Mathilde Nødskov Aguirre Houlberg, Line Brok Nørreslet, Emma Louise Gersling Wolff, Sebastian Vigand Svendsen, Kristian Fredløv Mose, Charlotte G. Mortz
Background
Globally, 20% of children and up to 10% of adults have atopic dermatitis (AD). The impaired skin barrier function among AD patients may predispose them to a higher risk of contact allergy.
Objectives
This study aimed to evaluate the prevalence of contact allergy to preservatives and emulsifiers in AD patients compared with other dermatological patients (non-AD) patch tested in the period 2006–2023, as well as assess clinical relevance.
Methods
A retrospective analysis of patch test data was performed among 7936 patients consecutively patch tested with preservatives and emulsifiers in the baseline series at the Department of Dermatology and Allergy Centre, Odense University Hospital, Denmark.
Results
Overall, no association between AD and contact allergy to preservatives was found. However, significantly more AD patients compared to non-AD patients had contact allergy to 2-Bromo-2-Nitropropane-1,3-Diol (1.8% versus 0.6%) and the emulsifier decyl glucoside (14.3% versus 3.1%). Non-AD patients had significantly more contact allergy to benzisothiazolinone (15.4%) compared to AD patients (8.1%).
Conclusions
This study showed no overall association between AD and a higher risk of developing contact allergy to preservatives, although differences were identified for a few individual preservatives and for decyl glucoside.
{"title":"Contact Allergy to Preservatives and Emulsifiers in Patients With or Without Atopic Dermatitis","authors":"Mathilde Nødskov Aguirre Houlberg, Line Brok Nørreslet, Emma Louise Gersling Wolff, Sebastian Vigand Svendsen, Kristian Fredløv Mose, Charlotte G. Mortz","doi":"10.1111/cod.70036","DOIUrl":"10.1111/cod.70036","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Globally, 20% of children and up to 10% of adults have atopic dermatitis (AD). The impaired skin barrier function among AD patients may predispose them to a higher risk of contact allergy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>This study aimed to evaluate the prevalence of contact allergy to preservatives and emulsifiers in AD patients compared with other dermatological patients (non-AD) patch tested in the period 2006–2023, as well as assess clinical relevance.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A retrospective analysis of patch test data was performed among 7936 patients consecutively patch tested with preservatives and emulsifiers in the baseline series at the Department of Dermatology and Allergy Centre, Odense University Hospital, Denmark.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Overall, no association between AD and contact allergy to preservatives was found. However, significantly more AD patients compared to non-AD patients had contact allergy to 2-Bromo-2-Nitropropane-1,3-Diol (1.8% versus 0.6%) and the emulsifier decyl glucoside (14.3% versus 3.1%). Non-AD patients had significantly more contact allergy to benzisothiazolinone (15.4%) compared to AD patients (8.1%).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This study showed no overall association between AD and a higher risk of developing contact allergy to preservatives, although differences were identified for a few individual preservatives and for decyl glucoside.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10527,"journal":{"name":"Contact Dermatitis","volume":"94 1","pages":"73-80"},"PeriodicalIF":4.6,"publicationDate":"2025-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145437620","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<p>Injection site reactions (ISRs) due to biologics are frequent with an incidence ranging from 0.5% to 40%, depending on the medication. However, the origin of these reactions often remains unclear [<span>1, 2</span>]. We present a case of hypersensitivity reaction at the guselkumab injection site.