Formaldehyde-allergic Patients Research Articles

Negative formaldehyde release from textiles washed with a formaldehyde-containing laundry soap according to manufacturer instructions: An application of chromotropic acid testing.

Formaldehyde is a common preservative used to prevent microbial growth in water. It can be found in personal care products and household cleaning products, including laundry detergents. Formaldehyde has frequently been recognised as a cause of allergic contact dermatitis, but whether it remains present in textiles washed with formaldehyde-containing laundry detergents is unknown. This study aimed to utilise the chromotropic acid method (CAM) to assess formaldehyde release from textiles washed with a laundry detergent known to contain formaldehyde. Textiles were laundered with a detergent containing calcium formate at four concentrations (0×, 0.5×, 1× and 5× the recommended amount per manufacturer label) and kept wet or allowed to dry. Select textiles were subjected to an additional rinse cycle. Textiles were then tested utilising the CAM. A sample of the pure laundry detergent was also tested using the CAM. The CAM was positive only for wet textiles washed at 5× the recommended concentration of detergent and pure detergent. All dry textiles were negative. Formaldehyde release was not detected from any textiles washed following the manufacturer's recommendations. Once dry, it is likely safe for formaldehyde-allergic patients to wear textiles washed with formaldehyde-containing detergents.

Undeclared formaldehyde levels in patient consumer products: formaldehyde test kit utility

Purpose: Formaldehyde allergic contact dermatitis (ACD) may be due to products with free formaldehyde or formaldehyde-releasing agents; however, assessment of formaldehyde levels in such products is infrequently conducted. The present study quantifies total releasable formaldehyde from “in-use” products associated with formaldehyde ACD and tests the utility of commercially available formaldehyde spot test kits.Materials and Methods: Personal care products from 2 patients with ACD to formaldehyde were initially screened at the clinic for formaldehyde using a formaldehyde spot test kit. Formaldehyde positive products were sent to the laboratory for confirmation by gas chromatography-mass spectrometry. In addition, 4 formaldehyde spot test kits were evaluated for potential utility in a clinical setting.Results: Nine of the 10 formaldehyde spot test kit positive products obtained from formaldehyde allergic patients had formaldehyde with total releasable formaldehyde levels ranging from 5.4 to 269.4 µg/g. Of these, only two shampoos tested listed a formaldehyde-releasing agent in the ingredients or product literature. Subsequently, commercially available formaldehyde spot test kits were evaluated in the laboratory for ability to identify formaldehyde in personal care products.Conclusions: Chemical based formaldehyde spot test were more reliable than the enzymatic based test in identifying product releasable formaldehyde content. It is concluded that product labeled ingredient lists and available information are often inadequate to confirm the potential for formaldehyde exposure and chemical based spot test kits may have utility for identification of potential formaldehyde exposure from personal care products.

Allergic reactions to lower concentrations of nickel sulfate and formaldehyde often appear later than reactions to higher concentrations.

A late-appearing patch test reaction may be a sign of active sensitization or represent a delayed elicitation reaction. To retrospectively study the effect of concentration on the time course of allergic reactions to routine concentration dilution series of formaldehyde and nickel sulfate. We tested concentration dilution series of 2%, 1%, 0.32% and 0.1% formaldehyde and 5%, 1.6%, 0.5% and 0.16% nickel sulfate, respectively. The last readings were performed on day 4 to day 6. We included patients with allergic reactions to either of the two lowest concentrations in each dilution series and whose tests had been read three times. Forty-two nickel-allergic and 23 formaldehyde-allergic patients fulfilled the inclusion criteria. In 26 (62%) of the nickel-sensitive patients, reactions to lower concentrations appeared later than reactions to the highest concentration. Of the formaldehyde-sensitive patients, 17 (74%) developed one or two allergic reactions to lower concentrations later than reactions to the highest concentration, and one (4%) patient developed allergic reactions to lower concentrations sooner than a reaction to the highest concentration. The remaining patients showed all allergic reactions at the same reading. In these selected, relatively strongly sensitized patients, allergic reactions to lower concentrations quite regularly appeared later than reactions to higher concentrations.

