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Contact Allergy in Children Referred for Patch TestingNorth American Contact Dermatitis Group Data, 2001-2004
Kathryn A. Zug, MD;
Daniel McGinley-Smith, MD;
Erin M. Warshaw, MD;
James S. Taylor, MD;
Robert L. Rietschel, MD;
Howard I. Maibach, MD;
Donald V. Belsito, MD;
Joseph F. Fowler Jr, MD;
Frances J. Storrs, MD;
Vincent A. DeLeo, MD;
James G. Marks Jr, MD;
C. G. Toby Mathias, MD;
Melanie D. Pratt, MD;
Denis Sasseville, MD
Arch Dermatol. 2008;144(10):1329-1336.
Objectives To determine the frequency of positive and relevant patch tests in children referred for patch testing in North America; to compare results of patch testing children and adults; and to compare our results with international data on contact allergy in children.
Design Retrospective cross-sectional analyses of North American Contact Dermatitis Group (NACDG) data from January 1, 2001, through December 31, 2004. Patch test reactions for allergens that were positive and considered of clinical importance to the patient's eczematous problem were defined as being of current or past relevance.
Setting Clinical patch test data from 13 NACDG members, primarily a referral population.
Patients The pediatric population (hereafter referred to as "children") was defined as patients aged 0 to 18 years (n = 391). Patients 19 years and older constituted the comparison adult group (n = 9670).
Main Outcome Measures The frequency of positive patch test reactions and number of relevant ones. Secondary measures included the association of atopic markers, frequency of irritant reactions, and sources of relevant supplementary allergens.
Results No significant difference in the overall frequency of at least 1 relevant positive patch test reaction was noted in children (51.2%) compared with adults (54.1%). The most frequent positive reactions in children were to nickel (28.3%), cobalt chloride (17.9%), thimerosal (15.3%), neomycin sulfate (8.0%), gold sodium thiosulfate (7.7%), and fragrance mix (5.1%). For children aged 0 to 18 the most frequent relevant positive reactions were to nickel sulfate (26.0%), cobalt (12.4%), neomycin (4.4%), fragrance mix (4.1%), gold (3.6%), and quaternium 15 (3.6%). The frequency of irritant reactions in adults and children was similar. Of the children with a relevant positive reaction, 34.0% had atopic dermatitis included as one of their final diagnoses, compared with 11.2% of adults (P < .001). Fifteen percent and 39% of children had relevant allergens not included in the NACDG series and a commercially available skin patch test (T.R.U.E. TEST [thin-layer rapid use epicutaneous test], panel 1.1 and 2.1; Allerderm, Phoenix, Arizona), respectively.
Conclusions Adults and children in this group are equally likely to have allergic contact dermatitis; frequency of relevant allergen reactions differs.
Author Affiliations: Section of Dermatology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire (Drs Zug and McGinley-Smith); Dermatology Departments, University of Minnesota and Veterans Affairs Medical Center, Minneapolis (Dr Warshaw) and University of Missouri, Kansas City (Dr Belsito); Departments of Dermatology, Cleveland Clinic, Cleveland, Ohio (Dr Taylor), University of California, San Francisco (Dr Maibach); University of Louisville, Louisville, Kentucky (Dr Fowler); Oregon Health Science University, Portland (Dr Storrs); Columbia University St Luke's Roosevelt Hospital Center, New York, New York (Dr De Leo); Pennsylvania State University, Hershey (Dr Marks); and University of Cincinnati, Cincinnati, Ohio (Dr Mathias); Section of Dermatology, Univeristy of Arizona Department of Veterans Affairs Health Care System, Tucson (Dr Rietschel); and Divisions of Dermatology, University of Ottawa, Ottawa, Ontario (Dr Pratt), and McGill University, Royal Victoria Hospital, Montreal, Quebec (Dr Sasseville), Canada.
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