Faculty Bibliography

OBJECTIVE:To review of contact dermatitis (CD) and its key allergens and provide updates and recommendations for the practicing allergist. DATA SOURCES/METHODS:Through the use of various scientific search engines (eg, PubMed and MEDLINE), we reviewed literature on CD, patch tests (PTs), key allergens, occupational dermatitis, and treatment. STUDY SELECTIONS/METHODS:Studies on CD, important allergens, and PTs were considered. RESULTS:Contact-induced dermatitis may be due to allergic CD, irritant CD, systemic CD, contact urticaria, and protein CD. Key allergens include metals (nickel, gold), topical medicaments (topical corticosteroids), and cosmetics and personal care products (fragrances and preservatives such as methyl- and methylchloro-isothiazolinone). Present relevance of a positive PT result is the combination of definite, probable, and possible relevance and should be correlated with the patient's history and physical examination. Treatment of allergic CD includes identification of relevant allergens, patient education, avoidance, and provision of alternative products the patient can use. CONCLUSION/CONCLUSIONS:CD is a common inflammatory skin disease and should be suspected in patients presenting with acute, subacute, or chronic dermatitis. The gold standard for diagnosing allergic CD is a PT. This article provides practical recommendations for the diagnosis and management of CD commonly seen by the allergist in their practice.

BACKGROUND:Existing literature on the prevalence of positive reactions to allergens is largely derived from dermatologists who practice at large academic centers. Data from other providers, including allergists who practice in various other settings, is important to assess a more representative and accurate prevalence of contact allergy. OBJECTIVE:To determine the prevalence of contact allergy among individuals with at least one positive patch test result by comparing data for positive patch test reaction rates of common contact allergens from 3 groups based in different practice settings, 2 of which are academic. METHODS:We retrospectively analyzed patch test results of an academic center (January 1, 2011, to December 4, 2015) and a national contact allergen database (March 1, 2015, to September 1, 2016). Data from a third, academic-based group was obtained separately from the published literature. Logistic regression analysis was used to compare positive reaction rates of the widely available, patch test allergens among the 3 groups. RESULTS:The positive reaction rates for 10 of 36 compared allergens (28%) were significantly higher (p < 0.05) for the national contact allergen database compared with both the academic groups. CONCLUSION/CONCLUSIONS:Positive reaction rates to common allergens used in patch testing may be underreported in the literature. Limitations of our study included the retrospective nature of the study, different date ranges among the three groups, and the absence of all allergens tested by the national contact allergen database.

The implementation of treatment guidelines for atopic dermatitis is challenging, in part because of different guidance documents being used by different groups of specialists and in part because the language of guidelines often reflects the evidence base rather than the practical "how to." The Atopic Dermatitis Yardstick is part of a series developed in response to the need to proactively address the loss of disease control for atopic illnesses at all levels of severity. It presents a comprehensive update on how to conduct a sustained step-up in therapy for the patient with inadequately controlled or poorly controlled atopic dermatitis. Patient profiles, based on current guidelines and the authors' combined clinical experience, provide a practical and clinically meaningful guide to aid physicians in helping their patients achieve the goal of clear to almost clear. The intent is not to replace guidelines but to complement their recommendations incorporating the latest research and therapies.

Atopic dermatitis (AD) is a common, chronic, relapsing, inflammatory skin disease that affects children and adults. Until recently, the only Food and Drug Administration-approved systemic treatment option for patients with moderate-to-severe AD was systemic steroids, which are not recommended by current guidelines and are commonly associated with disease rebound. Instead, clinicians choose from several off-label immunosuppressants, which can have serious adverse effects. A significant number of these patients go untreated. Research on the immunopathogenesis of AD has paved the way for new, targeted, systemic therapies for moderate-to-severe AD. In early 2017, the Food and Drug Administration approved dupilumab for adults with moderate-to-severe AD whose disease is not adequately controlled with topical therapies. Although the national guidelines can be very helpful to clinicians, the process for updating them does not allow for timely incorporation of novel therapies. A steering committee of AD experts, including dermatologists, allergists, and a patient advocacy group representative, developed recommendations on the basis of a literature review and expert opinion to help clinicians understand how new therapies fit into the current treatment paradigm and to provide practical recommendations for assessing AD severity, treatment response, and treatment failure.