Allergic dermatitis in children

Sharon E. Jacobs, MD: “There are over 4,000 chemicals that we are exposed to on a daily basis, and only 35 of them are acknowledged by the Food and Drug Administration as allergens.”

Conventional wisdom long has suggested that allergic dermatitis is uncommon in children. The reality is, children suffer from allergic dermatitis as frequently as adults. The most common culprits are chemicals in personal care products.

“There are over 4,000 chemicals that we are exposed to on a daily basis, and only 35 of them are acknowledged by the Food and Drug Administration as allergens,” said Sharon E. Jacobs, MD, professor of dermatology at Loma Linda University and founder/CEO of The Dermatitis Academy, an online information resource for patients and parents. “Children with persistent allergic contact dermatitis need patch testing just as much as adults do.”

Dr. Jacobs explored the current realities of allergic contact dermatitis in children Friday during “The Truth About Pediatric Contact Dermatitis” (U009). Data from the Pediatric Contact Dermatitis Registry found that 48 percent of children tested were contact sensitized with 65 percent clinical relevance—rates nearly identical to published adult data.

More recent data from a survey of 252 pediatric providers found that children with allergic dermatitis are 17 times more likely to have a positive patch test than children without allergic dermatitis and 110 times more likely to have generalized involvement.

“We need to test more children,” Dr. Jacobs said. “We are missing a lot of patients who need serious help. Patients with allergic dermatitis have a history of dermatitis for 3.5 years compared to 1.8 years for other patients.”

Pediatric patch test studies identified the top allergens as: neomycin, balsam of Peru, fragrance mixes, lanolin, cocamidopropylbetaine, formaldehyde, corticosteroids, methylchlorisothiazolinone (MCI)/methylisothiazolinone (MI), propylene glycol, and benzalkonium chloride.

Other common pediatric allergens include detergents, parthenolide/compositae, nickel, cobalt, colophene, chromates, glucoside, and p-phenylenediamine, or PPD.

Those agents are commonly used in fragrances, cleaning products, cell phones, metal furniture, jewelry, foods, henna, medications, personal care, and other products commonly found in homes, schools, daycare centers, and parents’ skin.

A third of toys have been found to release nickel and cobalt. Toilet seats in schools and other public areas may be cleaned with harsh detergents and incompletely rinsed, causing allergic reactions. Black henna tattoos are a common source of allergens and should never be applied to children. Glucoside is found in many personal care products, including infant sunscreens.

“One of the most common sources of allergens is cosmetics, fragrances, hair dyes, and personal products used by parents,” Dr. Jacobs said. “Sometimes finding the source takes some sleuthing. It can be as obvious as a new rubber mat in a daycare center or as elusive as glue used in a bra or shoes.”

One of the most effective steps to treat allergic dermatitis is to remove the allergen. Pre-emptive avoidance strategy (PEAS) can effectively cure about one-third of children with persistent allergic dermatitis.

Avoidance may mean removing the product from the environment, such as offensive fragrance. It may also mean protecting items that cannot be avoided, such as putting duct tape over the rubber on soccer shin guards that are emitting allergens.

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