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Horváth HR, Szilágyi D, Andrási N, Balla Z, Visy B, Farkas H. Hypersensitivity reactions amongst Hungarian Patients with Hereditary Angioedema due to C1-Inhibitor Deficiency. World Allergy Organ J 2023; 16:100833. [PMID: 37920275 PMCID: PMC10618765 DOI: 10.1016/j.waojou.2023.100833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 10/03/2023] [Accepted: 10/08/2023] [Indexed: 11/04/2023] Open
Abstract
Background In hereditary angioedema (HAE) due to C1-inhibitor deficiency (C1-INH-HAE), bradykinin-mediated submucosal and/or subcutaneous angioedema dominates the clinical picture. The deficiency of C1-inhibitor can lead to the over-activation of the complement system. Complement plays an important role in all types of hypersensitivity reactions. On the other hand, during the degranulation of mast cells, heparin is also released amongst other substances. Heparin can activate the plasma kinin-kallikrein system, leading to bradykinin generation. These observations suggest a possible connection between C1-INH-HAE and mast cell-mediated hypersensitivity reactions. Objective To assess the occurrence of hypersensitivity reactions in the Hungarian C1-INH-HAE population. Methods Patients filled out a questionnaire of 112 questions, either online or on paper. The questions were about hypersensitivity and C1-INH-HAE symptoms, the relation between these 2, general health, and demographic data. The study protocol was approved by the institutional review board of Semmelweis University, Budapest, and informed consent was obtained from the participants. Results One hundred and six patients (64 female, 42 male, median age 46 years) responded, with 63.2% having hypersensitivity. Hypersensitivity was provoked by pollen in 25.5% of patients, by contact sensitivity in 22.6%, by food in 21.7%, by insect sting in 19.8%, by pet in 15.1%, by drug in 14.2%, by dust mite in 5.7%, and by mold in 1.9%. In 11 patients, hypersensitivity symptoms appeared after the diagnosis of C1-INH-HAE. Six hypersensitive patients experienced improvement in their symptoms; 42 remained the same, but none experienced worsening after the diagnosis of C1-INH-HAE. In 7.8% of the hypersensitive patients, a C1-INH-HAE attack worsened the hypersensitivity symptoms, while 15.7% of the hypersensitive patients experienced a C1-INH-HAE attack provoked by contact with the provoking factor. Conclusion While 63.2% of our C1-INH-HAE patients have reported hypersensitivity symptoms, Eurostat's latest data puts the prevalence of self-reported allergies in Hungary at 19.3%. Since in our experience most Hungarian patients report hypersensitivity reactions as allergies, this may support a possible connection between the 2 diseases, but further molecular studies are needed.
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Affiliation(s)
- Hanga Réka Horváth
- Hungarian Angioedema Center of Reference and Excellence, Department of Internal Medicine and Haematology, Semmelweis University, Budapest, Hungary
- Doctoral School, Semmelweis University, Budapest, Hungary
| | - Dávid Szilágyi
- Hungarian Angioedema Center of Reference and Excellence, Department of Internal Medicine and Haematology, Semmelweis University, Budapest, Hungary
| | - Noémi Andrási
- Hungarian Angioedema Center of Reference and Excellence, Department of Internal Medicine and Haematology, Semmelweis University, Budapest, Hungary
- Doctoral School, Semmelweis University, Budapest, Hungary
- Pediatric Center, Tűzoltó Street Department, Semmelweis University, Budapest, Hungary
| | - Zsuzsanna Balla
- Hungarian Angioedema Center of Reference and Excellence, Department of Internal Medicine and Haematology, Semmelweis University, Budapest, Hungary
- HNO-Praxis Schaffhausen, Schaffhausen, Switzerland
| | - Beáta Visy
- Hungarian Angioedema Center of Reference and Excellence, Department of Internal Medicine and Haematology, Semmelweis University, Budapest, Hungary
- Heim Pál National Institute of Pediatrics, Budapest, Hungary
| | - Henriette Farkas
