Contact allergy in children: an update

Abstract

Contact dermatitis in children is not uncommon. Most cases are misdiagnosed as endogenous eczema. Irritant contact dermatitis is probably more common than allergic contact dermatitis. Most epidemiology studies are based on referral populations in hospitals and the actual incidence in the community is unknown. The reported prevalence of contact allergy in patch test clinics varies from 24 to 66%. Common contact allergens include metals (e.g., nickel), mercurials (medicament), fragrance mix and rubber chemicals. Allergic and irritant contact dermatitis are often clinically indistinguishable from each other and an accurate diagnosis is possible only after a detailed history, physical examination and patch test. Occasionally, the location and morphology of the dermatitis may give a clue to diagnosis. Patch testing is seldom carried out in children, and dermatologists should be encouraged to perform the test where allergic contact dermatitis is suspected. There are similarities between pediatric and adult contact dermatitis and the same patch-test allergen concentrations can be used as in adults with minor modifications. Contact urticaria to natural rubber latex in children should not be overlooked. Children with atopic dermatitis and those with multiple surgical interventions are at a higher risk. Once diagnosed, strict avoidance of products containing natural rubber latex should be advised, as contact urticaria to natural rubber latex can be life threatening.