1
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Wang KL, Rainosek EM, Yang YW, Cantwell HM, Drage LA, Yiannias JA, Davis MDP, Hall MR, Youssef MJ. Pediatric Patch Testing at Mayo Clinic Between 2016 and 2020. Dermatitis 2024; 35:355-360. [PMID: 38320242 DOI: 10.1089/derm.2023.0353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
Background: Allergic contact Dermatitis (ACD) is a common condition within the pediatric population. Patch testing is an important way to identify relevant allergens. Objective: To provide an update of the common contact allergens seen in children based on patch testing data at our institution from 2016 to 2020. Methods: We performed a retrospective analysis of patch test data from children aged 1-18 years from 2016 to 2020 at Mayo Clinic. Reaction rates were compared to the rates reported by the Pediatric Contact Dermatitis Registry (PCDR). Results: One hundred ninety-two children aged 1-18 were patch tested to various allergens. A total of 15,457 allergens were tested, with 291 positive tests. The top 5 allergens with highest positive reaction rates were hydroperoxides of linalool, hydroperoxides of limonene, methylisothiazolinone, nickel, and cobalt. Seven of the top 38 allergens with the highest reaction rates are not currently included in the Mayo Clinic Pediatric Patch Test Series, and 11 are not currently included in the Pediatric Baseline Series (as developed by the Pediatric Contact Dermatitis Workgroup). Conclusions: Patch testing is a useful tool to diagnose children with ACD. With new products and exposures, there is an opportunity to expand current pediatric patch testing series.
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Affiliation(s)
- Katherine L Wang
- From the Mayo Clinic Alix School of Medicine, Jacksonville, Florida, USA
| | - Erin M Rainosek
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Yul W Yang
- Department of Dermatology, Mayo Clinic, Scottsdale, Arizona, USA
| | - Hafsa M Cantwell
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Lisa A Drage
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota, USA
| | - James A Yiannias
- Department of Dermatology, Mayo Clinic, Scottsdale, Arizona, USA
| | - Mark D P Davis
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Matthew R Hall
- Department of Dermatology, Mayo Clinic, Jacksonville, Florida, USA
| | - Molly J Youssef
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota, USA
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota, USA
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2
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Johnson W, Bergfeld WF, Belsito DV, Hill RA, Klaassen CD, Liebler DC, Marks JG, Shank RC, Slaga TJ, Snyder PW, Fiume M, Heldreth B. Amended Safety Assessment of Mentha piperita (Peppermint)-Derived Ingredients as Used in Cosmetics. Int J Toxicol 2023; 42:117S-143S. [PMID: 37800357 DOI: 10.1177/10915818231205837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/07/2023]
Abstract
The Expert Panel for Cosmetic Ingredient Safety (Panel) reviewed the safety of M piperita (peppermint)-derived ingredients. The Panel reviewed data relevant to the safety of these ingredients. Because final product formulations may contain multiple botanicals, each containing the same constituent(s) of concern, formulators are advised to be aware of these constituents and avoid reaching levels that may be hazardous to consumers. Industry should continue to use good manufacturing practices to limit impurities that could be present in botanical ingredients. The Panel concluded that M piperita (Peppermint) Oil, Extract, Leaf, and leaf-derived ingredients are safe in cosmetics in the present practices of use and concentration when formulated to be non-sensitizing, and that the available data are insufficient for determining that M piperita (Peppermint) Flower/Leaf/Stem Extract, M piperita (Peppermint) Flower/Leaf/Stem Water, and M piperita (Peppermint) Meristem Cell Culture are safe under the intended conditions of use in cosmetic formulations.
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Affiliation(s)
- Wilbur Johnson
- Cosmetic Ingredient Review Former Senior Scientific Analyst/Writer
| | | | | | - Ronald A Hill
- Expert Panel for Cosmetic Ingredient Safety Former Member
| | | | | | - James G Marks
- Expert Panel for Cosmetic Ingredient Safety Former Member
| | - Ronald C Shank
- Expert Panel for Cosmetic Ingredient Safety Former Member
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3
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Sharifi-Rad J, Quispe C, Turgumbayeva A, Mertdinç Z, Tütüncü S, Aydar EF, Özçelik B, Anna SW, Mariola S, Koziróg A, Otlewska A, Antolak H, Sen S, Acharya K, Lapava N, Emamzadeh-Yazdi S, Martorell M, Kumar M, Varoni EM, Iriti M, Calina D. Santalum Genus: phytochemical constituents, biological activities and health promoting-effects. Z NATURFORSCH C 2023; 78:9-25. [PMID: 36069757 DOI: 10.1515/znc-2022-0076] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 07/15/2022] [Indexed: 01/11/2023]
Abstract
Santalum genus belongs to the family of Santalaceae, widespread in India, Australia, Hawaii, Sri Lanka, and Indonesia, and valued as traditional medicine, rituals and modern bioactivities. Sandalwood is reported to possess a plethora of bioactive compounds such as essential oil and its components (α-santalol and β-santalol), phenolic compounds and fatty acids. These bioactives play important role in contributing towards biological activities and health-promoting effects in humans. Pre-clinical and clinical studies have shown the role of sandalwood extract as antioxidant, anti-inflammatory, antibacterial, antifungal, antiviral, neuroleptic, antihyperglycemic, antihyperlipidemic, and anticancer activities. Safety studies on sandalwood essential oil (EO) and its extracts have proven them as a safe ingredient to be utilized in health promotion. Phytoconstituents, bioactivities and traditional uses established sandalwood as one of the innovative materials for application in the pharma, food, and biomedical industry.
