Contact Dermatitis

<jats:title>ABSTRACT</jats:title><jats:sec><jats:title>Background</jats:title><jats:p>Contact allergy is common in children, but no paediatric baseline series (<jats:styled-content style="fixed-case">pEBS</jats:styled-content>) exists in Europe, despite recommendations in several countries.</jats:p></jats:sec><jats:sec><jats:title>Objectives</jats:title><jats:p>To collect and compare patch testing data from European centres to propose a common <jats:styled-content style="fixed-case">pEBS</jats:styled-content>, possibly adapted by age group.</jats:p></jats:sec><jats:sec><jats:title>Materials and Methods</jats:title><jats:p>Data from 13 centres in 12 European countries were aggregated, covering 1816 children (1099 girls, 60.5%), aged 0–16 years, tested with the adult <jats:styled-content style="fixed-case">EBS</jats:styled-content> (<jats:styled-content style="fixed-case">aEBS</jats:styled-content>) and other frequent allergens between 2018 and 2022. Allergen selection followed adult criteria, with a stricter cut‐off for inclusion, requiring at least 1% positive reactions (lower 95% <jats:styled-content style="fixed-case">CI</jats:styled-content>) in children.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>A total of 17 allergens from the <jats:styled-content style="fixed-case">aEBS</jats:styled-content> caused positive reactions in ≥ 1% of children (lower 95% <jats:styled-content style="fixed-case">CI</jats:styled-content>). Common allergens included metals, fragrances, and preservatives. Tixocortol‐21‐pivalate was included despite its lower frequency due to its difficult‐to‐suspect nature. Additional frequent allergens were hydroperoxides of limonene and linalool, Amerchol L‐101, and sorbitan sesquioleate. In total, 18 allergens were identified as potentially qualifying for a <jats:styled-content style="fixed-case">pEBS</jats:styled-content>, with a further 7 as recommended additions.</jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p>Results from patch testing children across europe highlight a common set of frequent allergens, which should be considered for a <jats:styled-content style="fixed-case">pEBS.</jats:styled-content></jats:p></jats:sec>

publication_history

received

accepted

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Variability in Paediatric Patch Test Practices Across Europe: A Survey From the European Baseline Series (EBS) Working Party on Behalf of the European Society of Contact Dermatitis (ESCD)

Patch Test Results in a Dutch Paediatric Population With Suspected Contact Allergy: A Retrospective Cohort Study

Patch Test Results in Children and Adolescents Across Europe. Analysis of the ESSCA Network 2002–2010

Pediatric Allergy and Immunology

Contact Allergy in a Paediatric Population Observed in a Tertiary Referral Centre in Belgium

Patch‐Test Results in Terms of the Recently Recommended Allergens in Children and Adolescents: A Retrospective Cohort Study Over 22 Years From Turkey

Allergens Responsible for Contact Allergy in Children From 2010 to 2024: A Systematic Review and Meta‐Analysis

Pediatric Baseline Patch Test Series: Pediatric Contact Dermatitis Workgroup

Dermatitis

Allergic Contact Dermatitis in Children and Proposal for an Australian Paediatric Baseline Series

Australasian Journal of Dermatology

Allergic Contact Reaction to Antiseptics in Very Young Children

Journal of the European Academy of Dermatology and Venereology

Non‐Occupational Allergic Contact Dermatitis From Epoxy Resin in Children's Games

“Slime”: A New Fashion Among Children Causing Severe Hand Dermatitis

Isothiazolinones Common in Children's Toy Slime

Contact Allergy to Fragrances and Parabens in an Atopic Baby

Use of Self‐Applied Sculptured Gel Nails May Increase the Risk of Allergy to (Meth)acrylates in Children and Adolescents

Hand Eczema From Nail (Meth)acrylates in an 11‐Year‐Old Child

Allergic Contact Dermatitis in Children: Trends in Allergens, 10 Years on. A Retrospective Study of 500 Children Tested Between 2005 and 2014 in One UK Centre

