Patch test in Brazilian children with a clinical diagnosis of atopic dermatitis: a cross-sectional study using an extended patch test battery
Main Article Content
Keywords
Adolescent, allergic contact dermatitis, atopic dermatitis, child, patch test
Abstract
Introduction: Atopic dermatitis (AD) is a chronic and relapsing inflammatory skin disease mainly affecting children. Similarly, Allergic contact dermatitis (ACD) is an inflammatory skin disease, but unlike AD it results from direct exposure to an external agent. Theoretically, the impaired skin barrier facilitates the penetration of potential allergens. Therefore, AD patients are at risk for an associated ACD, exacerbating their skin condition. Because eczema is similar, performing a patch test (PT) for the differential diagnosis is essential.
Methods: In this cross-sectional transversal study, we performed a PT with 30 sensitizers in 26 children with AD, selected according to established criteria for suspected ACD, and treated at an AD center of a pediatric university hospital in Rio de Janeiro. Clinical presentation, patient profile, main sensitizers, and frequency of ACD caused by therapeutic skincare products were evaluated.
Results: In all, 23 (88.5%) patients reacted to at least one allergen, 21 (80.7%) had a relevant positive patch test, and 15 (57.7%) were polysensitized. The main positive sensitizers were nickel (38.5%), blue disperse (30.8%), fragrance mix (30.8%), and neomycin (23.1%). Nineteen (73%) patients reacted to substances present in therapeutic or skincare products.
Conclusion: Our data underscore the importance of performing a PT in AD children whose eczema has atypical distribution. The expressive percentage of positive tests, especially of allergens in skincare products, indicates the constant need to review the proposed treatments. Therefore, we recommend a specific and expanded PT battery for pediatric AD patients, including a negative control, to increase sensitivity for diagnosing ACD.
References
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15. Boonstra M, Rustemeyer T, Middelkamp-Hup MA. Both children and adult patients with difficult-to-treat atopic dermatitis have high prevalences of concomitant allergic contact dermatitis and are frequently polysensitized. J Eur Acad Dermatol Venereol. 2018;32(9):1554–61. 10.1111/jdv.14973
16. Zug KA, Pham AK, Belsito DV, DeKoven JG, DeLeo VA, Fowler JF, et al. Patch testing in children from 2005 to 2012: Results from the North American contact dermatitis group. Dermat Contact Atopic Occup Drug. 2014;25(6):345–55. 10.1097/DER.0000000000000083
17. Kundu RV, Scheman AJ, Gutmanovich A, Hernandez C. Contact dermatitis to white petrolatum. Skinmed. 2004;3(5):295–6. 10.1111/j.1540-9740.2004.03590.x
18. Tam CC, Elston DM. Allergic contact dermatitis caused by white petrolatum on damaged skin. Dermat Contact Atopic Occup Drug. 2006;17(4):201–3. 10.2310/6620.2006.06010
19. Carlsen BC, Andersen KE, Menné T, Johansen JD. Patients with multiple contact allergies: A review. Contact Dermatitis. 2008;58(1):1–8. 10.1111/j.1600-0536.2007.01232.x
20. Carlsen BC, Andersen KE, Menné T, Johansen JD. Characterization of the polysensitized patient: A matched case-control study. Contact Dermatitis. 2009;61(1):22–30. 10.1111/j.1600-0536.2009.01573.x
21. Francuzik W, Geier J, Schubert S, Worm M. A case-control analysis of skin contact allergy in children and adolescents. Pediatr Allergy Immunol. 2019;30(6):632–7. 10.1111/pai.13069
