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Acidic oral environments may trigger systemic contact dermatitis via ionization of metals, including palladium. A patch test revealed a late delayed positive response to palladium, emphasizing the need for nuanced diagnostic approaches for allergy management.

Key Clinical Message Symmetrical drug‐related intertriginous and flexural exanthema, commonly known as “baboon syndrome” due to its typical involvement of the gluteal area, is an erythematous symmetrical rash associated with systemic drug administration.

Key Clinical Message: Symmetrical drug‐related intertriginous and flexural exanthema, commonly known as "baboon syndrome" due to its typical involvement of the gluteal area, is an erythematous symmetrical rash associated with systemic drug administration. [ABSTRACT FROM AUTHOR]

Contact dermatitis (CD) is an inflammatory skin disease of eczema that is elicited by chemicals or metal ions that have toxic effects without eliciting a T‐cell response (contact elicitation) or by small reactive chemicals that modify proteins and induce innate and adaptive immune responses (contact allergens). The clinical condition is characterized by localized skin rash, pruritus, redness, swelling, and lesions, which are mainly detected by patch tests and lymphocyte stimulation. Heavy metals such as palladium (Pd), platinum (Pt), and titanium (Ti) are ubiquitous in our environment. These heavy metals have shown CD effects as allergic agents. Immunological responses result from the interaction of cytokines and T cells. Occupational metal CD accounts for most cases of work‐related cutaneous disorders. In this systematic review, the allergic effects of heavy metals, including Pd, Pt, and Ti, and the mechanisms, clinical manifestations, prevalence, and therapeutic approaches are discussed in detail. Furthermore, the therapeutic approaches introduced to treat CD, including corticosteroids, topical calcineurin inhibitors, systemic immunosuppressive agents, phototherapy, and antihistamines, can be effective in the treatment of these diseases in the future. Ultimately, the insights identified could lead to improved therapeutic and diagnostic pathways. [ABSTRACT FROM AUTHOR]

Chidubem AV Okeke,1 Ramona Khanna,2 Alison Ehrlich3 1Department of Dermatology, Howard University College of Medicine, Washington, DC, USA; 2Georgetown University School of Medicine, Washington, DC, USA; 3Foxhall Dermatology, Washington, DC, USACorrespondence: Chidubem AV Okeke, Department of Dermatology, Howard University College of Medicine, 520 W Street NW, Room 3035/3036, Washington, DC, USA, Email chidubem.okeke@bison.howard.eduAbstract: The recent global pandemic has resulted in increased use of quaternary ammonium compounds (QACs). Currently, QACs are active ingredients in 292 disinfectants recommended by the US EPA for use against SARS-CoV-2. Among QACs, benzalkonium chloride (BAK), cetrimonium bromide (CTAB), cetrimonium chloride (CTAC), didecyldimethylammonium chloride (DDAC), cetrimide, quaternium-15, cetylpyridinium chloride (CPC), and benzethonium chloride (BEC) were all identified as potential culprits of skin sensitivity. Given their widespread utilization, additional research is needed to better classify their dermal effects and identify other cross-reactors. In this review, we aimed to expand our knowledge about these QACs to further dissect its potential allergic and irritant dermal effects on healthcare workers during COVID-19.Keywords: patch test, systemic contact dermatitis, hypersensitivity, allergic contact dermatitis, COVID-19, healthcare

Abstract Contact dermatitis (CD) is an inflammatory skin disease of eczema that is elicited by chemicals or metal ions that have toxic effects without eliciting a T‐cell response (contact elicitation) or by small reactive chemicals that modify proteins and induce innate and adaptive immune responses (contact allergens). The clinical condition is characterized by localized skin rash, pruritus, redness, swelling, and lesions, which are mainly detected by patch tests and lymphocyte stimulation. Heavy metals such as palladium (Pd), platinum (Pt), and titanium (Ti) are ubiquitous in our environment. These heavy metals have shown CD effects as allergic agents. Immunological responses result from the interaction of cytokines and T cells. Occupational metal CD accounts for most cases of work‐related cutaneous disorders. In this systematic review, the allergic effects of heavy metals, including Pd, Pt, and Ti, and the mechanisms, clinical manifestations, prevalence, and therapeutic approaches are discussed in detail. Furthermore, the therapeutic approaches introduced to treat CD, including corticosteroids, topical calcineurin inhibitors, systemic immunosuppressive agents, phototherapy, and antihistamines, can be effective in the treatment of these diseases in the future. Ultimately, the insights identified could lead to improved therapeutic and diagnostic pathways.

