A day in the life of a patch tester – Glove Protection – Formaldehyde

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It’s so true not all gloves are created equally!  There’s thickness, pliability, and then there is materials!!!   Did you know that latex does NOT adequately protect against formaldehyde?  It is INADEQUATE.
Oh yes!  Have seen fresh young medical student sensitized in anatomy lab by using [and reusing 🙁 ] latex gloves… when instead they should have been doubling up on the nitrile!

 

Here’s a great link from Umass, Boston:

https://www.umb.edu/ehs/lab_safety/ch_em_plan/appd

Latex gloves are inadequate, fragile and ‘perform very poorly against Organic Solvents.

They are also INADEQUATE protection for:

Most Aldehydes, including Formaldehyde…

Nitrile, the blue-purple ones, on the other hand,  WILL withstand:

Alcohols

Inorganic Acids and Bases including Chromic Acid, and Most Organic Acids

Organosilanes

Organic Nitrates and Nitrites

Some Aldehydes, including Formaldehyde and Glutaraldehyde’

 

https://www.umb.edu/ehs/lab_safety/ch_em_plan/appd

Nonfat milk (casein) binds formaldehyde in the wash

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Formaldehyde most definitely can be a cause of reactions to clothing!

It can be adult and children’s clothing – pants, shirts, underwear and bras. In an interview on bra reactions Dr. Joel Dekoven said “…in fact most physicians don’t know that…” (4:11)

 

So what can be done?  Wash clothes at least twice before wearing.  Select 100% cotton (or single fiber – no blends), except no RAYON!

What else can be done?

Treat your wash with non-fat milk!

Back in 1974, Dr. Subbart describe a method for binding free formaldehyde that was released in the wash:
F. James Stubbart, MD  Nonfat Dry Milk Helps Prevent Formaldehyde Dermatitis.  August 1, 1974, Vol 110, No. 2

“Formaldehyde present in clothing and sheets can produce allergic reactions. Most frequently, it is an irritant, especially to dry skin and areas exposed to increased friction or perspiration.Casein is an innocuous compound that, when added to formaldehyde, produces insoluble compounds used to make items, such as buttons, billiard balls, and water-proof adhesives. A small handful of nonfat dry milk added to the laundry rinse water precipitates free formaldehyde, this results in reduction of the skin irritation. This process also makes clothing and sheets feel softer. In some fabrics, the formaldehyde continues to be released, and after a few days the rinsing must be repeated.Excessive quantities of harsh laundry detergents may cause the same problem of itching.”

Available at http://archderm.jamanetwork.com/article.aspx?articleid=534309

 

~1/4 cup of non-fat dry milk into the wash…

A day in the life of a patch tester – Teens and padded bras – Formaldehyde

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When you look into the eyes of a saddened 14 yo girl who’s dermatitis for the last 7 months has been so severe that we can’t see her nipples from her areola — your heart just breaks.  You just have to find the answer and we did – patch testing revealed PTBFR in the foam of her bra…
The question is – what do you do?  Cotton bras!!!  But the teen says to me – I need padding – My ‘Macgyver-work around” cotton nursing pads sewn into a cotton bra!  
Herro EM1, Friedlander SF, Jacob SE.Bra-associated allergic contact dermatitis: p-tert-butylphenol formaldehyde resin as the culprit.  Pediatr Dermatol. 2012 Jul-Aug;29(4):540-1. doi: 10.1111/j.1525-1470.2011.01533.x. Epub 2011 Oct 20.

“P-tert-butylphenol formaldehyde resin (PTBPFR) is recognized as a significant source of allergic contact dermatitis in adults and children in association with athletic gear, shoes, and neoprene. To our knowledge, this is the first case report of allergic contact dermatitis with PTBPFR associated with padded foam bras.”

Access the article here: http://www.ncbi.nlm.nih.gov/pubmed/22011272

“I can’t find a bra – my underwear make me itch!” – living with formaldehyde allergy

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At the final patch test reading visit, once a positive reaction has been found, clinical relevance to the current dermatitis must be determined… then safe alternatives found… a challenge for the formaldehyde allergic person is clothing (textiles)…

Back in 2008, Dr. Andrew Scheman (Director of the Contact Allergen Management Program for the ACDS) led out a partnership initiative to form a collaborative [namely the American Contact Alternatives Group -ACAG]  which would work to find and share safe alternatives with each other and our patients, resulting in this manuscript:

