Prevalence of contact allergy in the general population: A systematic review and meta-analysis

Allergens Responsible for Contact Allergy in Children From 2010 to 2024: A Systematic Review and Meta-Analysis

Contact allergy (CA) is a frequent condition in children; however, newer estimates of the prevalence of CA in children are lacking. Herein, we aim to provide an estimate of the prevalence of CA in children from 2010 to 2024. Two authors independently searched PubMed, Embase and Web of Science for studies reporting the prevalence of positive patch tests (PPTs) to allergens in populations including ≥ 100 children (< 18 years). Proportion meta-analyses were conducted to calculate the pooled prevalence estimates of CA in children. Seventeen studies comprising 11 593 children undergoing patch testing with 4176 (36%) PPTs were eligible for inclusion. The allergen with the highest prevalence was nickel (11.9% [95% confidence interval [CI], 8.6%-15.71%]), followed by cobalt (6.6% [95% CI, 4.2%-9.5%]), cocamidopropyl betaine (5.5% [95% CI, 3.1-8.7]), bacitracin (5.2% [95% CI, 1.2%-10.0%]), fragrance mix I (4.8% [95% CI, 2.9%-7.1%]) and methylisothiazolinone (4.3% [95% CI, 2.2%-7.2%]). Children with atopic dermatitis had higher rates of PPTs for cocamidopropyl betaine, propylene glycol, lanolin alcohol and carba mix. Across geographical areas, higher prevalences of several allergens were found in the United States compared to Europe, for example, for methylisothiazolinone. This meta-analysis confirmed that CA is frequent in children across geographical areas; however, differences in the frequency of top allergens depend on regulatory interventions, indicating their value.

Self-reported Nickel Allergy among Schoolchildren: Trends in Prevalence, Risk Factors, and Atopic Comorbidity

Nickel allergy is common among children. The present study investigated prevalence trends of self-reported nickel allergy, risk factors, and atopic comorbidity among children. Eight-year-old children from Norrbotten County, Sweden, were recruited in 1996 (n = 3,430), 2006 (n = 2,585), and 2017 (n = 2,785). Self-reported nickel allergy decreased from 7.7% (2006) to 6.1% (2017; p = 0.024) and was significantly more common among girls. In 1996, only children with atopic dermatitis answered questions on nickel allergy. Among children with atopic dermatitis, no significant decrease was seen over the years 1996 to 2017. Ear piercing (odds ratio [OR] 1.93, 95% confidence interval [CI] 1.39-2.68 and OR 5.57, 95% CI 3.71-8.38) and female sex (OR 4.05, 95% CI 2.68-6.13 and OR 1.73, 95% CI 1.09-2.74) were risk factors for self-reported nickel allergy in 2006 and 2017, respectively. Self-reported nickel allergy was significantly more prevalent among children with atopic dermatitis than without in 2006 (12.3% vs 6.4%; p < 0.001) and 2017 (11.5% vs 5.1%; p < 0.001), and among children with allergic rhinitis in 2017 (8.6% vs 4.7%; p = 0.015). In conclusion, we found a decreasing prevalence of self-reported nickel allergy, but not among children with atopic dermatitis. Ear piercing and female sex were strongly associated with nickel allergy. Our findings also suggest that nickel allergy is associated with atopic dermatitis and allergic rhinitis.

Predicting the skin sensitizing potential of pesticides using Pred-skin 3.0-A web-based prediction tool

Pesticide usage is increasing due to growing needs of agriculture and horticulture. Occupational dermal exposure to pesticides at an acute or chronic low-level could result in contact dermatitis and various skin cancers. Hence, detailed understanding about the Adverse Outcome Pathways (AOP) or Chemical Sensitization Pathway (CSP) behind pesticides belonging to various categories has to be investigated. Animal models of skin sensitization testing at times either over or under predict the human responses due to species-to-species variability. This necessitates the need for prediction tools for skin sensitizing potential of various chemicals. Pred-skin 3.0, is a consensus Naïve Bayes model-based prediction tool which utilizes various human, LLNA, and non-animal data to predict skin sensitization. Although, this tool was never used for predicting skin sensitizing potential of pesticides. Henceforth, the current study aims to test the applicability of this prediction tool in predicting skin sensitizing potential of 96 pesticides belonging to three Major classes. The Bayesian outcome of Pred Skin prediction tool provided a good concordance of 72.72 % with the existing animal skin sensitizing data as well as 63.46 % with the non-sensitizer data.

Imprecise Coding in Allergic Contact Dermatitis: A Register-Study From Northern Finland Between Years 1999 and 2022

BACKGROUND

Registry-based data are increasingly used in dermatological research. A recent epidemiological study has shown that the use of non-specific diagnostic codes is common among dermatologists.

OBJECTIVES

To study closely the use of the diagnostic codes L23.8 ('allergic contact dermatitis [ACD] for other agents') and L23.9 ('ACD with unspecified cause') by using single-centre data.

PATIENTS/MATERIALS/METHODS

This retrospective study included all patients whose record contained at least one entry of either code, recorded at the Oulu University Hospital, Finland, between the Years 1999 and 2022.

RESULTS

The database search retrieved records of 472 patients with the L23.8 code, 264 patients with L23.9. Over the 20-year follow-up period, the use of L23.8 increased and that of L23.9 decreased. In most (85.1%) cases, the L23.8 code was used even though the more specified L23 code could have been chosen. In one-third of cases, L23.8 was used to cover ACD with multiple allergens that would otherwise be identified by their specific sub-codes. The L23.9 code was used most often prior to patch testing (69.1% cases).

CONCLUSIONS

This study revealed several imprecisions in the use of both codes. Our study highlights the importance of correct coding in clinical practice, as it emphasises the most common pitfalls.

Clinical Characteristics and Patch Test Results in 57 Patients with Contact Dermatitis in Southern Taiwan

Background/Objectives: Patch testing is a valuable clinical tool for identifying the causes of allergic contact dermatitis (ACD). This study aimed to identify common allergens in southern Taiwan. Methods: A retrospective review of patch test data from April 2019 to May 2023 was conducted at a tertiary medical center. The European Baseline Series of allergens was utilized to evaluate and identify the causes of dermatitis. The prevalence rates of contact sensitization to each allergen were calculated. Results: A total of 57 patients (mean age 41.8 years) with contact dermatitis who underwent patch testing were included. The most common allergens were cobalt chloride (24.6%), followed by fragrance mix I (19.3%), Peru balsam (17.5%), nickel (II) sulfate hexahydrate (15.8%), benzisothiazolinone (15.8%), 4-Phenylenediamine (PPD) base (10.5%), and methyldibromo glutaronitrile (10.5%). Patients with positive patch test results frequently had a history of allergic rhinitis (26.3%), atopic dermatitis (24.6%), urticaria (21.1%), and elevated immunoglobulin E (IgE) levels (28.1%). The hairdressing profession was associated with a higher risk of hand eczematous dermatitis. Conclusions: Positive patch test results were observed in 86% of patients diagnosed with contact dermatitis. This study found that cobalt, rather than nickel, was the most prevalent allergen in patients with contact dermatitis. Elevated IgE levels were observed in ACD patients, with the hands being the most frequently affected area. Occupations as accountants, secretaries, and in the hairdressing and cosmetics industries were strongly associated with hand eczematous dermatitis. The early identification of allergens and appropriate treatment strategies significantly reduced recurrence rates and improved outcomes. For individuals with specific allergies, ongoing avoidance of identified allergens is crucial to managing and preventing allergic reactions. Further research is needed to elucidate the mechanisms and responses to novel therapies, including biologic agent- and nanotechnology-based treatments.

