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Oppel E, Högg C, Oschmann A, Summer B, Kamann S. Contact allergy to the Dexcom G6 glucose monitoring system -role of 2,2'-methylenebis(6-tert-butyl-4-methylphenol) monoacrylate in the new adhesive. Contact Dermatitis 2022; 87:258-264. [PMID: 35503433 DOI: 10.1111/cod.14141] [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: 10/24/2021] [Revised: 04/15/2022] [Accepted: 04/30/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Skin reactions to the glucose monitoring systems Dexcom G5 and G6 have been rare. In 2019, the components of the adhesive were exchanged for better skin fixation. Since then, more and more patients experienced severe skin reactions. A few months ago, 2,2'-methylenebis(6-tert-butyl-4-methylphenol) monoacrylate (MBPA) was identified as a new component in the adhesive of the G6 model. Furthermore, it was suspected that isobornylacrylate (IBOA) was also a component of the exchanged adhesive. OBJECTIVES Our objective was to investigate if MBPA plays a major role in the increasing skin problems of patients without a history of IBOA-sensitization. Furthermore, our aim was to examine whether IBOA is contained in the newer model adhesive and may also contribute to allergic contact dermatitis (ACD). PATIENTS AND METHODS Five patients with a newly occurred ACD caused by the glucose monitoring system Dexcom G6 were investigated. Patch testing including MBPA in 3 different concentrations, as well as IBOA were performed. Gas chromatography-mass spectrometry of the newer system Dexcom G6 was carried out. RESULTS All patients were shown to be sensitized to MBPA, while MBPA 0,5% showed the strongest reaction. On the other hand, IBOA was tested negative. CONCLUSION In our study group MBPA was observed to be the triggering allergen of the recently changed adhesive.
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Affiliation(s)
- Eva Oppel
- Department of Dermatology and Allergology, University Hospital LMU, Munich, Germany
| | - Christof Högg
- Department of Conservative Dentistry and Periodontology, University Hospital LMU, Munich, Germany.,Walther Straub Institute of Pharmacology and Toxicology, Faculty of Medicine LMU, Munich, Germany
| | - Anna Oschmann
- Department of Dermatology and Allergology, University Hospital LMU, Munich, Germany
| | - Burkhard Summer
- Department of Dermatology and Allergology, University Hospital LMU, Munich, Germany
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Kamann S, Wagner N, Oppel E. Moderne Sensortechnik zur kontinuierlichen Glukosemessung: Anwendungseinschränkungen durch Kontaktallergien. J Dtsch Dermatol Ges 2021; 19:1715-1722. [PMID: 34894186 DOI: 10.1111/ddg.14621_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 07/30/2021] [Indexed: 11/29/2022]
Affiliation(s)
| | - Nicola Wagner
- Hautklinik, Universitätsklinik Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen
| | - Eva Oppel
- Klinik für Dermatologie und Allergologie, Ludwig-Maximilians-Universität, München
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Kamann S, Wagner N, Oppel E. Modern diabetes devices for continuous blood sugar measuring: Limitations due to contact allergies. J Dtsch Dermatol Ges 2021; 19:1715-1721. [PMID: 34751512 DOI: 10.1111/ddg.14621] [Citation(s) in RCA: 3] [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] [Received: 03/05/2021] [Accepted: 07/30/2021] [Indexed: 12/29/2022]
Abstract
During the past years, diabetes diseases have increased significantly worldwide. However, new technologies such as continuous glucose measurement using a subcutaneous sensor are developing just as rapidly. A continuous improvement in insulin pump therapy is also contributing to an improved quality of life. A common feature of these modern devices for diabetes therapy is that they remain fixed in place on the skin for several days. In recent years, skin reactions, in particular pronounced contact dermatitis due to the devices and their adhesives have been increasingly reported. In particular, isobornyl acrylate, which used to be included in a glucose measurement sensor set, was identified as a main allergen. Development of contact allergy can result both in a necessity to quit the measuring system and in allergic cross-reactions to other systems.
