Relevant Contact Allergens Research Articles

Are "clean" products safe for children? An analysis of contact allergens in "clean" children's products from a popular retailer.

Considering consumer trends toward the use of "clean" personal care products and increasing recognition of childhood allergic contact dermatitis, we sought to characterize the allergen profile of such children's products. Ingredients of baby washes/shampoos, bubble baths, and moisturizers identified using the "Clean Baby" filter on Target®'s online marketplace were analyzed for relevant pediatric contact allergens. Product compositions declared fragrance in 82% of products, Compositae in 46%, cocamidopropyl betaine in 45%, glucosides in 37%, propylene glycol in 12%, lanolin in 1%, and no allergens in 9%-methylisothiazolinone and formaldehyde were not found. Children are greatly impacted by atopic dermatitis and skin barrier dysfunction, which underscores a need for greater public awareness of sensitizing and irritating ingredients, particularly regarding pediatric personal care products.

When protective gloves do not protect-unexpected findings in adental assistant

We report on a38-year-old dental assistant who developed erythema and dryness of the skin of the hands 12years after she had started the job. After healing for 3months she developed eczema lesions on the body, especially on the back of the hands, arms, neck, and legs. Contact dermatitis was suspected. We diagnosed atopic dermatitis and allergic contact dermatitis to different thiurames and to three of the seven protective gloves she had worn professionally. Carbamates were identified in those protection gloves. Thus, we assume two skin diseases: atopic hand eczema and atopic dermatitis of the body as well as intermittent contact dermatitis to occupationally relevant contact allergens. By using thiuram- and carbamate-free protective gloves and implementing skin protection and skin care measures, the skin disease has been completely cured to this day.

CD4+ T cells inhibit the generation of CD8+ epidermal-resident memory T cells directed against clinically relevant contact allergens.

CD8+ epidermal-resident memory T (TRM ) cells play central roles in local flare-up responses to experimental contact allergens by inducing massive influx of neutrophils to the epidermis upon allergen challenge. Whether similar immunopathogenic mechanisms are involved in the responses to clinically relevant contact allergens is unknown. The immune response to cinnamal, ρ-phenylenediamine (PPD) and methylisothiazolinone (MI) was studied in a well-established mouse model for allergic contact dermatitis that includes formation of TRM cells by ELISA, flow cytometry, fluorescence microscopy analyses and cell depletion protocols. We show that the formation of CD4+ and CD8+ epidermal TRM cells and the inflammatory response are highly allergen-dependent. However, the magnitude of the flare-up responses correlated with the number of epidermal CD8+ TRM cells, CXCL1/CXCL2 release and recruitment of neutrophils to the epidermis. Finally, depletion of CD4+ T cells strongly enhanced the number of epidermal CD8+ TRM cells, the flare-up response and the epidermal infiltration of neutrophils for all allergens. As the first, this study demonstrates that clinically relevant contact allergens have the ability to generate pathogenic, epidermal CD8+ TRM cells that recruit neutrophils following re-exposure to the allergen, but that this normally is counteracted by the simultaneous induction of anti-inflammatory CD4+ T cells.

Importance of Supplemental Patch Testing Beyond a Screening Series for Patients With Dermatitis

