The European baseline series and recommended additions: 2023.

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

European patch test results with audit allergens as candidates for inclusion in the European Baseline Series, 2019/20: Joint results of the ESSCAA and the EBSB working groups of the ESCD, and the GEIDACC.

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.

Patch test results with the European baseline series, 2019/20-Joint European results of the ESSCA and the EBS working groups of the ESCD, and the GEIDAC.

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.

The European baseline series: Criteria for allergen inclusion (with reference to formaldehyde releasers).

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.

Methylchloroisothiazolinone and methylisothiazolinone contact allergy: an occupational perspective.

BACKGROUND: Sensitivity to either methylchloroisothiazolinone (MCI)/methylisothiazolinone (MI) or MI has increased, with a reported frequency of up to 11.1% among dermatitis patients, the main context being allergic contact dermatitis caused by MCI or MCI/MI in personal care products. Case reports have described occupational allergic contact dermatitis caused by MI in paints and within the beauty industry. PATIENTS/MATERIALS/METHODS: This study identified incident cases of occupational allergic contact dermatitis caused by MCI/MI and or MI reported from 1996 to 2012 to a UK-wide surveillance scheme (EPIDERM), with the aim of identifying changes in incidence over the study period. RESULTS: The data show an increase in occupational allergic contact dermatitis caused by MCI/MI and or MI from 1996 to 2012 of 4.1% [95% confidence interval (CI) 1.6-6.9] per annum. Analysis by industry showed a 3.8% (95% CI: -0.3 to 8.0) per annum increase in those exposed to personal care products in the workplace as a primary exposure [healthcare workers, 8.1% (95% CI: 2.1-14.4) per annum; beauty workers, 6.6% (95% CI: -2.2 to 16.2) per annum; hairdressers, 1.5% (95% CI: -4.7 to 8.1) per annum]. There was a 6.3% (95% CI: 1.8-10.9) per annum increase for manufacturing workers. A statistically significant rise in the frequency of occupational allergic contact dermatitis was shown to be attributable to MCI/MI and or MI between 1996 and 2012. CONCLUSION: The findings support recommendations for a review of the regulations relating to MCI/MI and/or MI in cosmetic and personal care products and in industrial settings.

UK rates of occupational skin disease attributed to rubber accelerators, 1996-2012.

BACKGROUND: Natural and synthetic rubbers containing rubber accelerators are well-known causes of allergic contact dermatitis (ACD). Latex contact urticaria (CU) has been widely reported, especially when powdered latex glove use was commonplace. Consequently, interventions to reduce latex exposure by altering glove manufacture were introduced. OBJECTIVE: This study aimed to analyse trends in UK-reported incidence of occupational skin disease associated with rubber accelerators. METHOD: We analysed cases reported to EPIDERM (part of The Health and Occupation Research network) of occupational ACD caused by natural and synthetic rubber products, between 1996 and 2012. RESULTS: For the studied period, a decreasing incidence of ACD associated with rubber products was found, with an average annual change of -1.2% [95% confidence interval (CI) -3.1 to 0.7]. The number of cases of latex CU (n = 580) significantly declined. The number of cases of ACD caused by mercapto mix and mercaptobenzothiazole (n = 177) and thiuram mix (n = 603) also declined. Reports of ACD associated with carba mix and its constituents (n = 219) increased significantly, by an average annual percentage of 10.1% (95%CI: 6.1-14.2). Twenty-six cases of ACD caused by rarer rubber compounds were identified, highlighting skin disease attributable to less widely recognized chemicals. CONCLUSIONS: These data show a falling reported incidence of occupational ACD attributed to rubber chemicals, but within this a significant rise attributable to the constituents of the carba mix. Clinicians should recognize the changing diversity of chemicals used in rubber manufacturing, and consider including carba mix in their baseline series and testing beyond this in suspect cases to avoid false-negative results.

The spontaneous resolution of photosensitivity and contact allergy in a patient with chronic actinic dermatitis.

