Octylisothiazolinone-A New Sensitizer in Over-Ear Headphones.

Octylisothiazolinone (OIT) is used as an antifungal agent by the leather industry. To show sensitization to OIT from leather, and to highlight the potential implications when cross-reactivity between OIT and methylisothiazolinone (MI) is studied. Two patients with allergic contact dermatitis caused by a leather belt and shoes, respectively, were patch tested with methylchloroisothiazolinone (MCI)/MI, MI, MCI, OIT, and benzisothiazolinone (BIT). High-performance liquid chromatography with ultraviolet detection (HPLC-UV) was used to detect isothiazolinone derivatives in leather goods. Additionally, files of OIT-sensitized patients, observed at the KU Leuven department during the period 1990-2015, were retrospectively analysed. Both patients had been primarily sensitized to OIT, but the diagnosis in one of them could be achieved only when a higher patch test concentration of OIT (1000 ppm pet.) was used. HPLC-UV confirmed the presence of OIT in their leather goods. Non-relevant sensitization to MI was noted in both cases. Four additional cases of OIT sensitization from leather could be retrieved from the KU Leuven database. Non-occupational sensitization to OIT from leather may occur. Patch test concentrations of >250 ppm pet. may be necessary for diagnosis, and to show cross-reactivity with MI. Safer use limits for OIT in the leather industry may be needed.

BACKGROUND AND OBJECTIVESContact allergy is associated with a significant morbidity all over the world. This study was performed to investigate the pattern of sensitization by contact allergens in the local population.DESIGN AND SETTINGRetrospective study to investigate patch test reactivity among patients with clinical diagnosis of contact dermatitis who were referred to the allergy clinic at the King Khalid University Hospital, Riyadh, between April 2008 and March 2010.PATIENTS AND METHODSOf the 196 patients referred to the allergy clinic over the 2-year period, 91 (46.4%) patients reacted to one or more patch test allergens, and these patients were included in this study. The study group included 82 (91.1%) of Saudi nationality and 9 (8.9%) patients of other nationalities. The patch test was performed using the T.R.U.E TEST, containing 24 allergens/allergen mixes.RESULTSOf the 91 cases who reacted positively to one or more allergens, 67 (73.6%) were females with a mean age of 37 (8.3 years) and 24 (26.4%) were males with a mean age of 34 (11.6 years). Thirty-three (36.2%) patients reacted to nickel sulfate, 14 (15.3%) to p-phenylenediamine, 13 (14.2%) to p-tert-butylphenol-formaldehyde resin, 13 (14.2%) to thimerosal, and 9 (9.8%) to colophony. Reactivity against the rest of the allergens was not remarkable. A significantly higher percentage of females reacted to nickel sulfate (84.8% vs 15.2% in males; P=.0001), p-tert-butylphenol-formaldehyde resin (92.3% vs 7.7%; P=.0001), and thimerosal (76.9% vs 23.1%; P=.03).CONCLUSIONSPatch test reactivity to nickel sulfate was high. The pattern of contact allergy observed in this study indicates the need for large-scale investigations to identify local allergens responsible for contact allergy and for formulation of policies directed towards avoidance of exposure.

Since the introduction of active vaccination against SARS-CoV-2 infection, there has been a debate about the risk of developing severe allergic or anaphylactic reactions among individuals with a history of allergy. Indeed, rare cases of severe allergic reactions have been reported in the United Kingdom and North America. By february 2021 a rate of 4,5 severe allergic reactions occurred among 1 million patients vaccinated with the mRNA-based COVID-19 vaccines, which is higher than the generally expected rate of severe allergic reactions to vaccinations of around 1 in 1 million.

Atopic dermatitis (AD) is a complex disease with elevated risk of respiratory comorbidities.1,2 Severely affected patients are often treated with immune-modulating systemic drugs.3,4 On March 11th 2020, the World Health Organization declared the 2019 novel coronavirus severe acute respiratory syndrome (SARS-Cov-2) epidemic to be a pandemic. The number of cases worldwide is increasing exponentially and poses a major health threat, especially for those who are elderly, immuno-compromised, or have comorbidities. This also applies to AD patients on systemic immune-modulating treatment. In these days of uncertainty, reallocation of medical resources, curfew, hoarding, and shutdown of normal social life, patients, caregivers and doctors ask questions regarding the continuation of systemic immune-modulating treatment of AD patients. The ETFAD decided to address some of these questions here.