- Hungarian Angioedema Center of Reference and Excellence, Department of Internal Medicine and Haematology, Semmelweis University, Budapest, Hungary
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Németh D, Temesvári E, Holló P, Pónyai G. Preservative Contact Hypersensitivity among Adult Atopic Dermatitis Patients. Life (Basel) 2022; 12:life12050715. [PMID: 35629382 PMCID: PMC9147108 DOI: 10.3390/life12050715] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 04/28/2022] [Accepted: 05/05/2022] [Indexed: 01/19/2023] Open
Abstract
Atopic dermatitis (AD) is a chronic inflammatory disease characterised by an impaired skin barrier. The prolonged use of topical preparations containing medications, emollients, fragrances and preservatives may increase the risk of contact hypersensitivity (CHS). In the Allergy Outpatient Unit of the Department of Dermatology, Venereology and Dermatooncology of Semmelweis University, 5790 adult patients were patch tested between 2007–2021 with the European Environmental Baseline Series according to international standards. Among all the tested adult patients, 723 had preservative CHS (PCHS) and 639 had AD. Among the 723 PCHS patients, 68 (9.4%) had AD; the female to male ratio was 3:1 in this group. Out of 639 AD patients, 68 had PCHS (10.6%). In the AD-PCHS group, 83.8% had CHS to methylisothiazolinone (MI) (tested from 2014), 36.8% to Kathon CG®, 16.2% to methyldibromo-glutaronitrile, 11.8% to paraben, 7.4% to formaldehyde, 4.4% to para-tert-butylphenol-formaldehyde resin and 1.5% to Quaternium-15. The most common concomitant PCHS combination was Kathon CG® + MI. Most patients (32.4%) belonged to the age group of 21–30, and skin symptoms affected mostly the limbs and face. The most common other concomitant allergens were nickel, lanolin alcohol and balsam of Peru. Preservatives (especially MI and Kathon CG®) are important contact allergens in adult AD, mostly among young women. The rate of AD in the PCHS group and the rate of PCHS in the AD group is remarkable; thus, the role of PCHS should be highlighted in the topical therapy and in the prevention of possible AD exacerbations.
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Affiliation(s)
- Dominik Németh
- Department of Dermatology, Venereology and Dermatooncology, Semmelweis University, 41 Mária Street, 1085 Budapest, Hungary; (E.T.); (P.H.); (G.P.)
- Károly Rácz Doctoral School of Clinical Medicine, Semmelweis University, 26 Üllői Street, 1085 Budapest, Hungary
- Correspondence: ; Tel.: +36-20-476311; Fax: +36-1267-6974
| | - Erzsébet Temesvári
- Department of Dermatology, Venereology and Dermatooncology, Semmelweis University, 41 Mária Street, 1085 Budapest, Hungary; (E.T.); (P.H.); (G.P.)
| | - Péter Holló
- Department of Dermatology, Venereology and Dermatooncology, Semmelweis University, 41 Mária Street, 1085 Budapest, Hungary; (E.T.); (P.H.); (G.P.)
| | - Györgyi Pónyai
- Department of Dermatology, Venereology and Dermatooncology, Semmelweis University, 41 Mária Street, 1085 Budapest, Hungary; (E.T.); (P.H.); (G.P.)
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Burnett CL, Bergfeld WF, Belsito DV, Klaassen CD, Liebler DC, Marks JG, Peterson LA, Shank RC, Slaga TJ, Snyder PW, Heldreth B. Amended Safety Assessment of Methylchloroisothiazolinone and Methylisothiazolinone as Used in Cosmetics. Int J Toxicol 2021; 40:20S-33S. [PMID: 34259066 DOI: 10.1177/10915818211016382] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The Expert Panel for Cosmetic Ingredient Safety (Panel) reassessed the safety of the mixture Methylchloroisothiazolinone (MCI)/Methylisothiazolinone (MI), which functions as a preservative in cosmetic products. The Panel reviewed relevant animal and human data provided in this safety assessment, and data from the previously published safety assessment of this mixture, and concluded that MCI/MI is safe in cosmetics when formulated to be nonsensitizing, based on the results of a quantitative risk assessment or similar methodology; however, at no point should concentrations exceed 7.5 ppm in leave-on products or 15 ppm in rinse-off products.
