ESSCA results with the baseline series, 2002-2012: p-phenylenediamine.

BACKGROUND: Allergic contact dermatitis caused by p-phenylenediamine (PPD) is common among all age groups and both sexes. Monitoring of prevalence and intensity of sensitization is important. OBJECTIVE: To evaluate contact allergy to PPD in Europe, and to compare reaction intensities in different European regions. METHODS: Data collected by the European Surveillance System on Contact Allergies (ESSCA) network between 2002 and 2012 from 12 European countries were analysed regarding prevalence, grading of positive reactions to PPD, and relevance. RESULTS: A total of 99 926 PPD-positive patients from 63 departments were included for analysis. The overall (2002-2012) prevalence of PPD sensitization in Europe is ∼4%. Stratified for country, the highest overall standardized prevalence was found in Lithuania, and the lowest in Slovenia. The prevalence of PPD sensitization did not decline over the years. In the southern European countries, higher numbers of strong and extremely strong reactions were registered. The clinical relevance of PPD sensitization varied from half to three-quarters. CONCLUSION: The prevalence of PPD sensitization has not changed over time. Strong and extremely strong patch test reactions are seen more often in the South, probably because of the higher number of PPD-containing hair dye products.

Patch test results of the European baseline series among patients with occupational contact dermatitis across Europe - analyses of the European Surveillance System on Contact Allergy network, 2002-2010.

BACKGROUND: Occupational contact dermatitis is one of the most common occupational diseases in Europe. In order to develop effective preventive measures, detailed and up-to-date data on the incidence, main causes and professions at risk of occupational contact dermatitis are needed. OBJECTIVES: To describe the pattern of patch test reactivity to allergens in the European baseline series of patients with occupational contact dermatitis in different occupations. METHODS: We analysed data collected by the European Surveillance System on Contact Allergy (ESSCA) network from 2002 to 2010, from 11 European countries. RESULTS: Allergens in the European baseline series associated with an at least doubled risk of occupational contact dermatitis include: thiuram rubber chemical accelerators, epoxy resin, and the antimicrobials methylchloroisothiazolinone/methylisothiazolinone, methyldibromo glutaronitrile, and formaldehyde. The highest risk of occupational contact dermatitis was found in occupations classified as 'other personal services workers', which includes hairdressers, nursing and other healthcare professionals, precision workers in metal and related materials, and blacksmiths, tool-makers and related trades workers. CONCLUSIONS: In the planning and implementation of measures aimed at preventing occupational contact dermatitis, the focus should be on the identified high-risk occupational groups and the most common occupational allergies.

ESSCA results with the baseline series, 2009-2012: rubber allergens.

BACKGROUND: Allergic contact dermatitis caused by rubber allergens is common, and causes significant patient morbidity. Contemporary data are important to allow appropriate preventive measures and identification of contact allergy trends. OBJECTIVES: To describe the pattern of patch test reactivity to rubber allergens, including those in the European baseline series. METHODS: Data collected by the European Surveillance System on Contact Allergies (ESSCA) network between 2009 and 2012 from 12 European countries were analysed. RESULTS: Contact allergy to thiuram mix declined over the studied time period, with an overall prevalence of 1.87%. The prevalence of allergy to carba mix was 2.29%, and was significantly increasing. Prevalence rates of sensitization to other rubber allergens were largely unchanged. Statistical analysis with the MOAHLFA index confirmed the strong links between rubber allergy and occupational hand dermatitis. CONCLUSIONS: Changing patterns of allergy to rubber additives have been identified. Inclusion of carba mix in the European baseline series may be appropriate.

[Preservatives as important etiologic factors of allergic contact dermatitis]. / Konserwanty jako istotne czynniki etiologiczne alergicznego kontaktowego zapalenia skóry.

