The conifer – balsam of Peru connection discussed – Systemic Contact Dermatitis

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Systemic contact dermatitis is a systemic response to an allergen in a previously sensitized individual.  This article presents a case of a woman with ‘dyshidrotic hand eczema’ who developed blisters after eating chocolate.  She also had fever and an elevated immune cell count.  This patient benefited from a BOP-reduced diet.

…”many of the components of BP can be present as unrecognized, ‘‘hidden’’ allergens in different food items.” … ” Patients with BP contact allergy are often allergic to colophonium, balsam of Tolu, wood tar, turpentine, styrax or propolis, all of which can contain similar or related allergens.”

Conifers (evergreens, pine trees) are sources of colophonium.

http://medicaljournals.se/acta/content/download.php?doi=10.1080/00015550310016599

For more information on the balsam of Peru diet visit us at:

https://www.dermatitisacademy.com/bop-diet/

 

SNAS – 700 patients evaluated

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This is important work from the Italians… 700 patients evaluated with the systemic nickel allergy syndrome having both skin and GI symptoms.  Patch testing helped confirm the diagnosis.

Tammaro A1, Romano I1, De Marco G1, Parisella FR2, Pigliacelli F1, D’Arino A1, Persechino F3, Gaspari AA2, Persechino S1.

Effects of TIO NICKEL in patients with ACD and SNAS: experience on 700 patients in Italy.

J Eur Acad Dermatol Venereol. 2016 Aug 12. doi: 10.1111/jdv.13916. [Epub ahead of print]
Abstract
The nickel is causes of allergic contact dermatitis (ACD) and of “systemic nickel allergy syndrome” (SNAS). From 2009 to 2015 a very large number of patients with allergies, presented to our Department of Dermatology and Allergology at Sant’Andrea Hospital in Rome; 700 of these showed an allergic reaction to nickel with a double clinical manifestation, skin and gastrointestinal symptoms, between 25 and 60 years old. Regarding the skin manifestation, the diagnosis was confirmed by Patch Test SIDAPA standard series. The results were positive for nickel sulphate with +2 to +3, using the ICDRG scoring system, and also to others allergens (Table 1). This article is protected by copyright. All rights reserved.

 

http://onlinelibrary.wiley.com/doi/10.1111/jdv.13916/pdf

Octylisothiazolinone! Anti-fungal on Leather!

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This is an important article this week, because OIT isn’t just an occupational allergen and it can cross-react with MI.
Contact Dermatitis. 2016 Aug 19. doi: 10.1111/cod.12670. [Epub ahead of print]

Octylisothiazolinone, an additional cause of allergic contact dermatitis caused by leather: case series and potential implications for the study of cross-reactivity with methylisothiazolinone.

Abstract

BACKGROUND:

Octylisothiazolinone (OIT) (CAS no. 26530-20-1) is used as an antifungal agent by the leather industry.

OBJECTIVES:

To show sensitization to OIT from leather, and to highlight the potential implications when cross-reactivity between OIT and methylisothiazolinone (MI) is studied.

METHODS:

Two patients with allergic contact dermatitis caused by a leather belt and shoes, respectively, were patch tested with methylchloroisothiazolinone (MCI)/MI, MI, MCI, OIT, and benzisothiazolinone (BIT). High-performance liquid chromatography with ultraviolet detection (HPLC-UV) was used to detect isothiazolinone derivatives in leather goods. Additionally, files of OIT-sensitized patients, observed at the KU Leuven department during the period 1990-2015, were retrospectively analysed.

RESULTS:

Both patients had been primarily sensitized to OIT, but the diagnosis in 1 of them could be achieved only when a higher patch test concentration of OIT (1000 ppm pet.) was used. HPLC-UV confirmed the presence of OIT in their leather goods. Non-relevant sensitization to MI was noted in both cases. Four additional cases of OIT sensitization from leather could be retrieved from the KU Leuven database.

CONCLUSIONS:

Non-occupational sensitization to OIT from leather may occur. Patch test concentrations of >250 ppm pet. may be necessary for diagnosis, and to show cross-reactivity with MI. Safer use limits for OIT in the leather industry may be needed.

© 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

KEYWORDS:

CAS no. 26530-20-1; allergic contact dermatitis; biocide; cross-reaction; fungicide; high-performance liquid chromatography; leather; methylisothiazolinone; octylisothiazolinone; shoes

For more information:
http://onlinelibrary.wiley.com/journal/10.1111/(ISSN)1600-0536/earlyview

 

 

Test your Colophony savvy

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Read more

Test your Benzalkonium Chloride Savvy

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Read more

Test your Uroshiol Savvy

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Test your knowledge of common items containing the allergen Uroshiol

Read more

FDA data on the TRUE Test

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This article updated in Nov 2015 on the Thin-layer Rapid Use Epicutaneous (T.R.U.E.) test discusses Indications and Usage, Dosage and Administration, and Contraindications, Timing of the Reads, Interpretation Instructions — use in specific populations (pregnancy, nursing, pediatric) — detailed allergen composition and the ten clinical studies were conducted in North America and Europe evaluating sensitivity and specificity, and/or agreement with a reference allergen…

 

To read full article: http://www.fda.gov/downloads/BiologicsBloodVaccines/Allergenics/UCM294327.pdf

High concentrations of isothiazolinone and mislabeling – Belgium

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This article discusses the evaluation of MI in products in Belgium and the verification of accurate labeling and regulatory compliance.  They found that concentrations of MI may be “(too) high” and labelling may be incorrect.

