Allergic Contact Dermatitis

Allergic contact dermatitis is an immunologic cell-mediated response to an exposure to an antigenic substance. The most common sensitizing agents are medications, plants, insect and snake bites, and certain food products. The percentage of workers who react to these agents varies widely. For example, only 6% of persons react to nickel, whereas as many as 70% react to poison oak or poison ivy. From 10% to 17% of workers who use latex gloves react to latex. Sensitization to one chemical may induce a cross-sensitization or cross-reactivity to related chemicals (1,8,9,27).

The rash is usually pruritic and typically appears in areas exposed to the sensitizing agent. It usually has an asymmetric or unilateral distribution and is characterized by erythema, vesicles, and severe edema. Treatment typically includes topical and systemic steroids, antihistamines, and tricyclics. Desensitization serums to many substances commonly found in agriculture are available from allergists and supply companies (Figure 18.1) (1,8,9,18).

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