Sensitizing potential of 14 mono (meth) acrylates in the guinea pig

The activity of methacrylate esters in skin sensitisation test methods II. A review of complementary and additional analyses

Allergic contact dermatitis is an important occupational health issue, and there is a need to identify accurately those chemicals that have the potential to induce skin sensitisation. Hazard identification was performed initially using animal (guinea pig and mouse) models. More recently, as a result of the drive towards non-animal methods, alternative in vitro and in silico approaches have been developed. Some of these new in vitro methods have been formally validated and have been assigned OECD Test Guideline status. The performance of some of these recently developed in vitro methods, and of 2 quantitative structure-activity relationships (QSAR) approaches, with a series of methacrylate esters has been reviewed and reported previously. In this article that first review has been extended further with additional data and complementary analyses. Results obtained using in vitro methods (Direct Peptide Reactivity Assay, DPRA; ARE-Nrf2 luciferase test methods, KeratinoSens and LuSens; Epidermal Sensitisation Assay, EpiSensA; human Cell Line Activation Test, h-CLAT, and the myeloid U937 Skin Sensitisation test, U-SENS), and 2 QSAR approaches (DEREK™-nexus and TIMES-SS), with 11 methacrylate esters and methacrylic acid are reported here, and compared with existing data from the guinea pig maximisation test and the local lymph node assay. With this series of chemicals it was found that some in vitro tests (DPRA and ARE-Nrf2 luciferase) performed well in comparison with animal test results and available human skin sensitisation data. Other in vitro tests (EpiSensA and h-CLAT) proved rather more problematic. Results with DEREK™-nexus and TIMES-SS failed to reflect accurately the skin sensitisation potential of the methacrylate esters. The implications for assessment of skin sensitising activity are discussed.

The activity of methacrylate esters in skin sensitisation test methods: A review

Skin sensitisation associated with allergic contact dermatitis is an important occupational and environmental disease. The identification of skin sensitisation hazards was traditionally performed using animal tests; originally guinea pig assays and subsequently the murine local lymph node assay (LLNA). More recently there has, for a variety of reasons, been an increased interest in, and requirement for, non-animal assays. There are now available both validated in vitro assays and a variety of approaches based on consideration of quantitative structure-activity relationships (QSAR). With the increased availability and use of non-animal alternatives for skin sensitisation testing there is a continuing need to monitor the performance of these approaches using series of chemicals that do not normally form part of validation exercises. Here we report studies conducted with 11 methacrylate esters and methacrylic acid in which results obtained with 3 validated in vitro tests for which there are OECD guidelines (the Direct Peptide Reactivity Assay, DPRA; ARE-Nrf2 luciferase test methods, and - with some chemicals - a dendritic cell activation test, the myeloid U937 Skin Sensitisation test [U-SENS] assay) have been compared with QSAR approaches (DEREK and TIMES-SS), and with LLNA and guinea pig maximisation test (GPMT) data. The conclusions drawn from these data are that - with this series of chemicals at least - there is a strong correlation between the results of animal tests and the in vitro assays considered, but not with either DEREK or TIMES-SS.

Final Report on Ethyl Methacrylate

Ethyl Methacrylate is the ester of ethyl alcohol and methacrylic acid used as the major structural monomer of artificial fingernail formulations that are cross-linked with one or more multifunctional methacrylates. Ethyl methacrylate monomer is polymerized rapidly and very little free monomer is available even during filing of the fingernails. The oral LD50 for rats ranged from 12.7 to 18.14 g/kg, with lesions in the respiratory system and hemoglobinuria observed in treated animals. Ocular, nasal, and respiratory tract irritation was observed in acute inhalation tests using rats. Very little toxicity was seen in subchronic studies using rabbits. Ethyl Methacrylate caused irritation and vehicle dependent sensitization in animals, but no photosensitization. Evidence of embryotoxic and teratogenic effects were observed in pregnant rats after intraperitoneal injection of Ethyl Methacrylate at a range of concentrations. Both positive and negative mutagenicity test data were found. Clinical testing showed little evidence of irritation, although case studies report allergic contact dermatitis as a result of exposure to Ethyl Methacrylate and related methacrylates with application of artificial fingernails. Occupational contact dermatitis from acrylates and methacrylates are also reported, with some evidence for cross-reactivity between the two chemical classes. Based on the sensitizing potential of this ingredient the CIR Expert Panel recommended that fingernail enhancement formulations with Ethyl Methacrylate be applied only by trained individuals and that the ingredient not be used in products intended for retail sale (currently, these products are believed to be sold only for application by a trained individual). Because of the low likelihood of significant exposure if such formulations are applied properly, the Expert Panel concluded that the ingredient is safe as used, with the caveat that skin contact should be avoided.

Assessment of the skin sensitising potency of the lower alkyl methacrylate esters

There is continued interest in, and imperatives for, the classification of contact allergens according to their relative skin sensitising potency. However, achieving that end can prove problematic, not least when there is an apparent lack of concordance between experimental assessments of potency and the prevalence allergic contact dermatitis as judged by clinical experience. For the purpose of exploring this issue, and illustrating the important considerations that are required to reach sound judgements about potency categorisation, the lower alkyl methacrylate esters (LAM) have been employed here as a case study. Although the sensitising potential of methyl methacrylate (MMA) has been reviewed previously, there is available new information that is relevant for assessment of skin sensitising potency. Moreover, for the purposes of this article, analyses have been extended to include also other LAM for which relevant data are available: ethyl methacrylate (EMA), n-butyl methacrylate (nBMA), isobutyl methacrylate (iBMA), and 2-ethylhexyl methacrylate (EHMA). In addressing the skin sensitising activity of these chemicals and in drawing conclusions regarding relative potency, a number of sources of information has been considered, including estimates of potency derived from local lymph node assay (LLNA) data, the results of guinea pig assays, and data derived from in silico methods and from recently developed in vitro approaches. Moreover, clinical experience of skin sensitisation of humans by LAM has also been evaluated. The conclusion drawn is that MMA and other LAM are contact allergens, but that none of these chemicals has any more than weak skin sensitising potency. We have also explored here the possible bases for this modest sensitising activity. Finally, the nature of exposure to LAM has been reviewed briefly and on the basis of that information, together with an understanding of skin sensitising potency, a risk assessment has been prepared.

