Faculty Bibliography

Because both atopic dermatitis (AD) and contact dermatitis (CD) are characterized by a similar morphologic appearance and similar distribution of skin involvement, the diagnosis of CD in AD has been difficult. Historically, it was thought that patients with AD were unable or less likely to develop CD due to various studies in which patients with AD stimulated with strong allergens failed to develop sensitization at rates similar to patients without AD. However, more recent evidence from the United States and Europe has shown that patients with AD have similar if not higher rates of positive patch test results to common contact allergens, including metals and fragrance, than those patients without AD. In this review, we highlight evidence for and against the role of contact allergy in patients with AD and seek to give clinically relevant management recommendations for the evaluation of CD in the patient with AD.

The use of cellular phones has risen exponentially with over 300 million subscribers. Nickel has been detected in cell phones and reports of contact dermatitis attributable to metals are present in the literature. We determined nickel and cobalt content in popular cell phones in the United States. Adults (>18 years) who owned a flip phone, Blackberry^®, or iPhone^® were eligible. Seventy-two cell phones were tested using SmartPractice's^® commercially available nickel and cobalt spot tests. Test areas included buttons, keypad, speakers, camera, and metal panels. Of the 72 cell phones tested, no iPhones or Droids^® tested positive for nickel or cobalt. About 29.4% of Blackberrys [95% confidence interval (CI), 13%-53%] tested positive for nickel; none were positive for cobalt. About 90.5% of flip phones (95% CI, 70%-99%) tested positive for nickel and 52.4% of flip phones (95% CI, 32%-72%) tested positive for cobalt. Our study indicates that nickel and cobalt are present in popular cell phones. Patients with known nickel or cobalt allergy may consider their cellular phones as a potential source of exposure. Further studies are needed to examine whether there is a direct association with metal content in cell phones and the manifestation of metal allergy.

Adverse drug reactions occur commonly and primarily manifest in a myriad of cutaneous eruptions. The use of drug patch testing in the diagnosis of specific drug eruptions is increasing; however, a standardized approach to this methodology is currently lacking. A review of current literature was performed on the available evidence of patch testing for drugs. This review addresses the use of patch testing for specific cutaneous adverse drug reactions and for specific classes of drugs including antimicrobials, anticonvulsants, antiretrovirals, glucocorticoids, and nonsteroidal anti-inflammatory drugs. In addition, the approach to performing patch testing to drugs in the clinical arena as well as current contraindications for drug patch testing is reviewed.

Allergic contact dermatitis in children is underdiagnosed and undertreated, and its incidence is increasing. Appropriate history taking and the suspicion for allergic contact dermatitis is essential, and patch testing remains the gold standard in diagnosis. Avoidance of the offending allergen, once identified, is the first goal of treatment. Medical therapies include topical corticosteroid and topical immunomodulators. In severe cases, oral corticosteroids or immunomodulators are utilized, although prospective randomized trials for the treatment of this disease in children are lacking. A PubMed literature search was performed to identify publications on allergic contact dermatitis in the pediatric population with the keywords: dermatitis, children, allergic contact dermatitis, pediatrics, contact hypersensitivity, contact allergy, treatment, and management. This review will address the major principles behind the diagnosis and management of this disease in the pediatric population, and highlight useful strategies that may result in improved treatment of this condition.

BACKGROUND:Although the identification and management of anaphylaxis in an emergency department setting has been well studied, our understanding of the risk factors for admission in a community-based hospital is lacking. OBJECTIVE:To determine the demographics and the predictors of hospitalization, in patients presenting with anaphylaxis to a community-based emergency department (ED). METHODS:We performed a five-year retrospective chart review of all patients seen in the ED of Winthrop University Hospital, a community-based institution, with an International Classification of Diseases, 9(th)Edition code related to anaphylaxis. RESULTS:Fifty-eight visits met inclusion criteria, of which 34% resulted in hospital admission (95% CI: 22-48%). Univariate predictors for admission included (1) the involvement of 2, 3, and 4 organ systems (26%, 55%, and 75%, respectively; P < .02); (2) gastrointestinal symptoms vs no symptoms (59% vs 24%, P < .02); (3) non-sting (ingested and other allergens) vs insect sting allergen (50% vs 12.5%, P < .005); and (4) a history of an ED visit for anaphylaxis vs none (67% vs 30%, P < .05). Multivariate analysis (logistic regression) confirmed non-sting allergens (p < 0.02) and number of organ systems involved (P < .05) as independent predictors of hospitalization. CONCLUSION/CONCLUSIONS:In our study population, the involvement of multiple organ systems, particularly gastrointestinal involvement, a history of ED visits for anaphylaxis, and involvement of ingested or other allergens (non-sting) demonstrated higher admission rates.