Systemic contact dermatitis is a rash secondary to systemic exposure to allergens after sensitization. Numerous agents are implicated including Balsam of Peru, a plant-derived compound often used for flavoring and fragrance. Alcoholic beverages can contain many possible allergens, including cinnamon, vanilla, citrus peels, and Balsam of Peru. Herein, we describe two patients presenting with recurrent, diffuse, erythematous, and pruritic cutaneous eruptions suspicious for contact dermatitis. Based on clinical history, exam, and formal and at-home patch testing results, we believe the most likely etiology was Balsam of Peru within the alcohol beverages leading to systemic contact dermatitis. Both patients markedly improved after avoidance of their alcoholic beverages. Overall, systemic contact dermatitis secondary to alcohol consumption is a rare phenomenon, whereas Balsam of Peru is a relatively common allergen. Suspicion must be high to identify possible allergens (including Balsam of Peru) exposure within alcoholic beverages such as artificial flavorings, aromas, and mixtures.

Keywords: allergic contact dermatitis; case report; doxepin; eczema; pruritus; systemic contact dermatitis EN allergic contact dermatitis case report doxepin eczema pruritus systemic contact dermatitis 137 139 3 07/11/23 20230801 NES 230801 Doxepin is a tricyclic antidepressant able to block H1 and H2 receptors. Allergic contact dermatitis, case report, doxepin, eczema, pruritus, systemic contact dermatitis It is likely that cutaneous sensitization to topical doxepin gradually developed, and that the oral intake of doxepin not only reinforced the occurrence of localized ACD, but also eventually provoked the development of systemic allergic dermatitis. [Extracted from the article]

The literature on systemic allergic dermatitis (SAD; also known as systemic contact dermatitis) is reviewed. Both topical drugs (from absorption through mucosae or skin) and systemic drugs (oral, parenteral, rectal) may be responsible for the disorder. The topical route appears to be rare with 41 culprit topical drugs found to cause SAD in 95 patients. Most reactions are caused by budesonide (especially from inhalation), bufexamac, and dibucaine. SAD from systemic drugs is infrequent with 95 culprit drugs found to cause SAD in 240 patients. The drugs most frequently implicated are mitomycin C, methylprednisolone (salt, ester), and hydrocortisone (salt). The largest group of culprit drugs consisted of corticosteroids (19%), being responsible for >30% of the reactions, of which nearly 40% were not caused by therapeutic drugs, but by drug provocation tests. The most frequent manifestations of SAD from drugs are eczematous eruptions (scattered, widespread, generalized, worsening, reactivation), maculopapular eruptions, symmetrical drug‐related intertriginous and flexural exanthema (SDRIFE [baboon syndrome]) and widespread erythema or erythroderma. Therapeutic systemic drugs hardly ever cause reactivation of previously positive patch tests and infrequently of previous allergic contact dermatitis. The pathophysiology of SAD has received very little attention. Explanations for the rarity of SAD are suggested. [ABSTRACT FROM AUTHOR]

Abstract Background A subset of patients with positive patch tests demonstrates systemic contact dermatitis (SCD) upon ingestion or inhalation of the allergen. Concern has been raised about the use of patch tests for protein allergens (APTs) to detect SCD in atopic dermatitis (AD) patients. Methods We present atopy patch test (APT) data for 97 people. We reviewed APTs and tests for antigen‐specific immunoglobulin E (IgE) to the same allergen in pediatric AD patients. We compared the frequency of APTs as a function of age in AD patients. To study the irritancy potential of APTs, we prospectively tested consenting non‐AD dermatitis patients undergoing evaluation for allergic contact dermatitis and healthy controls to an APT panel. Results APT demonstrated fewer positive results than serum‐specific IgE or skin prick tests to the same allergen. Positive APT to food was more common in children under 3 years, whereas positive APT to aeroallergens were more common in teens and adults. Only positive APTs to dust mite were significantly more common positive in subjects without AD. Conclusion Our aggregate findings suggest that most APTs, but not dust mite, behave like conventional patch tests to low‐potency allergens. They are more likely to be positive in patients with chronically inflamed skin and to identify allergens that cause SCD. The higher prevalence of APT positivity to foods in young children is consistent with food allergy as a trigger of AD (also known as SCD) being more common in children than adults. Positive APTs define patients who may have SCD; negative APTs may guide elimination diets.