Methyl methacrylate and respiratory sensitization: a critical review

Methyl methacrylate (MMA) is a respiratory irritant and dermal sensitizer that has been associated with occupational asthma in a small number of case reports. Those reports have raised concern that it might be a respiratory sensitizer. To better understand that possibility, we reviewed the in silico, in chemico, in vitro, and in vivo toxicology literature, and also epidemiologic and occupational medicine reports related to the respiratory effects of MMA. Numerous in silico and in chemico studies indicate that MMA is unlikely to be a respiratory sensitizer. The few in vitro studies suggest that MMA has generally weak effects. In vivo studies have documented contact skin sensitization, nonspecific cytotoxicity, and weakly positive responses on local lymph node assay; guinea pig and mouse inhalation sensitization tests have not been performed. Cohort and cross-sectional worker studies reported irritation of eyes, nose, and upper respiratory tract associated with short-term peaks exposures, but little evidence for respiratory sensitization or asthma. Nineteen case reports described asthma, laryngitis, or hypersensitivity pneumonitis in MMA-exposed workers; however, exposures were either not well described or involved mixtures containing more reactive respiratory sensitizers and irritants. The weight of evidence, both experimental and observational, argues that MMA is not a respiratory sensitizer.

The potential dermal irritating effect of residual (meth)acrylic monomers in pressure sensitive adhesive tapes

It is generally thought that residual unpolymerized (meth)acrylic monomers commonly found in pressure sensitive adhesive tapes for medical use may cause dermal irritation, but a systematic study has never been carried out. Therefore, we assessed the potential dermal irritating effect of residual (meth)acrylic monomers. We studied seven acrylic monomers, acrylic acid (AA), methyl acrylate (MA), ethyl acrylate (EA), n-butyl acrylate (n-BA), n-hexyl acrylate (n-HA), 2-ethylhexyl acrylate (2-EHA) and 2-hydroxyethyl acrylate (HEA), as well as three methacrylic monomers, methacrylic acid (MAA), methyl methacrylate (MMA) and 2-hydroxyethyl methacrylate (2-HEMA). We first examined their cytotoxic effect on a cultured dermis model using the MTT method to determine their EC(50) and then performed a primary irritation test in rabbits using the monomers at three different concentrations (i.e., EC(50) , one-tenth EC(50) and 10 times EC(50)). Marked variations were found in cytotoxic and dermal irritating activities among the (meth)acrylic monomers tested. HEA exhibited the most potent dermal irritation having the lowest erythema dose (the concentration which gives a primary dermal irritation index of 1.00) of 460 ppm. But the other monomers exhibited less potent dermal irritation (lowest erythema doses > or =1000 ppm). For the monomers, significant correlation was found between cytotoxic activity and in vivo dermal irritating activity. Our results show that residual unpolymerized (meth)acrylic monomers in adhesive tapes are unlikely to induce skin irritation except for HEA. This study also suggests that cultured skin models are extremely useful as a screening method for chemical substances that could potentially cause dermal irritating activity.

Methacrylate and acrylate allergy in dental personnel

BACKGROUND

Methacrylates are important allergens in dentistry.

OBJECTIVE

The study aimed to analyse patch test reactivity to 36 acrylic monomers in dental personnel in relation to exposure.

METHODS

We reviewed the test files at the Finnish Institute of Occupational Health from 1994 to 2006 for allergic reactions to acrylic monomers in dental personnel and analysed the clinical records of the sensitized patients.

RESULTS

32 patients had allergic reactions to acrylic monomers: 15 dental nurses, 9 dentists, and 8 dental technicians. The dentists and dental nurses were most commonly exposed to 2-hydroxyethyl methacrylate (2-HEMA), triethyleneglycol dimethacrylate (TREGDMA), and 2,2-bis[4-(2-hydroxy-3-methacryloxypropoxy) phenyl]propane (bis-GMA). 8 dentists and 12 dental nurses were allergic to 2-HEMA. The remaining dentist was positive to bis-GMA and other epoxy acrylates. The remaining 3 dental nurses reacted to diethyleneglycol diacrylate (DEGDA) or triethyleneglycol diacrylate (TREGDA), but not to monofunctional and multifunctional methacrylates. Our dental technicians were mainly exposed and sensitized to methyl methacrylate (MMA) and ethyleneglycol dimethacrylate (EGDMA). 1 technician reacted only to 2-HEMA, and another to ethyl methacrylate (EMA) and ethyl acrylate (EA).

CONCLUSIONS

2-HEMA was the most important allergen in dentists and dental nurses, and MMA and EGDMA in dental technicians. Reactions to bis-GMA, DEGDA, TREGDA, EMA and EA were relevant in some patients.

Comparative analysis of skin sensitization potency of acrylates (methyl acrylate, ethyl acrylate, butyl acrylate, and ethylhexyl acrylate) using the local lymph node assay

There are currently available no systematic experimental data on the skin sensitizing properties of acrylates that are of relevance in occupational settings. Limited information from previous guinea-pig tests or from the local lymph node assay (LLNA) is available; however, these data are incomplete and somewhat contradictory. For those reasons, we have examined in the LLNA 4 acrylates: butyl acrylate (BA), ethyl acrylate (EA), methyl acrylate (MA), and ethylhexyl acrylate (EHA). The LLNA data indicated that all 4 compounds have some potential to cause skin sensitization. In addition, the relative potencies of these acrylates were measured by derivation from LLNA dose-response analyses of EC3 values (the effective concentration of chemical required to induce a threefold increase in proliferation of draining lymph node cells compared with control values). On the basis of 1 scheme for the categorization of skin sensitization potency, BA, EA, and MA were each classified as weak sensitizers. Using the same scheme, EHA was considered a moderate sensitizer. However, it must be emphasized that the EC3 value for this chemical of 9.7% is on the borderline between moderate (<10%) and weak (>10%) categories. Thus, the judicious view is that all 4 chemicals possess relatively weak skin sensitizing potential.

