Atopy and other risk factors for UK dentists reporting an adverse reaction to latex gloves

A study was conducted to assess the significance of a personal history of atopy and other risk factors for UK dentists reporting an adverse reaction to natural rubber latex (NRL) gloves. 2535 dentists completed a self-administered questionnaire and, of these, 1034 (group 1) reported an adverse reaction to NRL gloves and 1501 (group 2) did not. Risk factors investigated were: sex, years in clinical practice, exposure to gloves and a history of atopy or food allergy. The signs and symptoms reported by group 1 dentists were recorded. Logistic regression analysis was used to identify a set of risk factors that produced the most discrete model for a dentist reporting an adverse reaction to NRL gloves. A personal history of atopy was a significant risk factor. Dentists with a history of eczema and hand eczema in childhood were most likely to report an adverse reaction to NRL gloves.     

Prognosis in nickel allergy and hand eczema

63 female patients with nickel allergy and hand eczema were reinvestigated 6 years after the primary investigation. 30% of the patients were healed. Patients with the pompholyx-type eczema had the worst prognosis. The start of hand eczema was not correlated to any particular occupation. There was a strong correlation between a history of metal sensitivity and a positive patch test reaction. High frequencies of personal and family atopy were found, and atopy made the prognosis worse. Determination of serum IgE was not found to be of any use in predicting the prognosis in patients with nickel allergy and hand eczema.     

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.     

Atopic dermatitis in older patients: particular points

We review the particular characteristics of atopic dermatitis (AD) in adult life, and compare findings with those of AD in childhood. AD affects 1–3% of adults world‐wide, and can present as adult‐onset AD, or as infantile/childhood AD that persists, or recurs after many years. Eczema in adults usually exists for years, compromising quality of life, sex life and occupational choices. The flexural areas, shoulders, head‐and‐neck, and hands are typically affected. In elderly adults, eczematous erythroderma is common. The intrinsic (non‐IgE‐allergic) eczema subtype affects 5–15% of cases. Classical food allergy has a low importance, although non‐IgE‐mediated and pseudoallergic reactions can cause eczema. Sensitivity to aeroallergens, especially dust mite, is demonstrated in the majority of adult AD patients, including elderly adults, by immunoglobulin E‐mediated tests and/or atopy patch tests. Occupational allergic and irritant contact dermatitis is increased. In adults, as in children, Staphylococcus aureus colonization is very high, whereas adult skin is more heavily colonized with Malassezia yeasts. Immediate and delayed sensitization to Malassezia sympodialis is specific for intrinsic and extrinsic AD, occurring especially in head‐and‐neck eczema. Concerning therapy, older patients are prone to certain adverse drug effects. In conclusion, differences exist between childhood and adult disease. As we should be seeing more adults with AD in the future, there is a need for more clinical and immunological studies in older patients.     

Are infantile seborrheic and atopic dermatitis clinical variants of the same disease?

BACKGROUND: The relationship between infantile seborrheic dermatitis (ISD) and infantile atopic dermatitis (IAD) is controversial. METHODS: Ninety-six children aged 2-12 months diagnosed with atopic dermatitis and a comparable control group of healthy children were evaluated. Demographic data, personal history of ISD and personal or family history of atopy was considered in both groups. RESULTS: A personal history of ISD was found in 49% of IAD cases and in 17% of controls (P < 0.05). CONCLUSIONS: Our result and those of the literature do not demonstrate a relationship between ISD and IAD. However, a number of cases of AD have an ISD-like clinical picture. It is probable that ISD is a syndrome and not a disease.     