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Affiliation(s)
| | - Cristina Quispe
- Facultad de Ciencias de la Salud, Universidad Arturo Prat, Avda. Arturo Prat 2120, 1110939, Iquique, Chile
| | - Aknur Turgumbayeva
- Higher School of Medicine, Al-Farabi Kazakh National University, Almaty, Kazakhstan.,School of Pharmacy, JSC "S. D. Asfendiyarov Kazakh National Medical University", Almaty, Kazakhstan
| | - Zehra Mertdinç
- Faculty of Chemical and Metallurgical Engineering, Department of Food Engineering, Istanbul Technical University, 34469 Maslak, Istanbul, Turkey
| | - Sena Tütüncü
- Faculty of Chemical and Metallurgical Engineering, Department of Food Engineering, Istanbul Technical University, 34469 Maslak, Istanbul, Turkey
| | - Elif Feyza Aydar
- Faculty of Chemical and Metallurgical Engineering, Department of Food Engineering, Istanbul Technical University, 34469 Maslak, Istanbul, Turkey
| | - Beraat Özçelik
- Faculty of Chemical and Metallurgical Engineering, Department of Food Engineering, Istanbul Technical University, 34469 Maslak, Istanbul, Turkey.,BIOACTIVE Research & Innovation Food Manufacturing Industry Trade LTD Co., Maslak, Istanbul 34469, Turkey
| | - Stępień-Warda Anna
- Department of Forage Crop Production, Institute of Soil Science and Plant Cultivation - State Research Institute, Czartoryskich 8, 24-100 Puławy, Poland
| | - Staniak Mariola
- Department of Forage Crop Production, Institute of Soil Science and Plant Cultivation - State Research Institute, Czartoryskich 8, 24-100 Puławy, Poland
| | - Anna Koziróg
- Faculty of Biotechnology and Food Sciences, Lodz University of Technology, Institute of Fermentation Technology and Microbiology, Wolczanska 171/173, 90 - 924 Lodz, Poland
| | - Anna Otlewska
- Faculty of Biotechnology and Food Sciences, Lodz University of Technology, Institute of Fermentation Technology and Microbiology, Wolczanska 171/173, 90 - 924 Lodz, Poland
| | - Hubert Antolak
- Faculty of Biotechnology and Food Sciences, Lodz University of Technology, Institute of Fermentation Technology and Microbiology, Wolczanska 171/173, 90 - 924 Lodz, Poland
| | - Surjit Sen
- Molecular and Applied Mycology and Plant Pathology Laboratory, Department of Botany, University of Calcutta, 700019, Kolkata, India.,Department of Botany, Fakir Chand College, Diamond Harbour, West Bengal, 743331, India
| | - Krishnendu Acharya
- Department of Botany, Fakir Chand College, Diamond Harbour, West Bengal, 743331, India
| | - Natallia Lapava
- Medicine Standartization Department of Vitebsk State Medical University, Vitebsk, Republic of Belarus
| | - Simin Emamzadeh-Yazdi
- Department of Plant and Soil Sciences, University of Pretoria, Gauteng 0002, Pretoria, South Africa
| | - Miquel Martorell
- Department of Nutrition and Dietetics, Faculty of Pharmacy, Centre for Healthy Living, University of Concepción, 4070386 Concepción, Chile.,Universidad de Concepción, Unidad de Desarrollo Tecnológico, UDT, 4070386 Concepción, Chile
| | - Manoj Kumar
- Chemical and Biochemical Processing Division, ICAR - Central Institute for Research on Cotton Technology, 400019 Mumbai, India
| | - Elena Maria Varoni
- Department of Biomedical, Surgical and Dental Sciences, Università degli Studi di Milano, 20133 Milano, Italy.,National Interuniversity Consortium of Materials Science and Technology (INSTM), 50121 Firenze, Italy
| | - Marcello Iriti
- National Interuniversity Consortium of Materials Science and Technology (INSTM), 50121 Firenze, Italy.,Department of Agricultural and Environmental Sciences, Università degli Studi di Milano, 20133 Milano, Italy
| | - Daniela Calina
- Department of Clinical Pharmacy, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
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4
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Omeragic E, Dedic M, Elezovic A, Becic E, Imamovic B, Kladar N, Niksic H. Application of direct peptide reactivity assay for assessing the skin sensitization potential of essential oils. Sci Rep 2022; 12:7470. [PMID: 35523830 PMCID: PMC9076902 DOI: 10.1038/s41598-022-11171-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 04/13/2022] [Indexed: 11/24/2022] Open
Abstract
Plant-derived products are frequently found as ingredients in cosmetics. However, the current data show non-neglectable skin sensitizing potential of these preparations suggesting an urgent need for data regarding their health safety profile. The aim of this study was to assess the skin sensitization potential of commercial essential oils by selected Lamiaceae species (Lavandula angustifolia, Melissa officinalis, Mentha longifolia, Thymus vulgaris, Salvia officinalis, and Rosmarinus officinalis) using a chemistry-based Direct Peptide Reactivity Assay (DPRA) in order to predict their potential allergic properties. In the DPRA assay, nucleophile-containing synthetic peptides (cysteine peptide and lysine peptide) were incubated with the test substance for 24 h. Depletion of the peptide in the reaction mixture was measured by high-pressure liquid chromatography (HPLC) using UV detection and the average peptide depletion data for cysteine and lysine was then calculated. Menthae longifoliae aetheroleum showed no or minimal reactivity with 4.48% cysteine depletion, Rosmarini aetheroleum and Salviae aetheroleum showed low reactivity with the 12.79% and 15.34% of cysteine depletion, respectively, while the other analyzed essential oils showed moderate reactivity with the cysteine depletion between 23.21 and 48.43%. According to DPRA predictive analysis, only Menthae longifoliae aetheroleum can be classified as negative, while all other essential oils may be classified as positive, thus having the potential to cause skin sensitization.
