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Background: Reports of allergic contact dermatitis (ACD) to phytonadione epoxide (PE) in cosmetics suggest that PE is as powerful a sensitiser as its parent compound phytonadione. Objective: To evaluate a case series of ACD to PE in Spain. Methods: We reviewed the records of 20 patients with ACD to cosmetics containing PE diagnosed across Spain between January 2019 and June 2023. Results: All 20 patients developed patch test (PT) or repeated open application test (ROAT) reactions to cosmetics containing PE. All involved women with eyelid eczema. PT or ROAT with PE preparations were positive in 17/20 (85%). PE at 1%, 5%, 10% and 20% in pet. was patch‐tested in 8/17, 14/17, 11/17 and 8/17 patients; being positive in 6/8 (75%), 13/14 (92.85%), 11/11 (100%) and 8/8 (100%), respectively. Conclusion: Regulators should, not only ban the specific dangerous cosmetic ingredients, but also consider to ban or keep under close surveillance those closely related products or derivatives that might potentially cause similar harmful effects. PTs with PE are suggested to be performed at a 5% concentration in pet. Higher concentrations (10% pet.) should be tested whenever PTs with 5% pet. PE are negative. [ABSTRACT FROM AUTHOR]

Background: Atopic dermatitis (AD) and allergic contact dermatitis (ACD) are inflammatory skin conditions whose association is not clearly defined. Objectives: To identify differences in ACD profile between patients with and without AD among those referred for patch testing. Additionally, to determine the prevalence of sensitisation to standard Spanish contact allergens in both groups. Methods: We analysed two groups (AD and non‐AD) within the Spanish Registry of Research in Contact Dermatitis and Cutaneous Allergy (REIDAC). Contact allergy, clinical relevance and epidemiological data were compared between them. Results: A total of 5055 patients were included. Among them, 23% (1168) had a history or final diagnosis of AD. At least one positive reaction was seen in 468 (40%) of AD patients and 1864 (48%) of non‐AD patients. In both groups, the most common positive reactions were to nickel sulphate, methylchloroisothiazolinone/methylisothiazolinone and cobalt chloride. Age‐adjusted OR for sensitisation to nickel sulphate was 0.72 (95% CI: 0.61–0.86), indicating a decreased likelihood of sensitisation in AD patients compared to non‐AD individuals. Conclusions: We did not find an increased presence of ACD in patients with AD referred for patch testing, exhibiting similar profiles to non‐AD population, except for a negative relationship between AD and sensitisation to nickel sulphate. [ABSTRACT FROM AUTHOR]

Background: Budesonide and tixocortol pivalate as markers of contact allergy to corticosteroids have been questioned, as they are not able to detect a significant percentage of allergic patients. Objectives: To investigate the potential role of clobetasol propionate in enhancing corticosteroid sensitisation detection. Methods: Between January 2022 and December 2023, patients who attended centres involved in the Spanish Registry of Research in Contact Dermatitis and Cutaneous Allergy were tested with an extended baseline series that included budesonide, tixocortol pivalate, clobetasol propionate 0.1% in ethanol and 1% in petrolatum. Results: A total of 4338 patients were tested. Twenty‐four patients were allergic to budesonide (0.55%, 95% CI: 0.37–0.82); nine patients were allergic to tixocortol pivalate (0.21%, 95% CI: 0.11–0.39); and 23 patients were allergic to clobetasol (0.53%, 95% CI: 0.35–0.79). Only four of those patients allergic to clobetasol were detected by budesonide and one by tixocortol pivalate. No significant differences in the number of positive tests were found between clobetasol in petrolatum or ethanol. Conclusions: In Spain budesonide remains the main corticosteroid allergy marker whereas the role of tixocortol pivalate is questionable. The addition of clobetasol propionate to the Spanish baseline series would improve the ability to detect patients allergic to corticosteroids. [ABSTRACT FROM AUTHOR]

Patch testing is the only clinically applicable diagnostic method for Type IV allergy. The availability of Type IV patch test (PT) allergens in Europe, however, is currently scarce. This severely compromises adequate diagnostics of contact allergy, leading to serious consequences for the affected patients. Against this background, the European Society of Contact Dermatitis (ESCD) has created a task force (TF) (i) to explore the current availability of PT substances in different member states, (ii) to highlight some of the unique characteristics of Type IV vs. other allergens and (iii) to suggest ways forward to promote and ensure availability of high‐quality patch testing substances for the diagnosis of Type IV allergies throughout Europe. The suggestions of the TF on how to improve the availability of PT allergens are supported by the ESCD, the European Academy of Allergy and Clinical Immunology, and the European Academy of Dermatology and Venereology and intend to provide potential means to resolve the present medical crisis. [ABSTRACT FROM AUTHOR]

Background: A global epidemic of allergic contact dermatitis to (meth)acrylates has been described in relation to the widespread use of manicure products. Objectives: To evaluate the frequency of sensitization to 2‐hydroxyethyl methacrylate (2‐HEMA) among consecutively patch tested patients with eczema in Spain; the percentage of current relevance; the MOAHLFA index; and, the potential sources of exposure to (meth)acrylates. Methods: From January 2019 to December 2022, 2‐HEMA 2% pet. was prospectively patch tested in 24 REIDAC (Spanish Allergic Contact Dermatitis Registry) centres. Results: Six thousand one hundred thirty‐four patients were consecutively patch tested with 2‐HEMA 2% pet. 265/6134 (4.3%) were positive. Positive reactions of current relevance were identified to involve 184/265 (69%). The efficiency (number of patch tests needed to detect relevant positive patch test reactions) was 34 (6134/184). The variable 'occupational' was found to be significantly associated with a higher risk for relevant positive reactions to 2‐HEMA (OR: 10.9; 95% CI: 8.1–14.9). Conclusion: (Meth)acrylate sensitization is a prevalent health issue in Spain. 2‐HEMA 2% pet. has been identified to be a highly effective (meth)acrylate allergy marker in the GEIDAC baseline series. The responsible authorities should implement policies guaranteeing accurate labelling of industrial, medical, and consumer materials while ensuring the enforcement of said labelling through appropriate legal means. [ABSTRACT FROM AUTHOR]

Background: Current frequency and features for positivity to textile dye mix (TDM) in Spain are unknown. Objectives: To study the frequency, clinical features and simultaneous positivity between TDM, para‐phenylenediamine (PPD) and specific disperse dyes. Materials and Methods: We analysed all consecutive patients patch‐tested with TDM from the Spanish Contact Dermatitis Registry (REIDAC), from 1 January 2019 to 31 December 2022. Within this group, we studied all selected patients patch‐tested with a textile dye series. Results: Out of 6128 patients analysed, 3.3% were positive to the TDM and in 34% of them, the sensitization was considered currently relevant. TDM positivity was associated with working as a hairdresser/beautician and scalp, neck/trunk and arm/forearm dermatitis. From TDM‐positive patients, 57% were positive to PPD. One hundred and sixty‐four patients were patch‐tested with the textile dye series. Disperse Orange 3 was the most frequent positive dye (16%). One of every six cases positive to any dye from the textile dye series would have been missed if patch‐tested with the TDM alone. Conclusions: Positivity to TDM is common in Spain and often associated with PPD sensitization. TDM is a valuable marker of disperse dyes allergy that should be part of the Spanish and European standard series. [ABSTRACT FROM AUTHOR]

