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Macchione M, Yoshizaki K, Frias DP, Maier K, Smelan J, Prado CM, Mauad T. Fragrances as a trigger of immune responses in different environments. Toxicol In Vitro 2024; 96:105769. [PMID: 38142785 DOI: 10.1016/j.tiv.2023.105769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 12/18/2023] [Indexed: 12/26/2023]
Abstract
Fragrances can cause allergic skin reactions, expressed as allergic contact dermatitis and reactions in the respiratory tract that range from acute temporary upper airway irritation to obstructive lung disease. These adverse health effects may result from the stimulation of a specific (adaptive) immune response. Th1 cells, which essentially produce interleukin-2 (IL-2) and interferon-γ (IFN-γ), play a key role in allergic contact dermatitis and also on allergic sensitization to common allergens (e.g., nickel and fragrance). It has been shown that fragrance allergy leads to Th2/Th22 production of IL-4, IL-5 and IL-13, controlling the development of IgE and mediating hypersensitivity reactions in the lung, such as asthma. Cytokines released during immune response modulate the expression of cytochrome P450 (CYPs) proteins, which can result in alterations of the pharmacological effects of substances in inflammatory diseases. The mechanisms linking environment and immunity are still not completely understood but it is known that aryl hydrocarbon receptor (AhR) is a sensor with conserved ligand-activated transcription factor, highly expressed in cells that controls complex transcriptional programs which are ligand and cell type specific, with CYPs as targeted genes. This review focuses on these important aspects of immune responses of the skin and respiratory tract cells, describing some in vitro models applied to evaluate the mechanisms involved in fragrance-induced allergy.
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Affiliation(s)
- M Macchione
- Laboratory of Experimental Environmental Pathology, Department of Pathology, Sao Paulo University Medical School, Sao Paulo, Brazil.
| | - K Yoshizaki
- Laboratory of Experimental Environmental Pathology, Department of Pathology, Sao Paulo University Medical School, Sao Paulo, Brazil
| | - D P Frias
- Laboratory of Experimental Environmental Pathology, Department of Pathology, Sao Paulo University Medical School, Sao Paulo, Brazil
| | - K Maier
- Laboratory of Experimental Environmental Pathology, Department of Pathology, Sao Paulo University Medical School, Sao Paulo, Brazil
| | - J Smelan
- Laboratory of Experimental Environmental Pathology, Department of Pathology, Sao Paulo University Medical School, Sao Paulo, Brazil
| | - C M Prado
- Federal University of Sao Paulo, Santos, Brazil
| | - T Mauad
- Laboratory of Experimental Environmental Pathology, Department of Pathology, Sao Paulo University Medical School, Sao Paulo, Brazil
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Bruze M, Marmgren V, Zimerson E, Antelmi A, Svedman C, Mowitz M. Contact allergy to oxidised geraniol may be over-represented in individuals with photocontact allergy to ketoprofen. Contact Dermatitis 2024; 90:79-83. [PMID: 37840237 DOI: 10.1111/cod.14437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 09/07/2023] [Accepted: 09/29/2023] [Indexed: 10/17/2023]
Abstract
BACKGROUND Simultaneous overrepresentations of contact allergies and photocontact allergies are common in individuals with photocontact allergy to ketoprofen. AIMS To investigate whether contact allergy to oxidised (ox.) geraniol, geraniol, geranial, neral and citral is overrepresented in individuals with photocontact allergy to ketoprofen. METHODS The contact allergy rates to ox. geraniol, geraniol, geranial, neral and citral in routinely patch tested dermatitis patients were compared with the corresponding rates in individuals with photocontact allergy to ketoprofen. RESULTS Allergic patch test reactions were noted to ox. geraniol 11% (n = 39, 5.8%), ox. geraniol 6% (n = 12, 1.8%), geraniol 6% (n = 2, 0.3%), geranial (n = 18, 2.7%), neral (n = 7, 1.0%) and citral (n = 15, 2.2%). In those four patients who were diagnosed with photocontact allergy to ketoprofen during the test period, a significant overrepresentation (p = 0.020) of simultaneous contact allergy to ox. geraniol 11% was demonstrated. Overrepresentation of simultaneous contact allergy to various combinations of ox. geraniol, ox. limonene and ox. linalool was also noted in ketoprofen-photoallergic patients. CONCLUSIONS Contact allergy to ox. geraniol, geranial and citral is common in routinely tested dermatitis patients. There is an overrepresentation of simultaneous contact allergy to ox. geraniol, ox. limonene and ox. linalool in patients with photocontact allergy to ketoprofen.
