Exposures and reactions to allergens among hairdressing apprentices and matched controls

Background. Early and extensive exposures to chemical substances such as are found in hair dyes, perfumes and nickel are known risk factors for allergic reactions. Hairdressing apprentices belong to a high‐risk group, as they are exposed both occupationally and personally. Objectives. To estimate the degree of exposure and adverse skin reactions to chemical substances in a cohort of hairdressing apprentices, at the start of their education, as compared with a matched sample from the general population. Materials. During their first 2 weeks of training, 382 hairdressing apprentices were enrolled in this study. All apprentices completed a self‐administered questionnaire that included questions regarding, for example, exposures and skin reactions to hair dye, perfumed products, and piercings. For comparison, the questionnaire was sent to a control group from the general population, matched on age, sex, and postal code (n = 1870). Results. Within the previous year, 95.2% of hairdressing apprentices and 66.9% of the control group had dyed their hair (p < 0.001); the apprentices dyed their hair, on average, 6.6 times per year, as compared with 3.7 times per year in the control group (p < 0.001). The mean age of the first hair dying among the apprentices was 12.1 years, as compared with 13.3 years for the matched control group (p < 0.001). The hairdressing apprentices reported more eczematous reactions to hair dye (p = 0.002) than the controls. Semi‐permanent so‐called ‘black henna tattoos' had been carried out in 48.1% of the apprentices, as compared with 31.0% of the controls (p < 0.001). Conclusions. Both hairdressing apprentices and the matched control group of young people from the general population were highly exposed to potent allergens. The hairdressing apprentices were even more exposed to products containing hair dye substances and piercings, and reported more adverse reactions to hair dye products than their matched controls from the general population.     

Hand eczema in hairdressers: a Danish register-based study of the prevalence of hand eczema and its career consequences

Background. Occupational hand eczema is common in hairdressers, owing to wet work and hairdressing chemicals. Objectives. To estimate the prevalence of hand eczema and its career consequences among hairdressers in Denmark. Methods. A register‐based study was conducted, comprising all graduates from hairdressing vocational schools from 1985 to 2007 (n = 7840). The participants received a self‐administered postal questionnaire including questions on hand eczema, atopic dermatitis, and career change. A response rate of 67.9% (n = 5324) was obtained. Results. Of the respondents, 44.3% no longer worked as hairdressers and had worked for an average of 8.4 years in the profession before leaving it. Hand eczema was more common among ex‐hairdressers (48.4%) than among current hairdressers (37.6%) (p < 0.0001), and significantly more ex‐hairdressers (26.8%) than current hairdressers (15.7%) had chronic hand eczema (p < 0.0001). Of the respondents with hand eczema, 75% were aged 15–24 years at onset, and 45.5% gave hand eczema as a reason for career change. In this group, logistic regression analysis showed that chronic hand eczema contributed the most to the decision to change career (odds ratio 50.12; 95% confidence interval 18.3–137). Conclusions. Hairdressers work an average of 8.4 years in the profession before leaving it, and hand eczema contributes significantly to this career change.     

Hairdressers with dermatitis should always be patch tested regardless of atopy status

Background: Allergic contact dermatitis is common in hairdressers because of their exposure to chemicals used in hair dyes and permanent wave solutions. Atopic individuals are known to have a higher prevalence of leaving the profession due to morbidity associated with hand eczema. Objectives: To assess which chemicals are responsible for allergic contact dermatitis in hairdressers and whether the prevalence is the same according to atopy status. Methods: A total of 729 hairdressers who had been patch tested were retrospectively identified. Allergic reactions to relevant allergens from the extended European baseline series and hairdressing series were analysed against history of atopic eczema. Results: Of the total, 29.9% of patients had a current or past history of atopic eczema. The most frequent positive allergens from the European baseline series were nickel sulfate (32.1%) and p‐phenylenediamine (19.0%) and from the hairdressing series were glyceryl monothioglycolate (21.4%) and ammonium persulfate (10.6%). There was no significant difference between people with or without a history of atopic eczema, except for fragrance mix I and nickel sulfate. Conclusions: We present findings from the largest cohort of hairdressers patch tested from a single centre. It is necessary to patch test hairdressers with dermatitis, regardless of a history of atopy. Strategies to reduce prevalence of allergic contact dermatitis are required.     

