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-     

A half of schoolchildren with ‘ISAAC eczema’ are ill with allergic contact dermatitis

Background Similarity in clinical symptoms between atopic eczema (AE) and allergic contact dermatitis (ACD) may lead to misdiagnoses in both clinical practice and epidemiological studies. As patch testing for contact allergy does not seem popular among paediatric allergists, the resulting bias leads mainly to under diagnosing of ACD and over diagnosing of AE in children and adolescents. Objectives To assess the frequency of AE and ACD among children and adolescents who answered affirmatively the eczema module of ISAAC questionnaire. Methods Of 9320 schoolchildren involved in an allergy screening programme, 143 consecutive participants were recruited for the present study. The inclusion criterion was affirmative answers to questions from the eczema module of the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire. The children were examined by two allergists: a paediatrician and a dermatologist, and the children underwent patch testing. Results We diagnosed AE in 46 (55.4%) children and 18 (30.0%) adolescents, whereas 32 (38.6%) children and 31 (51.7%) adolescents were diagnosed with ACD, with a considerable overlap of both diseases. Nine of 46 (19.6%) children and 13 of 25 (52.0%) adolescents with affirmative answers to the question about flexural eczema were diagnosed with ACD, while lacking features sufficient for the diagnosis of AE according to Hanifin and Rajka. Based on the indices from the whole population tested (9320 pupils), a rough estimate of the general ACD prevalence was 5.8% for adolescents, and 8.5% for children, which is close to the figure of 7.2% observed previously in Danish schoolchildren. Conclusions Our data demonstrate that ‘ISAAC eczema’ is an epidemiological entity that embraces comparable portions of cases of atopic eczema and allergic contact dermatitis, and possibly also other less frequent pruritic dermatoses. Each case of chronic recurrent dermatitis in children requires differential diagnosis aimed at allergic contact dermatitis and inflammatory dermatoses other than atopic eczema, even when predominantly localized in flexural areas.     

Nickel sensitization in adolescents and association with ear piercing,use of dental braces and hand eczema. The Odense Adolescence Cohort Study on Atopic Diseases and Dermatitis (TOACS)

The prevalence of nickel allergy (sensitization) and the associations with ear piercing, use of dental braces and hand eczema were assessed in a cohort of 1,501 8th grade schoolchildren (aged 12-16 years) in Odense, Denmark. Nickel allergy was found in 8.6% and was clinically relevant in 69% of cases. Nickel allergy was found most frequently in girls and the association with ear piercing was confirmed. Application of dental braces (oral nickel exposure) prior to ear piercing (cutaneous nickel exposure) was associated with a significantly reduced prevalence of nickel allergy. In adolescents a significant association was found between hand eczema and nickel allergy. A follow-up study of this population is planned in order to assess the course and development of contact dermatitis, hand eczema and atopic diseases in adulthood and after choice of occupation.     

Type I sensitization in adolescents: prevalence and association with atopic dermatitis. The Odense Adolescence Cohort Study on Atopic Diseases and Dermatitis (TOACS)

The prevalence of Type I sensitization and its relationship to atopic dermatitis were assessed in a cohort of 1501 8th grade schoolchildren (aged 12-16) in Odense, Denmark. The protocol included a questionnaire, a clinical examination, IgE measurements and skin prick tests. A history of atopic dermatitis was found in 21.3%, allergic asthma in 6.9% and allergic rhinitis in 15.7% of the adolescents. One or more positive specific IgE measurements (CAP FEIA) were found in 29.6% of the schoolchildren (inhalant allergens 28.4%, food allergens 8.5%, pityrosporum ovale 1.5%) and a considerable proportion were sensitized without clinical relevance. The association between atopic dermatitis and Type I sensitization was related to concomitant inhalant allergy. A clear association with atopic dermatitis was indicated only for the allergen pityrosporum ovale.     