Patterns of care and referral in children with atopic dermatitis and concern for food allergy

Although many providers believe that up to 30% of atopic dermatitis (AD) is food induced, food challenge studies show that food-induced eczematous reactions are rare. When food allergy is suggested to cause AD, it often leads to allergy testing with a high false-positivity rate, in turn further focusing parents on food allergy. Study subjects were children less than 11 years old with AD and food allergy suspicion. Prior diagnoses, provider, and testing patterns were assessed by questionnaire given to the parents. Thirty-eight patients with AD were enrolled. Most subject's parents suspected food allergy induced AD. Initial skin diagnoses were made by pediatricians (79%) and family practitioners (18%) as eczema. Allergy was suggested by providers as cause for AD in 63% of the present study's patients. Seventy-nine percent had allergy testing. Greater than 90% of parents claimed their children had food allergy and food-induced AD. Sixty-six percent had positive food allergy tests and 37% had definite history of immediate IgE reactions to food. The majority of this population had allergy suggested as causative for eczema by their primary care provider and were subsequently evaluated by allergist and allergy testing. Consensus about the role of food allergy between the different providers of AD in children would result in more effective, efficient, and less costly health care.     

Work-related hand eczema in atopics

549 individuals with severe (group 1), 406 with moderate (group 2) atopic dermatitis in childhood, 222 with respiratory allergy but no atopic dermatitis in childhood (group 3), and 199 without personal or family atopy (group 4) were studied as to occupational health symptoms due to hand eczema. In groups 1, 2 and 4, there was a slightly significant difference (P less than 0.05) between the frequency of hand eczema in individuals with and without occupational exposure to chemicals, water, soil or wear (friction). Despite no such work, 55% in group 1 and 44% in group 2 had developed hand eczema. About 1/4 of the atopics in extreme risk occupations, such as ladies' hairdressers and nursing assistants, had not developed hand eczema. Altogether, 9% in groups 1 and 2 and 3% in group 4 had changed their jobs due to hand eczema, the majority from work with to work without exposure to chemicals, water, soil or wear. Social factors had usually contributed to the change. The healing rate after taking up a new occupation was 15% in group 1, 36% in group 2 and 67% (4 out of 6) in group 4. The majority of the patients whose eczema had not healed had improved in their new occupations. It is claimed that medical reasons for change of occupation should be carefully weighed against social reasons.     

特应性皮炎临床特点和诊断标准的探讨

目的 探讨康克非和田润梅提出的特应性皮炎(AD)诊断标准(简称康田标准)的适用性。方法 用康田标准对917例经Hanifin和Rajka诊断标准(简称HR标准)确诊的AD患者进行诊断,并分析AD患者的遗传过敏史及其临床特点。结果 888例AD患者符合康田标准,占96.84%.有个人或家族过敏史者占83.21%.婴儿期AD患者面部皮炎的发生率高于儿童期和青少年、成人期,而其干皮症、鱼鳞病、毛周角化、眶周黑晕的发生率又低于儿童期和青少年、成人期。结论 遗传过敏史是AD诊断中的一个重要因素。康田标准是一个合理实用的诊断标准,值得推广使用。     

An epidemiological comparison between occupational and non-occupational hand eczema

Thirty-four per cent of 2110 patients with eczema attending a contact dermatitis clinic had hand eczema. Fifty-five per cent (395 of 721) had contact dermatitis and 45% (326 of 721) had endogenous/unclassifiable eczema. Thirty-five per cent of cases (217 of 721) were occupational eczema. An epidemiological comparison of patients with occupational and non-occupational hand eczema (defined as eczema occurring on the hands up to the wrist line) was made. Hand eczema was more common in males in both groups, and there was a significantly larger proportion of males in the occupational group (65%) than the non-occupational group (51%) (P less than 0.001). The prevalence of a personal or family history of atopy was significantly lower in the occupational group (7%) than the non-occupational group (15%) (P less than 0.005). Irritant contact dermatitis occurred in a larger proportion of patients in the occupational group (76%) than the non-occupational group (39%) (P less than 0.0001). There was no significant difference between the proportions of patients with positive patch test reactions in the occupational group (34%) and the non-occupational group (41%). Potassium dichromate, and epoxy resin allergy occurred significantly, more frequently, in the occupational group whereas fragrance-mix allergy was significantly more frequent in the non-occupational group.     