“Aerts O1, Meert H2, Goossens A3, Janssens S2, Lambert J1, Apers S2.  Methylisothiazolinone in selected consumer products in Belgium: Adding fuel to the fire?  Contact Dermatitis. 2015 Sep;73(3):142-9. doi: 10.1111/cod.12449.

Methylisothiazolinone (MI) contact allergy is severely affecting consumers with allergic contact dermatitis, owing to its presence in cosmetics, household detergents, and water-based paints, in particular. Data on the true isothiazolinone concentrations in these products are scarce, and labelling may be incorrect.”
“OBJECTIVES:
To report on the MI concentrations in such products marketed in Belgium, in order to verify the accuracy of labelling (when applicable) and compliance with EU regulations.
MATERIALS AND METHODS:
Thirty cosmetics (18 leave-on and 12 rinse-off), eight detergents and four paints were analysed for MI by the use of high-performance liquid chromatography with ultraviolet detection.
RESULTS:
The analysed leave-on, and to a lesser extent the rinse-off, cosmetics, contained MI at concentrations far exceeding the permitted 100 ppm use concentration. Household detergents contained high concentrations of MI, and mislabelling occurred for both cosmetics and detergents. The (limited) data on paints are in line with the existing literature.
CONCLUSION:
Cosmetics and detergents may facilitate contact sensitization because of a (too) high MI concentration, and mislabelling may make its avoidance extremely difficult. Safer use concentrations and correct labelling should be ensured by adequate quality control.”

This is not an OPEN ACCESS article.  The article can be rented at: http://onlinelibrary.wiley.com/wol1/doi/10.1111/cod.12449/full

Free Article: MCI-MI ‘Outstanding Emerging Allergen’ Thailand

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This article from King Chulalongkorn Memorial Hospital in Thailand compares the authors patch test result between current (2012-2015) and their prior report (2003-2004).  The authors named MCI-MI an “outstanding emerging causative allergen” in their current clinical experience and found MCI-MI to be the most common preservative causing contact allergy (formaldehyde is second).  The MCI-MI prevalence was found to be related to personal care products.  Also of importance,  the prevalence of paraben (another preservative) allergen dropped possibly related to decreased exposure and decreased use in products.
Patterns and risk factors of causative contact allergens in Thai adult patients with contact dermatitis at King Chulalongkorn Memorial Hospital.  Dararattanaroj W1, Pootongkam S, Rojanawatsirivej N, Wongpiyabovorn J.  Asian Pac J Allergy Immunol. 2016 Jun 30. doi: 10.12932/AP0757.

“BACKGROUND:
Surveillance on common allergens identified by patch testing plays an important role in emerging allergen detection, which leads to both individual and societal level prevention.
OBJECTIVE:
To study the changes in the pattern of contact sensitization and to identify risk factors associated with allergens.
METHOD:
The data of 206 patients who underwent patch testing at King Chulalongkorn Memorial Hospital during 2012 to 2015 were assessed. The associations between patient risk factors and positive reactions to each allergen were evaluated. The results were compared with data from 2003-2004.
RESULTS:
The top five most common allergens during 2012-2015 were nickel sulfate (19.4%), methylchloroisothiazolinone/ methylisothiazolinone (MCI/MI) (13.6%), fragrance mix I (FM I) (10.7%), carba mix (9.2%) and cobalt chloride (6.3%) whereas, during 2003-2004, these were nickel sulfate, cobalt chloride, FM I, potassium dichromate and Myroxylon pereirae. A positive patch test to nickel was strongly associated with a history of metal and seafood allergy (p±0.001; OR, 4.94; 95% CI = 2.33-10.47 and p=0.028; OR, 2.55; 95% CI, 1.11-5.85, respectively). MCI/MI was correlated with a history of personal care products allergy, and fragrance was correlated with a history of urticaria (p=0.005; OR, 4.05; 95% CI = 1.54-10.66 and p=0.031; OR, 2.71; 95% CI, 1.10-6.68, respectively).
CONCLUSIONS:
There was an alteration in the pattern of contact sensitization detected by our standard series. MCI/MI has become the most common preservative causing contact allergy.”

Link here to read the full OPEN ACCESS article:

http://thailand.digitaljournals.org/index.php/APJAI/article/viewFile/29955/30258

To learn more about the second methylisothiazolinone epidemic – click here:

https://www.dermatitisacademy.com/wp-content/uploads/2016/05/Update-on-Isothiazolinones.pdf

 

Also:

Bunyavaree M1, Kasemsarn P1, Boonchai W1.  Cosmetic preservative labelling on the Thai market.
Contact Dermatitis. 2016 Apr;74(4):217-21. doi: 10.1111/cod.12520. Epub 2016 Jan 22.

” International brand cosmetics were more likely to contain non-formaldehyde-releasing preservatives than domestically produced brands. Isothiazolinone-based preservatives, which are responsible for the current increase in the prevalence of contact allergy, were found at a significant frequency in domestically produced, leave-on cosmetic products.”