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Botvid S, Bennike NH, Simonsen AB, Johansen JD, Uter W. Contact sensitization to fragrance mix I and fragrance mix II among European dermatitis patients: A systematic review. Contact Dermatitis 2024. [PMID: 38945918 DOI: 10.1111/cod.14618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 05/21/2024] [Accepted: 05/25/2024] [Indexed: 07/02/2024]
Abstract
BACKGROUND Fragrance substances are a frequent cause of contact allergy worldwide. Fragrance exposure varies by sex, age and possibly country, influenced by cosmetic availability, environmental conditions and cultural practices. OBJECTIVES To systematically review and gather prevalence of sensitization to fragrance mix I (FM I) and fragrance mix II (FM II) in consecutively patch-tested European dermatitis patients. METHOD A total of 4134 publications on patch test results of European dermatitis patients, published from 1981 to 2022, were systematically reviewed according to a previously registered and published PROSPERO protocol. RESULTS Eighty-four eligible original articles were analysed. Overall prevalence of sensitization to fragrance mix I (FM I) was 6.81% (95% CI: 6.37-7.28), and FM II was 3.64% (95% CI: 3.3-4.01). Sensitization to FM I was most prevalent in Central and Eastern Europe and to FM II in Western Europe. No clear time trends were observed. Among paediatric dermatitis patients, sensitization prevalence for FM I and FM II was 4.09% (95% CI: 3.37-4.96) and 2.17% (95% CI: 1.53-3.07). CONCLUSION The frequency of positive patch test results for both FMI and FMII remains high. Sensitization is also prevalent among children. Enhanced regulation and labelling of cosmetic products play a vital role in averting exposure and sensitization to fragrance allergens.
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Affiliation(s)
- Sofia Botvid
- The National Allergy Research Centre (Videncenter for Allergi), Department of Allergy, Dermatology and Venerology, Copenhagen University Hospital Herlev-Gentofte, Gentofte Hospital, Hellerup, Denmark
- Faculty of Health and Medical Sciences, Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Niels H Bennike
- The National Allergy Research Centre (Videncenter for Allergi), Department of Allergy, Dermatology and Venerology, Copenhagen University Hospital Herlev-Gentofte, Gentofte Hospital, Hellerup, Denmark
| | - Anne Birgitte Simonsen
- The National Allergy Research Centre (Videncenter for Allergi), Department of Allergy, Dermatology and Venerology, Copenhagen University Hospital Herlev-Gentofte, Gentofte Hospital, Hellerup, Denmark
- Faculty of Health and Medical Sciences, Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Jeanne Duus Johansen
- The National Allergy Research Centre (Videncenter for Allergi), Department of Allergy, Dermatology and Venerology, Copenhagen University Hospital Herlev-Gentofte, Gentofte Hospital, Hellerup, Denmark
- Faculty of Health and Medical Sciences, Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Wolfgang Uter
- Department of Medical Informatics, Biometry and Epidemiology, University of Erlangen/Nürnberg, Erlangen, Germany
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2
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Stingeni L, Hansel K, Corazza M, Foti C, Schena D, Fabbrocini G, Patruno C, Bianchi L, Tramontana M, Guarneri F, Biondi F, Bruni M, Marietti R, Napolitano M, Schettini N, Sensini C. Contact allergy to hydroxyisohexyl 3-cyclohexene carboxaldehyde in Italy: Prevalence, trend, and concordance with fragrance mix II. Contact Dermatitis 2023; 88:129-133. [PMID: 36305627 DOI: 10.1111/cod.14240] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 10/20/2022] [Accepted: 10/23/2022] [Indexed: 01/14/2023]
Abstract
BACKGROUND Hydroxyisohexyl 3-cyclohexene carboxaldehyde (HICC), contained in fragrance mix II (FM II), has been recognized as a contact sensitizer since the mid-1990s. After several attempts to reduce its use during the last two decades, HICC was permanently banned from the European market in August 2021. OBJECTIVES To assess the prevalence and the time trend of contact allergy to HICC and to investigate the concordance of HICC allergy compared to FM II allergy in an unselected Italian patch test population. METHODS/PATIENTS Retrospective analysis on demographics and patch test results of HICC-sensitized and/or FM II-sensitized patients was performed over a 6-year period (2016-2021) at 6 patch test Clinics in Italy. RESULTS Among 7266 patients (4942 females, 68.0%, mean age 45.4 ± 20.6 years), 1% (70) resulted positive to HICC and 2.1% (153) to FM II. Clinical relevance was documented in 72.9% (51/70) of HICC positive patients. Among the 169 HICC and/or FM II positive patients, 9.5% had a positive reaction to HICC only, 31.9% to both HICC and FM II, and 58.6% to FM II only. The prevalence trend line of HICC positive reactions showed a decrease from 1.15% (2016) to 0.96% (2021). CONCLUSIONS We documented a decreasing trend of HICC allergy in Italy, in line with the data recently reported in literature. Nevertheless, HICC should be maintained in the baseline series to monitor the benefits of its ban from the European market.
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Affiliation(s)
- Luca Stingeni
- Section of Dermatology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Katharina Hansel
- Section of Dermatology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Monica Corazza
- Section of Dermatology, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Caterina Foti
- Section of Dermatology, Department of Biomedical Science and Human Oncology, University of Bari, Bari, Italy
| | - Donatella Schena
- Section of Dermatology and Venereology, Department of Medicine, University of Verona, Verona, Italy
| | - Gabriella Fabbrocini
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Cataldo Patruno
- Section of Dermatology, Health Sciences Department, Magna Graecia University, Catanzaro, Italy
| | - Leonardo Bianchi
- Section of Dermatology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Marta Tramontana
- Section of Dermatology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Fabrizio Guarneri
- Section of Dermatology, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
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Ševčík V, Andraščíková M, Vavrouš A, Moulisová A, Vrbík K, Bendová H, Jírová D, Kejlová K, Hložek T. Market surveillance: analysis of perfuming products for presence of allergens and prohibited substances. CHEMICAL PAPERS 2022. [DOI: 10.1007/s11696-022-02225-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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4
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Updated Criteria to Include Contact Allergens in the European Baseline Series With Suggested Additions. CURRENT TREATMENT OPTIONS IN ALLERGY 2022. [DOI: 10.1007/s40521-022-00302-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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5
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Ito A, Suzuki K, Matsunaga K, Yagami A, Ito T, Tamagawa-Mineoka R, Adachi A, Sugiura M, Miyazawa H, Kato A, Nakada T, Nishioka K, Kubota Y, Matsukura S, Watanabe Y, Asada H, Kanto H. Patch testing with the Japanese baseline series 2015: a four-year experience. Contact Dermatitis 2021; 86:189-195. [PMID: 34921568 DOI: 10.1111/cod.14027] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 12/09/2021] [Accepted: 12/13/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND The Japanese baseline series (JBS), established in 1994, was updated in 2008 and in 2015. The JBS 2015 is a modification of the Thin-layer Rapid Use Epicutaneous (TRUE) test (SmartPractice Denmark, Hillerød, Denmark). No nationwide studies concerning the TRUE test have previously been reported. OBJECTIVES To determine the prevalence of sensitizations to JBS 2015 allergens from 2015 to 2018. METHODS We investigated JBS 2015 patch test results using the web-registered Skin Safety Case Information-Net (SSCI-Net) from April 2015 to March 2019. RESULTS Patch test results of 5865 patients were registered from 63 facilities. The five allergens with the highest positivity rates were gold sodium thiosulfate (GST, 25.7%), nickel sulfate (24.5%), urushiol (9.1%), p-phenylene diamine (PPD, 8.9%) and cobalt chloride (8.4%). The five allergens with the lowest positivity rates were mercaptobenzothiazole (0.8%), formaldehyde (0.9%), paraben mix (1.1%), mercapto mix (1.1%), and PPD black rubber mix (1.4%). CONCLUSIONS Nickel sulfate and GST had the highest positivity rates. The JBS 2015, including a modified TRUE test, is suitable for baseline series patch testing. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Akiko Ito
