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BACKGROUND: Nickel-induced proliferation or cytokine release by peripheral blood mononuclear cells may be used for in vitro diagnosis of nickel allergy.OBJECTIVES: Aim of this study was to explore the nickel-specific cytokine profile to further elucidate the pathogenesis of nickel allergic contact dermatitis (ACD) and to identify potential new biomarkers for nickel ACD.METHODS: Peripheral blood mononuclear cells from patients and controls were cultured with T-cell skewing cytokine cocktails and/or nickel. Cytokine and chemokine concentrations were assessed in culture supernatants using validated multiplex assays. Specific cytokine production was related to history of nickel allergy and patch-test results.RESULTS: Twenty-one of the 33 analytes included in the analysis were associated with nickel allergy and included type1 (TNF-α, IFN-γ, TNF-β), type 2 (IL-3, IL-4, IL-5, IL-13), type 1/2 (IL-2, IL-10), type 9 (IL-9), type 17/1 (IL-17A[F], GM-CSF, IL-21) and type 22 (IL-22) derived cytokines as well as the T-cell/antigen presentation cell derived factors Thymus and activation regulated chemokine (TARC), IL-27 and IP-10. Receiver operator characteristics (ROC) analysis showed that IL-5 was the strongest biomarker for nickel allergy.CONCLUSIONS: A broad spectrum of 33 cytokines and chemokines is involved in the allergen-specific immune response in nickel allergic patients. IL-5 remains, next to the lymphocyte proliferation test, the strongest biomarker for nickel allergy.

ispartof: CONTACT DERMATITIS vol:87 issue:5 pages:468-471 ispartof: location:England status: published

An aqueous antiseptic containing "chlorhexidine digluconate/benzalkonium chloride/benzyl alcohol" (CBB) is widely used in France. The only previous documented study dealing with allergic contact dermatitis (ACD) to this antiseptic is one small case series in children. The French Vigilance Network for Dermatology and Allergy (REVIDAL-GERDA) has collected many cases in the last few years.To evaluate the clinical and sensitization profiles of patients diagnosed with ACD to CBB.We performed a retrospective study of patients with contact dermatitis to CBB and positive tests to CBB and/or at least one of its components. All patients had to be tested with all components of CBB.A total of 102 patients (71 adults and 31 children) were included. The lesions were extensive in 63% of patients and 55% had delayed time to diagnosis. CBB patch tests were positive in 93.8% of cases. The allergen was identified in 97% of patients, mainly benzyl alcohol in adults (81.7%) and chlorhexidine digluconate in children (54.8%). About 32.4% of the patients were sensitized to several components.CBB is a cause of ACD at all ages. The components of the antiseptic should be tested. The sensitization profile seems to be different between adults and children.

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. (Less)

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 to cinnamal (23.3% vs 10.0%), and eugenol compared to isoeugenol (23.3% vs 6.7%), was observed in ketoprofen-photoallergic patients, while the relationship was the opposite in dermatitis group (0.7% vs 1.05%; 0.4% vs 0.9%). 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 to dermatitis patients and the general population. This article is protected by copyright. All rights reserved. (Less)

Background Limited data exists on occupational allergic contact dermatitis (OACD) in Turkey. Objectives To investigate the epidemiologic profile of OACD in Turkey. Methods A retrospective cohort study on 294 patients with OACD among 2801 consecutively patch-tested patients in the allergy unit of the dermatology department of Istanbul Faculty of Medicine between 1996-2019. Results The overall prevalence of OACD was 10.5%, showing a male predominance. OACD was most frequently seen in construction workers (45.2%), followed by hairdressers, metalworkers, healthcare workers, and miscellaneous. The main relevant allergens were chromium in cement, thiurams in rubber gloves, hairdressing chemicals, resins/glues/plastics, metals, isothiazolinones, and fragrances. Hands were the mainly involved site (95.6%). Airborne eczema was observed in 21.4%. Hand&foot eczema and co-sensitizations to chrome&thiuram and chrome&cobalt were significantly associated with being a construction worker. Sensitizations to isothiazolinones in house painters, ammonium persulfate and p-phenylenediamine in hairdressers, and colophonium increased after 2010. Conclusion These were the largest data on OACD from Turkey, reflecting the importance of rubber glove allergy in all occupations and the striking increase in ammonium persulfate allergy among hairdressers. Chrome and cobalt were still the main cement allergens in Turkey, where the cement directive is not yet in force. This article is protected by copyright. All rights reserved.

