Original article
Inflamed skin predisposes to sensitization to less potent allergens

Previously presented as an oral abstract at the 2014 American Contact Dermatitis Society annual meeting (Denver, CO, March 2014) and as a poster at the 2015 World Congress of Dermatology (Vancouver, BC, Canada, June 2015).
https://doi.org/10.1016/j.jaad.2016.03.010Get rights and content

Background

Irritant dermatitis, caused by genetic barrier dysfunction in atopic dermatitis or wet work in hand dermatitis, induces innate immune response that might predispose to allergic contact sensitization to less potent sensitizers.

Objectives

We sought to determine if positive patch test results to less potent allergens are more prevalent in patients with a history of childhood flexural dermatitis or current wet work.

Methods

We examined our database of patients presenting to a contact dermatitis clinic tested to potential contact allergens as indicated by their history. Allergens from our most recent standard were studied if they could be classified as weak, moderate, or strong sensitizers based on published data from the local lymph node assay. Patients were stratified by a history of childhood-onset flexural dermatitis as a proxy for atopic dermatitis and by occupation.

Results

History of childhood-onset dermatitis predisposed to contact allergy to weak sensitizers and wet work to medium-potency sensitizers. Neither predisposed to contact allergy from strong sensitizers.

Limitations

Association cannot prove causation.

Conclusions

We conclude that strong sensitizers do not require wet work or atopy to cause sensitization. Barrier defects associated with childhood eczema and wet work may promote sensitization to weak antigens.

Section snippets

Methods

This was a retrospective study using a database of all 1828 patients patch tested for suspicion of allergic contact dermatitis in the University Hospital Case Medical Center Dermatology Clinic, 2003 through 2013. The statistics reported here were for the 1650 subjects evaluable for occupational classification of wet or dry work. The study was granted approval from the university institutional review board. All patents underwent patch testing with the university's standard series and specialty

Results

Of our 1650 patients, two-thirds were female and one-third was male. In all, 18% (291 patients) had a history of childhood dermatitis, a proxy for atopic dermatitis. A total of 37% (606 patients) had hand dermatitis, and wet workers were 2.4 times more likely to present to our clinic with hand dermatitis (Table III). Among dry workers, subjects with a history of childhood dermatitis were 1.4 times more likely to present with hand dermatitis compared with subjects without a history of childhood

Discussion

Patients with a history of childhood dermatitis as a proxy for genetic barrier impairment/atopic dermatitis are more likely than subjects without a history of childhood dermatitis to react to weak allergens. However, most standard screening series are composed of potent sensitizers that cause allergic contact dermatitis in the general population. This implies the need to use an extended standard series including more allergens of lower potency when patch testing for allergic contact dermatitis

References (17)

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Funded by a Research Award from the American Contact Dermatitis Society.

Conflicts of interest: None declared.

Reprints not available from the authors.

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© 2016 by the American Academy of Dermatology, Inc.