Patch test screening series for patients with dermatitis are limited and may miss clinically relevant contact allergens. To characterize individuals with dermatitis who showed clinically relevant patch test findings to supplemental (nonscreening) allergens or substances. A 17-year, retrospective cross-sectional analysis (January 1, 2001, to December 31, 2018) of North American Contact Dermatitis Group (NACDG) data from multiple centers in North America was conducted. A total of 43 417 patients with dermatitis underwent patch testing to the NACDG screening series in a standardized manner with 65 to 70 allergens and supplemental allergens as clinically indicated. Patients with 1 or more clinically relevant reactions to a supplemental (nonscreening) allergen/substance were analyzed between November 18, 2020, and March 12, 2021. The main outcomes were to assess the number of patients with clinically relevant reactions to supplemental (nonscreening) allergens and compare characteristics (including demographic characteristics and occupations) between patients with a clinically relevant patch test reaction to 1 or more supplemental allergens or substances (supplement-positive) and those without a reaction (supplement-negative) using odds ratios (ORs) and 95% CIs. Secondary outcomes included sources of allergic contact dermatitis and, for occupationally related cases, specific occupations and industries. Of 43 417 patients included in the study who underwent patch testing to the NACDG screening series (65-70 allergens), 9507 individuals (21.9%) had currently relevant reactions to 1 or more supplemental allergens or substances. Of these, 6608 were women (69.5%) and the mean (SD) age was 47.2 (0.54) years. Compared with patients who had supplement-negative results, patients with supplement-positive findings were significantly less likely to be male (OR, 0.90; 95% CI, 0.85-0.94; P < .001) and/or have atopic dermatitis (OR, 0.89; 95% CI, 0.84-0.93; P < .001). Common primary sites of dermatitis in 9499 patients with supplement-positive findings included the face (2856 [30.1%]), hands (2029 [21.4%]), and scattered/generalized distribution (1645 [17.3%]). Frequent sources of supplemental allergens in 9235 patients included personal care products (4746 [51.4%]) and clothing/wearing apparel (1674 [18.1%]). Of 9362 patients with available data, supplemental allergens/substances were occupationally related in 1580 (16.9%); of those with identified occupations, 25.1% (384 of 1529) were precision production, craft, or repair workers. Of 9507 patients with supplement-positive findings, 2447 (25.7%) had no currently relevant reactions to NACDG screening allergens. This cross-sectional study found that 21.9% of patients who underwent patch testing to an allergen screening series of 65 to 70 allergens had at least 1 relevant reaction to supplemental allergens/substances. Of these, one-quarter reacted only to a supplemental allergen/substance. Screening series include common, important allergens, but these findings suggest that the addition of specialty allergens and personal or work products is critical for the successful diagnosis and management of allergic contact dermatitis.

Developing a cosmetic series: Results from the ESSCA network, 2009‐2018

There is considerable variability across European patch test centres as to which allergens are included in local and national cosmetics series. To propose a standardized, evidence-based cosmetic series for Europe based on up-to-date analysis of relevant contact allergens. We collated data from the European Surveillance System on Contact Allergies (ESSCA) from 2009 to 2018 to determine which cosmetic allergens produce a high yield of contact allergy. Contact allergens with a prevalence of >0.3% that were considered relevant were included. Rare contact allergens were excluded if deemed no longer relevant or added to a supplemental cosmetic series for further analysis. Sensitization prevalences of 39 cosmetic contact allergens were tabulated. Thirty of these allergens yielded >0.3% positive reactions and are therefore included in our proposed European cosmetic series. Six were considered no longer relevant and therefore excluded. Three were included in a supplementary European cosmetic series. An additional nine allergens were included in either the core or supplemental European cosmetic series following literature review. We have derived a potential European cosmetic series based upon the above methods. This will require ongoing investigation based upon the changing exposure profiles of cosmetic allergens as well as new and evolving substances.

Trend of relevant contact allergens of the feet in Spain over a period of 10 years.

Allergic contact dermatitis (ACD) of the feet accounts for approximately 10% of all patch tested patients. To study the clinical profile of patients with feet dermatitis and relevant contact allergens in Spain over a 10-year period. Retrospective observational study of patients with suspected ACD from the GEIDAC (Spanish Research Group on Contact Dermatitis and Cutaneous Allergy) baseline series from eight hospitals in Spain between 2004 and 2014. The clinical data collected from each patient were age, sex, occupation, history of atopic dermatitis, and eczema location. A total of 450 cases clinically presented dermatitis affecting the feet; of these, 41% of were males and 5.6% were suspected to be of occupational origin. As much as 47% were diagnosed with ACD, 20% with atopic dermatitis/dyshidrotic eczema, and 5% with psoriasis. The "feet group" included statistically significantly more females in the age range of 21 to 60 years. The most frequent relevant contact allergens were potassium dichromate, cobalt(II) chloride, p-tert-butylphenol formaldehyde resin, mercapto mix, and mercaptobenzothiazole. ACD is the most frequent clinical diagnosis of feet dermatitis in our series. The most frequent allergens are similar to those published in other series of foot ACD in Europe and the trend has not changed in the studied decade.