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Affiliation(s)
- Magnus Bruze
- Department of Occupational and Environmental Dermatology, Skåne University Hospital, Lund University, Malmö, Sweden
| | - Victoria Marmgren
- Department of Occupational and Environmental Dermatology, Skåne University Hospital, Lund University, Malmö, Sweden
| | - Erik Zimerson
- Department of Occupational and Environmental Dermatology, Skåne University Hospital, Lund University, Malmö, Sweden
| | - Annarita Antelmi
- Department of Occupational and Environmental Dermatology, Skåne University Hospital, Lund University, Malmö, Sweden
| | - Cecilia Svedman
- Department of Occupational and Environmental Dermatology, Skåne University Hospital, Lund University, Malmö, Sweden
| | - Martin Mowitz
- Department of Occupational and Environmental Dermatology, Skåne University Hospital, Lund University, Malmö, Sweden
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Peter N, Lichter J, Hagvall L, Bock U, Blömeke B. Common fragrance chemicals activate dendritic cells in coculture with keratinocytes. Contact Dermatitis 2023. [PMID: 37088539 DOI: 10.1111/cod.14324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Accepted: 04/05/2023] [Indexed: 04/25/2023]
Abstract
BACKGROUND Fragrances are important contact allergens; however, investigation of their skin sensitization potency has been challenging in new approach methods (NAMs). Many fragrance chemicals are susceptible to autoxidation or can be metabolized by enzymes constitutively expressed in skin keratinocytes. Strong sensitizers can be formed in both of these processes. Further, keratinocytes can modulate the dendritic cell (DC) activation and maturation potential, a key event in the acquisition of contact allergy. OBJECTIVES To evaluate the 2D coculture model consisting of keratinocytes and DCs using different weak to moderate sensitizing fragrance chemicals. Further, to investigate fragrances and related oxidation products in the in vitro model and compare to in vivo data. METHODS Chemicals were tested in the coculture activation test (COCAT), consisting of HaCaT keratinocytes and THP-1 cells. THP-1 cell surface expression of costimulatory and adhesion molecules (CD86 and CD54) collected after 24 h incubation with the chemicals was analysed using flow cytometry. RESULTS Twenty-four molecules were tested positive, three were negative (n = 27). Four pairs were evaluated, with aldehydes showing a 6- to 13-fold stronger responses compared to their corresponding alcohols. CONCLUSIONS Results provide insight into the activation of DC in their natural environment of keratinocytes. α,β-Unsaturated alcohols were classified as weaker sensitizers compared to their corresponding aldehydes. In sum, testing of fragrances retrieved results in good agreement with in vivo data.
