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

Contact allergy can manifest in a variety of ways clinically. Systemic contact allergy may occasionally present with pain in muscles and joints. Fibromyalgia is a chronic rheumatic disease characterized by pain and with virtually unknown aetiology.The aim of this study was to investigate the contact allergy rates to the sensitizers in a baseline series and compare with corresponding rates in dermatitis patients and the general population.Patch testing with the Swedish baseline series was performed in 120 individuals with fibromyalgia. Fisher's exact test was used for pair-wise comparisons of contact allergy rates between the fibromyalgia group and two control groups, dermatitis patients and individuals in the general population.Contact allergy was significantly more common in the fibromyalgia group compared to the general population concerning nickel and the fragrance markers Myroxolon pereirae and fragrance mix I. There were fewer allergic reactions to preservatives in the fibromyalgia group compared with the dermatitis group.Myroxolon pereirae and fragrance mix I represent besides fragrance allergy also allergy to flavouring substances which indicate that oral exposure to flavouring substances and hygiene products might be important for sensitization and possibly elicitation of systemic contact allergy symptoms in fibromyalgia individuals.

Disperse dyes (DDs) are the most prevalent causes of textile-related allergic contact dermatitis and are used for colouring synthetic textile materials based on fibres such as polyester, acrylic, acetate and polyamide. Eight DDs are included in a textile dye mix (TDM) 6.6% petrolatum (pet.) in the European baseline patch test series.The aim of this study was to patch test TDM 6.6% pet. positive individuals with the extracts of synthetic fibre clothes that do not contain any of the pure DDs present in the TDM 6.6% to study the reactivity pattern.Seventy-three TDM-positive former patients tested between 2012 and 2017 at the Department of Occupational and Environmental Dermatology in Malmö, Sweden were invited to join the study, 10 participated. Twenty-four textile items (collected in nine countries in Europe, Asia and North America in 2012) were extracted in dichloromethane. The TDM 6.6% was patch tested simultaneously with the 24 textile item preparations in petrolatum made from the extracts. Prior to patch testing the participants filled the 7-question questionnaire regarding possible symptoms from textile exposure.Ten individuals, agreed to join the study. Eight of them reacted to TDM 6.6%. Nine participants reacted to 20 of 24 extracts. One reacted to 19 extracts, another to 14, 3 to 5 extracts, 1 to 4, 1 to 3 extracts and 2 to 2 extracts. One was negative to all tested preparations including TDM 6.6%. The participants mainly reacted to six textile extracts. All controls tested negatively to tested extracts. Four individuals of the 10 TDM-allergic individuals previously had had problems after wearing clothes. Four out of the 10 participants had had atopic eczema in childhood. All women had dyed their hair with permanent hair dyes but none of the males.TDM-positive patients react to textile extracts made from synthetic garments, even if they do not contain any of the pure DDs present in TDM 6.6%. More studies are needed to pin-point the culprit haptens in these extracts.

Preservatives are usually added to a wide array of consumer products to prevent growth of microbes and to prevent product destabilization and degradation. However, many of these preservatives are common skin sensitizers and may cause allergic contact dermatitis. The amount of preservatives may vary per country or region according to their respective legislation and may be reported in differences in prevalence rates of contact dermatitis.To examine and identify preservatives in consumer products in accordance with Philippine legislation. To verify the accuracy of the list of ingredients of Philippine cosmetic products as legislated by the Philippine Bureau of Food and Drug Administration.A total of 65 commonly used Philippine consumer products ranging from liquid facial and body washes, bar soaps, laundry detergents, feminine hygiene washes and wipes, shampoos and conditioners, sunblock, and moisturizers were selected. Ingredients noted on labels were documented. Products were subsequently investigated chemically for the presence of methylchloroisothiazolinone, methylisothiazolinone, or formaldehyde.The preservatives most commonly used in cosmetic products in the Philippine market are methylchloroisothiazolinone (MCI), methylisothiazolinone (MI), and/or formaldehyde. In accordance with Philippine legislation, almost all products provided a detailed ingredient list as printed on the packaging. Measurements of MCI/MI ranged from less than 1 ppm to 16 ppm, and MI ranged from only less than 1 ppm to 66 ppm, whereas formaldehyde was noted to range from less than 2.5 ppm to greater than 40 ppm in the products tested. Most products are manufactured by international brands, with a few products being manufactured locally.The preservatives found in cosmetic products were MCI, MI, and formaldehyde. Discrepancies were found in the preservatives and labeling of these products, with a majority of investigated Philippine products labeled inaccurately with varying concentrations of preservatives.