Skin sensitizers enhance superoxide formation by polycyclic aromatic hydrocarbons via the aldo-keto reductase pathway

Exposure to combustion-derived airborne polycyclic aromatic hydrocarbons (PAHs) may harm human skin, exacerbate cutaneous inflammatory diseases and accelerate skin aging. The toxicity of PAHs is unleashed upon their metabolic activation by cytochrome P450 (CYP) 1 monooxygenases, resulting in the formation of reactive intermediates that form mutagenic DNA adducts. Moreover, PAHs cause oxidative stress, which is primarily due to aldo-keto reductases (AKRs), such as AKR1C3, which convert CYP1-derived PAH-trans-diols to PAH-catechols. The catechols undergo autooxidation leading to the formation of reactive oxygen species (ROS) and PAH-quinones. The latter are highly reactive, mitotoxic and are reduced back to PAH-catechols, thus facilitating redox cycling. As AKR1C expression is inducible by other NRF2-stimulating chemicals, we tested the hypothesis that co-exposure of HaCaT keratinocytes to skin sensitizers and the PAH benzo[a]pyrene (BaP) enhances ROS formation. We observed a synergistic effect of the skin sensitizers on the BaP-induced expression of the NRF2 target genes heme oxygenase-1, sulfiredoxin-1 and AKR1C3. In fact, co-exposure to the skin sensitizers also enhanced the BaP-induced formation of superoxide anions. Intriguingly, the co-exposure-related ROS formation was abolished upon inhibition of either CYP1A1 or AKR1C3. Testing of additional skin-sensitizing compounds, differing in their mode of action, indicated that especially potent Michael acceptors enhance the toxicity of BaP by increasing AKR1C3 expression and, presumably, downstream BaP-quinone formation. Our study reveals potential health risks associated with the simultaneous exposure to common skin-sensitizing substances and ubiquitous PAHs, and implies a role for NRF2 in mediating PAH toxicity.

Exploring New Horizons In Allergic Contact Dermatitis Treatment: The Role of Emerging Therapies

The resistant and recalcitrant nature of severe allergic contact dermatitis (ACD) makes treatment challenging. With advances in the understanding of the cellular and molecular pathogenesis of this dermatosis, new therapeutic options are emerging. In particular, the use of biologic drugs such as dupilumab and small molecule inhibitors, such as JAK inhibitors have gained momentum given the cross-cutting inhibition of multiple cytokine actions. This article aims to review the current available data on the use of biologic drugs and small molecule inhibitor drugs in the management of ACD. Results suggest that iJAKs, such as abrocitinib, tofacitinib, upadacitinib, and baricitinib; although biologic drugs, such as dupilumab show significant promise in refractory ACD, more long-term clinical trials are needed to confirm their safety and efficacy profile.

Patch Test Results with the Latin American Baseline Series in a Colombian Population. 2016-2021

Background: Contact dermatitis (CD) is one of the most prevalent skin diseases. It is commonly divided into irritant contact dermatitis (ICD) and allergic contact dermatitis (ACD). Patch testing is a procedure used to support the diagnosis of ACD. This test should be interpreted along with the clinical history and morphology of the skin lesions to determine clinical relevance. Objective: To describe the sensitization patterns of patients undergoing patch testing with the Latin American baseline series. Methods: A single-center retrospective study was performed. For the study, patients older than 18 years with a clinical diagnosis of contact dermatitis, who underwent patch testing using the Latin American baseline series were considered. These tests took place at the Alma Mater Hospital of Antioquia between January 1, 2016, and December 31, 2021. Results: A total of 648 patients were included. Patch tests were positive in 63% of cases, with a mean age of 51.5 years. Around 36.6% had atopy-related diseases. The main occupation was housework (30.7%). The hands were the most affected area in the body (31%). The main allergens were nickel sulfate (34%), sodium tetrachloropalladate (24.2%), and thimerosal (8.0%). Fifteen allergens had a percentage below 1%. Hydrocortisone and budesonide did not yield positive results. Conclusion: Nickel sulfate was the most frequent allergen, and women were the most affected. The information gathered could be useful for adjusting the allergens that should be included in the regional baseline series, taking into account the frequency found.

Photobiomodulation suppresses allergic contact dermatitis by inhibiting T-cell activation

BACKGROUND

Allergic contact dermatitis (ACD) is a dermal inflammatory disease caused by allergic reactions to substances that contact the skin. The hyperactivation of T cells plays an important role in its pathogenesis. Photobiomodulation (PBM) is an efficacious therapeutic approach for suppressing inflammatory diseases.

OBJECTIVE

This study aimed to evaluate the potentially beneficial role of PBM in ACD models and investigate its possible mechanisms.

METHODS

In this study, the ACD model of C57BL/6 mice was produced and treated with PBM, and the number of T cells was evaluated. In an in vitro study, naïve T cells were isolated and intervened with PBM. The markers of T cell activation were detected by flow cytometer. Transforming growth factor-β (TGF-β) and reactive oxygen species (ROS) were detected to investigate the mechanism.

RESULTS

PBM effectively inhibited the inflammatory response by impeding the number of T cells in the ACD model. And in vitro studies showed that PBM could directly moderate the activation of naïve T cells and possess the capability to impede T cell activation via TGF-beta signaling pathway.

CONCLUSION

Our finding elucidates the potential mechanism underlying the inhibitory effects of PBM in inflammatory diseases and furnishes a theoretical foundation for its clinical application.

Skin sensitisation elicitation: Evaluation of the general threshold and considerations for use

BACKGROUND

Allergic contact dermatitis (ACD) is an immune response to chemical haptens, involving induction and elicitation phases. Quantitative risk assessment (QRA) reviewing the skin sensitisation potential for all ingredients and using chemical-specific induction thresholds for skin allergens remains the current best approach for the safety evaluation of consumer products. However, elicitation thresholds have utility in secondary protection for pre-sensitised consumers.

OBJECTIVES

The objectives were to (1) review the current elicitation threshold database, (2) evaluate whether predicted relationships between chemical induction and elicitation potencies enable elicitation threshold prediction and (3) discuss elicitation threshold utility as a secondary method of consumer protection.

