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.

Evaluation of Antimicrobial Effect of Air-Polishing Treatments and Their Influence on Human Dental Pulp Stem Cells Seeded on Titanium Disks.

Dental implants are one of the most frequently used treatment options for tooth replacement, and titanium is the metal of choice due to its demonstrated superiority in resisting corrosion, lack of allergic reactions and mechanical strength. Surface roughness of titanium implants favors the osseointegration process; nevertheless, its topography may provide a suitable substrate for bacterial biofilm deposition, causing peri-implantitis and leading to implant failure. Subgingival prophylaxis treatments with cleansing powders aimed to remove the bacterial accumulation are under investigation. Two different air-polishing powders-glycine and tagatose-were assayed for their cleaning and antimicrobial potential against a Pseudomonas biofilm and for their effects on human dental pulp stem cells (hDPSCs), seeded on sandblasted titanium disks. Immunofluorescence analyses were carried out to evaluate cell adhesion, proliferation, stemness and osteogenic differentiation. The results demonstrate that both the powders have a great in vitro cleaning potential in the early period and do not show any negative effects during hDPSCs osteogenic differentiation process, suggesting their suitability for enhancing the biocompatibility of titanium implants. Our data suggest that the evaluated cleansing systems reduce microbial contamination and allow us to propose tagatose as an adequate alternative to the gold standard glycine for the air-polishing prophylaxis treatment.

Allergic contact dermatitis from sorbitans in beer and bread.

Sorbitol-derived compounds have been increasingly recognized as a cause of delayed hypersensitivity reactions. We present a case of recurrent allergic contact dermatitis (ACD) that lasted 6 months in which the patient retrospectively correlated new lesion appearance with consumption of specific types of beer and bread. Patch testing using the North American Contact Dermatitis Group Standard Series with supplemental allergens was positive for sorbitan sesquioleate (SSO) and sorbitan monooleate (SMO). Avoidance of beer and bread led to complete clinical resolution. Sorbitol in beer and bread is not well documented but likely is related to the yeast cultures used for fermentation and leavening. Sorbitol is utilized as an osmotic stabilizer in yeast culture preparation and is found in commercially prepared brewer's and baker's yeasts. We propose that trace amounts of sorbitans in yeast-containing products can cause ACD. Systematized ACD poses a challenge for dermatologists to diagnose, as the pattern can be nonspecific and skin testing does not always produce meaningful results. Because it is difficult to elicit history and correlate exposures with worsening of skin symptoms, a trial of dietary avoidance may be necessary to determine the diagnosis of systematized ACD. When patch testing is positive for SSO and SMO, the dermatologist should inquire about dietary habits with attention to beer and bread.

Adding sorbitan sesquioleate to the European baseline series: Necessary, reasonable, or unavoidable?

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.

Effect of Oil Type and Emulsifier on Oil Absorption of Steam-and-fried Instant Noodles.

The effects of four different frying oils and three emulsifiers on oil absorption by steam-and-fried instant noodles were evaluated. The blended oil (high oleic sunflower oil/soybean oil/palm oil = 24:25:1 (v/v/v)) containing approximately 50% oleic acid was chosen as the proper frying oil due to lower oil absorption by instant noodle compared to palm, soybean, and high oleic sunflower oils. Among the four oils, the interfacial tension between high oleic sunflower oil and instant noodle was the lowest (0.073 mN/m), resulting in the highest oil uptake (15.47%), while the lowest interfacial tension (0.30 mN/m) between blended oil and instant noodle resulted in the lowest oil uptake by the fried product (12.63%). Scanning electron microscopy (SEM) and confocal laser scanning microscopy (CLSM) were used to observe surface properties and oil distribution. The instant noodle fried in blended oil was found to have uniform oil distribution and smooth surface. After selecting the proper frying oil, three emulsifiers (soybean lecithin, Tween-80, Span-80, at 0.2% (v/v)) were added to the blended frying oil. Adding emulsifier into frying oil significantly decreased the interfacial tension between frying oil and instant noodle. Among the three emulsifiers, addition of soybean lecithin resulted in the lowest interfacial tension (0.010 mN/m) and the highest oil uptake (18.36%). Therefore, from this study, we do not recommend adding emulsifier into frying oil.

