ALLERGOLOGICAL SURVEY (CONTACT-DERMATITIS AND IGE MEDIATED SENSITIZATION) IN 251 PATIENTS WITH SEVERE OR MODERATE ATOPIC-DERMATITIS - FREQUENCY AND INTEREST OF INVESTIGATING CONTACT-DERMATITIS AND FOOD AND INHALLANT ALLERGIES

Introduction. Because of the increased recruitment of uncontrolled ato pic dermatitis (AD) necessitating chronic use of dermocorticosteroids, we developed a prospective allergologic survey in a serie of 251 pati ents presenting with moderate or severe AD. Patients and method. 251 p atients were refered for allergologic assessment and followup. The cli nical severity was assessed by use of standardized scores. Patients we re grouped by age: group 1 (70 children younger than 2 years), group 2 (93 children between 2 and 7 years), group 3 (23 children between 7 a nd 15 years), group 4 (65 children over 15 years and adults). All the patients were systematically screened for contact dermatitis and IgE m ediated sensitization (inhallant and food allergens) with blood tests for IgE, prior to evaluation of clinical relevance. Results. Aero-alle rgen sensitization was demonstrated in 51 p. 100 of children and 89 p. 100 of adults. It was present earlier in severe AD with main clinical involvement for nose and throat and respiratory symptoms. Clinical re sponsibility for dermatitis was documented in only 6 p. 100 of AD. Foo d allergy was early incriminated as flare factors in most of severe AD (96 p. 100 of children and 81 p. 100 of adults) with major and persis tant improvement under eviction diet. Main allergens were eggs (96 p. 100), pea-nuts (29 p. 100), shellfish (24 p. 100), milk (20 p. 100), f lour (14 p. 100), fish (14 p. 100), soybeans (8,9 p. 100). Food allerg y to yeasts (7,2 p. 100) was important in adults. Food allergy is the earliest allergy in the course of severe AD and the number of involved trophallergens increases in older patients. Patch tests were positive in 40 p. 100 of patients (i. e. 31 p. 100 of children and 66 p. 100 o f adults) with a greater incidence in moderate AD. Main allergens were metals (54 p. 100), fragrances (19 p. 100), balsam of Peru (10 p. 100 ), parabens (8 p, 100) and lanoline (4 p. 100). Conclusion. When AD is not efficiently controlled by dermocorticosteroids, allergologic scre ening and treatment of children and adults proves to be very interesti ng. Specific measures regarding food allergy and contact dermatitis re duce or vanish cutaneous flares. As for inhallant sensitizations, Derm atologists should be awared that they may play a role regarding assess ment of sensitization and prevention of respiratory symptoms in modera te and severe AD since the risk of complications is important in both groups.