METHODS

In total, 28 publications (with 39 elicitation datasets) were included in non-linear regression analysis to derive elicitation thresholds for 22 allergens, including fragrances, preservatives and metals.

RESULTS

The median elicitation threshold (ED10) for the expanded database was 0.95 μg/cm2, which supports previously published general elicitation thresholds. The derived ED10 for each chemical had only weak to moderate correlation with corresponding induction thresholds, thus limiting suitability as the predictive model.

CONCLUSIONS

Assessment of current EU fragrance allergen labelling and sensitiser labelling under the globally harmonised system in the context of general and chemical-specific elicitation thresholds shows that current practices are health protective.

Interference of the positioning of nickel, chromium and cobalt in the results of patch tests

BACKGROUND

The positioning of substances, which are co-sensitizers and/or with a tendency to cross-react, is not considered in the technique when applying patch tests (PT).

OBJECTIVE

To investigate the interference of the positioning of nickel (Ni), chromium (Cr) and cobalt (Co) in patch tests (PT) results, when applied close or distant from each other.

METHODS

PT were performed in patients suspected of allergic contact dermatitis (ACD), using the standard battery (SB), with substances showing a tendency towards cross-react and co-sensitizers applied far apart, and an additional battery (AB) with the metals placed close to each other. For tabulation purposes, only the 96-h reading was considered.

RESULTS

Of the 86 tested patients, 33 (38%) had negative testing for metals and 53 (62%) had one or more positive (+) tests for Ni, Cr and/or Co. Concordant results in both tests (SB/ AB) occurred in 18/53 (34%) and 35/53 (66%) had discordant results. Regarding the SB, of the 159 tests with metals (53 patients, three metals), 57 tests were (+) and 102 (-). In the AB, 87 tests were (+) and 72 (-), a statistically significant difference (p < 0.05). Of the 57 (+) tests in the SB, 35 were for Ni, 18 for Co and four for Cr. In AB the number of (+) tests was 87, with 45 (+) tests for Ni, 35 for Co and seven for Cr. The difference in the number of positive tests between the two batteries was statistically significant for Co and Ni.

STUDY LIMITATIONS

The number of cases.

CONCLUSION

The results showed that the positioning of the metals interferes with the PT results and should be considered as part of the PT application technique.

The Interaction Among Effector, Regulatory, and Tγδ Cells Determines the Development of Allergy or Tolerance to Chromium

Background/Objectives: Chromium, a common environmental and occupational sensitizer, frequently induces allergic contact dermatitis (ACD). This study investigates the role of CD4+ (T helper), CD8+ (T cytotoxic), regulatory (Tregs: CD4+CD25+ and CD8+CD25+), and gamma delta (Tγδ) T cells in chromium tolerance versus hypersensitivity. Methods: Six chromium-allergic patients and six healthy controls were recruited, confirmed via patch testing. Peripheral blood mononuclear cells (PBMCs) were isolated and cultured, with chromium exposure and proliferation assays conducted. Specific T cell subtypes were isolated and analyzed for chromium-specific proliferative responses, cytokine production, and metabolic activity. Results: Chromium-allergic individuals exhibited broad proliferation across PBMC and T cell subsets, contrasting with restricted responses in controls. Treg cells in healthy subjects effectively suppressed T cell proliferation in response to chromium, while allergic individuals showed unmodulated T cell activity, indicative of impaired regulatory function. Cytokine analysis revealed elevated IL-2 and TNF-α but absent IL-10 in allergic patients. Metabolic assessments showed higher glycolytic activity in Tregs of healthy controls, suggesting enhanced regulatory potential. Conclusions: These findings highlight the importance of balanced effector and regulatory T cell interactions for chromium tolerance. Dysregulated Treg and Tγδ cell functions in allergic individuals may contribute to hypersensitivity, with implications for targeted therapeutic strategies to restore immune balance and reduce allergic responses in chromium-sensitive patients.

Contact Sensitization to Allergens in Synthetic Hair and Related Hair Practices: A Review

Scalp contact dermatitis (SCD) represents a less common manifestation of contact dermatitis and is susceptible to misdiagnosis due to its atypical clinical presentations, including hair thinning, eczematous lesions, and scalp pruritus. Notably, personal care products are recognized as common etiologies in the development of SCD. Synthetic hair extensions, with prevalent use in individuals of color, are also known to cause contact dermatitis, due to allergenic components such as acrylates and disperse dyes. This review summarizes documented cases of contact dermatitis secondary to synthetic hair and provides an overview of prevalent ethnic hairstyling practices associated with synthetic hair installation. Hair styling practices detailed include braids and installation of wigs, and the related hair products that may be used to maintain these hairstyling practices. Upon surveying common hair styling products utilized, the most common hapten observed was fragrance. Ultimately, contact dermatitis stemming from synthetic hair warrants consideration as a pivotal differential diagnosis in individuals who regularly utilize synthetic hair products.

Incidence of allergic contact dermatitis in Finland 1998-2021: A nationwide registry-based study

BACKGROUND

Allergic contact dermatitis (ACD) may be chronic and can cause distress, disability, and absence from work. Nationwide epidemiological studies of ACD are sparse.

OBJECTIVES

To use national registry data to study the incidence and aetiology of ACD in the working age population of Finland.

METHODS

Patient records from the years 1998-2021 were obtained from the Finnish Care Register for Health Care. Study subjects aged 18-65 years were selected on the basis of a diagnosis of ACD.

RESULTS

Total number of study subjects was 26 701. The incidence of ACD increased until 2016 after which it started to decrease. The increase was more marked in females and ACD was particularly common in women reporting reactions to cosmetics and other chemical products and in people of both sexes reacting to adhesives. The incidence 'ACD of unspecific cause' has decreased since 2016. The most commonly reported allergens were metals, followed by cosmetics. One fourth of subjects had ≥2 ACD diagnoses.

CONCLUSIONS

The incidence of ACD in working age subjects rose from 1998 to 2016, especially in females. However, the incidence has been decreasing since 2016. Our findings highlight the ongoing and even increasing burden of ACD among the working age population.

Just scratching the surface: A review of pediatric skin allergies

The skin is a large and sophisticated organ populated by innate and adaptive immune effector cells. These immune cells provide a critical first line of defense against pathogens, but genetic and environmental factors can lead to inappropriate signaling that may manifest as hypersensitivity. The most common cutaneous allergic disorders in children include atopic dermatitis, urticaria/angioedema, and contact dermatitis. In this review, we will briefly review these conditions, with a focus on recent developments in our understanding of the diagnosis and management of these disorders.