- Department of Dermatology, Nagata Clinic, Niigata, Niigata, Japan.,Japanese Contact Dermatitis Research Group, Nagoya, Aichi, Japan
| | - Kayoko Suzuki
- Japanese Contact Dermatitis Research Group, Nagoya, Aichi, Japan.,Department of Allergology, Fujita Health University School of Medicine, Nagoya, Aichi, Japan
| | - Kayoko Matsunaga
- Japanese Contact Dermatitis Research Group, Nagoya, Aichi, Japan.,Department of Integrative Medical Science for Allergic Disease, Fujita Health University School of Medicine, Nagoya, Aichi, Japan
| | - Akiko Yagami
- Japanese Contact Dermatitis Research Group, Nagoya, Aichi, Japan.,Department of Allergology, Fujita Health University School of Medicine, Nagoya, Aichi, Japan
| | - Takashi Ito
- Japanese Contact Dermatitis Research Group, Nagoya, Aichi, Japan.,Department of Dermatology, Toho University Omori Medical Center, Tokyo, Japan
| | - Risa Tamagawa-Mineoka
- Japanese Contact Dermatitis Research Group, Nagoya, Aichi, Japan.,Department of Dermatology Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Kyoto, Japan
| | - Atsuko Adachi
- Japanese Contact Dermatitis Research Group, Nagoya, Aichi, Japan.,Department of Dermatology, Hyogo Prefectural Kakogawa Medical Center, Kakogawa, Hyogo, Japan
| | - Mariko Sugiura
- Japanese Contact Dermatitis Research Group, Nagoya, Aichi, Japan.,Environmental Dermatology & Allergology, Daiichi Clinic, Nagoya, Aichi, Japan
| | - Hitoshi Miyazawa
- Japanese Contact Dermatitis Research Group, Nagoya, Aichi, Japan.,Nishi-Sapporo Skin and Allergy Clinic, Sapporo, Hokkaido, Japan
| | - Atsuko Kato
- Japanese Contact Dermatitis Research Group, Nagoya, Aichi, Japan.,Department of Dermatology, Gokeikai Osaka Kaisei Hospital, Osaka, Osaka, Japan
| | - Tokio Nakada
- Japanese Contact Dermatitis Research Group, Nagoya, Aichi, Japan.,Department of Dermatology, Showa University Fujigaoka Hospital, Yokohama, Kanagawa, Japan
| | - Kazue Nishioka
- Japanese Contact Dermatitis Research Group, Nagoya, Aichi, Japan.,Joy Dermatological Clinic, Sanyo-Onoda, Yamaguchi, Japan
| | - Yumiko Kubota
- Japanese Contact Dermatitis Research Group, Nagoya, Aichi, Japan.,Department of Dermatology, Fukuoka Sanno Hospital, Fukuoka, Fukuoka, Japan
| | - Setsuko Matsukura
- Japanese Contact Dermatitis Research Group, Nagoya, Aichi, Japan.,Department of Dermatology, Saiseikai Yokohamashi Nanbu Hospital, Yokohama, Kanagawa, Japan
| | - Yuko Watanabe
- Japanese Contact Dermatitis Research Group, Nagoya, Aichi, Japan.,Watanabe Skin and Plastic Surgery Clinic, Matsuyama, Ehime, Japan
| | - Hideo Asada
- Japanese Contact Dermatitis Research Group, Nagoya, Aichi, Japan.,Department of Dermatology, Nara Medical University School of Medicine, Kashihara, Nara, Japan
| | - Hiromi Kanto
- Japanese Contact Dermatitis Research Group, Nagoya, Aichi, Japan.,Department of Dermatology, Toho University Omori Medical Center, Tokyo, Japan
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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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Marmgren V, Mowitz M, Zimerson E, Hindsén M, Bruze M. Contact allergy to fragrance mix I and its components in individuals with photocontact allergy to ketoprofen. Contact Dermatitis 2021; 85:660-670. [PMID: 34414573 DOI: 10.1111/cod.13958] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 08/13/2021] [Accepted: 08/16/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Contact allergy to fragrance mix I (FM I) is over-represented in patients photoallergic to ketoprofen. The prevalence of contact allergy to two components of FM I, cinnamal and cinnamyl alcohol, in ketoprofen-photoallergic patients is higher than in dermatitis patients. OBJECTIVE To explore the prevalence of contact allergy to FM I and its individual components in patients with photocontact allergy to ketoprofen, and to compare with a dermatitis and the general population. METHODS Data on patch and photopatch tests performed between 2009-2018 were collected. Ketoprofen-photoallergic patients were compared with dermatitis patients and published data on the general population regarding the prevalence and the distribution of contact allergy to FM I and its components. RESULTS A higher prevalence of contact allergy to cinnamyl alcohol compared with cinnamal (23.3% vs 10.0%), and eugenol compared with isoeugenol (23.3% vs 6.7%), was observed in ketoprofen-photoallergic patients, while the relationship was the opposite in the dermatitis group (0.7% vs 1.05%; 0.4% vs 0.9%). The overall prevalence of contact allergy to several components of FM I was significantly higher in ketoprofen-photoallergic patients. CONCLUSIONS Contact allergy to FM I and many of its components is over-represented in patients photoallergic to ketoprofen compared with dermatitis patients and the general population.
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Affiliation(s)
- Victoria Marmgren
- Department of Occupational and Environmental Dermatology, Lund University, Skåne University Hospital, Malmö, Sweden.,Department of Dermatology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Martin Mowitz
- Department of Occupational and Environmental Dermatology, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Erik Zimerson
- Department of Occupational and Environmental Dermatology, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Monica Hindsén
- 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
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8
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Sánchez-Pujol MJ, Docampo-Simón A, Mercader P, González-Pérez R, Hervella-Garcés M, Sanz-Sánchez T, Córdoba S, Sánchez-Pérez J, Heras-Mendaza F, Giménez-Arnau AM, Gatica-Ortega ME, Pastor-Nieto MA, Zaragoza V, Carrascosa JM, García-Bravo B, Ruiz-González I, Borrego L, Sánchez-Pedreño P, de Frutos JO, Armario-Hita JC, García-Gavín J, Fernández-Redondo V, Serra E, Silvestre JF. Frequency of sensitization to the individual fragrances of fragrance mix I and II according to the factors included in the MOAHLFA index. Contact Dermatitis 2021; 84:395-406. [PMID: 33534191 DOI: 10.1111/cod.13801] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 01/05/2021] [Accepted: 01/30/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Fragrances constitute the second most frequent cause of allergic contact dermatitis in Spain. OBJECTIVES To determine the rate of sensitization to the individual fragrances of fragrance mix (FM) I and FM II for each of the demographic and clinical factors included in the MOAHLFA (male, occupational dermatitis, atopic dermatitis, hand dermatitis, leg dermatitis, facial dermatitis, age) index. METHODS We conducted a 5-year retrospective study in 23 Spanish centres. We identified the patients who had undergone patch testing with a specific fragrance series after reacting positively to fragrance markers in a baseline series. We obtained the MOAHLFA index items in this population, then calculated for each demographic and clinical factor the frequencies of sensitization to the individual fragrances of FM I and FM II. RESULTS A specific fragrance series was patch tested in 1013 patients. The most frequent allergens in men, women, children, and retired people were Evernia prunastri (16%), geraniol (16.6%), isoeugenol (17.9%), and geraniol (22.4%), respectively. Citral (20.5%) and hydroxyisohexyl 3-cyclohexene carboxaldehyde (HICC) (14.5%) were the most common allergens in occupational eczemas and were also associated with a large proportion of hand and facial dermatitis. CONCLUSIONS Frequency of sensitization to the individual fragrances of FM I and FM II varies with age, sex, affected body region, and history of occupational or atopic dermatitis.
