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Introduction: Patch test results may be influenced by age-related factors. However, there is still discordant evidence between age and patch test results., Objectives: We aim to evaluate the patch test results reflecting skin sensitisation, their relevance and association with clinical features by age group., Methods: Prospective multicentric study of all patients patch tested with the Spanish baseline series in participating centres. Age groups were pre-defined as children (0- to 11-years), adolescents (12- to 18-years), young adults (19- to 30-years), middle-aged adults (31- to 65-years) and older adults (≥66-years). Occurrence of sensitisation, relevance and clinical features were compared by age group. Factors associated with skin sensitisation were investigated with multivariate logistic regression., Results: A total of 13 368 patients were patch-tested. Differences in positive patch test results and relevance by age were detected with the highest proportion in middle-aged adults. Age-related trend differences were found for nickel, potassium dichromate, caines, colophony, Myroxylon pereirae resin, 2-hydroxyethyl methacrylate and limonene hydroperoxide. The multivariate logistic analysis (adjusted for sex, atopic dermatitis, body location and occupational dermatitis) showed an association between the age group of 31-65 (OR: 1.41, 95% CI: 1.26-1.58) and above 66-years (OR: 1.15, 95% CI: 1.01-1.32) with a higher proportion of positive results, compared with young adults., Conclusions: Positive patch test results vary according to age, with the highest occurrence in middle-aged adults. Most haptens did not present age-related differences, reinforcing the use of baseline series regardless of age., (© 2024 The Author(s). Contact Dermatitis published by John Wiley & Sons Ltd.)

Background: The textile dye mix (TDM) 6.6% in petrolatum contains Disperse Blue (DB) 35, Disperse Yellow 3, Disperse Orange (DO) 1 and 3, Disperse Red 1 and 17, and DB 106 and 124. The most frequent allergen in TDM-positive patients is DO 3. Around 85% of para-phenylenediamine (PPD)-allergic dermatitis patients have been positive to DO 3. There has been a discussion to exclude DO 3 from TDM 6.6% because of strong simultaneous reactions to TDM and PPD., Objectives: To study if DO 3 can be excluded from TDM 6.6%., Methods: Patch tests were performed on 1481 dermatitis patients with TDM 6.6%, TDM 7.0% (without DO 3 but the other disperse dyes at 1.0% each), DO 3 1.0%, and PPD 1.0% pet., Results: Contact allergy to TDM 6.6% was 3.6% and to TDM 7.0% was 3.0%. All 26 DO 3-positive patients were positive to PPD. The 44 patients positive to TDM 7.0% plus the 13 positive to PPD and TDM 6.6% but negative to TDM 7.0% were 57, outnumbering the 53 positive to TDM 6.6%., Conclusion: TDM 7.0% can replace TDM 6.6% in the Swedish baseline series, since TDM 7.0% together with PPD 1.0% will detect patients with textile dye allergy., (© 2022 The Authors. Contact Dermatitis published by John Wiley & Sons Ltd.)

Background: Several cases of allergic contact dermatitis (ACD) to the glucose sensor FreeStyle Libre have been reported. Isobornyl acrylate (IBOA) and N,N-dimethylacrylamide (DMAA) are known culprit allergens., Objectives: To evaluate patients with suspected ACD to FreeStyle Libre in a standardized manner, present causative allergens, and assess patient-reported implications., Methods: A total of 15 patients with suspected ACD to FreeStyle Libre were patch tested with the Swedish baseline series and a new medical device series. IBOA and DMAA were tested at 0.1% and 0.3% in petrolatum (pet.). Readings were performed on day (D) 3 and D7. Background data, details on skin reactions, and associated implications were assessed using a questionnaire., Results: Thirteen patients were sensitized to IBOA and four to DMAA. Two positive reactions to IBOA and one to DMAA were seen only at 0.3% concentration on D7. Median duration of sensor use before dermatitis onset was 6 months. Half the number of the patients took precautions in everyday life due to sensor-related skin reactions. Six patients discontinued sensor usage., Conclusions: Patients with suspected ACD to glucose sensors should be evaluated with a relevant patch test series containing IBOA and DMAA. Adding the 0.3% pet. concentration is recommended. The reading on D7 is necessary., (© 2020 The Authors. Contact Dermatitis published by John Wiley & Sons Ltd.)

Background: Eyelids are frequent sites of contact dermatitis. No prospective study focused on eyelid allergic contact dermatitis (EACD) has yet been published, and this topic has never been studied in French patients., Objectives: To prospectively evaluate the usefulness of an eyelid series in French patients patch tested because of EACD, and to describe these patients., Methods: We prospectively analysed standardized data for all patients referred to our departments between September 2014 and August 2016 for patch testing for suspected EACD as the main reason. All patients were patch tested with an eyelid series, the European baseline series (EBS), the French additional series, and their personal products. Patch testing with additional series and repeated open application tests (ROATs) or open tests were performed if necessary. A standardized assessment of the relevance was used, and the analysis of the results was focused on patients having positive test results with a current certain relevance., Results: Two-hundred and sixty-four patients (238 women and 26 men) were included. Three-hundred and twenty-two tests gave positive results in 167 patients, 84 of whom had currently relevant reactions: 56 had currently relevant positive test reactions to the EBS, 16 had currently relevant positive test reactions to their personal products, 8 had currently relevant positive test reactions to the French additional series, and 4 had currently relevant positive test reactions to the eyelid series. Sixty-seven per cent of all relevant cases were related to cosmetic products. The most frequent allergens with current relevance were methylisothiazolinone (10.2%), fragrance mix I (3%), nickel (2.7%), hydroxyperoxides of linalool (2.7%) and limonene (2.3%), and Myroxylon pereirae (2.3%). Current atopic dermatitis was found in 9.5% of patients. The duration of dermatitis was shorter (23.2 vs 34.2 months; P = .035) in patients with currently relevant test reactions. The percentage of currently relevant tests remained the same when atopic patients or dermatitis localized only on the eyelids were taken into account., Conclusion: In French patients, testing for EACD with the extended baseline series and personal products, also including ROATs and use tests, appears to be adequate, considering the currently relevant positive test reactions. The regular addition of an eyelid series does not seem to be necessary., (© 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

