ATOPIC DERMATITIS “ACTOPIC ECZEMA OR ATOPIC
DERMATITIS/ECZEMA SYNDROME (AEDS)”
® Type 1 immediate hypersensitivity
® Chronic pruritis (ITCHY) inflammatory skin disease.
® Inflammation and hyper reactivity of the skin.
® Increased serum IgE level and peripheral eosinophils.
® atopic dermatitis often linked in a process called ATOPIC MARCH that often leads
to asthma, allergic rhinitis, or food allergy.
® usually begins in childhood and goes away before teenage (COMMON IN INFANTS
& YOUND CHILDREN)
AT RISK: FAMILY HISTORY OF:
• Type 1 allergy (food allergy)
• Allergic rhinitis/ Hay fever
• Asthma
CAUSES or TRIGGERS:
• Detergent
• Dust
• Animals (fur)
• Sprays
• Perfumes
• Hot & colds make condition worse
MANIFESTATION:
• Pruritus (Itching)
• Hyperirritability of the skin
• Inflammation
• Hives
• Dryness/scaling (scaly patches)/crusting (thickening) of skin
• leather like skin
ITCHINESS SCARTCHING. WEEP CLEAR FLUID/BLEED. INFECTIONS
• Flare up/ remission/ exacerbation/ worsening of symptoms can occur.
COMPLICATION: IINFECTION (Causative agent: Staphylococcus aureus)
® susceptible to infection [skin infection, warts, herpes simplex virus (HPV)]
DIAGNOSIS:
• History: food, contact with irritants, family history
• Blood test (Specific IgE)
MANAGEMENTS:
1. Avoid contact with irritants and allergens
2. Wear cotton fabric
3. Wash with mild soaps
4. Moisturizing creams
5. Avoid animals, dust, sprays, and perfumes.
6. Topic corticosteroids (betamethasone) – relieved itchiness, redness, or dryness of
skin
7. NSAID – manage inflammation
8. Antipuritic: antihistamine [cetirizine (Zyrtec), diphenhydramine (Benadryl)]
9. Antibiotics
10. Immune suppressants (cyclosporine, tacrolimus, pimecrolimus)
LATEX ALLERGY
® Allergic reaction to natural rubber proteins from the sap of the rubber tree
“Heveabrasiliensis.”
AT RISK:
• Health care workers
• Patient with atopic dermatitis
• Multiple surgeries (Spina bifida)
• Food handlers
• Hairdressers
• Automobile mechanics
4 ROUTES OF EXPOSURE:
1. CUTANEOUS: gloves, ballons.
2. PERCUTANEOUS/PARENTERAL: IV line, catheters
3. MUCOUSAL: latex condoms
4. AEROSOLS: powder from latex gloves
CROSS REACTION IN PEOPLE WHO ARE ALLERGIC TO CERTAIN FOOD:
• Kiwis
• Bananas
• Pineapples
• Mangoes
• Passion/tropical fruit
• Avocados
• Chestnuts
• Hazelnuts
• Grapes
• Potato
CLINICAL MANIFESTATION:
• Rhinitis (from inhaled latex powder)
• Contact dermatitis
• Conjunctivitis/pink eyes
• Urticaria/hives
• Asthma
• Anaphylaxis
INITIAL SYMPTOMS within minutes after exposure to latex: itching, erythema, or local
urticaria
TYPE IV REACTION MEDIATED BY T CELSS (DELAYED HYPERSENSITIVITY TO LATEX)
® Usually appear on the back of the hands.
• Lesions
• Papules
• Pruritus
• Edema
• Erythema (redness)
• Crusting
• Thickening of skin
TYPE I ALLERGIC REACTION MEDIATED BY THE IgE MAST CELL SYSTEM (IMMEDIATE
HYPERSENSITIVITY)
• Rhinitis
• Conjunctivitis (pink eye)
• Asthma
• ANAPHYLAXIS (hypo-tachy-tachy: hypotension, tachycardia/ increased heart rate,
tachypnea/ increased respiratory rate)
Rapid onset of signs & symptoms:
• Urticaria (Hives)
• Wheezing
• Dyspnea
• Laryngeal edema
• Bronchospasm
• Tachycardia
• Angioedema
• Hypotension
• Cardiac arrest
DIAGNOSTIC:
• Skin testing
• Patch testing
• Serum-specific IgE
• Level of Hevea latex specific IgE antibody
MANAGEMENT:
• Avoid latex-based product (e.g., latex condom)
• Antihistamine
• Epinephrine (EpiPen)
ü Patient with type 1 latex sensitivity/ allergic reaction work in a latex free
environment
ü If patient has latex allergy remove any latex-based product/materials from the
vicinity/area
ü Lambskin condom/polyurethane condom can be used
ü Vinyl/polymer gloves can be used
ü Cloth barrier in BP cuff or tubing
COLD URTICARIA
2 TYPES:
1. Familial atypical cold urticaria (FACU)
- Autosomal dominant condition, inherited from one affected patient, and
symptoms usually begin at birth within the first 6 months of life.
2. Acquired cold urticaria (ACU)
- Frequently affects children and young adults.
CAUSES: any cold stimuli
• Cold environment
• Cold food (ice cream)
CLINICAL MANIFESTATIONS:
• Urticaria (hives)
• Redness
• Itching
• Swelling
• Burning feeling in the area
• Fever
• Chills
• Conjunctivitis
• Sweating
• FACU manifestation can be precipitated by the patient merely entering a 4ºC.
• ANAPHYLAXIS
DIAGNOSTIC:
• PHYSICAL TESTING
- Ice cube provocation testing involves applying ice cubes to the skin of the
forearm for 1-5 mins.
MANAGEMENT:
ü Avoid cold stimuli (drinking ice-cold beverages/frozen food/ice cream)
ü Take Antihistamine before exposure to cold to help reduce risk of symptoms.
ü Before swimming, dip hand in the water first to see any skin reactions.
ü Carry epinephrine (EpiPen)
DERMATITIS MEDICAMENTOSA (DRUG REACTIONS)
® type I hypersensitivity disorder
® skin rashes associated with certain medications.
® CAUSE FATAL ANAPHYLAXIS
® Parenteral administration incurs the greatest risk
® Cutaneous (skin) rashes are among the most common adverse reactions to
medication.
® MOST COMMON MEDICATION CAUSES DRUG REACTION: antibiotics (penicillin,
cephalosporin, sulphonamide).
CLINICAL MANIFESTATION:
• Skin rashes
• Urticari
• Itchy
• Redness
• Swelling
• SOB
• Skin eruption (severe)
• ANAPHYLAXIS
DIAGNOSTIC:
• Intradermal Skin test
• Skin prick test
• Blood test (Specific IgE)
• Patch test
MANAGEMENT:
ü Carry epinephrine (EpiPen)
ü If patient develop allergic (adverse) reaction after administration of medication
DISCONTINUE THE MEDICATION.
ü if new medication is prescribed (antibiotics) skin test is initiated first before
administration.
ü Antihistamines to relieve mild symptoms such as rash, hives, and itching
ü Bronchodilators such as albuterol (moderate wheezing or cough)
ü Corticosteroids applied to the skin, given by mouth, or given through a vein
(intravenously)
