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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.

BACKGROUND: Contact allergy to fragrance mix I (FM I) is over-represented in patients photoallergic to ketoprofen. The prevalence of contact allergy to two components of FM I, cinnamal and cinnamyl alcohol, in ketoprofen-photoallergic patients is higher than in dermatitis patients.OBJECTIVE: To explore the prevalence of contact allergy to FM I and its individual components in patients with photocontact allergy to ketoprofen, and to compare with a dermatitis and the general population.METHODS: Data on patch and photopatch tests performed between 2009-2018 were collected. Ketoprofen-photoallergic patients were compared with dermatitis patients and published data on the general population regarding the prevalence and the distribution of contact allergy to FM I and its components.RESULTS: A higher prevalence of contact allergy to cinnamyl alcohol compared to cinnamal (23.3% vs 10.0%), and eugenol compared to isoeugenol (23.3% vs 6.7%), was observed in ketoprofen-photoallergic patients, while the relationship was the opposite in dermatitis group (0.7% vs 1.05%; 0.4% vs 0.9%). Overall prevalence of contact allergy to several components of FM I was significantly higher in ketoprofen-photoallergic patients.CONCLUSIONS: Contact allergy to FM I and many of its components is over-represented in patients photoallergic to ketoprofen compared to dermatitis patients and the general population. This article is protected by copyright. All rights reserved. (Less)

Background: Non-occupational cases of contact dermatitis to finished wood are occasionally reported from contact with wooden jewellery, musical instruments, knife handles and wooden footwear. Two female patients, 26 and 34 years old, developed acute eczema on the wrists after they worn in the summer a kind of catholic bracelet called “memorabilia” made by single wooden chunks with over-impressed iconic religious images. Objectives: To identify the culprit photoallergen responsible for the reported adverse reactions suspected to be a compound of the wooden bracelets. Methods: Three months after the resolution of the dermatitis, patch test and photo-patch tests were performed with the S.I.D.A.P.A. (Italian Society of Allergic, Occupational and Environmental Dermatology) standard series, and with wood sawdust obtained from both bracelets and tested at 5% in pet. A thin-layer chromatogram (TLC) strip and an extract made from the bracelets were tested in both the patients as patch test and photo-patch test. The extracts of the wooden bracelets were analyzed by gas chromatography – mass spectrometry (GC-MS). Results: Patch tests and photo-patch test with standard series turned out negative. Photo-patch tests with wood sawdust in pet. 5% evidenced a positive reaction (++) in both patients. Two chemicals were detected in the wooden bracelets with GC-MS: dibutylphthalate, commonly used as plasticizer, and 8,8-dimethyl-2H,8H-benzo[1,2-b:3,4-b']dipyran-2-one, a coumarin. Patch test with TLC did not elicit positive reactions but the photo-patch test with TLC gave positive reactions in both the patients to the same invisible spot on the strips. Two coumarins (8,8-dimethyl-2H,8H-benzo[1,2-b:3,4-b']dipyran-2-one and 8,8-dimethyl-2H,8H-benzo[1,2-b:5,4-b']dipyran-2-one) were detected in the spot with GC-MS. Conclusion: Coumarins are chemicals found in many plants with a known photo-allergic potential. They are probably the main photo-allergens in religious wooden bracelets instead of quinones and psoralens hypothesized in previous reports.

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.

Background: The animal assay Guinea Pig Maximization Test (GPMT) uses Freund’s complete adjuvant (FCA) to enhance the dermal sensitization in the animals. In a previous study, the degree of sensitization when investigating diphenylmethane-4,4′-diisocyanate (4,4′-MDI) varied. 4,4′-MDI is known to be a reactive diisocyanate and concern was risen that its instability and reaction with FCA might affect the outcome. Objectives: To investigate the stability of 4,4′-MDI and its possible reaction with components in FCA. Methods: The same preparations as used in the GPMT were prepared, i.e. 1.0% w/v 4,4ʹ-MDI in FCA/paraffin oil (40/60 v/v) and stored under different conditions for 48 hours. The content of 4,4′-MDI in both FCA/paraffin oil mixtures as well as in samples of pure substance were monitored by chemical analysis using gel permeation chromatography (GPC). Results: The 4,4′-MDI content in pure substance can decrease substantially within a few months. A rapid decrease in 4,4′-MDI concentration was also seen in 4,4′-MDI/FCA preparations stored in refrigerator and room temperature. Conclusion: The outcome of 4,4ʹ-MDI sensitization in GPMT might be affected by the instability of the pure substance as well as its reaction with FCA. Major effects can be expected if these two factors are interacting. Hence, fresh 4,4ʹ-MDI should be used and preparations of induction substances should be prepared in close connection to the intradermal injection.

