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de Groot AC, Rustemeyer T. 2-Hydroxyethyl methacrylate (HEMA): A clinical review of contact allergy and allergic contact dermatitis. Part 2. Cross- and co-sensitization, other skin reactions to HEMA, position of HEMA among (meth)acrylates, sensitivity as screening agent, presence of HEMA in commercial products and practical information on patch test procedures. Contact Dermatitis 2024; 90:1-16. [PMID: 37778325 DOI: 10.1111/cod.14430] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Revised: 09/08/2023] [Accepted: 09/14/2023] [Indexed: 10/03/2023]
Abstract
This is the second part of a literature review of the clinical aspects of contact allergy to and allergic contact dermatitis from 2-hydroxyethyl methacrylate (HEMA). Topics include cross- and co-sensitization, atypical manifestations of contact allergy, frequency of positive patch tests to HEMA compared with other (meth)acrylates, sensitivity of HEMA as a screening agent, the presence of HEMA in commercial products, and practical information on patch testing procedures. Primary sensitization to methacrylates including HEMA may result in methacrylate and acrylate cross-sensitization. There is a strong cross-allergy between HEMA, ethylene glycol dimethacrylate (EGDMA), and hydroxypropyl methacrylate; many reactions to EGDMA are cross-reactions to primary HEMA sensitization. Rare atypical manifestations of HEMA-allergy include lichen planus, lymphomatoid papulosis, systemic contact dermatitis, leukoderma after positive patch tests, and systemic side effects such as nausea, diarrhoea, malaise, and palpitations. The occurrence of respiratory disease caused by methacrylates such as asthma is not infrequent. HEMA is the most frequently patch test-positive methacrylate. It is a good screening agent for allergy to other (meth)acrylates. Patch test sensitization to HEMA 2% pet. is extremely rare. There are (some) indications that HEMA is frequently used in dental products and nail cosmetics.
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Affiliation(s)
| | - Thomas Rustemeyer
- Dermato-Allergology and Occupational Dermatology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
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de Groot AC, Rustemeyer T. 2-Hydroxyethyl methacrylate (HEMA): A clinical review of contact allergy and allergic contact dermatitis-Part 1. Introduction, epidemiology, case series and case reports. Contact Dermatitis 2023; 89:401-433. [PMID: 37752620 DOI: 10.1111/cod.14405] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 07/31/2023] [Accepted: 08/04/2023] [Indexed: 09/28/2023]
Abstract
2-Hydroxyethyl methacrylate (HEMA) has been increasingly recognised as a contact allergen and was added to the European baseline series in 2019. In this article (2 parts), the results of an extensive literature review of the clinical aspects of contact allergy/allergic contact dermatitis to HEMA are presented. In part 1, the epidemiology of HEMA contact allergy is discussed and detailed information on published case series and case reports presented. HEMA is an important cause of contact allergy/allergic contact dermatitis in North America and Europe with recent prevalences of >3% in the USA + Canada and 1.5%-3.7% in Europe. Currently, most cases are caused by nail cosmetics, both in consumers and professional nail stylists. In our literature review, we have found 24 studies presenting case series of patients with allergic contact dermatitis attributed to HEMA and 168 case reports. However, the presence of HEMA in the products causing ACD was established in only a minority. Part 2 will discuss cross- and co-sensitisation, and other skin reactions to HEMA, will assess whether HEMA is the most frequent (meth)acrylate allergen and how sensitive HEMA as a screening agent is, investigate the presence of HEMA in commercial products and provide practical information on patch testing procedures.