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Affiliation(s)
- Elma Omeragic
- University of Sarajevo-Faculty of Pharmacy, Zmaja od Bosne 8, 71 000, Sarajevo, Bosnia and Herzegovina.
| | - Mirza Dedic
- University of Sarajevo-Faculty of Pharmacy, Zmaja od Bosne 8, 71 000, Sarajevo, Bosnia and Herzegovina
| | - Alisa Elezovic
- University of Sarajevo-Faculty of Pharmacy, Zmaja od Bosne 8, 71 000, Sarajevo, Bosnia and Herzegovina
| | - Ervina Becic
- University of Sarajevo-Faculty of Pharmacy, Zmaja od Bosne 8, 71 000, Sarajevo, Bosnia and Herzegovina
| | - Belma Imamovic
- University of Sarajevo-Faculty of Pharmacy, Zmaja od Bosne 8, 71 000, Sarajevo, Bosnia and Herzegovina
| | - Nebojsa Kladar
- University of Novi Sad-Faculty of Medicine, Hajduk Veljkova 3, 21000, Novi Sad, Serbia
| | - Haris Niksic
- University of Sarajevo-Faculty of Pharmacy, Zmaja od Bosne 8, 71 000, Sarajevo, Bosnia and Herzegovina
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5
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Geier J, Schubert S, Reich K, Skudlik C, Ballmer-Weber B, Brehler R, Weisshaar E, Uter W. Contact sensitization to essential oils: IVDK-data of the years 2010 - 2019. Contact Dermatitis 2022; 87:71-80. [PMID: 35417610 DOI: 10.1111/cod.14126] [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: 02/03/2022] [Revised: 04/05/2022] [Accepted: 04/08/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Essential oils (EOs) are widely used in cosmetics, perfumes, massage fluids, aroma therapy, and natural medicine. Some essential oils contain contact sensitizers. OBJECTIVES To describe the frequency of sensitization to EOs in dermatitis patients presenting in skin clinics including concomitant reactions, to evaluate the EO patch test preparations, and to identify patient groups with an increased risk of EO sensitization. PATIENTS AND METHODS Retrospective analysis of data from the Information Network of Departments of Dermatology (IVDK), 2010-2019. RESULTS Twelve EOs were patch tested in an aimed manner in 10 930 patients, of whom 908 (8.3%) reacted to at least one EO. Only 6 EOs elicited more than 1% positive patch test reactions: ylang ylang (I + II) oil (3.9%), lemongrass oil (2.6%), jasmine absolute (1.8%), sandalwood oil (1.8%), clove oil (1.6%), and neroli oil (1.1%). Concomitant reactions among EOs or to EOs and fragrances were frequent. Among EO-positive patients, women, leg dermatitis patients, patients aged 40 years or more, masseurs and cosmeticians were over-represented. CONCLUSIONS Sensitization to EOs occurs, albeit infrequently in most cases. Masseurs and cosmeticians have an increased risk of sensitization to EOs. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Johannes Geier
- Information Network of Departments of Dermatology (IVDK), Institute at the University Medical Center Göttingen, Göttingen, Germany
| | - Steffen Schubert
- Information Network of Departments of Dermatology (IVDK), Institute at the University Medical Center Göttingen, Göttingen, Germany
| | - Kristian Reich
- Translational Research in Inflammatory Skin Diseases, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christoph Skudlik
- Institute for Interdisciplinary Dermatologic Prevention and Rehabilitation (iDerm) at the University of Osnabrück and Dermatologic Centre, Trauma Hospital Hamburg, Hamburg, Germany
| | - Barbara Ballmer-Weber
- Clinic of Dermatology and Allergology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland, and Department of Dermatology, University Hospital Zuerich, Zuerich, Switzerland
| | - Randolf Brehler
- Department of Dermatology, University Hospital Münster, Münster, Germany
| | - Elke Weisshaar
- Unit for Occupational Dermatology, Department of Dermatology, Ruprecht-Karls University Heidelberg, Germany
| | - Wolfgang Uter
- Department of Medical Informatics, Biometry and Epidemiology, University of Erlangen/Nürnberg, Erlangen, Germany
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6
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Low Prevalence of Fragrance Contact Allergy Among Turkish Population: A 24-Year, Cross-Sectional, Tertiary Single-Center, Retrospective Study. Dermatitis 2021; 33:373-381. [PMID: 34882115 DOI: 10.1097/der.0000000000000822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Limited data exist on fragrance contact allergy among Turkish population. OBJECTIVE The aim of this study was to investigate the frequency and characteristics of fragrance contact allergy in Turkey. METHODS A retrospective cohort study was conducted on 2566 patients consecutively patch tested with the European baseline series and additionally with a fragrance series (n = 358) at a tertiary referral center between 1996 and 2019. RESULTS One hundred sixty-three patients (6.4%) (male/female, 1.5:1) were sensitized with at least 1 fragrance allergen. Fragrance mix (FM) I was most frequently positive (3.9%), followed by Myroxylon pereirae (3.1%), FM II (2%), and hydroxyisohexyl 3-cyclohexene carboxaldehyde (0.5%), the latter exclusively positive in FM II-positive patients. Among 358 patients patch tested with a fragrance series, positive patch test reactions were observed in 38 patients, including 8 who did not react to baseline fragrance markers. Clinically relevant fragrance allergy was established in 128 patients (78.5%) from nonoccupational (72.4%) and occupational (6.1%) sources. CONCLUSIONS The low prevalence, the middle-aged male preponderance, and the predominant involvement of hands were unusual findings. Rose/citrus-flavored perfumes and eau de cologne, which are traditionally preferred in our country, were important elicitors of fragrance contact allergy, especially among middle-aged and older men.