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Affiliation(s)
- María J Sánchez-Pujol
- Department of Dermatology, Hospital General Universitario de Alicante-ISABIAL, Alicante, Spain
| | - Alexandre Docampo-Simón
- Department of Dermatology, Hospital General Universitario de Alicante-ISABIAL, Alicante, Spain
| | - Pedro Mercader
- Department of Dermatology, Hospital General Universitario Jose M Morales Meseguer, Murcia, Spain
| | | | | | | | - Susana Córdoba
- Department of Dermatology, Hospital Universitario de Fuenlabrada, Fuenlabrada, Spain
| | | | | | - Ana M Giménez-Arnau
- Department of Dermatology, Hospital del Mar, Universitat Autònoma Barcelona, Barcelona, Spain
| | | | - María A Pastor-Nieto
- Department of Dermatology, Hospital Universitario de Guadalajara, Guadalajara, Spain
| | - Violeta Zaragoza
- Department of Dermatology, Consorci Hospital Universitari de Valencia, Valencia, Spain
| | - José M Carrascosa
- Department of Dermatology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Begoña García-Bravo
- Department of Dermatology, Hospital Universitario Virgen de la Macarena, Sevilla, Spain
| | | | - Leopoldo Borrego
- Department of Dermatology, Hospital Universitario Insular de Gran Canaria, Universidad de Las Palmas de Gran Canaria, Las Palmas, Spain
| | | | - Javier O de Frutos
- Department of Dermatology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - José C Armario-Hita
- Department of Dermatology, Hospital Universitario de Puerto Real, Cádiz, Spain
| | - Juan García-Gavín
- Department of Dermatology, Complejo Hospitalario Universitario de Vigo, Vigo, Spain
| | - Virginia Fernández-Redondo
- Department of Dermatology, Hospital Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - Esther Serra
- Department of Dermatology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Juan F Silvestre
- Department of Dermatology, Hospital General Universitario de Alicante-ISABIAL, Alicante, Spain
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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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The Effect of Atopy in the Prevalence of Contact Sensitization: The Experience of a Greek Referral Center. Dermatol Res Pract 2020; 2020:3946084. [PMID: 33133180 PMCID: PMC7568788 DOI: 10.1155/2020/3946084] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 07/05/2020] [Accepted: 08/24/2020] [Indexed: 12/13/2022] Open
Abstract
Contact dermatitis is a well-known skin condition, which is related to stimuli and environmental exposure to chemicals, affecting all ages as well as both genders. In the present work, we attempt to investigate the patterns of contact sensitization, with respect to the personal history of atopy (AT), in Greece in a large number of allergens, using patch testing. The retrospective analysis included clinical routine data of 1978 patients collected from 2014 to 2016 in the Laboratory of Patch Testing, National Referral Centre of Occupational Dermatoses. Sensitization, in all cases, was tested with 28 allergens of the European baseline series as adjusted to our local circumstances and clinical experience. A total population of 1978 patients was evaluated, with a male-to-female ratio of 0.45 (1359 females/619 males). From our patient cohort, 693 (35%) patients were evaluated with a history of atopy, while 1285 (65%) were nonatopic. The five most prevalent allergens in the total population without AT were nickel sulphate 5% (15.47%), fragrance mix (I) 8% (9.10%), balsam of Peru (6.47%), cobalt chloride 1% (4.70%), and thiomersal 0.1% (4.10%). Respectively, in the total population with AT, the five most prevalent allergens were nickel sulphate 5% (10.36%), fragrance mix (I) 8% (5.11%), balsam of Peru (3.29%), thiomersal 0.1% (3.03%), and cobalt chloride 1% (2.78%). Contact dermatitis surveillance is of great importance towards the clinical and systematic understanding of the disease. Further studies should be directed towards that end, in order to facilitate more effective health policies.
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12
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Uter W, Bauer A, Belloni Fortina A, Bircher AJ, Brans R, Buhl T, Cooper SM, Czarnecka-Operacz M, Dickel H, Dugonik A, Geier J, Giménez-Arnau AM, Gonçalo M, Johansen JD, Johnston GA, Mahler V, Rustemeyer T, Sanchez-Perez J, Schuttelaar MLA, Simon D, Spiewak R, Valiukevičienė S, Weisshaar E, White IR, Wilkinson M. Patch test results with the European baseline series and additions thereof in the ESSCA network, 2015-2018. Contact Dermatitis 2020; 84:109-120. [PMID: 32945543 DOI: 10.1111/cod.13704] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 09/12/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Clinical surveillance of the prevalence of contact allergy in consecutively patch tested patients is a proven instrument to continually assess the importance of contact allergens (haptens) assembled in a baseline series. OBJECTIVES To present current results from the European Surveillance System on Contact Allergies, including 13 countries represented by 1 to 11 departments. METHODS Anonymized or pseudonymized patch test and clinical data from various data capture systems used locally or nationally as transferred to the Erlangen data centre were pooled and descriptively analysed after quality control. RESULTS In the 4 years (2015-2018), data from 51 914 patients patch tested with the European baseline series (EBS) of contact allergens were analysed. Contact allergy to nickel was most frequent (17.6% positive), followed by contact allergy to fragrance mix I (6.9%), methylisothiazolinone (MI; 6.2%), and Myroxylon pereirae resin (balsam of Peru; 5.8%). CONCLUSIONS While the prevalence of MI contact allergy decreased substantially following regulatory intervention, the persistently high levels of allergy to metals, fragrances, other preservatives, and rubber chemicals point to problems needing further research and, potentially, preventive efforts. Results with national additions to the baseline series provide important information on substances possibly to be considered for inclusion in the EBS.