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 dermatitis in adolescent boys is associated with greater psychological morbidity compared with girls of the same age: the Young-HUNT study

BACKGROUND: Having atopic dermatitis (AD) as well as other chronic diseases is often associated with reduced mental health. Adolescents with AD are thought to be especially vulnerable, but few studies have included an ample number of young people. OBJECTIVES: To study self-reported mental distress among boys and girls 13-19 years of age with AD compared with mental distress among healthy adolescents as well as mental distress among adolescents with other chronic diseases or complaints, such as headache, neck or shoulder pain, asthma, allergy and rhinitis. METHODS: The Young-HUNT study was conducted as a cross-sectional, population-based survey in 1995-97. All students in Nord-Trondelag County, Norway, aged 13-19 years were invited, and some 89% participated. A questionnaire on mental and somatic health, life-style and social conditions was completed during one school hour. RESULTS: A total of 4384 girls and 4433 boys participated. The prevalence of mental distress was higher among older teenagers, and more than every fourth girl aged 17-19 reported mental distress. Although more girls than boys reported mental distress, AD, headache and neck or shoulder pain, the odds for reporting both AD and mental distress were higher for boys [odds ratio (OR) = 2.1 (1.6-2.9)] compared with girls [OR = 1.3 (1.1-1.6)]. A corresponding sex difference in reporting mental distress was also seen for some other chronic diseases or complaints. CONCLUSIONS: In adolescents aged 13-19 years there was a strong and significant association between self-reported mental distress and AD as well as headache and neck or shoulder pain for both sexes. Although boys reported fewer complaints as AD, they perceived the complaints a heavier burden than did the girls.     

Contact allergy to glucocorticosteroids in patients with chronic venous leg ulcers, atopic dermatitis and contact allergy

The aim of the study was to assess the prevalence of contact allergy to glucocorticosteroids in patients with chronic venous leg ulcers (CVLU), atopic dermatitis (AD) and contact dermatitis (CD), and in a group of healthy individuals; and to estimate differences among these patient groups. Patch tests with the European standard series, antibiotics, glucocorticosteroid contact allergy screening markers and ointment vehicles were performed in a population of 140 patients. Positive patch tests results were recorded in 80% and contact allergy to glucocorticosteroids in 40% of CVLU patients. In the group of AD patients, the respective figures were 30% and 3%. In the group of CD patients, allergic type of disease was detected in 80% and positive patch tests for glucocorticosteroids in 20% of patients. In healthy individuals, allergic contact reaction was observed in 17% of cases. Statistically significant differences among patient groups were found according to the prevalence of contact allergy, polyvalent allergy and contact allergy to glucocorticosteroids. We suggest that glucocorticosteroid contact allergy should be considered as a crucial clinical problem in patients with inflammatory dermatoses like CVLU, AD and CD.     

Atopy, nickel sensitivity, occupation, and clinical patterns in different types of hand dermatitis.

BACKGROUND: The etiologic diagnosis of hand dermatitis (HD) is often difficult. Knowledge of the relationship between atopy and nickel sensitivity as risk factors for HD is limited. OBJECTIVE: To compare irritant contact dermatitis, allergic contact dermatitis, and dyshidrotic eczema relative to personal atopy, patch-testing results, occupation, and clinical patterns. Methods: From patients referred for patch testing, 714 consecutive individuals with HD were retrospectively studied. RESULTS: Half of the patients had eczema confined to the palms. The dorsal pattern was more prevalent in atopic patients, compared to nonatopic patients. Irritant contact dermatitis was the most frequent diagnosis (55.3%), followed by allergic contact dermatitis (24.4%) and dyshidrotic eczema (20.3%). Among housewives, health workers, and mechanics, irritants were of much greater importance than allergens whereas among hairdressers and bricklayers, the opposite was found. The prevalence of personal atopy did not differ significantly between different types of HD. Nickel sensitivity was much less frequent in irritant contact dermatitis than in allergic contact dermatitis or dyshidrotic eczema. The distribution of clinical patterns was similar. CONCLUSION: This study suggests that different etiologic diagnoses of HD cannot be distinguished by clinical pattern, prevalence of personal atopy, or nickel-sensitivity.     

