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Background: Nickel is the leading cause of contact allergy in Europe, with 14.5% of the adult population being sensitized. Despite regulations limiting nickel release from consumer items, the incidence and prevalence of nickel allergy remain high. Objective: To investigate the clinical and subclinical immune response to low‐dose nickel exposure on nickel pre‐exposed skin to assess the adequacy of current regulatory limits. Method: Nickel‐allergic and healthy controls were patch tested with nickel twice with a 3–4 weeks interval. The first exposure used the diagnostic concentration of 2000 μg/cm2 nickel sulphate, and the same skin areas were then re‐exposed to 0.2, 0.5, 12.8 and 370 μg/cm2 nickel sulphate. After 48 h, the patch reactions were examined for clinical signs of eczema, and skin biopsies were collected. The transcriptomic immune profile was analysed with Nanostring nCounter and quantitative polymerase chain reaction. Results: Two nickel‐allergic participants (15%) had clinical reactions to the regulatory limiting doses for nickel (0.2/0.5 μg/cm2) following re‐exposure. There was immune activation in all skin areas following re‐exposure to nickel, predominantly mediated by up‐regulation of cytokines and chemokines. In all nickel re‐exposed skin areas, 81 genes were up‐regulated independent from the clinical response. In skin areas exposed to 0.2 μg/cm2, 101 immune‐related genes were differentially expressed, even when no clinical response was observed. Healthy controls showed up‐regulation of three genes in response to nickel re‐exposures without any clinical reactions. Conclusion: Immune activation can be induced in skin with local memory to nickel upon challenge with nickel doses within the regulatory limits. Our findings suggest that the regulatory limits in the European nickel regulation may not provide sufficient protection for consumers against low‐dose exposures. [ABSTRACT FROM AUTHOR]

Background: Occupational contact dermatitis (OCD) is a prevalent, often chronic disease that poses a risk for job loss and decreased quality of life. In Germany, a multi‐step prevention programme emphasising early detection and highly specialised multidisciplinary treatment has been implemented with great success. Objectives: To examine the effectiveness of a Danish‐adapted version of the German prevention effort on OCD severity, quality of life and occupational consequences at 3‐month follow‐up. Methods: Randomised, controlled trial. Participants were recruited after the first referral from General Practitioner to Dermatologist with suspected OCD. The intervention group (IG) received a Danish‐adapted, multidisciplinary intervention, while the control group (CG) navigated the Danish healthcare system without interference from the study. OCD severity, occupational consequences and quality of life were assessed at 3‐month follow‐up using self‐reported questionnaires. Results: A statistically significant decrease in the severity of eczema was found at 3‐month follow‐up in the IG compared to the CG. The IG were statistically significantly more likely to have seen a dermatologist at 3‐month follow‐up. Higher treatment level in the IG was indicated by the results but was not statistically significant. No significant difference was found in quality of life or occupational consequences. Conclusions: These initial findings suggest that early and specialised treatment of OCD improves OCD prognosis. [ABSTRACT FROM AUTHOR]

Background: Occupational contact dermatitis (OCD) is a common occupational disease. Atopic dermatitis (AD) is a known risk factor for OCD. Objectives: To determine the prevalence of previously diagnosed AD among young workers with recognized OCD and assess its impact on OCD prognosis. Methods: A retrospective cohort study. A questionnaire was sent to 6251 workers with recognized OCD who were under 35 years at notification (response rate: 47%). Of the respondents, 2392 answered a question about previous doctor‐diagnosed AD and were included in the study. Eczema severity, occupational consequences and quality of life were examined using statistical analyses comparing workers with and without previously diagnosed AD. Results: The prevalence of previously diagnosed AD was 41.8% (95% CI: 39.8–43.8). Women had a higher AD prevalence, and workers with AD reported OCD at a younger age. Workers with AD reported more frequent and severe eczema symptoms and had a higher risk of OCD negatively affecting job and occupation choices. Health‐related quality of life was more adversely affected in workers with AD. Conclusions: AD significantly impacts severity and has long‐term consequences for young people with OCD. Targeted prevention strategies need to be developed. [ABSTRACT FROM AUTHOR]

Background: Rubber accelerators are used in the production of rubber gloves and may cause contact allergy. Objectives: To estimate long‐term trend and prevalence of contact allergy to rubber accelerators for a 30‐year period in Denmark, high‐risk occupations, and exposures. Methods: Data from all patients with contact dermatitis consecutively patch tested at the department of Skin and Allergy Gentofte hospital with the rubber accelerators from the European baseline series (EBS) from 1990 to 2019, were analysed. Further, patients under suspicion of rubber accelerator contact allergy were additionally patch‐tested with rubber accelerators from the specialised rubber series from 2005 to 2019 and these were additional extracted. Results: The overall prevalence of contact allergy to one or more of the rubber accelerators from the EBS series was 2.7% with a significant decline in the first 12‐years, followed by a stable frequency in the past 18‐years. Associations with occupational contact dermatitis, hand dermatitis, and leg/foot dermatitis were found. Wet‐work occupations were most often affected and gloves the most frequent exposure. Conclusions: Contact allergy to one or more of the rubber accelerators from the EBS is frequent and has been unchanged for several decades, which calls for prevention. [ABSTRACT FROM AUTHOR]

Introduction: Hairdressers are exposed to wet work and manifold allergens at work, rendering exposure complex and the aetiology of occupational hand eczema (OHE) often multifactorial in this occupational group. Objectives: To identify exposure patterns associated with increased risk of hand eczema in hairdressers. Methods: All hairdressers graduating from 2004 to 2007 and 2015 to 2018 received a questionnaire in 2009 and 2020, respectively. Current exposures (with or without regular glove use) and OHE were self‐reported, and their association examined. Patterns of exposure were identified by latent class analysis (LCA). Results: A total response of 39.9% (668/1675) was obtained. Six exposure profiles (#1–6) were identified by LCA across 11 tasks performed with or without gloves as well as deep conditioning, that is, 23 task items. Compared to profile #1 with the lowest OHE risk (reference) an increased risk of current OHE were seen in profile #4 [adjusted odds ratio [aOR] 6.5, 95% confidence interval [CI] 1.5–44.8 and #6 (aOR 39.4, 95%CI 6.1–362.8)] in logistic regression analysis. Profile #1 and #6 had performed the same tasks, but in profile #6 regular glove use was performed in 9.1% (1/ 11) of tasks compared to 72.7% (8/11) of tasks in profile #1 (p = 0.002). Conclusion: Although occupational exposures in hairdressing are complex, meaningful patterns associated with a wide range of OHE risk can be identified by LCA. The increase of OHE risk seems predominantly to be due to poor compliance with protective gloves. LCA could be applied to further fields of complex (skin) exposures. [ABSTRACT FROM AUTHOR]