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Affiliation(s)
- Wolfgang Uter
- Department of Medical Informatics, Biometry and Epidemiology, University of Erlangen/Nürnberg, Erlangen, Germany
| | - Andrea Bauer
- Department of Dermatology, University Allergy Centre, Medical Faculty Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | - Anna Belloni Fortina
- Dermatology Unit, Department of Paediatrics, University of Padova, Padova, Italy
| | - Andreas J Bircher
- Allergy Unit, Department of Dermatology, University Hospital Basel, Basel, Switzerland.,Faculty of Biomedicine, Università della Svizzera Italiana, Lugano, Switzerland
| | - Richard Brans
- Department of Dermatology, Environmental Medicine and Health Theory, University of Osnabrück, Osnabrück, Germany
| | - Timo Buhl
- Department of Dermatology, Venereology and Allergology, University Medical Center Göttingen, Göttingen, Germany
| | - Susan M Cooper
- Department of Dermatology, Oxford University Hospitals NHS Trust, Oxford, UK
| | | | - Heinrich Dickel
- Department of Dermatology, Venereology and Allergology, St. Josef Hospital, Ruhr University Bochum, Bochum, Germany
| | - Aleksandra Dugonik
- Department of Dermatology, University Medical Centre Maribor, Maribor, Slovenia
| | - Johannes Geier
- Information Network of Department of Dermatology, University Medical Center, Göttingen, Germany
| | - Ana M Giménez-Arnau
- Department of Dermatology, Hospital del Mar. Universitat Autònoma and Pompeu Fabra, Barcelona, Spain
| | - Margarida Gonçalo
- Department of Dermatology, Coimbra University Hospital and Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Jeanne D Johansen
- National Allergy Research Centre, Department of Skin and Allergy, Gentofte Hospital, Hellerup, Denmark
| | | | - Vera Mahler
- Department of Dermatology, University Hospital Erlangen, Erlangen, Germany, Paul-Ehrlich-Institut, Langen, Germany
| | - Thomas Rustemeyer
- Department of Dermatology, Free University of Amsterdam, Amsterdam, The Netherlands
| | - Javier Sanchez-Perez
- Dermatology Department, Hospital Universitario de la Princesa, Instituto de Investigación Sanitaria la Princesa (IIS-IP), Madrid, Spain
| | - Marie L A Schuttelaar
- Department of Dermatology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Dagmar Simon
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Radoslaw Spiewak
- Department of Experimental Dermatology and Cosmetology, Jagiellonian University Medical College, Krakow, Poland
| | - Skaidra Valiukevičienė
- Department of Skin and Venereal Diseases, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Elke Weisshaar
- Department of Clinical Social Medicine, Occupational and Environmental Dermatology, University Hospital Heidelberg, Heidelberg, Germany
| | - Ian R White
- Cutaneous Allergy Team, St. John's Institute of Dermatology, Guy's Hospital, London, UK
| | - Mark Wilkinson
- Dermatology Department, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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13
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Boyvat A, Kalay Yildizhan I. Patch test results of the European baseline series among 1309 patients in Turkey between 2013 and 2019. Contact Dermatitis 2020; 84:15-23. [PMID: 32618364 DOI: 10.1111/cod.13653] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 06/23/2020] [Accepted: 07/01/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Prevalences of sensitivity to contact allergens change over time as a result of variations in allergen exposure. OBJECTIVES The aim of the study was to describe trends in sensitisation to allergens of the European baseline series in Turkey between 2013 and 2019. METHODS The patch test results of 1309 patients with suspected allergic contact dermatitis (ACD) were analysed retrospectively, and the prevalence of contact allergies to European baseline series allergens was compared with previous data (for 1998-2005). RESULTS A total of 534 (40.8%) patients exhibited one or more positive patch test reaction. The five most frequent allergens were nickel sulfate (19.6%), potassium dichromate (6.5%), cobalt chloride (6%), Myroxylon pereirae resin (5%), and p-phenylenediamine (PPD; 3.7%). Statistically significant increases in the prevalence of sensitisation to methylchloroisothiazolinone/methylisothiazolinone (MCI/MI; P < .001), Myroxylon pereirae resin (P < .001), PPD (P = .008), and fragrance mix I (P = .036) were observed in the 2013 to 2019 period compared with the 1998 to 2005 period. Conversely, positive reactions to neomycin sulfate (P = .029), clioquinol (P = .031), and primin (P = .001) decreased significantly. CONCLUSION This study provides a comprehensive profile of ACD in Turkey. The remarkable increase in the MI and MCI/MI contact allergy observed underlines the urgent need for regulatory measures to reduce exposure to MI and MCI/MI in Turkey.
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Affiliation(s)
- Ayse Boyvat
- Department of Dermatology, School of Medicine, Ankara University, Ankara, Turkey
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Bruze M, Ale I, Andersen KE, Cannavó A, Diepgen T, Elsner P, Goh CL, Gonçalo M, Goossens A, McFadden J, Nixon R, Puangpet P, Sasseville D. Contact Allergy to Fragrance Mix II and Hydroxyisohexyl 3-Cyclohexene Carboxaldehyde: A Retrospective Study by International Contact Dermatitis Research Group. Dermatitis 2020; 31:268-271. [DOI: 10.1097/der.0000000000000545] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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15
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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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16
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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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18
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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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Sensitization to Fragrance mix-1 in Patients with Contact Dermatitis in Nord-East of Italy: 1996–2016 Time Trend and Gender Effect. COSMETICS 2019. [DOI: 10.3390/cosmetics6020022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
(1) Background: Fragrance sensitization is common in Italy and their constituents are used in many cosmetics and detergents. The objective of the study was to analyze the temporal trend of sensitivity to fragrance mix-1 in northeastern Italy and to evaluate gender differences; (2) Methods: From 1996 to 2016, 27,381 consecutive patients with suspected allergic contact dermatitis were patch tested. Individual characteristics were collected through a standardized questionnaire in six departments of dermatology or occupational medicine; (3) Results: The overall prevalence of sensitization to fragrance mix-1 was 7.3%; the prevalence was significantly higher in women (7.7%) than in men (6.3%). From 1996 to 2016, we observed an increase of this sensitization, ranging from 6.2% to 7.7% in males and from 7.2% to 9.1% in females; (4) Conclusions: Our study showed that contact allergy to fragrance mix-1 is important in both sexes and prevalence is increasing over time, despite the introduction of new fragrances with lower sensitization potential. There is the need to reduce the use of fragrances mix-1 to stop the increase of sensitization in exposed subjects.
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Fragrance inhalation and adverse health effects: The question of causation. Regul Toxicol Pharmacol 2019; 104:151-156. [PMID: 30904429 DOI: 10.1016/j.yrtph.2019.03.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2018] [Revised: 02/18/2019] [Accepted: 03/16/2019] [Indexed: 12/28/2022]
Abstract
The toxicology of fragrance materials is largely well understood. Although most are benign, a minority have the potential to cause adverse health effects, notably allergic contact dermatitis resulting from skin sensitization. As a consequence, industry guidelines have banned certain materials and strictly limited the use of others. Recently, data have been published that have been interpreted to suggest that inhalation of fragrances is associated with the occurrence of a variety of health effects, ranging from headaches to asthma attacks. In this review, the evidence basis for these assertions is examined critically and the biological basis and mechanistic plausibility for causation by fragranced products of these health effects is explored. This review concludes that respiratory effects, including irritation and allergy appear highly unlikely to occur by this route. While some sensory/psychosomatic effects are possible, this does not explain the very high rates of adverse effects reported in the recently published questionnaire studies, which this review concludes are more likely to be attributed to methodological weaknesses. Ultimately, it is concluded that adverse health effects arising from fragrance inhalation are uncommon and remain to be identified and confirmed by methodologically rigorous epidemiological investigations supported by a convincing biological and mechanistic basis.
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21
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Hafner MDFS, Munhoz SDG, Jeldes AG, Lazzarini R. Positive results of patch tests with fragrance markers: analysis of a 15-year period at a Brazilian dermatology center. An Bras Dermatol 2019; 93:910-912. [PMID: 30484545 PMCID: PMC6256219 DOI: 10.1590/abd1806-4841.20187743] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Accepted: 03/07/2018] [Indexed: 11/22/2022] Open
Abstract
Fragrances may cause allergic contact dermatitis. Data on patients who were patch tested, between 2000 and 2015, with fragrance allergens included in the Brazilian baseline series (balsam of Peru, colophony and fragrance mix I), were collected and analyzed. Of these patients, 258 (13.8%) were positive for fragrance markers, 9.8% being positive for fragrance mix I. Among these 258 there was a predominance of women in their 40s, with hand eczema. The frequency of sensitization to fragrances, as well as the epidemiological profile, was supported by the literature. Fragrance mix I was the main marker. It is important to expand the fragrance markers used in the Brazilian baseline series of patch tests.
