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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.)

The allergens causing mango dermatitis have long been suspected to be alk(en)yl catechols and/or alk(en)yl resorcinols on the basis of observed cross-sensitivity reactions to mango in patients known to be sensitive to poison ivy and oak (Toxicodendron spp.). Earlier, we reported the 3 resorcinol derivatives: heptadecadienylresorcinol (I), heptadecenylresorcinol (II) and pentadecylresorcinol (III); collectively named 'mangol', as mango allergens. In this study, we extracted the 1st 2 components (I and II) from the Philippine mango, adjusted them to 0.05% concentration in petrolatum and patch tested the components on 2 subjects with mango dermatitis. Both subjects reacted to I. 1 subject also elicited a weaker positive reaction to II. To investigate the cross-reaction between mangol and urushiol, we also patch tested the same subjects with urushiol. The subject sensitive to II reacted to urushiol. 6 subjects with a history of lacquer contact dermatitis and positive reactions to urushiol were similarly patch tested. 5 persons reacted to I. 2 subjects also exhibited a slower but positive reaction to II. This is the 1st report in which heptadec(adi)enyl resorcinols known to be present in mango have been shown to elicit positive patch test reactions in mango-sensitive patients.

Fibreglass-reinforced plastics (FRP) factory workers are at high risk of developing occupational dermatoses because of their exposure to many chemicals used in the manufacture of plastics as well as to glass fibre or dust. Patch tests were carried out on 29 workers involved in FRP manufacturing processes where unsaturated polyester (UP) resin was used, to investigate the causes of their skin problems. Of the 22 workers who reported experiencing skin problems, 16 showed positive results to at least 1 chemical, including 6 cases of multiple sensitivity. 2 showed positive reactions to UP base resin, 6 to cobalt chloride, 5 to benzoyl peroxide (BPO), 4 to methyl ethyl ketone peroxide (MEKPO), 2 to para-tertiary butyl catechol (PTBC), 1 to styrene and 1 to formaldehyde. After taking into account their exposures and reported causes by questionnaires and their patch test results, 7 cases were diagnosed as allergic contact dermatitis (ACD) due to chemicals, 3 as irritant contact dermatitis (ICD) due to chemicals, and 3 as dermatitis due to mechanical irritation (MI) from glass fibre or dust, as well as 9 as ACD and/or MI. 18 of the total of 29 subjects (62.1%), including 2 workers without a history of skin problems, were sensitized to at least 1 chemical. Cobalt, peroxides, PTBC and UP base resin were the common causes of ACD.

Para-tertiary-butylcatechol (PTBC) has been patch tested in Europe at 1% in petrolatum (pet.) and is now suspected of induction of patch test sensitization. A prospective study was initiated to obtain detailed data on this undesirable risk. A dilution series of PTBC (1%, 0.5%, 0.25%, 0.1% pet.) was used. Patch tests were read on days (D) 1-3, 7, 14 and 21 after application. Patients who were unable to return for late readings were telephoned and asked to report any reaction at the patch test sites. 40 out of 46 patients included completed the study. Patch tests were negative in 35 patients. 4 patients showed a positive patch test at later readings only (D7-D21); 2 patients reacted to a concentration as low as 0.1%. Rechallenge was performed in 2 of these patients, revealing a clearly positive reaction as early as D2 after patch test application. PTBC clearly induced patch test sensitization in 10% of the patients. It cannot be excluded that patch testing with 0.25% PTBC or with even lower concentrations might induce patch test sensitization. The optimal patch test concentration still has to be determined but may be within the range of 0.01% to 0.25% PTBC.

This investigation was conducted to study the relationship between the different intensities of sensitization to urushiol induced by the maximization test method (MT) or by the ear-flank method (EF) in guinea pigs, and hyposensitization induced by repeated oral and/or epicutaneous administration of the allergen, and to compare the immune tolerance achieved between these routes of dosing. During the observation period of 10 weeks, both oral and epicutaneous administration produced hyposensitization to urushiol after weak sensitization by EF; however, only combined administrations via the oral and epicutaneous routes achieved hyposensitization after potent sensitization, while inadequate tolerance was induced by oral dosing and none by epicutaneous dosing. Thus, it is indicated that difficulty in establishing immune tolerance may increase with increasing intensity of primary sensitization, and that hyposensitizing potency tends to increase in the order epicutaneous, oral and combined (e.p.+p.o.) administrations of urushiol.

