LAUSR

An 8-year-old atopic girl was referred to our Contact Eczema Department with an acute facial rash after applying a wet wipe to her face. Her personal history of interest included abdominal pain after ingestion of chamomile tea in two previous episodes. The mother provided a photo showing the itchy erythematous facial rash (Figure 1A) that appeared within minutes of applying the wet wipe (Toallitas Bebe Frescas y Perfumadas con Aloe Vera y Camomila; Deliplus, Mercadona S.A., Spain). The rash disappeared after 30 minutes. Chamomile was found among the ingredients of the wipe. The girl had used the same wipes on a previous occasion with the same skin reaction. Her mother denied applying chamomile tea to the skin previously. No contact with plants by the patient was reported. Specific immunoglobulin E (IgE) was requested for chamomile, artemisia, and ragweed in serum. Patch tests were performed with the European Comprehensive Baseline Series (Chemotechnique Diagnostics, Vellinge, Sweden), plant series (Chemotechnique Diagnostics), Aloe vera plant gel “as is” (home preparation), and chamomile extract 2% pet. (home preparation). Photopatch was performed with the wet wipe “as is” (2 2 cm), Compositae mix II 2.5% pet., sesquiterpenic lactones mix 0.1% pet., and chamomile extract 2% pet. A semiopen test was performed with wet wipe “as is,” A vera plant gel “as is,” and chamomile extract 2 % pet. Results were interpreted according to the criteria of the ICDRG. Patch tests were read on day (D) 2 and D4. The patient showed a positive patch test reaction (erythema and mild oedema in the semiocclusion zone) to the wet wipe “as is” at 20 minutes (+/++ +; Figure 1B). The rest of the investigation showed no positivity. Only the specific IgE for chamomile was 20.8 UI/mL (<0.1 UI/mL). The wet wipe skin prick test showed a positive urticarial reaction after 15 minutes (7 5 mm), positive histamine (8 8 mm), and negative control with saline (0 0 mm). Ten controls subjected to the patch test with wet wipe were all negative. Contact urticaria caused by wet wipe was diagnosed, and the main culprit suspected was chamomile. Avoidance of cosmetic products and foods/drinks containing chamomile was recommended. The importance of avoiding chamomile was explained to the mother because of the risk of anaphylaxis. Follow-up at 3 months showed no rash or other digestive problems.