Background: The burden of occupational hand eczema in hairdressers is high, and (partly strong) allergens abound in the hair cosmetic products they use. Objectives: To systematically review published evidence concerning contact allergy to an indicative list of active ingredients of hair cosmetics, namely, p‐phenylenediamine (PPD), toluene‐2,5‐diamine (PTD), persulfates, mostly ammonium persulfate (APS), glyceryl thioglycolate (GMTG), and ammonium thioglycolate (ATG), concerning the prevalence of sensitization, particularly in terms of a comparison (relative risk; RR) between hairdressers and non‐hairdressers. Methods: Following a PROSPERO‐registered and published protocol, eligible literature published from 2000 to February 2021 was identified, yielding 322 publications, and extracted in standardized publication record forms, also considering risk of bias. Results: Based on 141 publications, the contact allergy prevalence to PPD was 4.3% (95% CI: 3.8–4.9%) in consecutively patch tested patients. Other ingredients were mostly tested in an aimed fashion, yielding variable, and partly high contact allergy prevalences. Where possible, the RR was calculated, yielding an average increased sensitization risk in hairdressers of between 5.4 (PPD) and 3.4 (ATG). Additional evidence related to immediate‐type hypersensitivity, experimental results, exposures, and information from case reports was qualitatively synthesized. Conclusions: An excess risk of contact allergy is clearly evident from the pooled published evidence from the last 20 years. This should prompt an improvement in working conditions and product safety. [ABSTRACT FROM AUTHOR]

The European baseline series was last updated in 2019. This article discusses the reasoning behind a further iteration of the series for 2023. [ABSTRACT FROM AUTHOR]

Occupational hand eczema is frequent in metalworkers. The contribution of metal allergies is poorly elucidated even though such exposures are common at the workplace. To estimate the prevalence of metal allergy to cobalt (Co), chromium (Cr) and nickel (Ni) in metalworkers and compare these to estimates from the European Surveillance System on Contact Allergies (ESSCA). Two authors independently searched PubMed for studies reporting on the prevalence of metal allergy in metalworkers. Proportion meta‐analyses were performed to calculate the pooled proportions of metal allergy in metalworkers. In total, 29 studies (22 from Europe) were included yielding 5691 subjects for quantitative analysis. The pooled proportion (95% confidence interval) of Co, Cr and Ni in European metalworkers with dermatitis referred to patch test clinics was 8.2% (5.3%–11.7%), 8.0% (5.1%–11.4%), and 11.0% (7.3%–15.4%), respectively. The corresponding estimates for unselected metalworkers from workplace studies were 4.9% (2.4%–8.1%), 5.2% (1.0%–12.6%), and 7.6% (3.8%–12.6%), respectively. In comparison, the prevalence of metal allergy in 13 382 consecutive European males with dermatitis was 3.9% (3.6%–4.2%), 4.4% (4.1%–4.8%) and 6.7% (6.3%–7.0%) for Co, Cr and Ni, respectively. Data on sex, age, body piercings and atopic dermatitis in metalworkers with metal allergy was mostly lacking. Metal allergy to all three metals was significantly more common in European metalworkers with dermatitis attending patch test clinics as compared to ESSCA data, indicating a relationship to occupational exposures, however, confounders could not be accounted for. [ABSTRACT FROM AUTHOR]

Background: Compliance with glove use and safe work practices are important factors in primary prevention of occupational hand eczema (OHE) in hairdressers. Objective: To assess the risk OHE and compliance with skin protective measures in hairdressers trained before and after implementation of a nationwide skin protection program in Danish hairdressing vocational schools in 2011. Methods: A repeated cross‐sectional study was performed. A questionnaire was sent in 2009 and 2020. The Danish Labour Market Supplementary Pension Scheme provided information on yearly payments from the hairdressing profession. Results: A response rate of 66.6% (305/460) was obtained in the 2009 survey and of 29.9% (363/1215) in the 2020 survey. The career time prevalence of OHE decreased from 42.8% to 29.0% (adjusted odds ratio 0.55 95% confidence interval [CI] 0.40‐0.77) and the incidence rate of OHE decreased from 57.5 (95%CI 48.4‐68.4) to 42.0 (95%CI 34.6‐50.9) per 1000 person years (incidence rate ratio 0.73 [95%CI 0.56‐0.95] between the two surveys). A statistically significant (P <.05) increase in glove use when doing wet‐work and when handling hair dyes, permanent wave solutions and bleaching products was observed in the 2020 compared to the 2009 survey. Conclusion: Our data suggest that skin protection training during apprenticeship reduces the risk of OHE in hairdressers. The lack of primary prevention of OHE in hairdressing vocational schools may be a missed opportunity in the prevention of the disease. [ABSTRACT FROM AUTHOR]

In Germany, a stepwise multidisciplinary approach has been established to prevent occupational skin diseases (OSDs), primarily occupational contact dermatitis. This review aims to perform a systematic evaluation of the short‐ and long‐term effects of the German secondary and tertiary individual prevention programmes (SIP and TIP, respectively) for OSDs. Primary outcomes were continuation of employment, severity of hand dermatitis, and quality of life (QoL). The PubMed and Embase databases were searched for studies reporting the effects of the SIP and TIP. A total of 19 studies encompassing 5527 patients with OSDs were included: 11 studies evaluated the SIP and 8 evaluated the TIP. Following the SIP, approximately 70% to 90% and 60% to 70% of patients remained in their occupation after 1 and 5 years, respectively. At 3 years after the TIP, 82.7% of patients remained in their occupation and exhibited a significant decrease in hand dermatitis severity, as well as an increase in QoL. Most of these studies were uncontrolled and the interventions, outcomes, and measurement instruments used were heterogeneous. The SIP and TIP lead to decreased disease severity, improved QoL, and enabled most patients to continue working in their chosen professions. Implementing a similar multidisciplinary approach across Europe may be beneficial. [ABSTRACT FROM AUTHOR]

