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Background Metalworkers are exposed to a variety of contact allergens by handling tools, metals, metalworking fluids (MWFs), oils and greases, rubber materials, and so on. Most large‐scale reports on contact allergy due to MWFs are more than 10‐years‐old, and there are only few studies on contact allergy in mechanics and other metal workers not exposed to MWFs. Objectives To describe a current spectrum of contact sensitization in metalworkers with occupational dermatitis (OD). Patients and Methods Retrospective analysis of patch test data collected by the Information Network of Departments of Dermatology (IVDK; 2010–2018), stratifying for 804 cutting metalworkers, 2197 mechanics, and 355 other metalworkers. Results Cutting metalworkers were most frequently sensitized to monoethanolamine (12.6%), colophonium/abietic acid (11.4%) and formaldehyde releasers (up to 8.5%) from the MWF series, and formaldehyde (4.6%) and iodopropynyl butylcarbamate (4.6%) from the baseline series. Sensitization among mechanics and other metalworkers indicates possible occupational exposure to MWFs, glues, and resins, although this may not be expected from their job titles. Conclusions The spectrum of MWF contact allergens remained largely unchanged during the last years. Taking a comprehensive occupational history is indispensable in order to not miss relevant allergen exposures.

Background Allergic contact dermatitis (ACD) has become more frequent in children. The prevalence of contact sensitization varies with respect to age, sex, and geographic localization. Objective The aim of the study was to investigate the experience of a tertiary health center regarding the patch test results of contact sensitization in children without atopic dermatitis. Methods This is a retrospective review of 89 children (30 boys and 59 girls) who were aged between 3 and 18 years and who were diagnosed with ACD between July 2013 and July 2017. Children with a known history of atopic dermatitis were excluded. All patients were tested with the TRUE (Thin-layer Rapid Use Epicutaneous) test series. Results The most frequently determined allergens by TRUE test were methylchloroisothiazolinone (n = 7 [16.3%]), disperse blue 106 (n = 5 [11.6%]), and bacitracin (n = 5 [11.6%]). Formaldehyde-related allergens produced 15 positives. Conclusions Preservatives, such as methylchloroisothiazolinone, formaldehyde, and formaldehyde releasers, emerge as the most frequent allergens in children who undergo patch testing because of ACD. This finding might be attributed to the increase in the utilization of these chemical compounds in personal hygiene products for children.

Background Allergic contact dermatitis is a challenging diagnostic problem in children. Although epicutaneous patch testing is the diagnostic standard for confirmation of contact sensitization, it is less used in children by dermatologists treating children, pediatric dermatologists, and pediatricians, when compared with adult practitioners. Objective The aim of the study was to create and evaluate standardization of a pediatric patch test series for children older than 6 years. Methods We surveyed dermatologists and allergists conducting epicutaneous patch testing in children attending the 2017 American Contact Dermatitis Society meeting held in Washington, DC. This was followed by discussion of collected data and consensus review by a pediatric contact dermatitis working group at the conference. Conclusions A baseline pediatric patch test panel was established through working group consensus.

Background Dental technicians (DTs) are at increased risk for allergic contact sensitization. Objectives To assess the current spectrum of occupational sensitization in DTs with occupational contact dermatitis (OCD). Methods A retrospective analysis of Information Network of Departments of Dermatology patch test data from the years 2001-2015 concerning DTs with OCD was performed. Results Patients of the study group (226 DTs with OCD) were significantly more often diagnosed with allergic contact dermatitis (37.6% versus 18.5%; p = 0.0002) than patients of the control group (124 DTs without OCD). In the study group, positive reactions were most frequently observed to methacrylates and/or acrylates (n = 67). Of these, 61 patients showed positive reactions to at least one of the five most frequent allergens in this group, namely 2-hydroxyethyl methacrylate, 2-hydroxypropyl methacrylate, methyl methacrylate, ethyl methacrylate, and/or ethylene glycol dimethacrylate. In contrast, no positive reactions to diurethane dimethacrylate (DUDMA) occurred. Among allergens of the German Contact Dermatitis Research Group series 'dental metals', positive reactions were less frequent and were mainly to palladium chloride (n = 6). Conclusions The present data analysis showed that the sensitization spectrum and spectrum of cross-reactivity are largely unchanged as compared with the 1990s. It can be concluded that test recommendations are still valid and useful, except for the methacrylate DUDMA, which could be omitted.