Background: Eugenol is a known contact sensitiser included in fragrance mix I. Objective: To assess the allergic reactivity to eugenol in different concentrations using patch test as well as repeated open application test (ROAT). Methods: Overall 67 subjects from 6 European dermatology clinics participated in the study. The ROAT was performed for 21 days twice a day, applying 3 dilutions of eugenol (2.7%–0.5%) and a control. Before and after the ROAT, patch testing with 17 dilutions of eugenol (2.0%–0.00006%) and controls was performed. Results: Out of the 34 subjects with contact allergy to eugenol, 21 (61.8%) showed a positive patch test before ROAT was performed, the lowest positive concentration was 0.031%. The ROAT was positive in 19 (55.9%) of the 34 subjects, the time until a positive reaction occurred was negatively associated with the concentration of the ROAT solution, as well as with the allergic reactivity of the subjects as defined by patch testing. In the patch test after ROAT, 20 of the 34 test subjects (58.8%) showed a positive reaction. In 13 (38.2%) of the 34 test subjects, the patch test result was not reproduceable, still 4 (31.0%) of these 13 subjects developed a positive ROAT. Conclusion: Eugenol can provoke a positive patch test reaction in a very low dose; besides, this hypersensitivity may persist even if a former positive patch test is not reproduceable. [ABSTRACT FROM AUTHOR]

Limonene and linalool are among the most common fragrance terpenes used in everyday products. They are pre‐haptens, forming hydroperoxides (Lim‐OOHs, Lin‐OOHs) upon oxidation and inducing frequent positive patch test reactions in patients with dermatitis, and yet they are not routinely tested in Europe. This review evaluates current patch testing with Lim‐OOHs and Lin‐OOHs by asking whether hydroperoxide patch testing is warranted, examining the difficulties or challenges related to reading and interpreting hydroperoxide patch test results with currently available material, and assessing their relevance. Studies are increasingly pointing to high percentages of positive reactions in patients consecutively patch tested with these oxidized products. An association between a positive clinical history and a strong patch test reaction has been described, but problems with doubtful/irritant reactions have also been reported. Considering the high frequency of relevant positive reactions, the incorporation of Lim‐OOHs 0.3% and Lin‐OOHs 1% in the baseline series may be justified. Since exposure, sensitization, and elicitation limits of Lim‐OOHs and Lin‐OOHs in the products still need to be better determined, an assessment of previous exposure, possible sensitizations, and reactions may help to improve the clinical assessment. [ABSTRACT FROM AUTHOR]

Background: Current frequency and risk factors for sensitization to methylisothiazolinone (MI), methylchloroisothiazolinone/methylisothiazolinone (MCI/MI), benzisothiazolinone (BIT) and octylisothiazolinone (OIT) in Spain are not well known. Objectives: To study the frequency of sensitization, risk factors and simultaneous sensitization between the four isothiazolinones. Materials and Methods: We analysed all 2019–2021 consecutive patients patch‐tested with MI (0.2% aq.), MCI/MI (0.02% aq.), BIT (0.1% pet.) and OIT (0.1% pet) within the Spanish Contact Dermatitis Registry (REIDAC). Results: A total of 2511 patients were analysed. Frequencies of sensitization were: any isothiazolinone 15.7%, MI 6.8%, MCI/MI 4.8%, BIT 3.5% and OIT 0.5%. MI and MCI/MI sensitization was associated with being occupationally active, hand dermatitis, detergents and age over 40. BIT sensitization was associated with leg dermatitis and age over 40. About one in nine MI‐positive patients were positive to BIT, whereas one in five BIT‐positive patients were positive to MI. Conclusions: Sensitization to MI, MCI/MI and BIT is still common in Spain, while sensitization to OIT is rare. Currently, sensitization to MI and MCI/MI seems to be occupationally related. Although its origin is unknown, sensitization to BIT is more frequent in patients aged over 40 years. Simultaneous sensitization between MI and BIT is uncommon. [ABSTRACT FROM AUTHOR]

The European baseline series was last updated in 2019. This article discusses the reasoning behind a further iteration of the series for 2023. [ABSTRACT FROM AUTHOR]

Background: Different textile constituents may act as allergens and/or irritants and provoke textile contact dermatitis (TCD). Objectives: To report a case of TCD caused by ethylene glycol monododecyl ether and 2,4‐dichlorophenol, present in a bikini. Methods: A woman presented with an eczematous, pruritic rash in the area of the bikini straps and back. Patch testing was performed with the European baseline, textile, sunscreen, and photo‐patch series, the bikini "as is", and ethanol and acetone extracts of the bikini. Thin‐layer chromatography (TLC) of the extracts and gas chromatography–mass spectrometry (GC–MS) analysis were used to elucidate the culprit agents. Results: Positive reactions were found to the bikini "as is" and to the ethanol and acetone extracts. Patch testing with TLC strips showed a strong reaction to spots‐fractions 3 and 4. GC–MS was performed to identify substances in each fraction and those suspected to be skin sensitisers were patch tested. On day (D) 4 positive reactions to ethylene glycol monododecyl ether (irritant reaction) and 2,4‐dichlorophenol (++) were observed. Conclusion: A myriad of chemical compounds can be found in clothing. Ethylene glycol monododecyl ether and 2,4‐dichlorophenol were identified as the potential culprits of this bikini TCD. Highlights: We have combined chemical analyses (thin‐layer chromatography and gas chromatography–mass spectrometry) to study a case of textile contact dermatitis.As such, the presence of a myriad of chemical compounds was found in a bikini, suggesting that clothing in general may become impregnated or contaminated by a wide range of external substances that may be harmful to the skin.Textile contact dermatitis could in this case be attributed to ethylene glycol monododecyl ether (CAS No. 4536‐30‐5) and 2,4‐dichlorophenol (CAS No. 120‐83‐2), the latter not yet previously described as a textile contact allergen. [ABSTRACT FROM AUTHOR]

Background: Continual analyses of patch test results with the European baseline series (EBS) serve both contact allergy surveillance and auditing the value of included allergens. Objectives: To present results of current EBS patch testing, obtained in 53 departments in 13 European countries during 2019 and 2020. Methods: Anonymised or pseudonymised individual data and partly aggregated data on demographic/clinical characteristics and patch test rest results with the EBS were prospectively collected and centrally pooled and analysed. Results: In 2019 and 2020, 22 581 patients were patch tested with the EBS. Sensitization to nickel remained most common (19.8 [19.2–20.4]% positivity [95% confidence interval]). Fragrance mix I and Myroxylon pereirae yielded very similar results with 6.80 (6.43–7.19)% and 6.62 (6.25–7.00)% positivity, respectively. Formaldehyde at 2% aq. yielded almost one percentage point more positive reactions than 1% concentration (2.49 [2.16–2.85]% vs. 1.59 [1.33–1.88]); methylchloroisothiazolinone/methylisothiazolinone (MCI/MI) and MI alone up to around 5% positives. Among the new additions, propolis was most commonly positive (3.48 [3.16–3.82]%), followed by 2‐hydroxyethyl methacrylate (2.32 [2.0–2.68]%). Conclusion: Ongoing surveillance on the prevalence of contact sensitization contributes to an up‐to‐date baseline series containing the most frequent and/or relevant contact sensitizers for routine patch testing in Europe. [ABSTRACT FROM AUTHOR]