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Affiliation(s)
- Niklas Peter
- Department of Environmental Toxicology, Trier University, Trier, Germany
| | - Jutta Lichter
- Department of Environmental Toxicology, Trier University, Trier, Germany
| | - Lina Hagvall
- Department of Dermatology and Venereology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Udo Bock
- Department of Environmental Toxicology, Trier University, Trier, Germany
| | - Brunhilde Blömeke
- Department of Environmental Toxicology, Trier University, Trier, Germany
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Chen J, Yi Z, Yin J, Dong S, Wang L, Li Y. Determination of Fragrance Allergens in Paper Personal Care Products by Headspace (HS) Solid-Phase Microextraction (SPME) Gas Chromatography-Mass Spectrometry (GC-MS) with Response Surface Methodology (RSM) Optimization. ANAL LETT 2022. [DOI: 10.1080/00032719.2022.2149769] [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]
Affiliation(s)
- Jing Chen
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu China
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
| | - Zonghui Yi
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu China
| | - Jiangwei Yin
- Baoan District Center for Disease Control and Prevention, Shenzhen, China
| | - Simin Dong
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu China
| | - Lian Wang
- Chengdu Center for Disease Control and Prevention, Chengdu, China
| | - Yongxin Li
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu China
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Omeragic E, Dedic M, Elezovic A, Becic E, Imamovic B, Kladar N, Niksic H. Application of direct peptide reactivity assay for assessing the skin sensitization potential of essential oils. Sci Rep 2022; 12:7470. [PMID: 35523830 PMCID: PMC9076902 DOI: 10.1038/s41598-022-11171-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 04/13/2022] [Indexed: 11/24/2022] Open
Abstract
Plant-derived products are frequently found as ingredients in cosmetics. However, the current data show non-neglectable skin sensitizing potential of these preparations suggesting an urgent need for data regarding their health safety profile. The aim of this study was to assess the skin sensitization potential of commercial essential oils by selected Lamiaceae species (Lavandula angustifolia, Melissa officinalis, Mentha longifolia, Thymus vulgaris, Salvia officinalis, and Rosmarinus officinalis) using a chemistry-based Direct Peptide Reactivity Assay (DPRA) in order to predict their potential allergic properties. In the DPRA assay, nucleophile-containing synthetic peptides (cysteine peptide and lysine peptide) were incubated with the test substance for 24 h. Depletion of the peptide in the reaction mixture was measured by high-pressure liquid chromatography (HPLC) using UV detection and the average peptide depletion data for cysteine and lysine was then calculated. Menthae longifoliae aetheroleum showed no or minimal reactivity with 4.48% cysteine depletion, Rosmarini aetheroleum and Salviae aetheroleum showed low reactivity with the 12.79% and 15.34% of cysteine depletion, respectively, while the other analyzed essential oils showed moderate reactivity with the cysteine depletion between 23.21 and 48.43%. According to DPRA predictive analysis, only Menthae longifoliae aetheroleum can be classified as negative, while all other essential oils may be classified as positive, thus having the potential to cause skin sensitization.
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Affiliation(s)
- Elma Omeragic
- University of Sarajevo-Faculty of Pharmacy, Zmaja od Bosne 8, 71 000, Sarajevo, Bosnia and Herzegovina.
| | - Mirza Dedic
- University of Sarajevo-Faculty of Pharmacy, Zmaja od Bosne 8, 71 000, Sarajevo, Bosnia and Herzegovina
| | - Alisa Elezovic
- University of Sarajevo-Faculty of Pharmacy, Zmaja od Bosne 8, 71 000, Sarajevo, Bosnia and Herzegovina
| | - Ervina Becic
- University of Sarajevo-Faculty of Pharmacy, Zmaja od Bosne 8, 71 000, Sarajevo, Bosnia and Herzegovina
| | - Belma Imamovic
- University of Sarajevo-Faculty of Pharmacy, Zmaja od Bosne 8, 71 000, Sarajevo, Bosnia and Herzegovina
| | - Nebojsa Kladar
- University of Novi Sad-Faculty of Medicine, Hajduk Veljkova 3, 21000, Novi Sad, Serbia
| | - Haris Niksic
- University of Sarajevo-Faculty of Pharmacy, Zmaja od Bosne 8, 71 000, Sarajevo, Bosnia and Herzegovina
