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Background: Benzisothiazolinone (BIT; CAS no. 2634‐33‐5) is used as a biocide in various products, including water‐based paints, metalworking fluids, and household products. In recent years, increasing sensitization rates have been observed in Europe. Objective: To describe a time trend of sensitization to BIT, analyse concomitant reactions, and identify patients with increased risk of BIT sensitization. Methods: Retrospective analysis of data from 26 739 patients patch tested with BIT, sodium salt, 0.1% petrolatum as part of several special test series within the Information Network of Departments of Dermatology (IVDK), 2002 to 2021. Results: Positive reactions to BIT were noted in 771 patients (2.9%). Sensitization frequency varied over time and increased in recent years, peaking at 6.5% in 2020. Painters and metalworkers handling metalworking fluids, but not cleaners, had a significantly increased risk of BIT sensitization. From our data, there is no evidence of immunological cross‐reactivity between BIT and other isothiazolinones. Conclusion: The increasing frequency of sensitization justifies adding BIT to the baseline series. More research on the clinical relevance of positive patch test reactions to BIT and the cause for the rising numbers of BIT sensitization is needed. [ABSTRACT FROM AUTHOR]

Background: Occupational skin diseases have led the occupational disease statistics in Europe for many years. Especially occupational allergic contact dermatitis is associated with a poor prognosis and low healing rates leading to an enormous burden for the affected individual and for society. Objectives: To present the sensitization frequencies to the most relevant allergens of the European baseline series in patients with occupational contact dermatitis (OCD) and to compare sensitization profiles of different occupations. Methods: The data of 16 022 patients considered having OCD after patch testing within the European Surveillance System on Contact Allergies (ESSCA) network between January 2011 and December 2020 were evaluated. Patients (n = 46 652) in whom an occupational causation was refuted served as comparison group. Results: The highest percentages of OCD were found among patients working in agriculture, fishery and related workers, metal industry, chemical industry, followed by building and construction industry, health care, food and service industry. Sensitizations to rubber chemicals (thiurams, carbamates, benzothiazoles) and epoxy resins were associated with at least a doubled risk of OCD. After a decline from 2014 onwards, the risks to acquire an occupation‐related sensitization to methyl(chloro)isothiazolinone (MCI/MI) and especially to methylisothiazolinone (MI) seem to increase again. Sensitization rates to formaldehyde were stable, and to methyldibromo glutaronitrile (MDBGN) slightly decreasing over time. Conclusions: Among allergens in the European Baseline Series, occupational relevance is most frequently attributed to rubber accelerators, epoxy resins and preservatives. [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]

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]

Background Hydroxyisohexyl 3-cyclohexene carboxaldehyde (HICC) is a synthetic fragrance chemical and an important contact allergen, at least in Europe. Despite this importance, little is known about risk factors associated with this allergen. Objective To examine factors from the history and clinical presentation of patch tested patients associated with HICC sensitization. Methods Contact allergy surveillance data of 95 637 patients collected by the Information Network of Departments of Dermatology (IVDK, www.ivkd.org) in 2002-2011 were analysed. Point and interval estimates of the relative risk were derived from multifactorial logistic regression modelling. Results The overall prevalence of HICC sensitization was 2.24%. The strongest risk factors were polysensitization and dermatitis of the axillae, followed by dermatitis at other sites. No consistent and significant time trend was observed in this analysis. As compared with the youngest patients, the odds of HICC sensitization increased approximately three-fold in the 52-67-year age group, and strongly declined with further increasing age. Conclusions The risk pattern with regard to age and affected anatomical site differed from that observed with other fragrance screening allergens. Cosmetic exposure, as broadly defined here, was a stronger and more prevalent individual risk factor than occupational exposure. [ABSTRACT FROM AUTHOR]

To study the frequency of sensitization to 26 fragrances to be labelled according to current European regulation. During 4 periods of 6 months, from 1 January 2003 to 31 December 2004, 26 fragrances were patch tested additionally to the standard series in a total of 21 325 patients; the number of patients tested with each of the fragrances ranged from 1658 to 4238. Hydroxymethylpentylcyclohexene carboxaldehyde (HMPCC) was tested throughout all periods. The following frequencies of sensitization (rates in %, standardized for sex and age) were observed: tree moss (2.4%), HMPCC (2.3), oak moss (2.0), hydroxycitronellal (1.3), isoeugenol (1.1), cinnamic aldehyde (1.0), farnesol (0.9), cinnamic alcohol (0.6), citral (0.6), citronellol (0.5), geraniol (0.4), eugenol (0.4), coumarin (0.4), lilial (0.3), amyl-cinnamic alcohol (0.3), benzyl cinnamate (0.3), benzyl alcohol (0.3), linalool (0.2), methylheptin carbonate (0.2), amyl-cinnamic aldehyde (0.1), hexyl-cinnamic aldehyde (0.1), limonene (0.1), benzyl salicylate (0.1), γ-methylionon (0.1), benzyl benzoate (0.0), anisyl alcohol (0.0). 1) Substances with higher sensitization frequencies were characterized by a considerable number of ‘++/+++’ reactions. 2) Substances with low sensitization frequencies were characterized by a high number of doubtful/irritant and a low number of stronger (++/+++) reactions. 3) There are obviously fragrances among the 26 which are, with regard to contact allergy, of great, others of minor, and some of no importance at all. [ABSTRACT FROM AUTHOR]