Chronic actinic dermatitis (CAD) is an uncommon photodermatosis in which patients typically exhibit photosensitivity together with contact allergy. Improvement of the photosensitivity over time is well recognized in a proportion of patients but the concurrent resolution of contact allergy is rare. We report on a 46-year-old female with longstanding CAD who demonstrated resolution of both of these features.

Contact allergy to progesterone and estradiol in a patient with multiple corticosteroid allergies.

A 61-year-old woman with a persistent hand and foot dermatitis developed multiple contact allergies to topical steroids. She had a past history of allergic contact dermatitis (ACD) to a hormone replacement patch containing both estrogen and progesterone. The aim of this report is to highlight the potential cross-reactions between topical corticosteroids and sex steroids. Patch testing with a standard series, a corticosteroid series, and the sex steroids progesterone and estradiol was performed. Positive ACD reactions to hydroxyprogesterone, progesterone, and estradiol occurred. There were also multiple corticosteroid allergies. This case demonstrates that patients who develop contact allergies to sex steroids are at risk of developing multiple corticosteroid allergies.

Effective prescribing in steroid allergy: controversies and cross-reactions.

Contact allergy to topical corticosteroids should be considered in all patients who do not respond to, or are made worse by, the use of topical steroids. The incidence of steroid allergy in such patients is reported as 9% to 22% in adult patients and in 25% of children. It can often go undiagnosed for a long time in patients with a long history of dermatologic conditions and steroid use. Although rare, both immediate and delayed-type hypersensitivity reactions have been reported to systemic corticosteroids with an incidence of 0.3%. Reported reactions range from localized eczematous eruptions to systemic reactions, anaphylaxis, and even death. Delayed type reactions to systemically administered steroids may present as a generalized dermatitis, an exanthematous eruption, or occasionally, with blistering or purpura. In this contribution, we clarify the issues surrounding the pathogenesis of steroid allergy, cover the importance of cross-reactions, and describe strategies for the investigation and management for patients with suspected steroid allergy.

Contact sensitivity to preservatives in the UK, 2004-2005: results of multicentre study.

Preservative sensitivity in the UK was last assessed in 2000. Given the changes in preservative usage, we have re-evaluated our patch test data in order to detect any changes in the trend of sensitization. The results of patch testing using the extended British Contact Dermatitis Society Standard series were collected from 9 dermatology centres in the UK. Positive reactions to each of 10 preservative allergens were captured together with the MOAHFLA indices for each centre. In total, 6958 patients were tested during the period 2004-2005. The current data were compared with previously published data. Formaldehyde and methylchloroisothiazolinone/methyl-isothiazolinone have the highest positivity rates at 2.0% and chloroxylenol the lowest at 0.2%. Parabens mix has the highest irritancy rate. Compared with the UK data in 2000, the positivity rate of imidazolidinyl urea (0.02 < P < 0.05) has significantly increased and that of methyldibromo glutaronitrile has significantly reduced (P < 0.001).

Materials and allergens within spectacle frames: a review.

The materials that have been reported as causing allergic contact dermatitis within spectacle frames are identified, and their most likely location on the frame is highlighted. The lack of any real control over spectacle frame quality and content is indicated to be a problem, as is the difficulty in determining the true source of many frames. Much of the information must be obtained from anonymous sources in the industry, historical 'common knowledge' of indeterminate source or reports of dermatological problems.

Type IV hypersensitivity to vitamin K.

The day after intramuscular injection of vitamin K1 (phytomenadione) into her thigh, a 27-year-old-woman with normal liver function developed a relapsing and remitting eczematous reaction localized to the injection site, and later a further eczematous reaction under an adhesive dressing (Duoderm). On patch testing, she was positive to vitamin K1 and cross-reacted to vitamin K4; she was also positive to colophonium and to ester gum rosin, the dressing adhesive. Recurrent angioedema persisted for several months and, 2 years later, symptoms were still occurring over the injection sites. Structure-activity relationships among vitamin K allergens are discussed.