Validation of self-reporting of hand eczema among Danish hairdressing apprentices

Background. Hairdressing apprentices have a high incidence of hand eczema. Most studies use self‐reported hand eczema as a cost‐effective method to estimate the prevalence of hand eczema. No validation studies on self‐reported hand eczema among hairdressing apprentices exist. Objectives. To evaluate the validity of self‐reporting of hand eczema among Danish hairdressing apprentices. Methods. During their first 2 weeks of training, 502 hairdressing apprentices were enrolled in this study. All apprentices completed a self‐administered questionnaire including questions regarding, for example, current hand eczema, and they were all clinically examined for hand eczema three times during the first part of their education by use of the Hand Eczema Severity Index. The validity of self‐reporting of hand eczema was measured with the clinical examination as the gold standard. Results. The sensitivity of self‐reporting of hand eczema was 70.3%, and the specificity was 99.8%. The positive predictive value was 96.3%, and the negative predictive value was 98.5%. Conclusions. We found good agreement between self‐reporting of hand eczema and clinical examination. There was good sensitivity and high specificity. Self‐reporting of hand eczema among hairdressing apprentices is considered to be a valid method for estimating the prevalence of hand eczema, although it might underestimate the true prevalence.     

Filaggrin null mutations increase the risk and persistence of hand eczema in subjects with atopic dermatitis: results from a general population study

Summary Background Hand eczema is prevalent in the general population. It remains unclear whether or not filaggrin gene (FLG) null mutations increase the overall risk of hand eczema or only increase the risk of hand eczema in subjects with atopic dermatitis. Objectives To investigate the association between FLG null mutations and hand eczema. Methods A random sample of 3335 adults from the general population in Denmark was patch tested, FLG genotyped for R501X and 2282del4 null mutations and questioned about hand eczema. Results Participants with combined presence of atopic dermatitis and FLG null mutation status had a significantly higher prevalence of hand eczema, an earlier onset of hand eczema and a higher persistence of hand eczema compared with subjects with normal FLG status and absence of atopic dermatitis. Logistic regression analyses revealed positive associations between hand eczema within the past 12 months and FLG null mutation status in participants with a history of atopic dermatitis [odds ratio (OR) 2·98; 95% confidence interval (CI) 1·27–7·01], but not in subjects without atopic dermatitis (OR 0·82; 95% CI 0·41–1·67). Conclusions FLG null mutations were significantly associated with hand eczema (< 12 months) in subjects with atopic dermatitis. Combined atopic dermatitis and filaggrin null mutation status was strongly associated with early onset of hand eczema and hand eczema persistence.     

Distinct SPINK5 and IL-31 polymorphisms are associated with atopic eczema and non-atopic hand dermatitis in Taiwanese nursing population

Abstract: The term ‘hand dermatitis’ describes inflammatory skin condition localized to the hands. Nurses working at hospital settings are prone to develop hand dermatitis. The current study aimed to evaluate whether certain genetic polymorphisms were associated with the development of atopic eczema or non‐atopic hand dermatitis in Taiwanese population. Nurses of Kaohsiung Medical University Hospital were recruited. Atopic eczema, non‐atopic hand dermatitis and normal control groups were identified. The serine protease inhibitor Kazal type 5 (SPINK5), filaggrin and interleukin‐31 (IL‐31) gene variants were compared between the diseased and control groups. Our results showed that rs2303070 T allele of SPINK5 (assuming recessive model; OR = 3.58, 95% CI 1.63–7.84; P = 0.0014) and rs7977932 G allele of IL‐31 (assuming recessive model; OR = 18.25, 95% CI = 3.27–101.94; P = 0.0009) were associated with increased risks of developing atopic eczema, while rs6892205 G allele of SPINK5 (assuming dominant model; OR = 3.79, 95% CI 1.55–9.28; P = 0.0036) was associated with the development of non‐atopic hand dermatitis. In summary, our results showed that distinct SPINK5 and IL‐31 gene variants were associated with the development of atopic eczema and non‐atopic hand dermatitis. The barrier function, particularly those regulated by SPINK5, may play an important role in the development of both atopic eczema and non‐atopic hand dermatitis.     