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)

Chromium (Cr) contact allergy is frequent in many industrialized countries. The knowledge of the factors that can influence percutaneous penetration is very important assessing the risk of human exposure.The aim of the study was to compare the concentration of Cr in various skin layers using 2 different vehicles.Full-thickness (approximately 1 mm) porcine ear skin was mounted in Franz-type diffusion cells. Duplicate potassium dichromate preparations in 0.5% petrolatum (pet) and 0.5% in aqua (aq) were applied to the donor compartment facing the epidermis for 24 hours. After the experiment, the porcine skin samples were cut with a microtome. All samples were analyzed for total Cr concentration by inductively coupled plasma sector field mass spectrometry. The limit of detection was 0.001 μg/cm3.Chromium was detected in both recipient phases. The distribution of Cr in the skin is similar for pet and aq preparations, but the concentration of Cr detected in the skin was almost 2 times lower for pet comparing aq preparations.Both vehicles were suitable for penetrating the skin. Less Cr is found in the skin when pet is used as a vehicle. Acid wipe sampling and finger immersion test results might be false-negative for Cr in occupations involving contact with Cr salts in aq solutions.

The clinical usefulness of the atopy patch test (APT) is unclear for investigating aeroallergen- and food-triggered atopic dermatitis (AD).This study aimed to assess the prevalence of positive APT reactions in a population of adolescents and investigate possible associations between the APT, specific serum (s) immunoglobulin E (IgE) tests, self-reported atopic conditions and health-related quality of life.A population-based study was performed on 211 adolescents (13-14 years old). Collected data included questionnaires, an APT with food and aeroallergens and s-IgE tests.Positive APT reactions were observed in 9.0% (19/211) of the adolescents. Timothy grass was the top allergen with 11 (5.2%) positive reactions, followed by cat dander (2.8%) and house dust mites (2.4%). Rhinoconjunctivitis increased the odds of any positive APT (crude odds ratio: 3.32; 95% confidence interval [CI]: 1.17–9.40), particularly when an APT was positive for aeroallergens (odds ratio: 5.02, 95% CI: 1.54-16.42). There was no association between a positive APT and AD. Four adolescents without AD and no IgE-sensitization had a positive APT.Based on a population of adolescents, the APT is associated with rhinoconjunctivitis but not AD. This finding should be taken into consideration in further attempts to clarify the role of the APT in the clinical setting.

A patient received enoxaparin sodium subcutaneous injections for prophylaxis after surgery and developed inflammatory skin reactions on injection sites on Day 5 after the first administration. Patch test was performed with baseline series and low-molecular-weight heparins (LMWHs) at different concentrations and showed positive reactions to neomycin and LMWHs. Cross-reactivity between neomycin and LMWHs was suspected due to similar structure.To establish the evidence of possible cross reaction between neomycin and LMWHs by patch testing.Patch testing of 12 individual controls with a history of neomycin contact allergy was performed.Positive patch test reactions to enoxaparin sodium, tinzaparin sodium, and neomycin sulphate were reported in the patients. None of the controls reacted to LMWHs.There was no proof of cross reaction between neomycin and LMWHs in this study, suggesting that the simultaneous reaction may be a coincidence. Since the number of individuals studied was low, allergy to LMWHs following injection in individuals with a history of neomycin allergy should be further investigated.

Background: Polyaminopropyl biguanide (INCI name) and polyhexamethylene biguanide (PHMB) are polymeric biguanides. PHMB is a broad-spectrum antimicrobial substance used as a preservative in many products. Due to our limited knowledge on PHMB contact allergy frequency and the fact that cases of allergic contact dermatitis to PHMB might be missed, we have included PHMB as a screening allergen since 2016. Objective: To report the prevalence of positive patch-test reactions to PHMB as a screening allergen in patients with suspected allergic contact dermatitis. Methods: A retrospective analysis of 1760 patch tested patients from July 2016 to December 2018 was performed. Polyaminopropyl biguanide 2.0% aqua was included in the extended Malmo baseline series during the study period. Results: Of all patients, 1204 (68.4%) were female. Positive patch-test reactions were reported in 19 patients (1.1%). The most common sites of lesions were face, head, and neck (52.6%). There was a significant correlation between concomitant reactions to PHMB and other cosmetic-related allergens. Conclusion: The prevalence of positive reactions to PHMB was higher than that previously reported. Patch testing with PHMB should be performed in patient with dermatitis who have lesions on the face, head, and neck. (Less)