</p><p>A 62-year-old woman presented with severe plaque psoriasis and psoriatic arthritis, with a history of allergic asthma and contact dermatitis to fragrances. Plaque psoriasis started at age 8 and arthritis symptoms appeared around age 50, worsening at age 56. She was previously treated with methotrexate, which was stopped because of hepatic cytolysis. Subsequently, treatment with subcutaneous guselkumab (Tremfya, Janssen-Cilag) was initiated at 100 mg at Week 0, Week 4, and then administered every 8 weeks in the thigh.</p><p>Two days after the first injection, she developed a large itchy erythematous and edematous plaque at the site of injection. After the second injection, 4 weeks later, the same reaction occurred but more severe within 24 h. Following the third injection, 8 weeks later, a large edematous plaque with vesicles and a bulla secondarily hemorrhagic appeared within one hour (Figure 1A,B). Blood tests showed a normal eosinophil count and a C reactive protein of 18.6 mg/L. No skin biopsy was performed. The last episode resolved within 10 days after treatment with antihistamines and topical corticosteroid. An antiseptic solution Biseptine and a bandage Mepilex border flex were also used at the time of the third injection but were later used without further reaction.</p><p>Patch tests performed with the European baseline series and polysorbate 80 (5% pet), an excipient in Tremfya (Chemotechnique Diagnostics, Vellinge, Sweden) and personal products such as Biseptine, Tremfya and Mepilex border flex, all tested ‘as is’ were all negative on Day 2 and Day 4 except for fragrance mix I with a past relevance. An intradermal test (IDT) done with 0.03 mL of Tremfya (100 mg/mL) showed an immediate positive reaction with an erythematous papule and extensive erythema after 30 min. Delayed reading, at 24 h, revealed persistent inflammation with a central vesicle. Biopsy demonstrated perivascular and interstitial inflammation, with a dermal eosinophilic infiltrate and flame figures suggesting (but not specific) of eosinophilic cellulitis (Figure S1). Direct immunofluorescence showed isolated C3 vascular deposition without specificity. Hypersensitivity to polysorbate 80 was excluded by a negative IDT to triamcinolone acetonide (Kenacort retard, 40 mg/mL), which also contains polysorbate 80 [<span>3</span>]. The IDT with Tremfya in a patient who received this treatment without adverse reaction was negative at both readings.</p><p>One year later, the patient received the etanercept biosimilar (Benepali, Samsung Bioepis, Netherlands), a fusion protein targeting TNF alpha and free of polysorbate. After the first subcutaneous injection, she developed an ISR
{"title":"Severe Delayed Hypersensitivity Reaction at Guselkumab Injection Site","authors":"Salomé Allichon, Julie Litovsky, Michèle Sanchez, Céline Girard, Guillaume Granier, Luc Durand, Maxime Henrion, Christelle Philibert, Cosette Le Souder, Nadia Raison-Peyron","doi":"10.1111/cod.70034","DOIUrl":"10.1111/cod.70034","url":null,"abstract":"<p>Injection site reactions (ISRs) due to biologics are frequent with an incidence ranging from 0.5% to 40%, depending on the medication. However, the origin of these reactions often remains unclear [<span>1, 2</span>]. We present a case of hypersensitivity reaction at the guselkumab injection site.</p><p>A 62-year-old woman presented with severe plaque psoriasis and psoriatic arthritis, with a history of allergic asthma and contact dermatitis to fragrances. Plaque psoriasis started at age 8 and arthritis symptoms appeared around age 50, worsening at age 56. She was previously treated with methotrexate, which was stopped because of hepatic cytolysis. Subsequently, treatment with subcutaneous guselkumab (Tremfya, Janssen-Cilag) was initiated at 100 mg at Week 0, Week 4, and then administered every 8 weeks in the thigh.