Several disperse dyes (DDs) are still considered to be the most important allergens in textile dermatitis, but there are sparse data about their current use in textiles. The aim of this review was to evaluate published studies and reports on contact allergy to DDs published in PubMed during the last 22 years (1990-2012). Prevalence data are provided by study and by dye, as well as by the described clinical peculiarities of DD dermatitis. We reviewed 54 studies. In total, 26 DDs were tested. The average prevalence in screening studies was >1% for Disperse Blue 106, Disperse Blue 124, and Disperse Orange 3. There is a lack of data on patch testing with Disperse Blue 26, Disperse Blue 102, Disperse Orange 37, Disperse Orange 149, Disperse Yellow 23 and Disperse Yellow 49, which are listed as allergens by the EU Commission. It is necessary to check the purity and identity of dyes used for patch testing, confirm the clinical relevance of positive reactions by patch testing with suspected textiles, and, if the results are positive, determine the culprit dye.

Introduction . Disturbed indoor climate may in some cases be associated with illness. In the present paper, we report the results from a thorough investigation of office workers in Greenland, who developed skin and/or airway problems after moving into renewed offices. Material and methods . In 2009 the office of the Bank of Greenland had a total renovation of the building, including new furniture and carpets. Symptoms developed within the first year after moving back into the renewed buildings. After removal of carpets in the building, symptoms significantly improved. Workers were examined in 2009 and re-examined in 2013, including clinical examination, patch test and when relevant also skin prick tests and histamine release test. Isothiazolinones and fumarates, both able to cause airway as well as skin symptoms, were isolated from carpets before testing, and included in the test series. Results . In total, 32 out of 80 workers (40%) developed symptoms; 27 reported eczema, 20 rhinitis and 4 urticaria. Eczema was located on the hands and/or lower arms in 18 workers, on the face in 10 workers and on legs/trunk in 12 workers. After intervention in the office, 22 workers with eczema reported significant improvement, all cases of hand eczema cleared and 16 workers with rhinitis also improved. Positive patch tests to carpet extracts were found significantly more frequent in the worker cohort than in a control group comprising 47 dermatitis patients (p

Atranol and chloroatranol are strong contact allergens in oak moss absolute, a lichen extract used in perfumery. Fifteen subjects with contact allergy to oak moss absolute underwent a repeated open application test (ROAT) using solutions of an untreated oak moss absolute (sample A) and an oak moss absolute with reduced content of atranol and chloroatranol (sample B). All subjects were in addition patch-tested with serial dilutions of samples A and B. Statistically significantly more subjects reacted to sample A than to sample B in the patch tests. No corresponding difference was observed in the ROAT, though there was a significant difference in the time required to elicit a positive reaction. Still, the ROAT indicates that the use of a cosmetic product containing oak moss absolute with reduced levels of atranol and chloroatranol is capable of eliciting an allergic reaction in previously sensitised individuals.