Contact Sensitization to Fragrance Mix I and Fragrance Mix II Among European Dermatitis Patients: A Systematic Review

EAACI Position Paper for Practical Patch Testing in Allergic Contact Dermatitis in Children

Contact Allergy to Hydroperoxides of Limonene and Linalool in a Pediatric Population

Journal of the American Academy of Dermatology

Allergic Contact Dermatitis, Mimicking Atopic Dermatitis, Associated With the Use of Essential Oils in “Home‐Made” Cosmetics and Aromatherapy Diffusers

Severe Intractable Eyelid Dermatitis Probably Caused by Exposure to Hydroperoxides of Linalool in a Heavily Fragranced Shampoo

Fragrance Allergens in Cosmetic Products Marketed for Children in Denmark

Limonene and Linalool Hydroperoxides Review: Pros and Cons for Routine Patch Testing

Contact allergy is common in children, but no paediatric baseline series (pEBS) exists in Europe, despite recommendations in several countries.
To collect and compare patch testing data from European centres to propose a common pEBS, possibly adapted by age group.
Data from 13 centres in 12 European countries were aggregated, covering 1816 children (1099 girls, 60.5%), aged 0-16 years, tested with the adult EBS (aEBS) and other frequent allergens between 2018 and 2022. Allergen selection followed adult criteria, with a stricter cut-off for inclusion, requiring at least 1% positive reactions (lower 95% CI) in children.
A total of 17 allergens from the aEBS caused positive reactions in ≥ 1% of children (lower 95% CI). Common allergens included metals, fragrances, and preservatives. Tixocortol-21-pivalate was included despite its lower frequency due to its difficult-to-suspect nature. Additional frequent allergens were hydroperoxides of limonene and linalool, Amerchol L-101, and sorbitan sesquioleate. In total, 18 allergens were identified as potentially qualifying for a pEBS, with a further 7 as recommended additions.
Results from patch testing children across europe highlight a common set of frequent allergens, which should be considered for a pEBS.

Contact Allergy in Children in Europe: A Proposal for a Paediatric European Baseline Series.

Contact Allergy in Children in Europe: A Proposal for a Paediatric European Baseline Series

Journal of Investigative Dermatology

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Increased sensitivity of histidinemic mice to UVB radiation suggests a crucial role of endogenous urocanic acid in photoprotection

J Invest Dermatol

The influence of skin microorganisms on cutaneous immunity

Nat Rev Immunol

Regulation of the histidine utilization (hut) system in bacteria

Microbiol Mol Biol Rev

Reproducible, interactive, scalable and extensible microbiome data science using QIIME 2

Nat Biotechnol

Skin contact irritation conditions the development and severity of allergic contact dermatitis

Challenges in exploring and manipulating the human skin microbiome

Microbiome

Eavesdropping on the conversation between immune cells and the skin epithelium

Int Immunol

Ultraviolet radiation, both UVA and UVB, influences the composition of the skin microbiome

Exp Dermatol

DADA2: high-resolution sample inference from Illumina amplicon data

Nat Methods

GMPR: a robust normalization method for zero-inflated count data with application to microbiome sequencing data

PeerJ

Mechanism of immune suppression by ultraviolet irradiation in vivo. I. Evidence for the existence of a unique photoreceptor in skin and its role in photoimmunology

J Exp Med

Ultraviolet radiation-induced upregulation of antimicrobial proteins in health and disease

Photochem Photobiol Sci

The role of urocanic acid in UVB-induced suppression of immunity to Trichinella spiralis infection in the rat

Immunology

UV-B radiation induces the expression of antimicrobial peptides in human keratinocytes in vitro and in vivo

J Allergy Clin Immunol

The multiple roles of urocanic acid in health and disease

The degradation of L-histidine and trans- and cis-urocanic acid by bacteria from skin and the role of bacterial cis-urocanic acid isomerase

J Photochem Photobiol B

Skin pH-dependent Staphylococcus aureus abundance as predictor for increasing atopic dermatitis severity