Regularly updating the prevalence of fragrance contact allergy (CA) is important. Patch testing with fragrance markers in the baseline series and the ingredients of fragrance mixes (FMs) is still debated.To update the prevalence and clinical characteristics of patients with fragrance CA. To establish the results of patch testing with individual allergens of FMs.A retrospective analysis of 3539 patients with dermatitis who were patch tested with the baseline series and FMs ingredients during 2016 to 2020 was performed.The prevalence of fragrance CA was 13%. About 10% of these patients with fragrance CA would be missed if the individual ingredients were not tested. Unlike hydroxyisohexyl 3-cyclohexene carboxaldehyde, there was no decreasing trend of CA to Evernia prunastri (oakmoss) extract after the EU regulation came into force. Patients with CA from only one ingredient of the mixes or having a weak positive reaction to the ingredients were significantly missed when tested with only the fragrance markers in the baseline series.Patch testing with individual fragrance allergens is crucial for experts to expand knowledge in the fragrance CA field. The concentrations of the allergens in FMs may need to be adjusted to detect patients with fragrance CA, since some were significantly overlooked.

International audience; Background: Allergic contact dermatitis (ACD) and photoallergic contact dermatitis (PACD) to benzophenone present in printing ink have been reported. However, precise chemical analyses and extended photo-patch tests have not been performed in these cases.Objectives: To determine which component present in a magazine cover are responsible for a patient's skin reaction, to determine the primary sensitizer, and precisely diagnose ACD and PACD.Methods: After initial photo-patch tests were performed on a patient with a history of reaction to magazine covers after sun exposure, gas chromatography-mass spectrometry and high-performance liquid chromatography analyses of the magazine covers, and additional photo-patch tests were performed.Results: The first photo-patch test results confirmed PACD to ketoprofen and fenofibrate and evoked PACD to the magazine covers. 4-methyl benzophenone (4-MBP) and 1-hydroxy-cyclohexyl-phenyl-ketone (1-HCPK) were found in the magazine cover. Additional photo-patch tests confirmed PACD to 1-HCPK and to benzophenone, and photo-aggravated ACD to 4-MBP. The primary sensitizer was ketoprofen.Conclusions: Benzophenones are present in a wide variety of products, without always being listed on the packaging. Patients previously sensitized to other ketones, such as ketoprofen, may react to benzophenones without being able to avoid contact with these molecules. New regulations may be needed for more efficient eviction advice.Highlights: Photoallergic contact dermatitis to covers of a magazine was diagnosed and thorough investigation was necessary to identify the haptens responsible. Chemical analyses of the covers revealed the presence of 4-methyl benzophenone (4-MBP) and 1-hydroxy-cyclohexyl-phenyl-ketone (1-HCPK) Photo-patch tests suggested photo-aggravation of contact dermatitis to 4-MBP and benzophenone, and photoallergy to 1-HCPK and ketoprofen. Ketoprofen was the most likely primary sensitizer.

Recently, aluminum chloride hexahydrate (ACH) 10.0% petrolatum (pet) was recommended for patch testing to detect aluminum contact allergy. Aluminum lactate (AL) may be as reliable a test substance as ACH.We aimed to investigate the frequencies of aluminum allergy when ACH and AL were used in patch testing consecutive patients.Petrolatum preparations of ACH 10.0% and AL 12.0% were added to the baseline series in 2010-2017. Aluminum chloride hexahydrate 10.0% pet was added to the children baseline series from July 1, 2012, to December 31, 2017.A total of 5448 patients were patch tested with the extended baseline series and 196 children with the extended children baseline series. Forty-eight of the 5448 adults (0.9%) and 10 of the 196 children (5.1%) were diagnosed with aluminum contact allergy. A significant difference was found between the aluminum allergy frequencies in children and adults patch tested with ACH in 2013-2017 (P0.001). The difference between the frequencies of contact allergies for the 2 aluminum salts is not statistically significant.Patch testing with ACH and AL demonstrated similar contact allergy frequencies. To detect aluminum allergy, patch testing with ACH 10.0% pet is recommended. Aluminum chloride hexahydrate 10.0% pet should be considered for inclusion in baseline series for patch testing adults and children.

