Background. Acrylates constitute an important cause of occupational contact dermatitis. Isobornyl acrylate sensitization has been reported in only 2 cases. We encountered an industrial process operator with occupational contact dermatitis caused by isobornyl acrylate.
Objectives. (i) To investigate whether it is relevant to add isobornyl acrylate to the (meth)acrylate test series. (ii) To report patients with (meth)acrylate contact allergy at an occupational dermatology clinic.
Patients/materials/methods. Our patch test database was screened for positive reactions to (meth)acrylates between 1993 and 2012. A selected group of 14 patients was tested with an isobornyl acrylate dilution series: 0.3%, 0.1%, 0.033%, and 0.01%. Readings were performed on D2, D3, and D7.
Results. One hundred and fifty-one patients were tested with our (meth)acrylate series; 24 had positive reactions. Most positive reactions were to 2-hydroxypropyl acrylate, 2-hydroxyethyl acrylate, 2-hydroxypropyl methacrylate, and diethyleneglycol diacrylate. Hypothetical screening with 2-hydroxypropyl acrylate, ethyleneglycol dimethacrylate, ethoxylated bisphenol A glycol dimethacrylate and trimethylolpropane triacrylate identified 91.7% of the 24 patients. No positive reactions were observed in 14 acrylate-positive patients tested with the isobornyl acrylate dilution series. The 0.3% isobornyl acrylate concentration induced irritant reactions in 3 patients.
Conclusions. We report a rare case of allergic contact dermatitis caused by isobornyl acrylate. However, this study provides insufficient support for isobornyl acrylate to be added to a (meth)acrylate series.
Several disperse dyes (DDs) are still considered to be the most important allergens in textile dermatitis, but there are sparse data about their current use in textiles. The aim of this review was to evaluate published studies and reports on contact allergy to DDs published in PubMed during the last 22 years (1990–2012). Prevalence data are provided by study and by dye, as well as by the described clinical peculiarities of DD dermatitis. We reviewed 54 studies. In total, 26 DDs were tested. The average prevalence in screening studies was >1% for Disperse Blue 106, Disperse Blue 124, and Disperse Orange 3. There is a lack of data on patch testing with Disperse Blue 26, Disperse Blue 102, Disperse Orange 37, Disperse Orange 149, Disperse Yellow 23 and Disperse Yellow 49, which are listed as allergens by the EU commission. It is necessary to check the purity and identity of dyes used for patch testing, confirm the clinical relevance of positive reactions by patch testing with suspected textiles, and, if the results are positive, determine the culprit dye.
]]>Background. Two readings of patch test reactions are recommended.
Objectives. To evaluate the outcome of a second patch test reading of TRUE Test® allergens on D6/7 in relation to negative or doubtful reactions on D3/4.
Methods. This was a retrospective investigation of patch test data from January 1992 to October 2011 from consecutive eczema patients tested with the TRUE Test® panels.
Results. In the period of nearly 20 years, a total of 9997 patients were tested. The total number of positive reactions to the 29 allergens was 6509; 4.4% were positive on D6/7 and negative on D3/4; and 9.1% were positive on D6/7 after a doubtful (?+) reaction on D3/4. Neomycin was the most frequent allergen giving delayed positive reactions (57%), followed by budesonide (42%) and hydrocortisone-17-butyrate (31%).
Conclusion. A total of 4.4% of positive TRUE Test® reactions would be missed, and 9.1% might be missed, if only one reading was performed on D3/4. The results emphasize that many doubtful reactions at D3/4 may develop into positive reactions at a later reading. This may have important implications for evaluation of the clinical relevance of the test result.
Background. Occupational hand eczema is common in hairdressers, owing to excessive exposure to wet work and hairdressing chemicals.
Objectives. To quantify occupational skin exposure and the use of protective gloves among hairdressers in Denmark.
Methods. A register-based study was conducted comprising all graduates from hairdressing vocational schools from 1985 to 2007 (n = 7840). The participants received a self-administered postal questionnaire in May 2009, including questions on hairdressing tasks performed in the past week at work and the extent of glove use. A response rate of 67.9% (n = 5324) was obtained.