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Affiliation(s)
- Stefanie Kamann
- Department of Dermatology and Allergology, Feldafing, Germany
| | - Nicola Wagner
- Department of Dermatology, University Medical Center Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Eva Oppel
- Department of Dermatology and Allergology, Ludwig-Maximilian University, Munich, Germany
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Freckmann G, Buck S, Waldenmaier D, Zschornack E, Link M, Jendrike N, Obstfelder I, Vetrugno S, Kamann S, Haug C. Skin Reaction Report Form: Development and Design of a Standardized Report Form for Skin Reactions Due to Medical Devices for Diabetes Management. J Diabetes Sci Technol 2021; 15:801-806. [PMID: 32202129 PMCID: PMC8258512 DOI: 10.1177/1932296820911105] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Skin reactions due to medical devices for diabetes management have become a common problem in diabetes technology. There is a varying degree in how detailed skin reactions are described in scientific literature and diabetes practice, and no uniform structured documentation is given. Whereas most articles only describe findings, some others already document final diagnoses, such as contact dermatitis. Furthermore, inconsistent wordings for comparable issues were used. METHODS A more detailed and standardized documentation, possibly facilitated by a generally accepted guideline for structured descriptions, of skin reactions could be helpful to enable better differentiations between the described skin reactions. Therefore, a report form to assess skin reactions due to medical devices in diabetes therapy was developed and will be presented in this article. RESULTS The one-page report form is divided into four categories and a separate instruction paper. Beside general information the form includes the location, size, severity and duration of skin appearances, the grading of itching, and suspected diagnoses. CONCLUSION A consistent use of the form in daily practice and clinical trials could facilitate a fast and standardized documentation and help to evaluate the occurrence and severity of different skin reactions due to medical devices in diabetes management.
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Affiliation(s)
- Guido Freckmann
- Institut für Diabetes-Technologie, Forschungs- und Entwicklungsgesellschaft mbH, Lise-Meitner-Straße, Ulm, Germany
| | - Sina Buck
- Institut für Diabetes-Technologie, Forschungs- und Entwicklungsgesellschaft mbH, Lise-Meitner-Straße, Ulm, Germany
- Sina Buck, MSc, Institut für Diabetes-Technologie, Forschungs- und Entwicklungsgesellschaft mbH an der Universität Ulm, Lise-Meitner-Straße 8/2, 89081 Ulm, Germany.
| | - Delia Waldenmaier
- Institut für Diabetes-Technologie, Forschungs- und Entwicklungsgesellschaft mbH, Lise-Meitner-Straße, Ulm, Germany
| | - Eva Zschornack
- Institut für Diabetes-Technologie, Forschungs- und Entwicklungsgesellschaft mbH, Lise-Meitner-Straße, Ulm, Germany
| | - Manuela Link
- Institut für Diabetes-Technologie, Forschungs- und Entwicklungsgesellschaft mbH, Lise-Meitner-Straße, Ulm, Germany
| | - Nina Jendrike
- Institut für Diabetes-Technologie, Forschungs- und Entwicklungsgesellschaft mbH, Lise-Meitner-Straße, Ulm, Germany
| | - Ines Obstfelder
- Institut für Diabetes-Technologie, Forschungs- und Entwicklungsgesellschaft mbH, Lise-Meitner-Straße, Ulm, Germany
| | - Sara Vetrugno
- Institut für Diabetes-Technologie, Forschungs- und Entwicklungsgesellschaft mbH, Lise-Meitner-Straße, Ulm, Germany
| | | | - Cornelia Haug
- Institut für Diabetes-Technologie, Forschungs- und Entwicklungsgesellschaft mbH, Lise-Meitner-Straße, Ulm, Germany
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Oppel E, Kamann S, Heinemann L, Klein A, Reichl FX, Högg C. Freestyle libre 2: The new isobornyl acrylate free generation. Contact Dermatitis 2020; 83:429-431. [PMID: 32542740 DOI: 10.1111/cod.13638] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 06/11/2020] [Accepted: 06/13/2020] [Indexed: 02/06/2023]
Affiliation(s)
- Eva Oppel
- Department of Dermatology and Allergology, University Hospital, LMU Munich, Munich, Germany
| | - Stefanie Kamann
- Department of Allergy, Dermatology Feldafing, Feldafing, Germany
| | | | - Anna Klein
- Department of Dermatology and Allergology, University Hospital, LMU Munich, Munich, Germany
| | - Franz-Xaver Reichl
- Department of Conservative Dentistry and Periodontology, University Hospital, LMU Munich, Munich, Germany.,Walther Straub Institute of Pharmacology and Toxicology, Faculty of Medicine, LMU Munich, Munich, Germany
| | - Christof Högg
- Department of Conservative Dentistry and Periodontology, University Hospital, LMU Munich, Munich, Germany.,Walther Straub Institute of Pharmacology and Toxicology, Faculty of Medicine, LMU Munich, Munich, Germany
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Kamann S, Heinemann L, Oppel E. Usage of Hydrocolloid-Based Plasters in Patients Who Have Developed Allergic Contact Dermatitis to Isobornyl Acrylate While Using Continuous Glucose Monitoring Systems. J Diabetes Sci Technol 2020; 14:582-585. [PMID: 31538817 PMCID: PMC7576941 DOI: 10.1177/1932296819876964] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Continuous glucose monitoring (CGM) systems replace more and more capillary self-monitoring of blood glucose by patients with diabetes. However, at least a subset of patients experience adverse skin reactions such as severe allergic contact dermatitis (ACD) after prolonged usage of CGM systems. A major allergen isobornyl acrylate (IBOA) has been identified recently. OBJECTIVES After developing an ACD, patients have difficulties in continuing the usage of their CGM system (and also of, eg, certain patch pumps). Most of such patients look for possibilities to continue the usage of, eg, a CGM system that requires intermittent scanning (iscCGM, Freestyle Libre). PATIENTS AND METHODS Eight patients with a known ACD were supplied with different hydrocolloid-based plasters (n = 5 with Hansaplast blister plaster, n = 2 with Cutimed Hydro B from BSN, and n = 1 with Stomahesive baseplate from Convatec). They attached these plasters to their skin underneath their iscCGM system. RESULTS All patients were able to continue the usage of this iscCGM system when using such plasters. CONCLUSION Patients with ACD benefit from the usage of such plasters; however, some limitations have to be acknowledged.