Allergic contact dermatitis (ACD) is a common skin condition caused by contact with an exogenous agent that elicits an inflammatory response. Patch testing (PT) is considered the gold standard for diagnosing ACD. Unfortunately, PT may not be available to some patients due to insurance and financial limitations, contributing to health care disparity and leaving patients with undiagnosed, incompletely managed dermatitis that can have further detrimental health and occupational effects. For other patients, PT is precluded by lack of availability of specialist/expert care, comorbid medications, or diffuse disease. This article will present a patient with ACD and will work through the differential diagnosis and share strategies for empiric avoidance of suspected/common triggers. The epidemiology of ACD with respect to race and ethnicity, considerations for affordability of hypoallergenic products, access to testing, and the need for future research are addressed in this article., (Copyright © 2024 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.)

Acidic oral environments may trigger systemic contact dermatitis via ionization of metals, including palladium. A patch test revealed a late delayed positive response to palladium, emphasizing the need for nuanced diagnostic approaches for allergy management., Competing Interests: Partially supported by the Scientific Research Fund of the 10.13039/501100003478Ministry of Health, Labour and Welfare, Japan (grant 21FE2001) and the Japanese Agency for Medical Research and Development (grants 23ek0410090 and 23ek0410106). Disclosure of potential conflict of interest: T. Adachi recieved honoraria for lectures from Torii Pharmaceutical Co. The rest of the authors declare that they have no relevant conflicts of interest., (© 2024 The Author(s).)

Systemic contact dermatitis (SCD) is a generalized reactivation of type IV hypersensitivity skin diseases in individuals with previous sensitization after a contact allergen is administered systemically. Patients with SCD may consider their dermatitis unpredictable and recalcitrant since the causative allergens are difficult to find. If a patient has a pattern of dermatitis suggestive of SCD but fails to improve with conventional treatment, SCD should be taken into consideration. If doctors are not familiar with the presentations of SCD and the possible routes of allergen sensitization and exposure, the diagnosis of SCD may be delayed. In this work, we summarized all of the routes through which allergens can enter the body and cause SCD, including oral intake, local contact (through skin, inhalation, nasal spray and anal application), implants, and other iatrogenic or invasive routes (intravenous, intramuscular, intraarticular, and intravesicular). This will provide a comprehensive reference for the clinicians to identify the culprit of SCD. [ABSTRACT FROM AUTHOR]

Systemic contact dermatitis is a dermatitis that may occur in previously sensitized individuals (usually through the skin or mucosa) when they are re-exposed to the allergen systemically (oral, rectal, inhaled, intravesical, intravenous...). Although many drugs have been implicated as a cause of systemic contact dermatitis, local anesthetics derived from caines have been rarely reported. We present a case of systemic contact dermatitis after performing a digital rectal examination with a urological lubricant containing amethocaine.

Baboon syndrome, case report, systemic contact dermatitis, vaccine, coronavirus disease, symmetric drug-related intertriginous and flexural exanthema Keywords: baboon syndrome; case report; coronavirus disease; symmetric drug-related intertriginous and flexural exanthema; systemic contact dermatitis; vaccine EN baboon syndrome case report coronavirus disease symmetric drug-related intertriginous and flexural exanthema systemic contact dermatitis vaccine 91 93 3 06/14/22 20220701 NES 220701 CASE REPORT A 53-year-old man presented with an erythematous papular skin eruption. Symmetric drug-related intertriginous and flexural exanthema-like eruption related to coronavirus disease 2019 vaccine. [Extracted from the article]

Abstract Systemic contact dermatitis (SCD) is a condition occurring in previously sensitized individuals after systemic re‐exposure to the same or cross‐reacting substance. Pigmented systemic contact dermatitis after intake of cobalt containing diet has never been reported.

