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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)

Background: Patients with hand eczema often describe symptoms such as pain, clumsiness and difficulty flexing their fingers, thus impairing the function of the hand. Objective: The aim of this study was to investigate whether hand eczema is associated with a measurable impairment of hand strength and dexterity. We also studied the relationship between hand function and the ability to perform activities of daily living (ADL), pain level and quality of life measured with the Dermatology Life Quality Index (DLQI). Methods: Twenty-one participants with ongoing hand eczema were examined with well-established methods for measuring hand grip strength, pinch strength and dexterity. A questionnaire was designed to investigate perceived ability to perform ADL. The participants were also asked to grade their current pain level, and the DLQI was used to assess the participants' quality of life. A group of 12 participants was reinvestigated when healed. Results: The participants demonstrated a significant improvement in all functional tests when healed. There was a strong correlation between ADL and both dexterity and hand grip strength. There was also a strong correlation between ADL and pain. All participants reported some difficulty performing ADL. Conclusions: Our results suggest that ongoing hand eczema may lead to a measurable decrease of strength and dexterity of the hand, leading to an impairment of the ability to perform ADL and consequently to a poorer quality of life.

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: Isobornyl acrylate (IBOA) has recently been identified as one sensitizer in the FreeStyle Libre glucose sensor. Analyses with gas chromatography-mass spectrometry (GC-MS) have indicated the presence of N,N-dimethylacrylamide (DMAA) in the sensor. Material and methods: Seven patients were referred for patch testing after developing skin reactions when using FreeStyle Libre. All patients were patch tested with IBOA and DMAA. Two patients were tested with adhesive patches that had been removed from the sensors “as is,” and two patients were tested with acetone extracts of materials from the sensor. The extracts were analysed with GC-MS. Results: Six patients reacted to both IBOA and DMAA, and one patient reacted only to DMAA. Positive reactions were also observed in both patients tested with the adhesive patch "as is". One patient reacted to both an extract of the adhesive patch and an extract of the sensor itself. When analysed with GC-MS, IBOA was found in both extracts and DMAA was found in the extract of the sensor. Conclusion: Both IBOA and DMAA may be present in adhesives used in medical devices such as glucose sensors or insulin pumps, and should be patch tested when suspected contact allergic reactions to these products are investigated. (Less)

Background: Dermatitis caused by occupational contact allergy to rubber additives such as diphenylguanidine (DPG) in medical gloves is a hazard for healthcare workers. Both the duration of exposure to medical gloves and the number of gloves used per day vary. The use of alcoholic skin disinfectants before glove donning is mandatory. Objectives: To assess whether skin exposure to the rubber accelerator DPG released from glove material is influenced by alcoholic hand disinfectants, time, and pH. Methods: With the use of ethanol washes, the amount of DPG left on the hands after wearing of gloves for 60 minutes was measured, and comparisons between hands exposed and not exposed to alcoholic disinfectant before glove donning were made. With the use of artificial sweat buffered at pH 4, 5, and 6, DPG release from the insides of gloves at different times was measured. Results: The use of alcoholic disinfectant prior to polyisoprene glove donning increased the amount of DPG recovered from the hands. Of the DPG released from polyisoprene gloves into artificial sweat, almost 84% was released within 10 minutes. pH did not influence the rate of release. Conclusions: The use of alcoholic disinfectant increased skin exposure to the rubber accelerator DPG. Even a short duration of use of gloves results in substantial exposure to DPG. (Less)

The COVID-19 pandemic has led to enhanced hygiene procedures and use of personal protective equipment, but also to increased attention to occupational skin disease in healthcare workers. The occurrence of hand and facial skin disease in > 5,000 Swedish healthcare workers was investigated in a questionnaire survey. Levels of skin exposure related to hygiene procedures and personal protective equipment were recorded. Caring for patients with COVID-19 entailed higher levels of wet work and face mask exposures, and was associated with higher 1-year prevalence of both hand eczema (36%) and facial skin disease (32%) compared with not being directly engaged in COVID-19 care (28% and 22%, respectively). Acne and eczema were the most common facial skin diseases; for both, a dose-dependent association with face mask use was found. Dose-dependent associations could be shown between hand eczema and exposure to soap and gloves, but not to alcohol-based hand disinfectants.

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)

Background: Hand eczema (HE) in healthcare workers (HCWs) is common. Besides wet work, healthcare work also implies exposure to contact allergens. Objectives: To assess HE and contact allergy related to occupational exposures in HCWs. Methods: In a cross-sectional study, 311 HCWs with HE within the preceding 12 months and a control group of 114 HCWs without HE were investigated with the baseline series and a special patch test series based on substances found in the gloves, soaps, alcoholic hand disinfectants and hand creams provided at the hospitals. Results: Contact allergy to rubber additives was significantly more common in HCWs with HE (6%) than in HCWs without HE (1%, P =.02). The corresponding percentages for fragrances were 11% and 3%, respectively (P =.004). Occupational HE was found in 193 of 311 (62%) HCWs. Of these, 22 of 193 (11%) had occupational allergic contact dermatitis, including 17 with glove-related rubber contact allergy. Contact allergy to diphenylguanidine was as common as contact allergy to thiurams. Occupational contact allergy to rubber additives was significantly associated with sick-leave related to HE. Conclusion: Contact allergy to rubber additives in medical gloves is the most common cause of occupational allergic contact dermatitis in HCWs. Aimed patch testing with relevant rubber additives is mandatory when HE in HCWs is investigated. (Less)