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Affiliation(s)
- Stefanie Kamann
- Dermatology and Allergology, Feldafing, Germany
- Stefanie Kamann, MD, Dermatology and Allergology, Seewiesstraße 1, 82340 Feldafing, Germany.
| | | | - Eva Oppel
- Department of Dermatology and Allergology, Ludwig-Maximilian University, Munich, Germany
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Abstract
Background: Along with increased usage of continuous glucose monitors, flash glucose monitors, and patch pumps by patients with diabetes, the frequency of skin reactions has also increased. Skin irritation and itching can be annoying to users. However, more serious contact allergies to one or more components of the adhesives or plastic material of the housing of the devices can become lifelong. Redness and itchiness are so strong that patients can no longer use a particular system. In August 2017, a major culprit allergen, isobornyl acrylate (IBOA), was identified for these more serious reactions. Objectives: Our objective was to evaluate IBOA content in different medical products. Methods: The plastic material used for the housing of the Freestyle Libre (n = 3), Dexcom G6 (n = 3), and Enlite (n = 4) was analyzed for IBOA content by gas chromatography-mass spectrometry. Adhesives of the different systems were also analyzed. Results: IBOA was found in the housings of Freestyle Libre and Enlite sensor, but not in the Dexcom G6. Conclusions: Patients with an IBOA allergy should consider switching to a medical product without IBOA. Furthermore, removal of IBOA from devices that contact the skin is encouraged.
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Affiliation(s)
| | - Eva Oppel
- Department of Dermatology and Allergology, Ludwig-Maximilian University, Munich, Germany
| | - Fangfang Liu
- Department of Conservative Dentistry and Periodontology, University Hospital, Ludwig-Maximilian University, Munich, Germany
- Walther-Straub-Institute of Pharmacology and Toxicology, Ludwig-Maximilian University, Munich, Germany
| | - Franz-Xaver Reichl
- Department of Conservative Dentistry and Periodontology, University Hospital, Ludwig-Maximilian University, Munich, Germany
- Walther-Straub-Institute of Pharmacology and Toxicology, Ludwig-Maximilian University, Munich, Germany
| | | | - Christof Högg
- Department of Conservative Dentistry and Periodontology, University Hospital, Ludwig-Maximilian University, Munich, Germany
- Walther-Straub-Institute of Pharmacology and Toxicology, Ludwig-Maximilian University, Munich, Germany
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Pleus S, Ulbrich S, Zschornack E, Kamann S, Haug C, Freckmann G. Documentation of Skin-Related Issues Associated with Continuous Glucose Monitoring Use in the Scientific Literature. Diabetes Technol Ther 2019; 21:538-545. [PMID: 31335203 DOI: 10.1089/dia.2019.0171] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background: The average wear time of continuous glucose monitoring (CGM) systems steadily increased over the last years. Increased wear times are likely achieved by using adhesives with a longer adherence time, which may have a more pronounced effect on the skin than adhesives with shorter adherence time. Methods: In this project, a structured literature search was performed to assess how potential skin-related issues with CGM usage have been reported in scientific literature in the last 5 years. The literature search was performed with four search terms in the PubMed database. Results: In sum, 279 articles were analyzed. Skin-related issues were mentioned in 19.0% of articles (53 out of 279). With respect to articles mentioning skin-related issues, CGM performance or efficacy was the study's main topic of most of these studies, whereas the minority used CGM as "add-on" to assess other objectives. There was a varying degree in how detailed skin-related issues were described and no uniform structured documentation was given. While some articles only described findings, other articles already documented final diagnoses, such as contact dermatitis. Furthermore, inconsistent wordings for comparable issues were used. The most frequent issues were pain, itching, erythema, bleeding, bruising, and allergic reactions. Conclusion: To draw possible conclusions about the occurrence of skin-related issues during CGM use, more reports about skin-related issues in scientific literature are needed. A more detailed and uniformly structured documentation, possibly facilitated by a generally accepted guideline for structured descriptions, of skin-related issues could be helpful to enable clear differentiations between the described skin reactions.