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Geier J, Schubert S, Reich K, Skudlik C, Ballmer-Weber B, Brehler R, Weisshaar E, Uter W. Contact sensitization to essential oils: IVDK-data of the years 2010 - 2019. Contact Dermatitis 2022; 87:71-80. [PMID: 35417610 DOI: 10.1111/cod.14126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 04/05/2022] [Accepted: 04/08/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Essential oils (EOs) are widely used in cosmetics, perfumes, massage fluids, aroma therapy, and natural medicine. Some essential oils contain contact sensitizers. OBJECTIVES To describe the frequency of sensitization to EOs in dermatitis patients presenting in skin clinics including concomitant reactions, to evaluate the EO patch test preparations, and to identify patient groups with an increased risk of EO sensitization. PATIENTS AND METHODS Retrospective analysis of data from the Information Network of Departments of Dermatology (IVDK), 2010-2019. RESULTS Twelve EOs were patch tested in an aimed manner in 10 930 patients, of whom 908 (8.3%) reacted to at least one EO. Only 6 EOs elicited more than 1% positive patch test reactions: ylang ylang (I + II) oil (3.9%), lemongrass oil (2.6%), jasmine absolute (1.8%), sandalwood oil (1.8%), clove oil (1.6%), and neroli oil (1.1%). Concomitant reactions among EOs or to EOs and fragrances were frequent. Among EO-positive patients, women, leg dermatitis patients, patients aged 40 years or more, masseurs and cosmeticians were over-represented. CONCLUSIONS Sensitization to EOs occurs, albeit infrequently in most cases. Masseurs and cosmeticians have an increased risk of sensitization to EOs. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Johannes Geier
- Information Network of Departments of Dermatology (IVDK), Institute at the University Medical Center Göttingen, Göttingen, Germany
| | - Steffen Schubert
- Information Network of Departments of Dermatology (IVDK), Institute at the University Medical Center Göttingen, Göttingen, Germany
| | - Kristian Reich
- Translational Research in Inflammatory Skin Diseases, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christoph Skudlik
- Institute for Interdisciplinary Dermatologic Prevention and Rehabilitation (iDerm) at the University of Osnabrück and Dermatologic Centre, Trauma Hospital Hamburg, Hamburg, Germany
| | - Barbara Ballmer-Weber
- Clinic of Dermatology and Allergology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland, and Department of Dermatology, University Hospital Zuerich, Zuerich, Switzerland
| | - Randolf Brehler
- Department of Dermatology, University Hospital Münster, Münster, Germany
| | - Elke Weisshaar
- Unit for Occupational Dermatology, Department of Dermatology, Ruprecht-Karls University Heidelberg, Germany
| | - Wolfgang Uter
- Department of Medical Informatics, Biometry and Epidemiology, University of Erlangen/Nürnberg, Erlangen, Germany
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Krijl RC, Ipenburg NA, Franken SM, Rustemeyer T. What is the added value of patch testing with 30 fragrance allergens in addition to the European baseline series? Contact Dermatitis 2022; 86:390-397. [PMID: 35122278 PMCID: PMC9302649 DOI: 10.1111/cod.14065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 01/26/2022] [Accepted: 02/02/2022] [Indexed: 11/29/2022]
Abstract
Background Patch testing with the fragrance allergy markers in the European baseline series (EBS) does not identify all patients with fragrance allergy. Hydroperoxides of linalool and limonene have been shown to be useful allergens in detecting fragrance sensitization. Objectives To evaluate the added value of testing with 30 fragrance allergens in addition to the EBS. Methods All patients with suspected fragrance allergy who underwent patch testing at the Amsterdam University Medical Centers between November 2019 and January 2021 to the EBS and fragrance series were included. Results Of 323 patients tested, 162 (50.2%) were found to be fragrance sensitized. The most sensitizing single allergens were the hydroperoxides of linalool (1.0 and 0.5% pet.) and limonene (0.3 and 0.2% pet.). Testing with the hydroperoxides of linalool and limonene identified 62 fragrance‐sensitized patients (38.3%) who could not be detected by the common fragrance markers. Of all fragrance‐sensitized patients, 21 (13.0%) would have been missed when not testing with the fragrance series. Conclusions Patch testing with the fragrance series in addition to the EBS is valuable. To reduce the risk of false‐negative reactions, it is advisable to test the hydroperoxides of linalool and limonene.
Highlights
Of the 323 patients with suspected fragrance allergy, 162 (50.2%) were found to be fragrance sensitized. Testing with the hydroperoxides of linalool and limonene identified 62 fragrance‐sensitized patients (38.3%) who could not be detected by the European baseline series (EBS) fragrance markers. When not tested with the fragrance series, 21 (13.0%) of the sensitized patients would have been missed. Routinely performing patch testing with the fragrance series in addition to linalool and limonene hydroperoxide as part of the EBS is recommended.