Ten‐year trends in contact allergy to formaldehyde and formaldehyde‐releasers

Preservatives such as formaldehyde and formaldehyde-releasers are common causes of contact allergy. To examine trends in contact allergy to formaldehyde and formaldehyde-releasers in patch tested patients in Denmark over a 10-year period (2007-2016), and to investigate relevant sources of formaldehyde among the patients. A cross-sectional registry study on patch test data from patients tested with formaldehyde and formaldehyde-releasers (N = 8463) was performed. The presence of released formaldehyde in products from formaldehyde-allergic patients was identified with chemical analyses (chromotropic acid or acetylacetone test). The prevalence of contact allergy to formaldehyde 1% was 1.5%, and ranged between 0.97% and 2.3%, with a decreasing trend in this 10-year period. Contact allergy to formaldehyde 2% was found in 2.4%, and no significant trend was observed. Quaternium-15 was the formaldehyde-releaser most often positive (0.86%). Patients allergic to formaldehyde often had simultaneous positive patch test reactions to formaldehyde-releasers (36%). Almost 63% of the patients with formaldehyde allergy used products that released formaldehyde; cosmetics were the most common sources. Although contact allergy to formaldehyde 1% decreased in this 10-year time period, contact allergies to formaldehyde and formaldehyde-releasers overall remain frequent in patients. In most cases, formaldehyde-allergic patients are exposed to ≥1 products containing formaldehyde. Improved regulation on permitted amounts of free formaldehyde in cosmetics is still warranted, including direct labelling of formaldehyde when it is present in small but relevant amounts.

Formaldehyde in cosmetics in patch tested dermatitis patients with and without contact allergy to formaldehyde.

Formaldehyde is a well-known contact sensitizer. Formaldehyde releasers are widely used preservatives in cosmetics. To survey the release of formaldehyde in cosmetics brought by patients investigated because of suspected allergic contact dermatitis, to compare it with information given by the manufacturers on the packages, and to investigate whether formaldehyde-allergic patients are potentially exposed to more cosmetics releasing formaldehyde than dermatitis patients without contact allergy to formaldehyde. Cosmetics from 10 formaldehyde-allergic and 30 non-allergic patients (controls) matched for age and sex were investigated with the chromotropic acid spot test, which is a semiquantitative method measuring the release of formaldehyde. Formaldehyde was found in 58 of 245 (23.7%) products. Twenty-six of 126 (20.6%) leave-on products released formaldehyde, and 17 of 26 (65.4%) of these were not declared to contain formaldehyde or formaldehyde releasers. Among the rinse-off products, there were 32 of 119 (26.8%) formaldehyde-releasing products, and nine of 32 (28.0%) of these were not labelled as containing formaldehyde or formaldehyde releasers. Five of 10 formaldehyde-allergic patients brought leave-on products with ≥ 40 ppm formaldehyde, as compared with 4 of 30 in the control group (p = 0.029). Cosmetic products used by formaldehyde-allergic patients that are not declared to contain formaldehyde or formaldehyde-releasing preservatives should be analysed.

Skincare products containing low concentrations of formaldehyde detected by the chromotropic acid method cannot be safely used in formaldehyde-allergic patients.

