The outcome of 9 years of consecutive patch testing with 4,4′-diaminodiphenylmethane and 4,4′-diphenylmethane diisocyanate

Isocyanates may contribute to allergic contact dermatitis from diabetes devices and wound dressings

BACKGROUND

Isocyanates are well-known occupational allergens, but can also be present in medical devices.

OBJECTIVES

To highlight that contact sensitization to isocyanates might contribute to allergic contact dermatitis (ACD) from polyurethane (PU)-containing diabetes devices and wound dressings.

PATIENTS AND METHODS

Nineteen patients with suspected allergic contact dermatitis (ACD) from diabetes devices and/or wound dressings were patch tested to an isocyanate series. Four wound dressings, 6 diabetes devices and 4 monomeric isocyanate patch test preparations were analysed with gas chromatography - mass spectrometry (GC/MS).

RESULTS

Eight patients reacted to isocyanates and corresponding amines: 3 to isophorone diisocyanate (IPDI), 4 to 4,4'-diaminodiphenylmethane (MDA), 4 to 2,4-toluene diisocyanate (TDI) and 1 to polymeric methylene diphenyl diisocyanate (PMDI). Three of 4 wound dressings contained isocyanates (MDI, TDI and/or IPDI), whereas 5 of 6 diabetes devices contained 4,4'-methylene diphenyl diisocyanate (MDI), and one of them also IPDI. None of the medical devices contained 1,6-hexamethylene diisocyanate (HDI). Contrary to IPDI, and especially MDI, only the concentration of the TDI patch test preparation corresponded approximately (80%) to its label.

CONCLUSION

Patch tests with isocyanates may be worth-while in patients with suspected ACD from PU-containing medical devices. Besides MDA, and PMDI, also TDI might potentially be a marker for MDI-sensitization. This article is protected by copyright. All rights reserved.

Sensitizing Capacities and Cross-Reactivity Patterns of Some Diisocyanates and Amines Using the Guinea-Pig Maximization Test. Can p-phenylenediamine be Used as a Marker for Diisocyanate Contact Allergy?

Background:

Isocyanates are mainly considered respiratory allergens but can also cause contact allergy. Diphenylmethane-4,4′-diamine (4,4′-MDA) has been considered a marker for diphenylmethane-4,4′-diisocyanate (4,4′-MDI) contact allergy. Furthermore, overrepresentation of positive patch-test reactions top-phenylenediamine (PPD) in 4,4′-MDA positive patients have been reported.

Objectives:

To investigate the sensitizing capacities of toluene-2,4-diisocyanate (2,4-TDI) and PPD and the cross-reactivity of 4,4′-MDA, 2,4-TDI, dicyclohexylmethane-4,4′-diamine (4,4′-DMDA), dicyclohexylmethane-4,4′-diisocyanate (4,4′-DMDI), 4,4′-MDI and PPD.

Methods:

The Guinea Pig Maximization Test (GPMT) was used.

Results:

PPD was shown to be a strong sensitizer (p<0.001). Animals sensitized to PPD showed cross-reactivity to 4,4′-MDA (p<0.001). Animals sensitized to 4,4′-MDA did not show cross-reactivity to PPD. 8 animals sensitized to 2,4-TDI were sacrificed due to toxic reactions at the induction site and could thus not be fully evaluated.

Conclusion:

PPD was shown to be a strong sensitizer. However, it cannot be used as a marker for isocyanate contact allergy. On the other hand, positive reactions to 4,4′-MDA could indicate a PPD allergy. The intradermal induction concentration of 2,4-TDI (0.70% w/v) can induce strong local toxic reactions in guinea-pigs and should be lowered.

Sensitization and cross-reactivity patterns of contact allergy to diisocyanates and corresponding amines: investigation of diphenylmethane-4,4'-diisocyanate, diphenylmethane-4,4'-diamine, dicyclohexylmethane-4,4'-diisocyanate, and dicylohexylmethane-4,4'-diamine

Background

Isocyanates are used in polyurethane production. Dermal exposure to isocyanates can induce contact allergy. The most common isocyanate is diphenylmethane diisocyanate used for industrial purposes. The isomer diphenylmethane‐4,4′‐diisocyanate (4,4′‐MDI) is used in patch testing. Diphenylmethane‐4,4′‐diamine (4,4′‐MDA) is its corresponding amine. Concurrent reactions to 4,4′‐MDI and 4,4′‐MDA have been reported, as have concurrent reactions to 4,4′‐MDI and dicyclohexylmethane‐4,4′‐diisocyanate (4,4′‐DMDI).

Objectives

To investigate the sensitization capacities and the cross‐reactivity of 4,4′‐MDI, 4,4′‐MDA, 4,4′‐DMDI, and dicyclohexylmethane‐4,4′‐diamine (4,4′‐DMDA).

Methods

The guinea‐pig maximization test (GPMT) was used.

Results

The GPMT showed sensitizing capacities for all investigated substances: 4,4′‐MDI, 4,4′‐MDA, 4,4′‐DMDI, and 4,4′‐DMDA (all p < 0.001). 4,4′‐MDI‐sensitized animals showed cross‐reactivity to 4,4′‐MDA (p < 0.001) and 4,4′‐DMDI (all p < 0.05). 4,4′‐MDA‐sensitized animals showed cross‐reactivity to 4,4′‐DMDA (p = 0.008).

Conclusion

All of the investigated substances were shown to be strong sensitizers. Animals sensitized to 4,4′‐MDI showed cross‐reactivity to 4,4′‐MDA and 4,4′‐DMDI, supporting previous findings in the literature. The aromatic amine 4,4′‐MDA showed cross‐reactivity to the aliphatic amine 4,4′‐DMDA.

Diaminodiphenylmethane Sensitization in north-eastern Italy from 1996 to 2012

BACKGROUND

4,4'-Diaminodiphenylmethane (DDM) is an aromatic amine used as a hardener, insulator and anticorrosive. Exposure implies risk of being sensitized and developing contact dermatitis.

OBJECTIVE

The aim of this study was to determine the occurrence of contact sensitization to DDM among patients with contact dermatitis and the role of occupational exposure.

PATIENTS AND METHODS

From 1996 to 2012, 24 056 consecutive patients with suspected allergic contact dermatitis were patch tested in north-eastern Italy. Individual characteristics were collected through a standardized questionnaire in eight departments of dermatology and occupational medicine.

RESULTS

The overall prevalence of DDM sensitization was 2.5% (n = 599) with a decreasing trend in considered years. Trieste area had the higher prevalence of sensitization (3.2%). Mechanics and chemical industry workers had a significant higher risk of being sensitized to DDM.

CONCLUSION

DDM sensitization is decreasing in years and is associated with some occupational exposures.