Para-tertiary-butylcatechol (PTBC) is a rare allergen which is used in the rubber, paint and petroleum industries. We present 9 patients who were sensitized to PTBC and examined at the Finnish Institute of Occupational Health (FIOH) between 1974 and 1995. 3 of the patients had been exposed to PTBC in their work. 2 of them also had allergic reactions to para-tertiary-butylphenol (PTBP)-formaldehyde resin and to PTBP. 5 of the patients became sensitized to PTBC from patch testing. PTBC was found to be one of the most common causes of active sensitization in our clinic. Accordingly, at the FIOH, the patch test concentration of PTBC was lowered to 0.25% and this lower concentration is recommended for general use.

The relative alkylation index (RAI), a theoretically derived parameter intended to quantify the relative extent of carrier haptenation resulting from a given dose of a given sensitizer, has previously been successfully applied to the analysis of relative sensitization potential and dose-response data for a variety of contact allergens which are directly electrophilic. Here the RAI concept is applied to analysis of data on compounds related to urushiol (i.e., 3-substituted catechols), the naturally occurring mixture of allergens responsible for contact allergy to poison ivy and poison oak. These allergens are believed to act as pro-electrophiles, being oxidized to electrophilic orthoquinones in vivo. It is found that the various types of urushiol derivatives fit the same sort of RAI-sensitization relationships as expected theoretically and as found previously with direct acting electrophiles. There is evidence that in many cases, the test conditions were such that overload effects, whereby the degree of sensitization induced decreases with increasing carrier haptenation, applied. It is also concluded that the question as to the relative sensitization potencies of the naturally occurring urushiols remains open. The commonly held view that with these materials, sensitization potential increases with increasing unsaturation in the 3-hydrocarbyl chain of the 3-hydrocarbyl catechols, is based on evidence that is capable of alternative interpretation.

Japanese lacquer is made from the sap of the Japanese lacquer tree (Toxicodendron vernicifluum), a member of the Anacardiacae plant family. Objects painted with this material are described collectively as lacquerware. Both fresh lacquer and lacquerware may evoke allergic contact reactions ascribable to the urushiols contained therein. In this study, we have examined the effects of heating on the ability of lacquerware to elicit an allergic contact reaction. Lacquer films prepared with and without heat treatment were tested on urushiol-sensitive subjects. Patch test reactions were strongest to untreated film and decreased with increasing level of heat treatment. Assays for free urushiol in the lacquer films demonstrated that free urushiol content decreased with increasing heat treatment and that urushiols with saturated and monounsaturated alk(en)yl chains predominated.

8 subjects learning the art of lacquerware were patch tested to urushiol before and after contact with lacquer, in order to document whether hyposensitization to urushiol occurred among Japanese lacquer craftsmen. Simultaneously, we performed patch tests on 2 urushiol-sensitized controls who had no contact with lacquer during the investigation. Lacquer is made from the sap of the Japanese lacquer tree and raw lacquer is composed of 60-65% urushiol and its oligomer. 5 of the 8 subjects showed positive reactions to urushiol 1 month after their first contact. They became negative or less positive after prolonged (9 or 10 months) exposure to lacquer. As reactions to urushiol decreased, dermatitis became less severe. Controls showed consistently high reactions. However, 1 subject showed persistently strong reactions to urushiol. Unlike the other 7 subjects, he was previously sensitized to urushiol before the first contact with lacquer. The remaining 2 subjects showed no reaction throughout our investigation. These results strongly suggest that hyposensitization to urushiol does occur among Japanese lacquer craftsmen.

Case reports are described of individuals who developed acute contact dermatitis after contact with the resin from the Rhus verniciflua (Toxidendron vernicifluum). Potential problems from possible extensive urban planting of this species are discussed.

19 adults were patch tested to urushiol, the allergen in poison ivy/oak, to determine their sensitivity to this allergen after working in a cashew nut shell oil (CNSO) processing plant. The cashew nut tree and poison ivy/oak are in the same botanical family. Anacardiaceae, and they share similar chemicals which cause allergic contact dermatitis. 13 of the 19 workers had a preemployment history of poison ivy sensitivity, with 10 developing CNSO dermatitis. After working in this factory for several months, 9 of the 13 noticed a decreased sensitivity or no sensitivity to poison ivy/oak. When tested to urushiol extract, only 3 reacted positively, 2 minimally. These results imply that hyposensitization to poison ivy/oak occurred in these employees after development of hardening to cashew nut shell oil.