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Affiliation(s)
- Stefan Pleus
- Institut für Diabetes-Technologie, Forschungs- und Entwicklungsgesellschaft mbH an der Universität Ulm, Ulm, Germany
| | - Sina Ulbrich
- Institut für Diabetes-Technologie, Forschungs- und Entwicklungsgesellschaft mbH an der Universität Ulm, Ulm, Germany
| | - Eva Zschornack
- Institut für Diabetes-Technologie, Forschungs- und Entwicklungsgesellschaft mbH an der Universität Ulm, Ulm, Germany
| | | | - Cornelia Haug
- Institut für Diabetes-Technologie, Forschungs- und Entwicklungsgesellschaft mbH an der Universität Ulm, Ulm, Germany
| | - Guido Freckmann
- Institut für Diabetes-Technologie, Forschungs- und Entwicklungsgesellschaft mbH an der Universität Ulm, Ulm, Germany
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Oppel E, Kamann S, Heinemann L, Reichl F, Högg C. The implanted glucose monitoring system Eversense: An alternative for diabetes patients with isobornyl acrylate allergy. Contact Dermatitis 2019; 82:101-104. [DOI: 10.1111/cod.13392] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 08/22/2019] [Accepted: 08/27/2019] [Indexed: 12/13/2022]
Affiliation(s)
- Eva Oppel
- Department of Dermatology and AllergologyLudwig‐Maximilian University Munich Germany
| | | | | | - Franz‐Xaver Reichl
- Department of Conservative Dentistry and PeriodontologyUniversity Hospital, Ludwig‐Maximilian University Munich Germany
- Walther‐Straub‐Institute of Pharmacology and Toxicology, Ludwig‐Maximilian University Munich Germany
| | - Christof Högg
- Department of Conservative Dentistry and PeriodontologyUniversity Hospital, Ludwig‐Maximilian University Munich Germany
- Walther‐Straub‐Institute of Pharmacology and Toxicology, Ludwig‐Maximilian University Munich Germany
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Kamann S, Oppel E. Hydrocolloid blister plaster decreases allergic contact dermatitis caused by Freestyle Libre and isobornyl acrylate. Contact Dermatitis 2019; 81:380-381. [DOI: 10.1111/cod.13329] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 05/06/2019] [Accepted: 05/29/2019] [Indexed: 11/27/2022]
Affiliation(s)
| | - Eva Oppel
- Department of Dermatology and AllergologyLudwig‐Maximilian University Munich Germany
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Oppel E, Kamann S, Reichl F, Högg C. The Dexcom glucose monitoring system—An isobornyl acrylate‐free alternative for diabetic patients. Contact Dermatitis 2019; 81:32-36. [DOI: 10.1111/cod.13248] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 02/13/2019] [Accepted: 02/17/2019] [Indexed: 12/23/2022]
Affiliation(s)
- Eva Oppel
- Department of Dermatology and Allergy University Hospital, LMU Munich Munich Germany
| | - Stefanie Kamann
- Department of Allergy Dermatology Feldafing Feldafing Germany
| | - Franz‐Xaver Reichl
- Department of Conservative Dentistry and Periodontology University Hospital, LMU Munich Munich Germany
- Walther Straub Institute of Pharmacology and Toxicology Faculty of Medicine, LMU Munich Munich Germany
| | - Christof Högg
- Department of Conservative Dentistry and Periodontology University Hospital, LMU Munich Munich Germany
- Walther Straub Institute of Pharmacology and Toxicology Faculty of Medicine, LMU Munich Munich Germany
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Speck U, Häckel A, Schellenberger E, Kamann S, Löchel M, Clever YP, Peters D, Scheller B, Trog S, Bettink S. Drug Distribution and Basic Pharmacology of Paclitaxel/Resveratrol-Coated Balloon Catheters. Cardiovasc Intervent Radiol 2018; 41:1599-1610. [PMID: 29968090 PMCID: PMC6132862 DOI: 10.1007/s00270-018-2018-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 06/20/2018] [Indexed: 11/16/2022]
Abstract
Purpose To experimentally investigate a new homogenously paclitaxel/resveratrol-coated balloon catheter in terms of transport of the coating to the treated tissue and local effects including histology and functional tests. Methods Adherence of the coating to the balloon was explored by in vitro simulation of its passage to the lesion. Paclitaxel and resveratrol transfer to the vessel wall was investigated in porcine coronary and peripheral arteries. Matrix-assisted laser desorption/ionization (MALDI) was used for direct microscopic visualization of paclitaxel in arterial tissue. Inhibition of neointimal proliferation and tolerance of complete coating and resveratrol-only coating was investigated in pigs 4 weeks after treatment, and the effect of resveratrol on inflammation and healing after 3 and 7 days. Results Drug loss on the way to the lesion was < 10% of dose, while 65 ± 13% was detected at the site of balloon inflation. After treatment similar proportions of drug were detected in coronary and peripheral arteries, i.e., 7.4 ± 4.6% of dose or 125 ± 74 ng/mg tissue. MALDI showed circumferential deposition. Inhibition of neointimal proliferation by paclitaxel/resveratrol coating was significant (p = 0.001) whereas resveratrol-only coating did not inhibit neointimal proliferation. During the first week after treatment of peripheral arteries with resveratrol-only balloons, we observed nominally less inflammation and fibrin deposition along with a significant macrophage reduction and more pronounced re-endothelialization. No safety issues emerged including left ventricular ejection fraction for detection of potential distal embolization after high-dose treatment of coronary arteries. Conclusions Paclitaxel/resveratrol-coated balloons were effective and safe in animal studies. Beyond acting as excipient resveratrol may contribute to vascular healing.