Background Irritant contact dermatitis (ICD) is caused by the acute locally toxic effect of a strong irritant, or the cumulative exposure to various weaker physical and/or chemical irritants. Objectives To describe characteristics of patients with ICD in the population patch tested in the European Surveillance System on Contact Allergies (ESSCA; www.essca-dc.org) database. Methods Data collected by the ESSCA in consecutively patch tested patients from January 2009 to December 2018 were analyzed. Results Of the 68 072 patients, 8702 patients were diagnosed with ICD (without concomitant allergic contact dermatitis [ACD]). Hand and face were the most reported anatomical sites, and 45.7% of the ICD was occupational ICD (OICD). The highest proportions of OICD were found in metal turners, bakers, pastry-cooks and confectionery makers. Among patients diagnosed with ICD, 45% were found sensitized with no relevance for the current disease. Conclusions The hands were mainly involved in OICD also in the subgroup of contact dermatitis patients, in whom relevant contact sensitization had been ruled out, emphasizing the need for limiting irritant exposures. However, in difficult to treat contact dermatitis, unrecognized contact allergy, or unrecognized clinical relevance of identified allergies owing to incomplete or wrong product ingredient information must always be considered. This article is protected by copyright. All rights reserved.

BACKGROUND In March 2014, the European Commission issued a new regulation restricting the content of hexavalent chromium (Cr) in leather to no more than 3 mg/kg. We previously performed a questionnaire study in January 2014 to characterize our patients with Cr contact allergy prior to regulatory intervention. OBJECTIVES To assess whether clinical characteristics, self-reported sources of Cr exposure, and burden of disease changed in patients with Cr allergy over time. METHODS A questionnaire study was performed among 172 adult dermatitis patients with Cr allergy and 587 age- and sex-matched dermatitis patients without Cr allergy. A questionnaire was sent to all dermatitis patients patch tested from 2003 to 2018 in August 2019. RESULTS The overall response rate was 61.2% (759/1241). Patients with Cr allergy were still more commonly affected by current foot dermatitis (odds ratio [OR] 3.82, 95% confidence interval [CI] 2.07-7.08) and hand dermatitis (OR 1.98, 95% CI 1.13-3.49) compared with controls diagnosed during 2013 to 2018. The proportion of patients with Cr allergy reporting dermatitis caused by leather exposure did not change during 2003 to 2012 vs 2013 to 2018 (71.0% vs 66.2%, P = .5). Furthermore, estimates on occupational performance and disease severity (eg, current dermatitis), number of anatomical locations with dermatitis, worst-case dermatitis, and effect on work were similar in patients with Cr allergy for 2003 to 2012 vs 2013 to 2018. CONCLUSION No immediate sign of improvement was found in patients with Cr allergy concerning severity of disease and dermatitis from leather exposures 5 years after adoption of the regulation against hexavalent Cr in leather. The regulation may have to be revised for better protection of those already sensitized.

Background Formaldehyde is an important contact sensitizer. Formaldehyde releasing substances induce positive reactions in formaldehyde-allergic patients, but there are also reactions independent of formaldehyde allergy. In an earlier study, stronger formaldehyde reactions led to more positive reactions to quaternium-15. Objectives To analyze patterns of positive patch test reactions to formaldehyde and different formaldehyde releasers. Methods Patch test files of 1497 patients investigated during the period November 2007-August 2020 were retrospectively reviewed for positive reactions to formaldehyde and its releasers. During the study period, almost all (≥99.3%) patients were tested with a formaldehyde dilution series and six formaldehyde releasers. Results Ninety-three patients tested positive to formaldehyde; 80% of these had positive reactions to at least one formaldehyde releaser, most often benzylhemiformal. There were only nine independent contact allergies to formaldehyde releasers. There were only two reactions to 2-bromo-2-nitropropane-1,3-diol and they occurred in formaldehyde-negative patients. In patients with extreme (+++) reactions to formaldehyde, concomitant positive reactions to any of the other 11 investigated formaldehyde releasers were more common than in patients with milder formaldehyde reactions. Conclusions Strong formaldehyde reactions were associated with positive reactions to formaldehyde releasers.

