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were children aged 0 to 16 years&#44; and of these&#44; 144 &#40;54&#46;3&#37;&#41; had positive results to at least 1 allergen &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> and <a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">Of the 144 sensitized children&#44; 113 &#40;84&#37;&#41; had positive patch test results with present relevance&#46; A total of 302 patch test results were positive &#40;mean of 2&#46;1 positive results per patient&#41;&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">The mean &#40;SD&#41; age of patients referred to the clinic was 11&#46;1 &#40;3&#46;7&#41; years&#46; No significant differences in age were found between children with and without ACD&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">As for distribution by sex&#44; 155 of the 265 children were girls &#40;58&#46;5&#37;&#41; and 110 were boys &#40;41&#46;5&#37;&#41;&#46; The group of sensitized patients comprised 85 girls &#40;59&#37;&#41; and 59 boys &#40;41&#37;&#41;&#59; the group of nonsensitized patients comprised 70 girls &#40;57&#46;9&#37;&#41; and 51 boys &#40;42&#46;1&#37;&#41;&#46; The chi-square test revealed no significant association between sex and a positive patch test result&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">No significant differences were found in the prevalence of sensitization with respect to age at onset &#40;0-2 years&#44; 2-5 years&#44; 5-10 years&#44; 10-15 years&#44; and &#62;<span class="elsevierStyleHsp" style=""></span>15 years&#41;&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Positive reactions are shown by site in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#46; The most commonly affected area was the trunk &#40;16 positive results in 20 patients with lesions on the trunk &#91;80&#37;&#93;&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall">Of the 265 children studied&#44; 70 &#40;26&#46;4&#37;&#41; had a history of atopy&#46; The prevalence of sensitization in children with no history of atopy was 1&#46;3 times higher than in children with a history of atopy&#46; The chi-square test revealed a slightly significant difference &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;049&#41; between the absence of a personal history of atopy and ACD&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">The most common allergens were&#44; in descending order of frequency&#44; thiomersal &#40;27 cases&#41;&#44; colophony &#40;24 cases&#41;&#44; paraphenylenediamine &#40;PPDA&#44; 22 cases&#41;&#44; metals &#40;potassium dichromate&#44; 21 cases&#59; mercury&#44; 21 cases&#59; and nickel&#44; 17 cases&#41;&#44; fragrances &#40;mixes <span class="elsevierStyleSmallCaps">i</span> and <span class="elsevierStyleSmallCaps">ii</span>&#44; 11 cases&#59; Peru balsam&#44; 6 cases&#41;&#44; and rubber &#40;mercapto mix&#44; 12 cases&#59; thiuram mix&#44; 4 cases&#41;&#46; The highest percentages of relevant cases were observed for colophony &#40;100&#37;&#41;&#44; ketoprofen &#40;100&#37;&#41;&#44; and PPDA &#40;86&#46;4&#37;&#41;&#46; The lowest percentages of relevant cases were observed for Peru balsam &#40;33&#46;3&#37;&#41;&#44; nickel &#40;29&#46;4&#37;&#41;&#44; and thiomersal &#40;22&#46;2&#37;&#41;&#46; <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a> shows the most common allergens and cases with present relevance&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0065" class="elsevierStylePara elsevierViewall">Thiomersal was the most common allergen&#44; with 27 positive patch test results&#44; although the relevance was unknown in most cases &#40;87&#46;8&#37;&#41;&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">We found 17 cases of sensitization to nickel&#44; with a prevalence of sensitization that was 6-fold higher in girls &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;01&#41;&#46; More than half of the children who were sensitized to nickel &#40;58&#46;8&#37;&#41; were cosensitized to cobalt&#46; During the period 2010-2015&#44; cases of sensitization to nickel decreased by 71&#37; compared with 2004-2009&#46; No cases of sensitization to nickel were diagnosed during the last 3 years of the study period &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0075" class="elsevierStylePara elsevierViewall">We recorded 22 cases of sensitization to PPDA&#44; with a stable number of cases over time &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; All the cases appeared after placement of a temporary black henna tattoo&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Of the 21 cases of sensitization to chrome&#44; 15 &#40;71&#46;4&#37;&#41; involved the feet and were all associated with footwear and considered to be of present relevance&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">Sensitization to mercury was considered to be of present relevance in 8 cases &#40;38&#46;1&#37;&#41;&#46; In 11 cases of sensitized children &#40;52&#46;3&#37;&#41;&#44; the patient was also sensitized to thiomersal&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">The most commonly used additional test series were footwear and preservatives &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46; Of the 302 positive patch test results&#44; 262 &#40;87&#37;&#41; were diagnosed using the standard series&#44; and only 40 &#40;13&#37;&#41; were confirmed allergens from additional series&#46; The patient&#39;s own products were patch tested in 53 cases and confirmed the diagnosis in 17 cases&#59; these would have gone undetected if the patient&#39;s own products &#40;mainly sunscreens and topical drugs&#41; had not been used in the patch test&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discussion</span><p id="par0095" class="elsevierStylePara elsevierViewall">We found that the prevalence of sensitization in children referred to our skin allergy clinic was 54&#46;3&#37;&#44; which is similar to data reported elsewhere&#46;<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">4&#8211;10</span></a> However&#44; this parameter is very variable and depends on referral criteria&#44; epidemiological characteristics&#44; and exposure to allergens in the study population&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">In contrast with our findings&#44; many studies report a greater prevalence of ACD in females&#46;<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">6&#44;7</span></a> Hormonal and exposure-related factors have been suggested&#44; although most cases seem to be associated with more frequent wearing of jewelry and ear piercing at an early age in the case of nickel allergy&#46; Although we did not find significant differences in the prevalence of sensitization between boys and girls&#44; the prevalence of sensitization to nickel was 6-fold higher in girls&#44; consistent with findings reported elsewhere&#46; This could explain the female predominance of pediatric ACD found in many studies where nickel is the main cause of the condition&#46;<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">6&#44;7</span></a></p><p id="par0105" class="elsevierStylePara elsevierViewall">The association between atopy and ACD is controversial&#46;<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">1&#44;2&#44;6</span></a> In our study&#44; we found a slightly statistically significant lower prevalence of ACD in atopic children&#46; This result is consistent with the lower incidence of skin allergy in patients with atopy reported elsewhere&#46;<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">1&#44;2&#44;7</span></a></p><p id="par0110" class="elsevierStylePara elsevierViewall">The most frequent allergens in our study were mercury compounds&#44; metals present in jewelry&#44; PPDA&#44; products present in footwear&#44; and fragrances&#46; These allergens and their prevalence are very similar to those found in adults during the same period &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0115" class="elsevierStylePara elsevierViewall">Mercury compounds were the most frequent group of allergens in the children we studied&#46; In the case of thiomersal&#44; the relevance of most reactions was unknown&#46; This observation is consistent with those of other studies&#44; where thiomersal was reported to be a very prevalent allergen in the general population&#44; albeit with a low number of cases of relevant sensitization&#46;<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">1&#44;7&#44;8</span></a> Consequently&#44; withdrawal of thiomersal from the standard series is currently being evaluated&#46; Contact with broken mercury thermometers or use of antiseptics based on mercury compounds are additional routes of sensitization to mercury&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">Jewelry and metals present in clothing and footwear were the second most common cause of sensitization after thiomersal&#46; This observation is consistent with findings from many pediatric series&#44; in which nickel was the most common allergen&#46;<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">7&#44;11&#44;12</span></a> Cosensitization to cobalt is common in patients sensitized to nickel or chrome&#46;<a class="elsevierStyleCrossRefs" href="#bib0220"><span class="elsevierStyleSup">13&#44;14</span></a> The number of cases of sensitization to nickel has fallen considerably since the implementation of European legislation on nickel content in jewelry&#46;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">15</span></a></p><p id="par0125" class="elsevierStylePara elsevierViewall">We detected a high number of positive reactions to PPDA&#44; which is the third most frequent cause of ACD in our setting&#46; As reported elsewhere&#44; temporary black henna tattoos were the most frequent cause of sensitization&#46;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">16</span></a> Use of PPDA in cosmetic products &#40;with the exception of hair dyes&#41; has been prohibited in the European Union since 2009&#46;<a class="elsevierStyleCrossRefs" href="#bib0240"><span class="elsevierStyleSup">17&#44;18</span></a> The number of cases of sensitization to PPDA fell during 2010-2015 compared with 2004-2009&#44; although cases are still being reported despite the fact that its use in cosmetics is banned&#46; Sensitization to PPDA is particularly important owing to the possibility of life-threatening