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Which children should we patch test?
1Department of Dermatology, Royal Hospital for Sick Children, Yorkhill, Glasgow, UK. paula_e_beattie@hotmail.com
Insights
Allergic contact dermatitis (ACD) in children is rising, with nickel and rubber allergies being most common. Increased patch testing is recommended for children with dermatitis, especially on eyelids or hands.
Area of Science:
- Pediatric Dermatology
- Allergology
- Contact Dermatitis
Background:
- Childhood allergic contact dermatitis (ACD) was once rare but is now increasingly reported.
- This rise may be due to increased allergen exposure and more frequent patch testing in children.
- Changes in children's environmental exposures likely contribute to the growing incidence of ACD.
Purpose of the Study:
- To identify common contact allergens in children with suspected allergy.
- To determine the rate of positive patch-test reactions in pediatric patients.
- To analyze allergen prevalence based on dermatitis presentation and location.
Main Methods:
- Retrospective case study of 114 children aged 3–15 years undergoing patch testing over three years.
- Patch testing included standard series, medicament series, and specific series for corticosteroids, shoes, fragrances, cosmetics, and rubber.
- Indications for testing included uncontrolled atopic dermatitis, localized dermatitis, or known allergen reactions.
Main Results:
- 54% of children showed relevant positive patch-test reactions.
- Nickel was the most frequent allergen (20%), followed by rubber chemicals (10%) and fragrance (7.2%).
- Higher positive reaction rates were observed in children with eyelid (86%) and hand (71%) dermatitis.
Conclusions:
- The incidence of childhood ACD, particularly nickel and rubber allergies, is increasing, possibly due to evolving fashions and hobbies.
- Contact allergy should be considered in all children presenting with dermatitis.
- Increased frequency of patch testing is advised for pediatric patients with suspected contact allergy, especially those with eyelid or hand dermatitis.
Background:
Allergic contact dermatitis (ACD) in childhood was considered rare until recently. However, reports are increasing, which may reflect an increased incidence and/or more frequent patch testing of children. It is also likely that allergen exposure in children has changed with time.
Aims:
To determine the most common contact allergens and the rate of positive patch-test reactions among children with suspected contact allergy.
Methods:
We carried out a retrospective case study of 114 children (66 girls and 48 boys) aged from 3 to 15 years (median 11.5) patch tested over a 3-year period. Indications for patch testing included uncontrolled or deteriorating atopic dermatitis, localized dermatitis or a history of reacting to a specific allergen.
Results:
Of 110 children for whom we had notes, 83 (75%) had a history of atopy. Positive reactions that were of current, past or possible relevance were seen in 61 children (54%); in 58 (52%) of 111 tested with the standard series (SS) and in 6 (10%) of 60 tested with the medicament series. None of the children patch tested to the corticosteroid (n = 47), shoe (n = 15), fragrance (n = 12), cosmetic (n = 10) or rubber (n = 5) series had a positive reaction. However, 11 (10%) reacted to rubber allergens within the SS and one of five to their own shoes. The lowest rate of relevant positive reactions was among those with deteriorating atopic dermatitis (22%) and facial (33%) or perioral dermatitis (40%), and the highest rate amongst those with eyelid (86%) or hand (71%) dermatitis. Nickel was the most common allergen (20%) in line with previous reports (82% female), followed by rubber chemicals (10%), fragrance (7.2%), cobalt (5.4%) and lanolin (wool alcohol) (4.5%).
Conclusions:
The reported incidence of ACD among children, in particular nickel and rubber allergy, appears to be increasing, which may relate to changing fashions and hobbies. Contact allergy should be considered in all children with dermatitis, particularly with eyelid or hand dermatitis, and patch testing carried out more frequently.