Clinically relevant contact allergens in the modern era

Clinically relevant contact allergens in the modern era

894 Comprehensive patch testing in 22 patients with lichen planopilaris

Limited studies have identified an association between frontal fibrosing alopecia (FFA) and leave-on facial skin care products. Although debated, allergic contact dermatitis to these personal care products may contribute to the lymphocytic inflammation affecting the hair follicle unit. This case series sought to identify relevant allergens in patients with lichen planopilaris (LPP) and/or FFA who were seen in an alopecia clinic and referred to patch testing. Patients underwent patch testing with the American Contact Dermatitis Society Core Allergen Series I-VIII, Cosmetic and Hairdresser Series in addition to 8 other potential allergens. Patch tests were applied to the back and read at 48 and 96 hours. Equivocal (+/-) reactions were not included in the results. Between January 2018 and December 2018, 22 female patients with a mean age of 60 years old (range 30-75) underwent patch testing. The majority of patients were Caucasian (95%) and either peri- or post-menopausal (90%) with histological and clinical evidence of LPP (55%), FFA (36%), or LPP/FFA overlap (9%). In total, 77% of patients demonstrated clinically relevant allergens found in cosmetics and personal care products applicable to the head and neck. The mean number of relevant positive allergens was 2 (range 1-8) with more than one-fourth of patients having 4 or more relevant allergens. Half of the patients (50%) had allergens relevant to both facial skin and hair care products. Fragrance mix and fragrance cross reactors (23%), ammonium persulfate (18%), MI and MCI/MI (18%), and dodecyl gallate (18%) represented the most common relevant allergens in these patients. The overall prevalence of patients with relevant positive allergens in this case series (77%) was higher than previous studies which reported on all positive allergens in Brazilian (59%) and British patients (53%) with FFA exclusively. Given the prevalence of relevant contact allergens in females with LPP/FFA, clinicians may consider patch testing for this patient population.

Sesame allergies: clinical significance, diagnosis, and therapy

Sesame (Sesameum indicum) belongs to the pedalium family (Pedaliaceae) and is used primarily in the preparation of food, especially in oriental and Asian cuisine. As a so-called emerging allergen, it is becoming increasingly relevant in the everyday routine of physicians active in the field of allergology in the wake of the globalization of dietary habits and the general trend towards vegetarian and vegan lifestyles. Due to the increased occurrence of anaphylactic reactions to sesame, the European Union has included sesame in the list of food allergens requiring labeling. In addition to its use in private and industrial food preparation, sesame is also utilized in the cosmetics and pharmaceutical industries. This paper is an overview of selected scientific articles and is based on research in PubMed and specialist databases. Immediate-type IgE-mediated reactions (type I according to Coombs and Gell), as well as delayed-type contact allergic reactions (type IV according to Coombs and Gell), to products containing sesame and sesame oil have been described. The clinical spectrum is broad and ranges from contact urticaria and dermatitis to fatal anaphylaxis. Important allergens in immediate-type allergy include albumins, vicilins, oleosins, and globulins; relevant contact allergens include sesamolin, sesamin, and sesamol. The diagnostic work-up for suspected sesame allergy includes skin tests, which should preferentially be carried out with native allergens due to their higher sensitivity and specificity, as well as determination of sesame-specific IgE antibodies. However, lipophilic oleosins in particular are underrepresented in analytical methods. Differentiated, component-based IgE diagnostic testing is desirable. Oral provocation is the gold standard, whereby it is important to ensure low and safe initial doses as well as adequate maximum doses. Beside diagnostic measurements including skin tests, detection of IgE antibodies and oral provocation tests, the education of patients with sesame allergy is of particular importance. This serves, firstly, to prevent recurrence of allergen exposure and, secondly, should contain information on self-management in the case of repeated reactions. The value of oral tolerance induction and preventive measures such as early introduction as a dietary supplement remains to be clarified in the future.