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Affiliation(s)
| | | | | | | | | | - James G Marks
- Expert Panel for Cosmetic Ingredient Safety Former Member
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High rate of sensitization to Kathon CG, detected by patch tests in patients with suspected allergic contact dermatitis. An Bras Dermatol 2020; 95:194-199. [PMID: 32156503 PMCID: PMC7175102 DOI: 10.1016/j.abd.2019.09.026] [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: 11/01/2018] [Accepted: 09/01/2019] [Indexed: 12/02/2022] Open
Abstract
Background Kathon CG, a combination of methylchloroisothiazolinone and methylisothiazolinone, is widely used as preservative in cosmetics, as well in household cleaning products, industrial products such as paints and glues. It has emerged as an important sensitizing agent in allergic contact dermatitis. Objectives This study evaluated the reactivity to this substance in patients subjected to patch tests at the Dermatology Institute in Bauru, São Paulo from 2015 to 2017 and its correlation with other preservatives, the professional activity and location of the lesions. Methods The patients were submitted to standard series of epicutaneous tests, standardized by the Brazilian Group Studies on Contact Dermatitis. Results Out the 267 patients tested, 192 presented positivity to at least one substance and 29 of the patients (15.10%) presented reaction to Kathon CG, with predominance of the female gender (n = 27); main professional activity associated with Kathon CG sensibilization was cleaning (17.24%), followed by aesthetic areas (13.79%) and health care (10.34%). The most prevalent sensitizations among the substances tested were nickel sulphate (56.3%), followed by cobalt chloride (23.4%), neomycin (18.2%), potassium dichromate (17.7%), thimerosal (14.5%), formaldehyde (13.2%), paraphenylenediamine (9.3%), and fragrance mix (8.3%). Study limitations We do not have data from patients that were submitted to patch test a decade ago in order to confront to current data and establish whether or no sensitization to Kathon CG has increased. Conclusion High positivity to Kathon CG corroborates the recent findings in the literature, suggesting more attention to concentration of this substance, used in cosmetics and products for domestic use.
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Pónyai G, Németh I, Nagy G, Fábos B, Irinyi B, Dinnyés M, Altmayer A, Temesvári E. Methylchloroisothiazolinone/methylisothiazolinone and methylisothiazolinone hypersensitivity in 1122 patients: A national multicenter study organized by the Hungarian Contact Dermatitis Group. Contact Dermatitis 2019; 81:467-469. [PMID: 31373004 DOI: 10.1111/cod.13370] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 07/24/2019] [Accepted: 07/30/2019] [Indexed: 02/03/2023]
Affiliation(s)
- Györgyi Pónyai
- Department of Dermatology, Venerology and Dermato-Oncology, Semmelweis University, Budapest, Hungary
| | - Ilona Németh
- Department of Dermatology, Venerology and Dermato-Oncology, Semmelweis University, Budapest, Hungary
| | - Gabriella Nagy
- Department of Dermatology, Central Hospital of Borsod-Abaúj-Zemplén County, Miskolc, Hungary
| | - Beáta Fábos
- Department of Dermatology, Kaposi Mór Teaching Hospital, Kaposvár, Hungary
| | - Beatrix Irinyi
- Dermatology Clinic, University of Debrecen - Medical Center, Debrecen, Hungary
| | - Mária Dinnyés
- Dermatology Outpatient Unit of Szt. László and Szt, István Hospital, Budapest, Hungary
| | - Anita Altmayer
- Department of Dermatology and Allergology of the Szent-Györgyi Albert Health Center, University of Szeged, Szeged, Hungary
| | - Erzsébet Temesvári
- Department of Dermatology, Venerology and Dermato-Oncology, Semmelweis University, Budapest, Hungary
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PANICO A, SERIO F, BAGORDO F, GRASSI T, IDOLO A, DE GIORGI M, GUIDO M, CONGEDO M, DE DONNO A. Skin safety and health prevention: an overview of chemicals in cosmetic products. JOURNAL OF PREVENTIVE MEDICINE AND HYGIENE 2019; 60:E50-E57. [PMID: 31041411 PMCID: PMC6477564 DOI: 10.15167/2421-4248/jpmh2019.60.1.1080] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 01/14/2019] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Cosmetic products contain a wide range of chemicals to which we are exposed every day. The aim of the study was to determine the presence of potential dangerous substances which can cause adverse health effects by examining product labels. MATERIALS AND METHODS A