Dermatite atopique et allergie alimentaire chez l'enfant

Food allergy is known to provoke flares of atopic dermatitis (AD). The prevalence of food allergy in infants with atopic dermatis has been estimated to be 40%. Atopy patch testing is a novel approach to diagnose food-induced AD, but standardization of atopy patch test extracts needs addional studies. Oral food challenge is the gold standard for diagnose of food allergy. Nevertheless, the method used for oral food challenges in cases of late eczematous reactions remains to be defined. Food appears to aggrevate eczematous lesions in young children, and it is recognized that allergy testing needs to be standardized in order to prove that relationship.     

Patch testing for allergic contact dermatitis in the allergist office

The identification of allergens responsible for allergic contact dermatitis (ACD) is key to the management of this disease. The patch test (PT) is the only safe, objective, scientific, and practical method for the diagnosis of ACD. There is no single PT panel that will screen all the relevant allergens in a patient’s environment. It is generally thought that 20 to 30 allergens in routine screening tests can identify 50% to 70% of clinically relevant ACD. However, the usefulness of patch testing is enhanced with the number of allergens tested. Although the PT might be simple to apply, it might be difficult to read, interpret, and correlate to the patient’s symptoms. A familiarity with the patient’s environment, the process of the industry in that environment, and the uses of various chemicals in the industry is needed in most cases.     

Contact sensitization in children with atopic dermatitis

Background

Atopic dermatitis is a common illness in childhood. Children with atopic dermatitis are prone to develop cutaneous sensitization due to skin barrier dysfunction.

Role of aeroallergens in the etiopathogenesis of atopic dermatitis

Atopic dermatitis is a chronic relapsing inflammatory skin disease. It is most frequent in childhood and its clinical manifestations vary with age. The etiopathogenic mechanisms that explain this process are still poorly understood; several studies performed in adults speculate on the possible role of aeroallergens through direct contact with the skin but, because the etiology of this disease varies with age, studies in children of different ages are required.Aims: (i) To determine whether children with atopic dermatitis are sensitized to inhalant allergens. (ii) To determine whether these inhalant allergens cause dermatitis or whether they provoke allergic respiratory disease (asthma, rhinitis) concomitant with atopic dermatitis. (iii) To evaluate whether sensitization to a particular allergen takes place at any age or whether there are differences according to age.Material and methods: This study was performed in the following groups: (i) 64 children with atopic dermatitis, divided into two subgroups, one consisting of 37 children who also presented allergic respiratory disease (asthma, rhinitis) (AR) and another subgroup of 27 patients who presented atopic dermatitis only. (ii) Control group: eight children who presented AR only, to determine whether this group reacted to patch testing with inhalant allergens. (iii) Control group: seven healthy children to rule out non-specific positive tests in the non-atopic population. All groups were divided by age according to the phases of atopic dermatitis: early childhood phase (< 2 years): 21, childhood phase (2-10 years): 37, adolescent phase (> 10 years): 21. In all children total serum IgE determination (RIA), allergen-specific IgE determination (RAST), prick- and patch test were performed. In the three tests the same allergens were used, consisting of the usual components of standardized inhalant and food allergens. When the results of patch testing were positive, biopsy and histopathological analysis were performed and monoclonal antibodies were used to determine reproducibility of the eczematous lesion.Results: Sensitization was found to differ among patients with atopic dermatitis according to whether they presented respiratory symptoms and according to age with a clear predominance of food sensitization in the group aged less than 2 years. In the group aged 2-10 years, mixed sensitization predominated, mainly because of simultaneous respiratory involvement, but it is highly probably that inhalant allergens participate in the etiopathogenesis of atopic dermatitis. In children aged more than 10 years sensitization to inhalant allergens predominated as most presented respiratory symptoms. Patch testing was positive in 34.3 % of patients with atopic dermatitis and approximately half were positive to dust mites. The patch test is of great diagnostic value in atopic dermatitis and none of the tests were positive in the control group. All the biopsies of patch tests with inhalant allergens reproduced the lesions typical of eczema, demonstrating their involvement in the etiopathogenesis of dermatitis.     