severe acute reactions&#44; potential long-term sequelae&#44; and the ubiquitous presence of the allergen in many products in daily use&#44; as well as its cross-reactivity with drugs from the <span class="elsevierStyleItalic">para-</span> group &#40;eg&#44; oral antidiabetic drugs&#44; topical anesthetics&#44; and sulfamides&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0250"><span class="elsevierStyleSup">19&#8211;21</span></a> Despite the health alert and legislative initiatives&#44; more legal and educational measures are necessary if we are to regulate exposure of children to PPDA&#44; specifically through temporary black henna tattoos&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">Footwear is a common cause of ACD in children&#46;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">22</span></a> The most frequent allergens in footwear-associated ACD in children are potassium dichromate &#40;used to tan natural leather&#41; and p-tert butylphenol formaldehyde &#40;used as an adhesive&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0180"><span class="elsevierStyleSup">5&#44;7&#44;13</span></a> The European Commission regulation limiting the use of chrome salts in skin products that came into force on May 1&#44; 2015 is expected to lead to a decrease in the frequency of chrome-induced ACD in the coming years&#46;<a class="elsevierStyleCrossRefs" href="#bib0230"><span class="elsevierStyleSup">15&#44;23</span></a></p><p id="par0135" class="elsevierStylePara elsevierViewall">Colophony is a resin that is present in many adhesive health products&#46; It is a major cause of iatrogenic ACD &#40;<a class="elsevierStyleCrossRef" href="#fig0020">Fig&#46; 4</a>&#41;&#44; although there may also be cases of pediatric ACD caused by colophony in leather shoes&#44; lipstick&#44; and even musical instruments&#46;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">24</span></a> Sensitization to colophony could be a marker of fragrance allergy&#46;<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">25</span></a> In the population we studied&#44; all the cases of colophony allergy were associated with the use of adhesive dressings&#44; thus confirming the major iatrogenic role of this substance&#46;</p><elsevierMultimedia ident="fig0020"></elsevierMultimedia><p id="par0140" class="elsevierStylePara elsevierViewall">Most cases of sensitization in our study were diagnosed using the standard series&#46; The European Academy of Allergology and Clinical Immunology &#40;EAACI&#41; recently proposed a reduced standard series for children &#40;<a class="elsevierStyleCrossRef" href="#tbl0025">Table 5</a>&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">3</span></a> However&#44; consistent with most epidemiological studies on pediatric ACD&#44; we believe that the GEIDAC standard series is more useful when testing children&#44; because the reduced series proposed by the EAACI does not include cobalt chloride&#44; PPDA&#44; potassium dichromate&#44; mercury&#44; or Peru balsam&#44; all of which are among the 10 most frequent allergens in our study&#46; Furthermore&#44; the series does not include methylisothiazolinone alone&#44; which is recommended based on increasing evidence from studies showing that the methylisothiazolinone&#47;methylchloroisothiazolinone mix patch is insufficient&#46;<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">6&#44;26</span></a></p><elsevierMultimedia ident="tbl0025"></elsevierMultimedia><p id="par0145" class="elsevierStylePara elsevierViewall">The allergens that most frequently caused ACD in children in our study &#40;see above&#41; are classic allergens &#40;thiomersal&#44; metals&#44; colophony&#41; with well-recognized clinical manifestations&#46; In the case of many of these allergens&#44; various legislative measures have been put in place to limit the risk of sensitization&#44; and this may explain the decreasing number of cases referred for evaluation in our study &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; However&#44; in recent years&#44; there have been reports of emerging allergens whose growing importance lies in their ubiquity and frequency of sensitization&#44; as well as in their poorer legal regulation&#46;<a class="elsevierStyleCrossRefs" href="#bib0280"><span class="elsevierStyleSup">25&#8211;28</span></a> Such is the case of fragrances and preservatives in cosmetics&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">Fragrances constitute a broad group of chemical compounds&#46; Some studies place them as the second most common cause of contact allergy in adults in our setting&#44; immediately after metals&#46; These findings agree with our results in that fragrances were the fourth most common cause of ACD after thiomersal&#44; metals&#44; and PPDA&#46; Patients with a positive result to fragrance markers in the standard series &#40;fragrance mix <span class="elsevierStyleSmallCaps">i</span> and <span class="elsevierStyleSmallCaps">ii</span>&#44; colophony&#44; and Peru balsam&#41; must undergo patch testing with a specific fragrance series in order to identify the individual fragrances the patient is sensitized to so that he&#47;she can avoid them&#46; It is important to remember that fragrances are present not only in perfumes and colognes&#44; but also in a wide rage of products such as lipstick &#40;<a class="elsevierStyleCrossRef" href="#fig0025">Fig&#46; 5</a>&#41; and makeup&#46;</p><elsevierMultimedia ident="fig0025"></elsevierMultimedia><p id="par0155" class="elsevierStylePara elsevierViewall">As for preservatives&#44; methylchloroisothiazolinone and methylisothiazolinone are among the most frequent allergens in adult ACD in the most recent series&#46;<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">28</span></a> In our study&#44; we found no cases of sensitization to methylchloroisothiazolinone and methylisothiazolinone in children&#46; Nevertheless&#44; these allergens are present in a wide rage of cosmetic products that are widely used in this age group &#40;eg&#44; gels&#44; shampoos&#44; wipes&#44; and moisturizing creams&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0285"><span class="elsevierStyleSup">26&#44;27</span></a> Some studies have shown a growing number of cases of allergy to methylchloroisothiazolinone and methylisothiazolinone in children and warn that in the future&#44; these could be among the most common allergens in this population&#46;<a class="elsevierStyleCrossRefs" href="#bib0285"><span class="elsevierStyleSup">26&#44;27</span></a></p><p id="par0160" class="elsevierStylePara elsevierViewall">Finally&#44; with respect to legislation on allergens affecting children&#44; regulation of cosmetic products for children is lacking&#44; despite the strict regulation of allergens in children&#39;s toys&#46;<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">29</span></a> The year 2012 saw the publication of a resolution from the Council of Europe aimed at regulating cosmetic products for children aged under 3 years&#46;<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">30</span></a> However&#44; the resolution is limited to general guidelines&#44;<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">31</span></a> without establishing which substances should be avoided in children&#44; apart from those already banned in Directive 76&#47;768&#47;EEC<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">17</span></a> and in Regulation EC 1223&#47;2009&#46;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">18</span></a> Thus&#44; it is necessary to establish legislative measures to protect children&#8212;a particularly vulnerable group&#8212;from exposure to potential allergens that are currently in the cosmetic products usually aimed at this population&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">In conclusion&#44; ACD is a common condition in the pediatric population and must be taken into consideration when addressing a child with suggestive eczematous lesions and a compatible clinical history&#46; Some classic allergens rarely lead to relevant sensitization or their incidence is decreasing&#46; On the other hand&#44; new allergens are emerging&#44; especially in cosmetic products for children&#44; which are often are poorly regulated&#46; We should be alert to the presence of ACD due to emerging allergens that cause clinical manifestations that differ from those of &#8220;classic&#8221; allergens&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Ethical Disclosures</span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Protection of humans and animals</span><p id="par0170" class="elsevierStylePara elsevierViewall">The authors declare that no tests were carried out in humans or animals for the purposes of this study&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Confidentiality of data</span><p id="par0175" class="elsevierStylePara elsevierViewall">The authors declare that they have followed their institutional protocols on publication of patient data&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Right to privacy and informed consent</span><p id="par0180" class="elsevierStylePara elsevierViewall">The authors declare that no private patient data appear in this article&#46;</p></span></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Conflicts of Interest</span><p id="par0185" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Background</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Few epidemiological studies have investigated the incidence of allergic contact dermatitis in children&#46; Underdiagnosis has been observed in some studies&#44; with many cases in which the condition is not suspected clinically and patch tests are not performed&#46; However&#44; the prevalence of pediatric sensitization to allergens has been reported to be as high as 20&#37;&#44; and the diagnosis should therefore be contemplated as a possibility in this age group&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Material and methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">We performed a retrospective analysis of the skin allergy database of the Dermatology Department of Consorcio Hospital General Universitario de Valencia&#46; Children between 0 and 16 years of age diagnosed with allergic contact dermatitis in the previous 15 years &#40;between 2000 and 2015&#41; were included in the