</p><p>Two days after the first injection, she developed a large itchy erythematous and edematous plaque at the site of injection. After the second injection, 4 weeks later, the same reaction occurred but more severe within 24 h. Following the third injection, 8 weeks later, a large edematous plaque with vesicles and a bulla secondarily hemorrhagic appeared within one hour (Figure 1A,B). Blood tests showed a normal eosinophil count and a C reactive protein of 18.6 mg/L. No skin biopsy was performed. The last episode resolved within 10 days after treatment with antihistamines and topical corticosteroid. An antiseptic solution Biseptine and a bandage Mepilex border flex were also used at the time of the third injection but were later used without further reaction.</p><p>Patch tests performed with the European baseline series and polysorbate 80 (5% pet), an excipient in Tremfya (Chemotechnique Diagnostics, Vellinge, Sweden) and personal products such as Biseptine, Tremfya and Mepilex border flex, all tested ‘as is’ were all negative on Day 2 and Day 4 except for fragrance mix I with a past relevance. An intradermal test (IDT) done with 0.03 mL of Tremfya (100 mg/mL) showed an immediate positive reaction with an erythematous papule and extensive erythema after 30 min. Delayed reading, at 24 h, revealed persistent inflammation with a central vesicle. Biopsy demonstrated perivascular and interstitial inflammation, with a dermal eosinophilic infiltrate and flame figures suggesting (but not specific) of eosinophilic cellulitis (Figure S1). Direct immunofluorescence showed isolated C3 vascular deposition without specificity. Hypersensitivity to polysorbate 80 was excluded by a negative IDT to triamcinolone acetonide (Kenacort retard, 40 mg/mL), which also contains polysorbate 80 [<span>3</span>]. The IDT with Tremfya in a patient who received this treatment without adverse reaction was negative at both readings.</p><p>One year later, the patient received the etanercept biosimilar (Benepali, Samsung Bioepis, Netherlands), a fusion protein targeting TNF alpha and free of polysorbate. After the first subcutaneous injection, she developed an ISR ","PeriodicalId":10527,"journal":{"name":"Contact Dermatitis","volume":"94 1","pages":"89-91"},"PeriodicalIF":4.6,"publicationDate":"2025-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/cod.70034","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145408392","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Reiko Yatabe, Naoki Kajita, Keiji Akamine, Riku Hamada, Koichi Yoshida
{"title":"Contact Urticaria Caused by Ultrasound Gel Containing Phenoxyethanol in a 4-Year-Old Boy","authors":"Reiko Yatabe, Naoki Kajita, Keiji Akamine, Riku Hamada, Koichi Yoshida","doi":"10.1111/cod.70039","DOIUrl":"10.1111/cod.70039","url":null,"abstract":"","PeriodicalId":10527,"journal":{"name":"Contact Dermatitis","volume":"94 1","pages":"98-99"},"PeriodicalIF":4.6,"publicationDate":"2025-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145387434","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Hairdressers apprentices (HA) are exposed to skin hazards during vocational education.
Objectives
To assess the use of protective gloves and moisturisers, and their relationship with parameters of skin barrier function and hand eczema (HE) among HAs during their 3-year education.
Participants and Methods
HAs from 25 Croatian schools were followed up at the end of each of the school years (N = 337, 317, and 174, respectively). Protocol included a questionnaire with evaluation of self-reported skin symptoms, glove use, and skin care during practical training, Osnabrueck Hand Eczema Severity Index (OHSI) for clinical skin assessment, skin pH, and transepidermal water loss (TEWL) measurements.
Results
The use of protective gloves and moisturisers was insufficiently implemented throughout the schooling. Glove usage was related to lower hand TEWL at the 1st follow-up and lower OHSI at the 2nd follow-up. Use of moisturisers was related to lower skin pH at the 1st follow-up. During the 3rd follow-up, glove usage was related to higher OHSI and skin pH, and use of moisturisers was associated with clinical signs of HE.
Conclusion
Results suggest a positive effect of protective measures on skin barrier function and prevention of HE during the first 2 years of schooling. Their insufficient implementation from the beginning of education results in late implementation at a secondary prevention level.
