Contact Dermatitis Associated With Food: Retrospective Cross-Sectional Analysis of North American Contact Dermatitis Group Data, 2001 - 2004

Erin M. Warshaw; Nina C. Botto; Kathryn A. Zug; Donald V. Belsito; Howard I. Maibach; Denis Sasseville; Joseph F. Fowler, Jr.; Frances J. Storrs; James S. Taylor; Vincent A. DeLeo; James G. Marks, Jr.; C.G. Toby Mathias; Melanie D. Pratt; Robert L. Rietschel


Dermatitis. 2008;19(5):252-260. 

In This Article


Demographics, Diagnoses, and Sites of Involvement

Between 2001 and 2004, 10,061 patients were patch-tested by the NACDG; 109 patients (1.1%) had 122 currently relevant allergic reactions or irritant sources associated with food codes. The demographics of these 109 patients are listed in Table 1 . Female sex and Caucasian race were most common, and the average age was 46.5 years (range, 11-92 years). Patients with allergic rhinitis, atopic dermatitis, and asthma made up 22.9%, 16.5%, and 12.8% of the total study population, respectively. A final diagnosis of ACD (85.3% [93 of 109 patients]) or ICD (25.7% [28 patients]) was most common, followed by a diagnosis of atopic dermatitis or contact urticaria (each 13.8% [15 patients]) (the total diagnosis percentages are greater than 100% because each patient could have up to three diagnoses). The most common sites of dermatitis in these 109 patients were hands (36.7% [40 patients]), scattered or generalized sites (20.2% [22]), arms (17.4% [19]), and face (9.2% [10]); lips (6.4% [7]) and anal and genital areas (4.6% [5]) were less commonly involved (again, the total site percentages are greater than 100% because up to three sites could be reported for each patient).

NACDG Standard Series Allergens Associated with Food

Allergic reactions and relevant irritant sources are summarized in Table 2 . Of 122 total food sources identified, 78 were currently relevant positive patch-test reactions to NACDG standard series allergens (definite, 1.3%; probable, 42.3%; possible, 56.4%). The most common allergens ascribed to a food source were nickel sulfate (48.7%), Myroxilon pereirae (25.6%), and propylene glycol (6.4%) ( Table 3 ). Only three (3.8%) of these reactions were considered to be occupation related.

Non-NACDG Standard Allergens Associated with Food

Allergens other than those on the NACDG standard tray included personal items (such as pieces of actual food) and purified commercial allergens. There were 20 reactions to nonstandard allergens. Most were associated with unspecified food products (n = 9) or fruits/nuts/vegetables (n = 7) ( Table 4 ).

Relevant Irritant Sources Associated with Food

There were 24 relevant irritant sources attributed to food. The most common sources were general food products (n = 8), bakery products (n = 5), fruits/nuts/vegetables (n = 4), and meat/poultry (n = 4) (see Table 4 ).

Relationship to Occupation

In the overall database, 320 patients (3.0%) worked in a food industry (manufacturing, wholesale, or retail) and 182 patients (1.8%) were categorized as having a food-related occupation (eg, cook, bartender, wait staff, butcher, baker); however, the current analysis concerned only distinct food-related reactions. In the current analysis, a relationship to occupation was found in 20.5% of reactions (allergic reactions and relevant irritant sources). Irritants were more likely to be occupation related than allergens (see Table 2 ). Dermatitis associated with food was most common among cooks (40%), followed by bakers, restaurant managers, and grocery store stockers and baggers (12%, respectively) ( Table 5 ).


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