Background Allergy evaluation by patch testing with povidone-iodine (PVP-I) or iodine remains challenging, because current patch test preparations frequently lead to false positive or irritant skin reactions. Objectives To investigate different preparations for iodine patch tests and to assess their clinical relevance with repeated open application tests (ROATs). Methods We monocentrically analyzed 95 patients with suspected allergy to disinfectants in retrospect who underwent parallel iodine patch testing with four preparations: PVP-I 2% aq., 5% aq., 10% aq. and iodine 0.5% pet. Results In 27/95 (28.4%) patients, we found positive reactions to one of the four test preparations. After ROATs in 22 of these 27 positively tested individuals, only one patient was diagnosed with iodine allergy. In contrast, 31/95 (32.6%) patients showed irritant or questionable patch test reactions on day 2 (D2) and/or D3 and/or D7 to one or more test preparations. Testing with PVP-I 2% aq. resulted in the lowest number of questionable skin reactions while detecting the single allergic patient. Conclusion PVP-I 2% aq. was found to be the optimal patch test preparation. In general, iodine allergy appears to be substantially overestimated, and positive patch test responses to iodine should prompt an urgent ROAT for confirmation before diagnosing iodine allergy. This article is protected by copyright. All rights reserved.

Background Contact allergy from acrylic compounds is a "hot topic". Knowledge on the exact chemical composition of acrylic products is superficial. Aims To retrospectively describe patients with allergic reactions to acrylic compounds. Methods We included patients who had been tested with acrylate patch test series and displayed allergic reactions to at least one acrylic compound. Chemical analyses were often performed when safety data sheets of implicated products failed to reveal acrylic compounds to which the patient tested positive. Results In 2010-2019 a total of 55 patients met the inclusion criteria. Eight cases of allergic contact dermatitis were due to anaerobic sealants, seven to dental products, three to windscreen glues, seven to eyelash glues and/or nail products in the beauty sector, three to UV-cured printing inks, two to paints/lacquers, and one to polyester resin system. The origin of these contact allergies was occupational with the exception of four beauty sector workers who had developed eyelid symptoms from eyelash extensions glued onto their own eyelashes. We invariably detected methacrylate monomers in 15 chemical analyses of 12 different anaerobic sealants. Conclusions Safety data sheets of anaerobic sealants often lack warnings for skin sensitization, although these products regularly contain sensitizing methacrylates.

Background Fragrances are the most common cause of cosmetic contact allergy. Up-to-date information on contact allergy frequencies and relevance aids primary and secondary preventive measures. Objectives To determine the prevalence, associated factors and concomitant reactions in fragrance allergy among Thais. Methods This retrospective study collected data from 2012 to 2019. The patient characteristics of fragrance and non-fragrance allergy groups were compared. Concurrent positive reactions of fragrance allergens (fragrance mix I, fragrance mix II, Myroxylon pereirae resin and hydroxyisohexyl 3-cyclohexene carboxaldehyde) and other baseline-series allergens were analysed. Results Of 1,032 patients, 175 (17.0%) had fragrance allergy, with 57.7% of clinical relevance. Fragrance mix I showed the highest prevalence (9.4%). The associated factors were being elderly, lesions on the extremities, metal allergy history, and long lesion duration. Contact allergies to epoxy resin and Compositae plants were significantly associated with fragrance allergy (odds ratios, 5.95 [5.21-6.80] and 4.42 [1.58-12.36], respectively). No significant associations between colophonium (previously proposed as a fragrance marker) and fragrance allergens were found. Conclusions The prevalence of fragrance contact allergy remains high and should be considered in old patients presenting with long-standing eczema on the extremities. Unlike reports from other countries, varied, significant, concomitant reactions were observed. This article is protected by copyright. All rights reserved.