Safety of intracranial venous stenting in patients with nickel allergy

BACKGROUND

Nickel hypersensitivity is the most common metal related allergy. Nickel containing alloys are frequently used in endovascular devices. The use of intracranial stents in patients with nickel hypersensitivity appears to be safe, but these small series only evaluated arterial stent placement. This case series aimed to assess the safety of intracranial venous stent placement in patients with documented nickel allergy.

METHODS

In this retrospective multicenter case series, patients with idiopathic intracranial hypertension and documented nickel allergy underwent treatment with a permanently implanted nickel containing stent in the dural venous sinuses.

RESULTS

Nine patients with nickel allergy were included. All patients reported clinical improvement in their idiopathic intracranial hypertension symptoms. Of the five patients who had follow-up intracranial venous imaging, all stents remained patent. No patients experienced intraoperative, postoperative, or long term procedure related complications, with follow-up ranging from 1.8 weeks to 49.1 months.

CONCLUSION

In this limited case series, the use of nickel containing stents in intracranial venous sinuses in patients with nickel allergy did not result in any allergic reaction or adverse outcome.

Contact Dermatitis in the United States: A Population-Based Study on Patient Visit Characteristics and Treatment Prescription Patterns

Background: Contact dermatitis (CD) affects ∼15% of the general population over a lifetime. However, there is a lack of epidemiological studies on treatment patterns for CD. Objective: We aim to analyze the patient characteristics and prescribing patterns among dermatologists and general practitioners (GPs) (internal medicine [IM] and family medicine [FM]) for CD in the United States. Methods: We conducted a population-based study using the National Ambulatory Medical Care Survey. Results: We identified 178,017,680 weighted patient visits for CD from 2001 to 2016. Dermatologists saw more white and non-Hispanic patients than GPs. GPs were less likely to prescribe ultrahigh potency topical corticosteroids (FM OR 0.27; P < 0.001, IM OR 0.41; P < 0.001) and more likely to prescribe oral antihistamines (FM OR 3.71; P < 0.001, IM OR 3.56; P < 0.001), oral corticosteroids (FM OR 5.35; P < 0.001, IM OR 6.87; P < 0.001), and injectable corticosteroids (FM OR 3.42; P = 0.006, IM OR 5.68; P < 0.001) than dermatologists. Conclusions: Across CD visits, GPs were less likely than dermatologists to prescribe ultrahigh potency topical corticosteroids and more likely than dermatologists to prescribe oral antihistamines and systemic corticosteroid therapy.

Toll-Like Receptors and Contact Dermatitis

Contact dermatitis (CD) is a common cutaneous inflammatory condition that affects millions of people worldwide. Xenobiotic agents are frequently encountered in substances used in everyday life, making it difficult to avoid personal and occupational exposure. Toll-like receptors (TLRs) are transmembrane receptors that modulate the innate immune system in response to tissue injury or infection. TLRs play a key role in the pathophysiology of contact dermatitis. TLR signaling is involved in three major forms of CD: protein CD, allergic contact dermatitis (ACD), and irritant CD. Of the 10 TLRs found in humans, three play an important role in ACD. This makes TLRs a useful potential therapeutic target to consider against CD. In this review, we discuss the role of TLRs in CD and summarize current and emerging treatments for CD that target TLRs.

Managing dry skin in patients with comorbidities or with advanced age: unmet needs and roles for products containing potential emollient-plus ingredients

In dry skin (DS), skin-barrier function is easily disturbed and moisturizing factors in the stratum corneum are reduced. Despite being a common condition, DS is often overlooked in patients with advanced age or comorbid diseases. In September 2022, specialists in dermatology and skin care met to discuss unmet needs and management of patients with DS with existing medical conditions or DS induced by ongoing pharmacological treatments. There was consensus about the need to improve the current understanding and management of DS in patients with comorbidities, including type 2 diabetes, chronic kidney disease, radiodermatitis, and photodamaged skin. Clinical guidance related to optimal treatment of DS in patients with advanced age or comorbid diseases is needed. Dexpanthenol-containing emollients have been shown to provide rapid relief from the symptoms and clinical signs of skin inflammation and are well-tolerated and effective in terms of moisturizing and soothing DS and maintaining skin-barrier function. Thus, dexpanthenol-containing emollients may play an important role in future management of DS. Further research is needed to elucidate the efficacy of dexpanthenol across the spectrum of DS, irrespective of comorbidity status or age.

Chemical-Specific T Cell Tests Aim to Bridge a Gap in Skin Sensitization Evaluation

T cell activation is the final key event (KE4) in the adverse outcome pathway (AOP) of skin sensitization. However, validated new approach methodologies (NAMs) for evaluating this step are missing. Accordingly, chemicals that activate an unusually high frequency of T cells, as does the most prevalent metal allergen nickel, are not yet identified in a regulatory context. T cell reactivity to chemical sensitizers might be especially relevant in real-life scenarios, where skin injury, co-exposure to irritants in chemical mixtures, or infections may trigger the heterologous innate immune stimulation necessary to induce adaptive T cell responses. Additionally, cross-reactivity, which underlies cross-allergies, can only be assessed by T cell tests. To date, several experimental T cell tests are available that use primary naïve and memory CD4+ and CD8+ T cells from human blood. These include priming and lymphocyte proliferation tests and, most recently, activation-induced marker (AIM) assays. All approaches are challenged by chemical-mediated toxicity, inefficient or unknown generation of T cell epitopes, and a low throughput. Here, we summarize solutions and strategies to confirm in vitro T cell signals. Broader application and standardization are necessary to possibly define chemical applicability domains and to strengthen the role of T cell tests in regulatory risk assessment.

Characterization of Pediatric Patch Testing: A Retrospective Review, 2020-2023

Background: Recent evidence shows similar rates of allergic contact Dermatitis® (ACD) among children and adults despite children accounting for less than 10% of patch testing subjects. With a need for in-depth analyses of pediatric ACD, we herein characterize a pediatric cohort at a large North American patch testing center. Methods: A retrospective chart review was conducted for 135 patients ages 1-17 years who underwent patch testing from July 2020 from August 2023. Data were stratified by age 1-5, 6-11, and 12-17 years. Significance-Prevalence Index Numbers (SPIN) were calculated. Results: A total of 86% were sensitized, 40% had a relevant reaction, and positivity rates were equal between males and females. Top allergens by SPIN differed with age, but overall were linalool hydroperoxides (SPIN = 11.01), propylene glycol (10.30), limonene hydroperoxides (10.27), fragrance mix I (5.62), and lanolin (4.90). In total, 14% of the top allergens were not represented on the North American Contact Dermatitis® Group standard series. Of those tested to personal products, 45% had positive reactions and 72% of which were relevant. Conclusions: Emulsifiers and fragrances were the most relevant allergen categories, with the impact of emulsifiers not previously reported. ACD may affect males and females equally in this population. Supplemental allergens and personal products tested "as-is" contribute to conclusive pediatric patch testing.