{"title":"Effectiveness of Skin Protection Measures Among Hairdressing Apprentices in Croatia: Results of a Follow-Up Study","authors":"Željka Babić, Jelena Macan","doi":"10.1111/cod.70038","DOIUrl":"10.1111/cod.70038","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Hairdressers apprentices (HA) are exposed to skin hazards during vocational education.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To assess the use of protective gloves and moisturisers, and their relationship with parameters of skin barrier function and hand eczema (HE) among HAs during their 3-year education.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Participants and Methods</h3>\u0000 \u0000 <p>HAs from 25 Croatian schools were followed up at the end of each of the school years (<i>N</i> = 337, 317, and 174, respectively). Protocol included a questionnaire with evaluation of self-reported skin symptoms, glove use, and skin care during practical training, Osnabrueck Hand Eczema Severity Index (OHSI) for clinical skin assessment, skin pH, and transepidermal water loss (TEWL) measurements.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The use of protective gloves and moisturisers was insufficiently implemented throughout the schooling. Glove usage was related to lower hand TEWL at the 1st follow-up and lower OHSI at the 2nd follow-up. Use of moisturisers was related to lower skin pH at the 1st follow-up. During the 3rd follow-up, glove usage was related to higher OHSI and skin pH, and use of moisturisers was associated with clinical signs of HE.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Results suggest a positive effect of protective measures on skin barrier function and prevention of HE during the first 2 years of schooling. Their insufficient implementation from the beginning of education results in late implementation at a secondary prevention level.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10527,"journal":{"name":"Contact Dermatitis","volume":"94 1","pages":"52-59"},"PeriodicalIF":4.6,"publicationDate":"2025-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/cod.70038","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145376416","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jose Hernán Alfonso, Pål Graff, Carla Viegas, Astrid Haaskjold Lossius, Elke Eriksen
Introduction
Hand eczema, skin barrier function and skin microbial contamination among waste workers are underexplored. This study aims to assess: (1) the prevalence and risk factors of hand eczema, (2) the levels of transepidermal water loss (TEWL), and (3) skin microbial contamination in waste sorting workers.
Methods
Using the Nordic Occupational Skin Questionnaire—2002, data were collected from 69 waste sorting workers and 25 office personnel. TEWL was measured with a Tewameter (TM 300, Courage+ Khazaka Electronic, Köln). Microbial skin samples were collected from the left dorsal hand with sterile swabs (Copan, Italy) and cultured. Analyses included descriptive statistics and multivariate logistic regression.
Results
The hand eczema prevalence was 25% among waste workers and 40% in office personnel. The prevalence of hand eczema was significantly lower among exposed workers compared to controls (p = 0.012). TEWL and fungal concentrations were comparable across groups. Atopic dermatitis (AD) and nicotine use were significant predictors of HE. The prevalence of hand eczema experienced during the past week was significantly associated with elevated bacterial concentrations (p value = 0.05) in both groups.
Conclusions
Waste sorting workers had up to 2.4 times higher prevalence of hand eczema compared with the general population, but a lower prevalence than office workers in the same industry. These findings may reflect a potential healthy worker effect. The potential role of bacterial concentrations in the occurrence of hand eczema warrants further investigation.
