Pediatric Contact Dermatitis Registry Data on Contact Allergy in Children With Atopic Dermatitis

Original Investigation

Sharon E. Jacob, MD¹; Maria McGowan, MD²; Nanette B. Silverberg, MD³; et alJanice L. Pelletier, MD^4,5; Luz Fonacier, MD^6,7; Nico Mousdicas, MD⁸; Doug Powell, MD⁹; Andrew Scheman, MD¹⁰; Alina Goldenberg, MD, MAS¹¹

Author Affiliations

JAMA Dermatol. Published online February 22, 2017. doi:10.1001/jamadermatol.2016.6136

 

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Key Points

Question  Does having atopic dermatitis (AD) influence sensitization patterns and allergic contact dermatitis development among children?

Findings  In this retrospective case review, which included 1142 children younger than 18 years, those with AD had statistically significant increased frequency of reactions to cocamidopropyl betaine, wool alcohol, lanolin, tixocortol pivalate, and parthenolide, and lower frequency of reaction to methylisothiazolinone, cobalt, and potassium dichromate.

Meaning  Children with AD showed significant reaction patterns to allergens found in their skin care preparations.

Abstract

Importance  Atopic dermatitis (AD) and allergic contact dermatitis (ACD) have a dynamic relationship not yet fully understood. Investigation has been limited thus far by a paucity of data on the overlap of these disorders in pediatric patients.

Objective  To use data from the Pediatric Contact Dermatitis Registry to elucidate the associations and sensitizations among patients with concomitant AD and ACD.

Design, Setting, and Participants  This retrospective case review examined 1142 patch test cases of children younger than 18 years, who were registered between January 1, 2015, and December 31, 2015, by 84 health care providers (physicians, nurse practitioners, physician assistants) from across the United States. Data were gathered electronically from multidisciplinary providers within outpatient clinics throughout the United States on pediatric patients (ages 0-18 years).

Exposures  All participants were patch-tested to assess sensitizations to various allergens; history of AD was noted by the patch-testing providers.

Main Outcomes and Measures  Primary outcomes were sensitization rates to various patch-tested allergens.

Results  A total of 1142 patients were evaluated: 189 boys (34.2%) and 363 girls (65.8%) in the AD group and 198 boys (36.1%) and 350 girls (63.9%) in the non-AD group (data on gender identification were missing for 17 patients). Compared with those without AD, patch-tested patients with AD were 1.3 years younger (10.5 vs 11.8 years; P < .001) and had longer history of dermatitis (3.5 vs 1.8 years; P < .001). Patch-tested patients designated as Asian or African American were more likely to have concurrent AD (odds ratio [OR], 1.92; 95% CI, 1.20-3.10; P = .008; and OR, 4.09; 95% CI, 2.70-6.20; P <.001, respectively). Patients with AD with generalized distribution were the most likely to be patch tested (OR, 4.68; 95% CI, 3.50-6.30; P < .001). Patients with AD had different reaction profiles than those without AD, with increased frequency of reactions to cocamidopropyl betaine, wool alcohol, lanolin, tixocortol pivalate, and parthenolide. Patients with AD were also noted to have lower frequency of reaction to methylisothiazolinone, cobalt, and potassium dichromate.

Conclusions and Relevance  Children with AD showed significant reaction patterns to allergens notable for their use in skin care preparations. This study adds to the current understanding of AD in ACD, and the continued need to investigate the interplay between these disease processes to optimize care for pediatric patients with these conditions.