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Özkaya E, Mangır Ö. High prevalence but no current clinical relevance of methyldibromo glutaronitrile since its ban in Turkey in 2015. Contact Dermatitis 2024. [PMID: 39034492 DOI: 10.1111/cod.14642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2024] [Revised: 06/29/2024] [Accepted: 07/03/2024] [Indexed: 07/23/2024]
Abstract
BACKGROUND Regulatory actions significantly reduced methyldibromo glutaronitrile (MDBGN)-induced allergic contact dermatitis (ACD) from cosmetics in Europe. Turkey banned MDBGN in 2015. OBJECTIVES To assess sensitization and ACD rates to MDBGN before and after its ban in Turkey. METHODS Data from 2653 consecutively patch tested patients between 1996 and 2023 with MDBGN 0.1% pet. (n = 573) or 0.2%-0.3% pet. (n = 1310) or 0.5% pet. (n = 770) were analysed. MDBGN was tested as MDBGN/phenoxyethanol (PE) in 1434 patients. RESULTS The sensitization prevalence was 1.7% (45/2653), peaking at 5.3% in 2018 and 2023 with MDBGN 0.3% pet. There was a two-fold male predominance, with patients exclusively ≥20 years old. None of the patients reacted to PE. ACD occurred in 0.7% (19/2653), mainly affecting hands and linked to non-occupational exposure (78.9%), particularly from rinse-off/leave-on cosmetics. The pattern of 'middle-aged men with hand eczema and fragrance allergy' was particularly notable. Occupational ACD was rare (21.1%), occurring mainly in hairdressers from hair gel. Positive reactions with current clinical relevance dropped from 48.3% (1996-2014) to zero after 2015 (p < 0.001). CONCLUSIONS The ban effectively reduced MDBGN-induced ACD in Turkey, yet the prevalence of positive patch test reactions remains high, likely due to past exposures or other undisclosed sources. We suggest continued testing of MDBGN in the EBS in Turkey.
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Affiliation(s)
- Esen Özkaya
- Department of Dermatology and Venereology, İstanbul Faculty of Medicine, İstanbul University, Istanbul, Turkey
| | - Ömer Mangır
- Department of Dermatology and Venereology, İstanbul Faculty of Medicine, İstanbul University, Istanbul, Turkey
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Decision making in next generation risk assessment for skin allergy: Using historical clinical experience to benchmark risk. Regul Toxicol Pharmacol 2022; 134:105219. [PMID: 35835397 DOI: 10.1016/j.yrtph.2022.105219] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 05/24/2022] [Accepted: 06/30/2022] [Indexed: 11/23/2022]
Abstract
Our aim is to develop and apply next generation approaches to skin allergy risk assessment that do not require new animal test data and better quantify uncertainties. Quantitative risk assessment for skin sensitisation uses safety assessment factors to extrapolate from the point-of-departure to an acceptable human exposure level. It is currently unclear whether these safety assessment factors are appropriate when using non-animal test data to derive a point-of departure. Our skin allergy risk assessment model Defined Approach uses Bayesian statistics to infer a human-relevant metric of sensitiser potency with explicit quantification of uncertainty, using any combination of human repeat insult patch test, local lymph node assay, direct peptide reactivity assay, KeratinoSens™, h-CLAT or U-SENS™ data. Here we describe the incorporation of benchmark exposures pertaining to use of consumer products with clinical data supporting a high/low risk categorisation for skin sensitisation. Margins-of-exposure (potency estimate to consumer exposure level ratio) are regressed against the benchmark risk classifications, enabling derivation of a risk metric defined as the probability that an exposure is low risk. This approach circumvents the use of safety assessment factors and provides a simple and transparent mechanism whereby clinical experience can directly feed-back into risk assessment decisions.