Background Skin and oral mucosa are continuously exposed to potential metal sensitizers while hosting abundant microbes, which may influence the host response to sensitizers. This host response may also be influenced by the route of exposure that is skin or oral mucosa, due to their different immune properties. Objective Determine how commensal Streptococcus mitis influences the host response to nickel sulfate (sensitizer) and titanium(IV) bis(ammonium lactato)dihydroxide (questionable sensitizer) in reconstructed human skin (RHS) and gingiva (RHG). Methods RHS/RHG was exposed to nickel or titanium, in the presence or absence of S. mitis for 24 hours. Histology, cytokine secretion, and Toll‐like receptors (TLRs) expression were assessed. Results S. mitis increased interleukin (IL)‐6, CXCL8, CCL2, CCL5, and CCL20 secretion in RHS but not in RHG; co‐application with nickel further increased cytokine secretion. In contrast, titanium suppressed S. mitis–induced cytokine secretion in RHS and had no influence on RHG. S. mitis and metals differentially regulated TLR1 and TLR4 in RHS, and predominantly TLR4 in RHG. Conclusion Co‐exposure of S. mitis and nickel resulted in a more potent innate immune response in RHS than in RHG, whereas titanium remained inert. These results indicate the important influence of commensal microbes and the route of exposure on the host's response to metals., Host response to S. mitis and metals.

Background: Lanolin is often included when patch testing for common contact allergens. The clinical relevance of a positive patch test reaction to lanolin markers is, however, still a subject for debate. Objectives: To evaluate Amerchol L101 as a marker of lanolin allergy and investigate the clinical impact of lanolin-containing moisturizers on healthy and damaged skin using the repeated open application test (ROAT). Methods: Twelve test subjects and 14 controls were patch tested with Amerchol L 101 and additional lanolin markers. Subsequently, a blinded ROAT was performed on the arms of the study participants for 4 weeks. Each participant applied a lanolin-free cream base and two different lanolin-containing test creams twice daily on one arm with intact skin and on the other arm with irritant dermatitis, induced by sodium lauryl sulfate (SLS). Results: Eleven test subjects (92%) had positive patch test reactions to Amerchol L 101 when retested and one test subject (8%) had a doubtful reaction. None of the study participants had any skin reactions to the ROAT on intact skin and all participants healed during the ROAT on damaged skin. Conclusions: Lanolin-containing emollients do not cause or worsen existing dermatitis when performing ROAT in volunteers patch test positive to Amerchol L101. (Less)

Background The number of patients with contact dermatitis from glucose sensors and insulin infusion sets is increasing. Patch testing is challenging because of a lack of information concerning the constituent materials of medical devices. Objectives To report on products and causes of allergic reactions to glucose sensors or insulin infusion sets over a 5-year period and suggest a short screening series. Methods Analysis of patch test data from consecutive patients suspected of allergic contact dermatitis (ACD) to glucose sensors and/or insulin infusion sets from 2015-2019. Results Patient numbers increased from 4 to 15 per year; 30/38 (78.9%) were children. In 29 (76.3%), a diagnosis of allergic/probable ACD was established, mostly due to the tapes of the device or allergens in these tapes (n = 23) followed by allergens in the device housing (n = 10). Isobornyl acrylate, abitol, and colophonium were the most common allergens. Information from manufacturers was often difficult to obtain and, if accessible, inadequate. For this reason, the diagnosis was delayed for more than 1.5 years in 12 (31%) patients. Conclusions The increasing number of patients, mostly children, with ACD from devices used in treatment of type 1 diabetes demonstrates the importance of this problem. Allergies can easily be overlooked, due to the lack of mandatory labeling of the constituent materials of the devices.

Background Occupational contact urticaria due to inhalation of legume pest allergens has rarely been described. Objective To determine the cause of an outbreak of airborne contact urticaria, asthma, and anaphylaxis in farmers and agronomists studying the disinsectization of dried peas. Peas were treated with aluminum phosphide (EPA). Methods Extracts prepared from Bruchus lentis and Bruchus pisorum bodies and from healthy legumes, EPA-treated legumes, and infested legumes, were used for in vivo tests (skin prick testing, oral, and specific bronchial challenge for the diagnosis of asthma and anaphylaxis) in affected patients and in five control patients with severe legume hypersensitivity. Open application, patch testing with the most common legume insecticides, molecular analysis, and IgE immunoblotting were undertaken. Results We found positive responses (prick, provocation, immune detection) to parasitic pea extracts and B. pisorum. A 25 kDa band was detected in the western blot of all patients who worked with infested EPA-treated peas. Bands from B. pisorum extract were detected in all patients. No responses to pea allergens were found in any patient, unlike in legume allergy controls. Oral provocation tests were negative. Conclusion B. pisorum is a cause of contact urticaria and may cause occupational hives, anaphylaxis, and asthma. The allergen may enter by inhalation or puncture of setae released by B. pisorum. HIGHLIGHTS : Allergic reactions may be caused by inhaling legume dust or vapors, but occupational allergy after inhalation or contact of legume pest allergens has rarely been described. Bruchus pisorum is an allergenic source that may cause occupational urticaria, anaphylaxis, and asthma. To the best of our knowledge, this is the first report on allergy caused by this invasive species Pea pest proteins may cause IgE-mediated allergy in patients inhaling infested pea particles. Agronomists, cooks, farmers, and grocery workers are occupational populations at risk.

