Elżbieta Paśnicka, Marek Paśnicki

Contact allergy and allergic contact dermatitis in children and adolescents with chronic eczema

Contact allergy and allergic contact dermatitis in children and adolescents with chronic eczema

Spiewak. R1: Grubska-Suchanek, E2; Pasnicki, M3; Krakowski, A4; Cisowska, A5 ^agiellonian University, Department of Experimental Dermatology and Cosmetology, Krakow, Poland; 2Medical University of Gdansk, Department of Dermatology, Venereology and Allergology, Gdansk, Poland; 3NZOZ Allergicus-Dent, Zary, Poland; 4NZOZ Krak-Med, Kolbuszowa, Poland; sDermatology Practice, Kamienna Gora, Poland

Background: Patch test is the gold standard of eczema diagnosis in every age group. The prevalence of allergic contact dermatitis (ACD) in children and adolescents is comparable to that of atopic dermatitis. The aim of the present study was to analyse the frequency of contact allergy and ACD in children and adolescents with chronic eczema.

Method: KRAK study is a multi-centre patch test study of patients with chronic eczema. Eleven participating Polish dermatology and allergy centres submit data of all patients patch tested with the Polish Baseline Series (Chemotechnique Diagnostics). The series consists of the European Baseline Series plus propolis and palladium – two relevant sensitizers in Polish paediatric and adult populations. Among all data submitted in 2011 by the KRAK study group members, 127 patch test results of children (0-13 y.o., N=64) and adolescents (14-20 y.o., N=63) were Identified and included into the present study.

Result: Altogether, 127 children and adolescents (36 boys and 91 girls) were patch tested in 5 out of 11 participating centres. At least one positive reaction to haptens from the Polish Baseline Series was recorded in 83 patients (65.4%). In 59 patients (46.5%), the tests were considered clinically relevant (i.e. were deemed as the ultimate cause of their eczema). The figures for frequent sensitizers (at least 3% of the study group) are shown in the table below.

Hapten Total, positive (n,%) Total clinically relevant (n,%) Children, positive (n,%) Children, clinically relevant (n, %) Adolescents, positive (n, %) Adolescents, clinically relevant (n,%)
Nickel sulphate 5% pet. 44

(34.6%)

36

(28.3%)

19

(29.7%)

14 (21.9%) 25 (39.7%) 22 (34.9%)
Cobalt chloride 1% pet. 28

(22.0%)

15 (11.8%) 16

(25.0%)

9 (14.1%) 12 (19.0%) 6 (9.5%)
Potassium dlchromate 0.5% pet. 26

(20.5%)

15 (11.8%) 19

(29.7%)

10 (15.6%) 7 (11.1%) 5 (7.9%)
Paraphenylenediamine 1% pet. 12

(9.4%)

6 (4.7%) 8 (12.5%) 5 (7.8%) 4 (6.3%) 1 (1.6%)
Propolis 10% pet. 12

(9.4%)

5 (3.9%) 11

(17.2%)

5 (7.8%) 1 (1.6%) 0 (0.0%)
Palladium chloride 2% pet. 12

(9.4%)

4 (3.1%) 6 (9.4%) 2 (3.1%) 6 (9.5%) 2 (3.2%)
Fragrance Mix 118% pet. 10

(7.9%)

4 (3.1%) 4 (6.3%) 2 (3.1%) 6 (9.5%) 2 (3.2%)
Neomycin sulphate 20% pet. 6 (4.7%) 2 (1.6%) 4 (6.3%) 2 (3.1%) 2 (3.2%) 0 (0.0%)
Balsam of Peru (Myroxylon pereirae) 25% pet. 6 (4.7%) 1 (0.8%) 4 (6.3%) 1 (1.6%) 2 (3.2%) 0 (0.0%)
Colophonium 20% pet. 5 (3.9%) 4 (3.1%) 2 (3.1%) 2 (3.1%) 3 (4.8%) 2 (3.2%)
Wool alcohols (lanolin) 30% pet. 5 (3.9%) 3 (2.4%) 3 (4.7%) 3 (4.7%) 2 (3.2%) 0 (0.0%)
Paraben Mix 16% pet. 4 (3.1%) 4 (3.1%) 3 (4.7%) 3 (4.7%) 1 (1.6%) 1 (1.6%)
Kathon CG (MI/MCI) 0.01% aqua 4 (3.1%) 2 (1.6%) 3 (4.7%) 2 (3.1%) 1 (1.6%) 0 (0.0%)

 

No differences in sensitization rates were observed between prepubertal boys and girls (0-13 y.o.). Among adolescents, girls were more frequently sensitized to nickel (46.9% vs 14.3% in boys, p=0.058), while boys were more frequently sensitized to Fragrance mix I (28.6% vs 4.1% in girls, p=0.025). There was also a tendency to more frequent propolis sensitization among boys (both age groups combined: 16.7% vs 6.6% in girls, p=0.080). Also interestingly, 4 patients (3.1%) reacted to palladium but not to nickel, suggesting that under modern environmental exposures palladium is not just a mere cross­reactivity to nickel, as believed previously.

Conclusion: Allergic contact dermatitis is a frequent cause of eczema in children and adolescents. These patients are most frequently sensitized to metals and cosmetic ingredients. Natural remedies containing balsam of Peru and propolis should be avoided in children with eczema due to frequent sensitizations. Palladium and propolis are frequent sensitizers and should be included into routine patch testing of children.