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Sukakul T, Uter W, Gonçalo M, Huggard J, Ljubojević Hadžavdić S, Schuttelaar MLA, Svedman C, Vey M, Isaksson M, Niklasson B, Rustemeyer T, Bruze M. Results of patch testing with five fragrance materials hitherto not tested: A dose-finding study in the clinical population. Contact Dermatitis 2024; 90:566-573. [PMID: 38387040 DOI: 10.1111/cod.14525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 01/18/2024] [Accepted: 02/08/2024] [Indexed: 02/24/2024]
Abstract
BACKGROUND Quantitative risk assessment (QRA) for skin sensitization is used to derive safe use levels of sensitising fragrance ingredients in products. Post-marketing surveillance of the prevalence of contact allergy to these ingredients provides relevant data to help evaluate the performance of these measures. OBJECTIVES To determine a suitable patch test concentration for five fragrance materials that had hitherto not been tested on a regular basis. These concentrations are then to be used in a surveillance study with patch testing consecutive patients over an extended monitoring period. MATERIALS AND METHODS Furaneol, CAS.3658-77-3; trans-2-hexenal, CAS.6728-26-3; 4,8-dimethyl-4,9-decadienal, CAS.71077-31-1; longifolene, CAS.475-20-7; benzaldehyde, CAS.10052-7, were patch tested with other fragrance allergens in four clinics. Patch testing was conducted in three rounds, starting with the lowest concentrations of the five ingredients. The doses were increased in the subsequent rounds if no late-appearing positive reactions and virtually no irritant reactions were reported. RESULTS Overall, 373 patients were tested. No positive allergic reaction was reported to the five ingredients. Patch test results of other fragrance allergens are reported. CONCLUSIONS The highest test concentrations are each considered safe for patch testing consecutive patients. Further surveillance based on these preparations will evaluate the hypothesis that QRA-driven consumer product levels of these fragrances can prevent sensitization.
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Affiliation(s)
- Thanisorn Sukakul
- Department of Occupational and Environmental Dermatology, Faculty of Medicine, Lund University, Malmö, Sweden
| | - Wolfgang Uter
- Department of Medical Informatics, Biometry and Epidemiology, University of Erlangen/Nürnberg, Erlangen, Germany
| | - Margarida Gonçalo
- Department of Dermatology, Coimbra University Hospital and Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Joseph Huggard
- The Huggard Consulting Group, S.A.R.L., Itzig, Luxembourg
- IFRA VP Scientific Affairs and IDEA Management Team, Brussels, Belgium
| | - Suzana Ljubojević Hadžavdić
- Department of Dermatology and Venereology, School of Medicine University of Zagreb, University Hospital Center Zagreb, Zagreb, Croatia
| | - Marie L A Schuttelaar
- Department of Dermatology, University Medical Center Groningen, Groningen, The Netherlands
| | - Cecilia Svedman
- Department of Occupational and Environmental Dermatology, Faculty of Medicine, Lund University, Malmö, Sweden
| | - Matthias Vey
- The Huggard Consulting Group, S.A.R.L., Itzig, Luxembourg
- IFRA VP Scientific Affairs and IDEA Management Team, Brussels, Belgium
| | - Marléne Isaksson
- Department of Occupational and Environmental Dermatology, Faculty of Medicine, Lund University, Malmö, Sweden
| | | | - Thomas Rustemeyer
- Department of Dermatology-Allergology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Magnus Bruze
- Department of Occupational and Environmental Dermatology, Faculty of Medicine, Lund University, Malmö, Sweden
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2
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Sukakul T, Bruze M, Mowitz M, Antelmi A, Boonchai W, Dahlin J, Hamnerius N, Hauksson I, Lejding T, Svedman C. Simultaneous patch testing with fragrance markers in the baseline series and the ingredients of fragrance mixes ‐ an update from southern Sweden. Contact Dermatitis 2022; 86:514-523. [PMID: 35152428 PMCID: PMC9314710 DOI: 10.1111/cod.14072] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 02/09/2022] [Accepted: 02/10/2022] [Indexed: 11/28/2022]
Abstract
Background Regularly updating the prevalence of fragrance contact allergy (CA) is important. Patch testing with fragrance markers in the baseline series and the ingredients of fragrance mixes (FMs) is still debated. Objectives To update the prevalence and clinical characteristics of patients with fragrance CA. To establish the results of patch testing with individual allergens of FMs. Methods A retrospective analysis of 3539 patients with dermatitis who were patch tested with the baseline series and FMs ingredients during 2016 to 2020 was performed. Results The prevalence of fragrance CA was 13%. About 10% of these patients with fragrance CA would be missed if the individual ingredients were not tested. Unlike hydroxyisohexyl 3‐cyclohexene carboxaldehyde, there was no decreasing trend of CA to Evernia prunastri (oakmoss) extract after the EU regulation came into force. Patients with CA from only one ingredient of the mixes or having a weak positive reaction to the ingredients were significantly missed when tested with only the fragrance markers in the baseline series. Conclusions Patch testing with individual fragrance allergens is crucial for experts to expand knowledge in the fragrance CA field. The concentrations of the allergens in FMs may need to be adjusted to detect patients with fragrance CA, since some were significantly overlooked.
