Acrylic Allergy: How Nail Salons Sparked a Contact Allergy Epidemic
Acrylic allergy is a Type IV delayed hypersensitivity reaction to uncured (meth)acrylate monomers — not cured acrylic products. Named ACDS Allergen of the Year 2012, it predominantly affects women (94%) through UV-cured gel nails and acrylic nail services. The key allergen is 2-HEMA (2-hydroxyethyl methacrylate). Standard nitrile gloves do not protect against acrylate monomers. Cross-reactivity means nail sensitization can later trigger reactions to dental materials, medical adhesives, and ECG electrodes.
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Key facts
NACDG positivity rates for acrylates rose from 2.0–2.6 percent in 2007–2014 to 3.4 percent in 2015–2016, driven by the nail cosmetics industry.
In populations specifically evaluated for nail cosmetic exposure, acrylate contact dermatitis positivity rates reach 22 to 72 percent.
Among NACDG acrylate ACD patients, 94 percent are female, directly reflecting the demographics of nail cosmetic users and workers.
The key screening allergen 2-HEMA (1% petrolatum) was added to the European Baseline Patch Test Series in 2019, but it is NOT in the TRUE Test.
Standard nitrile gloves do not adequately protect against acrylate monomers, which penetrate nitrile within minutes of contact.
What Is Acrylic Allergy?

Acrylic allergy is a Type IV delayed hypersensitivity contact dermatitis caused by sensitization to (meth)acrylate monomers — the reactive chemical building blocks of acrylic and gel nail products, dental resins, medical adhesives, and industrial coatings.
The American Contact Dermatitis Society named acrylates its Contact Allergen of the Year in 2012, recognizing the rapidly growing epidemic of sensitization driven by the nail cosmetics industry.
The critical clinical insight — one that is poorly understood by both patients and many salon workers — is that it is the uncured monomer that causes sensitization, not the finished cured product. Fully cured, hardened acrylic nails, dental fillings, or industrial coatings are generally non-sensitizing because the polymerization reaction has locked the reactive monomers into a polymer matrix. The problem occurs during application, when uncured liquid monomer or unpolymerized gel is in direct contact with skin.
The gender disparity in acrylic contact dermatitis is striking: the NACDG reports 94% female predominance in patients with acrylate ACD, directly reflecting the demographics of nail cosmetic users and workers. NACDG positivity rates have shown a statistically significant upward trend — from 2.0–2.6% (2007–2014) to 3.4% (2015–2016) and 3.2% (2019–2020) — and in populations specifically evaluated because nail cosmetics are suspected, positivity rates reach 22–72%.
The clinical consequences extend beyond the fingertips: once sensitized to acrylates through nail products, patients may subsequently react to dental materials (methacrylate-based resins in composite fillings), medical adhesives (ECG electrodes, glucose monitors, wound closure strips), hearing aid housings, and orthopedic bone cements.
Acrylic Allergy Symptoms
Recognizing symptoms early helps you get the right treatment faster.
Fingertip eczema
moderateErythema, vesicles, and fissuring on the fingertips and nail fold areas — the primary presentation site from nail product monomer contact.
Pruritus
moderateIntense itching of the affected finger and hand areas, typically appearing 24–96 hours after acrylate exposure as part of the Type IV delayed reaction.
Fingertip paresthesias
moderateTingling, burning, or numbness in the fingertips — a distinctive symptom of acrylate contact allergy that may precede visible skin changes, particularly with HEMA-containing products.
Onycholysis
moderateSeparation of the nail plate from the nail bed, often misinterpreted as fungal nail infection or psoriasis; a recognized nail change from chronic acrylate contact dermatitis.
Hand eczema
moderateSpread of eczematous reaction beyond the fingertips to the dorsal hand and between fingers, typically in nail technicians with occupational exposure.
Eyelid and facial dermatitis
moderateTransfer of acrylate monomer from fingertips to eyes and face can cause periorbital and facial contact dermatitis in sensitized individuals who touch their face habitually.
Cross-reactive medical device reactions
moderateSensitized patients may develop unexpected reactions to ECG electrode adhesives, continuous glucose monitor sensors, wound closure strips, or hearing aid housings due to shared acrylate components.