analysis&#46; Epidemiological &#40;age&#44; sex&#44; history of atopy&#41; and clinical &#40;site of the lesions&#44; allergen series applied&#44; positive reactions&#44; and their relevance&#41; variables were gathered&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Patch tests had been performed on 4&#44;593 patients during the study period&#46; Of these&#44; 265 &#40;6&#37;&#41; were children aged between 0 and 16 years&#46; A positive reaction to at least one of the allergens tested was observed in 144 &#40;54&#46;3&#37;&#41; patients in that group&#46; The allergens most frequently identified were the following &#40;in decreasing order of frequency&#41;&#58; thiomersal&#44; cobalt chloride&#44; colophony&#44; paraphenylenediamine&#44; potassium dichromate&#44; mercury&#44; and nickel&#46; The sensitization was considered relevant in 177 &#40;61&#46;3&#37;&#41; cases&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">More than half of the children studied showed sensitization to 1 or more allergens&#44; with a high percentage of relevant sensitizations&#46; All children with a clinical suspicion of allergic contact dermatitis should be referred for patch testing&#46; As no standardized test series have been developed for this age group&#44; a high level of clinical suspicion and knowledge of the allergens most commonly involved are required when selecting the allergens to be tested&#46;</p></span>"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introducci&#243;n</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Los estudios epidemiol&#243;gicos sobre incidencia de dermatitis al&#233;rgica de contacto en poblaci&#243;n pedi&#225;trica son escasos&#46; Algunos trabajos consideran que se trata de una entidad infradiagnosticada&#44; y que en muchos casos no se sospecha cl&#237;nicamente&#44; no realiz&#225;ndose pruebas epicut&#225;neas&#46; No obstante se han comunicado tasas prevalencia de hasta el 20&#37; de sensibilizaci&#243;n a al&#233;rgenos en la poblaci&#243;n pedi&#225;trica&#44; por lo que probablemente deber&#237;a ser tenida en cuenta como una posibilidad diagn&#243;stica en este grupo de edad&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Material y m&#233;todo</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Se ha realizado un an&#225;lisis retrospectivo de la base de datos de alergia cut&#225;nea del servicio de Dermatolog&#237;a del Hospital General seleccionando los casos diagnosticados en ni&#241;os de entre 0 y 16 a&#241;os durante los u¿ltimos 15 a&#241;os &#40;a&#241;o 2000 hasta 2015&#41;&#46; El estudio incluye variables epidemiol&#243;gicas &#40;edad&#44; sexo&#44; antecedentes de atopia&#41; y cl&#237;nicas &#40;localizaci&#243;n de las lesiones&#44; bater&#237;as de al&#233;rgenos empleadas&#44; al&#233;rgenos positivos y su relevancia&#41;&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">De los 4&#46;593 pacientes estudiados con pruebas epicut&#225;neas en los u¿ltimos 15 a&#241;os&#44; 265 &#40;6&#37;&#41; correspond&#237;an a ni&#241;os de 0-16 a&#241;os&#46; Ciento cuarenta y cuatro pacientes &#40;54&#44;3&#37;&#41; mostraron positividad para al menos uno de los al&#233;rgenos parcheados&#46; Los al&#233;rgenos m&#225;s frecuentemente identificados fueron en orden decreciente&#58; tiomersal&#44; cloruro de cobalto&#44; colofonia&#44; parafenilendiamina&#44; dicromato pot&#225;sico&#44; mercurio y n&#237;quel&#46; La sensibilizaci&#243;n fue considerada de relevancia presente en 177 casos &#40;61&#44;3&#37;&#41;&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusi&#243;n</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">M&#225;s de la mitad de los ni&#241;os estudiados mostraron sensibilizaci&#243;n a uno o m&#225;s al&#233;rgenos&#44; con un porcentaje importante de sensibilizaciones relevantes&#46; Todo ni&#241;o con sospecha cl&#237;nica de dermatitis al&#233;rgica de contacto deber&#237;a ser remitido para realizaci&#243;n de pruebas epicut&#225;neas&#46; Al no existir pruebas estandarizadas en este colectivo se requiere un alto nivel de sospecha cl&#237;nica y un conocimiento de los al&#233;rgenos m&#225;s frecuentemente implicados de cara a seleccionar los al&#233;rgenos a parchar&#46;</p></span>"
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        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Please cite this article as&#58; Ortiz Salvador JM&#44; Esteve Mart&#237;nez A&#44; Subiabre Ferrer D&#44; Victoria Mart&#237;nez AM&#44; de la Cuadra Oyanguren J&#44; Zaragoza Ninet V&#46; Dermatitis al&#233;rgica de contacto pedi&#225;trica&#46; Estudio cl&#237;nico-epidemiol&#243;gico en un hospital terciario&#46; Actas Dermosifiliogr&#46; 2017&#59;108&#58;571&#8211;578&#46;</p>"
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                  <table border="0" frame="\n
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                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Total</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Positive Patch</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Negative Patch</th></tr><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">&#40;N<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>265&#41;</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Test Result &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>144&#41;</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Test Result &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>121&#41;</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Sex&#44; No&#46; &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Boys&#44; 59 &#40;41&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Girls&#44; 85 &#40;59&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Boys&#44; 51 &#40;42&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Age range&#44; y</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1-16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2-16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1-16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2-16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2-16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2-16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="7" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="7" align="left" valign="top"><span class="elsevierStyleItalic">Age group&#44; No&#46; &#40;&#37;&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>0-2 y&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1 &#40;0&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0 &#40;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1 &#40;0&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0 &#40;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0 &#40;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0 &#40;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>2-5 y&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7 &#40;2&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7 &#40;2&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2 &#40;1&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3 &#40;2&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5 &#40;4&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4 &#40;3&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>5-10 y&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">30 &#40;11&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">40 &#40;15&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">16 &#40;11&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">21 &#40;14&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">14 &#40;11&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">19 &#40;15&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>10-15 y&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">58 &#40;21&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">85 &#40;32&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">32 &#40;22&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">44 &#40;30&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">26 &#40;21&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">41 &#40;33&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>15 y&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">14 &#40;5&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">23 &#40;8&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8 &#40;5&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">17 &#40;11&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6 &#40;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6 &#40;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td-with-role" title="table-head ; entry_with_role_rowhead " align="left" valign="top" scope="col">Site&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</th></tr><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Foot&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">63&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">33 &#40;52&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Face&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">24 &#40;48&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Hand&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">49&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">27 &#40;55&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Arm&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">22 &#40;55&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Leg&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">27 &#40;67&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Trunk&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">16 &#40;80&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Flexures&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8 &#40;53&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Neck&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">11 &#40;55&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Generalized&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0 &#40;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
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                0 => "xTab1450865.png"
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          "en" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Location of Lesions&#46;</p>"
        ]
      ]
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        "identificador" => "tbl0015"