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Affiliation(s)
- Thanisorn Sukakul
- Department of Occupational and Environmental Dermatology Lund University, Skåne University Hospital Malmö Sweden
| | - Magnus Bruze
- Department of Occupational and Environmental Dermatology Lund University, Skåne University Hospital Malmö Sweden
| | - Martin Mowitz
- Department of Occupational and Environmental Dermatology Lund University, Skåne University Hospital Malmö Sweden
| | - Annarita Antelmi
- Department of Occupational and Environmental Dermatology Lund University, Skåne University Hospital Malmö Sweden
| | - Waranya Boonchai
- Department of Dermatology Faculty of Medicine Siriraj Hospital, Mahidol University Bangkok Thailand
| | - Jakob Dahlin
- Department of Occupational and Environmental Dermatology Lund University, Skåne University Hospital Malmö Sweden
| | - Nils Hamnerius
- Department of Occupational and Environmental Dermatology Lund University, Skåne University Hospital Malmö Sweden
| | - Inese Hauksson
- Department of Occupational and Environmental Dermatology Lund University, Skåne University Hospital Malmö Sweden
| | - Tina Lejding
- Department of Occupational and Environmental Dermatology Lund University, Skåne University Hospital Malmö Sweden
| | - Cecilia Svedman
- Department of Occupational and Environmental Dermatology Lund University, Skåne University Hospital Malmö Sweden
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3
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Shcherbakova A, Strömstedt AA, Göransson U, Gnezdilov O, Turanov A, Boldbaatar D, Kochkin D, Ulrich-Merzenich G, Koptina A. Antimicrobial and antioxidant activity of Evernia prunastri extracts and their isolates. World J Microbiol Biotechnol 2021; 37:129. [PMID: 34232401 PMCID: PMC8263414 DOI: 10.1007/s11274-021-03099-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 06/23/2021] [Indexed: 11/26/2022]
Abstract
Lichens are symbiotic organisms formed by a fungus and one or more photosynthetic partners which are usually alga or cyanobacterium. Their diverse and scarcely studied metabolites facilitate adaptability to extreme living conditions. We investigated Evernia prunastri (L.) Ach., a widely distributed lichen, for its antimicrobial and antioxidant potential. E. prunastri was sequentially extracted by hexane (Hex), dichloromethane (DCM) and acetonitrile (ACN) that were screened for their antioxidant and antimicrobial (against Staphylococcus aureus, Pseudomonas aeruginosa, Escherichia coli and Candida albicans) activities. The Hex extract possessed the highest antioxidant capacity (87 mg ascorbic acid/g extract) corresponding to the highest content of phenols (73 mg gallic acid/g extract). The DCM and Hex extracts were both active against S. aureus (MICs of 4 and 21 µg/ml, respectively) but were less active against Gram-negative bacteria and yeast. The ACN extract exhibited activity on both S. aureus (MIC 14 µg/ml) and C. albicans (MIC 38 µg/ml) and was therefore further fractionated by silica gel column chromatography. The active compound of the most potent fraction was subsequently characterized by 1H and 13C-NMR spectroscopy and identified as evernic acid. Structural similarity analyses were performed between compounds from E. prunastri and known antibiotics from different classes. The structural similarity was not present. Antioxidant and antimicrobial activities of E. prunastri extracts originate from multiple chemical compounds; besides usnic acid, most notably evernic acid and derivatives thereof. Evernic acid and its derivatives represent possible candidates for a new class of antibiotics.