Dental work reactions
moderateContact stomatitis or dermatitis of the perioral area from methacrylate-containing dental composite resins, bonding agents, or prosthetic materials in previously nail-sensitized patients.
When to see a doctor
Acrylic contact dermatitis primarily affects the fingertips, nail folds, and periungual skin — the areas most exposed to uncured monomer during nail product application. In nail technicians, the dominant site is the dominant working hand. In clients, reactions typically involve multiple fingers where gel or acrylic was applied. The classic presentation is an eczematous rash on the fingertips and nail fold areas: erythema, vesicles, fissuring, and intense pruritus appearing 24–96 hours after exposure. Chronic exposure leads to thickened, fissured fingertip skin and onycholysis (separation of the nail plate from the nail bed) in some cases — nail changes can be the first or most prominent feature, mimicking psoriasis or fungal nail disease. A distinctive and important feature is the development of paresthesias (tingling, burning, or numbness) in the fingertips — particularly with HEMA-containing products. These sensory changes may precede visible skin changes and can be severe enough to affect hand function. Because of the broad acrylate family cross-reactivity, sensitized patients may experience unexpected reactions to dental materials, medical adhesives (wound closure strips, ECG electrodes, continuous glucose monitor adhesives), and even hearing aids — sometimes years after the original nail product sensitization, creating diagnostic confusion.
Acrylates and Respiratory Allergy
Acrylate contact allergy is primarily a skin condition, but inhalation concerns exist in occupational settings. Nail salons with poor ventilation produce acrylate vapors and dust during acrylic nail filing, which can cause respiratory irritation and — in some cases — occupational asthma in heavily exposed workers. Methyl methacrylate (MMA) and other volatile acrylate monomers have been documented to cause occupational asthma through both IgE-mediated sensitization and direct respiratory irritation. Proper ventilation systems in nail salons are important for both respiratory health and skin sensitization prevention. For patients with established acrylate contact allergy, the primary respiratory concern is occupational — typically in nail technicians rather than clients. If you are a nail salon worker experiencing both skin and respiratory symptoms, both dermatology and pulmonology evaluations may be warranted.
Complications of Acrylic Contact Allergy
Acrylic contact allergy has clinical consequences that extend well beyond the nail salon. The most clinically significant complication is the development of cross-reactive sensitization that affects subsequent medical and dental care. Once sensitized to acrylate monomers through nail products, patients may react to methacrylate-containing dental composites, bonding agents, and denture materials. This can make routine dental restorative work problematic — dentists must be informed of the acrylate allergy to select appropriate alternative materials. Bone cements used in orthopedic procedures (hip and knee replacements) often contain methacrylates; preoperative allergy evaluation is important. For patients with medical devices requiring adhesives — continuous glucose monitors, cardiac rhythm monitors, wound closure systems — acrylate sensitization can interfere with essential medical management and requires device-specific alternative selection.
Cross-reactive dental material sensitization
Sensitized patients may react to methacrylate resins in dental composites, bonding agents, and prosthetics — potentially complicating routine dental restorative care.
Medical device adhesive reactions
ECG electrodes, continuous glucose monitor sensors, cardiac monitors, and wound closure strips containing acrylate adhesives can cause reactions in sensitized patients, interfering with medical monitoring.
Occupational inability to continue work
Nail technicians who develop acrylate sensitization typically must leave the profession, as continuing the same exposure causes worsening sensitization and increasingly severe reactions.
Chronic nail changes
Onycholysis and nail dystrophy from chronic acrylate contact dermatitis can persist even after allergen avoidance, requiring prolonged nail recovery.
Polysensitization
Acrylate sensitization makes individuals prone to additional chemical sensitivities through continued barrier disruption, potentially expanding the allergen profile over time.
What Causes Acrylic Allergy?
The (meth)acrylate family is large and hierarchical in sensitization potency. Diacrylates and triacrylates are the most potent sensitizers, followed by monoacrylates, with MMA (methyl methacrylate) having relatively lower sensitization potential. UV-cured gel nail products contain a range of methacrylate monomers; acrylic nail products use liquid monomer-powder polymer systems that contain methacrylate monomers as the reactive liquid phase.