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7
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Lee EB, Lobl M, Ford A, DeLeo V, Adler BL, Wysong A. What Is New in Occupational Allergic Contact Dermatitis in the Year of the COVID Pandemic? Curr Allergy Asthma Rep 2021; 21:26. [PMID: 33779825 PMCID: PMC8006117 DOI: 10.1007/s11882-021-01000-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2021] [Indexed: 12/17/2022]
Abstract
Purpose of Review This article aims to summarize some recent trends in occupational allergic contact dermatitis (ACD), including dermatitis related to pandemic-level personal protective equipment in healthcare workers, hazards patients may experience when working from home, and occupational perspectives on the recent American Contact Dermatitis Society (ACDS) allergens of the year and ACDS Core Allergen Series updates. Recent Findings Recent ACDS Allergens of the Year may be particularly relevant to healthcare workers, including isobornyl acrylate, which is present in glucose sensors and propylene glycol present in hand cleansers and disinfectants. Lavender, limonene, and linalool, all of which are new additions to the ACDS Core Allergen Series, have been reported as causes for occupational ACD in massage therapists and aromatherapists. Isothiazolinone allergy continues to rise in both consumer and occupational settings. Finally, the COVID-19 pandemic has resulted in a wave of occupational ACD in healthcare workers to personal protective equipment, and revealed new potential allergens for individuals working from home. Summary Occupational allergic contact dermatitis continues to exert a significant occupational disease burden. Remaining aware of the current trends in allergens may allow for earlier recognition, diagnosis, and treatment, subsequently helping our patients to work in healthier and safer environments.
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Affiliation(s)
- Erica B Lee
- Department of Dermatology, University of Nebraska Medical Center, 985645 Nebraska Medical Center, Omaha, NE, 68198-5645, USA
| | - Marissa Lobl
- Department of Dermatology, University of Nebraska Medical Center, 985645 Nebraska Medical Center, Omaha, NE, 68198-5645, USA
| | - Aubree Ford
- Department of Dermatology, University of Nebraska Medical Center, 985645 Nebraska Medical Center, Omaha, NE, 68198-5645, USA
| | - Vincent DeLeo
- Department of Dermatology, Keck School of Medicine of University of Southern California, Los Angeles, CA, USA
| | - Brandon L Adler
- Department of Dermatology, Keck School of Medicine of University of Southern California, Los Angeles, CA, USA
| | - Ashley Wysong
- Department of Dermatology, University of Nebraska Medical Center, 985645 Nebraska Medical Center, Omaha, NE, 68198-5645, USA.
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8
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Barbaud A, Lafforgue C. Risks associated with cosmetic ingredients. Ann Dermatol Venereol 2021; 148:77-93. [PMID: 33642039 DOI: 10.1016/j.annder.2020.04.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 07/29/2019] [Accepted: 04/22/2020] [Indexed: 12/13/2022]
Abstract
The media and social networks often echo fears about the potential toxicity of cosmetics and the dangers they pose to the environment. Dermatologists may be asked about these topics, but despite regulatory labelling constraints and the proliferation of specialized sites and applications, they do not always have access to reliable information. It is for this reason that we are providing the present overview of current knowledge on the subject.
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Affiliation(s)
- A Barbaud
- Sorbonne université, INSERM, institut Pierre-Louis d'Epidemiologie et de santé publique, AP-HP, Sorbonne université, hopital Tenon, service de dermatologie et allergologie, 4 rue de la Chine, 75020 Paris, France.
| | - C Lafforgue
- Unité de dermopharmacologie et cosmétologie, faculté de pharmacie, université Paris sud - Paris Saclay, 5, rue J.B. Clément, 92296 Chatenay-Malabry cedex, France
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9
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Sharmeen JB, Mahomoodally FM, Zengin G, Maggi F. Essential Oils as Natural Sources of Fragrance Compounds for Cosmetics and Cosmeceuticals. Molecules 2021; 26:molecules26030666. [PMID: 33514008 PMCID: PMC7865210 DOI: 10.3390/molecules26030666] [Citation(s) in RCA: 128] [Impact Index Per Article: 42.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 01/23/2021] [Accepted: 01/23/2021] [Indexed: 11/16/2022] Open
Abstract
Fragrance is an integral part of cosmetic products and is often regarded as an overriding factor in the selection of cosmetics among consumers. Fragrances also play a considerable role in masking undesirable smells arising from fatty acids, oils and surfactants that are commonly used in cosmetic formulations. Essential oils are vital assets in the cosmetic industry, as along with imparting pleasant aromas in different products, they are able to act as preservatives and active agents and, simultaneously, offer various benefits to the skin. Moreover, the stimulating demand for natural ingredients has contributed massively to a renewed interest in cosmetic and wellness industries in plant derivatives, especially essential oils. This has led popular cosmetic companies to endorse natural fragrances and opt for minimally processed natural ingredients, given the potentially adverse health risks associated with artificial fragrance chemicals, which are major elements of cosmetics. Among the high-valued essential oils used as fragrances are citrus, lavender, eucalyptus, tea tree and other floral oils, among others, while linalool, geraniol, limonene, citronellol, and citral are much-appreciated fragrance components used in different cosmetics. Thus, this review aimed to highlight the enormous versatility of essential oils as significant sources of natural fragrances in cosmetics and cosmeceuticals. Moreover, a special focus will be laid on the different aspects related to essential oils such as their sources, market demand, chemistry, fragrance classification, aroma profile, authenticity and safety.