Background. To investigate the dermal uptake of 4,4'-diphenylmethane diisocyanate (4,4'-MDI), a study was performed in which 2 female volunteers were exposed to 10 and 25 mg, respectively, of 4,4'-MDI by applying 2.0% 4,4'-MDI in petrolatum over areas where the surface concentration corresponded to 800 µg/cm(2) . Ten days later, they developed eczematous dermatitis at the area of application. Objectives. To investigate whether the dermal application caused active sensitization to 4,4'-MDI. Methods. Chemical analysis of the 4,4'-MDI preparation used in the application and the amount of 4,4'-MDI not absorbed by the skin was performed with liquid chromatography-mass spectrometry. The volunteers were tested with serial dilutions of 4,4'-MDI and the potentially cross-reacting substances 4,4'-diaminodiphenylmethane (4,4'-MDA), p-phenylenediamine (PPD), and dicyclohexylmethane-4,4'-diisocyanate (DMDI). Results. Patch test results suggested that the volunteers were actively sensitized to 4,4'-MDI following the dermal uptake study, as they reacted positively to 4,4'-MDA, a marker for 4,4'-MDI allergy. No positive reactions were seen to PPD or DMDI. Chemical investigation confirmed that the correct concentration had been used for the dermal uptake study, and showed that about 70% of the applied 4,4'-MDI was not absorbed. Conclusions. A dermal uptake study with 4,4'-MDI in 2.0% pet. with an occlusion time of 8 hr induced active sensitization to 4,4'-MDI and subsequently to 4,4'-MDA.

Disperse dyes are the most common contact sensitizers among textile dyes. The main aim of this study was to investigate the outcome of patch testing with a textile dye mix 6.6%. A total of 2,049 patients from Sweden and 497 from Belgium were tested with the mix, consisting of Disperse (D) Blue 35, D Yellow 3, D Orange 1 and 3, D Red 1 and 17, 1.0% each, and D Blue 106 and D Blue 124, 0.3% each. Of the total number, 65 patients, 2.6%, tested positively to the mix, 4.2% of the Belgian patients and 2.1% of the Swedish patients. Patch testing with the mix 6.6% revealed significantly more patients with contact allergy compared with testing with a previous mix 3.2% (p

BACKGROUND: Disperse dyes (DDs) are the most common sensitizers among textile dyes, but there is little knowledge of the clinical relevance of positive patch test reactions. OBJECTIVE: To investigate if patient-reported textile-related skin problems can be explained by contact allergy to eight different DDs and/or to chemically related substances, by occupation or by atopic constitution, and if the skin problems are influenced by age or sex. METHODS: A questionnaire on textile-related skin problems was answered by 858 of 982 consecutively patch tested patients in Malmö, Sweden and in Leuven, Belgium. The baseline series used for patch testing was supplemented with a textile dye mix (TDM) consisting of the eight DDs and with the separate dyes. The association between textile-related skin problems and contact allergy to the DDs and other risk factors was investigated using multiple logistic regression analysis. RESULTS: Eighteen per cent of the patients suspected textiles as a cause of their skin problems. Atopic constitution and female sex were risk factors for skin reactions. Synthetic materials were the most common textiles to give skin problems. A significant association was found between self-reported textile-related skin problems and contact allergy to para-phenylenediamine (PPD) [adjusted odds ratio (OR) 2.1; 95% confidence interval (CI) 1.0-4.3]. A similar, but more imprecise, adjusted OR was found for TDM (OR 1.9; 95% CI 0.57-5.6). Contact allergy to black rubber mix was too rare to be evaluated. CONCLUSIONS: Contact allergy to PPD was a more prevalent indicator for skin reactions to textiles than the TDM used in this study. ispartof: British Journal of Dermatology vol:160 issue:1 pages:107-115 ispartof: location:England status: published

Contact allergy to disperse dyes in textiles is documented in prevalence studies from southern Europe. To evaluate the prevalence of allergic patch test reactions to different textile dyes in southern Sweden, and to look at the sites of dermatitis in individuals hypersensitive to textile dyes, we retrospectively investigated 3325 consecutively patch-tested patients. They had all been patch tested with the standard test series supplemented with a textile dye mix (TDM) consisting of 8 disperse dyes, i.e. Disperse (D) Blue 35, 106 and 124, D Yellow 3, D Orange 1 and 3 and D Red 1 and 17. All but 3 of the TDM-positive patients were additionally tested with the separate dyes included in the mix. The frequency of contact allergy to TDM was 1.5%, which is comparable with studies from southern Europe. The most common dye allergen was D Orange 1. The high prevalence of allergic reactions to D Orange 1 was unexpected, whereas test reactions to D Blue 106 and 124 were lower than expected from other studies. Compared to all tested patients, the TDM-positive patients more often had dermatitis on their arms, face, neck and axillary folds, and women also had a higher frequency of hand dermatitis.

