Protein contact dermatitis L23.6

Allergic contact dermatitis on hands and forearms, caused by repeated contact with various protein-containing products (e.g. meat, flour). S.a. flour protein dermatitis and contact urticaria. Which protein determinants are of essential importance for sensitisation has not yet been conclusively clarified (Parkinson E et al. 2017)

• Allergic contact dermatitis of the immediate type ( atopy patch test, type 4 reaction to type 1 allergens).
• The causative proteins can be divided into 4 >main groups:
• animal proteins as main group
• Grains and flours
• (protolytic) enzymes
• Fruits, vegetables, spices, plants

In so-called contact reactions of the immediate type, inflammatory skin changes (sometimes also accompanying mucous membrane reactions) usually occur within a few minutes. The clinical spectrum is wide and ranges from local sensations without visible correlations, itching, redness and swelling, in extreme cases also to anaphylactic shock (see below contact urticaria). In some cases, this "non-eczematous" initial picture, which can be described as contact urticaria, changes into eczematous dermatitis within a few weeks. Protein contact dermatitis may also play a role in dermatitis caused by cosmetics (Delaunay J et al. 2018).

Spongiotic dermatitis of varying degrees of acuteity.

• Epicutaneous test with the allergens in question.
• Epicutaneous re-exposure in the area of skin lesions of the allergens known from the intradermal test.
• Prick test
• Friction test
• Serological detection of specific IgE.

1. Delaunay J et al (2018) Occupational immediate contact allergy to hydrolysed wheat protein after cosmetic exposure
   . Contact dermatitis 78:291-292.
2. Krüger U, Fuchs Th (2007) Contact urticaria and protein contact dermatitis in occupational dermatology. Derm Occupation and environment 55: 107-111
3. Hjorth N, Roed-Petersen J (1975) Occupational eczema caused by proteins. Z Hautkr 50: 851-852
4. Hjorth N, Roed-Petersen J (1976) Occupational protein contact dermatitis in food handlers. Contact Dermatitis 2: 28-42
5. Laukkanen A et al (2007) Lactase-induced occupational protein contact dermatitis and allergic rhino-conjunctivits. Contact dermatitis 57: 89-93
6. Parkinson E et al (2017) Determination of Protein Haptenation by Chemical Sensitisers within theComplexity
   of the Human Skin Proteome. Toxicol Sci doi: 10.1093/toxsci/kfx265.
7. Vanstreels L et al (2012) Protein contact dermatitis in a butcher. Dermatologist 63: 926-928