Allergen Research Articles

The use of carvone in consecutive patch testing.

Carvone (l-carvone) is a mint-tasting flavour additive that most of us is exposed to and can cause allergic contact reactions. To analyse the frequency and the relevance of positive carvone reactions in a dermatitis population. A retrospective analysis of dermatitis patients consecutively tested with carvone from 2017 to 2021. Data were retrieved from the department's patch-test database. Of 3554 patients tested with carvone, 28 (0.79%) had a positive reaction. Carvone-positive patients had higher mean age, were significantly more likely female (p< 0.001) and had often an intraoral/lip involvement (p< 0.001). In the carvone-positive group, 50% (n= 14) had a relevant reaction, and in 4 of 14, the relevance was first revealed after test reading. Of the carvone-positive patients, 18 of 28 did not have a coexisting allergy to a fragrance/flavour allergen and of these 44% had a relevant allergy. The study suggests that a significant fraction of relevant carvone contact allergies may be overlooked if the allergen is not tested. Furthermore, as the exposure is widespread, inclusion of carvone in the Swedish baseline series may be justified even if the contact allergy prevalence is below 1%.

Popular sunscreens marketed to individuals with skin of color: Cost, marketing claims, and allergenic ingredients

There is increasing awareness of the negative effects of ultraviolet (UV) light in individuals with skin of color (SOC), especially in regards to pigmentation disorders induced and/or exacerbated by UV exposure.1 As a result, there has been a surge in sunscreens marketed to this population. We aimed to characterize cost, marketing claims, and potential allergenic ingredients in sunscreens marketed to individuals with SOC. Sunscreens were identified on Google Search via internet search terms: "sunscreen" plus "skin of color," "dark skin," "brown skin" "LatinX skin" and/or "black skin" (December 2021, October 2022). Price, marketing claims, and ingredients were extracted from manufacturers' websites. Potential allergens were defined based on the American Contact Dermatitis Society (ACDS) 2020 Core series (90 allergens, includes benzophenone-3/4). Cross-reactors/synonyms were combined into allergen categories based on ACDS Contact Allergen Management Plan (CAMP) cross-reactor classification (contactderm.org/camp); if multiple ingredients in a sunscreen were represented by a single allergen category, it was counted only once. A similar approach was utilized for marketing categories. Cost and Claims, Twelve sunscreens were identified. Average cost was $19.30/oz (range: $6.33-$50.00, SD=$11.35). Common claims were "no white cast" (91.7%), being free of an ingredient (83.3%), and "moisturizing" (75.0%) (Table 1). More than half of sunscreens (58.3%, 7/12) contained a chemical sunscreen agent. Five (41.7%) sunscreens contained a physical UV-blocker. All identified sunscreens contained at least one allergen (Table 2). Average number of allergens per product was 4.7 (range from 1-8). The most common allergens were fragrance/botanicals (83.3%), tocopherol (83.3%), sodium benzoates/derivatives (58.3%), and sorbitan sesquiolate/derivatives (58.3%). Average cost of sunscreens marketed to individuals with SOC was $19.30/oz, much higher than the median price of $3.32/oz reported in a separate study of 65 popular sunscreens.2 As many of the sunscreens in our study were sold by smaller businesses, higher prices may be due to higher production costs or a perceived smaller market.

Potential Allergens in Wound Care Products.

Patients with chronic wounds have an increased risk of developing allergic contact dermatitis (ACD). Reports of ACD to wound care products are not uncommon. To minimize contact sensitization in patients with chronic wounds, allergenic ingredients should be avoided when possible. With more than 5000 wound care products available in the United States, it is essential to understand which products can be chosen to minimize allergen exposures. Ingredients in wound care products in 5 wound care clinics across 2 institutions were cross-referenced with the American Contact Dermatitis Society core allergen series 2020. Of the 267 wound care products included, 97 (36.3%) contained at least one allergen, including 31 dressings/wraps (22.3%), 25 medications (69.4%), 12 cleaning supplies (36.3%), 16 tapes/glues (80%), 2 instruments (14.3%), 8 emollients and vehicles (61.5%), 1 ostomy product (11.1%), and 2 odor-eliminating products (66.7%). Thirty-four different allergens were identified across all products. The most common allergens present in the included items were acrylates and propylene glycol, followed by parabens, cetyl stearyl alcohol, tocopherol, fragrance, and phenoxyethanol. Many wound care products contain at least one contact allergen, highlighting the importance of clinician education on ACD in the context of wound care product selection.