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Affiliation(s)
- Ulrich Speck
- Department of Radiology, Experimental Radiology, Charité, 10098, Berlin, Germany.
| | - Akvile Häckel
- Department of Radiology, Experimental Radiology, Charité, 10098, Berlin, Germany
| | - Eyk Schellenberger
- Department of Radiology, Experimental Radiology, Charité, 10098, Berlin, Germany
| | - Stefanie Kamann
- Department of Radiology, Experimental Radiology, Charité, 10098, Berlin, Germany
| | | | - Yvonne P Clever
- Clinical and Experimental Interventional Cardiology, University of Saarland, 66421, Homburg, Saarland, Germany
| | | | - Bruno Scheller
- Clinical and Experimental Interventional Cardiology, University of Saarland, 66421, Homburg, Saarland, Germany
| | | | - Stephanie Bettink
- Clinical and Experimental Interventional Cardiology, University of Saarland, 66421, Homburg, Saarland, Germany
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Oppel E, Högg C, Summer B, Ruëff F, Reichl FX, Kamann S. Isobornyl acrylate contained in the insulin patch pump OmniPod as the cause of severe allergic contact dermatitis. Contact Dermatitis 2018; 79:178-180. [DOI: 10.1111/cod.13017] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2018] [Revised: 03/26/2018] [Accepted: 03/27/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Eva Oppel
- Department of Dermatology and Allergology; Ludwig-Maximilian University, Munich; Munich Germany
| | - Christof Högg
- Department of Conservative Dentistry and Periodontology, University Hospital; Ludwig-Maximilian University, Munich; Munich Germany
- Walther-Straub Institute of Pharmacology and Toxicology; Ludwig-Maximilian University, Munich; Munich Germany
| | - Burkhard Summer
- Department of Dermatology and Allergology; Ludwig-Maximilian University, Munich; Munich Germany
| | - Franziska Ruëff
- Department of Dermatology and Allergology; Ludwig-Maximilian University, Munich; Munich Germany
| | - Franz-Xaver Reichl
- Department of Conservative Dentistry and Periodontology, University Hospital; Ludwig-Maximilian University, Munich; Munich Germany
- Walther-Straub Institute of Pharmacology and Toxicology; Ludwig-Maximilian University, Munich; Munich Germany
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Abstract
In the past decade, new diabetes technologies, including continuous glucose monitoring (CGM) systems, support patients with diabetes in their daily struggle with achieving a good glucose control. However, shortly after the first CGM systems appeared on the market, also the first concerns about adverse skin reactions were raised. Most patients claimed to suffer from (sometimes severe) skin irritation, or even allergy, which they related to the (acrylate-based) adhesive part of the device. For a long time the actual substance that caused these skin reactions with, for example, the Flash Glucose Monitoring system (iscCGM; Freestyle® Libre) could not be identified; however, recently Belgian and Swedish dermatologists reported that the majority of their patients that have developed a contact-allergic while using iscCGM react sensitively to a specific acrylate, that is, isobornyl acrylate (IBOA). Subsequently they showed by means of gas chromatography-mass spectrometry that this substance is present in the case of the glucose sensor attached by an adhesive to the skin. We report three additional cases from Germany, including a 10-year-old boy, suffering from severe allergic contact dermatitis to IBOA.
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Affiliation(s)
- Stefanie Kamann
- Pöcking, Germany
- Stefanie Kamann, MD, Waldstr 1a, Pöcking, 82343, Germany.
