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In Patients Reactive to Balsam of Peru and Fragrance Mix, Restricted Diet Helps

Systemic contact dermatitis develops after an individual ingests or otherwise takes in an allergen to which he or she has been sensitized; on patch testing, such an allergen will cause a reaction. Metals, poison ivy, fragrances, and several drugs are among substances reported to cause reactions. These investigators retrospectively studied 71 patients with suspected contact dermatitis and positive reactions to balsam of Peru, fragrance mix, cinnamic aldehyde, or balsam of tolu. Physicians had recommended that 45 of these patients follow a balsam-restricted diet, because positive reactions to these substances may indicate allergy to balsam-related foods.

Ten patients did not follow the recommended diet. Twenty-one (47 percent) of the 45 patients who were directed to the diet had complete or significant improvement of their dermatitis, but the report is unclear on whether all of these 21 patients with improvement followed the diet. Of the 10 patients who did not modify their diets, 2 improved. The foods that patients reported most often as triggering dermatitis were tomatoes, citrus foods, and spices. The author of an accompanying editorial suggests that the patients most likely to benefit from the diet are those with chronic dermatitis not improved by avoiding known allergens and those whose dermatitis is on both hands or feet, the anogenital area, or the skin folds. The editorialist recommends a trial of 4 weeks of this very restricted diet followed by, if improvement occurs, reintroduction of individual foods every couple of weeks.

Comment: My first reaction to discussions of restricted diets for contact dermatitis was disbelief, because the patch-test reaction is a classic delayed hypersensitivity, and the quicker effect after ingestion of an allergen suggested a different mechanism. Since then, I have received reliable reports of quick exacerbations of generalized eczema following ingestion of certain foods, and I am now a believer. These results further demonstrate the benefit of patch testing for patients with unexplained dermatitis.

— Jeffrey P. Callen, MD

Published in Journal Watch Dermatology December 11, 2001

Citation(s):

Salam TN and Fowler JF Jr. Balsam-related systemic contact dermatitis. J Am Acad Dermatol 2001 Sep 45 377-381.

• Medline abstract (Free)

Belsito DV. Surviving on a balsam-restricted diet: Cruel and unusual punishment or medically necessary therapy? J Am Acad Dermatol 2001 Sep 45 470-472.

• Medline abstract (Free)