Familial background of respiratory atopy. A factor of type I allergy to house dust mite in patients with atopic dermatitis

Skin prick and radioallergosorbent tests with the house dust mite were performed in 120 patients with atopic dermatitis. The results showed that about 60% of the patients had type I allergy to the mite. Results of the prick and radioallergosorbent tests did not relate to the severity of skin involvement, nor to the seasonal fluctuation of the disease. Positive skin and radioallergosorbent tests occurred in many patients with atopic dermatitis who had a personal or family history of respiratory atopy. However, both of these tests were negative in the majority of patients with "pure" atopic dermatitis who had neither a personal nor a family history of respiratory atopy. It was suggested that a familial background of respiratory atopy is an important factor for the development of type I allergy to the house dust mite in patients with atopic dermatitis.     

Reduced allergy rates in atopic eczema to contact allergens used in both skin products and foods: atopy and the 'hapten-atopy hypothesis'

Background:  Food allergy is strongly associated with atopy. This retrospective study investigates whether atopic status affects responses to contact allergens also found in food. We compared incidences of atopic dermatitis/eczema (AD) in subjects who were patch-test positive (PT+) to diallyl disulfide from handling garlic and parabens used as a skin cream/ointment and food preservative with the incidence in those subjects who were PT+ to chemicals encountered at skin surfaces (lanolin and nickel).
Results:  36 658 patients with eczema/dermatitis were patch tested (1980–2006). 10 326 (28.2%) had AD. 13/83 (15.6%) PT+ subjects to diallyl disulfide/garlic had AD (AD/total population versus AD/diallyl disulfide PT+, P  = 0.011). 54/239 parabens PT+ had AD (22.6%), while 181/608 lanolin PT+ had AD (29.8%) ( P  < 0.05).
Conclusions:  Contact allergy to haptens with oral and skin exposure is reduced in AD compared with non-AD, unlike food protein hypersensitivity. Lanolin frequency was not decreased. Possible explanations include (i) confounding factors, e.g. AD subjects handle garlic less than non-AD subjects, or (ii) AD patients tolerate haptens efficiently, secondary to their atopic status, or (iii) oral tolerance of haptens antagonizes tolerance of food proteins, contributing to development of atopy (hapten-atopy hypothesis). The recent upsurge of atopy took place when gut exposure to haptens in processed foods increased dramatically.     

