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Uter W, Wilkinson SM, Aerts O, Bauer A, Borrego L, Buhl T, Cooper SM, Dickel H, Gallo R, Giménez-Arnau AM, John SM, Navarini AA, Pesonen M, Pónyai G, Rustemeyer T, Schliemann S, Schubert S, Schuttelaar MLA, Valiukevičienė S, Wagner N, Weisshaar E, Gonçalo M. European patch test results with audit allergens as candidates for inclusion in the European Baseline Series, 2019/20 - Joint results of the ESSCA A and the EBS B working groups of the ESCD, and the GEIDAC C. Contact Dermatitis 2022; 86:379-389. [PMID: 35099073 DOI: 10.1111/cod.14059] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 01/25/2022] [Accepted: 01/26/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND In 2019, a number of allergens (haptens), henceforth, 'the audit allergens,' were considered as potential additions to the European baseline series (EBS), namely, sodium metabisulfite, 2-bromo-2-nitropropane-1,3-diol, diazolidinyl urea, imidazolidinyl urea, Compositae mix II (2.5 or 5% pet), linalool hydroperoxides (lin-OOH), limonene hydroperoxides (lim-OOH), benzisothiazolinone (BIT), octylisothiazolinone (OIT), decyl glucoside, lauryl glucoside; Evernia furfuracea (tree moss), was additionally tested by some departments, too. OBJECTIVES To collect further data on patch test reactivity and clinical relevance of the audit allergens in consecutive patients across Europe. METHODS Patch test data covering the audit allergens in 2019 and 2020 were collected by those departments of the ESSCA testing these, as well as further collaborators from the EBS working group of the ESCD, and the Spanish GEIDAC. As patch test outcome, reactions between day (D) 3 and D5 were considered. RESULTS Altogether n=12403 patients were tested with any of the audit allergen. Positive reactions were most common to lin-OOH 1% pet. (8.74 (8.14-9.37)), followed by lin-OOH 0.5% pet., and lim-OOH 0.3% pet (5.41 (4.95-5.89)). Beyond these terpene hydroperoxides, BIT 0.1% pet. was the second most common allergen with 4.72 (4.2-5.28), followed by sodium metabisulfite 1% pet. (3.75 (3.32-4.23)) and Compositae mix 5% pet. (2.31 (1.84-2.87). For some allergens, clinical relevance was frequently difficult to ascertain. CONCLUSIONS Despite many positive patch test reactions, it remains controversial whether lin- and lim-OOH should be tested routinely, while at least the two preservatives BIT and sodium metabisulfite appear suitable. The present results are a basis for further discussion among the ESCD members and ultimately decision on their implementation into routine testing. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Wolfgang Uter
- Department of Medical Informatics, Biometry and Epidemiology, University of Erlangen/Nürnberg, Erlangen, Germany
| | - S Mark Wilkinson
- Dermatology Department, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Olivier Aerts
- Department of Dermatology, University Hospital Antwerp (UZA) and Research group Immunology, Infla-Med Centre of Excellence, University of Antwerp, Antwerp, Belgium
| | - Andrea Bauer
- Department of Dermatology, University Allergy Centre, Medical Faculty Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | - Leopoldo Borrego
- Complejo Hospitalario Universitario Insular Materno Infantil. Universidad de las Palmas de Gran Canaria, Spain
| | - 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
| | - Rosella Gallo
- Clinica Dermatologica, Department of Health Sciences, University of Genoa, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Ana M Giménez-Arnau
- Department of Dermatology, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Swen M John
- Department of Dermatology and Environmental Medicine, Institute for Interdisciplinary Dermatologic Prevention and Rehabilitation (iDerm), University of Osnabrück, Osnabrück, Germany.,Lower Saxony Institute for Occupational Dermatology (NIB), Osnabrück, Germany
| | | | - Maria Pesonen
- Occupational Health Unit, Finnish Institute of Occupational Health, Helsinki, Finland
| | - Györgyi Pónyai
- Semmelweis University, Department of Dermatology, Venerology and Dermatooncology, Budapest, Hungary
| | - Thomas Rustemeyer
- Department of Dermatology-Allergology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | | | - Steffen Schubert
- Information Network of Departments of Dermatology, Institute at the University Medical Centre Göttingen, Göttingen, Germany
| | - Marie-Louise A Schuttelaar
- Department of Dermatology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Skaidra Valiukevičienė
- Department of Skin and Venereal Diseases, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Nicola Wagner
- Department of Dermatology, University Hospital of Erlangen, University of Erlangen-, Nuremberg, (FAU), Erlangen, Germany
| | - Elke Weisshaar
- Occupational Dermatology, Department of Dermatology, University Hospital Heidelberg, Heidelberg, Germany
| | - Margarida Gonçalo
- Department of Dermatology, University Hospital and Faculty of Medicine, University of Coimbra, Coimbra, Portugal
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Brites GS, Ferreira I, Sebastião AI, Silva A, Carrascal M, Neves BM, Cruz MT. Allergic contact dermatitis: From pathophysiology to development of new preventive strategies. Pharmacol Res 2020; 162:105282. [PMID: 33161140 DOI: 10.1016/j.phrs.2020.105282] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Revised: 10/29/2020] [Accepted: 10/30/2020] [Indexed: 11/25/2022]
Abstract
As the body's first line of defense, the skin is the organ most frequently exposed to chemicals present in personal hygiene products, household products, or materials used in the work environment. In this context, skin disorders account for more than 40 % of all occupational and work-related diseases, constituting a significant public health burden. Among skin disorders, allergic contact dermatitis (ACD) is the most prevalent occupational disease and the most common form of immunotoxicity in humans. ACD is a T-cell-mediated skin inflammation resulting from the priming and expansion of allergen-specific CD4+ and CD8+ T cells. The clinical condition is characterized by local skin rash, itchiness, redness, swelling, and lesions, being mainly diagnosed by the patch test. Upon ACD diagnosis, avoiding the exposure to the triggering allergen is the mainstay of treatment to prevent future flares. In cases where avoidance is not possible, the use of a standard of care interim treatments such as steroid creams or ointments, barrier creams, and moisturizers are strongly recommended to alleviate symptoms. In this review, we sought to provide the reader with an overview of the pathophysiology of ACD as well as the currently available pharmacological treatment options. Furthermore, a comprehensive outline of several preventive strategies is also provided.