BACKGROUND: Preservatives present in cosmetics and other industrial products can cause allergic contact dermatitis. The aim of the study was to assess the frequency of allergy to selected preservatives in consecutive patients examined due to contact dermatitis in the Nofer Institute of Occupational Medicine, Lódz, and to establish whether individuals sensitized to formaldehyde react simultaneously to formaldehyde releasers. MATERIAL AND METHODS: A group of 405 patients (308 females and 97 males) was examined in 2011-2013. In all participants patch tests with a series of 13 preservatives (paraben mix, formaldehyde, Quaternium 15, chloromethylisothiazolinone/methylisothiazolinone mix, methyldibromoglutaronitrile, diazolidinyl urea, imidazolidinyl urea, DMDM hydantoin, 2-bromo-2-nitropropane-1,3-diol, iodopropynyl butylcarbamate, benzalkonium chloride, sodium metabisulfite, produced by Chemotechnique Diagnostics, Sweden) were performed. RESULTS: Of the 405 patients 74 (including 52 females) showed positive results of patch tests. Contact allergy to at least 1 preservative was noted in 47 (11.6%) patients, including 34 (11%) females and 13 (13.4%) males. Methylisothiazolinone proved to be the most frequent sensitizer--4.7% (5.2% females, 3.1% males) while parabens, 2-bromo-2-nitropropane-1,3-diol and imidazolidinyl urea (0.2%) were found to be the least frequent. Fourteen (3.4%) participants, 10 women and 4 men, were allergic to formaldehyde and/or formaldehyde releasers. In 11 (78.6%) of them monovalent hypersensitivity was observed. In 13 (3.2% of the examined group) patients allergy to preservatives might have been of occupational origin. CONCLUSIONS: Preservatives, particularly isothiazolinones, are significant causal factors of allergic contact dermatitis, including occupational cases. Individuals sensitized to formaldehyde may react simultaneously to formaldehyde releasers, however, such reactions are relatively rare.

[Isothiazolinones as causal factors of contact allergy epidemics in the 20th and 21st centuries]. / Izotiazolinony jako przyczyna epidemii alergii kontaktowej XX i XXI wieku.

Chloromethylisothiazolinone (MCI) and methylisothiazolinone (MI) have been widely used as preservatives in cosmetics, household products and industrial products since the late 1970s. First cases of contact allergy to the MCI/MI combination were noted in 1980-1982 in Sweden. Then, a significant increase in the frequency of sensitization to these compounds was observed in many European centers. The increase has been stopped by the introduction of legislation on their maximum concentrations in consumer and industrial products in Europe and in some non-European countries. But approval of the use of MI alone without limits in industrial products (from 2000) and at a maximum concentration of 100 ppm in cosmetics (from 2005) resulted in an unprecedented increase in the number of individuals sensitized to this compound. Allergic contact dermatitis due to MI occurs in both adults and children. It is often manifested by severe symptoms, which may be also induced by airborne exposure. The most important sources of sensitization include cosmetic products and paints. To counteract the increasing problem of contact allergy epidemic to MI, the recommendations have been developed, suggesting the ban on the use of MI in "leave-on" cosmetics and maximum concentration of 15 ppm in "rinse-off" products. The recommendations are likely to be implemented in 2014.

[Manicurists and pedicurists - occupation group at high risk of work-related dermatoses]. / Manikiurzystki i pedikiurzystki jako grupa zawodowa o istotnym ryzyku dermatoz zwiazanych z prac.

In recent years occupational skin and respiratory diseases have been more and more frequently diagnosed in small production and service enterprises. The awareness of occupational exposure and its possible health effects among their workers and employers is not sufficient. Beauty salons, in addition to hairdressers and beauticians, frequently employ manicurists and pedicurists. The workers often happen to perform various activities interchangeably. the health status of beauty salons workers has rarely been assessed. The most numerous reports concern hairdressers. In this occupational group, the occurrence of skin lesions induced by wet work and frequent allergy to metals, hair dyes and bleaches and perm solutions has been emphasized, while information about health hazards for being a manicurist or pedicurist in beauty salons is seldom reported. The aim of this paper is to present professional activities (manicure and pedicure, methods of nail stylization), occupational exposure and literature data on work-related adverse health effects in manicurists and pedicurists. Wet work and exposure to solvents, fragrances, resins, metals, gum, detergents may cause skin disorders (contact dermatitis, urticaria, angioedema, photodermatoses), conjunctivitis, anaphylaxis, respiratory tract diseases, including asthma. The discussed occupations are also associated with the increased incidence of bacterial (particularly purulent), viral and fungal infections and cancer.

Contact allergy to metals in adolescents: nickel release from metal accessories 7 years after the implementation of the EU Nickel Directive in Poland.