Formaldehyde is a well-known contact sensitizer. Formaldehyde releasers are widely used preservatives in skincare products. It has been found that formaldehyde at concentrations allowed by the European Cosmetics Directive can cause allergic contact dermatitis. However, we still lack information on whether formaldehyde at low concentrations affects dermatitis in formaldehyde-allergic individuals. To study the effects of low concentrations of formaldehyde on irritant contact dermatitis in formaldehyde-allergic individuals. Fifteen formaldehyde-allergic individuals and a control group of 12 individuals without contact allergy to formaldehyde and formaldehyde releasers were included in the study. The individuals performed the repeated open application test (ROAT) during 4weeks with four different moisturizers releasing formaldehyde in concentrations that had been determined as >40, 20-40, 2·5-10 and 0p.p.m. by the chromotropic acid (CA) spot test. Dimethyloldimethylhydantoin was used as a formaldehyde releaser in the moisturizers. The ROAT was performed on areas of experimentally induced sodium lauryl sulfate dermatitis. The study was double blind, controlled and randomized. Nine of the 15 formaldehyde-allergic individuals had reappearance or worsening of dermatitis on the areas that were treated with moisturizers containing formaldehyde. No such reactions were observed in the control group (P<0·001) or for the moisturizers without formaldehyde in the formaldehyde-allergic individuals (P<0·001). Our results demonstrate that the low concentrations of formaldehyde often found in skincare products by the CA method are sufficient to worsen an existing dermatitis in formaldehyde-allergic individuals.

Formaldehyde.

Formaldehyde is the American Contact Dermatitis Society Contact Allergen of the Year for 2015. The exposure is widespread, and contact allergy might be difficult to suspect in the individual dermatitis patient. The relevance of contact allergy to formaldehyde might also be difficult to evaluate. Recently, however, several studies have been performed aimed at enhancing the patch test technique and evaluating the clinical relevance of contact allergy to formaldehyde. The patch test concentration of formaldehyde has been recommended by the European Environmental Contact Dermatitis Research Group to be 2.0%, that is, the dose of 0.60 mg/cm (wt/vol) instead of 1.0%, which is the concentration previously used for the baseline series in most countries. Without causing any more irritant reactions, the patch test concentration of 2.0% detects twice as many contact allergies and enables the diagnosis of formaldehyde-allergic patients who otherwise would have been missed. The studies that underpin the decision were performed in Europe and partly in the United States. The Finn Chamber patch test system was used. The allergen dose per area was kept uniform with a micropipette. This report describes the background for routinely using formaldehyde 2.0% instead of 1.0% and for using a micropipette when applying the test solution.

Formaldehyde exposure and patterns of concomitant contact allergy to formaldehyde and formaldehyde‐releasers

Formaldehyde and formaldehyde-releasers are widely used in consumer products and may often cause contact allergy. To investigate the prevalence of concomitant contact allergy to formaldehyde and formaldehyde-releasers in dermatitis patients, and to determine the sources of formaldehyde exposure based on personal and occupational products obtained from dermatitis patients. Patch test data from referred dermatitis patients with a positive patch test reaction to formaldehyde or formaldehyde-releasers were analysed. For the period 2000-2008, the formaldehyde content in products obtained from formaldehyde-allergic patients was analysed by chromotropic acid test and/or acetylacetone test. Patients allergic to a formaldehyde-releaser often had simultaneous contact allergy to formaldehyde. Other combinations were also prevalent. In patients who reacted to more than two formaldehyde-releasers, nearly all reacted simultaneously to formaldehyde. Seventy-five percent of the formaldehyde-allergic patients used a product that contained formaldehyde. The main source of formaldehyde exposure was cosmetics (78%). Concomitant contact allergy to formaldehyde and formaldehyde-releaser remains common. Furthermore, contact allergy to a formaldehyde-releaser was nearly always concomitant with another formaldehyde-releaser. Formaldehyde was commonly found in personal products used by formaldehyde-allergic patients.

Sodium Hydroxymethylglycinate

Sodium hydroxymethylglycinate (SHMG) is a preservative used in many commercially available products, including shampoos, conditioners, soaps, moisturizers, body sprays, baby wipes, room sprays, cleaning agents, and pesticides. It is in a class of chemicals known as formaldehyde-releasing preservatives. Notably, members of this class have been associated with allergic contact dermatitis, possibly due to the agents themselves, the formaldehyde they release, or both. Studies on SHMG in animals have demonstrated potential for sensitization and dermatitis, and formaldehyde-allergic patients have been reported to improve when products containing SHMG are avoided. Patients and providers need to be aware of this preservative.

