Alternatives for Allergens in the 2018 American Contact Dermatitis Society Core Series: Report by the American Contact Alternatives Group

Assessment of Contact Allergens in "Hypoallergenic" Athletic Shoes by Mass Spectrometry

Background: Identification of athletic shoes for patients with contact allergy is difficult. Company reports of allergen content are often incorrect. Objectives: To determine whether chemical analysis of 4 athletic shoes, previously reported to be free of the most common contact allergens, contain quantifiable allergen levels. Methods: Samples from the uppers and insoles of 4 shoes believed to be free of common allergens were assessed by mass spectrometry. A total of 4 rubber accelerators and 2 adhesives were directly quantified and additional 7 rubber accelerators were assessed using semiquantitative measures. Results: Aside from carbamates (assayed as 59 ppm zinc in insoles) in SeaVee's Sixty-Six sneakers, para-tertiarybutylphenol formaldehyde resin (PTBFR) (assayed as 7.6 ppm paratertiary butylphenol or 4-tertiary butylphenol [4TBP] in uppers) in Allbirds Tree Runners and rosin (assayed as 628 ppm sodium abietate in uppers) and carbamates (24 ppm zinc in uppers) in Saucony Jazz sneakers, these shoes had low levels of all allergens assayed in this study. Tom's Carlo sneakers contained rosin (127 ppm sodium abietate in insoles), PTBFR (6.5 ppm 4TBP in uppers), and carbamates (112 ppm sodium abietate in insoles) but had low levels of all other assayed allergens. Conclusions: Although identifying allergen-free shoes is challenging, the results of this analysis will help patch testing physicians recommend athletic shoes to patients with specific allergies.

Medical Adhesive Allergens: Retrospective Analysis of Cross-Sectional Data from the North American Contact Dermatitis Group, 2001-2018

BACKGROUND

Identification of allergens causing medical adhesive contact allergy is difficult.

OBJECTIVE

Characterize the demographics, clinical characteristics, patch test results and occupational data for North American Contact Dermatitis Group (NACDG) patients with medical adhesive contact allergy.

METHODS

Retrospective study of 43,722 NACDG patients patch-tested 2001-2018, with: 1) medical adhesive (tapes/band aids/adhesive aids/suture glue) source, 2) positive patch test, and 3) final primary diagnosis of allergic contact dermatitis.

RESULTS

313 (0.7%) patients met inclusion criteria. Compared to other patients with final primary diagnosis of allergic contact dermatitis, medical adhesive allergy patients were less likely male (odds ratio 0.58, 95% confidence interval [0.45-0.77]) and/or age >40 (0.76 [0.6-0.96]). The most common NACDG screening series allergens were colophony (80.7%), balsam of Peru (3.9%), 2-hydroxyethyl methacrylate (2.7%) and carba mix (2.7%). One-fourth (79/313, 25.2%) had positive patch test reactions to supplemental allergens/materials, and 17.3% (54/313) only had reactions to supplemental allergens/materials.

LIMITATIONS

Results of comprehensive patch testing may be prone to referral population selection bias and may not be representative of the general dermatology population.

CONCLUSION

Colophony was the most common allergen. Supplemental allergens and materials should be tested in the evaluation of suspected medical adhesive contact allergy.

Identifying Safe Alternatives for Contact Allergy Patients

Allergen avoidance is the most effective treatment of contact allergy. Patient improvement ultimately relies on identification of safe alternative products, which can be used by the patient. Safe personal care product options typically can be found using ingredient database programs. Avoidance of allergens in other products (eg, shoes, clothing, and dental care) often is challenging. This article discusses specific safe alternatives for the 80 allergens on the 2017 American Contact Dermatitis Society core allergen series.

Pediatric Allergic Contact Dermatitis

Allergic contact dermatitis (ACD) affects up to 20% of adults and children, although children are infrequently patch tested. Available data suggest that children and adults, with or without atopic dermatitis, have the same prevalence of ACD. Patch testing is the gold standard for evaluation of ACD. The Pediatric Baseline Series was recently published by expert consensus for use in pediatric patch testing, with additional allergens tested as guided by history. This article examines methods of patch testing and up-to-date data on pediatric ACD. The top allergens are reviewed, and avoidance strategies are discussed.