Skin sensitization potency of methyl methacrylate in the local lymph node assay: comparisons with guinea-pig data and human experience

There is compelling evidence that contact allergens differ substantially (by 4 or 5 orders of magnitude) with respect to their inherent skin-sensitizing potency. Relative potency can now be measured effectively using the mouse local lymph node assay (LLNA) and such data form the basis of risk assessment and risk management strategies. Such determinations also facilitate distinctions being drawn between the prevalence of skin sensitization to a particular contact allergen and inherent potency. The distinction is important because chemicals that are implicated as common causes of contact allergy are not necessarily potent sensitizers. One example is provided by nickel that is undoubtedly a common cause of allergic contact dermatitis, but is a comparatively weak sensitizer in predictive tests. In an attempt to explore other examples of contact allergens where there may exist a discrepancy between prevalence and potency, we describe here analyses conducted with methyl methacrylate (MMA). Results of LLNA studies have been interpreted in the context of historical clinical data on occupational allergic contact dermatitis associated with exposure to MMA.

Guinea pig maximization tests with formaldehyde releasers

The guinea pig maximization test was used to evaluate the sensitizing potential of formaldehyde and 6 formaldehyde releasers (Forcide 78, Germall 115, Grotan BK, Grotan OX, KM 200 and Preventol D2). The tests were carried out in 2 laboratories (Copenhagen and Stockholm), and although we intended the procedures to be the same, discrepancies were observed, possibly due to the use of different animal strains, test concentrations and vehicles. The sensitizing potential was in general found to be stronger in Stockholm compared to Copenhagen: formaldehyde sensitized 50% of the guinea pigs in Copenhagen and 95% in Stockholm. For Grotan BK, the corresponding rates were 20% and 74%. Forcide 78, KM 200 and Preventol D2 sensitized 20% to 25% of the animals in Copenhagen, while Germall 115 and Grotan OX sensitized 60% to 70% of the animals in Stockholm.

Bonding efficacy and side effects of the high purity glyceryl mono-methacrylate

The purpose of this study was to examine the efficacy of experimentally developed high purity glyceryl mono-methacrylate (GM) as a dentine primer and to evaluate the possibility of allergic reaction. The efficacy of experimental dentine primers was evaluated by measuring the polymerization contraction gap width and the tensile bond strength. Allergic reaction was evaluated by the guinea-pig maximization test. The skin reaction was evaluated according to the criteria of the International Contact Dermatitis Research Group. Contraction gap formation was completely prevented and the tensile bond strength was not significantly affected by priming with GM on high-purity GM. The allergic response decreased when high-purity GM was employed as the challenger. It was concluded that the clinical use of the high-purity GM is beneficial as the delayed allergic reaction could be avoided with no detrimental effect on the dentine bonding.

Comparison of two in vitro dendritic cell maturation models for screening contact sensitizers using a panel of methacrylates

Allergen-induced emigration and maturation of dendritic cells (DC) are pivotal steps in sparking off allergic contact dermatitis. In vitro models, reflecting these steps, may provide tools for assessment of sensitizing capacities of putative contact allergens. Here, we evaluated the applicability of such models for a panel of methacrylate congeners, the sensitizing properties of which were established previously in clinical and experimental animal studies. First, using interleukin-4 (IL-4)/granulocyte-macrophage colony-stimulating factor (GM-CSF)-induced, blood monocyte-derived DC, hapten-induced up-regulation of maturation/ activation markers, including CD80, CD83, CD86, chemokine receptors CXCR4 and CCR5, as well as the drug resistance related molecules P-glycoprotein (Pgp) and lung resistance protein (LRP), were monitored by flow cytometry. Of note, whereas CD86 and CXCR4 were most sensitive in discriminating between the contact sensitizers and irritants included in the panel, i.e. sodium dodecyl sulphate (SDS) and croton oil (CO), assessment of CD83 and LRP expression reflected the relatively lower sensitizing capacity of methyl methacrylate. Second, using ex vivo skin explant cultures, allergen-induced LC migration from epidermal to basal membranous and dermal skin structures was most reliably monitored by CDla, as compared with Pgp, LRP, HLA-DR or CD54 staining. The extent of CD1a+ LC migration was found to closely correlate with the sensitizing capacities of the panel of test compounds. These results support the view that both in vitro models can provide valuable data on contact sensitizing properties, and add chemokine receptors and drug resistance related molecules to the list of DC membrane markers revealing allergenic signaling.