Current cosmetic regulations primarily focus on protecting consumers, not the professional user who is subjected to a partly different, and certainly more intense exposure to hazardous substances. Against this background, this systematic review aims to compile and appraise evidence regarding skin toxicity of 2-hydroxyethyl methacrylate (HEMA; CAS no. 212-782-2) and ethyl cyanoacrylate (ECA; CAS no. 7085-85-0) contained in cosmetic glues used among hairdressers and beauticians who perform nail treatments and eyelash extension as well as hair extension applications. This systematic review followed the Preferred Reporting Items for Systematic review and Meta-Analysis (PRISMA) 2020 recommendations for reporting systematic reviews and meta-analysis. In total, six publications from six countries were eligible for this systematic review. A meta-analysis revealed that hairdressers and beauticians have a ninefold increased risk of developing contact allergy to HEMA compared with controls who are not hairdressers and beauticians. Results for ECA are lacking. The results of this systematic review clearly show that--regarding contact allergy to acrylates--it is not appropriate to apply risk assessment for consumers to hairdressers and beauticians who occupationally handle cosmetic glues. The regulations in existence do not adequately address occupational risks for hairdressers and beauticians connected with the use of acrylate-containing cosmetic substances and need reconsideration. [ABSTRACT FROM AUTHOR]

Hairdressers are at high risk of developing occupational hand eczema. Opinions on the health and safety concerns of nonfood consumer products, such as cosmetics and their ingredients, consider the exposure of a "common consumer," which may not account for occupational exposure of hairdressers. As a result, there is a parlous scenario in which serious safety concerns about occupational exposures are present. The purpose of this review is to compare the frequency of exposure to various types of hair cosmetic products among hairdressers and consumers. Database searches for this review yielded a total of 229 articles; 7 publications were ultimately included. The analysis showed that—dependent on the task—hairdressers were exposed 4 to 78 times more than consumers to a wide spectrum of hair cosmetic products used in their daily working life, ranging from shampoos, conditioners, oxidative and nonoxidative hair colors, to bleaching agents. The highest frequency was found for coloring hair with oxidative hair color. Consumer use frequency does not appear to be appropriate for representing hairdresser exposure. The current standards do not effectively address the occupational risks associated with hairdressers' use of cosmetics. The findings of this study should cause current risk‐assessment procedures to be reconsidered. [ABSTRACT FROM AUTHOR]

Background: Studies on the causes and consequences of occupational contact dermatitis (OCD) among young workers are non‐existent. Objectives: Determine causes and consequences of OCD among workers younger than 35 years of age. Methods: A questionnaire was sent to 6251 workers younger than 35 years at notification with recognized OCD (response rate 47%). Results: The most prevalent occupations were health care workers, kitchen workers, nursery teachers, and hairdressers and beauticians. Seventy‐six percent still had eczema, and 77% of these had eczema half to all the time over the last 3 months, with 61% evaluating their eczema as moderate to very severe. Fifty‐three percent had changed their occupation since notification, and 42.5% had lost their job because of OCD. Allergic OCD increased the odds ratio (OR) for facial or foot eczema, job loss, change in work tasks, difficulties finding work, decrease in income, and sick leave. Age at notification of 25 years of age or younger increased the risk of job loss and feeling restricted in choice of job. Workers in the food industry had a higher OR for job loss, whereas hairdressers and beauticians had a higher risk of job loss and a decrease in income. Conclusions: The severe, long‐term consequences of OCD notification signify the need for further preventive strategies among young workers. [ABSTRACT FROM AUTHOR]

Regular and correct glove use is important[3] and it may impair compliance when almost one-third of the hairdressers report gloves as reasons for their hand eczema, as hairdressers may begin to question the overall benefit of gloves. Of these, 93.8% (544/580) had worked in the hairdressing occupation at the onset of hand eczema and 84.1% (487/579) believed their hand eczema were caused or exacerbated by their occupation. Keywords: contact dermatitis; hairdressers; hand eczema; occupational disease EN contact dermatitis hairdressers hand eczema occupational disease 162 164 3 01/13/23 20230201 NES 230201 INTRODUCTION Hairdressers have a high incidence of occupational hand eczema (OHE).[1] The risk of OHE in hairdressers is associated with a high degree of occupational exposure to wet work and allergens in hair cosmetics. [Extracted from the article]

Background: Hairdressers are commonly affected by hand eczema (HE) due to skin hazardous exposure such as irritants and allergens in the work environment. Objective: To give an overview of the current prevalence, incidence, and severity, as well as the pattern of debut and the contribution of atopic dermatitis on HE in hairdressers. Methods: A systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta‐Analysis (PRISMA) guidelines was performed. Studies published from 2000 to April 2021 that fulfilled predefined eligibility criteria were retrieved. Results: A pooled lifetime prevalence of 38.2% (95% confidence interval [CI] 32.6‐43.8), a pooled 1‐year prevalence of 20.3% (95% CI 18.0‐22.6), and a pooled point prevalence of 7.7% (95% CI 5.8‐9.6) of HE was observed in hairdressers. The lifetime prevalence in fully trained hairdressers and hairdressing apprentices was almost identical. The pooled incidence rate of HE was 51.8 cases/1000 person‐years (95% CI 42.6‐61.0) and the pooled prevalence of atopic dermatitis was 18.1% (95% CI 13.6‐22.5). Conclusion: HE is common in hairdressers and most hairdressers have debut during apprenticeship. The prevalence of atopic dermatitis in hairdressers is comparable with estimates in the general population, indicating that occupational exposures are the main factor in the increased prevalence of HE in hairdressers. This warrants a strategic and collective effort to prevent HE in hairdressers. [ABSTRACT FROM AUTHOR]

Background: No biomarkers have been identified that can classify subtypes of hand eczema (HE). Although skin biopsies represent the gold standard for investigations of the skin, the invasive technique is not favorable when investigating skin from sensitive areas. Recent advances in the use of skin‐tape strips for molecular investigations enable noninvasive investigations of HE. Objective: By using whole transcriptome sequencing (WTS), the molecular profile of HE according to different localizations on the hands, etiologies, and clinical/morphological subtypes was investigated. Methods: Thirty adult, Danish HE patients, 12 with and 18 without concurrent atopic dermatitis (AD), as well as 16 controls were included. Tape strip samples were collected from lesional, nonlesional, and healthy skin. Total RNA was extracted and WTS was performed. Results: The largest molecular difference of HE patients with and without AD was found in nonlesional skin areas and included a downregulation of CXCL8 for HE patients without AD. Differences between allergic and irritant contact dermatitis included epidermal biomarkers such as EPHA1. Conclusion: Skin tape strip samples could be used to assess the gene expression profile of HE on different localizations of the hands. The skin tape strip method identified new molecular markers that showed promising result for the identification of HE subtypes. [ABSTRACT FROM AUTHOR]