Allergy

Prolonged increase of cis-urocanic acid levels in human skin and urine after single total-body ultraviolet exposures

Photochem Photobiol

Photoisomerization spectrum of urocanic acid in human skin and in vitro: effects of simulated solar and artificial ultraviolet radiation

Br J Dermatol

16S based microbiome analysis from healthy subjects' skin swabs stored for different storage periods reveal phylum to genus level changes

Front Microbiol

Skin-restricted commensal colonization accelerates skin graft rejection

JCI Insight

Moderated estimation of fold change and dispersion for RNA-seq data with DESeq2

Genome Biol

Effect of the GC content of DNA on the distribution of UVB-induced bipyrimidine photoproducts

An action spectrum for the production of cis-urocanic acid in human skin in vivo

The effect of ultraviolet B irradiation and urocanic acid isomers on dendritic cell migration

Characterization of a monoclonal antibody to cis-urocanic acid: detection of cis-urocanic acid in the serum of irradiated mice by immunoassay

Commensal-dendritic-cell interaction specifies a unique protective skin immune signature

Nature

A commensal strain of Staphylococcus epidermidis protects against skin neoplasia

Sci Adv

Mechanisms for control of skin immune function by the microbiome

Curr Opin Immunol

Immunosuppression by ultraviolet B radiation: initiation by urocanic acid

Immunol Today

Effects of ultraviolet A radiation on survival and growth of Gram negative bacteria

Trends Photochem Photobiol

Ultraviolet exposure regulates skin metabolome based on the microbiome

Sci Rep

The skin microbiome: is it affected by UV-induced immune suppression?

Skin microbiome modulates the effect of ultraviolet radiation on cellular response and immune function

iScience

Persistent neutrophil infiltration and unique ocular surface microbiome typify dupilumab-associated conjunctivitis in patients with atopic dermatitis

Ophthalmol Sci

The SILVA ribosomal RNA gene database project: improved data processing and web-based tools

Nucleic Acids Res

Effects of cage-change frequency and bedding volume on mice and their microenvironment

J Am Assoc Lab Anim Sci

Antimicrobial peptides and the skin immune defense system

cis-urocanic acid, a sunlight-induced immunosuppressive factor, activates immune suppression via the 5-HT2A receptor

Proc Natl Acad Sci USA

Behaviour and sun exposure in holidaymakers alters skin microbiota composition and diversity

Front Aging

Development of sequencing-based methodologies to distinguish viable from non-viable cells in a bovine milk matrix: a pilot study

Ensembl Genomes 2022: an expanding genome resource for non-vertebrates

PD-L1 enhanced by cis-urocanic acid on Langerhans cells inhibits Vγ4+ γδT17 cells in imiquimod-induced skin inflammation

Introducing EzBioCloud: a taxonomically united database of 16S rRNA gene sequences and whole-genome assemblies

Int J Syst Evol Microbiol

Acinetobacter as a potentially important producer of urocanic acid in chub mackerel, a histidine metabolite of emerging health concern

Eur Food Res Technol

The skin microbiome plays an important role in health and disease. We have recently shown that microbes living on the skin regulate the immunomodulatory properties of UVR, but the underlying mechanisms remain to be uncovered. Using a preclinical model of immunosuppression against the chemical allergen 2,4-dinitrofluorobenzene, 16S microbiome sequencing, in vitro cultures, high-performance liquid chromatography-mass spectrometry and the generation of gnotobiotic-like mice, we report that acute UVB radiation induces a transient and significant restructuring of bacterial communities on the skin through one of its major photoproducts, cis-urocanic acid. Certain bacteria, such as Staphylococcus epidermidis, use urocanase (HutU) to metabolize cis-urocanic acid to proliferate. This in turn affects the concentration of cis-urocanic acid on the skin, limiting its ability to suppress adaptive immune responses and induce tolerance to 2,4-dinitrofluorobenzene. Interestingly, addition of a topical urocanase inhibitor restricts the metabolism of cis-urocanic acid by HutU+ bacteria and restores immunosuppression. Overall, these results illustrate how, by harnessing a unique nutrient produced in response to UVR, urocanase-positive skin-resident bacteria can fine tune immune responses to environmental antigens. They should open new avenues to enhance the beneficial effects of phototherapy protocols and sun protection.