How it works
Acrylate monomers function as Michael acceptor haptens — electrophilic molecules that react with nucleophilic residues (cysteine sulfhydryl groups, lysine amino groups) on skin proteins, forming covalent hapten-protein conjugates. These conjugates are processed by Langerhans cells and dendritic cells, which migrate to regional lymph nodes and present the acrylate-hapten complexes to naive T lymphocytes. The resulting pool of sensitized CD4+ and CD8+ T cells mounts a delayed inflammatory response upon re-exposure, producing the eczematous contact dermatitis 24–96 hours after contact. Cross-reactivity within the acrylate family is extensive — sensitization to one acrylate typically confers reactivity to multiple related compounds.
The primary exposure pathway is skin contact with uncured monomer during product application — whether a nail technician repeatedly working with the products or a client whose cuticle area or surrounding skin contacts the liquid monomer or gel before UV curing. The sensitization risk is highest when monomer contact is prolonged and involves broken or macerated skin around the nail fold.
Dentistry historically was the primary sensitization source for acrylates before the nail salon epidemic. Dental composites, bonding agents, and denture materials contain methacrylate monomers that can sensitize patients and dental workers. Since the 2010s, however, nail cosmetics have substantially overtaken dentistry as the dominant sensitization pathway.
Industrial acrylate exposures include UV-cured coatings, printing inks, adhesives, and composites — occupational settings that can produce significant sensitization, particularly in workers without adequate protection.
Risk factors to watch for
Nail technician occupation
Daily repeated exposure to uncured acrylate monomers during client application represents the highest cumulative sensitization risk. Studies show 22–72% positivity in nail technicians evaluated for suspected acrylate exposure.
Gel nail and acrylic nail use
Regular clients of gel nail and acrylic nail services accumulate acrylate monomer skin contact over time, particularly through leaking or poorly fitting forms and cuticle-area contact during application.
Female sex
94% of NACDG acrylate ACD patients are female, reflecting the demographics of nail cosmetic users. Women are at substantially higher risk in this exposure context.
Inadequate glove protection
Standard nitrile gloves do not protect against acrylate monomers, which penetrate nitrile within minutes. Nail technicians using nitrile gloves may have a false sense of protection while remaining fully exposed.
Dental restorative work
Methacrylate-containing dental composites and bonding agents represent a secondary sensitization pathway for patients undergoing extensive dental work, as well as for dental professionals.
The Allergy Cascade
Exposure
Allergen contact
Detection
Immune recognition
IgE Response
Antibody production
Mast Cells
Histamine release
Symptoms
Allergic reaction
1.Exposure
Allergen contact
2.Detection
Immune recognition
3.IgE Response
Antibody production
4.Mast Cells
Histamine release
5.Symptoms
Allergic reaction
Diagnosing Acrylic Contact Allergy
Diagnosing acrylate contact allergy requires patch testing performed by a board-certified dermatologist. The key screening allergen is 2-HEMA (2-hydroxyethyl methacrylate) at 1% in petrolatum, which was added to the European Baseline Series in 2019. Acrylates are in the NACDG supplemental series but are notably absent from the TRUE Test — a significant testing gap that means patients patch tested only with the TRUE Test panel may miss acrylate sensitization. A comprehensive acrylate panel includes 2-HEMA and other relevant monomers: 2-HPMA, EGDMA, TEGDMA, and others relevant to the patient's exposure history. Bis-GMA (used in dental composites) and epoxy acrylates share approximately 20% cross-reactivity with DGEBA-based epoxy resins. Patch test readings for acrylates should include both 48h and 96h time points. The exposure history — type of nail products used, frequency of gel nail services, occupation — is essential context for interpreting patch test results. At-home IgE allergy testing such as Curex's 40+ allergen panel covers IgE-mediated inhalant and food allergies, not Type IV contact allergy to acrylates. For the contact allergy diagnosis, in-person patch testing with a dermatologist or contact allergy specialist is the required pathway.
Patch Testing with 2-HEMA (European Baseline)
2-Hydroxyethyl methacrylate (2-HEMA) at 1% in petrolatum is the key acrylate screening allergen, added to the European Baseline Series in 2019. Patch applied under occlusion for 48 hours, read at 48h and 96h.
Extended Acrylate Panel
Comprehensive testing of the full range of relevant acrylate monomers (2-HEMA, 2-HPMA, EGDMA, TEGDMA, DPHA, bis-GMA, ethyl acrylate, etc.) for detailed profiling of sensitization pattern.