Association between non‐atopic hand eczema and interleukin‐13 gene polymorphism in Taiwanese nursing population

Chronic hand eczema is an important occupational skin disease with atopic dermatitis (AD) and wet work being the most important risk factors. This study was launched to analyse the potential association between AD‐related inflammation genes and development of non‐atopic hand eczema among nurses in University Hospital. Atopic eczema, non‐atopic hand dermatitis and control groups were identified. The association between occurrence of non‐atopic hand eczema and interleukin (IL)‐13, IL‐4 and IL‐5 gene variants was analysed. IL13 rs20541 A allele [assuming recessive model; odds ratio (OR) = 3.38, 95% CI: (1.63–7.00)] showed association with development of non‐atopic hand eczema. Additive score analyses showed combination of this gene variant with previously identified risk factors including certain SPINK5 polymorphism and more than 10 years of work experience conferred highest risk for development of non‐atopic hand eczema. As non‐atopic hand eczema made up significant portion of occupational skin diseases, further studies should be focused on this commonly encountered skin condition.     

What do trainee hairdressers know about hand dermatitis?

Hand dermatitis is an important cause of morbidity in hairdressers. We conducted a questionnaire survey of 121 trainee hairdressers from 2 hairdressing colleges in Burnley (UK). The questionnaire concerned the number and types of hairdressing procedures performed, previous and current medical history, awareness of risks to the skin from hairdressing, and knowledge of hand dermatitis prevention. 17% of the trainees suffered currently from hand dermatitis. This is likely to be due to the large amount of wet work done by apprentice hairdressers, particularly those who worked in salons. 2/3 of trainees were not aware that atopic eczema predisposed to hand dermatitis. Formal pre-school and pre-employment counselling was limited. Knowledge on hand care among trainees was not often translated into practice, with gloves being worn by only 9% when shampooing and 58% when perming. Prevention of hand dermatitis by education and pre-employment counselling is of fundamental importance.     

Hand eczema in patients with history of atopic manifestations in childhood

A follow-up study of two groups of individuals aged 24-44 years, with a history of severe and moderate atopic dermatitis in childhood (n = 549 and 406 respectively), showed that the most common site of atopic dermatitis was the hands. The prevalence of hand eczema in the two groups was 41% and 25% respectively. The corresponding figure for a group of 222 individuals with respiratory allergy, but not atopic dermatitis in childhood, was 5%, and for a control group (n = 199), without family or personal atopy, 4%. In all four groups the majority of the patients had mild to moderate hand eczema. The fingers were the most common site in all groups. In 69%, 55%, 36% and 12% respectively, hand eczema was found simultaneously with other eczematous manifestations. Irritants were considered by 71-96% in the four groups to aggravate the hand eczema. Contact with various food substances, particularly proteins, was regarded by 38%, 43%, 30% and 9% as an eliciting/aggravating factor. Dust was looked upon as an eliciting/aggravating factor by 25% and 20% of the individuals in the two groups with atopic dermatitis in childhood, but by no one in the control group.     