Systemic contact dermatitis (SCD) is a condition occurring in previously sensitized individuals after systemic re‐exposure to the same or cross‐reacting substance. Pigmented systemic contact dermatitis after intake of cobalt containing diet has never been reported. [ABSTRACT FROM AUTHOR]

Keywords: case report; patch test; spices; systemic contact dermatitis EN case report patch test spices systemic contact dermatitis 323 325 3 03/16/22 20220401 NES 220401 Systemic contact dermatitis (SCD) or systemically reactivated allergic contact dermatitis (ACD) is a hypersensitivity reaction caused by systemic exposure to the same or related allergen in an already sensitized person. Case report, patch test, systemic contact dermatitis, spices This may have been a type-IV hypersensitivity reaction; evidence favouring a type-III hypersensitivity reaction was insufficient.1 This case report highlights important factors to be considered when evaluating a case of generalized dermatitis, the importance of patch tests, and the role of spices and various ingredients used regularly in food, which may be one of the less commonly known triggers of SCD. [Extracted from the article]

Background: A subset of patients with positive patch tests demonstrates systemic contact dermatitis (SCD) upon ingestion or inhalation of the allergen. Concern has been raised about the use of patch tests for protein allergens (APTs) to detect SCD in atopic dermatitis (AD) patients. Methods: We present atopy patch test (APT) data for 97 people. We reviewed APTs and tests for antigen‐specific immunoglobulin E (IgE) to the same allergen in pediatric AD patients. We compared the frequency of APTs as a function of age in AD patients. To study the irritancy potential of APTs, we prospectively tested consenting non‐AD dermatitis patients undergoing evaluation for allergic contact dermatitis and healthy controls to an APT panel. Results: APT demonstrated fewer positive results than serum‐specific IgE or skin prick tests to the same allergen. Positive APT to food was more common in children under 3 years, whereas positive APT to aeroallergens were more common in teens and adults. Only positive APTs to dust mite were significantly more common positive in subjects without AD. Conclusion: Our aggregate findings suggest that most APTs, but not dust mite, behave like conventional patch tests to low‐potency allergens. They are more likely to be positive in patients with chronically inflamed skin and to identify allergens that cause SCD. The higher prevalence of APT positivity to foods in young children is consistent with food allergy as a trigger of AD (also known as SCD) being more common in children than adults. Positive APTs define patients who may have SCD; negative APTs may guide elimination diets. [ABSTRACT FROM AUTHOR]

Systemic contact dermatitis (SCD) traditionally refers to a skin condition where an individual who is cutaneously sensitized to an allergen will subsequently react to that same allergen or a cross reacting allergen via a different route. It occurs to allergens including metals, medications, and foods. The exact pathophysiology underlying this disease remains unknown, although it appears to be mediated by type 4 hypersensitivity reactions and possibly type 3 hypersensitivity reactions. The p-I concept (pharmacologic interaction with immunoreceptors) hypothesized that drugs are able to bind directly to a T cell receptor without first being presented by MHC (major histocompatibility complex) molecules and without prior metabolism, which would help explain why SCD can be seen on first exposure to medications. Nomenclature remains a challenge as SCD can be subcategorized using terms such as ACDS (allergic contact dermatitis syndrome) and its four clinical stages, Baboon syndrome, and SDRIFE (symmetrical drug-related intertriginous and flexural exanthema), which share many overlapping features. Food allergens may be responsible for uncontrolled or persistent symptoms in patients with contact dermatitis who do not respond to topical avoidance. With medications, symptoms may be induced by topical application versus systemic administration. Patch testing (PT) may be beneficial in diagnosing SCD caused by metals and many topical medications including corticosteroids, antimicrobials (ampicillin, bacitracin, erythromycin, neomycin, nystatin), NSAIDs (diclofenac, ibuprofen), anesthetics, and antihistamines (chlorphenamine, piperazine). Current treatment options include topical steroids and oral antihistamines for symptom relief and dietary avoidance to causative foods or metals. [ABSTRACT FROM AUTHOR]