BACKGROUND: Contact allergy among adolescents is an important issue. OBJECTIVES: To assess the prevalence of contact allergy to metals in adolescents aged 15 years and nickel release from metal accessories that are in direct contact with the skin. METHODS: Three hundred and nine females and 219 males, all 15 years old, from randomly selected secondary schools were examined and patch tested with nickel sulfate, cobalt chloride, palladium chloride, and potassium dichromate. Three hundred and ninety-nine metal accessories were tested with the dimethylglyoxime (DMG) test. RESULTS: 'Metal dermatitis' was reported by 19.4% of females and 0.5% of males. Positive patch test reactions were found in 8.5% of the adolescents (12.9% in females; 2.3% in males), namely to: nickel (12.3% of females; 1.4% of males); palladium (5.2% of females; 0.5% of males); cobalt (3.2% of females; 1.4% of males); and chromium (1.3% of females; 0.9% of males). Allergic contact dermatitis caused by metals was diagnosed in 9.7% of females and in 0.5% of males. Of the metal items, 26.1% gave positive DMG test results: 10.0% of earrings, 11.4% of snaps, and 56.2% of belt buckles. CONCLUSIONS: Despite the implementation of the Nickel Directive in Poland, nickel still remains an important causal factor for allergic contact dermatitis. Numerous metal accessories do not comply with the Directive.

Current patch test results with the European baseline series and extensions to it from the 'European Surveillance System on Contact Allergy' network, 2007-2008.

BACKGROUND: The pattern of contact sensitization to the supposedly most important allergens assembled in the baseline series differs between countries, presumably at least partly because of exposure differences. Objectives. To describe the prevalence of contact sensitization to allergens tested in consecutive patients in the years 2007 and 2008, and to discuss possible differences. METHODS: Data from the 39 departments in 11 European countries comprising the European Surveillance System on Contact Allergy network (www.essca-dc.org) in this period have been pooled and analysed according to common standards. RESULTS: Patch test results with the European baseline series, and country-specific or department-specific additions to it, obtained in 25 181 patients, showed marked international variation. Metals and fragrances are still the most frequent allergens across Europe. Some allergens tested nationally may be useful future additions to the European baseline series, for example methylisothiazolinone, whereas a few long-term components of the European baseline series, namely primin and clioquinol, no longer warrant routine testing. CONCLUSIONS: The present analysis points to 'excess' prevalences of specific contact sensitization in some countries, although interpretation must be cautious if only few, and possibly specialized, centres are representing one country. A comparison as presented may help to target in-depth research into possible causes of 'excess' exposure, and/or consideration of methodological issues, including modifications to the baseline series.

Dermatological screening and results of patch testing among Polish apprentice hairdressers.

BACKGROUND: High prevalence of occupational dermatoses among hairdressers has been confirmed in many studies, while work-related skin disorders in apprentice hairdressers are less known. OBJECTIVES: The aim of the study was to investigate the frequency of work-related skin disorders among apprentice hairdressers, and to identify the factors contributing to the development of dermatoses during vocational training. PATIENTS AND METHODS: One hundred thirty-nine apprentice hairdressers, aged 17-19 years, were included in the study. A questionnaire survey, personal interview, dermatological examination and patch tests were conducted. RESULTS: Present or past work-related skin conditions affecting the hands were reported by 43.9% of individuals, and diagnosed in 25.9% on dermatological examination. Positive patch test results were found in 38.1%. The most frequent allergens were nickel (29.3% of all tested) and ammonium persulfate (8.3%). Allergic contact dermatitis was recorded in 27.3%, and was of occupational origin in 87.9% of all tested individuals. Irritant contact dermatitis was diagnosed in 51.1% of participants (this prevalence was higher than that based only on an interview). Survey responses revealed inadequate knowledge of the risk of occupational skin diseases and protective measures. CONCLUSIONS: It is necessary to implement an educational programme for apprentice hairdressers, in order to increase their knowledge of the risk of skin damage and to promote appropriate use of protective measures, starting from the earliest stages of their training.

Systemic contact dermatitis to nickel present in cocoa in 14-year-old boy.

Systemic contact dermatitis can be elicited in nickel sensitive individuals by oral nickel exposure from food with high content of this metal, such as cocoa. We present a case report of a nonatopic teenager who developed allergic contact dermatitis due to nickel, cobalt, copper, and palladium, but exacerbations of skin lesions were mainly related to cocoa consumption.

