Original article:

Sharon E. Jacob, MD, Dathan Hamann, BS, Alina Goldenburg, BA, Elizabeth A. Connelly, MD Easter Egg Hunt Dermatitis: Systemic Allergic Contact Dermatitis Associated with Chocolate Ingestion PEDIATRIC DERMATOLOGY, Vol 32 ¡ No 2 ¡ 2015 pg 231-233

Review by James (Keith) Parker, BS. MSI, Loma Linda University

The North American Contact Dermatitis Group has found that there is a strong co-occurrence of allergic contact dermatitis (ACD) and atopic dermatitis (AD) in children.

Nickel is an especially common contact allergen in children, with an estimated prevalence of 26.2% in patch tested children!

Patients with ACD may experience systemic contact dermatitis (SCD) after ingestion of certain foods or certain drugs. Dietary restrictions can be used to avoid flares of ACD. The Jacob et al[i]. article reviewed a series of four case reports of nickel-sensitized children with AD that showed:

* Avoidance of “everyday” foods such as: peanuts, peanut butter, chocolate, oats, and processed American cheese – cleared 60 to 80% of their dermatitis when used along with standard therapeutics that had failed alone previously

* Each child had a flare about 48 to 96 hours after Easter Sunday

* Without their parents knowledge the children had binged on chocolate

* It is recommended to consider restricting chocolate consumption in children with nickel sensitization and widespread dermatitis

* The following foods contain 11 micrograms to more than 100 micrograms per serving of nickel: sunflower seeds – oat ring cereal – chocolate candy bars – chocolate syrup – granola with raisins – lima beans – chocolate chip cookies – brownies – pinto beans

[i] Sharon E. Jacob, MD, Dathan Hamann, BS, Alina Goldenburg, BA, Elizabeth A. Connelly, MD Easter Egg Hunt Dermatitis: Systemic Allergic Contact Dermatitis Associated with Chocolate Ingestion PEDIATRIC DERMATOLOGY, Vol 32 ¡ No 2 ¡ 2015 pg 231-233

Article by Peter Gust