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Geier J, Ballmer-Weber B, Buhl T, Rieker-Schwienbacher J, Mahler V, Dickel H, Schubert S. Is benzyl alcohol a significant contact sensitizer? J Eur Acad Dermatol Venereol 2022; 36:866-872. [PMID: 35080274 DOI: 10.1111/jdv.17968] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 01/07/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Benzyl alcohol is a widely used preservative, solvent, and fragrance material. According to published data, it is a rare sensitizer in humans. OBJECTIVES To identify characteristics and sensitization patterns of patients with positive patch test reactions to benzyl alcohol and to check the reliability of the patch test preparation benzyl alcohol 1% pet. PATIENTS AND METHODS Retrospective analysis of data from the Information Network of Departments of Dermatology (IVDK), 2010-2019. RESULTS Of 70,867 patients patch tested with benzyl alcohol 1% pet., 146 (0.21%) showed a positive reaction, most of them (89%) only weak positive. The number of doubtful and irritant reactions significantly exceeded the number of positive reactions. Reproducibility of positive test reactions was low. Among benzyl alcohol-positive patients, compared to benzyl alcohol negative patients, there were significantly more patients with leg dermatitis (17.8% vs. 8.6%), more patients aged 40 years or more (81.5% vs. 70.5%), and more patients who were tested because of a suspected intolerance reaction to topical medications (34.9% vs. 16.6%). Concomitant positive reactions were mainly seen to fragrances, preservatives, and ointment bases. CONCLUSIONS Sensitization to benzyl alcohol occurs very rarely, mainly in patients with stasis dermatitis. In view of our results, benzyl alcohol cannot be regarded as a significant contact allergen, and therefore marking it as skin sensitizer 1B and labelling it with H 317 is not helpful.
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Affiliation(s)
- J Geier
- Information Network of Departments of Dermatology (IVDK), Institute at the University Medical Center Göttingen, Göttingen, Germany
| | - B Ballmer-Weber
- Clinic of Dermatology and Allergology, Cantonal Hospital St, Gallen, St. Gallen, Switzerland
| | - T Buhl
- Department of Dermatology, Venereology and Allergy, University Medical Center Göttingen, Göttingen, Germany
| | - J Rieker-Schwienbacher
- Center for Dermatology, Phlebology and Allergology, Klinikum Stuttgart, Stuttgart, Germany
| | - V Mahler
- Department of Dermatology, University Hospital Erlangen, Erlangen, Germany.,current address Paul-Ehrlich-Institut, Langen, Germany
| | - H Dickel
- Department of Dermatology, Venereology and Allergology, St. Josef Hospital, Ruhr University Bochum, Bochum, Germany
| | - S Schubert
- Information Network of Departments of Dermatology (IVDK), Institute at the University Medical Center Göttingen, Göttingen, Germany
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Dear K, Palmer A, Nixon R. Contact allergy and allergic contact dermatitis from benzalkonium chloride in a tertiary dermatology center in Melbourne, Australia. Contact Dermatitis 2021; 85:146-153. [PMID: 33656745 DOI: 10.1111/cod.13826] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 01/30/2021] [Accepted: 02/03/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Benzalkonium chloride (BAK) is a quaternary ammonium compound that is used widely as an antiseptic and preservative. It is a strong irritant and considered a weak sensitizer. OBJECTIVE To analyze the temporal trend of BAK sensitization and the demographics of sensitized patients. METHODS We conducted a single-center retrospective study of 7390 patients who were patch tested with BAK between January 1, 2003 and December 31, 2019. RESULTS Of the 7390 patients who were patch tested to BAK, 108 (1.5%) had a positive reaction, with 21 reactions deemed clinically relevant (0.3% of total patch tested) and a further 5 doubtful reactions deemed clinically relevant, resulting in a total of 26 relevant reactions (0.4% of total patch tested). Common sources of exposure were ophthalmic drops (30.8%), topical antiseptic preparations (26.9%), cosmetics (15.4%), disinfectant solutions (11.5%), hand sanitizers (11.5%), and hand washes (7.7%). One fifth of patients with relevant reactions were health care workers. There has been a dramatic increase in the number of positive reactions since 2017, for reasons not totally clear. CONCLUSION Contact allergy (CA) and allergic contact dermatitis (ACD) in response to BAK are now increasing at our center. Awareness of this trend is important, given that the coronavirus disease 2019 (COVID-19) pandemic is likely to further expose people to BAK.