Background Earlier laboratory studies have shown that sodium tetrachloropalladate, Myroxylon pereirae, caine mix II, and palladium chloride trigger the release of aluminium (Al) from Finn Chambers (FC). Objectives To investigate whether aluminium realease from FC could influence the diagnostic outcome of patch testing with FC. Method A retrospective analysis of patch test results from 2010 to 2019 was performed. A two-sided Fisher's exact test was used to calculate any overrepresentation of contact allergy to Al among patients with positive reactions to sodium tetrachloropalladate, Myroxylon pereirae, caine mix II, and palladium chloride. Results A total of 5446 patients had been tested with FC during the study period. There was a significant overrepresentation of contact allergy to Al among patients with positive reactions to sodium tetrachloropalladate, Myroxylon pereirae, caine mix II, and palladium chloride. Patients with a strong Al allergy had significantly higher amounts of concomitant reactions to sodium tetrachloropalladate, Myroxylon pereirae, caine mix II, and palladium chloride compared to patients with weak Al allergy. These results were not seen for patients tested with Finn Chambers AQUA. Conclusion In patients with contact allergy to Al, patch testing with Finn chambers could give false-positive reactions to sodium tetrachloropalladate, Myroxylon pereirae, caine mix II, and palladium chloride.

Background: The textile dye mix (TDM) 6.6% pet. contains Disperse Blue (DB) 35, Disperse Yellow 3, Disperse Orange (DO) 1 and 3, Disperse Red 1 and 17, and DB 106 and 124. The most frequent allergen in TDM-positive patients is DO 3. Around 85% of p-phenylenediamine (PPD)-allergic dermatitis patients have shown positive patch test reactions to DO 3. There has been a discussion to exclude DO 3 from TDM 6.6% because of frequent, strong reactions to TDM 6.6% and PPD. Objectives: To study if DO 3 can be omitted from a TDM. Methods: Patch tests were performed on 2250 dermatitis patients with TDM 6.6%, TDM 5.6% pet., TDM 7.0% pet., and PPD 1.0% pet.; 122 patients were also patch tested with DO 3 1.0% pet. Results: Among the 2250 patients patch tested, contact allergy prevalence to TDM 6.6% was 2.4%, to TDM 5.6% 1.8%, and to TDM 7.0% 2.0%. Of the 54 TDM 6.6%-positive patients, 55.6% reacted to PPD; as much as 42.2% of PPD-allergic women and 50% of PPD-allergic men reacted to TDM 6.6%. Of the 17 DO 3-positive patients, 94.1% showed a positive reaction to PPD. Conclusion: Results indicate that DO 3 can probably be omitted from TDM, but patch testing with TDM 6.6%, TDM 7.0%, DO 3 1.0%, and PPD 1.0% simultaneously is needed to finally decide whether it is possible or not. (Less)

There have been reports of allergic contact dermatitis in response to the plastic part of eyewear. Different substances have been identified as the causative allergens: Solvent Orange 60,1 methylisothiazolinone,2 and triethylene glycol bis(−2ethylhexanoate).3 Here we present the first known case of allergic contact dermatitis caused by CI Solvent Yellow 14 (CAS no. 842–07‐9) used in the plastic part of the glasses, in the temple tips.

SummaryBackground Toothpastes have widespread use in the population, and contain flavours used to give a pleasant and often minty aroma. Flavours are prevalent allergens in toothpastes, and adverse reactions often present as perioral dermatitis or stomatitis. l-Carvone, a mint flavour found in spearmint oil, is one of these allergens. There are few studies on contact allergy to l-carvone, and some of them have indicated a positive relationship with oral lichenoid lesions. Objectives To qualitatively and quantitatively investigate the presence of l-carvone in commercially available toothpastes on the Swedish market. Methods l-Carvone in 66 toothpastes was analysed with straight-phase high-performance liquid chromatography. The product labels were studied with regard to limonene. Results l-Carvone was found in 64 of 66 toothpastes (concentration: 0.00005–0.35%). In 10 of these, the concentration exceeded 0.1%. Higher concentrations of l-carvone were found if limonene was listed on the label. Conclusion The majority of toothpastes on the Swedish market contain l-carvone, but the concentration hardly relates to the advertised flavour or labelled ingredients. It is hitherto unknown whether the found concentrations are sufficient for induction of contact allergy in individuals with healthy oral mucosa or in those with oral lichenoid lesions or other mucosal disease.

Background: In 2001, the EU nickel directive was introduced to prevent contact allergy to nickel. Contact allergy to palladium and/or cobalt is often seen together with contact allergy to nickel. Objectives: To compare the contact allergy prevalence of nickel, palladium, and cobalt allergy before and after the introduction of the EU nickel directive in consecutive patients with dermatitis. Methods: A retrospective analysis of patch test results from 1995–2016 was performed (n = 18 264). Chi-square tests were used to examine trends for nickel, palladium, and cobalt across test years. Logistic regression was used for associations. Results: The prevalence of nickel allergy decreased significantly in the youngest age group (6–30 years) for both female and male patients from 1995–1999 to 2012–2016: females: 33.4% to 19.1% (P

