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Mowitz M, Hosseini S, Siemund I, Ulriksdotter J, Svedman C. New device, 'old' allergens. Allergic contact dermatitis caused by the Dexcom G7 glucose sensor. Contact Dermatitis 2024; 90:495-500. [PMID: 38316128 DOI: 10.1111/cod.14514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 01/12/2024] [Accepted: 01/22/2024] [Indexed: 02/07/2024]
Abstract
BACKGROUND Allergic contact dermatitis (ACD) has been reported as an adverse effect from the use of several glucose sensors and insulin pumps from different manufacturers. Isobornyl acrylate (IBOA) has been identified as a major culprit sensitizer, but also other acrylates and (modified) colophonium have been reported as causes of ACD. OBJECTIVES To report the two first cases diagnosed with ACD caused by the Dexcom G7 (DG7) glucose sensor. PATIENTS AND METHODS Two children with suspected ACD from DG7 were patch tested with our medical device series with an addition of selected test preparations including two variants of modified colophonium - methyl hydrogenated rosinate (MHR) and glyceryl hydrogenated rosinate (GHR). Both patients were also tested with acetone extracts made from different parts of the DG7 sensor. The extracts were analysed by gas chromatography-mass spectrometry (GC-MS). RESULTS Both patients tested positive to IBOA, hydroabietyl alcohol and GHR. In addition, patient 1 had a positive reaction to MHR and patient 2 had a positive reaction to colophonium. The GC-MS analyses showed the presence of IBOA and colophonium-related substances in the DG7 extracts. CONCLUSIONS Both patients were diagnosed with contact allergy to well-known medical device-related sensitizers. The presence of IBOA and (modified) colophonium in a newly introduced (on the Swedish market in 2023) glucose sensor is remarkable and indicates an inadequate toxicological assessment of the materials used in the sensor.
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Affiliation(s)
- Martin Mowitz
- Department of Occupational and Environmental Dermatology, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Sarah Hosseini
- Department of Occupational and Environmental Dermatology, Lund University, Skåne University Hospital, Malmö, Sweden
- Department of Dermatology and Venereology, Ryhov County Hospital, Jönköping, Sweden
| | - Ingrid Siemund
- Department of Occupational and Environmental Dermatology, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Josefin Ulriksdotter
- Department of Occupational and Environmental Dermatology, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Cecilia Svedman
- Department of Occupational and Environmental Dermatology, Lund University, Skåne University Hospital, Malmö, Sweden
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Siemund I, Dahlin J, Mowitz M, Hamnerius N, Svedman C. Allergic contact dermatitis due to 1,6-hexanediol diacrylate in ostomy patients. Contact Dermatitis 2024; 90:501-506. [PMID: 38332444 DOI: 10.1111/cod.14516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 12/13/2023] [Accepted: 01/26/2024] [Indexed: 02/10/2024]
Abstract
BACKGROUND Many people live with ostomies after life-saving surgery. Ostomy patients often suffer from peristomal dermatitis. Allergic contact dermatitis (ACD) has been reported, mostly due to contact allergy (CA) to topical agents. OBJECTIVES We present three patients with therapy resistant peristomal dermatitis, suggesting ACD caused by different stoma products. METHODS Patch testing was performed with baseline series, additional series, and selected allergens. They were also tested with their own ostomy products as is and separate extracts of the products. Extracts were analysed using Gas Chromatography-Mass Spectrometry (GC-MS). RESULTS In all three patients we diagnosed CA to 1,6-hexanediol diacrylate (HDDA), +++ in case (C) 1 and 3, ++ in C 2. HDDA was detected in C 2's ostomy pouch adhesive and in C 1's and 3's flange extenders used to improve the adhesion of the ostomy pouches. CONCLUSION Therapy resistant peristomal dermatitis should always be suspected of ACD and patch testing, especially with the patient's own products, should be performed.