Chronic actinic dermatitis: A 5-year clinical analysis of 488 patients in China.

Chronic actinic dermatitis (CAD) is a spectrum of diseases with chronic photosensitivity occurring mostly among middle-aged and older men. We seek to explore the characteristics and pathogenesis of CAD among the Chinese population. The medical records of 488 CAD cases diagnosed by phototesting at Huashan Hospital, Fudan University from January 2014 to December 2018 were analyzed retrospectively. Among the 488 patients, 344 were male and 144 were female. 84.8% of the cases were over 40 years old at the age of onset, while the remaining with an early age of onset had a prevalence of atopic history of 21.6%. Up to 45.0% of the patients reported excessive sun exposure and outdoor activities before the initiation of symptoms. The typical skin lesions were erythema, papules and plaques laid predominantly in sun-exposed areas. 42.8% of the cases showed sensitivity to UVB only, 20.7% were both sensitive to UVA and UVB, and 18.2% had UVA sensitivity only. The most predominant photoallergens were chlorpromazine (80.1%), thimerosal (17.2%), potassium dichromate (12.7%), etc. The most prevalent patch test allergens were potassium dichromate (24.4%), thimerosal (20.5%), formaldehyde (16.8%), etc. CONCLUSIONS: CAD was more commonly seen in males over 40 years old. The action spectrum of Chinese patients is primarily in the UVB range. Exposure to excessive sunlight or contact allergens and photoallergens are important risk factors. Photobiology tests are essential in detecting photosensitivity and recognizing potential photosensitizers. Early avoidance of confirmed photoallergens and sun exposure may prevent photosensitive reactions from progressing into persistent photosensitivity.

Alkil glükozid szenzibilizáció – a környezetbarát termékek veszélyei Ajánlás a magyar környezeti standard sorba történő beemelésre

Alkyl glucosides are compounds with cleaning, foaming, and emulsifying properties. They have become increasingly popular in recent years due to their environmentally- friendly features. They are mainly used in products for environmentally conscious consumers. Alkyl glucosides are present in 10% of products according to the Contact Allergen Management Program (CAMP) database. They are present in shower gels, soaps, shampoos, sunscreens, detergents, hair dyes, perfumes, and deodorants. They are also found in wipes for newborns and infants, so there is a risk of early sensitization. Their presence has also been described in foam wound dressings and antimicrobial foam dressings. Their importance is highlighted by the fact that in 2017, the American Contact Dermatitis Society (ACDS) named alkyl glucosides as „allergens of the year”. The present article describes the frequency and characteristics of decyl glucoside and lauryl glucoside sensitization in patients patch tested between 2018 and 2021 at the Department of Dermatology, Venereology, and Dermatooncology of the Semmelweis University. From January 2018 to December 2021, a total of 1160 patients were patch tested and 30 patients (2,59%) had a positive reaction to at least one of the alkyl glucosides. 7 patients were sensitized only to decyl glucoside, 10 patients only to a lauryl glucoside, and 13 patients to both alkyl glucosides. 56.67% of the alkyl glucoside sensitized patients were female, and 26.67 - 26.67% were in the age group 20- 29 years and 60-69 years. Patients sensitized with alkyl glucoside most commonly had allergic contact dermatitis symptoms all over the body, on the face, and hands. The positive patch test reactions occurred mainly in the 72. hour. The most common co-sensitizations were methylisothiazolinone (MI) and nickel (II) sulfate. 30% of the alkyl glucoside sensitized patients had a history of atopic dermatitis. According to our results, we recommend the inclusion of decyl glucoside and lauryl glucoside in the Hungarian standard patch test series.

Prevalence of Contact Allergens in Natural Skin Care Products From US Commercial Retailers

This quality improvement study assesses the prevalence of contact allergens in personal care products classified as clean or natural among 3 national retailers in the US.

Identification of Allergenic Proteins in Velvet Mesquite (Prosopis velutina) Pollen: An Immunoproteomics Approach.