Amended final report on the safety assessment of ethyl methacrylate

Ethyl Methacrylate is a methacrylate ester used as a chemical additive in artificial fingernail enhancement products. These products may be applied by trained professionals or be provided directly to consumers with instructions for use. Ethyl Methacrylate readily polymerizes and rapidly reacts with multifunction methacrylates to form a highly cross-linked polymer. The oral LD(50) of Ethyl Methacrylate for rats ranged from 12.7 to 18.14 g/kg. In acute studies with rats, hemoglobinuria and respiratory tract lesions were observed. Animal studies indicate that Ethyl Methacrylate is a skin irritant and sensitizer. In some cases the results were dependent on the vehicle. Evidence of embryotoxicity and teratogenicity were observed in rats injected intraperitoneally with 0.1223 to 0.4076 ml/kg Ethyl Methacrylate. Positive evidence of mutagenicity was observed in the L5178Y mouse lymphoma cell assay, but not in two Ames tests. Case reports cite examples of individuals suffering allergic contact dermatitis from exposure to Ethyl Methacrylate and related methacrylates, and some degree of cross-reactivity appears to exist between widely used acrylates and methacrylates. Information from several clinical registries of sensitization reactions to various agents reported that Ethyl Methacrylate is a sensitizer, but not a potent one. Because Ethyl Methacrylate monomer is short-lived in the normal course of using artificial fingernail-enhancement products, the primary hazard is expected to be inadvertant skin contact. In order to avoid sensitization, it is necessary to avoid skin contact. It is recommended that fingernail-enhancement products containing Ethyl Methacrylate include directions to avoid skin contact because of the sensitizing potential. Based on the available data on the formulation of nail products containing this ingredient, it is concluded that Ethyl Methacrylate is safe as used, when application is accompanied by directions for use as above.

Contact sensitivity to selected acrylate compounds in B6C3F1 mice: relative potency, cross reactivity, and comparison of test methods

Given the increasing prevalence of occupational sensitization to acrylate compounds, n-butyl acrylate (BAC), ethyl acrylate (EAC), and trimethylol propane triacrylate (TMT) were recommended by the National Toxicology Program for hypersensitivity testing in female B6C3F1 mice. The objectives of these studies were to determine the irritating and sensitizing potential of these three compounds using an irritation assay, the murine Local Lymph Node Assay (LLNA), and the Mouse Ear Swelling Test (MEST). The minimal irritating concentration for TMT was determined to be 1.0%, whereas BAC and EAC demonstrated no irritation up to 30%, the highest concentration tested. TMT tested positive in the LLNA at concentrations as low as 0.1% whereas an induction concentration of 0.3% was required to elicit a positive response in the MEST. Furthermore, BAC tested negative in the MEST at induction concentrations as high as 30%, but yielded positive results in the LLNA at concentrations as low as 20%. EAC, at all concentrations tested, was negative in both the MEST and the LLNA. Cross reactivity was only seen when mice were sensitized with TMT and challenged with BAC. In these studies, the LLNA was a more sensitive indicator of the allergic potential of these three acrylates when compared to the MEST.

Human T lymphocyte priming in vitro by haptenated autologous dendritic cells

Dendritic cells (DC), generated from adherent peripheral blood mononuclear cells (PBMC) by culturing with granulocyte-macrophage colony-stimulating factor (GM-CSF) and IL-4, were used to study in vitro sensitization of naive, hapten-specific T cells and to analyse cross-reactivities to related compounds. DC were hapten-derivatized with nickel sulphate (Ni) or 2-hydroxyethyl-methacrylate (HEMA), followed by tumour necrosis factor-alpha (TNF-alpha)-induced maturation, before autologous T cells and a cytokine cocktail of IL-1beta, IL-2 and IL-7 were added. After T cell priming for 7 days, wells were split and challenged for another 7 days with Ni or HEMA, and potentially cross-reactive haptens. Hapten-specificity of in vitro priming was demonstrated by proliferative responses to the haptens used for priming but not to the unrelated haptens. Highest priming efficiencies were obtained when both IL-4 and IL-12 were added to the cytokine supplement. Marked interferon-gamma (IFN-gamma) release (up to 4 ng/ml) was found when IL-12 was included in the cultures, whereas IL-5 release (up to 500 pg/ml) was observed after addition of IL-4 alone, or in combination with IL-12. Nickel-primed T cells showed frequent cross-reactivities with other metals closely positioned in the periodic table, i.e. palladium and copper, whereas HEMA-primed T cells showed distinct cross-reactivities with selected methacrylate congeners. Similar cross-reactivities are known to occur in allergic patients. Thus, in vitro T cell priming provides a promising tool for studying factors regulating cytokine synthesis, and cross-reactivity patterns of hapten-specific T cells.

Cross-reactivity patterns of contact-sensitizing methacrylates

Methacrylates are well-known contact sensitizers with increasing frequency of contact leading to occupational skin disease. Here, we developed an animal model to facilitate studies on the sensitizing capacities and cross-reactivity patterns between four clinically most important allergens: methacrylate (MMA), 2-hydroxyethyl methacrylate (2-HEMA), 2-hydroxypropyl methacrylate (2-HPMA) and ethyleneglycol dimethacrylate (EGDMA). Inbred guinea pigs were immunized by ic injections of 300 microliters of 1.0 M methacrylate solutions in Freund's complete adjuvant into both flanks, both ears, and the neck. After 14 days open skin tests were performed with 50% MMA, 2-HEMA, or 2-HPMA or 10% EGDMA solutions in 40% DMSO in ethanol. Cross-reactivities were investigated 14 days later by skin testing with all four methacrylates. Using this newly developed protocol, strongly positive skin tests for methacrylates could be induced in almost all guinea pigs (MMA 26/26, 2-HEMA 16/18, 2-HPMA 15/16 and EGDMA 11/11). Whereas EGDMA induced only weak or infrequent cross-reactivities, 2-HEMA sensitization led to strong cross-reactions to all other methacrylates. Both MMA and 2-HPMA induced strong cross-reactivity to EGDMA but only weak to moderate reactivities to the other methacrylates. The absence of strong cross-reactions with monomethacrylates in EGDMA (dimethacrylate)-sensitized animals may be explained by the predominance of highly EGDMA-specific T-cells in these animals. In contrast, sensitization with MMA, 2-HEMA, and 2-HPMA would lead to recruitment of T-cells cross-reactive to the other monomethacrylates, according to their molecular similarities. The strong skin hypersensitivities observed for EGDMA in these latter groups are ascribed to enzymatic degradation into monomethacrylate compounds, notably 2-HEMA, at a rate sufficient to elicit cognate effector T-cells. The results of this study offer new insights in the development of methacrylate hypersensitivities and common cross-sensitization patterns in clinical practice.