Hand dermatitis in a prospectively-followed cohort of hairdressing apprentices:nal results of the POSH study

The incidence of hand dermatitis is high in the hairdressing trade; the individual disease burden is substantial, as are the costs of treatment, workers compensation and retraining programs. To evaluate the risk of developing occupational irritant hand dermatitis associated with several potential risk factors, namely constitution (atopy) and occupational exposure, an observational prospective population-based cohort study set in vocational training schools in northwest Germany, recruiting 2352 hairdressing apprentices, was performed. Unprotected wet work of more than 2 h per day is the major significant risk factor; low ambient absolute humidity is equally associated with a significantly increased risk. Compared to the youngest age group, risk diminishes with increasing age. Constitutional risk factors are difficult to evaluate because of selective dropout of atopic participants. For primary prevention, a population approach, improving working conditions and skin protection for all exposed, appears to be the most beneficial.     

FS02.6Patch test reactivity to nickel sulphate and fragrance mix in unselected children

Aim:  To investigate the occurrence of hand eczema after 20 years in schoolgirls previously patch‐tested to nickel.
Methods:  In 1982–83, 960 schoolgirls, aged 8, 11 and 15 years, were investigated for the occurrence of nickel allergy (Larson‐Stymne B and Widström L, Contact Dermatitis 1985:13:289–293). The girls were patch‐tested and the prevalence of nickel allergy was 9%. Twenty years later, the same individuals have received a questionnaire regarding hand eczema and factors of importance for the development of hand eczema. After two reminders, the response rate was 81%.
Results:  In total 17.5% of the girls reported hand eczema after the age of 15. The 1‐year prevalence of hand eczema was 12.6%. Of the previously patch‐tested schoolgirls who answered the questionnaire, 63 were sensitive to nickel. In this study, the prevalence of hand eczema among those 63 was 16%, compared to 17% in the non‐sensitive group (NS). Excluding persons with atopic dermatitis, the prevalence of hand eczema was 12.5% in the nickel‐sensitive group, and 10% among the others (NS). 32% of the persons who had had atopic dermatitis reported hand eczema after 15 years of age, compared to 10% of those with no history of atopic dermatitis (p < 0.001).
Conclusion:  Contact allergy to nickel in early childhood (8–15 years) did not seem to increase the prevalence of hand eczema later in life. The prevalence of hand eczema was increased by a factor of three among those with a history of atopic dermatitis, which is in accordance with earlier reports.     

Atopic signs and symptoms: assessing the 'atopy score' concept

BACKGROUND: Score concepts have been suggested for the standardised diagnosis of atopic dermatitis, incorporating various anamnestic and clinical minor criteria of atopy, including the 'Erlangen Score', developed in the hospital-based setting of a dermatitis clinic. OBJECTIVE: To evaluate the properties of this score in the context of a population-based epidemiological study. METHODS: The association between relevant atopic criteria and previous or current flexural eczema was evaluated in 2,352 hairdressing apprentices. RESULTS: The association was not as strong as in the patient-based studies, comparing the respective odds ratios. Accordingly, the discriminating power of the Erlangen Score was poor, resulting in low sensitivity (55.7%) and specificity (73.8%) for, e.g., 8 points as cutpoint. CONCLUSION: While the score appears useful to summarise minor criteria, the individual relevance of its point values should not be overestimated in view of a low positive predictive value in a population (compared to a clinical) setting.     

Type I and Type IV allergy to unfractionated heparin and low-molecular-weight heparin with no reaction to recombinant hirudin

