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All contact dermatitis patients are told to avoid their specific allergens. As regards topical pharmaceutical agents, however, it is almost impossible for these patients to identify the products that contain their allergens. In order to provide reliable information for these patients, we have designed a computer assisted data systems. The CODEX (Contact Dermatitis index) system consists of three computer readable files: a Product File containing the complete composition of the pharmaceutical products on the Belgian market that are applied on the skin and the mucous membranes, a Patient File with the patient's anamnesis, and a Literature File with cross-referenced material on contact dermatitis. Each patient is given a list of the products that contain his/her allergen(s). The data bases are analyzed statistically and updated periodically. Cosmetics in general are excluded. [ABSTRACT FROM AUTHOR]

Background: The frequency of fragrance contact allergy has shown a fluctuating trend over the years., Objectives: To describe the frequency of positive reactions to the baseline screening agents and fragrance mix (FM) 1 and 2 components, to determine trends of the latter over the years, and to evaluate simultaneous reactions., Patients and Methods: This was a cross-sectional study on patch test results of 13 332 patients from January 1990 to December 2011., Results: Of the total population, 9.6% reacted positively to FM 1, and 6% of 3416 tested with FM 2 reacted positively. Of those tested with both, 30.4% of 349 FM 1-positive patients reacted to FM 2, and 51.7% of 205 FM 2-positive patients reacted to FM 1. Hydroxyisohexyl 3-cyclohexene carboxaldehyde (HICC) and FM 2 were tested simultaneously in 3401 patients: 6 reacted to HICC alone. Nine hundred and forty patients were tested with FM 1 ingredients and 205 with FM 2 ingredients; Evernia prunastri was the most frequent FM 1 allergen, and HICC was the most frequent FM 2 allergen. Simultaneous reactions were frequently observed., Conclusions: Fragrance-allergic subjects often show multiple positive reactions, some of which are highly significantly associated. Recently, there has been a decreasing trend in positivity for both Evernia prunastri and HICC, whereas a slight increase for cinnamyl alcohol has been observed., (© 2013 John Wiley & Sons A/S.)

Objectives: Reports about the nature of the ingredients responsible for allergic contact dermatitis caused by specific cosmetic products are scarce., Methods: Between January 2000 and December 2010, the specific cosmetic products having caused allergic contact dermatitis, as well as the individual allergenic cosmetic ingredients present in them, were recorded by use of a standardized form., Results: Among 11 different categories of cosmetic product, skin care products, followed by hair care and body-cleansing products, were most often involved. The presence of the allergenic ingredient(s) in a specific cosmetic product was confirmed according to the ingredient label in 959 of 1448 records. Six hundred and twenty-one of 959 concerned non-fragrance components, preservatives being responsible for 58% of them. Reactions to formaldehyde and formaldehyde-releasers were most often correlated with body-cleansing products, particularly 2-bromo-2-nitropropane-1,3-diol and skin care products. They were followed by the methylchloroisothiazolinone/methylisothiazolinone mixture, most frequently found as allergens in hair care and intimate hygiene products, and facial cleansers (in the last category together with diazolidinyl urea). Octocrylene was by far the most frequent (photo)allergen in sun care products., Conclusions: This study provides information on the presence and frequency of allergens in specific causal cosmetic products., (© 2011 John Wiley & Sons A/S.)

Background: Together with preservative agents, fragrance components are the most important sensitizing culprits in cosmetic products., Objectives: To identify the nature of the fragrance ingredients responsible for allergic contact dermatitis (ACD) from specific cosmetic products., Methods: Between 2000 and 2009, positive patch test reactions or positive usage tests with the patients' own cosmetic products, were recorded using a standardised form., Results: Of the 806 cosmetic records, corresponding to 485 patient files, 344 concerned reactions to fragrance ingredients that according to the label were present ('Presence Confirmed' [PC n = 301]) or suspected to be present ('Presence Not Confirmed' [PNC n = 376]) in the causal cosmetic products used, which belonged to 15 different categories, toilet waters/fine perfumes being the most frequent. Geraniol in fragrance mix I (FM I) and hydroxyisohexyl 3-cyclohexene carboxaldehyde (HICC) in FM II were the most frequent PC, and together with hydroxycitronellal and Evernia prunastri (oak moss) the most frequent PNC ingredients in the causal cosmetic products. Limonene was the most frequent PC confirmed fragrance allergen., Conclusions: This study not only underlines the usefulness of fragrance-ingredient labelling in order to identify the causal allergen(s) present in specific cosmetic products, but may also provide information on trends in the actual use of sensitizing fragrance ingredients in them., (© 2011 John Wiley & Sons A/S.)

Inhaled and intranasal corticosteroids (CS) are used to treat various inflammatory or allergic diseases of the upper and lower respiratory tract. Despite their wide use, only a few reports about their sensitization potential have been published. We determined the frequency, clinical signs and molecules responsible for skin allergic reactions following inhalation of corticosteroids amongst patients with identified and investigated "contact allergy" to corticosteroids. We reviewed clinical data, patch test results and sensitization sources in patients who reacted positively to corticosteroids tested in the K.U.Leuven Dermatology department during an 18-year period. 12 subjects (out of 315 with contact allergy to CS) presented with allergic manifestations due to nasal or orally inhaled corticosteroids, 11 of which were due to budesonide and one to tixocortol pivalate. Amongst patients with "contact allergy" to corticosteroids, very few were found with allergic manifestations due to inhaled corticosteroids. Budesonide was the major allergen found. Other inhalation corticosteroids such as beclomethasone, mometasone and fluticasone derivatives may, in most cases, still be used, since they do not cross react with budesonide.