Nickel allergy in the United States: A public health issue in need of a “nickel directive”

Allergic skin diseases

Contact DermatitisVolume 54, Issue 1 p. 71-71 Contact allergy to gold in patients with gold-plated intracoronary stents C. Svedman, C. Svedman Department of Occupational and Environmental Dermatology, Malmö University Hospital, S-20502, Malmó, SwedenSearch for more papers by this authorC. Tillman, C. Tillman Department of Occupational and Environmental Dermatology, Malmö University Hospital, S-20502, Malmó, SwedenSearch for more papers by this authorC. G. Gustavsson, C. G. Gustavsson Department of Occupational and Environmental Dermatology, Malmö University Hospital, S-20502, Malmó, SwedenSearch for more papers by this author H. Möller, H. Möller Department of Occupational and Environmental Dermatology, Malmö University Hospital, S-20502, Malmó, SwedenSearch for more papers by this authorB. Frennby, B. Frennby Department of Occupational and Environmental Dermatology, Malmö University Hospital, S-20502, Malmó, SwedenSearch for more papers by this authorM. Bruze, Corresponding Author M. Bruze Department of Occupational and Environmental Dermatology, Malmö University Hospital, S-20502, Malmó, SwedenCecilia Svedman Department of Occupational and Environmental Dermatology Malmó University Hospital S-20502, Malmö Sweden Tel: +464 033 7813 Fax: +464 336 213 e-mail: cecilia@svedman@sleane.seSearch for more papers by this author C. Svedman, C. Svedman Department of Occupational and Environmental Dermatology, Malmö University Hospital, S-20502, Malmó, SwedenSearch for more papers by this authorC. Tillman, C. Tillman Department of Occupational and Environmental Dermatology, Malmö University Hospital, S-20502, Malmó, SwedenSearch for more papers by this authorC. G. Gustavsson, C. G. Gustavsson Department of Occupational and Environmental Dermatology, Malmö University Hospital, S-20502, Malmó, SwedenSearch for more papers by this author H. Möller, H. Möller Department of Occupational and Environmental Dermatology, Malmö University Hospital, S-20502, Malmó, SwedenSearch for more papers by this authorB. Frennby, B. Frennby Department of Occupational and Environmental Dermatology, Malmö University Hospital, S-20502, Malmó, SwedenSearch for more papers by this authorM. Bruze, Corresponding Author M. Bruze Department of Occupational and Environmental Dermatology, Malmö University Hospital, S-20502, Malmó, SwedenCecilia Svedman Department of Occupational and Environmental Dermatology Malmó University Hospital S-20502, Malmö Sweden Tel: +464 033 7813 Fax: +464 336 213 e-mail: cecilia@svedman@sleane.seSearch for more papers by this author First published: 18 January 2006 https://doi.org/10.1111/j.0105-1873.2006.00737.xCitations: 1Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article.Citing Literature Volume54, Issue1January 2006Pages 71-71 RelatedInformation

Frequent use of methylchloroisothiazolinone/methylisothiazolinone (MCI/MI) and MI in cosmetic products has been the main cause of widespread sensitization and allergic contact dermatitis to these preservatives (biocides). Their use in non-cosmetic products is also an important source of sensitization. Less is known about sensitization rates and use of benzisothiazolinone (BIT), octylisothiazolinone (OIT), and dichlorooctylisothiazolinone (DCOIT), which have never been permitted in cosmetic products in Europe. BIT and OIT have occasionally been routinely patch-tested. These preservatives are often used together in chemical products and articles. In this study, we review the occurrence of contact allergy to MI, BIT, OIT, and DCOIT over time, based on concomitant patch testing in large studies, and case reports. We review EU legislations, and we discuss the role of industry, regulators, and dermatology in prevention of sensitization and protection of health. The frequency of contact allergy to MI, BIT, and OIT has increased. The frequency of contact allergy to DCOIT is not known because it has seldom been patch-tested. Label information on isothiazolinones in chemical products and articles, irrespective of concentration, is required for assessment of relevance, information to patients, and avoidance of exposure and allergic contact dermatitis.