22. Giordano-Labadie F, Rancé F, Pellegrin F, Bazex J, Dutau G, Schwarze HP. Frequency of contact allergy in children with atopic dermatitis: Results of a prospective study of 137 cases. Contact Dermatitis. 1999;40(4):192–5. 10.1111/j.1600-0536.1999.tb06032.x
23. Goldenberg A, Mousdicas N, Silverberg N, Powell D, Pelletier JL, Silverberg JI, et al. Pediatric contact dermatitis registry inaugural case data. Dermat Contact Atopic Occup Drug. 2016;27(5):293–302. 10.1097/DER.0000000000000214
24. Torres F, das Graças M, Melo M, Tosti A. Management of contact dermatitis due to nickel allergy: An update. Clin Cosmet Investig Dermatol (CCID). 2009;2:39–48. 10.2147/CCID.S3693
25. Neale H, Garza-Mayers AC, Tam I, Yu J. Pediatric allergic contact dermatitis. Part I: Clinical features and common contact allergens in children. J Am Acad Dermatol. 2021;84(2):235–44. 10.1016/j.jaad.2020.11.002
26. Warshaw EM, Zhang AJ, DeKoven JG, Maibach HI, Belsito DV, Sasseville D, et al. Epidemiology of nickel sensitivity: Retrospective cross-sectional analysis of North American-contact dermatitis group data 1994–2014. J Am Acad Dermatol. 2019;80(3):701–13. 10.1016/j.jaad.2018.09.058
27. Lisi P, Stingeni L, Cristaudo A, Foti C, Pigatto P, Gola M, et al. Clinical and epidemiological features of textile contact dermatitis: An Italian multicentre study. Contact Dermatitis. 2014;70(6):344–50. 10.1111/cod.12179
28. Felmingham C, Davenport R, Bala H, Palmer A, Nixon R. Allergic contact dermatitis in children and proposal for an Australian Paediatric Baseline Series. Australas J Dermatol. 2020;61(1):33–8. 10.1111/ajd.13169
29. Zafrir Y, Trattner A, Hodak E, Eldar O, Lapidoth M, Ben Amitai D. Patch testing in Israeli children with suspected allergic contact dermatitis: A retrospective study and literature review. Pediatr Dermatol. 2018;35(1):76–86. 10.1111/pde.13333
30. Romita P, Foti C, Stingeni L, Hansel K, Magrone T, Belsito DV, et al. Contact Allergy in Children with Atopic Dermatitis: A Retrospective Study. Endocr Metab Immune Disord-Drug Targets. 19(7):1083–7. 10.2174/1871530319666190211123342
31. Belloni Fortina A, Cooper SM, Spiewak R, Fontana E, Schnuch A, Uter W. Patch test results in children and adolescents across Europe. Analysis of the ESSCA Network 2002–2010. Pediatr Allergy Immunol Off Publ Eur Soc Pediatr Allergy Immunol. 2015;26(5):446–55. 10.1111/pai.12397
32. Rodrigues DF, Goulart EMA. Patch test results in children and adolescents. Study from the Santa Casa de Belo Horizonte Dermatology Clinic, Brazil, from 2003 to 2010. An Bras Dermatol. 2015;90:671–83. 10.1590/abd1806-4841.20153902
33. Ascha M, Irfan M, Bena J, Taylor JS, Sood A. Pediatric patch testing: A 10-year retrospective study. Ann Allergy Asthma Immunol. 2016;117(6):661–7. 10.1016/j.anai.2016.09.445
34. Isaksson M, Olhardt S, Rådehed J, Svensson Å. Children with atopic dermatitis should always be patch-tested if they have hand or foot dermatitis. Acta Derm Venereol. 2015;95(5):583–6. 10.2340/00015555-1995
35. Jacob SE, McGowan M, Silverberg NB, Pelletier JL, Fonacier L, Mousdicas N, et al. Pediatric contact dermatitis registry data on contact allergy in children with atopic dermatitis. JAMA Dermatol. 2017;153(8):765–70. 10.1001/jamadermatol.2016.6136
36. Simonsen AB, Johansen JD, Deleuran M, Mortz CG, Sommerlund M. Contact allergy in children with atopic dermatitis: A systematic review. Br J Dermatol. 2017;177(2):395–405. 10.1111/bjd.15628