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Affiliation(s)
- Gonçalo Sousa Brites
- Faculty of Pharmacy, University of Coimbra, Coimbra, 3000-548, Portugal; Center for Neuroscience and Cell Biology - CNC, University of Coimbra, Coimbra, 3004-504, Portugal
| | - Isabel Ferreira
- Faculty of Pharmacy, University of Coimbra, Coimbra, 3000-548, Portugal; Center for Neuroscience and Cell Biology - CNC, University of Coimbra, Coimbra, 3004-504, Portugal
| | | | - Ana Silva
- Center for Neuroscience and Cell Biology - CNC, University of Coimbra, Coimbra, 3004-504, Portugal
| | - Mylene Carrascal
- Center for Neuroscience and Cell Biology - CNC, University of Coimbra, Coimbra, 3004-504, Portugal; Tecnimede Group, Sintra, 2710-089, Portugal
| | - Bruno Miguel Neves
- Department of Medical Sciences and Institute of Biomedicine - iBiMED, University of Aveiro, Aveiro, 3810-193, Portugal
| | - Maria T Cruz
- Faculty of Pharmacy, University of Coimbra, Coimbra, 3000-548, Portugal; Center for Neuroscience and Cell Biology - CNC, University of Coimbra, Coimbra, 3004-504, Portugal.
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Contact Allergy-Emerging Allergens and Public Health Impact. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17072404. [PMID: 32244763 PMCID: PMC7177224 DOI: 10.3390/ijerph17072404] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 03/17/2020] [Accepted: 03/30/2020] [Indexed: 02/07/2023]
Abstract
Contact allergy (sensitisation) and allergic contact dermatitis (ACD) resulting from it have a considerable public health impact. For the present review, all pertinent articles were systematically searched via Medline and Web of Science™; additionally, all available issues of the journals "Contact Dermatitis" and "Dermatitis" were manually searched, covering the years 2018-2019, thereby extending and re-focusing a previous similar review. New allergens, or previously described allergens found in a new exposure context or of other current importance, are described in sections according to substance classes, e.g., metals, preservatives, fragrances. As a common finding in many investigations, a lack of information on product composition has been noted, for instance, regarding a newly described allergen in canvas shoes (dimethylthiocarbamylbenzothiazole sulfide) and, most notably, absence of co-operation from manufacturers of glucose-monitoring devices and insulin pumps, respectively. These latter devices have been shown to cause severe ACD in a considerable number of diabetic patients caused by the liberation of isobornyl acrylate and N,N'-dimethylacrylamide, respectively, as demonstrated by an international collaboration between dermatologists and chemists. Improved and complete ingredient labelling for all types of products, and not just cosmetics, must be put on the legislative agenda.
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Herman A, Aerts O, de Montjoye L, Tromme I, Goossens A, Baeck M. Isothiazolinone derivatives and allergic contact dermatitis: a review and update. J Eur Acad Dermatol Venereol 2018; 33:267-276. [PMID: 30284765 DOI: 10.1111/jdv.15267] [Citation(s) in RCA: 92] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 08/20/2018] [Indexed: 01/12/2023]
Abstract
Allergic contact dermatitis (ACD) from isothiazolinones has frequently been described in the literature. Following an epidemic of sensitization to methylchloroisothiazolinone/methylisothiazolinone (MCI/MI) in the 1980s, and more recently to MI, the Scientific Committee on Consumer Safety of the European Commission banned their use in leave-on products, while restricting that in rinse-off cosmetics. Despite a decreasing prevalence of ACD from MCI/MI and MI, cases caused by occupational exposure and non-cosmetic isothiazolinone sources are on the rise. Moreover, sensitization to newer and lesser known isothiazolinones has been reported. This paper reviews the epidemiology of contact allergy to different isothiazolinones, clinical presentation of isothiazolinone-induced ACD, most relevant sensitization sources and potential cross-reactions between isothiazolinone derivatives. It also provides an update on recent legislative measures.
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Affiliation(s)
- A Herman
- Department of Dermatology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - O Aerts
- Department of Dermatology, University Hospital Antwerp (UZA) and University of Antwerp (UA), Antwerp, Belgium
| | - L de Montjoye
- Department of Dermatology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - I Tromme
- Department of Dermatology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - A Goossens
- Department of Dermatology, University Hospital KU Leuven, Leuven, Belgium
| | - M Baeck
- Department of Dermatology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
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