Practical problems in the use of patch testing in the evaluation of patients with contact dermatitis

Arriving at a diagnosis of allergic contact dermatitis is a multistep procedure including the establishing of contact allergy, demonstration of current exposure to the sensitizer, and assessment of clinical relevance. Sometimes, these steps are easy to get through; at other times, there may be problems with every step. To demonstrate the possible difficulties and pitfalls in establishing the presence of contact allergy and diagnosing allergic contact dermatitis from exposure to the preservative methyldibromoglutaronitrile (MDBGN). Simultaneous patch-testing with petrolatum preparations of MDBGN at various concentrations, use testing, and chemical analysis with high-performance liquid chromatography (HPLC). Contact allergy to MDBGN was established in two cases, with MDBGN in petrolatum at 0.5%. Results of HPLC investigation of moisturizers used by the patients and yielding positive results on patch and use tests disagreed with the information about preservatives on the labels of the moisturizers and with the Material Safety Data Sheets (MSDSs). Patch testing with MDBGN in petrolatum at a concentration of less than 0.5% may fail to diagnose a clinically relevant contact allergy. The information on labels of products, on MSDSs, and from manufacturers may not be reliable, which indicates the need for chemical analyses.

Allergic contact dermatitis (ACD) is an important diagnostic consideration in the evaluation of patients presenting with vulval dermatoses. Although ACD coexisting with vulval dermatoses is uncommon, identifying and avoiding the allergens can have a positive impact on the management and quality of life of patients. The aim of this retrospective review of patch test data was to identify relevant allergens in patients presenting with vulval dermatoses in two specialist centres. Relevant data were extracted from electronic database and patch test departmental records between 2013 to 2023 from two specialist cutaneous allergy centres. Patch tests were performed in accordance with the International Contact Dermatitis Research Group and European Society of Contact Dermatitis guidelines. Patch test readings were performed on day 2 and day 4, and positive reactions were recorded. In total, 155 female patients with a mean age of 53.4 years were referred for patch testing. Vulval pruritus (37.5%) and vulval eczema (29%) were the two most common presenting complaints for patch test referral. All patients were tested to the standard and anogenital series, and some to extra series including medicaments, cosmetic, plants, acrylates, hairdressing and own products, depending on clinical history. Multiple allergens were identified including metals, topical drugs, fragrances, preservatives, cosmetic constituents and rubber additives. The most common clinically relevant allergens were fragrances (27.4%), preservatives (18.5%), textile dyes (4.5%) and medicaments (2.5%). Interestingly, 9.6% of patients were tested to the acrylate series, but none had a positive reaction. Fragrance allergy was prevalent in patients with a history of vulval lichen planus and lichen sclerosus. Numerous products were implicated in causing the dermatosis, including sanitary pads, wipes, shower gels and topical medications. Overall, 76% of patients noticed improvement after avoidance of relevant allergens. Patients with chronic vulval dermatoses are at increased risk of ACD and should be assessed for possible contact dermatitis. Patch testing is required to identify relevant contact allergens, the most common of which from our cohort include fragrances, preservatives, textile dyes and medicaments. These results are comparable with previous results reported by Woodruff and Vandeweege (Woodruff CM, Trivedi MK, Botto N, Kornik R. Allergic contact dermatitis of the vulva. Dermatitis 2018; 29: 233–43; Vandeweege S, Debaena B, Lapeere H, Verstraelen H. A systematic review of allergic and irritant contact dermatitis of the vulva: the most important allergens/irritants and the role of patch testing. Contact Dermatitis 2023; 88: 249–62). Patient education and follow-up are essential in optimizing treatment and preventing recurrence of vulval ACD.