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Affiliation(s)
| | | | - Ariel Garcia Jeldes
- Medical student, Faculdade de Ciências Médicas, Santa
Casa de São Paulo, São Paulo (SP), Brazil
| | - Rosana Lazzarini
- Dermatology Clinic, Santa Casa de São Paulo, São Paulo
(SP), Brazil
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22
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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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23
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Patch Testing: Technical Details and Interpretation. Contact Dermatitis 2019. [DOI: 10.1007/978-3-319-72451-5_62-1] [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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24
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Silvestre JF, Mercader P, González-Pérez R, Hervella-Garcés M, Sanz-Sánchez T, Córdoba S, Sánchez-Pérez J, Heras-Mendoza F, Giménez-Arnau AM, Gatica-Ortega ME, Pastor-NIeto MA, Zaragoza V, Carrascosa JM, García-Bravo B, Ruiz-González I, Borrego L, Sánchez-Pedreño P, de Frutos JO, Armario-Hita JC, García-Gavín J, Fernández-Redondo V. Sensitization to fragrances in Spain: A 5-year multicentre study (2011-2015). Contact Dermatitis 2018; 80:94-100. [DOI: 10.1111/cod.13152] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2018] [Revised: 09/23/2018] [Accepted: 09/27/2018] [Indexed: 11/27/2022]
Affiliation(s)
- Juan F. Silvestre
- Department of Dermatology; Hospital General Universitario de Alicante; Alicante Spain
| | - Pedro Mercader
- Department of Dermatology; Hospital General Universitario Jose M Morales Meseguer; Murcia Spain
| | | | | | | | - Susana Córdoba
- Department of Dermatology; Hospital Universitario de Fuenlabrada; Fuenlabrada Spain
| | | | | | | | | | | | - Violeta Zaragoza
- Department of Dermatology; Consorci Hospital Universitari de Valencia; Valencia Spain
| | - Jose M. Carrascosa
- Department of Dermatology; Hospital Universitari Germans Trias i Pujol; Badalona Spain
| | - Begoña García-Bravo
- Department of Dermatology; Hospital Universitario Virgen de la Macarena; Sevilla Spain
| | | | - Leopoldo Borrego
- Department of Dermatology; Hospital Universitario Insular de Gran Canaria; Las Palmas Spain
| | | | - Javier O. de Frutos
- Department of Dermatology; Hospital Universitario 12 de Octubre; Madrid Spain
| | | | - Juan García-Gavín
- Department of Dermatology; Complejo Hospitalario Universitario de Vigo; Vigo Spain
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Mauro M, Fortina AB, Corradin T, Marino A, Bovenzi M, Filon FL. Sensitization to, and allergic contact dermatitis caused by, colophonium in north-eastern Italy in 1996 to 2016 with a focus on occupational exposures. Contact Dermatitis 2018; 79:303-309. [PMID: 30182476 DOI: 10.1111/cod.13089] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 06/29/2018] [Accepted: 07/01/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND Colophonium is a natural substance derived from Pineaceae trees. It is used in a wide range of consumer and occupational products because of its tackiness, and is a known sensitizer. OBJECTIVES To analyse the temporal trend of contact allergy to colophonium in north-eastern Italy, and to evaluate the associations with occupations in our geographical area. METHODOLOGY From 1996 to 2016, 27 381 patients with suspected allergic contact dermatitis were patch tested in north-eastern Italy. Individual characteristics were documented by use of a standardized questionnaire in 6 departments of dermatology or occupational medicine. RESULTS The overall prevalence of colophonium sensitization was 1.67%; the prevalence was significantly higher in women (1.75%) than in men (1.49%). No significant differences among departments were observed. We found significant associations between colophonium sensitization and being a student (odds ratio [OR] 4.64; 95% confidence interval [CI]: 1.04-20.6), being a farmer or fishermen (OR 3.63; 95%CI: 1.21-10.84), being a housekeeper (OR 2.02; 95%CI: 1.08-3.77), and being retired (OR 2.06; 95%CI: 1.08-3.92). CONCLUSION Our study showed that contact allergy to colophonium is still relevant in north-eastern Italy. The frequency of sensitization has dropped significantly over a period of 10 years, but students and farmers/fishermen still have sensitization prevalences above 3.5%. Our results are in line with European data.
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Affiliation(s)
- Marcella Mauro
- Department of Medical Sciences, Clinical Unit of Occupational Medicine, University of Trieste, Trieste, Italy
| | - Anna Belloni Fortina
- Padua Hospital Internal Medicine Department - DIMED, Paediatric Dermatology Unit, University of Padua, Padova, Italy
| | - Teresa Corradin
- Pordenone Hospital - Internal and Specialistic Department, Ospedale Santa Maria degli Angeli, Pordenone, Italy
| | - Alessandro Marino
- Department of Medical Sciences, Clinical Unit of Occupational Medicine, University of Trieste, Trieste, Italy
| | - Massimo Bovenzi
- Department of Medical Sciences, Clinical Unit of Occupational Medicine, University of Trieste, Trieste, Italy
| | - Francesca Larese Filon
- Department of Medical Sciences, Clinical Unit of Occupational Medicine, University of Trieste, Trieste, Italy
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Abstract
PURPOSE OF REVIEW The environment for the developing children is complex as they are exposed to a variety of activities and settings where potential environmental allergens may be encountered. Recent evidence supports the clinical benefit of patch testing young children suffering from recalcitrant dermatitis. While patch testing has been recently approved by the Food and Drug Administration in children ages 6-18 years old, patch testing strategies for young children of preschool age (between 2 and 6 years old) have yet to be defined. RECENT FINDINGS Allergic contact dermatitis is underdiagnosed among pediatric patients, particularly those suffering from concomitant atopic dermatitis as the interplay between the two diseases is complex. Recent reports in literature supported the clinical value, safety, and efficacy of patch testing pediatric patients. This review provides an overview of specific pediatric allergens, special considerations, practical modifications, and systematic exposure-driven guidance approaches toward patch testing preschoolers.
