Contact allergies to dental materials in patients.

BACKGROUND: Concerns regarding contact allergies and intolerance reactions to dental materials are widespread among patients. Development of novel dental materials and less frequent amalgam use may alter sensitization profiles in patients with possible contact allergy. OBJECTIVES: To analyse current sensitization patterns to dental materials in patients with suspected contact allergy. METHODS: This retrospective, multicentre analysis from the Information Network of Departments of Dermatology (IVDK) selected participants from 169 834 people tested in 2005-2019 and registered with (i) an affected area of 'mouth' (and 'lips'/'perioral'), (ii) with the dental material in question belonging to one of three groups (dental filling materials, oral implants or dentures or equivalents) and (iii) with patch-testing done in parallel with the German baseline series, (dental) metal series and dental technician series. RESULTS: A total of 2730 of 169 834 tested patients met the inclusion criteria. The patients were predominantly women (81.2%) aged ≥ 40 years (92.8%). The sensitization rates with confirmed allergic contact stomatitis in women (n = 444) were highest for metals (nickel 28.6%, palladium 21.4%, amalgam 10.9%), (meth)acrylates [2-hydroxyethyl methacrylate (HEMA) 4.8%] and the substances propolis (6.8%) and 'balsam of Peru' (11.4%). The most relevant acrylates were HEMA, 2-hydroxypropyl methacrylate, methyl methacrylate, ethylene glycol dimethacrylate and pentaerythritol triacrylate. Few men were diagnosed with allergic contact stomatitis (n = 68); sensitization rates in men were highest for propolis (14.9%) and amalgam (13.6%). CONCLUSIONS: Allergic contact stomatitis to dental materials is rare. Patch testing should not only focus on metals such as nickel, palladium, amalgam and gold, but also (meth)acrylates and the natural substances propolis and 'balsam of Peru'.

A NIR fluorescence probe for monitoring Cys upregulation induced by balsam pear polysaccharide and imaging in zebrafish.

In this work, we introduced the acrylate recognition group into dicyanoisophorone derivative DCI-C-OH to construct the NIR fluorescent probe DCI-C-Cys with a large Stokes shift (240 nm). DCI-C-Cys could specifically respond to Cys, resulting in a 22-fold increase in fluorescence intensity at 702 nm. Meanwhile, the probe has the advantages of good water solubility, high sensitivity (93 nM), and excellent biocompatibility. Moreover, DCI-C-Cys successfully monitored endogenous and exogenous Cys in HepG2 cells and zebrafish. Most importantly, we found that balsam pear polysaccharide could lead to the increase of intracellular Cys levels, which might be conducive to the further study of the antioxidant mechanism of balsam pear polysaccharide.

Myroxylon pereirae (balsam of Peru): Still worth testing?

BACKGROUND: Because Myroxylon pereirae (MP), or balsam of Peru, is nowadays almost not used "as such," and fragrance mix 1 (FM1) apparently is more sensitive in detecting fragrance allergy, the usefulness of testing MP in baseline series was recently questioned. OBJECTIVES: Identification of the number of clinically relevant patch test reactions to MP not detected by FM1. METHODS: Retrospective analysis of 12 030 patients patch tested with MP and FM1 for contact dermatitis between January 2018 and December 2019 in 13 Italian dermatology clinics. RESULTS: Four hundred thirty-nine patients (3.6%) had a positive patch test reaction to MP; 437 (3.6%) had a positive patch test reaction to FM1. Positive reactions to both MP and FM1 were observed in 119 subjects (1.0%), 310 (2.6%) reacted to MP only, 304 (2.5%) to FM1 only, 5 to MP and sorbitan sesquioleate (SSO), 9 to FM1 and SSO, and 5 to MP, FM1, and SSO. Single sensitizations were clinically relevant in 75.2% of cases for MP (62.9% current, 12.3% past) and 76.3% for FM1 (70.1% current, 6.2% past). CONCLUSIONS: Based on our results, MP appears to be still worth testing along with FM1 in baseline series, because it allows detection of a remarkable number of fragrance allergies, often relevant, which would be otherwise missed.