The epidemiology of hand eczema in the general population – prevalence and main findings*

Numerous studies have investigated the prevalence and risk factors of hand eczema in the general population. These studies are of high value as they tend to be less biased than studies using clinical populations and as they are important for healthcare decision makers when they allocate resources. This study aimed to review the epidemiology of hand eczema in the general population. Literature was examined using Pubmed‐Medline, Biosis, Science Citation Index, and dermatology text books. On the basis of studies performed between 1964 and 2007, the point prevalence of hand eczema was around 4%, the 1‐year prevalence nearly 10%, whereas the lifetime prevalence reached 15%. Based on seven studies, the median incidence rate of hand eczema was 5.5 cases/1000 person‐years (women = 9.6 and men = 4.0). A high incidence rate was associated with female sex, contact allergy, atopic dermatitis, and wet work. Atopic dermatitis was the single most important risk factor for hand eczema. Hand eczema resulted in medical consultations in 70%, sick leave (> 7 days) in about 20%, and job change in about 10%. Mean sick time was longer among those with allergic hand eczema than those with atopic and irritant hand eczema. Moderate to severe extension of hand eczema was the strongest risk factor for persistence of hand eczema. Other risk factors included early onset of hand eczema and childhood eczema. The aetiology of hand eczema is multifactorial and includes environmental as well as genetic factors. Future studies should focus on unresolved areas of hand eczema, for example, genetic predisposition.     

The association between contact allergy and hand eczema in 2 cross-sectional surveys 8 years apart

Hand eczema is a recurrent chronic skin disease related to contact allergy and atopic dermatitis. When possible, efforts should be redoubled to eliminate provoking factors. Our objective was to assess changes in the prevalence of self-reported hand eczema and to evaluate the association between contact allergy and hand eczema among adult Danes before and after nickel exposure regulation in Denmark. In 1990 and 1998, random samples of 15-41-year-old persons were examined in 2 cross-sectional studies of the general population in Copenhagen, Denmark. The studies included questionnaires, patch and prick testing. From 1990 to 1998 the prevalence of a history of hand eczema increased significantly. This increase did not appear to be fully explained by changes in the prevalence of flexural eczema, prick test reactivity, patch test reactivity, and nickel allergy. In 1990, nickel allergy and allergic nickel contact dermatitis were significantly associated with a history of hand eczema among women. In 1998, these associations were not found. It can be concluded that, from 1990 to 1998, the prevalence of a history of hand eczema rose significantly. It was indicated that it might be possible to prevent the hand eczema related to nickel allergy by exposure regulation, public education or both.     

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.     

Allergic contact dermatitis in children and adolescents

From a clinical point of view, the prevalence of allergic contact dermatitis (ACD) among children and adolescents seems to be low. However, many children have dermatitis, most often atopic dermatitis. In selected cases, ACD is suspected, and the child is tested. The question remains, whether the prevalence of ACD in children really is low or whether the possibility of ACD is not sufficiently considered. During the last decade, reports have appeared on series of children and adolescents with contact allergy and ACD. Few cases have been reported in infants, but the development of contact allergy and ACD increases with age. Most studies include selected groups of children and adolescents with suspected ACD. Few studies have examined unselected populations, and most consider only the prevalence of contact allergy without evaluating the clinical relevance, e.g., the prevalence of ACD. Furthermore, no follow-up studies exist. Therefore, the incidence and prevalence of contact allergy and ACD in children and adolescents is largely unknown.     

Patch testing in Israeli children with suspected allergic contact dermatitis: A retrospective study and literature review

Background/objectives

Childhood allergic contact dermatitis is recognized as a significant clinical problem. The objective was to evaluate the rate of positive patch tests in Israeli children with clinically suspected allergic contact dermatitis, identify possible sex and age differences, compare results with those in Israeli adults, and review pediatric studies in the literature.

