Association between atopic dermatitis and contact sensitization: A systematic review and meta-analysis

Abstract

Background: It is unclear whether patients with atopic dermatitis (AD) have an altered prevalence or risk for contact sensitization. Increased exposure to chemicals in topical products together with impaired skin barrier function suggest a higher risk, whereas the immune profile suggests a lower risk.

Objective: To perform a systematic review and meta-analysis of the association between AD and contact sensitization.

Methods: The PubMed/Medline, Embase, and Cochrane databases were searched for articles that reported on contact sensitization in individuals with and without AD.

Results: The literature search yielded 10,083 citations; 417 were selected based on title and abstract screening and 74 met inclusion criteria. In a pooled analysis, no significant difference in contact sensitization between AD and controls was evident (random effects model odds ratio [OR] = 0.891; 95% confidence interval [CI] = 0.771-1.03). There was a positive correlation in studies that compared AD patients with individuals from the general population (OR 1.50, 95% CI 1.23-1.93) but an inverse association when comparing with referred populations (OR 0.753, 95% CI 0.63-0.90).

Limitations: Included studies used different tools to diagnose AD and did not always provide information on current or past disease. Patch test allergens varied between studies.

Conclusion: No overall relationship between AD and contact sensitization was found. We recommend that clinicians consider patch testing AD patients when allergic contact dermatitis is suspected.

Keywords: allergic contact dermatitis; atopic dermatitis; atopic risk factors; atopy; chromium; contact allergy; contact sensitization; eczema.