        "etiqueta" => "Table 3"
        "tipo" => "MULTIMEDIATABLA"
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          "leyenda" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Abbreviation&#58; PPDA&#44; paraphenylenediamine&#46;</p>"
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            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td-with-role" title="table-head ; entry_with_role_rowhead " align="left" valign="top" scope="col">Order&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col">Allergen&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col">Total&#44; No&#46; &#40;&#37;&#41;<br>N<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>265&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col">Present&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Relevance&#44; No&#46; &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Thiomersal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">27 &#40;10&#46;19&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6 &#40;22&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Cobalt chloride&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">24 &#40;9&#46;05&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">11 &#40;45&#46;83&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Colophony&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">24 &#40;9&#46;05&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">24 &#40;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">PPDA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">22 &#40;8&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">19 &#40;86&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Potassium dichromate&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">21 &#40;7&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">15 &#40;71&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Mercury&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">21 &#40;7&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8 &#40;38&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Nickel&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">17 &#40;6&#46;41&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5 &#40;29&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Fragrance mix &#40;<span class="elsevierStyleSmallCaps">i</span><span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleSmallCaps">ii</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">13 &#40;4&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7 &#40;53&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Mercapto mix&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">12 &#40;4&#46;53&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8 &#40;66&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Peru balsam&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6 &#40;2&#46;65&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2 &#40;33&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Thiuram mix&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4 &#40;1&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2 &#40;50&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Caine mix&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4 &#40;1&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0 &#40;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Ketoprofen&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4 &#40;1&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4 &#40;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Benzoyl peroxide&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3 &#40;1&#46;13&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2 &#40;66&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">p-tert-Butylphenol formaldehyde&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3 &#40;1&#46;13&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1 &#40;33&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Isoeugenol&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3 &#40;1&#46;13&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2 &#40;66&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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              "identificador" => "tblfn0005"
              "etiqueta" => "a"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Cases of present relevance are shown&#46;</p>"
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          "en" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Most Common Allergens and Their Prevalence in the Pediatric Patients Studied<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a></p>"
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        "etiqueta" => "Table 4"
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              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">N<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>4328&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Nickel&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">979 &#40;22&#46;62&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Cobalt chloride&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">403 &#40;9&#46;31&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Potassium dichromate&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">314 &#40;7&#46;26&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Paraphenylenediamine&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">239 &#40;5&#46;52&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Thiomersal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">236 &#40;5&#46;45&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Kathon&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">214 &#40;4&#46;94&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Peru balsam&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">195 &#40;4&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Fragrance mix&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">182 &#40;4&#46;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Mercury&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">130 &#40;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Thiuram mix&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">121 &#40;2&#46;78&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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Original Article
Pediatric Allergic Contact Dermatitis: Clinical and Epidemiological Study in a Tertiary Hospital
Dermatitis alérgica de contacto pediátrica. Estudio clínico-epidemiológico en un hospital terciario
J.M. Ortiz Salvador
Autor para correspondencia
Josema.ortiz.salvador@gmail.com

Corresponding author.
, A. Esteve Martínez, D. Subiabre Ferrer, A.M. Victoria Martínez, J. de la Cuadra Oyanguren, V. Zaragoza Ninet
Servicio de Dermatología, Consorcio Hospital General Universitario de Valencia, Valencia, España
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Allergic contact dermatitis &#40;ACD&#41; has traditionally been considered a disease of adults&#44; and eczematous reactions in children are generally considered to be atopic&#46; However&#44; awareness of the importance of ACD in younger patients has been growing in recent years&#46;<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">1&#8211;3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Epidemiological studies of pediatric ACD reveal that the incidence of this disease is increasing&#46;<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">4&#8211;7</span></a> Nevertheless&#44; the results of these studies are difficult to compare owing to differences in test methodologies&#44; patch test allergens&#44; demographics of the study population&#44; and the selection criteria applied to the children referred for evaluation&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">The objective of our study was to estimate the prevalence of ACD in children attending the skin allergy clinic of a tertiary hospital&#46; We also sought to determine the most frequent allergens and the clinical and epidemiological characteristics of children with ACD&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Materials and Methods</span><p id="par0020" class="elsevierStylePara elsevierViewall">We identified all children aged 0 to 16 years referred to the skin allergy unit of our department for patch testing&#46; In all cases&#44; the standard series of the Spanish Contact Dermatitis and Skin Allergy Research Group &#40;GEIDAC&#41; &#40;Martitor&#41; was applied&#44; as were the patient&#39;s own products and additional series depending on the degree of clinical suspicion in each case&#46; The allergens were applied to the apparently healthy skin of the patient&#39;s back and occluded for 48<span class="elsevierStyleHsp" style=""></span>hours&#46; Readings were taken at 48 and 96<span class="elsevierStyleHsp" style=""></span>hours&#46; The skin reaction was evaluated according to the criteria of the International Contact Dermatitis Research Group&#46; All clinical data and the results of the readings were stored prospectively in a computerized database&#46; The chi-square test was applied to compare percentages in the sensitized and nonsensitized populations&#46; The Mann-Whitney test was used to compare age in the different groups&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="par0025" class="elsevierStylePara elsevierViewall">We analyzed data from 4593 patients referred to the skin allergy clinic between the years 2000 and 2015&#46; Of this total&#44; 265 patients &#40;5&#46;7&#37;&#41; were children aged 0 to 16 years&#44; and of these&#44; 144 &#40;54&#46;3&#37;&#41; had positive results to at least 1 allergen &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> and <a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">Of the 144 sensitized children&#44; 113 &#40;84&#37;&#41; had positive patch test results with present relevance&#46; A total of 302 patch test results were positive &#40;mean of 2&#46;1 positive results per patient&#41;&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">The mean &#40;SD&#41; age of patients referred to the clinic was 11&#46;1 &#40;3&#46;7&#41; years&#46; No significant differences in age were found between children with and without ACD&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">As for distribution by sex&#44; 155 of the 265 children