37. Hamann CR, Bernard S, Hamann D, Hansen R, Thyssen JP. Is there a risk using hypoallergenic cosmetic pediatric products in the United States? J Allergy Clin Immunol. 2015;135(4): 1070–1. 10.1016/j.jaci.2014.07.066
38. Lazarov A. Textile dermatitis in patients with contact sensitization in Israel: A 4-year prospective study. J Eur Acad DermatolVenereol (JEADV). 2004;18(5):531–7. 10.1111/j.1468-3083.2004.00967.x
39. Owen JL, Vakharia PP, Silverberg JI. The role and diagnosis of allergic contact dermatitis in patients with atopic dermatitis. Am J Clin Dermatol. 2018;19(3):293–302. 10.1007/s40257-017-0340-7
2. Johansen J, Aalto-Korte K, Agner T, Andersen K, Bircher A, Bruze M, et al. European Society of Contact Dermatitis guideline for diagnostic patch testing–Recommendations on best practice. Contact Dermatitis. 2015;73(4):195–221. 10.1111/cod.12432
3. Motta AA, Aun MV, Kalil J, Giavina-Bianchi P. Dermatite de contato. Rev. bras. alerg. imunolpatol. 2011;34(3):73-82
4. Hanifin JM, Rajka G. Diagnostic features of atopic dermatitis. Acta Dermatovener (Stockholm). 1980;60(Suppl 92):44–7. 10.2340/00015555924447
5. Severity scoring of atopic dermatitis: the SCORAD index. Consensus Report of the European Task Force on Atopic Dermatitis. Dermatology. 1993;186(1):23-31. 10.1159/000247298. PMid: 8435513.
6. Chen JK, Jacob SE, Nedorost ST, Hanifin JM, Simpson EL, Boguniewicz M, et al. A pragmatic approach to patch testing atopic dermatitis patients: Clinical recommendations based on expert consensus opinion. Dermatitis. 2016;27(4):186–92. 10.1097/DER.0000000000000208
7. Fowler JFJ, Maibach HI, Zirwas M, Taylor JS, DeKoven JG, Sasseville D, et al. Effects of immunomodulatory agents on patch testing: expert opinion 2012. Dermatitis. 2012;23(6):301–3. 10.1097/DER.0b013e318275969f
8. Simonsen AB, Johansen JD, Deleuran M, Mortz CG, Skov L, Sommerlund M. Children with atopic dermatitis may have unacknowledged contact allergies contributing to their skin symptoms. J Eur Acad Dermatol Venereol. 2018;32(3):428–36. 10.1111/jdv.14737
9. Borok J, Matiz C, Goldenberg A, Jacob SE. Contact dermatitis in atopic dermatitis children–past, present, and future. Clin Rev Allergy Immunol. 2019;56(1):86–98. 10.1007/s12016-018-8711-2
10. Fortina AB, Fontana E, Peserico A. Contact sensitization in children: a retrospective study of 2,614 children from a single center. Pediatr Dermatol. 2016;33(4):399–404. 10.1111/pde.12873
11. Duarte IAG, Tanaka GM, Suzuki NM, Lazzarini R, Lopes AS de A, Volpini BMF, et al. Bateria de testes padrão preconizada pelo Grupo Brasileiro de Estudos em Dermatite de Contato: período de 2006 a 2011. An Bras Dermatol. 2013;88(6):1015–8.
12. Herro EM, Matiz C, Sullivan K, Hamann C, Jacob SE. Frequency of contact allergens in pediatric patients with atopic dermatitis. J Clin Aesthetic Dermatol. 2011;4(11):39–41.
13. Jacob SE, Herro EM, Sullivan K, Matiz C, Eichenfield L, Hamann C. Safety and efficacy evaluation of TRUE TEST panels 1.1, 2.1, and 3.1 in children and adolescents. Dermat Contact Atopic Occup Drug. 2011;22(4):204–10. 10.2310/6620.2011.11011
14. Cattani CAS, Oppermann K, Perazzoli S, Guarda NH, Baréa P, Bonamigo RR. Sensitizing agents found in children and adolescents with recalcitrant atopic dermatitis: a cross-sectional study with a pediatric battery. An Bras Dermatol. 2022 May-Jun;97(3):307-314. doi: 10.1016/j.abd.2021.08.005. Epub 2022 Feb 28. PMid: 35241316; PMCID: PMC9133262.