The value and limitations of rechallenge in the guinea pig maximization test

The guinea pig maximization test (GPMT) has played a primary rôle in the evaluation of potential skin contact sensitizers for 25 years. In the OECD Guideline 406 from 1993, it is specifically suggested that equivocal results from the initial challenge in the GPMT should be evaluated further with a repeated challenge. However, there exist few published rechallenge data and the guideline does not describe how rechallenge data should be interpreted. In this paper, we have used examples from published results to illustrate both the positive value and the limitations of repeated challenges, including cross challenge. Testing with modified concentrations may also help to indicate whether or not the response is allergic in nature, particularly where there has been a low level of skin reaction observed in shamtreated controls, or where a low level of skin reaction is the dominant response in the test animals. In conclusion, the data presented demonstrate that, as a tool for the investigation of skin sensitizing potential, the GPMT can benefit from an experienced scientific evaluation of rechallenge data, but that this information should not be treated in a mechanistic fashion.

Bioavailability of components of resin-based materials which are applied to teeth

Chemical components of many materials used in dental practice can move into the local biophase, where they can have beneficial or adverse effects. The strongest indirect evidence that components of resin-based materials used in dentistry can move into the biophase are the many reports of allergic dermatitis in dental personnel. Direct measurement of component release has shown that triethylene glycol dimethacrylate (TEGDMA), hydroxyethyl methacrylate (HEMA), and, in the case of some orthodontic cements, bis-glycidyl methacrylate and benzoyl peroxide can move into an aqueous medium from a range of resin-based materials which are applied to teeth as part of oral care. In the case of resin composite restorations, HEMA and TEGDMA are available in microgram quantities via the salivary surface in the minutes and hours after clinical placement and via dentin and pulp in the hours and days after placement. Fortunately, moderate thickness of dentin protects pulp tissue against local toxicity. There are no data which suggest that systemic toxicity is a risk with any of these materials. There are some case reports of allergic responses to the monomers in patients, but the incidence of such responses appears at present to be much lower than that in dental personnel.

A delayed hypersensitivity reaction to dentine primer in the guinea-pig

OBJECTIVE

This study was undertaken to examine the possibility of a delayed hypersensitivity reaction or contact dermatitis occurring in the guinea-pig in response to methacrylate derivatives used as experimental dentine primers.

METHODS

The dentine primers 2-HEMA, GM, MA and MMA were tested in a guinea-pig maximization test.

RESULTS

All the dentine primers tested produced positive delayed hypersensitivity reactions in the guinea-pig. MMA produced the most severe reaction.

CONCLUSION

It is concluded that in the clinical situation, clinicians and other members of the dental team should be aware of the need for careful handling of the dentine primers tested.

Occupational respiratory disease caused by acrylates

Acrylates are compounds used in a variety of industrial fields and their use is increasing. They have many features which make them superior to formerly used chemicals, regarding both their industrial use and their possible health effects. Contact sensitization is, however, one of their well known adverse health effects but they may also cause respiratory symptoms. We report on 18 cases of respiratory disease, mainly asthma, caused by different acrylates, 10 cases caused by cyanoacrylates, four by methacrylates and two cases by other acrylates.

The use and handling of acrylic bone cement in Danish orthopaedic departments

In order to evaluate the use and handling of acrylic bone cement, questionnaire were presented to all Danish orthopaedic departments in 1987 and again in 1992. Marked improvements in the environmental safety precautions for handling of bone cement had taken place during the 5-year period. In 1992, the intraoperative handling and use of bone cement is thus generally considered safe. Further improvements are still to be advocated in some departments. The exposure to methylmethacrylate monomer (MMA) vapour during the cementation procedures should be eliminated by local punctual field suction or change to a bone cement with a lower content of monomer (MMA/n-decylmethacrylate/isobornylmethylacrylate bone cement). Unnecessary manual contact with the cement should be avoided, and if contact is necessary, special protective gloves (butyl rubber gloves or 4H-gloves) should be used in addition to ordinary surgical gloves.

A statistical assessment of orthodontic practices, product usage, and the development of skin lesions

Recently there has been great interest in skin lesions on the hands of orthodontic personnel who are exposed to a wide variety of metals, bonding agents, and other materials. Thus this 1985 national survey of 448 Canadian orthodontists (response rate 49%) was undertaken to examine orthodontic practice activities, bonding agent and wire product use, and prevalence of skin lesions on the hands and their possible association with these products. About 13% of the 213 responding orthodontists and at least one other staff member in 18% of the orthodontic practices reported the occurrence of hand lesions (reactions) over the preceding 3 years typical of exposure to dental materials. In nearly one fourth of the offices, at least one person was affected. Regarding product use. Concise, Mono-Lok, and Endur bonding agents and stainless steel, Nitinol, and Elgiloy wires were used most often. The orthodontists reported frequent involvement in bonding activities and infrequent use of gloves. Of all the individual and combined materials and practice characteristics and activities tested singly and multivariately for statistical association with hand lesions, only the orthodontists' use of Mono-Lok, gloves, and the activity of frequently cleaning excess bonding agent were statistically related to the lesions. Multiple logistic regression suggested that the statistical effects of Mono-Lok use and removal of excess bonding agent were independent; thus removal of excess agent may have consequences for lesion development separate from Mono-Lok use.

