Patch Test Reactions Associated with Food Sources: A Retrospective Analysis of the North American Contact Dermatitis Group Data (2001–2018)

<u><b><i></i></b></u> <u><b><i>Background:</i></b></u> Contact dermatitis due to food exposure is underrecognized.<u><b><i>Objectives:</i></b></u> To characterize relevant allergens associated with food sources and analyze patient and clinical characteristics associated with food-related allergen exposure in patients with a currently relevant positive patch test reaction (PPTR).<u><b><i>Methods:</i></b></u> We retrospectively analyzed North American Contact Dermatitis Group data from 2001 to 2018, identifying relevant allergens linked to food sources. Patients with currently relevant PPTRs were divided into food-related and non-food-related exposure groups for comparison.<u><b><i>Results:</i></b></u> Among 43,722 patients, 867 (2.0%) had at least one currently relevant food-related PPTR, accounting for 936 PPTR reactions. The most common allergens were nickel (411, 43.9%), Balsam of Peru (BOP, 287, 30.7%), and fragrance mix 1 (FM1, 60, 6.4%). Carvone (24/139 [17.3%]) and sodium metabisulfite (10/87 [11.5%]) showed the highest food-related proportions. Among 867 food-related patients, the most commonly affected areas were generalized (30.22%) and the hand (19.26%). Patients having food-related PPTR were significantly less likely to involve the hand (OR, 0.59; <i>P</i> < 0.0001) and face (OR, 0.43; <i>P</i> < 0.0001) as compared with nonfood-related patients. Food exposure was associated with a higher likelihood of anogenital dermatitis (<i>P</i> ≤ 0.01 for nickel sulfate, BOP or FM1).<u><b><i>Conclusion:</i></b></u> Nickel, BOP, and FM1 were the most common food-related allergens. Common sites of dermatitis in patients with food-related PPTR were generalized, anogenital areas, and hands, although involvement of the hands and face was significantly less likely compared with nonfood-related cases.