SummaryBackground Textile dyes, rubber, elements or textile resins carry the risk of inducing allergic contact sensitization. Objectives To assess clinical data and patch test results for dermatitis patients with suspected textile allergy. Methods A retrospective analysis of Information Network of Departments of Dermatology data of the years 2007–2014 of patients patch tested because of suspected textile allergy was performed. Results Patients of the study group (n = 3207) suffered more frequently from leg, trunk and generalized dermatitis than patients of the control group (n = 95210). Among the allergens of the textile dye series, the highest frequency of positive reactions was observed for p-aminoazobenzene (5.1%) and p-phenylenediamine (PPD) (4.5%), followed by Disperse Orange 3 (3.1%), Disperse Blue 124 (2.3%), Disperse Blue 106 (2.0%), Disperse Red 17 (1.1%), and Disperse Yellow 3 (1.1%), partly with concomitant reactions. Patch testing with the patients' own textiles was performed in 315 patients, with positive reactions in 18 patients. These were mostly elicited by blue or black textiles with tight skin contact. Only 2 of these patients also reacted to textile dyes from the German Contact Dermatitis Research Group series. Conclusions For the comprehensive diagnosis of contact sensitization in patients with suspected textile dermatitis, combined patch testing is indicated, with (i) PPD and a textile dye series and (ii) patients' own clothing.

Background: Compositae contact sensitization may be difficult to diagnose, because of a lack of reliable screening allergens. Objectives: To assess the suitability of Compositae mix II 2.5% pet. (CM2.5) as a screening mix in the baseline series combined with sesquiterpene lactone (SL) mix and parthenolide (PTH). Methods: CM2.5 was added to the baseline series, which included SL mix and PTH 0.1% pet., in January 2015, and PTH was included in TRUE Test Panel 3 in October 2015. All Compositae-sensitive patients diagnosed or tested in the next 4 years were assessed. Results: Altogether, 57 patients (2.7%) presented with Compositae allergy. On primary testing in 53 newly diagnosed patients, SL mix elicited positive reactions most frequently (53% positive), followed by CM2.5 (47% positive), and PTH (45% positive). CM2.5 and PTH pet. elicited a few irritant reactions. Three patients had late reactions. Altogether, 16 patients (28%) were not detected by any of the three screening agents. Conclusions: SL mix is an indispensable, although insufficient, screening mixture in Denmark. It may be relatively safely supplemented with CM2.5 and PTH in the TRUE Test system for screening, but, when Compositae sensitization is suspected, further extracts should be tested on the basis of the history.

SCOPUS: le.j, info:eu-repo/semantics/published

Background: Limonene and linalool are common fragrance terpenes widely used in cosmetic, household and hygiene products. Their primary oxidation products formed after air exposure, the hydroperoxides, have been recognized as important contact haptens. Objectives: To investigate the prevalence of contact allergy to hydroperoxides of limonene (Lim-OOHs) and hydroperoxides of linalool (Lin-OOHs) in Spain, and to define the optimal concentration for screening in consecutive patients. Methods: Three different concentrations of Lim-OOHs (0.1%, 0.2% and 0.3% pet.) and Lin-OOHs (0.25%, 0.5% and 1.0% pet.) were simultaneously tested in 3639 consecutive patients at 22 departments of dermatology in Spain. Results: Lim-OOHs at 0.1%, 0.2% and 0.3% yielded positive patch test reactions in 1.4%, 3.4% and 5.1% of the tested patients, respectively; and Lin-OOHs at 0.25%, 0.5% and 1.0% yielded positive reactions in 1.3%, 2.9% and 4.9% of the tested patients, respectively. Few irritant (1.5–1.9%) and doubtful reactions (0.4–0.5%) to both terpene hydroperoxides were registered at the highest concentrations tested. Conclusions: Lim-OOHs and Lin-OOHs can be considered as common causes of contact allergy, and their inclusion in an extended baseline patch test series therefore seems to be appropriate. The patch test preparations of Lim-OOHs 0.3% pet. and Lin-OOHs 1.0% pet. are useful tools for screening of contact sensitization.

SummaryBackground Allergic contact dermatitis is known to occur in children with and without atopic dermatitis, but more data are needed on contact sensitization profiles in these two groups. Objectives To identify frequent allergens in children with and without atopic dermatitis suspected of having allergic contact dermatitis. Methods A retrospective analysis of children aged 0–17 years patch tested between 1996 and 2013 was performed. Results Of all 1012 children tested because of suspected contact dermatitis, 46% developed one or more positive reactions, the proportions for children with (n = 526) and without (n = 395) atopic dermatitis being 48% and 47%, respectively. Children with atopic dermatitis reacted more often to lanolin alcohols (30% pet., p = 0.030), Amerchol L-101 (p = 0.030), and fragrances [fragrance mix I (p = 0.048) and Myroxylon pereirae (p = 0.005)]. Allergens outside the European baseline series that frequently gave positive reactions in these groups included cocamidopropyl betaine and Amerchol L-101. Reactivity to these allergens was significantly more frequently found in atopic dermatitis children. Conclusion Sensitization prevalences in children with and without atopic dermatitis were similar, but children with atopic dermatitis reacted significantly more often to lanolin alcohols and fragrances. Testing with additional series besides the European baseline series may be necessary, as reactions to, for example, cocamidopropyl betaine and Amerchol L-101 may otherwise be missed.