Background: Parents report that children with aluminium contact allergy and vaccination granulomas may react to aluminium‐containing sunscreen following application. Objectives: To evaluate whether contact dermatitis develops following repeated application of aluminium‐containing sunscreens in children with aluminium sensitization and vaccination granulomas. Methods: Sixteen children aged 2‐9 years (mean age 5 years) with vaccination granulomas and a positive patch test reaction to aluminium chloride hexahydrate 2%/10% petrolatum completed a blinded repeated open application test (ROAT) with two daily applications of two sunscreens for 14 days. One cream contained aluminium and the other did not. The children served as their own controls. Results: Sixteen children completed the study. Only one child (6%) had a positive skin reaction during ROAT on day 2 to the sunscreen with aluminium. None reacted to the sunscreen without aluminium. Conclusions: Use of aluminium‐containing sunscreens may on a case basis lead to allergic contact dermatitis in aluminium allergic children. [ABSTRACT FROM AUTHOR]

Background: Facial allergic contact dermatitis caused by cosmetic products is common. New allergens in cosmetics continuously emerge. Objectives: To investigate characteristics of patients with facial dermatitis (FD) between 2010 and 2019 including patch test results from cosmetic‐related allergens and a new test series with cosmetic‐relevant natural ingredients (CRNIs). Methods: This is a retrospective study analysing demographics, clinical characteristics according to MOAHLFA index (male; occupation; atopic dermatitis; hand; leg; face; age ≥ 40 years), and patch test results to 27 cosmetic‐relevant allergens in FD patients. A prospective study evaluating a screening test series with CRNIs in consecutive FD patients for 1 year was also conducted. These patients received a questionnaire for collecting extra characteristics (eg, concerning quality of life). Results: Of 8740 tested patients, 2292 (26.2%) had FD. Of these, 30.6% had cosmetic‐induced FD. The most common cosmetic‐related allergens were fragrances and preservatives. The most common patch test‐positive CRNIs were hydroperoxides of limonene and linalool, and propolis. Potato and peanut were rare, but the most common prick test‐positive CRNIs, however, without any relation to the use of cosmetic products. FD affected nearly all patients' quality of life and caused limitations to their daily life. Conclusions: Updated management and quick diagnosis of FD is important to avoid negative impact on patients' quality of life. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Background: Chromium and cobalt are important skin sensitizers. It has, however, been difficult to identify causative exposures. Studies on nickel allergy have demonstrated piercing as critical for both sensitization and elicitation. It may be speculated that the same applies for chromium and cobalt. Objective: To examine the content and release of chromium and cobalt from earrings randomly purchased in Denmark. Methods: Three hundred four earrings were examined with x‐ray fluorescence (XRF) spectrometry. Earrings with measured content of chromium or cobalt were spot tested with diphenylcarbazide spot test (n = 166) or Nitroso‐R spot‐test (n = 99), respectively. Chromium and cobalt release were quantified in a selected subsample (n = 100) with the artificial sweat test (EN 1811). Results: Chromium was present in 54.6% (166/304) of earrings and cobalt was present in 72.0% (219/304),− measured by XRF. All chromium spot tests for chromium VI were negative. The cobalt spot test was positive for one component. Chromium release was found from 59/100 (median concentration = −0.06 μg/cm2/week) and cobalt release from 29/100 (median concentration = −0.06 μg/cm2/week) of earrings in tested subsample. Conclusion: Earrings for piercing release chromium and cobalt and may on a case basis be a source of chromium and cobalt allergy. [ABSTRACT FROM AUTHOR]

Background: Recent population‐based studies on the incidence rates (IRs) of occupational contact dermatitis (OCD) are sparse. Objectives: To determine the IRs of OCD and development thereof between 2007 and 2018 in known risk occupations. Methods: Data on all recognized cases of OCD were used to calculate IRs as the number of recognized OCD cases per 10 000 workers per year. Asymptotic chi‐square test was used to compare the IRs between 2007‐2012 and 2013‐2018. Results: The median age at notification of OCD was below 30 years for several of the examined occupations. Hairdressers and beauticians, bakers, dentists and dental assistants, and manufacturing of windmills had the highest overall IRs of OCD. We found a statistically significant increase in the IRs of OCD for child/nursery care workers. Conclusions: The median age at notification of OCD was low for several of the occupations, signifying the need for further preventive strategies among young people. Based on the IRs of OCD, future preventive efforts should be directed at hairdressers and beauticians, bakers, dentists and dental assistants, and manufacturing of windmills. Furthermore, the statistically significant increase in IRs of OCD among child/nursery care workers highlights the need for further preventive strategies in this field. [ABSTRACT FROM AUTHOR]

Background: Exposure to nickel releasing ear piercing jewellery may explain the persistently high prevalence of nickel allergy in Europe. While nickel release from earrings is regulated, field studies show that the regulation is not always respected. More knowledge is needed regarding the risk of piercing exposure including suitable screening methods. Objective: To examine the proportion of earrings on the Danish market that release more nickel than allowed, and to validate the use of the dimethylglyoxime (DMG) test as a screening tool. Methods: A total of 304 earrings were purchased and tested with the DMG test and X-ray fluorescence spectrometry. The level of nickel release was quantified in a selected subsample of 100 earrings by the European reference test EN 1811. The DMG spot test was validated against EN 1811 at different thresholds. Results: Excessive nickel release according to the European regulation was found in 45 (14.8%) tested earrings. The sensitivity of the DMG test decreased with reduced levels of nickel release (sensitivity of 45.2% at =0.2 µg/cm²/week vs 61.1% at >0.5 µg/cm²/week). Conclusion: Excessive nickel release is common in earrings on the Danish market. Because of low sensitivity, the DMG test has limited use in screening of earrings for research but may still be used clinically. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Background: Patch testing is the gold standard for identifying culprit allergens in allergic contact dermatitis; however, it is laborious and positive reactions are difficult to quantitate. Development of complementary in vitro tests is, therefore, of great importance. Objectives: This study aimed to improve the in vitro lymphocyte proliferation test (LPT) to detect allergic responses to nickel (Ni), cobalt (Co), and chromium (Cr). Methods: Twenty‐one metal allergic patients with a positive patch test to Ni (n=16), Co (n=8), and Cr (n=3) and 13 controls were included. All were tested by a flow cytometric LPT. Results: Metal‐reactive cells were identified as T helper (Th) cells with high expression of the memory marker CD45RO. Skin‐homing (cutaneous lymphocyte‐associated antigen positive [CLA+]) Ni‐reactive memory Th (Thmemhi) cells identified individuals with a positive patch test for Ni with 100% sensitivity (95% confidence interval [CI] 81%‐100%) and 92% specificity (95% CI 67%‐100%). Moreover, Co‐specific Thmemhi cells expressing CCR6 identified patients with a positive patch test for Co with 63% sensitivity (95% CI 31%‐86%) and 100% specificity (95% CI 77%‐100%). In Cr allergic individuals, Cr‐reactive Thmemhi cells tended to increased CLA and CCR6 expression. Conclusion: Metal‐reactive Th cells with high expression of CD45RO and coexpression of CLA and CCR6 improved the LPT, making it an attractive supplement to the patch test. [ABSTRACT FROM AUTHOR]