Background: In 2019, a number of allergens (haptens), henceforth, "the audit allergens," were considered as potential additions to the European Baseline Series (EBS), namely, sodium metabisulfite, 2‐bromo‐2‐nitropropane‐1,3‐diol, diazolidinyl urea, imidazolidinyl urea, Compositae mix II (2.5% or 5% pet), linalool hydroperoxides (lin‐OOH), limonene hydroperoxides (lim‐OOH), benzisothiazolinone (BIT), octylisothiazolinone (OIT), decyl glucoside, and lauryl glucoside; Evernia furfuracea (tree moss), was additionally tested by some departments as well. Objectives: To collect further data on patch test reactivity and clinical relevance of the audit allergens in consecutive patients across Europe. Methods: Patch test data covering the audit allergens in 2019 and 2020 were collected by those departments of the European Surveillance System on Contact Allergies testing these, as well as further collaborators from the EBS working group of the European Society of Contact Dermatitis (ESCD), and the Spanish Grupo Español de Investigación en Dermatitis de Contacto y Alergia Cutánea. As patch test outcome, reactions between day (D) 3 and D5 were considered. Results: Altogether n = 12 403 patients were tested with any of the audit allergen. Positive reactions were most common to lin‐OOH 1% pet. (8.74% [95%CI: 8.14–9.37%]), followed by lin‐OOH 0.5% pet., and lim‐OOH 0.3% pet (5.41% [95% CI: 4.95–5.89%]). Beyond these terpene hydroperoxides, BIT 0.1% pet. was the second most common allergen with 4.72% (95% CI: 4.2–5.28%), followed by sodium metabisulfite 1% pet. (3.75% [95%CI: 3.32–4.23%]) and Compositae mix 5% pet. (2.31% [95% CI: 1.84–2.87%]). For some allergens, clinical relevance was frequently difficult to ascertain. Conclusions: Despite many positive patch test reactions, it remains controversial whether lin‐ and lim‐OOH should be tested routinely, while at least the two preservatives BIT and sodium metabisulfite appear suitable. The present results are a basis for further discussion and ultimately decision on their implementation into routine testing among the ESCD members. Highlights: Twelve preservatives, fragrances, and emulsifiers were evaluated as potential additions to the European Baseline Series (EBS)The highest prevalences of positive reactions were to linalool hydroperoxides 1% pet. or 0.5% pet. and limonene hydroperoxides 0.3% pet. Benzisothiazolinone 0.1% pet. was positive in 4.7%, followed by sodium metabisulfite 1% pet. (3.8%) and Compositae mix 5% pet. (2.3%).The results are a basis for further discussion and ultimately a decision on their implementation into routine testing among the European Society of Contact Dermatitis (ESCD) members. [ABSTRACT FROM AUTHOR]

Background: Hand eczema is a common inflammatory skin disorder. Health care providers need continuously updated information about the management of hand eczema to ensure best treatment for their patients. Objectives: To update the European Society of Contact Dermatitis guideline on the diagnosis, prevention, and treatment on of hand eczema. Method: The Guideline Development Group (GDG) was established on behalf of the ESCD. A call for interest was launched via the ESCD website and via the ESCD members' mailing list. Appraisal of the evidence for therapeutic and preventive interventions was applied and a structured method of developing consensus was used and moderated by an external methodologist. The final guideline was approved by the ESCD executive committee and was in external review on the ESCD webpage for 1 month. Results: Consensus was achieved for several statements and management strategies. Conclusion: The updated guideline should improve management of hand eczema. [ABSTRACT FROM AUTHOR]

A major research topic consists of revealing the contribution of radical‐mediated reactions in dermatological diseases related to xenobiotic‐induced stress to succeed risk‐assessment procedures protecting producers and consumers. Allergic contact dermatitis is the clinically relevant consequence of skin sensitization, one of the most critical occupational and environmental health issues related to xenobiotics exposure. The first key event identified for the skin sensitization process to a chemical is its aptitude to react with epidermal proteins and form antigenic structures that will further trigger the immune response. Many chemical sensitizers are suspected to react through mechanisms involving radical intermediates. This review focuses on the recent progress we have accomplished over the last few years studying radical intermediates derived from skin‐sensitizing chemicals by electron paramagnetic resonance in combination with the spin‐trapping technique. Our work is carried out "from the molecule", performing studies in solution, "to the tissue", by the development of a methodology on a reconstructed human epidermis model, very close in terms of histology and metabolic/enzymatic activity to real human epidermis, that can be used as suitable biological tissue model. The benefits are to test chemicals under conditions close to human use and real‐life sensitization exposures and benefit from the three‐dimensional (3D) microenvironment. [ABSTRACT FROM AUTHOR]

Case report, contact dermatitis, hydroxychloroquine, patch test, photoallergy, drug-induced photosensitivity, phototoxicity (D) Phototest positivity (+) for hydroxychloroquine (HC) 48 h following irradiation (first test session, Dolquine being the commercial name for the drug in Spain). gl With the suspicion of a drug-induced reaction, and HC being the only imputable drug, patch testing (extended European baseline series and in-house prepared HC 5% pet.[5]) and photopatch testing (including HC 5% pet.) Keywords: case report; contact dermatitis; drug-induced photosensitivity; hydroxychloroquine; patch test; photoallergy; phototoxicity EN case report contact dermatitis drug-induced photosensitivity hydroxychloroquine patch test photoallergy phototoxicity 168 170 3 01/13/23 20230201 NES 230201 Despite hydroxychloroquine (HC) having well-known photoprotective properties, photo-induced dermatoses may occasionally be triggered by this drug.[[1], [3]] CASE REPORT A 73-year-old woman, with a past history of oral lichen planus and frontal fibrosing alopecia, consulted our department due to a skin rash located in photo-distributed areas (neck, arms, dorsum of the hands, and face) which developed in the previous 4 weeks (Figure 1A,B). [Extracted from the article]

Background: Allergic contact dermatitis from glucose sensors may interfere with their ongoing application. Objective: To evaluate a series of Spanish patients with contact dermatitis to glucose sensors regarding former sources of contact allergens, patch test results, and outcomes from the ongoing use of the device. Methods: A series of patients with contact dermatitis from glucose sensors was investigated in eight dermatology departments across Spain (epidemiological features, brands, latency time to develop dermatitis, the ability to continue using the devices as well as the patch test results). Results: Thirty patients were evaluated (mean age 20.9 years). A total of 66.7% were children and 66.7% female. Ninety per cent used Freestyle Libre (FSL). Eight of 26 (30.8%) reacted to isobornyl acrylate (IBOA) and two of 20 (10.0%) to N,N dimethylacrylamide (DMAA). The mean latency time to develop dermatitis was 9 months. Sixteen of 29 (55.2%) patients continued using the same sensor causing the reaction. Thirteen of 29 (44.8%) patients were unable to continue using the sensor because of severe reactions. Of these, five were positive to IBOA, one to IBOA and DMAA, one to DMAA, one to colophony, and one to isopropyl alcohol wipes. In one patient, the outcome was unknown. Conclusion: The frequency of sensitisation to IBOA and DMAA, was lower than in other European series, but similar to a previously published Spanish article. Legislation requiring manufacturers to provide information regarding the composition of medical devices and cooperate with the investigations into contact dermatitis is urgently needed. [ABSTRACT FROM AUTHOR]

Existing criteria for inclusion in the European baseline series are summarized. Additional criteria are developed to aid decision making where the current criteria do not yield an unequivocal result. These include a consideration of whether an allergen (hapten) is better placed in a special series and the frequency with which an allergen cross-reacts with existing markers in the baseline series. [ABSTRACT FROM AUTHOR]

