Abstract
Chemical allergy is of considerable importance to the toxicologist, who, amongst other things, has the responsibility of identifying and characterizing the skin (and respiratory) sensitizing potential of chemicals, and estimating the risk they pose to human health. Allergic contact dermatitis (ACD) is to a large extent a preventable disease. Although quantitative risk assessment (QRA) for contact allergy can be performed, it is reasonable to ask why the burden of the skin disease ACD appears to remain stubbornly high, and in particular, that the general level of ACD to sensitizing ingredients found in cosmetics has not fallen noticeably over recent decades; some could argue that it has increased. In this review, this conundrum is addressed, considering whether and to what extent the prevalence of cosmetic allergy is truly unchanged, whether the predicted test methods and potency estimations are sufficiently precise and how proposed changes to the QRA process (i.e., cumulative exposure) may ameliorate the situation. Improved and more widespread use of risk assessment, better education of risk assessors, better post-marketing surveillance and monitoring of dermatology clinic feedback to improve QRA, all together could help to “make contact allergy history”.
Highlights
At the core of toxicology lies the underlying premise that it is the dose that makes the poison, the original concept being attributed to Paracelsus or Philippus Aureolus Theophrastus Bombastus von Hohenheim [1]
Against this background must be set the reality that in vivo methods for the predictive identification of skin sensitizers have been available for many decades [5,6]. These methods are rightly regarded as generally predictive of human hazard [7,8] and for approaching 20 years, the lead method, the local lymph node assay (LLNA) has delivered information on the relative potency of identified skin sensitizers [9,10,11,12,13]. This information has been combined with information on human exposure in a process termed quantitative risk assessment (QRA) [14,15,16,17]
Allergic Contact Dermatitis to Cosmetic Ingredients. Other contributors to this Special Issue of the journal will provide much greater detail on the topic of those ingredients in cosmetics which are most commonly associated with the causation of contact allergy and allergic contact dermatitis (ACD), so these will not be reiterated here
Summary
At the core of toxicology lies the underlying premise that it is the dose that makes the poison, the original concept being attributed to Paracelsus or Philippus Aureolus Theophrastus Bombastus von Hohenheim [1]. It is important to recognize that skin sensitizers vary widely in their relative potency, with the consequence that the paradigms might better be represented as “risk = hazard (potency) ˆ exposure” Against this background must be set the reality that in vivo methods for the predictive identification of skin sensitizers have been available for many decades [5,6]. These methods are rightly regarded as generally predictive of human hazard [7,8] and for approaching 20 years, the lead method, the local lymph node assay (LLNA) has delivered information on the relative potency of identified skin sensitizers [9,10,11,12,13] This information has been combined with information on human exposure in a process termed quantitative risk assessment (QRA) [14,15,16,17]. Attention is given to the importance of monitoring the impact of improvements to risk assessment and risk management via the day-to-day assessment of contact allergy undertaken by dermatologists performing diagnostic patch testing in their clinics [18]
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