Scheman A1, Jacob S, Zirwas M, Warshaw E, Nedorost S, Katta R, Cook J, Castanedo-Tardan MP.  Contact Allergy: alternatives for the 2007 North American contact dermatitis group (NACDG) Standard Screening Tray.  Dis Mon. 2008 Jan-Feb;54(1-2):7-156.
http://www.ncbi.nlm.nih.gov/pubmed/18215657

Since then, the ACAG collaborative has continued to work together and share with each other resources we find…

Here is a resource from CottoniqueTM:

“Each country has its own manufacturing standards for acceptable levels for formaldehyde resins. A low indicator of formaldehyde releasing resin would be 75 ppm which is the Japanese standard, the US standard is somewhere near 300ppm, quite a difference.

Fabrics safe to wear: 100% silk, 100% linen (if it wrinkles easy), 100% polyester, 100% acrylic, 100% nylon, spandex, flannel (soft), wool (may cause irritation) and denim.

Do not wear these fabrics: Permanent press, wrinkle resistant, color-fast, stain-resistant, blends (including rayon, polyester-cotton), corduroy or shrink-proof wool.

It is suggested that you read the labels in your existing clothing and separate them in your closet so you will know what’s safe to wear. Always opt for loose fitting clothing since friction and perspiration can cause the condition to flare. Read the labels in any new clothing before you purchase. Clothes made in Japan are the safest and companies that sell clothes in Japan also have to meet the Japanese standard.

Companies that meet the Japanese standard: GAP, Old Navy, Banana Republic, Liz Claiborne, Eddie Bauer, Cuddle Duds and Levi Strauss. There may be others but these were on the list from the American Contact Dermatitis Society.”

Blog from Cottonique [https://www.cottonique.com/blogs/blog/2424702-the-contact-dermatitis-and-clothing-connection]  https://www.cottonique.com

 

The Dermatitis AcademyTM has no financial or relevant relationship with CottoniqueTM, nor certifies their wares.

day in life formaldehyde

A day in the life of a patch tester – Formaldehyde allergy – Surprise

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Formaldehyde allergy:  I saw a patient with ‘recalcitrant eczema’ who we diagnosed with a formaldehyde allergy by patch testing.  They were doing very well, minor flares here and there…and, then one day they came to see me with a horrific reaction on their face, chest and arms – new involved areas.

We reviewed the exposure sources – person hygiene products, aspartame, dishwashing soap, cleaning agents, building supplies – remodeling – the full investigative history gave no clues – until I asked the pivotal question, where were you 3-5 days before – did anything different happen?

“My car broke down”.

Me: ‘Did you work on it? Did you go to the automotive shop?’

All answers were no.

Me: ‘The how did you get to work?’

“I rode the bus.”

Then, there was that moment of pause –

Surprise!

“While I was waiting for the bus at the bus stop, a car backfired right there and exhaust smoke got all over us”.

In Florida, at that time, catalytic converters were not required on every vehicle…

The source of this totally compliant patient’s reaction – formaldehyde in the exhaust fumes!

 

Is this commonly reported?  No. could it have been potentially missed?  Yes.

Conclusion – always consider the timing of the “flare up” responses…

 

More on formaldehyde:  ”   It reaches the air via automobile exhaust fumes from vehicles without catalytic converters, or from any other plant which burns fossil fuels, including energy plants. Forest fires and waste incinerators also give off formaldehyde.

Symptoms of Formaldehyde Allergy” – read more here:

http://www.news-medical.net/health/Formaldehyde-Allergy.aspx

Formaldehyde and non-fat dry milk in the laundry? YES!

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Why would anyone add non-fat dry milk to the laundry?  Because the casein in the non-fat dry milk precipitates with the free formaldehyde and then it gets washed out better…

“Formaldehyde present in clothing and sheets can produce allergic reactions. Most frequently, it is an irritant, especially to dry skin and areas exposed to increased friction or perspiration.Casein is an innocuous compound that, when added to formaldehyde, produces insoluble compounds used to make items, such as buttons, billiard balls, and water-proof adhesives. A small handful of nonfat dry milk added to the laundry rinse water precipitates free formaldehyde, this results in reduction of the skin irritation. This process also makes clothing and sheets feel softer. In some fabrics, the formaldehyde continues to be released, and after a few days the rinsing must be repeated.Excessive quantities of harsh laundry detergents may cause the same problem of itching.”

http://archderm.jamanetwork.com/article.aspx?articleid=534309