Accurate assessments of the burden of hand eczema (HE) in the general population are important for public awareness and intervention. The aim of this systematic review and meta‐analysis was to provide updated estimates of prevalence and incidence, alongside additional epidemiological endpoints on HE in the general population. PubMed, Embase and Web of Science were searched for studies reporting the prevalence and/or incidence of HE in the general population. Proportion meta‐analyses were performed to calculate pooled estimates of prevalence, incidence, severity, and the proportion of individuals with HE and a history of atopic dermatitis. Sixty‐six studies were included in the quantitative analysis encompassing 568 100 individuals. The pooled estimates for lifetime, 1‐year, and point prevalence were 14.5% (95% confidence interval [CI]: 12.6–16.5), 9.1% (95% CI: 8.4–9.8) and 4.0% (95% CI: 2.6–5.7), respectively. The pooled incidence rate of HE was 7.3 cases/1000 person‐years (95% CI: 5.4–9.5). The occurrence of HE was 1.5–2 times higher in females than males. More than one third suffered from moderate/severe disease and around one third had a history of atopic dermatitis. HE was a recurrent, long‐lasting disease with an average age at onset of the early‐ to mid‐twenties. In conclusion; HE is a highly prevalent disease in the general population and carries a significant risk of long‐term or chronic disease. [ABSTRACT FROM AUTHOR]

Background: Hydroxyisohexyl 3‐cyclohexene carboxaldehyde (HICC) has been the most reported fragrance chemical for two decades and will be prohibited in cosmetic products from August 2021. Objectives: To describe the time trend of HICC contact allergy in European patients with dermatitis in 2009 to 2019, and the added value of testing HICC separately in the baseline series. Methods: Data were reviewed for 124 472 patients with dermatitis who were patch tested with HICC 5% pet. in the baseline series in the European Surveillance System on Contact Allergy (ESSCA) network (2009 to 2018) and at the Herlev‐Gentofte Hospital Department of Dermatology and Allergy (2009 to 2019). Results: Contact allergy to HICC was found in 1.98% of 9865 patients in Gentofte and 1.62% of 114 607 patients in the ESSCA network. Overall, the prevalence decreased annually, with 0.156 percentage points (P =.001) in Gentofte and 0.051 percentage points (P =.0002) in ESSCA. The frequency of missed contact allergy to HICC when testing only with fragrance mix II (FMII) was 0.17% (17/9865) and 0.35% (405/114607) of the whole test population in the Gentofte and ESSCA populations, respectively. Conclusions: This is the first study to demonstrate a significant decline in HICC allergy in European patients with dermatitis, most likely attributed to the upcoming European ban. [ABSTRACT FROM AUTHOR]

A recently used Plum hand disinfection gel declared THPE, but was not available for testing. Keywords: allergic contact dermatitis; CAS no. 102-60-3; case report; hand disinfection; tetrahydroxypropyl ethylenediamine EN allergic contact dermatitis CAS no. 102-60-3 case report hand disinfection tetrahydroxypropyl ethylenediamine 114 116 3 06/14/22 20220701 NES 220701 CASE 1 A 54-year-old man with a history of atopic dermatitis and mild interdigital hand eczema presented with erythematous swelling of the face and neck and aggravation of hand eczema during the coronavirus disease 2019 (COVID-19) pandemic (1½ years). [Extracted from the article]

Keywords: 2-hydroxyethyl methacrylate; artificial nail modelling systems; case report; dental plastic fillings; occupational contact dermatitis EN 2-hydroxyethyl methacrylate artificial nail modelling systems case report dental plastic fillings occupational contact dermatitis 106 108 3 06/14/22 20220701 NES 220701 2-Hydroxyethyl methacrylate (HEMA; CAS No. 868-77-9) is a plastic material used in printing industry, artificial nail modelling systems such as gel nails and long-lasting nail polish, and in dental plastic fillings. 2-hydroxyethyl methacrylate, case report, occupational contact dermatitis, artificial nail modelling systems, dental plastic fillings Local and systemic contact dermatitis elicited by dental plastic fillings in a patient allergic to 2-hydroxyethyl methacrylate. [Extracted from the article]

Copper, diagnostics, dimethylglyoxime, metal release, nickel, nickel allergy, DMG Keywords: copper; diagnostics; dimethylglyoxime; DMG; metal release; nickel; nickel allergy EN copper diagnostics dimethylglyoxime DMG metal release nickel nickel allergy 431 433 3 04/14/22 20220501 NES 220501 The dimethylglyoxime (DMG) spot test is widely used to screen for nickel release that may cause allergic nickel contact dermatitis in allergic individuals. The tested earring with nickel release of 0.87 g/cm SB 2 sb /week was expected to become DMG spot test positive, but this result was possibly masked due to the brown discolouration caused by a DMG-copper reaction (Figure 2). [Extracted from the article]

Background: Occupational contact dermatitis (OCD) is the most commonly recognized occupational disease in Denmark. Objectives: To examine the impact of recognized OCD on degree of employment, sick leave, unemployment, and job change. Methods: Data on all recognized individuals with OCD notified in Denmark between 2010 and 2015 (n = 8940) were linked to information on social transfer payments in the years before and after notification. The number of weeks on unemployment benefits or sick leave and the degree of employment during the 2 years prior to notification was compared with the 2 years following notification. Results: The degree of employment decreased on average 8.9 work‐hours/month, corresponding to an average annual loss of income per worker of approximately €1570. The average number of weeks that workers were receiving unemployment benefits and paid long‐term sick leave rose by 2.5 and 3.4 weeks, respectively, corresponding to an average additional annual cost per worker of approximately €420 and €770, respectively. Longer case‐processing time was significantly associated with lower degree of employment and higher levels of unemployment and sick leave. Conclusions: OCD has a significant negative impact on employment and economics, thus highlighting the need for a national, strategic action plan for effective prevention of OCD. [ABSTRACT FROM AUTHOR]