[Irritant contact dermatitis. Part III. Non-invasive methods to assess biophysical properties of the skin]. / Kontaktowe zapalenie skóry z podraznienia. Czesc III. Nieinwazyjne metody oceny wlasciwosci biofizycznych skóry.

Disturbances in biophysical properties of the skin during irritant reactions induced by exposure to chemicals may be assessed by several non-invasive methods. The most popular one involves determinations of transepidermal water loss, stratum corneum hydration, skin pH and evaluation of erythema, pigmentation and skin blood flow. Non-invasive techniques are also applied to assess individual skin susceptibility to irritants. In dermatology and cosmetology they provide information about efficacy and safety of medicines, cosmetics and hygiene products. Determinations of skin parameters may also be useful in diagnosing and monitoring of various dermatoses and in the observation of changes in skin properties caused by the disease.

[Wet work]. / Wet work--praca w srodowisku mokrym.

Wet work is one of the most important risk factors of occupational skin diseases. Exposure of hands to the wet environment for more than 2 hours daily, wearing moisture-proof protective gloves for a corresponding period of time or necessity to wash hands frequently lead to the disruption of epidermal stratum corneum, damage to skin barrier function and induction of irritant contact dermatitis. It may also promote penetration of allergens into the skin and increase the risk of sensitization to occupational allergens. Exposure to wet work plays a significant role in occupations, such as hairdressers and barbers, nurses and other health care workers, cleaning staff, food handlers and metalworkers. It is more common among women because many occupations involving wet work are female-dominated. The incidence of wet-work-induced occupational skin diseases can be reduced by taking appropriate preventive measures. These include identification of high-risk groups, education of workers, organization of work enabling to minimize the exposure to wet work, use of personal protective equipment and skin care after work.

[Erratum to the article "Allergy to isothiazolinones in recent years" (Med Pr. 2020;71(5):603-11)]. / Errata do artykulu "Alergia na izotiazolinony w ostatnich latach" (Med. Pr. 2020;71(5):603­611).

The original version of the article can be found at: https://doi.org/10.13075/mp.5893.01037.

[Allergy to isothiazolinones in recent years]. / Alergia na izotiazolinony w ostatnich latach.

BACKGROUND: Isothiazolinones are preservatives which are present in cosmetics, household chemicals and many other industrial products. Initially, a mixture of methylchloroisothiazolinone and methylisothiazolinone (MCI/MI - Kathon CG) was used, and then, from the beginning of the 21st century, only methylisothiazolinone. Due to a significant increase in the number of contact dermatitis caused by allergy to this compound, it was withdrawn from leave-on cosmetics, and its concentration in rinse-off cosmetics was reduced. The aim of the study was to analyze the incidence of contact allergy to isothiazolinones among patients in the Nofer Institute of Occupational Medicine, Lódz, the intensification of patch test results and hypersensitivity depending on the occupation, and to assess the contribution of immediate allergy to the occurrence of that hypersensitivity. MATERIAL AND METHODS: In a group of 1137 patients (832 females and 305 males) with suspected contact dermatitis, diagnosed in 2014-2018, patch tests series including methylchloroisothiazolinone/methylisothiazolinone (0.01%) and methylisothiazolinone (0.2%), produced by Chemotechnique Diagnostics, Sweden, were performed. In a group of 29 individuals with contact allergy to isothiazolinones, prick tests with methylisothiazolinone (0.001%, 0.01%, 0.1%, 1%) (Sigma-Aldrich, Germany) were conducted. RESULTS: Of the 1137 subjects, 95 (8.3%) were allergic to isothiazolinones, slightly more often females - 71 (8.5%) than males - 24 (7.9%). In total, 150 positive patch tests with isothiazolinones (13.2%) were obtained. The number of positive results with methylisothiazolinone alone (7.8%) was higher than the number with methylisothiazolinone from Kathon CG (5.4%). Among the subjects sensitized to methylisothiazolinone alone strongly positive patch tests (+++) concerned 60.7%. In the female group, office workers (42.3%) and medical staff (18.3%) predominated, and in the male group - locksmiths, turners, mechanics and similar ones (45.8%), and construction workers (25.0%). Prick tests with methylisothiazolinone were negative, and they became positive after 3-5 h. CONCLUSIONS: Isothiazolinones, particularly methylisothiazolinone, are significant causal factors of contact allergy, including that of occupational origin. They have strongly allergenic properties, and in patch tests they often give very severe inflammatory reactions. The issue of the role of immediate allergy in the pathogenesis of isothiazolinones sensitization requires further research. Med Pr. 2020;71(5):603-11.