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Affiliation(s)
- Jugreet B. Sharmeen
- Department of Health Sciences, Faculty of Medicine and Health Sciences, University of Mauritius, Réduit 80837, Mauritius;
| | - Fawzi M. Mahomoodally
- Department for Management of Science and Technology Development, Ton Duc Thang University, Ho Chi Minh City 758307, Vietnam
- Faculty of Applied Sciences, Ton Duc Thang University, Ho Chi Minh City 758307, Vietnam
- Correspondence:
| | - Gokhan Zengin
- Physiology and Biochemistry Research Laboratory, Department of Biology, Science Faculty, Selcuk University, Konya 42130, Turkey;
| | - Filippo Maggi
- School of Pharmacy, University of Camerino, via Sant’Agostino 1, 62032 Camerino, Italy;
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10
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Contact Allergy to Fragrances. Contact Dermatitis 2021. [DOI: 10.1007/978-3-030-36335-2_86] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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11
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Fragrance- and Botanical-Related Allergy and Associated Concomitant Reactions: A Retrospective Analysis of the North American Contact Dermatitis Group Data 2007–2016. Dermatitis 2020; 32:42-52. [DOI: 10.1097/der.0000000000000661] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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12
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Sindle A, Martin K. Art of Prevention: Essential Oils - Natural Products Not Necessarily Safe. Int J Womens Dermatol 2020; 7:304-308. [PMID: 34222588 PMCID: PMC8243157 DOI: 10.1016/j.ijwd.2020.10.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 10/20/2020] [Accepted: 10/30/2020] [Indexed: 11/04/2022] Open
Abstract
Aromatherapy is defined as the use of essential oils, through inhalation or direct application to the skin, to achieve physical, psychological, and spiritual well-being. It has become an increasingly popular trend in modern-day holistic approaches to health care. Essential oils are thought to be natural and pure products, some of the most common being lavender, tea tree, peppermint, and ylang-ylang. In recent years, however, the composition of these oils has been found to be more complex than previously thought. Increased use has led to increasing reports of allergic contact dermatitis (ACD), a delayed-type hypersensitivity reaction to allergens in sensitized individuals. Inquiring about essential oil use is important when conducting clinical evaluations of suspected ACD. Herein, the authors seek to highlight the possibility that natural products may not be necessarily as safe as once thought and in particular seek to highlight ACD caused by essential oils.
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Affiliation(s)
- Allison Sindle
- Department of Dermatology, University of Missouri, Columbia, MO, United States
| | - Kari Martin
- Department of Dermatology, University of Missouri, Columbia, MO, United States
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13
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Abstract
The American Contact Dermatitis Society Core Allergen series was introduced in 2013 and updated in 2017. Changes in our recommended allergens are again necessary, taking into account data from the American Contact Dermatitis Society's Contact Allergen Management Program top 100 allergens from 2018. For the updated series, we removed methyldibromoglutaronitrile and added new haptens: Lyral, Limonene, Linalool, carmine, benzyl salicylate, disperse yellow 3, jasmine, peppermint, pramoxine, shellac, and lauryl polyglucose (glucosides). These additional allergens should increase the yield of relevant positive reactions for our patients.
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14
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Lauriola MM, Sena P, De Bitonto A, Corazza M. Irritant contact dermatitis after a curious therapeutic use of oregano essential oil. Contact Dermatitis 2020; 83:129-130. [PMID: 32232859 DOI: 10.1111/cod.13540] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 03/28/2020] [Indexed: 10/24/2022]
Affiliation(s)
- Maria Michela Lauriola
- Istituti Ospedalieri Bergamaschi, Policlinico San Marco, Devision of Dermatology, Zingonia-Osio Sotto (Bg), Italy
| | - Paolo Sena
- Surgical department, UOC Dermatologia, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Antonio De Bitonto
- Istituti Ospedalieri Bergamaschi, Policlinico San Marco, Devision of Dermatology, Zingonia-Osio Sotto (Bg), Italy
| | - Monica Corazza
- Department of Medical Sciences, Section of Dermatology, University of Ferrara, Ferrara, Italy
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Abstract
Allergic contact dermatitis to fragrance is common. The prevalence of fragrance allergy in the general population is between 0.7% and 2.6%. In patch-test populations, the positive reaction rate to fragrances ranges from 5% to 11%. The most common fragrance screeners in most baseline series include fragrance mix 1, fragrance mix 2, and Balsam of Peru. The addition of hydroxyisohexyl 3-cyclohexene carboxaldehyde, hydroperoxides of limonene, and hydroperoxides of linalool to screening series can further aid in the diagnosis of fragrance allergy. In the proper clinical setting, supplemental patch testing with an additional fragrance or essential oil series should be considered.