were girls &#40;58&#46;5&#37;&#41; and 110 were boys &#40;41&#46;5&#37;&#41;&#46; The group of sensitized patients comprised 85 girls &#40;59&#37;&#41; and 59 boys &#40;41&#37;&#41;&#59; the group of nonsensitized patients comprised 70 girls &#40;57&#46;9&#37;&#41; and 51 boys &#40;42&#46;1&#37;&#41;&#46; The chi-square test revealed no significant association between sex and a positive patch test result&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">No significant differences were found in the prevalence of sensitization with respect to age at onset &#40;0-2 years&#44; 2-5 years&#44; 5-10 years&#44; 10-15 years&#44; and &#62;<span class="elsevierStyleHsp" style=""></span>15 years&#41;&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Positive reactions are shown by site in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#46; The most commonly affected area was the trunk &#40;16 positive results in 20 patients with lesions on the trunk &#91;80&#37;&#93;&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall">Of the 265 children studied&#44; 70 &#40;26&#46;4&#37;&#41; had a history of atopy&#46; The prevalence of sensitization in children with no history of atopy was 1&#46;3 times higher than in children with a history of atopy&#46; The chi-square test revealed a slightly significant difference &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;049&#41; between the absence of a personal history of atopy and ACD&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">The most common allergens were&#44; in descending order of frequency&#44; thiomersal &#40;27 cases&#41;&#44; colophony &#40;24 cases&#41;&#44; paraphenylenediamine &#40;PPDA&#44; 22 cases&#41;&#44; metals &#40;potassium dichromate&#44; 21 cases&#59; mercury&#44; 21 cases&#59; and nickel&#44; 17 cases&#41;&#44; fragrances &#40;mixes <span class="elsevierStyleSmallCaps">i</span> and <span class="elsevierStyleSmallCaps">ii</span>&#44; 11 cases&#59; Peru balsam&#44; 6 cases&#41;&#44; and rubber &#40;mercapto mix&#44; 12 cases&#59; thiuram mix&#44; 4 cases&#41;&#46; The highest percentages of relevant cases were observed for colophony &#40;100&#37;&#41;&#44; ketoprofen &#40;100&#37;&#41;&#44; and PPDA &#40;86&#46;4&#37;&#41;&#46; The lowest percentages of relevant cases were observed for Peru balsam &#40;33&#46;3&#37;&#41;&#44; nickel &#40;29&#46;4&#37;&#41;&#44; and thiomersal &#40;22&#46;2&#37;&#41;&#46; <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a> shows the most common allergens and cases with present relevance&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0065" class="elsevierStylePara elsevierViewall">Thiomersal was the most common allergen&#44; with 27 positive patch test results&#44; although the relevance was unknown in most cases &#40;87&#46;8&#37;&#41;&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">We found 17 cases of sensitization to nickel&#44; with a prevalence of sensitization that was 6-fold higher in girls &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;01&#41;&#46; More than half of the children who were sensitized to nickel &#40;58&#46;8&#37;&#41; were cosensitized to cobalt&#46; During the period 2010-2015&#44; cases of sensitization to nickel decreased by 71&#37; compared with 2004-2009&#46; No cases of sensitization to nickel were diagnosed during the last 3 years of the study period &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0075" class="elsevierStylePara elsevierViewall">We recorded 22 cases of sensitization to PPDA&#44; with a stable number of cases over time &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; All the cases appeared after placement of a temporary black henna tattoo&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Of the 21 cases of sensitization to chrome&#44; 15 &#40;71&#46;4&#37;&#41; involved the feet and were all associated with footwear and considered to be of present relevance&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">Sensitization to mercury was considered to be of present relevance in 8 cases &#40;38&#46;1&#37;&#41;&#46; In 11 cases of sensitized children &#40;52&#46;3&#37;&#41;&#44; the patient was also sensitized to thiomersal&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">The most commonly used additional test series were footwear and preservatives &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46; Of the 302 positive patch test results&#44; 262 &#40;87&#37;&#41; were diagnosed using the standard series&#44; and only 40 &#40;13&#37;&#41; were confirmed allergens from additional series&#46; The patient&#39;s own products were patch tested in 53 cases and confirmed the diagnosis in 17 cases&#59; these would have gone undetected if the patient&#39;s own products &#40;mainly sunscreens and topical drugs&#41; had not been used in the patch test&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discussion</span><p id="par0095" class="elsevierStylePara elsevierViewall">We found that the prevalence of sensitization in children referred to our skin allergy clinic was 54&#46;3&#37;&#44; which is similar to data reported elsewhere&#46;<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">4&#8211;10</span></a> However&#44; this parameter is very variable and depends on referral criteria&#44; epidemiological characteristics&#44; and exposure to allergens in the study population&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">In contrast with our findings&#44; many studies report a greater prevalence of ACD in females&#46;<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">6&#44;7</span></a> Hormonal and exposure-related factors have been suggested&#44; although most cases seem to be associated with more frequent wearing of jewelry and ear piercing at an early age in the case of nickel allergy&#46; Although we did not find significant differences in the prevalence of sensitization between boys and girls&#44; the prevalence of sensitization to nickel was 6-fold higher in girls&#44; consistent with findings reported elsewhere&#46; This could explain the female predominance of pediatric ACD found in many studies where nickel is the main cause of the condition&#46;<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">6&#44;7</span></a></p><p id="par0105" class="elsevierStylePara elsevierViewall">The association between atopy and ACD is controversial&#46;<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">1&#44;2&#44;6</span></a> In our study&#44; we found a slightly statistically significant lower prevalence of ACD in atopic children&#46; This result is consistent with the lower incidence of skin allergy in patients with atopy reported elsewhere&#46;<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">1&#44;2&#44;7</span></a></p><p id="par0110" class="elsevierStylePara elsevierViewall">The most frequent allergens in our study were mercury compounds&#44; metals present in jewelry&#44; PPDA&#44; products present in footwear&#44; and fragrances&#46; These allergens and their prevalence are very similar to those found in adults during the same period &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0115" class="elsevierStylePara elsevierViewall">Mercury compounds were the most frequent group of allergens in the children we studied&#46; In the case of thiomersal&#44; the relevance of most reactions was unknown&#46; This observation is consistent with those of other studies&#44; where thiomersal was reported to be a very prevalent allergen in the general population&#44; albeit with a low number of cases of relevant sensitization&#46;<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">1&#44;7&#44;8</span></a> Consequently&#44; withdrawal of thiomersal from the standard series is currently being evaluated&#46; Contact with broken mercury thermometers or use of antiseptics based on mercury compounds are additional routes of sensitization to mercury&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">Jewelry and metals present in clothing and footwear were the second most common cause of sensitization after thiomersal&#46; This observation is consistent with findings from many pediatric series&#44; in which nickel was the most common allergen&#46;<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">7&#44;11&#44;12</span></a> Cosensitization to cobalt is common in patients sensitized to nickel or chrome&#46;<a class="elsevierStyleCrossRefs" href="#bib0220"><span class="elsevierStyleSup">13&#44;14</span></a> The number of cases of sensitization to nickel has fallen considerably since the implementation of European legislation on nickel content in jewelry&#46;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">15</span></a></p><p id="par0125" class="elsevierStylePara elsevierViewall">We detected a high number of positive reactions to PPDA&#44; which is the third most frequent cause of ACD in our setting&#46; As reported elsewhere&#44; temporary black henna tattoos were the most frequent cause of sensitization&#46;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">16</span></a> Use of PPDA in cosmetic products &#40;with the exception of hair dyes&#41; has been prohibited in the European Union since 2009&#46;<a class="elsevierStyleCrossRefs" href="#bib0240"><span class="elsevierStyleSup">17&#44;18</span></a> The number of cases of sensitization to PPDA fell during 2010-2015 compared with 2004-2009&#44; although cases are still being reported despite the fact that its use in cosmetics is banned&#46; Sensitization to PPDA is particularly important owing to the possibility of life-threatening severe acute reactions&#44; potential long-term sequelae&#44; and the ubiquitous presence of the allergen in many products in daily use&#44; as well as its cross-reactivity with drugs from the <span class="elsevierStyleItalic">para-</span> group &#40;eg&#44; oral antidiabetic drugs&#44; topical anesthetics&#44; and sulfamides&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0250"><span class="elsevierStyleSup">19&#8211;21</span></a> Despite the health alert and legislative initiatives&#44; more legal and educational measures are necessary if we are to regulate exposure of children to PPDA&#44; specifically through temporary black henna tattoos&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">Footwear is a common cause of ACD in children&#46;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">22</span></a> The most frequent allergens in