Background: In 2005, methylisothiazolinone (MI) was allowed as a stand‐alone preservative in cosmetics. This resulted in an epidemic of allergic contact dermatitis to MI, mainly affecting women exposed to leave‐on cosmetics. Consequently, a regulation of Annex V in the European Union in 2017 banned the use of MI in leave‐on cosmetics and reduced the allowed concentration in rinse‐off products. Objective: To analyze the temporal trends in contact allergy to MI in Danish patients in relation to key events including European regulations over time. Methods: A retrospective study of consecutive patients patch tested with methylisothiazolinone from 2005 to 2019. Demographics and clinical characteristics in terms of MOAHLFA (male, occupational, atopic dermatitis, hand dermatitis, leg dermatitis, facial dermatitis and age >40 years), sources of exposure, and clinical relevance were analyzed in relation to key historical events. Results: Three hundred eighty of 12 494 patients (3.0%, 95CI: 2.7–3.4%) tested from 2005 to 2019 were sensitized to MI. An increasing trend in the prevalence of MI contact allergy from 2005 to 2019 (P <.01) was observed, although a decline in the absolute number of patch‐test positive patients was seen from 2013 and onward. A reduction in leave‐on cosmetics as a source of exposure was observed following the legislative ban in 2017, from 24.8% from in 2010 to 2013 to 6.2% in 2017 to 2019 (P <.01). Conclusion: The epidemic of MI contact allergy is declining in absolute terms, although the prevalence in the patch‐tested population has not returned to its pre‐epidemic levels. The legislative regulation of MI in 2017 has been effective in terms of leave‐on cosmetics as a source of exposure in MI allergic patients. The process of post‐marketing risk assessment of contact allergens in the European Union needs improvement. [ABSTRACT FROM AUTHOR]

Background: During the first wave of the COVID‐19 pandemic of Spring 2020, Denmark was one of the first countries to introduce lockdown measures, including closing of all daycare centers. Following the reopening of daycare centers, Danish Health Authorities implemented a mandatory intensive hand hygiene regimen. Objectives: To examine the occurrence and point prevalence of hand eczema as a consequence of more intensive hand hygiene among Danish children attending daycare. Methods: The heads of 1667 daycare centers in Denmark were contacted and asked to forward a link to a questionnaire to parents of the children attending the daycare center. Results: Among 6858 children, 12.1% had hand eczema before reopening of daycare centers, whereas 38.3% reported hand eczema after the children returned to daycare. Of the children who never had hand eczema, 28.6% developed hand eczema after returning to daycare. The risk of hand eczema was significantly associated with atopic dermatitis, female gender, higher age, and frequency of handwashing. Conclusion: Following the implemented hygiene regimen, a high proportion of young children rapidly developed hand eczema. Well‐established prophylactic skin care might have spared a proportion of the children from developing hand eczema. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Background: Naturally derived cosmetic product ingredients of both plant and animal origin are being included increasingly in product formulations in order to cater to consumer preferences. They may be an overlooked cause of reactions to cosmetic products in some patients with dermatitis. Objectives: To identify naturally derived cosmetic product ingredients with allergenic potential (type I and type IV) and propose a cosmetic screening test series. Methods: The study was conducted in two steps. The first step was a market survey using a nonprofit application helping consumers avoid problematic substances in cosmetic products. The application contained 10 067 cosmetic products that were label checked for naturally derived cosmetic product ingredients. The second step was a literature search to examine how frequently the naturally derived ingredients were described and related to allergic reactions in cosmetics or other topically administered products. Results: We identified 121 different naturally derived cosmetic product ingredients that were included in at least 30 cosmetic products. In total, 22 ingredients were selected for a screening test series. Conclusions: We propose a supplemental patch test and a prick test screening series with naturally derived cosmetic product ingredients for patients with skin reactions to cosmetic products, aiming to identify a cause in more patients than is currently possible. [ABSTRACT FROM AUTHOR]

Occupational hand eczema is common among hairdressers, and protective gloves are important in limiting exposure to irritants and allergens. Various glove types may differ in their protective ability, and their use may lead to hand eczema due to skin irritancy and allergy. MEDLINE was searched for studies investigating permeation of gloves to irritants and allergens used in the hairdressing trade, as well as adverse effects of glove use affecting hairdressers. Forty‐four studies were identified; nine reported on permeation. Of those, two in vitro studies found nitrile rubber (NR) gloves to give the best protection when handling hair dyes. Polyethylene (PE) gloves had the lowest reported break‐through time. The prevalence of sensitization to rubber materials in European hairdressers was as follows: thiuram mix, median 2.5% (range 0%‐8.2%), weighted average 3.0% (95% confidence interval [CI] 3.0%‐3.1%); mercapto mix, median 0.4% (range 0%‐3.3%), weighted average 0.5% (95% CI 0.47%‐0.50%), mercaptobenzothiazole, median 0.6% (range 0%‐6.6%), weighted average 0.7% (95% CI 0.6%‐0.7%), NRL‐type I allergy, median 1.3% (range 1%‐16.4%), weighted average 4.0% (95% CI 3.6%‐4.5%). In conclusion, NR gloves provide the best skin protection for hairdressers, although natural rubber latex (NRL) and polyvinylchloride (PVC) gloves may be sufficient in most cases. PE gloves are not recommended. Synthetic rubber gloves with low or no levels of accelerators are preferred. [ABSTRACT FROM AUTHOR]

Background: Aluminum contact allergy is mostly seen in children with vaccination granulomas, following immunization with aluminum‐adsorbed childhood vaccines. Objectives: To characterize a cohort of children with vaccination granulomas and aluminum allergy concerning early life conditions, exacerbating factors, avoidance behavior, treatments, and potential impact on quality of life. Methods: A questionnaire study was conducted among 177 children aged 0 to 15 years with vaccination granulomas and aluminum allergy, and a reference group of 61 children aged 3 to 14 years with various types of dermatitis undergoing patch testing. Results: All children in the granuloma group were reportedly affected by itch. Infection exacerbated the itch in 59%. Other worsening factors were eating tin‐foiled/canned food (31%) and use of aluminum‐containing sunscreen (46%). Many parents took precautions to avoid aluminum exposure. Children with granulomas were more likely to be nonadherent to the National Vaccination Program than the reference group (27% vs 2%, P <.001). Parents in the granuloma group reported a decreased life quality for both parents and children compared with the reference group. Conclusions: Itching vaccination granulomas and aluminum allergy have a considerable negative impact on affected children and their families, causing avoidance behavior, reduced adherence to vaccination programs, and a negative effect on the overall life quality. [ABSTRACT FROM AUTHOR]

