Aerosolized MI

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Aerosolized MI

Methylisothiazolinone (MI) is a preservative causing “an outbreak of allergy … which we have not seen before in terms of scale in our lifetime…I would ask the cosmetic industry not to wait for legislation but to get on and address the problem before the situation gets worse,” Dr. John McFadden, dermatologist at St. John’s Institution of Dermatology in London, 2013.  Duffin, C., Warning over ‘epidemic’ of skin allergies from chemical in cosmetics and household products, in The Telegraph.  It is not just a preservative in personal hygiene products, it is also in cleaning supplies, air fresheners and household paint.  Notably, reactions can occur through airborne exposures through aerosolized MI.

 

Discussion by Phillip Grigsby, BA. MS3 and Sharon Jacob, MD,  Loma Linda University School of Medicine and Department of Dermatology

Aerts et al. describe a case of a 4 year-old girl who was believed to have been sensitized by skin exposure to methylisothiazolinone (MI) that was contained in Scottex Fresh® moist toilet paper (Kimberly Clark).1 The child developed a papular eruption (dermatitis) over an erythematous base at the site of the wipe exposure that eventually subsided after application of topical steroids and cessation of exposure to the wipes. Six months later, she had a similar, papular dermatitis involving her face, including nasolabial folds and eyelids, which was morphologically similar to atopic dermatitis in an airborne (exposed area) distribution. It was resistant to more potent topical corticosteroids, and continued to wax and wane for another 4 weeks. The child was epicutaneously patch tested and found to be contact sensitized (immune system recognized) to 25 parts per million (ppm) of MI (well below the levels in both the wipes and paint). In review of exposures, it was noted that her parents painted her room with water-based paint. Analysis showed that the paint contained MI at 53 ppm. Aerosolized MI in the paint was determined to be contributory to the development of the new dermatitis in this MI sensitized child.

http://www.ncbi.nlm.nih.gov/pubmed/23510347

 

MI was originally formulated as Kathon®, a mixture of methylchloroisothiazolinone (MCI) and MI.  It has since been discontinued in the European Union due to high rates of allergic contact dermatitis.2 MI currently is allowed allowed in select products (leave on, rinse off) to 100 ppm. A review of the literature found 21 cases of aerosol-induced (aerosolized MI) dermatitis to MI.3-7 Aerts et al. point out the first child to be confirmed to have this reaction. Of note, a similar case has since been reported where a three year-old girl was sensitized by MI-containing wipes, and later developed an airborne spread allergic contact dermatitis after paint exposure.6 Notably, the mimickry to atopic dermatitis (eczema) increases the risk that this child could have gone mis- or undiagnosed. Patch testing was vital in correctly making her diagnosis of allergic contact dermatitis, with systemic (airborne) activation. It is important to note that MI as a stand alone substrate is not included on the commercially available patch test screening kit. Testing with the MCI-MI combination substrate can miss up to 40% MI reactions, likely because the low concentrations of MI in the tests.8

 

References

  1. Aerts O, Cattaert N, Lambert J, Goossens A. Airborne and systemic dermatitis, mimicking atopic dermatitis, caused by methylisothiazolinone in a young child. Contact Dermatitis. 2013;68(4):250-251. http://www.ncbi.nlm.nih.gov/pubmed/23510347.
  2. Aerts O, Goossens A, Giordano-Labadie F. Contact allergy caused by methylisothiazolinone: the Belgian-French experience. Eur J Dermatol. 2015;25(3):228-233. http://www.ncbi.nlm.nih.gov/pubmed/26412037.
  3. Bohn S, Niederer M, Brehm K, Bircher AJ. Airborne contact dermatitis from methylchloroisothiazolinone in wall paint. Abolition of symptoms by chemical allergen inactivation. Contact Dermatitis. 2000;42(4):196-201. http://www.ncbi.nlm.nih.gov/pubmed/10750849
  4. Lundov MD, Mosbech H, Thyssen JP, Menne T, Zachariae C. Two cases of airborne allergic contact dermatitis caused by methylisothiazolinone in paint. Contact Dermatitis. 2011;65(3):176-179. http://www.ncbi.nlm.nih.gov/pubmed/21827510
  5. Vanneste L, Persson L, Zimerson E, Bruze M, Luyckx R, Goossens A. Allergic contact dermatitis caused by methylisothiazolinone from different sources, including ‘mislabelled’ household wet wipes. Contact Dermatitis. 2013;69(5):311-312. http://www.ncbi.nlm.nih.gov/pubmed/24117741
  6. Madsen JT, Andersen KE. Airborne allergic contact dermatitis caused by methylisothiazolinone in a child sensitized from wet wipes. Contact Dermatitis. 2014;70(3):183-184. http://www.ncbi.nlm.nih.gov/pubmed/24588371
  7. Jensen JM, Harde V, Brasch J. Airborne contact dermatitis to methylchloroisothiazolinone/methylisothiazolinone in a boy. Contact Dermatitis. 2006;55(5):311. http://www.ncbi.nlm.nih.gov/pubmed/17026706
  8. Castanedo-Tardana MP, Zug KA. Methylisothiazolinone. Dermatitis. 2013;24(1):2-6. http://www.ncbi.nlm.nih.gov/pubmed/23340392.

 

Additional articles that may be of interest (Aerosolized MI):

Airborne exposure to preservative methylisothiazolinone causes severe allergic reactions.

http://www.ncbi.nlm.nih.gov/pubmed/23212711

Generalized allergic contact dermatitis caused by methylisothiazolinone in a spray tan.

http://www.ncbi.nlm.nih.gov/pubmed/26098619

Five cases of severe chronic dermatitis caused by isothiazolinones.

http://www.ncbi.nlm.nih.gov/pubmed/23782361

 

4 replies
  1. Amy Cupp
    Amy Cupp says:

    I have the same thing. I’m currently visiting my mom who uses MI in most of her products and the scent from her counter top cleaner has caused a flare worse than I have had in months since I cut MI out of my household. (I don’t have a valid patch test -I was allergic to the adhesive they secured my test with- but there is no question it is a trigger and for me, breathing it in is just as bad as touching it.)

  2. Linda watkins
    Linda watkins says:

    I also went into a shop and somebody had been spraying within 5 mins had to leave as my eyes got so bad they were watering and I couldn’t see. My face flared up and it was horrific for 24 hours.

  3. Dana Todd
    Dana Todd says:

    Some of my worst reactions are to paint, even after it’s dried. I get puffy eyes and also major back spasms and nerve pain centralized in my lower spine. The effect has lasted up to 5 days and left me bedridden. Happened once after inhaling commercial floor wax fumes as well (it was being done in my office and I breathed it for about an hour before I finally realized I was being poisoned).

  4. Paula
    Paula says:

    I too am a fellow MI sufferer confirmed via patch test and have noticed flare ups happen even when walking down the laundry aisle of a supermarket..airborne exposure seems to affect me more than contact exposure as the reaction covers a larger area of the body I am currently sitting writing this with burning cheeks, itchy nose and red sore itchy eyes and welts appearing on my face and body all this from a trip to the shops but i am also allergic to certain types of perfume/parfum so have constant reactions wherever i go..

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