Differential Diagnosis of Irritant Versus Allergic Contact Dermatitis Based on Noninvasive Methods

INTRODUCTION

Irritant contact dermatitis (ICD) is characterized by direct injury to the epidermal cells, activating the innate immune response. Allergic contact dermatitis (ACD), in contrast, is delineated by a delayed hypersensitivity reaction of type IV. Despite the distinct etiopathogenic mechanisms under-pinning each condition, the differentiation between them presents a significant diagnostic challenge.

OBJECTIVE

This study aimed to determine whether a combination of clinical evaluation and noninvasive measurements-encompassing oxidative stress, erythema, hydration, melanin content, transepidermal water loss (TEWL), hemoglobin concentration, and skin texture and volume-could distinguish ICD from ACD.

METHODS

Two cohorts, each comprising 21 patients, were evaluated: one diagnosed with ICD and the other with ACD. All participants underwent biophysical and clinical assessments, along with Antera® 3D evaluations. Tape strips were utilized for skin sampling, and oxidative stress levels were measured via fluorescence assessments.

RESULTS

ICD prompted an almost immediate inflammatory reaction (peaking at 24 hours), whereas ACD incited a delayed response (72 hours). Noninvasive evaluated parameters such as hemoglobin concentration, skin texture and volume, melanin content, erythema, and TEWL showed significant differences between the ICD and ACD cohorts (P < 0.05). The allergens amcinonide, nickel sulphate, cobalt chloride, budesonide, PPD, and thiuram mix were found to induce elevated levels of oxidative stress.

CONCLUSIONS

The evaluation of patients with noninvasive parameters, including transepidermal water loss (TEWL), hemoglobin concentration, and skin texture and volume, could markedly aid in distinguishing irritant contact dermatitis from allergic contact dermatitis (ACD). Nevertheless, the study was constrained by a limited sample size.

ZnO Nanoparticles as Potent Inducers of Dermal Immunosuppression in Contact Hypersensitivity in Mice

Nanosized zinc oxide (nZnO) metal particles are used in skin creams and sunscreens to enhance their texture and optical properties as UV filters. Despite their common use, little is known about the molecular mechanisms of nZnO exposure on damaged skin. We studied the effects of topically applied nZnO particles on allergic skin inflammation in an oxazolone (OXA)-induced contact hypersensitivity (CHS) mouse model. We investigated whether exposure to nZnO during the sensitization or challenge phase would induce immunological changes and modulate transcriptional responses. We followed skin thickness, cellular infiltration, and changes in the local transcriptome up to 28 days after the challenge. The responses peaked at 24 h and were fully resolved by 28 days. Co-exposure to nZnO and hapten did not interfere with the formation of the sensitization process. Conversely, during the hapten challenge, the application of nZnO fully suppressed the development of the CHS response by the inhibition of pro-inflammatory pathways, secretion of pro-inflammatory cytokines, and proliferation of immune cells. In differentiated and stimulated THP-1 cells and the CHS mouse model, we found that nZnO particles and Zn ions contributed to anti-inflammatory responses. The immunosuppressive properties of nZnO in inflamed skin are mediated by impaired IL-1R-, CXCR2-, and LTB4-mediated pathways. nZnO-induced dermal immunosuppression may be beneficial for individuals with contact allergies who use nZnO-containing cosmetic products. Our findings also provide a deeper understanding of the mechanisms of nZnO, which could be considered when developing nanoparticle-containing skin products.

Paracrine regulations of IFN-γ secreting CD4 + T cells by lumican and biglycan are protective in allergic contact dermatitis

The extracellular matrix (ECM) is known to regulate innate immune cells but its role in T cell functions is poorly understood. Here, we show a protective role for ECM proteoglycans, lumican and biglycan in hapten-induced contact dermatitis that is achieved through limiting proinflammatory CD4 + T cells. Lumican and biglycan-null mice develop significant inflammation with greater numbers of CD4 + T cells in hapten-challenged ear pinnae, while their draining lymph nodes show increased T-bet-STAT1 signaling, Th1 commitment, and IFN-γ secreting CD4 + T cell proliferation. Wild type mouse lymph node fibroblastic reticular cells secrete lumican, biglycan and decorin, a related proteoglycan, while none are expressed by naive or activated T cells. In vitro , lumican and biglycan co-localize with LFA-1 on T cell surfaces, and all three proteoglycans suppress LFA-1 mediated T cell activation. Overall, this study elucidates a novel paracrine regulation of Th1 cells by ECM proteoglycans to limit inflammation and tissue damage.

Contact Allergy Screening for Atopic Dermatitis

Atopic dermatitis (AD) and allergic contact dermatitis (ACD) are common inflammatory skin diseases in both children and adults that present similarly and often coexist. Patch testing is the gold standard for establishing the diagnosis of ACD and can often help distinct between the 2 conditions. Patch testing is more challenging in patients with underlying AD due to potential for angry back reactions. In this review, we discuss the current evidence and guidelines regarding the screening for contact allergies in patients with AD. We also discuss the most frequent relevant allergens in adults and children with atopic dermatitis.

Pioneering bioinformatics with agent-based modelling: an innovative protocol to accurately forecast skin or respiratory allergic reactions to chemical sensitizers

The assessment of the allergenic potential of chemicals, crucial for ensuring public health safety, faces challenges in accuracy and raises ethical concerns due to reliance on animal testing. This paper presents a novel bioinformatic protocol designed to address the critical challenge of predicting immune responses to chemical sensitizers without the use of animal testing. The core innovation lies in the integration of advanced bioinformatics tools, including the Universal Immune System Simulator (UISS), which models detailed immune system dynamics. By leveraging data from structural predictions and docking simulations, our approach provides a more accurate and ethical method for chemical safety evaluations, especially in distinguishing between skin and respiratory sensitizers. Our approach integrates a comprehensive eight-step process, beginning with the meticulous collection of chemical and protein data from databases like PubChem and the Protein Data Bank. Following data acquisition, structural predictions are performed using cutting-edge tools such as AlphaFold to model proteins whose structures have not been previously elucidated. This structural information is then utilized in subsequent docking simulations, leveraging both ligand-protein and protein-protein interactions to predict how chemical compounds may trigger immune responses. The core novelty of our method lies in the application of UISS-an advanced agent-based modelling system that simulates detailed immune system dynamics. By inputting the results from earlier stages, including docking scores and potential epitope identifications, UISS meticulously forecasts the type and severity of immune responses, distinguishing between Th1-mediated skin and Th2-mediated respiratory allergic reactions. This ability to predict distinct immune pathways is a crucial advance over current methods, which often cannot differentiate between the sensitization mechanisms. To validate the accuracy and robustness of our approach, we applied the protocol to well-known sensitizers: 2,4-dinitrochlorobenzene for skin allergies and trimellitic anhydride for respiratory allergies. The results clearly demonstrate the protocol's ability to differentiate between these distinct immune responses, underscoring its potential for replacing traditional animal-based testing methods. The results not only support the potential of our method to replace animal testing in chemical safety assessments but also highlight its role in enhancing the understanding of chemical-induced immune reactions. Through this innovative integration of computational biology and immunological modelling, our protocol offers a transformative approach to toxicological evaluations, increasing the reliability of safety assessments.