Delayed contact hypersensitivity and surgical glove penetration with acrylic bone cements

Skin hypersensitivity was investigated in guinea-pig maximization tests with extracts from pellets of conventional polymethyl-methacrylate (PMMA) bone cements (Palacos R, Simplex RO) and a new methylmethacrylate/n-decylmethacrylate/isobornylmethacrylate (MMA/DMA/IBMA) mixture (Boneloc), but none of the three cements produced evidence of delayed contact hypersensitivity. Testings of the pure monomer compounds showed MMA to be an extreme sensitizer, whereas DMA and IBMA were only mild sensitizers. Fingers from three brands of surgical rubber gloves and a polystyrene-butadiene glove were immersed in water and filled with conventional MMA monomer, MMA/DMA/IBMA monomer or bone cements in the dough state, allowing cure inside the glove. In the surrounding water, no DMA or IBMA could be detected. The MMA concentrations were lower with MMA/DMA/IBMA monomer and curing Boneloc cement. The most resistant to conventional PMMA cement was one of the rubber gloves, whereas the polystyrene-butadiene glove allowed the highest penetration, and even dissolved in MMA monomer. The potential occupational hazard of skin sensitization is reduced with MMA/DMA/IBMA bone cement, preferably in combination with rubber gloves; but also polystyrene-butadiene gloves provide adequate protection.

Occupational risks of (meth)acrylate compounds in embedding media for electron microscopy

(Meth)acrylates are the main constituents of embedding media widely used in electron microscopy research for low-temperature embedding of biological tissue. (Meth)acrylates toxicology is still incompletely understood and therefore an estimation of health hazards involved in handling must be inaccurate. (Meth)acrylate monomers are known to be harmful to skin and other tissues and may sensitize workers. Since low-temperature electron microscopy techniques have gained popularity in research laboratories, it is important to establish safety rules for handling the (meth)acrylate-containing solutions. The aim of our report is to review briefly the toxicological properties and occupational hazards of the chemicals involved, summarize our own experiences with resins and protective devices in this respect, give guidelines for safe embedding and pass on these data to all interested researchers in order that workers are not discouraged from using (meth)acrylate embedding media, but know the risks and how to minimize them.

Contact dermatitis from acrylate and methacrylate compounds in Lowicryl embedding media for electron microscopy

This report is about occupational contact dermatitis found in 3 out of 6 workers of a chemistry laboratory using Lowicryl embedding media, which contain (meth)acrylate monomer mixtures of known composition. The notation (meth)acrylates is used to refer to both acrylates and methacrylates. (Meth)acrylate monomers will polymerize in the absence of oxygen when induced by metal ions, peroxides, heat or ultraviolet light. The monomers are of low viscosity and remain in the liquid state at temperatures far below 0 degree C. The volatile compounds, some of which exhibit a most pungent odour, have a tendency to penetrate all tissue and to permeate into the finest fissures, a property which makes them suitable as sealants, glues, embedding material, etc. This and their toxicity may represent a danger to the health of individuals who need to work with them, especially if no precautions are taken. We show with patch testing that one patient reacted strongly to the compound 2-hydroxyethyl acrylate at the dilutions tested (0.5 and 1% v/v), but not at all to 10 other (meth)acrylates. In the same test, 3 volunteer controls were negative to 2-hydroxyethyl acrylate. We demonstrate that at maximum working concentration, 2-hydroxyethyl acrylate penetrates both latex and vinyl gloves and elicits irritant/allergic reactions on the patient and irritant reactions on a control. Finally, we discuss the necessary protective measures.

Laser-induced damage to transparent polymers: chemical effect of short-pulsed (Q-switched) Nd:YAG laser radiation on ophthalmic acrylic biomaterials. I. A review

The use of short-pulsed lasers in ophthalmic surgery inspired and called for research on the damage inflicted by the laser radiation upon the acrylic polymers from which artificial intraocular lenses are made. The possible release of toxic monomers by laser-induced depolymerization is of great concern but past investigations of this phenomenon have been very limited. The present knowledge of various types of laser-induced damage to transparent polymers is reviewed with particular emphasis on the acrylic materials and intraocular lenses.

Percutaneous absorption of 3 organic solvents in the guinea pig (I). Effect of physical and chemical injuries to the skin

The influence of injuries on the percutaneous absorption of 3 organic solvents (butanol, toluene, 1,1,1-trichloroethane) was studied in the guinea pig. Acute (stripping, sandpaper abrasion, needle abrasion, delipidization) and subacute (irritant and allergic contact dermatitis) injuries were induced by physical or chemical treatment of the skin. Absorption of solvents was quantified by blood analysis. Induction of acute injuries markedly altered the absorption pattern of the solvents and correlated to their water solubility. Absorption of toluene and trichloroethane was reduced and that of butanol was increased compared to normal untreated skin. Subacute injuries had a less pronounced effect. Irritant and allergic contact dermatitis reduced the absorption of toluene and trichloroethane, and no effect was seen for butanol. For hydrophobic solvents, it is concluded that in acute injuries strata other than stratum corneum hold the barrier properties.

Contact allergy to colour developing agents in the guinea pig

Colour developing agents, derivatives of p-phenylenediamine, can cause contact allergy. Patch test reactions to more than one colour developer are sometimes seen in patients. To study whether this is due to simultaneous sensitization or cross-reactivity, guinea pig maximization tests (GPMT) with CD-2, CD-3 and CD-4 were carried out. 5 experiments were performed, using pet. or water as vehicles. When pet. was used, the challenge concentrations could be raised and cross-reactivity between the colour developers, but not with p-phenylenediamine-dihydrochloride, was revealed. When water was used as vehicle, the challenge concentrations were limited because of staining of the test sites and irritation. CD-2, CD-3 and CD-4 were found to be extreme sensitizers according to the classification by Magnusson and Kligman. The importance of using an appropriate vehicle to obtain optimal conditions for the GPMT is stressed. To study the purity and stability of the chemicals used, analysis by HPLC of the test substances at different stages of the GPMT procedure was performed. Aqueous solutions of the colour developers were found to be unstable, while pet. mixtures were stable.