SummaryBackground Henna has a very low allergic potential, and severe allergic contact dermatitis is mainly caused by p-phenylenediamine (PPD), which is added to temporary black ‘henna tattoos’, and potentially also by some heavy metals. Objective To determine the presence of, and quantify, Lawsone, PPD and heavy metal contaminants (cobalt, nickel, lead, and chromium) in commercial temporary black henna tattoo mixtures (n = 25) sold in Turkey. Methods Lawsone and PPD concentrations were analysed with high-performance liquid chromatography, and heavy metal quantification was performed with inductively coupled plasma mass spectrometry. Results PPD was found in all 25 black henna tattoo samples purchased from tattoo shops; levels varied between 3.37% and 51.6%. Lawsone was detected (0.002–88.2%) in 21 of the 25 temporary black henna tattoo samples analysed. Heavy metal contaminant levels were 0.44–3.11 ppm for Co, 1.13–2.20 ppm for Ni, 1.59–17.7 ppm for Pb, and 35.0–76.9 ppm for Cr. Conclusions Our results suggest that commercial temporary black henna mixtures containing PPD levels up to 51.6% pose a risk of contact sensitization and severe allergic contact dermatitis among users. It is important to identify both the additives and metallic contaminants of black henna tattoo products; the significance of metal contaminants has still to be assessed.

Background The evidence on the safety of topical preparations containing emulsifiers is limited. Objectives The aims of the study were to assess (1) the prevalence of sensitization to some emulsifiers commonly found in topical products, (2) the sensitization to emulsifiers in relation to sex, age, and predisposing factors, and (3) the frequency of concomitant sensitization to other common allergens. Methods All consecutive patients presenting to the Allergy Unit of our Dermatological Department for allergological investigation were enrolled. All patients were patch tested with the Italian Societa Italiana di Dermatologia Allergologica Professionale ed Ambientale baseline series and an additional emulsifiers series. Doubtful patch test reactions were not considered. Results Of 310 patients, 50 (16%) were sensitized to emulsifiers with 72 positive reactions. Lauryl polyethylene glycol/polypropylene glycol-18/18 methicone gave 26 positive reactions, glyceryl oleate 19, myristyl alcohol, and Amerchol L101 11. Concomitant sensitization to emulsifiers was found in 16 patients. Patients allergic to emulsifiers showed concomitant allergic reactions to allergens commonly found in cosmetics. No significant differences by sex, age, atopic diathesis, and clinical pattern at presentation were noticed. Conclusions Contact allergy to emulsifiers is more frequent than reported. Patients allergic to emulsifiers show frequent positive patch tests to other constituents of cosmetics and topical products.

Summary Background Chromium is an important skin sensitizer. Exposure to it has been regulated in cement, and recently in leather. Studies on the deposition of chromium ions on the skin as a result of handling different chromium-containing materials are sparse, but could improve the risk assessment of contact sensitization and allergic contact dermatitis caused by chromium. Objectives To determine whether the handling of chromium-containing samples of leather and metal results in the deposition of chromium onto the skin. Methods Five healthy volunteers participated. For 30 min, they handled samples of leather and metal known to contain and release chromium. Skin deposition of chromium was assessed with the acid wipe sampling technique. Results Acid wipe sampling of the participants' fingers showed chromium deposition on the skin in all participants who had been exposed to leather (range 0.01–0.20 µg/cm2) and in 3 of 5 participants after they had manually handled metal discs (range 0.02–0.04 µg/cm2). Conclusions We found that samples of leather and metal had the ability to deposit chromium on the skin at significant levels, in spite of a short duration of exposure.

Background Atopic dermatitis is a common illness in childhood. Children with atopic dermatitis are prone to develop cutaneous sensitization due to skin barrier dysfunction. Aim The aim of this study was to evaluate the frequency of cutaneous sensitizations in patients with atopic dermatitis and to identify the most frequent causative allergens. Study design The study group consisted of 112 children with atopic dermatitis, aged 1–18 years (median 88.5 months) and 39 healthy controls, aged 1–8 years (median 88.48 months). Methods The diagnosis of atopic dermatitis was established by modified Hanifin and Rajka criteria; severity of the disease was assessed by scoring of atopic dermatitis. Serum blood eosinophil count, total IgE and skin prick tests for common aeroallergens and food allergens were performed. Patch tests with cosmetic series and European standard patch test series (Stallegenes© Ltd, Paris, France) were applied. Results Of the children with atopic dermatitis, 17% (n = 19) were sensitized to either cosmetic or standard series or both of them; no children in the control group had a positive patch test (p = 0.001). Atopy and severity of atopic dermatitis was not a significant risk factor for cutaneous sensitization. The most common allergens were Nickel sulphate and Methychloroisothiazinolone (4.5% and 4.5%) in the European standard patch test and cocamidoproplybetaine (12.5%) in the cosmetic series patch test. Conclusion Cutaneous sensitization can develop in children with atopic dermatitis, therefore allergic contact dermatitis should be kept in mind.