Results. Of the respondents, 55.7% still worked as hairdressers, and they formed the basis of this study. Daily wet work was excessive; 86.6% had wet hands for ≥2 hr, and 54% for ≥ 4 hr. Glove use was fairly frequent for full head hair colouring and bleaching procedures (93–97.7%), but less frequent for highlighting/lowlighting procedures (49.7–60.5%) and permanent waving (28.3%). Gloves were rarely worn during hair washing (10%), although this was more frequently the case after hair colouring procedures (48.9%).
Conclusions. Occupational skin exposure was excessive among hairdressers; the extent of wet work and chemical treatments was high, and glove use was inconsistent, especially for certain hair colouring procedures and wet work tasks.
Background. Persulfates have been reported to cause both delayed-type and immediate skin reactions. They may also cause immediate reactions of the mucous membranes of the bronchial system through inhalation, leading to asthma and rhinitis. Anaphylactic reactions caused by contact with persulfates are rare. The mechanism of immediate reactions caused by persulfates is unclear.
Objectives. To report 2 cases with systemic reactions after skin contact with persulfates, and to propose a test protocol for diagnosing immediate reactions caused by persulfates.
Methods. Prick tests with serial dilutions of ammonium and potassium persulfate were performed. Patch tests were also performed with the two agents. Persulfate-specific IgE was detected with two different IgE immunoblotting techniques.
Results. Prick tests were positive with ammonium and potassium persufate, but no specific IgE was detected in the serum. Patch tests showed early positive reactions to both persulfates in 1 patient.
Conclusions. Prick tests and patch tests can be valuable in the testing of patients with a suspicion of an immediate-type reaction caused by persulfates. The mechanism of these reactions remains unclear.
Background. Bromo-3-chloro-5,5-dimethylhydantoin (BCDMH) is a chemical used as a disinfectant for recreational water. BCDMH was described as being responsible for an epidemic of irritant contact dermatitis in the UK (1983), and its sensitizing capacity was also discussed.
Objectives. The aim of this study was to assess whether BCDMH used to disinfect swimming pools and spas can cause allergic contact dermatitis among its users.
Methods. Ten patients suffering from dermatitis associated with using swimming pools disinfected with BCDMH and 40 controls were studied. Several dilutions of BCDMH, 10% to 1 ppm, were patch tested.
Results. All 10 patients studied showed a positive patch test reaction to BCDMH 1% in petrolatum. At least one case showed occupational relevance, with a positive reaction even at 1 ppm.
Conclusion. On the basis of the clinical findings, the positive patch test reactions to BCDMH, and the negative patch test reactions in controls, the suggested diagnosis was allergic contact dermatitis caused by BCDMH used as a disinfectant in the swimming pool water. Contact allergy should be taken into consideration when patients suffer from swimming pool-associated itchy dermatitis.
Background. Chromium-tanned leather footwear, which releases >3 ppm hexavalent Cr(VI), may pose a risk of sensitizing and eliciting allergic dermatitis.
Objectives. To determine the content and potential release of chromium in leather footwear and to discuss the prevention of chromium contact allergy and dermatitis.
Methods. Sixty pairs of leather shoes, sandals and boots (20 children's, 20 men's, and 20 women's) were purchased in Copenhagen and examined with X-ray fluorescence spectroscopy. Chromium was extracted according to the International Standard, ISO 17075. The detection level for Cr(VI) was 3 ppm.
Results. Chromium was identified in 95% of leather footwear products, the median content being 1.7% (range 0–3.3%). No association with store category or footwear category was found. A tendency for there to be a higher chromium content in footwear with high prices was shown (ptrend = 0.001). Cr(VI) was extracted from 44% of 18 footwear products, and, in three items, more than 10 ppm was extracted. One shoe had 62 ppm Cr(VI) extracted. Sandals seemed to be over-represented among footwear with detectable Cr(VI). Cr(III) extraction reached a median value of 152 ppm.
Conclusions. Most leather footwear contained chromium. Cr(VI) was extracted from a high proportion of leather footwear; this poses a risk of sensitization.
Background. The development of mixes containing Compositae plant extracts has improved the diagnosis of Compositae contact allergy, but none of them has fulfilled the criteria for an ideal European plant mix.
Objective. To evaluate which constituents of two commercial Compositae mixes were most useful as screening agents.
Patients. These comprised 76 patients testing positive to Compositae mix 6% in petrolatum and 29 patients testing positive to Compositae mix 5% pet., all of whom were tested with constituents of the respective mixes.
