Pediatric Contact Dermatitis Allergens Vary by Age, Sex, Race

Jessica N. Pixley, MD

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Sensitization among pediatric patients with allergic contact dermatitis may vary based on age groups, gender, and race/ethnicity, according to new findings.

Data presented at the American Academy of Dermatology (AAD) 2024 Annual Meeting in San Diego, CA, last week showed a vacillation of most common allergens occurring on skin patch tests based very heavily on the age and gender of children. While there may be a myriad of reasons influencing this demographic-based disparity in sensitization, the investigative team suggests clinicians condone avoidance of allergens in pediatric patients based on these trends.

Led by Jessica N. Pixley, MD, of the department of dermatology at Wake Forest University School of Medicine, the North Carolina-based team of investigators sought to identify differences in allergens from patch tests conducts from 2017 – 2022. They stressed the significant commonality of allergic contact dermatitis—estimated to affect 1 in every 5 children—despite there being little research into the sex, racial and ethnicity associated differences in sensitization.

Pixley and colleagues provided pediatric, adolescent or partial patch tests to assess for <35, <80, or individually selected allergens, respectively. Mean patch test positivity was based on the number of strong or very strong reactions, while positive patch test rates were determined by the percentage of participants with ≥1 strong or very strong reaction.

They compared patch test results relative to patient characteristics including the following:

• Age group (0 - 5 years old, 6 – 11, and 12 – 18)
• Sex
• Ethnicity
• Racial group (White, Black / African American, Asian, Other)

The 5 most frequently positive patch allergens included:

• Propolis 10% pet
• Carmine 2.5%
• Cocamidopropyl betaine 1% aq
• Nickel sulfate hexahydrate 5% pet
• Amerchol L101 50% pet

Among children by race, propolis 10% was the most prevalent allergen in every demographic except for Asian (carmine 2.5%). Propolis 10% was additionally the most frequent allergen among girls and those in the age 6 – 11 and 12 – 18 age groups. Carmine 2.5% was the most common allergen among boys and children in the 0 – 5 age group.

Three in 10 White children (n = 121 [30.0%]) reported propolis 10% as an allergen—the highest rate of positivity for any allergen among each race/ethnicity. Hispanic children were approximately 50% more likely to test positive for cocamidopropyl (21.4%) than American Indian, Native Hawaiian or other Pacific Islander children (14.8%).

Overall, children in the 0 – 5 age group reported the highest number of positive reactions. The risk of sensitivity to multiple allergens appeared to vary based on each of child’s sex, age, race and ethnicity, however.

“It may be helpful to avoid the most common allergens empirically based on age and gender,” Pixley and colleagues concluded. “The etiology of these differences is likely multi-factorial and could include differences in genetic background and exposure patterns.”

References

1. ^{Pixley J, Kontzias C, Tao R, Srivastava R, et al. A Retrospective Study of Age, Sex, Racial, and Ethnic Differences in Pediatric Contact Dermatitis from 2017-2022. Paper presented at: American Academy of Dermatology (AAD) 2024 Annual Meeting. March 8 – 12, 2024. San Diego, CA.}
2. ^{Adler BL, DeLeo VA. Allergic Contact Dermatitis. JAMA Dermatol. 2021;157(3):364. doi:10.1001/jamadermatol.2020.5639}