Occupational contact allergy to formaldehyde and formaldehyde releasers

Formaldehyde allergy is common and usually derives from formaldehyde-releasing biocides in cosmetic and other products. To analyse patterns of patch test reactions to formaldehyde and formaldehyde-releasing compounds and the sources of sensitization. At the Finnish Institute of Occupational Health, we screened the patch test files for allergic reactions to formaldehyde and 12 formaldehyde-releasing compounds. All patients with contact allergy to any of the substances were included, and their records were reviewed. Between January 2001 and May 2007, we had patch tested 81 patients with formaldehyde allergy and 18 with independent allergy to some formaldehyde releaser. Of the formaldehyde allergies, 60 were new sensitizations, 25 of which were considered to be occupational. The most common source of occupational sensitization was metalworking fluids followed by creams and related products. Exposure to formaldehyde-releasing preservatives in liquid soaps and other rinse-off products was common in both occupational and non-occupational cases. Reactions to formaldehyde-releasing compounds were seen in 79% of the formaldehyde-allergic patients. Occupational formaldehyde allergy was common and occurred in metalworkers, hairdressers, masseurs, and workers using protective creams, detergents, and liquid soaps. When compared with studies on general dermatological patients, contact allergy to formaldehyde releasers without formaldehyde allergy was rare.

Sensitivity of Petrolatum and Aqueous Vehicles for Detecting Allergy to Imidazolidinylurea, Diazolidinylurea, and DMDM Hydantoin: A Retrospective Analysis from the North American Contact Dermatitis Group

To determine whether petrolatum or aqueous vehicles are more sensitive for detecting allergy to imidazolidinylurea (IU), diazolidinylurea (DU), and dimethylol dimethyl hydantoin (DM). The relationship of these allergens to formaldehyde sensitivity was also explored. Retrospective analysis of patients patch-tested by the North American Contact Dermatitis Group. All patients were simultaneously tested to seven allergens (formaldehyde, IU in petrolatum [pet], IU aqueous [aq], DU pet, DU aq, DM pet, and DM aq). Data were analyzed in pairs with various "gold standard" definitions of "true allergy" and adjusting for correlated data. Reaction to at least one of the seven allergens occurred in 2,398 patients. In all cases except one (which just approached statistical significance), the petrolatum-based allergen was statistically significantly more sensitive than the same allergen in an aqueous base. Most of the patients allergic to the three preservatives were also allergic to formaldehyde, but most formaldehyde-allergic patients were not allergic to the IU, DU, or DM. Of these two vehicles, petrolatum is significantly more sensitive than an aqueous vehicle is for detecting allergy to IU, DU, and DM.

Patch-Test Reactions to Formaldehydes, Bioban, and Other Formaldehyde Releasers

Contact allergy to formaldehyde, Bioban, and other formaldehyde releasers and cross-reactivity between them have been reported in the literature; however, not many studies have data on this cross-reactivity. To study (1) the rates of allergy to formaldehyde and to Bioban and other formaldehyde releasers and (2) the rates of cross-reactivity between them. We present a retrospective chart analysis of patch-test results for all patients referred for allergic contact dermatitis testing at the Milton S. Hershey Medical Center from June 2004 to September 2005. Anyone allergic to formaldehyde, Bioban, or other formaldehyde releasers was included. Cross-reactivity between the agents was then analyzed. The charts of 210 patients were analyzed. Of these patients, 24 (11%) were allergic to formaldehyde, Bioban, or other formaldehyde-releasing agents. Seventeen (8.1%) of the patients were allergic to formaldehyde, 15 (7.1%) were allergic to Bioban, and 20 (9.5%) were allergic to other formaldehyde-releasing agents. Eleven (65%) of the 17 formaldehyde-allergic patients were also allergic to Bioban. Of the 20 patients allergic to formaldehyde-releasing agents, 14 (70%) were also allergic to one of the three Bioban products tested. Of the 15 patients allergic to Bioban, 11 (73%) were allergic to formaldehyde, 14 (93%) were allergic to formaldehyde-releasing agents, and 11 (73%) were allergic to both formaldehyde and formaldehyde-releasing agents. A high cross-reactivity rate between formaldehyde, Bioban, and other formaldehyde-releasing agents was found.