Current Strategies in Treating Severe Contact Dermatitis in Pediatric Patients

Allergic contact dermatitis in children is underdiagnosed and undertreated, and its incidence is increasing. Appropriate history taking and the suspicion for allergic contact dermatitis is essential, and patch testing remains the gold standard in diagnosis. Avoidance of the offending allergen, once identified, is the first goal of treatment. Medical therapies include topical corticosteroid and topical immunomodulators. In severe cases, oral corticosteroids or immunomodulators are utilized, although prospective randomized trials for the treatment of this disease in children are lacking. A PubMed literature search was performed to identify publications on allergic contact dermatitis in the pediatric population with the keywords: dermatitis, children, allergic contact dermatitis, pediatrics, contact hypersensitivity, contact allergy, treatment, and management. This review will address the major principles behind the diagnosis and management of this disease in the pediatric population, and highlight useful strategies that may result in improved treatment of this condition.     

Invited Commentary: Recommendation for a North American Pediatric Patch Test Series

Given the increased recognition of pediatric allergic contact dermatitis and lack of patch testing consensus in children, we present a minimum basic 20-allergen North American pediatric series, for screening children ages 6–12 with suspected contact allergy.     

Étude comparative des « prick » et « patch » tests aux moisissures,aux dermatophytes et aux levures dans la dermatite atopique de la tête et du cou,la dermatite séborrhéique et le sébopsoriasis

Aim of the study. – The capacity of fungi to induce eczema in head and neck dermatitis has already been studied. Malassezia has often been implicated in two other dermatitis of the cephalic region (seborrhoeic dermatitis and sebopsoriasis). We have explored the cellular and IgE dependant reactions to different groups of fungi in these three dermatitis using “patch” and “prick” tests. Tested allergens were: Alternaria, Penicillium, Aspergillus, Cladosporium, Trichophyton, Epidermophyton, Candida albicans, Malassezia, Saccharomyces cerevisiae.Material and methods. – Seventy persons including 42 females (60%) and 28 males (40%) aged 40 years old in average were distributed in four groups: Head and neck dermatitis (24 patients), seborrheic dermatitis of the face (21 patients) and sebopsoriasis of the face (10 patients) compared to 15 controls without these dermatoses.Results and conclusions. – Globally, in “prick” and “patch” tests, yeasts had the highest number of positivity comparing to the two other groups. Malassezia was the leader in “prick tests”. In “patch tests”, the global results showed a positivity rate, which was clearly lower than those in “prick tests”. Detailed analysis of the results revealed that in the head and neck dermatitis the highest number of positive “patch tests” for all of these allergens is found. For the three other groups, no significant difference for these two techniques for any of these allergens has been detected.     

Une bouche en or

Contact dermatitis to gold has rarely been reported. This precious metal is generally considered as inert, insoluble and resistant to corrosion. Nevertheless, gold salts have a strong potential for sensitization. This condition can occur after contact with gold jewellery and dental alloys, after systemic therapy with gold salts and after occupational contact. The lesions may be expressed as contact dermatitis on the face, ear, neck and/or fingers, and as lichen planus and/or lichenoid stomatitis. The dermatitis is usually not very irritating and the lesions are rarely persistent. Diagnosis is based on the clinical history and examination, on the nature of the exposure sources, and on the results of patch tests with gold sodium thiosulfate (GSTS) at 0.5% in petrolatum. The patch test is read on days 2 and 3 and again after 1 and 3 weeks. Allergen avoidance can be expensive and tiresome, and improvement is not guaranteed. We report the case of a female patient who came to us complaining of burning in her mouth. She had polymetallism and lichenoid lesions facing gold tooth crowns. Patch tests were positive to GSTS at 72 h and at 1 week. Replacement of the gold crowns led to total disappearance of her symptoms within 1 year. Local factors, including humidity, temperature, acid pH, abrasion and contact with substance such as amino acids, bring about the liberation of the sensitizing metallic salts, which may be enhanced by galvanic corrosion secondary to the polymetallism.     