Exposure of cinnamyl alcohol in co-culture of BEAS-2B and dendritic cells: Interaction between CYP450 and cytokines

The prevalence of fragrances in various hygiene products contributes to their sensorial allure. However, fragrances can induce sensitization in the skin or respiratory system, and the mechanisms involved in this process are incompletely understood. This study investigated the intricate mechanisms underlying the fragrance's effects on sensitization response, focusing on the interplay between CYP450 enzymes, a class of drug-metabolizing enzymes, and the adaptive immune system. Specifically, we assessed the expression of CYP450 enzymes and cytokine profiles in culture of BEAS-2B and mature dendritic cells (mDC) alone or in co-culture stimulated with 2 mM of a common fragrance, cinnamyl alcohol (CA) for 20 h. CYP1A1, CYP1A2, CYP1B1, CYP2A6, and CYP2A13 were analyzed by RT-PCR and IL-10, IL-12p70, IL-18, IL-33, and thymic stromal lymphopoietin (TSLP) by Cytometric Bead Array (CBA). Through RT-PCR analysis, we observed that CA increased CYP1A2 and CYP1B1 expression in BEAS-2B, with a further increased in BEAS-2B-mDC co-culture. Additionally, exposure to CA increased IL-12p70 levels in mDC rather than in BEAS-2B-mDC co-culture. In regards to IL-18, level was higher in BEAS-2B than in BEAS-2B-mDC co-culture. A positive correlation between the levels of IL-10 and CYP1B1 was found in mDC-CA-exposed and between IL-12p70 and CYP1A1 was found in BEAS-2B after CA exposure. However, IL-12p70 and CYP1A2 as well as IL-18, IL-33, and CYP1A1 levels were negative, correlated mainly in co-culture control. These correlations highlight potential immunomodulatory interactions and complex regulatory relationships. Overall, exposure to CA enhances CYP450 expression, suggesting that CA can influence immune responses by degrading ligands on xenosensitive transcription factors.

Recognizing and Managing Allergic Contact Dermatitis: Focus on Major Allergens

Patch testing is the reference standard for the diagnosis of allergic contact dermatitis. Identification and avoidance of culprit allergens are essential in the treatment of this disease. Each year, new allergens are identified as emerging or important. The authors discuss allergens that are common, enduring, emergent, incompletely recognized, and controversial for the practicing allergist and dermatologist. This Clinical Management Review will encompass a review of fragrances, preservatives, rubber, acrylates, metals, and medications; their common sources of exposure; controversies in diagnosis and patch testing; management and how to avoid those allergens. This review will also include practical aspects of diagnosis and management and will provide resources that can be used as guidance for physicians and patients on nickel, methylchloroisothiazolinone/methylisothiazolinone, and fragrance, the most common allergens positive on patch testing.

Comorbid Scenarios in Contact Dermatitis: Atopic Dermatitis, Irritant Dermatitis, and Extremes of Age

Contact dermatitis (allergic and irritant) occurs when the skin encounters haptens that elicit a T cell-mediated hypersensitivity reaction (allergic) or a nonimmunologic, toxic reaction (irritant). Patch testing is the reference standard for diagnosing allergic contact dermatitis (ACD), although positive results are not always relevant. Therefore, the definitive diagnosis of ACD requires an astute clinician able to connect the results of patch testing appropriately with the clinical history and the cutaneous examination findings. Comorbid conditions such as atopic dermatitis can confound the accurate diagnosis of ACD because of the similarities in clinical presentation. Furthermore, both extremes of age can further challenge the diagnostic specificity of ACD owing to the maturing immune system and the space limitations present when the very young are patch tested. The goal of this Continuing Medical Education article is to discuss the challenges of diagnosing ACD in patients with unique comorbidities such as atopic dermatitis, given the morphologic similarities, and when to patch test these patients. Diagnosis of ACD will also be discussed in very young patients with a focus on patch test allergen selection despite the limited geographic space. The most common allergens reported in very young and old patients will also be discussed.

Beyond Avoidance: Advanced Therapies for Contact Dermatitis

Contact dermatitis (CD) is a common and burdensome condition divided into irritant contact dermatitis and allergic contact dermatitis. Treatment relies on accurate diagnosis and identification of the trigger, because definitive treatment is irritant or allergen avoidance. However, avoidance is not always possible, such as when the patient is reacting to a necessary medical device, when the trigger is integral to the patient's occupation, and when avoidance is practically untenable. In these cases, treatment is particularly challenging, especially because the literature on treatments in this clinical scenario is limited. In addition, CD has a complex pathophysiology that varies according to the trigger type, leading to variable treatment efficacy. This article reviews the current literature on treatments for CD with a focus on treatments when trigger avoidance is not feasible.

Proton pump inhibitor alters Th17/Treg balance and induces gut dysbiosis suppressing contact hypersensitivity reaction in mice

Proton pump inhibitors (PPIs), such as omeprazole, are the most commonly prescribed drugs. Treatment with PPIs alters gut microbiota composition and reduces the production of reactive oxygen (ROS) and proinflammatory IL-1β, IL-6, and TNF-α cytokines. Here, using the T cell-dependent contact hypersensitivity (CHS) response, an animal model of allergic contact dermatitis (ACD) that affects up to 30% of the population, we demonstrated that a two-week omeprazole treatment suppresses the development of CHS. Omeprazole treatment before CHS induction, reduced inflammatory response in ears measured by ear swelling, ear biopsy weight, MPO activity, and proinflammatory cytokine production. These changes were associated with reduced frequency of TCRαβ+ CD4+ IL-17A+ and TCRαβ+ CD8+ IL-17A+ T cells and increased frequency of TCRαβ+ CD4+ CD25+ FoxP3+ Treg, and TCRαβ+ CD4+ IL-10+ Tr1 cells in peripheral lymphoid organs. Omeprazole treatment decreased the production of ROS, TNF-α, and IL-6, which supported Th17 cell induction, and increased the frequency of Clostridium cluster XIVab and Lactobacillus, implicated in Treg cell induction. The fecal microbiota transplantation (FMT) experiment confirmed the role of omeprazole-induced changes in gut microbiota profile in CHS suppression. Our data suggests that omeprazole ameliorates inflammatory response mediated by T-cells.

Causal associations between fluid intake patterns and dermatitis risk: a Mendelian randomization study

BACKGROUND

Dermatitis is one of the most common skin disorders across the world. Atopic dermatitis (AD) and contact dermatitis (CD) are its two primary types. Few studies have focused on the causal relationship between fluid intake and dermatitis. With an Mendelian Randomization (MR), this study investigated the potential causal effects of alcohol, coffee, tea, and water intake on the risk of AD and CD.