Background: Corticosteroids may cause immediate or delayed hypersensitivity. In 1989, based on structural and clinical characteristics, we put forward a classification of corticosteroids into four cross-reacting groups, namely group A, B, C, and D, the latter later subdivided into two subgroups, i.e. D1 and D2. The constituents on the D-ring of the corticosteroid-molecule are considered to have a central role for binding to skin proteins and for cross-reactions patterns; however, halogenation of the molecules is also interfering., Objective: To study the clinical data and analyse simultaneous positive reactions obtained in a large group of corticosteroid-allergic patients., Methods: Patch tests were performed with the baseline series, to which hydrocortisone butyrate and prednisolone caproate were added, as well as with the corticosteroids to which the patients had been exposed. Three hundred and forty subjects with a presumed or proven corticosteroid allergy were further investigated with an extended series containing 72 molecules., Results: Out of 11 596 patients investigated, 315 subjects reacted positively to at least 1 corticosteroid-molecule, with most of them presenting with multiple positive reactions., Conclusion: A prevalence of corticosteroid allergy of 2.7% was found. Despite validity of the ABCD (sub)classification in many cases, possible adjustments may have to be considered.

Objectives: To determine which topical pharmaceutical products marketed in Belgium contain fragrances and to examine the nature of the fragrance allergens in specific pharmaceutical products having caused iatrogenic contact dermatitis., Methods: All topical pharmaceutical products marketed in Belgium, that is 3820 products, were examined as to their fragrance content as labelled. Data of 18, 960 patients investigated for contact allergy between 1978 and 2008 were retrieved from our database, including information on the nature of the topical pharmaceutical products used, the results of patch tests, and the sensitization sources., Results: Three hundred and seventy (10%) of 3280 of the topical pharmaceutical products were found to contain a total of 66 fragrance substances. Among 3378 patients suffering from iatrogenic allergic contact dermatitis, 127 were found to react to 48 specific products, for which 38 different fragrance substances gave relevant positive reactions. Women were more affected than men, and legs, hands, and face were the most commonly affected body sites., Conclusions: Fragrances, the presence of which is in most cases unnecessary, do contribute to iatrogenic allergic contact dermatitis. Moreover, sensitized patients have difficulties in avoiding their specific allergens because standardized labelling of the ingredients in pharmaceutical products is lacking.

Background: The widespread use of fragrance-containing products is probably the most important reason for its high impact in allergic contact dermatitis., Objectives: To describe the frequency of contact allergy to fragrance allergens as tested in the standard series, in relation to age, sex and lesion locations. To determine trends in frequency over the years and to study the association between positive tests observed with the different fragrance-allergy markers as well as between specific fragrance allergens and locations of the lesions., Patients/methods: 10 128 patients underwent patch testing between January 1990 and December 2005 at the Dermatology department in Leuven., Results: 1463 (14.5%), that is, 380 (26%) males and 1083 (74%) females, reacted positively to at least 1 fragrance-allergy marker in the standard series: 9% to fragrance mix I, 6% to Myroxylon pereirae, and 4.8% to colophonium (often in association), 2.1% to hydroxyisohexyl 3-cyclohexene carboxaldehyde and 2.1% to fragrance mix II, the latter 2 allergens having been introduced more recently. Over the years, fragrance contact allergy has shown a fluctuating trend. Hands and face were the most commonly affected body sites. Moreover, a significant association was found between specific fragrance allergens and certain locations., Conclusions: This study illustrates that fragrance contact allergy is common in patients suffering from contact dermatitis.

Background and Design: Most corticosteroid-allergic patients react to several corticosteroids. Irrefutable proof for the existence of cross-reactions is provided by reactions to substances to which the patient has never been exposed. Four groups of cross-reactions have been proposed, and our own observations support this. However, we have found that budesonide, in particular, tends to be involved not only in cross-reactions with corticosteroids of its own group (group B) but also with those of the ester group (group D). To test clinical observations on patients sensitive to corticosteroids and to establish a molecular basis for cross-reactivity patterns, a statistical analysis of our cases and a conformational study of major corticosteroids were performed., Results: Statistically highly significant positive or negative correlations were found for the combination of tixocortol pivalate plus hydrocortisone and hydrocortisone plus budesonide, respectively. This indicates that budesonide and hydrocortisone or tixocortol pivalate detect different groups of corticosteroid-sensitive patients. Moreover, significant positive correlations were found between budesonide and amcinonide, both molecules belonging to the acetonide group C, and also between budesonide and some esters of group D such as hydrocortisone-17 butyrate and alclometasone dipropionate. These clinical observations were fully supported by a conformational analysis of the electronic shape of corticosteroids involved in this study. Groups A, B, and D were found to be highly homogeneous within each group in terms of molecular structures, while significant differences were observed among the groups. The special behavior of budesonide can be fully explained on the base of its unique molecular structure. Finally, molecular characteristics have been defined for each group. This could be useful for the prediction of potential cross-reactions to new corticosteroid molecules., Conclusions: The statistical analysis confirms that tixocortol pivalate and hydrocortisone contact allergies are definitely associated, while reactions to budesonide are strongly correlated with the reactions to both the acetonide group and the ester group. These clinical observations are fully supported by the conformational analysis of the molecules involved in this study. Tixocortol pivalate and budesonide should certainly be added to the standard series for the detection of patients sensitized to corticosteroids.

An overview is given of the computer applications we have developed over the last twelve years in the field of contact dermatitis. The dissemination of exposure lists to sensitised individuals and the development of a knowledge-based system are mentioned only briefly. Priority here is given to the explanation of the graphical representation of the patient data collected since 1978 on 12,000 patients referred to three contact dermatitis units. More than a hundred parameters of each patient have been collected in a database. Several graphs are given of these data and are discussed in detail.