footwear-associated ACD in children are potassium dichromate &#40;used to tan natural leather&#41; and p-tert butylphenol formaldehyde &#40;used as an adhesive&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0180"><span class="elsevierStyleSup">5&#44;7&#44;13</span></a> The European Commission regulation limiting the use of chrome salts in skin products that came into force on May 1&#44; 2015 is expected to lead to a decrease in the frequency of chrome-induced ACD in the coming years&#46;<a class="elsevierStyleCrossRefs" href="#bib0230"><span class="elsevierStyleSup">15&#44;23</span></a></p><p id="par0135" class="elsevierStylePara elsevierViewall">Colophony is a resin that is present in many adhesive health products&#46; It is a major cause of iatrogenic ACD &#40;<a class="elsevierStyleCrossRef" href="#fig0020">Fig&#46; 4</a>&#41;&#44; although there may also be cases of pediatric ACD caused by colophony in leather shoes&#44; lipstick&#44; and even musical instruments&#46;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">24</span></a> Sensitization to colophony could be a marker of fragrance allergy&#46;<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">25</span></a> In the population we studied&#44; all the cases of colophony allergy were associated with the use of adhesive dressings&#44; thus confirming the major iatrogenic role of this substance&#46;</p><elsevierMultimedia ident="fig0020"></elsevierMultimedia><p id="par0140" class="elsevierStylePara elsevierViewall">Most cases of sensitization in our study were diagnosed using the standard series&#46; The European Academy of Allergology and Clinical Immunology &#40;EAACI&#41; recently proposed a reduced standard series for children &#40;<a class="elsevierStyleCrossRef" href="#tbl0025">Table 5</a>&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">3</span></a> However&#44; consistent with most epidemiological studies on pediatric ACD&#44; we believe that the GEIDAC standard series is more useful when testing children&#44; because the reduced series proposed by the EAACI does not include cobalt chloride&#44; PPDA&#44; potassium dichromate&#44; mercury&#44; or Peru balsam&#44; all of which are among the 10 most frequent allergens in our study&#46; Furthermore&#44; the series does not include methylisothiazolinone alone&#44; which is recommended based on increasing evidence from studies showing that the methylisothiazolinone&#47;methylchloroisothiazolinone mix patch is insufficient&#46;<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">6&#44;26</span></a></p><elsevierMultimedia ident="tbl0025"></elsevierMultimedia><p id="par0145" class="elsevierStylePara elsevierViewall">The allergens that most frequently caused ACD in children in our study &#40;see above&#41; are classic allergens &#40;thiomersal&#44; metals&#44; colophony&#41; with well-recognized clinical manifestations&#46; In the case of many of these allergens&#44; various legislative measures have been put in place to limit the risk of sensitization&#44; and this may explain the decreasing number of cases referred for evaluation in our study &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; However&#44; in recent years&#44; there have been reports of emerging allergens whose growing importance lies in their ubiquity and frequency of sensitization&#44; as well as in their poorer legal regulation&#46;<a class="elsevierStyleCrossRefs" href="#bib0280"><span class="elsevierStyleSup">25&#8211;28</span></a> Such is the case of fragrances and preservatives in cosmetics&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">Fragrances constitute a broad group of chemical compounds&#46; Some studies place them as the second most common cause of contact allergy in adults in our setting&#44; immediately after metals&#46; These findings agree with our results in that fragrances were the fourth most common cause of ACD after thiomersal&#44; metals&#44; and PPDA&#46; Patients with a positive result to fragrance markers in the standard series &#40;fragrance mix <span class="elsevierStyleSmallCaps">i</span> and <span class="elsevierStyleSmallCaps">ii</span>&#44; colophony&#44; and Peru balsam&#41; must undergo patch testing with a specific fragrance series in order to identify the individual fragrances the patient is sensitized to so that he&#47;she can avoid them&#46; It is important to remember that fragrances are present not only in perfumes and colognes&#44; but also in a wide rage of products such as lipstick &#40;<a class="elsevierStyleCrossRef" href="#fig0025">Fig&#46; 5</a>&#41; and makeup&#46;</p><elsevierMultimedia ident="fig0025"></elsevierMultimedia><p id="par0155" class="elsevierStylePara elsevierViewall">As for preservatives&#44; methylchloroisothiazolinone and methylisothiazolinone are among the most frequent allergens in adult ACD in the most recent series&#46;<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">28</span></a> In our study&#44; we found no cases of sensitization to methylchloroisothiazolinone and methylisothiazolinone in children&#46; Nevertheless&#44; these allergens are present in a wide rage of cosmetic products that are widely used in this age group &#40;eg&#44; gels&#44; shampoos&#44; wipes&#44; and moisturizing creams&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0285"><span class="elsevierStyleSup">26&#44;27</span></a> Some studies have shown a growing number of cases of allergy to methylchloroisothiazolinone and methylisothiazolinone in children and warn that in the future&#44; these could be among the most common allergens in this population&#46;<a class="elsevierStyleCrossRefs" href="#bib0285"><span class="elsevierStyleSup">26&#44;27</span></a></p><p id="par0160" class="elsevierStylePara elsevierViewall">Finally&#44; with respect to legislation on allergens affecting children&#44; regulation of cosmetic products for children is lacking&#44; despite the strict regulation of allergens in children&#39;s toys&#46;<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">29</span></a> The year 2012 saw the publication of a resolution from the Council of Europe aimed at regulating cosmetic products for children aged under 3 years&#46;<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">30</span></a> However&#44; the resolution is limited to general guidelines&#44;<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">31</span></a> without establishing which substances should be avoided in children&#44; apart from those already banned in Directive 76&#47;768&#47;EEC<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">17</span></a> and in Regulation EC 1223&#47;2009&#46;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">18</span></a> Thus&#44; it is necessary to establish legislative measures to protect children&#8212;a particularly vulnerable group&#8212;from exposure to potential allergens that are currently in the cosmetic products usually aimed at this population&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">In conclusion&#44; ACD is a common condition in the pediatric population and must be taken into consideration when addressing a child with suggestive eczematous lesions and a compatible clinical history&#46; Some classic allergens rarely lead to relevant sensitization or their incidence is decreasing&#46; On the other hand&#44; new allergens are emerging&#44; especially in cosmetic products for children&#44; which are often are poorly regulated&#46; We should be alert to the presence of ACD due to emerging allergens that cause clinical manifestations that differ from those of &#8220;classic&#8221; allergens&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Ethical Disclosures</span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Protection of humans and animals</span><p id="par0170" class="elsevierStylePara elsevierViewall">The authors declare that no tests were carried out in humans or animals for the purposes of this study&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Confidentiality of data</span><p id="par0175" class="elsevierStylePara elsevierViewall">The authors declare that they have followed their institutional protocols on publication of patient data&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Right to privacy and informed consent</span><p id="par0180" class="elsevierStylePara elsevierViewall">The authors declare that no private patient data appear in this article&#46;</p></span></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Conflicts of Interest</span><p id="par0185" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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            0 => "Skin allergy"
            1 => "Allergic contact dermatitis"
            2 => "Pediatric dermatology"
            3 => "Patch tests"
            4 => "Eczema"
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            0 => "Alergia cut&#225;nea"
            1 => "Dermatitis al&#233;rgica de contacto"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Background</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Few epidemiological studies have investigated the incidence of allergic contact dermatitis in children&#46; Underdiagnosis has been observed in some studies&#44; with many cases in which the condition is not suspected clinically and patch tests are not performed&#46; However&#44; the prevalence of pediatric sensitization to allergens has been reported to be as high as 20&#37;&#44; and the diagnosis should therefore be contemplated as a possibility in this age group&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Material and methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">We performed a retrospective analysis of the skin allergy database of the Dermatology Department of Consorcio Hospital General Universitario de Valencia&#46; Children between 0 and 16 years of age diagnosed with allergic contact dermatitis in the previous 15 years &#40;between 2000 and 2015&#41; were included in the analysis&#46; Epidemiological &#40;age&#44; sex&#44; history of atopy&#41; and clinical &#40;site of the lesions&#44; allergen series applied&#44; positive reactions&#44; and their relevance&#41; variables were gathered&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Patch tests had been performed on 4&#44;593 patients during the study period&#46; Of these&#44; 265 &#40;6&#37;&#41; were children aged between 0 and 16 years&#46; A positive reaction to at least one of the allergens tested was observed in 144 &#40;54&#46;3&#37;&#41; patients in that group&#46; The allergens most frequently identified were the following &#40;in decreasing order of frequency&#41;&#58; thiomersal&#44; cobalt chloride&#44; colophony&#44; paraphenylenediamine&#44; potassium dichromate&#44; mercury&#44; and nickel&#46; The sensitization was considered relevant in 177 &#40;61&#46;3&#37;&#41; cases&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">More than half of the children studied showed sensitization to 1 or more allergens&#44; with a high percentage of relevant sensitizations&#46; All children with a clinical suspicion of allergic contact dermatitis should be referred for patch testing&#46; As no standardized test series have been developed for this age group&#44; a high level of clinical suspicion and knowledge of the allergens most commonly involved are required when selecting the allergens to be tested&#46;</p></span>"