NACDG Supplemental Acrylate Series
The North American Contact Dermatitis Group supplemental series includes selected acrylates for broader screening in suspected cases.
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If you've spent months managing hand eczema and wonder whether immunotherapy could eliminate acrylate sensitivity, the honest answer is: it cannot — not for Type IV contact allergy. Acrylic contact allergy is a Type IV delayed hypersensitivity reaction mediated by sensitized T cells, not IgE antibodies. Allergen immunotherapy is not a standard treatment for Type IV contact dermatitis, and there are no approved SLIT or SCIT protocols for acrylate sensitization. Management of acrylic contact allergy relies on allergen avoidance, proper protective equipment guidance, and symptom management during active disease. For nail technicians, occupational medicine involvement is essential. For patients who have acrylate contact allergy alongside IgE-mediated respiratory allergies (hay fever, pet allergy, house dust mite), those IgE-mediated conditions can be addressed with SLIT. Providers like Curex offer at-home SLIT drops starting at $39/month for confirmed IgE-mediated conditions — these address the respiratory allergy component while acrylate avoidance manages the contact allergy.
Patch Test Confirmation
A board-certified dermatologist or contact allergy specialist performs an acrylate patch test panel including 2-HEMA to confirm acrylate sensitization.
Cease Nail Product Exposure
Discontinue gel nail services, acrylic nail applications, and any other uncured acrylate monomer contact. For nail technicians, this typically requires occupational change.
Communicate with Healthcare Providers
Inform your dentist and any physicians performing procedures involving acrylate-containing materials (bone cement, medical adhesives) about your confirmed sensitization.
Barrier Repair and Monitoring
Use emollients daily for skin barrier repair; monitor for cross-reactive reactions to medical devices, dental materials, or other acrylate-containing exposures.
“Complete cessation of uncured acrylate exposure leads to resolution in the majority of patients; sensitization persists but symptoms are controlled through avoidance”
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Living With Acrylic Contact Allergy
Living with acrylic contact allergy requires accepting that gel nail and acrylic nail services are no longer an option — which is a meaningful quality of life change for many patients who valued the cosmetic result. The transition can feel significant, but shellac (soak-off gel with lower monomer content) and regular nail polish do not contain the same reactive monomers and are generally tolerated after cessation of gel/acrylic services. The more significant long-term management challenge is the cross-reactive potential. Once sensitized to acrylates, patients should carry a medical alert card or inform healthcare providers at dental, orthopedic, and cardiology visits about their acrylate allergy, so that acrylate-containing materials can be selected around. Many dental offices have non-acrylate composite alternatives; medical device companies increasingly offer acrylate-free adhesive options for CGM sensors, ECG electrodes, and wound care products. For nail technicians, the career implications are often the hardest part of the diagnosis. Occupational medicine involvement, workers' compensation assessment, and vocational guidance are important resources. Some former nail technicians transition to nail care services that do not involve gel or acrylic application.
Inform All Healthcare Providers
Carry documentation of your acrylate allergy (confirmed allergen list from patch testing) and share it with dentists, orthopedic surgeons, cardiologists, and any provider using medical adhesives. Acrylate-free alternatives exist in most categories but must be requested in advance.
Regular Nail Polish Is Safe
Conventional nail polish and shellac (soak-off gel) do not contain the same reactive monomers responsible for sensitization and are generally tolerated. This allows continued nail cosmetic use without acrylate exposure.
Medical Device Planning
If you use a continuous glucose monitor, cardiac rhythm monitor, or require wound care, contact the device manufacturer about acrylate-free adhesive options before beginning use. This is increasingly available but requires proactive planning.
Document Your Sensitization Profile
Get a copy of your full patch test results including all positive acrylate allergens. This document is essential for dental and medical planning and should be kept in your medical records.
Seasonal Patterns
January - December
medium intensity
Prevention Tips
Use 4H or Silver Shield Gloves (Not Nitrile)
Standard nitrile gloves do not protect against acrylate monomers. Nail technicians must use 4H (Silver Shield) laminate gloves when working with uncured gel or acrylic products. This single change prevents the majority of occupational nail technician sensitizations.
