Occupational contact dermatitis, a review of contact dermatitis and a new instrument to asses chronic idiopathic urticaria and angioedema

June 11, 2018

The June issue of the Annals of Allergy, Asthma and Immunology is another installment of our renewed commitment to provide cutting edge information that can be used by practicing allergists-immunologists. This month’s emphasis is on allergic skin diseases and we have multiple articles on this broad topic. Three are of particular notice for our readers.

The first, written by Karin A. Pacheco, MD, MSPH, from Denver is an excellent review on the diagnosis and management of various forms of occupational contact dermatitis. All of us have been faced with the patient who presents with significant skin findings that are either obviously (or sometimes not so obviously) occupation related. The review methodically describes the “usual suspects” (as well as some not so usual) as occupationally related antigens to consider. Diagnostic criteria and an approach to management, including nonpharmacological factors, are described. This will be an extremely useful overview and contains multiple citations to direct the reader for further in-depth information.

Another extremely practical and useful article is from Luz Fonacier, MD, FACAAI, from Long Island who has written an excellent review on the broader topic of contact dermatitis (CD). CD is a common inflammatory skin disease and should be suspected in patients presenting with acute, subacute or chronic symptoms of dermatitis. The gold standard for diagnosing allergic CD is patch testing. This article provides practical recommendations for the diagnosis and management of CD commonly seen by the allergist-immunologist in daily practice.

A third article that has potential for clinical practice is by Marcus Maurer, MD, and colleagues from Germany and South Dakota and Genenetch in California. They examine the validity and potential clinical utility of a new instrument to assess disease activity for both chronic idiopathic urticaria and angioedema. Termed the “Validity and Responsiveness of the Urticaria Activity and Impact Measure (U-AIM)m,” it is a nine question, seven day retrospective assessment that allows clinicians to assess disease activity for both disease staging as well as response to interventional therapy. The gold standard currently used in both the U.S. and Europe is the Urticaria Activity Score which is somewhat laborious (daily diary for seven days) and does not assess angioedema. This article describes the value and limitations of this instrument as both a research tool and a potential clinical tool in the office. A good understanding of the strengths and limitations of this test can be useful to us as a new clinical tool as well as assessing practical effectiveness of future therapies for chronic urticaria-angioedema.

I hope these and other articles in the June issue of the Annals will be of interest and utility to you, our readers. As always, we welcome comments on our content and invite you to share such comments with other readers through our Correspondence feature. See our website for further details.

Gailen D. Marshall, Jr., MD, PhD, FACAAI