Lifestyle Choices

Almost everything can cause an allergy in someone, somewhere! The medical literature is full of reports of strange skin allergies: clarinet players with lip blisters from an allergy to the bamboo reed; drivers with allergic reactions to steering wheels; chefs with allergies to pineapple juice, corn and other moist foods.

An allergic contact dermatitis is a specific sensitivity in a person with a genetic predisposition. In contrast an irritant contact dermatitis occurs in everyone who touches the irritating substance (as described previously), though some people are more sensitive than others, reacting to lower concentrations or fewer contacts. To suffer an allergic reaction, that person must already have been exposed to the substance. The skin irritation appears after a second or third (or even a one-thousandth) contact only on the specific area which touched the allergen.

Gardeners and flower arrangers beware! The most common allergic contact dermatitis results from contact with plants, especially poison ivy in the United States or poison sumac in Europe (hence the saying: Leaflets three, let it be). Exposure happens by inadvertently brushing against the leaves and then depositing the plant’s oil (oleoresin) on the skin. A characteristic red, swollen, blistering, itchy skin irritation develops 12 to 48 hours later. Lovely flowers can also cause this uncomfortable and sometimes frightening reaction, including chrysanthemum and dahlias when injured, the “hairs” of orchids and primroses, and tulip bulbs.

A common misconception is that the blister fluid on the skin is contagious. This is not true! The blistering appears to evolve with more blisters appearing over several days because initially the plant oil was deposited in varying concentrations. The earliest blisters are areas exposed to high concentrations of the oil; later blisters had less concentrated contact. If you realize you have touched a plant allergen, wash the area thoroughly (including under your fingernails!) within 20 minutes of contact to prevent the rash. Remember to wash everything that was in contact with the plant, because unless completely removed, the oil can remain active for years. The burning of many plants causes the oil to vaporize, thereby contacting all exposed skin and often causing very severe allergic dermatitis.

Another very frequent cause of allergic dermatitis is nickel, a frustrating problem since nickel is everywhere! Necklaces, earrings, rings, bracelets, costume jewelry, hairpins, belt buckles, watch bands, zippers (zips), scissors, door handles, pens, knitting needles, screws in orthopaedic implants, coins — all contain nickel! You can test for nickel by purchasing a kit containing dimethylglyoxine. If you are allergic, you can cover these commonly used objects and even jewelry with cellophane wrap or with clear nail varnish. Stainless steel or gold jewelry can be worn. Be sure that any cooking utensils are made of stainless steel, enamel, or are coated.

Other common causes of contact allergy are chromatin (in different materials such as cement, photographic processes, metals, dyes, detergents, rubber, leather, and cosmetic ingredients.

Obviously the treatment is to avoid the allergens! You and your dermatologist must work together as detectives to discover the precise cause. Sometimes a patch test (applying all possible culprits to the skin for two days) is necessary. Patch testing is important in allergies to cosmetics, since the precise component can be identified and avoided. Meanwhile, the itchy rash can be treated with topical steroids.

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