Baseline series fragrance markers fail to predict contact allergy.

BACKGROUND: Negative patch test results with fragrance allergy markers in the European baseline series do not always predict a negative reaction to individual fragrance substances. OBJECTIVES: To determine the frequencies of positive test reactions to the 26 fragrance substances for which labelling is mandatory in the EU, and how effectively reactions to fragrance markers in the baseline series predict positive reactions to the fragrance substances that are labelled. METHODS: The records of 1951 eczema patients, routinely tested with the labelled fragrance substances and with an extended European baseline series in 2011 and 2012, were retrospectively reviewed. RESULTS: Two hundred and eighty-one (14.4%) (71.2% females) reacted to one or more allergens from the labelled-fragrance substance series and/or a fragrance marker from the European baseline series. The allergens that were positive with the greatest frequencies were cinnamyl alcohol (48; 2.46%), Evernia furfuracea (44; 2.26%), and isoeugenol (40; 2.05%). Of the 203 patients who reacted to any of the 26 fragrances in the labelled-fragrance substance series, only 117 (57.6%) also reacted to a fragrance marker in the baseline series. One hundred and seven (52.7%) reacted to either fragrance mix I or fragrance mix II, 28 (13.8%) reacted to Myroxylon pereirae, and 13 (6.4%) reacted to hydroxyisohexyl 3-cyclohexene carboxaldehyde. CONCLUSIONS: These findings confirm that the standard fragrance markers fail to identify patients with contact allergies to the 26 fragrances.

Patch testing in patients treated with systemic immunosuppression and cytokine inhibitors.

BACKGROUND: Currently, there is little data available on the reliability of patch testing in patients taking immunosuppressive agents other than systemic corticosteroids. OBJECTIVES: We present data from 38 patients who were patch tested whilst taking various immunomodulating agents to determine if positive reactions can be elicited. PATIENT/MATERIALS/METHODS: Between September 2006 and May 2009, 38 patients attending the St John's Institute of Dermatology were patch tested whilst taking immunosuppressive agents including azathioprine, ciclosporin, infliximab, adalimumab, etanercept, methotrexate, mycophenolate mofetil, and tacrolimus. RESULTS: Positive patch test reactions of varying degrees and significance were elicited in: 2 of 10 patients on azathioprine; 5 of 11 patients on ciclosporin; 1 patient on ciclosporin and Fumaderm; 1 patient on infliximab; 1 patient on infliximab and methotrexate; 1 of 2 patients on adalimumab; 1 patient on etanercept and methotrexate; 3 of 4 patients on methotrexate; 1 of 3 patients on mycophenolate mofetil; and 1 patient on mycophenolate mofetil and tacrolimus. Negative patch test reactions occurred in 1 patient on azathioprine and ciclosporin; 1 patient on infliximab and azathioprine; and 1 patient on mycophenolate and ciclosporin. CONCLUSIONS: Positive patch test reactions can be elicited in patients taking azathioprine, ciclosporin, infliximab, adalimumab, etanercept, methotrexate, mycophenolate mofetil, and tacrolimus. However, it remains unclear what effect these immunosuppressive drugs may have on suppressing allergic patch test reactions and further studies should be carried out to determine the reliability of testing in these circumstances.

Hairdressers with dermatitis should always be patch tested regardless of atopy status.

BACKGROUND: Allergic contact dermatitis is common in hairdressers because of their exposure to chemicals used in hair dyes and permanent wave solutions. Atopic individuals are known to have a higher prevalence of leaving the profession due to morbidity associated with hand eczema. OBJECTIVES: To assess which chemicals are responsible for allergic contact dermatitis in hairdressers and whether the prevalence is the same according to atopy status. METHODS: A total of 729 hairdressers who had been patch tested were retrospectively identified. Allergic reactions to relevant allergens from the extended European baseline series and hairdressing series were analysed against history of atopic eczema. RESULTS: Of the total, 29.9% of patients had a current or past history of atopic eczema. The most frequent positive allergens from the European baseline series were nickel sulfate (32.1%) and p-phenylenediamine (19.0%) and from the hairdressing series were glyceryl monothioglycolate (21.4%) and ammonium persulfate (10.6%). There was no significant difference between people with or without a history of atopic eczema, except for fragrance mix I and nickel sulfate. CONCLUSIONS: We present findings from the largest cohort of hairdressers patch tested from a single centre. It is necessary to patch test hairdressers with dermatitis, regardless of a history of atopy. Strategies to reduce prevalence of allergic contact dermatitis are required.

Epidemiological data on consumer allergy to p-phenylenediamine.

Many women and men now dye their hair. p-Phenylenediamine (PPD) is a frequent and important component of permanent hair dye products; exposure to it may cause allergic contact sensitization, acute dermatitis, and severe facial oedema. To increase our understanding of PPD allergy, we reviewed published literature containing PPD patch test data from dermatitis patients and individuals in the general population. This was performed to estimate the median prevalence and the weighted average of PPD sensitization and thereby assess the burden of PPD-containing hair care products on health. Literature was examined using PubMed-MEDLINE, Biosis, and Science Citation Index. The median prevalence among dermatitis patients was 4.3% in Asia, 4% in Europe, and 6.2% in North America. A widespread increase in the prevalence of PPD sensitization was observed among Asian dermatitis patients. In Europe, a decrease in the 1970s was replaced by a plateau with steady, high prevalences ranging between 2% and 6%. The prevalence remained high in North America, although a decreasing tendency was observed. Contact allergy to PPD is an important health issue for both women and men. More stringent regulation and enforcement are required as public health measures to reduce the burden of disease that exposure to PPD has brought to populations.