When allergen avoidance is not feasible, treatment options for allergic contact dermatitis (ACD) include topical and systemic corticosteroids, phototherapy, systemic immunosuppressants and immunomodulators.1 Positive reactions to patch testing can be maintained on dupilumab.2 The effects of systemic JAK inhibitors on treatment of ACD and results of patch testing are still uncertain. A 54-year-old male working as an industrial mechanic in a pulp and paper industry presented at the ACD clinic for patch testing. Medical history included severe dermatitis with vesiculobullous lesions of the hands and feet, prurigo-like lesions, and leg ulcers since 2016. He had no history of atopic dermatitis. Treatment with topical and systemic corticosteroids (up to 1.5 mg/kg/day for 6 months) as well as with cyclosporine (4 mg/kg/day for 8 months) were ineffective. Patient was started on dupilumab in January 2020, with partial improvement of dermatitis but with persistent leg ulcers. Baseline clinical parameters were as follows: DLQI = 24, EASI = 16.9 and BSA = 20%. Patch testing with the North American standard series, cosmetic, corticosteroid and medicament series (Chemotechnique) was performed under dupilumab. A diagnosis of ACD was made with polysensitization to multiple allergens found to have clinical relevance (Table 1; Figure 1A). The patient's severe dermatitis persisted despite dupilumab therapy and attempts to avoid contact allergens. Dupilumab was stopped 1 year after its initiation due to inefficacy. Topical treatments containing allergens were discontinued but complete avoidance of shoe and rubber allergens was difficult. The patient was then started on upadacitinib 15 mg/day (DLQI = 17; EASI = 16.2; BSA = 11%), which was increased to 30 mg/day 2 months later. Complete clearance of dermatitis was observed 1 month after increased dosage, without adverse effect. The patient was able to return to work on a full-time basis after being on sick leave related to his skin disease for the past 2 years. Patch testing was repeated with the North American standard series, cosmetic, corticosteroid, rubber and medicament series (Chemotechnique) 4 months after being on upadacitinib at 30 mg/day. Remarkably, all positive patch test reactions disappeared except for reactions to lanolin and fusidic acid which remained strongly positive (Table 1; Figure 1B). Upadacitinib and abrocitinib are selective JAK1 inhibitors approved for the treatment of atopic dermatitis. Their use in the treatment of severe ACD is off-label. To our knowledge, patch testing under JAK inhibitors was never reported previously. Our patient had proven ACD to the ‘core molecule’ of corticosteroids, lanolin, thiuram mix and 4-tert-butylphenolformaldehyde resin. Repeated patch testing under upadacitinib did not exhibit sensitization to corticosteroids, rubber accelerators, nor formaldehyde resin. Interestingly, the weakest reactions (1+) to allergens under dupilumab were also the ones that were not reproducible when patch tested under upadacitinib. Conversely, positive patch testing results with fusidic acid and lanolin were reproduced under upadacitinib. Our case shows that upadacitinib can induce false negative reactions when patch testing selected allergens as well as completely resolve ACD to those allergens, possibly indicating different pathophysiological ways for some allergens. Consequently, we hypothesize that corticosteroids, thiuram and 4-tert-butylphenol formaldehyde resin allergy to be mediated via the JAK pathway, while lanolin and fusidic acid allergy to be mediated via another pathway. These findings bring possible clinical insights and relevance to prior laboratory findings that showed biomarkers to differ in ACD versus irritant contact dermatitis, as well as between different allergens.3 Moreover, upadacitinib could be considered in the treatment of severe recalcitrant ACD when complete avoidance of some allergens, including corticosteroids, thiurams and 4-tert-butylphenol formaldehyde resin, is not possible. Laurence Mainville has no conflict of interest to declare. Marie-Claude Houle received speaker's fees from Sanofi. Hélène Veillette received speaker's fees from AbbVie, Janssen, Novartis, Sanofi Genzyme, Bausch Health and Sun Pharma. She worked on advisory committees (Novartis, Sandoz, Pfizer, Sanofi Genzyme, Sun Pharma and UCB), and contributed to clinical trials (Sanofi, GlaxoSmithKline, Bellus Health, AnaptysBio, Boehringer-Ingelheim, Abbvie and Moderna). Informed written consent was obtained regarding included images.

