Contact allergy to methyldibromo glutaronitrile - data from a 'front line' network

Risk management of skin sensitisers: A commentary

Historically, allergic contact dermatitis (ACD) to chemicals encouraged hazard identification improvements, more sophisticated risk assessment and implementation of regulatory strategies, including banning of specific sensitising substances. The validation process applied to hazard identification methods demonstrates their accuracy; their use to characterise sensitiser potency facilitates quantitative and transparent risk assessment. Diagnostic patch testing at dermatology clinics worldwide delivers feedback showing where risk assessment/management has been insufficient or did not target the exposure of concern, thereby facilitating improvements. When urgent action to protect human health was required, regulations limited/banned, specific skin sensitisers. This can be seen in practice with the fragrance industry, a known source of ACD, thus requiring risk management, usually restrictions to limit allergy induction, and very rarely specific bans on ingredients. Experience and development of more sophisticated tools, e.g. to assess aggregate exposure from multitude of consumer product types, has led to repeated adaptation of risk assessment and promulgation of updated fragrance use limits. Although targeted control may not always lead to rapid change in the overall clinical picture, it is preferable to a blanket undifferentiated regulatory control of all sensitisers, resulting in unwarranted restrictions for many uses of no health concern, with consequent substantial socio-economic impacts.

Characterizing Adduct Formation of Electrophilic Skin Allergens with Human Serum Albumin and Hemoglobin

Skin (contact) allergy, the most predominant form of immunotoxicity in humans, is caused by small electrophilic compounds (haptens) that modify endogenous proteins. Approximately 20% of the general population in the Western world is affected by contact allergy. Although the importance of the hapten–protein conjugates is well established in the initiation of the immunological reaction, not much progress has been made regarding identification of these conjugates in vivo or exploration of their potential as diagnostic tools. In this study, the human serum albumin (HSA) and human hemoglobin (Hb) adductome for three representative contact allergens with different chemical properties, 1-chloro-2,4-dinitrobenzene (DNCB), 1,2-epoxy-3-phenoxypropane (PGE), and 2-bromo-2-(bromomethyl)glutaronitrile (MDBGN), were studied. Plasma and red blood cell lysate were used as a source for HSA and Hb, respectively. The Direct Peptide Reactivity Assay was used to investigate adduct formation of MDBGN with nucleophilic moieties and revealed that MDGBN is converted to 2-methylenepentanedinitrile in the presence of sulfhydryl groups prior to adduct formation. Following incubation of HSA and Hb with haptens, an Orbitrap Q Exactive high-resolution mass spectrometer was used to perform an initial untargeted analysis to screen for adduct formation, followed by confirmation by targeted Parallel Reaction Monitoring analysis. Although a subset of adducted sites was confirmed by targeted analysis, only some of the adducted peptides showed an increase in the relative amount of the adducted peptide with an increased concentration of hapten. In total, seven adduct sites for HSA and eight for Hb were confirmed for DNCB and PGE. These sites are believed to be the most reactive. Further, three of the HSA sites (Cys₃₄, Cys₆₂, and Lys₁₉₀) and six of the Hb sites (subunit α: Val₁, His₄₅, His₇₂; subunit β: Cys₉₃, His₉₇, and Cys₁₁₂) were haptenated already at the lowest level of hapten to protein molar ratio (0.1:1), indicating that these sites are the most likely to be modified in vivo. To the best of our knowledge, this is the first time that the adductome of Hb has been studied in the context of contact allergens. Identification of the most reactive sites of abundant proteins, such as HSA and Hb, is the first step toward identification of contact allergy biomarkers that can be used for biomonitoring and to develop better diagnostic tools based on a blood sample.

Simple and rapid analysis of methyldibromo glutaronitrile in cosmetic products by gas chromatography mass spectrometry

A simple and rapid gas chromatography (GC) method with mass spectrometry (MS) detection has been developed for the determination of methyldibromo glutaronitrile (MDBGN) in cosmetic products. The presence of this preservative in commercial cosmetic samples is prohibited since 2007 because of its allergenic properties. The analyzed products were opportunely diluted in methanol and MDBGN was separated by fused silica capillary column and detected by electron impact (EI)-MS in positive ionization mode with a total run time of 7 min. The assay was validated in the range 0.005-0.100 mg MDBGN per g of examined product with good determination coefficients (r(2)≥0.99) for the calibration curves. At three concentrations spanning the linear dynamic range of the calibration curves, mean recoveries were always higher than 95% for MDBGN in the tested cosmetics. This method was successfully applied to the analysis of cleansing gels, shampoo and solar waters to disclose the eventual presence of MDBGN illegally added in cosmetic products.

