Children with atopic dermatitis may have unacknowledged
contact allergies contributing to their skin symptoms
* J.D. Johansen,
Department of Dermatology and Venereology, Aarhus University Hospital,Aarhus, Denmark
National Allergy Research Centre, Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen,
Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
Department of Dermatology and Allergy Centre, Odense University Hospital, Odense, Denmark
*Correspondence: A.B. Simonsen. E-mail: firstname.lastname@example.org
Background Whether children with atopic dermatitis have an altered risk of contact allergy than children without atopic
dermatitis is frequently debated and studies have been conﬂicting. Theoretically, the impaired skin barrier in atopic der-
matitis (AD) facilitates the penetration of potential allergens and several authors have highlighted the risk of underesti-
mating and overlooking contact allergy in children with atopic dermatitis.
Objective To determine the prevalence of contact allergy in Danish children with atopic dermatitis and explore the
problem of unacknowledged allergies maintaining or aggravating the skin symptoms.
Methods In a cross-sectional study, 100 children and adolescents aged 5–17 years with a diagnosis of atopic dermati-
tis were patch tested with a paediatric series of 31 allergens.
Results Thirty per cent of the children had at least one positive patch test reaction, and 17% had at least one contact
allergy that was relevant to the current skin symptoms. The risk of contact allergy was signiﬁcantly correlated to the
severity of atopic dermatitis. Metals and components of topical skincare products were the most frequent sensitizers.
Conclusion Patch testing is relevant as a screening tool in the management of children with atopic dermatitis as they
may have unacknowledged contact allergies contributing to or maintaining their skin symptoms. Children with atopic
dermatitis seem to be at greater risk of sensitization to certain allergens including metals and components of skincare
Received: 11 August 2017; Accepted: 20 November 2017
Conﬂicts of interest
This work was supported by The Lundbeck Foundation.
Atopic dermatitis (AD) is the most common inﬂammatory skin
disease of childhood. It has a common phenotypic expression,
characterized by dry and itchy skin with chronic or recurrent
episodes of dermatitis at typical anatomical sites.
lence of AD has dramatically increased over the last three dec-
ades and now affects between 15% and 30% of children in
Allergic contact dermatitis (ACD) is the skin manifestation of
a delayed-type hypersensitivity reaction that typically develops
after prolonged or repeated skin exposure to chemical allergens.
Although previously considered rare, it is now recognized as a
common skin disease in children.
Clinically, AD and allergic
contact dermatitis may be difﬁcult to distinguish as they both
present as dermatitis and may co-exist.
Whether children with
AD have an altered risk of contact allergy as compared to chil-
dren without AD is frequently discussed and past ﬁndings have
been conﬂicting. Authors of early experimental studies found
reduced sensitization among patients with AD as compared to
but recent research suggests that contact allergy and
allergic contact dermatitis may be a signiﬁcant problem in AD
The impaired skin barrier in AD facilitates the pen-
etration of potential allergens
and as children with AD are
exposed to emollients and topical agents from an early age and
for prolonged periods of time,
this could theoretically increase
the risk of contact sensitization to both ingredients and
© 2017 European Academy of Dermatology and Venereology
2018, 32, 428–436