Results. The majority of patients tested positive to parthenolide or parthenolide-containing extracts, followed by German chamomile, yarrow, and arnica. As German chamomile is a weak sensitizer, the results suggest cross-reactions or reactions to unknown allergens. No one was positive to Roman chamomile.
Conclusions. Even though parthenolide seems to be a suitable supplement to the baseline series, the results emphasize that it is important to patch test with extracts of native or locally grown plants, not only because of the geographical variation, but also because of the potential unknown allergens contained in short ether preparations and the variability in the individual patient's exposure and cross-reaction patterns.
Background. Two preparations are currently in use for the diagnosis of allergic contact dermatitis caused by Asteraceae: (i) Sesquiterpene lactone (SL) mix [three pure sesquiterpene lactones (STLs)], whose use has been questioned, owing to an insufficient rate of true-positive results; and (ii) Compositae mix, consisting of five Asteraceae extracts, which is problematic because of lack of standardization and questionable reproducibility.
Objectives. To analyse the reasons for the narrow sensitivity of SL mix from a chemoinformatic point of view, and to propose a solution by rational selection of alternative constituents for a new SL mix II covering a broader cohort of allergic patients.
Materials/methods. Structural and biological information on allergenic STLs was retrieved from databases and the literature, and molecular modelling and chemoinformatic computations were performed.
Results. An explanation for the insufficient hit rate of SL mix is that the three constituents possess extremely similar molecular structures/properties and do not represent well the structural diversity of allergenic STLs. STLs that are known as constituents of Compositae mix plants show much a wider diversity, which explains the higher positive rate.
Conclusions. On the basis of their positions in chemical property space, a new collection of STLs that more evenly cover the overall structural diversity spectrum is proposed. SL mix II is likely to detect a larger number of patients sensitized to Asteraceae.
Background. The warm und humid environment, friction and occlusion within shoes make the feet to a favorable body site to acquire allergic contact dermatitis.
Objectives. To evaluate and compare patch test results in patients with suspected contact allergy of the feet with the results in those with concomitant involvement of the feet/legs, feet/hands, and all others tested (excluding secondary involvement of the feet in ‘others’), with regard to specific patterns of clinical data and patch test results.
Methods. For the present cross-sectional study, data were collected by the 59 participating centres of the Information Network of Departments of Dermatology in Germany, Austria, and Switzerland, including 102 209 patients patch-tested between January 2001 and December 2010.
Results. Allergens that were significantly over-represented in the tested 2671 foot patients included potassium dichromate, colophonium, and p-tert-butylphenol-formaldehyde resin. Among materials brought in by the patients, shoe pieces (27.5%), topical medications/pharmaceutical products (24.4%) and cosmetics (16.8%) played a major role. The final diagnoses of vesicular and hyperkeratotic dermatitis, as well as psoriasis, were significantly more common among foot patients.
Conclusions. Chromium compounds and adhesives were the most common causes of allergic contact dermatitis among our foot patients. Psoriasis should be considered, particularly when the hands are concomitantly affected.
Henna, the dried and powdered leaf of Lawsonia inermis, is widely used as a dye for the skin, hair, and nails, and as an expression of body art, especially in Islamic and Hindu cultures. As it stains the skin reddish-brown, it is also called red henna. Black henna is the combination of red henna with p-phenylenediamine (PPD), and is used for temporary ‘black henna tattoos’. This article provides a full review of the side-effects of topical application of red and black henna, both cutaneous (allergic and non-allergic) and systemic. Red henna appears to be generally safe, with rare instances of contact allergy and type I hypersensitivity reactions. In children with glucose-6-phosphate dehydrogenase deficiency, topical application of henna may cause life-threatening haemolysis. Black henna tattoos will induce contact allergy to its ingredient PPD at an estimated frequency of 2.5%. Once sensitized, the patients may experience allergic contact dermatitis from the use of hair dyes containing PPD. There are often cross-reactions to other hair dyes, dyes used in textiles, local anaesthetics, and rubber chemicals. The sensitization of children to PPD may have important consequences for health and later career prospects. Systemic toxicity of black henna has been reported in certain African countries.
Being a contact allergen of general relevance, p-phenylenediamine (PPD) is patch tested in the baseline series. However, PPD 1% in petrolatum may actively sensitize. Patch testing with PPD at 0.35% pet. proved to be safe, as far as active sensitization is concerned.