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Affiliation(s)
| | - Thomas Rustemeyer
- Dermato-Allergology and Occupational Dermatology, Amsterdam University Medical Centers, Amsterdam, AZ, The Netherlands
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Acrylates as a significant cause of allergic contact dermatitis: new sources of exposure. Postepy Dermatol Alergol 2021; 38:555-560. [PMID: 34658693 PMCID: PMC8501444 DOI: 10.5114/ada.2020.95848] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 02/11/2020] [Indexed: 11/22/2022] Open
Abstract
Acrylate monomers have a wide range of applications. Since the 1950s, many reports of occupational origin allergic contact dermatitis due to (meth)acrylate monomers have been published. During last decades, (meth)acrylate allergy has undergone an occupational shift from dentistry toward beauty industry and medical devices. The aim of the study was to conduct a literature review on acrylates as a cause of allergic contact dermatitis, current sources of exposure as well as identification of professional groups with an increased risk of this allergy and methods of effective prevention. Database review: Medline search (PubMed), Wiley Online Library and Web of Science base in years 1956–2019 using the following keywords: acrylates, manicurists, dentists, dental technicians, medical devices, occupational exposure, and allergic contact dermatitis. 204 346 articles containing the term ‘acrylates‘ have been found. They include 2 042 articles with the word ‘manicurists’, 169 919 – ‘dentists’, 218 236 – ‘dental technicians’, 2 427 418 – ‘medical devices’. Fifty-nine articles were chosen based on analysis of abstracts and full texts. In the past allergy to acrylates was mainly of occupational origin and dental technicians were the most often affected professional group. Since the long-lasting manicure has become popular, this problem concerns both manicurists and their customers. Moreover, the new significant trend is non-occupational allergic contact dermatitis caused by medical devices especially dedicated to diabetes patients.
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Moshirfar M, Bundogji N, Tukan AN, Huynh R. Intraocular Acrylic Allergy: Is it Something to Sneeze at? Ophthalmol Ther 2021; 10:393-396. [PMID: 34260041 PMCID: PMC8319285 DOI: 10.1007/s40123-021-00374-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 07/01/2021] [Indexed: 01/01/2023] Open
Abstract
Cataract surgery is most commonly performed with acrylic intraocular lens (IOL) implantation. To date, there have been no reported cases of intraocular acrylic allergy despite increasing rates of acrylic-induced contact dermatitis elsewhere in the body. Concern regarding acrylate sensitization is gaining traction in the ophthalmology community. This commentary explores the lack of intraocular atopy and whether an acrylic allergy necessitates extensive preoperative consideration.
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Affiliation(s)
- Majid Moshirfar
- Hoopes Vision Research Center, Hoopes Vision, 11820 S. State St., Ste.200, Draper, UT, 84020, USA.
- John A. Moran Eye Center, University of Utah School of Medicine, Salt Lake City, UT, USA.
- Utah Lions Eye Bank, Murray, UT, USA.
| | - Nour Bundogji
- University of Arizona College of Medicine Phoenix, Phoenix, AZ, USA
| | - Alyson N Tukan
- University of Arizona College of Medicine Phoenix, Phoenix, AZ, USA
| | - Rachel Huynh
- University of Utah School of Medicine, Salt Lake City, UT, USA
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Occupational Methacrylate Allergy in Dental Personnel. ALLERGIES 2021. [DOI: 10.3390/allergies1020010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Purpose of the article: Acrylate and methacrylate (MA) use in the dental industry is widespread, being utilized in dental prostheses and composite resins, dentin bonding materials, and glass ionomers. However, occupational methacrylate allergy in dental personnel is a growing phenomenon. The aims of this retrospective observational study are to evaluate the risk of occupational contact dermatitis following exposure to methacrylates in dental personnel and to identify possible preventive measures. Materials and Methods: A total of 126 subjects exposed to acrylic and methacrylic resins in their professional context and who reported clinical manifestations were included from our outpatient department database. These were subdivided into two groups: 81 dental technicians and 45 dental hygienists. All the subjects had undergone patch testing with a “methacrylate series” (FIRMA) and readings were taken after 2 days (D2), 4 days (D4), and 7 days (D7). Results: A significantly higher incidence of methacrylate allergy was found in the dental technician group compared to the dental hygienists. Among the dental technicians, 40.7% of the subjects presented skin manifestations. The hands were the most frequently affected sites. Conclusion: Our results confirm the high sensitizing potential of MA in the workplace for dental personnel and in particular an increased professional risk in work where the hands are directly involved (dental technicians). Patch testing as an integrated part of a screening tray is needed for a complete evaluation of occupational skin allergy due to MA in dental personnel. The adoption of proper primary preventive measures, including gloves, protective eyewear, face shields, and disposable gowns, can be useful in preventing new cases of contact dermatitis, which may lead to a change of occupation in dental personnel.