Aim:  To investigate the risk of adult hand eczema and possible influence on later working life in persons with childhood atopic dermatitis.
Method:  After reviewing medical records from the school healthcare in Stockholm regarding individuals born 1960–69, 600 individuals where signs of atopic dermatitis were noted ("cases") and 600 matched controls without eczema or allergic disease ("controls") were identified. 405 cases and 378 controls answered a questionnaire regarding past and present skin disease, choice of job, exposure at work and possible change of job due to eczema.
Results: Hand eczema was more than 3 times more common among cases, 42%, compared to controls, 13%(p < 0.001). Hand eczema during the past 12 months was reported by 24% of the cases and 9% of the controls (p < 0.001). The proportion of individuals working in jobs with high‐risk for hand eczema was equal between the groups, as well as exposure to water, detergents, chemicals and hand washing. Among the cases 9% reported change of job due to eczema compared to 2% of controls (p < 0.001) and sick leave 10% compared to 2%(p < 0.001).
Conclusions: Childhood atopic dermatitis is a risk factor for hand eczema. As the proportion of individuals in jobs with high‐risk for hand eczema and the exposure was the same in cases and controls measures preventive measures are important to reduce consequences like sick leave and change of job.     

Prevalence of atopic dermatitis, asthma, allergic rhinitis, and hand and contact dermatitis in adolescents. The Odense Adolescence Cohort Study on Atopic Diseases and Dermatitis

BACKGROUND: Atopic diseases are common in children and adolescents. However, epidemiological knowledge is sparse for hand eczema and allergic contact dermatitis in this age group. Furthermore, no population-based studies have evaluated the prevalence of atopic diseases and hand and contact dermatitis in the same group of adolescents. OBJECTIVES: To assess prevalence measures of atopic dermatitis (AD), asthma, allergic rhinitis and hand and contact dermatitis in adolescents in Odense municipality, Denmark. METHODS: The study was carried out as a cross-sectional study among 1501 eighth grade school children (age 12-16 years) and included questionnaire, interview, clinical examination and patch testing. RESULTS: The lifetime prevalence of AD was 21.3% (girls 25.7% vs. boys 17.0%, P < 0.001) using predefined questionnaire criteria. The 1-year period prevalence of AD was 6.7% and the point prevalence 3.6% (Hanifin and Rajka criteria). In the interview the lifetime prevalence of inhalant allergy was estimated as 17.7% (6.9% allergic asthma, 15.7% allergic rhinitis). The lifetime prevalence of hand eczema based on the questionnaire was 9.2%, the 1-year period prevalence was 7.3% and the point prevalence 3.2%, with a significant predominance in girls. A significant association was found both between AD and inhalant allergy, and between AD and hand eczema using lifetime prevalence measures. The point prevalence of contact allergy was 15.2% (girls 19.4% vs. boys 10.3%, P < 0.001), and present or past allergic contact dermatitis was found in 7.2% (girls 11.3% vs. boys 2.5%). Contact allergy was most common to nickel (8.6%) and fragrance mix (1.8%). CONCLUSIONS: High prevalence figures were found for atopic diseases, hand eczema and allergic contact dermatitis, and the diseases were closely associated. A considerable number of adolescents still suffers from AD, and a considerable sex difference was noted for hand eczema and allergic contact dermatitis. Nickel allergy and perfume allergy were the major contact allergies. In the future this cohort of eighth grade school children will be followed up with regard to the course and development of atopic diseases, hand eczema and contact dermatitis.     

Sites of dermatitis in a patch test population: hand dermatitis is associated with polysensitization

Background  Sites of dermatitis in larger series of contact allergic patients are rarely reported. Increased risk of polysensitization has been linked only to stasis dermatitis and leg ulcers. However, a large proportion of polysensitized individuals may have dermatitis in other skin areas.
Objectives  To examine the site of dermatitis at time of first appearance in contact allergic individuals with special focus on the distribution of dermatitis in polysensitized individuals and to examine if widespread dermatitis is more frequent in polysensitized than in single/double-sensitized patients.
Methods  A matched case–control study was carried out including 394 polysensitized and 726 single/double-sensitized patients who responded to a postal questionnaire. All subjects were recruited from a hospital patch test population.
Results  The hands were the most frequent and the anogenital region was the least frequent skin area affected with dermatitis. Dermatitis on the hands/wrists [odds ratio (OR) 1·58], in the armpits (OR 1·56) and on the back (OR 1·91) was positively associated with polysensitization. The hands were the only skin area with dermatitis which maintained the association to polysensitization in two subpopulations consisting of, respectively, individuals with and without atopic eczema. Dermatitis on the scalp was negatively associated with polysensitization (OR 0·66) primarily for individuals without atopic eczema. The dermatitis did not seem to be more widespread in polysensitized compared with single/double-sensitized patients.
Conclusions  Special awareness in patients with hand dermatitis seems justified either to prevent development of multiple contact allergies or to document polysensitization as an aetiological factor.     

