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Allergy to Clothing

Allergy to clothing is quite common. The reaction is due to the contact of clothing to the skin. The eczema type reaction is either the primary irritant type or the delayed type hypersensitivity.

It is now a generally accepted norm that cotton clothing is softer on the skin. The fibres in wool, nylon and other man-made fabrics tend to irritate the skin. Pure 100% cotton or a high cotton mix are now more widely preferred.

A brief description of different fabrics and their effect on skin:

  • Cotton is rarely considered a sensitizing agent but the azo dyes, formaldehyde resins used in the fabric to give an attractive finish may cause sensitization.
  • Wool may be a primary irritant, but it causes seasonal allergy.
  • Silk rarely causes allergy. It is lightweight, breathable and can help regulate body temperature; keeping the body warm in winter and cool in summer.
  • Polyesters - Synthetic fibres such as acrylic, nylon or spandex which are used in socks, skirts, sarees frequently cause irritation. The irritation may be due to the material itself, the dye or due to the finish of the fabric.
  • Spandex - This is a non-rubber, stretchable, polyurethane fibre which is used for socks, brassieres, underwears. The allergen in these fabrics is mercaptobenzothiazole.

Causes of textile allergy –

  • Dyes and formaldehyde resins – Cotton is rarely a sensitizing agent, but the dyes and finish may cause allergy. Formaldehyde resins are used on fabrics to impart wrinkle resistance during wear and laundering to 100% cotton and to cotton/polyester blend fabrics.
  • Remnants of soaps on washed clothing are an important cause of allergy especially the undergarments.
  • Elastic in clothing material especially undergarments such as brassieres and the waistband in underwear or pants can cause allergy where there is contact of the clothing item with the skin. The areas involved are subjected to friction and perspiration, which contribute to the uncomfortable skin lesions.
  • Friction from clothing also cause a condition called intertrigo. This rash is a result of friction and sweating in high heat conditions.
  • Allergy on the hands caused by use of protective latex gloves (rubber additives, anti-oxidants, preservatives or the latex protein).
  • Other materials known to cause allergy include chemicals used in processing leather shoes and belts such as dyes, chromium and formaldehyde tanning agents and glue products.
  • Clothing that is contaminated with oils, pesticides, greases, coal tar can cause allergy and folliculitis due to heat and friction.
  • Fine metallic dust particles such as antimony that are capable of imbedding into the clothing fabric can result in irritant skin reactions.

Symptoms:

  • Eczema type lesions at the site of intimate contact with clothing. It is commonly seen on the trunk and thighs.
  • In the preliminary stages, clothing allergy appears as a pruritic erythematous papulovesicular eruption which gradually becomes chronic and lichen like if not timely diagnosed and treated.
  • Presence of red, macerated skin on the waistband area, under the arms and the inner thighs. This rash can become secondarily infected with bacterial organisms in hot, humid environments. The rash is more common in heavy and obese individuals.
  • Itching at the site of contact.
  • Socks allergy is quite common. The lesion is confined to the area covered by socks and is generally in a ring form, encircling the upper part of the socks. The whole area covered may be eczematous if the reaction is due to the fabric of the socks.
  • Some people experience itching and tearing eyes and, shortness of breath. This is more common in people who wear tight fitting rubber gloves.

What factors aggravate allergy to clothing?

  • Tender and sensitive skin such as that of infants.
  • Obesity
  • Hyperhidrosis: tends to leach dyes from the fabrics to the skin surface causing dermatitis.
  • Moisture: causes more hydration of the epidermis, which enhances more penetration of the sensitizers.
  • Increased skin surface lipids
  • Tight clothing
  • Skin Condition: repeated friction, trauma, damaged skin facilitate clothing allergy
  • Sebum, lack of cleanliness, overheating of the skin surface have an important effect.
  • Some types of cloths such as khaki may cause purpuric or lichenoid dermatitis in the areas covered by the fabric. This type of dermatitis is due to the azo dyes, formaldehyde and finishes rather than the type of cloth.

Precautionary suggestions to avoid clothing allergy:

  • Patients are generally advised to wear only cotton clothes and avoid fully synthetic ones.
  • Although synthetic clothes do not absorb sweat and are uncomfortable in summer, they are free from formaldehyde and safe for formaldehyde allergic individuals. Patients who are allergic to formaldehyde should avoid wrinkle resistant clothing and blended fabrics (polyester/cotton). It is generally recommended that such clothes should be washed before wearing to reduce the level of free formaldehyde.
  • Choose clothing that can be easily boil washed. Dust mites and their allergens that get into clothing can thus be destroyed. Avoid 'crease-free', 'non-iron' or 'flame resistant' fabrics because the chemical treatments used can trigger allergy. 
  • Buy garments that fit and are not too loose, especially underwear and night wear.
  • Cold and hot humid weather aggravate the skin problem. It is important to keep skin in optimum condition both in winter and summer. But that does not mean by any way to occlude the skin surface with several layers of garments as these may play an important role in exacerbating allergy.