Allergic Contact Dermatitis Evaluation: Strategies for the Preschooler

Purpose of Review

The environment for the developing children is complex as they are exposed to a variety of activities and settings where potential environmental allergens may be encountered. Recent evidence supports the clinical benefit of patch testing young children suffering from recalcitrant dermatitis. While patch testing has been recently approved by the Food and Drug Administration in children ages 6–18 years old, patch testing strategies for young children of preschool age (between 2 and 6 years old) have yet to be defined.

Recent Findings

Allergic contact dermatitis is underdiagnosed among pediatric patients, particularly those suffering from concomitant atopic dermatitis as the interplay between the two diseases is complex. Recent reports in literature supported the clinical value, safety, and efficacy of patch testing pediatric patients.

Summary

This review provides an overview of specific pediatric allergens, special considerations, practical modifications, and systematic exposure-driven guidance approaches toward patch testing preschoolers.

     

This month in Scandinavian Journal of Gastroenterology

Background: Allergic diseases and seronegative spondyloarthropathies are frequently observed in ulcerative colitis (UC). In this report we have investigated possible relationships between IgE-mediated allergic disease (AD), allergic contact dermatitis (ACD) and seronegative spondyloarthropathy (SpA) in UC patients at different grades and extensions of mucosa inflammation. Methods: Forty-five UC consecutive outpatients were graded according to clinical, endoscopic and histologic activity scores. SpA was diagnosed according to the European Spondyloarthropathy Study Group criteria. AD was detected by skin prick tests and confirmed by specific provocation tests, while ACD was diagnosed using the European standard series of patch tests. Thirty-seven patients' spouses or partners served as controls. Results: Fourteen patients and 1 control subject showed SpA ( P = 0.001). Diagnosis of rhinitis, conjunctivitis or asthma was made in 19 patients and in 5 controls ( P = 0.004), while ACD was found in 10 and in 4 ( P = 0.17), respectively. In UC, AD coexisted with SpA in 2 cases ( P = 0.01), AD with ACD in 1 case ( P = 0.03) and ACD with SpA in 5 ( P = 0.24). Conclusions: Notwithstanding the high frequency of AD and SpA found in UC, the concurrence of AD with SpA or ACD is an unusual finding, while SpA and ACD may coexist. These data suggest that, in UC, atopy and seronegative arthritis, as well as atopy and delayed-type allergy, are strongly polarized conditions tending to mutual exclusion. In UC, the presence of AD without SpA or ACD, and of SpA or ACD without AD may indicate subgroups of patients in which T-helper-2 cell or T-helper-1 cell responses predominate.     

武汉市370例变应性接触性皮炎患者斑贴结果

目的分析武汉市引起变应性接触性皮炎的主要变应原,以及变应原与性别、年龄、职业、发病部位的关系,为本地区变应性接触性皮炎的防治和斑贴试验选择提供依据。方法对2010年1月至2012年12月华中科技大学同济医学院附属同济医院过敏反应科370例变应性接触性皮炎门诊患者进行斑贴试验,计算不同性别、年龄、职业和发病部位,各种变应原斑贴试验的阳性率,比较变应原阳性率差别。结果370例变应性接触性皮炎患者斑贴试验总阳性率为76．76％,阳性率居前5位的变应原为硫酸镍（34．32％）、芳香混合物（18．65％）、氯化钴（18．38％）、重铬酸钾（17．30％）及甲醛（12．70％）。不同性别、年龄、职业人群中变应原阳性率各异且不同发病部位的主要变应原也不同。结论性别、年龄、职业及发病部位等因素对变应原的阳性率均有影响;硫酸镍、芳香}昆合物、氯化钴、重铬酸钾以及甲醛是武汉地区变应性接触性皮炎的主要变应原。     