Background Differentiation between irritant and allergic skin reactions in epicutaneous patch testing is based largely on subjective clinical criteria, with the risk of high intraobserver and interobserver variability. Novel dermatological imaging using optoacoustic mesoscopy allows quantitative three-dimensional assessment of microvascular biomarkers.Objectives We investigated the potential of optoacoustic imaging to improve the precision of patch test evaluation.Methods Sixty-nine test reactions and 48 healthy skin sections in 52 patients with suspected type IV allergy were examined using raster-scan optoacoustic mesoscopy.Results We identified biomarkers from the optoacoustic images. Allergic reactions were associated with higher fragmentation of skin vasculature than irritant reactions (19.5 +/- 9.7 vs 14.3 +/- 3.7 fragments/100 pixels(2); P < .05), as well as lower ratio of low- to high-frequency acoustic signals (1.6 +/- 0.5 vs 2.0 +/- 0.6, P < .05). Allergic reactions graded "++" showed higher vessel fragmentation than reactions graded "+" (25.4 +/- 13.2 vs 17.1 +/- 6.5 fragments/100 pixels(2); P < .05). A linear model combining the biomarkers fragmentation and frequency ratio could differentiate allergic from irritant test reactions with an area under the receiving operator characteristic curve of 0.80 (95% confidence interval 0.64-0.91), reaching a sensitivity of 81% and specificity of 63%.Conclusions Optoacoustic mesoscopy shows potential to help in differentiating between allergic and irritant test reactions based on novel biomarkers that may reflect vasodilation, vessel tortuosity, and edema.

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Patch tests are highly recommended in eczema patients with eyelid involvement. Sunscreen constitutes a potential cause of eyelid or facial allergic contact dermatitis, and should be considered in patients with refractory eczema on these locations. We report a patient sensitized to several emerging allergens such as bis-ethylhexyloxyphenol methoxyphenyl triazine (Tinosorb S), Scutellaria baicalensis extract, and propylene glycol with an eyelid dermatitis. Patch tests to the combined ingredients propylene carbonate, cyclopentasiloxane, and disteardimonium hectorite; and talc, Cl 77 491, and dimethicone/methicone copolymer were also positive. We highlight the importance of systematically patch testing with the cosmetics brought in by our patients, as well as with the individual ingredients whenever positive. The identification of emerging allergies to new compounds in cosmetics mainly depends on this practice.

Background Sensitization to methylisothiazolinone (MI) has seen an exceptional epidemic, mainly attributed to its use in cosmetics. Objectives To trace the epidemic of MI allergy (2009-2018), and to analyze a possible change of patients' characteristics. Methods Informationsverbund Dermatologischer Kliniken-data of patients patch tested between 2009 and 2018 with MI (0.05% aq.) were analyzed concerning anamnestic items and sensitization frequencies. Results Overall, 4.9% reacted positive to MI. Comparing sensitization to MI in three periods (2009, 2013/14, and 2017/18), there was an increase to 7% in 2013 and a decrease to 3.4% in 2018. The MOAHLFA Index (M=Men, O=Occupational Dermatitis, A=Atopic Dermatitis, L=Leg Dermatitis, F=Face Dermatitis, A= Age > 40) for the period 2013/14 is characterized by a lower proportion of occupational dermatitis and a higher proportion of face dermatitis. The period 2017/18 is characterized by increases of occupational dermatitis and hand dermatitis, and a decrease of face dermatitis. Painters, personal care workers, and hairdressers were particularly affected. Sensitization in hairdressers and personal care workers (mostly cosmeticians) decreased after the peak in 2013/14, whereas sensitization to MI in painters continued to increase. Conclusions After an unprecedented epidemic of MI allergy, mainly caused by its use in cosmetics, the continuous use of MI in industrial applications, for example, paints, and subsequent sensitization remain a matter of concern.