Sorbitan sesquioleate; a rare cause of contact allergy in consecutively patch tested dermatitis patients.

BACKGROUND: Sorbitan sesquioleate (SSO) has been added to fragrance mix I (FM I) as an emulsifier since the 1990s. Being a contact allergen itself, SSO has the potential to cause false-positive reactions to FM I. Recent results obtained with selected FM I-positive patients have shown that 5% have concomitant positive reactions to SSO. OBJECTIVES: To investigate the 5-year prevalence of contact allergy to SSO and evaluate the importance of SSO allergy when patch test results for FM I are interpreted. METHODS: This was a retrospective database study of consecutively patch tested eczema patients (n = 4,637) from 2010 to 2014. All patients were tested with our baseline series including FM I and SSO 20% in pet. RESULTS: Sensitization to SSO was identified in 9 (0.2%) patients. The proportion of FM I-positive patients with concomitant positive reactions to SSO was 1.4%. CONCLUSIONS: SSO is a rare cause of contact allergy, with a 5-year prevalence of 0.2% in consecutively tested patients. Contact allergy to the emulsifier does not play a major role when the overall frequency of contact allergy to FM I is evaluated. However, to correctly diagnose individual patients, concomitant patch testing with FM I and SSO is encouraged.

Reactivity to sorbitan sesquioleate affects reactivity to fragrance mix I.

BACKGROUND: Fragrance mix I (FM I) and its single constituents contain 5% and 1% sorbitan sesquioleate (SSO), respectively. SSO is a rare sensitizer and a potential irritant. OBJECTIVES: To determine whether the outcome of the FM I breakdown test is affected by positive patch test reactivity to SSO. METHODS: A retrospective analysis of data from the Information Network of Departments of Dermatology, 1998-2013, was performed. RESULTS: The full FM I breakdown test including SSO was tested in 2952 patients. Of these, 154 (5.2%) had a positive patch test reaction to SSO 20% pet. and 2709 (91.8%) had a negative patch test reaction. Positive reactions to one or more of the single fragrances contained in the mix were significantly more common (82.5% versus 57.3%) in SSO-positive patients, who also had more multiple reactions than FM I-positive patients with negative SSO reactions (61.5% versus 21.3% patients with reactions to two or more fragrances). CONCLUSIONS: Our results indicate that reactivity to SSO markedly affects the outcome of patch testing with FM I and its single constituents. SSO must be an obligatory part of the full FM I breakdown test, and should ideally be included in the baseline series.

Contact allergy to sorbitans: a follow-up study.

BACKGROUND: Sorbitan sesquioleate (SSO), an emulsifier in many corticosteroids, was previously found positive in 8.9% of 112 dermatitis patients. OBJECTIVE: The objective of this study was to present data on 24 of 591 dermatitis patients with reactions to SSO and/or sorbitan monooleate (SMO) on patch testing. METHODS: A retrospective chart review was conducted on 591 consecutive dermatitis patients patch tested from November 2008 to May 2010. In addition to being tested to a modified North American Contact Dermatitis Group standard series, all patients were tested to a cosmetic series. RESULTS: Of the 591 patients tested, 24 reacted to SSO and/or SMO (4.1%), 19 (3.2%) reacted to SSO alone, 1 (0.17%) to SMO alone, and 4 (0.68%) reacted to both. Of the 24 sorbitan-allergic patients, 2 (8.3%) reacted to any of 4 corticosteroid screening chemicals tested. CONCLUSIONS: In this follow-up study, 4.1% of 591 dermatitis patients reacted to SSO and/or SMO. Given the presence of SSO in many popular topical corticosteroid formulations, clinicians should consider allergy to sorbitans when patients do not improve with topical corticosteroid therapy.