洗涤剂椰油酰胺丙基甜菜碱过敏

目的观察洗涤剂椰油酰胺丙基甜菜碱（CAPB）在北京协和医院变态反应科接触性皮炎患者中的斑贴试验阳性率。方法对本科门诊湿疹患者进行常见的10种接触性过敏原的斑贴试验：香料混合物、柳硫汞、咪唑烷基脲、甲醛、凯松CG、对苯二胺、硫酸镍、重铬酸钾、氯化钴和CAPB，观察CAPB的阳性率。结果在进行斑贴试验的562例湿疹患者中。CAPB阳性5例，其中4例为全身皮炎，1例为面部皮炎。5例进行相关化妆品或洗涤用品的斑贴试验均有阳性反应。结论本院接触性皮炎患者中的CAPB阳性率低于其他报道，但考虑到洗涤剂的广泛应用,应在怀疑化妆品过敏引起的湿疹皮炎患者中常规进行CAPB斑贴试验。     

Ulcerative colitis,seronegative spondyloarthropathies and allergic diseases: the search for a link

BACKGROUND: Allergic diseases and seronegative spondyloarthropathies are frequently observed in ulcerative colitis (UC). In this report we have investigated possible relationships between IgE-mediated allergic disease (AD), allergic contact dermatitis (ACD) and seronegative spondyloarthropathy (SpA) in UC patients at different grades and extensions of mucosa inflammation. METHODS: Forty-five UC consecutive outpatients were graded according to clinical, endoscopic and histologic activity scores. SpA was diagnosed according to the European Spondyloarthropathy Study Group criteria. AD was detected by skin prick tests and confirmed by specific provocation tests, while ACD was diagnosed using the European standard series of patch tests. Thirty-seven patients' spouses or partners served as controls. RESULTS: Fourteen patients and 1 control subject showed SpA (P = 0.001). Diagnosis of rhinitis, conjunctivitis or asthma was made in 19 patients and in 5 controls (P = 0.004), while ACD was found in 10 and in 4 (P = 0.17), respectively. In UC, AD coexisted with SpA in 2 cases (P = 0.01), AD with ACD in 1 case (P = 0.03) and ACD with SpA in 5 (P = 0.24). CONCLUSIONS: Notwithstanding the high frequency of AD and SpA found in UC, the concurrence of AD with SpA or ACD is an unusual finding, while SpA and ACD may coexist. These data suggest that, in UC, atopy and seronegative arthritis, as well as atopy and delayed-type allergy, are strongly polarized conditions tending to mutual exclusion. In UC, the presence of AD without SpA or ACD, and of SpA or ACD without AD may indicate subgroups of patients in which T-helper-2 cell or T-helper-1 cell responses predominate.     

Thermography: High sensitivity and specificity diagnosing contact dermatitis in patch testing

Background

Patch testing of contact allergens to diagnose allergic contact dermatitis (ACD) is a traditional, useful tool. The most important decision is the distinction between allergic and irritant reactions, as this has direct implications on diagnosis and management. Our objective was to evaluate a new method of non-contact infrared reading of patch tests. Secondary objectives included a possible correlation between the intensity of the patch test reaction and temperature change.

Faut-il contre-indiquer l’utilisation des émollients à base d’avoine chez l’enfant atopique ?

Atopic dermatitis is the first atopic symptom. Local treatment makes use of emollient cream. Oat cream extracts were suspected of causing sensitization. This study was performed in 202 children with atopic dermatitis. Two subgroups were analysed: group 1, 105 children who had applied oat cream (Exomega®, Laboratoires Ducray, France) and group 2, 97 children who had never applied oat cream. Patch tests were positive for Rhealba® oat extract (total extract or protein fractions) in five cases (2.4%): three in group 1 and two in group 2. This result is clinically relevant in group 1, with increased eczema after use of Exomega®. Oat oral food challenge was negative in three children with an oat-positive skin prick test. There was no statistical difference between the two groups concerning age or positivity of oat tests and the results of other allergologic tests. Relevant oat cream allergy in children with atopic dermatitis concerned 1.4% of cases. These data suggest that emollient patch tests should be performed in children with atopic dermatitis, in order to use or exclude emollient cream. Further studies are required to evaluate changes in oat sensitization in older children.     

