Patch testing in children

Abstract

92 children (45 girls, 47 boys), mean age 9.3 years (3-14.75), were referred to the Contact Dermatitis Investigation Unit, Belvidere Hospital, Glasgow, for patch testing during the period 1979-93 for the investigation of allergic contact dermatitis (ACD). The diagnoses at the time of referral were atopic dermatitis (45), non-atopic with localized dermatitis (26), juvenile plantar dermatosis (15), orofacial granulomatosis (2), vaccination reaction (2) and atypical psoriasis (2). In total, there were 55 positive reactions in 30 children. The commonest allergens were metals (18), fragrances (11) and rubber compounds (6). The patient groups with the highest yield of positive patch tests were those patients with atopic dermatitis who had a good history of a precipitating contact factor (4/5), and non-atopic patients with dermatitis of hand and/or feet (7/14). Our findings suggest that allergic contact dermatitis is more common in children than generally appreciated and that patch testing is a practicable and clinically worthwhile procedure in children.

Allergic Contact Dermatitis in Children

“…While some authors (Weston et al, 1986;Barros et al, 1991;Stables et al, 1996) detected similar prevalence in both boys and girls, other (Dotterund & Falk, 1995;Wantke et al, 1996;Goossens & Morren, 2006) reported a higher prevalence in girls. This is especially the case for nickel (Brasch & Geier, 1997;Wöhrl et al, 2003) and after the age of 12 (Rademaker & Forsyth, 1989;Rudzki & Rebandel, 1996;Katsarou et al, 1996;Goossens & Morren, 2006).…”

“…Of these, about 56-93% was of current relevance (Weston & Weston, 1984;Pevny et al, 1984b;Fisher, 1994a;Rudzki & Rebandel, 1996;Stables et al, 1996;Manzini et al, 1998;Bruckner et al, 2000;Machovcová et al, 2001;Wöhrl et al, 2003;Heine et al, 2004;Lewis et al, 2004;Jøhnke et al, 2004;Vozmediano & Hita, 2005;Wahlberg & Lindberg, 2006;Goossens & Morren, 2006;Jacob et al, 2008). Among the children with a positive patch test 3.2% to 54.4% had multiple contact allergies (Mortz & Andersen, 1999).…”

“…Patch testing in symptomatic children with dermatitis has revealed positive reactions in 15% to 52% of subjects (Rademaker & Forsyth, 1989;De Groot, 1990;Katsarou et al, 1996;Rudzki & Rebandel, 1996;Stables et al, 1996;Shah et al, 1997;Vozmediano & Hita, 2005;Goossens & Morren, 2006;Wahlberg & Lindgerg, 2006). Some authors have indicated that ACD is less prevalent in patients with AD (Uhr, 1960;Rystedt, 1985;De Groot, 1990;Katsarou et al, 1996;Stables et al, 1996;Brasch & Geier, 1997). Several authors were unable to detect differences between atopic and nonatopic subjects in this regard (Marghescu, 1985;Pambor et al, 1991;Goossens et al, 1995;Akhavan & Cohen, 2003;Beattie et al, 2007;Milingou et al, 2010).…”

“…Some authors have recommended lower concentrations (Hjorth, 1981;Pambor et al, 1991), particularly with regard to specific allergens such as nickel and formaldehyde (Fisher, 1991), mercurials (Fisher, 1994b), potassium dichromate and thiuram mix (Fisher, 1994b). The others use the same test concentrations as those used in adults (Pevny et al, 1984a;Pevny et al, 1984b;Stables et al, 1996;Seidenari et al, 1992;Motolese et al, 1995;Worm et al, 2007). …”

“…Clinical relevance was confirmed if the allergen was found to be present in the patient's environment, the dermatitis corresponded to point(s) of contact with the allergen and the dermatitis significantly improved upon isolation of the allergen, or recurred with re-challenge (positive use test) . Reported clinical relevance in children has been varied between 20% and 93% (Pevny et al, 1984b;Rademaker & Forsyth, 1989;Pambor et al, 1991;Stables, 1996;Mortz & Andersen, 1999).…”