Risk factors for atopic dermatitis in New Zealand children at 3.5 years of age

BACKGROUND: The prevalence of atopic dermatitis (AD) is increasing in Western societies. The hygiene hypothesis proposes that this is due to reduced exposure to environmental allergens and infections during early life. OBJECTIVES: To examine factors associated with a diagnosis of AD at 3.5 years of age, especially those factors implicated by the hygiene hypothesis. METHODS: The Auckland Birthweight Collaborative study is a case-control study of risk factors for small for gestational age babies. Cases were born at term with birthweight < or = 10th centile; controls were appropriate for gestational age, with birthweight > 10th centile. The infants were assessed at birth, 1 year and 3.5 years of age. Data were collected by parental interview and examination of the child. AD was defined as the presence of an itchy rash in the past 12 months with three or more of the following: history of flexural involvement; history of generally dry skin; history of atopic disease in parents or siblings; and visible flexural dermatitis as per photographic protocol. Statistical analyses took into account the disproportionate sampling of the study population. RESULTS: Analysis was restricted to European subjects. Eight hundred and seventy-one children were enrolled at birth, 744 (85.4%) participated at 1 year, and 550 (63.2%) at 3.5 years. AD was diagnosed in 87 (15.8%) children seen at 3.5 years. The prevalence of AD did not differ by birthweight. AD at 3.5 years was associated with raised serum IgE > 200 kU L(-1), and wheezing, asthma, rash or eczema at 1 year. In multivariate analysis, adjusted for parental atopy and breastfeeding, AD at 3.5 years was associated with atopic disease in the parents: maternal atopy only, adjusted odds ratio (OR) 3.83, 95% confidence interval (CI) 1.20-12.23; paternal atopy only, adjusted OR 3.59, 95% CI 1.09-11.75; both parents atopic, adjusted OR 6.12, 95% CI 2.02-18.50. There was a higher risk of AD with longer duration of breastfeeding: < 6 months, adjusted OR 6.13, 95% CI 1.45-25.86; > or = 6 months, adjusted OR 9.70, 95% CI 2.47-38.15 compared with never breastfed. These findings remained significant after adjusting for environmental factors and a personal history of atopy. AD at 3.5 years was associated with owning a cat at 3.5 years (adjusted OR 0.45, 95% CI 0.21-0.97) but not with owning a dog at 3.5 years, pets at 1 year, nor with older siblings. Furthermore, AD at 3.5 years was not associated with gender, socioeconomic status, maternal smoking, parity, damp, mould, immunizations, body mass index or antibiotic use in first year of life. CONCLUSIONS: A personal and a parental history of atopic disease are risk factors for AD at 3.5 years. Duration of breastfeeding was associated with an increased risk of AD. No association was found with those factors implicated by the hygiene hypothesis. This study suggests that breastfeeding should not be recommended for the prevention of AD.     

Vesikulöse Veränderungen in palmoplantarer Lokalisation im Kindesalter

BACKGROUND AND OBJECTIVE: Palmoplantar vesicles in children have various underlying causes, requiring different therapies. We evaluated the most common underlying diseases and determined simple criteria for differentiation. PATIENTS/METHODS: Within a two years period all children up to 14 years of age who presented with acral vesicles were included in this study. RESULTS: The most common causes of acral vesicles in a group of 32 patients, were dyshidrotic eczema with (n=11) or without atopic diathesis (n=11) and scabies (n=7). Rarely, the cause of vesicular lesion was tinea (n=2) or infantile acropustulosis (n=1). While dyshidrotic eczema was a disease of late childhood, palmoplantar lesions caused by scabies developed in younger children up to the age of 4 years. Scabies in contrast to infantile acropustulosis tend to present with more generalized lesions, not being restricted to acral location. Dyshidrotic eczema revealed lesions bilaterally and in case of atopy, additional body areas were involved. Unilateral presentation was a clue for tinea. CONCLUSIONS: Acral vesicles in childhood can be diagnostically discriminated by the age of the patient and the distribution of the lesions.     

Facial atopic dermatitis is associated with sensitization to cow's milk,egg whites,and peanuts in children under 36 months

Atopic dermatitis (AD) in early childhood often precedes the development of food sensitization and allergy, but the role of treating AD to prevent food allergy remains poorly understood. Our objective was to assess the relationship between facial dermatitis and food sensitization to cow's milk, egg whites, and peanuts in early childhood, as aggressive treatment of facial dermatitis could serve as a potential opportunity for food sensitization prevention. By 3 years of age, food sensitization levels to cow's milk, egg whites, and peanuts were 48% greater in children with facial AD than in children with no facial involvement of their AD. Additional research is needed to determine if facial involvement of AD in infants and young children is associated with increased food allergy.     

Nickel allergy and hand eczema--a 20-year follow up

The aim of this study was to investigate the occurrence of hand eczema after 20 years in women patch tested to nickel during childhood. In 1982-1983, 960 schoolgirls were patch tested for nickel allergy; its prevalence was found to be 9%. 20 years later, the same individuals received a questionnaire regarding hand eczema and factors of importance for the development of hand eczema. 735 of 908 women (80.9%) answered the questionnaire. In total, 17.6% of respondents reported hand eczema after the age of 15 years, and the 1-year prevalence was 12.8%. There was no statistically significant difference in the occurrence of hand eczema between the groups who had previously tested positive and negative for nickel allergy. 38.3% of the respondents considered themselves to be nickel sensitive at the time they answered the questionnaire; in this group, the reported prevalence of hand eczema after age 15 was 22.5%. 31.4% of those with a history of atopic dermatitis reported hand eczema after age 15, compared with 10.6% of those without (P < 0.001). In conclusion, contact allergy to nickel in childhood did not seem to increase the prevalence of hand eczema later in life.     