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The European Baseline Series. Contact Dermatitis 2021. [DOI: 10.1007/978-3-030-36335-2_64] [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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Databases and Networks: The Benefit for Research and Quality Assurance in Patch Testing. Contact Dermatitis 2021. [DOI: 10.1007/978-3-030-36335-2_54] [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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Eleftheriadou V, Roche L, Bourke J, Buckley D, Orton D, Stone N, Wilkinson S, Thompson D, Johnston G. Allergic contact dermatitis to nonmethacrylate nail allergens in the
UK. Br J Dermatol 2020; 183:754-756. [PMID: 32275769 DOI: 10.1111/bjd.19116] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- V. Eleftheriadou
- Department of Dermatology University Hospitals of Leicester NHS Trust Leicester LE1 5WW UK
| | - L. Roche
- Department of Dermatology South Infirmary Victoria University Hospital Old Blackrock Road Cork Ireland
| | - J.F. Bourke
- Department of Dermatology South Infirmary Victoria University Hospital Old Blackrock Road Cork Ireland
| | - D.A. Buckley
- Department of Dermatology Royal United Hospital Bath BA1 3NG UK
| | - D.I. Orton
- Department of Dermatology Hillingdon Hospital Pield Heath Road Uxbridge UB8 3NN UK
| | - N.M. Stone
- Department of Dermatology Royal Gwent Hospital Cardiff Road Newport NP20 2UB UK
| | - S.M. Wilkinson
- Department of Dermatology Chapel Allerton Hospital Chapeltown Road Leeds LS7 4SA UK
| | - D.A. Thompson
- Birmingham Skin Centre, Sandwell and West Birmingham Hospitals Birmingham B18 7QH UK
| | - G.A. Johnston
- Department of Dermatology University Hospitals of Leicester NHS Trust Leicester LE1 5WW UK
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Contact Dermatitis Associated With Nail Care Products: Retrospective Analysis of North American Contact Dermatitis Group Data, 2001–2016. Dermatitis 2020; 31:191-201. [DOI: 10.1097/der.0000000000000583] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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The European Baseline Series. Contact Dermatitis 2020. [DOI: 10.1007/978-3-319-72451-5_64-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Rolls S, Chowdhury MM, Cooper S, Cousen P, Flynn AM, Ghaffar SA, Green CM, Haworth A, Holden C, Johnston GA, Naidoo K, Orton DI, Reckling C, Sabroe RA, Scorer M, Stone NM, Thompson D, Wakelin S, Wilkinson M, Buckley DA. Recommendation to include hydroxyethyl (meth)acrylate in the British baseline patch test series. Br J Dermatol 2019; 181:811-817. [PMID: 30703264 DOI: 10.1111/bjd.17708] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/25/2019] [Indexed: 12/25/2022]
Abstract
BACKGROUND (Meth)acrylates are potent sensitizers and a common cause of allergic contact dermatitis (ACD). The frequency of (meth)acrylate ACD has increased with soaring demand for acrylic nails. A preliminary audit has suggested a significant rate of positive patch tests to (meth)acrylates using aimed testing in patients providing a clear history of exposure. To date, (meth)acrylates have not been routinely tested in the baseline patch test series in the U.K. and Europe. OBJECTIVES To determine whether inclusion of 2-hydroxyethyl methacrylate (2-HEMA) 2% in petrolatum (pet.) in the baseline series detects cases of treatable (meth)acrylate ACD. METHODS During 2016-2017, 15 U.K. dermatology centres included 2-HEMA in the extended baseline patch test series. Patients with a history of (meth)acrylate exposure, or who tested positive to 2-HEMA, were selectively tested with a short series of eight (meth)acrylate allergens. RESULTS In total 5920 patients were consecutively patch tested with the baseline series, of whom 669 were also tested with the (meth)acrylate series. Overall, 102 of 5920 (1·7%) tested positive to 2-HEMA and 140 (2·4%) to at least one (meth)acrylate. Had 2-HEMA been excluded from the baseline series, (meth)acrylate allergy would have been missed in 36 of 5920 (0·6% of all patients). The top (meth)acrylates eliciting a positive reaction were 2-HEMA (n = 102, 1·7%), 2-hydroxypropyl methacrylate (n = 61, 1·0%) and 2-hydroxyethyl acrylate (n = 57, 1·0%). CONCLUSIONS We recommend that 2-HEMA 2% pet. be added to the British baseline patch test series. We also suggest a standardized short (meth)acrylate series, which is likely to detect most cases of (meth)acrylate allergy.