Sensitization to patch test acrylates

Data on allergic contact dermatitis from acrylates and 4 patients sensitized during routine patch testing are reported. During 1982-1985, we used 7 different acrylates for tests. 1 patient out of 22 (= 4.5%) was sensitized to ethyl acrylate and butyl acrylate (1% pet.). Since September 1985, we have used a commercial (meth)acrylate series containing 28 substances. 3 of 24 patients tested became sensitized to ethyl acrylate, 2-hydroxyethyl acrylate and 2-hydroxypropyl acrylate (0.5% pet.). Because active sensitization with acrylates can be very harmful, it may be necessary to use lower concentrations than recommended. Currently, we test ethyl acrylate, 2-hydroxyethyl acrylate and 2-hydroxypropyl acrylate at 0.167% pet.

Experiences with Freund's complete adjuvant test (FCAT) when screening for contact allergens in colophony

A procedure, using Freund's complete adjuvant test (FCAT), for the determination of the allergenic potential of fractions and components in colophony of the gum rosin type is described and discussed. Gum rosin was shown to be a potent sensitizer in 11 test series (153 animals). FCAT is compared with the guinea pig maximization test (GPMT). Gum rosin was a potent sensitizer according to this method as well. The FCAT method was found to be advantageous over the GPMT method in that it is technically simpler to use and a smaller amount of test substance is needed. However, closed challenge was preferred to the prescribed open challenge. The importance of statistical evaluation of the results obtained in predictive testing is stressed.

Skin protection against methylmethacrylate

Ordinary surgical rubber gloves are penetrated by methylmethacrylate monomer (MMA) in less than 1 minute, as demonstrated by gas chromatographic measurements. A three-layered PVP glove, 0.07 mm thick--consisting of an outer layer of polyethylene, an intermediary layer of ethylene vinyl alcohol copolymer, and an inner layer of polyethylene--was impervious for 20 minutes, whereas a viton-butyl rubber glove, 0.27 mm thick, was impervious for 15 minutes. The PVP glove is recommended to orthopedic surgeons, nurses, and other handling acrylic bone cements to avoid sensitization, and is especially recommended to persons with known contact allergy to MMA.

Development and validation of an alternative dermal sensitization test: the mouse ear swelling test (MEST)

Traditional predictive tests for dermal sensitization in humans use the albino guinea pig as a model. A number of factors make the prospect of an alternative attractive. Guinea pig designs are labor intensive, require significant animal, caging, and husbandry resources, and are expensive. Extensive development and validation was conducted of an alternative using swelling of mouse ears as a quantitative end point. Ten strains of mice, ten age groups, both sexes, induction forms (number, route, timing), the use of an adjuvant, different vehicles and intervals to challenge, two induction sites, and three measurement intervals were evaluated. A methodology was developed for preparing induction sites to increase test sensitivity. A small battery of standard compounds was used to evaluate these design variables and a final test design was developed. The basic process was also demonstrated to occur in rats and guinea pigs and to be dose responsive. The final mouse ear swelling test (MEST) design was used to evaluate 72 materials representing a broad spectrum of chemicals and testing problems. These included 49 known positives and 23 known negatives. Guinea pig maximization test data on 37 of these resulting by studies conducted in our laboratories, along with closed patch guinea pig and human test data on many of these compounds, are also reported here for the first time. The MEST correctly identified 71 of 72 materials as potential human sensitizers or nonsensitizers. Additionally, both the efficacy of an occluded patch induction method and the duration of responsiveness of mice were evaluated. In the studies, the MEST was found to be an accurate, sensitive, and efficient alternative test design for evaluating delayed-contact sensitization.

Contact dermatitis to anaerobic sealants

High-performance polymerizable anaerobic sealants originated in 1953 and are used to lock metal parts together chemically. A case of hand contact dermatitis from Loctite RC/601, 242, and 504 is reported in a 60-year-old machine assembler. This diagnosis was documented by positive patch tests of the product and of three of the components: polyethylene glycol dimethacrylate, hydroxypropyl, and hydroxyethyl methacrylate. This is the third report of contact dermatitis caused by these sealants in the United States, is the second in the world on hydroxypropyl methacrylate, and is another example of the wide environmental use of potentially sensitizing acrylic resins.

Influence of the vehicle on elicitation of contact allergic reactions to acrylic compounds in the guinea pig

Many factors can influence the elicitation of hypersensitivity reactions in guinea pigs and humans. The effect which the vehicle might have on the test response in guinea pigs sensitized with various acrylic compounds, using the "guinea pig maximization test", has been investigated. A marked decrease in the number of positive animals was seen when acetone was used as test vehicle, compared to petrolatum. The same result was seen with alcohol as vehicle, when neopentyl glycol diacrylate (NPGDA) was used as an acrylic monomer model. The patch test locations on the guinea pig flank, also affected the test response. Half of the animals did not react when challenged near the abdomen, compared to a test site near the back. By means of HPLC-analysis, the possible adsorption of the acrylic monomer to the aluminium chamber or filter paper disc, was analysed. Our findings did not indicate that adsorption occurs. A decrease in the amount of acrylic monomer in the chamber with increasing time, was noted. There was a marked difference in the monomer residue between solutions with (darkness) and without (daylight) inhibitor. The monomer decrease was also more affected by an aluminium surface than a glass or filter paper surface. Aluminium oxide probably enhances the polymerization process. The discrepancy between the test results in this study, when petrolatum and acetone were used as test vehicles, is due to a polymerization process of the acrylic compounds. Thus, the petrolatum vehicle probably prevents polymerization of the acrylic monomer.