L'eczéma de contact systémique au nickel est rare. Nous rapportons un cas d'eczéma de contact systémique au nickel d'une canule métallique de trachéotomie. Patiente de 84 ans avec aux antécédents une intolérance aux bijoux fantaisie. A présenté 48 heures après la mise en place d'une canule de trachéotomie une éruption érythémateuse prurigineuse généralisée. Le test au dimethylglyoxime effectué sur la canule de trachéotomie était positif. Les tests épicutanés confirmaient la sensibilisation au nickel. Le diagnostic retenu était celui de dermatite de contact systémique au nickel de la canule de trachéotomie par libération transcutanée de sulfate de nickel favorisé par la rupture de la continuité de la peau en regard de la plaie de la trachéotomie. Nickel-induced systemic contact dermatitis is rare. Herein we report a case of nickel-induced systemic contact dermatitis following use of a metal tracheostomy cannula. n 84-year-old female patient with a history of intolerance to costume jewelry presented diffuse pruritic erythematous rash 72 hours after tracheostomy cannula insertion. Dimethylglyoxime testing of the metal tracheostomy cannula was positive and patch testing confirmed nickel sensitization. This is thus a case of nickel-induced systemic contact dermatitis caused by the release of nickel sulfate from a metal tracheostomy cannula that was resorbed via the tracheostomy lesion. [ABSTRACT FROM AUTHOR]

Introduction: Systemic contact dermatitis (SCD) is a systemic reactivation of a previous allergic contact dermatitis. The initial exposure may usually be topical, followed by oral, intravenous or inhalation exposure leading to a systemic hypersensitivity reaction. A case of a 27 year-old male with SCD due to nickel is reported Case Report: A 27 year-old male presented with recurrent pruritic eruption consist of deep seated vesicles on both palmar and left plantar since 6 months before admission. This complaint began after patient consumed excessive amounts of chocolate, canned food, and beans. The patient worked as a technician in a food factory. History of allergy due to nickel was acknowledged since childhood. The clinical presentation was diffuse deep seated vesicles, and multiple erythematous macules to plaques, with collarette scale. Patch test using the European standard showed a +3 result to nickel. The patient was diagnosed as systemic contact dermatitis due to nickel. The treatments were topical corticosteroid and patient education of avoidance of both contact and systemic exposure to nickel. The patient showed clinical improvement after 2 weeks. Discussion: SCD was diagnosed due to the history of massive consumption of food containing nickel in a patient who had initial sensitization to nickel, with clinical features and the patch test result. Advice to be aware of nickel and its avoidance is important in SCD management.

Skin diseases in the vulvar area include a variety of disorders many of which have a chronic course with significant morbidity. It is important to be aware of the symptoms, signs and diagnostic tools in order to optimise treatment. Herein, the most common eczematous diseases of the vulvar area, i.e. lichen simplex chronicus, seborrhoeic dermatitis, atopic dermatitis, irritant contact dermatitis, and non-systemic and systemic allergic contact dermatitis are reviewed. Allergic contact urticaria is also described. [ABSTRACT FROM AUTHOR]

Contact dermatitis is an inflammatory skin reaction caused by direct contact with chemical substances in the environment and can either be irritant or allergic in nature. The clinical symptoms of contact dermatitis, include local skin rash, itching, redness, swelling, and lesions. Nowadays, 15–20% of people have some degree of contact dermatitis, which can be more or less severe. Immune responses in allergic contact dermatitis (ACD) are due to the effects of cytokines and allergen-specific CD4+ and CD8+ T cells on the skin. Acids and alkalis such as drain cleaners, plants such as poinsettias, hair colors, and nail polish remover, are all prominent causes of irritant contact dermatitis (ICDs). Heavy metals are metallic elements with a high atomic weight that are hazardous in low quantities and are known to cause dermatitis after systemic or local exposure. Nickel (Ni), chromium (Cr), lead (Pb), and copper (Cu) are among the most common heavy metals used in various industries. Metal allergies may cause ACD and also systemic contact dermatitis (SCD). Contact dermatitis is detected by laboratory tests such as patch testing, lymphocyte stimulation test (LST), and evaluation of cytokine production by primary cultures of peripheral blood mononuclear cells. This article presents an update on the epidemiological and clinical characteristics of ACD and SCD caused by three heavy metals (Cr, Cu, and Pb). Ni is not discussed due to recent coverage. Furthermore, the effects of contact sensitivity to some other heavy metals, such as gold (Au), cobalt (Co), palladium (Pd), and mercury (Hg) are discussed. [Display omitted] [ABSTRACT FROM AUTHOR]