Contact allergy to lanolin: temporal changes in prevalence and association with atopic dermatitis.

Lanolin has been tested as lanolin alcohols (30% pet.) in baseline patch test series since 1969, and this has shown clinically relevant allergic contact dermatitis cases. To investigate the temporal development of lanolin allergy (i.e. positive reaction to lanolin alcohols and/or Amerchol™ L-101), and the association between contact allergy to lanolin and patient characteristics from the MOAHLFA index. A retrospective observational study of consecutively patch tested dermatitis patients (n = 9577) between 1 January 2004 and 31 December 2015 with lanolin alcohols 30% pet. and Amerchol™ L-101 50% pet. was performed. The prevalence of lanolin allergy increased from 0.45% in 2004 to 1.81% in 2015. In age-adjusted and sex-adjusted analyses, weak, significant associations were found between atopic dermatitis and lanolin and lanolin alcohols allergy, respectively, but no association with Amerchol™ L-101 allergy was found. Among 9286 dermatitis patients who were tested with both allergens, 108 had a positive test reaction to either lanolin alcohols or Amerchol™ L-101, whereas only 29 patients had positive test reactions to both markers. The prevalence of lanolin contact allergy has increased over a 12-year period, and inclusion of Amerchol™ L-101 will increase the chance of detecting lanolin contact allergy. Patch testing with lanolin is helpful in atopics with dermatitis and suspected cosmetic allergy.

Diagnosis and management of allergic contact dermatitis in children: common allergens that can be easily missed.

Contact dermatitis is an economically burdensome pediatric disease, and it is important to know the top allergens that have remained as top offenders for over the last decade. A comparative analysis of the 20-allergen screen was done against the current top 40 pediatric allergens, and it revealed that the 20-allergen screening series would have theoretically only captured 47.5% of the relevant contact allergens (52.5% failure to detect rate). In addition, the T.R.U.E. Test (SmartPractice, Phoenix, Arizona, USA) would have revealed 60% of the top 40 allergens (40% failure to detect rate). Patch testing in children has become a more common practice, and management requires the identification and avoidance of the offending allergen from the sensitized person's environment.

Self-reported hand eczema among dental workers in Japan - a cross-sectional study.

Dental workers are considered to have a high risk of developing occupational hand eczema. To estimate the prevalence of work-related hand eczema and associated risk factors in dental workers in Japan. A self-administered questionnaire was sent by mail to all dental clinics of Kumamoto City, Japan. In addition, patch testing with 24 dentistry-related allergens was offered. In total, 46.4% of dental workers (n = 528: response 31.4%, based on 97 clinics) reported a lifetime history of chronic hand eczema. The 1-year prevalence was 36.2%. According to logistic regression analysis, the most important risk factors for the 1-year prevalence were a personal history of atopic dermatitis [odds ratio (OR) 4.7, 95% confidence interval (CI): 2.2-8.8], asthma and/or allergic rhinitis (OR 2.0, 95%CI: 1.3-3.0), dry skin (OR 1.7, 95%CI: 1.1-2.7), shorter duration of work (OR 2.0, 95%CI: 1.2-3.5 for up to 10 years versus >20 years), and washing hands >10 times per day (OR 1.6, 95%CI: 1.0-2.5). Fifty-four workers were patch tested. Rubber chemicals and acrylates were the most frequent occupationally relevant contact allergens. Dental workers in Japan have a high prevalence of hand eczema. Health education to prevent hand eczema and more frequent patch testing are needed.

Foot contact dermatitis: nitrofurazone as the main cause in a retrospective, cross-sectional study over a 16-year period from Turkey.