Background Ultraviolet (UV)-curing nail polishes based on acrylates or methacrylates are currently also available for non-professional use. The Swedish Medical Products Agency recently prohibited one brand of UV-curing polish, because several consumers reported undesirable effects after using it. Objectives To investigate whether consumers with undesirable effects after using the UV-curing nail polish that was later prohibited were contact allergic to the polish and its individual ingredients. Materials/methods Eight patients who had reported severe skin reactions after the use of the UV-curing polish were patch tested with two coatings of the nail polish and its ingredients at five dermatology departments in Sweden. Results All patients tested except one showed contact allergic reactions to one or several of the acrylate-based or methacrylate-based ingredients in the nail polish. Conclusions The non-professional use of UV-curing nail polishes poses a risk of sensitization from acrylates and methacrylates.

Carvone (l-carvone), a mint flavour in spearmint oil, is considered a mild skin sensitizer. Carvone-sensitization may be linked to oral/perioral signs and oral lichen planus, but studies are sparse. The prevalence of patch test reactions to carvone and relevant findings from the positive group were investigated. Records for patch-tested patients at the Malmö clinic, for the period 1996 to 2016, were studied. Carvone-positive and carvone-negative patients were compared regarding patch test data from baseline series and dental series. Dental series-tested carvone-positive patients were also compared with a matched group. A total of 147 out of 4,221 referred patients had a positive patch test to carvone. Sensitized patients had higher mean age and were primarily women; 73% had oral signs and 57% had oral lichen. Concomitant patch test reactions to gold, nickel and mercury were common. In the matched group-comparison carvone-positive patients had a higher frequency of oral lichen, but no difference was found in sensitization to gold and mercury.

The possible impact of metal release from coronary artery stents has, with their increased use, become a concern.

Trifluoroacetic acid is a very strong carboxylic acid. The acid has been suspected to have similar toxic effects as hydrofluoric acid on skin contact. Hydrofluoric acid is highly toxic, owing to skin penetration by fluoride ions. A spill of hydrofluoric acid on the skin may be fatal. As trifluoroacetic acid contains fluorine, patients with chemical burns caused by trifluoroacetic acid have been given particular attention when treated in the hospital.

For investigation of chemical exposure in allergic individuals, spot tests are invaluable. A reagent may react with a specific compound to give a specific typical colour, and thus indicate the presence of the specific substance. Spot tests can give both false-negative and false-positive reactions. To confirm the presence of the substance and quantify it, more sophisticated methods are required. On the basis of a positive cobalt spot test result, a woman was initially diagnosed with an occupational allergic contact dermatitis caused by cobalt.

Toothpastes have widespread use in the population, and contain flavours to give a pleasant and often minty aroma. Flavours are prevalent allergens in toothpastes, and adverse reactions often present as perioral dermatitis or stomatitis. l-Carvone, a mint flavour found in spearmint oil, is one of these allergens. There are few studies on contact allergy to l-carvone, and some of them have indicated a positive relationship with oral lichenoid lesions.To qualitatively and quantitatively investigate the presence of l-carvone in commercially available toothpastes on the Swedish market.l-Carvone in 66 toothpastes was analysed with straight-phase high-performance liquid chromatography. The product labels were studied with regard to limonene.l-Carvone was found in 64 of 66 toothpastes (concentration: 0.00005-0.35%). In 10 of these, the concentration exceeded 0.1%. Higher concentrations of l-carvone were found if limonene was listed on the label.The majority of toothpastes on the Swedish market contain l-carvone, but the concentration hardly relates to the advertised flavour or labelled ingredients. It is hitherto unknown whether the found concentrations are sufficient for induction of contact allergy in individuals with healthy oral mucosa or in those with oral lichenoid lesions or other mucosal disease.

Ultraviolet (UV)-curing nail polishes based on acrylates or methacrylates are currently also available for non-professional use. The Swedish Medical Products Agency recently prohibited one brand of UV-curing polish, because several consumers reported undesirable effects after using it.To investigate whether consumers with undesirable effects after using the UV-curing nail polish that was later prohibited were contact allergic to the polish and its individual ingredients.Eight patients who had reported severe skin reactions after the use of the UV-curing polish were patch tested with two coatings of the nail polish and its ingredients at five dermatology departments in Sweden.All patients tested except one showed contact allergic reactions to one or several of the acrylate-based or methacrylate-based ingredients in the nail polish.The non-professional use of UV-curing nail polishes poses a risk of sensitization from acrylates and methacrylates.

