Abstract
BackgroundThe prevalence of lanolin contact allergy in dermatitis patients varies from 1.2% to 6.9%. Different lanolin derivatives are used in patch testing.ObjectivesTo determine which combination of lanolin derivatives is most effective in patch testing for the diagnosis of lanolin contact allergy.MethodsA retrospective analysis of patients patch tested between 2016 and 2017 was performed. Patients were eligible if they had been tested with lanolin alcohol 30% pet., Amerchol L101 50% pet., and a supplementary series containing other lanolin derivatives. Lanolin alcohol and Amerchol L101 were tested in duplicate.ResultsOf 594 patients, 28.6% (95% confidence interval [CI]: 25.1%‐32.3%) had a positive patch test reaction to at least one lanolin derivative. Reactions to lanolin alcohol (14.7%, 95%CI: 11.3%‐18.2%) and Amerchol L101 (15.0%, 95%CI: 11.5%‐18.5%) were common in the routinely tested series. Reactions to other test preparations were significantly less frequent (P < 0.05). The addition of Amerchol L101 to lanolin alcohol significantly increased the number of positive cases (odds ratio 1.79, P < 0.001).ConclusionsThe combination of lanolin alcohol and Amerchol L101 is effective in patch testing for the diagnosis of lanolin contact allergy. Routinely testing with other lanolin derivatives may not be worthwhile, as it detects only a few additional patients.
Highlights
Lanolin is a complex mixture of sterols, fatty alcohols and fatty acids with a varying composition.[1]
Patients with atopic dermatitis were more likely to have lanolin contact allergy (P = 0.008, odds ratio [OR] 1.75, 95%CI: 1.16-2.63), and patients with aged ≥40 years were less likely to have lanolin contact allergy (P = 0.007, OR 0.57, 95%CI: 0.38-0.86)
The supplementary tested series were significantly associated with lanolin contact allergy (P = 0.002) (Table 3)
Summary
Lanolin is a complex mixture of sterols (wool wax alcohols), fatty alcohols and fatty acids with a varying composition.[1]. Is the standard patch test agent for diagnosing lanolin contact allergy, and has been included in the European baseline series (EBS) since 1969.1,2,6,11 supplementary patch testing with other lanolin derivatives seems to improve the identification of lanolin-sensitive patients.[2,10,12] Particular attention is being payed to Amerchol L101 50% pet., which is a mixture of 10% lanolin alcohols and mineral oil.[7,11] Several studies reported more reactions to Amerchol L101 than to lanolin alcohol.[2,10,11,13] in a recent multicentre study,[13] a group of 79 969 patients were simultaneously tested with both lanolin alcohol and Amerchol L101: more patients reacted only to Amerchol L101 (2.05%) than only to lanolin alcohol (1.19%) (P < 0.001) This raises the question of which lanolin products (eg, acetylated lanolin, hydrogenated lanolin, or ointments such as Eucerin) may be used as patch test preparations. Testing with other lanolin derivatives may not be worthwhile, as it detects only a few additional patients
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