Airborne contact dermatitis L23.8

Author: Prof. Dr. med. Peter Altmeyer

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Last updated on: 29.10.2020

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Synonym(s)

Aerogenic contact allergic eczema; Aerogenic contact dermatitis; Airborne allergy; Airborne contact allergic eczema; Airborne contact allergy; Airborne contact dermatitis; Airborne Contact Dermatitis; Airborne contact eczema; Bush Dermatitis; Dermatitis airborne contact dermatitis; Feverfew allergy; Rush Dermatitis

Definition
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Allergic contact dermatitis (aerogenic allergic contact dermatitis) caused by airborne components of plants (mainly of the compositae family), as well as by various chemical products, medicines or perfumes.

Etiopathogenesis
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It has been proven that the skin (especially in cases of disorders of the skin barrier) can also serve as a gateway for the penetration of aerogenously transmitted allergens, including pollen. Already within minutes (30 min.) the skin is able to internalize appropriately applied pollen allergens.

The high sensitizing capacity of aerogenic contact allergens is mainly due to compounds of the sesquiterpenlactone substance class. They are found in high concentrations in the leaves and stems of many composites (e.g. feverfew, camomile blossom extract, fern extract, lesser celandine extract). They can also be found in some plants from other families, e.g. laurel (cross allergies).

There may also be phototoxic side effects (see phototoxicity below).

Airborne Contact Dermatitis has also been described with professionally relevant volatile chemical products such as rosin or epoxy resins. Fragrances are also of importance.

Less frequently, aerogenically transmitted poisonous hairs of the larvae of the oak processionary moth (see oak below; see caterpillar dermatitis below) are the cause (the microscopically small poisonous hairs are spread aerogenically up to 100 metres).

Clinical features
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Subacute, extensive dermatitis in the area of the unclothed areas, especially on the face and décolleté.

In contrast to light-induced dermatoses, airborne contact dermatitis also causes dermitic changes on the upper eyelids (see eyelid eczema), retroauricularly and below the chin.

A seasonal dependence (May-September) of dermatitis is characteristic for the "plant-induced" forms and thus diagnostically pioneering.

If the seasonal dependence is missing, e.g. in case of occupational dependence (improvement during holidays) volatile chemical products (e.g. 2-aminothiophenol; epoxy resins) may be considered.

A dependence on the use of volatile cosmetics (e.g. perfumes) has to be checked.

Differential diagnosis
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Therapy
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Acute phase: Treatment of dermatitis according to its stage (see dermatitis, contact dermatitis, allergies).

Internal therapy
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Only in cases of weeping and extensive dermatitis is systemic therapy with glucocorticoids (50-100mg prednisolone i.v.) and antihistamines (e.g. dimetinden (Fenistil) 2 times/day 1 amp. i.v. or desloratadine (Aerius) 1-2 times/day 1 tbl. p.o. possibly necessary.

Prophylaxis
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Avoid the allergen if possible.

In case of a pollen-associated syndrome, it is recommended to apply creams or lotions containing lipid or dexpanthenol several times a day to the exposed skin areas, which should be moisturized in the meantime. This has been proven to prevent the direct pollen approach to the skin and thus the constant re-exposure to the allergen.

Case report(s)
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Medical history: The 54-year-old florist noticed an increasing itching and burning of the entire facial skin, the back of the hands and wrists during a "normal" working day at lunchtime. In the evening hours, the entire facial skin was reddened, swollen and itching, so that the medical emergency service had to be consulted.

Findings: The entire skin of the face including the eyelids was reddened over the entire surface, diffuse swelling; in some areas the skin of the face began to weep (Fig.). The retroauricular region, the anterior and lateral neck, the neck and the back of the hand were also inflamed. The clothed forearms, the upper body and the scalp showed no changes. The boundary zone to the skin areas covered by the clothing was blurred. There was no feeling of illness, no fever, no painful lymphadenopathy.

Diagnosis: Acute dermatitis with mainly Airborne Contact Dermatitis

Therapy and course: In an emergency, the patient was treated with a glucocorticoid externum and several times renewed saline dressings. In addition, she received systemic prednisolone (dosage 100mg in tablet form) and a high-dose antihistamine. The results were significantly improved within 3 days (see Fig. 2). Within the next 14 days, the skin condition normalized under creeping therapy with glucocorticoid ointments.

4 weeks after the "airborne contact dermatitis" had subsided, proof of (occupationally induced) type IV sensitization could be provided against a composite mix.

Abstract: Special characteristics of the composite allergens are their potential to trigger airborne dermatitis, tendency to chronic courses, wide distribution in different plant families, to which contact must be avoided if sensitization is present. The different forms of exposure and manifestation of the composite allergy cause a continuum from "minor" to "severe" effects of an allergy with regard to closed work opportunities.

Summary: (Airborne Contact Dermatitis):

Acute, sub-acute or chronic, extensive dermatitis in the area of the unclothed areas, especially the face.

In contrast to light-induced dermatoses, airborne contact dermatitis also causes dermatitic changes on the upper eyelids (see eyelid dermatitis), retroauricularly and below the chin.

A seasonal dependency (May-September) of eczema is characteristic for the "plant-induced" "outdoor" forms and thus is diagnostically groundbreaking. If there is no seasonal dependence, e.g. in the case of occupational dependence (improvement during holidays) volatile chemical products (e.g. 2-aminothiophenol; epoxy resins) may be considered. Furthermore also volatile cosmetics (e.g. perfumes).

Literature
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  1. Bonomonte D et al (2002) Occupational airborne allergic contact dermatitis from 2-aminothiophenol. European J Dermatol 12: 592-593
  2. Custis NJ et al (2003) Quantitative measurement of airborne allergens from dust mites, dogs, and cats using an ion-charging device. Clin Exp Allergy 33: 986-991
  3. Huygens S, Goossens A (2001) An update on airborne contact dermatitis. Contact Dermatitis 44: 1-6
  4. Ramesh M et al (2000) Airborne contact dermatitis to epoxy resin. Indian J Dermatol 45: 141-142
  5. Meinke M et al (2010) In-vivo and in vitro studies of skin care products for the reduction of pollen allergens in hair follicles. Allergo J 18: 56 (Poster 37, EADV Congress 2010)

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Last updated on: 29.10.2020