Elastic-free face masks can help some with allergies stay safe during COVID-19, expert says

Yashu Dhamija, MD, a first-year fellow in the UC Division of Immunology, Allergy, and Rheumatology, presented his findings in an abstract while discussing a medically challenging case at the virtual American College of Allergy, Asthma and Immunology (ACAAI) scientific meeting held November 13-15.

"How do you help patients manage a condition that puts them at risk for something like COVID-19?" asked Dhamija. "We definitely want our patients to use masks and apply social distancing. That's a must. But they can avoid elastic components and use face masks that use the knot tie method around the back of the head to keep the masks up."

Dhamija treated a patient who had been diagnosed with contact dermatitis, a reaction to allergens that touch or have contact with the skin. It is different from allergies to things such as dog or cat dander because with contact dermatitis the body's response is not immediate."

"What makes contact dermatitis tricky is that it can be delayed so you may expose your skin to something and a reaction may not occur until days later," said Dhamija. "Intermittent reactions can be tricky because you don't know what the patient is exposing themselves to and the allergen could be at work or home."

Contact dermatitis can affect up to 6% of the U.S. population.

The case report Dhamija discussed before the ACAAI involved a patient who visited a hospital emergency room three times during the spring with complaints of a facial rash and eyelid swelling. The patient was sent home with prednisone and was seen one to two weeks later during a telemedicine appointment during which he reported the rash had been going on for two weeks.

Physicians realized the rash occurred where the elastic parts of his facial mask would rest, explains Kristin Schmidlin, MD, an assistant professor in the UC Division of Immunology, Allergy, and Rheumatology and co-author of the abstract at ACAAI.

Schmidlin said physicians reduced the amount of prednisone and advised use of topical triamcinolone, a steroid that helps reduce inflammation and is commonly used in treating mouth sores. She said the patient was also advised to use a cotton-based, dye-free mask without elastic.

The patient was able to find a cloth mask and reported improved symptoms a week later, said Schmidlin.

The Centers for Disease Control and Prevention offers some guidelines for making masks at home and that's a starting point for individuals with contact dermatitis.

"Instead of using elastics in a facial mask, I would modify it and use cotton-based knot ties around the back of the head to hold the mask in place," says Dhamija. "We also advise patients to call companies that make facial masks to find out what's in the product if labeling does not contain enough details."

"There are immune reactions to allergens that can be life-threatening but when it comes to contact dermatitis, it doesn't escalate that far. We can quickly identify the allergen and stop the offending agent. But, some cases can be severe," said Dhamija. "Treatment usually means avoiding the agent or we can use a topical or oral steroid if needed. It depends on how severe the reaction is and how much of the body is affected. We also take into account how it is impacting the patient's life or ability to work, for example."

"Patch testing is a tool we use to detect contact dermatitis," said Dhamija. "It's good to speak with your primary care doctor or ask for a referral to an allergist if you have concerns. Patch testing involves placing a compound we suspect is a problem to your skin. We have you return a few days later and we see if there is a reaction."

Dhamija said there is abundant literature documenting patients with contact dermatitis because of allergens such as elastic bands in FFP2 masks, N95 respirators, neoprene rubber masks and medical masks containing formaldehyde or rubber components using carbamates or thiurams.