The major causative agents in allergic contact dermatitis of the foot may differ from country to country. Sufficient data on foot eczema in patients from Turkey are lacking. To identify the clinically relevant contact allergens in foot eczema and determine the role of patch test series and patients' own materials in the detection of the responsible allergens. Among 1753 patients patch tested between 1996 and 2012 in our clinic, 53 with suspected allergic foot eczema were enrolled in this retrospective, cross-sectional study. Forty nine patients were patch tested with the extended European baseline series, 49 with supplemental series including rubber, leather, topical drugs, textile, cosmetic series containing preservatives and emulgators and varnish/plastic/glue series, and 37 with their own substances. Thirty of the 53 patch tested patients showing sensitization to at least one clinically relevant allergen were diagnosed with allergic foot eczema. The main eliciting agent was nitrofurazone (n = 8), followed by leather shoe allergens, ie, potassium dichromate (n = 6), p-tert-butylphenol formaldehyde resin and formaldehyde, in the second range. Rubber shoe allergens were less frequently observed (n = 3). In more than 1/3 of the patients, the causative agent could only be identified by testing the patient's own substances and/or supplemental series. Nitrofurazone was the leading causative agent followed by leather shoe allergens. Pediatric patients were frequently sensitized with shoe allergens. Patch testing with patient's own substances had a critical value in the detection of the causative agent in a significant number of patients.

Mechanistic Understanding of Contact Allergy

Cosmetic products contain potential contact allergens or precursors that require metabolic conversion or oxidation to generate contact allergens. The most relevant contact allergens are fragrances and preservatives. These substances can pose hazards to human health due to their ability to activate T cells that can cause allergic contact dermatitis, an inflammatory skin disease. In recent years, much progress has been made in the elucidation of the mechanistic basis for immune system activation by contact allergens. This is essential for the development of better diagnostic tools, targeted therapies and animal-free in vitro assays for contact allergen identification. This overview will highlight some aspects of the activation of innate and adaptive immune responses by contact allergens.

The first Australian Baseline Series: Recommendations for patch testing in suspected contact dermatitis.

Patch testing is a standard diagnostic tool used in the identification of causative allergens in allergic contact dermatitis. Ongoing surveillance of rates of allergen positivity is vitally important to detect trends and allow comparisons between countries. The objective of this study was to propose the first evidence-based Australian baseline series, based on retrospective review of our patch test data. We aimed to identify the most important and most relevant allergens in our population. We conducted a 10-year (2001-2010) retrospective review of data from the contact dermatitis clinic and the occupational dermatitis clinic from our institution. We patch tested 5281 patients in all. The top 20 allergens with the highest number of relevant positive patch test reactions were: fragrance mix 1: nickel, potassium dichromate, Myroxylon pereirae, formaldehyde, p-phenylenediamine (PPD), thiuram mix, colophony (rosin), dermatophagoides mix, ammonium persulfate, quaternium-15, cobalt chloride, methylchloroisothiazolinone or methylisothiazolinone, diazolidinylurea, epoxy resin, 1,3-dimethylol-5,5-dimethyl hydantoin, Compositae mix, toluenesulfonamide formaldehyde resin, basic red 46 and imidazolidinyl urea. We have elucidated the most frequent and relevant contact allergens in our patient population and used this information to construct the first Australian baseline series.

Contact allergy masquerading as seronegative Sjögren's syndrome

Primary Sjögren's syndrome is an autoimmune disease that presents with xerostomia and keratoconjunctivitis sicca (due to chronic lymphocytic inflammation of the salivary and lacrimal glands) and in some cases extraglandular features. Patients typically have positive antinuclear, anti-Ro, and anti-La antibodies; however, around 20% to 30% do not and are therefore termed seronegative. We present a case of a 58-year-old woman who was originally diagnosed with seronegative Sjögren's syndrome based on the American-European classification system. She had complete resolution of her clinical features on identification and avoidance of relevant contact allergens. Contact allergy should be considered in the differential diagnosis of seronegative Sjögren's syndrome, especially where atypical features such as facial rash, normal salivary gland imaging, or lichenoid histology exist.

