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Patch Testing in Pediatric Patients with Atopic Disease
Sunday, March 6, 2016
South Exhibit Hall H (Convention Center)
Irum Noor, DO, Melanie Chong, MD, Mark A. Davis-Lorton, MD FAAAAI, Marcella R. Aquino, MD FAAAAI, Luz S. Fonacier, MD FAAAAI
Rationale:  Allergic contact dermatitis (ACD) accounts for 20% of childhood dermatitis. ACD is under diagnosed in patients with atopic disease. Our objective was to examine patch testing outcomes in atopic children. 

Methods: A retrospective analysis of 23 children (ages 5-18) who underwent patch testing (PT) in our allergy practice from 2009 to 2014 was performed. PT was performed with either Thin-layer Rapid Use Epicutaneous Test (T.R.U.E. test), North American Contact Dermatitis Group Standard (NACDG), and/or allergens customized from patient history. Data collected included the location of dermatitis, duration of dermatitis prior to patch test, presence of atopy (eczema, allergic rhinitis, asthma), positive allergens, and improvement of dermatitis post-PT.   

Results: All patients had a history of atopy (18 eczema, 19 allergic rhinitis, 6 asthma). The face was the most common location (60.8% = 14/23) followed by scattered generalized (39.1% = 9/23). A positive PT was observed in 86.9% (20/23) of patients. The most common clinically relevant allergens were nickel sulfate (13%), wool wax alcohols (13%), and fragrance mix I (13%). The final diagnosis in the majority of patients (19/23) was ACD. The remaining four patients had either irritant contact dermatitis or just atopic dermatitis. With allergen avoidance and adherence to medical therapy, all patients (14/14) with documented follow up noted dermatitis improvement. 

Conclusions: Patch testing is an important diagnostic tool in pediatric patients with a history of atopic disease. In our cohort of patients, the vast majority had at least one positive clinically relevant allergen and allergen avoidance led to improvement of dermatitis.