Background The number of patients affected by allergies is increasing worldwide. The resulting allergic diseases are leading to significant costs for health care and social systems. Integrated care pathways are needed to enable comprehensive care within the national health systems. The ARIA (Allergic Rhinitis and its Impact on Asthma) initiative develops internationally applicable guidelines for allergic respiratory diseases. Methods ARIA serves to improve the care of patients with allergies and chronic respiratory diseases. In collaboration with other international initiatives, national associations and patient organizations in the field of allergies and respiratory diseases, real-life integrated care pathways have been developed for a digitally assisted, integrative, individualized treatment of allergic rhinitis (AR) with comorbid asthma. In the present work, these integrated care pathways have been adapted to the German situation and health system. Results The present ICP (integrated care pathways) guideline covers key areas of the care of AR patients with and without asthma. It includes the views of patients and other healthcare providers. Discussion A comprehensive ICP guideline can reflect real-life care better than traditional guideline models.

Cosmetics and skin care products for neonates and infants are considered as ‘‘hypoallergenic’’, “tested” or ‘‘safe’’. Nevertheless, the prevalence of haptens in these products is a matter of concern, since allergic contact dermatitis in children is gaining an importance. We aimed to assess the prevalence of haptens in cosmetics designed for children younger than 1 year. To identify haptens, the components of the cosmetics listed on packaging were compared with substances from European baseline series, Cosmetics series and Fragrance series. Survey comprised 212 cosmetics among which 186 (87.7%) contained at least one hapten from reference lists. Altogether there were 41 different haptens found in cosmetics. Number of sensitizers per product ranged between 1–12 and, each product contained 2.51 haptens on average. The most abundant sensitizers were cocamidopropyl betaine, tocopherol, propylene glycol, fragrances, lanolin. Majority of products for children were labeled as hypoallergenic/dermatologically tested/safe for children etc. from which 85% contained haptens. This survey highlights the extent of presence of haptens in cosmetics for children under the first year of age.

Allergic contact dermatitis is an important diagnostic consideration in the evaluation of patients presenting with vulvar complaints. The high prevalence of contact sensitization in the vulvar region is likely multifactorial. We review the extant literature regarding key predisposing factors in the pathogenesis of vulvar allergic contact dermatitis, as well as the most commonly implicated allergens as identified by a number of retrospective studies and case series. On the basis of our findings, we provide diagnostic and therapeutic recommendations for practicing clinicians.

Background The Compositae plant family includes many thousands of species, making it one of the most widespread group of plants worldwide. Sensitization to Compositae allergens may occur in private or in occupational settings. Objectives To monitor the current spectrum of sensitization to Compositae allergens, especially in cooks and florists. Methods We retrospectively analysed patch test results obtained with two Compositae mixes (CMs) (CM I and CM II; switch in October 2011), their individual components, and sesquiterpene lactone (SL) mix in 1492 cooks, 851 florists, and a control group (118 358 other patients) registered in the IVDK, 2007 to 2016. Results Florists reacted significantly more frequently to CM I and II (CM I, 8.7%; CM II, 10.6%) than did cooks (CM I, 2.1%; CM II, 0.8%) and controls (CM I, 1.3%; CM II, 1.2%). Additional testing with SL mix detected 14.3% more sensitizations than CM I or CM II alone. Conclusions Florists are at considerable risk of sensitization to Compositae allergens. Patch testing with both CM and SL mix is recommended.

In the first conundrum, permanent hair dyeing involves the use of aromatic amines such as p-phenylenediamine (PPD), whose oxidation is pivotal to the dyeing process, but also generates potent allergens. Despite prolonged efforts by industry to search for safer alternatives, hair dyeing is still reliant on this type of aromatic amine. In the second conundrum, patch testing with 1% PPD remains the most useful screen for hair dye contact allergy. However, there is a very small but real risk of actively sensitizing the patient. Lowering the PPD concentration below 1% significantly reduces test sensitivity and diagnostic utility. Here, we argue that by applying Friedmann's principles of contact sensitization each conundrum can be addressed from a new perspective. These principles indicate that, when the exposed area of skin is small (

Background: Due to the sensitizing constituents of eye cosmetics, allergic contact dermatitis is considered a frequent cause of eyelid dermatitis. An association between eyelid dermatitis and nickel contained in make-ups remains controversial. Objective: The study aimed to assess the association between nickel allergy, the use of pigmented makeup products and self-reported eyelid dermatitis. Method: This multi-centric, cross-sectional study enrolled 165 women sensitized to nickel (patients) and 103 women without intolerance to metals (controls). We recorded: demographics, atopy, use of pigmented eye cosmetics (mascara, eyeshadow, eyeliner, eyebrow pencil), and previous eyelid dermatitis. Among the patients, any co-sensitization to cosmetics or metals was recorded. Results: 87.3% of the patients and 91.3% of the controls reported their use of eye make-up; 44.9% and 52.4%, respectively, reported previous episodes of eyelid dermatitis, without significant differences. The occurrence of eyelid dermatitis was significantly associated with the use of eye make-up products, both in general and considering each product separately. Age, atopy, or co-sensitization to other metals or cosmetics did not affect the occurrence of eyelid dermatitis. Conclusion: Nickel allergy should not be considered the main risk factor for eyelid dermatitis. The use of pigmented eye make-up may be a triggering factor for eyelid dermatitis, probably due to an irritant action.