A pesticide patch test series was tested in 200 subjects, 50 of whom were agricultural workers. Positive reactions to fungicides were found in 24, almost all to thiophthalimides, especially captan, difolatan and folpet. Reactions to bis-dithiocarbamates and benomyl were rare, and to other pesticides not significant.

Patch tests with 24 Compositae species were performed on 81 patients suspected of having a plant dermatitis, of whom 16 had positive reactions to various species. When Compositae were included in the standard series, 10 of 488 consecutive patients (2%) were found to be sensitive to one or more species. Most of the positive test reactions were relevant. Fourteen of 16 sensitivities could have been detected by testing with two mixtures of Compositae. Alantolactone could not serve as a screening agent, since four of seven Compositae-sensitive patients had negative reactions to it. Concomitant reactions to balsams were found in four of 10 patients with unexpected sensitivy to Compositae. The clinical pattern of Compositae dermatitis may be that of a lichenified photo dermatitis. These cases are invariably missed, unless patch tests with Compositae are performed. Another group of patients have hadn eczema and also require patch tests with Compositae for etiological diagnosis. Because positive, relevant reactions are common, inclusion of a safe and reliable Compositae screening test in the standard series is urgently required. At the present stage, however, our test materials are sometimes irritant and they have occassionally caused active sensitization.

Background: Quantitative risk assessment (QRA) for skin sensitization is used to derive safe use levels of sensitising fragrance ingredients in products. Post-marketing surveillance of the prevalence of contact allergy to these ingredients provides relevant data to help evaluate the performance of these measures., Objectives: To determine a suitable patch test concentration for five fragrance materials that had hitherto not been tested on a regular basis. These concentrations are then to be used in a surveillance study with patch testing consecutive patients over an extended monitoring period., Materials and Methods: Furaneol, CAS.3658-77-3; trans-2-hexenal, CAS.6728-26-3; 4,8-dimethyl-4,9-decadienal, CAS.71077-31-1; longifolene, CAS.475-20-7; benzaldehyde, CAS.10052-7, were patch tested with other fragrance allergens in four clinics. Patch testing was conducted in three rounds, starting with the lowest concentrations of the five ingredients. The doses were increased in the subsequent rounds if no late-appearing positive reactions and virtually no irritant reactions were reported., Results: Overall, 373 patients were tested. No positive allergic reaction was reported to the five ingredients. Patch test results of other fragrance allergens are reported., Conclusions: The highest test concentrations are each considered safe for patch testing consecutive patients. Further surveillance based on these preparations will evaluate the hypothesis that QRA-driven consumer product levels of these fragrances can prevent sensitization., (© 2024 The Authors. Contact Dermatitis published by John Wiley & Sons Ltd.)

Background: The baseline series includes common allergens, evolves over time, and differs by location. Our study aims to characterize allergen sensitization trends among the Israeli population during the last two decades, compare our results to American and European registries, as well as to highlight significant allergens in additional series outside the European baseline series (OEBS)., Methods: We analysed patch test results of 2086 patients from a designated contact dermatitis clinic in Tel Aviv between 2019 and 2022, compared them to European and North American registries and to 2156 patch test results conducted in Israel two decades ago., Results: 38.6% of patients had at least one positive reaction to an allergen in the European baseline series (EBS), nickel sulphate (14.6%), fragrance mix I (4.6%), and Methylchloroisothiazolinone methylisothiazolinone (MCI/MI; 3.7%) were the most common among them. N-Isopropyl N-Phenyl-4-Phenylenediamine (NIPPD; 0%), Propolis (0.1%), Sesquiterpene lactone mix (0.1%), and Budesonide (0.1%) elicited a sensitization frequency significantly lower than the proposed threshold for baseline inclusion. Chi-square test revealed a statistically significant decrease (p < 0.05) in the sensitization frequency of fragrance mix I, Formaldehyde, Potassium dichromate, Neomycin sulphate, Myroxylon pereirae, Sesquiterpene lactone, and NIPPD during the last two decades. The overall sensitization frequency to the majority of allergens was lower in our cohort in comparison to the North American and European registries., Conclusions: MCI/MI and 2-hydroxyethyl methacrylate-2 (HEMA) are common, relevant allergens, with high SPIN (significance and prevalence index number) and should be better regulated by the authorities. While among the EBS, NIPPD, Propolis, Sesquiterpene lactone, and Budesonide usually do not elicit a positive reaction and therefore should be reconsidered in baseline series, among the OEBS, Chloramphenicol, Quaternium 15, Propyl gallate, and Amerchol L101 have elicited high SPIN values and should be vigilantly examined in the suitable clinical scenario. Significantly lower sensitization frequency to propolis raises the possibility of a protective effect due to early oral exposure among the Israeli population., (© 2024 The Authors. Contact Dermatitis published by John Wiley & Sons Ltd.)

