Children with AD more likely to patch-test positive for allergic contact dermatitis
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Key takeaways:
- Children with atopic dermatitis had more positive patch-test results compared with children without AD (2.3 vs. 1.9).
- Authors recommend children with atopic dermatitis should obtain patch testing.
Children with vs. without atopic dermatitis are more likely to have positive patch-test reactions for allergic contact dermatitis, according to a study.
Allergic contact dermatitis (ACD) is often misconstrued as AD in children, and patch-testing is often not performed to diagnose.
In fact, according to Hadley Johnson, BS, of University of Minnesota Medical School, and colleagues, even though the estimated prevalence of ACD in children is 16.5%, this population receives less than 10% of patch tests.
Therefore, in this retrospective study, Johnson and colleagues determined if children with vs. without AD have a higher prevalence of ACD and which allergens are most common.
Using the Pediatric Allergic Contact Dermatitis Registry from 2018 to 2022, the researchers compiled general and patch-testing data on 912 children, 615 of whom had AD.
Demographic data showed that children with AD were more likely to have atopic comorbidities such as asthma (OR = 3.09; 95% CI, 2.02-4.72) and allergic rhinitis (OR = 1.94; 95% CI, 1.39-2.7). Prior to patch testing, children with AD also experienced longer durations of dermatitis than children without AD (4.1 years vs. 1.6 years; P < .0001).
During patch testing, children with AD proved to have a higher number of positive reactions (OR = 1.57; 95% CI, 1.14-2.14) and positive results overall (2.3 vs. 1.9; P = .012) compared with children without AD.
Both children with and without AD most commonly tested positive for nickel as an allergen. Cobalt was also in the top five allergens for both groups, whereas fragrances (fragrance mix 1 and hydroperoxides of linalool), preservatives (methylchloroisothiazolinone and methylisothiazolinone) and neomycin were in the top 10.
Methylisothiazolinone was the second most common allergen in children with AD, whereas the fragrance balsam of Peru was the second most common in children without AD.
Children with AD were much more likely to be patch test-positive for certain allergens including bacitracin (OR = 3.23; 95% CI, 1.12-9.35), carba mix (OR = 3.36; 95% CI, 1.17-9.7) and cocamidopropyl betaine (OR = 3.69; 95% CI, 1.74-7.84).
“Children with AD develop more PPT reactions and are more likely to react to at least one or more allergens on patch testing than children without AD,” the authors concluded. “Our findings support the importance of referring children with AD for patch testing to consider ACD as an important comorbidity.”
Perspective
Back to TopThe findings of this study seem reasonable as atopics are hyper-immune, have a decreased barrier function of their skin and possibly greater exposure to allergens. Due to the chronic nature of the disease, multiple skin care products are used, further increasing exposure to potential allergens. Often caregivers are unaware of "hidden" ingredients in skin care products or frequent allergens, such as preservatives, surfactants and lanolin.
The potential implications of this study are an increased awareness to the possibility of two processes occurring. If a patient has an unusual distribution of their AD, or the disease is refractory to treatment, perhaps allergic contact dermatitis is a consideration and patch testing would reveal an environmental factor that could be altered, improving the patient's quality of life, and decreasing the need for prescription medications that could have potential health and financial consequences. Treatment approaches to AD depend on the severity of the condition. Universally, AD patients skin regimen should include the use of mild "clean" cleansers, without fragrance and sensitizing chemicals.
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