Octocrylene is an ultraviolet (UV)B and UVAII absorber that was introduced some 15 years ago, and is now widely used in sunscreen agents and skin care cosmetics. Since 2003, several studies, notably from France, Belgium, Spain, and Italy, have reported an increasing number of patients with photocontact allergy to octocrylene. This reaction is seen mainly in adult patients who have previously used topical products containing the non-steroidal anti-inflammatory drug ketoprofen. Photosensitization to ketoprofen leads, in many cases, to photocontact allergy to octocrylene; the mechanism of this reaction is unknown. Contact allergy to octocrylene also occurs, but is far less frequent, and is seen, in most cases, in children, resulting from the use of octocrylene-containing sunscreen products. In this article, (photo)contact allergy to octocrylene is fully reviewed.

Determination of airborne isocyanates as di-n-butylamine derivatives using liquid chromatography and tandem mass spectrometry

An air sampling method for the determination of isocyanates, aminoisocyanates and amines formed during the thermal degradation of polyurethane (PUR) is presented. The method is based on the collection of air samples using impinger flasks containing di-n-butylamine (DBA) in toluene with a glass fibre filter in series. Isocyanates are derivatized with DBA to urea derivatives, and amines are derivatized in a subsequent work-up procedure with ethyl chloroformate (ET) to carbamate esters. Amine, aminoisocyanate and isocyanate derivatives were characterized using liquid chromatography-time of flight mass spectrometry (LC-TOFMS) and liquid chromatography-chemiluminescent nitrogen detection (LC-CLND). Quantification was performed by LC-MS, monitoring molecular ions [MH]+ in the electrospray mode. The instrumental detection limits for amines, aminoisocyanates and isocyanates were in the ranges 30–40, 2–3 and 3–70 fmol, respectively. Thermal degradation products of PUR were observed in high concentrations during welding in district heating pipes and PUR-coated metal sheets. Eleven isocyanates, three amines and five aminoisocyanates were identified. The concentrations of isocyanates, aminoisocyanates and amines in samples collected in the smoke close to the welding spot were in the ranges 150–650, 4–290 and 1–70 ppb, respectively. In samples collected in the breathing zone, isocyanates and aminoisocyanates were observed in the ranges 9–120 and 4–19 ppb, respectively. The compounds were present in both gas and particle phases. Volatile compounds dominated in the gas phase, whereas less volatile compounds dominated in the particle phase. The method presented makes it possible to sample and determine amines and aminoisocyanates, in addition to isocyanates. The need to monitor these compounds is clearly illustrated by the high concentrations found during the thermal degradation of PUR.

Rubber accelerators are common contact allergens in healthcare personnel, owing to exposures from medical gloves.To analyse glove extracts used for patch testing for the presence of guanidine-type accelerators, and to describe the results of patch testing with triphenylguanidine (TPG) in 2 cases of contact allergy and with TPG added to the rubber series.Gas chromatography-mass spectrometry and liquid chromatography with ultraviolet detection were used for analysis of glove extracts. Patch tests were performed with guanidine accelerators detected in the extracts.TPG, an accelerator not previously reported as being present in rubber gloves, was found in the glove extracts. Patch testing with TPG showed relevant contact allergic reactions in patients with hand dermatitis caused by rubber gloves.Chemical analysis of extracts for patch testing is important in the identification of new possible allergens. In this case, a rubber accelerator previously not reported as a possible contact allergen was found in extracts of surgical gloves.

The performance of a dry sampler, with an impregnated denuder in series with a glass fibre filter, using di-n-butylamine (DBA) for airborne isocyanates (200ml min(-1)) is investigated and compared with an impinger flask with a glass fibre filter in series (1 l min(-1)). An exposure chamber containing 1,6-hexamethylene diisocyanate (HDI), isophorone diisocyanate (IPDI), and 2,4- and 2,6-toluene diisocyanate (TDI) in the concentration range of 5-205 μg m(-3) [0.7-33 p.p.b.; relative humidity (RH) 50%], generated by gas- and liquid-phase permeation, was used for the investigation. The precision for the dry sampling for five series with eight samplers were in the range of 2.0-6.1% with an average of 3.8%. During 120-min sampling (n = 4), no breakthrough was observed when analysing samplers in series. Sixty-four exposed samplers were analysed after storage for 0, 7, 14, and 21 days. No breakdown of isocyanate derivatives was observed. Twenty-eight samplers in groups of eight were collecting isocyanates during 0.5-32h. Virtually linear relationships were obtained with regard to sampling time and collected isocyanates with correlation coefficients in the range of 0.998-0.999 with the intercept close to the origin. Pre- or post-exposure to ambient air did not affect the result. Dry sampling (n = 48) with impinger-filter sampling (n = 48) of thermal decomposition product of polyurethane polymers, at RH 20, 40, 60, and 90%, was compared for 11 isocyanate compounds. The ratio between the different isocyanates collected with dry samplers and impinger-filter samplers was in the range of 0.80-1.14 for RH = 20%, 0.8-1.25 for RH = 40%, 0.76-1.4 for RH = 60%, and 0.72-3.7 for RH = 90%. Taking into account experimental errors, it seems clear that isocyanic acid DBA derivatives are found at higher levels in the dry samples compared with impinger-filter samplers at elevated humidity. The dry sampling using DBA as the reagent enables easy and robust sampling without the need of field extraction.

