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.

Systemic contact dermatitis--kids and ketchup.

Systemic manifestations of allergic contact dermatitis due to consumption of foods containing balsam of Peru (Myroxylon pereirae)-associated chemicals have recently been reported in children. We present seven children with widespread, recalcitrant dermatitis who experienced 60-80% clearance after initiating a diet low in balsam of Peru, specifically the tomato product ketchup. Furthermore, because we have observed a high prevalence of ketchup in our pediatric patients' diets, we recommend consideration of moderate consumption of this product in patients with recalcitrant widespread dermatitis.

Recommendations for a screening series for allergic contact eyelid dermatitis.

BACKGROUND: Although allergic contact dermatitis of the eyelids is a common condition, limited information is available regarding the selection of patch-testing chemicals for proper evaluation. OBJECTIVE: The purpose of this analysis was to evaluate the relevance of allergens responsible for allergic eyelid dermatitis among a series of patch-tested patients attending our clinic at the University of Miami and compare these results to published studies in the literature. METHODS: Data were retrospectively reviewed for eyelid-only dermatitis from clinically relevant patch-test evaluations performed between December 2004 and January 2007. RESULTS: Formaldehyde was the most frequently encountered antigen, accounting for 45.83% (11/24) of the cases, followed by nickel 33.33% (8/24) and balsam of Peru (Myroxylon pereirae) 29.17% (7/24). In addition, not only did we find a higher prevalence of certain allergens when compared with other studies, but we identified several relevant allergens not previously reported at other referral centers. CONCLUSIONS: The allergens found to be relevant in eyelid dermatitis vary among different regions. These data may help contribute to generating a standard screening tool to improve the detection and management of these cases.

Allergic contact dermatitis to Pampers Drymax.

We present four cases of children less than 2 years of age, seen in four different practices, with a similar, unique, and specific presentation of diaper dermatitis, all while using Pampers Baby Dry with Drymax technology. To date, no reported cases exist of allergic contact dermatitis to Pampers Dryweave in medical literature.

Bra-associated allergic contact dermatitis: p-tert-butylphenol formaldehyde resin as the culprit.

P-tert-butylphenol formaldehyde resin (PTBPFR) is recognized as a significant source of allergic contact dermatitis in adults and children in association with athletic gear, shoes, and neoprene. To our knowledge, this is the first case report of allergic contact dermatitis with PTBPFR associated with padded foam bras.

Frequency of contact allergens in pediatric patients with atopic dermatitis.

OBJECTIVE: The authors compared the prevalence of positive patch tests in atopic pediatric patients versus nonatopic controls and sought to determine if statistically significant allergen prevalence differences existed between the two groups. DESIGN: Retrospective chart review. SETTING: Rady Children's Hospital, San Diego, California. PARTICIPANTS: Patients with suspected allergic contact dermatitis between the ages of 6 and 18 years who had been enrolled in the Pediatric Research Equity Act Thin-layer Rapid Use Epicutaneous Test trial. MEASUREMENTS: Statistical analysis used Z-scores to compare associations between positive reactions in atopic versus nonatopic patients and the prevalence of individual chemicals in either group. RESULTS: RESULTS showed that at least one allergen reaction was noted in 78 percent (n=79) of the patients, 89 percent (n=48) in atopic patients, and 66 percent (n= 31) in the nonatopic patients (Z-score 2.78). Eczema area and severity index scores ranged from 0 to 41.75. Eczema area and severity index scores greater than 10 correlated with a higher probability of more than three positive patch tests (Z-score [-]3.28). Statistically significant differences were also observed between atopic and nonatopic patients in regards to contact allergens, with 20 percent (n=11) of atopic patients exhibiting positive patch tests to Myroxylon pereirae and 19 percent (n=10) of those with atopic dermatitis having reactions to fragrance mix. CONCLUSION: The authors concur with prior studies that performing systematic patch testing is indicated in children with moderate-to-severe atopic dermatitis, given the high rate of contact allergy in the atopic group, especially those with eczema area and severity index scores greater than 10. Furthermore, prevention through exposure avoidance to the most frequent contact allergens, especially fragrances in patients with atopic dermatitis, is recommended.

Safety and efficacy evaluation of TRUE TEST panels 1.1, 2.1, and 3.1 in children and adolescents.

BACKGROUND: The Thin-layer Rapid Use Epicutaneous (TRUE) Test has approval for adults. OBJECTIVE: To evaluate the efficacy and safety of TRUE Test panels 1.1, 2.1, and 3.1 in children and adolescents suspected of having allergic contact dermatitis (ACD). METHODS: An open-label prospective study was performed, analyzing 102 consecutive patients aged 6 to 18 years referred for suspected ACD, between December 2008 and October 2009. Patch tests were applied for 48 hours, and evaluations of skin reactions were conducted at days 3 and 7, with a follow-up visit 3 weeks after the initial applications. RESULTS: The mean age of all enrolled subjects was 11.6 years, and subjects included 52% females and 48% males. Positive reactions noted in more than 10% of the children were to nickel sulfate (29.7%), p-tert-butylphenol formaldehyde resin (16.8%), wool alcohols (15.8%), fragrance mix (12.9%), and cobalt dichloride (12.9%). Of the 101 subjects, 77 (76.2%) tested positive to one or more of the 28 allergens. No meaningful differences were observed in the frequency or severity of adverse events; reports of burning and stinging following patch removal; or the frequency, intensity, or symptoms of persistent reactions when evaluated by age, sex, or race. CONCLUSION: Patch testing is efficacious and safe in the pediatric population.

Ultraviolet protective eyewear for Wood's light use.

When interpreting delayed patch test reads for children suspected of having contact dermatitis, we use the Wood's light to illuminate the highlighter outlines we made at the first read. Our pediatric patients wear single-use ultraviolet protective goggles to shield their retinas, because children have a propensity to attempt to look into the Wood's lamp.

Compositae-associated allergic contact dermatitis from bisabolol.

BACKGROUND: Compositae-related chemicals cause allergic contact dermatitis (ACD) in children with atopic dermatitis (AD). Moisturizers can be an overlooked exposure source. OBJECTIVE: To evaluate ACD in children with recalcitrant AD and a reported history of intolerance to Aquaphor Healing Ointment (AHO) moisturizer. METHODS: We retrospectively reviewed charts of children patch-tested to the ingredients of AHO moisturizer who had a history of intolerance, as well as of additional patch-tested patients with exposure to bisabolol in their personal hygiene products and without a history of product intolerance. RESULTS: Seven patients, six of whom had AD, had been referred to our clinic with a history of intolerance to the moisturizer. They were patch-tested with their moisturizer and the components provided by Beiersdorf. Of these, four had positive reactions to their AHO moisturizer and to bisabolol, a Compositae derivative. CONCLUSION: Bisabolol, a sesquiterpene alcohol, should be considered a potential cause of ACD in children with AD and a history of moisturizer intolerance.