The sesquiterpene lactones (SLs) are secondary plant metabolites, which are widespread in the Compositae/Asteraceae plant family. The first SLs were detected more than 100 years ago, and allergic contact dermatitis from Compositae has been reported since the beginning of the 1900s, but it was not until the late 1960s and early 1970s that a collaboration between dermatologists, chemists and botanists led to the detection of SLs as the main allergens of Compositae plants. In the 1980s, the SL mix, consisting of equimolar amounts of alantolactone, costunolide and dehydrocostus lactone, was developed as a screening agent for Compositae sensitisation. Today, after inclusion of SL mix in the baseline series, the mean prevalence of reactions in Europe is around 1%, and in North America 0.8%. In countries outside Europe and North America, the prevalence ranges between 0% and 10.7%. The detection rate of SL mix is lower than that of some plant extracts, and ideally, SL mix should be supplemented with a mix of SLs from locally prevalent allergenic plants. The prevalence of positive reactions to SL mix suggests continued baseline testing in most European countries, North America, New Zealand, Australia and probably some Chinese centres., (© 2023 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background: A modulating effect of aluminium regarding type IV reactions might exist but has not been further investigated., Objectives: The aim of this study was to investigate the effect on patch test reactions when adding aluminium chloride hexahydrate (Al-Cl) to common test preparations., Materials and Methods: Al-Cl in different concentrations was added to nickel sulphate 15.0% aqua (Ni), methylisothiazolinone 0.2% aqua (MI) and fragrance mix I 10.0% aqua/ethanol (FM I). The Ni preparations were tested in 120 consecutive patients. MI and FM I were tested in participants known to have contact allergy to the respective allergen. McNemar's test was used to decide which Ni preparation had the highest sensitivity. Wilcoxon signed-rank test was used to calculate pairwise comparison in summarized test score for the preparations with MI and FM I., Results: Adding Al-Cl 20.0%/30.0% to Ni identified twice as many patients with contact allergy to nickel compared to Ni without Al-Cl. Adding Al-Cl 20.0%/10.0% to MI, decreased the patch test reactivity compared to MI without Al-Cl. No differences in patch reactivity were noticed when adding Al-Cl to FM I., Conclusion: Al-Cl 20.0% or 30.0% seems to enhance the patch test reactivity to Ni 15.0% aqua., (© 2023 The Authors. Contact Dermatitis published by John Wiley & Sons Ltd.)

Background: The two dialkylthiocarbamyl benzothiazole sulphides, dimethyl-thiocarbamylbenzothiazole sulphide (DMTBS) and diethylthio-carbamylbenzothiazole sulphide (DETBS) were shown to be good markers of both thiuram and mercaptobenzothiazole sensitivity., Objectives: To investigate if DMTBS and/or DETBS could be better markers of contact allergy to common rubber additives than the ones currently used., Methods: Sixty-eight dermatitis patients were patch tested with DMTBS and DETBS, both at 1% in petrolatum (pet). Because of late reactions in 10 patients, these were retested to DMTBS and DETBS in serial dilutions. Tetramethylthiuram monosulphide (TMTM) 1.0% pet was also tested., Results: At the initial reading Days 3 and 7, no reactions were noted to DMTBS or DETBS. At retesting, 10 of the 68 (15%) patients reacted positively to lower concentrations of DMTBS than the initial test concentration. Seven of 8 also reacted to TMTM. Three of them had positive reactions to DEBTS. All 10 patients had reactions to more diluted solutions to DMBTS than to DEBTS (p = 0.0077; Mc-Nemar test, two-sided)., Conclusions: Results speak for patch test sensitization to DMTBS with cross-reactivity to TMTM and also DEBTS. DMTBS and DEBTS could be new markers of rubber allergy but a safe test concentration must be found., (© 2023 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background: Continual analyses of patch test results with the European baseline series (EBS) serve both contact allergy surveillance and auditing the value of included allergens., Objectives: To present results of current EBS patch testing, obtained in 53 departments in 13 European countries during 2019 and 2020., Methods: Anonymised or pseudonymised individual data and partly aggregated data on demographic/clinical characteristics and patch test rest results with the EBS were prospectively collected and centrally pooled and analysed., Results: In 2019 and 2020, 22 581 patients were patch tested with the EBS. Sensitization to nickel remained most common (19.8 [19.2-20.4]% positivity [95% confidence interval]). Fragrance mix I and Myroxylon pereirae yielded very similar results with 6.80 (6.43-7.19)% and 6.62 (6.25-7.00)% positivity, respectively. Formaldehyde at 2% aq. yielded almost one percentage point more positive reactions than 1% concentration (2.49 [2.16-2.85]% vs. 1.59 [1.33-1.88]); methylchloroisothiazolinone/methylisothiazolinone (MCI/MI) and MI alone up to around 5% positives. Among the new additions, propolis was most commonly positive (3.48 [3.16-3.82]%), followed by 2-hydroxyethyl methacrylate (2.32 [2.0-2.68]%)., Conclusion: Ongoing surveillance on the prevalence of contact sensitization contributes to an up-to-date baseline series containing the most frequent and/or relevant contact sensitizers for routine patch testing in Europe., (© 2022 The Authors. Contact Dermatitis published by John Wiley & Sons Ltd.)