To determine whether PPD 0.3% pet. reliably detects PPD sensitization.
Patch testing with PPD 0.3% pet. and 1% pet. synchronously was performed in consecutive patients in a multicentre study within the Information Network of Departments of Dermatology.
Altogether, 2042 patients were patch tested. PPD 1% pet. yielded 6.0% positive reactions (n = 123), and PPD 0.3% pet. yielded 4.7% (n = 95). The synchronous reproducibility of PPD reactions was similar as known from parallel patch tests with identical PPD concentrations. The diagnostic properties of PPD 0.3% pet. expressed as reaction index and positivity ratio were good. Of the 123 patients reacting to PPD 1% pet., 32 (26%) had no positive reaction to PPD 0.3% pet. In 22 of these 32 patients (69%), no clinical relevance could be found.
As patch testing with PPD 0.3% pet. is reliable according to our results, we recommend replacing PPD 1% pet. in the baseline series with PPD 0.3% pet.
p-Phenylenediamine (PPD) is the primary patch test screening agent for hair dye contact allergy, and approximately 100 different hair dye chemicals are allowed.
To examine whether PPD is an optimal screening agent for diagnosing hair dye allergy or whether other clinically important sensitizers exist.
Two thousand nine hundred and thirty-nine consecutive patients in 12 dermatology clinics were patch tested with five hair dyes available from patch test suppliers. Furthermore, 22 frequently used hair dye ingredients not available from patch test suppliers were tested in subgroups of ∼ 500 patients each.
A positive reaction to PPD was found in 4.5% of patients, and 2.8% reacted to toluene-2,5-diamine (PTD), 1.8% to p-aminophenol, 1% to m-aminophenol, and 0.1% to resorcinol; all together, 5.3% (n = 156). Dying hair was the most frequently reported cause of the allergy (55.4%); so-called ‘temporary henna’ tattoos were the cause in 8.5% of the cases. p-Methylaminophenol gave a reaction in 20 patients (2.2%), 3 of them with clinical relevance, and no co-reaction with the above five well-known hair dyes.
Hair dyes are the prime cause of PPD allergy. PPD identifies the majority of positive reactions to PTD, p-aminophenol and m-aminophenol, but not all, which justifies additional testing with hair dye ingredients from the used product.
Simultaneous contact allergies to Disperse Orange 1, 4-nitroaniline and p-aminodiphenylamine (PADPA), as well as to other disperse azo dyes and to p-phenylenediamine (PPD), have been reported. Cross-reactivity is one of the possible explanations for simultaneous reactions between PPD and disperse azo dyes. Some metabolites from the azo reduction of these disperse azo dyes could be sensitizers, as human skin bacteria produce azo reductases.
To investigate the sensitizing capacity of Disperse Orange 1, PADPA and 4-nitroaniline, and the cross-reactivity between these substances and Disperse Yellow 3, its potential metabolites from azo reduction (4-aminoacetanilide and 2-amino-p-cresol), and PPD.
The guinea-pig maximization test was used.
It was found that both Disperse Orange 1 and PADPA are strong sensitizers and cross-react with each other. We were unable to sensitize guinea-pigs with 4-nitroaniline tested in equimolar concentrations to Disperse Orange 1.
The results indicate that patients sensitized primarily to Disperse Orange 1 will also react to PADPA, which can be found mainly in hair dyes. PPD, 4-nitroaniline, 4-aminoacetanilide, 2-amino-p-cresol and Disperse Yellow 3 did not show any cross-reactivity with Disperse Orange 1 or PADPA.
Octylisothiazolinone is a biocide that has been reported as a moderate, but rare contact allergen.
To investigate the occurrence of octylisothiazolinone contact allergy and allergic contact dermatitis diagnosed and registered in the Allergen Bank at Odense University Hospital during the past 20 years. Octylisothiazolinone has been used for targeted testing only.
All octylisothiazolinone-patch test results registered in the Allergen Bank between January 1992 and February 2012 were analyzed.
A total of 20 out of 648 patients patch tested with octylisothiazolinone had positive reactions. The majority of the patients (90%) with relevant sensitizations to octylisothiazolinone had been exposed in occupational settings and most patients were painters.
Octylisothiazolinone is a relevant sensitizer.