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Affiliation(s)
- A Shcherbakova
- Volga State University of Technology, Lenin Sq., 3, Yoshkar-Ola, Russia, 424000
- Pharmacognosy, Department of Pharmaceutical Biosciences, Uppsala University, 751 24, Uppsala, Sweden
- Medical Clinic III, AG Synergy Research and Experimental Medicine, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - A A Strömstedt
- Pharmacognosy, Department of Pharmaceutical Biosciences, Uppsala University, 751 24, Uppsala, Sweden
| | - U Göransson
- Pharmacognosy, Department of Pharmaceutical Biosciences, Uppsala University, 751 24, Uppsala, Sweden
| | - O Gnezdilov
- FRC Kazan Scientific Center, Zavoisky Physical-Technical Institute, Russian Academy of Sciences, Sibirsky Tract, 10/7, Kazan, Russia, 420029
| | - A Turanov
- FRC Kazan Scientific Center, Zavoisky Physical-Technical Institute, Russian Academy of Sciences, Sibirsky Tract, 10/7, Kazan, Russia, 420029
| | - D Boldbaatar
- Pharmacognosy, Department of Pharmaceutical Biosciences, Uppsala University, 751 24, Uppsala, Sweden
- The Liver Center, Dalai Tower, Unesco Street 31, Sukhbaatar District, Ulaanbaatar, 14230, Mongolia
| | - D Kochkin
- Faculty of Biology, Lomonosov Moscow State University, GSP-1, 1-12 Leninskiye Gory, Moscow, Russia, 119234
| | - G Ulrich-Merzenich
- Medical Clinic III, AG Synergy Research and Experimental Medicine, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - A Koptina
- Pharmacognosy, Department of Pharmaceutical Biosciences, Uppsala University, 751 24, Uppsala, Sweden.
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4
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Chipinda I, Anderson SE, Siegel PD. Laboratory Techniques for Identifying Causes of Allergic Dermatitis. Immunol Allergy Clin North Am 2021; 41:423-438. [PMID: 34225898 DOI: 10.1016/j.iac.2021.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
This article reviews the laboratory's role in identifying causes of chemical-induced allergic dermatitis. Several topics will be discussed. Allergen hazard identification refers to testing of chemicals for their sensitization potential. Animal-based, in silico, in chemico, and in vitro tests have been developed to identify the skin sensitization hazard of potential chemical allergens, but only a few of these are accepted by regulatory agencies. Laboratory investigations have also evaluated the stability of several commercially available allergic contact dermatitis patch tests. Such studies are considered product testing and are usually conducted in analytical chemistry laboratories.
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Affiliation(s)
- Itai Chipinda
- Global Product Stewardship & Toxicology, Phillips 66, Bartlesville, OK 74003, USA
| | - Stacey E Anderson
- Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Morgantown, WV 26505, USA.
| | - Paul D Siegel
- Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Morgantown, WV 26505, USA
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5
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Chemical Methods for Detection of Allergens and Skin Exposure. Contact Dermatitis 2021. [DOI: 10.1007/978-3-030-36335-2_27] [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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7
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Identification of Allergens in Complex Mixtures and Products. Contact Dermatitis 2021. [DOI: 10.1007/978-3-030-36335-2_5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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8
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Avonto C, Chittiboyina AG, Khan SI, Dale OR, Parcher JF, Wang M, Khan IA. Are atranols the only skin sensitizers in oakmoss? A systematic investigation using non-animal methods. Toxicol In Vitro 2020; 70:105053. [PMID: 33212168 DOI: 10.1016/j.tiv.2020.105053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 11/09/2020] [Accepted: 11/12/2020] [Indexed: 10/23/2022]
Abstract
Oakmoss and treemoss absolutes are the major natural extracts of concern as potential sources of skin sensitizers in cosmetics and personal care products (PCP). Two single constituents, atranol and chloroatranol, have been identified as primary culprits in both lichens, and industrial self-regulation has been proposed to limit their contents to less than 100 ppm. Nonetheless, evidence points to the presence of additional candidate skin sensitizers in these multicomponent extracts. These observations, along with a lack of data from non-animal alternative methods and the chemical variability of commercial absolutes, prompted further investigation of oakmoss absolute along with altranol-like compounds in these extracts. The major chemical constituents of a commercial sample were identified by two independent analytical techniques, GC-MS and HPLC-DAD-MS. The crude oakmoss extract and pure compounds were assayed with two in chemico methods (HTS-DCYA and DPRA) to gauge their chemical reactivity. Activation of inflammatory responses in vitro was also investigated by KeratinoSens™ and human cell line activation tests (h-CLAT). Based on weight of evidence, orcinol, ethyl orsellinate, and usnic acid were classified as candidate sensitizers, along with both atranols and oakmoss extract.