Urocanase-Positive Skin-Resident Bacteria Metabolize cis-Urocanic Acid and in Turn Reduce the Immunosuppressive Properties of UVR.

Urocanase-Positive Skin-Resident Bacteria Metabolize cis-Urocanic Acid and in Turn Reduce the Immunosuppressive Properties of UVR

Dermatology Foundation

Prevalence of contact allergy in the general population: a systematic review and meta-analysis

Age-related differences in patch testing results among children: analysis of North American contact dermatitis group data, 2001-2018

J Am Acad Dermatol

Patterns of atopic eczema disease activity from birth through midlife in 2 British birth cohorts

JAMA Dermatol

Can atopic dermatitis and allergic contact dermatitis coexist?

Cutis

Pediatric contact dermatitis registry data on contact allergy in children with atopic dermatitis

Terminology of contact dermatitis

Acta Derm Venereol

Diagnostic features of atopic dermatitis

The burden of atopic dermatitis: summary of a report for the National Eczema Association

The role and diagnosis of allergic contact dermatitis in patients with atopic dermatitis

Am J Clin Dermatol

Contact allergy-emerging allergens and public health impact

Int J Environ Res Public Health

Atopic dermatitis

N Engl J Med

North American Contact Dermatitis Group patch test results: 2017-2018

Prevalence of fragrance allergy

Dermatology

Propolis: its role and efficacy in human health and diseases

Molecules

Cocamidopropyl betaine is commonly found in hypoallergenic personal care products for children

Expanded series and personalized patch tests for children: a retrospective cohort study

Positive patch test reactions to carba mix and thiuram mix: the North American Contact Dermatitis Group experience (1994-2016)

Allergic contact dermatitis caused by synthetic rubber gloves in healthcare workers: sensitization to 1,3-diphenylguanidine is common

Medical adhesive allergens: retrospective analysis of cross-sectional data from the North American Contact Dermatitis Group, 2001-2018

Assessment of the quality of life (QoL) of patients with dermatitis and the impact of patch testing on QoL: a study of 519 patients diagnosed with dermatitis

An economic evaluation of patch testing in the diagnosis and management of allergic contact dermatitis

Am J Contact Dermat

As both allergic contact dermatitis and atopic dermatitis (AD) have similar clinical presentations and are characterized by spongiotic dermatitis on skin biopsy, many children with AD are not referred for patch testing and allergic contact dermatitis is underdiagnosed.
To provide updated prevalence data of common contact allergens in children with and without AD.
This is a retrospective case-control study using the Pediatric Allergic Contact Dermatitis Registry from 2018 to 2022.
A total of 912 children were included (615 with AD and 297 without AD). Children with AD were more likely to have a longer history of dermatitis (4.1 vs 1.6 years, P < .0001), have seen more providers (2.3 vs 2.1, P = .003), have greater than 1 positive patch test (PPT) result (P = .005), have a greater number of PPT results overall (2.3 vs 1.9, P = .012), and have a more generalized distribution of dermatitis (P = .001). PPT to bacitracin (P = .030), carba mix (P = .025), and cocamidopropyl betaine (P = .0007) were significantly increased in children with AD compared to those without AD.
Technical variation between providers and potential for misclassification, selection, and recall biases.
Children with AD are significantly more likely to have PPT reactions and should be referred for evaluation of allergic contact dermatitis and obtain patch testing.

Prevalence of allergic contact dermatitis in children with and without atopic dermatitis: A multicenter retrospective case-control study.

Prevalence of allergic contact dermatitis in children with and without atopic dermatitis: A multicenter retrospective case-control study

Papers