The European baseline series in 10 European Countries, 2005/2006--results of the European Surveillance System on Contact Allergies (ESSCA).

BACKGROUND: Continual surveillance based on patch test results has proved useful for the identification of contact allergy. OBJECTIVES: To provide a current view on the spectrum of contact allergy to important sensitizers across Europe. PATIENTS/METHODS: Clinical and patch test data of 19 793 patients patch tested in 2005/2006 in the 31 participating departments from 10 European countries (the European Surveillance System on Contact Allergies' (ESSCA) www.essca-dc.org) were descriptively analysed, aggregated to four European regions. RESULTS: Nickel sulfate remains the most common allergen with standardized prevalences ranging from 19.7% (central Europe) to 24.4% (southern Europe). While a number of allergens shows limited variation across the four regions, such as Myroxylon pereirae (5.3-6.8%), cobalt chloride (6.2-8.8%) or thiuram mix (1.7-2.4%), the differences observed with other allergens may hint on underlying differences in exposures, for example: dichromate 2.4% in the UK (west) versus 4.5-5.9% in the remaining EU regions, methylchloroisothiazolinone/methylisothiazolinone 4.1% in the South versus 2.1-2.7% in the remaining regions. CONCLUSIONS: Notwithstanding residual methodological variation (affecting at least some 'difficult' allergens) tackled by ongoing efforts for standardization, a comparative analysis as presented provides (i) a broad overview on contact allergy frequencies and (ii) interesting starting points for further, in-depth investigation.

[Irritant contact dermatitis. Part II. Evaluation evaluation of skin irritation potential of chemicals]. / Kontaktowe zapalenie skóry z podraznienia. Czesc II. Metody badania dzialania drazniacego substancji chemicznych.

The evaluation of skin irritation potential of chemicals is essential to secure the safety of individuals exposed to several substances designed for industrial, pharmaceutical or cosmetic use. Until recently, preclinical safety assessment of chemicals was largely based on animal experiments. Ethical concerns and the limited value of animal models in evaluating human skin irritation potential resulted in the development of alternative in vitro methods, such as EpiDerm, EPISKIN or SkinEthic, to assess irritation, i.e. cell cultures and human epidermis models. International organizations like the European Centre for the Validation of Alternative Methods (ECVAM) promotes and monitors the development of nonanimal tests. Human patch tests and use tests also provide an opportunity to identify substances with significant skin irritation potential without recourse to the use of animals. These tests are useful to assess skin irritation potential of cosmetics and detergents.

[Occupational contact dermatitis in hairdressers]. / Zawodowe kontaktowe zapalenie skóry u fryzjerów.

Numerous data from the medical literature show that working as a hairdresser is associated with the highest risk of occupational contact dermatitis. In Europe, hairdressers rank first of all occupation groups with the highest prevalence of occupational dermatitis. It is estimated that 10-20% and even 50% of hairdressers are affected with skin disorders. Skin problems occur soon after commencing hairdressing, in the first 2 years of work, sometimes during vocational training. The most common factors contributing to skin damage include water, shampoos, detergents, conditioners, hair dyes, bleaches, permanent wave solutions and components of gloves. Water and wet work are prime skin irritants - causal factors of irritant contact dermatitis while p-phenylenediamine, glyceryl monothioglycolate, ammonium persulfate and also fragrances, preservatives, disinfectants and metals are the most important allergens, which induce allergic contact dermatitis.

[The role of regulatory T cells in allergic contact dermatitis]. / Rola limfocytów T regulatorowych w alergicznym kontaktowym zapaleniu skóry.

Regulatory T cells (Treg) play a crucial role in the regulatory mechanisms of immune system. They are responsible for the induction and maintenance of immune tolerance. They are also involved in the pathogenesis of autoimmune and allergic diseases and implicated in transplant rejection and immunopathology of cancers. Treg cells constitute the population of lymphocytes heterogeneous in their phenotype. CD4+CD25+Foxp3+ cells are most important among Treg subsets. Modification of Treg actvity may be useful in the therapy of different diseases, including allergic disorders.