Background Red tattoos are prone to allergic reactions. The identity of the allergen(s) is mostly unknown. Objectives Chemical analysis of human skin biopsies from chronic allergic reactions in red tattoos to identify culprit pigment(s) and metals. Material and methods One hundred four dermatome biopsies were analyzed by matrix‐assisted laser desorption/ionization tandem mass spectrometry (MALDI‐MS/MS) for identification of commonly used organic pigments. Metal concentrations were assessed by inductively coupled plasma (ICP)‐MS and x‐ray fluorescence (XRF). Fourteen patients had cross‐reactions in other red tattoos. Results In total, the identified pigments were mainly azo Pigment Red (P.R.) 22 (35%), P.R. 210 (24%), P.R. 170 (12%), P.R. 5 (0.9%), P.R. 112 (0.9%), and Pigment Orange (P.O.) 13 (11%). P.R. 122 (0.9%) and Pigment Violet (P.V.) 23 (8%) were also common. P.R. 22, P.R. 170, and P.R. 210 also dominated in patients with cross‐reactions. In 22% of the biopsies, no red pigment was detected. Element analysis indicated the presence of the sensitizers nickel and chromium. Conclusions P.R. 22, P.R. 170, and P.R. 210 were identified as the prevailing pigments behind chronic allergic reactions in red tattoos. The epitope causing the reaction might be a pigment‐degradation product. Metal contamination may derive from different sources, and its role in red tattoo allergy cannot be ascertained., First study on chemical analysis of human skin biopsies from chronic allergic reactions in red tattoos to identify culprit pigment(s) and metals.Pigment Red (P.R.) 22, P.R.170, and P.R.210 were the prevailing pigments behind chronic allergic reactions in red tattoos. The epitope causing the reaction might be a pigment‐degradation product.Metal contamination is very common in any tattoo ink stock product, and its role in red tattoo allergy appears dubious.

BACKGROUND Hair cosmetics such as hair dyes, bleaching, waving, and cleansing products are composed of numerous chemical ingredients. Allergic reactions to these contact allergens, other than p-phenylenediamine, are rarely reported. OBJECTIVES To study the incidence of patch test reactions to hair cosmetic allergens and identify the factors associated with hair cosmetic allergy in Thailand. METHODS We retrospectively reviewed the case records of patients who underwent patch testing from 2009 to 2018. Patients with at least one positive patch test reaction to a potential contact allergen associated with hair cosmetic ingredients were studied. RESULTS Overall, 2842 patients were patch tested. Of the hair cosmetic allergen categories, preservatives had the highest rate of positive reactions, followed by surfactants and hair dyes. Perming agents were less problematic in comparison. The hands, head, and neck were the predominately affected sites of allergic reactions to hair cosmetic ingredients. CONCLUSIONS Preservatives, surfactants, and hair dyes are important contact allergens, whereas perming agents are less likely to cause allergic reactions. Hair cosmetic ingredients are regulated by national agencies, which influences their extent of exposure and rates of contact allergies. Further continuous observation of hair cosmetic allergy is needed to provide the best patient care.

Background: Tree moss (Pseudevernia furfuracea [L.] Zopf.), a lichen growing on conifers, is a frequent fragrance sensitizer. Previous studies have shown two subgroups of tree moss-allergic patients: a group sensitized to common allergens of tree and oak moss (Evernia prunastri), and another group sensitized to colophonium-derived allergens, which may contaminate tree moss extract. Objectives: To report the results of including tree moss extract in the baseline series and discuss the clinical implications. Methods: Tree moss extract was included in the baseline series and sensitized patients were assessed for concomitant allergy to colophonium and oak moss, and the relevance of these reactions was analyzed. Results: Altogether, 22 of 632 patients (3.5%) had positive reactions to tree moss. Eight patients were sensitized to tree moss only (among fragrance allergens) and 75% had relevant reactions to colophonium. Fourteen patients were sensitized to other fragrance allergens as well and 28.5% had relevant colophonium reactions. Conclusions: The prevalence of positive tree moss reactions is high enough to justify its inclusion in the baseline series. If tree moss is not included, patients with positive colophonium reactions should be informed of possible (false) cross-reactivity to tree moss to avoid this labeled fragrance allergen.