SummaryBackground Fragrance mix I (FM I) and fragrance mix II (FM II) are included in the European baseline series as screening substances for fragrance contact allergy. Objectives To investigate the frequency of allergic reactions to FM I, FM II and their ingredients in consecutively patch tested patients. Materials and methods A retrospective analysis of data from 4430 patients patch tested between 2009 and 2015 was performed. Results Of the patients, 6.5% were FM I-positive and 3.2% were FM II-positive. Forty-five per cent of FM I-positive patients did not have positive reactions to FM I ingredients. Thirty-five per cent of those who were FM II-positive did not have positive reactions to FM II ingredients. Twenty-seven per cent of those with positive reactions to one or more of the FM I ingredients were FM I-negative, and 36% of those who had positive reactions to one or more of the FM II ingredients were FM II-negative. The allergens with the highest pick-up rates were Evernia prunastri (1.8%), cinnamal (1.3%), citral (1.2%), and hydroxyisohexyl 3-cyclohexene carboxaldehyde (1.2%). Significant differences were observed in the proportions of positive reactions to FM I, FM II, eugenol, isoeugenol, and farnesol when results from patch testing with materials from different suppliers were compared. Conclusions There is a risk of missing fragrance contact allergy when testing with only the fragrance mixes is performed. The use of preparations from different suppliers may affect the patch test results.

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: Contact allergies to the preservatives formaldehyde and methylchloroisothiazolinone (MCI)/methylisothiazolinone (MI) have been reported to appear together at a statistically significant level. Recently, revisions concerning the patch test preparations of MCI/MI, MI and formaldehyde have been recommended for the European baseline series. Aim: To investigate (i) the number of concomitant contact allergies to the preservatives, (ii) the number of concomitant contact allergies to the preservatives and the fragrance mixes (FM I and FM II) and (iii) gender differences. Methods: Patients tested with the Swedish baseline series during the period 2012-2014 at the Department of Occupational and Environmental Dermatology in Malmo, Sweden were investigated. Results: 2165 patients were patch tested with the baseline series (34% males and 66% females). Contact allergies to formaldehyde and MCI/MI and/or MI were significantly associated (p (Less)

Background: Five workers from a plant manufacturing concrete wall panels and beams were referred to our department because of suspected occupational dermatitis. When patch tested, 3 workers reacted to potassium dichromate. Four workers reacted to ethylenediamine dihydrochloride, without any obvious exposure. Owing to the high proportion of workers with recent-onset skin disease, an investigation of all workers at the plant was initiated. Objectives: To investigate the prevalence of occupational dermatitis and contact allergy in the workers at the plant. Methods: All 24 workers at the plant underwent a clinical investigation and were patch tested. Results: Four cases of allergic occupational contact dermatitis and 3 cases of irritant occupational contact dermatitis were diagnosed. Contact allergy to potassium dichromate was found in 4 workers. All 4 also reacted to ethylenediamine dihydrochloride and/or amines that were present as additives in the cement. Conclusions: Chromate contact allergy can still be found in concrete workers, despite the legislation regulating the amount of hexavalent chromium (chromate) in cement. Occupational contact allergy to amines can be found in workers exposed to cement and concrete, so amines should be tested in these workers.

In rubber materials, both natural rubber and synthetic rubber, several different contact allergenic chemicals are added to the batch before vulcanization. These compounds are relevant for investigation of rubber allergy of workers in rubber factories. The number of workers in the rubber industry has declined, owing to increased automation of the process; however, the number of users of rubber products, such as rubber gloves, is increasing. Furthermore, users of finished rubber products are exposed to allergens other than those affecting workers in rubber factories because of chemical reactions during vulcanization between different additives, altering their structures. Our experience with thiuram mono- and disulfides is that during vulcanization, monosulfides are formed from disulfides. We have also seen that in rubber vulcanized with both thiurams and mercaptobenzothiazole compounds, chemicals are formed that contain both thiocarbamate and a mercaptobenzothiazole structure. Two examples of this are dimethylthiocarbamylbenzothiazole sulfide (DMTBS) and diethylthiocarbamylbenzothiazole sulfide (DETBS). The latter is a commercial accelerator with the name Ethylac. In an earlier study in which we patch tested 24 volunteers with a known allergy to thiuram mix and/or mercapto mix, we observed positive reactions to DMTBS (1% petrolatum) and/or DETBS (1% petrolatum) in 20 subjects. So far we have seen positive reactions to either DMTBS or DETBS in two patients who were investigated because of their dermatitis related to the rubber in their swimming goggles. Chemical analysis of the swimming goggles showed them to contain DMTBS and DETBS, respectively. Furthermore, several patients in the Netherlands and Belgium with allergy to their shoes were found to be allergic to DMTBS. Chemical analysis of these shoes has been performed and DMTBS was identified in the rubber lining. The allergy to DMTBS is an example of how a powerful allergen can be formed during vulcanization as a result of chemical reactions between well-known haptens. It also illustrates that chemical investigations of patients' rubber items can uncover the presence of allergens that were not added during manufacturing and therefore never show up in declarations from the producers. (Less)

Formaldehyde is a well-known contact sensitizer. Formaldehyde releasers are widely used preservatives in cosmetics.