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Dittmar D, Uter W, Bauer A, Fortina AB, Bircher AJ, Czarnecka‐Operacz M, Dugonik A, Elsner P, Gallo R, Ghaffar SA, Giménez‐Arnau A, Johnston GA, Kręcisz B, Filon FL, Rustemeyer T, Sadowska‐Przytocka A, Sánchez‐Pérez J, Schnuch A, Simon D, Spiewak R, Spring P, Corradin MT, Valiukevičienė S, Vok M, Weisshaar E, Wilkinson M, Schuttelaar ML, Aberer W, Ballmer‐Weber B, Grabbe J, Beiteke U, Brasch J, Fuchs T, John SM, Mahler V, Pesonen M, Jolanki R, Rantanen T, Armario‐Hita JC, Fernández‐Redondo V, García‐Gavín J, Mercader P, Ruiz I, Silvestre JF, Balato A, Ayala F, Peserico A, Sliuziaviciene G, Kieć‐Świerczyńska M, Kmecl T, Pandurovic MK, Kecelj N, Lunder T, Simončič Godnič M, Chowdhury MMU, Cooper SM, English JSC, Cousen P, Horne HL, Gawkrodger DJ, Holden C, Sabroe R, Green CM, King CM, Ormerod AD, Samson JE, Statham B, Stone N, White I. European Surveillance System on Contact Allergies (ESSCA): polysensitization, 2009–2014. Contact Dermatitis 2018; 78:373-385. [DOI: 10.1111/cod.12966] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Revised: 12/14/2017] [Accepted: 12/18/2017] [Indexed: 12/28/2022]
Affiliation(s)
- Daan Dittmar
- University of Groningen, University Medical Centre GroningenDepartment of Dermatology 9700 RB Groningen The Netherlands
| | - Wolfgang Uter
- Department of Medical Informatics, Biometry and EpidemiologyUniversity of Erlangen/Nürnberg 91054 Erlangen Germany
| | - Andrea Bauer
- Department of DermatologyUniversity Allergy Centre, University Hospital Carl Gustav Carus, Technical University of Dresden 01307 Dresden Germany
| | - Ana B. Fortina
- Dermatology Unit, Department of PaediatricsUniversity of Padova 35137 Padova Italy
| | - Andreas J. Bircher
- Allergy Unit, Department of DermatologyUniversity Hospital 4031 Basel Switzerland
| | | | - Aleksandra Dugonik
- Department of DermatologyUniversity Medical Centre Maribor 2000 Maribor Slovenia
| | - Peter Elsner
- Department of DermatologyUniversity Hospital Jena 07743 Jena Germany
| | - Rosella Gallo
- Section of Dermatology, DISSAL – Department of Health SciencesUniversity of Genoa 16132 Genoa Italy
| | - Sharizan A. Ghaffar
- Department of DermatologyNinewells Hospital and Medical School Dundee DD1 9SY UK
| | - Anna Giménez‐Arnau
- Department of DermatologyHospital del Mar. Universitat Autònoma and Pompeu Fabra 08003 Barcelona Spain
| | - Graham A. Johnston
- Department of DermatologyLeicester Royal Infirmary Leicester, LE1 5WW, UK
| | - Beata Kręcisz
- Faculty of Medicine and Health ScienceThe Jan Kochanowski University 25‐317 Kielce Poland
| | | | - Thomas Rustemeyer
- Department of DermatologyFree University of Amsterdam 1081 HV Amsterdam The Netherlands
| | | | - Javier Sánchez‐Pérez
- Dermatology DepartmentHospital Universitario de la Princesa, Instituto de Investigación Sanitaria la Princesa (IIS‐IP) 28006 Madrid Spain
| | - Axel Schnuch
- Information Network of Departments of Dermatology at the University of Göttingen 37075 Göttingen Germany
| | - Dagmar Simon
- Department of DermatologyInselspital, Bern University Hospital, University of Bern 3010 Bern Switzerland
| | - Radoslaw Spiewak
- Department of Experimental Dermatology and CosmetologyJagiellonian University Medical College 30‐688 Krakow Poland
| | - Philipp Spring
- Department of DermatologyCentre Hospitalier Universitaire Vaudois 1011 Lausanne Switzerland
| | - Maria T. Corradin
- Department of DermatologyHospital of Pordenone 33170 Pordenone Italy
| | - Skaidra Valiukevičienė
- Department of Skin and Venereal DiseasesLithuanian University of Health Sciences 44307 Kaunas Lithuania
- Lithuanian University of Health Sciences Hospital 50009 Kaunas Lithuania
| | - Marko Vok
- Dermatovenerološka ambulanta 6310 Izola Slovenia
| | - Elke Weisshaar
- Department of Clinical Social Medicine, Occupational and Environmental DermatologyUniversity Hospital Heidelberg 69117 Germany
| | - Mark Wilkinson
- Dermatology, Leeds Teaching Hospitals NHS Trust Leeds LS7 4SA UK
| | - Marie L. Schuttelaar
- University of Groningen, University Medical Centre GroningenDepartment of Dermatology 9700 RB Groningen The Netherlands
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Dittmar D, Ofenloch RF, Schuttelaar MLA. Persistence of contact allergy: a retrospective analysis. Contact Dermatitis 2017; 78:143-150. [DOI: 10.1111/cod.12912] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Revised: 09/20/2017] [Accepted: 09/24/2017] [Indexed: 02/06/2023]
Affiliation(s)
- Daan Dittmar
- Department of Dermatology; University Medical Centre Groningen, University of Groningen; 9700 RB, Groningen The Netherlands
| | - Robert F. Ofenloch
- Department of Clinical Social Medicine, Occupational and Environmental Dermatology; University Hospital Heidelberg; 69115, Heidelberg Germany
| | - Marie L. A. Schuttelaar
- Department of Dermatology; University Medical Centre Groningen, University of Groningen; 9700 RB, Groningen The Netherlands
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Uter W, Amario-Hita J, Balato A, Ballmer-Weber B, Bauer A, Belloni Fortina A, Bircher A, Chowdhury M, Cooper S, Czarnecka-Operacz M, Dugonik A, Gallo R, Giménez-Arnau A, Johansen J, John S, Kieć-Świerczyńska M, Kmecl T, Kręcisz B, Larese Filon F, Mahler V, Pesonen M, Rustemeyer T, Sadowska-Przytocka A, Sánchez-Pérez J, Schliemann S, Schuttelaar M, Simon D, Spiewak R, Valiukevičienė S, Weisshaar E, White I, Wilkinson S. European Surveillance System on Contact Allergies (ESSCA): results with the European baseline series, 2013/14. J Eur Acad Dermatol Venereol 2017. [DOI: 10.1111/jdv.14423] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- W. Uter
- Department of Medical Informatics; Biometry and Epidemiology; Friedrich-Alexander-University Erlangen/Nürnberg; Erlangen Germany
| | - J.C. Amario-Hita
- Department of Dermatology; University Hospital of Puerto Real; Cádiz Spain
| | - A. Balato
- Department of Advanced Biomedical Sciences; University of Naples Federico II; Napoli Italy
| | - B. Ballmer-Weber
- Department of Dermatology; University Hospital Zürich; Zürich Switzerland
- Centre for Dermatology and Allergology; Kantonsspital Luzern; Luzern Switzerland
| | - A. Bauer
- Department of Dermatology; University Hospital Carl Gustav Carus; Technical University of Dresden; Dresden Germany
| | - A. Belloni Fortina
- Pediatric Dermatology Unit; Department of Medicine DIMED; University of Padova; Padova Italy
| | - A. Bircher
- Allergology Unit; Department of Dermatology; University Hospital Basel; Basel Switzerland
| | - M.M.U. Chowdhury
- The Welsh Institute of Dermatology; University Hospital of Wales; Cardiff UK
| | | | | | - A. Dugonik
- Department of Dermatology; University Medical Center Maribor; Maribor Slovenia
| | - R. Gallo
- Clinica Dermatologica; IRCCS - AOU San Martino - IST and Department of Health Sciences; University of Genoa; Genoa Italy
| | - A. Giménez-Arnau
- Department of Dermatology; Hospital del Mar; Universitat Autónoma; Barcelona Spain
| | - J.D. Johansen
- National Allergy Centre/Department of Dermatology; Gentofte Hospital; University of Copenhagen; Hellerup Denmark
| | - S.M. John
- Department of Dermatology; Institute for Interdisciplinary Dermatologic Prevention and Rehabilitation (iDerm); University of Osnabrück; Lower Saxony Institute for Occupational Dermatology (NIB); Osnabrück Germany
| | - M. Kieć-Świerczyńska
- Department of Dermatology; Nofer Institute of Occupational Medicine; Łodz Poland
| | - T. Kmecl
- Department of Dermatology; General Hospital Celje; Celje Slovenia
| | - B. Kręcisz
- Department of Dermatology; Nofer Institute of Occupational Medicine; Łodz Poland
- Faculty of Medicine and Health Science; Institute of Medical Science; Jan Kochanowski University; Kielce Poland
| | - F. Larese Filon
- Department of Public Health, Occupational Medicine; University of Trieste; Trieste Italy
| | - V. Mahler
- Department of Dermatology; University Hospital Erlangen; Friedrich-Alexander-University Erlangen-Nürnberg; Erlangen Germany