Targeted testing with diethylthiourea often reveals clinically relevant allergic contact dermatitis caused by neoprene rubber

Diethylthiourea is widely used in the rubber industry, particularly in neoprene rubber, and may cause allergic contact dermatitis. However, as thiourea allergens are not part of the European baseline series, the diagnosis of allergic contact dermatitis caused by thiourea compounds depends on clinical suspicion and aimed testing. The aims of this study were to evaluate the occurrence of sensitization to diethylthiourea during a 19-year period by using data from the Allergen Bank database at the Department of Dermatology and Allergy Centre, Odense University Hospital, and to evaluate whether the yield of aimed patch tests with diethylthiourea differed between the dermatologists in practice and those working in the dermatology department. A total of 239 patients were patch tested with diethylthiourea 1% in petrolatum obtained from the Allergen Bank. The records for patients with positive reactions were evaluated retrospectively. One hundred and fifty-one patients were tested by 27 different dermatologists in private practice, and positive reactions were found in 16% (24/151) of the patients; 88 patients were tested at the dermatology department, and positive reactions were found in 15% (13/88). Thus, 15% (37/239) had positive patch test reactions to diethylthiourea, all with current clinical relevance and all strong. Clinical suspicion of neoprene rubber allergy and subsequent aimed patch testing with diethylthiourea give a high yield of clinically relevant allergic patch test reactions for both dermatologists in practice and dermatologists in the hospital department.

Tacrolimus 0.1% vs mometasone furoate topical treatment in allergic contact hand eczema: a prospective randomized clinical study

Tacrolimus is a macrolide immunosuppressant that has been demonstrated to inhibit T-lymphocyte activation without the side-effects of corticosteroids. The safety profile of tacrolimus makes it a promising therapeutic option for dermatitis. To evaluate and compare the therapeutic ability of tacrolimus 0.1% ointment and mometasone furoate 0.1% ointment in patients with chronic hand eczema and positive patch tests. Thirty adults with chronic hand eczema and positive patch test reaction to relevant contact allergens were treated with tacrolimus 0.1% ointment or mometasone furoate 0.1% ointment in a single-centre, randomized comparative study. The scores of the evaluated clinical parameters (erythema, infiltration, vesiculation, desquamation, presence of cracks and itching) did not differ between Groups A and B at any of the four time points (p>0.05).On the other hand, in both groups, a significant difference was detected in all parameters between baseline and Day 90 recorded values. Tacrolimus is a promising alternative therapy for contact dermatitis patients as it is effective from the first month of treatment, well tolerated and offers similar therapeutic results to topical corticosteroid therapy.

The detection of clinically relevant contact allergens with a standard screening tray of 28 allergens

A standard method for diagnosing allergic contact dermatitis in the United States is the thin-layer rapid use epicutaneous (TRUE) test (TRUE Test™), which consists of three panels containing 20 individual allergens and eight allergen mixes. Previous studies had raised concern regarding the adequacy of the initial two-panel TRUE Test™ system (16 individual allergens and seven allergen mixes) in fully assessing patients with possible allergic contact dermatitis. We sought to investigate the effectiveness of the current three-panel TRUE Test™ as the sole diagnostic tool for detecting allergic contact dermatitis. This study was a retrospective analysis of 2088 patients who underwent patch testing between 1995 and 2010. Study groups were analysed to determine whether positive reactions were to allergens and/or mixes present in the TRUE Test™ panels. Of the 2088 patch-tested patients, 1385 had at least one positive reaction. Among these 1385 patients, 27.6% were fully evaluated by use of only the TRUE Test™ series, 49.9% were partially evaluated, and 22.5% did not have any of their allergens detected. On assessment for clinical relevance, similar percentages were observed. In our study, the current TRUE Test™ series of 28 allergens would have completely identified allergens in only 27.6% of patients. Broadening the standard panel to include common allergens causing >50% of allergic contact dermatitis cases in a given geographical location and aim testing allergens on the basis of the patient's history will increase the test's sensitivity.

Contact Dermatitis of the Vulva

Contact dermatitis of the vulva is common, with irritant contact dermatitis occurring more frequently than allergic contact dermatitis. Patients with chronic vulvar dermatoses are at greater risk and should continually be reassessed for possible contact dermatitis. Comprehensive and specific questioning about hygiene practices and product use is necessary to elicit a history of contactant use. Patch testing is required to identify relevant contact allergens, the most common of which include medicaments, preservatives, and fragrances. Patient education and follow-up are essential in optimizing treatment and preventing recurrence of vulvar contact dermatitis.