For investigation of chemical exposure in allergic individuals, spot tests are invaluable. A reagent may react with a specific compound to give a specific typical colour, and thus indicate the presence of the specific substance. Spot tests can give both false-negative and false-positive reactions. To confirm the presence of the substance and quantify it, more sophisticated methods are required. On the basis of a positive cobalt spot test result, a woman was initially diagnosed with an occupational allergic contact dermatitis caused by cobalt.To investigate cobalt release from three different metal weaves to which our patient was occupationally exposed.The cobalt gel test and atomic absorption spectroscopy (AAS) were used to investigate the metal weaves. Two types of extract based on artificial sweat and nitric acid, respectively, were investigated with AAS.No cobalt release was demonstrated with AAS.When a diagnosis of allergic contact dermatitis caused by a sensitizer based on a positive spot test result will have far-reaching consequences, such as change of work, retraining, and claim on and payment of worker's compensation, conformational analysis must be performed.

Trifluoroacetic acid is a very strong carboxylic acid. The acid has been suspected to have similar toxic effects as hydrofluoric acid on skin contact. Hydrofluoric acid is highly toxic, owing to skin penetration by fluoride ions. A spill of hydrofluoric acid on the skin may be fatal. As trifluoroacetic acid contains fluorine, patients with chemical burns caused by trifluoroacetic acid have been given particular attention when treated in the hospital.To gather the known cases of trifluoroacetic acid burns from our department to give an overview of how they were exposed, the clinical presentation, and treatment.Five patients with chemical skin burns caused by trifluoroacetic acid were reviewed with regard to the extent of the burn, treatment, blood samples taken, and systemic effects.The chemical burns reported were limited (1% of the total body surface). The burns healed as expected for chemical burns caused by acids. None of the patients showed any symptoms or signs that are typical for hydrofluoric acid burns.Localized chemical burns caused by trifluoroacetic acid should be regarded as being similar to burns from other acids, with the exception of hydrofluoric acid. To our knowledge, there are no indications that trifluoroacetic acid causes the same toxic effects as hydrofluoric acid.

In some industries, the temperature and the humidity will vary greatly between different work places, such as outdoor work in arctic or tropical climates. There is therefore a need to test respirator filters at conditions that simulate conditions that are relevant for the industries that they are used in. Filter cartridges were exposed to controlled atmospheres of varying isocyanate concentration, air humidity, and temperature in an exposure chamber. For isocyanic acid (ICA) and methyl isocyanate (MIC), the exposure concentrations were between 100 and 200 p.p.b., monitored using a proton transfer reaction mass spectrometer. ICA and MIC were generated by continuous thermal degradation of urea and dimethylurea. The breakthrough was studied by collecting air samples at the outlet of the filter cartridges using impinger flasks or dry samplers with di-n-butylamine as derivatization reagent for isocyanates followed by liquid chromatography tandem mass spectrometry (LC-MS/MS) analysis. For hexamethylene diisocyanate (HDI) and isophorone diisocyanate (IPDI), the exposure concentrations were between 4 and 20 p.p.b. and were generated by wet membrane permeation. To reveal the profile of adsorption in different layers of the respirator filters, representative samples from each of the layers were hydrolyzed. The hydrolysis products hexamethylene diamine and isophorone diamine were determined after derivatization with pentafluoropropionic anhydride (PFPA) followed by LC-MS/MS analysis. The two filter types studied efficiently absorbed both ICA and MIC. There was no trend of impaired performance throughout 48-h exposure tests. Even when the filters were exposed to high concentrations (approximately 200 p.p.b.) of ICA and MIC for 96 h, the isocyanates were efficiently absorbed with only a limited breakthrough. The majority of the HDI and IPDI (>90%) were absorbed in the top layers of the absorbant, but HDI and IPDI penetrated farther down into the respirator filters during 120 h of exposure as compared to 16 h exposure.