15. Boonstra M, Rustemeyer T, Middelkamp-Hup MA. Both children and adult patients with difficult-to-treat atopic dermatitis have high prevalences of concomitant allergic contact dermatitis and are frequently polysensitized. J Eur Acad Dermatol Venereol. 2018;32(9):1554–61. 10.1111/jdv.14973
16. Zug KA, Pham AK, Belsito DV, DeKoven JG, DeLeo VA, Fowler JF, et al. Patch testing in children from 2005 to 2012: Results from the North American contact dermatitis group. Dermat Contact Atopic Occup Drug. 2014;25(6):345–55. 10.1097/DER.0000000000000083
17. Kundu RV, Scheman AJ, Gutmanovich A, Hernandez C. Contact dermatitis to white petrolatum. Skinmed. 2004;3(5):295–6. 10.1111/j.1540-9740.2004.03590.x
18. Tam CC, Elston DM. Allergic contact dermatitis caused by white petrolatum on damaged skin. Dermat Contact Atopic Occup Drug. 2006;17(4):201–3. 10.2310/6620.2006.06010
19. Carlsen BC, Andersen KE, Menné T, Johansen JD. Patients with multiple contact allergies: A review. Contact Dermatitis. 2008;58(1):1–8. 10.1111/j.1600-0536.2007.01232.x
20. Carlsen BC, Andersen KE, Menné T, Johansen JD. Characterization of the polysensitized patient: A matched case-control study. Contact Dermatitis. 2009;61(1):22–30. 10.1111/j.1600-0536.2009.01573.x
21. Francuzik W, Geier J, Schubert S, Worm M. A case-control analysis of skin contact allergy in children and adolescents. Pediatr Allergy Immunol. 2019;30(6):632–7. 10.1111/pai.13069
22. Giordano-Labadie F, Rancé F, Pellegrin F, Bazex J, Dutau G, Schwarze HP. Frequency of contact allergy in children with atopic dermatitis: Results of a prospective study of 137 cases. Contact Dermatitis. 1999;40(4):192–5. 10.1111/j.1600-0536.1999.tb06032.x
23. Goldenberg A, Mousdicas N, Silverberg N, Powell D, Pelletier JL, Silverberg JI, et al. Pediatric contact dermatitis registry inaugural case data. Dermat Contact Atopic Occup Drug. 2016;27(5):293–302. 10.1097/DER.0000000000000214
24. Torres F, das Graças M, Melo M, Tosti A. Management of contact dermatitis due to nickel allergy: An update. Clin Cosmet Investig Dermatol (CCID). 2009;2:39–48. 10.2147/CCID.S3693
25. Neale H, Garza-Mayers AC, Tam I, Yu J. Pediatric allergic contact dermatitis. Part I: Clinical features and common contact allergens in children. J Am Acad Dermatol. 2021;84(2):235–44. 10.1016/j.jaad.2020.11.002
26. Warshaw EM, Zhang AJ, DeKoven JG, Maibach HI, Belsito DV, Sasseville D, et al. Epidemiology of nickel sensitivity: Retrospective cross-sectional analysis of North American-contact dermatitis group data 1994–2014. J Am Acad Dermatol. 2019;80(3):701–13. 10.1016/j.jaad.2018.09.058
27. Lisi P, Stingeni L, Cristaudo A, Foti C, Pigatto P, Gola M, et al. Clinical and epidemiological features of textile contact dermatitis: An Italian multicentre study. Contact Dermatitis. 2014;70(6):344–50. 10.1111/cod.12179
28. Felmingham C, Davenport R, Bala H, Palmer A, Nixon R. Allergic contact dermatitis in children and proposal for an Australian Paediatric Baseline Series. Australas J Dermatol. 2020;61(1):33–8. 10.1111/ajd.13169
29. Zafrir Y, Trattner A, Hodak E, Eldar O, Lapidoth M, Ben Amitai D. Patch testing in Israeli children with suspected allergic contact dermatitis: A retrospective study and literature review. Pediatr Dermatol. 2018;35(1):76–86. 10.1111/pde.13333