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Affiliation(s)
- Cristina Avonto
- National Center for Natural Products Research, Research Institute of Pharmaceutical Sciences, School of Pharmacy, The University of Mississippi, University, MS 38677, United States of America.
| | - Amar G Chittiboyina
- National Center for Natural Products Research, Research Institute of Pharmaceutical Sciences, School of Pharmacy, The University of Mississippi, University, MS 38677, United States of America
| | - Shabana I Khan
- National Center for Natural Products Research, Research Institute of Pharmaceutical Sciences, School of Pharmacy, The University of Mississippi, University, MS 38677, United States of America; Division of Pharmacognosy, Department of BioMolecular Sciences, School of Pharmacy, The University of Mississippi, University, MS 38677, United States of America
| | - Olivia R Dale
- National Center for Natural Products Research, Research Institute of Pharmaceutical Sciences, School of Pharmacy, The University of Mississippi, University, MS 38677, United States of America
| | - Jon F Parcher
- National Center for Natural Products Research, Research Institute of Pharmaceutical Sciences, School of Pharmacy, The University of Mississippi, University, MS 38677, United States of America
| | - Mei Wang
- National Center for Natural Products Research, Research Institute of Pharmaceutical Sciences, School of Pharmacy, The University of Mississippi, University, MS 38677, United States of America
| | - Ikhlas A Khan
- National Center for Natural Products Research, Research Institute of Pharmaceutical Sciences, School of Pharmacy, The University of Mississippi, University, MS 38677, United States of America; Division of Pharmacognosy, Department of BioMolecular Sciences, School of Pharmacy, The University of Mississippi, University, MS 38677, United States of America
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9
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Chittiboyina AG, Wang M, Avonto C, Parcher JF, Khan IA. Chromatographic analyses and unambiguous identification of atranol‐like secondary metabolites in oakmoss absolute. FLAVOUR FRAG J 2020. [DOI: 10.1002/ffj.3578] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Amar G. Chittiboyina
- National Center for Natural Products Research School of Pharmacy The University of Mississippi, University MS USA
| | - Mei Wang
- National Center for Natural Products Research School of Pharmacy The University of Mississippi, University MS USA
| | - Cristina Avonto
- National Center for Natural Products Research School of Pharmacy The University of Mississippi, University MS USA
| | - Jon F. Parcher
- National Center for Natural Products Research School of Pharmacy The University of Mississippi, University MS USA
| | - Ikhlas A. Khan
- National Center for Natural Products Research School of Pharmacy The University of Mississippi, University MS USA
- Divison of Pharmacognosy Department of BioMolecular Sciences School of Pharmacy The University of Mississippi, University MS USA
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10
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Chemical Methods for Detection of Allergens and Skin Exposure. Contact Dermatitis 2020. [DOI: 10.1007/978-3-319-72451-5_27-2] [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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11
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Bruze M, Mowitz M, Ofenloch R, Coenraads P, Diepgen TL, Elsner P, Gonçalo M, Naldi L, Svensson Å. The significance of batch and patch test method in establishing contact allergy to fragrance mix I—EDEN Fragrance Study Group. Contact Dermatitis 2019; 81:104-109. [DOI: 10.1111/cod.13253] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 02/20/2019] [Accepted: 02/23/2019] [Indexed: 02/06/2023]
Affiliation(s)
- Magnus Bruze
- Department of Occupational and Environmental DermatologySkåne University Hospital, Lund University Malmö Sweden
| | - Martin Mowitz
- Department of Occupational and Environmental DermatologySkåne University Hospital, Lund University Malmö Sweden
| | - Robert Ofenloch
- Department of Social MedicineOccupational and Environmental Dermatology, University of Heidelberg Heidelberg Germany
| | - Pieter‐Jan Coenraads
- Department of Dermatology, University of GroningenUniversity Medical Centre Groningen Groningen The Netherlands
| | - Thomas L. Diepgen
- Department of Social MedicineOccupational and Environmental Dermatology, University of Heidelberg Heidelberg Germany
