Allergic contact dermatitis: effect of age
ABSTRACT The relationship between allergic contact dermatitis (ACD) and age has not been well documented. We searched for articles and textbooks based on age-ACD relationship and evaluated relevant data. The frequency of skin reactions to allergens increased with age in some studies, whereas others showed no definite effect. This might be caused by variations in study design, genetic factors or by external influences such as from different regions and environmental exposure. In general, investigators agree that elderly patients were more likely to have multiple contact allergies than younger persons. This may be because of the frequent use of topical medicaments and having a longer time for potential allergen exposure. However, a review of marketed transdermal products for ACD shows a very low incidence, and no age-related effects were reported. One exception to this low incidence of ACD is the transdermal product, Catapres-TTS(®) (clonidine), which has a reported incidence rate of ~16%. The generally low incidence of ACD in marketed products and the conflicting findings in the prevalence of specific age-related ACD indicate the need for further investigation as to the proclivity for developing new sensitivities with age.
Contact Dermatitis 07/2013; 69(1):53-5. DOI:10.1111/cod.12093 · 3.62 Impact Factor
[Show abstract] [Hide abstract]
ABSTRACT: The ability to be sensitized to experimental contact allergens declines significantly with increasing age, from as early as age 40 years. In contrast, the rate of contact allergy to chemical allergens (haptens) in cosmetic products significantly increases with age. This has been explained previously on the basis of greater cumulative exposure in the older age groups. However, outbreaks of contact allergy to preservatives in cosmetic products recorded soon after their introduction to the market have also shown a significantly higher rate among older adult age groups. This association with increasing age cannot be readily explained by exposure history or pattern, and is not compatible with a sensitizing/stimulatory reaction that degrades with age as the sole immune response. From this, the existence of a second, tolerizing/regulatory arm to the immune response to cutaneous haptens that possibly becomes less effective with age at a higher rate than the sensitizing/stimulatory arm can be inferred. This reinforces the view that current clinical and experimental observations of allergic contact dermatitis are best explained by an immune system with the functional ability to produce both sensitizing/stimulatory and tolerizing/regulatory responses.Contact Dermatitis 09/2013; 69(3):129-37. DOI:10.1111/cod.12100 · 3.62 Impact Factor
[Show abstract] [Hide abstract]
ABSTRACT: Background. Two readings of patch test reactions are recommended. Objectives. To evaluate the outcome of a second patch test reading of TRUE Test® allergens on D6/7 in relation to negative or doubtful reactions on D3/4. Methods. This was a retrospective investigation of patch test data from January 1992 to October 2011 from consecutive eczema patients tested with the TRUE Test® panels. Results. In the period of nearly 20 years, a total of 9997 patients were tested. The total number of positive reactions to the 29 allergens was 6509; 4.4% were positive on D6/7 and negative on D3/4; and 9.1% were positive on D6/7 after a doubtful (?+) reaction on D3/4. Neomycin was the most frequent allergen giving delayed positive reactions (57%), followed by budesonide (42%) and hydrocortisone-17-butyrate (31%). Conclusion. A total of 4.4% of positive TRUE Test® reactions would be missed, and 9.1% might be missed, if only one reading was performed on D3/4. The results emphasize that many doubtful reactions at D3/4 may develop into positive reactions at a later reading. This may have important implications for evaluation of the clinical relevance of the test result.Contact Dermatitis 02/2013; 68(2):94-7. DOI:10.1111/cod.12004 · 3.62 Impact Factor