Several types of alopecia may be triggered by scalp allergic contact dermatitis (ACD) including telogen effluvium1 and scarring alopecia.2 We hereby describe an unusual case of alopecia areata (AA) activated by severe ACD to a permanent hair dye. A 24-year-old male patient with no personal/family history of autoimmune disease, but with a history of henna tattoo reaction at the age of 12, presented with acute exudative dermatitis on his scalp, ears and neck following the first self-application of a black-coloured hair dye. Two weeks later, he suddenly developed patchy non-scarring scalp and beard hair-loss compatible with AA. Hair re-growth was slowly achieved upon treatment with oral and topical corticosteroids, and topical minoxidil (Figure 1) within 5 months. Patch tests were performed 15 months after the ACD reaction with the Spanish Contact Dermatitis Research Group (GEIDAC) baseline series (TRUE Test, AllergEaze, SmartPractice), supplementary allergens (AllergEaze) and a hairdressing series (AllergEaze), on Finn Chamber (SmartPractice) occluded for 48 h. Scoring readings were conducted according to the European Society of Contact Dermatitis (ESCD) guidelines.3 We observed intense reactions to p-phenylenediamine (PPD), PPD-related substances, hydroquinone and pyrogallol (Table 1; Figure S1). Two years after the events of ACD and AA, the patient was subsequently diagnosed with multiple sclerosis (MS). No flare-ups of the AA were observed within an 8-year follow-up. The likelihood of sensitization to PPD through the exposure to temporary ‘black henna tattoos’ is high (2.5%)4 and ACD reactions elicited by PPD among patients sensitized this way are often severe. Concomitant reactions to other p-aminoaryl compounds are also more frequent among individuals sensitized to PPD through exposure to henna tattoos than among hairdressers or hair dye users.5 Our patient likely became sensitized to PPD in the ‘black henna tattoo’ as a child and rapidly developed intense ACD after the first use of a black hair dye many years later. Strong patch test reactions suggested severe sensitization to hair dye components. We observed severe sensitization to PPD-chemically-related compounds likely due to co-sensitization or cross-reactivity. AA is an autoimmune disease that targets hair follicles leading to inflammatory non-scarring hair loss. AA may improve at the areas involved by other dermatoses such as psoriasis or ACD, the latter being the basis for the immune therapy with potent allergens such as diphenylcyclopropenone (diphencyprone). This is explained by a Rënbok6, 7 (reverse Koebner) phenomenon, originally described in patients with AA and psoriasis,7 which reflects a competition between different T-cell populations leading to a switch in the local cytokine milieu. Conversely, the Koebner phenomenon has also been described to cause AA relapse, for example, after performing perilesional trichograms.8 There is one prior report on AA developing 2 weeks after the second self-application of a permanent hair dye.9 The patient noticed slight burning but no other reactions. A ‘use test’ on his arm with the dye as is performed by the patient 3 weeks thereafter, triggered intense contact dermatitis at his face, arm and hand as well as a worsening of scalp hair loss.9 The authors hypothesized that ‘irritation’ caused by the dye could have disrupted the normal hair follicle immune privilege increasing the risk of AA.9 We believe that another possible explanation is that the initially subtle burning reaction experienced by the patient was truly allergic, as in our patient. Hypothetically, interactions among overlapping inflammatory pathways underlying ACD and AA could have played a role in the AA elicitation in both cases. Interestingly, our patient was subsequently diagnosed with MS, which has rarely been described as a co-morbidity of AA. In predisposed individuals, MS may be diagnosed prior to or after AA.10 AA may also be triggered by alemtuzumab, a therapy used in MS. This case further illustrates a possible association between AA and MS. We believe ACD should be considered a trigger for AA in predisposed individuals. Interactions among inflammatory pathways may likely be involved. Maria-Elena Gatica-Ortega: Conceptualization; formal analysis; funding acquisition; investigation; methodology; supervision; validation; visualization; writing – review and editing; writing – original draft. Elena Vera-Iglesias: Investigation. Blas Gómez-Dorado: Investigation. Cristina Pérez-Hortet: Investigation. María Antonia Pastor-Nieto: Conceptualization; investigation; funding acquisition; writing – original draft; validation; visualization; methodology; writing – review and editing; formal analysis. The authors declare no conflict of interest. The authors obtained informed written consent from the patient for the photographs to be published. FIGURE S1 Patch tests with readings performed on day (D) D2 (A) and D4 (B). Strong reactions to p-phenylenediamine (PPD), p-aminodiphenylamine, p-aminophenol, toluene-2,5-diamine sulphate and o-nitro-p-phenylenediamine; moderate reactions to 3-aminophenol and hydroquinone; and, weak reactions to pyrogallol, N-isopropyl-N-phenyl-4-phenylenediamine, disperse Blue 106 and rubber mix. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