METHODS

Utilizing genetic variants as instrumental variables (IVs), a two-sample MR analysis was implemented based on data from the UK Biobank and FinnGen r9 consortium. Fluid intake was categorized into alcohol, coffee, tea, and water intake. Causal estimates were analyzed through Inverse Variance Weighted (IVW), MR-Egger, and weighted median methods. Cochran's Q, MR-Egger intercept, and MR-PRESSO tests were conducted to assess potential heterogeneity and pleiotropy.

RESULTS

Water intake exhibited a significant causal effect on raised CD risk (IVW OR = 2.92, 95% CI: 1.58-5.41, p = <0.01). Coffee intake was associated with increased CD risk (IVW OR = 2.16, 95% CI: 1.19-3.91, p = 0.01). Conversely, tea intake demonstrated a protective effect on AD risk (IVW OR = 0.71, 95% CI: 0.56-0.91, p = <0.01).

CONCLUSION

This MR study suggests a potential association where water and coffee intake may be linked to an elevated risk of CD, while tea intake may potentially have a mitigating effect on AD risk. Modifying fluid intake patterns could be a targeted approach for dermatitis prevention, emphasizing the need for additional longitudinal studies to validate and expand upon these findings.

Eyelid dermatitis in patch-tested adult patients: a systematic review with a meta-analysis

Eyelid dermatitis (ED) affects a cosmetically significant area and leads to patients' distress. Despite ongoing and recent research efforts, ED remains a multidisciplinary problem that needs further characterization. We aimed to evaluate the atopic eyelid dermatitis (AED) frequency in ED patients and to perform their clinical profiling. PubMed databases were searched from 01.01.1980 till 01.02.2024 to PRISMA guidelines using a search strategy: (eyelid OR periorbital OR periocular) AND (dermatitis or eczema). Studies with patch-tested ED patients were included. Proportional meta-analysis was performed using JBI SUMARI software. We included 65 studies across Europe, North America, Asia and Australia, with a total of 21,793 patch-tested ED patients. AED was reported in 27.5% (95% CI 0.177, 0.384) of patch-tested ED patients. Isolated ED was noted in 51.6% (95% CI 0.408, 0.623) of 8453 ED patients with reported lesion distribution, including 430 patients with isolated AED. Our meta-analysis demonstrated that the AED frequency in patch-tested ED patients exceeded the previous estimate of 10%. Isolated AED was noted in adult patients, attending contact allergy clinics. Future studies are needed to elucidate the global prevalence and natural history of isolated AED in adults.

Contact sensitization and self-reported eczema in Swedish painters with occupational exposure to isothiazolinones

BACKGROUND

Due to an increasing occupational usage of isothiazolinone (IT)-containing preservatives, and their potential to cause skin sensitization and allergic contact dermatitis, that is, chronic disease, there is a need for more knowledge on how highly exposed workers are affected.

OBJECTIVES

The overall objective was to explore dermatological symptoms of potentially long-lasting or chronic character in Swedish painters.

METHODS

Building painters from western and southern Sweden were initially invited to perform a questionnaire on occurrence of skin symptoms. Participants with affirmative responses, and the right inclusion criteria, were further invited to patch testing with four different ITs: benzisothiazolinone (BIT), methylisothiazolinone, methylchloroisothiazolinone and octylisothiazolinone.

RESULTS

There was a tendency towards higher occurrence of positive patch test reactions among the painters compared with occupationally unexposed registry patients; however, not statistically significant differences. BIT was the substance most frequently causing positive test results in both groups. The occurrence of adult-onset eczema was higher in painters than in the control group of electricians, and just shy of statistical significance concerning any of several skin locations (face/legs/arms/hands).

CONCLUSION

Building painters present with positive patch test reactions to common paint preservatives (ITs), and they report adult-onset eczema more often than do less occupationally exposed groups.

How Allergists Can Perform an Occupational History in Every Patient

The occupational history is often neglected in the routine evaluation of new patients with asthma, chronic rhinitis, or dermatologic complaints. Such omissions are inadvertent because work-related conditions are often not prioritized. There also may be lack of awareness of the scope of respiratory or cutaneous allergens capable of inducing occupational asthma (OA) or work-related contact dermatitis. Evidence exists suggesting that the occupational history is often neglected among primary care physicians and specialists. Failure to diagnose OA in a timely fashion by identifying occupational sources of exposure, for example, may result in unnecessary morbidity in workers whose exposure is not modified. In this commentary, we propose a brief intake survey to be administered to all patients coming to an allergy practice to quickly screen for possible work-related respiratory symptoms and another for occupational dermatitis. This would require minimal physician time and could be self-administered at the initial encounter and incorporated into the medical record. A positive response to either survey should trigger a more detailed evaluation by the allergy specialist. More detailed approaches for stepwise clinical evaluation of the worker suspected of OA and contact dermatitis are discussed.

Are "clean" products safe for children? An analysis of contact allergens in "clean" children's products from a popular retailer

BACKGROUND

Considering consumer trends toward the use of "clean" personal care products and increasing recognition of childhood allergic contact dermatitis, we sought to characterize the allergen profile of such children's products.

METHODS

Ingredients of baby washes/shampoos, bubble baths, and moisturizers identified using the "Clean Baby" filter on Target®'s online marketplace were analyzed for relevant pediatric contact allergens.

RESULTS

Product compositions declared fragrance in 82% of products, Compositae in 46%, cocamidopropyl betaine in 45%, glucosides in 37%, propylene glycol in 12%, lanolin in 1%, and no allergens in 9%-methylisothiazolinone and formaldehyde were not found.

CONCLUSION

Children are greatly impacted by atopic dermatitis and skin barrier dysfunction, which underscores a need for greater public awareness of sensitizing and irritating ingredients, particularly regarding pediatric personal care products.

Less efficient skin penetration of the metal allergen Pd2+ compared to Ni2+ and Co2+ from patch test preparations

BACKGROUND

Contrary to Ni2+- and Co2+-induced allergic contact dermatitis (ACD), reactions against Pd2+ are rare. However, Pd2+ activates a larger T cell fraction in vitro, suggesting an inefficient skin penetration.

OBJECTIVES

This study compares Ni2+, Co2+ and Pd2+ skin penetration from commonly used diagnostic patch test preparations (PTPs) and aqueous metal salt solutions.

METHODS

Using Franz diffusion cell assays, we applied the metals in PTPs (5% NiSO4, 1% CoCl2, 2% PdCl2 and 3% Na2PdCl4) and in solution to pigskin for 48 h, thereby mirroring the time frame of a patch test. The different compartments were analysed individually by inductively coupled plasma mass spectrometry.