Atopic Dermatitis and Celiac Disease: A Cross-Sectional Study of 116,816 Patients

Background

Both atopic dermatitis and celiac disease are often accompanied by other immune-mediated disorders.

Objective

The objective of this study was to evaluate the potential association between atopic dermatitis and celiac disease in a broad community-based population.

Methods

A cross-sectional observational design was used. Demographic and clinical data were collected for patients enrolled in a large health management organization who were diagnosed with atopic dermatitis by a dermatologist in 2002–17. The presence of celiac disease/celiac disease-related morbidities was recorded for the whole group, for adults (age > 18 years), and for adults with moderate-to-severe atopic dermatitis. Findings were compared with a matched control group without atopic dermatitis.

Results

The study group included 116,816 patients of whom 45,157 were adults; 1909 adult patients had moderate-to-severe atopic dermatitis. Compared to the respective control subjects, the prevalence rate of celiac disease in the whole group was 0.6% vs. 0.4%; in the adults, 0.6% vs. 0.3%; and in the adults with moderate-to-severe atopic dermatitis, 0.8% vs. 0.3% (p < 0.001 for all). On multivariate analysis, atopic dermatitis was associated with a significantly higher prevalence of celiac disease (odds ratio = 1.609, 95% confidence interval 1.42–1.82, p < 0.001) in the entire study population and each subgroup.

Conclusions

We observed a significant association between atopic dermatitis and celiac disease. This association emphasizes the need for timely screening of gastrointestinal morbidities in individuals with atopic dermatitis to prevent long-term complications.

     

Development of occupational skin diseases during vocational training in baker and confectioner apprentices: a follow-up study

Baker and confectioner apprentices have been included in a prospective follow-up study in the region of East Thuringia, to evaluate risk factors for the development of hand dermatitis. Starting in August 1996, the apprentices have been interviewed and examined in a standardized way right at the beginning ( n =91) of their vocational training, 6 ( n =79) and 12 months ( n =63) later. To gain objective data, TEWL score was also assessed at 3 standardized sites on the hands. In their case histories, 3.3% ( n =3) of the apprentices reported hand dermatitis. The 1st assessment after 2 to 4 weeks vocational training revealed hand eczema in 17.5% ( n =16) of the individuals. At the follow-up after 6 months of training 29.1% ( n =23), and after 12 month of training 27.0% ( n =17), of the apprentices had hand dermatitis of mild to moderate severity. Within 6 months, the TEWL score rose significantly ( p <0.001) from 11.9 g m⁻² h⁻¹ (± 5.4) to 16.8 g m⁻² h⁻¹ (± 9.5). After 12 months, the TEWL score was 14.9 g m⁻² h⁻¹ (± 4.6). For the atopic skin diathesis (> 10 points of Diepgen's atopy score), there was a significant tendency to be a predictive factor for the development of occupational hand dermatitis. TEWL score failed to correlate with the development of skin damage in our study. The same was true for respiratory atopy and metal sensitization.     