30. Romita P, Foti C, Stingeni L, Hansel K, Magrone T, Belsito DV, et al. Contact Allergy in Children with Atopic Dermatitis: A Retrospective Study. Endocr Metab Immune Disord-Drug Targets. 19(7):1083–7. 10.2174/1871530319666190211123342
31. Belloni Fortina A, Cooper SM, Spiewak R, Fontana E, Schnuch A, Uter W. Patch test results in children and adolescents across Europe. Analysis of the ESSCA Network 2002–2010. Pediatr Allergy Immunol Off Publ Eur Soc Pediatr Allergy Immunol. 2015;26(5):446–55. 10.1111/pai.12397
32. Rodrigues DF, Goulart EMA. Patch test results in children and adolescents. Study from the Santa Casa de Belo Horizonte Dermatology Clinic, Brazil, from 2003 to 2010. An Bras Dermatol. 2015;90:671–83. 10.1590/abd1806-4841.20153902
33. Ascha M, Irfan M, Bena J, Taylor JS, Sood A. Pediatric patch testing: A 10-year retrospective study. Ann Allergy Asthma Immunol. 2016;117(6):661–7. 10.1016/j.anai.2016.09.445
34. Isaksson M, Olhardt S, Rådehed J, Svensson Å. Children with atopic dermatitis should always be patch-tested if they have hand or foot dermatitis. Acta Derm Venereol. 2015;95(5):583–6. 10.2340/00015555-1995
35. Jacob SE, McGowan M, Silverberg NB, Pelletier JL, Fonacier L, Mousdicas N, et al. Pediatric contact dermatitis registry data on contact allergy in children with atopic dermatitis. JAMA Dermatol. 2017;153(8):765–70. 10.1001/jamadermatol.2016.6136
36. Simonsen AB, Johansen JD, Deleuran M, Mortz CG, Sommerlund M. Contact allergy in children with atopic dermatitis: A systematic review. Br J Dermatol. 2017;177(2):395–405. 10.1111/bjd.15628
37. Hamann CR, Bernard S, Hamann D, Hansen R, Thyssen JP. Is there a risk using hypoallergenic cosmetic pediatric products in the United States? J Allergy Clin Immunol. 2015;135(4): 1070–1. 10.1016/j.jaci.2014.07.066
38. Lazarov A. Textile dermatitis in patients with contact sensitization in Israel: A 4-year prospective study. J Eur Acad DermatolVenereol (JEADV). 2004;18(5):531–7. 10.1111/j.1468-3083.2004.00967.x
39. Owen JL, Vakharia PP, Silverberg JI. The role and diagnosis of allergic contact dermatitis in patients with atopic dermatitis. Am J Clin Dermatol. 2018;19(3):293–302. 10.1007/s40257-017-0340-7
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May 1, 2024
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Raad Rigolon, J., Saintive Barbosa, S., & Simões Goudouris, E. (2024). Patch test in Brazilian children with a clinical diagnosis of atopic dermatitis: a cross-sectional study using an extended patch test battery. Allergologia Et Immunopathologia, 52(3), 78-86. https://doi.org/10.15586/aei.v52i3.1024
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Author Biography
Janete Raad Rigolon, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
How to Cite
Raad Rigolon, J., Saintive Barbosa, S., & Simões Goudouris, E. (2024). Patch test in Brazilian children with a clinical diagnosis of atopic dermatitis: a cross-sectional study using an extended patch test battery. Allergologia Et Immunopathologia, 52(3), 78-86. https://doi.org/10.15586/aei.v52i3.1024