| | - Peter Elsner
- Department of DermatologyUniversity Hospital Jena Jena Germany
| | - Margarida Gonçalo
- Clinic of DermatologyUniversity Hospital and Faculty of Medicine, University of Coimbra Coimbra Portugal
| | - Luigi Naldi
- Department of Dermatology, Azienda Ospedaliera papa Giovanni XXIII, BergamoCentro Studi GISED—FROM Presidio Ospedaliero Matteo Rota Bergamo Italy
| | - Åke Svensson
- Department of DermatologySkåne University Hospital, Lund University Malmö Sweden
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12
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Chemical Methods for Detection of Allergens and Skin Exposure. Contact Dermatitis 2019. [DOI: 10.1007/978-3-319-72451-5_27-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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13
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Identification of Allergens in Complex Mixtures and Products. Contact Dermatitis 2019. [DOI: 10.1007/978-3-319-72451-5_5-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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15
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Mowitz M, Svedman C, Zimerson E, Isaksson M, Pontén A, Bruze M. Simultaneous patch testing with fragrance mix I, fragrance mix II and their ingredients in southern Sweden between 2009 and 2015. Contact Dermatitis 2017; 77:280-287. [DOI: 10.1111/cod.12834] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Revised: 04/27/2017] [Accepted: 04/28/2017] [Indexed: 02/05/2023]
Affiliation(s)
- Martin Mowitz
- Lund University, Department of Occupational and Environmental Dermatology; Lund University, Skåne University Hospital; 205 02 Malmö Sweden
| | - Cecilia Svedman
- Lund University, Department of Occupational and Environmental Dermatology; Lund University, Skåne University Hospital; 205 02 Malmö Sweden
| | - Erik Zimerson
- Lund University, Department of Occupational and Environmental Dermatology; Lund University, Skåne University Hospital; 205 02 Malmö Sweden
| | - Marléne Isaksson
- Lund University, Department of Occupational and Environmental Dermatology; Lund University, Skåne University Hospital; 205 02 Malmö Sweden
| | - Ann Pontén
- Lund University, Department of Occupational and Environmental Dermatology; Lund University, Skåne University Hospital; 205 02 Malmö Sweden
| | - Magnus Bruze
- Lund University, Department of Occupational and Environmental Dermatology; Lund University, Skåne University Hospital; 205 02 Malmö Sweden
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Andersen F, Andersen KH, Bernois A, Brault C, Bruze M, Eudes H, Gadras C, Signoret ACJ, Mose KF, Müller BP, Toulemonde B, Andersen KE. Reduced content of chloroatranol and atranol in oak moss absolute significantly reduces the elicitation potential of this fragrance material. Contact Dermatitis 2014; 72:75-83. [DOI: 10.1111/cod.12312] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Revised: 09/09/2014] [Accepted: 09/12/2014] [Indexed: 02/05/2023]
Affiliation(s)
- Flemming Andersen
- Department of Dermatology and the Allergy Centre; Odense University Hospital; Sdr. Boulevard 29 5000 Odense C Denmark
- Dermatological Investigations Scandinavia; J. B. Winsløwparken 9 5000 Odense C Denmark
| | - Kirsten H. Andersen
- Department of Dermatology and the Allergy Centre; Odense University Hospital; Sdr. Boulevard 29 5000 Odense C Denmark
- Dermatological Investigations Scandinavia; J. B. Winsløwparken 9 5000 Odense C Denmark
| | - Armand Bernois
- LVMH Recherche; Avenue de Verdun 185 45800 Saint Jean de Braye France
| | - Christophe Brault
- LVMH Recherche; Avenue de Verdun 185 45800 Saint Jean de Braye France
| | - Magnus Bruze
- Department of Occupational and Environmental Dermatology; Skåne University Hospital, Lund University; Södra Förstadsgatan 101 214 28 Malmö Sweden
| | - Hervé Eudes
- Biolandes; Route de Bélis 40420 Le Sen France
| | | | | | - Kristian F. Mose
- Department of Dermatology and the Allergy Centre; Odense University Hospital; Sdr. Boulevard 29 5000 Odense C Denmark
- Dermatological Investigations Scandinavia; J. B. Winsløwparken 9 5000 Odense C Denmark
| | | | - Bernard Toulemonde
- International Flavors & Fragrances; Parc Industriel Les Bois de Grasse 06130 Grasse France
| | - Klaus Ejner Andersen
- Department of Dermatology and the Allergy Centre; Odense University Hospital; Sdr. Boulevard 29 5000 Odense C Denmark
- Dermatological Investigations Scandinavia; J. B. Winsløwparken 9 5000 Odense C Denmark
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