| | - M. Pesonen
- Occupational Medicine; Finnish Institute of Occupational Health (FIOH); Helsinki Finland
| | - T. Rustemeyer
- Department of Dermatology; Free University of Amsterdam; Amsterdam The Netherlands
| | | | - J. Sánchez-Pérez
- Department of Dermatology; Hospital Universitario la Princesa; Madrid Spain
| | - S. Schliemann
- Department of Dermatology and Allergology; University Hospital Jena; Jena Germany
| | - M.L. Schuttelaar
- Department of Dermatology; University Medical Centre Groningen; University of Groningen; Groningen The Netherlands
| | - D. Simon
- Department of Dermatology; Inselspital; Bern University Hospital; University of Bern; Bern Switzerland
| | - R. Spiewak
- Department of Experimental Dermatology and Cosmetology; Faculty of Pharmacy; Jagiellonian University Medical College; Krakow Poland
| | - S. Valiukevičienė
- Department of Skin and Venereal Diseases; Lithuanian University of Health Sciences; Kaunas Lithuania
| | - E. Weisshaar
- Department of Clinical Social Medicine; University Hospital Heidelberg; Heidelberg Germany
| | - I.R. White
- St. John's Institute of Dermatology; Guy's Hospital; London UK
| | - S.M. Wilkinson
- Dermatology; Leeds Teaching Hospitals NHS Trust; Leeds UK
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Consumption of cosmetic products by the French population. Third part: Product exposure amount. Food Chem Toxicol 2017; 106:209-222. [DOI: 10.1016/j.fct.2017.05.049] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Revised: 05/17/2017] [Accepted: 05/24/2017] [Indexed: 11/21/2022]
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Bennike NH, Zachariae C, Johansen JD. Non-mix fragrances are top sensitizers in consecutive dermatitis patients - a cross-sectional study of the 26 EU-labelled fragrance allergens. Contact Dermatitis 2017; 77:270-279. [DOI: 10.1111/cod.12822] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Revised: 03/22/2017] [Accepted: 03/24/2017] [Indexed: 02/05/2023]
Affiliation(s)
- Niels H. Bennike
- Department of Dermatology and Allergy, National Allergy Research Centre, Herlev-Gentofte Hospital; University of Copenhagen; 2900 Hellerup Denmark
| | - Claus Zachariae
- Department of Dermatology and Allergy, Herlev-Gentofte Hospital; University of Copenhagen; 2900 Hellerup Denmark
| | - Jeanne D. Johansen
- Department of Dermatology and Allergy, National Allergy Research Centre, Herlev-Gentofte Hospital; University of Copenhagen; 2900 Hellerup Denmark
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Deza G, García-Bravo B, Silvestre JF, Pastor-Nieto MA, González-Pérez R, Heras-Mendaza F, Mercader P, Fernández-Redondo V, Niklasson B, Giménez-Arnau AM. Contact sensitization to limonene and linalool hydroperoxides in Spain: a GEIDAC * prospective study. Contact Dermatitis 2017; 76:74-80. [PMID: 27896835 DOI: 10.1111/cod.12714] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Revised: 09/11/2016] [Accepted: 09/21/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Limonene and linalool are common fragrance terpenes widely used in cosmetic, household and hygiene products. Their primary oxidation products formed after air exposure, the hydroperoxides, have been recognized as important contact haptens. OBJECTIVES To investigate the prevalence of contact allergy to hydroperoxides of limonene (Lim-OOHs) and hydroperoxides of linalool (Lin-OOHs) in Spain, and to define the optimal concentration for screening in consecutive patients. METHODS Three different concentrations of Lim-OOHs (0.1%, 0.2% and 0.3% pet.) and Lin-OOHs (0.25%, 0.5% and 1.0% pet.) were simultaneously tested in 3639 consecutive patients at 22 departments of dermatology in Spain. RESULTS Lim-OOHs at 0.1%, 0.2% and 0.3% yielded positive patch test reactions in 1.4%, 3.4% and 5.1% of the tested patients, respectively; and Lin-OOHs at 0.25%, 0.5% and 1.0% yielded positive reactions in 1.3%, 2.9% and 4.9% of the tested patients, respectively. Few irritant (1.5-1.9%) and doubtful reactions (0.4-0.5%) to both terpene hydroperoxides were registered at the highest concentrations tested. CONCLUSIONS Lim-OOHs and Lin-OOHs can be considered as common causes of contact allergy, and their inclusion in an extended baseline patch test series therefore seems to be appropriate. The patch test preparations of Lim-OOHs 0.3% pet. and Lin-OOHs 1.0% pet. are useful tools for screening of contact sensitization.
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Affiliation(s)
- Gustavo Deza
- Department of Dermatology, Hospital del Mar, Institut Mar d'Investigacions Mèdiques, Universitat Autònoma de Barcelona (UAB), 08003 Barcelona, Spain
| | - Begoña García-Bravo
- Department of Dermatology, University Hospital Virgen Macarena, 41009 Sevilla, Spain
| | - Juan F Silvestre
- Department of Dermatology, University Hospital of Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante- Fundación FISABIO, 03010 Alicante, Spain
| | - Maria A Pastor-Nieto
- Department of Dermatology, University Hospital of Guadalajara, 19002 Guadalajara, Spain
| | | | | | - Pedro Mercader
- Department of Dermatology, University Hospital Morales Meseguer, 30008 Murcia, Spain
| | - Virginia Fernández-Redondo
- Department of Dermatology, University Hospital Santiago de Compostela, 15706 Santiago de Compostela, Spain
| | - Bo Niklasson
- Chemotechnique Diagnostics, 235 39 Vellinge, Sweden
| | - Ana M Giménez-Arnau
- Department of Dermatology, Hospital del Mar, Institut Mar d'Investigacions Mèdiques, Universitat Autònoma de Barcelona (UAB), 08003 Barcelona, Spain
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Engfeldt M, Hagvall L, Isaksson M, Matura M, Mowitz M, Ryberg K, Stenberg B, Svedman C, Bruze M. Patch testing with hydroxyisohexyl 3-cyclohexene carboxaldehyde (HICC) - a multicentre study of the Swedish Contact Dermatitis Research Group. Contact Dermatitis 2016; 76:34-39. [DOI: 10.1111/cod.12699] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Revised: 08/26/2016] [Accepted: 08/29/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Malin Engfeldt
- Department of Occupational and Environmental Dermatology; Lund University, Skåne University Hospital; 205 02 Malmö Sweden
| | - Lina Hagvall
- Department of Dermatology; Sahlgrenska University Hospital; 413 45 Gothenburg Sweden
| | - Marléne Isaksson
- Department of Occupational and Environmental Dermatology; Lund University, Skåne University Hospital; 205 02 Malmö Sweden
| | - Mihály Matura
- Unit of Occupational and Environmental Dermatology; Institute of Environmental Medicine, Karolinska Institute and Centre for Occupational and Environmental Medicine; 113 65 Stockholm Sweden
| | - Martin Mowitz
- Department of Occupational and Environmental Dermatology; Lund University, Skåne University Hospital; 205 02 Malmö Sweden
| | - Kristina Ryberg
- Department of Dermatology; Uddevalla Hospital; 451 80 Uddevalla Sweden
| | - Berndt Stenberg
- Department of Public Health and Clinical Medicine, Dermatology & Venerology; Umeå University; 901 85 Umeå Sweden
| | - Cecilia Svedman
- Department of Occupational and Environmental Dermatology; Lund University, Skåne University Hospital; 205 02 Malmö Sweden
| | - Magnus Bruze
- Department of Occupational and Environmental Dermatology; Lund University, Skåne University Hospital; 205 02 Malmö Sweden
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35
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Uter W, Spiewak R, Cooper SM, Wilkinson M, Sánchez Pérez J, Schnuch A, Schuttelaar ML. Contact allergy to ingredients of topical medications: results of the European Surveillance System on Contact Allergies (ESSCA), 2009-2012. Pharmacoepidemiol Drug Saf 2016; 25:1305-1312. [DOI: 10.1002/pds.4064] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2016] [Revised: 06/21/2016] [Accepted: 06/21/2016] [Indexed: 11/07/2022]
Affiliation(s)
- Wolfgang Uter
- Department of Medical Informatics, Biometry and Epidemiology; University of Erlangen/Nürnberg; Erlangen Germany