Background: Exposure to metalworking fluids (MWFs) is a well‐known cause of occupational contact dermatitis. Objectives: We aimed to (1) determine the amount of nickel, chromium, and cobalt in large samples of used and unused MWFs collected from metalworking plants in Denmark, and (2) evaluate a handheld x‐ray fluorescence (XRF) device as a screening instrument for metals in MWFs. Methods: A handheld XRF device was used to screen for metals in MWFs. All samples were also analyzed for concentrations of nickel, chromium, and cobalt using graphite furnace atomic absorption spectroscopy (GFAAS). Results: GFAAS analysis showed that 13 of 80 samples (16.3%) contained >1 mg/kg (ppm) nickel (range: 6.4‐17.7 mg/kg), 3 of 80 (3.8%) contained >1 (range: 1.4‐3.1) mg/kg chromium, and 1 of 80 (1.3%) contained 1.3 mg/kg cobalt. XRF‐screening detected nickel in eight samples (range: 2.5‐15.5 mg/kg), but only one sample with 3.0 (±0.5) mg/kg was found subsequently to contain 9.9 (0.02) mg/kg nickel by GFAAS. Although no chromium was found by XRF analysis, cobalt was found in two samples with 6 (±1.5) mg/kg and 5 (±1.5) mg/kg, subsequently found to contain 0.1 (±0.01) mg/kg and 0.08 (±0.01) mg/kg by GFAAS. Similar concentrations of nickel were found in used (N = 6, range: 6.4‐17.7 mg/kg) and unused MWFs (N = 7, range: 9.1‐17.3 mg/kg). Conclusion: Considerable levels of nickel, chromium, and cobalt were found in some used and unused MWFs indicating that these might represent a source of metal allergy. The XRF device is a poor screening test for these metals in MWFs. [ABSTRACT FROM AUTHOR]

Background: There is currently no agreed cosmetic series for use across Europe. Objectives: To establish allergens currently tested in local and national cosmetic series. Method: Members of the European Surveillance System on Contact Allergy and the European Cooperation in Science and Technology project TD1206 ("StanDerm") were surveyed to establish their current practice. Results: A wide range of allergens was tested but there was significant variation between centres on the allergens considered to be important in screening for allergy to cosmetics. The number of allergens tested in addition to the baseline series varied between 2 and 50. Conclusions: There is a need for further investigation to establish the frequency and relevance of reactions to cosmetic allergens to enable an agreed evidence‐based cosmetic series to be produced. Criteria for inclusion need to be established. [ABSTRACT FROM AUTHOR]

Background: Hand eczema is a disease with large variation in clinical presentation and severity. Scoring systems for quantitative severity assessment exist. However, they are observer‐dependent. An objective quantitative tool for scoring of hand eczema would improve categorization of hand eczema. Objective: To investigate the usefulness of multispectral imaging in assessing severity of hand eczema with respect to extent and the different morphological features. Methods: Patients with hand eczema (n = 60) and healthy controls (n = 28) were included. The severity of hand eczema was assessed by a dermatologist using the Hand Eczema Severity Index (HECSI) and a global assessment (Physician Global Assessment [PGA]). Multispectral imaging of the hand was performed on all patients and controls using the VideometerLab Instrument. Results: Areas of the morphological elements identified by multispectral imaging were statistically significantly correlated with the PGA scores. Analyzed by Cohen's kappa, a moderate agreement between imaging‐based severity assessment and PGA was found. The imaging‐based severity assessment was also correlated with HECSI (Spearman rho 0.683, P < .001). Still, the imaging‐based algorithm was not capable of differentiating hand eczema patients from controls. Conclusions: Multispectral imaging allows quantitative measurements of different skin parameters to be performed. In its present form, multispectral imaging cannot replace the clinical assessment of a dermatologist. However, after refinement, this or similar technologies could prove useful. [ABSTRACT FROM AUTHOR]

Nickel is the most frequent cause of contact allergy worldwide and has been studied extensively. This clinical review provides an updated overview of the epidemiology, exposure sources, methods for exposure quantification, skin deposition and penetration, immunology, diagnosis, thresholds for sensitization and elicitation, clinical pictures, prevention, and treatment. The implementation of a nickel regulation in Europe led to a decrease in the prevalence of nickel allergy, and changes in the clinical picture and disease severity. Nevertheless, the prevalences of nickel allergy in the European general population are approximately 8% to 19% in adults and 8% to 10% in children and adolescents, with a strong female predominance. Well‐known consumer items such as jewellery and metal in clothing are still the main causes of nickel allergy and dermatitis, although a wide range of items for both private and occupational use may cause dermatitis. Allergic nickel dermatitis may be localized to the nickel exposure site, be more widespread, or present as hand eczema. Today, efficient methods for exposure quantification exist, and new insights regarding associated risk factors and immunological mechanisms underlying the disease have been obtained. Nevertheless, questions remain in relation to the pathogenesis, the persistent high prevalence, and the treatment of severe cases. [ABSTRACT FROM AUTHOR]

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 χ2 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. [ABSTRACT FROM AUTHOR]

Background: Fragrance contact allergy is common, but few studies on quality of life (QoL) in affected patients exist. Recently, the disease‐specific Fragrance Quality of Life Index (FQLI) was developed. Objectives: To characterize QoL in European dermatitis patients with fragrance contact allergy at the time of diagnosis. Methods: This was a cross‐sectional study, in which 2011 Danish, British, Spanish and German adult consecutive dermatitis patients were invited to complete a questionnaire on self‐reported disease severity, the Dermatology Life Quality Index (DLQI), and the FQLI immediately prior to being patch tested. Results: One thousand seven hundred and fifty‐eight patients responded, and 259 (14.7%; country range 11.7%‐18.5%) were fragrance‐positive. Among these, the total (SD) DLQI score was 6.2 (5.6) and the total (SD) FQLI score was 60 (25), with both estimates being comparable to those in fragrance‐negative patients. Adjusting the total FQLI score for age, sex and self‐rated disease severity showed a higher (ie, worse) score in fragrance‐positive patients (3.6‐point increase; 95% confidence interval: 0.30‐6.8 points; P = 0.03). Specifically, contact allergy to oxidized linalool was associated with greater impairment in QoL. Conclusions: QoL in patients with fragrance contact allergy is impaired at a level comparable to that in other patch tested dermatitis patients, at the time of diagnosis, across several European countries. [ABSTRACT FROM AUTHOR]