Background: Fragrances constitute the second most frequent cause of allergic contact dermatitis in Spain. Objectives: To determine the rate of sensitization to the individual fragrances of fragrance mix (FM) I and FM II for each of the demographic and clinical factors included in the MOAHLFA (male, occupational dermatitis, atopic dermatitis, hand dermatitis, leg dermatitis, facial dermatitis, age) index. Methods: We conducted a 5‐year retrospective study in 23 Spanish centres. We identified the patients who had undergone patch testing with a specific fragrance series after reacting positively to fragrance markers in a baseline series. We obtained the MOAHLFA index items in this population, then calculated for each demographic and clinical factor the frequencies of sensitization to the individual fragrances of FM I and FM II. Results: A specific fragrance series was patch tested in 1013 patients. The most frequent allergens in men, women, children, and retired people were Evernia prunastri (16%), geraniol (16.6%), isoeugenol (17.9%), and geraniol (22.4%), respectively. Citral (20.5%) and hydroxyisohexyl 3‐cyclohexene carboxaldehyde (HICC) (14.5%) were the most common allergens in occupational eczemas and were also associated with a large proportion of hand and facial dermatitis. Conclusions: Frequency of sensitization to the individual fragrances of FM I and FM II varies with age, sex, affected body region, and history of occupational or atopic dermatitis. [ABSTRACT FROM AUTHOR]

Background: Clinical surveillance of the prevalence of contact allergy in consecutively patch tested patients is a proven instrument to continually assess the importance of contact allergens (haptens) assembled in a baseline series. Objectives: To present current results from the European Surveillance System on Contact Allergies, including 13 countries represented by 1 to 11 departments. Methods: Anonymized or pseudonymized patch test and clinical data from various data capture systems used locally or nationally as transferred to the Erlangen data centre were pooled and descriptively analysed after quality control. Results: In the 4 years (2015‐2018), data from 51 914 patients patch tested with the European baseline series (EBS) of contact allergens were analysed. Contact allergy to nickel was most frequent (17.6% positive), followed by contact allergy to fragrance mix I (6.9%), methylisothiazolinone (MI; 6.2%), and Myroxylon pereirae resin (balsam of Peru; 5.8%). Conclusions: While the prevalence of MI contact allergy decreased substantially following regulatory intervention, the persistently high levels of allergy to metals, fragrances, other preservatives, and rubber chemicals point to problems needing further research and, potentially, preventive efforts. Results with national additions to the baseline series provide important information on substances possibly to be considered for inclusion in the EBS. [ABSTRACT FROM AUTHOR]

Background: Studies suggest that patch testing with formaldehyde releasers (FRs) gives significant additional information to formaldehyde 1% aq. and should be considered for addition to the European baseline series (EBS). It is not known if this is also true for formaldehyde 2% aq. Objectives: To determine the frequency of sensitization to formaldehyde 2% aq. and co‐reactivity with FRs. To establish whether there is justification for including FRs in the EBS. Materials and Methods: A 4‐year, multi‐center retrospective analysis of patients with positive patch test reactions to formaldehyde 2% aq. and five FRs. Results: A maximum of 15 067 patients were tested to formaldehyde 2% aq. and at least one FR. The percentage of isolated reactions to FR, without co‐reactivity to, formaldehyde 2% aq. for each FR were: 46.8% for quarternium‐15 1% pet.; 67.4% imidazolidinyl urea 2% pet.; 64% diazolidinyl urea 2% pet.; 83.3% 1,3‐dimethylol‐5, 5‐dimethyl hydantoin (DMDM) hydantoin 2% pet. and 96.3% 2‐bromo‐2‐nitropropane‐1,3‐diol 0.5% pet. This demonstrates that co‐reactivity varies between FRs and formaldehyde, from being virtually non‐existent in 2‐bromo‐2‐nitropropane‐1,3‐diol 0.5% pet. (Cohen's kappa: 0, 95% confidence interval [CI] −0.02 to 0.02)], to only weak concordance for quaternium‐15 [Cohen's kappa: 0.22, 95%CI 0.16 to 0.28)], where Cohen's kappa value of 1 would indicate full concordance. Conclusions: Formaldehyde 2% aq. is an inadequate screen for contact allergy to the formaldehyde releasers, which should be considered for inclusion in any series dependant on the frequency of reactions to and relevance of each individual allergen. [ABSTRACT FROM AUTHOR]

Background: There is considerable variability across European patch test centres as to which allergens are included in local and national cosmetics series. Objectives: To propose a standardized, evidence‐based cosmetic series for Europe based on up‐to‐date analysis of relevant contact allergens. Methods: We collated data from the European Surveillance System on Contact Allergies (ESSCA) from 2009 to 2018 to determine which cosmetic allergens produce a high yield of contact allergy. Contact allergens with a prevalence of >0.3% that were considered relevant were included. Rare contact allergens were excluded if deemed no longer relevant or added to a supplemental cosmetic series for further analysis. Results: Sensitization prevalences of 39 cosmetic contact allergens were tabulated. Thirty of these allergens yielded >0.3% positive reactions and are therefore included in our proposed European cosmetic series. Six were considered no longer relevant and therefore excluded. Three were included in a supplementary European cosmetic series. An additional nine allergens were included in either the core or supplemental European cosmetic series following literature review. Conclusion: We have derived a potential European cosmetic series based upon the above methods. This will require ongoing investigation based upon the changing exposure profiles of cosmetic allergens as well as new and evolving substances. [ABSTRACT FROM AUTHOR]

Introduction: Allergic contact dermatitis (ACD) of the feet accounts for approximately 10% of all patch tested patients. Objective: To study the clinical profile of patients with feet dermatitis and relevant contact allergens in Spain over a 10‐year period. Methods: Retrospective observational study of patients with suspected ACD from the GEIDAC (Spanish Research Group on Contact Dermatitis and Cutaneous Allergy) baseline series from eight hospitals in Spain between 2004 and 2014. The clinical data collected from each patient were age, sex, occupation, history of atopic dermatitis, and eczema location. Results: A total of 450 cases clinically presented dermatitis affecting the feet; of these, 41% of were males and 5.6% were suspected to be of occupational origin. As much as 47% were diagnosed with ACD, 20% with atopic dermatitis/dyshidrotic eczema, and 5% with psoriasis. The "feet group" included statistically significantly more females in the age range of 21 to 60 years. The most frequent relevant contact allergens were potassium dichromate, cobalt(II) chloride, p‐tert‐butylphenol formaldehyde resin, mercapto mix, and mercaptobenzothiazole. Conclusions: ACD is the most frequent clinical diagnosis of feet dermatitis in our series. The most frequent allergens are similar to those published in other series of foot ACD in Europe and the trend has not changed in the studied decade. [ABSTRACT FROM AUTHOR]

Background: There is currently no agreed cosmetic series for use across Europe. Objectives: To establish allergens currently tested in local and national cosmetic series. Method: Members of the European Surveillance System on Contact Allergy and the European Cooperation in Science and Technology project TD1206 ("StanDerm") were surveyed to establish their current practice. Results: A wide range of allergens was tested but there was significant variation between centres on the allergens considered to be important in screening for allergy to cosmetics. The number of allergens tested in addition to the baseline series varied between 2 and 50. Conclusions: There is a need for further investigation to establish the frequency and relevance of reactions to cosmetic allergens to enable an agreed evidence‐based cosmetic series to be produced. Criteria for inclusion need to be established. [ABSTRACT FROM AUTHOR]