Formaldehyde is a well-known contact sensitizer. Formaldehyde releasers are widely used preservatives in skincare products. It has been found that formaldehyde at concentrations allowed by the European Cosmetics Directive can cause allergic contact dermatitis. However, we still lack information on whether formaldehyde at low concentrations affects dermatitis in formaldehyde-allergic individuals.To study the effects of low concentrations of formaldehyde on irritant contact dermatitis in formaldehyde-allergic individuals.Fifteen formaldehyde-allergic individuals and a control group of 12 individuals without contact allergy to formaldehyde and formaldehyde releasers were included in the study. The individuals performed the repeated open application test (ROAT) during 4 weeks with four different moisturizers releasing formaldehyde in concentrations that had been determined as 40, 20-40, 2·5-10 and 0 p.p.m. by the chromotropic acid (CA) spot test. Dimethyloldimethylhydantoin was used as a formaldehyde releaser in the moisturizers. The ROAT was performed on areas of experimentally induced sodium lauryl sulfate dermatitis. The study was double blind, controlled and randomized.Nine of the 15 formaldehyde-allergic individuals had reappearance or worsening of dermatitis on the areas that were treated with moisturizers containing formaldehyde. No such reactions were observed in the control group (P 0·001) or for the moisturizers without formaldehyde in the formaldehyde-allergic individuals (P 0·001).Our results demonstrate that the low concentrations of formaldehyde often found in skincare products by the CA method are sufficient to worsen an existing dermatitis in formaldehyde-allergic individuals.

Background: Historically, allergic contact dermatitis caused by hexavalent chromium [Cr(VI)] in cement was the most common cause of invalidity attributable to skin disease in Sweden. Since the legislation to reduce Cr(VI) in cement was introduced in 1989, we rarely see allergic contact dermatitis caused by cement. Objectives: To examine the frequency of contact allergy to Cr(VI) in southern Sweden in 2005-2014. Methods: We investigated the occurrence of positive reactions to potassium dichromate 0.5% pet. in consecutively tested dermatitis patients, and compared the occurrence of atopic dermatitis, localization of dermatitis and simultaneous positive reactions to cobalt chloride and nickel sulfate in the Cr(VI)-positive patients with those in a group of patients with a similar age and sex distribution. Results: In total, 6482 patients were tested, and 233 Cr(VI)-allergic individuals were found (3.6%). A significantly higher proportion of atopic dermatitis was found among Cr(VI)-allergic patients, and a significantly higher share of foot dermatitis was found among Cr(VI)-allergic women, than among controls. Cr(VI) allergy was less likely when both nickel allergy and cobalt allergy were present. Conclusion: A relatively high frequency of contact allergy to Cr(VI) was found. The cause has shifted from cement exposure to other exposures, probably mainly leather. (Less)

Fragrance mix I (FM I) and fragrance mix II (FM II) are included in the European baseline series as screening substances for fragrance contact allergy.To investigate the frequency of allergic reactions to FM I, FM II and their ingredients in consecutively patch tested patients.A retrospective analysis of data from 4430 patients patch tested between 2009 and 2015 was performed.Of the patients, 6.5% were FM I-positive and 3.2% were FM II-positive. Forty-five per cent of FM I-positive patients did not have positive reactions to FM I ingredients. Thirty-five per cent of those who were FM II-positive did not have positive reactions to FM II ingredients. Twenty-seven per cent of those with positive reactions to one or more of the FM I ingredients were FM I-negative, and 36% of those who had positive reactions to one or more of the FM II ingredients were FM II-negative. The allergens with the highest pick-up rates were Evernia prunastri (1.8%), cinnamal (1.3%), citral (1.2%), and hydroxyisohexyl 3-cyclohexene carboxaldehyde (1.2%). Significant differences were observed in the proportions of positive reactions to FM I, FM II, eugenol, isoeugenol, and farnesol when results from patch testing with materials from different suppliers were compared.There is a risk of missing fragrance contact allergy when testing with only the fragrance mixes is performed. The use of preparations from different suppliers may affect the patch test results.