RESULTS

Metal ions were mainly retained in the upper stratum corneum layers. After application of PTPs, concentrations in the viable skin were lower for Pd2+ (1 and 7 μM) compared to Ni2+ and Co2+ (54 and 17 μM).

CONCLUSIONS

Ni2+ and Co2+ penetrated the skin more efficiently than Pd2+ and thus may sensitize and elicit ACD more easily. This was observed for ions applied in petrolatum and aqueous solutions. We hypothesize that the differently charged metal complexes are responsible for the varying skin penetration behaviours.

Protein Haptenation and Its Role in Allergy

Humans are exposed to numerous electrophilic chemicals either as medicines, in the workplace, in nature, or through use of many common cosmetic and household products. Covalent modification of human proteins by such chemicals, or protein haptenation, is a common occurrence in cells and may result in generation of antigenic species, leading to development of hypersensitivity reactions. Ranging in severity of symptoms from local cutaneous reactions and rhinitis to potentially life-threatening anaphylaxis and severe hypersensitivity reactions such as Stephen-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN), all these reactions have the same Molecular Initiating Event (MIE), i.e. haptenation. However, not all individuals who are exposed to electrophilic chemicals develop symptoms of hypersensitivity. In the present review, we examine common chemistry behind the haptenation reactions leading to formation of neoantigens. We explore simple reactions involving single molecule additions to a nucleophilic side chain of proteins and complex reactions involving multiple electrophilic centers on a single molecule or involving more than one electrophilic molecule as well as the generation of reactive molecules from the interaction with cellular detoxification mechanisms. Besides generation of antigenic species and enabling activation of the immune system, we explore additional events which result directly from the presence of electrophilic chemicals in cells, including activation of key defense mechanisms and immediate consequences of those reactions, and explore their potential effects. We discuss the factors that work in concert with haptenation leading to the development of hypersensitivity reactions and those that may act to prevent it from developing. We also review the potential harnessing of the specificity of haptenation in the design of potent covalent therapeutic inhibitors.

The role of the environment in allergic skin disease

PURPOSE OF REVIEW

This paper explores how environmental factors influence allergic skin diseases, including atopic dermatitis (AD), contact dermatitis (CD), urticaria, angioedema, and reactions to drugs and insect bites.

RECENT FINDINGS

Research indicates a significant impact of environmental elements on allergic skin diseases. High air pollution levels exacerbate symptoms, while climate change contributes to increased skin barrier dysfunction, particularly affecting AD. Allergen prevalence is influenced by climate and pollution. Irritants, like those in detergents and cosmetics, play a major role in CD. Plants also contribute, causing various skin reactions. Understanding the interplay between environmental factors and allergic skin diseases is crucial for effective management. Physicians must address these factors to support patient well-being and promote skin health amidst environmental changes.

Triggered Skin Sensitivity: Understanding Contact Dermatitis

Dermatitis, the incendiary reaction of the skin to various components, can manifest in various types, including atopic dermatitis, contact dermatitis, nummular eczema, seborrhoea, and stasis dermatitis. Atopic dermatitis is the most common skin disease in children and has a growing prevalence in recent years. It is characterized by extreme tingling, eczemous skin injuries, dryness of the skin, and a family history of atopic illnesses. Contact dermatitis (CD) is a common, irritating skin disorder caused by allergens and aggravating elements in the environment. It is the most common cause of work-related dermatitis and plays a substantial role in hand and face dermatitis. A complete restorative history is essential for establishing CD and identifying the allergies that cause it. Fix testing, skin tests for fast contact reactions, serum allergen-specific IgE testing, subjective and quantitative evaluation of allergens inside probable items patients were exposed to, and challenge testing are among the other diagnostic techniques. To avoid a breakdown and the continuation of the skin illness, early and suitable therapy is critical. Allergic dermatitis to contact (ACD) develops during the normal, delayed incendiary reaction and has a perplexing etiology. Accurate identification of the allergen that is causing the reaction allows for adequate individual avoidance. The major treatment alternatives continue to be corticosteroids. Nickel-contact dermatitis is an allergic reaction that affects both children and adults. Adverse contact dermatitis (ACD) is a frequent skin reaction to a common allergen that can affect both children and adults. Less than 10% of all diagnostic procedures in pediatric patients involve checking for ACD symptoms. To answer the clinical question, a thorough history is gathered based on appearance, age group, and dermatitis type. According to pediatricians in the US, metals, perfumes, topical antimicrobials, excessive chemicals, and fabric softeners are the most typical allergens.

Prevalence of potential contact allergens in best-selling baby cleansers

Many baby cleansers are promoted as hypoallergic products; however, these claims are not typically validated. This study assessed the 50 best-selling baby cleansers from online retailer Amazon for potential allergens. We found that the presence of most marketing claims, including "hypoallergenic" or "allergy-tested," did not correlate with the number of potential allergens in a cleanser. Furthermore, the total number of marketing claims of a cleanser was positively correlated with the number of allergens, highlighting the discordance between marketing claims and allergen content in baby cleansers.

Prevalence of Occupational Contact Dermatitis Among Dental Personnel Using the Nordic Occupational Skin Questionnaire-2002: A Prospective Cross-Sectional Study

BACKGROUND

Occupational skin disease (OSD), such as contact dermatitis, is widespread among dental professionals; however, reports regarding its prevalence have inconsistent findings and methodology. Therefore, we conducted a cross-sectional survey using a self-reported questionnaire to estimate the prevalence of work-related and occupational exposure-induced skin diseases.

METHODOLOGY

A self-administered questionnaire, based on the validated Nordic Occupational Skin Questionnaire-2002, was distributed to 15 dental clinics in Israel in the first half of 2022. The questionnaire included questions about the occupation, exposure, and history of atopic disease, dry skin, and hand/arm and wrist eczema, as well as participant demographics.

RESULTS

Overall, 312 dental professionals completed the questionnaires. Response rate was 80%. The lifetime prevalence of self-reported skin symptoms was 19.23%. Significant risk factors included exposure to metal objects, odds ratio (OR): 2.43, 95% confidence interval (CI): [1.02, 5.78]; p < .05, dry skin (OR: 3.54, 95% CI: [1.93, 6.5]; p < .001), itching when sweating (OR: 2.89, 95% CI: [1.39, 6]; p < .05), contact urticaria (OR: 10.67, 95% CI: [4.46, 25.49]; p < .001), hay fever (OR: 2.25, 95% CI: [1.14, 4.42]; p < .05), allergic symptoms (OR; 2.33, 95% CI: [1.18, 4.58]; p < .05), and asthma (OR: 4.8, 95% CI: [2.17, 10.36]; p < .001).

CONCLUSIONS

This is the first study to use the NOSQ-2002 among dental professionals. Our study provides a better understanding of the prevalence and consequences of OSDs among dental personnel by utilizing the validated tool NOSQ-2002.