| | - Olivier Aerts
- Department of Dermatology, University Hospital Antwerp and University of Antwerp, Antwerp, Belgium
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Haase N, Rüder C, Haase H, Kamann S, Kouno M, Morano I, Dechend R, Zohlnhöfer D, Haase T. Protective Function of Ahnak1 in Vascular Healing after Wire Injury. J Vasc Res 2017; 54:131-142. [PMID: 28468000 DOI: 10.1159/000464287] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 09/21/2016] [Accepted: 02/13/2017] [Indexed: 01/17/2023] Open
Abstract
AIM Vascular remodeling following injury substantially accounts for restenosis and adverse clinical outcomes. In this study, we investigated the role of the giant scaffold protein Ahnak1 in vascular healing after endothelial denudation of the murine femoral artery. METHODS The spatiotemporal expression pattern of Ahnak1 and Ahnak2 was examined using specific antibodies and real-time quantitative PCR. Following wire-mediated endothelial injury of Ahnak1-deficient mice and wild-type (WT) littermates, the processes of vascular healing were analyzed. RESULTS Ahnak1 and Ahnak2 showed a mutually exclusive vascular expression pattern, with Ahnak1 being expressed in the endothelium and Ahnak2 in the medial cells in naïve WT arteries. After injury, a marked increase of Ahnak1- and Ahnak2-positive cells at the lesion site became evident. Both proteins showed a strong upregulation in neointimal cells 14 days after injury. Ahnak1-deficient mice showed delayed vascular healing and dramatically impaired re-endothelialization that resulted in prolonged adverse vascular remodeling, when compared to the WT littermates. CONCLUSION The large scaffold and adaptor proteins Ahnak1 and Ahnak2 exhibit differential expression patterns and functions in naïve and injured arteries. Ahnak1 plays a nonredundant protective role in vascular healing.
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Affiliation(s)
- Nadine Haase
- Experimental and Clinical Research Center (a joint cooperation of the MDC and the Charité Medical Faculty), Berlin, Germany
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Haase T, Krost A, Sauter T, Kratz K, Peter J, Kamann S, Jung F, Lendlein A, Zohlnhöfer D, Rüder C. In vivo biocompatibility assessment of poly (ether imide) electrospun scaffolds. J Tissue Eng Regen Med 2015; 11:1034-1044. [PMID: 25712330 DOI: 10.1002/term.2002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [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: 03/30/2014] [Revised: 11/25/2014] [Accepted: 12/17/2014] [Indexed: 12/18/2022]
Abstract
Poly(ether imide) (PEI), which can be chemically functionalized with biologically active ligands, has emerged as a potential biomaterial for medical implants. Electrospun PEI scaffolds have shown advantageous properties, such as enhanced endothelial cell adherence, proliferation and low platelet adhesion in in vitro experiments. In this study, the in vivo behaviour of electrospun PEI scaffolds and PEI films was examined in a murine subcutaneous implantation model. Electrospun PEI scaffolds and films were surgically implanted subcutaneously in the dorsae of mice. The surrounding subcutaneous tissue response was examined via histopathological examination at 7 and 28 days after implantation. No serious adverse events were observed for both types of PEI implants. The presence of macrophages or foreign body giant cells in the vicinity of the implants and the formation of a fibrous capsule indicated a normal foreign body reaction towards PEI films and scaffolds. Capsule thickness and inflammatory infiltration cells significantly decreased for PEI scaffolds during days 7-28 while remaining unchanged for PEI films. The infiltration of cells into the implant was observed for PEI scaffolds 7 days after implantation and remained stable until 28 days of implantation. Additionally some, but not all, PEI scaffold implants induced the formation of functional blood vessels in the vicinity of the implants. Conclusively, this study demonstrates the in vivo biocompatibility of PEI implants, with favourable properties of electrospun PEI scaffolds regarding tissue integration and wound healing. Copyright © 2015 John Wiley & Sons, Ltd.
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Affiliation(s)
- Tobias Haase
- Berlin-Brandenburg Centre for Regenerative Therapies, Berlin, Germany.,Department of Cardiology, Campus Virchow Klinikum, Charité, Berlin, Germany
| | - Annalena Krost
- Berlin-Brandenburg Centre for Regenerative Therapies, Berlin, Germany
| | - Tilman Sauter
- Berlin-Brandenburg Centre for Regenerative Therapies, Berlin, Germany.,Institute of Biomaterial Science, Helmholtz-Zentrum Geesthacht, Teltow, Germany.,Institute of Biochemistry and Biology, University of Potsdam, Germany
| | - Karl Kratz
- Berlin-Brandenburg Centre for Regenerative Therapies, Berlin, Germany.,Institute of Biomaterial Science, Helmholtz-Zentrum Geesthacht, Teltow, Germany
| | - Jan Peter
- Berlin-Brandenburg Centre for Regenerative Therapies, Berlin, Germany
| | - Stefanie Kamann
- Berlin-Brandenburg Centre for Regenerative Therapies, Berlin, Germany.,Department of Cardiology, Campus Virchow Klinikum, Charité, Berlin, Germany
| | - Friedrich Jung
- Berlin-Brandenburg Centre for Regenerative Therapies, Berlin, Germany.,Institute of Biomaterial Science, Helmholtz-Zentrum Geesthacht, Teltow, Germany
