A Dog Lover’s Dilemma- Airborne Allergic Contact Dermatitis
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Airborne allergic contact dermatitis (AACD) can be caused by airborne chemicals settling on exposed body parts. Repeated exposure to an allergen can induce AACD in the areas of exposed skin (typically the face, hands, and forearms).

A 67-year-old white female presented with a 4 month history of a severe pruritic facial and hand dermatitis. She admitted allergy to Trimox (Amoxicillin) and food allergy to lobster (although she never had prick testing performed).

A skin biopsy from her hand revealed a spongiotic dermatitis. She still had flaring of her dermatitis despite completing her second course of oral prednisone. She was prescribed prednisone, oral loratadine, and topical hydrocortisone for her face, and was recommended patch testing. She underwent patch testing with the NACDG80 panel and two additional items (her dog’s fur and tylosin (Tylan) powder, a canine medication).

On patch testing, she reacted to Quaternium 15 (1+ at 72 h) and 10% Tylan powder in petrolatum (1+ at 48h and 72h). Patch testing of five controls to Tylan powder in petrolatum did not reveal any reactivity to this antibiotic. The Tylan powder reactivity was considered to be possibly relevant, as well as the Quaternium 15 reactivity. She was given a safe shopping list for Quaternium 15 allergen avoidance and advised to discontinue the use of the Tylan powder additive in her dog’s food, and to vacuum clean her kitchen of any residual powder in the environment. After three months of discontinuation of the use of Tylan powder, her hand dermatitis resolved completely, and her facial dermatitis was greatly improved.

Airborne allergic contact dermatitis to tylosin can be diagnosed by careful patient history and the addition of pet products in patch testing. There was recovery after discontinuation of the offending product.

Source: https://www.jaadcasereports.org/article/S2352-5126(20)30805-5/fulltext?rss=yes