Summary Background Sunflowers may cause dermatitis because of allergenic sesquiterpene lactones (SLs). Contact sensitization to sunflower seeds has also been reported, but the allergens are unknown. Objectives To analyse sunflower seeds for the presence of SLs and to assess the prevalence of sunflower sensitization in Compositae-allergic individuals. Patients/materials/methods Sunflower-sensitive patients were identified by aimed patch testing. A dichloromethane extract of whole sunflower seeds was analysed by liquid chromatography-mass spectrometry and high-performance liquid chromatography. Results The prevalence of sensitivity to sunflower in Compositae-allergic individuals was 56%. A solvent wash of whole sunflower seeds yielded an extract containing SLs, the principal component tentatively being identified as argophyllin A or B, other SLs being present in minute amounts. Conclusions The concentration of SLs on the sunflower seeds is considered high enough to elicit dermatitis in sensitive persons, and it seems appropriate to warn Compositae-allergic subjects against handling sunflower seeds.

Ingredients found in the nail cosmetic industry, including but not limited to methacrylate and acrylate monomers, formaldehyde, and toluene sulfonamide-formaldehyde resin, can incite allergic contact dermatitis. An eczematous outbreak presents on areas surrounding the nail plate and may spread through contact transfer of the allergen, commonly to the face and neck. Even components that were originally deemed nonsensitizing, such as the ubiquitous cyanoacrylate adhesive family, have been found to be allergenic. They do not, however, cross-react with methacrylates and acrylates. Alternative options for individuals with allergic contact dermatitis reactions to these ingredients can be avoidance of these procedures or use of products that are "3, 4, 5 free" in which the common allergens dibutyl phthalate, toluene, and formaldehyde are absent. In cases where strengthening of the nail is the sole purpose, nail wraps or preformed nails can be applied for non-cyanoacrylate-sensitive individuals.

PURPOSE OF REVIEW: Preservatives are well known skin sensitizers and represent one of the main causes of contact allergy. The purpose of this article is to review the current state of contact sensitization induced by preservatives and point future alternatives for products' preservation. RECENT FINDINGS: Isothiazolinones currently are the most common preservatives responsible of contact allergy in Europe and in the United States, and although some regulatory interventions have been taken place, the current contact allergy outbreak is not yet under control. Despite the ban of methyldibromo glutaronitrile from cosmetics in Europe, sensitized patients are still diagnosed, suggesting other nonregulated sources of exposure. Sensitization rates to formaldehyde and formaldehyde-releasers are lower in Europe in comparison with the United States due to stricter regulations regarding their use. Prevalence of contact allergy to parabens has remained stable over the last decades, whereas iodopropynyl butylcarbamate is an emerging allergen with an increasing prevalence. Future alternatives for products' preservation look for a broad antimicrobial spectrum, but with a better safety profile (in terms of sensitization) than the currently available compounds. SUMMARY: Given the high rates of sensitization reported over the last years, timely regulatory actions are urgently required for some preservatives that currently represent a concern for public health.

SummaryBackground Modern dressings (MDs) may have a low sensitization rate, but there is a lack of prospective studies in patients with chronic leg ulcers (CLUs) to evaluate this. Objectives To determine the rate of sensitization (contact allergy) to MDs and substances present in dressings. Patients and methods A prospective multicentre study was carried out in patients with CLUs at five French dermatology departments; patch tests were performed with the European baseline series and with an additional 27 individual allergens and 10 MDs. Results Among 354 patients (226 women and 128 men) with CLUs, 59.6% had at least one positive patch test reaction to an MD and 19% had at least one sensitization to an MD. The number of positive test reactions per patient was correlated with the duration of ulcerative disease, but not with ulcer duration, the cause of the ulcer, or the presence of surrounding eczematous lesions. For 11 of 45 patients sensitized to Ialuset cream®, more detailed information could be obtained with sensitization to sodium dehydroacetate (5 cases) or Lanette SX® (3 cases). Conclusions Sensitization to MDs is not rare. It is absolutely necessary to label all components of MDs on their packaging and to avoid some sensitizing molecules, such as colophonium derivatives or any strong sensitizers.