        "secciones" => array:4 [
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            "titulo" => "Background"
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            "titulo" => "Material and methods"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introducci&#243;n</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Los estudios epidemiol&#243;gicos sobre incidencia de dermatitis al&#233;rgica de contacto en poblaci&#243;n pedi&#225;trica son escasos&#46; Algunos trabajos consideran que se trata de una entidad infradiagnosticada&#44; y que en muchos casos no se sospecha cl&#237;nicamente&#44; no realiz&#225;ndose pruebas epicut&#225;neas&#46; No obstante se han comunicado tasas prevalencia de hasta el 20&#37; de sensibilizaci&#243;n a al&#233;rgenos en la poblaci&#243;n pedi&#225;trica&#44; por lo que probablemente deber&#237;a ser tenida en cuenta como una posibilidad diagn&#243;stica en este grupo de edad&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Material y m&#233;todo</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Se ha realizado un an&#225;lisis retrospectivo de la base de datos de alergia cut&#225;nea del servicio de Dermatolog&#237;a del Hospital General seleccionando los casos diagnosticados en ni&#241;os de entre 0 y 16 a&#241;os durante los u¿ltimos 15 a&#241;os &#40;a&#241;o 2000 hasta 2015&#41;&#46; El estudio incluye variables epidemiol&#243;gicas &#40;edad&#44; sexo&#44; antecedentes de atopia&#41; y cl&#237;nicas &#40;localizaci&#243;n de las lesiones&#44; bater&#237;as de al&#233;rgenos empleadas&#44; al&#233;rgenos positivos y su relevancia&#41;&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">De los 4&#46;593 pacientes estudiados con pruebas epicut&#225;neas en los u¿ltimos 15 a&#241;os&#44; 265 &#40;6&#37;&#41; correspond&#237;an a ni&#241;os de 0-16 a&#241;os&#46; Ciento cuarenta y cuatro pacientes &#40;54&#44;3&#37;&#41; mostraron positividad para al menos uno de los al&#233;rgenos parcheados&#46; Los al&#233;rgenos m&#225;s frecuentemente identificados fueron en orden decreciente&#58; tiomersal&#44; cloruro de cobalto&#44; colofonia&#44; parafenilendiamina&#44; dicromato pot&#225;sico&#44; mercurio y n&#237;quel&#46; La sensibilizaci&#243;n fue considerada de relevancia presente en 177 casos &#40;61&#44;3&#37;&#41;&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusi&#243;n</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">M&#225;s de la mitad de los ni&#241;os estudiados mostraron sensibilizaci&#243;n a uno o m&#225;s al&#233;rgenos&#44; con un porcentaje importante de sensibilizaciones relevantes&#46; Todo ni&#241;o con sospecha cl&#237;nica de dermatitis al&#233;rgica de contacto deber&#237;a ser remitido para realizaci&#243;n de pruebas epicut&#225;neas&#46; Al no existir pruebas estandarizadas en este colectivo se requiere un alto nivel de sospecha cl&#237;nica y un conocimiento de los al&#233;rgenos m&#225;s frecuentemente implicados de cara a seleccionar los al&#233;rgenos a parchar&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Please cite this article as&#58; Ortiz Salvador JM&#44; Esteve Mart&#237;nez A&#44; Subiabre Ferrer D&#44; Victoria Mart&#237;nez AM&#44; de la Cuadra Oyanguren J&#44; Zaragoza Ninet V&#46; Dermatitis al&#233;rgica de contacto pedi&#225;trica&#46; Estudio cl&#237;nico-epidemiol&#243;gico en un hospital terciario&#46; Actas Dermosifiliogr&#46; 2017&#59;108&#58;571&#8211;578&#46;</p>"
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                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Total</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Positive Patch</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Negative Patch</th></tr><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">&#40;N<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>265&#41;</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Test Result &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>144&#41;</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Test Result &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>121&#41;</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Sex&#44; No&#46; &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Boys&#44; 110 &#40;41&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Girls&#44; 155 &#40;58&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Boys&#44; 59 &#40;41&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Girls&#44; 85 &#40;59&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Boys&#44; 51 &#40;42&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Girls&#44; 70 &#40;57&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Age range&#44; y</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1-16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2-16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1-16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2-16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2-16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2-16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="7" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="7" align="left" valign="top"><span class="elsevierStyleItalic">Age group&#44; No&#46; &#40;&#37;&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>0-2 y&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1 &#40;0&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0 &#40;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1 &#40;0&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0 &#40;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0 &#40;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0 &#40;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>2-5 y&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7 &#40;2&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7 &#40;2&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2 &#40;1&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3 &#40;2&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5 &#40;4&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4 &#40;3&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>5-10 y&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">30 &#40;11&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">40 &#40;15&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">16 &#40;11&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">21 &#40;14&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">14 &#40;11&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">19 &#40;15&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>10-15 y&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">58 &#40;21&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">85 &#40;32&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">32 &#40;22&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">44 &#40;30&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">26 &#40;21&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">41 &#40;33&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>15 y&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">14 &#40;5&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">23 &#40;8&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8 &#40;5&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">17 &#40;11&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6 &#40;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6 &#40;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td-with-role" title="table-head ; entry_with_role_rowhead " align="left" valign="top" scope="col">Site&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col">Total&#44; No&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col">Positive Patch Test&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Result&#44; No&#46; &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Foot&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">63&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">33 &#40;52&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Face&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">24 &#40;48&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Hand&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">49&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">27 &#40;55&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Arm&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">22 &#40;55&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Leg&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">27 &#40;67&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Trunk&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">16 &#40;80&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Flexures&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8 &#40;53&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Neck&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">11 &#40;55&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Generalized&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0 &#40;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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          "leyenda" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Abbreviation&#58; PPDA&#44; paraphenylenediamine&#46;</p>"