Systemic drug-related intertriginous and flexural exanthema (SDRIFE) is a recently coined term to describe an uncommon adverse cutaneous drug reaction described previously as intertriginous drug eruption or flexural drug exanthema. Characteristic flexural erythema notably of the axillae and groins following systemic administration of offending drug may eventuate to TEN-like eruption with relative absence of systemic involvement. Beta-lactam antibiotics like amoxicillin remain the most common offending drug. A1-year-old boy developed SDRIEF overnight after oral amoxicillin(125mg) given for upper respiratory infection. The eruptions deteriorated evolving to TEN-like skin tenderness and exfoliation despite withdrawal of offending drug and treatment with oral cetirizine and prednisolone. It subsided within 1-2days after intravenous immunoglobulin treatment. The putative drugs and various pathogenetic mechanisms proposed for this very unusual adverse cutaneous drug reaction reflects that the nomenclature SDRIFE, intertriginous drug eruption or flexural drug exanthema is just semantics. [ABSTRACT FROM AUTHOR]

Allergic contact dermatitis is a common diagnosis resulting from exposure to a chemical or chemicals in a patient's personal care products, home, or work environment. Once patch testing has been performed, the education and management process begins. After the causative allergens have been identified, patient education is critical to the proper treatment and management of the patient. This must occur if the dermatitis is to resolve. Detailed education is imperative, and several resources are highlighted. Photoallergic contact dermatitis and occupational contact dermatitis are other considerations a clinician must keep in mind. [ABSTRACT FROM AUTHOR]

Systemic contact dermatitis (SCD) is a skin inflammation occurring in a patient after systemic administration of a hapten, which previously caused an allergic contact skin reaction in the same person. Most frequently, hypersensitivity reactions typical for SCD occur after absorption of haptens with food or inhalation. Haptens occur mainly in the forms of metals and compounds present in natural resins, preservatives, food thickeners, flavorings and medicines. For many years, several studies have been conducted on understanding the pathogenesis of SCD in which both delayed type hypersensitivity (type IV) and immediate type I are observed. Components of the complement system are also suspected to attend there. Helper T cells (Th) (Th1 and Th2), cytotoxic T lymphocytes (Tc), and NK cells play a crucial role in the pathogenesis of SCD. They secrete a number of pro-inflammatory cytokines. In addition, regulatory T cells (Tregs) have an important role. They control and inhibit activity of the immune system during inflammation. Tregs release suppressor cytokines and interact directly with a target cell through presentation of immunosuppressive particles at the cell surface. Diagnostic methods are generally the patch test, oral provocation test, elimination diet and lymphocyte stimulation test. There are many kinds of inflammatory skin reactions caused by systemic haptens' distribution. They are manifested in a variety of clinical phenotypes of the disease. [ABSTRACT FROM AUTHOR]

Food allergy is relatively common in both children and adults, and its prevalence is increasing. Early exposure of food allergens onto skin with an impaired epidermal barrier predisposes to sensitization and prevents the development of oral tolerance. While immediate-type food allergies are well described, less is known about delayed-type food allergies manifesting as dermatitis. This is due, in part, to limitations with current diagnostic testing for delayed-type food allergy, including atopy patch testing. We conducted a systematic review of food avoidance diets in delayed-type food allergies manifesting as dermatitis. While beneficial in some clinical circumstances, avoidance diets should be used with caution in infants and children, as growth impairment and developmental delay may result. Ultimately, dermatitis is highly multifactorial and avoidance diets may not improve symptoms of delayed-type food allergy until combined with other targeted therapies, including restoring balance in the skin microbiome and re-establishing proper skin barrier function. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 64-year-old female with a pacemaker implanted in the pectoral region for treating presyncope and second-degree atrioventricular AV block. Topics discussed include bacterial swabs which gave negative results, pacemaker component allergy which is a rare cause of erythema, and failure to diagnose that will lead to surgical interventions.

Systemic contact dermatitis is a skin reaction that occurs after systemic exposure to a previously encountered allergen. Such exposure may occur via oral, intravenous, percutaneous, or inhalational routes. After exposure, dermatitis may occur at various sites. One clue to the diagnosis is the occurrence of recurrent episodes of contact dermatitis despite topical avoidance of known allergens. The treatment of systemic contact dermatitis involves avoidance of all systemic exposure to an allergen, which includes removal of the allergen from the diet. In this review, we focus on four major dietary allergens and describe relevant dietary sources to serve as a guide for patient education. These allergens are nickel, balsam of Peru, propylene glycol, and formaldehyde. [ABSTRACT FROM AUTHOR]