Background: For health care personnelhandhygieneandwearing appropriate protective gloves are compulsory. We have noticed an increase of hand eczema caused by contact allergy from rubber chemicals such as diphenylguanidine (DPG) in synthetic rubber gloves used by surgeons and surgical nurses. The exposure time to surgical gloves as well as the number of gloves used per day vary. Furthermore surgery very often includes the use of skin disinfectants before glove donning. Objectives: Does the exposure time influence the amount of DPG released from the gloves? Does the exposure of skin disinfectants before glove donning influence the release of DPG? Methods: Using synthetic sweat, the amount of DPG released from the inside of the gloves at different timeswas measured by HPLC. The remaining extractable DPG was estimated by washing the inside of the gloves with ethanol (50% in water) for 10min. The amount of DPG found on the hands exposed to 3ml skin disinfectant allowed to dry prior to glove donning was compared to the amount found on unexposed hands. After wearing gloves for 60 min the handswerewashedwith ethanol and the amount of DPG recovered was analysed with HPLC. Results: After 10, 30, 60 and 180 min approximately 73%, 79%, 82%, 87% of the total amount of DPG was released. For all comparisons the amount of DPG released was higher on the hand exposed to disinfectants compared with the unexposed hand. Conclusions: A comparatively short exposure time to gloves (10min) implies a substantial exposure to DPG. Thus, repeated usage of glovesmight enhance skin exposure to this rubber chemical. Skin disinfectants does increase the amount of DPG released from the gloves. Thus, possibly the components of the disinfectant remaining on the skin or some othermechanism add to the exposure to DPG. (Less)

Summary Background Vulcanization of rubber changes its allergen pattern. Objectives To estimate the contact allergic reactivity profile of users of finished rubber products. Methods Twenty-four patients with known contact allergy to rubber accelerators were patch tested with 21 compounds found in chemical analyses of vulcanized rubber products. No diphenylguanidine, p-phenylenediamine antioxidants or thioureas were included in the study. Results Thiuram monosulfides formed during vulcanization showed generally stronger test reactions than the corresponding thiuram disulfides. We also obtained more positive thiuram reactions to the monosulfides than to the disulfides. A positive reaction to a dithiocarbamate was accompanied by a positive reaction to the corresponding thiuram, except for 1 patient. The nitrogen substituents showed only minor differences between the methyl, ethyl and pentamethylene groups, but the butyl derivatives gave, in most cases, a negative response. Dialkylthiocarbamyl benzothiazole sulfides, formed between thiurams and mercaptobenzothiazoles during vulcanization, showed strong test reactions in almost all patients who were sensitive to dithiocarbamates, thiurams, or mercaptobenzothiazoles. Conclusions We found thiuram monosulfides to be better markers of thiuram sensitivity than the corresponding disulfides or dithiocarbamates. Surprisingly, the dialkylthiocarbamyl benzothiazole sulfides were good markers of both thiuram and mercaptobenzothiazole sensitivity. This is an unexpected finding that needs to be confirmed in a larger study.

Five workers from a plant manufacturing concrete wall panels and beams were referred to our department because of suspected occupational dermatitis. When patch tested, 3 workers reacted to potassium dichromate. Four workers reacted to ethylenediamine dihydrochloride, without any obvious exposure. Owing to the high proportion of workers with recent-onset skin disease, an investigation of all workers at the plant was initiated.To investigate the prevalence of occupational dermatitis and contact allergy in the workers at the plant.All 24 workers at the plant underwent a clinical investigation and were patch tested.Four cases of allergic occupational contact dermatitis and 3 cases of irritant occupational contact dermatitis were diagnosed. Contact allergy to potassium dichromate was found in 4 workers. All 4 also reacted to ethylenediamine dihydrochloride and/or amines that were present as additives in the cement.Chromate contact allergy can still be found in concrete workers, despite the legislation regulating the amount of hexavalent chromium (chromate) in cement. Occupational contact allergy to amines can be found in workers exposed to cement and concrete, so amines should be tested in these workers.

Background An increased frequency of occupational contact hand dermatitis among surgical operating theatre personnel has been noticed. Objectives To evaluate patients with occupational contact dermatitis caused by their rubber gloves, and to describe a method for analysing the content of the allergens in the gloves. Materials and methods Patch tests were performed with the baseline series, a rubber chemical series, and the patients' own gloves. A method for analysing 1,3-diphenylguanidine (DPG) and cetylpyridinium chloride in the gloves was developed. Results Contact allergy to thiuram mix was found in 8 of 16 patients, whereas 12 of 16 patients reacted to DPG. In 7 of 8 patients, contact allergy to cetylpyridinium chloride was found. In the patients' gloves, cetylpyridinium chloride and DPG were detected at higher concentrations on the inside of the gloves than on the outside. Most patients had worked for decades in their present occupations, but their hand dermatitis had only been present for months. Conclusion Contact allergy to DPG in gloves has been disputed, but, in this study, we were able to confirm the presence of DPG and cetylpyridinium chloride in the causative gloves by using a modified method for the analysis. The presence of these chemicals in gloves caused an increase in occupational contact dermatitis in surgical operating theatre personnel. (Less)