Background: Atopic dermatitis (AD) and allergic contact dermatitis (ACD) are inflammatory skin conditions whose association is not clearly defined., Objectives: To identify differences in ACD profile between patients with and without AD among those referred for patch testing. Additionally, to determine the prevalence of sensitisation to standard Spanish contact allergens in both groups., Methods: We analysed two groups (AD and non-AD) within the Spanish Registry of Research in Contact Dermatitis and Cutaneous Allergy (REIDAC). Contact allergy, clinical relevance and epidemiological data were compared between them., Results: A total of 5055 patients were included. Among them, 23% (1168) had a history or final diagnosis of AD. At least one positive reaction was seen in 468 (40%) of AD patients and 1864 (48%) of non-AD patients. In both groups, the most common positive reactions were to nickel sulphate, methylchloroisothiazolinone/methylisothiazolinone and cobalt chloride. Age-adjusted OR for sensitisation to nickel sulphate was 0.72 (95% CI: 0.61-0.86), indicating a decreased likelihood of sensitisation in AD patients compared to non-AD individuals., Conclusions: We did not find an increased presence of ACD in patients with AD referred for patch testing, exhibiting similar profiles to non-AD population, except for a negative relationship between AD and sensitisation to nickel sulphate., (© 2024 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Introduction: Tert-butylphenol (TBP) derivatives, antioxidants in adhesives and diabetes devices, may provoke allergic contact dermatitis (ACD)., Objectives: The objective of this study is to report sensitization to TBP derivatives in medical devices and to highlight that tert-butylhydroquinone (BHQ) and tert-butylcatechol (TBC) are potential screeners in this regard., Methods: Fifteen patients with ACD from adhesives and diabetes devices were patch tested to different TBPs: BHQ 1% pet., TBC 0.25% pet., BHA 2% pet., BHT 2% pet., 4-tert-butylphenol (TBP) 1% pet. and 2,4-di-tert-butylphenol (di TBP) 1% pet. The culprit devices (medical adhesives, sanitary pads, diabetes devices) and TBP patch preparations were analysed using gas chromatography-mass spectrometry (GC-MS)., Results: BHQ (9/13), TBC (7/13), and to a lesser extent BHT (3/15), BHA (2/15) and TBP (2/13) gave positive reactions. Seven patients had developed ACD from adhesives and diabetes devices, respectively, and one patient from sanitary pads. GC-MS analyses of the medical devices and patch test materials confirmed the presence of the patch-test positive TBPs, or chemically related derivatives, or, interestingly, tert-butylbenzoquinones (BBQ) were found, that is, spontaneously formed, highly reactive TBP metabolites, likely (pseudo-) cross reacting with the patch tested TBPs., Conclusion: TBPs might be overlooked sensitizers in medical devices, and BHQ and TBC are potential screeners in this regard., (© 2024 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background: Budesonide and tixocortol pivalate as markers of contact allergy to corticosteroids have been questioned, as they are not able to detect a significant percentage of allergic patients., Objectives: To investigate the potential role of clobetasol propionate in enhancing corticosteroid sensitisation detection., Methods: Between January 2022 and December 2023, patients who attended centres involved in the Spanish Registry of Research in Contact Dermatitis and Cutaneous Allergy were tested with an extended baseline series that included budesonide, tixocortol pivalate, clobetasol propionate 0.1% in ethanol and 1% in petrolatum., Results: A total of 4338 patients were tested. Twenty-four patients were allergic to budesonide (0.55%, 95% CI: 0.37-0.82); nine patients were allergic to tixocortol pivalate (0.21%, 95% CI: 0.11-0.39); and 23 patients were allergic to clobetasol (0.53%, 95% CI: 0.35-0.79). Only four of those patients allergic to clobetasol were detected by budesonide and one by tixocortol pivalate. No significant differences in the number of positive tests were found between clobetasol in petrolatum or ethanol., Conclusions: In Spain budesonide remains the main corticosteroid allergy marker whereas the role of tixocortol pivalate is questionable. The addition of clobetasol propionate to the Spanish baseline series would improve the ability to detect patients allergic to corticosteroids., (© 2024 The Author(s). Contact Dermatitis published by John Wiley & Sons Ltd.)

