OCCUPATIONAL PROTEIN CONTACT-DERMATITIS WITH TYPE-I ALLERGY TO DIFFERENT KINDS OF MEAT AND VEGETABLES

Objective: Even though occupational protein contact dermatitis is not an uncommon finding in occupational dermatology, reports about multipl e sensitizations are rare. High-molecular-weight substances such as pr oteins can pass the epidermis only if it is damaged and cause a sensit ization. In a high percentage of cases, atopic dermatitis might be the cause of this damage but cannot be regarded as the only cause. An int eresting case is presented that was carefully worked up. Methods: Scra tch, intracutaneous, and prick or prick-to-prick tests with native occ upational allergens were performed as single tests. The patient was pa tch-tested with the European Standard Series. The determination of all ergen-specific IgE was performed by ImmunoCAP. The results were subdiv ided into six classes. In addition, oral provocations with relevant al lergens were performed. Results: The skin tests showed positive type I allergies to beef, lamb, horse, and pork meat, to pork and horse bloo d as well as to rye and wheat flour, raw potato, and pasta. Weak posit ive reactions could be found for fowl, duck, goose, and turkey in intr acutaneous testing. The ImmunoCAP showed elevated specific IgE values for pork meat, raw potato, and rye and wheat flour. The oral provocati on did not show any systemic or skin change. Conclusions: This case re port demonstrates how an initial case of contact urticaria turns into protein contact dermatitis. It shows that the diagnosis can be made by means of scratch or prick tests with native occupational allergens. T he determination of allergen-specific IgE by ImmunoCAP might be helpfu l, but a negative result does not exclude protein contact dermatitis.