Isocyanates in the workplace atmosphere are typically present both in gas and particle phase. The health effects of exposure to isocyanates in gas phase and different particle size fractions are likely to be different due to their ability to reach different parts in the respiratory system. To reveal more details regarding the exposure to isocyanate aerosols, a denuder-impactor (DI) sampler for airborne isocyanates was designed. The sampler consists of a channel-plate denuder for collection of gaseous isocyanates, in series with three-cascade impactor stages with cut-off diameters (d(50)) of 2.5, 1.0 and 0.5 mum. An end filter was connected in series after the impactor for collection of particles smaller than 0.5 mum. The denuder, impactor plates and the end filter were impregnated with a mixture of di-n-butylamine (DBA) and acetic acid for derivatization of the isocyanates. During sampling, the reagent on the impactor plates and the end filter is continuously refreshed, due to the DBA release from the impregnated denuder plates. This secures efficient derivatization of all isocyanate particles. The airflow through the sampler was 5 l min(-1). After sampling, the samples containing the different size fractions were analyzed using liquid chromatography-mass spectrometry (LC-MS)/MS. The DBA impregnation was stable in the sampler for at least 1 week. After sampling, the DBA derivatives were stable for at least 3 weeks. Air sampling was performed in a test chamber (300 l). Isocyanate aerosols studied were thermal degradation products of different polyurethane polymers, spraying of isocyanate coating compounds and pure gas-phase isocyanates. Sampling with impinger flasks, containing DBA in toluene, with a glass fiber filter in series was used as a reference method. The DI sampler showed good compliance with the reference method, regarding total air levels. For the different aerosols studied, vast differences were revealed in the distribution of isocyanate in gas and different particle size fractions. The opportunity to obtain detailed information regarding the distribution of isocyanates in aerosols in addition to the total air levels make the DI sampler a valuable tool for studies of possible health effects in the different parts of the airways.

A new type of isocyanate sampler has been used to investigate aging aerosols generated during thermal degradation of polyurethane (PUR). The sampler consists of a denuder connected in series with a three-stage cascade impactor and a filter. The denuder collects gas-phase isocyanates. The three impactor stages had cut-off diameters (d(50)) of 2.5, 1.0 and 0.5 mum, respectively. The end filter collects particles0.5 mum. For derivatization of isocyanates in the sampler, di-n-butylamine mixed with an equimolar amount of acetic acid was used for impregnation of the sampler stages. Consecutive sampling using three denuder-impactor samplers was performed in a test chamber, with a total sampling time of 9 min. Analysis of air samples was performed using liquid chromatography-mass spectrometry (LC-MS)/MS. Particle size measurements were performed using a scanning mobility particle sizer (SMPS). A time-dependent behavior was observed for aromatic diisocyanates during aging of the aerosol. Thermal degradation of different PUR materials showed different distribution of isocyanates between gas and particles. Aromatic diisocyanates (toluene diisocyanate (TDI) and methylene diphenyl diisocyanate) were initially in gas phase and associated to very small particles. After a few minutes most of these isocyanates were associated with particles1 mum. Monoisocyanates and hexamethylene diisocyanate (HDI) were not found to be associated with particles.

An air sampling method for simultaneous determination of organic acid anhydrides and isocyanates is presented. Air samples are collected in impinger flasks filled with 0.01 M di-n-butylamine (DBA) in a mixture of toluene-acetonitrile (7:3, v/v) with a 13 millimetre glass fibre filter in series. The amount of anhydrides and isocyanates are determined as their amide and urea derivatives using LC-MS. Four anhydrides, maleic anhydride (MA), phthalic anhydride (PA), tetrahydrophthalic anhydride (TA) and cis-hexahydrophthalic anhydride (HA) and 11 isocyanates could be separated in 9 minutes using gradient elution. Anhydride-DBA derivatives in standard solutions were quantified using LC with chemiluminescent nitrogen detection (CLND). Anhydride-DBA derivatives were found to be stable for at least two months when stored in acetonitrile or toluene in the freezer. The yield of DBA derivatives of anhydrides in the 0.01 M DBA in toluene-acetonitrile (7:3, v/v) was in the range of 70-95%. Using MS and negative electrospray ionisation (ES-) linear calibrations curves were obtained for the anhydrides with correlation coefficients ranging from 0.9970-0.9997. The instrumental detection limit for the anhydrides ranged from 10-30 fmol, based on a signal to noise root mean square (RMS) ratio of 3. Monitoring positive and negative ions simultaneously, both isocyanates and anhydrides could be determined as their DBA derivatives in the same chromatographic run. When air samples were collected during thermal degradation of different coated metal sheets both anhydrides and isocyanates were present in the same samples and all the studied anhydrides were found.