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Affiliation(s)
- Rosalie C Krijl
- Department of Dermatology, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Norbertus A Ipenburg
- Department of Dermatology, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Sylvie M Franken
- Department of Dermatology, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Thomas Rustemeyer
- Department of Dermatology, Amsterdam University Medical Centers, Amsterdam, the Netherlands
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Karlberg AT, Lepoittevin JP. One hundred years of allergic contact dermatitis due to oxidized terpenes: What we can learn from old research on turpentine allergy. Contact Dermatitis 2021; 85:627-636. [PMID: 34453446 DOI: 10.1111/cod.13962] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 08/20/2021] [Accepted: 08/25/2021] [Indexed: 11/30/2022]
Abstract
Although in recent years the focus on sensitizing terpene oxidation products has been on oxidized limonene and linalool, the autoxidation of terpenes in relation to allergic contact dermatitis is not new and dates back to the early part of the 20th century with the use of turpentine causing occupational contact dermatitis in painters. This review is written in a way as to allow us to get closer to the work of the scientists in earlier days, to participate in the successes, and also to observe the weak points. The researchers concluded that the main culprit in Scandinavian turpentine was Δ3 -carene hydroperoxides. This explains its high sensitizing effect compared with French turpentine which is of the Iberian type with no or only traces of Δ3 -carene. Historical exposure to turpentine showed that ending the industrial exposure stopped the occupational skin sensitization. Patch test studies demonstrated that monoterpene hydroperoxides, far from being an obsolete source of contact allergy solely related to turpentine, is a common cause of contact allergy in the population. A hundred years of extensive chemical and clinical studies worldwide should be sufficient to meet the evidence requirement regarding allergic contact dermatitis caused by terpenes. HIGHLIGHTS: The autoxidation of terpenes in relation to allergic contact dermatitis is not new and dates back to the early part of the 20th century with the use of turpentine. The main culprit in Scandinavian turpentine was Δ3 -carene hydroperoxides. This explains its high sensitizing effect compared with French turpentine with no or only traces of Δ3 -carene. Recent patch test studies demonstrated that monoterpene hydroperoxides, far from being an obsolete source of contact allergy solely related to turpentine, is a common cause of contact allergy in the population.
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Affiliation(s)
- Ann-Therese Karlberg
- Department of Chemistry and Molecular Biology, University of Gothenburg, Gothenburg, Sweden
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Alessandrello C, Gammeri L, Sanfilippo S, Cordiano R, Brunetto S, Casciaro M, Gangemi S. A spotlight on lime: a review about adverse reactions and clinical manifestations due to Citrus aurantiifolia. Clin Mol Allergy 2021; 19:12. [PMID: 34303384 PMCID: PMC8310597 DOI: 10.1186/s12948-021-00152-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 07/16/2021] [Indexed: 11/10/2022] Open
Abstract
Lime (Citrus aurantiifolia) is a plant belonging to the family of Rutaceae and to the genus Citrus. The fruit is widely used in the United States, Mexico, Southeast Asia, Latin America, but is increasingly widespread all over the world. It is used as a fresh fruit, in the preparation of foods, sweets and drinks and its oils are used in the cosmetic and pharmaceutical industry. The main adverse reactions to lime seem to be represented by contact dermatitis, allergic and phototoxic type. In the context of allergic forms, several allergens have been identified in the citrus family, the main one being limonene, but no noteworthy cross-reactivity has been identified. However, a case of fruit protein contact dermatitis has been described, showing sensitization to other fruits, such as kiwi, avocado, pineapple and apple. There are several molecules responsible for phototoxic reactions and mainly belonging to the coumarin and furocoumarins families. Reactions related to ingesting the fruit or inhaling pollen from the tree appear to be rare, as there are no known cases reported in the literature. The increasing diffusion of lime in Europe must pay attention to possible adverse reactions due to contact with this fruit, which seem destined to increase in future years. Further importance must be placed on patch tests and on the possibility of using alternative extracts to classic fragrance mixes.