Patch test results with the European baseline series and additions thereof in the ESSCA network, 2015-2018.

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.

Hermit Treutler's Jerusalem Balsam.

This paper describes research about a historical bottle found in the Polish town of Skarszewy in 2004. Upon discovery, the find was labeled "In Nazareth Aechter Jerusalemer Balsam im goldnen Engel", sealed and ⅓ filled with liquid. The Jerusalem Balsam mentioned on the label was a popular medicament in Europe in the 18th century. From 1719 it was produced by Father Antonio Menzani da Cuna in the Franciscan Pharmacy at the convent of Saint Savior in Jerusalem. In the 19th century, the Balsam became extremely popular in Silesia thanks to the hermit Johannes Treutler from Marianska Hill near Klodzko. It's fame spread north to Prussia and south to Bohemia (Czechia). After the hermit's death, the license for production was obtained by the owner of the Mohren-Apotheke pharmacy, but he had to deal with unfair competition from other pharmacies counterfeiting the Balsam. An attempt was made to determine where the found bottle came from. In the course of the research, it was found that the medicine certainly does not come from authorized production sources, as evidenced by accurate label comparisons.

Dr. Seth Arnold's Balsam: A Rebus Mystery Solved (Almost).

The term rebus is exemplified in Figure 1. "Two bee oar knot two bee" is an easy rebus to figure out, while others are much more challenging. A simple definition of this unique concepts is; "A rebus is a code or reference where pictures, letters, or symbols represent certain words or phrases…"1 Along with hidden image puzzle cards,2 some purchasers of Victorian Era advertising used rebus puzzle cards to challenge peoples' "figuring out" abilities. An example is this card for "The Great Household Remedy," Dr. Seth Arnold's Balsam (Figs. 2 and 3). The text on the reverse side of the card offered this patent medicine for treatment of "Diarrhoea, Dysentery, and for all Bowel Complaints." Additionally, "FOR CHILDREN TEETHING" it could give "the little sufferers REST, SLEEP, HEALTH" and saves lives. A testimonial by James F. Carlen even claimed that sick children treated with medicines, different from Seth Arnold's Balsam, died!

Contemporary analytical techniques reveal the secret composition of a 19th century Jerusalem Balsam.

In 1719, Antonio Menzani di Cuna from the Saint Savior monastery published an alcoholic extract formula made from plant and herb resins under the name Jerusalem Balsam. The Balsam gained high popularity due to its remedial benefits. At the end of the 19 th century, Jerusalem Balsam produced by the hermit Johannes Treutler was found to be particularly popular. We analysed a sample of a valuable find coming from the last decade of the 19 th century, making it probably the oldest surviving Jerusalem Balsam in the world. The purpose of this work was to investigate the composition of the historical sample and to try to determine the origin of its components. This was achieved by comparing the profile of volatile compounds extracted from the balsam using HS-SPME technique with the profile characteristic for plant resins as classic ingredients of the Johannes Treutler formula. The use of two chromatographic columns of different polarity, as well as the transformation of the polar components of the sample into TMS derivatives, allowed to obtain new information on the historical composition of the Balsam. Also, it can be stated with high probability that plant resins were indeed used in the production of the Balsam as referred to in the original recipe of Johannes Treutler. We also discuss challenges in determining the original composition of the Balsam.

Myroxylon pereirae resin (balsam of Peru) - A critical review of the literature and assessment of the significance of positive patch test reactions and the usefulness of restrictive diets.