Summary Background Cobalt contact sensitization in consecutively tested patients is common. The sources of exposure, and thus clinical relevance, are mostly unclear. Objective To examine (i) long-term time trends of sensitization, (ii) risk factors that may point to relevant exposures, and (iii) coupling with nickel sensitization. Methods Data of all patients patch tested with cobalt(II) chloride hexahydrate (1% pet.) between 1992 and 2012 (n = 185 050) in the Information Network of Departments of Dermatology (IVDK, www.ivkd.org) were subjected to descriptive stratified and Poisson regression analysis. Results The overall prevalence of positive patch test reactions was 5.23% (95% confidence interal 5.13–5.33%). Regarding time trends, there were significant increases for males aged 18–44 years and for females aged ≥45 years, and a significant variation of co-reactivity with nickel over time. Female sex almost doubled the risk of sensitization; age ≥45 years was associated with a 30% decrease in the risk of positive patch test reactions to cobalt, and atopic eczema with an approximately 20% increase. Conclusions Notwithstanding some diagnostic difficulties with the test preparation, a persistent, notable proportion of cobalt sensitization, isolated or coupled with nickel allergy, can be observed. This warrants further in-depth research into causative exposures, both at the workplace and in consumers.

Background The preservative methylisothiazolinone (MI) is used in combination with methylchloroisothiazolinone (MCI), but the MCI/MI mixture has been identified as highly allergenic. MI is considered to be less allergenic, and since the mid-2000s has been widely used alone, but is now clearly identified as a contact allergen. The French Vigilance Network for Dermatology and Allergy of the Study and Research Group on Contact Dermatitis (REVIDAL-GERDA) added MI to its baseline patch testing series in 2010. Objective To evaluate the change in the proportion of MI-positive tests in France between 2010 and 2012. Patients/materials/methods We conducted a nationwide, multicentre, retrospective study of all MI-tested patients between 2010 and 2012. Results Sixteen centres participated in the study (7874 patients were tested). Patch tests were performed mainly at a concentration of MI 200 ppm aq. We observed a significant increase in the proportion of MI-positive tests in 2012 and 2011 as compared with 2010 (5.6%, 3.3%, and 1.5%, respectively; p Conclusions We report a significant increase in the number of MI-positive tests. MI is confirmed to be a rapidly emerging allergen, as also observed in other European countries.

Atopic dermatitis and allergic contact dermatitis are both common skin diseases having an immune pathogenesis. There has been considerable interest about their inter-relationships with regard to altered susceptibility. Recent investigations have shed new light on this important question, and in this article, we explore whether there is evidence that atopic dermatitis affects the risk of contact sensitization and allergic contact dermatitis. The use of topical products to treat xerotic and inflamed skin in atopic dermatitis often results in a higher prevalence of sensitization to, for example, fragrances and other ingredients in emollients. Moreover, the prevalence of metal allergy seems to be increased, probably due to compromised chelation of the metals in the stratum corneum of patients with atopic dermatitis. However, conversely, the T-helper cell 2 bias that characterizes immune responses in atopic dermatitis appears to lower the risk of contact sensitization compared to healthy controls. Based on these observations, we conclude that multiple factors affect the association between atopic dermatitis and contact sensitization, and that these need to be appreciated in the clinical management of atopic dermatitis patients.

SummaryBackground The preservative methylisothiazolinone (MI) has become an important allergen, with a dramatic increase in sensitization prevalence being seen over the last few years. Objective To examine risk factors associated with MI sensitization, in order to identify targets of prevention aimed at curtailing the present epidemic. Methods On the basis of contact allergy surveillance data collected by the Information Network of Departments of Dermatology (www.ivkd.org), 2009–2012, in the course of 28 922 patch tests with MI, 500 ppm in water, included in a series of cosmetic preservatives, logistic regression analysis was employed to quantify the risk associated with a number of putative risk factors. Results The prevalence of MI sensitization increased from 1.94% in 2009 to 6.02% in 2012, the increase being mainly driven by female patients aged ≥ 40 years, patients with face dermatitis, and the use of cosmetics. Adjusted multifactorial analysis additionally identified several occupations (e.g. painters and beauticians) and ano-genital dermatitis as risk factors for MI sensitization. Conclusions The present use concentrations of MI, both cosmetic and industrial, are too high; (self-)regulatory action is urgently needed. MI should be added to the baseline series.

BACKGROUND Patients with chronic leg ulcers typically experience contact allergy to topical treatments. Although declared as hypoallergenic, modern wound dressings have caused several reported cases of contact allergy. OBJECTIVE The aim of the study was to evaluate any allergenic potential of modern wound dressings in patients with leg ulcers. METHODS Seventy-one patients were included in our prospective observation. Patch tests were performed with a selection of 10 modern wound dressings and with selected allergens according to series of the German Contact Dermatitis Research Group (DKG). RESULTS Of 70 patients eligible for evaluation, 12 (17%) were positive for the hydrogel NuGel, followed by the hydrocolloid NuDerm (n = 7/70, 10%) and the ionic silver-containing wound dressing Aquacel Ag and the gauze Adaptic (both n = 4/70, 5%). Patients with recalcitrant ulcers of prolonged duration showed a significant higher number of epicutaneous sensitizations to wound dressings than patients with shorter ulcer duration. CONCLUSIONS The allergenic potential of modern wound dressings should not be underestimated. There is need for precise declaration of all ingredients.