Diglycidyl ether of bisphenol A (DGEBA) is the monomer and main allergen in the most common epoxy resin, DGEBA-R. Epoxy resin(s) based on bisphenol F (DGEBF-R) contains the 3 isomers of the diglycidyl ether of bisphenol F. Contact allergy to these isomers (p,p'-DGEBF, o,p'-DGEBF and o,o'-DGEBF) has not previously been described in humans. To investigate contact allergies to the DGEBF isomers in patients with contact allergy to DGEBF-R, 9 patients were patch-tested with dilution series of the isomers. All 9 were found to have contact allergy to p,p'-DGEBF and 7/9 to o,p'-DGEBF. Additionally, of 20 workers employed in epoxy-based manufacture and with contact allergy to DGEBA-R and DGEBF-R, 18 reacted to p,p'-DGEBF and 15/20 to o,p'-DGEBF. According to a guinea pig maximization test, all 3 DGEBF isomers are strong sensitizers. Still, o,o'-DGEBF elicited only 3 positive reactions in all participants.

Contact allergy to p-tert-butylphenol-formaldehyde resin is not rare. This resin consists of a large number of substances, most of which are unknown. For diagnostic and preventive reasons, the chemical identity of the sensitizers should be known as well as their sensitizing capacities, cross-reaction patterns and presence in the environment. The aim of this study was to investigate the sensitizing capacities and cross-reaction patterns for 5-tert-butyl-2-hydroxy-3-hydroxymethyl-benzaldehyde and 5-tert-butyl-2-hydroxy-benzaldehyde in the guinea pig maximization test. 2,6-Dimethylol p-tert-butylphenol, p-tert-butylcate chol, 2-methylol p-tert-butylphenol, p-tert-butylphenol, 4-tert-butyl-2-(5-tert-butyl-2-hydroxy-3-hydroxymethyl-benzyloxymethyl)-6-hydroxymethyl-phenol and 4-tert-butyl-2-(5-tert-butyl-2-hydroxy-benzyloxymethyl)-phenol were used as potential cross-reacting substances. 5-tert-Butyl-2-hydroxy-3-hydroxymethyl-benzaldehyde was shown to be a sensitizer (p = 0.041). In animals induced with this compound no cross-reactions to the putative cross-reacting substances were seen. In contrast, 5-tert-butyl-2-hydroxy-benzaldehyde failed to induce sensitization and no cross-reactions were detected.

A particular phenol-formaldehyde resin of the resol type (P-F-R-2) was shown in a previous study to be a good tracer of patients with contact allergy to phenol-formaldehyde resins. Eleven patients with sensitivity to P-F-R-2 participated in the study in which chromatographically separated fractions of P-F-R-2 were patch tested. This procedure was repeated until a positive reaction to a single substance was noted. In this study 3 new sensitizers are reported. Investigations by mass spectrometry and nuclear magnetic resonance spectrometry identified the compounds to be 4,4′-dihydroxy-3-(hydroxymethyl)-diphenyl methane (4,4′-H-3-HPM), 4,4′-dihydroxy-3,3′-di-(hydroxymethyl)-diphenyl methane (4,4′-H-3,3′-HPM), and 4,4′-dihydroxy-3,5-di-(hydroxymethyl)-diphenyl methane (4,4′-H-3,5-HPM). Six of the 11 patients reacted to at least one of these compounds. All 6 patients reacted to 4,4′-H-3,3′-HPM and 5 reacted simultaneously to 4,4′-H-3-HPM. Four patients reacted to all 3 compounds tested. By patch testing with serial dilutions (ethanol 99.5%) of the three 4,4′-H-HPM, positive reactions were noted down to 0.5 × 10 −6 %, 1.0 × 10 −6 %, and 1.3 × 10 −3 % w/v for 4,4′-H-3-HPM, 4,4′-H-3,3′-HPM, and 4,4′-H-3,5-HPM, respectively.