{"title":"Hand Eczema, Risk Factors and Microbial Skin Contamination in the Norwegian Waste Sorting Industry: A Cross-Sectional Study","authors":"Jose Hernán Alfonso, Pål Graff, Carla Viegas, Astrid Haaskjold Lossius, Elke Eriksen","doi":"10.1111/cod.70037","DOIUrl":"10.1111/cod.70037","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Hand eczema, skin barrier function and skin microbial contamination among waste workers are underexplored. This study aims to assess: (1) the prevalence and risk factors of hand eczema, (2) the levels of transepidermal water loss (TEWL), and (3) skin microbial contamination in waste sorting workers.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Using the Nordic Occupational Skin Questionnaire—2002, data were collected from 69 waste sorting workers and 25 office personnel. TEWL was measured with a Tewameter (TM 300, Courage+ Khazaka Electronic, Köln). Microbial skin samples were collected from the left dorsal hand with sterile swabs (Copan, Italy) and cultured. Analyses included descriptive statistics and multivariate logistic regression.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The hand eczema prevalence was 25% among waste workers and 40% in office personnel. The prevalence of hand eczema was significantly lower among exposed workers compared to controls (<i>p</i> = 0.012). TEWL and fungal concentrations were comparable across groups. Atopic dermatitis (AD) and nicotine use were significant predictors of HE. The prevalence of hand eczema experienced during the past week was significantly associated with elevated bacterial concentrations (<i>p</i> value = 0.05) in both groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Waste sorting workers had up to 2.4 times higher prevalence of hand eczema compared with the general population, but a lower prevalence than office workers in the same industry. These findings may reflect a potential healthy worker effect. The potential role of bacterial concentrations in the occurrence of hand eczema warrants further investigation.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10527,"journal":{"name":"Contact Dermatitis","volume":"94 1","pages":"60-66"},"PeriodicalIF":4.6,"publicationDate":"2025-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/cod.70037","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145372440","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Marta Marchetti, Alessandro Marti, Maria Rita Messina, Giovanni Paoletti, Enrico Heffler
{"title":"Allergic Contact Dermatitis to Clonidine Transdermal Patch: Insights From a Rare Case With Prolonged Cutaneous Exposure","authors":"Marta Marchetti, Alessandro Marti, Maria Rita Messina, Giovanni Paoletti, Enrico Heffler","doi":"10.1111/cod.70035","DOIUrl":"10.1111/cod.70035","url":null,"abstract":"","PeriodicalId":10527,"journal":{"name":"Contact Dermatitis","volume":"94 1","pages":"86-88"},"PeriodicalIF":4.6,"publicationDate":"2025-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145354008","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Adrien Bénic, Evangéline Clark, Pascal Demoly, Anca Mirela Chiriac
<p>A 38-year-old man with a history of allergic rhinitis experienced seven episodes of anaphylaxis at home, one of which progressed to anaphylactic shock. He denied any medication use, ingestion of specific foods or Hymenoptera stings prior to these episodes.</p><p>The initial evaluation was conducted in an allergist's office. The baseline serum tryptase level was 4.10 μg/L. Skin testing for common food allergens yielded negative results, with an appropriate positive histamine control.</p><p>The patient was subsequently referred to our unit for further assessment. On detailed re-questioning, he reported that his anaphylactic reactions consistently coincided with periods during which his children were receiving penicillin therapy, and he was able to identify specific triggers for two of these episodes (Table 1).</p><p>Serum-specific IgE testing for beta-lactams (ImmunoCAP, Thermo Fisher Scientific/Phadia, Uppsala, Sweden) was positive only for amoxicillin (0.26 kU<sub>A</sub>/L). Total serum IgE was not assessed.</p><p>Skin testing for beta-lactams was performed in accordance with established guidelines [<span>1</span>]. Skin prick tests produced immediate positive reactions to amoxicillin (0.2 mg/mL; 1:100) and ampicillin (2 mg/mL; 1:10), whereas intradermal tests yielded an immediate positive reaction to penicillin G (10,000 IU/mL; undiluted), confirming sensitisation to penicillins.</p><p>The absence of hypersensitivity to alternative beta-lactams—specifically the cephalosporins cefuroxime and ceftriaxone—was demonstrated by negative skin tests (20 mg/mL; undiluted) and negative drug provocation tests at daily therapeutic doses of 1000 and 2000 mg, respectively.</p><p>‘Allergy by proxy’ refers to hypersensitivity reactions arising from unintentional exposure to an allergen used by another individual. Such exposure may occur directly, through physical contact with the person carrying the allergen, or indirectly, via contact with allergen-contaminated objects [<span>2</span>]. A well-documented example is kissing-induced allergy syndrome, in which oral exposure to amoxicillin-containing saliva triggers an allergic reaction [<span>3</span>]. Similarly, anaphylaxis has been reported during sexual intercourse as a result of vaginal exposure to penicillin-containing semen [<span>4</span>].