Velvet mesquite (Prosopis velutina) is a native legume of the southwestern United States and northwestern Mexico, contributing significantly to the desert ecosystem and playing key ecological roles. It is also an important cause of allergic respiratory disease widely distributed in the Sonoran, Chihuahuan, and Mojave Deserts. However, no allergens from velvet mesquite pollen have been identified to date. Pollen proteins were extracted and analyzed by one- and two-dimensional electrophoresis and immunoblotting using a pool of 11 sera from mesquite-sensitive patients as the primary antibody. IgE-recognized protein spots were identified by mass spectrometry and bioinformatics analysis. Twenty-four unique proteins, including proteins well known as pollen, food, airway, or contact allergens and four proteins not previously reported as pollen allergens, were identified. This is the first report on allergenic proteins in velvet mesquite pollen. These findings will contribute to the development of specific diagnosis and treatment of mesquite pollen allergy.

Contact Allergy in the Elderly: A Study of 600 Patients.

The proportion of elderly in the general population is increasing. Ageing of the skin and immune system can modify the features of contact hypersensitivity (CH). The number of epidemiological studies according to the age-related features of CH is very limited. We aimed to analyse the clinical characteristics of CH in an elderly patient population. A total of 600 patients (patient age > 60 years old) were patch tested with the European Environmental Baseline Series (EEBS) and 440 of them with the Complementary Fragrance Series (CFS) at the same time according to the actual international methodological standards in the Allergy Outpatient Unit of Department of Dermatology, Venereology and Dermato-Oncology of Semmelweis University between 2015–2019. Out of 600 tested patients, 54.8% had at least one allergen positivity. Female predominance was observed (78.7%). The most common diagnosis was contact dermatitis (63.7%), followed by psoriasis (6.2%). Most of the cases (58.0%) were found in the age group of 60–69. The five most common contact allergens were benzoic acid, methylisothiazolinone (MI), wood tar, nickel, and balsam of Peru. Allergic skin symptoms are present in all ages and also in the elderly. According to our data, the most common contact allergens are preservatives, followed by balsam of Peru among men and nickel among women. In case of contact dermatitis, stasis dermatitis, rosacea, and atopic dermatitis are worth patch testing to verify CH even in those above 60 years old.

Allergen Composition, Marketing Claims, and Affordability of Pediatric Sunscreens.

Childhood sun exposure is associated with development of future skin cancers. Sunscreens are an important tool to prevent harmful ultraviolet rays. The aims of the study are to evaluate sunscreens targeted to children and to analyze cost, marketing claims, ingredients, and allergens to help consumers select products. The top 50 pediatric sunscreens across retailers were analyzed for their cost, marketing claims, ingredients, vehicles, and containers. Ingredients were compared with the American Contact Dermatology Society 2020 Core Allergen List. The mean price was $6.20 per ounce (range, $0.25-$39.98). The mean sun protection factor was 48.5 (range, 30-100; SD, 48.5). There was a mean of 17.5 ingredients and a mean of 1.1 allergens in products. On average, products marketed as "sensitive skin" were not only significantly more expensive ($8.90 vs $3.50 per ounce, P = 0.01) but also were significantly more likely to not contain any allergens (36.0%, n = 18 vs 12%, n = 6; P = 0.05). Products with mineral-only UV blockers were significantly less likely to have any allergen when compared with products that had chemical UV blockers (5.6%, n = 1 vs 94.4%, n = 17; P = 0.02). The current market of pediatric sunscreens varies significantly in price, marketing claims, and active ingredients. Products marked as suitable for sensitive skin had significantly fewer allergens, but a majority of these products still had at least one allergen. Many sunscreens contain contact allergens, which is an important selection consideration.

The Patient Perspective: The Everyday Hazards of Fragrance Allergy.

