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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 oxidized (ox.) linalool and ox. limonene has been reported to have a high prevalence, raising the question of inclusion into the baseline series. However, several important issues should be clarified and further investigated before inclusion can be warranted.OBJECTIVES: To report the trends of ox. terpenes allergy in patients with dermatitis, features of the patch test reactions, and clinical characteristics of the patients.METHODS: A retrospective analysis of 5773 patients was performed. All patients were patch tested with baseline series, individual ingredients of fragrance mix I and II, ox. linalool, and ox. limonene from 2013 to 2020.RESULTS: The prevalence rates of contact allergy to ox. linalool and ox. limonene were 7.0% and 5.1%, respectively. Significantly increasing trends of contact allergy were observed. More than 95% of contact allergy cases were identified on Day 3/4. Patients with contact allergy to ox. linalool and ox. limonene were significantly younger than those with contact allergy to other fragrances and were predominantly female. Strong reactions were associated with older age and multiple fragrance allergies.CONCLUSIONS: Contact allergy to ox. linalool and ox. limonene is becoming increasingly important, and findings show intriguing features. More studies concerning the clinical relevance before recommending these substances for screening are required. (Less)

Background: 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.

Background: We observed an increasing number of patients who presented with facial or retro-auricular dermatitis after skin contact with plastic spectacles or plastic covered temples. Objectives: To identify the allergens in plastic spectacles that may cause allergic contact dermatitis. Methods: All patients with suspected allergic contact dermatitis to eyewear were tested with Solvent Orange 60 (SO60), four additionally with Solvent Yellow 14 (SY14), and five with scrapings from their own spectacles. In one case, a chemical analysis of the spectacles was performed to uncover the causative allergen. Results: Three patients were allergic to SO60, two patients to SY14, and two patients were allergic to both SO60 and SY14. Conclusion: Patients with suspected allergic contact dermatitis from spectacles should be tested with SO60 and SY14, and based on findings from previous reports, also with Solvent Red 179.

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.

International audience; Background: Different textile constituents may act as allergens and/or irritants and provoke textile contact dermatitis (TCD).Objectives: To report a case of TCD caused by ethylene glycol monododecyl ether and 2.4-dichlorophenol present in a bikini.Methods: A woman presented with an eczematous, pruritic rash in the area of the straps and back. Patch testing was performed with the European baseline, textile, sunscreen and photo-patch series, the bikini “as is”, and ethanol and acetone extracts of the bikini. Thin-layer chromatography (TLC) of the extracts and gas chromatography-mass spectrometry (GC-MS) analysis were used to elucidate the culprit agents.Result: Positive reactions were found to the bikini “as is”, and to the ethanol and acetone extracts. Patch testing with TLC strips showed a strong reaction to particular fractions (3 and 4). GC-MS was performed to identify substances in each fraction, and those suspected to be skin sensitizers were patch tested. On day 4 (D4) positive reactions to ethylene glycol monododecyl ether (IR) and 2.4-dichlorophenol (++) were observed.Conclusion: A myriad of chemical compounds can be found in clothing. Ethylene glycol monododecyl ether and 2.4-dichlorophenol were identified as the potential culprits of this bikini TCD.

Background 1,6‐Hexanediol diacrylate (1,6‐HDDA) is a multifunctional acrylate and a potent sensitizer. Objectives To report a case of allergic contact dermatitis caused by 1,6‐HDDA in a hospital wristband. Methods A male patient presented with eczema on his wrist where he had worn a hospital wristband. Patch testing was performed with our extended European baseline series, additional series, and pieces of the hospital wristband. Thin‐layer chromatography (TLC) was performed with extracts from the wristband and gas chromatography‐mass spectrometry was used for chemical analysis. Results Positive reactions were found to pieces of the wristband, including adhesive rim (+++), inside (+++), and outside (++); to multiple allergens in the (meth)acrylates series; and to extracts of the wristband in acetone and ethanol. Chemical analysis of the ethanol extract showed presence of lauryl acrylate and 1,6‐HDDA. Patch testing with TLC strips and subsequent chemical analysis showed that the substance causing the strongest reaction was 1,6‐HDDA, to which the patient had a confirmed positive patch test reaction. Conclusion 1,6‐HDDA was identified as the culprit allergen responsible for allergic contact dermatitis caused by the hospital wristband.

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.

is missing (Letter).

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.