title: Balsam-related systemic contact dermatitis.
abstract: BACKGROUND
  Positive patch tests to balsam of Peru (BOP) or fragrance mix (FM) suggest the possibility of systemic contact dermatitis from balsam-related foods and spices.
  
  
  OBJECTIVE
  This was a retrospective study to determine whether avoidance of balsam-related foods results in an improvement of dermatitis in these patients.
  
  
  METHODS
  A review of the records of all patients seen from July 1 to Dec 31, 1998 with positive patch tests to BOP, FM, cinnamic aldehyde, and balsam of tolu was performed 9 to 14 months after their evaluation in a tertiary dermatology center. All patients were contacted via telephone to assess the status of their dermatitis and whether they were able to note any specific balsam-related food allergies.
  
  
  RESULTS
  A total of 75 patients were identified, and 71 could be contacted. Fourteen were only allergic to BOP or FM on testing; 31 were positive to BOP/FM and other allergens with presumed relevance to BOP/FM; 26 were positive to BOP/FM and others with other allergens felt to be responsible for the dermatitis and were not placed on a BOP diet. Excluding this last group, 21 of 45 (47%) had complete or significant improvement that they related to dietary modification. Ten did not modify their diet, with 8 reporting no improvement. Eight improved with fragrance or other allergen avoidance only, and 6 modified their diet unsuccessfully. Most commonly implicated foods included tomatoes, citrus, and spices.
  
  
  CONCLUSIONS
  Almost half of the subjects with positive patch tests to BOP or FM who followed a BOP reduction diet reported significant to complete improvement of their dermatitis.
authors.affiliation: Division of Dermatology, University of Louisville, Louisville, KY, USA.
authors.forename: T N
authors.initials: TN
authors.lastname: Salam
authors.forename: J F
authors.initials: JF
authors.lastname: Fowler
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000485:Allergens / Q000009:adverse effects*; D001453:Balsams / Q000009:adverse effects*; D017449:Dermatitis, Allergic Contact / Q000175:diagnosis* / Q000178:diet therapy* / Q000209:etiology; D005260:Female; D005512:Food Hypersensitivity / Q000150:complications*; D006801:Humans; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D010328:Patch Tests; D012189:Retrospective Studies; D012720:Severity of Illness Index
chemical_list: D000485:Allergens; D001453:Balsams; C025080:Peruvian balsam