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Affiliation(s)
- Margo J Reeder
- Department of Dermatology, University of Wisconsin School of Medicine and Public Health, 1 South Park Street, 7th Floor, Madison, WI 53715, USA.
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16
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Contact Allergy to Fragrances. Contact Dermatitis 2020. [DOI: 10.1007/978-3-319-72451-5_86-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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17
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Gurnee EA, Kamath S, Kruse L. Complementary and alternative therapy for pediatric acne: A review of botanical extracts, dietary interventions, and oral supplements. Pediatr Dermatol 2019; 36:596-601. [PMID: 31231870 DOI: 10.1111/pde.13904] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Many supplements and products containing botanical extracts are marketed to patients for the treatment of acne vulgaris. Additionally, increasing attention has been paid to the role of diet in acne vulgaris. Studies on this topic including pediatric patients are limited, with variable efficacy data. Despite these limitations, knowledge of alternative therapies in pediatric acne vulgaris is often expected from pediatric dermatologists. Here we review available data on the efficacy of complementary and alternative medicines for treatment of acne in pediatric patients, focusing on topical, oral, and dietary modifications.
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Affiliation(s)
- Emily A Gurnee
- Division of Dermatology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois.,Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Sonia Kamath
- Division of Dermatology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois.,Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Lacey Kruse
- Division of Dermatology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois.,Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.,Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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18
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Bingham LJ, Tam MM, Palmer AM, Cahill JL, Nixon RL. Contact allergy and allergic contact dermatitis caused by lavender: A retrospective study from an Australian clinic. Contact Dermatitis 2019; 81:37-42. [DOI: 10.1111/cod.13247] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 02/10/2019] [Accepted: 02/14/2019] [Indexed: 11/28/2022]
Affiliation(s)
| | - Mei M. Tam
- Skin and Cancer Foundation Inc. Carlton Victoria Australia
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19
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de Groot AC. Myroxylon pereirae
resin (balsam of Peru) – A critical review of the literature and assessment of the significance of positive patch test reactions and the usefulness of restrictive diets. Contact Dermatitis 2019; 80:335-353. [DOI: 10.1111/cod.13263] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 03/02/2019] [Accepted: 03/04/2019] [Indexed: 11/30/2022]
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20
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Goodier MC, Zhang AJ, Nikle AB, Hylwa SA, Goldfarb NI, Warshaw EM. Use of essential oils: A general population survey. Contact Dermatitis 2019; 80:391-393. [PMID: 30548272 DOI: 10.1111/cod.13198] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 12/04/2018] [Accepted: 12/09/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Molly C Goodier
- University of Minnesota Medical School, Minneapolis, Minnesota.,Department of Medicine, University of Minnesota, Minneapolis, Minnesota.,Department of Dermatology, Hennepin County Medical Center, Minneapolis, Minnesota.,Department of Dermatology, Minneapolis Veterans Affairs Medical Center, Minneapolis, Minnesota
| | - Amy J Zhang
- University of Minnesota Medical School, Minneapolis, Minnesota.,Department of Dermatology, Park Nicollet Contact Dermatitis Clinic, Bloomington, Minnesota.,Department of Dermatology, Minneapolis Veterans Affairs Medical Center, Minneapolis, Minnesota
| | - Anne B Nikle
- Department of Dermatology, Park Nicollet Contact Dermatitis Clinic, Bloomington, Minnesota.,Department of Dermatology, Minneapolis Veterans Affairs Medical Center, Minneapolis, Minnesota
| | - Sara A Hylwa
- Department of Dermatology, University of Minnesota, Minneapolis, Minnesota.,Department of Dermatology, Park Nicollet Contact Dermatitis Clinic, Bloomington, Minnesota.,Department of Dermatology, Hennepin County Medical Center, Minneapolis, Minnesota
| | - Noah I Goldfarb
- Department of Medicine, University of Minnesota, Minneapolis, Minnesota.,Department of Dermatology, University of Minnesota, Minneapolis, Minnesota.,Department of Dermatology, Minneapolis Veterans Affairs Medical Center, Minneapolis, Minnesota.,Department of Internal Medicine, Minneapolis Veterans Affairs Medical Center, Minneapolis, Minnesota
| | - Erin M Warshaw
- Department of Medicine, University of Minnesota, Minneapolis, Minnesota.,Department of Dermatology, University of Minnesota, Minneapolis, Minnesota.,Department of Dermatology, Park Nicollet Contact Dermatitis Clinic, Bloomington, Minnesota.,Department of Dermatology, Minneapolis Veterans Affairs Medical Center, Minneapolis, Minnesota
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21
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An Update on Fragrance Contact Dermatitis. CURRENT TREATMENT OPTIONS IN ALLERGY 2019. [DOI: 10.1007/s40521-019-0196-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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22
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Hon KL, Ng WGG, Kung JSC, Leung PC, Leung TF. Pilot Studies on Two Complementary Bath Products for Atopic Dermatitis Children: Pine-Tar and Tea. MEDICINES 2019; 6:medicines6010008. [PMID: 30626074 PMCID: PMC6473907 DOI: 10.3390/medicines6010008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 12/24/2018] [Accepted: 12/28/2018] [Indexed: 11/16/2022]
Abstract
Background: Few standardized bath product clinical trials were performed for atopic dermatitis patients. Pine-tar and green tea extracts are plant-derived products that have been described as having anti-allergic effects which may reduce AD disease severity. Methods: The efficacy of two complementary bath products was studied and compared. Efficacy and acceptability of the bath products were measured by patient general acceptability of treatment (GAT: very good, good, fair or poor), disease severity (SCORAD: SCoring Atopic Dermatitis), quality of life (CDLQI: Children Dermatology Life Quality Index), and pertinent clinical parameters were measured before and after four weeks of treatment. Sample size calculations for further clinical trials were performed. In one group, nine AD patients were subjected to bathing with a pine-tar bath oil for 10–15 min daily for four weeks. In another group, 20 AD subjects bathed with a teabag containing green tea extracts for four weeks. Results: Significant improvements in clinical- and patient-orientated parameters were found in the pine-tar bathing group, but not the tea-bag bathing group. Both groups reported very good/good GAT on the studied products. Teabag bathing was considered not efficacious for further clinical trials. Conclusions: The pilot studies provided preliminary data on the efficacy of pine tar bath oil. We do not document a significant efficacy for bathing with tea extracts. Bathing with pine-tar is potentially a complementary topical treatment with good patient acceptance and adherence, but further evidence-based research for its recommendations is needed.
