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Contact sensitization to common haptens is associated with atopic dermatitis: new insight

Authors

  • J.P. Thyssen,

    1. National Allergy Research Centre, Department of Dermato-Allergology, Copenhagen University Hospital Gentofte, Niels Andersens Vej 65, 2900 Hellerup, Denmark
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  • A. Linneberg,

    1. Research Centre for Prevention and Health, Copenhagen University Hospital Glostrup, Denmark
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  • K. Engkilde,

    1. National Allergy Research Centre, Department of Dermato-Allergology, Copenhagen University Hospital Gentofte, Niels Andersens Vej 65, 2900 Hellerup, Denmark
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  • T. Menné,

    1. National Allergy Research Centre, Department of Dermato-Allergology, Copenhagen University Hospital Gentofte, Niels Andersens Vej 65, 2900 Hellerup, Denmark
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  • J.D. Johansen

    1. National Allergy Research Centre, Department of Dermato-Allergology, Copenhagen University Hospital Gentofte, Niels Andersens Vej 65, 2900 Hellerup, Denmark
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  • Funding sources
    The Danish Board of Health, The Danish Environmental Protection Agency, The Copenhagen County Research Foundation, The Velux Foundation, Denmark and The Danish Scientific Research Council. Study sponsors had no role in the design, collection or interpretation of data. J.P.T.’s salary was paid by an unrestricted award from the Leo Pharma Research Foundation.

  • Conflicts of interest
    None declared.

Jacob Pontoppidan Thyssen.
E-mail: jacpth01@geh.regionh.dk

Summary

Background  It has been much debated whether atopic dermatitis (AD) is associated with contact sensitization as past findings have been conflicting. A positive association might change our clinical practice.

Objectives  To investigate the association between AD and contact sensitization taking the likely route of allergen exposure into account.

Methods  Questionnaire and clinical data from a cross-sectional study performed in a general population in Copenhagen. In total, 3202 adults aged 18–69 years were patch tested, filaggrin genotyped for 2282del4 and R501X and questioned about AD.

Results  The variable ‘contact sensitization to at least one allergen, but not nickel and thimerosal’ was significantly associated with AD (odds ratio 2·53, 95% confidence interval 1·59–4·04). The higher prevalence of contact sensitization was driven mainly by fragrance chemicals. In a subanalysis in nonpierced women, a positive association was also found for nickel sensitization. Nickel and thimerosal sensitization may introduce bias in data analysis as these allergies often develop following skin piercing where the skin compartments are bypassed.

Conclusions  We suspect that individuals with self-reported AD from this study mainly had mild disease. However, clinicians should be aware of increased levels of contact sensitization in individuals with AD. Patch testing should therefore be considered at an early point in individuals with a history of AD and active disease. The fundamental relationship between atopic disease and environmental chemical exposure may be of a more complex and intimate nature than previously supposed.

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