Summary: Background: In 2011, a multicentre study was conducted in order to determine how hair dye manufacturers instructed consumers to perform a self‐test prior to dyeing their hair, in order to identify individuals who are likely to react upon subsequent hair dyeing. A number of concerns were raised concerning the variability in instructions between products and producers, and the safety and validity of this tool. Objectives: To perform a 5‐year follow‐up study in order to determine whether manufacturers still recommend a self‐test, and if so, whether the procedures have been changed. Methods: During March 2016, a total of 40 oxidative hair dye products from 21 different manufacturers were bought in retail stores in 8 European countries. Results: The consumers were instructed to perform a self‐test prior to hair dyeing for 39 of the products; however, the procedures varied greatly regarding the method of application, the amount of hair dye applied, the location and size of the application area, the number of applications, whether or not rinsing was performed after application, the reading times, and how a positive reaction was defined. Conclusions: Self‐testing is still recommended by almost all manufacturers of permanent hair dyes. There are major variations in the instructions, even in products from the same manufacturer. The previously raised concerns regarding safety and validity still remain. [ABSTRACT FROM AUTHOR]

A spectrum of hypersensitivity reactions ranging from immediate type I responses (urticaria, angioedema, oral allergy syndrome) to delayed type IV reactions (contact dermatitis) have been described. Furthermore, isolated cases of non-occupational PCD, and cases showing both positive prick-by-prick and patch tests have been reported.7-9 To the best of our knowledge, there are no previous reports of PCD due to mango. Keywords: case report; mango; patch test; protein contact dermatitis EN case report mango patch test protein contact dermatitis 458 460 3 05/06/21 20210601 NES 210601 Immediate contact skin reactions are considered a subset of the contact urticaria syndrome, which includes contact urticaria and protein contact dermatitis (PCD). [Extracted from the article]

Background: Positive patch test reactions to mixtures of oxidized terpenes containing allergenic hydroperoxides are frequently reported. However, human sensitization data for these hydroperoxides are not available. Objectives: To analyse and evaluate the human sensitization potential and potency of hydroperoxides in vitro by using human cells. Materials/Methods: Limonene‐1‐hydroperoxide, limonene‐2‐hydroperoxide, citronellol‐7‐hydroperoxide, cumene hydroperoxide, 1‐(1‐hydroperoxy‐1‐methylethyl)cyclohexene and mixtures of citronellol hydroperoxides (isomers at positions 6 and 7) and linalool hydroperoxides (isomers at positions 6 and 7) were studied. All compounds were synthesized except for cumene hydroperoxide, which was commercially available. Their potential and potency to activate dendritic cells (DCs) was evaluated by measuring the upregulation of CD86 and CD54 on THP‐1 cells upon exposure in the cocultured activation test (COCAT) consisting of HaCaT cells (human keratinocyte cell line) and THP‐1 monocytes (as a surrogate for DCs). Results: Hydroperoxides upregulated CD86 and/or CD54 on cocultured THP‐1 cells in a concentration‐dependent manner. The results are comparable with their sensitization potency ranking in predictive animal models. Conclusions: For the first time, the human sensitization potential and potency of several hydroperoxides were determined by the use of human cells and the COCAT method. [ABSTRACT FROM AUTHOR]

Background: Fragrance contact allergy is common, but few studies on quality of life (QoL) in affected patients exist. Recently, the disease‐specific Fragrance Quality of Life Index (FQLI) was developed. Objectives: To characterize QoL in European dermatitis patients with fragrance contact allergy at the time of diagnosis. Methods: This was a cross‐sectional study, in which 2011 Danish, British, Spanish and German adult consecutive dermatitis patients were invited to complete a questionnaire on self‐reported disease severity, the Dermatology Life Quality Index (DLQI), and the FQLI immediately prior to being patch tested. Results: One thousand seven hundred and fifty‐eight patients responded, and 259 (14.7%; country range 11.7%‐18.5%) were fragrance‐positive. Among these, the total (SD) DLQI score was 6.2 (5.6) and the total (SD) FQLI score was 60 (25), with both estimates being comparable to those in fragrance‐negative patients. Adjusting the total FQLI score for age, sex and self‐rated disease severity showed a higher (ie, worse) score in fragrance‐positive patients (3.6‐point increase; 95% confidence interval: 0.30‐6.8 points; P = 0.03). Specifically, contact allergy to oxidized linalool was associated with greater impairment in QoL. Conclusions: QoL in patients with fragrance contact allergy is impaired at a level comparable to that in other patch tested dermatitis patients, at the time of diagnosis, across several European countries. [ABSTRACT FROM AUTHOR]

Background: There is an ongoing discussion on whether routinely patch testing with p‐phenylenediamine (PPD) 1.0% pet. is safe, owing to the risk of patch test sensitization. Late‐appearing patch test reactions may reflect patch test sensitization, but may also be attributable to a low degree of pre‐existing sensitization. Objectives: To follow the positive patch test reactions to PPD and its salt PPD dihydrochloride (PPD‐DHC) in order to characterize reaction patterns concerning time and dose in PPD‐sensitized individuals. Methods: Volunteers with previous reactions to PPD 1.0% were included and patch tested with PPD and PPD‐DHC in equimolar dilution series. There were then seven follow‐up visits over a period of 28 days. Results: Twenty‐six volunteers completed the study, of whom 23 of 26 (88%) reacted to PPD 1.0%, and 69% reacted to PPD 0.32%. Altogether, 42% and 27% reacted to the corresponding equimolar concentrations of PPD‐DHC. After day 7, no new reactions were observed to any concentration tested, either of PPD or of PPD‐DHC. Conclusion: No late‐appearing reactions to PPD or PPD‐DHC were observed at any dose. There is a risk of missing contact allergy when the dose is decreased. [ABSTRACT FROM AUTHOR]

Background: Analyses of the European Surveillance System on Contact Allergies (ESSCA) database have focused primarily on the prevalence of contact allergies to the European baseline series, both overall and in subgroups of patients. However, affected body sites have hitherto not been addressed. Objective: To determine the prevalence of contact allergies for distinct body sites in patients with allergic contact dermatitis (ACD). Methods: Analysis of data collected by the ESSCA (www.essca‐dc.org) in consecutively patch tested patients, from 2009 to 2014, in eight European countries was performed. Cases were selected on the basis of the presence of minimally one positive patch test reaction to the baseline series, and a final diagnosis of ACD attributed to only one body site. Results: Six thousand two hundred and fifty‐five cases were analysed. The head and hand were the most common single sites that ACD was attributed to. Differences between countries were seen for several body sites. Nickel, fragrance mix I, cobalt and methylchloroisothiazolinone/methylisothiazolinone were the most frequent allergens reported for various body sites. Conclusions: Distinct allergen patterns per body site were observed. However, contact allergies were probably not always relevant for the dermatitis that patients presented with. The possibility of linking positive patch test reactions to relevance, along with affected body sites, should be a useful addition to patch test documentation systems. [ABSTRACT FROM AUTHOR]

Background: Fragrance chemicals constitute the second most frequent cause of contact allergy in Spain. There are no data available concerning the individual fragrances that are most frequently involved. Objectives: To describe the diagnostic contribution provided by specific fragrance series to the results obtained with baseline series fragrance markers by correlating the results of both series. Materials and methods: We performed a 5‐year retrospective study of fragrance marker‐positive patients tested with specific fragrance series in 23 Spanish centres. We collected the demographic and clinical characteristics, and compared the results of patch tests obtained from different suppliers. Results: Of 19 588 patients patch tested with the Spanish baseline series, 1590 (8.1%) reacted positively to a fragrance marker. Of these, 1013 (63.7%) were patch tested with a fragrance series, and 664 patients reacted positively to at least one individual fragrance other than hydroxyisohexyl 3‐cyclohexene carboxaldehyde. Geraniol was the most frequent allergen. Positive reactions to substances not included in fragrance mix (FM) I or FM II were found in 230 patients. Of the 436 FM I‐positive patients and the 419 FM II‐positive patients, 184 (42%) and 64 (39.1%), respectively, had no positive reactions to fragrance series. In the case of FM I, negative results were more common when individual fragrances were patch tested at low concentrations. Conclusions: We recommend patch testing all patients positive for any fragrance marker with a specific fragrance series. The correlation between the results of baseline series and fragrance series could be improved by increasing the concentrations of individual fragrances. [ABSTRACT FROM AUTHOR]

The article focuses on the European baseline series (EBS) of contact allergens (haptens) which is used in Europe as a patch test screen in the diagnosis of allergic contact dermatitis. It comments on an update of the EBS with the European Society of Contact Dermatitis working group European Surveillance System of Contact Allergy to provide evidence-based changes to the series. It mentions specific haptens that have not been included in the EBS including sodium metabisulfite, and decyl glucoside.