Contact sensitization is common and affects up to 20% of the general population. The clinical manifestation of contact sensitization is allergic contact dermatitis. This is a clinical expression that is sometimes difficult to distinguish from other types of dermatitis, for example irritant and atopic dermatitis. Several studies have examined the pathogenesis and severity of allergic contact dermatitis by measuring the absence or presence of various biomarkers. In this review, we provide a non-systematic overview of biomarkers that have been studied in allergic contact dermatitis. These include genetic variations and mutations, inflammatory mediators, alarmins, proteases, immunoproteomics, lipids, natural moisturizing factors, tight junctions, and antimicrobial peptides. We conclude that, despite the enormous amount of data, convincing specific biomarkers for allergic contact dermatitis are yet to be described.

Hypersensitivity to para-phenylenediamine (PPD) and related compounds induced by temporary black henna tattoos has become a serious health problem worldwide. Different patterns of sensitization with various clinical aspects are described in literature due to PPD associated to henna tattoo and these manifestations are likely correlated with the immunological and dermatological pathomechanisms involved. Henna is the Persian name of the plant Lawsonia inermis, Fam. Lythraceae. It is a woody shrub that grow in regions of North Africa, South Asia, India and Sri Lanka. Nowadays it is rather frequent to see temporary “tattoos” performed with henna. To make tattoos darker and long-lasting PPD has been associated to henna in tattoo drawings mixtures, so obtaining “black henna”. In these years there has been a rise of contact sensitization to PPD and in medical literature an increased number of cases have been reported on temporary henna tattoo application. Here we review the various clinical patterns related to PPD and henna tattoo, to investigate the possible link between clinic-morphological pictures and the immunological response to PPD and henna. The literature underlines that different clinical manifestations are related to black henna containing PPD, and its derivative products may cause delayed-type as well as immediate-type reactions. Further studies are needed to investigate the relationship between clinical and morphological aspects of PPD contact dermatitis and the T cell subsets predominance.

Background. Although heterozygous filaggrin gene (FLG) mutation carriers seem to have an increased risk of atopic, irritant and allergic nickel dermatitis, it remains unclear whether the risk of contact sensitization to allergens other than nickel is also elevated in FLG mutation carriers. Objectives. We hypothesized that heterozygous FLG mutation carriers who suffer from dermatitis will have strongly reduced or even absent filaggrin levels during episodes of inflammation, potentially increasing the penetration of contact allergens, and hence the risk of becoming sensitized. Materials and methods. During 2006–2008, 3335 randomly invited 18–69-year-old adult Danes participated in a general health examination, filled out a questionnaire, and were genotyped for the R501X and 2282del4 mutations in FLG. Results. A logistic regression analysis restricted to individuals who reported atopic dermatitis and frequent episodes of hand eczema showed a strong association between FLG mutations and contact sensitization to allergens other than nickel (odds ratio 5.71; 95% confidence interval 1.31–24.94). In participants without dermatitis, no association was found between contact sensitization and FLG mutations. Conclusion. FLG mutation carriers with self-reported dermatitis have an increased risk of contact sensitization to substances other than nickel, whereas FLG mutations alone may not, or may only slightly, increase the risk of sensitization.

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Background Experimental studies have shown that individuals with atopic dermatitis are likely to have suppressed contact sensitivity secondary to their disease whereas some clinical and epidemiological studies have shown that individuals with atopic dermatitis might have a higher prevalence of contact sensitization than controls. The objective was to study the association between contact sensitization and, respectively, atopic dermatitis and asthma using clinical databases. Methods Record linkage of two different registers was performed: (i) a tertiary hospital register of dermatitis patient's patch tested for contact sensitivity and (ii) the Danish National Patient Register containing nationwide hospital discharge diagnoses and outpatient contacts. Results An inverse association was found between contact sensitization and, respectively, presumed severe atopic dermatitis (OR, 0.70; 95% CI, 0.61–0.81) and asthma (OR, 0.61; 95% CI, 0.42–0.90) when linkage was performed. Inverse associations were found for all groups of chemicals and metals except for sensitization to fragrances and topical drugs where positive associations were identified. A significant positive association between fragrance sensitization and presumed mild–moderate atopic dermatitis was also found when data from hospital register only were used, suggesting an overall higher prevalence of fragrance sensitization in patients with atopic dermatitis. Conclusions Our findings support that patients with severe atopic dermatitis and asthma have an overall lower prevalence of contact sensitization when compared with controls, whereas mild-to-moderate disease does not suppress contact sensitization. The prevalence of contact sensitization to fragrance chemicals was higher in patients with atopic dermatitis. Patients should be instructed to avoid scented moisturizers and products containing highly sensitizing substances.