total of 283 products were collected from various shops in Lecce (Italy) and divided into 3 categories: rinse-off, leave-on and make-up. The label of every product was examined and a list including fragrances, preservatives and other chemicals of concern was created. RESULTS Fragrances were present in 52.3% of the examined products, mostly limonene (76.9%) and linalool (64.6%) but also citronellol (34.1%), geraniol (31.5%), coumarin (30%) and hexyl cinnamal (29.2%). Preservatives showed a rate of 60% and the most frequently identified were phenoxyethanol (48.7%), sodium benzoate (35.6%), potassium sorbate (22%), methylparaben (15.2%) and MI/MCI (9.9%). The other chemicals of concern were detected in 58% of products; included PEGs (62.3%), acrylate copolymer (34%), petrolatum (17.2%), polysorbates (14,8%), BHT (14.7%), ethylhextyl methoxycinnamate (13.6%), benzophenone-1 (3.7%), benzophenone-3 (4.9%), BHA (1.6%), cocamide DEA and toluene (1.2%). CONCLUSIONS The use of many of these substances is allowed within certain limits, due to their toxicity at higher concentrations. Other important aspects should be considered as, for instance, the possibility of long-term effects. On the other hand, other substances may induce several acute adverse side-effects, i.e. contact dermatitis and allergic reactions. For these reasons, an enhancement of the criteria used for cosmetics formulation is required since many chemicals used singularly or combined are potentially unsafe.
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Affiliation(s)
- A. PANICO
- Department of Biological and Environmental Science and Technology, University of Salento, Lecce, Italy
| | - F. SERIO
- Department of Biological and Environmental Science and Technology, University of Salento, Lecce, Italy
| | - F. BAGORDO
- Department of Biological and Environmental Science and Technology, University of Salento, Lecce, Italy
| | - T. GRASSI
- Department of Biological and Environmental Science and Technology, University of Salento, Lecce, Italy
| | - A. IDOLO
- Department of Biological and Environmental Science and Technology, University of Salento, Lecce, Italy
| | - M. DE GIORGI
- Department of Biological and Environmental Science and Technology, University of Salento, Lecce, Italy
| | - M. GUIDO
- Department of Biological and Environmental Science and Technology, University of Salento, Lecce, Italy
- Interuniversity Research Centre on Influenza and other transmitted infections (CIRI-IT), Genoa, Italy
| | - M. CONGEDO
- Operating Unit of Dermatology, Vito Fazzi Hospital, Lecce, Italy
| | - A. DE DONNO
- Department of Biological and Environmental Science and Technology, University of Salento, Lecce, Italy
- Interuniversity Research Centre on Influenza and other transmitted infections (CIRI-IT), Genoa, Italy
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Abstract
BACKGROUND Contact hypersensitivity is common in adolescents, but data in the literature are limited. Adolescents often use cosmetics, wear jewelry, and obtain tattoos, which can be sources of allergens. METHODS This was a retrospective, noninterventional cohort study of 100 adolescents (aged 13-18; 74 girls, 26 boys) who were consecutively patch tested. RESULTS We detected contact hypersensitivity in 51 of the 100 patch-tested patients (51%): 52.7% of the girls and 46.2% of the boys were sensitized. The most common allergens were nickel (17%), thimerosal (12%), para-phenylenediamine (8%), cobalt (7%), and fragrance mix I (6%). Thirteen percent of the reactions did not appear until the seventh day. The majority of clinical lesions affected the hands and face. The most common contact allergens were mercury derivatives, lanolin, and para-phenylenediamine in boys and nickel, thimerosal, para-phenylenediamine, cobalt, and fragrance mix I in girls. Of the 47 adolescents with atopic dermatitis 51.1% had contact hypersensitivity. In this group, skin care product ingredients were the typical allergens (25.5%). The most common contact allergens of those with atopic dermatitis were nickel (12.8%), lanolin (10.6%), and thimerosal (8.5%). CONCLUSION Contact hypersensitivity is common in adolescents. For patients with therapy-resistant skin lesions affecting the face and hands, patch testing with an evaluation for 7 days is recommended. Our results provide the first data on frequency of contact hypersensitivity in this age group in Hungary. Metals, fragrances, mercuric derivatives, dyeing materials, and skin care products were the most common allergens.