Allergic contact dermatitis (ACD) is often under-recognized in the pediatric population. In the first years of life ACD it is often confused with other types of dermatitis, such as irritant dermatitis or atopic eczema (AE). In the last two decades an increase in ACD in children and adolescents was observed, reaching similar frequencies to those seen in adults (20-70%). ACD acquired in childhood may have a significant impact for patients and their families, and may compromise decisions concerning occupation in adulthood. We conducted a retrospective review including all children and adolescents 18 years or younger with a suspected ACD, attending the Unit of Allergy and Department of Dermatology, University of Uruguay, over a 9-year period (January 1, 2004–June 30, 2013). Patch tested was performed with allergens from the International Standard Series and additional allergens reported to be frequent in children and others which were relevant to the clinical situation. One-hundred fifty-seven children and adolescents (61% females and 39% males) were patch tested. Twenty-three percent of them were 10 years or younger. Fifty-nine percent of the children and 53 percent of the adolescents tested positive to at least one allergen. Sixty percent of these reactions were deemed to be of current relevance, 16% have probable or possible relevance, 11% past relevance and 13% of all positive reactions were of unknown relevance. The most common allergens were nickel, neomycin, thimerosal, fragrance mix, cobalt and thiuram mix. Very few irritant reactions were seen and no active sensitization was observed. Contact sensitization is an important pathogenic factor for the development of dermatitis in children and adolescents. Patch testing should be utilized more frequently as a valuable diagnostic tool in the pediatric setting when the clinical presentation is suggestive of ACD.

Context: The true incidence of allergic contact dermatitis (ACD) in a society is very difficult to estimate since its diagnosis depends on several factors. Patch testing is a useful tool to detect the allergens and improve the quality of life. Aims: The study was undertaken to determine the clinical pattern of ACD and find the causative allergen using patch test at a Rural Tertiary Care Center. Settings and Design: A 1-year study of 60 patients suspected with ACD was carried out at the Department of Dermatology. Demographic variables, clinical history, and examination were carried out. Subjects and Methods: Patch testing was done after a week of subsidence of active eczema utilizing the Indian Standard Series containing 20 allergens. Results were read on 2 nd and 3 rd day. Grading of the reactions was done based on the International Contact Dermatitis Research Group guidelines. Statistical Analysis Used: Descriptive analysis was used. Results: Of 60 patients, 60% were males and 40% were females. The most common site affected was hand in 56.66% followed by head and neck in 33.33% and feet in 21.66%. Positive result to patch test was seen in 51.33% patients. The most common allergen was Parthenium in 23.33% patients followed by fragrance mix in 11.66% patients. Grade 1 positivity was seen in 73.91%, 17.39% showed grade 2, 7.24% showed grade 3, and only 1.44% showed grade 4 positive reaction. Conclusions: In this era of urbanization and cosmetics, it is very important to keep the provisional diagnosis of ACD in all suspected cases of eczema, and a patch testing should be recommended. It helps in saving healthcare resources and decreasing the financial burden. Such studies at a large scale will help in establishing the prevalence of particular allergen in that area and help in spreading awareness in the community.