</p><p>In this case, the patient experienced severe IgE-mediated hypersensitivity reactions attributable to ‘allergy by proxy’, resulting from indirect exposure to amoxicillin via contact with items contaminated during his children's penicillin therapy. In the absence of any prior personal use of beta-lactams, sensitization to penicillins likely occurred through repeated cutaneous or mucosal exposure to penicillin residues within the household.</p><p>The patient was advised to strictly avoid all penicillins and to remain vigilant regarding their use by household members. Considering the patient's history of anaphylactic reactions to trace amounts of penicillins, alo
{"title":"Allergy by Proxy to Penicillins Presenting as Recurrent Idiopathic Anaphylaxis Within the Household: A Case Report","authors":"Adrien Bénic, Evangéline Clark, Pascal Demoly, Anca Mirela Chiriac","doi":"10.1111/cod.70014","DOIUrl":"10.1111/cod.70014","url":null,"abstract":"<p>A 38-year-old man with a history of allergic rhinitis experienced seven episodes of anaphylaxis at home, one of which progressed to anaphylactic shock. He denied any medication use, ingestion of specific foods or Hymenoptera stings prior to these episodes.</p><p>The initial evaluation was conducted in an allergist's office. The baseline serum tryptase level was 4.10 μg/L. Skin testing for common food allergens yielded negative results, with an appropriate positive histamine control.</p><p>The patient was subsequently referred to our unit for further assessment. On detailed re-questioning, he reported that his anaphylactic reactions consistently coincided with periods during which his children were receiving penicillin therapy, and he was able to identify specific triggers for two of these episodes (Table 1).</p><p>Serum-specific IgE testing for beta-lactams (ImmunoCAP, Thermo Fisher Scientific/Phadia, Uppsala, Sweden) was positive only for amoxicillin (0.26 kU<sub>A</sub>/L). Total serum IgE was not assessed.</p><p>Skin testing for beta-lactams was performed in accordance with established guidelines [<span>1</span>]. Skin prick tests produced immediate positive reactions to amoxicillin (0.2 mg/mL; 1:100) and ampicillin (2 mg/mL; 1:10), whereas intradermal tests yielded an immediate positive reaction to penicillin G (10,000 IU/mL; undiluted), confirming sensitisation to penicillins.</p><p>The absence of hypersensitivity to alternative beta-lactams—specifically the cephalosporins cefuroxime and ceftriaxone—was demonstrated by negative skin tests (20 mg/mL; undiluted) and negative drug provocation tests at daily therapeutic doses of 1000 and 2000 mg, respectively.</p><p>‘Allergy by proxy’ refers to hypersensitivity reactions arising from unintentional exposure to an allergen used by another individual. Such exposure may occur directly, through physical contact with the person carrying the allergen, or indirectly, via contact with allergen-contaminated objects [<span>2</span>]. A well-documented example is kissing-induced allergy syndrome, in which oral exposure to amoxicillin-containing saliva triggers an allergic reaction [<span>3</span>]. Similarly, anaphylaxis has been reported during sexual intercourse as a result of vaginal exposure to penicillin-containing semen [<span>4</span>].</p><p>In this case, the patient experienced severe IgE-mediated hypersensitivity reactions attributable to ‘allergy by proxy’, resulting from indirect exposure to amoxicillin via contact with items contaminated during his children's penicillin therapy. In the absence of any prior personal use of beta-lactams, sensitization to penicillins likely occurred through repeated cutaneous or mucosal exposure to penicillin residues within the household.</p><p>The patient was advised to strictly avoid all penicillins and to remain vigilant regarding their use by household members. Considering the patient's history of anaphylactic reactions to trace amounts of penicillins, alo","PeriodicalId":10527,"journal":{"name":"Contact Dermatitis","volume":"94 1","pages":"81-82"},"PeriodicalIF":4.6,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/cod.70014","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145124359","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Anne Birgitte Simonsen, Thomas Rustemeyer, Suzana Ljubojevicé Hadzavdic, Radoslaw Spiewak, Anna Belloni Fortina, Margarida Gonçalo, Ana Maria Giménez Arnau, Nidia Planella-Fontanillas, Marie L. A. Schuttelaar, Heinrich Dickel, Jonathan White, Györgyi Pónyai, S. Mark Wilkinson, Esen Özkaya, Ella Dendooven, Nives Pustišek, Jeanne Duus Johansen, Olivier Aerts, the European Baseline Series (EBS) Working Party of the European Society of Contact Dermatitis (ESCD)
Background
Contact allergy is common in children, but no paediatric baseline series (pEBS) exists in Europe, despite recommendations in several countries.