The cosmetic industry producing hair dyes has, for many years, recommended that their consumers perform ‘a hair dye allergy self-test' or similar prior to hair dyeing, to identify individuals who are likely to react upon subsequent hair dyeing. This review offers important information on the requirements for correct validation of screening tests, and concludes that, in its present form, the hair dye self-test has severe limitations: (i) it is not a screening test but a diagnostic test; (ii) it has not been validated according to basic criteria defined by scientists; (iii) it has been evaluated in the wrong population group; (iv) skin reactions have been read by dermatologists and not by the targeted group (consumers and hairdressers); (v) hair dyes contain strong and extreme sensitizers that are left on the skin in high concentrations, potentially resulting in active sensitization; and (vi) recommendations and instructions on how to perform the hair dye self-test vary greatly even among products from the same company, again suggesting that the basis for safe use of the test has not been determined. If the use of a hair dye self-test to predict contact sensitization becomes widespread, there is severe risk that a tool has been marketed that may cause morbidity in European consumers.

BACKGROUND: Few studies have addressed the frequency and the consequences of the appropriateness of referrals for patch testing. OBJECTIVES: To analyse the appropriateness of referrals for patch testing among patients seen in the Allergy Unit, University of Ferrara, and to evaluate whether this selection influences the results of the test. PATIENTS AND METHODS: One thousand six hundred and twenty-seven consecutive patients were enrolled, and 1528 patients were patch tested. On the basis of the history and clinical picture, the appropriateness of referrals for patch testing was judged. RESULTS: Of the patients, 82.30% attended the Allergy Unit with a clinical presentation and/or history considered to be an appropriate indication for patch testing. The rate of appropriate referrals for patch testing from dermatologists was significantly higher (p < 0.001) than that for referrals from other physicians. The sensitization rate was significantly higher among the appropriate referrals than among the inappropriate ones, both in the entire sample (p < 0.001) and in atopic patients (p = 0.012). CONCLUSIONS: Clinical experience was seen to be crucial for the appropriate selection of patients. Furthermore, appropriate referral for patch testing was shown to influence the sensitization rate.

Background: Contact hypersensitivity quantitative risk assessment (QRA) for fragrance ingredients is being used to establish new international standards for all fragrance ingredients that are potential skin sensitizers. Objective: The objective was to evaluate the retrospective clinical data on three fragrance ingredients in order to provide a practical assessment of the predictive value of the QRA approach. It is important to have data to assess that the methodology provides a robust approach for primary prevention of contact sensitization induction for fragrance ingredients identified as potential sensitizers. Methods: This article reviews clinical data for three fragrance ingredients cinnamic aldehyde, citral, and isoeugenol to assess the utility of the QRA approach for fragrance ingredients. Results: This assessment suggests that had the QRA approach been available at the time standards were established for these fragrance ingredients, the clinical response might have been noticeably improved. Prospectively, with the establishment of QRA-derived standards, there should be a continued downward trend in patch test-positive rates for cinnamic aldehyde, citral, and isoeugenol over time. Conclusion: While it is recognized that the availability of retrospective data is limited, a longitudinal review of these data gives confidence that the QRA approach should be an effective tool for primary prevention. This study also highlights the importance of continued active monitoring of clinical patch-test data for fragrance ingredients. (Less)

The diagnosis of contact sensitization relies on patch testing. The selection of allergens to be applied is a crucial aspect. In principle, those (and only those) allergens should be tested which can be regarded as suspects based on the individual patients history. However, suspicion does not only rely on individual history. Those allergens which have proven to be frequent sensitizers in large-scale patch test studies may be important in the case in question, too. This is the rationale of the Baseline series. These series are useful to diagnose contact sensitization which was initially not suspected based on the history. The composition of the Baseline series thus depends on the descriptive statistics of the most frequent contact sensitizers. This implies that the composition should adapt to a pattern of allergen exposure which may change over time and which may differ between countries. The Baseline series of the DKG underwent significant changes in the last 20 years. These comprise the inclusion of new allergens, the exclusion of obsolete allergens or the adaption of concentration or vehicle to new evidence. While there is a considerable amount of variation among the allergens included in the Baseline series, a certain set of allergens seems to be of secular importance. Previous and current analyses of the IVDK on the other hand show that the Baseline series only diagnoses about 42% of all contact sensitizations. Thus, in each case the application of additional test series should be contemplated. However, in times of dwindling health care resources it should be stressed that the application of the patch test Baseline series must be considered as the minimal standard and that according to Calnan: "The greatest abuse of patch testing is failure to use it".