Formaldehyde-related textile allergy: an update.

Part I of this study explores whether clothing today contains formaldehyde levels likely to cause contact allergy in formaldehyde-allergic patients. Part II of this study examines whether current reactions to textiles may be due to allergy to textile resins and whether individuals with formaldehyde-related textile allergy will react to the newer low formaldehyde resins used in the textile industry. Part I: free formaldehyde was measured in 16 fabric specimens produced in the US and overseas. Additionally, since the textile industry has moved to the use of newer methods for measuring fabric formaldehyde content, the newer methodology was compared with the older methods used in the medical literature. Part II: 10 subjects with known textile contact allergy were patch tested to available Chemotechnique textile resins and 6 new low-formaldehyde resins used by the textile industry. Part I: 8 fabric specimens yielded no detectable formaldehyde and 7 specimens yielded <200 ppm free formaldehyde, using Schiff's reagent and Merck testing methods. 1 specimen showed approximately 2000 ppm formaldehyde, as measured by the Merck test, but only 24 ppm free formaldehyde when retested by the method described in Japanese Law #112. Part II: all subjects reacted strongly to formaldehyde and DMDHEU (the predominant resin currently used in textiles). 6 subjects reacted to EUMF. 2 subjects had mild reactions to the newer low-formaldehyde resins and 1 to the non-formaldehyde Fixapret NF. Our results suggest that most clothing today yields free formaldehyde levels unlikely to cause contact allergy in formaldehyde-allergic individuals. Japanese method #112 is the recommended methodology to measure free formaldehyde in future studies. DMDHEU may now represent the main cause of textile allergy and may be a better screen than EUMF for this problem. Newer resins yielding fabrics with <75 ppm free formaldehyde may cause occasional reactions, but are more likely to be tolerated by individuals with textile contact allergy. Treatment of these individuals should be directed at identification of reliable sources of garments utilizing these newer resins.

Patch test reactivity to DMDM hydantoin. Relationship to formaldehyde allergy.

The relationship between contact allergy to formaldehyde and positive patch test reactions to DMDM hydantoin was investigated. 35 formaldehyde-allergic patients were patch tested with serial dilutions of formaldehyde (0.1%-0.3%-1.0% aq.) and DM hydantoin (the non-formaldehyde-containing parent compound of DMDM hydantoin). 21 were also patch tested with MDM hydantoin (1 molecule formaldehyde) in serial dilutions: 7 (33%) reacted to 1 or more concentrations. The other 14 were also tested with DMDM hydantoin (2 molecules formaldehyde) in serial dilutions: 8 (57%) reacted to 1 or more concentrations. Patients patch-test-positive to formaldehyde 0.1% and/or 0.3% tended to show more patch test reactivity to (D)MDM hydantoin than those who reacted only to 1%. Aqueous solutions of (D)MDM hydantoin in concentrations as used in cosmetic products therefore contain enough free formaldehyde to cause dermatitis in a patch test system in some formaldehyde-allergic patients: 12 such patients applied a cream containing 1% DMDM hydantoin to the flexor aspect of the lower arm twice daily for 1 week; 4 (33%) developed dermatitis. The use of a cream containing 0.25% DMDM hydantoin in these 4 patients still caused dermatitis in 1 and provoked itching in another. An increase in the use of DMDM hydantoin in cosmetic products will also inevitable increase the risk of cosmetic dermatitis in consumers allergic to formaldehyde.