Seborrhoeic eczema—a disease entity or a clinical variant of atopic eczema?

One hundred and thirty-eight children seen at the Dermatology Clinic between 1969 and 1972 were reviewed. The study comprised two groups--a study group of 76 children diagnosed as having seborrhoeic eczema, and a group of 62 children seen over the same time period at the same clinic and diagnosed as having atopic eczema. The children were examined and a family history obtained with particular reference to past or present history of atopic diseases. Serum IgE, blood eosinophil count, pulmonary function tests and skin prick testing to various allergens were measured in the two groups. In the seborrhoeic group, 19% had eczema, 20% had abnormal pulmonary function clinically; 25% had a raised eosinophil count, 44% a raised IgE level, 89% positive skin prick testing, and 52% a peak flow less than 80% of predicted value. These results indicate a closer than expected association between infantile seborrhoeic eczema and atopic disease.     

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.     

Precipitins to dietary proteins in atopic eczema

Precipitating antibodies to foods have been assayed in three groups of patients with atopy. Forty-five per cent of patients with atopic eczema and IgE-mediated food allergy had precipitins to foods in their serum compared with only 15% of patients with atopic eczema without evidence of food allergy, and 16% of patients with atopic asthma and/or rhinitis. It is likely that this results from increased intestinal permeability in the group with eczema and food allergy.     

Predictors of atopic dermatitis in Leicester children

There is little contemporary data available on the prevalence of atopic dermatitis (AD) or the risk factors associated with this disease. We therefore performed a prospective study of 1-year-oId children based on a cohort of consecutive births in Leicester hospitals. Parents of 1800 children born between March and May 1992 were asked at the time of the birth to allow their child to be entered on a register. A sample of 499 of these children were invited for interview and examination at 1 year of age. Data were collected on gestational maturity, birth weight, feeding pattern, family history of eczema and atopy, social class and other parameters. Four hundred and thirteen of the 499 children were examined (83%). The overall point prevalence of AD was 10.7% (95% confidence interval, 7·7%–13·7%). The most significant risk factor for a child developing AD was a parental history of eczema.     

The Prevalence, Characteristics of and Risk Factors for Eczema in Belgian Schoolchildren

Abstract:  Childhood eczema is common in infants, but its nature and extent during later childhood remains unclear. In this cross-sectional study we examined the prevalence and characteristics of eczema in an unbiased community population of 2,021 Belgian schoolchildren, aged 3.4 to 14.8 years with skin prick testing and parental questionnaires. Our study identified an eczema prevalence of 23.3% and a considerable allergic co-morbidity, mainly in sensitized children. The reported prevalence of eczema in infancy was 18.5% and for current eczema 11.6%. The overall sensitization rate (33.2%) as well as sensitization rates for the individual allergens were significantly higher in children with "eczema ever." Sensitization to Dermatophagoides pteronyssinus (19.6%), mixed grass pollen (15.1%), and cat (9.1%) were most common. Until the age of 6 years, boys with eczema were significantly more sensitized than girls (p = 0.007). Children with both eczema in infancy and current eczema show a tendency to be more sensitized than children with eczema in infancy only or current eczema only, but significance was only noted for a few individual allergens. Analysis of factors associated with eczema revealed a predominantly atopic profile characterized by family or personal history of allergy. Breastfeeding and environmental factors seemed to assume little relevance except for a protective effect of prematurity and having a dog at birth.