Background: Assessment of the clinical relevance of patch test reactions is an essential part of the diagnostic work‐up of patients with (occupational) contact dermatitis. However, final diagnostic information, particularly the clinical relevance of allergic patch test reactions, has hitherto been ill‐represented in clinical documentation systems (patch test software) and surveillance registries based on these. Objectives: To develop, implement as a pilot study, and analyse concerning feasibility and contents a new concept of representing the full scope of diagnostic information utilized in the diagnosis of patients with (occupational) contact dermatitis. Methods: On the basis of a European working group discussion on items to document and catalogue lists to use for this purpose, an online documentation system to collect data was set up, followed by pilot use involving 9 dermatology departments across Europe. Results: Data on 176 patients with suspected occupational hand dermatitis were included; among these, work‐relatedness was confirmed in 150, and in 53 non‐occupational aetiology was the sole or a contributory cause. Data were further analysed with regard to occupations, product categories, substances (haptens), source of information on which the evaluation was based, and various combinations of these factors, to illustrate the usefulness of the proposed data representation. Conclusions: An improved method of data collection is presented that more accurately links allergen to exposure and to clinical disease and patient history, and thus better represents clinical relevance. This enables more precise analysis of the causation of contact dermatitis, occupational or non‐occupational, and thereby better targeting of prevention. The development of future databases should incorporate the above considerations to record the results of investigation. [ABSTRACT FROM AUTHOR]

Background: Irritant exposure may be a contributory cause or the sole cause of (occupational) hand dermatitis. However, the documentation of irritant exposures in clinical practice is not standardized. Objectives: To examine the feasibility and usefulness of a form with different items addressing both occupational and non‐occupational irritant exposures in a semiquantitative way. Methods: Between May 2016 and May 2017, successive patients with work‐related hand dermatitis, irrespective of aetiology, were examined in 9 specialized European departments. Department‐specific investigation was supplemented with the above proforma. The results were recorded by use of an anonymized secured online documentation system in a pilot study. Results: Altogether, 193 patients were included; 114 females and 79 males, with a mean age of 40 years (range 18–68 years). The most common occupational group comprised healthcare workers (n = 35); occupational exposure of the hands to gloves, dusts and water without detergents of >2 hours/day was seen in 54.5%, 24.4% and 24.3% of patients, respectively. Non‐occupational exposures rarely exceeded 2 hours/day. Conclusions: It is hoped that the set of descriptors will offer a basis for (clinical) epidemiological studies assessing the role of irritant exposures in occupational hand dermatitis, and to support a high level of quality and consistency in daily patient care. [ABSTRACT FROM AUTHOR]

Background: Polysensitization, defined as being allergic to three or more haptens from the European baseline series, is considered to reflect increased susceptibility to developing a contact allergy, and is likely to be associated with an impaired quality of life. Objectives: To evaluate the prevalences of polysensitization across Europe and to analyse factors associated with polysensitization. Methods: Patch test data collected by the European Surveillance System on Contact Allergies (ESSCA; www.essca‐dc.org) in consecutively patch tested patients from January 2009 to December 2014, comprising 11 countries and 57 departments, were retrospectively analysed. Results: A total of 86 416 patients were available for analysis, showing a standardized prevalence of polysensitization of 7.02%, ranging from 12.7% (Austria) to 4.6% (Italy). Allergen pairs with the strongest association are reported for the total population, for South Europe, and for North/Central Europe. Overall, polysensitized patients showed a higher percentage of extreme (+++) positive patch test reactions than oligosensitized patients. Female sex, occupational dermatitis and age > 40 years were risk factors for polysensitization. Conclusions: The varying prevalences of polysensitization across Europe most likely reflect differences in patient characteristics and referral patterns between departments. Known risk factors for polysensitization are confirmed in a European dermatitis population. [ABSTRACT FROM AUTHOR]

Summary: Background: Allergic contact dermatitis (ACD) caused by nail acrylates, also including methacrylates and cyanoacrylates here, is being increasingly reported. Methods: A retrospective study in 11 European Environmental Contact Dermatitis Research Group (EECDRG) clinics collected information on cases of ACD caused by nail acrylates diagnosed by aimed testing between 2013 and 2015. Results: Among 18 228 studied patients, 136 had ACD caused by nail acrylates (0.75%; 95%CI: 0.60–0.90), representing 67.3% (95%CI: 60.4–73.7) of ACD cases caused by acrylates. There were 135 females and 1 male, with a mean age ± standard deviation of 36.7 ± 12.2 years; 59 (43.4%) were exposed as consumers, and 77 (56.6%) were occupationally exposed. Occupational cases were more frequent in southern Europe (83.7%), and were younger (mean age of 33.4 ± 8.9 years); most developed ACD during the first year at work (65.0%), and at least 11.7% had to leave their jobs. Skin lesions involved the hands in 121 patients (88.9%) and the face in 50 (36.8%), with the face being the only affected site in 14 (10.3%). Most patients reacted to two or more acrylates on patch testing, mainly to 2‐hydroxyethyl methacrylate (HEMA) (92.5%), 2‐hydroxypropyl methacrylate (88.6%), ethylene glycol dimethacrylate (69.2%), and ethyl cyanoacrylate (9.9%). Conclusions: Nail cosmetics were responsible for the majority of ACD cases caused by acrylates, affecting nail beauticians and consumers, and therefore calling for stricter regulation and preventive measures. As HEMA detects most cases, and isolated facial lesions may be overlooked, inclusion of this allergen in the baseline series may be warranted. [ABSTRACT FROM AUTHOR]

Summary: Background: An increasing incidence of contact allergy to methylisothiazolinone (MI) has been seen, caused, in particular, by cosmetic products and paints. A study from 2015 showed that 93.0% of paints bought in five European countries contained MI. New regulations have been discussed for paints in the EU, which may have influenced this market. Objectives: To re‐evaluate the use and concentrations of MI and four other isothiazolinones in water‐based wall paints. Methods: Water‐based white wall paints (n = 60) were purchased in retail stores in five European countries: Denmark, France, Germany, Sweden, and the United Kingdom. The paints were analysed for isothiazolione content by the use of high‐performance liquid chromatography coupled to ultraviolet detection, and the results were confirmed with high‐performance liquid chromatography–tandem mass spectrometry. Results: MI was identified in 55 (91.7%) of the paints, with concentrations ranging from 1.1 to 142.7 ppm. The other isothiazolinones were identified in 20.0% [methylchloroisothiazolinone (MCI)] to 88.3% [benzisothiazolinone (BIT)] of the paints. BIT concentrations varied significantly between countries, whereas MI and MCI concentrations did not. There were no statistically significant differences in MI, MCI and BIT concentrations between the current study and the 2015 study. Conclusions: MI and other isothiazolinones are widely used in paints available in Europe. Their use does not seem to be decreasing. [ABSTRACT FROM AUTHOR]