| | - Andreas Lendlein
- Berlin-Brandenburg Centre for Regenerative Therapies, Berlin, Germany.,Institute of Biomaterial Science, Helmholtz-Zentrum Geesthacht, Teltow, Germany.,Institute of Biochemistry and Biology, University of Potsdam, Germany
| | - Dietlind Zohlnhöfer
- Berlin-Brandenburg Centre for Regenerative Therapies, Berlin, Germany.,Department of Cardiology, Campus Virchow Klinikum, Charité, Berlin, Germany
| | - Constantin Rüder
- Berlin-Brandenburg Centre for Regenerative Therapies, Berlin, Germany.,Department of Cardiology, Campus Virchow Klinikum, Charité, Berlin, Germany
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Rüder C, Haase T, Krost A, Langwieser N, Peter J, Kamann S, Zohlnhöfer D. Combinatorial G-CSF/AMD3100 treatment in cardiac repair after myocardial infarction. PLoS One 2014; 9:e104644. [PMID: 25121738 PMCID: PMC4133256 DOI: 10.1371/journal.pone.0104644] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2013] [Accepted: 07/15/2014] [Indexed: 11/18/2022] Open
Abstract
AIMS Several studies suggest that circulating bone marrow derived stem cells promote the regeneration of ischemic tissues. For hematopoietic stem cell transplantation combinatorial granulocyte-colony stimulating factor (G-CSF)/Plerixafor (AMD3100) administration was shown to enhance mobilization of bone marrow derived stem cells compared to G-CSF monotherapy. Here we tested the hypothesis whether combinatorial G-CSF/AMD3100 therapy has beneficial effects in cardiac recovery in a mouse model of myocardial infarction. METHODS We analyzed the effect of single G-CSF (250 µg/kg/day) and combinatorial G-CSF/AMD3100 (100 µg/kg/day) treatment on cardiac morphology, vascularization, and hemodynamics 28 days after permanent ligation of the left anterior descending artery (LAD). G-CSF treatment started directly after induction of myocardial infarction (MI) for 3 consecutive days followed by a single AMD3100 application on day three after MI in the G-CSF/AMD3100 group. Cell mobilization was assessed by flow cytometry of blood samples drawn from tail vein on day 0, 7, and 14. RESULTS Peripheral blood analysis 7 days after MI showed enhanced mobilization of white blood cells (WBC) and endothelial progenitor cells (EPC) upon G-CSF and combinatorial G-CSF/AMD3100 treatment. However, single or combinatorial treatment showed no improvement in survival, left ventricular function, and infarction size compared to the saline treated control group 28 days after MI. Furthermore, no differences in histology and vascularization of infarcted hearts could be observed. CONCLUSION Although the implemented treatment regimen caused no adverse effects, our data show that combinatorial G-CSF/AMD therapy does not promote myocardial regeneration after permanent LAD occlusion.
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Affiliation(s)
- Constantin Rüder
- Berlin Brandenburg Center for Regenerative Therapies (BCRT), Berlin, Germany
- Department of Cardiology, Campus Virchow Klinikum, Charité Berlin, Germany
| | - Tobias Haase
- Berlin Brandenburg Center for Regenerative Therapies (BCRT), Berlin, Germany
- Department of Cardiology, Campus Virchow Klinikum, Charité Berlin, Germany
| | - Annalena Krost
- Berlin Brandenburg Center for Regenerative Therapies (BCRT), Berlin, Germany
| | - Nicole Langwieser
- Berlin Brandenburg Center for Regenerative Therapies (BCRT), Berlin, Germany
| | - Jan Peter
- Berlin Brandenburg Center for Regenerative Therapies (BCRT), Berlin, Germany
| | - Stefanie Kamann
- Berlin Brandenburg Center for Regenerative Therapies (BCRT), Berlin, Germany
| | - Dietlind Zohlnhöfer
- Berlin Brandenburg Center for Regenerative Therapies (BCRT), Berlin, Germany
- Department of Cardiology, Campus Virchow Klinikum, Charité Berlin, Germany
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Oppel T, Pavicic T, Kamann S, Bräutigam M, Wollenberg A. Pimecrolimus cream (1%) efficacy in perioral dermatitis ? results of a randomized, double-blind, vehicle-controlled study in 40 patients. J Eur Acad Dermatol Venereol 2007; 21:1175-80. [PMID: 17894701 DOI: 10.1111/j.1468-3083.2007.02191.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [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: 11/26/2022]
Abstract
BACKGROUND Perioral dermatitis (POD) is a common skin disease and difficult to treat. Pimecrolimus cream (1%) successfully controls atopic eczema. OBJECTIVE Our aim was to investigate its efficacy in POD. STUDY DESIGN Single-centre, randomized, double-blind, vehicle-controlled study including 40 POD patients with a 4-week treatment and a 4-week follow-up. Efficacy was assessed by a novel Perioral Dermatitis Severity Index (PODSI) and Finlay's Dermatology Life Quality Index (DLQI). SETTING Outpatient clinics of a large dermatological hospital in Munich, Germany. RESULTS During treatment, the PODSI was significantly lower in the pimecrolimus group compared with vehicle (P = 0.005-0.02) whereas at follow-up, no significant differences were observed. At week 2, the responder rates (> or = 50% PODSI improvement) were 50% with pimecrolimus cream (1%) and 25% with vehicle (P = 0.095). DLQI was improved in pimecrolimus group compared with vehicle. CONCLUSION Results suggest that pimecrolimus cream (1%) effectively treats acute-stage POD.