Methods

The study sample included 343 children and adolescents (197 female, 146 male; 1‐18 years of age, mean age 11.8 years) with clinically suspected allergic contact dermatitis who underwent patch testing with a standard pediatric series of 23 allergens at a tertiary medical center from 1999 to 2012. Data on clinical characteristics and test results were collected retrospectively from the medical files.

Results

Ninety‐eight subjects (28.6%) (75 girls [38.1%], 23 boys [15.8%]) had at least one positive reaction. The most frequent reactions were to nickel sulfate, followed by potassium dichromate and cobalt chloride. Nickel sulfate sensitivity was more common in girls, especially those younger than 3 years and older than 12 years. The prevalence of contact sensitization was similar in subjects with and without atopic dermatitis (50% and 51%, respectively).

Conclusion

Nickel is the most common allergen in Israeli children, especially girls. Patch testing should be performed in children with clinically suspected allergic contact dermatitis regardless of atopic background.     

过敏性皮肤病患者斑贴试验结果分析及临床意义

目的研究过敏性皮肤病患者斑贴试验结果及临床意义.方法对254例湿疹、56例慢性荨麻疹、28例特应性皮炎患者进行斑贴试验检测.结果三组患者中阳性率较高的致敏原有四种物质相同,分别为硫酸镍、重铬酸甲、卡巴混合物、芳香混合物;特应性皮炎组阳性率(64.29%)明显低于湿疹组(79.92%),慢性荨麻疹(76.79%)与湿疹二组阳性率之间差异无显著性.结论过敏性皮肤病患者阳性率较高的致敏原具有相同性;硫酸镍、重铬酸甲、卡巴混合物、芳香混合物具有较高的致敏性;斑贴试验主要用于检测外源性变应原,特应性皮炎的病因可能以内源性为主;接触性过敏原可以引起接触性荨麻疹;斑贴试验阳性致敏原常是引起面部湿疹、手湿疹的致病因素.     

Hand dermatitis and allergic patch test reactions caused by nickel in electroplaters

A worksite survey was conducted in all 38 Finnish electroplating plants. All workers ( n =163) who worked with nickel plating (bath workers, hangers and solution makers) were interviewed with a questionnaire about symptoms of nickel dermatitis, hand dermatitis, and about protective measures, atopy, etc. Patch testing with nickel sulfate was done with the TRUE Test^TM method. All the workers, 94 men and 69 women, answered the questionnaire. The mean age of women was 41.1 years, and of men 43.1 years, respectively. Men had longer occupational exposure to nickel (14 years) than women (10 years). Most workers used protective gloves. 35% of women and 30% of men reported present or past hand dermatosis. 19% reported a history of atopic dermatitis. 15% of women ( n = 8) and 4% ( n = 2) of men had an allergic patch test reaction to nickel sulfate. 70% of those with an allergic patch test reaction to nickel reported past or present hand eczema. The prevalence of nickel allergy among the electroplaters was similar to that of patients in patch test clinics in Finland. An allergic patch test reaction to nickel sulfate does not necessarily oblige an electroplater to change jobs.     

儿童期特应性皮炎145例临床分析

目的探讨儿童期特应性皮炎(AD)患儿临床特征及常见特异性变应原分布。方法回顾性分析2013年7月-2014年7月在湖南省儿童医院皮肤科门诊就诊的145例儿童期AD患儿的临床资料,总结其性别比例、地域、加重季节、临床表现及血清特异性变应原分布等特征。结果 145例患儿年龄2~12岁,66.9%有过敏性疾病家族史,其中以过敏性鼻炎(40.7%)最为常见。居住在城市患儿明显高于农村,两者间比值为1.7:1;皮损加重季节以夏、秋季为主,占63.4%。根据AD评分(scoring atopic dermartitis,SCORAD)标准,中度儿童期AD患儿多见(61.4%),且男童比女童较为严重,差异有统计学意义(P<0.05)。血清特异性IgE以吸入性过敏原为主(61.5%),其中户尘螨、粉尘满、屋尘最为常见。结论儿童期AD患儿城市多于农村,常夏秋季节加重,男患儿皮损较女患儿严重,多并发过敏性鼻炎,过敏原以吸入性变应原为主。     