To the Editor: In the US, 3.5% of the population has allergic contact dermatitis to fragrance.1 Based on the North American Contact Dermatitis Group data, fragrances were the fourth most common allergen.2 It can be difficult to avoid fragrance, which are virtually ubiquitous in everyday products. Even products labeled as “unscented” or “fragrance-free” may still contain a fragrance. The Contact Allergen Management Program contains a list of fragrance-free products, but it is not comprehensive. Fragrance are also one of the most common causes of airborne contact dermatitis. However, patients have limited control over, or knowledge of, the products used in public environments. Experts have proposed using barrier creams that might prevent airborne allergens from contacting skin, but there have not been formal studies demonstrating their efficacy.3 Fragrance can restrict individuals from accessing the most necessary of locations, such as public restrooms. The pervasiveness of airborne fragrances in public can necessitate meticulous planning for each outing, and new places are even more of a challenge. “Every time I go to a new location, I have to inquire what products are used,” explained Ms Brodd, a patient with allergic contact dermatitis. “Sometimes, there are power dynamics in play, such as in the workplace, and I end up having to deal with my reaction.” Similarly, Ms Ault and a friend recently encountered difficulties with newly installed fragrance machines at a health club chain. The chain's leadership and the fragrance company provided similar statements that the fragrances are “safe” because their fragrance suppliers are part of the International Fragrance Association. The International Fragrance Association is a self-regulatory global representative body of the fragrance industry. Even with assistance from her dermatologist, the general manager of the club only agreed to unplug the scent machine 15 minutes before Ault's arrival. Is this a violation of the US Americans with Disabilities Act (ADA)? The ADA defines disability as “a physical or mental impairment that substantially limits 1 or more major life activities of such individual.”4 These major life activities can include caring for oneself, concentrating, and working. The ADA prohibits discrimination based on disabilities in employment, public services, and privately owned public accommodations. However, receiving a reasonable accommodation due to their disability is challenging for individuals with fragrance allergy. The solution may not be found in the courts, but in developing fragrance-free policies, which have started to gain momentum in businesses and institutions. A fragrance-free policy may be an equitable option for a business with a patron who has a fragrance allergy. The Centers for Disease Control and Prevention has prohibited fragranced products in “all interior space owned, rented, or leased” by the Centers for Disease Control and Prevention since 2009.5 The Canadian Centre for Occupational Health and Safety provides useful fact sheets on how to implement scent-free policies.6 Steps to consider include the following: conducting an employee survey to assess the issue, creating a representative committee to draft a policy, providing education to all employees about the reasoning behind the policy, addressing concerns honestly, and being open to revision. Guidelines should stress that this policy applies to everyone and that fragrance-containing products are not limited to perfume and cologne. Other useful tips include posting a list of approved unscented products, reviewing ingredients of products used by your organization, and placing policy statement notices in visible areas. Malina Yamashita Peterson, BS Department of Dermatology Park Nicollet Health Services Minneapolis, MN University of Minnesota Medical School Minneapolis [email protected]Michelle Xiong, BS Department of Dermatology Park Nicollet Health Services Minneapolis, MN Warren Alpert Medical School of Brown University Providence, RIMelanie Ault, BA, JD, MAPA, CAPALiz Brodd, BSKristi Harvey, BSN, RNHeather Meng, MA, BS, BA Contact Dermatitis Discussion Group Participant and AdvocateSara Hylwa, MD Department of Dermatology Park Nicollet Health Services Minneapolis, MN Department of Dermatology University of Minnesota Minneapolis

Topical Application of Metal Allergens Induces Changes to Lipid Composition of Human Skin.

Lipids are an important constituent of skin and are known to be modified in many skin diseases including psoriasis and atopic dermatitis. The direct effects of common metallic contact allergens on the lipid composition of skin has never been investigated, to the best of our knowledge. We describe skin lipid profiles in the stratum corneum and viable epidermis of ex vivo human skin from a female donor upon exposure to three metal allergens (nickel, cobalt and chromium) visualised using time-of-flight secondary ion mass spectrometry (ToF-SIMS), which allows for simultaneous visualisation of both the allergen and skin components such as lipids. Multivariate analysis using partial least squares discriminant analysis (PLS-DA) indicated that the lipid profile of metal-treated skin was different to non-treated skin. Analysis of individual ions led to the discovery that cobalt and chromium induced increases in the content of diacylglycerols (DAG) in stratum corneum. Cobalt also induced increases in cholesterol in both the stratum corneum and viable epidermis, as well as monoacylglycerols (MAG) in the viable epidermis. Chromium caused an increase in DAG in viable epidermis in addition to the stratum corneum. In contrast, nickel decreased MAG and DAG levels in viable epidermis. Our results indicate that skin lipid content is likely to be altered upon topical exposure to metals. This discovery has potential implications for the molecular mechanisms by which contact allergens cause skin sensitization.