Burden of atopic dermatitis in Japanese adults: Analysis of data from the 2013 National Health and Wellness Survey

Atopic dermatitis is a chronic inflammatory skin disease. The objective of this study was to characterize the burden of atopic dermatitis in Japanese adult patients relative to the general population. Japanese adults (≥18 years) with a self‐reported diagnosis of atopic dermatitis and adult controls without atopic dermatitis/eczema/dermatitis were identified from the 2013 Japan National Health and Wellness Survey. Atopic dermatitis patients were propensity‐score matched with non‐atopic dermatitis controls (1:2 ratio) on demographic variables. Patient‐reported outcome data on comorbidities, mood and sleep disorders, health‐related quality of life, work productivity and activity impairment, and health‐care resource utilization were analyzed in atopic dermatitis patients and matched controls. A total of 638 Japanese adult patients with atopic dermatitis were identified, of whom 290 (45.5%) rated their disease as “moderate/severe” and 348 (54.5%) as “mild”. The analysis cohort comprised 634 atopic dermatitis patients and 1268 matched controls. Atopic dermatitis patients reported a significantly higher prevalence of arthritis, asthma, nasal allergies/hay fever, anxiety, depression and sleep disorders compared with controls (all P < 0.001). Atopic dermatitis patients also reported a significantly poorer health‐related quality of life, higher overall work and activity impairment, and higher health‐care resource utilization (all P < 0.001). Self‐rated disease severity was not associated with disease burden, except for a significantly higher overall work and activity impairment. In conclusion, Japanese adult patients with atopic dermatitis reported a substantial disease burden relative to adults without atopic dermatitis, suggesting an unmet need for effective strategies targeting disease management.     

Filaggrin loss-of-function mutation R501X and 2282del4 carrier status is associated with fissured skin on the hands: results from a cross-sectional population study

Background Filaggrin metabolites act as osmolytes and are important for skin hydration. Carriers of filaggrin loss‐of‐function mutations have a higher prevalence of atopic dermatitis and dry skin. There is also evidence to suggest that filaggrin mutations increase the risk of hand eczema in atopic individuals. In our clinic, we have observed a distinct phenotype of hand eczema in patients with filaggrin mutation carrier status, characterized by fissured dermatitis on the dorsal aspect of the hands and with only sparse involvement of the palms including fine scaling. Objectives To investigate whether filaggrin loss‐of‐function mutations are associated with skin fissures on the hands and/or fingers in the general population. Methods Participants in a population‐based study were questioned about skin symptoms, genotyped for filaggrin mutation, patch tested for nickel allergy and skin prick tested. Results In an adjusted logistic regression analysis, filaggrin mutation status was significantly associated with fissured skin on the hands and/or fingers in adults (odds ratio 1·93, 95% confidence interval 1·05–3·55) and showed a nearly significant negative interaction with atopic dermatitis (P = 0·055), suggesting that the effect was predominantly in subjects without atopic dermatitis. Conclusions Filaggrin loss‐of‐function mutations seem not only to increase the risk of atopic dermatitis and dry skin but also the risk of fissures on the hands and/or fingers in subjects without atopic dermatitis. Prophylactic emollient therapy should be particularly encouraged in filaggrin loss‐of‐function mutation carriers.     

Contact allergy and allergic contact dermatitis in adolescents: prevalence measures and associations. The Odense Adolescence Cohort Study on Atopic Diseases and Dermatitis (TOACS)

The aims of this cross-sectional study were to establish the prevalence measures of contact allergy and allergic contact dermatitis in 8th grade schoolchildren (aged 12-16 years) in Odense, Denmark, and to examine the associations with atopic dermatitis, inhalant allergy and hand eczema. Contact allergy to a standard series allergen was found in 15.2% of schoolchildren. The point prevalence of allergic contact dermatitis was 0.7% and the lifetime prevalence 7.2%, predominantly in girls. The most common contact allergens were nickel (8.6%) and fragrance mix (1.8%). Nickel allergy was clinically relevant in 69% and fragrance allergy in 29% of cases. A significant association was found between contact allergy and hand eczema while no association was found between contact allergy and atopic dermatitis or inhalant allergy. In the future this cohort of schoolchildren will be followed with regard to the course and development of atopic diseases, hand eczema and contact dermatitis. Key words: school-