In this article, contact allergy to Myroxylon pereirae resin (MP) (balsam of Peru) is reviewed. The topics presented include the uses, the chemical composition, the frequency of sensitization, the relevance of positive reactions, the MP-containing products causing allergic contact dermatitis, co-reactivity with other fragrance and non-fragrance materials, the sensitizers, the usefulness of MP as a "marker" of fragrance allergy, and the effectiveness of, and indications for, "balsam-restrictive" diets. Sensitization to MP occurs in 4% to 8% of patients routinely tested for suspected contact dermatitis. There are few adequate data on relevance. Topical pharmaceuticals were formerly, but are not today, important sources of sensitization. Cosmetics and foods or drinks are hardly ever products responsible for sensitization to MP. Positive patch test reactions in the large majority probably result from previous sensitization to MP constituents because of their presence in fragrances and fragranced products, MP thereby acting as marker (or "indicator") of fragrance allergy. However, fragrance mix I is a more sensitive marker, and the added diagnostic value of testing with MP is unknown. The allergenic ingredients of MP include isoeugenol, eugenol and cinnamyl alcohol, but there are other-largely unknown-chemicals that are responsible for contact allergy. Suggestions are given for further research to address questions thus far unanswered and to improve patient care.

Systemic contact dermatitis related to alcoholic beverage consumption.

Systemic contact dermatitis is a rash secondary to systemic exposure to allergens after sensitization. Numerous agents are implicated including Balsam of Peru, a plant-derived compound often used for flavoring and fragrance. Alcoholic beverages can contain many possible allergens, including cinnamon, vanilla, citrus peels, and Balsam of Peru. Herein, we describe two patients presenting with recurrent, diffuse, erythematous, and pruritic cutaneous eruptions suspicious for contact dermatitis. Based on clinical history, exam, and formal and at-home patch testing results, we believe the most likely etiology was Balsam of Peru within the alcohol beverages leading to systemic contact dermatitis. Both patients markedly improved after avoidance of their alcoholic beverages. Overall, systemic contact dermatitis secondary to alcohol consumption is a rare phenomenon, whereas Balsam of Peru is a relatively common allergen. Suspicion must be high to identify possible allergens (including Balsam of Peru) exposure within alcoholic beverages such as artificial flavorings, aromas, and mixtures.

Contact dermatitis and patch testing for the allergist.

OBJECTIVE: To review of contact dermatitis (CD) and its key allergens and provide updates and recommendations for the practicing allergist. DATA SOURCES: Through the use of various scientific search engines (eg, PubMed and MEDLINE), we reviewed literature on CD, patch tests (PTs), key allergens, occupational dermatitis, and treatment. STUDY SELECTIONS: Studies on CD, important allergens, and PTs were considered. RESULTS: Contact-induced dermatitis may be due to allergic CD, irritant CD, systemic CD, contact urticaria, and protein CD. Key allergens include metals (nickel, gold), topical medicaments (topical corticosteroids), and cosmetics and personal care products (fragrances and preservatives such as methyl- and methylchloro-isothiazolinone). Present relevance of a positive PT result is the combination of definite, probable, and possible relevance and should be correlated with the patient's history and physical examination. Treatment of allergic CD includes identification of relevant allergens, patient education, avoidance, and provision of alternative products the patient can use. CONCLUSION: CD is a common inflammatory skin disease and should be suspected in patients presenting with acute, subacute, or chronic dermatitis. The gold standard for diagnosing allergic CD is a PT. This article provides practical recommendations for the diagnosis and management of CD commonly seen by the allergist in their practice.

Photo-patch and patch tests in patients with dermatitis over the photo-exposed areas: A study of 101 cases from a tertiary care centre in India.

BACKGROUND: Many patients with dermatitis over photo-exposed body areas are positive to many contact allergens and have a pre-existing allergic contact dermatitis. METHODS: This study included patients who presented to a tertiary centre in India with dermatitis on photo-exposed body areas suspected of chronic actinic dermatitis. Their detailed histories were recorded and cutaneous and systemic examinations were performed. Patch testing was done in all the patients and photo-patch testing was carried out in 86 patients. RESULTS: Altogether 101 patients were included (69 males, 32 females). The most common presentation was lichenified hyperpigmented plaques on the photo-exposed sites. Photosensitivity was recorded in 64 (63%) patients and summer exacerbation in 52 (52%). Exposure to the Parthenium hysterophorus weed was recorded in 70 (69%) patients, 27 (26.7%) had a history of hair dye application and 20 (20%) had a history of atopy. Photo-patch test was positive in 11 (12.8%) patients and patch testing was positive in 71 (70%). Parthenium hysterophorus was the most common allergen implicated and was positive in three (4%) photo-patch and 52 (52%) patch tests. Other positive photo-patch test allergens were perfume mix, balsam of Peru, thiuram mix, Compositae mix and promethazine hydrochloride. Other common patch test allergens were parthenolide, colophony, fragrance mix and p-phenylenediamine (PPD) base. CONCLUSION: In the Indian population parthenium and perfume mix are the most common photoallergens in patients with dermatitis over photo-exposed areas, while parthenium, colophony, fragrance mix and PPD are the common positive allergens.

