Contact Dermatitis • Contact Points PROTEIN CONTACT DERMATITIS IN BIRD-EGG SYNDROME • BERBEGAL ET AL. Protein contact dermatitis caused by chicken meat in bird-egg syndrome Laura Berbegal 1 , Francisco J. DeLeon 2 , Iris González 3 and Juan F. Silvestre 3 1 Dermatology Department, Hospital Marina Salud, 03700, Dénia, Alicante, Spain , 2 Dermatology Department, Hospital Universitario Morales Meseguer, 30008, Murcia, Spain , and 3 Dermatology Department, Hospital General Universitario de Alicante, 03010, Alicante, Spain doi:10.1111/cod.12805 Key words: -livetin; bird-egg syndrome; case report; chicken meat allergy; Gal d 5; protein contact dermatitis; serum albumin. Protein contact dermatitis (PCD) is a frequently under- diagnosed entity. Clinically, it presents with cutaneous symptoms (pruritus, urticaria, and eczema) following contact with the responsible allergen, and it primarily affects the hands (1). PCD is often occupational, especially in patients working as food handlers (2). In these cases involving food, it is important to rule out oral allergy syndrome (pruritus of the mouth, paresthesia, chelitis, and lip oedema), although the culprit food is frequently well tolerated when eaten (3). Case Report A 30-year-old female of fce worker was referred because of a 1-year history of erythematous and scaly lesions on the palms of the hands (Fig. 1a). A previous skin biopsy had been compatible with eczema. The past medical history included atopic dermatitis during childhood, and allergic rhinitis with positive prick test results for cat, dog and horse epithelium, feathers, and dust mites. The patient also had food allergies for egg yolk and prawns (positive in prick tests and for specifc IgE). The patient had been diagnosed with bird-egg syndrome, and avoided consuming both egg yolk and poultry, despite not having gastrointestinal symptoms when eating cooked chicken. However, during the history- taking, she mentioned pruritus when handling raw poultry. Patch testing with the Spanish baseline series (4) showed positive reactions to nickel sulfate [day (D) 2, ++; D4, ++], with past relevance. The prick-by-prick test with chicken meat gave a positive result (Fig. 1b). Following a Correspondence: Laura Berbegal De Gracia, Hospital Marina Salud. C/ Beni- adla SN. 03700 Dénia (Alicante), Spain. Email: lauraberbegal@gmail.com Conflicts of interest: All authors declare that they have no conflict of interests. period of glove use and topical treatment with corticos- teroids, the lesions on the hands disappeared (Fig. 1c). The fnal diagnosis was PCD in the context of bird-egg syndrome. Discussion In egg allergy, the protein fractions of the egg white are considered to be the main allergens. However, in bird-egg syndrome, patients are sensitized to the egg yolk via bird proteins that are also found in feathers, droppings, and chicken serum. The responsible allergen for this cross-reactivity seems to be -livetin, or chicken serum albumin (Gal d 5). -Livetin is a partially ther- mostable protein; that is, heat reduces its allergenicity, so that many patients tolerate cooked meat and fried eggs (5). These patients suffer from rhinoconjunctivitis and asthma following contact with bird antigens via feathers, droppings, serum, and meat. Gastrointestinal symptoms or oral allergy symptoms (lip oedema and oral pruri- tus) may also occur after consumption of egg yolk or chicken meat. Some authors have also described contact urticaria as a local reaction to skin contact with raw meat (6). As in our case, other studies have reported that patients with bird-egg syndrome may present with a concomitant allergy to fsh/shellfsh (in up to 30% of cases) (6). To our knowledge, this is the frst reported case of PCD in a patient with bird-egg syndrome. Unlike many other reported cases, our case is not occupational; as we all handle food to some extent, it is important to generally consider this diagnosis. It is interesting to highlight the symptoms that -livetin (chicken serum albumin) may cause in these patients in terms of PCD or contact urticaria, in addition to the respiratory and digestive symptoms already known to occur in this syndrome. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd Contact Dermatitis, 77, 250–267 253