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              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td-with-role" title="table-head ; entry_with_role_rowhead " align="left" valign="top" scope="col">Order&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col">Allergen&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col">Total&#44; No&#46; &#40;&#37;&#41;<br>N<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>265&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col">Present&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Relevance&#44; No&#46; &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Thiomersal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">27 &#40;10&#46;19&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6 &#40;22&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Cobalt chloride&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">24 &#40;9&#46;05&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">11 &#40;45&#46;83&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Colophony&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">24 &#40;9&#46;05&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">24 &#40;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">PPDA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">22 &#40;8&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">19 &#40;86&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Potassium dichromate&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">21 &#40;7&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">15 &#40;71&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Mercury&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">21 &#40;7&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8 &#40;38&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Nickel&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">17 &#40;6&#46;41&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5 &#40;29&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Fragrance mix &#40;<span class="elsevierStyleSmallCaps">i</span><span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleSmallCaps">ii</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">13 &#40;4&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7 &#40;53&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Mercapto mix&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">12 &#40;4&#46;53&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8 &#40;66&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Peru balsam&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6 &#40;2&#46;65&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2 &#40;33&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Thiuram mix&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4 &#40;1&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2 &#40;50&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Caine mix&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4 &#40;1&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0 &#40;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Ketoprofen&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4 &#40;1&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4 &#40;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Benzoyl peroxide&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3 &#40;1&#46;13&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2 &#40;66&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">p-tert-Butylphenol formaldehyde&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3 &#40;1&#46;13&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1 &#40;33&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Isoeugenol&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3 &#40;1&#46;13&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2 &#40;66&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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              "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Cases of present relevance are shown&#46;</p>"
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        "descripcion" => array:1 [
          "en" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Most Common Allergens and Their Prevalence in the Pediatric Patients Studied<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a></p>"
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        "mostrarFloat" => true
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">N<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>4328&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Nickel&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">979 &#40;22&#46;62&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Cobalt chloride&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">403 &#40;9&#46;31&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Potassium dichromate&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">314 &#40;7&#46;26&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Paraphenylenediamine&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">239 &#40;5&#46;52&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Thiomersal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">236 &#40;5&#46;45&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Kathon&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">214 &#40;4&#46;94&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Peru balsam&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">195 &#40;4&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Fragrance mix&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">182 &#40;4&#46;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Mercury&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">130 &#40;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Thiuram mix&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">121 &#40;2&#46;78&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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          "leyenda" => "<p id="spar0100" class="elsevierStyleSimplePara elsevierViewall">Abbreviations&#58; ACD&#44; allergic contact dermatitis&#59; EAACI European Academy of Allergy and Clinical Immunology&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Allergens Recommended by the EAACI as the Standard Series in Children&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Nickel sulfate&#58; 5&#37; pet&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Thiuram mix&#58; 1&#37; pet&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Mercapto mix&#58; 1&#37; pet&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Mercaptobenzothiazole&#58; 2&#37; pet&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Fragrance mix <span class="elsevierStyleSmallCaps">i&#58;</span> 8&#37; pet&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Fragrance mix <span class="elsevierStyleSmallCaps">ii&#58;</span> 14&#37; pet&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Colophony&#58; 20&#37; pet&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Methylchloroisothiazolinone&#47;Methylisothiazolinone&#58; 100<span class="elsevierStyleHsp" style=""></span>ppm aq&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Sesquiterpene lactone mix&#58; 0&#46;1&#37; pet&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">Series Recommended by the EAACI for the Study of ACD in Children&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:31 [
            0 => array:3 [
              "identificador" => "bib0160"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:3 [
                  "comentario" => "quiz 668"
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Pediatric allergic contact dermatitis&#58; Lessons for better care"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "A&#46; Goldenberg"
                            1 => "N&#46; Silverberg"
                            2 => "J&#46;I&#46; Silverberg"
                            3 => "J&#46; Treat"
                            4 => "S&#46;E&#46; Jacob"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jaip.2015.02.007"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Allergy Clin Immunol Pract&#46;"
                        "fecha" => "2015"
                        "volumen" => "3"
                        "paginaInicial" => "661"
                        "paginaFinal" => "667"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26362549"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0165"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Allergic contact dermatitis in children&#58; Which factors are relevant&#63; &#40;review of the literature&#41;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "F&#46;B&#46; De Waard-van der Spek"
                            1 => "K&#46;E&#46; Andersen"
                            2 => "U&#46; Darsow"
                            3 => "C&#46;G&#46; Mortz"
                            4 => "D&#46; Orton"
                            5 => "M&#46; Worm"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/pai.12043"
                      "Revista" => array:5 [
                        "tituloSerie" => "Pediatr Allergy Immunols&#46;"
                        "fecha" => "2013"
                        "volumen" => "24"
                        "paginaInicial" => "321"
                        "paginaFinal" => "329"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0170"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "EAACI position paper for practical patch testing in allergic contact dermatitis in children"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "F&#46;B&#46; De Waard-van der Spek"
                            1 => "U&#46; Darsow"
                            2 => "C&#46;G&#46; Mortz"
                            3 => "D&#46; Orton"
                            4 => "M&#46; Worm"
                            5 => "A&#46; Murao"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/pai.12463"
                      "Revista" => array:6 [
                        "tituloSerie" => "Pediatr Allergy Immunol&#46;"
                        "fecha" => "2015"
                        "volumen" => "26"
                        "paginaInicial" => "598"
                        "paginaFinal" => "606"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26287570"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
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Información del artículo
ISSN: 15782190
Idioma original: Inglés
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