Importance: The common use of isothiazolinones as preservatives is a global cause of allergic contact dermatitis. Differences in allowable concentrations of methylisothiazolinone (MI) exist in Europe, Canada, and the US., Objective: To compare the prevalence of positive patch test reactions to the methylchloroisothiazolinone/methylisothiazolinone (MCI/MI) combination and MI alone in North America and Europe from 2009 to 2018., Design, Setting, and Participants: This retrospective analysis of North American Contact Dermatitis Group, European Surveillance System on Contact Allergies (ESSCA), and the Information Network of Departments of Dermatology (IVDK) databases included data from patients presenting for patch testing at referral patch test clinics in North America and Europe., Exposures: Patch tests to MCI/MI and MI., Main Outcomes and Measures: Prevalence of allergic contact dermatitis to MCI/MI and MI., Results: From 2009 to 2018, participating sites in North America and Europe patch tested a total of 226 161 individuals to MCI/MI and 118 779 to MI. In Europe, positivity to MCI/MI peaked during 2013 and 2014 at 7.6% (ESSCA) and 5.4% (IVDK) before decreasing to 4.4% (ESSCA) and 3.2% (IVDK) during 2017 and 2018. Positive reactions to MI were 5.5% (ESSCA) and 3.4% (IVDK) during 2017 and 2018. In North America, the frequency of positivity to MCI/MI increased steadily through the study period, reaching 10.8% for MCI/MI during 2017 and 2018. Positive reactions to MI were 15.0% during 2017 and 2018., Conclusions and Relevance: The study results suggest that in contrast to the continued increase in North America, isothiazolinone allergy is decreasing in Europe. This trend may coincide with earlier and more stringent government regulation of MI in Europe.

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., (© 2020 The Authors. Contact Dermatitis published by John Wiley & Sons Ltd.)

Positive reactions to fragrance mix I (FM I) are frequent in consecutively patch tested patients suspected of having allergic contact dermatitis. However, the FM I test preparations contain 5% of the emulsifier sorbitan sesquioleate (SSO), and it is well known that SSO can cause contact allergic reactions in its own right. Indeed, the available data show that some patients with contact allergy to SSO react to FM I but are not allergic to fragrances. When SSO is not tested, this situation may go unnoticed, a wrong diagnosis of fragrance allergy may be given to the patient, and unjustified advice to avoid fragrances and fragranced products will be given in such cases. To avoid such suboptimal patient care, we postulate that testing with SSO in all patch tested individuals is mandatory. As it is well known that only a minority of FM I-reactive patients will undergo a breakdown test with the ingredients and SSO, testing with SSO in all patients can only be achieved by adding it to the European baseline series. Not testing with SSO may also result in misinterpretation of patch test reactions to Myroxylon pereirae resin and 2-hydroxyethyl methacrylate in the baseline series, as both (may) contain SSO, and, for the same reason, of reactions to several other hapten test materials., (© 2019 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background: The preservative methylisothiazolinone (MI) has become an important allergen, with a dramatic increase in sensitization prevalence being seen over the last few years., Objective: To examine risk factors associated with MI sensitization, in order to identify targets of prevention aimed at curtailing the present epidemic., Methods: On the basis of contact allergy surveillance data collected by the Information Network of Departments of Dermatology (www.ivkd.org), 2009-2012, in the course of 28,922 patch tests with MI, 500 ppm in water, included in a series of cosmetic preservatives, logistic regression analysis was employed to quantify the risk associated with a number of putative risk factors., Results: The prevalence of MI sensitization increased from 1.94% in 2009 to 6.02% in 2012, the increase being mainly driven by female patients aged≥ 40 years, patients with face dermatitis, and the use of cosmetics. Adjusted multifactorial analysis additionally identified several occupations (e.g. painters and beauticians) and ano-genital dermatitis as risk factors for MI sensitization., Conclusions: The present use concentrations of MI, both cosmetic and industrial, are too high; (self-)regulatory action is urgently needed. MI should be added to the baseline series., (© 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background: Essential oils are used in perfumery and in products for aromatherapy or balneotherapy. Previous studies have shown some to be important contact sensitizers. A practical diagnostic approach, based on the results of a large, central European network and other evidence, is needed., Methods: Data of the Information Network of Departments of Dermatology (IVDK; www.ivdk.org) on all patients patch tested between January 2000 and December 2008 with essential oils were retrospectively analysed., Results: 15 682 patients of 84 716 consulting in the period had been tested with at least one essential oil, and 637 reacted positively to at least one of the essential oils, most commonly to ylang-ylang oil (I and II) (3.1% as weighted mean of positive tests in special series and consecutive testing), lemongrass oil (1.8%), jasmine absolute (1.6%), sandalwood oil and clove oil (1.5% each). Cross-reactivity between distillate and main allergen, if available, was marked., Conclusions: Patch testing the important essential oils should be considered in patients with a suggestive history. Additionally, culprit products brought in by the patient should be tested, closing a diagnostic gap by (i) including those other essential oils not included in the commercial test series and (ii) providing a means of testing with the oxidized substances to which the patient had actually been exposed., (© 2010 John Wiley & Sons A/S.)