BACKGROUND: Hand eczema is more common in healthcare workers compared to the general population. The hands are subject to changing occupational exposures due to mandatory hygiene regulations for health care workers.OBJECTIVES: To describe the exposure due to hygiene procedures and investigate the associations between occupational hand washing, use of non-sterile gloves, and hand disinfectant and self-reported hand eczema.METHODS: Cross-sectional study with an electronic questionnaire distributed to 28 762 hospital employees in southern Sweden. Respondents working as nurses, assistant nurses or physicians constituted the group of healthcare workers analysed. Adjustments were made for gender, age, wet work at home, life-style factors and atopic dermatitis.RESULTS: 12 288 (43%) responded including 9051 healthcare workers. In this group the 1-year prevalence of self-reported hand eczema was 21%. On a daily basis, 30% reported hand washing with soap >20 times at work, 45% used hand disinfectants >50 times, and 54% used non-sterile gloves > 2 hours. After adjustment for confounding factors, a dose-dependent association with self-reported hand eczema was found for the daily number of hand washes with soap at work and time working with disposable gloves, but not for alcoholic disinfectant use. Hand washing outside work was not associated with self-reported hand eczema in the adjusted multivariate analysis.CONCLUSIONS: In this study, we found a higher 1-year prevalence of self-reported hand eczema among Swedish healthcare workers than reported in the general population. Hand washing with soap and use of disposable gloves were associated with the occurrence of self-reported hand eczema in a dose-dependent way. Use of hand disinfectant was not associated with self-reported hand eczema. This article is protected by copyright. All rights reserved.

Contact allergies to the preservatives formaldehyde and methylchloroisothiazolinone (MCI)/methylisothiazolinone (MI) have been reported to appear together at a statistically significant level. Recently, revisions concerning the patch test preparations of MCI/MI, MI and formaldehyde have been recommended for the European baseline series.To investigate (i) the number of concomitant contact allergies to the preservatives, (ii) the number of concomitant contact allergies to the preservatives and the fragrance mixes (FM I and FM II) and (iii) gender differences.Patients tested with the Swedish baseline series during the period 2012-2014 at the Department of Occupational and Environmental Dermatology in Malmö, Sweden were investigated.2165 patients were patch tested with the baseline series (34% males and 66% females). Contact allergies to formaldehyde and MCI/MI and/or MI were significantly associated (p 0.001). The associations between contact allergy to MCI/MI and/or MI and FM I and/or FM II, and between formaldehyde and FM I and/or FM II as well as, were statistically significant (p 0.001).Contact allergies to formaldehyde and MCI/MI and/or MI are significantly associated, as well as contact allergies to these preservatives and fragrance allergy. Males and females do not differ significantly concerning contact allergy to fragrances.

Formaldehyde is a well-known contact sensitizer. Formaldehyde releasers are widely used preservatives in cosmetics.To survey the release of formaldehyde in cosmetics brought by patients investigated because of suspected allergic contact dermatitis, to compare it with information given by the manufacturers on the packages, and to investigate whether formaldehyde-allergic patients are potentially exposed to more cosmetics releasing formaldehyde than dermatitis patients without contact allergy to formaldehyde.Cosmetics from 10 formaldehyde-allergic and 30 non-allergic patients (controls) matched for age and sex were investigated with the chromotropic acid spot test, which is a semiquantitative method measuring the release of formaldehyde.Formaldehyde was found in 58 of 245 (23.7%) products. Twenty-six of 126 (20.6%) leave-on products released formaldehyde, and 17 of 26 (65.4%) of these were not declared to contain formaldehyde or formaldehyde releasers. Among the rinse-off products, there were 32 of 119 (26.8%) formaldehyde-releasing products, and nine of 32 (28.0%) of these were not labelled as containing formaldehyde or formaldehyde releasers. Five of 10 formaldehyde-allergic patients brought leave-on products with ≥ 40 ppm formaldehyde, as compared with 4 of 30 in the control group (p = 0.029).Cosmetic products used by formaldehyde-allergic patients that are not declared to contain formaldehyde or formaldehyde-releasing preservatives should be analysed.

Formaldehyde is the American Contact Dermatitis Society Contact Allergen of the Year for 2015. The exposure is widespread, and contact allergy might be difficult to suspect in the individual dermatitis patient. The relevance of contact allergy to formaldehyde might also be difficult to evaluate. Recently, however, several studies have been performed aimed at enhancing the patch test technique and evaluating the clinical relevance of contact allergy to formaldehyde. The patch test concentration of formaldehyde has been recommended by the European Environmental Contact Dermatitis Research Group to be 2.0%, that is, the dose of 0.60 mg/cm (wt/vol) instead of 1.0%, which is the concentration previously used for the baseline series in most countries. Without causing any more irritant reactions, the patch test concentration of 2.0% detects twice as many contact allergies and enables the diagnosis of formaldehyde-allergic patients who otherwise would have been missed. The studies that underpin the decision were performed in Europe and partly in the United States. The Finn Chamber patch test system was used. The allergen dose per area was kept uniform with a micropipette. This report describes the background for routinely using formaldehyde 2.0% instead of 1.0% and for using a micropipette when applying the test solution.