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Affiliation(s)
- Kam Lun Hon
- Department of Paediatrics, The Chinese University of Hong Kong, Hong Kong 00852, China.
| | - Wing Gi Gigi Ng
- Department of Paediatrics, The Chinese University of Hong Kong, Hong Kong 00852, China.
| | - Jeng Sum C Kung
- Department of Paediatrics, The Chinese University of Hong Kong, Hong Kong 00852, China.
| | - Ping Chung Leung
- Institute of Chinese Medicine, The Chinese University of Hong Kong, Hong Kong 00852, China.
| | - Ting Fan Leung
- Department of Paediatrics, The Chinese University of Hong Kong, Hong Kong 00852, China.
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Hon KL, Kung JS, Ng WGG, Leung TF. Testing an Ectoin Containing Emollient for Atopic Dermatitis. Curr Pediatr Rev 2019; 15:191-195. [PMID: 30987568 DOI: 10.2174/1573396315666190415144244] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Revised: 03/11/2019] [Accepted: 03/18/2019] [Indexed: 11/22/2022]
Abstract
AIM To describe the methodology in studying patient's acceptability and efficacy of an ectoin containing emollient for atopic dermatitis (AD). METHODS We described the methodology that we used in studying emollients and moisturisers, and patient acceptability of a group of AD patients before and following usage of an ectoin-containing proprietary emollient. These data were also compared with other brand emollients that we previously reported, namely Restoradom®, Ezerra® and Ezerra plus®. RESULTS 30 subjects (50% Male, Mean (SD) age: 9.8 (3.6) years with AD used the trial emollient W for four weeks. AD severity of subjects (by objective SCORAD) was moderate (n=22) and severe (n=8). Compliance was good and patients generally managed to use the moisturisers daily, with individual reports of a 'tingly' sensation by some subjects when applied to inflamed wounds. 63% reported "very good" or "good", whereas 37% reported "fair" or "poor" acceptability of the moisturisers. Following use of the trial emollient, area affected, disease intensity and severity significantly improved, as demonstrated in objective SCORAD (p=0.002). There were also significant improvements in POEM (p=0.035), and PADQLQ scores (p=0.017). For skin measurements, only transepidermal water loss had improved (p=0.035) after the treatment. There was no significant improvement of itch or sleep scores, skin hydration, pH, S. aureus colonization status, or need for use of topical medications. When compared with historical data of other emollients, the mean age of patients on emollient W was younger; efficacy and acceptability among these emollients were similar. CONCLUSION Methodology of emollient research is described. Doctors should provide evidencebased information about the efficacy of emollients. The ectoin-containing proprietary emollient improves disease and quality of life following its use in 4 weeks. Efficacy and acceptability are similar among 4 proprietary emollients.
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Affiliation(s)
- Kam Lun Hon
- Department of Paediatrics, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Jeng Sum Kung
- Department of Paediatrics, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Wing Gi Gigi Ng
- Department of Paediatrics, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Ting Fan Leung
- Department of Paediatrics, The Chinese University of Hong Kong, Shatin, Hong Kong
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25
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Uter W, Werfel T, White IR, Johansen JD. Contact Allergy: A Review of Current Problems from a Clinical Perspective. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15061108. [PMID: 29844295 PMCID: PMC6025382 DOI: 10.3390/ijerph15061108] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 05/20/2018] [Accepted: 05/26/2018] [Indexed: 12/17/2022]
Abstract
Contact allergy is common, affecting 27% of the general population in Europe. Original publications, including case reports, published since 2016 (inclusive) were identified with the aim of collating a full review of current problems in the field. To this end, a literature search employing methods of systematic reviewing was performed in the Medline® and Web of Science™ databases on 28 January 2018, using the search terms (“contact sensitization” or “contact allergy”). Of 446 non-duplicate publications identified by above search, 147 were excluded based on scrutiny of title, abstract and key words. Of the remaining 299 examined in full text, 291 were deemed appropriate for inclusion, and main findings were summarised in topic sections. In conclusion, diverse sources of exposures to chemicals of widely-differing types and structures, continue to induce sensitisation in man and may result in allergic contact dermatitis. Many of the chemicals are “evergreen” but others are “newcomers”. Vigilance and proper investigation (patch testing) are required to detect and inform of the presence of these haptens to which our populations remain exposed.
