Sensitizing agents found in children and adolescents with recalcitrant atopic dermatitis: a cross-sectional study with a pediatric battery

Cattani and colleagues patch tested 54 patients aged 4 to 18 years with recalcitrant atopic dermatitis in Porto Alegre. Sensitisation was 37.07 percent (20 of 54). Allergic contact dermatitis was 27.7 percent (15 of 54). The most frequent allergen was nickel sulfate. This is a clinical sensitisation study. It does not measure nickel in a food, a garment, or a toy.

Key numbers

Table 3: nickel sulfate was positive in 9 patients (16.7 percent), 0 of the male patients and 9 of 35 female patients (25.7 percent), p = 0.019. Ages 4 to 9 years: 7 of 31 (22.6 percent). Ages 10 to 18 years: 2 of 23 (8.7 percent), p = 0.273. Clinical relevance was marked Yes.

The battery lists nickel sulfate at 5.0 percent in petrolatum. That is the test preparation, not contamination of a product. Potassium bichromate was in the same battery and was negative. Other positives were disperse blue 3 (5.6 percent), fragrance mix I 3 (5.6 percent), neomycin 2 (3.7 percent), formaldehyde 1 (1.9 percent), fragrance mix II 1 (1.9 percent), and methylchloroisothiazolinone/methylisothiazolinone 1 (1.9 percent). Those are not metal concentrations.

Methods (brief)

Cross-sectional pediatric patch-test battery. Readings and clinical relevance are as reported by the authors. No product assay is described.

Evidence fitness

The table supports nickel sulfate positivity in this clinic sample, at the test concentration printed. It does not support a release rate from clothing snaps or a level in a wipe, cream, or food.

Limitations

Fifty-four referred patients with recalcitrant atopic dermatitis are not a population sample. A positive patch test is not a product measurement. The negative potassium bichromate result is a negative test in this battery, not a chromium survey.

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