Background: In 2019, a number of allergens (haptens), henceforth, "the audit allergens," were considered as potential additions to the European Baseline Series (EBS), namely, sodium metabisulfite, 2-bromo-2-nitropropane-1,3-diol, diazolidinyl urea, imidazolidinyl urea, Compositae mix II (2.5% or 5% pet), linalool hydroperoxides (lin-OOH), limonene hydroperoxides (lim-OOH), benzisothiazolinone (BIT), octylisothiazolinone (OIT), decyl glucoside, and lauryl glucoside; Evernia furfuracea (tree moss), was additionally tested by some departments as well., Objectives: To collect further data on patch test reactivity and clinical relevance of the audit allergens in consecutive patients across Europe., Methods: Patch test data covering the audit allergens in 2019 and 2020 were collected by those departments of the European Surveillance System on Contact Allergies testing these, as well as further collaborators from the EBS working group of the European Society of Contact Dermatitis (ESCD), and the Spanish Grupo Español de Investigación en Dermatitis de Contacto y Alergia Cutánea. As patch test outcome, reactions between day (D) 3 and D5 were considered., Results: Altogether n = 12 403 patients were tested with any of the audit allergen. Positive reactions were most common to lin-OOH 1% pet. (8.74% [95%CI: 8.14-9.37%]), followed by lin-OOH 0.5% pet., and lim-OOH 0.3% pet (5.41% [95% CI: 4.95-5.89%]). Beyond these terpene hydroperoxides, BIT 0.1% pet. was the second most common allergen with 4.72% (95% CI: 4.2-5.28%), followed by sodium metabisulfite 1% pet. (3.75% [95%CI: 3.32-4.23%]) and Compositae mix 5% pet. (2.31% [95% CI: 1.84-2.87%]). For some allergens, clinical relevance was frequently difficult to ascertain., Conclusions: Despite many positive patch test reactions, it remains controversial whether lin- and lim-OOH should be tested routinely, while at least the two preservatives BIT and sodium metabisulfite appear suitable. The present results are a basis for further discussion and ultimately decision on their implementation into routine testing among the ESCD members., (© 2022 The Authors. Contact Dermatitis published by John Wiley & Sons Ltd.)

Background: Contact allergy to oxidized (ox.) linalool and ox. limonene has been reported to have a high prevalence, raising the question of inclusion into the baseline series. However, several important issues should be clarified and further investigated before inclusion can be warranted., Objectives: To report the trends of ox. terpenes allergy in patients with dermatitis, features of the patch test reactions, and clinical characteristics of the patients., Methods: A retrospective analysis of 5773 patients was performed. All patients were patch tested with baseline series, individual ingredients of fragrance mix I and II, ox. linalool, and ox. limonene from 2013 to 2020., Results: The prevalence rates of contact allergy to ox. linalool and ox. limonene were 7.0% and 5.1%, respectively. Significantly increasing trends of contact allergy were observed. More than 95% of contact allergy cases were identified on Day 3/4. Patients with contact allergy to ox. linalool and ox. limonene were significantly younger than those with contact allergy to other fragrances and were predominantly female. Strong reactions were associated with older age and multiple fragrance allergies., Conclusions: Contact allergy to ox. linalool and ox. limonene is becoming increasingly important, and findings show intriguing features. More studies concerning the clinical relevance before recommending these substances for screening are required., (© 2021 The Authors. Contact Dermatitis published by John Wiley & Sons Ltd.)

Background: Contact allergy to fragrance mix I (FM I) is over-represented in patients photoallergic to ketoprofen. The prevalence of contact allergy to two components of FM I, cinnamal and cinnamyl alcohol, in ketoprofen-photoallergic patients is higher than in dermatitis patients., Objective: To explore the prevalence of contact allergy to FM I and its individual components in patients with photocontact allergy to ketoprofen, and to compare with a dermatitis and the general population., Methods: Data on patch and photopatch tests performed between 2009-2018 were collected. Ketoprofen-photoallergic patients were compared with dermatitis patients and published data on the general population regarding the prevalence and the distribution of contact allergy to FM I and its components., Results: A higher prevalence of contact allergy to cinnamyl alcohol compared with cinnamal (23.3% vs 10.0%), and eugenol compared with isoeugenol (23.3% vs 6.7%), was observed in ketoprofen-photoallergic patients, while the relationship was the opposite in the dermatitis group (0.7% vs 1.05%; 0.4% vs 0.9%). The overall prevalence of contact allergy to several components of FM I was significantly higher in ketoprofen-photoallergic patients., Conclusions: Contact allergy to FM I and many of its components is over-represented in patients photoallergic to ketoprofen compared with dermatitis patients and the general population., (© 2021 The Authors. Contact Dermatitis published by John Wiley & Sons Ltd.)

Objective: Photoallergic reactions due to topical ketoprofen are common. As some simultaneous contact allergies have been described in the literature, we aimed to get an overview of the pattern of reactivity towards common allergens in the baseline series in ketoprofen-photoallergic individuals., Methods: Using our database, we found 94 patients with photocontact allergy to ketoprofen diagnosed during 1999-2018. Approximately 12 800 patients patch tested with the baseline series during the same time frame served as controls. Data on patch testing with the baseline series of 518 individuals belonging to the general population were obtained from an earlier study, and a comparison of allergy rates was made with the ketoprofen group., Results: Contact allergy to fragrance mix I and Myroxylon pereirae was overrepresented among patients with photocontact allergy to ketoprofen (42.3% vs. 6.6% and 47.9% vs. 6.6%, p < 0.001, respectively). Significant overrepresentation was also shown for 4-tert-butylphenolformaldehyde resin (PTBP-F-R), phenol formaldehyde resin (PFR-2), black rubber mix, budesonide (all p < 0.001), and fragrance mix II (p = 0.02). The pattern was similar, but with lower significance levels for fragrance mix II and budesonide, regardless of whether or not the individuals had been photopatch tested because of a suspected photoallergic contact dermatitis from ketoprofen., Conclusion: Contact allergy to fragrance mix I, Myroxylon pereirae, black rubber mix, PFR-2, PTBP-FR, and to a somewhat lower extent, to fragrance mix II and budesonide, is common in individuals photoallergic to ketoprofen. It remains to be seen whether sensitisation to ketoprofen leads to simultaneous sensitisation to a number of other, chemically non-related, substances., (© 2024 The Author(s). Contact Dermatitis published by John Wiley & Sons Ltd.)