Contact dermatitis

Contact dermatitis (CD) is among the most common inflammatory dermatological conditions and includes allergic CD, photoallergic CD, irritant CD, photoirritant CD (also called phototoxic CD) and protein CD. Occupational CD can be of any type and is the most prevalent occupational skin disease. Each CD type is characterized by different immunological mechanisms and/or requisite exposures. Clinical manifestations of CD vary widely and multiple subtypes may occur simultaneously. The diagnosis relies on clinical presentation, thorough exposure assessment and evaluation with techniques such as patch testing and skin-prick testing. Management is based on patient education, avoidance strategies of specific substances, and topical treatments; in severe or recalcitrant cases, which can negatively affect the quality of life of patients, systemic medications may be needed.

A review of acrylates: Super glue, nail adhesives, and diabetic pump adhesives increasing sensitization risk in women and children

Allergic contact dermatitis (ACD) is a cutaneous type IV hypersensitivity immune reaction mounted against substances in contact with the skin to which the patient has been sensitized. ACD is common, affecting approximately 72 million Americans per year, and is more common in women. One common contact allergen group is acrylates, which are monomers that are polymerized in the making of glues, adhesives, and plastic materials. It is the monomers that are sensitizing, whereas the final polymers are inert. Acrylates were the 2012 Contact Allergen of the Year with the specific acrylate, isobornyl acrylate, being the 2020 Contact Allergen of the Year. This article reviews the history of acrylate use, epidemiology, and both known and emerging sources of acrylates resulting in ACD.

Scalp involvement in patients referred for patch testing: Retrospective cross-sectional analysis of North American Contact Dermatitis Group data, 1996 to 2016

BACKGROUND

Scalp conditions are often multifactorial.

OBJECTIVE

To characterize patients with scalp involvement and patch-testing outcomes.

METHODS

Retrospective cross-sectional analysis of North American Contact Dermatitis Group data (1996-2016). Study groups included patients with scalp involvement (≤3 anatomic sites coded) with or without additional sites.

RESULTS

A total of 4.8% of patients (2331/48,753) had scalp identified as 1 of up to 3 affected anatomic sites. Approximately one-third of "scalp-only" individuals had a specific primary diagnosis of allergic contact dermatitis (38.6%), followed by seborrheic dermatitis (17.2%) and irritant contact dermatitis (9.3%). When adjacent anatomic sites were affected, allergic contact dermatitis was more frequently identified as the primary diagnosis (>50%). The top 5 currently clinically relevant allergens in scalp-only patients were p-phenylenediamine, fragrance mix I, nickel sulfate, balsam of Peru, and cinnamic aldehyde. Methylisothiazolinone sensitivity was notable when adjacent anatomic sites were involved. The top 3 specifically identified sources for scalp-only allergens were hair dyes, shampoo/conditioners, and consumer items (eg, hair appliances, glasses).

LIMITATIONS

Tertiary referral population.

CONCLUSION

Isolated scalp involvement was less likely to be associated with allergic contact dermatitis than when adjacent anatomic sites were involved. Overlap with multiple diagnoses was frequent, including seborrheic dermatitis, irritant dermatitis, other dermatoses, or all 3. p-Phenylenediamine was the most common allergen.

Flexible and water-stable graphene-based electrodes for long-term use in bioelectronics

We present the first demonstration of bioelectrodes made from laser-reduced graphene oxide (rGO) on flexible polyethylene terephthalate (PET) substrates that overcome two main issues: using hydrogel on skin interface with standard Ag/AgCl bioelectrodes vs. low signal to noise ratio with capacitance or dry electrodes. Today we develop a dry rGO bioelectrode technology with long-term stability for 100 h in harsh environments and when in contact with skin. Reliability tests in different buffer solutions with pH from 4.8 to 9.2 tested over 24 h showed the robustness of rGO electrodes. In terms of signal to noise ratio, our bioelectrodes performance is comparable to that of commercial ones. The bioelectrodes demonstrate an excellent signal to noise ratio, with a signal match of over 98% with respect to state-of-the-art electrodes used as a benchmark. We attribute the unique stability of our bioelectrodes to the rGO/PET interface modification and composite formation during laser processing used for GO reduction. The rGO/PET composite formation assertion is confirmed by mechanical stripping experiments and visual examination of re-exposed PET. The method developed here is simple, cost-effective, maskless, and can be scaled-up, allowing sustainable manufacture of arbitrary-shaped flexible electrodes for biomedical sensors and wearables.

Allergic contact dermatitis caused by wound closure tape in a pediatric patient

Wound care products are emerging as causes of allergic contact dermatitis (ACD). There are increasing reports of ACD to certain medical adhesives; however, there are no published reports of contact sensitization solely due to wound closure tape such as Steri-Strips™. Herein, we present the first confirmed case of ACD in a child caused by wound closure tape.