Cross-reactions among hair dye allergens

Abstract

Background: p-Phenylenediamine (PPD) is an important hair dye allergen, but there remains a reasonable suspicion that other hair dye chemicals may also be responsible for a proportion of the clinical burden of hair dye allergy. Objective: To assess to what extent presently assessed additional patch test agents contribute to the diagnosis of non-PPD hair dye allergy. Methods: A retrospective analysis was conducted of patch test results with hair dye allergens, focusing on the extent to which patients who were positive for allergic reactions to other hair dye allergens also had a concomitant positive reaction to PPD. Results: For the hair dye allergens other than p-toluenediamine (PTD), reactions in the absence of a concomitant positive reaction to PPD were very rare. Positive reactors to PTD were also positive for reactions to PPD in 5 of every 6 cases. Pyrogallol positives often occurred in the absence of a PPD positive, but were never judged to be of clinical relevance. Conclusions: Hair dye chemicals other than PPD may be of importance, but the presently tested materials, with the possible exception of PTD, are normally positive only when a PPD-positive reaction is also present, suggesting that their use in patch testing in hair dye allergy is likely to be of limited value.