Background: The number of commercially available plant allergens/extracts is limited and therefore patch testing with fresh/dried plant material may be a necessary supplement in diagnosing plant allergy., Objectives: To evaluate the usefulness of patch testing with plants "as is" compared to patch testing with commercial and in-house produced plant test materials and to report on species eliciting positive patch test reactions., Patients/materials/methods: Consecutive eczema patients, who were patch tested between January 2019 and December 2023 and who had at least one positive reaction to a plant allergen and/or extract and/or plant "as is" were included in the study., Results: A total 57 out of 1893 patients tested (3%) were sensitised to plants. Compositae plants were the most frequent sensitizers, followed by tomato, tulipalin A, falcarinol, and Philodendron plants. In 12 patients (21%), the diagnosis was based on patch testing with fresh plants only. Occupational sensitization occurred in 32%. Other sensitizers included Hydrangea, Pelargonium zonale, and Monstera., Conclusions: A large minority of plant-sensitised patients would have been undiagnosed without patch testing with plants "as is." Most of the culprit plants were known sensitizers, but not commercially available, and these and new species taken into cultivation makes patch testing with fresh plants unavoidable and worthwhile., (© 2024 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background: Regulatory actions significantly reduced methyldibromo glutaronitrile (MDBGN)-induced allergic contact dermatitis (ACD) from cosmetics in Europe. Turkey banned MDBGN in 2015., Objectives: To assess sensitization and ACD rates to MDBGN before and after its ban in Turkey., Methods: Data from 2653 consecutively patch tested patients between 1996 and 2023 with MDBGN 0.1% pet. (n = 573) or 0.2%-0.3% pet. (n = 1310) or 0.5% pet. (n = 770) were analysed. MDBGN was tested as MDBGN/phenoxyethanol (PE) in 1434 patients., Results: The sensitization prevalence was 1.7% (45/2653), peaking at 5.3% in 2018 and 2023 with MDBGN 0.3% pet. There was a two-fold male predominance, with patients exclusively ≥20 years old. None of the patients reacted to PE. ACD occurred in 0.7% (19/2653), mainly affecting hands and linked to non-occupational exposure (78.9%), particularly from rinse-off/leave-on cosmetics. The pattern of 'middle-aged men with hand eczema and fragrance allergy' was particularly notable. Occupational ACD was rare (21.1%), occurring mainly in hairdressers from hair gel. Positive reactions with current clinical relevance dropped from 48.3% (1996-2014) to zero after 2015 (p < 0.001)., Conclusions: The ban effectively reduced MDBGN-induced ACD in Turkey, yet the prevalence of positive patch test reactions remains high, likely due to past exposures or other undisclosed sources. We suggest continued testing of MDBGN in the EBS in Turkey., (© 2024 The Author(s). Contact Dermatitis published by John Wiley & Sons Ltd.)

Background: A considerable share of patients tested with a baseline patch test series respond with a positive reaction to more than one allergen, and some associations between synchronous positive reactions to distinct baseline patch allergens have been described in the literature., Objectives: To evaluate the prevalence of sensitization to haptens of the European baseline series as well as the prevalence of oligosensitization and polysensitization and the most significant associated positive patch test reactions in Slovenia., Methods: Patch testing data collected by the Slovenian E-Surveillance System from January 2008 to December 2017 were retrospectively analysed., Results: Of a total of 15 171 patients analysed, 39.29% showed at least one positive reaction. The highest prevalences were noted for metals (nickel[II]sulfate hexahydrate: 16.33%) and fragrances (fragrance mix I: 6.70%). The correlation analysis showed the strongest correlation between mercapto mix and 2-mercaptobenzothiazole (61.2%), fragrance Mix II and hydroxyisohexyl 3-cyclohexene carboxaldehyde (50.5%), and potassium dichromate and cobalt(II) chloride hexahydrate (33.3%)., Conclusions: Sensitization prevalences to the most common haptens were described, and their strongest correlations on a national level quantified. A comparison with other European results confirms already known associations between allergens in terms of cross-reactivity., (© 2020 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Existing criteria for inclusion in the European baseline series are summarized. Additional criteria are developed to aid decision making where the current criteria do not yield an unequivocal result. These include a consideration of whether an allergen (hapten) is better placed in a special series and the frequency with which an allergen cross-reacts with existing markers in the baseline series., (© 2021 John Wiley & Sons A/S . Published by John Wiley & Sons Ltd.)

