ACD to cigarettes – Balsam of Peru and Chocolate fragrance

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“Additives to Cigarette Tobacco…

Cocoa Products

Cocoa and cocoa products are used as a main flavor additive in the Philip Morris cigarette brands (Philip Morris USA, Richmond, VA)-Virginia Slims, Marlboro, and Parliament (Table 2).[10]Cocoa is from the Sterculiaceae family (also called the Malvaceae family). Cocoa beans are processed into cocoa powder to make chocolate.[11] Individuals who are allergic to balsam of Peru or fragrance mix are encouraged to avoid chocolate as part of the [LOW] balsam of Peru diet because chocolate can cause their dermatitis to flare. Salem and Fowler reported that of their patients who had positive patch-test reactions to balsam of Peru or fragrance mix, 47% had a “complete or significant improvement” in their dermatitis on the balsam of Peru diet.[12] In addition, the cocoa in cigarettes contains alkaloids that can alter how the body processes nicotine. For example, theobromine (a component of chocolate), is a bronchodilator and increases the amount of cigarette smoke inhaled.[13]

In their case report of airborne ACD from cigarettes, Kato and colleagues postulated that the allergen was “volatile” because the patient had a positive reaction to unsmoked tobacco and a negative reaction to smoked tobacco.[6] In particular, it was noted that the patient’s specific brand of cigarettes contained a chocolate fragrance.[6] The patient had only a positive patch-test reaction to her brand of cigarettes, and she recovered when she stopped smoking. This case report implies that chocolate may be an airborne allergen in cigarettes.”

Furthermore:

“Cigarette Filters, Filter Adhesives, and Cigarette Paper

Cigarette filters and cigarette paper could also be sources of airborne ACD. Philip Morris lists more than 75 ingredients in cigarette paper and filter paper”!

And!

Colophony:

“resins and rosins are found in the filter paper and monogram ink…”
Read more here: http://www.medscape.com/viewarticle/589970_3

New article came out on isothiazolinone cross reactivity (mice)

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Br J Dermatol. 2016 Jun 25. doi: 10.1111/bjd.14825. [Epub ahead of print]

Cross-reactivity between methylisothiazolinone, octylisothiazolinone and benzisothiazolinone using a modified local lymph node assay.

Schwensen JF1, Menné Bonefeld C2, Zachariae C3, Agerbeck C2, H Petersen T2, Geisler C2, E Bollmann U4, Bester K4, D Johansen J1.

Author information

Abstract

BACKGROUND:

In the light of the exceptionally high rates of contact allergy to the preservative methylisothiazolinone (MI), information about cross-reactivity between MI, octylisothiazolinone (OIT) and benzisothiazolinone (BIT) is needed.

OBJECTIVES:

To study cross-reactivity between MI and OIT, and, MI and BIT.

METHODS:

Immune responses to MI, OIT and BIT were studied in vehicle and MI-sensitised female CBA mice by a modified local lymph node assay. The inflammatory response was measured by ear thickness, cell proliferation of CD4+ and CD8+ T cells and CD19+ B cells in the auricular draining lymph nodes.

RESULTS:

MI induced significant, strong, concentration-dependent immune responses in the draining lymph nodes following the sensitisation phase of three consecutive days. Groups of MI sensitised mice were challenged on day 23 with 0.4% MI, 0.7% OIT and 1.9% BIT; concentrations corresponding to their individual EC3-values. No statisticly significant difference in proliferation of CD4+ and CD8+ T cells was observed between mice challenged with MI in comparison to mice challenged with BIT and OIT.

CONCLUSION:

Our data indicate cross-reactivity between MI, OIT and BIT, when the potency of the chemical was taken into account in choice of challenge concentration. This means that MI sensitised individuals may react to OIT and BIT if exposed to sufficient concentrations. This article is protected by copyright. All rights reserved.

This article is protected by copyright. All rights reserved.

http://www.ncbi.nlm.nih.gov/pubmed/27343839

Free Article – American Contact Alternatives Group (ACAG) – Hair Products

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The American Contact Alternatives Group evaluates allergen trends and alternative products – Check out the free article here:

Part 2 of a 4-part series Hair Products: Trends and Alternatives: Data from the American Contact Alternatives Group. Scheman A, Jacob S, Katta R, Nedorost S, Warshaw E, Zirwas M, Bhinder M J Clin Aesthet Dermatol. 2011 Jul;4(7):42-6.

…
“To provide updated data on usage of ingredients that are common potential contact allergens in several categories of hair products. To identify useful alternative products with few or no common contact allergens.  — Data on allergens and alternatives for hair products is not widely published. This article reviews some of the common potential allergens in hair products, including shampoos, conditioners, and styling products. Suitable available alternative products for patients with contact allergy are listed.”