Systemic contact dermatitis (SCD), a cutaneous reaction that is a direct manifestation of systemic exposure to a known allergen in a sensitized individual, has been increasingly recognized as a cause of persistent cutaneous contact dermatitis that is refractory to conventional therapies. While SCD in response to drugs has been described well in the literature, SCD to allergens in common foodstuffs is a less well-articulated phenomenon. Several foods that are universally consumed throughout the world contain potent allergens including nickel, balsam of Peru, trace metals, urushiol, and sesquiterpene lactones as well as a host of others that may cause a distinctive clinical picture. In this review article, the authors review the typical presentation and prevalence of SCD to foods, pathophysiology, the most common offensive ingestible food allergens, several appropriate diets, and effectiveness of dietary avoidance for situations in which SCD is suspected. [ABSTRACT FROM AUTHOR]

Background: This is the first randomized, double-blind, placebo-controlled trial (EUDRACT No. 2009-013923-43) evaluating nickel oral hyposensitizing treatment (NiOHT) in patients with 'systemic nickel allergy syndrome' (SNAS), characterized by Ni-allergic contact dermatitis and systemic reactions after eating Ni-rich food. Methods: Adults with positive Ni-patch test, who reported symptoms suggesting SNAS, which improved after Ni-poor diet, and were positive to Ni-oral challenge were eligible. Patients were randomly assigned to three treatments (1.5 μg, 0.3 μg, or 30 ng Ni/week) or placebo for a year, with progressive reintroduction of Ni-rich foods form the 5th month. Out of 141 patients randomized, 113 completed the trial. Endpoints were efficacy and tolerability of treatment. Results: During Ni-rich food re-introduction, the 1.5 μg Ni/week group had a mean VAS score significantly higher than placebo (p = 0.044), with significant improvement of gastrointestinal symptoms (p = 0.016;) and significantly fewer rescue medications. Cutaneous manifestations also improved but without reaching statistical significance. After the treatment, oral challenge with higher Ni doses than at baseline were needed to cause symptoms to flare-up in significantly more patients given 1.5 μg Ni/week than placebo (p = 0.05). Patients reported no side-effects. Conclusions: NiOHT is effective in SNAS, in particular on gastrointestinal manifestations, with trend toward improvement of cutaneous symptoms. [ABSTRACT FROM AUTHOR]

Systemic contact dermatitis (SCD) describes a hypersensitivity skin reaction following systemic re-exposure of an allergen in previously sensitized patients. Neomycin is an aminoglycoside antibiotic that, when taken orally, suppresses intestinal bacteria and is used in preoperative bowel surgery to reduce the risk of infection. While oral neomycin has been commonly associated with adverse reactions like nausea, vomiting, and Clostridium difficile–associated colitis, the poor intestinal absorption of oral neomycin makes systemic contact dermatitis an unusual adverse reaction. Herein we present a rare case of systemic contact dermatitis following oral neomycin administration. [ABSTRACT FROM AUTHOR]

Systemic contact dermatitis (SCD) refers to a skin condition where an individual who is cutaneously sensitized to an allergen will subsequently react to that same allergen or a cross-reacting allergen via the systemic route. It occurs to allergens including metals, medications, and foods. There has been recent interest in metal allergy as it relates to the implantation of devices such as orthopedic, dental, cardiac, and gynecologic implants. This review will briefly address all causes of systemic contact dermatitis with a special and expanded focus on metal implant allergy. We present literature on SCD to various metal biomedical devices, patch testing for diagnosis of metal allergy pre and post implantation and treatment. [ABSTRACT FROM AUTHOR]

Background Although unexpected and paradoxical, allergic hypersensitivity to corticosteroids is a common finding, delayed-type reactions being much more frequently encountered than the immediate-type ones. Although the skin is the main sensitization and elicitation route, other routes, amongst them systemic administration of corticosteroids may exceptionally be involved. Objective To determine the frequency, clinical presentation and cross-reactivity patterns for allergic reactions following systemic administration of corticosteroids amongst patients with identified and investigated 'contact allergy' to corticosteroids. Methods We reviewed clinical data, patch test results and sensitization sources in patients who reacted positively to corticosteroids tested in the K. U. Leuven Dermatology department during an 18-year period. Results Sixteen subjects (out of 315 with CS delayed-type hypersensitivity) presented with allergic manifestations due to systemic administration of corticosteroids. Most patients reacted to molecules from the three groups of the recently reappraised classification. Conclusion The reactions observed seem to be in most cases 'systemic contact dermatitis' due to oral or parenteral re-exposure of sensitized individuals with the respective corticosteroids previously applied topically. Moreover, most patients seem to be able to react to any corticosteroid molecules and therefore need a systematic individualized evaluation of their sensitization/tolerance profile. [ABSTRACT FROM AUTHOR]