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Affiliation(s)
- Ingrid Siemund
- Department of Occupational and Environmental Dermatology, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Jakob Dahlin
- Department of Occupational and Environmental Dermatology, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Martin Mowitz
- Department of Occupational and Environmental Dermatology, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Nils Hamnerius
- Department of Occupational and Environmental Dermatology, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Cecilia Svedman
- Department of Occupational and Environmental Dermatology, Lund University, Skåne University Hospital, Malmö, Sweden
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Comstedt LR, Siemund I, Dahlin J, Bruze M, Svedman C. Effects of aluminium chloride added to common patch test substances. Contact Dermatitis 2023; 88:456-462. [PMID: 36840428 DOI: 10.1111/cod.14299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 02/09/2023] [Accepted: 02/13/2023] [Indexed: 02/26/2023]
Abstract
BACKGROUND A modulating effect of aluminium regarding type IV reactions might exist but has not been further investigated. OBJECTIVES The aim of this study was to investigate the effect on patch test reactions when adding aluminium chloride hexahydrate (Al-Cl) to common test preparations. MATERIALS AND METHODS Al-Cl in different concentrations was added to nickel sulphate 15.0% aqua (Ni), methylisothiazolinone 0.2% aqua (MI) and fragrance mix I 10.0% aqua/ethanol (FM I). The Ni preparations were tested in 120 consecutive patients. MI and FM I were tested in participants known to have contact allergy to the respective allergen. McNemar's test was used to decide which Ni preparation had the highest sensitivity. Wilcoxon signed-rank test was used to calculate pairwise comparison in summarized test score for the preparations with MI and FM I. RESULTS Adding Al-Cl 20.0%/30.0% to Ni identified twice as many patients with contact allergy to nickel compared to Ni without Al-Cl. Adding Al-Cl 20.0%/10.0% to MI, decreased the patch test reactivity compared to MI without Al-Cl. No differences in patch reactivity were noticed when adding Al-Cl to FM I. CONCLUSION Al-Cl 20.0% or 30.0% seems to enhance the patch test reactivity to Ni 15.0% aqua.
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Affiliation(s)
- Lisbeth Rosholm Comstedt
- Department of Occupational and Environmental Dermatology, Skåne University Hospital, Lund University, Malmö, Sweden
| | - Ingrid Siemund
- Department of Occupational and Environmental Dermatology, Skåne University Hospital, Lund University, Malmö, Sweden
| | - Jakob Dahlin
- Department of Occupational and Environmental Dermatology, Skåne University Hospital, Lund University, Malmö, Sweden
| | - Magnus Bruze
- Department of Occupational and Environmental Dermatology, Skåne University Hospital, Lund University, Malmö, Sweden
| | - Cecilia Svedman
- Department of Occupational and Environmental Dermatology, Skåne University Hospital, Lund University, Malmö, Sweden
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Siemund I, Dahlin J. Occupational allergic contact dermatitis to dibutyl maleate and dibutyl fumarate present in a safety shoe: A reason for concern? Contact Dermatitis 2021; 85:582-584. [PMID: 34028835 DOI: 10.1111/cod.13907] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 05/18/2021] [Accepted: 05/19/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Ingrid Siemund
- Department of Occupational and Environmental Dermatology, Lund University, Skåne University Hospital, Malmö, Sweden.,Department of Dermatology and Venerology, Skåne University Hospital, Lund University, Lund, Sweden
| | - Jakob Dahlin
- Department of Occupational and Environmental Dermatology, Lund University, Skåne University Hospital, Malmö, Sweden
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Bruze M, Mowitz M, Netterlid E, Siemund I, Svedman C. Patch testing with aluminum chloride hexahydrate in petrolatum. Contact Dermatitis 2020; 83:176-177. [DOI: 10.1111/cod.13571] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 04/22/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Magnus Bruze
- Department of Occupational and Environmental DermatologyLund University, Skåne University Hospital Mamö Sweden
| | - Martin Mowitz
- Department of Occupational and Environmental DermatologyLund University, Skåne University Hospital Mamö Sweden
| | - Eva Netterlid
- Department of Occupational and Environmental DermatologyLund University, Skåne University Hospital Mamö Sweden
| | - Ingrid Siemund
- Department of Occupational and Environmental DermatologyLund University, Skåne University Hospital Mamö Sweden
| | - Cecilia Svedman
- Department of Occupational and Environmental DermatologyLund University, Skåne University Hospital Mamö Sweden
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Dizdarevic A, Troensegaard W, Uldahl A, Bergendorff O, Siemund I, Svensson Å, Sonesson A. Intervention study to evaluate the importance of information given to patients with contact allergy: a randomized, investigator-blinded clinical trial. Br J Dermatol 2020; 184:43-49. [PMID: 32282934 DOI: 10.1111/bjd.19119] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/03/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND In contact dermatitis, it is crucial to understand and remember the outcome of patch testing. Unfortunately, many patients do not remember the results of their patch tests. OBJECTIVES Our aim was to evaluate the effects of an intervention programme in which extensive information on specific contact allergy was provided, in individuals with positive patch test reactions. METHODS The study was designed as a randomized, investigator-blinded clinical trial. Participants with positive test reactions were randomized into two groups that received either standard information according to clinical routine or standard information and a reminder letter. Knowledge of contact allergies was evaluated using questionnaires 12 months after inclusion. RESULTS There were 184 adults included in the trial and the response rate at 1-year follow-up was 78% (143 of 184). Sixty-five per cent (45 of 69) in the intervention group and 54% (40 of 74) in the control group reported the correct name of the allergen (P = 0·23). Participants with several - as opposed to few - positive patch test reactions had difficulty in remembering the correct names of the allergens (P = 0·001). Moreover, the type of allergy had an influence on their ability to remember the name of the allergen correctly and their ability to make changes in lifestyle. CONCLUSIONS The intervention performed did not significantly affect the participants' ability to remember their contact allergy. To achieve better knowledge and changes in lifestyle, efforts to inform should concentrate on individuals with several positive patch test reactions, those with particular allergens, individuals over 60 years of age, and - concerning changes in lifestyle - males.