Background: There is an ongoing discussion on whether routinely patch testing with p‐phenylenediamine (PPD) 1.0% pet. is safe, owing to the risk of patch test sensitization. Late‐appearing patch test reactions may reflect patch test sensitization, but may also be attributable to a low degree of pre‐existing sensitization. Objectives: To follow the positive patch test reactions to PPD and its salt PPD dihydrochloride (PPD‐DHC) in order to characterize reaction patterns concerning time and dose in PPD‐sensitized individuals. Methods: Volunteers with previous reactions to PPD 1.0% were included and patch tested with PPD and PPD‐DHC in equimolar dilution series. There were then seven follow‐up visits over a period of 28 days. Results: Twenty‐six volunteers completed the study, of whom 23 of 26 (88%) reacted to PPD 1.0%, and 69% reacted to PPD 0.32%. Altogether, 42% and 27% reacted to the corresponding equimolar concentrations of PPD‐DHC. After day 7, no new reactions were observed to any concentration tested, either of PPD or of PPD‐DHC. Conclusion: No late‐appearing reactions to PPD or PPD‐DHC were observed at any dose. There is a risk of missing contact allergy when the dose is decreased. [ABSTRACT FROM AUTHOR]

Background: Contact allergy to oxidized limonene, with hydroperoxides of limonene (Lim‐OOHs) as the main allergens, is common. However, high proportions of weak positive and doubtful patch test reactions have been reported. Objectives: To determine the clinical relevance, elicitation threshold and dose‐response relationship of Lim‐OOHs in individuals with a positive or doubtful patch test reaction to standard Lim‐OOHs 0.3% pet. Methods: A multicentre 3‐week double‐blind vehicle‐controlled repeated open application test (ROAT) study with a simulated fine fragrance containing Lim‐OOHs at 1260, 420 and 140 ppm, equal to a dose/area per application of Lim‐OOHs of 3.0, 0.99 and 0.33 μg/cm2, was performed. Results: Among 11 subjects allergic to Lim‐OOHs, 11 (100%), 7 (64%), and 3 (27%), respectively, reacted to the applied doses. No reactions were seen in 17 healthy controls exposed to the highest dose. This difference in reactivity was statistically significant (P < 0.0001). Among 13 subjects with doubtful patch test reactions to Lim‐OOHs, two (15%) had positive ROAT reactions to the highest Lim‐OOH dose applied (P = 0.36 as compared with controls). Conclusions: Contact allergy to Lim‐OOHs is of clinical relevance in patients with positive patch test reactions. A doubtful patch test reaction to Lim‐OOHs 0.3% pet. can be of clinical relevance. [ABSTRACT FROM AUTHOR]

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 χ2 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. [ABSTRACT FROM AUTHOR]

Background: Contact allergy and allergic contact dermatitis are frequent conditions in the general population. Objectives: To provide an updated estimate of the prevalence of contact allergy in the general population based on data from our previous review combined with new data from an updated search for relevant studies published between 2007 and 2017. Methods: Two authors independently searched PubMed for studies reporting on the prevalence of contact allergy in samples of the general population. Proportion meta‐analyses were performed to calculate the pooled prevalence estimates of contact allergy. Results: A total of 28 studies were included in the analysis, covering 20 107 patch tested individuals from the general population. Overall, the pooled prevalence of contact allergy was 20.1% (95% confidence interval [CI]: 16.8%‐23.7%). In children and adolescents (<18 years), the prevalence was 16.5% (95%CI: 13.6%‐19.7%). The prevalence was significantly higher in women (27.9% [95%CI: 21.7%‐34.5%]) than in men (13.2% [95%CI: 9.3%‐17.6%]). The most common allergen was nickel (11.4% [95%CI: 9.4%‐13.5%]), followed by fragrance mix I (3.5% [95%CI: 2.1%‐5.4%]), cobalt (2.7% [95%CI: 2.1%‐3.4%]), Myroxylon pereirae (1.8% [95%CI: 1.0%‐2.7%]), chromium (1.8% [95%CI: 1.3%‐2.6%]), p‐phenylenediamine (1.5% [95%CI: 1.0%‐2.1%]), methylchloroisothiazolinone/methylisothiazolinone (1.5% [95%CI: 0.8%‐2.5%]), and colophonium (1.3% [95%CI: 1.0%‐1.6%]). Conclusions: This meta‐analysis confirmed that at least 20% of the general population are contact‐allergic to common environmental allergens. It highlights the need for more effective preventive strategies for common allergens in consumer goods, cosmetics, and the workplace. [ABSTRACT FROM AUTHOR]

Background: Knowledge about the skin deposition and penetration of nickel into the stratum corneum (SC) after short contact with metallic items is limited. Objective: To quantify nickel skin deposition and penetration into the SC after short contact with metallic nickel. Methods: Sixteen nickel‐allergic participants and 10 controls were exposed to 3 pure nickel discs and 1 aluminium disc on each volar forearm for 3 × 10 minutes. Before exposure, 1 forearm was irritated with 0.5% sodium lauryl sulfate under 24‐hour occlusion. Immediately, as well as 24 and 72 hours after metallic disc exposure, outer SC layers were removed with adhesive tapes and the nickel content was measured. Results: Nickel deposition and SC penetration capable of eliciting allergic nickel dermatitis were found immediately and after 24 hours. Significantly higher nickel amounts were found on normal skin and in the SC of nickel‐allergic participants than in controls both immediately and after 24 hours, and on irritated skin immediately after exposure. Conclusions: Nickel deposition and SC penetration is considerable after nickel skin exposure of 3 × 10 minutes. Combined with the allergic responses resulting from the same exposures reported previously, this study highlights that short skin exposure to nickel‐releasing items may cause allergic nickel dermatitis. [ABSTRACT FROM AUTHOR]

The article focuses on the European baseline series (EBS) of contact allergens (haptens) which is used in Europe as a patch test screen in the diagnosis of allergic contact dermatitis. It comments on an update of the EBS with the European Society of Contact Dermatitis working group European Surveillance System of Contact Allergy to provide evidence-based changes to the series. It mentions specific haptens that have not been included in the EBS including sodium metabisulfite, and decyl glucoside.