Background: Clinical surveillance of the prevalence of contact allergy in consecutively patch tested patients is a proven instrument to continually assess the importance of contact allergens (haptens) assembled in a baseline series., Objectives: To present current results from the European Surveillance System on Contact Allergies, including 13 countries represented by 1 to 11 departments., Methods: Anonymized or pseudonymized patch test and clinical data from various data capture systems used locally or nationally as transferred to the Erlangen data centre were pooled and descriptively analysed after quality control., Results: In the 4 years (2015-2018), data from 51 914 patients patch tested with the European baseline series (EBS) of contact allergens were analysed. Contact allergy to nickel was most frequent (17.6% positive), followed by contact allergy to fragrance mix I (6.9%), methylisothiazolinone (MI; 6.2%), and Myroxylon pereirae resin (balsam of Peru; 5.8%)., Conclusions: While the prevalence of MI contact allergy decreased substantially following regulatory intervention, the persistently high levels of allergy to metals, fragrances, other preservatives, and rubber chemicals point to problems needing further research and, potentially, preventive efforts. Results with national additions to the baseline series provide important information on substances possibly to be considered for inclusion in the EBS., (© 2020 The Authors. Contact Dermatitis published by John Wiley & Sons Ltd.)

Background: Methylchloroisothiazolinone/methylisothiazolinone (MCI/MI) and MI allergy caused a global epidemic during the period 2010 to 2015, reaching its peak in 2013/14., Objective: To investigate the characteristics of MCI/MI and MI allergy in Turkey over 24 years., Methods: A total of 2310 patients patch tested between 1996 and 2019 with MCI/MI 0.01% aq. or MCI/MI 0.02% aq., with or without MI 0.2% aq., were analyzed., Results: The overall prevalence of contact sensitization was 3.3% (n = 77) with a peak level of 16.4% in 2015. The prevalence gradually decreased thereafter, but was still high (6.5%) in 2019. Seventy-three patients had clinically relevant sensitizations. MI could detect clinically relevant sensitizations in all seven patients with a negative patch test reaction to MCI/MI 0.02%. Non-occupational allergic contact dermatitis (ACD) was most frequently seen, mainly in women, with hand/face eczema from rinse-off or leave-on cosmetics, such as wet wipes. Occupational ACD was mainly seen among men with airborne eczema from wall paints in house painters, or with hand eczema from hair gel/wax in men's barbers., Conclusions: The prevalence of MCI/MI and MI sensitization in Turkey following the peak in 2015 is still high. This is probably due to the currently allowed level of 100 ppm for MI in rinse-off cosmetics. This needs to be urgently reduced., (© 2020 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background: Allergic contact dermatitis (ACD) has been reported as an adverse effect from the use of several glucose sensors and insulin pumps from different manufacturers. Isobornyl acrylate (IBOA) has been identified as a major culprit sensitizer, but also other acrylates and (modified) colophonium have been reported as causes of ACD., Objectives: To report the two first cases diagnosed with ACD caused by the Dexcom G7 (DG7) glucose sensor., Patients and Methods: Two children with suspected ACD from DG7 were patch tested with our medical device series with an addition of selected test preparations including two variants of modified colophonium - methyl hydrogenated rosinate (MHR) and glyceryl hydrogenated rosinate (GHR). Both patients were also tested with acetone extracts made from different parts of the DG7 sensor. The extracts were analysed by gas chromatography-mass spectrometry (GC-MS)., Results: Both patients tested positive to IBOA, hydroabietyl alcohol and GHR. In addition, patient 1 had a positive reaction to MHR and patient 2 had a positive reaction to colophonium. The GC-MS analyses showed the presence of IBOA and colophonium-related substances in the DG7 extracts., Conclusions: Both patients were diagnosed with contact allergy to well-known medical device-related sensitizers. The presence of IBOA and (modified) colophonium in a newly introduced (on the Swedish market in 2023) glucose sensor is remarkable and indicates an inadequate toxicological assessment of the materials used in the sensor., (© 2024 The Authors. Contact Dermatitis published by John Wiley & Sons Ltd.)

Background: Many people live with ostomies after life-saving surgery. Ostomy patients often suffer from peristomal dermatitis. Allergic contact dermatitis (ACD) has been reported, mostly due to contact allergy (CA) to topical agents., Objectives: We present three patients with therapy resistant peristomal dermatitis, suggesting ACD caused by different stoma products., Methods: Patch testing was performed with baseline series, additional series, and selected allergens. They were also tested with their own ostomy products as is and separate extracts of the products. Extracts were analysed using Gas Chromatography-Mass Spectrometry (GC-MS)., Results: In all three patients we diagnosed CA to 1,6-hexanediol diacrylate (HDDA), +++ in case (C) 1 and 3, ++ in C 2. HDDA was detected in C 2's ostomy pouch adhesive and in C 1's and 3's flange extenders used to improve the adhesion of the ostomy pouches., Conclusion: Therapy resistant peristomal dermatitis should always be suspected of ACD and patch testing, especially with the patient's own products, should be performed., (© 2024 The Authors. Contact Dermatitis published by John Wiley & Sons Ltd.)