The preservative methylchloroisothiazolinone/methylisothiazolinone (MCI/MI) is a well-known sensitiser and present in most baseline series since at least 20 years. The proportions of MCI/MI are 3:1. MI alone has been used as a preservative in occupational and household products, and cosmetics since less than 10 years. MCI/MI tested at 100 ppm fails to detect a significant percentage of contact-allergic reactions to MI. Our aim was to investigate whether a separate test preparation with MI picks up additional cases of contact allergy to MI not detected with MCI/MI 200 ppm. MI was inserted into the baseline series of the Malmo clinic in 2003 starting at 475 ppm, then 900 ppm, then 1,000 ppm, 1,500 ppm and finally 2,000 ppm. In 5,881 consecutively tested dermatitis patients the contact allergy rate for MI varied between 0.5 and 6.5%, with a marked increase in recent years. The contact allergy rate to MI 2,000 ppm alone, not traced by MCI/MI 200 ppm, varied between 0 and 1.9%. In conclusion, due to the increase of contact allergy to MI not traced by MCI/MI 200 ppm, MI in water at 2,000 ppm should be tested in a baseline series. Independent of patch test technique a dose of 60 µg/cm should not be exceeded to avoid adverse reactions and particularly patch test sensitisation. (Less)

Due to the clinical findings in a single patient's case, formaldehyde was suspected to be present in clinically relevant levels in reusable protective gloves. Therefore, 9 types of gloves were investigated with the semi-quantitative chromotropic acid method. It was found that 6/9 gloves emitted some formaldehyde and that 4/9 gloves emitted > or =40 microg of formaldehyde. Most of the formaldehyde was found on the inside of the gloves. To get an indication of the clinical relevance, a comparison with a protective cream declared to contain the formaldehyde-releasing agent diazolidinyl urea was performed by comparing areas of gloves with areas of cream layers with thickness 1-2 mg/cm(2). It was found that the amounts of formaldehyde emitted from the gloves might be in the same range as emitted from a layer of cream.

An outbreak of suspected contact dermatitis among subway construction workers was suspected to be due to a new bisphenol A/F-based epoxy resin system (ERS). The construction workers used ERSs during the insertion of iron bars into concrete walls. The objective of the study was to determine the components (if any) of the ERS responsible for the contact allergy. Patch testing was performed on 20 of the 22 construction workers who had had contact with the ERS, and to the various subcomponents of component A on 5 of the 7 who reacted to this component. 9 patients (9/22, 40.9%) had clinical symptoms and signs of suspected contact dermatitis at presentation. 7 of these 9, but none of the 11 asymptomatic individuals, were positive to component A, while all were negative to component B. Of the 5 cases receiving further patch testing, all reacted to m-xylylene diamine, 4 to 1,6-hexanediol diglycidyl ether, 3 to epoxy resins of the bisphenol F-type and trimethylolpropane triglycidyl ether 0.25% petrolatum, and only 1 to epoxy resins of the bisphenol A-type. Contact allergy to ERSs may involve hardeners and diluents as well as resins, and patch testing for reaction to all components should be performed.

The currently used patch test concentration of formaldehyde (1.0% aqua; 0.30 mg/cm(2) ) has been shown to fail to detect ˜ 50% of contact allergies to formaldehyde.

Over a short period of time, there was an outbreak of work-related skin lesions among workers at a company producing flooring laminate boards, after the introduction of a water-repellent lacquer based on diphenylmethane-4,4'-diisocyanate (MDI). In 5 workers, patch testing was performed with a standard series, an isocyanate series and work-environmental products when indicated. 3 of the workers were tested with the lacquer, and contact allergy was found with concurrent reactions to 4,4'-diaminodiphenylmethane (MDA). 1 of the 3 workers also showed a simultaneous reaction to MDI, whereas 1 showed a positive reaction to dicyclohexylmethane-4,4'-diisocyanate (HMDI). Of the 2 individuals not tested with the lacquer, 1 reacted to both MDI and MDA, whereas the other reacted to a soap used at work. In 3 of 4 cases, the isocyanate reactions appeared after D3. Occupational contact with isocyanates should not exclusively be focused upon respiratory hazards, as this report shows that skin contamination probably increases the risk of developing contact allergy to isocyanates and isocyanate-related substances. When aiming at diagnosing contact allergy to isocyanates, it is desirable to perform a late reading, as positive reactions appear late. MDA appears to be a good marker for isocyanate hypersensitivity.

In a plant producing advanced components for engines and drivelines we undertook a survey of occupational dermatoses, based on a questionnaire, clinical examination, and patch testing with a standard series and a series of samples from the working environment. The questionnaire was given to all 430 employees and it was answered and returned by 382 of these. 214 reported having had or having skin manifestations during the time of employment suspected of being work-related. 183 employees (164 metal workers, 19 office staff) participated in the clinical investigation, 182 (163 metal workers, 19 office staff) being patch tested. Occupational dermatoses were diagnosed in 23 of these 163 (14.1%) and in 1 of these 19 (5.3%). In all, irritant contact dermatitis was diagnosed in 12 metal workers, occupational allergic contact dermatitis in 11 (10 metal workers and 1 office clerk) and folliculitis in 1 metal worker. In the 11, neat oils were the cause in 4 workers, a water-based cutting fluid in 3 and various biocides in 4.