Background Corticosteroids are among the most commonly used topical drugs. Contact allergy to these exists, but can be easily missed. Corticosteroid screening markers have been included in the baseline series with the aim of detecting most of the sensitized patients. Objectives To assess the prevalence of contact allergy to topical corticosteroids in Spain and examine the usefulness of corticosteroid markers to detect contact allergy to corticosteroids. Methods In total, 3699 patients referred to 20 dermatology departments across Spain for patch testing with the baseline series, including budesonide and tixocortol pivalate, were also tested with six supplementary corticosteroids (methylprednisolone aceponate, mometasone furoate, prednicarbate, clobetasol propionate, betamethasone 17-valerate, and betamethasone 17,21-dipropionate). Additionally, 2547 (68.8%) patients were tested with hydrocortisone 17-butyrate. Results Fifty-four patients showed positive reactions to at least one of all tested corticosteroids (1.46%). Thirty-nine (1.05%) reacted to at least one of the additionally tested corticosteroids; among these, 24 of 39 (61.5%) did not react to any of the corticosteroid allergy screening markers tested. Conclusions More than half of the patients who were allergic to the additionally tested corticosteroids were not detected with the corticosteroid allergy markers. An update of the corticosteroid allergy screening markers is encouraged, with consideration of group 3 corticosteroids. [ABSTRACT FROM AUTHOR]

Background The use of methylisothiazolinone ( MI) in cosmetic products has caused an unprecedented epidemic of MI contact allergy. Current data concerning exposures at a European level are required. Objectives To describe demographics and MI exposures for European patients with MI contact allergy. Methods Eleven European dermatology departments from eight European countries prospectively collected data between 1 May and 31 October 2015 among consecutive patients who had positive patch test reactions to MI (2000 ppm aq.). Results A total of 6.0% (205/3434; range 2.6-13.0%) of patients had positive patch test reactions to MI. Dermatitis most frequently affected the hands (43.4%), face (32.7%), arms (14.6%), and eyelids (11.7%); 12.7% had widespread dermatitis. For 72.7% (149/205), MI contact allergy was currently relevant mainly because of exposure to cosmetic products (83.2%; 124/149). Of these 124 patients, 19.5% were exposed to leave-on and rinse-off cosmetic products, 24.8% only to leave-on cosmetic products and 38.9% only to rinse-off cosmetic products containing MI or methylchloroisothiazolinone/ MI. The majority of these (79%) noted onset of their dermatitis between 2013 and 2015. Fifteen patients (7.3%) had previously experienced allergic reactions when they were in newly painted rooms. Conclusion Clinically relevant MI contact allergy remains prevalent across European countries, mainly because of exposure to rinse-off and leave-on cosmetic products. [ABSTRACT FROM AUTHOR]

Background Limonene and linalool are common fragrance terpenes widely used in cosmetic, household and hygiene products. Their primary oxidation products formed after air exposure, the hydroperoxides, have been recognized as important contact haptens. Objectives To investigate the prevalence of contact allergy to hydroperoxides of limonene (Lim-OOHs) and hydroperoxides of linalool (Lin-OOHs) in Spain, and to define the optimal concentration for screening in consecutive patients. Methods Three different concentrations of Lim-OOHs (0.1%, 0.2% and 0.3% pet.) and Lin-OOHs (0.25%, 0.5% and 1.0% pet.) were simultaneously tested in 3639 consecutive patients at 22 departments of dermatology in Spain. Results Lim-OOHs at 0.1%, 0.2% and 0.3% yielded positive patch test reactions in 1.4%, 3.4% and 5.1% of the tested patients, respectively; and Lin-OOHs at 0.25%, 0.5% and 1.0% yielded positive reactions in 1.3%, 2.9% and 4.9% of the tested patients, respectively. Few irritant (1.5-1.9%) and doubtful reactions (0.4-0.5%) to both terpene hydroperoxides were registered at the highest concentrations tested. Conclusions Lim-OOHs and Lin-OOHs can be considered as common causes of contact allergy, and their inclusion in an extended baseline patch test series therefore seems to be appropriate. The patch test preparations of Lim-OOHs 0.3% pet. and Lin-OOHs 1.0% pet. are useful tools for screening of contact sensitization. [ABSTRACT FROM AUTHOR]

Background Limonene and linalool are common fragrance terpenes. Both oxidized R -limonene and oxidized linalool have recently been patch tested in an international setting, showing contact allergy in 5.2% and 6.9% of dermatitis patients, respectively. Objective To investigate concomitant reactions between oxidized R-limonene and oxidized linalool in consecutive dermatitis patients. Methods Oxidized R-limonene 3.0% (containing limonene hydroperoxides 0.33%) and oxidized linalool 6% (linalool hydroperoxides 1%) in petrolatum were tested in 2900 consecutive dermatitis patients in Australia, Denmark, Singapore, Spain, Sweden, and the United Kingdom. Results A total of 281 patients reacted to either oxidized R-limonene or oxidized linalool. Of these, 25% had concomitant reactions to both compounds, whereas 29% reacted only to oxidized R-limonene and 46% only to oxidized linalool. Of the 152 patients reacting to oxidized R-limonene, 46% reacted to oxidized linalool, whereas 35% of the 200 patients reacting to oxidized linalool also reacted to oxidized R-limonene. Conclusions The majority of the patients (75%) reacted to only one of the oxidation mixtures, thus supporting the specificity of the reactions. The concomitant reactions to the two fragrance allergens suggest multiple sensitizations, which most likely reflect the exposure to the different fragrance materials in various types of consumer products. This is in accordance with what is generally seen for patch test reactions to fragrance materials. [ABSTRACT FROM AUTHOR]

Background Methylisothiazolinone ( MI) [with methylchloroisothiazolinone ( MCI) in a ratio of 1:3, a well-recognized allergenic preservative] was released as an individual preservative in the 2000s for industrial products and in 2005 for cosmetics. The high level of exposure to MI since then has provoked an epidemic of contact allergy to MI, and an increase in MI/ MCI allergy. There are questions concerning the MI/ MCI cross-reaction pattern. Objectives To bring a new perspective on the MI/ MCI cross-reactivity issue by studying their in situ chemical behaviour in 3D reconstructed human epidermis ( RHE). Methods MI and MCI were synthesized with 13C substitution at positions C-4/ C-5 and C-5, respectively. Their in situ chemical behaviours in an RHE model were followed by use of the high-resolution magic angle spinning nuclear magnetic resonance technique. Results MI was found to react exclusively with cysteine thiol residues, whereas MCI reacted with histidines and lysines. The reaction mechanisms were found to be different for MI and MCI, and the adducts formed had different molecular structures. Conclusion In RHE, different MI/ MCI reactions towards different nucleophilic amino acids were observed, making it difficult to explain cross-reactivity between MI and MCI. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 35-year-old non-atopic female with pruritic eruption for four months and a family history of parapsoriasis. The patient was diagnosed with lymphomatoid contact dermatitis due to an allergy from limonene hydroperoxides in personal hygiene products. She experienced a complete clearance of her lesions after administering topical corticosteroids and exposure to the sun.