Background: Current frequency and features for positivity to textile dye mix (TDM) in Spain are unknown., Objectives: To study the frequency, clinical features and simultaneous positivity between TDM, para-phenylenediamine (PPD) and specific disperse dyes., Materials and Methods: We analysed all consecutive patients patch-tested with TDM from the Spanish Contact Dermatitis Registry (REIDAC), from 1 January 2019 to 31 December 2022. Within this group, we studied all selected patients patch-tested with a textile dye series., Results: Out of 6128 patients analysed, 3.3% were positive to the TDM and in 34% of them, the sensitization was considered currently relevant. TDM positivity was associated with working as a hairdresser/beautician and scalp, neck/trunk and arm/forearm dermatitis. From TDM-positive patients, 57% were positive to PPD. One hundred and sixty-four patients were patch-tested with the textile dye series. Disperse Orange 3 was the most frequent positive dye (16%). One of every six cases positive to any dye from the textile dye series would have been missed if patch-tested with the TDM alone., Conclusions: Positivity to TDM is common in Spain and often associated with PPD sensitization. TDM is a valuable marker of disperse dyes allergy that should be part of the Spanish and European standard series., (© 2024 The Authors. Contact Dermatitis published by John Wiley & Sons Ltd.)

Background: 2-Hydroxyethyl methacrylate (HEMA) was added to the European baseline series (EBS) in 2019. Few recent data are available on the frequency and relevance of positive reactions to this hapten., Objectives: To investigate the frequency and relevance of positive patch tests to HEMA in the EBS in a university hospital in Amsterdam, The Netherlands., Patients and Methods: Retrospective study in patients with positive patch tests to HEMA investigated between June 2019 and August 2023., Results: Of 2927 consecutive patients, 88 (79 women and 9 men; 3.0%) had a positive reaction to HEMA. The prevalence in women was 3.9%, in men 1.0%. Forty-three (49%) reactions were judged to be of current clinical relevance and 21 (24%) of past relevance. In this group of 64 patients with relevant reactions, 18 (28%) had occupational contact with (meth)acrylate-containing products, of who 11 (61%) were nail stylists. In 46 patients with non-occupational allergic contact dermatitis, 31 (67%) had allergic reactions to nail cosmetics. Glues and glue-containing products accounted for 22% of the materials causing allergic contact dermatitis and dental products for 8%., Conclusions: Allergic reactions to HEMA are very frequent in women investigated in Amsterdam. Nearly two thirds of cases were caused by nail cosmetics., (© 2023 The Authors. Contact Dermatitis published by John Wiley & Sons Ltd.)

Background: A global epidemic of allergic contact dermatitis to (meth)acrylates has been described in relation to the widespread use of manicure products., Objectives: To evaluate the frequency of sensitization to 2-hydroxyethyl methacrylate (2-HEMA) among consecutively patch tested patients with eczema in Spain; the percentage of current relevance; the MOAHLFA index; and, the potential sources of exposure to (meth)acrylates., Methods: From January 2019 to December 2022, 2-HEMA 2% pet. was prospectively patch tested in 24 REIDAC (Spanish Allergic Contact Dermatitis Registry) centres., Results: Six thousand one hundred thirty-four patients were consecutively patch tested with 2-HEMA 2% pet. 265/6134 (4.3%) were positive. Positive reactions of current relevance were identified to involve 184/265 (69%). The efficiency (number of patch tests needed to detect relevant positive patch test reactions) was 34 (6134/184). The variable 'occupational' was found to be significantly associated with a higher risk for relevant positive reactions to 2-HEMA (OR: 10.9; 95% CI: 8.1-14.9)., Conclusion: (Meth)acrylate sensitization is a prevalent health issue in Spain. 2-HEMA 2% pet. has been identified to be a highly effective (meth)acrylate allergy marker in the GEIDAC baseline series. The responsible authorities should implement policies guaranteeing accurate labelling of industrial, medical, and consumer materials while ensuring the enforcement of said labelling through appropriate legal means., (© 2024 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background: Eyelid dermatitis is a frequent reason of dermatological consultation. Its aetiology is not univocal, being contact dermatitis, both allergic and irritant, the most frequent. The primary sources of allergen exposure include cosmetics, metals, and topical medications, from direct, indirect, or airborne contact., Objectives: To define the frequency of positive patch test reactions to SIDAPA baseline series allergens, to document positive allergens, and to precise the final diagnosis in patients with eyelid involvement., Methods: A total of 8557 consecutive patients from 12 Italian Dermatology Clinics underwent patch testing with SIDAPA baseline series in 2018 and 2019. Patients were divided into two groups: (i) with eyelid involvement with or without other involved sites (E-Group) and (ii) without eyelid involvement (NE-Group). The final diagnosis and the frequency of positive relevant patch test reactions were evaluated., Results: E-Group consisted of 688 patients (females 78.6%, mean age 45.3 years), 8.0% of 8557 consecutively patch-tested patients. The final diagnosis in E-Group was ADC in 42.4%, ICD in 34.2%, and AD in 30.5%. The highest reaction rates were elicited by nickel sulphate and methylchloroisothiazolinone/methylisothiazolinone in both E-Group and NE-Group, even if these allergens were significantly more frequently positive in NE-Group patients than in E-Group ones. Positive patch test reactions to fragrance Mix II, dimethylaminopropylamine, and sorbitan sesquiolate were significantly more frequent in E-Group patients than in NE-Group ones., Conclusions: Eyelid dermatitis is a frequent dermatological complaint. Allergic contact dermatitis is the most frequent diagnosis commonly caused by nickel sulphate, isothiazolinones, and fragrances. The surfactants dimethylaminopropylamine and sorbitan sesquioleate are emerging causes of eyelid allergic contact dermatitis., (© 2024 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)