Ensure Complete UV Curing
Incomplete UV curing leaves residual uncured monomer in contact with the nail fold and fingertip skin. Follow manufacturer curing times precisely; LED and UV lamp output should be regularly tested.
Minimize Skin Contact During Application
Technique refinement to avoid gel or liquid monomer contact with the cuticle and nail fold skin is the most effective client-protection measure. Experienced, technically careful application significantly reduces sensitization risk.
Recognize Early Symptoms
Fingertip tingling, burning, or early redness after gel or acrylic services are warning signs that should trigger cessation and dermatologist evaluation before full sensitization develops.
Ventilate Properly
Salon ventilation reduces acrylate vapor exposure for both respiratory health and sensitization prevention. Local exhaust ventilation at the nail table is more effective than general room ventilation.
Prognosis for Acrylic Contact Allergy
The prognosis for acrylic contact allergy depends on how quickly the diagnosis is made and exposure is ceased. Patients who stop acrylate exposure promptly after the first signs of sensitization typically recover well, with active dermatitis resolving within weeks and minimal long-term skin changes. Patients who continue exposure after sensitization — common in nail technicians who do not recognize the occupational origin of their dermatitis — may develop chronic, severe hand eczema with permanent skin thickening, nail changes, and ongoing functional impairment even after eventual cessation. The cross-reactive complications (dental, medical device) persist for life, requiring ongoing communication with healthcare providers. However, with awareness and planning, most sensitized patients can access the dental care and medical devices they need through careful material selection.
Key takeaways
Named ACDS Allergen of the Year 2012, reflecting the nail salon sensitization epidemic with 94% female predominance
The uncured monomer sensitizes — cured acrylic is generally non-allergenic; understanding this distinction guides avoidance correctly
2-HEMA is the key screening allergen (1% petrolatum), added to European Baseline Series in 2019, but NOT in the TRUE Test
Nitrile gloves do not protect against acrylate monomers — 4H or Silver Shield laminate gloves are required
Cross-reactivity with dental materials, bone cements, and medical adhesives requires lifelong provider communication
Acrylate contact allergy has become a genuine epidemic driven by the gel nail industry — nail technicians are told nitrile gloves protect them, but they don't. The cross-reactivity to dental composites and medical adhesives is high-stakes: once I confirm sensitization, I notify the patient's dentist before any procedure.
Frequently Asked Questions
Acrylic allergy is a Type IV delayed hypersensitivity contact dermatitis caused by sensitization to uncured (meth)acrylate monomers. Named ACDS Allergen of the Year 2012, it predominantly affects women through nail cosmetics (gel nails, acrylic nails) and occupational exposure for nail technicians. Fully cured acrylic is generally non-allergenic — the reactive uncured monomer during application causes sensitization. NACDG positivity rates reach 22–72% in populations where nail cosmetics are suspected. Persistent dermatitis around your nails or fingertips after nail services should prompt a dermatologist referral for patch testing.
Once sensitization has occurred, acrylate contact allergy is typically permanent — the immune memory for the allergen persists indefinitely. However, active symptoms (eczema, itching) resolve when exposure stops. Most patients achieve complete symptom control through cessation of gel nail and acrylic nail services. The cross-reactive potential for dental composites, medical adhesives, and orthodontic materials requires ongoing provider communication even after symptoms have resolved. A board-certified dermatologist should confirm the full extent of your sensitization through comprehensive patch testing so you understand which other materials may still pose a cross-reaction risk.
Dried, fully cured acrylic paint contains polymerized acrylic polymer that is generally non-sensitizing. The sensitization risk comes from contact with uncured acrylic monomer, which is present in wet acrylic paint before it dries. Artists working extensively with liquid acrylic paint — particularly with damaged or macerated skin — are at some risk of sensitization, though the sensitization rate from paint use is lower than from nail cosmetics due to different monomer compositions and lower skin contact intensity. If you develop hand or fingertip eczema while working with acrylic paints, dermatologist evaluation and patch testing is appropriate.
2-HEMA (2-hydroxyethyl methacrylate) is a methacrylate monomer widely used in gel nail products, dental composites, and medical adhesives. It is the key screening allergen for acrylate contact allergy, added to the European Baseline Patch Test Series in 2019. A positive 2-HEMA test at 1% petrolatum indicates significant acrylate sensitization with likely cross-reactivity to other acrylate monomers. Importantly, 2-HEMA is not in the TRUE Test, so patients evaluated with only TRUE Test panels may have false-negative results. Always request a full acrylate panel when nail cosmetic exposure is part of your clinical history.