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Affiliation(s)
- S Rolls
- Royal United Hospital Bath, Bath, U.K
| | | | - S Cooper
- Oxford University Hospital, Oxford, U.K
| | - P Cousen
- South Tees Hospital NHS Foundation Trust, Middlesbrough, U.K
| | - A M Flynn
- South Infirmary Victoria University Hospital, Cork, Ireland
| | | | | | - A Haworth
- Portsmouth Hospital NHS Trust, Portsmouth, U.K
| | - C Holden
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, U.K
| | | | - K Naidoo
- South Tees Hospital NHS Foundation Trust, Middlesbrough, U.K
| | | | - C Reckling
- Kent and Canterbury Hospital, Canterbury, U.K
| | - R A Sabroe
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, U.K
| | - M Scorer
- Leicester Royal Infirmary, Leicester, U.K
| | - N M Stone
- Royal Gwent and Nevill Hall Hospitals, Newport, U.K
| | - D Thompson
- Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, U.K
| | - S Wakelin
- Imperial College Healthcare NHS Trust, London, U.K
| | - M Wilkinson
- Leeds Teaching Hospital NHS Trust, Leeds, U.K
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Wilkinson M, Gonçalo M, Aerts O, Badulici S, Bennike NH, Bruynzeel D, Dickel H, Garcia-Abujeta JL, Giménez-Arnau AM, Hamman C, Isaksson M, Johansen JD, Mahler V, Niklasson B, Orton D, Pigatto P, Ponyai G, Rustemeyer T, Schuttelaar MLA, Spiewak R, Thyssen JP, Uter W. The European baseline series and recommended additions: 2019. Contact Dermatitis 2018; 80:1-4. [PMID: 30421432 DOI: 10.1111/cod.13155] [Citation(s) in RCA: 127] [Impact Index Per Article: 21.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2018] [Revised: 09/30/2018] [Accepted: 10/01/2018] [Indexed: 02/06/2023]
Affiliation(s)
| | - Margarida Gonçalo
- Clinic of Dermatology, University Hospital and Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Olivier Aerts
- University Hospital Antwerp (UZA) and University of Antwerp (UA), Antwerp, Belgium
| | | | - Niels H Bennike
- National Allergy Research Centre, Department of Dermatology and Allergy, Copenhagen University Hospital Herlev-Gentofte, Hellerup, Denmark
| | | | - Heinrich Dickel
- Department of Dermatology, Venereology and Allergology, Ruhr University Bochum, Bochum, Germany
| | | | | | - Curt Hamman
- Contact Dermatitis Institute, Phoenix, Arizona
| | - Marléne Isaksson
- Department of Occupational and Environmental Dermatology, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Jeanne D Johansen
- National Allergy Research Centre, Department of Dermatology and Allergy, Copenhagen University Hospital Herlev-Gentofte, Hellerup, Denmark
| | | | | | | | - Paolo Pigatto
- IRCCS Galeazzi Orthopaedic Institute, Milan Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Gyorgyi Ponyai
- Department of Dermatology, Venerology and Dermatooncology, Semmelweis University, Budapest, Hungary
| | | | - Marie L A Schuttelaar
- University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | | | - Jacob P Thyssen
- National Allergy Research Centre, Department of Dermatology and Allergy, Copenhagen University Hospital Herlev-Gentofte, Hellerup, Denmark
| | - Wolfgang Uter
- Department of Medical Informatics, Biometry and Epidemiology, University of Erlangen-Nürnberg, Erlangen, Germany
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