FO64: Controversies and Challenges in Contact … F064...FO64: Controversies and Challenges in...
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FO64:ControversiesandChallengesinContactDerma88s:SystemicAllergensandAvoidanceDiets
BrianC.Machler,M.D.CenterforDermatology,FlorhamPark,NJ
NYUSchoolofMedicine,RonaldPerelmanDepartmentofDermatologyUniversityofMiami,DepartmentofDermatology&CutaneousSurgery
SystemicContactDerma88s(SCD)
• Acutaneous,mucosal,orvisceralimmunereac8onuponsystemicre-exposuretoaknownTypeIV,lymphocyte-mediatedallergeninasensi8zedindividual
RoutesofExposureforSCD
• Transepidermal• Transmucosal• Oral• Intravenous• Subcutaneous• Intramuscular• Inhala8on
SCD
• Shouldbeconsideredinpa8entswithaposi8vepatchtesttoanallergen(knowntocauseSCD)whohavenotclearedaVeravoidanceofcutaneousexposure.
Presenta8onsofSCD• Flare-upofexis8ng,previousACDorpatchtestreac8ons
• Pompholyx/Dyshidrosis/VesicularDerma88s• Maculopapularerup8on• ChronicPruritus• Exfolia8veErythroderma/Toxiderma• ChronicUr8caria• Erythemamul8formeandvasculi8s• SDRIFE(SymmetricDrug-RelatedIntertriginousandFlexuralErythema)/“BaboonSyndrome”
• AGEP• Hyperkerato8cpapulesoftheelbows• Pruritusani• EyelidDerma88s
SCDExtracutaneousManifesta8ons
• Headache• Fa8gue,Fibromyalgia,Jointpain,ChronicFa8gue
• Gastrointes8nalSx• RespiratorySx• Fever• Vasculi8cdisturbances
CommonCausesofSCD• Metals:Nickel,Cobalt,Gold,Chromium
• Medica8ons:Aminoglycosides,Cor8costeroids,Ethylenediamine
• PlantsandHerbs:Compositae,Anacardiaceae,BalsamofPeru,Propolis
• Other:Formaldehyde,PropyleneGlycol, Methylisothiazolinone
SpecificAllergenswithDietaryExposure
• Urushiol• Nickel• BalsamofPeru• CompositaeandSesquiterpeneLactone• Formaldehyde• PropyleneGlycol• Carmine
NickelDietHeavyHi_ers
• Soy• PeanutsandotherNuts• Legumes• Chocolateandcocoa• Oats• WholeWheatFlours
BOPFreeDiet• NoCitrus
• Nodanish,bakerygoods,candy,gum• Nospicessuchascinnamon,cloves,vanilla,curry,allspice,anise,andginger
• Nospicycondimentssuchasketchup,chilisauce,barbecuesauce
• Nopickles• Nowine,beer,ginorvermouth• Noperfumedorflavoredteaortobacco• Nochocolateoricecream• NoColaorotherspicedsoVdrinks• NoChili,Pizza,ItalianorMexicanfoodswithredsauces• NoTomatoes
BOPCrossReactors• BalsamofTolu• Beeswax• Colophony• EugenolandIsoeugenol• FragranceMix• Propolis• Styrax• Turpen8ne• WoodTar
PropolisandSCD
• Propolisor“beeglue”isamixtureoftreeandflowerresinscollectedbyworkerbeestorepairandbuildnests
• Commonlyusedinmedicines,cosme8cs,lozengesandsyrups
• Cancausereac8onsinBOPallergicpa8ents
PropyleneGlycol
• Anexcipientusedincosme8cs,medicaments,andfoods
• Infoodsitisusedasahumectant,preserva8ve,andsoVeningagentaswellasasolventforflavoringsandcolors
Formaldehyde
• AspartameisbrokendownbythelivertoMethanolwhichleadstotheforma8onof
• MostreportedcasesofformaldehyderelatedSCDfromaspartamehaveEYELIDinvolvement
“Inac8veIngredients”inMedica8ons
• AspartameinMotelukastchewabletabs• PropyleneGlycol,BenzoicAcid,Azodyes,Sorbitan,andParabensinoralan8histamines
• PropolisinGummyVitamins
Compositae/Asteraceae
• Aplantfamilywhosemainallergenissesquiterpenelactoneandparthenolide
• Includeschrysanthemums,daisy,ragweed,feverfew,sunflower,chamomile,endive,arugula,ar8choke,echinacea,chicoryle_ucesandroot,andelecampane.
Carmine
• Anaturaldye(NaturalRed4)fromthedriedfemalecochinealinsectDactylopiuscoccus
• Ancienttex8leandornamentaldyeusedinfoods,drinks,drugsandcosme8cs
• Immediatehypersensi8vityreac8onstoproteinshavebeenreportedmorecommonlythanACD
Carmine
• Salami,sausages• OldversionsofCampari• Popsicles,fruitjuices,candy• Yogurt• Ar8ficialcrabandfishpaste• Genericazithromycin
HowtoHandletheDiet
• Elimina8ondietforatleast3-4weeks• Reintroduc8onofsuspectedtriggerfoodsoneaweek
• EncourageuseofFoodDiary/App• ConsiderreferraltoAllergistforAllergenChallengeandDesensi8za8onTherapy
• Givepa8entscopiesofprimaryar8cles
ReferencesofAr8clesandSitestogivetopa8entswithSCD
Mislankar,M,ZirwasMJ.Lownickel-dietscoringsystemforsystemicnickelallergy.Derma88s.2013Jul-Aug;24(4):190-5.FabbroSK,ZirwasMJ.Systemiccontactderma88stofood:nickel,BOP,andmore.CurrAllergyAsthmaRep.2014Oct;14(10):463.SchemanA,RakowskiEM,ChouV,ChhatriwalaA,RossJ,JacobSE.BalsamofPeru,PastandFuture.Derma88s.2013Jul-Aug;24(4):153-60.SalamTN,FowlerJFJr.JBalsam-relatedsystemiccontactderma88s.AmerAcadDermatol.2001Sep;45(3):377-81.SchemanA,ChaC,JacobSE,NedorostS,FoodAvoidanceDietsforSystemic,Lip,andOralContactAllergy:AnAmericanContactAlterna8vesGroupAr8cleDerma88sAcademy(www.derma88sacademy.com)