The high frequency of contact allergy to gold in patients with dermatitis was established after exhaustive skin testing, determining the right test agent, the best concentration, and repeated test readings. Metallic gold in contact with skin is slowly ionized, permitting absorption and haptenisation. Contact allergy to gold is statistically correlated to the presence of dental gold. But in many case reports it has also been attributed to wearing gold jewellery, albeit not statistically demonstrated. Epicutaneous testing with gold salts increases the blood gold level, and by intramuscular injection systemic contact dermatitis is provoked in an allergic individual. In coronary heart disease, gold-coated intravascular stents have been shown to be correlated to contact allergy and even to an increased risk of restenosis. Gold is far from inert. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 26-year old non-atopic woman with systemic contact dermatitis caused by the smoke of cashew oil inhaled during roasting of raw cashews. During the diagnosis it was discovered that a medical history of poison ivy in which urushiol, catechol compounds and phenol compounds also found in cashew oil led to the cross reaction to the Anacardiaceae genera.

A 45-year-old woman reported recurrent episodes of urticaria, which had first appeared about one year earlier, when she started a diet which included eating frozen vegetable soup almost daily. Patch tests with the standard European series, food preservatives and colourings were performed and the results were only positive (+++, following the International Contact Dermatitis Research Group criteria) for p-aminoazobenzene. After avoiding eating frozen vegetable soup from a coloured plastic wrapper, which was probably coloured with para-amino compounds that cross-reacted with p-aminoazobenzene, the patient's urticaria rapidly disappeared. [ABSTRACT FROM AUTHOR]

The term Baboon syndrome (BS) was introduced in 1984 to describe the characteristic development of diffuse bright red erythema on the gluteal and anogenital area - resembling the red rump of baboons as a particular clinical form of systemic allergic dermatitis. Additional symmetrical involvement of the upper inner thighs in a V-shaped pattern and major flexures occur frequently. Symmetrical flexural eczema in the absence of gluteal erythema would be better termed systemic allergic dermatitis, and not BS. Approximately 120 cases of BS have been reported to date. Systemic exposure to contact allergens (e.g., mercury) and systemic use of drugs usually without known prior cutaneous sensitization (e.g., amoxicillin) were the main causes. Ethical concern based on the comparison to an animal led to controversy as to whether to continue using the term or to avoid it completely. Such figurative allusions enable a first-glance diagnosis and reflect the terminological richness in dermatology. The acronym SDRIFE (symmetrical drug-related intertriginous and flexural exanthema) was recently proposed to replace BS in systemic drug-related cases. This is a comprehensive review of the previously documented findings in BS regarding its clinical features, histopathology and pathogenesis, with special focus on the causative agents and terminology. Furthermore, a subclassification of BS is proposed regarding both the causative agent and a demonstrable previous cutaneous sensitization: contact allergen-induced BS (excluding drugs), contact allergenic drug-induced BS and non-contact allergenic drug-induced BS. [ABSTRACT FROM AUTHOR]

An allergic dermatitis reaction may develop after systemic exposure to a hapten that reaches the skin through haematogenous transport. This condition can be observed with and without previous cutaneous sensitization to the hapten but has traditionally been described following topical exposure. A heterogeneous clinical picture, in combination with limited insight to its pathomechanisms, makes such systemic reactions an area in need of further study. This article summarizes knowledge about systemic dermatitis elicited by drugs, with a special emphasis on possible pathomechanisms. A list of putative pathomechanisms is offered for future research. Literature was examined using PubMed–MEDLINE, EMBASE, Biosis, and Science Citation Index. Based on the literature, it is likely that humoral type 3, delayed-type hypersensitivity, and drug-driven (i.e. p-i concept) reactions are involved. As commonly used terms may be misleading because skin contact is not a prerequisite, we suggest that the term ‘systemic allergic dermatitis’ should be used in the future. [ABSTRACT FROM AUTHOR]