In this study, the sensitizing capacities of the 3 main low-molecular-weight isomers of epoxy resins based on diglycidyl ether of biphenol F (DGEBF) were investigated in a guinea pig maximization test (GPMT). The isomers are p,p'-DGEBF, o,p'-DGEBF, and o,o'-DGEBF. The sensitization capacities were compared to diglycidyl ether of bisphenol A (DGEBA), which is the main constituent in the most common epoxy resin. The cross-reaction pattern between all 4 compounds was also investigated. It was found that all 3 DGEBF isomers were potent sensitizers. It was also found that p,p'-DGEBF, o,p'-DGEBF, and DGEBA cross-reacted with one another, and that animals induced with o,o'-DGEBF reacted significantly only to o,p'-DGEBF, but not to the other 2 DGEBF isomers or DGEBA.

The materials in plastic protective gloves are thought to cause less contact allergy than rubber gloves. Our aim was to estimate the frequency of delayed reactions to different types of reusable protective gloves among dermatitis patients. 2 x 2 cm pieces of polyvinyl chloride (PVC) gloves, nitrile gloves, and natural rubber latex (NRL) gloves were tested as is in consecutive dermatitis patients tested with the baseline series. Among 658 patients, 6 patients reacted to PVC gloves and 6 patients to the NRL gloves. None reacted to both these types of gloves. Five of six patients with reactions to rubber gloves reacted to thiuram mix in the baseline series. Delayed reactions to reusable PVC gloves may be as common as to reusable NRL gloves. In contrast to most reactions to the NRL glove, the reactions to the PVC glove had no obvious association with reactions to any allergen(s) in the baseline series.

A golfer presented with facial and hand eczema. He had exacerbations of his hand eczema prior to golf tournaments. Being an authorized golf club repairman, he had been working with a two-part glue containing an epoxy resin (ER) based on diglycidyl ether of bisphenol A (DGEBA) and the hardener diethylenetriamine (DETA) for approximately 4 years before he developed any skin problems. He was patch-tested with the standard, which contains an ER based on DGEBA (DGEBA-R), epoxy (containing DETA), and rubber glove series and had positive reactions to DGEBA-R only. Other work materials (a latex glove, a golf glove made of leather, and part of the handle of his own golf club "as is" and in a methyl tert-butyl ether extract) were tested, with negative results. Allergic contact dermatitis from ER affects the skin by direct contact; the dermatitis is usually localized to the hands and forearms. If the face and eyelids are involved, the dermatitis may be due to exposure to airborne hardeners or reactive diluents, exposure to airborne dust from residual monomers, or ectopic allergic reactions. Our repairman had sandpapered an old glued surface, which may have led to possible airborne dust formation, thus explaining the facial eczema. Therefore, a worker with contact allergy to ER may continue working provided the skin is protected from contamination.

The currently used patch test concentration of formaldehyde (1.0% aqua; 0.30 mg/cm(2)) has been shown to fail to detect ~ 50% of contact allergies to formaldehyde.To justify the inclusion of formaldehyde 2.0% aqua (0.60 mg/cm(2)) in the European baseline patch test series.A survey of the reported frequencies of contact allergy to formaldehyde found with formaldehyde 2.0% aqua as compared with 1.0% aqua was performed. Studies that describe a standardized patch test technique for obtaining a correct dose per unit area were included. Experimental provocation tests in patients with contact allergy to formaldehyde detected only with 2.0% aqua were also surveyed.In a multicentre study performed in 12 dermatology clinics among 3591 individuals, 3.4% reacted to 2.0%, and 1.8% reacted to 1.0% (p0.001). A randomized double-blind repeated open application test performed in individuals reacting only to 2.0% but not to 1.0% showed that 9 of 17 formaldehyde-allergic individuals reacted to a moisturizer that contained formaldehyde (p0.001).It is recommended that formaldehyde 2.0% aqua (0.60 mg/cm(2)) should replace formaldehyde 1.0% in the European baseline series from 2014. With the Finn Chamber(®) technique, a standardized amount of 15 µl of the solution obtained by using a micropipette should be used.