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Affiliation(s)
- Clara Alessandrello
- School and Operative Unit of Allergy and Clinical Immunology, Policlinico "G. Martino", Department of Clinical and Experimental Medicine, University of Messina, 98125, Messina, Italy
| | - Luca Gammeri
- School and Operative Unit of Allergy and Clinical Immunology, Policlinico "G. Martino", Department of Clinical and Experimental Medicine, University of Messina, 98125, Messina, Italy
| | - Serena Sanfilippo
- School and Operative Unit of Allergy and Clinical Immunology, Policlinico "G. Martino", Department of Clinical and Experimental Medicine, University of Messina, 98125, Messina, Italy
| | - Raffaele Cordiano
- School and Operative Unit of Allergy and Clinical Immunology, Policlinico "G. Martino", Department of Clinical and Experimental Medicine, University of Messina, 98125, Messina, Italy
| | - Silvia Brunetto
- School and Operative Unit of Allergy and Clinical Immunology, Policlinico "G. Martino", Department of Clinical and Experimental Medicine, University of Messina, 98125, Messina, Italy
| | - Marco Casciaro
- School and Operative Unit of Allergy and Clinical Immunology, Policlinico "G. Martino", Department of Clinical and Experimental Medicine, University of Messina, 98125, Messina, Italy.
| | - Sebastiano Gangemi
- School and Operative Unit of Allergy and Clinical Immunology, Policlinico "G. Martino", Department of Clinical and Experimental Medicine, University of Messina, 98125, Messina, Italy
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Geier J, Schubert S, Schnuch A, Szliska C, Weisshaar E, Kränke B, Werfel T, Ruëff F, Schröder-Kraft C, Buhl T. A negative breakdown test in a fragrance mix I-positive patient does not rule out contact allergy to its fragrance constituents. Contact Dermatitis 2021; 84:407-418. [PMID: 33533485 DOI: 10.1111/cod.13803] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 01/19/2021] [Accepted: 01/26/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND In about half of the patients reacting positive to fragrance mix I (FM I), breakdown testing remains negative. This raises the question of whether the reaction to FM I is false-positive, or the breakdown test is false-negative. OBJECTIVES To identify characteristics and sensitization patterns of patients positive to FM I, but not to its fragrance constituents. PATIENTS AND METHODS Retrospective analysis of data from the Information Network of Departments of Dermatology (IVDK) between 2005 and 2019. Three patient groups were defined according to their reaction pattern: Group I, FM I positive and ≥1 single fragrance positive in the breakdown test (n = 1912); Group II, FM I positive and breakdown test negative (n = 1318); Group III, FM I negative (n = 19 790). RESULTS Regarding the pattern of concomitant reactions to other fragrances, Group II had an intermediate position between Group I and Group III. In other respects (age and sex distribution, frequency of sensitization to non-fragrance baseline series allergens), Group II rather resembled Group I. CONCLUSIONS Not every positive reaction to FM I in patients with negative breakdown tests is false-positive. There may be false-negative reactions to the single fragrance components when patch tested at 1% pet. Raising patch concentrations of some single fragrances is recommended.
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Affiliation(s)
- Johannes Geier
- Information Network of Departments of Dermatology (IVDK), Institute at the University Medical Center Göttingen, Göttingen, Germany
| | - Steffen Schubert
- Information Network of Departments of Dermatology (IVDK), Institute at the University Medical Center Göttingen, Göttingen, Germany
| | - Axel Schnuch
- Information Network of Departments of Dermatology (IVDK), Institute at the University Medical Center Göttingen, Göttingen, Germany
| | | | - Elke Weisshaar
- Occupational Dermatology, Department of Dermatology, Ruprecht-Karl University Heidelberg, Heidelberg, Germany
| | - Birger Kränke
- Department of Dermatology and Venereology, Medical University of Graz, Graz, Austria
| | - Thomas Werfel
- Department of Dermatology and Allergy, Division of Immunodermatology and Allergy Research, Hannover Medical School, Hannover, Germany
| | - Franziska Ruëff
- Department of Dermatology and Allergology, Ludwig-Maximilian University of Munich, Munich, Germany
| | - Claudia Schröder-Kraft
- Institute for Interdisciplinary Dermatologic Prevention and Rehabilitation (iDerm) of the University of Osnabrück and Dermatologic Center, BG Trauma Hospital Hamburg, Hamburg, Germany
| | - Timo Buhl
- Department of Dermatology, Venereology and Allergy, University Medical Center Göttingen, Göttingen, Germany
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