The additive value of patch testing non-commercial test substances and patients' own products in a clinic of occupational dermatology.

Commercial patch test substances do not cover all occupational contact allergens. Workplace materials and in-house test substances are tested to complement the investigation of occupational skin disease (OSD). To quantify the additional value of testing workplace materials and non-commercial in-house test substances in the diagnosis of OSD. Patients files of 544 patients patch tested at the Finnish Institute of Occupational Health in 2015-2019 were reviewed for occupation, diagnoses and patch test results. OSD was diagnosed in 353 (64.9%) of the patients. A total of 206 (37.9%) patients had occupational allergic contact dermatitis (OACD). In 19 (3.5%) patients, the only clues to the diagnoses of OACD were positive reactions to workplace materials, and in 20 (3.7%) patients, the diagnosis of OACD was based on commercially unavailable test substances. In 167 OACD cases diagnosed by commercial test substances, additional causes were found in 17 by testing patients' own and non-commercial test substances. In 43 (7.9%) cases, positive reactions to workplace materials reinforced diagnoses based on commercial test substances. The overall additive value of testing own products was 16.7% (91 cases). We would have missed 39 (18.9%) of our 206 OACD cases if we had solely used commercial test substances.

Patch testing results in adult patients with dermatitis during the coronavirus disease 2019 pandemic

Allergic contact dermatitis (ACD) represents a delayed hypersensitivity reaction to a contact allergen with variable presentations, including erythema, vesiculation, or lichenification, depending on the allergen, exposure, and chronicity. Patch testing (PT) is the reference standard for identifying contact allergens implicated in ACD. Among the general adult population, ACD has a prevalence of approximately 21%.1 Positive PT reactions in the evaluation of occupational ACD occur in up to 25% to 36% of health care workers (HCWs).

Patch testing with the European baseline series and 10 added allergens: Single-centre study of 748 patients.

The European baseline series (EBS) of contact allergens is subject to change. An allergen is considered for inclusion when routine patch testing of patients with suspected contact dermatitis results in ≥0.5% prevalence rate. We aimed to determine the frequency of sensitizations to 30 EBS allergens and 10 locally added allergens. Additionally, we assessed the strength and evolution of reactions to all tested allergens and co-reactivity of additional allergens. Patch testing with our baseline series of 40 allergens was done in 748 consecutive adults. Tests were applied to the upper back and removed by patients after 48 h. Readings were done on Day 3 (D3) and D6 or D7 (D6/7). Positive reactions fulfilled the criteria of at least one plus (+) reaction. A retrospective analysis was done. Eight allergens not listed in the EBS had ≥0.5% prevalence rate (i.e., cocamidopropyl betaine, thiomersal, disperse blue mix 106/124, 2-bromo-2-nitropropane-1,3-diol, diazolidinyl urea, propylene glycol, Compositae mix II and dexamethasone-21-phosphate), and 16.6% of positive reactions would have been missed without D6/7 readings. We propose further studies to evaluate whether cocamidopropyl betaine, disperse blue mix 106/124, 2-bromo-2-nitropropane-1,3-diol, diazolidinyl urea and Compositae mix II need to be added to the EBS.

CD17: Ironing water: an under‐recognized source of contact allergens

CD17: Ironing water: an under‐recognized source of contact allergens

Hypertrophic plaques on the vulva

An otherwise healthy woman in her 40s presented with a 2-year history of itching of the vulva. She had been diagnosed with dermatitis and prescribed topical corticosteroids, but to little effect. She denied high-risk sexual contacts or exposure to potential contact allergens. Physical examination revealed well-demarcated white-red and hypertrophic plaques, with scattered dotlike erosions. As shown in Figure 1, vulvar skin changes were visualized as the patient retracted the surrounding tissues. Histopathologic examination revealed a proliferation of Paget cells within the surface squamous epithelium (Figure 2), with the Paget cells displaying positive staining for carcinoembryonic antigen and cytokeratin (CK) 7, and negative staining for AE1/AE3, CK20, and melan-A.

Heat Shock Protein 90's Mechanistic Role in Contact Hypersensitivity.

