Source: Spiewak R. Interwencje dietetyczne w alergicznym wyprysku kontaktowym - kiedy maja uzasadnienie? Przeglad Lekarski 2015; 72(12): 754-758. (in Polish).
|
This paper focuses on three questions of dietetic interventions in allergic contact dermatitis: 1) in which cases it is justified to suspect that an ingested hapten causes allergic reaction, 2) how to verify the causal relationship between the hapten and current disease, and 3) in which cases dietary interventions are justified? Clinical studies, cases, and reasoning collated in this article indicate that contact allergy to food haptens should be suspected when symptoms are consistent with the clinical picture of systemic reactivation of allergic contact dermatitis or systemic photoallergy. Positive patch test result is not sufficient as confirmation of causality - the clinical relevance should be judged by means of double-blind placebocontrolled provocation with hapten in question. If such challenge appears not feasible, the relevance may be confirmed indirectly by the clearance of symptoms after introducing a low-hapten diet with remission lasting for at least 4 weeks after withdrawal of pharmacotherapy, and the recurrence of symptoms following the return to the old diet. In the majority of cases, "nickel-free" or "low nickel" diets are burdensome and with no real benefit. Nickel is the fifth most abundant element on Earth and even most restrictive diets could reduce nickel load by 50% at best. In the EU alone, 65 million people are allergic to nickel, while only 1-11% of patients with clinical nickel allergy will experience benefits from "nickel-free" diets. Indiscriminate introduction of such dietary regimens based merely on positive patch test results poses a considerable burden to individuals and society, therefore, it is not recommended. Key words: eczema, contact allergy, food allergy, allergic contact dermatitis, food allergens, food haptens, systemic reactivation of allergic contact, dermatitis, nickel, diet. |
Links: |
(English version of the full article will be posted here in the future... if you need it, please contact the author)
Contact allergy to food haptens should be suspected in the presence of symptoms of systemic reactivation of allergic contact dermatitis (diffuse eczema, generalized eczema, eczema affecting the flexural and fold areas), or possibly in the presence of symptoms of systemic photoallergy (diffuse eczema affecting areas exposed to sunlight). A positive patch test result is not sufficient to confirm a causal relationship between the ingested hapten and eczema; the next step should be to verify the clinical significance of the reaction using double-blind, placebo-controlled challenge tests. If challenge tests are not possible, in clinical practice, indirect confirmation of such a relationship may be provided by a relief of symptoms after implementing a diet with a minimal content of the given hapten and the lack of relapse on the diet despite discontinuing pharmacotherapy for a minimum of 4 weeks, as well as recurrence of symptoms after reintroducing foods containing the given hapten. Uncritically recommending "low-nickel" diets based solely on a positive nickel patch test should be considered a mistake, as this approach will not bring the expected benefits in the vast majority of patients.
3. Spiewak R: Definicje. W: Spiewak R (red.): Alergia kontaktowa i alergiczny wyprysk kontaktowy. Mediton. Łódź, 2015: 7-9.
4. Spiewak R: Patch testing for contact allergy and allergic contact dermatitis. Open Allergy J. 2008; 1: 42-51.
5. Spiewak R: [Contact allergy and allergic contact dermatitis]. Alergol Pol - Pol J Allergol. 2014; 1: 150-157.
6. Spiewak R: Wyprysk i alergia pokarmowa - czy istnieje związek przyczynowo-skutkowy? Przegl Lek. 2013; 70: 1051-1055.
7. Jacob SE, Goldenberg A, Nedorost S, Thyssen JP, Fonacier L, Spiewak R: Flexural eczema versus atopic dermatitis. Dermatitis 2015; 26: 109-115. doi: 10.1097/DER.0000000000000102.
12. Johansen JD, Aalto-Korte K, Agner T, Andersen KE, Bircher A, Bruze M, Cannavó A, Giménez-Arnau A, Gonçalo M, Goossens A, John SM, Lidén C, Lindberg M, Mahler V, Matura M, Rustemeyer T, Serup J, Spiewak R, Thyssen JP, Vigan M, White IR, Wilkinson M, Uter W.: European Society of Contact Dermatitis guideline for diagnostic patch testing - recommendations on best practice. Contact Dermatitis. 2015; 73: 195-221. doi: https://doi.org/10.1111/cod.12432.
13. Spiewak R: Diagnostyka alergicznego wyprysku kontaktowego. W: Spiewak R (red.): Alergia kontaktowa i alergiczny wyprysk kontaktowy. Mediton. Łódź, 2015: 25-34.
15. Spiewak R: Ocena skuteczności zabiegów w estetologii medycznej i kosmetologii: jak zmierzyć obiektywnie wrażenia subiektywne? Acad Aesthet Anti-Aging Med. 2013; 4: 3-12.
31. Spiewak R, Piętowska J, Curzytek K: Nickel: a unique allergen - from molecular structure to European legislation. Expert Rev Clin Immunol. 2007; 3: 851-859. doi: https://doi.org/10.1586/1744666x.3.6.851
35. Spiewak R: Food-provoked eczema: a hypothesis on the possible role of systemic contact allergy to haptens present in both cosmetics and foods. Estetol Med Kosmetol. 2011; 1: 35-40. doi: https://doi.org/10.14320/EMK.2011.006.
36. Spiewak R: Systemic photoallergy to terbinafine. Allergy 2010; 65: 1071-1072. doi: https://doi.org/10.1111/j.1398-9995.2009.02311.x.
37. Spiewak R: The frequency and causes of photoallergic contact dermatitis among dermatology outpatients. Acta Dermatovenerol Croat. 2013; 21: 230-235. [PDF from publisher's site]
© Radoslaw Spiewak (contact).
This page is part of the www.RadoslawSpiewak.net website.
Document created: 8 January 2016, last updated: 7 August 2026.