| | - Radoslaw Spiewak
- Department of Experimental Dermatology and Cosmetology, Faculty of Pharmacy; Jagiellonian University Medical College; Krakow Poland
| | | | - Mark Wilkinson
- Department of Dermatology; Chapel Allerton Hospital; Leeds UK
| | | | - Axel Schnuch
- Information Network of Departments of Dermatology (IVDK); University Medicine Göttingen; Göttingen Germany
| | - Marie-Louise Schuttelaar
- Department of Dermatology; University Medical Centre Groningen, University of Groningen; Groningen the Netherlands
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36
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Fragrance Allergens, Overview with a Focus on Recent Developments and Understanding of Abiotic and Biotic Activation. COSMETICS 2016. [DOI: 10.3390/cosmetics3020019] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Sabroe RA, Holden CR, Gawkrodger DJ. Contact allergy to essential oils cannot always be predicted from allergy to fragrance markers in the baseline series. Contact Dermatitis 2016; 74:236-41. [PMID: 26806578 DOI: 10.1111/cod.12528] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2015] [Revised: 11/25/2015] [Accepted: 10/04/2015] [Indexed: 12/01/2022]
Abstract
BACKGROUND Essential oils are fragrance substances that are labelled on cosmetic products by their INCI names, potentially confusing consumers. OBJECTIVES To establish whether contact allergy to essential oils might be missed if not specifically tested for. METHODS We tested 471 patients with 14 essential oils and 2104 patients with Melaleuca alternifolia oil between January 2008 and June 2014. All patients were tested with fragrance mix I, fragrance mix II, hydroxyisohexyl 3-cyclohexene carboxaldehyde, and Myroxylon pereirae. Three hundred and twenty-six patients were tested with hydroperoxides of limonene and linalool. RESULTS Thirty-four patients had a +/++/+++ reaction to at least one essential oil. Eleven had no reaction to any of the six marker fragrance substances. Thus, 4 of 11 positive reactions to M. alternifolia oil, 2 of 7 reactions to Cymbopogon flexuosus oil, 1 of 5 reactions to Cananga odorata oil, 3 of 4 reactions to Santalum album oil and 2 of 3 reactions to Mentha piperita oil would have been missed without individual testing. CONCLUSION A small number of patients who are allergic to essential oils could be missed if these are not specifically tested. Labelling by INCI names means that exposure may not be obvious. Careful inspection of so-called 'natural' products and targeted testing is recommended.
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Affiliation(s)
- Ruth A Sabroe
- Department of Dermatology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, S10 2JF, UK
| | - Catherine R Holden
- Department of Dermatology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, S10 2JF, UK
| | - David J Gawkrodger
- Department of Dermatology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, S10 2JF, UK
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38
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Bruze M. Thoughts on how to improve the quality of multicentre patch test studies. Contact Dermatitis 2016; 74:168-74. [DOI: 10.1111/cod.12507] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Accepted: 10/21/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Magnus Bruze
- Department of Occupational and Environmental Dermatology; Skåne University Hospital, Lund University; S-205 02 Malmö Sweden
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39
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Fragrance sensitisers: Is inhalation an allergy risk? Regul Toxicol Pharmacol 2015; 73:897-902. [DOI: 10.1016/j.yrtph.2015.09.031] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Accepted: 09/28/2015] [Indexed: 12/20/2022]
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40
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Affiliation(s)
- W. Uter
- Department of Medical Informatics, Biometry and Epidemiology; Friedrich-Alexander University, Erlangen/Nürnberg; Waldstr. 6 91054 Erlangen Germany
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41
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Diepgen TL, Ofenloch R, Bruze M, Cazzaniga S, Coenraads PJ, Elsner P, Goncalo M, Svensson Å, Naldi L. Prevalence of fragrance contact allergy in the general population of five European countries: a cross-sectional study. Br J Dermatol 2015; 173:1411-9. [PMID: 26332456 DOI: 10.1111/bjd.14151] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/21/2015] [Indexed: 11/25/2022]
Abstract
BACKGROUND Contact allergy to fragrances is assessed mostly in clinical populations of patients. Studies in the general population are scarce and vary in their methodology across countries. OBJECTIVES To determine the prevalence of fragrance contact allergy in the European general population and to assess the clinical relevance of positive patch test reactions to different fragrances. METHODS In five European countries (Germany, Italy, the Netherlands, Portugal and Sweden) a random sample from the general population aged 18-74 years was drawn. In total, 12 377 subjects were interviewed in this cross-sectional study and a random sample (n = 3119) was patch tested using the TRUE Test and Finn Chamber techniques. Patch test procedures were harmonized by mandatory training before the study and monitoring during the study. RESULTS The highest prevalence for contact allergy of 2·6% [95% confidence interval (CI) 2·1-3·2] was found for fragrance mix (FM) I in petrolatum, with a high content of atranol and chloratranol, followed by 1·9% (95% CI 1·5-2·4) for FM II in petrolatum. The conservatively estimated prevalence of fragrance contact allergy was 1·9% (95% CI 1·5-2·5). This is defined as the existence of a positive patch test to FM I or FM II; any of their individual materials; Myroxylon pereirae; sesquiterpene lactones or 3- and 4-hydroxyisohexyl 3-cyclohexene carboxaldehyde that show clinical relevance, defined conservatively as lifetime avoidance of scented products and an itchy skin rash lasting > 3 days in a lifetime. Using the reported lifetime prevalence of any contact dermatitis instead of the lifetime prevalence of any itchy skin rash, the prevalence is 0·8% (95% CI 0·5-1·2). The prevalence rates of contact allergy to fragrances in women are about twice those in men. CONCLUSIONS This study helps to identify targets for prevention of fragrance allergy.
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Affiliation(s)
- T L Diepgen
- Department of Social Medicine, Occupational and Environmental Dermatology, University Hospital Heidelberg, Thibautstraße 3, 69115, Heidelberg, Germany
| | - R Ofenloch
- Department of Social Medicine, Occupational and Environmental Dermatology, University Hospital Heidelberg, Thibautstraße 3, 69115, Heidelberg, Germany
| | - M Bruze
- Department of Occupational and Environmental Dermatology, University Hospital Malmö, S-20502, Malmö, Sweden
| | - S Cazzaniga
- Department of Dermatology, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Centro Studi GISED - FROM Presidio Ospedaliero Matteo Rota, Via Garibaldi 13/15, 24122, Bergamo, Italy
| | - P J Coenraads
- Occupational and Environmental, Dermatology Unit, State University Hospital, P.O. Box 30.001, NL-9700 RB, Groningen, the Netherlands
| | - P Elsner
- Klinik für Dermatologie und dermatologische Allergologie, Klinikum der FSU Jena, Erfurter Str. 35, D-07740, Jena, Germany
| | - M Goncalo
- Clinica de Dermatologia, Hospital da Universidade Praceta Motal Pinto, Rua Infanta D.Maria, n 30-A-3D, P-3000-075, Coimbra, Portugal
| | - Å Svensson
- Department of Dermatology, University Hospital Malmö, S-20502, Malmö, Sweden
| | - L Naldi
- Department of Dermatology, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Centro Studi GISED - FROM Presidio Ospedaliero Matteo Rota, Via Garibaldi 13/15, 24122, Bergamo, Italy
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