Hyperglycemia-induced endoplasmic reticulum stress in endothelial cells.

OBJECTIVE: Hyperglycemia-induced endothelial cell dysfunction in vascular disease can occur due to increased oxidative stress and a concomitant increase in endoplasmic reticulum (ER) stress. To investigate whether these cellular stresses are independent or causally linked, we determined whether or not specific glycolytic intermediates that induce oxidative stress also induce ER stress. METHODS: Human umbilical vein endothelial cells were treated with dextrose, partially metabolizable (e.g., fructose and galactose) and non-metabolizable sugars (e.g., 3-O-methyglucose), and various intermediates of the glycolytic and tricarboxylic acid pathways. Activation of the unfolded protein response and subsequent generation of ER stress was measured by the ER stress-responsive alkaline phosphatase method, and superoxide (SO) generation was measured using the hydro-ethidene-fluorescence method. The mitochondrial origin of the SO and the generation of ER stress by dextrose and the intermediate metabolites were confirmed with experiments using allopurinol and diphenyleneiodonium chloride to block SO generation by xanthine oxidase and nicotinamide adenosine dinucleotide phosphate oxidase, respectively. RESULTS: Although ER stress could be induced by glycolytic intermediates up to and including pyruvate, the SO generation occurred in the presence of glycolytic and mitochondrial metabolites. CONCLUSION: Although the mitochondria are the site of signals generated by dextrose to initiate oxidative stress, the dextrose-induced ER stress, unlike SO generation, does not require pyruvate oxidation in the mitochondria.

Sorbitan sesquioleate, a common emulsifier in topical corticosteroids, is an important contact allergen.

BACKGROUND: In the past, sorbitan sesquioleate (SSO) was reported as an uncommon allergen, but recent data suggest SSO may be an important sensitizer. OBJECTIVE: To present data on 13 of 112 dermatitis patients who reacted to SSO and/or sorbitan monooleate (SMO) on patch testing. METHODS: A retrospective data analysis was conducted on data from 112 dermatitis patients patch-tested from December 2006 to May 2007. All patients were tested with a modified North American Contact Dermatitis Group standard series, a cosmetic series, and a fragrance series. RESULTS: Of 112 patients, 10 (8.9%) reacted to SSO, 1 (0.9%) to SMO, and 2 (1.8%) to both. Nine of 12 (75%) SSO-positive patients were using topical corticosteroids emulsified with sorbitan derivatives or sorbitol; 2 of the 13 sorbitan-allergic patients were allergic to one or more corticosteroid screening chemicals tested. CONCLUSION: SSO is a common emulsifier derived from sorbitol and is used in many high- to super-potent corticosteroids. It has only recently been identified as an important contact allergen. The high prevalence of reactions to sorbitol derivatives in this small group of patients suggests that these chemicals may be sensitizing when applied to dermatitic skin. Larger studies should be conducted to confirm these findings.

Sorbitan sesquioleate: an emerging contact allergen.

Sorbitol-based emulsifiers such as sorbitan sesquioleate (SSO) are commonly used in topical corticosteroids, topical antibiotics, topical antifungals, moisturizing creams and lotions, and topical retinoids. Contact dermatitis from sorbitol derivatives appears to be increasingly prevalent. Patch-testing with SSO can be useful in the work-up of patients with presumptive cosmetic allergic contact dermatitis. Those sensitized to SSO can be counseled to avoid sorbitol-containing products, especially topical corticosteroids. Herein we discuss case reports of SSO allergy and a recent case series of 12 of 112 dermatitis patients (10.7%) patch-tested during a 6-month period who showed contact allergy to SSO. We provide a list of key corticosteroids and products that can contain SSO, sorbitol, or sorbitol derivatives.