Objectives
To collect and compare patch testing data from European centres to propose a common pEBS, possibly adapted by age group.
Materials and Methods
Data from 13 centres in 12 European countries were aggregated, covering 1816 children (1099 girls, 60.5%), aged 0–16 years, tested with the adult EBS (aEBS) and other frequent allergens between 2018 and 2022. Allergen selection followed adult criteria, with a stricter cut-off for inclusion, requiring at least 1% positive reactions (lower 95% CI) in children.
Results
A total of 17 allergens from the aEBS caused positive reactions in ≥ 1% of children (lower 95% CI). Common allergens included metals, fragrances, and preservatives. Tixocortol-21-pivalate was included despite its lower frequency due to its difficult-to-suspect nature. Additional frequent allergens were hydroperoxides of limonene and linalool, Amerchol L-101, and sorbitan sesquioleate. In total, 18 allergens were identified as potentially qualifying for a pEBS, with a further 7 as recommended additions.
Conclusion
Results from patch testing children across europe highlight a common set of frequent allergens, which should be considered for a pEBS.
{"title":"Contact Allergy in Children in Europe: A Proposal for a Paediatric European Baseline Series","authors":"Anne Birgitte Simonsen, Thomas Rustemeyer, Suzana Ljubojevicé Hadzavdic, Radoslaw Spiewak, Anna Belloni Fortina, Margarida Gonçalo, Ana Maria Giménez Arnau, Nidia Planella-Fontanillas, Marie L. A. Schuttelaar, Heinrich Dickel, Jonathan White, Györgyi Pónyai, S. Mark Wilkinson, Esen Özkaya, Ella Dendooven, Nives Pustišek, Jeanne Duus Johansen, Olivier Aerts, the European Baseline Series (EBS) Working Party of the European Society of Contact Dermatitis (ESCD)","doi":"10.1111/cod.70033","DOIUrl":"10.1111/cod.70033","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Contact allergy is common in children, but no paediatric baseline series (pEBS) exists in Europe, despite recommendations in several countries.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To collect and compare patch testing data from European centres to propose a common pEBS, possibly adapted by age group.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Materials and Methods</h3>\u0000 \u0000 <p>Data from 13 centres in 12 European countries were aggregated, covering 1816 children (1099 girls, 60.5%), aged 0–16 years, tested with the adult EBS (aEBS) and other frequent allergens between 2018 and 2022. Allergen selection followed adult criteria, with a stricter cut-off for inclusion, requiring at least 1% positive reactions (lower 95% CI) in children.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 17 allergens from the aEBS caused positive reactions in ≥ 1% of children (lower 95% CI). Common allergens included metals, fragrances, and preservatives. Tixocortol-21-pivalate was included despite its lower frequency due to its difficult-to-suspect nature. Additional frequent allergens were hydroperoxides of limonene and linalool, Amerchol L-101, and sorbitan sesquioleate. In total, 18 allergens were identified as potentially qualifying for a pEBS, with a further 7 as recommended additions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Results from patch testing children across europe highlight a common set of frequent allergens, which should be considered for a pEBS.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10527,"journal":{"name":"Contact Dermatitis","volume":"94 1","pages":"28-39"},"PeriodicalIF":4.6,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/cod.70033","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145091399","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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