Filaggrin null alleles are not associated with hand eczema or contact allergy

BACKGROUND: The filaggrin protein is a key component of stratum corneum and homo- or heterozygotes for the filaggrin variant alleles R501X and 2282del4 have varying degrees of impaired skin barrier. The variant alleles have repeatedly been shown to be associated with atopic dermatitis. Any possible association with hand eczema or contact allergy are unexplored. OBJECTIVES: To explore associations between the variant alleles, hand eczema, contact allergy and atopic dermatitis. METHODS: In total, 183 adult individuals participated in a clinical examination of the hands, patch testing and filaggrin genotyping. Children without any evidence of atopic dermatitis from the Copenhagen Prospective Study on Asthma in Childhood (COPSAC) study were used as controls. The chi(2) test was used for comparison of allele frequencies. RESULTS: The majority (73%) had hand eczema, 25% had contact allergy and 14% had a diagnosis of atopic dermatitis. The association between atopic dermatitis and the filaggrin variant alleles was confirmed (odds ratio 3.5, P = 0.015). Allele frequencies in individuals with hand eczema or contact allergy were not statistically significantly increased. CONCLUSION: There is no association between the variant alleles and hand eczema or contact allergy.     

Sesquiterpene lactone mix patch testing supplemented with dandelion extract in patients with allergic contact dermatitis, atopic dermatitis and non-allergic chronic inflammatory skin diseases

We investigated the value of patch testing with dandelion (Compositae) extract in addition to sesquiterpene lactone (SL) mix in selected patients. After we detected a case of contact erythema multiforme after patch testing with dandelion and common chickweed (Caryophyllaceae), additional testing with common chickweed extract was performed. A total of 235 adults with a mean age of 52.3 years were tested. There were 66 men and 169 women: 53 consecutive patients with allergic contact dermatitis (ACD); 43 with atopic dermatitis (AD); 90 non-atopics suffering from non-allergic chronic inflammatory skin diseases; 49 healthy volunteers. All were tested with SL mix 0.1% petrolatum (pet.) and diethyl ether extracts from Taraxacum officinale (dandelion) 0.1 and 3.0% pet. and from Stellaria media (common chickweed) 0.1 and 3% pet. A total of 14 individuals (5.9%) showed allergic reaction (AR) to at least 1 of the plant allergens, 4 (28.6%) to common chickweed extract, and 11 (78.6%) to Compositae allergens. These 11 persons made the overall prevalence of 4.7%: 8 (3.4%) were SL-positive and 3 (1.3%) reacted to dandelion extract. 5 persons (45.5%) had AD, 2 had ACD, 2 had psoriasis and 2 were healthy controls. The Compositae allergy was relevant in 8 cases (72.7%). The highest frequency of SL mix sensitivity (9.3%) was among those with AD. Half the SL mix-sensitive individuals had AD. ARs to dandelion extract were obtained only among patients with eczema. A total of 9 irritant reactions (IRs) in 9 individuals (3.8%) were recorded, 8 to SL mix and 1 to common chickweed extract 3.0% pet. No IR was recorded to dandelion extract (P = 0.007). Among those with relevant Compositae allergy, 50.0% had AR to fragrance mix and balsam of Peru (Myroxylon pereirae resin) and colophonium. SLs were detected in dandelion but not in common chickweed. Our study confirmed the importance of 1 positive reaction for emerging, not fully established, Compositae allergy. In conclusion, the overall prevalence of 4.7% in our study represents a basal SL mix detection rate of 3.4% reinforced and safely supplemented by testing with the dandelion extract.     

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.