Despite the known dangers of contact allergens and their long-lasting use as models in immunology, their molecular mode of action largely remains unknown. In this study, we report that a contact allergen, 1-chloro-2,4-dinitrobenzene (DNCB), elicits contact hypersensitivity through binding the protein we identify. Starting from an unbiased sampling of proteomics, we found nine candidate proteins with unique DNCB-modified peptide fragments. More than half of these fragments belonged to heat shock protein 90 (HSP90), a common stress-response protein and a damage-associated molecular pattern, and showed the highest probability of incidence. Inhibition and short hairpin RNA knockdown of HSP90 in human monocyte cell line THP-1 suppressed the potency of DNCB by >80%. Next, we successfully reduced DNCB-induced contact hypersensitivity in HSP90-knockout mice, which confirmed our findings. Finally, we hypothesized that DNCB-modified HSP90 activates the immune cells through HSP90's receptor, CD91. Pretreatment of CD91 in THP-1 cell lines and BALB/c mice attenuated the potency of DNCB, consistent with the result of HSP90-knockout mice. Altogether, our data show that DNCB-HSP90 binding plays a role in mediating DNCB-induced contact hypersensitivity, and the activation of CD91 by DNCB-modified HSP90 proteins could mediate this process.

Contact Allergens in Over-the-Counter Topical Antihistamine and Mast Cell Stabilizer Ophthalmic Agents.

Contact Allergens in Over-the-Counter Topical Antihistamine and Mast Cell Stabilizer Ophthalmic Agents.

Detection of the peripheral blood antigens and clinical value in recurrent aphthous ulcer: A cross-section study

Recurrent aphthous ulcer (RAU) is one of the most common diseases of oral mucosa, which is generally believed to be related to immunity, though the etiology is still unclear. It is suspected that allergies are directly related to RAU. So we sought to explore the relationship between hypersensitivity and RAU. 40 RAU patients who were in ulceration period and 40 people who were in good health were selected from Jan 2016 to Feb 2017, matched in age and sex. The peripheral blood antigens of 40 RAU patients and 40 healthy people was tested, and serum specific IgE (sIgE) with 6 groups of antigens and total IgE (tIgE) analysis was performed to identify IgE-mediated allergic reaction possibly affecting RAU. We then investigated the food intolerance and IgG levels to discover the correlation between non-IgE mediated allergic reaction and RAU. The positive cases and rate of sIgE in RAU group was higher than that of control, but the difference was not statistically significant (P＞0.05). Positive grade of animal fur scraps (EX1), house dust mixed (HX2) and the serum tIgE concentration of the RAU group were significantly higher than the control group (P＜0.05).The number of food intolerance in RAU group was significantly higher than that in control group (P＜0.05). Our findings suggested certain correlation between RAU and anaphylaxis. Daily contact allergens and food intolerance may be one of the causes of RAU. Moreover, this provides reference value for clinical diagnosis and treatment.

Preclinical Efficacy of a Capsid Virus-like Particle-Based Vaccine Targeting IL-1β for Treatment of Allergic Contact Dermatitis.

Hypersensitivity to a contact allergen is one of the most abundant forms of inflammatory skin disease. Today, more than 20% of the general population are sensitized to one or more contact allergens, making this disease an important healthcare issue, as re-exposure to the allergen can initiate the clinical disease termed allergic contact dermatitis (ACD). The current standard treatment using corticosteroids is effective, but it has side effects when used for longer periods. Therefore, there is a need for new alternative therapies for severe ACD. In this study, we used the versatile Tag/Catcher AP205 capsid virus-like particle (cVLP) vaccine platform to develop an IL-1β-targeted vaccine and to assess the immunogenicity and in vivo efficacy of the vaccine in a translational mouse model of ACD. We show that vaccination with cVLPs displaying full-length murine IL-1β elicits high titers of neutralizing antibodies, leading to a significant reduction in local IL-1β levels as well as clinical symptoms induced by treatment with 1-Fluoro-2,4-dinitrobenzene (DNFB). Moreover, we show that a single amino acid mutation in muIL-1β reduces the biological activity while maintaining the ability to induce neutralizing antibodies. Collectively, the data suggest that a cVLP-based vaccine displaying full-length IL-1β represents a promising vaccine candidate for use as an alternative treatment modality against severe ACD.