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Affiliation(s)
- A Dizdarevic
- Department of Dermatology and Venereology, Skåne University Hospital, Malmö, Sweden.,Department of Clinical Sciences, Lund University, Lund, Sweden
| | - W Troensegaard
- Department of Dermatology and Venereology, Skåne University Hospital, Malmö, Sweden.,Department of Clinical Sciences, Lund University, Lund, Sweden
| | - A Uldahl
- Department of Dermatology and Venereology, Skåne University Hospital, Malmö, Sweden.,Department of Clinical Sciences, Lund University, Lund, Sweden
| | - O Bergendorff
- Department of Occupational and Environmental Dermatology, Skåne University Hospital, Malmö, Sweden
| | - I Siemund
- Department of Dermatology and Venereology, Skåne University Hospital, Malmö, Sweden.,Department of Occupational and Environmental Dermatology, Skåne University Hospital, Malmö, Sweden.,Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Å Svensson
- Department of Dermatology and Venereology, Skåne University Hospital, Malmö, Sweden.,Department of Clinical Sciences, Lund University, Lund, Sweden
| | - A Sonesson
- Department of Dermatology and Venereology, Skåne University Hospital, Malmö, Sweden.,Department of Clinical Sciences, Lund University, Lund, Sweden
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Siemund I, Mowitz M, Zimerson E, Bruze M, Hindsén M. Variation in aluminium patch test reactivity over time. Contact Dermatitis 2017; 77:288-296. [DOI: 10.1111/cod.12836] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Revised: 04/27/2017] [Accepted: 05/02/2017] [Indexed: 02/06/2023]
Affiliation(s)
- Ingrid Siemund
- Department of Occupational and Environmental Dermatology; Skåne University Hospital, Lund University; 205 02 Malmö Sweden
- Department of Dermatology and Venereology; Skåne University Hospital, Lund University; 221 85 Lund Sweden
| | - Martin Mowitz
- Department of Occupational and Environmental Dermatology; Skåne University Hospital, Lund University; 205 02 Malmö Sweden
| | - Erik Zimerson
- Department of Occupational and Environmental Dermatology; Skåne University Hospital, Lund University; 205 02 Malmö Sweden
| | - Magnus Bruze
- Department of Occupational and Environmental Dermatology; Skåne University Hospital, Lund University; 205 02 Malmö Sweden
| | - Monica Hindsén
- Department of Occupational and Environmental Dermatology; Skåne University Hospital, Lund University; 205 02 Malmö Sweden
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Netterlid E, Hindsén M, Siemund I, Björk J, Werner S, Jacobsson H, Güner N, Bruze M. Does allergen-specific immunotherapy induce contact allergy to aluminium? Acta Derm Venereol 2013; 93:50-6. [PMID: 22948339 DOI: 10.2340/00015555-1409] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Persistent, itching nodules have been reported to appear at the injection site after allergen-specific immuno-therapy with aluminium-precipitated antigen extract, occasionally in conjunction with contact allergy to aluminium. This study aimed to quantify the development of contact allergy to aluminium during allergen-specific immunotherapy. A randomized, controlled, single-blind multicentre study of children and adults entering allergen-specific immunotherapy was performed using questionnaires and patch-testing. A total of 205 individuals completed the study. In the 3 study groups all subjects tested negative to aluminium before allergen-specific immunotherapy and 4 tested positive after therapy. In the control group 4 participants tested positive to aluminium. Six out of 8 who tested positive also had atopic dermatitis. Positive test results were found in 5/78 children and 3/127 adults. Allergen-specific immunotherapy was not shown to be a risk factor for contact allergy to aluminium. Among those who did develop aluminium allergy, children and those with atopic dermatitis were more highly represented.
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Affiliation(s)
- Eva Netterlid
- Faculty of Medicine, Department of Clinical Sciences, Lund University, SE-205 02 Malmö, Sweden.
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Isaksson M, Siemund I, Bruze M. Allergic contact dermatitis from ethylcyanoacrylate in an office worker with artificial nails led to months of sick leave. Contact Dermatitis 2007; 57:346-7. [DOI: 10.1111/j.1600-0536.2007.01133.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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