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Affiliation(s)
| | - Erzsébet Temesvári
- Department of Dermatology, Venerology and Dermato-oncology, Semmelweis University, Budapest, Hungary
| | - Ilona Németh
- Department of Dermatology, Venerology and Dermato-oncology, Semmelweis University, Budapest, Hungary
| | - Miklós Sárdy
- Department of Dermatology, Venerology and Dermato-oncology, Semmelweis University, Budapest, Hungary
| | - Györgyi Pónyai
- Department of Dermatology, Venerology and Dermato-oncology, Semmelweis University, Budapest, Hungary
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Uter W, Werfel T, White IR, Johansen JD. Contact Allergy: A Review of Current Problems from a Clinical Perspective. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15061108. [PMID: 29844295 PMCID: PMC6025382 DOI: 10.3390/ijerph15061108] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 05/20/2018] [Accepted: 05/26/2018] [Indexed: 12/17/2022]
Abstract
Contact allergy is common, affecting 27% of the general population in Europe. Original publications, including case reports, published since 2016 (inclusive) were identified with the aim of collating a full review of current problems in the field. To this end, a literature search employing methods of systematic reviewing was performed in the Medline® and Web of Science™ databases on 28 January 2018, using the search terms (“contact sensitization” or “contact allergy”). Of 446 non-duplicate publications identified by above search, 147 were excluded based on scrutiny of title, abstract and key words. Of the remaining 299 examined in full text, 291 were deemed appropriate for inclusion, and main findings were summarised in topic sections. In conclusion, diverse sources of exposures to chemicals of widely-differing types and structures, continue to induce sensitisation in man and may result in allergic contact dermatitis. Many of the chemicals are “evergreen” but others are “newcomers”. Vigilance and proper investigation (patch testing) are required to detect and inform of the presence of these haptens to which our populations remain exposed.
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Affiliation(s)
- Wolfgang Uter
- Department of Medical Informatics, Biometry and Epidemiology, University of Erlangen/Nürnberg, 91054 Erlangen, Germany.
| | - Thomas Werfel
- Division of Immunodermatology and Allergy Research, Department of Dermatology and Allergy, Hannover Medical School, 30625 Hannover, Germany.
| | - Ian R White
- St John's Institute of Dermatology, Guy's Hospital, London SE1 9RT, UK.
| | - Jeanne D Johansen
- Department of Dermatology and Allergy, National Allergy Research Centre, Copenhagen University Hospital Herlev and Gentofte, 2900 Hellerup, Denmark.
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Diczig B, Németh I, Sárdy M, Pónyai G. Contact hypersensitivity in rosacea - a report on 143 cases. J Eur Acad Dermatol Venereol 2018. [DOI: 10.1111/jdv.14922] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- B. Diczig
- Department of Dermatology, Venereology and Dermatooncology; Semmelweis University; Budapest Hungary
| | - I. Németh
- Department of Dermatology, Venereology and Dermatooncology; Semmelweis University; Budapest Hungary
| | - M. Sárdy
- Department of Dermatology, Venereology and Dermatooncology; Semmelweis University; Budapest Hungary
| | - G. Pónyai
- Department of Dermatology, Venereology and Dermatooncology; Semmelweis University; Budapest Hungary
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