Background Allergic contact dermatitis caused by glucose sensors has become an increasing problem. Contact allergies to isobornyl acrylate, colophonium, ethyl cyanoacrylate and N,N-dimethylacrylamide have been reported. However, there is a paucity of information regarding the prevalence of sensor-related dermatitis and detailed patient histories. Objectives To evaluate diabetes patients who have developed allergic contact dermatitis caused by glucose sensors. Patients and methods Seventy patients with suspected contact allergy to glucose sensors referred to university hospital dermatology clinics in southern Finland were patch tested with the baseline series, an isobornyl acrylate dilution series, and a number of other acrylates. Atopic constitution, contact allergies, the severity of the dermatitis and the ability to continue with the same or another type of sensor were recorded. Results Positive patch test reactions to isobornyl acrylate were seen in 51 of 63 (81%) Freestyle Libre users. Colophonium or its derivatives gave positive reactions in five of seven Medtronic Enlite users. The median duration of sensor use before dermatitis was 6 months. The estimated prevalences of contact allergy to sensor adhesives were 0.7% for Freestyle Libre and 0.8% for Enlite. Conclusions We suggest that patients who have difficulties in finding a tolerable glucose sensor or an insulin pump should be patch tested.

Background Cobalt contact allergy is common, but clinical relevance is often difficult to determine. Objectives To examine the aetiology, prevalence and clinical characteristics of cobalt-allergic patients who were patch tested between 2002 and 2017 at the Department of Dermatology and Allergy, Herlev-Gentofte Hospital. Methods Patch test data, along with patient characteristics and causative exposures, from all adult dermatitis patients seen and tested between 2002 and 2017 were analysed. Associations were tested with the χ 2 test and logistic regression. Results A total of 13 475 adults aged 18 to 99 years were patch tested. The overall prevalence of cobalt allergy and the prevalence of isolated cobalt allergy were 3.3% and 1.5%, respectively. The prevalence of isolated cobalt allergy decreased from 2.4% in 2006 to 2009 to 1.1% in 2014 to 2017 (Ptrend = 0.00003). Leather exposure as a relevant cause of allergic cobalt dermatitis increased from 3.7% in 2002 to 2009 to 8.3% in 2010 to 2017 (P = 0.04). The current clinical relevance of positive patch test reactions, that is, a positive reaction to cobalt combined with a history of current skin exposure to a source of cobalt, was 20.1%. Conclusions We conclude that cobalt allergy is relatively common, but causative exposures are largely unknown, and the proportion of positive patch test reactions with clinical relevance is low. It is therefore currently unclear how we can better protect consumers and workers from cobalt exposure.

Background Lavender is commonly used in aromatherapy and in a broad range of personal and household products. It has been identified as a contact sensitizer, and has been reported to cause allergic contact dermatitis (ACD). Objectives To report our experience with contact allergy and ACD caused by lavender, and to raise awareness of lavender as a potential contact allergen. Method A retrospective database review was performed of patients attending patch testing clinics at the Skin and Cancer Foundation, Victoria, Australia, from January 1, 1993 to December 31, 2017. Results Among the 2178 patients patch tested with lavender over this period, a total of 58 positive reactions were recorded in 49 individuals, giving a positive patch test prevalence for patients tested with lavender of 2.2%. Twenty-seven patients were diagnosed with ACD. The most common sources of exposure to lavender were personal care products and essential oils. Of the patients with ACD, 74% were tested with lavender absolute, with positive results in 90% of cases. Conclusion Lavender is an uncommon cause of ACD but is important to consider, given the potential for exposure through the use of personal care items and essential oils.

BACKGROUND: There is considerable interest in understanding the immunological variables that have the greatest influence on the effectiveness of sensitization by contact allergens, particularly in the context of developing new paradigms for risk assessment of novel compounds OBJECTIVES: To examine the relationship between patch test score for 3 different contact allergens and the characteristics of T-cell responses.PATIENTS/MATERIALS/METHODS: A total of 192 patients with confirmed nickel, p-phenylenediamine (PPD) or methylisothiazolinone allergy were recruited from the Contact Dermatitis Investigation Unit at Salford Royal Hospital. Severity of allergy was scored by patch testing and peripheral blood lymphocytes characterized for T cell phenotype by flow cytometry and proliferative activity by radiolabelled thymidine incorporation. Comparisons were drawn with buffy coat samples from healthy volunteers.RESULTS: Patch test positivity to nickel, PPD and MI was associated with changes in the phenotype of peripheral blood T-cells: increases in naïve cells, decreases in Treg cell frequency and the CD4+ :CD8hi ratio and increased expression of the skin homing marker CLA, particularly for those patients with a +++ patch test score.CONCLUSIONS: This increased understanding of the characteristics of the T cell responses to contact allergens may provide parameters to better measure health risks associated with skin sensitization. This article is protected by copyright. All rights reserved.