No — this is a critical and often misunderstood safety point. Standard nitrile gloves do not adequately protect against acrylate monomers, which penetrate nitrile within minutes. Nail technicians who wear only nitrile gloves may have a false sense of protection while remaining fully exposed to sensitizing monomers. The appropriate glove material for acrylate protection is 4H (Silver Shield) laminate gloves, which provide significantly better barrier protection against monomer penetration. These laminate gloves are thicker and reduce tactile sensitivity, so proper fit and workflow adaptation are important for professional nail settings.
Yes — this is one of the most important clinical implications of acrylate sensitization. Dental composite resins, bonding agents, denture base materials, and orthodontic adhesives contain methacrylate monomers that cross-react with acrylates in nail products. Sensitized patients can develop contact stomatitis or perioral dermatitis from dental procedures. Inform your dentist about your confirmed acrylate allergy before any restorative procedure so they can consider alternative materials such as glass ionomer cement or ceramic restorations where clinically feasible. Cross-reactivity means nail product sensitization can affect your dental care indefinitely.
Both gel nails and acrylic nails can cause acrylate contact allergy through the same Type IV mechanism. Gel nail products primarily use methacrylate monomers polymerized with UV light; acrylic nail products use liquid methacrylate monomer mixed with polymer powder that polymerizes through chemical initiation. Both contain reactive uncured monomers that cause sensitization before curing is complete. Patients sensitized by one type will typically react to the other due to extensive cross-reactivity within the acrylate family, so switching between gel and acrylic nail services is not a safe management strategy for a sensitized individual.
The nail technician epidemic reflects a combination of factors: high cumulative monomer exposure from daily repeated work with uncured products, persistent use of inadequate protection (nitrile gloves that do not protect against acrylates), poor ventilation in many salons, and limited industry awareness about sensitization risk. The 94% female predominance in NACDG acrylate ACD data reflects both the demographics of the nail salon workforce and clientele. The ACDS named acrylates Allergen of the Year in 2012 specifically to increase clinical and public awareness of this occupational health problem.
Regular nail polish and most shellac (soak-off gel) products do not contain the same reactive methacrylate monomers responsible for sensitization, and they are generally tolerated by acrylate-sensitized individuals. The key distinction is that UV-cured gel nail products and liquid-monomer acrylic systems are off-limits for sensitized patients. Patch testing can confirm the specific acrylates you are sensitized to, which helps determine which nail products — if any — remain safe for you. Consulting a dermatologist before restarting any nail service is strongly advisable rather than attempting to self-test a new product.
Sensitization develops over weeks to months of repeated exposure, and most patients use gel or acrylic nails for months to years before symptoms appear — the initial sensitization phase is clinically silent. Once sensitized, the reaction follows the Type IV delayed pattern: symptoms appear 24–96 hours after exposure. Many patients report that symptoms appeared suddenly after a service they had repeatedly used without any problem, reflecting completion of the sensitization phase on a previous visit. Nail technicians with recurring hand dermatitis should seek patch testing promptly, as continued high-dose monomer exposure deepens and entrenches sensitization.
Medical References
- [1]Warshaw EM, et al. North American Contact Dermatitis Group patch test results: 2019–2020. Dermatitis. 2023;34(1):16–29.
- [2]Gonçalo M, et al. ESSCA results with the European Baseline Series, 2013/14: acrylates/methacrylates. Contact Dermatitis. 2018;78(4):224–229.
- [3]Sasseville D. Acrylates in nail products — ACDS Allergen of the Year 2012. Dermatitis. 2012;23(1):3–7.
- [4]Smedile M, et al. Occupational contact dermatitis from acrylates in nail technicians: a systematic review. Contact Dermatitis. 2021;85(1):10–18.
- [5]Aalto-Korte K, et al. Patch testing with acrylates in Finland 2009–2018. Contact Dermatitis. 2020;83(1):36–43.
- [6]American Contact Dermatitis Society. Allergen of the Year Archive — Acrylates 2012. ACDS.
This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider with questions about a medical condition. Content reviewed by board-certified allergists at Curex.
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