title: Food allergy preceded by contact urticaria due to the same food: involvement of epicutaneous sensitization in food allergy.
abstract: BACKGROUND
  There have recently been reports suggesting that sensitization to food allergens may occur outside the intestinal tract, especially through the skin. To clarify the role of epicutaneous sensitization in food allergy, we investigated the clinical characteristics of adult patients with food allergies preceded by contact urticaria due to the same foods.
  
  
  METHODS
  We investigated clinical characteristics of 15 patients (20-51 years of age; 5 men and 10 women), who had food allergies preceded by contact urticaria.
  
  
  RESULTS
  Fourteen patients were contact urticaria due to the causative foods during occupationally cooking, whereas 1 patient during face pack. In the occupational group, causative foods included rice, wheat, fruits, vegetables, fish, shrimp and cuttlefish; in the fresh cucumber paste case the cause was cucumber. In the 15 patients, the causative foods were fresh, not processed, and were tolerated by most (9/15, 60%) after heating. Regarding to symptoms after ingestion of the causative foods, the most frequently induced symptoms was oral symptoms (14/15, 93.3%), followed by urticaria (4/15, 26.7%), abdominal symptoms (3/15, 20%). The duration between the start of jobs or face pack, and the onset of contact urticaria was from 1 month to 19 years (mean, 8.7 years). The duration between the onset of contact urticaria and the onset of food allergy was from a few weeks to 6 years (mean, 11 months). One sushi cook experienced severe anaphylactic shock after ingestion of fish. In the occupational group, 13 of 15 patients (86.7%) had atopic dermatitis or hand eczema, indicating that the impaired skin barrier might be a risk for food allergies induced by epicutaneous sensitization.
  
  
  CONCLUSIONS
  Epicutaneous sensitization of foods could induce food allergy under occupational cooking and skin-care treatment with foods in adults.
authors.affiliation: Department of Environmental Immuno-Dermatology, Yokohama City University Graduate School of Medicine, Kanagawa, Japan. Electronic address: ninomata@med.yokohama-cu.ac.jp.
authors.forename: Naoko
authors.initials: N
authors.lastname: Inomata
authors.affiliation: Department of Environmental Immuno-Dermatology, Yokohama City University Graduate School of Medicine, Kanagawa, Japan.
authors.forename: Mayumi
authors.initials: M
authors.lastname: Nagashima
authors.affiliation: Department of Environmental Immuno-Dermatology, Yokohama City University Graduate School of Medicine, Kanagawa, Japan.
authors.forename: Amiko
authors.initials: A
authors.lastname: Hakuta
authors.affiliation: Department of Environmental Immuno-Dermatology, Yokohama City University Graduate School of Medicine, Kanagawa, Japan.
authors.forename: Michiko
authors.initials: M
authors.lastname: Aihara
mesh_terms: D000328:Adult; D000485:Allergens / Q000276:immunology; D017449:Dermatitis, Allergic Contact / Q000150:complications* / Q000175:diagnosis / Q000276:immunology*; D005260:Female; D005502:Food / Q000009:adverse effects*; D005512:Food Hypersensitivity / Q000150:complications* / Q000175:diagnosis / Q000276:immunology*; D006801:Humans; D007073:Immunoglobulin E / Q000097:blood / Q000276:immunology; D008297:Male; D008875:Middle Aged; D012882:Skin Tests; D014581:Urticaria / Q000150:complications* / Q000175:diagnosis / Q000276:immunology*; D055815:Young Adult
chemical_list: D000485:Allergens; D007073:Immunoglobulin E
keywords: Anaphylaxis; Atopic dermatitis; Epicutaneous sensitization; Food allergy; Skin barrier