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Affiliation(s)
- Kate Dear
- Occupational Dermatology Research and Education Centre, Skin Health Institute, Carlton, Victoria, Australia
| | - Amanda Palmer
- Occupational Dermatology Research and Education Centre, Skin Health Institute, Carlton, Victoria, Australia
| | - Rosemary Nixon
- Occupational Dermatology Research and Education Centre, Skin Health Institute, Carlton, Victoria, Australia
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Whitehouse H, Uter W, Geier J, Ballmer-Weber B, Bauer A, Cooper S, Czarnecka-Operacz M, Dagmar S, Dickel H, Fortina AB, Gallo R, Giménez-Arnau AM, Johnston GA, Filon FL, Mahler V, Pesonen M, Rustemeyer T, Schuttelaar MLA, Valiukevičienė S, Weisshaar E, Werfel T, Wilkinson M. Formaldehyde 2% is not a useful means of detecting allergy to formaldehyde releasers- results of the ESSCA network, 2015-2018. Contact Dermatitis 2020; 84:95-102. [PMID: 32876992 DOI: 10.1111/cod.13691] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 08/13/2020] [Accepted: 08/26/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Studies suggest that patch testing with formaldehyde releasers (FRs) gives significant additional information to formaldehyde 1% aq. and should be considered for addition to the European baseline series (EBS). It is not known if this is also true for formaldehyde 2% aq. OBJECTIVES To determine the frequency of sensitization to formaldehyde 2% aq. and co-reactivity with FRs. To establish whether there is justification for including FRs in the EBS. MATERIALS AND METHODS A 4-year, multi-center retrospective analysis of patients with positive patch test reactions to formaldehyde 2% aq. and five FRs. RESULTS A maximum of 15 067 patients were tested to formaldehyde 2% aq. and at least one FR. The percentage of isolated reactions to FR, without co-reactivity to, formaldehyde 2% aq. for each FR were: 46.8% for quarternium-15 1% pet.; 67.4% imidazolidinyl urea 2% pet.; 64% diazolidinyl urea 2% pet.; 83.3% 1,3-dimethylol-5, 5-dimethyl hydantoin (DMDM) hydantoin 2% pet. and 96.3% 2-bromo-2-nitropropane-1,3-diol 0.5% pet. This demonstrates that co-reactivity varies between FRs and formaldehyde, from being virtually non-existent in 2-bromo-2-nitropropane-1,3-diol 0.5% pet. (Cohen's kappa: 0, 95% confidence interval [CI] -0.02 to 0.02)], to only weak concordance for quaternium-15 [Cohen's kappa: 0.22, 95%CI 0.16 to 0.28)], where Cohen's kappa value of 1 would indicate full concordance. CONCLUSIONS Formaldehyde 2% aq. is an inadequate screen for contact allergy to the formaldehyde releasers, which should be considered for inclusion in any series dependant on the frequency of reactions to and relevance of each individual allergen.
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Affiliation(s)
| | - Wolfgang Uter
- Department of Medical Informatics, Biometry and Epidemiology, University of Erlangen/Nürnberg, Erlangen, Germany
| | - Johannes Geier
- Information Network of Departments of Dermatology (IVDK), Institute at the University Medical Center Göttingen, Göttingen, Germany
| | - Barbara Ballmer-Weber
- Clinic for Dermatology and Allergology, Kantonsspital St. Gallen, St. Gallen, Switzerland.,Allergy Unit, Department of Dermatology, University Hospital Zürich, Zürich, Switzerland
| | - Andrea Bauer
- Department of Dermatology, University Hospital Carl Gustav Carus, Technical University of Dresden, Dresden, Germany
| | - Susan Cooper
- Dermatology Department, Oxford University Hospitals NHS Trust, Oxford, UK
| | | | - Simon Dagmar
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Heinrich Dickel
- Department of Dermatology, Venereology and Allergology, St. Josef Hospital, Ruhr University Bochum, Bochum, Germany
| | - Anna Belloni Fortina
- Pediatric Dermatology Unit, Department of Medicine DIMED, University of Padova, Padova, Italy
| | - Rosella Gallo
- Clinica Dermatologica, Department of Health Sciences, University of Genoa, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Ana M Giménez-Arnau
- Department of Dermatology, Hospital del Mar, Universitat Autónoma, Barcelona, Spain
| | | | - Francesca Laresse Filon
- Unit of Occupational Medicine, Department of Medical Sciences, University of Trieste, Trieste, Italy
| | - Vera Mahler
- Department of Dermatology, University Hospital Erlangen, Medical Faculty Friedrich-Alexander University, Erlangen-Nuremberg, Germany.,Paul-Ehrlich-Institut, Langen, Germany
| | - Maria Pesonen
- Finnish Institute of Occupational Health, Helsinki, Finland
| | - Thomas Rustemeyer
- Department of Dermatology, Free University of Amsterdam, Amsterdam, The Netherlands
| | - Marie L A Schuttelaar
- Department of Dermatology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Skaidra Valiukevičienė
- Department of Skin and Venereal Diseases, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Elke Weisshaar
- Department of Dermatology, Occupational Dermatology, University Hospital Heidelberg, Heidelberg, Germany
| | - Thomas Werfel
- Department of Immunodermatology and Experimental Allergy, Medizinische Hochschule Hannover, Hannover, Germany
| | - Mark Wilkinson
- Department of Dermatology, Chapel Allerton Hospital, Leeds, UK
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