The current spectrum of contact sensitization in patients with chronic leg ulcers or stasis dermatitis - new data from the Information Network of Departments of Dermatology (IVDK).

BACKGROUND: Patients with lower leg dermatitis, chronic venous insufficiency or chronic leg ulcers have a high prevalence of contact sensitization. OBJECTIVES: To identify the current spectrum of contact allergens in these patients. PATIENTS AND METHODS: Data of the Information Network of Departments of Dermatology on 5264 patients with the above diagnoses from the years 2003 to 2014 (study group) were compared with data on 4881 corresponding patients from 1994 to 2003 (historical control group) and with a current control group without these diagnoses (n = 55 510). RESULTS: Allergic contact dermatitis was diagnosed less frequently in the study group than in the historical control group (25.9% versus 16.9%; p < 0.001), and contact sensitization to most allergens had declined. The allergen spectrum, however, was largely unchanged. Important allergens are Myroxylon pereirae (balsam of Peru) (14.8% positive reactions), fragrance mix I (11.4%), lanolin alcohol (7.8%), colophonium (6.6%), neomycin sulfate (5.0%), cetearyl alcohol (4.4%), oil of turpentine (3.1%), and paraben mix (2.6%). Patch testing with additional series showed sensitization to Amerchol L-101 (9.7%), tert-butyl hydroquinone (8.7%), framycetin sulfate (5.0%), and gentamicin sulfate (3.1%). CONCLUSIONS: Topical preparations for treating the above-mentioned conditions should not contain fragrances, Myroxylon pereirae, and colophonium. The special allergen spectrum has to be considered in patch testing.

Contact Alopecia: Improvement of Alopecia with Discontinuation of Fluocinolone Oil in Individuals Allergic to Balsam Fragrance.

Inflammatory scalp dermatoses can be associated with alopecia, which is nonscarring and reversible in its early stages. This association has been described in seborrheic dermatitis, psoriasis, and atopic dermatitis. We describe three girls with alopecia aggravated by contact allergy to balsam fragrances. All three had complete resolution with avoidance of balsam of Peru and other balsam derivatives (including discontinuation of fluocinolone oil, which contains balsam of pine).

Contact sensitization in patients with suspected cosmetic intolerance: results of the IVDK 2006-2011.

BACKGROUND: Ingredients of leave-on cosmetics and body care products may sensitize. However, not every case of cosmetic intolerance is due to contact sensitization. OBJECTIVE: To describe the frequency of contact sensitization due to cosmetics in a large clinic population, and a possible particular allergen pattern. METHODS: Retrospective analysis of data from the Information Network of Departments of Dermatology, 2006-2011. RESULTS: Of 69 487 patients tested, 'cosmetics, creams, sunscreens' was the only suspected allergen source category in 10 124 patients (14.6%). A final diagnosis 'allergic contact dermatitis' was stated in 2658 of these patients (26.3%).Compared to a control group, there were significantly more reactions to fragrance mixes I and II, balsam of Peru, methylchloroisothiazolinone/methylisothiazolinone (MCI/MI) and lanolin alcohols. No special pattern of fragrance sensitization could be identified. Among the preservatives, MI was by far the leading allergen, while sensitization to other widely used compounds like parabens or phenoxyethanol was rare. CONCLUSIONS: True allergic reactions to cosmetic ingredients are rarer than generally assumed. Limitation of exposure to MI in leave-on cosmetics and body care products is urgently needed.