supplemental patch testing with an additional fragrance or essential oil series should be considered.
Topics: Allergens; Balsams; Cosmetics; Dermatitis, Allergic Contact; Facial Dermatoses; Female; Hand Dermatoses; Humans; Male; Odorants; Patch Tests; Perfume
PubMed: 32475515
DOI: 10.1016/j.det.2020.02.009