The role of patch testing for chemical and protein allergens in atopic dermatitis

Many patients who present for evaluation of allergic contact dermatitis have an atopic diathesis. Although the immunologic basis of atopic dermatitis differs from that of allergic contact dermatitis—and patients with atopic dermatitis are less easily sensitized under experimental conditions—atopic patients do develop allergic contact dermatitis, and patch testing is a valuable part of their medical care. Delayed (7-day) patch test readings are especially important in atopic patients to distinguish allergy from irritancy and to evaluate for steroid allergy. The utility of atopy patch tests to aeroallergens such as dust mite is increasingly recognized; aeroallergens may be the cause of a type of protein contact dermatitis.     

Adverse reactions to orthodontic appliances in nickel-allergic patients.

Nickel allergy (NA) is common and causes more cases of allergic contact dermatitis (ACD) than all other metals combined. Many orthodontic appliances (ODAs) contain nickel but their clinical relevance in nickel-allergic patients is unclear. We aimed to characterize the relationship between NA and ODAs because the medical literature investigating this is controversial. A survey concerning adverse reactions to ODAs in patients with NA was distributed to members of the Wisconsin Society of Orthodontics. Forty-three surveys were analyzed. The surveyed group was experienced, representing a mean of 21.2 years in practice and averaging 242 appliances placed per year per orthodontist. Most new patients with orthodontia were 10-18 years old. Most wires used were nickel-titanium alloy. Although 76% of orthodontists inquired about NA at initial evaluation, 37% still placed nickel-containing ODAs in known nickel-allergic patients. Fifty percent placed a single intraoral appliance, observing for reactions. Three orthodontists applied ODAs to the skin similar to patch testing. Only 8 patients with reactions to ODAs were described in detail, 6 were female patients and 6 were aged 13-14 years. Intraoral and extraoral reactions were mild; diffuse urticaria was reported in one patient. Treatment included removing the appliances or changing to nonnickel alternatives with favorable outcomes. These cases, which included >33,000 patients, suggest a prevalence of 0.03%. Adverse reactions to ODAs in patients with NA have been observed but are uncommon. Using suitable alternatives, patients usually can be accommodated.     

Exposure to dogs but not cats is associated to a decrease in the prevalence in atopic dermatitis amongst school-children

Introduction

The association regarding the exposure to pets, especially cats and dogs, and the prevalence of allergic diseases is inconsistent.

First-degree relatives are frequently affected in coeliac disease and dermatitis herpetiformis

BACKGROUND: Coeliac disease and dermatitis herpetiformis are phenotypically distinct gluten-sensitive diseases. Coeliac disease is known to cluster in families, whereas there is little evidence for dermatitis herpetiformis and for the occurrence of both diseases in the same families. METHODS: The study group comprised 380 patients with coeliac disease and 281 patients with dermatitis herpetiformis, with a total of 3158 first-degree relatives, followed up for a mean of 14 years. The patients were questioned about affected first-degree relatives. The prevalence and incidence of biopsy-proven coeliac disease and dermatitis herpetiformis in relatives were determined. RESULTS: Seventy-three (19.2%) patients with coeliac disease and 51 (18.1%) with dermatitis herpetiformis had affected first-degree relatives. The prevalence among relatives was similar for both diseases; 4.7% and 3.9% of the relatives had coeliac disease and 0.8% and 1.5% had dermatitis herpetiformis, respectively. The disease prevalence was 7% among siblings, 4.5% among parents and 3.5% among children. The annual incidence was 3/1,000 relatives, which is 15 times higher than among the general population. Coeliac disease and dermatitis herpetiformis were mixed in several multiple-case families. CONCLUSIONS: The present long-term follow-up study of coeliac disease and dermatitis herpetiformis shows that every fifth patient can have affected first-degree relatives, and that the prevalence among relatives is 5.5%. Dermatitis herpetiformis segregates also in the families of patients with coeliac disease, and vice versa, indicating the same genetic background.