ABSTRACT
Sorbitol-derived compounds have been increasingly recognized as a cause of delayed hypersensitivity reactions. We present a case of recurrent allergic contact dermatitis (ACD) that lasted 6 months in which the patient retrospectively correlated new lesion appearance with consumption of specific types of beer and bread. Patch testing using the North American Contact Dermatitis Group Standard Series with supplemental allergens was positive for sorbitan sesquioleate (SSO) and sorbitan monooleate (SMO). Avoidance of beer and bread led to complete clinical resolution. Sorbitol in beer and bread is not well documented but likely is related to the yeast cultures used for fermentation and leavening. Sorbitol is utilized as an osmotic stabilizer in yeast culture preparation and is found in commercially prepared brewer's and baker's yeasts. We propose that trace amounts of sorbitans in yeast-containing products can cause ACD. Systematized ACD poses a challenge for dermatologists to diagnose, as the pattern can be nonspecific and skin testing does not always produce meaningful results. Because it is difficult to elicit history and correlate exposures with worsening of skin symptoms, a trial of dietary avoidance may be necessary to determine the diagnosis of systematized ACD. When patch testing is positive for SSO and SMO, the dermatologist should inquire about dietary habits with attention to beer and bread.