Skin sensitization, false positives and false negatives: experience with guinea pig assays

The advent of the local lymph node assay (LLNA), and efforts to develop in vitro alternatives for the identification of skin sensitizing chemicals has focused attention on the issue of false positive and false negative results. In essence, the question becomes 'what is the gold standard?' In this context, attention has focused primarily on the LLNA as this is now the preferred assay for skin sensitization testing. However, for many years prior to introduction of the LLNA, the guinea pig maximization test and the occluded patch test of Buehler were the methods of choice. In order to encourage a more informed dialogue about the relative performance, accuracy and applicability of the LLNA and guinea pig tests, we have here considered the extent to which guinea pig methods were themselves subject to false positives and negative results. We describe and discuss here well-characterized examples of instances where both false negatives (including abietic acid and eugenol) or false positives (including vanillin and sulfanilic acid) have been recorded in guinea pig tests. These and other examples are discussed with particular reference to the fabrication of a gold standard dataset that is required for the validation of in vitro alternatives.

Occupational allergic contact dermatitis to methyldibromoglutaronitrile in hand degreasing toilet paper

We inform about a case of occupational allergic contact dermatitis (OACD) to methyldibromoglutaronitrile (MDBGN) in industrial hand degreasing moist toilet paper. To our knowledge, this is the first published case of OACD to MDBGN in industrial hand degreasing toilet papers. A cause-effect relationship seems to be clearly established. We believe that physicians must keep in mind that MDBGN is a strong allergen either mixed or as a single component of industrial moist toilet papers. MDBGN must be taken into account for OACD at an appropriate work environment.

Patch test results in patients with scalp dermatitis: analysis of data of the Information Network of Departments of Dermatology

BACKGROUND

Contact dermatitis of the scalp may develop primarily due to exposure to cosmetic products or secondarily due to application of topical medicaments on affected skin.

OBJECTIVES

To illustrate the current spectrum of allergens in scalp dermatitis.

PATIENTS/METHODS

Data of 1320 patients recorded by the Information Network of Departments of Dermatology (IVDK) between 1993 and 2003, who were patch tested to confirm or rule out (secondary) allergic contact dermatitis of the scalp, were analysed.

RESULTS

Sensitization to p-phenylenediamine, tolune-2,5-diamine, p-aminophenol, 3-aminophenol, p-aminoazobenzene, cocamidopropyl betaine and pyrogallol was significantly more common than in the remaining IVDK patients. In 690 patients, altogether 4070 patients' own products were patch tested. Medical products, hair tints and bleaches (HTB) and hair-cleansing products together caused nearly 2/3 of positive patch test reactions. Among these categories, HTB showed the highest percentage of positive patch test reactions; 24 of 29 HTB-positive patients had no positive reaction to any of the commercially available allergens.

CONCLUSIONS

In our subgroup of patients with scalp dermatitis, constituents of hair-colouring products were the most important allergens. As some ingredients of hair dyes are not contained in patch test series, testing of patients' own products is an important part of diagnostic workup, as otherwise sensitizations may be missed.

Allergic Contact Dermatitis to Cosmetics

Cosmetics are used to enhance one's appearance and are used by women worldwide. This article reviews the epidemiology, clinical features, and management of cosmetic allergic contact dermatitis. Additionally, several important cosmetic-related allergens are discussed.

Clinical update on contact allergy

PURPOSE OF REVIEW

The aim of this article is to review recent findings in contact allergy, regarding clinical research.

RECENT FINDINGS

The biocide methyldibromo glutaronitrile was identified to be an important sensitizer. Subsequently, it was banned from leave-on cosmetics in the European Union. Another group of important allergens that have been studied extensively included the fragrances oak moss absolute, isoeugenol, hydroxyisohexyl 3-cyclohexene carboxaldehyde and farnesol. A new fragrance mix II has been developed for standard testing, which includes the two latter compounds. Dose response studies have demonstrated broad individual variation of elicitation thresholds, dependent on the allergen concentration during induction, and other factors. Some unsuspected routes of exposure to allergens include oral, inhalational, connubial or airborne contact. Experimental studies provide a classification of newly introduced chemicals; increasingly, the local lymph node assay is supplementing and potentially replacing the guinea pig maximization test. Recent advances in occupational contact allergy include, for example, some attempts to improve diagnostics for epoxy resin and other plastic, glue, and cutting fluid components.

SUMMARY

Constant awareness for new allergens, confirmed by critical evaluation, standardization of patch test materials, and the identification of temporal patterns and subgroups at risk will improve both the diagnosis and prevention of allergic contact dermatitis.