Access the FREE article here: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3140904/

Free Article – American Contact Alternatives Group (ACAG) – Facial Cosmetics

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The American Contact Alternatives Group evaluates allergen trends and alternative products – Check out the free article here:

Part 1 of a 4-part series:

Facial Cosmetics: Trends and Alternatives: Data from the American Contact Alternatives Group.

Scheman A, Jacob S, Katta R, Nedorost S, Warshaw E, Zirwas M, Cha C.

“To provide updated data on usage of ingredients that are common potential contact allergens in several categories of facial cosmetics. To identify useful alternative products with few or no common contact allergens.”

“Data on allergen usage and alternatives for facial cosmetics is not widely published. This article reviews some of the common potential allergens in facial cosmetics, including blushers and bronzers, concealers, eyeliners, eyeshadows, foundations, loose and pressed powders, and mascaras. Suitable available alternative products for patients with contact allergy are listed.”

Check out the FREE article here:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3140901/

 

Late Delayed Reactions – 13%

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“Patch test readings are usually performed on day 2 (48 hours) and day 4 (96 hours). However, reports in the literature identify delayed allergy to metals, corticosteroids, antibiotics, some preservatives, acrylic and methacrylic monomers and p-phenylenediamine.”

 

This article discusses 203 patients that were patch tested to the British Society for Cutaneous Allergy standard series and twenty-six patients (12.8%) had new positive reactions on day 7 (168 hours), Including “mercury 0.5% (2/26); cobalt chloride 1% (2/26); colophony 20% (2/26); disperse blue mix 106/124 1% (2/26); preservatives (4/26) that included Methylchloroisothiazolinone/ methylisothiazolinone, sodium metabisulfite, and diazolidinyl urea; fragrances (7/26); and gentamycin sulfate 20% (1/26).” http://www.ncbi.nlm.nih.gov/pubmed/24030365

 

Late delayed reactions have been reported also in patch tested children in the US – “Twenty-five of the 38 children (66%) had a positive reaction at 48 hours; 32 children (84%) had a positive reaction at 72 hours (day 3); 19 children (50%) had a positive reaction at 168 to 216 hours (day 7-9). Of those 19, 16 (42%) had persistent reactions, while 5 children (13%) had new late delayed reactions. Among the new late delayed reactions, there were six allergens identified, four of which were considered of probable clinical relevance.”  (the four with probable relevance were: Formaldehyde and formaldehyde related chemicals:  Formaldehyde, Q15, Diazolidinyl urea, p-tert-butyl formaldehyde resin).  http://www.ncbi.nlm.nih.gov/pubmed/21208272

patch test

On patch testing and the T.R.U.E. test

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What is Patch Testing?  Patch testing is a method for diagnosing delayed type hypersensitivity.  Chemicals (haptens) are applied on the skin with wells adhered to an adhesive strip.  The wells may be hand-loaded (‘comprehensive’) patch testing or may be preloaded in gels (‘patch test kit’, e.g.: T.R.U.E. test).   They are then left in contact with the skin for up to 48h, then removed and checked.  They are then re-evaluated between 72-120h (sometimes later).  Some reactions can appear later and the patient should monitor their back for new reactions for up to 8 weeks.  If a new reaction presents, they should notify their provider.

What is the T.R.U.E. test?  The thin-layer rapid epicutaneous (T.R.U.E.) testT. is a commercially available patch test kit that is approved for use in adults in the US by the Food and Drug Administration.

What is it used for?  It is used to confirm the diagnosis of allergic contact dermatitis (ACD) – a delayed hypersensitivity reaction.

How effective is the test?  Data from the North American Contact Dermatitis Group (NACDG), a US-based research group of patch testers, suggest ” Using a conservative calculation (assuming that individual components of a mix would not have been detected with a mix and vice versa), the conservative hypothetical detection rate of T.R.U.E. TEST allergens would be 69.7%”.  Which means that theoretically ~70% of the reactions that the NACDG detected with their screening panel would have been also captured if the T.R.U.E. test were used.  We say ‘theoretically’  because they are different systems and can have inherent differences in detection rates (see below).  One limitation of patch testing (in general) is that it is a confirmatory test, so you can only detect what is tested for.  Testing the patients products (shin-guards, personal hygiene products, medicaments) is an important adjunct to the standard patch testing, and can provide vital information about additional potential allergens and their sources. http://www.ncbi.nlm.nih.gov/pubmed/25581671

How does patch system compare to comprehensive testing (methods)?  There are variations within the patch test systems:

Comprehensive testing – Comparative study of IQ-ultra and Finn Chambers: “Both patch tests had a significant agreement in detecting all of the allergens. An “almost perfect agreement” was noted for ethylenediamine dihydrochloride, quaternium-15, mercapto mix, black rubber mix, balsam of Peru, and nickel sulfate; “substantial agreement” for formaldehyde, bisphenol A epoxy resin, and 4-tert-butylphenol formaldehyde resin; and “moderate agreement” for potassium dichromate.” : http://www.ncbi.nlm.nih.gov/pubmed/22417991

T.R.U.E. test versus Comprehensive testing; “Discordant positive reactions were examined for clinical relevance. The Finn Chamber methodology was superior in detecting clinically relevant allergies to fragrance mix, balsam of Peru, and thiuram mix. T.R.U.E. Test performed somewhat better than the Finn Chamber in detecting relevant allergic reactions to nickel, neomycin, and methylchloroisothiazolinone/methylisothiazolinone. Neither T.R.U.E. Test nor Finn Chamber methodologies performed optimally in detecting relevant allergies to formaldehyde and carbamates. Practitioners limited to only the T.R.U.E. Test methodology need to be aware that relevant reactions to fragrances, rubber accelerators/pesticides (carbamates and thiurams), and formaldehyde may be missed with this system.” http://www.ncbi.nlm.nih.gov/pubmed/11712026

Methyisothiazolinone may be missed:  “The clinical manifestations of allergy to MCI/MI and MI are highly variable and diagnosis is often missed. In the standard patch test series of the Spanish Contact Dermatitis and Skin Allergy Research Group (GEIDAC), MCI/MI is tested at 100 ppm, but at this concentration, up to 50% of cases might go undetected. Furthermore, our data indicate that MCI/MI at 200 ppm would make it possible to diagnose more cases of contact allergy to MI. To improve the diagnosis of contact allergy to MCI/MI and MI, we believe that the test concentration of MCI/MI should be increased to 200 ppm in the GEIDAC standard series and that MI should be added in the GEIDAC standard series.”  http://www.ncbi.nlm.nih.gov/pubmed/24626102

Additional information: http://www.ncbi.nlm.nih.gov/pubmed/24117737

Fragrances can be volatile and should be loaded into the patch chamber as close in time to the application to the patient as possible “Within a couple of hours several fragrance allergens evaporate from test chambers to an extent that may affect the outcome of the patch test. Application to the test chambers should be performed as close to the patch test occasion as possible and storage in a refrigerator is recommended.”  : http://www.ncbi.nlm.nih.gov/pubmed/22803625

For more information on contact dermatitis and patch testing – please visit the Dermatitis Academy at https://www.dermatitisacademy.com

 

 

Formaldehyde exposure

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On Formaldehyde exposure …formaldehyde is an important irritant and allergen.  Irritants disrupt the skin and permit increased absorption of allergens…  “Formaldehyde is the simplest of the aldehydes (HCHO). It is a gas at room temperature. It is obtainable in crystalline form or as a liquid. … There are two major sources of formaldehyde: direct commercial manufacture and indirect production. Commercial formaldehyde is used mainly in the synthesis of disinfectants, cosmetics, deodorants, paper, dyes, photographic materials, textiles, inks, wood products, synthetic resins, preservatives, leather, fertilizers, and insecticides. Indirect production of formaldehyde may occur through the photochemical oxidation of airborne hydrocarbons from vehicle exhausts, the incomplete combustion of hydrocarbons in fuels, and other sources. Other sources in the atmosphere include cigarette smoking levels over 0.2 ppm have been observed and anaerobic decomposition of methane by microbes.”

…

“Studies to evaluate formaldehyde sensitivity have been done by several investigators over the past 80 years, starting in 1909. In the 1909 study, subjects developed stomach or intestinal pains, headaches, and itchy rashes on the chest and thigh after drinking milk that contained formaldehyde.”  Formaldehyde exposure has been studied for more than 80 years!!!

“The concentration of formaldehyde for inhalation provocation testing in our studies was <0.2 ppm. This is lower than the perceptible odor level of 1 ppm noted by NIOSH.”  Formaldehyde exposure needs to be further studied!

“In 1981, the Committee on Toxicology of the National Research Council estimated that as much as 10% of the total United States population may be hypersensitive to the irritant effects of formaldehyde.”  Formaldehyde exposure and the clinical effects from this need to be documented!

The above quotes are from the article from Pan et al.  for more information please read:

Yaqin Pan et al.  Formaldehyde Sensitivity  Clinical Ecology VI(3):79-84  http://www.aehf.com/articles/A44.htm

 

This week the Dermatitis Academy has led out a campaign for awareness on formaldehyde allergy.  Please visit our dedicated formaldehyde allergy page:https://www.dermatitisacademy.com/formaldehyde/