Keywords: allergic contact dermatitis; formaldehyde sensitization; TRUE Test EN allergic contact dermatitis formaldehyde sensitization TRUE Test 358 359 2 08/16/21 20210901 NES 210901 The optimal formaldehyde (FA) concentration for patch testing that allows to identify true FA sensitization has been studied and discussed over time. RESULTS A total of 52 patients reacted positively to FA 2% aq. (4.57%); only 13 patients (1.14%) reacted to FA in the TRUE Test and all of them showed a positive reaction to FA 2% aq. [Extracted from the article]

The present guideline summarizes all aspects of patch testing for the diagnosis of contact allergy in patients suspected of suffering, or having been suffering, from allergic contact dermatitis or other delayed-type hypersensitivity skin and mucosal conditions. Sections with brief descriptions and discussions of different pertinent topics are followed by a highlighted short practical recommendation. Topics comprise, after an introduction with important definitions, materials, technique, modifications of epicutaneous testing, individual factors influencing the patch test outcome or necessitating special considerations, children, patients with occupational contact dermatitis and drug eruptions as special groups, patch testing of materials brought in by the patient, adverse effects of patch testing, and the final evaluation and patient counselling based on this judgement. Finally, short reference is made to aspects of (continuing) medical education and to electronic collection of data for epidemiological surveillance. [ABSTRACT FROM AUTHOR]

Background Patch test results often vary between departments, and also between countries. Such variation may be partly attributable to systematic effects introduced by patient characteristics, differing exposures, patient selection, or methodological differences. Objective To examine the amount of variation of patient characteristics in terms of the MOAHLFA index and of the proportion of patients with at least one positive reaction to the ( European) baseline series (' P' measure), and to examine potential reasons for the variation. Methods A retrospective analysis was performed of patch test data from 63 530 consultations collected by 53 departments from 12 countries participating in the European Surveillance System on Contact Allergies ( ESSCA) ( ) between 2009 and 2012. Results Considerable variation in the prevalence of the MOAHLFA factors between departments was found, caused, for example, by differing specializations (e.g. occupational dermatology) or patient characteristics. Notable variation concerning the ' P' measure was observed; however, larger national networks (contributing to the ESSCA) tend to have quite similar ranges of this measure. Conclusions Data from one department per country give valuable insights into the spectrum of contact allergy prevalence rates in that country, but are not as representative as national data pooled from several departments. [ABSTRACT FROM AUTHOR]

Many key ingredients of hair cosmetics (in particular, dyes, bleaches, and hair-styling agents) are potent (strong to extreme) contact allergens. Some heterogeneity is apparent from published results concerning the range of allergens for which patch testing is important. The objective of the present review was to collect information on the current practice of using 'hair cosmetic series', and discuss this against the background of evidence concerning consumer/professional exposure and regulatory aspects to finally derive a recommendation for a ' European hair cosmetic series'. The methods involved (i) a survey targeting all members of the COST action ' StanDerm' ( TD1206) consortium, (ii) analysis of data in the database of the European Surveillance System on Contact Allergies ( ESSCA), and (iii) literature review. Information from 19 European countries was available, partly from national networks, and partly from one or several departments of dermatology or, occasionally, occupational medicine. Apart from some substances being tested only in single departments, a broad overlap regarding 'important' allergens was evident. Some of the substances are no longer permitted for use in cosmetics ( Annex II of the Cosmetics Regulation). An up-to-date ' European hair cosmetics series', as recommended in the present article, should (i) include broadly used and/or potent contact allergens, (ii) eliminate substances of only historical concern, and (iii) be continually updated as new evidence emerges. [ABSTRACT FROM AUTHOR]

Background The role of palladium and nickel sensitization in oral disease and dermatitis is not fully understood. Objectives To investigate whether sensitization to these metals was associated with exposure to dental alloys and oral and skin complaints/symptoms in a European multicentre study. Methods In six dermatology clinics, patch tests with palladium (3% Na2PdCl4; Pd = 102.0 µmol/g) and nickel (5% NiSO4. 6H2O; Ni = 190.2 µmol/g) were performed in consecutive patients, and patients' characteristics were collected with a questionnaire and a clinical investigation. Results In total, 906 patients were included, of whom 24.3% reacted to palladium and 25.2% to nickel. The rate of monosensitization was 6-7% for both metals. Palladium sensitization (as opposed to no sensitization to both metals) was associated with exposure to dental crowns [odds ratio ( OR) 2.0], skin reactivity to metals ( OR 2.8), oral lichenoid lesions ( OR 4.7), xerostomia ( OR 7.3), and metal taste ( OR 20.7), but not with eczema, stomatitis, or oral burning sensation. Additionally, xerostomia ( OR 8.7) and metal taste ( OR 4.6) were associated with sensitization to both metals. Conclusions Clinically, it is important for palladium-sensitized patients to undergo an oral examination, with particular attention to the presence of/exposure to dental crowns. In the case of metal contact allergy, exposure to dental crowns could play a role. [ABSTRACT FROM AUTHOR]

Background Recently, sodium tetrachloropalladate ( Na2PdCl4) was found to be a more sensitive palladium patch test allergen than palladium dichloride ( PdCl2). Objectives To determine the optimal test concentration of Na2PdCl4, to evaluate the prevalence of palladium sensitization with Na2PdCl4 and PdCl2, and to compare the results with nickel sensitization in a European multicentre study. Materials and methods In addition to the European or national baseline series including NiSO4·6H20 5% pet., consecutive patients were tested with PdCl2 and Na2PdCl4 2%, 3% and 4% pet. in eight European dermatology clinics. The age and sex distributions were also evaluated in patients sensitized to nickel and palladium. Results In total, 1651 patients were tested. Relative to 3% Na2PdCl4, 4% Na2PdCl4 did not add any information. Two per cent Na2PdCl4 resulted in more doubtful reactions and showed suboptimal reactivity. The prevalence of palladium sensitization doubled with Na2PdCl4 and was similar to that of nickel. Interestingly, in contrast to nickel sensitization, palladium sensitization was not related to female sex. Conclusions Three per cent Na2PdCl4 pet. is the most suitable patch test concentration. Sensitization to palladium is almost as prevalent as sensitization to nickel. The sex distribution is different between nickel-sensitized and palladium-sensitized patients, suggesting different sources of exposure. [ABSTRACT FROM AUTHOR]

Background Disperse dyes are well-known contact sensitizers. However, they are not included in the majority of commercially available baseline patch test series. Objectives To investigate the outcome of patch testing with a textile dye mix ( TDM) consisting of eight disperse dyes at dermatology clinics in various countries. Patients/materials/methods Two thousand nine hundred and seven consecutive dermatitis patients at 12 dermatology clinics representing nine countries were tested with a TDM at 6.6%, consisting of Disperse Blue 35, Disperse Yellow 3, Disperse Orange 1 and 3, and Disperse Red 1 and 17, all at 1.0%, and Disperse Blue 106 and Disperse Blue 124, each at 0.3%, provisionally included in the baseline series. Eighty-seven per cent of the patients allergic to the TDM were also tested with the eight separate dyes. Results Contact allergy to TDM was found in 108 patients (3.7%). The frequency of contact allergy varied from 2.1% to 6.9% in different centres. Simultaneous reactivity to p-phenylenediamine was found in 57 of the TDM-positive patients (53%). The most frequent dye allergen among the TDM-positive patients was Disperse Orange 3. The contact allergy could have explained or contributed to the dermatitis in approximately one-third of the patients for whom clinical relevance of the TDM contact allergy was recorded. Conclusions The TDM should be considered for inclusion in the European baseline series. [ABSTRACT FROM AUTHOR]