Induction of contact sensitivity to a broad variety of allergens with haptenized macrophages

Using guinea pigs an analysis could be made of various aspects of contact sensitivity (CS) induced by subcutaneous injection of syngeneic haptenized macrophages (oil-induced peritoneal exudate cells, PEC) as compared to epicutaneous sensitization. Very little PEC-bound hapten (dinitrochlorobenzene, or oxazolone) is needed for optimum sensitization. Nevertheless, both sensitization methods induce a state of CS that may last for over 6 months, give rise to hapten-specific antibodies with a similar isotype distribution, and show susceptibility to cyclophosphamide pretreatment. In addition, time courses and microscopic appearance of skin test reactions after either way of sensitization are identical. CS to a broad variety of physicochemically different antigens, including nickel, penicillin, and acrylates, is readily induced by syngeneic PEC, haptenized following a standardized procedure. As Freund's complete adjuvant is known to cause serious side effects like ulceration and long-lasting granuloma formation, immunization with haptenized PEC should now be considered as a clean and effective alternative in experimental CS studies.

Reactions in selected patients to 22 fragrance materials

182 patients on the basis of 6 criteria were suspected of suffering from contact sensitization to cosmetics. 77 (42%) gave a positive reaction to one or more of a series of 22 fragrance and flavor raw materials. The hands were most often involved. Cinnamic alcohol, hydroxycitronellal, eugenol, coumarin, and abitol gave the most common positive reactions; less frequent were cinnamic aldehyde, dihydrocoumarin and dimethylcitraconate. Their relevance could not be traced. However, the first 4 substances were the most frequently identified in 79 suspected cosmetics sent in for analysis by the patients or their physicians. The stability of room-stored petrolatum-fragrance mixtures should be checked.

Contact dermatitis to methyl methacrylate

2 cases of contact dermatitis to methyl methacrylate monomer are presented. The patients are nurses who mixed bone cement at orthopedic operations. During the procedure, they used 2 pairs of gloves (latex). Butyl rubber gloves are recommended for methyl methacrylate monomer to avoid sensitization and/or cumulative irritant contact dermatitis on the hands.

How sensitizing is chlorocresol? Allergy tests in guinea pigs versus the clinical experience

Chlorocresol is a biocide with widespread use in industry and pharmaceutical products. It is an occasional human contact sensitizer. The sensitizing potential of chlorocresol was judged strong using the guinea pig maximization test (GPMT) and doubtful in the less sensitive open epicutaneous test (OET). When different induction concentrations were used, the results indicated an optimal sensitizing concentration above which no further increase in the sensitization rate occurred. Rechallenge 2 weeks later showed a marked decrease in sensitivity. Consecutive human patch tests with chlorocresol 2% in pet. showed 11 reactions among 1462 patients tested, but none were explainable and reproducible during re-tests and provocative use tests, indicating that the GPMT overestimated the sensitization potential. The results from guinea pig allergy tests cannot stand alone but have to be validated by other sources of information.

The sensitizing potential of di-(meth)acrylates based on bisphenol A or epoxy resin in the guinea pig

Most composite materials in dentistry used today, contain resins based on dimethacrylates. BIS-GMA [2,2-bis-(4-(2-hydroxy-3-methacryloxypropoxy)phenyl)propane], the addition reaction product of bisphenol A and glycidyl methacrylate or an epoxy resin and methacrylic acid, is used most extensively. More recently, dimethacrylates based on bisphenol A, with various chain lengths have appeared on the market as a substitute for or in addition to BIS-GMA. Such compounds are BIS-MA [2,2-bis-(4-(methacryloxy)phenyl)propane], BIS-EMA [2,2-bis-(4-(2-methacryloxyethoxy)phenyl)propane] and BIS-PMA [2,2-bis-(4-(3-methacryloxypropoxy)phenyl)propane]. Increasing interest in the radiaton cure of coatings and printing inks have focused attention on these substances and on epoxy diacrylates as radiation-curable resins. The sensitizing capacity of the different acrylates based on bisphenol A or epoxy resin have been investigated with the guinea pig maximization test. The pattern of simultaneous reactivity of the compounds was also studied. Epoxy diacrylate [2,2-bis-(4-(2-hydroxy-3-acryloxy-propoxy)phenyl)propane], BIS-EMA and BIS-MA are shown to be strong sensitizers, while the linear fraction of BIS-GMA and its isomers and BIS-PMA have none or a low sensitizing capacity. The impurities in the BIS-GMA and BIS-MA batches seem to have high allergenic potential. These results stress the importance of a pure substance when discussing allergenicity and cross reactions.

Hand dermatitis in dental technicians

The incidence of hand dermatitis and contact allergies was analyzed among dental technicians. A survey was carried out by postal questionnaire. It was returned by 106 technicians (88%); 30 had had skin problems, and 20 (19%) had present eruptions. All 20 were invited to a detailed dermatological investigation, but only seven participated. Epicutaneous tests to prosthetic materials were negative in these patients. The hand eruptions in 4 patients appeared to be irritant. 4 other patients (4%), who had had previous hand dermatitis, had a history of positive patch test reactions to methyl methacrylate, but they had become symptomless and refused to participate in further studies.

Experimental sensitization of guinea pigs by drugs. Comparison of the maximization test with the wholly intradermal test

The capacity of tegobetain, pyrrolnitrin, tolcyclate and chlorquinaldol to induce delayed-type contact sensitization was studied in guinea pigs in 2 series of tests using the method of Magnusson & Kligman and the authors' modification of the wholly intradermal Draize technique. Histological examination of skin biopsies obtained from the test area demonstrated that tegobetain, pyrrolnitrin and tolcyclate are potential sensitizers.

The sensitizing potential of 2-ethylhexyl acrylate in the guinea pig

The sensitizing potential of 2-ethylhexyl acrylate in the guinea pig could be demonstrated by Freund's Complete Adjuvant Test. This acrylate ester is a common constituent of adhesive tape. Allergic reactions to several brands of adhesive tape were not observed in 2-ethylhexyl acrylate sensitized animals. Cross reactions with other acrylic monomers were observed.