Vulcanization of rubber changes its allergen pattern.To estimate the contact allergic reactivity profile of users of finished rubber products.Twenty-four patients with known contact allergy to rubber accelerators were patch tested with 21 compounds found in chemical analyses of vulcanized rubber products. No diphenylguanidine, p-phenylenediamine antioxidants or thioureas were included in the study.Thiuram monosulfides formed during vulcanization showed generally stronger test reactions than the corresponding thiuram disulfides. We also obtained more positive thiuram reactions to the monosulfides than to the disulfides. A positive reaction to a dithiocarbamate was accompanied by a positive reaction to the corresponding thiuram, except for 1 patient. The nitrogen substituents showed only minor differences between the methyl, ethyl and pentamethylene groups, but the butyl derivatives gave, in most cases, a negative response. Dialkylthiocarbamyl benzothiazole sulfides, formed between thiurams and mercaptobenzothiazoles during vulcanization, showed strong test reactions in almost all patients who were sensitive to dithiocarbamates, thiurams, or mercaptobenzothiazoles.We found thiuram monosulfides to be better markers of thiuram sensitivity than the corresponding disulfides or dithiocarbamates. Surprisingly, the dialkylthiocarbamyl benzothiazole sulfides were good markers of both thiuram and mercaptobenzothiazole sensitivity. This is an unexpected finding that needs to be confirmed in a larger study.

BACKGROUND: The currently used patch test concentration for formaldehyde is 1.0% (wt/vol) in water. However, clinical experience and previous studies suggest that 1.0% might be insufficient for detecting an optimized number of clinically relevant cases of contact allergy to formaldehyde. OBJECTIVES: To validate earlier patch test results for comparison of 1% (wt/vol) and 2% (wt/vol) formaldehyde in water, and to investigate co-reactivity with quaternium-15. MATERIALS AND METHODS: In 12 dermatology clinics, 3591 patients were routinely patch tested simultaneously with 2.0% (wt/vol) (0.60 mg/cm(2)) and 1.0% (wt/vol) (0.30 mg/cm(2)) formaldehyde. Micropipettes were used for delivering the exact dosage of the allergen. RESULTS: Significantly more patients reacted to 2.0% formaldehyde than to 1.0% (3.4% versus 1.8%, p < 0.001). Overall, there were no sex differences between those reacting positively to 2.0% and 1.0%. Of 25 quaternium-15-positive patients, 4 (0.1%) reacted positively without reacting to formaldehyde. CONCLUSION: On the basis of the results of this multicentre study, as well as of previous studies, it can be suggested that 2.0% (wt/vol) in water formaldehyde should be used in routine patch testing in the baseline series.

Sir, A Danish industry producing rotor blades for wind turbines with an epoxy-based technology had experienced an increased number of workers with dermatitis. To estimate the frequencies of work-related dermatitis, 603 workers were interviewed and clinically examined and 325 (82% men and 18% women) with suspected work-related dermatitis were patch-tested (to be published). As part of the results of the investigation, an association was found between contact allergy to epoxy resin and fragrance mix in the European standard series (odds ratio 5.5, 95% confidence interval (CI) 1.5‐17; p~0.009, Table I). No obvious gender differences were discerned, but the number of female workers was limited. To investigate whether the association between these allergens was restricted to the workers or indicated a possible, general phenomenon, the patch-test population of our department was analysed with respect to the corresponding association. RESULTS Among 4857 consecutively patch-tested patients (39% men and 61% women) with dermatitis 1995‐2002, simultaneous contact allergies to epoxy resin and fragrance mix were found in 11 patients (Table I). The odds ratio for simultaneous contact allergies among the patients was 2.8 (95% CI 1.3‐5.4; p~0.009 exact method provided by Stat Xact-5, Cytel Software Corp). Among our patients, the association between contact allergy to epoxy resin and fragrance mix was restricted to men. The odds ratio among the men was 6.2 (95% CI, 2.3‐15; pv0.001), while among women it was 1.1 (95% CI 0.22‐3.7; pw0.3). When testing the homogeneity of the odds ratios, the difference between men and women was statistically significant (p~0.02, Zelen’s test).

Background: It has been found that patch testing with 15μl formaldehyde 2.0% aq detects twice more allergies than testing with 1.0%. The clinical relevance of positive patch test reactions is often difficult to determine. Use tests are simple to do and help to evaluate the significance of patch test results. Objectives: To study the clinical relevance of contact allergy to formaldehyde detected by 2.0% (0.60 mg/cm²) but not by 1.0%. Patients/Methods: 18 patients positive to formaldehyde 2.0% but negative to 1.0% and a control group of 19 dermatitis patients without allergy to parabens, formaldehyde and formaldehyde releasers were included in the study. Formaldehyde 2000 ppm, the maximum concentration permitted in leave-on cosmetics according to the EU Cosmetics Directive, was added to a batch of a moisturiser preserved with parabens. The same batch without formaldehyde served as control. The study was double-blinded and randomised. The patients were provided with both moisturisers and instructed to apply one of them twice a day on a marked-out 5×5 cm area on the inside of one upper arm and the other moisturiser on the other arm. Reading of the test sites was done once a week for a maximum of 4 weeks. Results: In the control group there were no allergic reactions to any of the moisturisers. 9 of the 17 formaldehyde-allergic patients reacted with an allergic reaction to the moisturiser which contained formaldehyde (p

Keywords: epoxy resin; diglycidyl ether of bisphenol A; diglycidyl ether of bisphenol F; epoxy novolac resin; allergic contact dermatitis; occupational