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Affiliation(s)
- Wolfgang Uter
- Department of Medical Informatics, Biometry and Epidemiology, University of Erlangen/Nürnberg, 91054 Erlangen, Germany.
| | - Thomas Werfel
- Division of Immunodermatology and Allergy Research, Department of Dermatology and Allergy, Hannover Medical School, 30625 Hannover, Germany.
| | - Ian R White
- St John's Institute of Dermatology, Guy's Hospital, London SE1 9RT, UK.
| | - Jeanne D Johansen
- Department of Dermatology and Allergy, National Allergy Research Centre, Copenhagen University Hospital Herlev and Gentofte, 2900 Hellerup, Denmark.
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26
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Uter W. Weitere Duftstoffallergene. ALLERGO JOURNAL 2018. [DOI: 10.1007/s15007-018-1577-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Hon KL, Kung JSC, Ng WGG, Leung TF. Emollient treatment of atopic dermatitis: latest evidence and clinical considerations. Drugs Context 2018; 7:212530. [PMID: 29692852 PMCID: PMC5908267 DOI: 10.7573/dic.212530] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 03/11/2018] [Accepted: 03/14/2018] [Indexed: 12/11/2022] Open
Abstract
Aim To review current classes of emollients in the market, their clinical efficacy in atopic dermatitis (AD) and considerations for choice of an emollient. Methods PubMed Clinical Queries under Clinical Study Categories (with Category limited to Therapy and Scope limited to Narrow) and Systematic Reviews were used as the search engine. Keywords of ‘emollient or moisturizer’ and ‘atopic dermatitis’ were used. Overview of findings Using the keywords of ‘emollient’ and ‘atopic dermatitis’, there were 105 and 36 hits under Clinical Study Categories (with Category limited to Therapy and Scope limited to Narrow) and Systematic Reviews, respectively. Plant-derived products, animal products and special ingredients were discussed. Selected proprietary products were tabulated. Conclusions A number of proprietary emollients have undergone trials with clinical data available on PubMed-indexed journals. Most moisturizers showed some beneficial effects, but there was generally no evidence that one moisturizer is superior to another. Choosing an appropriate emollient for AD patients would improve acceptability and adherence for emollient treatment. Physician’s recommendation is the primary consideration for patients when selecting a moisturizer/emollient; therefore, doctors should provide evidence-based information about these emollients.
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Affiliation(s)
- Kam Lun Hon
- Department of Paediatrics, The Chinese University of Hong Kong, Hong Kong
| | | | - Wing Gi Gigi Ng
- Department of Paediatrics, The Chinese University of Hong Kong, Hong Kong
| | - Ting Fan Leung
- Department of Paediatrics, The Chinese University of Hong Kong, Hong Kong
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Wilkinson M, Gallo R, Goossens A, Johansen JD, Rustemeyer T, Sánchez-Pérez J, Schuttelaar ML, Uter W. A proposal to create an extension to the European baseline series. Contact Dermatitis 2017; 78:101-108. [PMID: 29194657 DOI: 10.1111/cod.12918] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2017] [Revised: 09/04/2017] [Accepted: 09/29/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND The current European baseline series consists of 30 allergens, and was last updated in 2015. OBJECTIVES To use data from the European Surveillance System on Contact Allergies (ESSCA) to propose an extension to the European baseline series in response to changes in environmental exposures. METHODS Data from departmental and national extensions to the baseline series, together with some temporary additions from departments contributing to the ESSCA, were collated during 2013-2014. RESULTS In total, 31689 patients were patch tested in 46 European departments. Many departments and national groups already consider the current European baseline series to be a suboptimal screen, and use their own extensions to it. The haptens tested are heterogeneous, although there are some consistent themes. Potential haptens to include in an extension to the European baseline series comprise sodium metabisulfite, formaldehyde-releasing preservatives, additional markers of fragrance allergy, propolis, Compositae mix, and 2-hydroxyethyl methacrylate. CONCLUSION In combination with other published work from the ESSCA, changes to the current European baseline series are proposed for discussion. As well as addition of the allergens listed above, it is suggested that primin and clioquinol should be deleted from the series, owing to reduced environmental exposure.
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Affiliation(s)
- Mark Wilkinson
- Department of Dermatology, Leeds Teaching Hospitals NHS Trust, Leeds, LS7 4SA, UK
| | - Rosella Gallo
- Clinica Dermatologica, Department of Health Sciences (DiSSAL), Università di Genova, Ospedale Policlinico San Martino, 16132, Genoa, Italy
| | - An Goossens
- Contact Allergy Unit, Department of Dermatology, University Hospital KU Leuven, 3000, Leuven, Belgium
| | - Jeanne D Johansen
- Department of Dermato-Allergology, National Allergy Research Centre, Gentofte Hospital, University of Copenhagen, 2900, Hellerup, Denmark
| | - Thomas Rustemeyer
- Department of Dermatology, Free University of Amsterdam, 1081 HV, Amsterdam, The Netherlands
| | | | - Marie L Schuttelaar
- Department of Dermatology, University Medical Centre Groningen, University of Groningen, 9713 GZ, Groningen, The Netherlands
| | - Wolfgang Uter
- Department of Medical Informatics, Biometry and Epidemiology, University of Erlangen/Nürnberg, 91054, Erlangen, Germany
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