BACKGROUND In 2012, Danish authorities submitted a proposal to the European Chemical Agency restricting the content of hexavalent chromium to a maximum of 3 ppm in leather goods. Following its adoption, this proposal was implemented in 2015 as a directive in the EU. OBJECTIVES To examine the temporal trend of chromium contact allergy in adult dermatitis patients patch tested between 2002 and 2017, and to determine clinical characteristics and causative exposures in these patients. METHODS All adult dermatitis patients patch tested between 2002 and 2017 were included. Patch test data were reviewed retrospectively. Comparisons were performed with the χ 2 test and logistic regression analysis. RESULTS A total of 13 379 adults aged 18 to 99 years were patch tested between 2002 and 2017. The overall prevalence of chromium allergy was 2.2%. An overall decreasing trend was found for the prevalence of chromium allergy (Ptrend = 0.00002). Specifically, a significant difference was found for the study periods 2010 to 2013 (Ptrend = 0.002) and 2014 to 2017 (Ptrend < 0.0001) as compared with 2002 to 2005. Leather remained the most important single cause of allergic contact dermatitis caused by chromium. The proportion of clinically relevant leather exposures increased from 42.3% during 2002 to 2009 to 54.8% during 2010 to 2017 (P = 0.04). CONCLUSIONS The prevalence of chromium allergy is decreasing. The EU Directive restricting the use of hexavalent chromium in leather goods is thought to be playing a central role in this change.

BACKGROUND: The use of disinfectants is part of the everyday life of people, especially in the medical profession. During the coronavirus disease 2019 (COVID-19) pandemic, the use of disinfectants continues to increase and is of fundamental importance in infection control. OBJECTIVES: To determine the frequency of sensitization and the value of patch testing to didecyldimethylammonium chloride (DDAC) and the alcohols ethanol, 1-propanol, and isopropanol. METHODS: Clinical patch test data of 145 patients with suspected contact allergy to disinfectants were retrospective analysed. RESULTS: Among the 145 patients patch tested with the different alcohols, only one nurse was detected with a possible allergy to 1-propanol. Additional patch testing in 84 patients with DDAC 0.05% resulted in five patients with weakly positive reactions only, without clinical relevance. Patch testing with DDAC 0.03% showed no positive reactions at all on day 3 readings. CONCLUSIONS: DDAC and alcohols are rarely responsible for allergic contact dermatitis. The accused products of the patients should be checked for other allergens and further additives with skin-irritating properties. Individual susceptibility and mishandling of the disinfectants should be considered.

BACKGROUND: Concomitant positive patch test reactions in patients sensitized to isobornyl acrylate (IBOA) have rarely been documented. OBJECTIVES: To report concomitant sensitizations in patients with allergic contact dermatitis (ACD) from the glucose sensor FreeStyle Libre and sensitized to IBOA. METHODS: In 2019, 26 patients with suspected ACD from FreeStyle Libre were patch tested to a baseline series and to a (meth) acrylate series containing IBOA and 2-phenoxyethyl acrylate (PEA) 0.1% pet. Diabetes devices and patch test preparations were analyzed with gas chromatography - mass spectrometry (GC-MS) for the presence of IBOA and PEA. RESULTS: Of the 26 patients, 18 (69%) were sensitized to IBOA, and eight (44%) and 11 (61%) of these were co-sensitized to sesquiterpene lactones and fragrances, respectively. Ten patients (56%) were co-sensitized to PEA, which, contrary to IBOA, could not be detected in any device. The PEA test material was shown to be contaminated with IBOA. CONCLUSIONS: Contact allergy to IBOA appears to be declining and IBOA-sensitized patients are most often co-sensitized to sesquiterpene lactones and fragrances. Vigilance is required when patch testing (acrylate) materials obtained from industry, as these might be contaminated and, hence, alter the results and their interpretation. ispartof: CONTACT DERMATITIS vol:84 issue:3 pages:166-174 ispartof: location:England status: published