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Affiliation(s)
- T Oppel
- Department of Dermatology and Allergy, Ludwig-Maximilians University, Munich, Germany
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Kamann S, Flaig MJ, Korting HC. Hydroxyethyl starch-induced itch: relevance of light microscopic analysis of semi-thin sections and electron microscopy. J Dtsch Dermatol Ges 2007; 5:204-8. [PMID: 17338795 DOI: 10.1111/j.1610-0387.2007.06239.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [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: 11/30/2022]
Abstract
BACKGROUND Hydroxyethyl starch (HES) is widely used as a plasma substitute for improving microcirculation. A major side effect of HES is severe pruritus caused by HES deposits in the skin. Since specific changes are difficult to see in paraffin sections, electron microscopy is the golden standard technique in the diagnosis of HES-induced skin disease. Our aim was to compare electron microscopic search for HES deposits with other techniques. PATIENTS AND METHODS During the last ten years, we biopsied 21 patients suspected of having HES-induced pruritus. We compared conventional microscopy with hematoxylin & eosin and toluidine blue-stained paraffin sections, toluidine blue-stained glycide ether-embedded, semithin sections and transmission electron microscopy. RESULTS In 9 patients specific HES deposits could be found by evaluating toluidine blue stained semithin sections by light microscopy alone. In 6 of these cases electron microscopy was also done and confirmed the findings. In contrast, no specific findings due to HES deposits could be detected by conventional histology. CONCLUSIONS If specific HES deposits are found in toluidine blue-stained, glycide ether-embedded semithin sections, electron microscopy is not required.
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Affiliation(s)
- Stefanie Kamann
- Clinic and Polyclinic for Dermatology and Allergology, Ludwig-Maximilian University, Munich, Germany.
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Kamann S, Flaig MJ, Korting HC. Hydroxyäthylstärke-induzierter Juckreiz - Relevanz der lichtmikroskopischen Untersuchung von Semidünnschnitten und der Elektronenmikroskopie. J Dtsch Dermatol Ges 2007. [DOI: 10.1111/j.1610-0387.2007.06239_supp.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 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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Rerinck H, Kamann S, Wollenberg A. Lymphocyte Response Pattern of Eczema Herpeticum Patients to Herpes Simplex Virus Antigen. J Allergy Clin Immunol 2007. [DOI: 10.1016/j.jaci.2006.12.155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Kamann S, Ruzicka T. Outside-Inside oder Inside-Outside? Hautarzt 2007; 58:72-6. [PMID: 17160535 DOI: 10.1007/s00105-006-1259-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- S Kamann
- Klinik und Poliklinik für Dermatologie und Allergologie, Ludwig-Maximilians-Universität München, Frauenlobstrasse 9-11, 80337, München, Germany.
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Abstract
Omeprazole is a proton pump inhibitor which reduces both basal and stimulated gastric acid secretion by inhibiting the parietal cell enzyme H(+)-K(+)-adenosine triphosphatase. Typical adverse effects of proton pump inhibitors are nausea, diarrhea, constipation and endocrinologic abnormalities such as gynecomastia. Cutaneous side effects are rare but may include contact dermatitis, lichenoid eruption, leukocytoclastic vasculitis or toxic epidermal necrolysis; anaphylaxis is rare. We identified omeprazole as the causative agent by oral challenge test in a patient who had developed anaphylaxis while taking several drugs.
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Affiliation(s)
- S Kamann
- Klinik und Poliklinik für Dermatologie und Allergologie, Ludwig-Maximilians-Universität, München, Germany.
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Abstract
Eczema herpeticum is an acute, disseminated herpes simplex virus infection which remains a feared complication of eczematous skin diseases, especially atopic dermatitis. The vesicular and erosive clinical picture is often accompanied by systemic signs and symptoms. Why some atopic patients experience multiple attacks of eczema herpeticum and others never have the disorder remains a mystery. Patients with severe or untreated atopic dermatitis are more likely to be affected. The pathogenesis appears to involve a complex interplay of factors, including demasking of binding sites for the virus through the dermatitis, failure to up-regulate antiviral proteins and a lack of plasmacytoid dendritic cells. Treatment of choice is systemic acyclovir therapy.
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Affiliation(s)
- H C Rerinck
- Klinik und Poliklinik für Dermatologie und Allergologie, Ludwig-Maximilians-Universität München, Frauenlobstrasse 9-11, 80337 München
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