Inflamed skin predisposes to sensitization to less potent allergens.
BACKGROUND
Irritant dermatitis, caused by genetic barrier dysfunction in atopic dermatitis or wet work in hand dermatitis, induces innate immune response that might predispose to allergic contact sensitization to less potent sensitizers.


OBJECTIVE
We sought to determine if positive patch test results to less potent allergens are more prevalent in patients with a history of childhood flexural dermatitis or current wet work.


METHODS
We examined our database of patients presenting to a contact dermatitis clinic tested to potential contact allergens as indicated by their history. Allergens from our most recent standard were studied if they could be classified as weak, moderate, or strong sensitizers based on published data from the local lymph node assay. Patients were stratified by a history of childhood-onset flexural dermatitis as a proxy for atopic dermatitis and by occupation.


RESULTS
History of childhood-onset dermatitis predisposed to contact allergy to weak sensitizers and wet work to medium-potency sensitizers. Neither predisposed to contact allergy from strong sensitizers.


CONCLUSIONS
Association cannot prove causation.


CONCLUSIONS
We conclude that strong sensitizers do not require wet work or atopy to cause sensitization. Barrier defects associated with childhood eczema and wet work may promote sensitization to weak antigens.
Department of Dermatology, University Hospital Case Medical Center, Case Western Reserve University, Cleveland, Ohio.
Nita
N
Kohli
Department of Dermatology, University Hospital Case Medical Center, Case Western Reserve University, Cleveland, Ohio. Electronic address: stn@case.edu.
Susan
S
Nedorost
D000485:Allergens / Q000276:immunology*; D003876:Dermatitis, Atopic / Q000276:immunology; D003877:Dermatitis, Contact / Q000276:immunology*; D009783:Dermatitis, Occupational / Q000276:immunology; D005260:Female; D006229:Hand Dermatoses / Q000276:immunology; D006801:Humans; D008297:Male; D010328:Patch Tests; D012189:Retrospective Studies; D012307:Risk Factors; D014867:Water
D000485:Allergens; D014867:Water
atopic dermatitis; contact sensitization; irritant dermatitis; occupational hand dermatitis; potency of contact allergens; systemic contact dermatitis; wet work